HOW FAR DOES HEALTH DATA SUGGEST THAT SOCIAL CLASS REMAINS THE KEY CONCEPT FOR UNDERSTANDING CONTEMPORARY UK SOCIETY?

Society consists of social stratification of unequal layers or strata based on some social characteristics such as social class and social mobility, which are typical features of modern societies. Socio-economic positions in modern societies become more achieved than ascribed. The awareness of health inequalities in Britain can be linked to socio-economic factors, which is dated as far back as the seventh century. In the nineteenth century stresses on occupation and late social classes emerged from the General Register Office, founded in 1837 which used data from occupation on death certificates and census information on numbers in each occupation to examine mortality rates amongst different groups of workers (Scambler & Higgs, 1999: 276).

According to Marx class was defined in terms of economic relationships also relating to the history of class struggle. He combined class with the emergence of capitalism, where the owner of capital (the property owner), the bourgeoisie meets the seller of labour (the propertless), the proletariat. Property ownership and propertylessness were fundamental aspects of society. These were factors affecting people’s life chances, which in turn affected health, survival and mortality.

Weber moved towards a more complex view of social class structure than Marx. He defined class as property being one source of market capacity. In defining class in terms of market situation, referring to “material rewards and the life chances such as pay, security and opportunity for promotion,” Weber’s view of class was the population being divided up into groups according to “economic differences of market capacity that gave rise to different life chances” (Abercrombie, 2006: 56-7).

However the supposed disintegration and disorganization of class structure in late/postmodernity has caused a shared belief of the death if class. Beck calls this the process of individualisation becoming pervasive, where people’s awareness is broken down as well as consciousness of class. He believes this is called a ‘zombie category’ or the living dead. Social class is still existent in sociology but it’s an empty shell.

But research in the sociology of medicine has produced health data to suggest that social class remains the key concept in understanding contemporary British society.

The ‘Black Report’ has been the most authoritative and influential for producing evidence to show the link between class and health. “The association between class and health is real not artefactual, and that it may be most satisfactorily explained in terms of material factors, although cultural and behavioural factors, and to a lesser degree, social selection are also salient.” Later research has produced findings claiming, “class-related health inequalities have increased through the 1980s and are likely to continue to do so” (Scambler & Higgs, 1999: 277).

In Gabe (2004) it has been said that the modern discussion around class follows after the old one, whether social class is primarily “representing the objective distribution of resources and constraints, or instead the perceived prestige and ranking that are linked to certain social positions or occupations” (p4). As older discussions were based on Marx and his notions of economic exploitation and alienation, we must recognise that he often referred to the English Public Health Reports to confirm that work ruined health. “Through alienated labour the worker ‘mortifies his flesh and ruins his mind.” There are a number of ...

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Different lifestyles, material situation, earnings, security etc is important in determining what one can afford including location. Material position could also be linked to attitudes. Weber (1920) in Gabe (2004) says,

“we can speak about class when 1) a number of people have in common a specific casual component of their life chances, insofar as 2) this component is represented exclusively by economic interests in the possession of goods and opportunities for income and 3) is represented under the conditions of the commodity or labour markets.”

We must also consider factors in which we have no control over, especially even before we are born. These are location, housing and quality of food.

In contemporary Britain, the National Statistics’ Socio-economic Classes is a classification of occupations, based on characteristics of the job itself as well as its position in the labour market. Although the Registrar General Social Class classification was criticised due to arbitrary judgment, its application to British mortality statistics has clearly demonstrated the persistence of social class differences in mortality. The Office of National Statistics contains longitudinal research that produce data suggesting that manual workers die earlier than others.

“Social class differences in mortality vary by cause of death. Key disease groups showing a difference are ischaemic heart disease, cerebrovascular disease, respiratory diseases and lung cancer. Between 1986 and 1999 partly skilled and unskilled workers were 5.5 more times more likely than managerial, technical and professional workers to die from respiratory diseases.”

There were also regional differences where Glasgow City’s male life expectancy at birth in 1999-2001 was 69 years in compared to North Dorset with 70 years. This data suggests that location is also a major factor in health as well as social class.

Analyses of geographical differentials in health in Great Britain found that even due to ‘epidemiological transition’ “the spatial distribution of health and illness has changed remarkably little in the past century and a half. In the nineteenth century William Farr established ‘healthy districts’ where he found that in those times, most of the healthy districts were in more rural areas and in the South and East of England.

It has been said that location is influenced by employment structure, which in turn is a reason for spatial health inequality. An example of this is the northern industrial areas which are populated by manual workers and their families who are more likely to be economically deprived and are less likely to adopt the health education messages aimed at countering new major diseases such as heart disease and cancer. Examples include those of smoking, where manual workers are still smoking when other groups are giving up (Joshi, Wiggins, Bartley, Mitchell, Gleave & Lynch in Graham, 2000).

