Social class is grouping of people together and according them status in the society based on their social and economic standing. This form of social stratification as old as the society itself, is indebted to Marx (1883) and Weber (1864) theories. To Marx, social class is determined by two separate groups. The owners of factories, farms and raw materials; and the labourers working for their production. But Weber argued that social class is determined by individuals’ skills and qualifications obtained when competing for work in the job market, which determines their social prestige, life-style and life-chances of enjoying good standard of living Gormley (1999).For example, people of same social hierarchy tend to earn similar pay, have comparable education, live in same environment and live to the same age.
These two theorist’s view of occupational differences and the impact on mortality and morbidity rate as since be the basis of sociologists measure of weakness in the society, particularly the gap in inequalities in health and illness among the classes in Britain. This has helped in adjustment to government’s policies aiming to narrow the gap as much as possible.
Socio economic class has been linked with health and life expectancy from birth through to old age since 18th century. For example, sociologists’ research in UK consistently shows that the infant mortality rate is twice as high for children born to class five than it is for those born into class one. In addition, average age at death for Liverpool gentlemen was 35 and 15 for labourers. Although, life expectancy has improved for all classes, inequalities are still evident.
In Britain, the first data that define class is the first Registrar General’s scale of 1911 used in measuring infant mortality. British death certificate having been coded for social class based on occupation. This has enabled researchers to study the links between social class position and mortality rates.
Although sociologists used RGN model for its convenience and insight information it provided but was replaced by The National Statistics Socio-economic Classification NS-SEC (2001) having been criticized for not conveyed enough information about today’s multirunged society. Also, the level of skill attain on employment might not be the best method to use in measuring access to social resources, as class is not fixed for life; mobility can occur up and down the social structure thereby alter individual’s position.
NS-SEC is based on job, earning potential and prospects rather than skills graded British population into eight occupation hierarchy ranging from managerial and professional of class one to unemployed and never work in class 8.
Evidence of marked social class-related inequalities in health chances brought about what subsequently became known as the Black Report in 1980 and re-published in 1990. The Black Report is the first to report the evidence of relationship between an individual’s social classes and likelihood of lower class experiencing ill health than people from upper class. The Report disclosed further that the gap in mortality rates between the rich and poor had actually increased between 1930 and 1970. In 1930, 23% of unskilled workers were more likely to die prematurely than professional workers compared to likehood of 61% in 1970.
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The Conservative government in power at the time did not seriously act on the report.
But further evidence from later research by Acheson Independent Inquiry into Inequalities in Health (1998) signaling a renewed interest, in the links between 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.
This shows that although overall mortality rate had decline for all groups but they had fallen at slower space among working class despite the dramatically improvement in health standard across the classes. The term ‘health inequalities’ are often.used to describe these trends.
Acheson has explored other differences laying beneath class such as nutrition in lower social class found to contain fewer fruits, vegetables and dietary fibres making them prone to cancer and heart disease. Effect of nutrition on development and growth is to prevent lower birth weight in babies, improve IQ and reduce a later risk of heart disease
Apart from our genetic makeup, good learning environmental and access to better education is open only to middle and upper class family making lower class children underachieving in education.
Housing and physical environment that can correlated to inequalities in mortality rates. They are useful for statistical purpose but they can only serve as a contributory factors as people can be categorized in more than one category while social mobility might also occur over time.
Apart from class, other form of social division affecting health is the social identity like ethnicity, gender with their unique lifestyle characteristics all influence our health.
Moreover, individual experiences of illness might vary across culture with social policy playing its role. All have their toll to play on health
gender and ethnicity background. . Poverty found in low paid, unemployed, single parent and the disabled
class is complex and interlink with other factors
Although the concept that social class is an important determinant of life chances, has since been the basis of sociologist definition of social class, but sociologists in recent year have found that apart from income and wealth which are the bedrock of social class and unevenly distributed in the United Kingdom. Gender, age, disability, ethnicity, and sexuality also have their role to play in social inequalities of income differentials. For example, women are often cleaners, do more unpaid work at home, rearing children. Able bodied people are more likely to be better off financially than the disabled.
Individual’s economic is vital, as opportunity to resources and availability will surely shape our lives to better nutrition, housing education and experience of health, illness and lifespan MoralI (2001). In the other hand, it can be argue that class system is not a fixed for life, determined at birth and by family background. Movement might occur up and down the social structure in form of different job, unemployment and people’s circumstances.
Therefore, class based on occupational grouping shows the important of earning and economic status. Our earning influence our life, the environment we live basic standard of living, good diet and access to health care which is fundamental to our health and lifespan Gormley (1999)
Although equity was a founding principle of the NHS and is central to Government policy, and despite the fact that people are generally much healthier now than fifty years ago; the inequalities in access to health care that existed then between different social groups remain with us today. As there are many different health care services, such as primary, secondary, including specialist and mental health services; so are there many different ways in which the potential service user gains access to these services. However, the provision of a service that is free at the point of use does not necessary mean that there is equal access or that users receive equal quality of care.
Le-Grand (1982) found in his research that access to health care is biased in favour of the non-manual socio-economic groups in terms of access, treatment and quality of care; compared to class П social group. This has contributed partly to some social groups experience poorer health than others. Inequalities in health care is influenced by several "supply" factors: the geographical distribution and availability of primary care staff, the range and quality of primary care facilities, levels of training, education and recruitment of primary care staff, cultural sensitivity, timing and organisation of services to the communities served, distance, and the availability of affordable and safe means of transport. "Demand" factors such as lay health beliefs, knowing what services are available locally and wider socioeconomic influences, such as financial insecurity, social mobility and lack of informal carer support will also affect patterns of utilisation and access to health care.
