Health and Social Class
The aim of this essay is to examine the influence that socio-economic status has on an individual’s health. “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1948. ) Social Stratification is a term used by sociologists to describe inequalities that exist between society and us as individuals and can also be described as a hierarchy with the less privileged people at the bottom and the more favoured people at the top. (Giddens, 2006)
Anthony Giddens (2006) defines class as “a large-scale group of people who share common economic resources, which strongly influence the type of lifestyle they are able to lead. ” (pg 300). Karl Marx, a sociologist in the 19th century supports this as he believes that class was “a group of people who stand in a common relationship to the means of production – the means by which they gain a livelihood”. (pg 301) Although the manuscripts that Marx was working on at the time of his death were disputed due to his discussions on class not always being consistent.
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Max Weber, a sociologist in the late 1800’s saw social stratification in different light. He agreed with Marx’s theory that society was in conflict due to resources and power however, he believed that social stratification wasn’t just about class but also about status and party and that class didn’t just derive from a person’s control on society or maybe the lack of control but that economic differences had an overall impact on a person’s life chances.
Weber’s writings show that there are other aspects apart from class and how they strongly influence people’s lives and this allowed a more flexible basis than Marx provided in order to analyse stratification. (Rose & Pevalin, 2001) identify two major traditions of socio-economic classification in Britain. The dominant one which was based on government statistics in relation to life, death and health and the other that was formed by British sociology as it analysed the various expressions of class identity and changes to in the British class structure from 1945 and onwards. O’Donnell, 2005) Class is more than just about money. A steel worker may earn the same salary than a store worker but this doesn’t necessarily mean that they fall into the same social class group. This matter will always be debated as some people consider themselves to be in a higher class than they actually are and it goes to show that there is no actually definition that everyone can agree on. In 1911 the Registrar-Generals’ Social Classification (RGSC) scale was devised.
This was in place to measure a person’s class based on their occupation and consisted of 6 different levels. I Professional, etc occupations, II Managerial and Technical occupations, III Skilled occupations, (N) Non-manual, (M) Manual, IV Partly skilled occupations, V Unskilled occupations. (Denny & Earle, 2005). The RGSC’s view was that social class described economic divisions of employment and industry. This scale intended to be more of a general classification of social advantage and disadvantage. (Fulcher & Scott, 2011).
This scale is now out of date as it allocated men on the basis of their occupation, married/cohabiting women on the basis of her partner’s occupation, children on the basis of their father’s occupation and single women on the basis of her own occupation. (Class Notes, 19. 06. 2012) Following a government review the National Statistics Socio-Economic Classification (NS-SEC) has been in use since 2001 replacing the Registrar-Generals’ Social Classification and since that time has been used for all official statistics and survey (Fulcher & Scott, 2011).
This scale provides similar data but it uses different categories. (Haralambos & Holborn, 2008). In 1980 the Labour Government published the Black Report chaired by Douglas Black. Although this report found that there had been several improvements in people’s health since the introduction of the welfare state it still indicated that there were widespread inequalities. The report gives a clear analysis of how inequality runs from the richest to the poorest.
Using the RGSC’s scales one of the reports most famous findings was that a child of an unskilled manual worker would die 7 years earlier than a child born to professional parents. (Macionis & Plummer, 2005). Other findings were that people in class V were more likely to die of conditions like heart disease, cancer or stroke than those in class IV. It was evident that people in class I had a longer life expectancy, better health with lower death rates. (O’Donnell, 2005).
The Black Report look at four main reasons which may explain the inequalities in health:- The Artefact Explanation Artefact being something made by people so there may have been some flaws in the findings. The official mortality and morbidity statistics could have been invalid or unreliable and it’s argued that observed social gradients in health maybe the product of poor quality data. Although this work confirmed that there were health inequalities it was suggested that it was underestimated by conventional analysis. Asthana & Halliday, 2006). A study showed The authors of the black report didn’t find this explanation very convincing based on the fact that working class groups have not contracted as much as is often supposed, while poor health affects all manual workers, not just those classified as unskilled. (Kirby et al, 2000) The Health/Social Explanation The social selection is based on a theory and it argues that health statuses influence social statue. For example; if your healthy then you get a better education resulting in better paid jobs etc. his indicates that people are in lower social classes because of the health rather than their class causing them poor health (Kirby et al 2000) although this only partially explains the link between health and social class. (Class notes 19. 06. 12). Equally there are arguments to say that good health improves your socio-economic status whereas poor health will disadvantage it (Stern, 1983 cited in Moore & Porter 1998). The Cultural/Behavioural Explanation This explanation believes that poor health is caused by behaviours specifically chosen by people and their lifestyles.
