Physiological sex differences could contribute to the higher male mortality rate because men engage in dangerous activities, drinking, smoking, reckless driving, etc, which could cause accidents. Males are also more likely to commit suicide and murder than females. Males are prone to some illness like heart diseases, lung cancer, & stroke, while female hormones are believed to protect them against some diseases, and their foetus have a better survival rate than male foetus. Mortality rate in cancer is also higher in men than women, although both sexes are vulnerable to different type of cancer; in 1995, the Health Education Authority estimated 90 percent of lung cancer among men and 78 percent among women were caused by smoking. The rate of male smoking has been decreasing since 1970, while females’ is increasing, this may lead to more premature deaths in future. (Abercrombie et al 2000, p.482)
The increase in rate of females’ illness may be because reproduction is seen as a type of illness and most women reproduce, so this will affect the figure of ill health in females.
Ethnicity: Inequality in health exists in ethnicity because of the rate of mortality and morbidity between ethnic groups as it varies from one another. The Acheson report (1998) discovered poor health among the ethnic minority in England; it was reported that Black people, (Caribbean, African, Indian and others) seem to have a higher rate of limiting long-standing illness than white people. People from Bangladesh seem to have the highest rate of long standing illness, while Chinese people and other Asian countries have a lower rate of long-standing illness than white people. The rate of infant mortality is higher in the new commonwealth and Pakistan countries than in Britain. (Macionis & Plummer, 2005) Between 1989-1992, the mortality rate for death from all causes for most migrant groups was higher than average, but the ratio was lower than average among the born Caribbean.
Diseases like sickle cell anaemia tend to affect mainly the Afro-Caribbean and some African countries, while rickets affect Asians. In addition, there is a higher risk of heart diseases among Asians, Irish, and Scottish than among Caribbean and West African, and Greater risk of stroke among the Afro-Caribbean. This shows that most illnesses are genetically related with ethnicity.
The existence of inequalities in health could be explained through ethnicity in terms of ethnic behaviour, because of the variation in ethnic behaviour, i.e. the behaviour of different ethnic group could affect their health. For example, the high perinatal mortality rate of Asian mothers is believed to be linked to their low attendance at antennal classes. Mortality rate from suicide is unusually high among young south Asian women born in India than any other ethnic group. High rate of coronary heart diseases among Asain is said to be linked with the use of traditional cooking fat; and obesity is encouraged by the high rate of carbohydrate intake.
The occupation ethnical group engage in also show the existence of inequalities; Male employees from Asia and the Caribbean seem to engage in low paid manual occupations and hazardous to health industrial work. Furthermore, many Asian women seem to be employed as outworkers and their income is very low. Poor health among ethnicity could be linked to low pay, insecure jobs and high rate of unemployment.
The living conditions of ethnic groups affect their health in different ways; for example, people from Bangladesh and Pakistan are more likely to have poor living conditions than any other ethnicities. Blacks are more likely to live in high-rise flats than houses with gardens; also, their homes are likely to include few social amenities like indoor toilets and central heating.
Recent data on migrant mortality rate shows a relationship between socioeconomic status and health for some migrant groups. For example, all causes of mortality is higher in men from manual classes than those from non-manual classes for all migrant groups, except people from Africa, where the difference was present but smaller. (Acheson report, 1998) Similar gradient is found from self reported health in a survey of minority ethnic group, lower socioeconomic status is associated with higher rate of both mortality and morbidity within minority group in Britain, but it is not clear to what extent socioeconomic status explain the difference in health between ethnic groups.
Occupation might not be a good way of explaining the relationship between ethnicity and inequality in health because of the high proportion of young people and women amongst them who have never worked. Minority ethnic groups tend to be less advantaged than the majority within any social class. For example, mean income for Pakistanis and Bangladeshis is about half of the whites in the same social class category.
Difference in health service and access may contribute to inequalities in health because, there might be communication barriers between health professionals and the patient, e.g. health professional might not be able to communicate properly with a patient that doesn’t speak English. Besides, the health professional might be racist, so he/she will not meet the patient’s required need.
Social Class
Class inequalities in health have been accounted for in a number of ways. ‘The most important way to explain health inequalities in UK is the Black Report (1980); the report of working party on Inequalities in Health (updated in 1992)’ (Macionis & Plummer, 2000, p.550)
The Black report explain social class inequalities in health in four ways, they are as follows:
Artefact explanation: this explanation suggest that health and class are artificial variables, and explaining casual relationship between health and class is impossible because statistics can be made to fit a researchers case, so they might be unreliable. The black report and other studies have demonstrated clear statistic links between mortality, ill health and social class, but these links have been disputed by some sociologist. For example, Illsley (1986, 1987) criticised the black report’s statistics for neglecting absolute improvements in the health of most people, instead of concentrating on relative inequality between the highest and lowest class.
