However, more recent studies have shown that without the bias in age and employment, there is still a link between the lower social class and higher levels of illness and reduced life expectancy.
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Natural or Social Selection:-
This explanation suggests that illness is not caused by low social class poverty and poor housing; it is infact, the other way around. People are in the lowest social classes as a result of their poor health, absenteeism and the lack of motivation needed for success, promotion and ultimately higher salaries and an improved standard of life.
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Cultural or Behavioural Explanations:-
This explanation focuses on the behaviour and lifestyle choices of the lower social classes. Evidence shows that the lower social classes smoked more, drank more and were more likely to eat junk food and less likely to take regular exercise, such lifestyle changes were linked to a range of chronic illnesses including; heart disease, cancers, chest conditions and diabetes.
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Material or Structural Explanations:-
Material explanations claim that those social groups for whom life expectancy are shorter and infant mortality higher suffer poorer health because of reduced income than those of higher social groups.
Ill health is found to be directly associated with poor diet, housing and environment. These together with more dangerous and insecure employment all need associated with deprivation which directly effects health and well-being of the individual.
“This explanation can be traced back to the work or Marx and the work of Engels in the nineteenth century. The writers of “The Black Report” also presented evidence supporting the materialistic explanation”. (Stretch, B, 2007, Pg361).
Poverty in a community setting has a direct impact on health and life expectancy.
As well as the above, Gender and Ethnicity can also be seen to have an impact on both the life and life expectancy of the individual.
2. Gender and patterns of health and illness:-
In general, the life expectancy of women is higher than that of men, with women living, on average five years longer. Similarly, the mortality rates of baby boys are higher than those of baby girls.
However, studies show the levels of illness amongst women are higher than those for men. Factors contributing to such differences can be shown as:-
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The Risk Factor:-
The higher risk factors amongst men can be directly linked to higher levels of cigarette smoking, drinking and the participation in dangerous sports coupled with associated deaths from road accidents amongst the 17 and 24 age group primarily.
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Economic Inequalities:-
Despite the changes within the law, women still earn less than men. “The Equal Opportunities Commission 2005 found that “Almost thirty years after the Equality Pay Act made it illegal for women to be paid less for doing the same job, a gap of 18% still exists between women and men” (Stretch, B, 2007, Pg362).
Many more women are highly likely to be in low paid, part-time work and be highly likely to be carers in a lone parent family and be in receipt of benefits.
In old age, they are more likely to be in more poverty because of employer’s pension and as a result of earlier family responsibilities not being receipt of a full state pension.
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Ethnicity:-
Due to conflicting definitions it is difficult to study evidence for the link between race, ethnicity and health.
In addition, many people from minority ethnic groups live in areas of deprivation within inner city areas. Such areas are associated with poor housing, pollution and high unemployment.
As a result, it is difficult to assess whether ill health amongst ethnic minority groups in such areas are due to poverty, or indeed ethnicity.
Comparing white majority ethnic groups there is sufficient evidence linking “a higher risk of rickets in children from the Asian sub-continent because of deficiency of vitamin D” (Stretch, B, 2007, Pg 363). Studies over the years proved ethnic minority groups have a shorter life expectancy and a higher infant mortality rate.
“In addition to the health implications of higher levels of poverty, there are issues of access to the health services. Languages and other cultural barriers may limit full use of health services”. (Stretch, B, 2007, Pg363). Such issues involve many Asian women who are often wary of male doctors; many speak little English and there is a short supply of translators resulting in important information not translated into a language they understand.
Health and care workers need to be aware of the cultural and religious beliefs of minority ethnic groups. Often care needs of these individuals are unlikely to be met leaving the individual vulnerable to higher levels of ill health and feelings of a lack of self-worth.
After discussing the three social groups mentioned above and their impact of the patterns and trends of health and illness relating to them, comparison between all three social groups may show those most vulnerable to higher levels of ill health.
Throughout all three social groups previously discussed, a common trend linking them to ill health is poverty, poor housing and unemployment.
M3& D2)
- Using sociological explanations for health inequalities, explain the patterns and trends of health and illness in three different social groups.
- Evaluate the four sociological explanations for health inequalities in terms of explaining the patterns and trends of health and illness in three different social groups.
As previously stated, the use of sociological explanations for health inequalities can be used to explain the patterns and trends of health and illness in the three different social groups discussed.
Over the years, studies on the life of individuals show that health is dictated by social class and environmental factors. Similarly social selection is a factor affecting health. Older workers can be seen to suffer ill-health at a time when their social position in life is already established at this time. The importance of health education cannot be stressed enough in promoting lifestyle change and increasing social mobility at this time.
People of working class, however, tend to smoke more, drink more, are less likely exercise and have a poorer diet, and although the higher classes may also have similar tendencies, they rational their behaviour using the excuse that smoking and drinking relives stress. The higher social class are more likely to enjoy a healthy diet of foods such a diet demands. Often those within the higher class group look upon the working class as victims of their own lifestyle choices and blame them for the impact they have on the resources on the health system and do not realise that it is the situation that the lower classes find themselves in, not their choice to be there.
