There are also problems with questioners.
It is not only the respondent but the questioners that contribute their own prejudice to the facts.
- Research generally has an idea what their research is looking for. Then thus research, either pro or con. Prejudice can creep in when a researcher unconsciously words questions in such a way that the answers support his or her contention or options, such leading questions.
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Another point to be considered is how the questions are worded. It is easy, and often subs conscious for the questioner to word the questions in such a way as to lead to respondent to reply in a certain way. (Taflinger, R., ‘the problems with statistics’ 1996. ).
Hospitals have been known to manipulate statistics so as to reach targets and all of this can interfere with the validity of the data findings.
The authors of the Black Report dismissed the artefact explanation as a reason for the inequalities. Consequently, it does not offer any better clarity to the complexities of health inequalities in society and so cannot be sustained.
There have been a number of studies that have used different measures of class and health and all have shown similar patterns. There is a consistent relationship with those in the lower social classes, always showing poorer health. This is the case; weather social class is measured by income, housing tenure, household possessions, or education. Further more, health has been measured according to mortality, morbidity (and thus itself has been measures in a number of different ways), and self-rated health. Again there is always a relationship. Therefore, the Artefact explanation cannot account for all these different studies ().
National/Social selection.
It could be argues that class differences are the result of human biological differences. The argument is that those who are fitter and in better health getter jobs. For example ‘‘an individual who is chronically sick or disabled may move down the social scales since they are unable to either find employment or are than their current employment suggests) ().
Conversely those in poor health are more likely to be unemployed with resultant consequences which are likely to affect their health.
The ethos of this explanation is similar to that of Social Darwinism which refers to varies ideologies based on a concept of competition among all individuals, groups and nations.
National selection explains speciation in populations as the outcome of competition between individual organisms for lifted resources, popularly known as ‘‘Survival of the fittest’’.
The natural or social selection explanation states that;
- People who experience poor health drift down social classes.
- People are in lower social classes because of their poor health rather than their class causing the poor health.
- Ill-health may lead to unemployment rather than unemployment leads to ill-health.
- This type of explanation has been involved to explain the preponderance of individuals with server mental disorders in social class (Townsend, P et al (1992).
Illness itself, because of resultant disability, unemployment, or demotion, according to this argument, causes the decline in social class.
Illness itself, because of resultant disability, unemployment, or demotion, according to this argument, causes the decline in social class.
This phenomenon known as the ‘‘drift hypothesis’ explains that less healthy people tend to drift down the social hierarchy.
An argument against this theory is that good health is not always a cause of upward mobility and in higher social classes who suffer poor health do not always drifts down.
The impact of ill health on downward mobility is very slight and tends to be limited to certain sexes and age groups, namely, men in their late middle age. Poor health can effect social mobility, but the size of the effect is very small to account for very much of the overall health differences.
Cultural/Behavioural Explanation:
Cultural/Behaviour explanations suggest that social class difference in health is a consequence of behaviours which people chose to engage in.
Thus the health differences emerge because the lower social groups have adopted more dangerous and health damaging behaviour they that of the higher social groups. ().
‘‘Such explanations, when applied to modern industrial societies, often focus on the individual as a unit of analysis emphasizing unthinking, reckless or irresponsible behaviour or incautious life-style as the moving determinant of poor health status.’’
(Townsend, P. et al (1992)
That explanations suggest that the lower class chose not to eat well, such as relying on cigarettes, chose to drink more alcohol and not to exercise. This explanations also suggests there is problems in the lower classes with Prenatal monitoring, vaccination and practising ‘‘safe sex’’. These are all behaviours that may damage a person’s health.
Coronary heart disease is one of the biggest single causes of disease is one of the biggest single causes of death with almost 115, 000 deaths each year in England. The death rate from coronary heart disease in people under 65 is almost three times higher in Manchester which would account for the lower class population than in Kingston and Richmond which would account for the high class population (Crittenden, M and Rashead, E (2007)
This explanation implies that lifestyle behaviours are the result of individuals free-choices. It implies that people harm themselves and their children by adopting health-damaging and reckless lifestyles
It suggest that because of culture of poverty, the poorer classes tend to live for today and ignore health guidelines about smoking and eating faulty, rich foods while lying around neglecting exercise. The individual is used as the unit of analysis implying is used as the unit of analysis implying that personal characteristics such as personality type or intelligence, determine their health behaviour.
Although some health treating lifestyle behaviours do have been criticized by opponents because it trends to blame the victim and absolves the social structure of responsibility.
The problem with this notion is that individual decision-making must always be seen in the context of the social structure and of the constrains that impede the behaviours of the people placed in different locations in the social structure.
The government tried to tackle health inequalities and their underlying causes by policy implications. By targeting help to disadvantaged communities.
Recent health policy interventions (choose Health; Making healthy choices easier (2004) which forced on lifestyle choices such as smoking or cancer originate from the behavioural explanation of health inequalities. This was identified as likely to have the most impact long term in improving the health of the population.
However, studies have also shown that the gradient is not sufficiently steep, nor the behaviours treating enough to account for the social class gradient in mortality.
Structural/Materialist Explanation;
The structural/Materialist explanation concentrates upon hazards which are inherent in society and which people have no choice but it be exposed to them. Therefore the lower class are exposing to more unhealthy environments.
This explanation emphasizes the role of economic and associated socio cultural factors in the distribution of health and well-being. For example, poor housing has implications in the health of the poorer classes.
Numerous factors come into play, the stress of living in poor conditioned, the dampness, the pollution experienced heating or rather lack of heating all of which have an impact on health.
The lower classes have less access to good schools, as these schools are usually in better class areas and transport links in poorer areas can be poor.
Studies have indicated the way in which lower income families attempt to reduce the stresses of living in a deprived way are Sweets are used to comfort children, since it is quick and easy. Breast feeding may be abandoned earlier to give more time to other family members. Smoking can ease the tension and be used as a coping mechanism (www.uwic .ac.uk/shss/dom/…/scexplandions/artefact.htm).
The idea is that there are direct and indirect links between material/economic deprivation and health. If born into higher social classes a person has an advantage to certain tenements of society which impact on a person’s health.
This pattern is evident by people in lower socio-economic status (SES) being exposed to relatively unhealthy and risky environments for example, types of employment.
Lower class people can have material constants on gaining access to information on healthy choices, such as diet or lifestyle. This can be caused by lack of education, longer distances to health facilities and work.
Poverty is the most important determinant of health as people in lower socio-economic status continue to be disadvantaged in terms or risks of ill health.
It is the materialist approach the Black Report adopted, which sees health as the result of political-economic differences or differences in the way members of different social classes are constrained to lead their lives.
However, many who support the behavioural explanation object to the materialist explanation on the idea that many current health problems such as cancer are associated with high-risk activities such as smoking which can be avoidable.
Despite the probable causes of patterns of ill-health and equality in the UK, and these explanations between health and social class and despite the welfare state and improvements in health in all sections of societies over the years this discrepancy of health including expectation of life, infant and maternal mortality and general level of health. Whilst the failure to close the social gap is a disgrace to some, others would argue that as in all levels of society there is no need for concern. Despite 60 years of The National Health Service, there remains marked differences in all parameters of health across the social class (www.patient.co.uk>patientPlus).
