A second approach is social selection. It claims that social class does not cause ill health, but that ill health may be a significant cause of social class. Yet, the problem with this approach is that its studies of health differences indicate that poor health is a result of poverty rather than the cause of it. Examples of this approach include, that the fit and healthy are more likely to be successful in life and upwardly mobile in terms of social class. The Marxist view, e.g. Bowles and Gintis (1976). It is believed that schools perform a ‘sifting, sorting procedure’ where they allocate the ‘right people’ for the various levels of jobs in society. Therefore, ill health would mean poor performance and these people are not allocated such jobs.
The cultural and behavioural explanations stresses that differences in health are best understood as being the result of cultural choices made by individuals or groups in the population. For example, in ‘Social Trends’ (1991) its reports that in 1986 25% of male non-manual workers smoke compared with 42% of manual workers. The functionalist view shown in Currie et al (1989) says, individuals from lower social classes tend to drink more, chose an unhealthy diet (higher sugar consumption and the eating of less fresh fruit) as well as not having an awareness of what sort of health care is available to them compared to the middle class people who tend to take more exercise and have a wider range of social activities than the working class. By the use of these methods it therefore reduces their levels of stress and can help maintain an overall higher standard of health. However, this argument involves a strong element of ‘victim blaming’ and it fails to ask why these groups have such poor diets and high alcohol and cigarette consumption. Critics point out that there could be reasons why people are ‘forced’ into an unhealthy lifestyle such as, hazardous work, bad housing, low income and unemployment.
The final approach is put forward by the critics of the cultural explanation and those who see a direct relationship between the differences in health and the unequal nature of British society. It claims that poor health is the result of ‘hazards to which some people have no choice but to be exposed given the present distribution of income and opportunity’ (Shaw et al, 1999). Poverty is the key factor that links a range of health risks. It is a known fact that poorer people have worse diets and worse housing condition and are more likely to be unemployed and generally have a more stressed, lower quality of life than other higher social classes.
Industries vary in how dangerous they are to their employees. For example, respiratory diseases are common amongst those working in road and building construction, as a result of the dust inhaled; while varies forms of cancer are associated with chemical industries.
Another factor is a person’s position at work. Workers with little power and control over their work tend to experience worse health compared to those who are given more responsibility. An example of this is research carried out on civil servants. It has shown that routine clerical officers are much more likely to die young than workers in higher grades. If you were to compare the highest and the lowest grades together it would show that in the lowest grade people are actually three times more likely to die before reaching the age of 65. Therefore, all these factors together would indicate many different things i.e. effects of a reduced income would mean a less nutritious diet and unemployment could lead to stress related diseases such as increased drinking, smoking and even suicide.
Geographical differences generally reflect differences in income and levels of deprivation. However an exception to this is the fact that, poorer people living in richer areas tend to have higher levels of health. This may be due to the fact that there are better health services and because the area is attractive for health professionals to live. A richer area could also provide more facilities e.g. parks, cinemas, shops and more open spaces. These facilities would probably help to decrease levels of stress for those living there. Overall, it seems that quality of life in poorer areas is generally lower and as a result standards are worse compared to richer areas that tend to have better standards of health care.
However, there have always been problems of measuring social class. Definitions of social class were based on the Registrar General’s five point scale. It does give some insight into working conditions, income, job security, standard of living and level of education. Yet, it comes under criticism due to the fact that it is hard to place everyone within this five point scale based only on jobs, as people can change class status throughout the life. Also, this scale does not account for people never been in work, people in the armed forces and the constant changing status of different jobs.
Genetic factors are also an important determinant of health but, so far, there is little evidence to suggest that one way or the other there are genetic influences on health inequality and most research has usually been focused on life style and other material factors.
In conclusion, these different explanations all suggest and support the view that higher social class positions are linked to better health. Traditionally, most sociologists have favoured structural explanations. However, a purely structural explanation negates individual choice and reduces people to the ‘puppets’ of the ‘society’.
