health inequalities and social class week 17 sociology of health and illness
TRANSCRIPT
Health inequalitiesand social class
Week 17Sociology of Health and Illness
Recap
• Thought about how health and illness are structured by society
• Considered the ‘sick role’, medicalisation and surveillance medicine
• Looked at ‘lay’ understandings of health
Outline
• Outline the impact of social class on heath
• Consider completing explanations
• Consider how health status is individualised
Impact of Social Class
• The impact of social class on health has been debated since the mid-19th century
• The poor are sicker and die earlier than the rich
• Charities and campaignsintervene to help– Factory and Sanitation Acts, Charity Hospitals
Treatment for all?
• During the early 20th century access to medical treatment was increased
• The most significant step wasthe National Health Service Act in 1946.
• The service launched on 5 July 1948, and it was hoped that this would significantly reduce health inequalities
NHS Introduction
• http://www.nationalarchives.gov.uk/films/1945to1951/filmpage_cyvgh.htm
Did it make a difference?
• A study was to commissioned in the 1970s by the Labour Government to examine health inequalities
• The Conservative governmenttried to bury the outcome
• But the ‘Black Report’ showed the extent of class differences
Health inequalities today
• Acheson Report (1998)– Death rates have fallen but class differences
increased for all major causes of death– Premature mortality (death < 65) is higher
among people who are unskilled.
• ONS found 18.3 disability-free years between best and worse areas
• Doring found up to 10 years life expectancy difference
• Why do you think the health inequalities have persisted?
• Should we be concerned about it?
Explaining class inequalities
• The Black Report set out for main reasons why an association between poverty and health could be seen– Artefact– Health Selection– Cultural – Materialist
• Each reason leads to different actions
Artefact?
• This reason suggests that the higher level of diagnosis and death is not ‘real’
• The social processes involved in
gathering and analysing statistics contributes to the gap
• Draws on ideas about the
social construction of illness
Health Selection
• This position argues that it is not the poor that get sick, but the sick who become poor.
• Serious illness or disability oftenhas a detrimental impact on employment and income
• Highlights discrimination within social structures
Cultural or behavioural
• Ways of living differ between social classes
• Lower social classes are unhealthy• Smoking• Drinking alcohol• Poor diet• Lack of exercise
• One side sees these as individual choices, the other rooted in social circumstances
Materialist or Structural
• Poverty is the major causation– Bad housing– Lack of money – Working conditions
• Poor outcomes not just linked to behaviour
• Economic measures to reduce poverty should be main goal
Two new theories
• Since the Black Report two additional explanations have been added– Psycho-social– Life course
• Both try to explain complexity and trends in health data
Psycho-social
• Data suggests that it is not wealth per se that is important in determining health
• Wilkinson suggests it is the degree of inequality (gap between rich and poor)
• Two key concepts are– Social cohesion– Self-esteem
• Reflected in current policy on social inclusion/exclusion
Life-course
• The life-course interpretation focuses on circumstances across the lifespan
• It includes an emphasis on
maternal health
• Health is a cumulative concept which can include material and cultural factors
• Which reason(s) for health inequality do you think is most likely?
Individualising health?
• The Black Report and most other sociological studies haveargued that the strongest explanations take seriously structural factors
• Social class matters, yet both individuals and governments stress behavioural factors
Marxist explanations
• Marxism has always seen disease (and treatment) as outcomes of capitalism
• Engels argued that industrial
capitalism caused ‘Social murder’
• Health care is part of the capitalist mode of production
Marxist explanations
• Navarro argues that the organisation of healthcare– Redefines social problems as medical ones
so legitimates the status quo– The emphasis on high-tech scientific medicine
forms part of the capitalist economy– Reproduces class inequalities within the
organisation of health care and patterns of consumption
• To what extend do you think healthcare is a part of the capitalist economy?
Marxist explanations
• Redefining social problems? – Shift-work sleep disorder?
• High-tech scientific medicine– 2002 Combined Profit of Top Ten
Pharmaceutical was over US$35 billion – NHS in England spends £7 billion pa
• Reproduces class inequalities– Middle-classes become doctors– Who shouts loudest gets treated?
Summary
• Look at the evidence for an association between class and health
• Considered different explanations
• Considered Marxist views on health as a part of the capitalist economy
Next week
• Continue to consider health inequalities by focusing on gender
• Do women get sicker but men die quicker?
• Look at explanations for gendered patterns