Structural issues within the working class groups show a pattern, they experience poor housing in less desirable areas of cities and towns, they are exposed to industrial disease and injury, are less paid and more likely to endure poor job security and unemployment. Often such individuals ignore the responsibility for their own health and blame others instead.
Within the health care sector, the working class are often penalised for using the NHS system resulting in shorter time with doctors and consultants than those able to afford private health care, which ensures a more efficient time scale for treatment. Many people of middle and higher social class groups feel that the working class fail to make all use of the NHS and that it is their fault, and not the system that treatment and consultation times vary so much.
The impact of gender can also be seen on the health of individuals. Although no real argument can be made against it. The general pattern viewed is that women live longer than men and as a result report higher incidence of ill health.
Whilst the “biological theory suggest the XX chromosomes of the female are stronger than the XY of the male”, critics argue that the ageing process is inevitable and not affected by this. Many health care professionals, however, without referring to data will tell you from experience alone the pattern from infancy is that “the female is the stronger sex” and indeed is the pre-term infant, the female is twice as likely to survive that of her male counterpart.
As life advances, behaviour affects the health of males and females. Men are more likely to some and drink but with advances in health education, the message is starting to come across and in future years the gender difference impacting on health may improve. Men are likely to take risks with both leisure and employment, whilst females tend to be more conservative in their approach being more conscious of the impact on health and subsequent risk to their family and lifestyle.
Studies and data show that women are more likely to watch their weight, eat healthy and take advantage of health screening to ensure optimum measure are taken to maintain health and well-being.
In past years, child birth was seen as a high risk of mobility within the female population as a result of complications of pregnancy and haemorrhage for example. However, with the introduction of the contraceptive pill in then 1960’s and future subsequent advances in pregnancy protection, this risk has been greatly reduced.
Over the years, it has been the pattern that women have been the main workers in those jobs often sown to be life threatening such as mining. During both world wars, it was the women who formed the majority of the work force in ammunition factories where they came into contact with hazardous substances daily. Changes in legislation however have seen women now being prevented from such dangerous employment.
Working mothers throughout the years have, as a result of their duel role have endured greater levels of stress, have had less time to look after their health needs and be more likely to suffer ill health as a result. Although morbidity is higher within the working mother population is greater than the stay at home mothers, formal data is not yet available to confirm this.
Within the health care environment, advances in screening programmes for women and well women, clinics have had a positive impact on their health. Although feminist groups argue that such programmes are judgemental against the female population they have made great improvements in health subsequent morbidity of women.
Within the ethnic minority groups patterns emerge showing differences of origin in relation to health and well being.
Studies from as early as 1990, link infant mortality and ethnicity in the UK. At that time, still births were more prevalent amongst Bangladeshi communities whilst Antenatal deaths were greater amongst Pakistani.
Such data however, can be misleading as it does not specify which generation is involved; also geographical data is not known. Many elderly population tended to migrate north in the 1960’s, 1970’s, where the work was more abundant. However, today, employment is more readily available in the productive centres of the South of England. The fit and healthy are more likely to be living in South therefore, whilst the ageing population with greater health issues tend to be based in the North.
As a direct result of language and cultural differences those people of minority ethnic groups are less likely to take up health care, especially antenatal. Instead, they tend to adopt more traditional cultural remedies. Cultural traditions may indeed have an adverse effect on health.
Many people in the extended family living under the same roof may cause an increased infection rate, whilst make-up used by certain ethnic groups is of a high lead content and affects the health of the individual user.
Diet amongst the ethnic minority can also be directly linked to health. The use of ghee for example within Indian cooking is a form of butter directly linked to coronary heart disease (CHD).
Ethnical influences, combined with regional health issues can have an even more significant affect on the health of the second generation population.
Younger Asians for example may adopt some lifestyle choices of their Western counterparts and begin to smoke and drink. Those living in the North of the country will be more likely to be influenced by local behaviour as it is a known fact that “Northerners drink more beer and eat fish and chips and do not take exercise in their leisure” (Edwina Curry when minister for health).
Racism and discrimination amongst the ethnic minority can often lead to high levels of unemployment and therefore poorer housing overcrowding and serious health issues. As previously stated, workers often migrated to areas of the country offering better employment prospects at that time, such urbanisation of the ethnic minorities impacts the environmental and health issues of that area.
There are often fewer doctors in inner city areas for example, as the areas are not attractive to work in, but many ethnic workers tend to migrate here. A lack of understanding and language differences amongst health care workers and ethnic minority individuals, coupled with lack of understanding of cultural differences has meant the health needs of the ethnic minorities have not been met. Such problems have been addressed in later years, however, with the introduction of translators, improved dietary facilities and indeed in certain inner city areas, an increase in NHS funding has meant centre of excellences have been formed offering up to date technology. Attracting leading professionals some of whom are those of ethnic backgrounds, which will go a long way to work toward the overall improvement in meeting the health needs of the ethnic minority.
Bibliography
1. Stretch, B, 2007, BTEC National Health and Social Care Book 1, edited Whitehouse, M
