The understanding of ‘what health is’, has largely been through the bio-medical model. This essentially views the body as a machine, with no connection to the social environment. When we become ill we visit a doctor he gives a diagnosis and a course of treatment, which, if taken as prescribed, cures us. However this understanding has come to be substantially questioned, and the increasing awareness of social structuring of life experiences, have bought the study of the ‘social’ at the centre of the analysis of health, Peterson. A & Waddel. C (1998).
Social factors shape illness. We see with unemployment, stress effects health, and asthma is triggered by damp housing, and so on. When moving away from the bio-medical model, one can see the effects of the environment on the individual’s health. This is a more ‘social model’ and is increasingly adapted today. When looking at ill health the individual is not disconnected from the environment. Rather a whole picture of the individual’s social environment is looked at. By using the social model for looking at the causes for poor health, a strong link has been found between poverty and poor health.
Sir Douglas Black published the ‘Black report’ in 1984, after studying patterns of morbidity, morality and health care, in post war Britain. This showed that their was a difference in the health of the classes. However the circulation of the report was limited and its recommendations were not given any official priority in Britain. In America patterns in the distribution of disease and its relationship to poverty are striking. It is found that the poorer the population the higher the risk of sickness and death. Conrad & Kern (1986).
Epidemiology bought the shift in studying individuals, to studying populations. This is the study of the effects of disease and illness within communities. As this area has grown so has the link between poverty and poor health. How poverty effects health is not entirely understood. However both have a relationship, this is statistically evident.
Health is related to a host of social factors, education, housing, environmental conditions, all of which are linked to income. It is clear that socio-economic status is associated with health. A very large number of diseases are associated with low socio-economic status. Most explanations say, poor housing, crowding, racial factors, low income, poor education and unemployment, all result in outcomes such as, poor nutrition, poor medical care, strenuous conditions of employment and increased exposure to noxious agents. All making certain individuals more vulnerable to ill health. Conrad & Kern (1986).
There is clear evidence to show social class differences among women, with regard to raised blood pressure. Those in higher classes are less likely than those in manual classes to have hypertension.
Birth weight is lower for babies whose fathers are in manual social classes. Birth weight is even lower for babies whose birth is registered solely by the mother. Low birth weight babies are born mainly in the lower classes. The lifestyle into which they are born accelerates the problem. For instance those in lower classes tend to smoke more than others, this effects infant health and causes low birth weight in unborn babies. Also the poor housing conditions in which they are bought up effects their health. Reduced birth weight is associated with increased morality and morbidity in the early years. Low birth weight increases the risk of developing a cardiovascular disease later in life. It could be said infant health is affected due to the incident of breastfeeding. Almost three quarters of those born in classes I are breastfeed up to almost 6 week. This declines in class with almost 1 quarter of babies in class V.
Statistics show consistently that those in the lower class have higher morality, morbidity and disability rates. Morality differentials increased dramatically in Britain during 1981-95 in line equally dramatic increases in income inequalities. It is found that most serious diseases such as premature birth, obesity, hypertension, coronary artery disease, are all more common in the lower classes. Previously their was an eight year gap in life expectancy between the affluent part of Sheffield and the more deprived inner city. Now there is a nine and half year gap between professional men and their unskilled manual counter parts. Shaw. M et al (2002). In Middlesbrough an industrial city the death rate is twice the national average. This suggests that it is something about the work environment which causes the manual workers to have poorer health and shorter life expectancy than other.
The Acheson report stated that the cause of poor health is not just that some people live in poor conditions rather it is that people live in a very unequal society. The psychological hurt by the fact that one is at the bottom of society is one factor which contributes to ill health. Sir Donald Acheson states that inequality itself makes people sick. He recommends raising the living standards of people on social security by giving more money.
Wilkinson asks why people living in countries such as Greece, Italy and Japan have higher life expectancy than those that live in richer countries such as United States and Germany. He suggests that the diminish of health is related to the increase in income, hence the widening of inequalities in income. Wilkinson, R.D (1996).
Over the last 20 years household income has grown, however this growth has not been the same across the classes and has lead to even further inequalities. The top deciles point more than doubled, from £233 per week, to £475 per week. The bottom deciles point rose by 62 per cent from £74 per week, to £119 per week. Official Documents (2002a) On-Line.
Japan is a testament of the affects of the narrowing of income distribution. Data shows an association between the narrowing of income differences and the rapid improvements in life expectancy in Japan. Wilkinson, R.D (1996). It is suggested that wealth creation is more important than wealth redistribution in countries such as Britain. A study carried out for the Joseph Rowntree Foundation into the ‘health gap’ argues that even the most modest redistribution of income and wealth would have a significant impact on morality rates in the lower classes.
According to Marxian writers such as V. Navarro, this whole situation is the result of capitalism. Navarro argues that patterns of morality and ill health in lower classes are related to occupational contexts. It is the manual working class that are exposed to dangerous work environments and dangerous cancerous substances at work, and it is the stresses of living in a capitalist society which makes these people ill.
In 10 years their has been an increase of 70-80 per cent of suicides committed by young working class men in Scotland. Marxist writers would argue that stresses of being in low paid jobs with no possibilities for further achievement leads these young men to turn to suicide. This is the effects of a capitalist system on the low waged exploited working class. Those in the lower classes have stressful lives, they have financial worries as they are financially exploited and so live in poor housing, have poor diets and have little leisure time to take exercise. The stress of this life leads to people smoking and drinking which in turn leads to poor health.
Navarro doubts that systems such as the National Health Service are established to eradicate inequality in health care. He argues that medicine like capitalism is in a state of crisis and is ineffective. Navarro is interested in the changing characteristics of the state, and the social control functions of medical health organisations such as the NHS. He suggests that socialized medicine represents a victory of labour over capital, as the working class fought and won a battle for a national system of health care. The NHS represents a truce in the class war. The capitalist lose nothing but indeed gain partially as the NHS diffuses class conflict providing benefits for working class without challenging the capitalist system. But the NHS operates in the interests of the capitalist class, by opening up new areas of economic exploitation as it is a market for goods produced by the pharmaceutical and medical supplies industries. Whose cost of service are largely borne by the working class and who than are further exploited through the payment of taxes which means although they receive the least benefit from this system, they pay an increasing proportion of its costs through taxation. Dobraszczyc. U (1989).
Navarro’s critics argue that Navarro’s theory is inadequate as it does not address the diversity of capitalist societies. Countries like Japan are highly capital yet inequalities in health in Japan are little.
Looking at the statistical evidence it is clear that there are inequalities between the healths of the classes. Various suggestions have been made by Governments reports and sociologist about the causes for these inequalities and the solution to eradicating them
The ‘Black report’ would suggest that these inequalities are a result of material inequalities, be that housing, transport or nutrition. However ‘Health of the Nation’ argues that inequalities are due to different life styles. Those in the lower classes have poorer diets, take less exercise, smoke and drink more. This is an individual responsibility and it is up to the individual to change their individual life style. Wilkinson points at the ‘income gap’, he suggests that reducing this will reduce inequalities in health. And Navarro blames the ‘capitalist system’ of society, criticizing the state for blaming the individual, and suggesting that this strategy of blaming the individual is done just to open up another market, that of medical insurance. The state encourages the individual to get better medical insurance in order to have better health.
Poverty is never written as the official cause of death on a death certificate. But statistics show that there is an intrinsic link between poverty and poor health. If the correct method to eradicate poverty was to be found, the effects of poverty on health would still be present for generations. As genetic also have a place in carrying the effects of deprivation. This is a deep rotted problem which would take decades to solve.
