HEALTH REPORTS AND THE ROLE OF HEALTH CARE

Social Research Update (University of Surrey)

The Report claimed that men from Social Class V were 2.5 times more likely to die before their retirement age than men from Social Class I meanwhile the death rate for women in Social Class V was twice as much than women from Social Class I.  Diseases usually associated with Social Classes I and II (cancer, stroke and heart disease) are seen to be more widespread amongst the working classes.  The following table is an example of statistics which can be used to demonstrate the clear difference between the classes.

Source:  International Centre for Health and Society (University College London)

We know that the principle source of ‘reliable’ national data comes from the Population Census which is updated every 10 years, and that the Government also conducts social surveys, which pull together information for social classifications.  But the overall statistics (as previously mentioned) could be questioned, as it may not include facts such as women seek more medical advice than men but this may be on behalf of either children or relatives.  It may also be inaccurate to conclude that men are healthier than women as they generally visit their doctors less than women.  

The basis of the Social Selection theory is that moves made by individuals into or out of occupations, social classes or unemployment are partly determined by a process of selection on health grounds.  So, people in good health are more likely to have higher status, skilled occupations.

This theory is politically important because it implies that the ‘health divide’ would remain despite any general improvements in the health of the population, as those in poor health would always drift to the bottom of the scale.  In other words, this theory suggests it is not just a case of position influencing health, but health influencing class position.

The Behavioural/Cultural theory blames those with ill health (primarily in the lower and working classes) for not looking after themselves properly.  An unhealthy lifestyle which consists of too much smoking, fatty foods and insufficient exercise are among the many causes of poor health.  It is  suggested that the ‘offenders’ are also guilty of not taking advantage of the facilities that would keep them healthy, e.g. attending medical check-ups and using family planning facilities. (Trowler 1996)  Although people can keep fit at little or no cost (local gym or walking/jogging), smoking may be more of a way of coping with a stressful life than merely an unhealthy indulgence.

The final explanation is the Materialist or Structural approach which points to material factors as the basis of poor health.  Of the four explanations for inequalities in health, the Black Report chose this theory, which resulted in the Government’s disapproval.  It argues that people receiving low income are unable to afford adequate diets.  The direct effect of material circumstances on health consists of factors such as unhealthy working conditions (e.g. exposure to hazardous materials such as asbestos), poor quality housing (e.g. dampness, which could lead to asthma and other chest complaints) and the lack of other important resources. (Jorgensen 1997)  The most fundamental indirect effect of a person’s material and social circumstances is related to income.

The Health Care Service is seen to favour the middle-class who knows how the system works and are more equipped (e.g. education/influence) than the working-class to take advantage of the services provided.   They are also able to receive better access by way of paying for private treatment.  The Black Report sums up the problem by stating that ‘…while genetic and cultural or behavioural explanations played their part, the predominant or governing explanation for inequalities in health lay in material deprivation’. (Sociology Review 1999)

It is without question that in order for any major improvements to be made, there needs to be a radical change (through Governmental policy) in the distribution of wealth.  ‘The best way to get rid of poverty – absolute or relative – is to forge a more genuinely equal society’  (Stephens et al 1998)

The Black Report concluded by recommending:

1. The abolition of child poverty,
2. Disability allowance for all ages,
3. Better working conditions and benefits,
4. Extensive and effective health care,
5. National health objectives to be set,
6. Health development council to be established, and
7. Improvement to research and statistical data relating to health.

In the forward section of the Black Report, Patrick Jenkin (Secretary of State for Social Services 1980) responded to this recommendation by saying:

‘I must make it clear that additional expenditure on the scale which could result from the report’s recommendations – the amount involved could be upwards of £2 billion a year – is quite unrealistic in present or any foreseeable economic circumstances …. I cannot, therefore, endorse the group’s recommendations.’ (The Black Report 1980)

In 1987, The Health Divide – Inequalities in Health in the 1980s was published by the Health Education Council.  This follow-up to the Black Report found that significant social inequalities in health had persisted throughout the 1980s, and also suggested that social-economic circumstances were playing the major part in causing these health variations. It also presented strong evidence that health inequalities between social groups had worsened since the 1950s, particularly in adults. (Whitehead 1992)  In the Report, Margaret Whitehead identified flaws in the Registrar-General’s classification system and declared:

‘The recent evidence continues to point to the very real differences in health between social groups which cannot be explained away as artifact.  On the contrary [new evidence suggests] the Registrar-General’s classification may under-estimate the size of the social class gradient in health.’

 M. Whitehead, The Health Divide – Inequalities in Health in the 1980s

The Department of Health published The Health of the Nation in 1992, which was made up of an examination regarding the different patterns of health of people in Britain.  It also featured a series of targets to be completed by the Government by the year 2000, e.g. deaths caused by heart disease and strokes to be reduced by 40 per cent. (Social Welfare Alive!)

The Department of Health further published a report in 1995 which noted that, ‘if everyone was as healthy as the middle-class, there would have been 1,500 fewer deaths a year among children under the age of one, and 17,000 fewer death among men aged 20-64.’ (Social Review 1999)

Based on the Behavioural/Cultural theory that health inequalities originate from people’s lifestyle and behaviour, in 1997, a British Government report called Nutritional Aspects of the Development of Cancer estimated that ‘…up to 70% of cancer cases were linked to the type of food people ate.’   Compared to cancers caused by the result of occupation or smoking, diet was considered ten times more important. (Ibid) 

In 1998, the Department of Health's Committee on Medical Aspects of Food Policy and Nutrition concluded that higher vegetable consumption would reduce the risk of colorectal cancer and gastric cancer. There was also weakly consistent evidence that higher fruit and vegetable consumption would reduce the risk of breast cancer. These cancers combined represent about 18% of the cancer problem in men and about 30% in women.  (DoH 1998)

The Government was seen to have finally accepted the reality of social class inequalities in health when in 1998 they published Our Healthier Nation.   In complete contrast to the arrival of the Black Report, the Government embraced this paper by publishing a full version on the Internet.  The centre of the Government’s strategy was to “improve the health of the worst off in society and to narrow the health gap”; with named settings for action (schools, workplaces and neighbourhoods) and four priority conditions (heart disease, accidents, cancer and mental health).  One of the other important components of the Green Paper was the emphasis on a ‘national contract for health’. Within this model, the Government (and other “national players”) are seen as partners with “local players and communities” and individuals, all working together to improve the nation’s health. It goes on to suggest that:

‘Individuals on their own can find it hard to make a difference. But with help from their families and support, when needed, from the community and local agencies they can make real changes. Local agencies need central Government to provide leadership and put in place the national building blocks and support. Without individuals, families and communities working together, Government achievements will be limited.’ (Our Healthier Nation 1998)

In 1997, Sir Donald Acheson was commissioned by the Government to carry out an ‘independent inquiry into inequalities in health’.  Acheson stated that ‘the key objective of our report is to contribute to the development of the Government’s strategy for health and an agenda for action on inequalities in the longer term [and to] ‘take into account the main features of “Our Healthier Nation”’ (Acheson 1998) At the end of the Report, Acheson’s committee recognised a variety of areas for future policy development in relation to health inequalities which included education, poverty and nutrition.  They also saw ways in which to reduce inequalities within the National Health Service.

This Review has detailed the wide and growing inequalities in health in Britain and has reviewed a number of Reports that have looked into ways of addressing these inequalities.  It seems only fitting to conclude with a quotation from Article 25(1) of the 1948-1998 Universal Declaration of Human Rights which states that:

‘Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.’ (Universal Declaration of Human Rights)

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