health - class link

8/7/2019 health - class link

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Health Inequalities

Explaining the

Social Class Health Link.


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Objectives

The student will be able to:-

Define the term social class and its

context.

Discuss possible explanations

Understand and discuss case studies.


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Background

Always been an association between health

and social class.

Includes all aspects:- expectation of life, infant

and adult mortality and general level of health.

Remains marked differences in all social classeswith health, with significant geographical

variation and gender.


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Sigerist, 1943

The task of medicine is to promote health, to

prevent disease, to treat the sick whenprevention is broken down and to rehabilitatethe people after they have been cured. Theseare highly social functions and we must look at

medicine as basically a social science.

The greatest influences on the improvement in

health with longer expectancy of life, lowerinfant mortality, etc., has not been so muchmedical discoveries as improved socialconditions.


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What is Social Class?

Often determined and measured by an

individuals:-

occupation

sex

class

race

employment.


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Explanations

There are four possible explanations:-

Artefact

Social selection

Behavioural / Cultural

Materialist


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Artefact

Suggests that it is difficult to measure health andsocial class. Is it possible to show any linkbetween the two?

There is a consistent relationship with poorerhealth in the lower social classes.

There is always a relationship between how socialclass is measured and health: income, education,

housing etc.

Unable to account for all the different studies.


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Social Selection

Determines social class through the process ofhealth-related mobility.

Suggests that the healthy are more likely tomove up and the unhealthy move down.

ExampleIndividual chronically sick or disabled, unable

to find employment or are under-employed,

may move down the social scale.


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Do the sick belong to lower classes?

Is it due to illness that they are unable to

climb up the social classes?

Is an individuals position in the social class

the cause of disease?

Points of view


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Schizophrenia studies

Tended to belong to the lower social classes.Not shown with their fathers shows the disease

causes the low social class not the vice versa.

Most chronic diseases tend to develop later on

in life, after careers have been decided,

association with social class is not found.

Not likely to be the complete picture.


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Behavioural / Cultural

Differences in behaviours that damage or failto promote health.

Suggests that lower social classes prefer lesshealthy lifestyles.

Someone who has been on their feet all day, isless likely to seek activity in the evening or

want to spend a lot of time cooking a

balanced meal.


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Differences in health occur in the lower social

groups because they adopt more dangerous

and health damaging behaviour.

Suggests that the lower social class choose to

smoke and drink more, not to exercise and do

not eat healthily.


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Evidence for Behaviour

DietSocial class V have a worst diet than social class I

Exercise

S.C. I exercise more in their leisure time than S.C. V

Smoking

S.C. V smoke more than S.C. I

Alcohol

Worse drinking habits in S.C. V


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Materialist

Concentrates on the hazards which are apparentin society. Some have no choice but to be exposed

to them, lower social classes are exposed to more

unhealthy environments.

Dangerous work, poorer housing, unable to use

health service.

Housing poor living conditions - damp, lack of

heating, pollution.


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Income rent comes first, so if money is short

food is the first to go.

Trying to overcome stresses of living on low

wages smoking, sweets for children,abandoning breast feeding etc.

TheB

lack report adopted the materialisticapproach.


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Is it a persons choice?

London housing estate gang crime

Unemployment

Points of view


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Other Relevant Factors

Cultural compatibility

Middle class are more likely to visit their GP, to

place a medical explanation on their ill health.

Use of Health Services

Middle to upper class more likely to use their GP

than lower class (i.e. unable to get time offwork).


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Social skills

Middle / upper class more confident, more wiling

to indulge in their symptoms and ask questions.

Influence of the health worker.

Health care professionals may make assumptions,

can influence the outcome of the consultation.

Outcome of consultation

Higher the social class, more likely to be referred

to a specialist.


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Medical consultations

Consultation times last longer for the higher

social classes an average of 6.1 minutes for class

I compared to social class V which lasts for 4.7

minutes.

More information is given to individuals in

higher social classes I and II compared to those

in social classes IV and V.


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Infant Mortality

Social Class Still Births Infant Deaths

I 3 6

II 3 5

III NM 4 6

III M 4 6

IV 6 8

V 6 11


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Mortality

Measurement of deaths in a given area.

Life expectancy has increases for both sexes

still higher for women.

Women live for an average of 81.6 years (2006)

Men live for an average of 77.4 years (2006)


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Gender and Health

Throughout the industrial world men live

shorter lives than women.

Used to be due to working environment and

conditions.

Men were more likely to die at any specificage than a woman


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Morbidity

The measure of sickness in a given area.

Women have higher rates of chronic disease:-

strokes

rheumatoid arthritis

diabetes etc.

Women are more likely to be hospitalised.


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Education

Key to improving health inequalities.

Need a change in attitude.

Knowing or risks and noting of risks are two

completely different matters.

Attitudes form early in children, need to be

influenced at an appropriate but early stage.


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How can education change an individuals lifeexpectancy?

Can it change the outlook?

Increase social status or class?

Can how an individual is educated, affect the

path they take later on in life?

Points of view


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Attitudes towards food.

A healthy diet from the outset is likely to

reduce the craving for food that is rich in fat,

salt and fast sugars.

Eating less meat and more vegetables is

cheaper.

Taste is acquired.


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Poverty

Must not be equated with social class.

What is seen as poverty in Britain is verydifferent to poverty in third world countries.

Only those on the very lowest incomes can beregarded as living in poverty.

Those most likely to be affected by poverty arethe elderly and young children.


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May be a result of:-

substance abusedrugs or alcohol

Leading to social exclusion including mental health.

Princes Trust disenfranchised youth.

Takes a person from a very privilegedbackground to do something about the failings

of society.


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Case Study

Herceptin - is not a drug but a monoclonalantibody (a type ofbiologic therapy).

It is very effective in women who have aparticular type ofbreast cancer.

The drug has caused controversy because it hascreated a 'post-code lottery' for treatment.

While some Primary Care Trust's say all early-breast cancer patients are eligible for the drug,others only grant funding for "exceptional cases".


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