But evidence from later research by Acheson Independent Inquiry into Inequalities in Health (1998) signal a renewed interest in health and social inequalities. It was given that as we enter twenty first century, people of lower social class still experience much worse health than those at the upper class.
Acheson (1998) explored other differences that influence health and life chances laying beneath social class. Income, access to the best educational opportunities, nutrition all affects human growth and development because of their influence on health and life chances. See figure 4.17 and figure 4.18 for data. Worryingly the health effects of pollution, access to good quality housing and exposure to substances such as tobacco smoke and lead, play an important role in influencing life chances. Senior and Viveash (1997).
The differences in the incidence of ill health by social class were explored in detail by Townsend and Davidson (1982). Four types of explanation of artefact of measurement, social selection, cultural differences and material inequalities are used to account for the persistence of class health inequalities, but three will be considered.
Social selection theory suggests that health is determined in social class through a process of health related social mobility. Downward drift hypothesis in support says that class V has reduced in size showing only people who have slide down from their socio-economic position due to poor health. According to Lundberg (1991) experiencing hardship in childhood might lead to downward slide in the social scale in the future as good health lead to social advancement. In contrast census data (at point in time) compared to longitudinal (through time) between 1971 and 1981 shows that selection theory is not adequate to measure the disparity among the classes. Goldblatt (1990), Marmot et al (1991).
Cultural explanation makes it clear that social class determines health through learned behavioral patterns and beliefs of different status groups explanation focuses on individual responsibility for their own health and the degree to which they jeopardise or enhance their chances of good health through the choices that they make about their lifestyles. Evidence from the General Household Surve (1993a) and the Health Survey of England (OPCS) and Calnan (1990) shows that major causes of death preventable by lifestyle are found in lower social class. For example smoking is the cause of lung cancer in 90 per cent of all cases, a lack of fibre in diet causes stomach and colon cancer, a lack of exercise is partly a cause in hypertension. Health improvement strategies and attendance of preventive services scores favourably for middle class and regional south east compared to lower class and residents in Manchester and Wales.
However the prefer lifestyle of lower social class is insufficient for cultural explanation of health inequalities. Marmot et al (1984) comparing individuals from social class I and V whose smoking, eating, drinking and exercise habits are broadly similar, found that health inequalities still persist. Brown Harris (1989) also argued that risk behaviours are unevenly distributed between social classes and people’s behaviour can be a response to social circumstances.
The material explanations blame factors such as poverty are a direct cause of mortality including poor housing conditions, educational provision, lack of resources in health and life threatening occupations for poor health experience by lower social class as they are more likely to be affected by these differences in circumstances of life that contributes to stress and depression as lifestyles tend to stay the same. Poverty limit choices, satisfying immediate gratification; it is about being denied the expectation of decent health, education, shelter, a social life and a sense of self esteem Marsh (2000). But it can be argue that while some disease are more widespread in rich nations, life expectancy is lower in poorer nations.
Contribution by the X factors explains why working class people with behaviours similar to those of middle class counterparts have worse health chances. Stress is commonly found amongst those lower down the social scale that lack autonomy and as a result does not feel in control of their lives. Feelings of inadequacy and life threatening occupations, often caused by low status. Analysis of international data shows that if others become richer, and your income remains the same, you are more likely to become ill Michael Marmot (1991).
Having discussed the link between class and health, the influence of social class on health care will also be examined. NHS was founded in 1948 as part of modern welfare state in Britain following the recommendations of the Beveridge Report, to serve as a road to health reconstruction and social progress.
Field and Taylor (1998) comment that although equity was a founding principle of NHS, but the principle of free services was soon challenged with high costs, demographic factors and political ideology. NHS has undergone several reforms but the health gap between the classes still widening. A right to a health care service does not imply that people have equal access and that quality care is given.
Morrall (2001) proposed that inequalities in access to health care are influenced by several supply factors: location, transport, poor care facilities, education and lack of information and staff training, inflexible opening times, disabled access, bed-blocking, long waiting lists.
Henley and Schott (1999) view that demand factors such individual attitudes and lay health beliefs, lack cultural sensitivity services, financial insecurity, charges, language and communication problems, social mobility and lack of informal carer for support might also affect patterns of utilisation and access to health care.
According to Gormley (1999) Tudor-Hart inverse care law suggested that communities most at risk of ill health tend to receive the least satisfactory in access to the full range of care services including prevention services of health promotion; additional inequalities are experienced among Bangladeshi women due to language barrier and cultural needs and religion.
Local studies have shows that access to women practitioners can also be a barrier to Asian women from taking attending cervical screening, access to female practitioners is poorer in areas with high concentrations of Asian residents and that practices with a female nurse are more likely to reach certain group. Health promotion claims by GPs are highest in the least deprived and lowest in the most deprived areas.
The Labour government considering Acheson Report (1998) and its likely effect embark on tackling wider influence such as poverty, education, social exclusion, employment, housing, ethnicity and the environment. The Department of Health (1998) published its proposals in latest White Paper which formed the basis of The Health Act (1999) brought integrated care to replace the internal market involving agencies working together more closely.
The new initiatives include: integrated care, Commission for Health Improvement act as quality assurance watchdog for clinical governance; Health Improvement Programmes involving under-represent groups under the NHS, the Health Action Zones is to trigger action programmes in deprived areas. NHS Direct and NHS direct Online provides 24 hour telephone advice on health issue and diagnostic website. National Institute for Clinical Excellence gives advice and assess new treatments and cost effective way to apply them. National Service Frameworks in partnership works to promote quality healthier lifestyles and prevent CHD and mental health for particular care groups. (DOH 2000).
But the critics said that abolishing the internal market has cut £1 billion of red tape costs over the lifetime of the parliament for investment in patient care. Morral (2001).
Whitehead et al (1995) explain two main approaches of health, the medical and social models. Medically, disease is caused by biological factors, and personal factors such as smoking and diet which shows the moral failings of the individual or sudden attack of disease. But the social model, emphasis on the social causes of ill-health and how social conditions influences health. But according to WHO (1984)define health as a state of complete physical, mental, and social well being, and not merely the absence of disease or deficiency while illness is the subjective feeling of being unwell. But there are cultural differences in how society classifies health, illness, the causes and the treatment. Gomm (1998).
Therefore looking at inequalities in health materialistic and cultural differences are probably the most important in explaining health inequalities in the UK. It appears that poverty and its associated culture are the main causes of poor health. Although social class is an important determinant of life chances but poverty should be tackle through redistribution of income and wealth. The successive governments have been preoccupied with health services rather than health. A return to the lesser income and wealth differentials of 1983 would prevent about 7500 deaths a year among people aged under 65 and 2500 lives a year would be saved by eliminating long-term unemployment; eradicating child poverty would reduce children mortality under 15 by 1500 Hills Joseph Rowntree Foundation (1998).
Sociology in relation to nursing profession is that knowledge, recognition and measurement of the extent of these inequalities has brought new considerations into debates about effective professional practice in diverse heath care Moreover it will empowered the medical profession to transform the future of clinical practice and shape our attitude and reasoning.
