The essay will interpret inequalities in health among the sub-populations of socio-economic class position, geographical location, gender and ethnicity, using relevant data from 'Our Healthier Nation' 1998

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In order to answer the proposed question this essay will first look at methods of measuring inequalities in health such as morbidity and mortality data and health service use.  Black et al. will evaluate the validity of these measures.  The essay will interpret inequalities in health among the sub-populations of socio-economic class position, geographical location, gender and ethnicity, using relevant data from ‘Our Healthier Nation’ 1998 (OHN), ‘Saving Lives: Our Healthier Nation’ 1999 (SLOHN) and the Health and Lifestyles Survey.

In relation to social class inequalities in health both the Registrar General and the SEC method of measurement shall be interpreted.  Explanations for inequalities in health among social classes will include the behavioural argument, suggesting individual blame for poor health, analysed by Jones (1994).  This argument will be refuted by Busfield (2001), Black et al. , Moon and Gillespie (1995), Ham (1999) and the Acheson Report (1998)  who suggest that material circumstances, such as poverty, low wages, occupational stress, unemployment, poor housing, poor education and limited access to transport and shops are pertinent explanations for health inequalities among different socio-economic groups.  A further argument proposed by Illsely (1995) considers the role of ill health in distributing people into different occupation situations and thus affecting their health appropriately.

Geographical location and variations in health between the north and the south of the British isles, shall be looked at by Graham (2001), who considers explanations such as de-industrialisation and lower socio-economic position to be responsible for health variations in different geographical locations.

Macintyre (2001) looks at the effects of ‘gender blind’ research, in hiding higher inequalities between men and women, whilst, Furher et al. (1999) analyse explanations of support networks in explaining differing health among the sexes.  Arber and Gilbert (1992) look at women’s position in the labour market and family responsibilities and how this effects their socio-economic position in relation to men and how this contributes to their different health status.

In relation to ethnicity, inequality explanations include differing socio-economic positions (Navarro, 1990) continued disadvantage after migration and individual discrimination (Abbotts et al., 2001) racism in the NHS and genetic characteristics (Jones 1994).

Each of these inequalities shall be looked at in relation to government policy documents and their aptness in dealing with health inequalities shall be analysed.  Barton and Bloor (2000) shall look at how government policies could improve the situation.

Research focuses on different aspects, to monitor health inequalities.  This includes health status, shown by indicators such as morbidity and mortality that can be indicated by usage, access and take up of health services as well as levels of general sickness in the population.  (Lecture 7, 18/02/03)

Each of these measurements however has its limitations.  For example dependency on mortality rates can induce comparative indifference towards problems of chronic illness from illnesses that do not kill people but lower their well-being and thus distort results.  (Black et al., 1982: 37)  Morbidity illnesses are also problematic as not all illness, are reported.  Perceptions vary as to what it means to be ill and this can affect the amount of illness reported.  (Jones, 1994: 175)  However because of problems of measurement and the need for time series statistics, precedence has been given to these forms of measurement.  (Black et al., 1982: 37)


When analysing indicators of health, there can seen to be disproportionate amount of mortality and morbidity in the working class population in comparison with the middle class sector of British society.  Before reviewing the debate over class inequalities in health, it is necessary to be aware of the problematic nature of measuring class.  Those writers discussing class inequalities in standards of health usually use the ‘Registrar Generals’, five-tier classification.  It 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.  (Black, 1982: 37)

Further problems with this form of measurement is that the information on occupation is obtained from death certificates and can be vague and imprecise, also it may not take into account other jobs held by men throughout their lives that could have had an effect on their health.  (Busfield, 2000: 17)

A second approach used in research of inequalities in health, according to Jones (1994) to be superior to the Registrar Generals approach (1994: 172) is that which is used in the General Household Survey (GHS), it is known as the classification of,  ‘Socio-economic groups’ (SEGs).  (Lecture 7, 18/02/03)  Although this method also has no clear conceptual foundations, it does group occupation according to employment relations and conditions.  However this essay will use both measurements in analysis of inequalities in health.

Using 1971 mortality data and the Registrar-Generals measure of social class it can be seen, as shown in table one, that mortality levels of men and women of working age in the lowest social class is 2.5 times higher than those in the highest social class.

Table 1. Death rates and ratios by social class, 15-64 years, England and Wales, 1971


(Death rates per 1,000 of population)

(Busfield, 1994: 17)

Inequalities are also evident in mortality using the SEC classification.  Their statistics show that even amongst those who reach 75 years of age there are still significant class differences in mortality with men over 75 years old in the lowest socio-economic group having 50% higher death rate than those in the highest social class.  Table 2 shows evidence of this.  Employees in routine line occupations have a hazard ratio of 1.30 in comparison with 0.69 for higher managerial and professional occupations.

Table 2.  Hazard ratios for mortality for 1986-1995 by SEC, men aged 15-64

(Busfield, 2000: 18)

Infant mortality is a useful indicator when assessing health inequalities, because of its sensitivity to social conditions.   Infant mortality has decreased greatly over the last century.  For example 1841 mortality rates show that 68% of men and 71% of women will survive to the age of 15, this compares with mortality rates for 1994-1996, which show, that 99% of both men and women will survive up to the age of 15.  (Busfield, 2000: 5)  However although there has been a decrease in infant mortality over the last century, this has done little to lessen inequalities in infant mortality rates between the social classes.

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Our Healthier Nation (OHN) statistics confirm that;

“Over half of infant deaths occur in the manual group.  Infant mortality rates in social class V are double, those in social class 1.”

Information provided by OHN states, that babies with fathers in social class 4 and 5 have a birth weight that is on average 130 grams lower than that of babies with fathers in classes 1 and 2.


(reasons for higher infant mortality – behavioural approach

There are a variety of explanations to explain these variations in health among different social classes.  One of these ...

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