Demonstrate how Inequalities can adversely affect the health of the family in the scenario.
Evidence of a link between socio-economic position and health dates back to ancient China, Greece and Egypt and is apparent today in all societies (Graham 2000). Inequalities in health and the risks of premature death have been recorded since the 19th century (Graham 2000). In the mid-nineteenth century the United Kingdom was undergoing rapid industrialisation. This was supported by adults and children labouring long hours in factories and mines. They lived in unsanitary and cramped housing which contributed to the low life expectancy. Since the 19th century death rates have fallen by half. Chronic disease in later life such as coronary heart disease and cancer dominate the mortality statistics (Graham 2000). Despite this ill health continues to follow the contours of disadvantage. This is a continuing cause for concern in the 21st century, especially when it is linked to maternity care. Therefore this essay will attempt to demonstrate how inequalities can adversely affect the health of the whole family in the scenario by examining relevant research into the health and social aspect that this family will encounter. It will also examine how the maternity services can provide adequate help and information to Mary during her pregnancy. It will cover housing, education, the environment and health.
One in four people in the UK live below the EC poverty line; this takes a heavy toll on health (DSS 1998, cited by Graham 2000). People's lifestyles and behaviour are recognised as causes to health problems. Smoking has been identified as the major preventable cause of premature death and is a habit with a sharp socio-economic gradient among both women and men. However, when looking back in history to the nineteenth century when manufactured cigarettes were not yet invented infectious diseases such as measles, whooping cough and diarrhoea were the major causes of death (Graham 2000). Another cause of health problems is diet, stress, housing, alcohol and substance misuse and exercise (Alderman et al 2000).
In April 1977 the then secretary of State assembled a Working Group to address the inequalities in health. Their objectives were to assemble all available information regarding the difference between the health status among the social classes. The Black Report (1980) was produced under the Chairmanship of Sir Douglas Black, it looked at the possible causes and the implications for policy, and to suggest further research. It suggested that the causes of health inequalities were so deep rooted that only major public expenditure would be capable of altering the pattern (Jenkin 1980). The evidence showed that there was a large gap in mortality between the social classes, and that instead of getting better the gap was widening. It documented that poor families are locked into poverty including educational, environmental and social disadvantage for a lifetime and sometimes generations. This showed huge implications on their health. The financial implications on the Health Service are immense. It showed that there were large numbers of young women among the working class that suffered from depressive illness, and that this in turn had a profound effect on family life and child-rearing. It also found that twice as many babies born into the social class of unskilled people die within the first month, than babies born to the social class of professionals. Approximately three times as many infants born to parents in the unskilled class die in their first year compared to infants born into the professional social class. Although attempts were made to suppress this report it was made more newsworthy by these actions and became to some the most important medical report since the war. With the election of the Labour government in 1997 a new inquiry was commissioned.
In July 1997, the then Secretary of State for Health commissioned Sir Donald Acheson to review and summarise inequality in health in England and to identify and prioritise areas for development of policies to reduce them. His report, "Independent Inquiry into Inequalities in Health", was published in 1998. His report recommended wide ranging changes in the way that health policies are made. His committee recommended policies to reduce poverty in families with children, by promoting material support for parents. It recommended that high priority was to be given to improving health and reducing health inequalities for women of childbearing age, expectant mothers and young children. The evidence to increase the rates of breastfeeding for health reasons was also documented, recommending that there should be an increase in the prevalence of breastfeeding. The development of programmes to help pregnant women to reduce or give up smoking before or during their pregnancy due to the evidence that the lower social classes are four times more likely to smoke in pregnancy (Foster et al 1995 cited in Acheson 1998). The report also revealed that in some areas inequalities in health have risen rather than declined. Towards the end of the last century it showed a continual link between poor health and social class (Alcock 2003).
In the last two decades of the 20th century, children replaced old people as the group most likely to be in poverty in the UK (DWP 2005). The present Labour government announced in 1999 that it would end child poverty in a generation. It promises to half child poverty by 2010 and end it by 2020. The results of this are already beginning to show with the child poverty rate falling steadily (Hirsch 2006). The Right Honorable John Hutton MP, Secretary of State for Work and Pensions stated in a speech before the Joseph Rowntree Foundation, on Thursday ...
This is a preview of the whole essay
In the last two decades of the 20th century, children replaced old people as the group most likely to be in poverty in the UK (DWP 2005). The present Labour government announced in 1999 that it would end child poverty in a generation. It promises to half child poverty by 2010 and end it by 2020. The results of this are already beginning to show with the child poverty rate falling steadily (Hirsch 2006). The Right Honorable John Hutton MP, Secretary of State for Work and Pensions stated in a speech before the Joseph Rowntree Foundation, on Thursday July 6th 2006 that child poverty is the principal cause of life chances. Children that are born into poverty are more likely to die prematurely and less likely to attend school regularly. Therefore they are less likely to attend college or further education which may force them into the worst jobs, or have no job at all. They are more likely to be victims of crime and to offend themselves (Hirsch 2006). The report highlighted the important progress made in tackling child poverty and the scale faced in meeting the Governments goal of eliminating child poverty by 2020.