It is believe that the middle class people tend to embrace on health enhancing behaviours like attending the gym, yoga classes, healthier eating like organic meals or food that are low in fat whilst the working class people value health detracting behaviours such as smoking, excess amounts of alcohol and unhealthy dietary choices and these activities are seen as detrimental to a person’s health ( O’Donnell 2005). The obvious one being that smoking can lead to heart disease and various forms of cancer whilst eating fatty foods can lead to heart disease or obesity.
Although it is evident that these behaviours are amongst working class people (Sheaff 2005) argues that these behaviours need to be understood as a coping mechanisms of the struggles of everyday life and these people may see this behaviour as their only enjoyment or pleasures they have. The Materialistic Explanation This final explanation is identified as the more dominant explanation. This outlines that health inequalities stem from low or unsecure incomes, unemployment or unstable employment, poor working conditions and poor housing in materially and culturally under-resourced neighbourhoods. O’Donnell 2005). (Moore & Porter 1998) suggest that for an individual who lives in poverty that their housing, diet and leisure circumstances are all inhibited by the material deprivation they live in. Overall the patterns in health inequalities between classes are seen as a result of material deprivation. (Giddens, 2006) The Black Report concluded that Britain’s health inequalities were determined by the inequalities in the distribution of status, wealth and power however, this view was not welcomed by the new conservative government of the 80’s (O’Donnell 2005).
An enquiry into Health Inequalities chaired by Sir Donald Acheson was set up in 1997 and the report of this enquiry was published in 1998. This report endorses the black report however it provides a more subtle and sophisticated explanation for the apparent health inequalities. The key point in this report is that an individual’s health is the result of a complex set of wider cultural and economic factors that interact with a series of personal choices based on biological and psychological influences. Acheson, 1998) This report observed that although the average mortality rate had fallen over the last fifty years that health inequalities still existed and in some instances had actually widened. (O’Donnell 2005) The report highlighted a range of areas where health inequalities can be reduced. It called for an increase in people benefits as it was believed that poverty had a disproportionate effect on children and that in the 1990’s a quarter of people were living below the poverty level resulting in them not having enough money to buy the necessities in order to keep in good health.
It also called for more funding in schools within deprived areas to allow teachers to promote health, not only juts teaching the children how to cook but educating them on budgeting for food etc. It proposed that schools should offer free fruit to the children to encourage healthy eating and also promote parenting and relationship classes on sex education and substance misuse as the report found that children from disadvantaged backgrounds are likely to achieve less and school resulting in the having low paid jobs leading into a vicious circle of health problems associated with low incomes and a perpetuation of the poverty trap.
It reiterated the need for an increase in benefits and education as the report suggests that babies born to fathers in lower social classes are on average 130 grams lighter than to those born to fathers in the higher classes. Low weight babies are more likely to be at increased risk of heart disease and developing illnesses later in life. (O’Donnell 2005) states that as a result of these inequalities it appears that the rich are getting richer whilst the poor are getting poorer.
In 2008 the government announced a review of health inequalities to be led by Michael Marmot. His review titled “Fair Society, Healthy Lives” was published in 2010 and highlighted the social gradient in health and the relationship between health and social inequalities. Its recommendations for action were focused on early childhood intervention and prevention, employment, the social environment and healthy communities and interventions across the social gradient. (Boardman et al 2010).
He states in his review that “People with higher socio-economic position in society have a greater array of life chances and more opportunities to lead a flourishing life. They also have better health. The two are linked: the more favoured people are, socially and economically, the better their health. This link between social conditions and health is not a footnote to the ‘real’ concerns with health-healthcare and unhealthy behaviours – it should become the main focus”. (Marmot Review, 2010: 3)
In conclusion this essay has outlined that there are in fact inequalities in health not only in Britain but all over the world and that these are due to socio-economic classes. The Black Report brought forward four explanations to account for these inequalities. “The Artefact Explanation” which suggests that inequalities do not really exist and that they only to appear to exist due to the way that class is constructed. The “Health/Social Explanation” which suggests that people are in lower classes due to their poor health rather than their class causing poor health.
The “Behavioural/Cultural Explanation” which suggests that poor health is caused by the person behaviour and finally the “Materialist Explanation” which was validated by the Acheson Report (1986) suggests that the material situation of the poor is seen as the most important factor in determining their poorer health although Marmot (2010) argues that health inequalities in Britain are preventable and that it’s not only a strong justice case but also a pressing economic case. Reference List Asthana, S & Halliday, J. (2006) What works in tackling Health Inequalities? Bristol: Policy Press.
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