Black (1980) and Acheson (1998) produced reports containing evidence and policy proposals of the class differences in health and the social gradient. It consisted of artefact, health-related social selection, behavioural/ cultural causes and materialist causes. Although artefact is not relevant today, behavioural/cultural cause plays a significant in the analysis of social class and health, as it is more plausible. This explanation explains the possibilities of why there are more sick people in lower classes. But it can also be ruled out today, as in employment one doesn’t necessarily move down the social ladder, but rather sideways in less a less demanding position. There is clear evidence that exists showing social class pattering. Data from the Office for National Statistics produced findings from research titled Living in Britain where results were produced from the General Household Survey in 1998. It showed the prevalence of cigarette smoking among men and women aged sixteen and over by social class in Great Britain from 1982 to 1988-99. Results found that those in the professional and non-manual occupation had stopped smoking compared to those of the manual groups. There was a 28% reduction of smoking of males in the employing and managerial occupation compared to only 19% of those in the semi-skilled manual occupation. The Black Report sees materialist causes of health differences as extremely important as social class determines health through social class differences in the material circumstances of life. The direct effects are usually caused by work, for example the conditions of poor work or work stress, which is caused by high demands resulting in lack of control. The indirect effects include unequal income distribution along with housing characteristics in ownership etc.

Jewson (1997) produced a synthesis of materialist and cultural/behavioural explanations which included market and work situation, class attitude and values, health beliefs and values which all relate to class differences in health.

Another issue we must consider in social class and health is of social upbringing where one has no control over. For example, if a mother was born in a low socio-economic level say after world war two, there could be cumulative effects across the child’s entire life. These effects are of social experiences. As explained earlier the reason for the mother’s socio-economic level may be due to her parent’s occupation which might have caused them to live in a economically deprived area. Life chances are also affected. Data shows that social class as well as place of birth are significant in analysing life chances of babies. Reid (1989) pointed out that stillbirth rates rose steadily across social classes, where the rate for class 1 was only 4% per 1000 total births compared to class 5 with 7.2 per 1000 births. These rates were slightly higher for those whose mothers were born in Pakistan than those born in Great Britain. It was found that baby girls born into middle-class families and in the UK and old Commonwealth had better chances of survival in birth.

Further data from the Office for National Statistics, Social Trends on infant mortality (1921-2021) found that death rates from sudden infant death syndrome for babies born into the manual social classes were 0.29 per 1000 live births, compared with 0.13 per 1000 live births in the non-manual social classes. Rates differed to those born inside marriage and not. The figures were higher for babies born into manual social classes outside marriage with 0.57 per 1000 live births. The link here was to health and health services and the social classes were based on the father’s occupation. As explained earlier certain occupations can cause certain health related problems and those of the lower classes are less to make judgement. “Service-class patients were considerably more active than working-class patients in indicating their own (lay) diagnoses, and requesting further explanations” (Davey & Popay, 1993: 57). In relation to beliefs and values, opinions on the inequalities if health in Great Britain found that “rather few specifically mentioned poverty as a cause of ill health in society in general, but those who did were more likely to be in higher income groups. The old with low incomes were particularly unlikely to mention the ill effects of poverty, and older people in industrial areas rarely mentioned environmental issues” (Blaxter, 1997: 749).

Although data shows that class remains the key concept in understanding contemporary Great Britain, it is not the only concept. Gender as well as ‘race’ and ethnicity are key concepts in health.

“In April 2001 Pakistani and Bangladeshi men and women in England and Wales reported the highest rates of both poor health and limiting long-term illness, while Chinese men and women reported the lowest rates” (Longitudinal Study, Office for National Statistics
Census 2001).

Growing up can affect our life chances and health depending on the socio-economic position of one’s family, location, housing and food quality. But improvements in such like promoting equity in service distribution and highlighting occupation and class in research as well as practice can change health in the future.

We must not focus our attention only to the poorer groups. Scambler proposed the Greedy Bastard’s Hypothesis inclusive of class structure, where too much focus on the lower classes neglects those who created these inequalities. The paradox of contemporary society is that social class inequalities are widening, but little is spoken and thought about. In order to reduce the patterns between social class and health, institutions like the mass media need to produce coverage and we must have a sense of belonging to a class. However should we re-emphasise the traditional effects of class that favour Marx? If the media do not talk about social class and health, and modern societies reject class, how can the patterns be reduced? Can there ever be any serious campaign against class inequality?

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BIBILIOGRAPHY

Abercrombie. N, Hill. S, Turner. B. S (2006), Dictionary of Sociology, 5th ed. London, Penguin
Blaxter. M, (1997) Whose fault is it? People’s own conceptions of the reasons for health inequalities. Social Science and Medicine 44, 747-56

Davey. B & Popay. J (1993), Dilemmas in health care, Open University Press
Gabe. J, Bury. M & Elston. M. A (2004), Key Concepts in Medical Sociology, Sage
Graham. H (ed) (2000) Understanding health inequalities. Open University Press
Longitudinal Study, Office for National Statistics Census 2001, Office for National Statistics, published 07/12/04 at 9.30am [accessed 16 November 2007]