Levels of children living in poverty in Wales has fallen since 2002. However 27% are still living in poverty (DWP 2005). Families in rural areas have limited access to many services and can feel very isolated. Children are particularly vulnerable to poverty as they are growing and developing in poor circumstances which affects their social behavior. Tackling childhood disadvantage is particularly important because childhood experience lays the foundations for later life (Croke & Crowley 2006). The children in the scenario are growing up in a low-income household. Evidence shows that they are more likely than other children in the higher social classes to have poor health, to do badly at school, become teenage mothers or come into early contact with the police and to be unemployed as adults or to earn lower wages (Hirsch 2006). These children are also more likely to be unable to enjoy the basic living standards such as adequate clothing and a balanced diet (Adelman et al 2000).
Mary and her family will have an extra mouth to feed which in turn will mean extra money. Having the right trainers or fashionable clothes puts enormous pressure on children and this can often result in them "bunking off" school in the hope that they do not have to "conform" to their peers views. Alongside this children need decent health, housing and wider opportunities to develop. Education is one of the most important childhood experiences that help to develop their future socio-economic level, health and criminal behaviour (Regan 2005).
Research has shown that children from poorer areas are more likely to be exposed to damp housing and a diet deficient in nutrients (Bennett 1996). They are also more likely to be exposed to passive smoking and suffer from psychological stress from being in a home environment where money is short, space in the home limited and growing up in declining and depressing inner cities (Bennett 1996). Research has also shown that children born into poor socio-economic families have a higher risk of low birth weight and obesity in later life. Children who live in overcrowded households with non-earning parents are more likely to suffer higher rates of mortality (Regan 2005). However, a report by the National Statistics Regional Trends found that over the last twenty years infant mortality has declined in all areas of the United Kingdom, Wales from 12.6 to 4.7 per 1,000 live births (National Statistics 2004 ).
Areas populated by poorer people experience more hazards such as environmental pollution, traffic pollution, traffic volume and accidents. These areas are less resourced when it comes to public transport, shops and primary health care services. According to Whitehead (1988) children from lower social groups have more accidents, this may be explained by their reckless, risk-taking behaviour and inadequate care by their parents. A materialistic view would be of unsafe play areas, lack of space to play in high rise housing coupled with the inability to supervise their behaviour. He concluded that the environment dictated the behaviour of both mother and child.
In this scenario the whole family will be affected by inequalities in health. Mary's elderly parents both suffer from illness. Her father suffers from asthma after working in the coal mines all his life, and her mother from arthritis. Her father is also at risk from COPD (Chronic obstructive Pulmonary Disease) as a result of working in the mines. This is a progressive disease that causes an obstruction of the airways. According to the National Statistics (2004) circularity disease was the highest single cause of death during 2001, averaging 378 per 100,000 for the United Kingdom. The scenario does not say if Mary's husband is obese, however if he is this significantly heightens his risk of ill health and chronic diseases. In winter the weather will affect both of them. Mary's mother has arthritis, inflammation of the joints which can be very painful and restricts movement. It is estimated that over 20 million people in the UK have a rheumatic disease (Weller 2000). With both parents illness restricting them to their own environment they could be at increased risk of becoming trapped in their own homes. With crime rates higher in poorer areas this could also have an affect on their quality of lives. Older people especially women are more likely to be the victims of theft. Fear of crime can cause mental stress and social exclusion. Older people tend to worry more about becoming victims, this may prevent them from attending local social events (Acheson 1998).
Both parents present more stress to Mary's already stressful life. Neither can offer her any financial help, and with transport costs to consider childcare is not an option. Mary's support is vital to them. This will put increased stress on Mary who is already struggling to stay in her part time job. With less money when she leaves work to visit her parents together with fatigue, this may prove to be detrimental to her health. Mary may have an increased risk of premature birth as preterm labour occurs in up to 10% of all births and accounts for more than 80% of infant death and disability (Mc Guire & Fowlie 2005). Therefore Mary's midwife should help her gain as much information and help as she can, involving as many agencies as the family permits. The midwife should also make sure that she has up to date knowledge on maternity benefits, help Mary and her family through the knowledge of other professionals claim all that they are entitled to. They must also discuss contraception. If Mary's husband does not consent to a vasectomy then an alternative form of contraception is needed to ensure that there is not another unplanned pregnancy. For the immediate future Mary must draw upon all the support around her. Her midwife must be aware of her circumstances, be observant for any deviations from the "normal" in her pregnancy and support Mary as much as she can.
