SOCIOLOGY
Contents 1
Action Plan 2
Inequalities in Health and Social Class 3 - 8
References 9 - 10
Appendices 11 - 17
Evaluation 18
ACTION PLAN
INEQUALITIES IN HEALTH AND SOCIAL CLASS
Britain has an advanced welfare system in the terms of health care and social security. The NHS began in the 1940’s and was built on the principle that health care should be freely and widely available to all. The health service is free at source. Anyone can see a doctor, visit a hospital and receive treatment. Although GP services and hospital care remain free, charges are levied for eye care, dental care and prescriptions. Despite the fact that there is an apparent availability of health care services there are still many inequalities in the health of different groups in society.
Much of the evidence on social differences in health in Britain is measured in terms of social or occupational class. Occupation is recorded in the census, on birth and death certificates and on some, but not all health records. From that the Registrar General classifies people into social classes. Men and single women are classified by their own occupation and children by the occupation of the head of the household. Married women are classified by their husband’s occupation, though their own occupation is available for analysis and is used in some studies.
Although this classification is based on employment it is important to realise that it is not just a measure of working conditions. The intention is to group together people with similar living standards and way of life indicated by their occupation. When the scale was first devised it was intended to reflect both wealth and poverty and the culture associated with each class. In 2001 the scale was updated to include eight social classes, (figure 1, page 11).
Many people believe that health and illness are largely determined by factors under an individual’s control, such as diet, ...
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Although this classification is based on employment it is important to realise that it is not just a measure of working conditions. The intention is to group together people with similar living standards and way of life indicated by their occupation. When the scale was first devised it was intended to reflect both wealth and poverty and the culture associated with each class. In 2001 the scale was updated to include eight social classes, (figure 1, page 11).
Many people believe that health and illness are largely determined by factors under an individual’s control, such as diet, exercise and sexual behaviour. All these things play an important role in health but there are many other important factors. Other influences on our health include poverty, social exclusion, employment, housing, education and environment, (figure 2, page 12).
In modern Britain poverty still exists and significant groups of the population are living in poverty. People who are poor are prevented from participating in normal day to day activities of the society in which they live; in effect they are socially excluded. According to www.jrf.org.uk , poor people in rented accommodation tend to live in unhealthy neighbourhoods, have poorer physical health, and be more socially excluded than home owners. Poor home owners, on the other hand, tend to suffer more from physical accommodation problems and poor mental health. Using the Poverty and Social Exclusion Survey, approach to the measurement of poverty, it is estimated that 25% of the adult population of Britain is poor. Amongst outright owners, the figure is 15%, and for people with a mortgage, 17%. In the private rented sector, over one third is defined as poor, and in the social rented sector, 61%.
The impact of unemployment on health has been studied over the years. According to www.greenhealth.org.uk , there is no reasonable doubt that unemployment has a detrimental affect on health. The unemployed and their families consult with their doctors more often. It has also been shown that among other things, weight gain, smoking, drug taking, attempted suicide and suicide itself are distinctly higher in the unemployed.
www.sheffield.nhs.uk , shows the deprivation analysis and death rates for Sheffield. It can be clearly seen that the poorer areas where there is more unemployment have much higher suicide rates (figure 3, page 13).
Drugs are also a more common feature in today’s society. The availability of drugs has become more widespread in recent years; quiet country areas have become just as much a target as urban inner cities. Drug use is both a response to social breakdown and an important factor in worsening the resulting inequalities in health. It offers users a mirage of escape from adversity and stress, but only makes problems worse.
The British Crime Survey has been used for a number of years to estimate the prevalence of drug use among the general population in England and Wales. (Figure 4, page 14) on social class, shows a contrast between cocaine and heroin use. Respondents in the ‘highest’ social class categories had a higher level of cocaine use. Heroin use was higher in the ‘lowest’ groups. This reinforces the point that different types of drugs have different relationships with socio-economic factors.
Employment status may also be linked to drug use. Within the last year use of any drug, heroin and class A drugs by 16-29 year olds was higher among the unemployed, (British Crime Survey, 2000, figure 5, page 15). A report looking at environmental factors and drug misuse found that any statistical relationship between drug use and deprivation seemed to apply more to problematic drug use (Advisory Council on the Misuse of Drugs, 1998).
Against this extremely negative picture can be set the many positive initiatives which have been taken around the country. There has been a dramatic re-awakening of interest in public health in the national and local authorities. There is a growing concern and pressure for action from the various professional associations. Numerous examples of individual health workers and health authorities are doing their best to counteract the inequality in health and health care which they face in their every day work.
Health Action Zones are new ways of tackling health inequalities in some of the most deprived areas in England. As well as tackling key priorities such as coronary heart disease, cancer and mental health, and issues such as teenage pregnancy, drug (misuse) prevention in vulnerable and young people and smoking cessation, they are addressing other independent and wider determinants of health. Additional priorities include housing, education and employment. The initiative brings together organisations within and beyond the NHS to develop and implement a locally agreed strategy to improve the health of local people. All the Health Action Zones are based on seven key founding principals, (figure 6, page 16).
