For instance, in 1988 10 percent of households with a non-white head were overcrowded, (less than one room per person) compared with only 1 percent of all house holds (Black 1988) Overcrowding and poor housing link race and ethnicity to social class in terms of unequal health experiences.
Also, ‘Of households with a head from a Pakistani or a Bangladeshi ethnic group, about one-third had less than one room per person’
This shows that it is not only ‘non-white’ people who live in terrible living conditions but it is specific to the type of ethnicity you are also.
‘Immigrants to this country whose ethnic identity is clearly visible in the colour of their skin, are known to experience greater difficulty in finding work and adequate housing’ (Smith 1976 Inequalities In Health) because of this records in mortality and morbidity are also higher.
Diseases also disproportionally affect certain groups,
‘Rickets in children of Asian origin , sickle-cell anaemia in people of Afro-Caribbean descent, and tuberculosis in several immigrant groups.’ (Donovan 1984)
‘Life-expectancy estimates show that in 1991 new-born girls could expect to live neatly six years longer than new-born boys, to 78.8years and 73.2 years respectively’ (Townsend/Davidson) Not only this but Females generally experience a smaller amount of aliments, diseases and general health difficulties than men throughout their lives.
One explanation to this is that Women are more likely to use health facilities when they are ill, for example, making appointments at the doctors surgery.
However, a good proportion of the time seeking medical help is related to pregnancy and birth issues.
The inequality in health regarding sex differences is regularly pin pointed to the generalized characteristics of men and women.
For example men have a higher morbidity because they have a more aggressive and violent behavior, which causes them to drink more alcohol, makes them more likely to commit suicide and to die in an accident such as a car crash.
‘During the 1980’s females increased their rates of seatbelt use to almost twice that of males, resulting in an increasing gender difference favoring females (Fhaner and Hane 1973)
So, with a focus on occupational class, what causes such drastic differences in health?
Peter Townsend and Nick Davidson outline four theoretical approaches in the edited edition of the Black Report (Inequalities in Health)
The ‘Artefact’ explanation suggests ‘both health and class are artificial variables thrown up by attempts to measure social phenomena and that the relationship between them may itself of little causal significance’ (Townsend/Davidson 1988)
It argues that the Registrar General method of measuring occupational class on a scale of six main classes, from Professional in class I to the Unskilled in Class V, over estimates the size of health differences.
The contrast between the occupational classes regarding health is due to statistical inaccuracies. For example ‘The scale is based on a man or single women's occupation and so a married women, is classified according to her husbands occupation, meaning the term has an inherent gender inaccuracy’ (Whitehead 1992).
The information regarding occupations is usually obtained from death certificates which can be vague and do not record every occupation an individual has had during their life-time, many occupations that are not recorded could have had an direct effect on health previously in life.
Surveys which are used to record statistics also have many major flaws, one of these being the fact that a percentage of the public do not wish to divulge personal information regarding occupation, illness and deaths within their families. This is also the case when recording number of patients at general practices, many people take care of themselves or simply ignore symptoms of illness.
A second theoretical approach to explaining health inequalities is that of natural or social selection. It suggests that health inequalities ‘result form a continuous process of social mobility, with those moving up being healthier than those moving down the social scale’ (Power/Manor/Fox Health and Class1991)
People with poor health seem to become concentrated in the lower socio-economic groups.
A study of infant mortality according to class of father and class of husband gave strong evidence to social selection, Illsley (1955) claimed that women who marry up the occupational classes were taller than those who marry downwards. The result of this was heavier babies and a lower scale of infant mortality.
Therefore a good status of health influences social class and not the other way round, the contrasting gap between the classes is inevitable
Fox (1984) however, argues that ‘differences in mortality are as wide at ages 65 as they are at younger ages, and since it is unlikely that social mobility is a significant factor at these ages it was concluded that selection would not play a significant role in explaining the differences observed.’
The cultural or behavioral explanations of inequalities in health stress the differences in life style choice of social groups.