Poorer people may have poor health because they have to live in places which are health damaging. Unhealthy homes suffer from other social and economic disadvantage (Alcock 2003). Lack of access to gardens, parks, shopping facilities pollution from noise, dirt and litter. Tenants' usually have no choice in the fuel that heats their homes. The cost of fuel is often high due to damp conditions and lack of insulation. This creates a major source of debt (Jones & Pickett 1993).
Poverty also increases the number of stressful life events. Poverty causes lack of control over events which can increase depressive illness. The coping mechanisms people use to overcome this stress may lead to worse problems. For example, drug abuse, alcohol abuse and smoking (Jones & Pickett 1993). In Mary's case she is at increased risk of developing post-natal depression, or even psychosis and twice as likely as men to suffer depression (Mc Guire & Fowlie 2005). One in four is likely to suffer from a serious depressive episode. However her husband is also likely to suffer from depression and low self esteem (Palmer et al 2006). According to Professor Nicholas Emler, a social psychologist, relatively low self-esteem is a risk factor for suicide, depression and victimisation (Palmer et al 2006).
Certain groups face high risks of poverty, 69% of those families are where the breadwinner (s) are unemployed. 26% of families that are also at high risk are those with an adult in part time work (Thomson et al 1998). Mary and her family fall into this category and will be at risk of a higher level of poverty when she ceases her part time job. Research has shown that there is a definite link between unemployment and ill-health, these include long-standing illness, mortality rates, disability and psychological disturbances (Jones & Pickett 1993). Although there are many Social factors that affect Mary's health there are also many physical conditions that she may suffer. Mc Guire & Fowlie (2005) suggest that women from poor socioeconomic backgrounds are more likely to endure preterm labour. However, some studies have shown that interventions such as better antenatal care, increased social support and a healthier diet during pregnancy does improve the outcome of preterm delivery ( Taylor & Field 2003).
Most women are aware of specific hazards in the area that they work. The most important time for teratogenic influences are in early and late pregnancy. As Mary works for a hairdresser she is at risk of chemical hazards. There are special codes of practice for certain toxic chemicals which safeguard pregnant women and their unborn child, Mary should consult her employer regarding the chemicals that she uses (Chamberlain & Morgan 2002). Mary may also be affected at work by passive smoking as there are no laws in force at present to avoid this. Mary has to stand for long periods of time, some studies have shown that this can increase preterm labour. Travelling to work can cause stress especially where there is heat, noise, fatigue and other people's tobacco smoke. Studies in Spain have showed that the likelihood of preterm labour increases with the duration of stressful public travel (Chamberlain & Morgan 2002).
Nutrition is also a key factor as it plays a crucial role in the growth and development of an infant. In June 1991 the National Children's Home charity commissioned a survey on the eating habits of low income families in Britain. The results showed that one in five parents regularly denied themselves food and one in ten children under five went without enough to eat at least once a month (Oppenheim 1993). Blincoe (2006), states that maternal nutrition is a contributing factor in the rise of prematurity and retarded growth. It is well noted that women who have poor diets, tend to give birth prematurely, and of low birth weight. A baby born at full term weighing less than 2.5kg is likely to suffer illness and may have difficulty feeding (Skeoch & Galea 1987).
Studies have shown that pregnant women in low social classes are more likely to deliver early and have a low birthweight baby that will need special care (Brooke et al 1989). A healthy pregnancy is aided by a diet providing calories and nutrients, with a supplement of folic acid in the early weeks of pregnancy. Proper nutrition during pregnancy plays a vital role in determining the health of the newborn child. Through the quantity and quality of what a pregnant woman eats, she provides the nourishment necessary to begin and maintain the growth and development of the fetus (Blincoe 2006).
If Mary wishes to breastfeed successfully she will need support from her midwife. A survey by The Office of national Statistics showed that in 2000 there was only a 2% rise in breastfeeding from the figures taken in 1995. The lowest rates for breastfeeding are found in socio-economically deprived families (Nicoll & Williams 2002). It is advisable therefore that as Midwives interact with parents during pregnancy labour and birth, they are best placed to give as much information to them as possible. With Mary's family there will be many forms of care and information that a number of professionals can give them. The NMC code of conduct (NMC 2004) states that midwives should promote the interests of clients, including helping them gain access any healthcare relevant to their needs (NMC 2004).