Each Health Action Zone focuses on addressing its major health and services priorities. Altogether more than £274 million was made available to assist these zones in the three years from April 1999. This funding has been used to leverage charges in the more substantial budgets of health and local authorities. The 26 health Action Zones (figure 7, page 17) range in population from 180,000 to 1.4 million people and cover over 13 million people in total. They are located in some of the most deprived areas in England, including inner cities, rural and ex-coalfield communities. (www.doh.gov.uk)
The government has also invested into another project called Sure Start. This is a cornerstone of the government’s drive to tackle child poverty and social exclusion. Its aims are to improve the health and well being of families and children before and from birth, so children are ready to flourish when they go to school. Based on firm evidence of what works, by 2004 there will be at least 500 Sure Start local programmes helping up to 400,000 children living in disadvantaged areas, including a third of under fours living in poverty. The government invested £452 million in Sure Start during the period 1999 - 2000 to 2001 - 2002. The Spending Review in July 2000 announced an extra £580 million for Sure Start over the period April 2001 to March 2004. (www.surestart.gov.uk).
The huge gap between the rich and the poor is morally wrong. There are many debates as to the causes of poverty, social change, increase in unemployment, the growing number of elderly people and lone parent families. This has resulted in the increased numbers of people living in poverty. Benefit levels are inadequate to enable people to live, even at subsistence level. Benefits and pensions need to be increased so that people who cannot work can share in the increased wealth and prosperity that most people in Britain are enjoying. The government has agreed to increase the national minimum wage but by less than the increase in average earnings. As a result of this the income gap will no doubt, continue to grow.
The current government is committed to reducing inequalities in health. Not only are they aiming to improve the health of the nation but also to improve the health of the worst off at a faster rate. The NHS plan has given prominence and priority to tackling health inequalities. Two new national targets to reduce infant mortality and life expectancy have been set. Across central and local government, key building blocks to tackle these inequalities have been put in place. These foundations now need to be built on, and the work they have stimulated make a step to change and reduce inequalities in health. In conclusion, poorer families need more income and better nutrition. Along with improved homes, better access to education is needed as well as health education and equal access to the best medical services according to their illness needs.
REFERENCES
Advisory Council on the Misuse of Drugs (1998). Drug Misuse and the Environment. London: Stationery office. [online] Available from:
http://www. homeoffice.gov.uk/rdsd/pdfs/hors224.pdf [Accessed 03/03/03]
Bills Of Health - Unemployment. [online] Available from:
http://www.greenhealth.org.uk/billsof health.ue_files/unemployment.htlm
[Accessed 20/02/03]
British Crime Survey (2000). [online] Available from:
http://www.homeoffice.gov.uk/rdsd/pdfs/hors224.pdf [Accessed 03/03/03]
Joseph Rowntree Foundation. [online] Available from:
http://www.jrf.org.uk/knowledge/findings/housing/113.asp [Accessed 20/02/03]
NHS Sheffield - Local health data (2000). [online] Available from:
http://www.sheffieldnhs.uk/health data/deprivation.htlm [Accessed 27/02/03]
Our Healthier Nation - The Causes of Ill Health (2002). [online] Available from: http://www.ohn.gov.uk [Accessed 20/02/03]
Primary Care: Health Action Zones (2001). Published by the Department of Health. [online] Available from: http://www.doh.gov.uk [Accessed 22/02/03]
Sure Start (1998). Comprehensive Spending Review: Cross Departmental Review of Provision for Young Children: Supporting papers, Volume 1 and 2 (1998).
HM Treasury. [online] Available from:
http://www.surestart.gov.uk/text/aboutHistory.cfm [Accessed 20/02/03]
The Registrar General (2001). [online] Available from:
http://www.rgo.act.gov.au.htm [Accessed 20/02/03]
APPENDICES
Figure 1: The new occupational scale (updated 2001)
Source: The Registrar General
Figure 2: Factors Affecting Health
Source: Our Healthier Nation – The Causes of Ill Health
Figure 3: Local Health Data, Sheffield
Source: NHS Sheffield
Figure 4: Percentage of respondents aged 16 to 29 using various drugs in the last year by social class
Source: 2000 British Crime Survey (weighted data)
Note: Social class groupings are defined as: Lowest = unskilled occupations; Intermediate = skilled occupations (manual and non manual) + partly skilled occupations; top two = professional + managerial and technical occupations.
Figure 5: Percentage of respondents aged 16 to 29 using various drugs in the last year by employment status
Source: 2000 British Crime Survey (weighted data)
Note: ‘Employed’ includes: people doing full-time or part-time work in the last week; working on a government supported training scheme; or doing unpaid work for own/family business. ‘Economically inactive’ includes: respondents of working age who are retired; going to school or college full-time; looking after home/family; are temporarily or permanently sick; or doing something else. ‘Unemployed’ includes those; actively seeking work, or waiting to take up work.
Figure 6: The Health Action Zones seven key founding principles
Source: Primary care: Health Action Zones
Figure 7: The 26 Health Action Zones designated areas:
Source: Primary Care: Health Action Zones
EVALUATION
I have enjoyed planning, researching and completing this assignment. I have learnt new skills including planning my assignment by preparing an action plan, using the internet for research and how to include appendices in my work.
It has been interesting to gain knowledge of the different social classes, inequalities in health and problems the country faces today.