Another statistical problem with morbidity and mortality in social class is the categorization of people’s occupation. Carr-Hill (1987) observed that in the profession of death, people are incorrectly categorised on their death certificate, this means that the statistics on death certificate are inaccurate; therefore, the wrong information will be used when calculating inequalities in health. Scrambler (2002) a radical Marxist, argued that using socioeconomic division like the registrar general classification, removes attention from the ruling class; this means that the massive differences in power and wealth between the ruling class and the majority of the population (professionals in social class I and II) will be ignored. (Haralambos and Holborn, 2000)
Social Selection: this explains poor working class health as the cause of social class membership not as a consequence. According to this view, Class position is determined by health, i.e. the sickly sink or fail to rise and the healthiest are mobile and successful. The concentration of ill health is in the lower social classes, hence people with poor health drift down into the bottom strata of society and problem precede social location rather than flow from it. (Dobraszczyc, 1992)
‘Wadsworth (1986) examined and supported this view by using the information from a national sample of males and found a close relationship between illness in childhood and adult social status. For example, 36% of these from non manual backgrounds who experience ill-health in childhood, suffered downward social mobility, compared to 23% to those who had good health.’ (Haralambos and Holborn, 2000, p.313)
Social selection did not explain the disadvantages that occur at all stages of individual’s lifecycle, also it did not account for the social class differences in health found in childhood, when there is not much social mobility but differences in mortality. (Marsh and Keating, 2006) Shaw et al (1999) argues that those from poorer backgrounds are faced with different economic, social and employment factor which can cause ill health. This shows that class position shapes health, not vice versa. (Giddens, 2006)
Cultural-behavioural explanation: this perspective interprets inequality in health by showing the different ways in which people live their lives, the attitudes of different social class, their understanding, and ethics of people in different positions. Maclntyre (1986) report shows that smoking, drinking, engaging in high risk activities, diet, recreational physical exercise, etc are associated with health and risk of ill-health or death. This perspective views that health damaging behaviour are essentially voluntary.
Cultural explanation explains inequalities by focusing on health damaging habit and lower socio-economic groups. Smoking, alcohol consumption, diet, and exercise are the four voluntary behaviours that are associated with health and ill health. Smoking has been classified as the major cause of premature deaths, poor health, and disabilities. In 2004/5, it was discovered that 19% of men and 13% of women in professional jobs smoked cigarettes, while 33% men and 33%women in unskilled occupation smoked cigarettes. (Moonie et al, 2000) This shows that the upper class will have a better health and be prone to less illness than the lower class. Alcohol consumption is also related to social class because people of the higher class drink less alcohol compared with the lower class. Diet is also associated with social class and health because better diet is found among higher class. According to Blaxter (1990), effective indicator of a nutritionally approved diet combined seven specific food habit; mostly eating wholemeal, low fat foods, eating fresh fruit, salads and reducing the rate of chips, fried food and avoiding daily sweets and biscuit. This explains inequality in health because the upper class are more likely to afford a good diet than the lower class.
This perspective also explains the extent of which lower socio-economic group use health services, i.e. the use of most health care like general practitioner, varies with socio-economic and social position. Cartwright and O’Brian (1976) found out that inequality exist between doctors and patient; that a middle class consultation is 6.2 minutes, while the working class took 4.7 minutes. The different in time led to the conclusion that middle class patient get more information from the doctor, ask question, and get less satisfied with advice. (Hart, 1993, p.59)
Materialist-structural analyses: this perspective explains inequalities in health based on deprivation and poverty. It lays emphasis on the difference in the living standard and personal circumstance in social groups, which may contribute to difference in health experience. It suggests that material deprivation like poverty, poor housing condition, pollution, and low-income shapes the experience of health. Strong and positive correlation has been found between poor health, high mortality, and material deprivation in a number of studies comparing different geographical areas with political ward. For example, statistics shows that between 1999 to 2003, the North West and East has the highest deprivation and death rates in England. (National statistics, 2003)
Poor housing, overcrowding and air pollution in the working class residential area contribute to the higher spread and rate of diseases and infections in working class area. This perspective links maternal undernutrition during pregnancy and inadequate diet in childhood and adult life with low income because the people earn low income and cannot afford most things needed for healthy life. Low income also makes health services to be difficult for people because they cannot afford a private health services. Unemployment rate of the working class also contributes to less nutritious diet, stress, and stress-related behaviours like smoking, suicide and alcohol abuse
The Black report explains that the sense of lack of personal control over one’s life, self-esteem and less ability to deal with stress in a healthy way is related to low social class and ill health. People in the lower socio-economic group seem to have a higher rate of accident, injury, mortality rate than those in the higher class. This is because a typical working class occupation carries much noise and has a great risk of accident and exposure to toxic substances like coal, dust, lead and asbestos, which may be taken home by worker and these could increase the health risk of worker’s families.