In conclusion, the Black Report followed by the Acheson Report brought inequalities in health and the mortality rates among the lower social classes to the forefront. Areas for the development of policies to reduce the inequalities suffered by lower social classes were proposed and some implicated. Unfortunately it also showed that some inequalities in health have risen, not declined and that there is a continual link between poor health and social class. The children in the scenario are growing up in a home of disadvantage. This may affect their chances of a good education and their future prospects as they mature to adulthood. They are likely to be undernourished and be growing up in cramped conditions that will affect their health. This will have a greater impact on them with another sibling joining their family, being another mouth to feed. The inability to travel between her parent's house and her own on a regular basis with a new baby and low income will have a considerable effect on Mary. There is a high risk of Mary becoming stressed and unable to cope at her inability to carry on caring for her parents as she has been doing. Mary's parents will also find this hard as they rely on her so much and may themselves become more socially disadvantaged.
It is clear that people from the lower socio-economic groups are disadvantaged. They are more likely to be living in poverty, be unemployed or their partner may be out of work. These families may live in cramped conditions, dependant on state benefits and undernourished. As midwives interact with families during pregnancy, birth and the postnatal period they are best placed to give parents information. Historically, midwives have focussed on maintaining good health within their remit of normal birth and the detection of any complications. However, the increasing shortage of midwives in the United Kingdom makes it more and more difficult to care properly for these socially disadvantaged women. The only way to change this situation is through legislation that pulls these women up from the lower social classes by giving them a decent amount of money to live on, and the chance to work if they want to by providing them with cheap, safe care for their children, or the chance to return to education to train for a career that may well see them promoted to the higher end of the social class scale.
References
Acheson, D. (1998) Independent Inquiry into Inequalities in Health Report. London: The Stationary Office.
Alcock, P. (2003) Social Policy in Britain. 2nd ed Hampshire: Palgrave McMillan.
Adleman, L. Ashworth, K. Middleton, S. (2000) Poverty and Social Exclusion in Britain. York: Joseph Rowntree Foundation
Bennett, N. (1996) Living in Britain. London: The Stationary office.
Black Report (1980) Inequalities in Health. London: Penguin.
Blincoe, A. (2006) "Infant Nutrition: Building health from the womb to weaning". The British Journal of Midwifery 14 (6) 361-364
Brooke, D. Anderson, H. Bland, J. (1989) "Effects on Birthweight of smoking, alcohol, caffeine, socio-economic factors and phyco-social stress. British Medical Journal:298 795-796
Chamberlain, G. & Morgan, M. (2002) ABC of Antenatal Care. London: Backwell
Croke, R. & Crowley, A. (2006) Righting the wrongs, The reality of children's rights in Wales [online]. Cardiff: The Wales Programme of Save The Children. Available at: http://www.crin.org/docs/save_wales_righting_wrongs.pdf {accessed 12th December 2006].
Department for Work and Pensions (2005) Households below Average Income. Statistics 1994/5 - 2003/04 16th ed
Graham, H. (2000) "Understanding Health Inequalities" MIDIRS Midwifery Digest 10 (2) 144-148
Hirsch, D. (2006) What Will it Take to End Child Poverty, Firing on all Cylinders. York: Joseph Rowntree Foundation.
Jones, D.N. & Pickett, J. (1993) Understanding Child Abuse. 2nd ed London: Mcmillan Educational.
McGuire, W. & Fowlie, P. (2005) ABC of Preterm Birth. Oxford : Blackwell publishing.
National Statistics (2004) Regional Trends. London: the Stationary Office, (38)
Nicoll, A. & Williams, A. (2002) Breast Feeding. London: Palgrave McMillan
Nursing and Midwifery Council (2004). The NMC code of professional conduct: standards for conduct, performance and ethics. London: NMC
Oppenheim, C. (1993) Poverty; The Facts. London: Child poverty Action Group.
Palmer, G. Maclnnes, T. Kenway, P (2006) Monitoring poverty and social exclusion. [online] York: York Publishing Services. Available at: http://www.jrf.org.uk/pressroom/releases/041206.asp [Accessed 11th December 2006].
Regan, S. (2005) Children in Acute Housing Need. York: Joseph Rowntree Foundation
Skeoch, C. & Galea, P. (1987) Prognosis for infants born at 23 to 28 week's gestation. British Medical Journal 294: 177-178
Taylor, S. & Field, D. (2003) Sociology of Health and Health Care. Blackwell. Oxford: Publishing Limited England.
Thomson, H. Holden, C. Hutt, G. Neggitt, C. Manuel, J. Collard, D (1998) Health & Social care. London: Hodder & Stoughton.
Townsend, P. & Davidson, N. (1982) Inequalities in Health: Black Report. London: Penguin.
Whitehead, M. (1988) The Health Divide. London: Penguin.
Weller, B. (2000) Bailliere's Nurses' Dictionary. London: Bailliere' Tindall.
04012593 1 Word Count 3,294