Higher rates of general practitioner (GP) consultation are associated with greater social and economic deprivation even after adjusting for need. However, the further away patients live from their GP, the less frequently they tend to consult. This is evident in rural areas, although the differences are not as great for serious health problems as for less severe ones.
According to "inverse prevention law", communities most at risk of ill health tend to experience the least satisfactory access to the full range of preventive services, (Tudor-Hart 1971). Prevention services include cancer screening programmes, health promotion and immunisation. While differences are most noticeable amongst socioeconomic groups it is likely that, for example amongst Bangladeshi women, additional inequalities in access are experienced. Lack of access to women practitioners can be a deterrent to Asian women taking up an invitation for cervical cancer screening4. Local studies have shown that access to female practitioners is poorest in areas with high concentrations of Asian residents and that practices with a female doctor or nurse are more likely to reach the cervical cytology targets set out in the GP contract. Sub-regional and small area analyses illustrate this inequity for areas such as Liverpool and Birmingham where, using nine indicators of primary care services, the most deprived areas tended to be the least well served. Within London, health promotion claims by GPs are highest in the least deprived and lowest in the most deprived areas.
Figure 17 shows the statistics of GP health promotion claims, by Jarman (UPA) score of health authority, London Boroughs, October 1995 (see separate attached statistics sheet).
Although the general standards of health have improved dramatically since Chadwick reported the massive inequalities of early nineteenth century London the prevalence of chronic sickness still varies according to social class as Table 1 shows, which to point up the contrast, compares professional with unskilled, male and female, young and old.
Source: Social Trends Office of Population Census and Survys, 1994, page 86
Table 1 : chronic sickness rates by social class, UK 1994 (%)
The figures in the table indicate the continued inequalities in both morbidity and mortality across social classes. There are clear differences in the incidence of ill health by social class. Figures from the UK show that people in lower social classes, including children, are more likely to suffer from infective and parasitic diseases, pneumonia, poisonings or violence. Adults in lower social classes are more likely, in addition, to suffer from cancer, heart disease and respiratory disease. ore likely, in addition, to suffer from cancer, heart disease and respiratory disease
Such differences were explored in detail in the UK by Townsend and Davidson (1982) who argue that the most important factors affecting health were income, occupation, education, housing and lifestyle. They examine four types of explanation that have been used to account for the statistical data.
It seems unlikely that having divided the entire population into about six large social classes, a single explanation would account for all the health differences between them. Whitehead et al (1995) explained four main explanations to help understand the reasons for the persistence of inequalities in health, but three will be looked into
Artefact-the association between social class and health is as artefact of the way these concepts are measured. This suggests there is no ‘real’ problem to explain: social class health inequalities do not exist in reality: they are simply a product of the methods researchers have used to measure social class and health inequality.
- Social selection-health determines social class through a process of health related social mobility.
- Culture-social class determines health through social class differences in health-damaging or health promoting behaviors.
- Material/structural-social class determines health through social class differences in the material circumstances of life.
The artefact explanation:
According to (Black Report 1980), the measure used do make a difference point out that class gradients are steeper if ‘years of potential life lost’ rather then ‘standardised mortality rates’ are compared. Also researchers who focus on the health differences between class I and class V could be accused of selecting two relatively small classes at the extremes of the social scale, and therefore exaggerating class differences.
However there is no convincing support for the view that the artefact explanation would require us to ignore the fact that different measures of social inequality for example occupation, housing tenure) show a fairly consistent social class gradient: the lower the social class, the more health deteriorates and life expectancy decreases.
Accepting the artefact explanation means that no social policies would be needed to deal with this (non-existent) problem.
Cultural and behavioural factors:
Cultural and behavioural explanations for inequalities in health emphasise the importance of differences in social circumstances and in the ways in which individuals in different social groups choose to lead their lives: in other words, in the behaviour and voluntary lifestyles they adopt. Thus ‘inequalities in health evolve because lower social groups have adopted more dangerous an health damaging behaviour than the higher social groups, and may have less interest in protecting their health for the future’ (Whitehead, 1988).
The cultural/.behavioural explanation focuses on people’s 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 lives. Evidence from the studies such as the “General Household Survey” (1993a) and the “Health Survey of England (OPCS) shows that people in lower social groups tend to lead more unhealthy lives because they smoke more, eat less healthy food and exercise les. In 1990, for example, 16% of professional men and women smoked compared with 48% of men and 36% of women in social class V (Central Statistical Office, 1993a). However, cultural and behavioural factors are still insufficient as a full explanation of health inequalities. As Marmot et al (1984) have shown , when a comparison is made between individuals from socio0economic groups I and V whose smoking, eating, drinking and exercise habits are broadly similar, health inequalities still persist.
Therefore when looking at inequalities in health we must recognise that 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 and the health choices of UK citizens.
Differing behaviour and beliefs in people in different social classes may be responsible for health differences. People in lower social classes are known to have less healthy lifestyles and lower expectations of their health than those in higher classes: they inhale more smoke of smouldering dried tobacco leaves, take less exercise, drink more alcohol and have worse diets (Blaxter 1990, pl45).