Causes ofInequalities in Health:

Socio-economic Status

Inequalities in Health

A number of studies have been carried out by A number of studies have been carried out by

various groups over the years.various groups over the years.

Their reports revealed:Their reports revealed: the the naturenature of health inequalities of health inequalities the the scalescale of the health inequalities of the health inequalities the the causescauses of these inequalities in the UK. of these inequalities in the UK.

ReportsReports

The Black ReportThe Black Report(1980)(1980)

The Health DivideThe Health Divide(1987)(1987)

Working Together for aWorking Together for aHealthier ScotlandHealthier Scotland

(1998)(1998)

The Acheson ReportThe Acheson Report(1998)(1998)

The following studies into health inequalities The following studies into health inequalities have found a have found a causalcausal link between link between social classsocial class and the and the incidence of ill health.incidence of ill health.

To understand the link between social class and ill health, we need to be clear what is meant by social class.

A person’s social class is based on a mixture of factors:

Occupation Income level

Housing Education

Social Class

Unskilled.Cleaner, labourer.

Semi-skilled manual.Assembly line worker, builder, lorry driver.

Skilled manual: Clerical and minor supervisory.Electrician, mechanic, plumber.

Non-manual: Clerical and minor supervisory.Clerk, police officer, shop assistant

Lower managerial, administrative, professional.Farmer, librarian, sales manager, teacher.

Higher managerial, administrative, professional.Accountant, bank manager, dentist, doctor, solicitor.

Categories

V

IV

IIIb

IIIa

II

I

Class

Registrar General’s Classificationof Social Class

The Black Report (1980)Remit

To investigate the problem of To investigate the problem of inequalities in health in the UK. inequalities in health in the UK.

To analyse the lifestyles and To analyse the lifestyles and health records of people from health records of people from all social classes (based on the all social classes (based on the Registrar General’s Registrar General’s categories).categories).

The Black Report (1980)

Findings

The health of the nation had improved The health of the nation had improved generally but the improvement had not been generally but the improvement had not been equal across all the social classes. equal across all the social classes.

Gap in inequalities of health between lower Gap in inequalities of health between lower and higher social classes was widening.and higher social classes was widening.

The Black Report (1980)

FindingsFindings Health standards were directly linked to social Health standards were directly linked to social

class.class. Ill health increased down the social scale.Ill health increased down the social scale. The problem had little to do with the NHS. The problem had little to do with the NHS. Problems were linked with social and economic Problems were linked with social and economic

factors such as:factors such as:– income income – unemploymentunemployment– poor environmentpoor environment– poor housing poor housing – educationeducation

Key causes of inequalities in health were:Key causes of inequalities in health were:

Low Low incomeincome

UnemploymentUnemployment

Sub standardSub standard housinghousing

PoorPoorenvironmentenvironment

Poor Poor educationeducation

The Black Report (1980)Findings

Government Government should adopt ashould adopt a

policy:policy:

aimed at reducingaimed at reducingpoverty inpoverty in

the UKthe UK

of spending of spending more money more money

ononhealth health

educationeducationand theand the

prevention ofprevention ofIllness.Illness.

The Black Report (1980)Recommendations

Report contained 37 recommendations which Report contained 37 recommendations which focused on two main areas:focused on two main areas:

Report did not Report did not explain inequalities explain inequalities

in health.in health.

Spending more on Spending more on health services would health services would

make no differencemake no differenceto health to health standards.standards.

Contrary to Contrary to what the what the

Report said, Report said, poor people poor people

did use health did use health services.services.

The Black Report (1980)Reaction by Government

When the Report was published there was a change of government. Conservatives were now in government and they criticised the Report.

Took theindividualistapproach –

people should eat, drink

and smoke less

Argued that individual behaviour within socialclasses shaped health

Regarded the Report

as old-fashioned, socialist

explanationsof ill-health

They wanted to reducepublic expenditure

Government Government disagreeddisagreed

Problem was:Problem was:

The Black Report (1980)

The Health Divide (1987)Remit

This Report, also called the Whitehead Report, concentrated on social class as one of the main causes of inequalities in health.

The Report was commissioned by the Health Education Council (HEC) in 1987 and headed by Margaret Whitehead.

Her remit was to update the evidence on inequalities in health and to assess the progress made since the Black Report six years earlier.

The Health Divide (1987)

The HEC was a quango – a body set up by the government but able to work independently, in theory.

Findings– Revealed that the gap between health

standards and social class had widened since the publication of the Black Report.

– Restated the direct link between health and social class.

The Health Divide (1987)

Government reaction Just when the Report was being commissioned, the

government announced that the HEC was to be scrapped.

HEC was campaigning on alcohol, tobacco and diet issues which upset some of the government’s financial supporters – tobacco manufacturers gave a lot to party funds.

One week before findings were due to be made public, a press conference was cancelled with no explanation. Clearly pressure had been put on the Chairman of the HEC to cancel because of the controversial nature of the report’s findings.

“Working Togetherfor a

Healthier Scotland”

The Acheson Report (1998)

This was an independent study into health inequality.

It was commissioned by the new Labour government in 1997, under the chairmanship of a former Chief Medical Officer for England and Wales, Sir Donald Acheson.

Remit – to investigate health inequalities in the UK.

The Acheson Report (1998)

It was a very comprehensive survey of those in society described as disadvantaged.

Its findings mirrored those of the Black Report.

The root cause of inequalities in health was poverty.

It concluded that in order improve the health of millions, the gap between the richest and poorest in UK society had to be reduced.

The Acheson Report (1998)Findings

Children from poor families weighed on average 1.30gms Children from poor families weighed on average 1.30gms less than those from wealthy familiesless than those from wealthy families

Infant mortality rates:Infant mortality rates:

– 7/1000 – lower social classes7/1000 – lower social classes

– 5/1000 – upper social classes 5/1000 – upper social classes

Long term illnessLong term illness

– 17% of profession men aged 45-64 17% of profession men aged 45-64

– 48% of lower class men aged 45-6448% of lower class men aged 45-64

Income levelsIncome levels

– 2.2 million children live on income levels 50% below the 2.2 million children live on income levels 50% below the national average national average

Health campaignsHealth campaigns

– Higher uptake of screening amongst upper social classes Higher uptake of screening amongst upper social classes – widened health gap– widened health gap

Coronary heart Coronary heart diseasediseaseStrokesStrokes

Lung cancerLung cancer

Accidents & Accidents & suicidessuicidesRespiratory Respiratory diseasesdiseases

Risk in

creases

Social Social class Iclass I

Social Social class Vclass V

The Acheson Report (1998)Findings

Poor men are 68% more likely to die in middle age than richer men.

Poor women are 55% more likely to die young.

Health inequalities start before birth

– A key factor in low weight babies is the mother’s birth weight and her pre-pregnant weight.

Scotland Health Survey 2003

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100.0150.0200.0250.0300.0

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100,

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Po

pu

lati

on

1 2 3 4 5 6 7 8 9 10

SIMD (Scottish Index of Multiple Deprivation)

(1 = least deprived and 10, most deprived)

Coronary Heart Disease and Deprivation Mortality Rates per 100,000, all ages

Crude Rateper 100,000Population