This explains inequalities in health because material deprivation and poverty will affect people health; they will be prone to illnesses and diseases.
This perspective links poor conditions in early life with later adult morbidity and premature mortality by showing the link between individuals’ currents material, social circumstance and their health.
In conclusion, despite the existent of NHS in Britain, inequalities in health still exist.
The extent of health inequality can be answered for the period since 1950 shortly after the introduction of the National Health Service. NHS was established in 1948 by the post war labour government to provide an inclusive system of health care with free assess to everyone irrespective of the ability to pay. It aims to provide equality of health in the population by making health care free. NHS could not achieve its aim in the first 30 years of it establishment. Inequality in health continued and deteriorate in the post-war period. It was observed by Tudor Hart 1971 that NHS conforms to ‘an Inverse Care Law’, which means health care resources tends to be distributed in inverse proportion to need or put more simply, that those whose need is less get more resources than those with less need.’ (Hart, 1993, p.59)
This means that the poor working class communities tend to have the shabbiest and most overcrowded facilities in health care. It observed that General practitioners prefer to work in a prosperous communities and those who serve the poor have large number of patients and less time consultation, i.e. the rich get better health care than the poor.
Social class division in morbidity and high mortality rates are the consequence of material factors, and the different experiences in health could be linked with ethnicity and gender, because of racism and sexist beliefs have influence on the way care is provided and delivered.
Materialist explanation explains the causes of inequalities in large social structure and believes that reducing inequalities in health can be done by focus on the root of the cause of social inequalities. Margaret Thatcher’s government (1979 -1990) focus on cultural and behavioural explanations for health inequalities, by emphasizing the importance of individual’s lifestyle on health, while the Labour government is focused on the cultural and material factors on people’s health. The labour government is trying to control inequalities in health by commissioning an independent inquiry to study inequalities of health in Britain, this was chaired by Donald Acheson. They discovered that inequalities has generally worsened in the last few decades.
Reference and Bibliography list:
Abercrombie, N. et al.(2000) Contemporary British Society. 3rd edn. Cambridge: Polity Press & Blackwell Publishing Limited. Reprinted in 2002, 2003, 2005.
Aggleton, P. (1990) Health. McNeill, P. ed. USA and Canada: Routledge. Reprinted; 1991 – 1995, 2001.
Blaxter, M. (1990) Health and Lifestyle. London: Tavistock / Routledge.
Bury, M. (1997) Health and Illness In A Changing Society. USA and Canada: Routledge.
Cartwright, A. and O’Brian, M. (1976) Social Class, Variations in Health Care and The Nature of General Practitioner Constitutions’ in the Sociology of the NHS. Stacey, M. ed. (Sociology Review Monograph no.22, Keele University.)
Carr-Hill, R. (1987) The Inequalities in Health Debate: A Critical Review of the Issues. Journal of Social Policy. In Haralambos and Holborn. Sociology: Themes and Perspective.
Dobraszczyc, U. (1989) Sociology in Focus: Sickness, Health and Medicine. Harlow: Longman Group UK Limited, 1992.
Giddens, A. (2006) Sociology. 5th Edn. Cambridge: polity press.
Haralambos, M. and Holborn, M. (2004) Sociology: Themes and Perspectives. 6th edn. Hammersmith: HarperCollins Publishers Limited.
Hart, N. (1985) the Sociology of Health and Medicine.- (Themes and Perspectives in Sociology) Oxford: The Alden Press. Reprinted, 1993.
Health and community service (2006) Available at: (Accessed: 19 February 2007)
Insurance Trader (2000) Available at: (Accessed: 21 February 2007)
Marsh, I. and Keating, M. (2006) Sociology: Making Sense of Society. 3rd edn. Harlow: Pearson Education Limited.
Macionis, J. and Plummer, K. (2005) Sociology: A Global Introduction. 3rd edn. Harlow: Pearson Education Limited.
Moonie, N. (2000) BTEC National Diploma Care. 3rd edn. Oxford: Heinemann.
Scambler, G. (2000) Health and Social Change: A Critical Theory. Buckingham: Open University Press.
National Stastics (2003) Available at: . (Accessed: 20th February 2007)
Population Health Forum (2003) Available at: (Accessed 20th February 2007).
World Health Organisation (2007) Available at: (Accessed: 24th February 2007).
Wikipedia project (2004) Available at: (Accessed 20th February 2007).