The Whitehead/Dahlgren model explains ‘there are a set of factors that are theorized to impact upon our likelihood of developing disease of dying prematurely’ (The Sociology of Health Inequalities 1998)
‘These factors, labeled ‘lifestyle, embrace behaviors over which we may be said to have some degree of control. They include smoking, alcohol consumption, eating patterns and propensity to exercise’
Lower social groups tend to adopt lifestyles which are more dangerous to health that of people in higher occupational classes.
There are many explanations for this, usually linking socio-economic status with bad health.
For example, families who live in council estates may not have access to purchasing food in large supermarkets with a large variety, instead have to buy food from small convenient corner shops which do not sell food from every food group needed in order to maintain a healthy diet.
Also, processed food high in fat and sugar such as crisps and chocolate tend to be cheaper than fresh fruit and vegetables but are of course, a lot lower in nutritional value.
‘A person cannot always help the way that they live. Low income determines the type of food that poor people can buy and therefore the amount of nutrients that a person can eat.’(Blackburn 1991).
Statistics in smoking give a good example of ‘blaming the victim’.
‘Smoking is frequently invoked to illustrate differences in health between classes, with implication that behavior patterns under an individual’s own control produce these social differences in mortality’ (Townsend1988)
The Acheson Report shows that two per cent of men and sixteen per cent of women in professional occupations smoke, whereas forty one per cent men and thirty six per cent women in unskilled occupations smoke.
The final theory of the causes of inequality in health is known as materialist or structuralist explanations. It entails that like the cultural explanation, people of lower occupational classes are subject to health inequalities because of their socio-economic status. The difference is, the previous theory suggests this is because of the life-style choices they make, however the structuralist theory emphasizes the fact that individuals in this position are forced to live this way due to the financial situations they are in.
It stresses that poverty, deprivation, the external environment and living conditions are the main causes of illness and mortality. These factors are out of the control of the individuals who live within them.
‘Among child pedestrians the risk of death from being hit by a motor vehicle is multiplied by five to seven times in passing from class I to class IV; for accidental death caused by fires, falls and drowning , the gap between the classes is even greater’ (Townsend/Davisdson 1988)
The Black report identifies that the drastic differences show that the accidents do not occur in a purely random fashion,
‘While the death of an individual child may appear as a random misfortune, the overall distribution clearly indicates the social nature of the phenomena’ (Townsend/Davidson 1988)
The social nature of the accident’s give a good example of the consequences of living in a poor area without adequately monitored play areas for children.
This can also be said for safe home furnishings and domestic appliances. The possibility of children having an accident from lower class families is also increased, there is less time for parents to monitor their children because for the majority of the time that parents have to go to work and the cost of additional childcare is not an option.
‘Class patterns of accidents has to be seen in the light of the great differences in the material resources of parents, which may place significant constraints on the routine level of care and protection that they are able to provide for their children’ (Townsend/Davidson 1988)
Families living in poverty find themselves trapped in a circle, they are twice as likely to have a baby which has lung, heart or reparatory problems due to low birth weight (pre-mature babies) problems are then passed onto the next generation.
The reason there is so many pre-mature babies is linked with parental poverty and a poor environment rather than the quality of medical care that a person receives. (From figures from the Black Report)
In conclusion, it is obvious that there is not one factor which can explain the inequalities in health in Britain, however Government policy and funding of the NHS, housing and employment opportunities show that this is an issue that is being addressed. Because expected life span is increasing as awareness into the importance of a healthy life style then there is still hope that the gaps between health and class, gender and ethnicity will decrease.
Bibliography
Townsend, P., Davidson, N. (eds) and Whitehead, M. (1992) Inequalities in Health: The Black Report / The Health Divide, Harmondsworth: Penguin.
Power, C. Manor, O. Fox.J (1991) Health and Class: The Early Years, London : Chapman & Hall
Bartley, M. Blane, D. Davey Smith. G (eds) (1998) The Sociology of Health Inequalities, Oxford: Blackwell
Townsend, P, Phillimore, P. Beattie, A (1989) Health and Deprivation, Inequality and the North, London: Routledge
Annandale, E. Hunt, K (eds) (2000) Gender Inequalities in Health, Buckingham: Open University Press
