However it is important to note that, due to poor income people in low socio economic groups cannot afford fruit and vegetables which tend to be expensive therefore they are bound to purchase cheap fatty foods that are economically viable to them. The Black report detailed that mortality rate was higher amongst people in lower classes. Mortality rate is lower classes would inevitably be higher in comparison to people in the higher echelons of the social structure because, other than access to National Health Service (NHS) treatment, the upper class can afford to seek treatment in private hospitals therefore reducing mortality rates in upper classes.
On the same note, it is true that social class plays a role in how healthy people are. Following on the previous point, there are services that are not accessible through the NHS where post code lotteries apply therefore people not within the catchments of that post code would have to seek treatment privately of which the lower class levels cannot access thereby bringing health inequality on the basis of affordability.
As discussed above, cultural explanation suggests that different social classes behave in different ways; the poor health in the lower social classes is caused by their behaving in ways that are more likely to affect their health. Supporters of this view such as the former Health Minster Edwina Currie’s condemnation of Northerners for eating unhealthy food stated that “Working class people smoke and drink excessively and they eat the wrong kind of food and take little exercise”. A close analysis of Currie’s comments, reflect that social class alone does not result in unhealthy living but peoples behaviour and style of living could lead to poor health. Contrary to the behavioural concept, Townsend (1990) and Davidson (1982) both argue that while some of the links between deprivation and ill health are still very poorly understood, life style is clearly far from the whole answer, as some people have more freedom than others by virtue of their individual situation and circumstances to choose a healthier lifestyle, as the unfortunate are being restrained from adopting healthier lifestyles, even when they would wish to do so because of poor income, housing, work and other social constraints.
In as much as we have discussed that the behaviour of people in the lower classes affects their health because of eating unhealthy food and lack of exercises. It is imperative to note that these people are financially poor and they cannot afford good quality food i.e. fruits and vegetables. In the UK, food that is central to good health tends to be more expensive than food which is high in cholesterol and fat (Giddens and Griffiths: 2006), therefore due to poverty the cheaper option would be more ideal. In this respect, poor people would be less healthy than more affluent people because of limited choices and poverty. Due to ACORN, a system for service delivery based on post codes, the poor tend to pay more towards insurance, interest for bank loans as well as utility charges therefore condemning the working class to more poverty and inevitably poor health.
Lewis (1960) explained the consistency of poverty and he stated that poor people have a distinct culture that is passed from generation to generation; therefore culture is the obstacle to a healthy lifestyle. In cases where dependency on the state transcends from generation to generation especially amongst people living in lower social classes, it is highly unlikely for such people to move out of poverty because they would have inherited the same habits that they were raised up in. The onus is on such people to change the culture of dependency to a culture of more economic active citizens so that their health and that of their children could improve hence a change in culture would result in healthier citizens albeit social class. As cited by Nettleton (2006), Arber and Cooper (2000 p 176) state that “…since the 1990s, the key material divide for children’s health is whether their parents are in paid employment, rather than their position in the class structure”
Cultural explanations essentially place the blame on individuals themselves, in what are called ‘victim-blaming’ theories. Supporters of this explanation argue that different social classes behave different, and that these behavioural differences lead to differences in health. However, despite societal behaviour and culture, the onus in on an individual to make such decisions whether to eat healthy or not. Whitehead and Dahlgren (1991) state that despite the influence of culture and society on lifestyles, lifestyle decisions to smoke, consume alcohol, eating patterns as well as propensity to exercise are within the control of individuals. People are capable of making decisions as to what lifestyle they would want to live by considering the effects of unhealthy lifestyles compared to health living.
At this point in time, it is evident that social status, poverty, culture and behaviour could lead to an unhealthy lifestyle through eating habits as well as the reluctance to exercise. Poor eating habits (high calorie diet), behaviour (smoking, consuming alcohols and reluctance to exercise generally result in poor health. Poor health would inevitably result in shorter life expectancies due to cholesterol related diseases, alcohol related diseases as well as smoking related diseased. It is evident from the research by the Office of National Statistics (ONS) 1991 that people in lower social classes are more prone to illness and diseases compared to people in the higher tier of the social structure. NOC reported that there are higher occurrences of all illnesses in men who are in lower social classes compared to those in higher social classes and the ailment rates are on a sliding scale with low disease and prevalence rate in the higher levels of social class. Based on this discussion it is inevitable that life expectancy would be higher in more affluent members of society compared to low class citizens. Nettleton (2006) p177, states that between 1997 and 1999, people in social class five (V) had a shorter life expectancy by four years at 77.1 compared to social class I that had an average life expectancy of 82.8 in men. Other researchers have concluded that behaviour affects life expectancy. As cited by Hunt, et al (2004), records from the National Statistics Office 2000 state that only 4% of women from professional households/backgrounds smoked during pregnancy compared to 26% of women form unskilled backgrounds. The behaviour of smoking was identified by the Acheson Report (1998) as a contributory factor for mortality differences between social classes. Smoking during pregnancy has been linked to resulting in underweight babies at birth (Woolston: 2006), therefore as cited by Popay et al (1998), Barker (1991, 1992, 1994) “demonstrated that the mortality from cardiovascular disease is elevated among men whose birth weight was low or who were particularly thin” From the discussion above there is a link between behaviour (smoking) and low birth weight and finally poor health and high mortality rate to babies or adults born will low weight.
The behavioural difference between the classes may help to account for differences in the health of babies born to women of different classes. For example, the lower the social class of the mother, the greater the risk of premature birth and low weight and the higher the infant mortality rate. However, its high profile in political debates in the 1980’s led to the inclusion of questions about smoking related diseases, notably coronary heart disease and lung cancer, in research on Whitehall civil servants by Marmot (1984). They found that even with non-smokers the risk of these diseases was still strongly associated with the grade of job held, thereby pointing to the inability of this model to fully explain most health inequalities, as cultural and behavioural differences only accounted for approximately 25% of all social class inequalities.
Another example to look at is education in relation to inequalities in social class. Research reveals that the higher the social class, the higher the levels of educational achievement. The children of parents in higher social classes are more likely to stay on in post compulsory education, more likely to achieve examination passes when at school, and more likely to gain university entrance. These features painted a true picture of British education in the twentieth century and can be argued to follow this trend today. However, whether there has been any reduction in the inequalities is more debatable, but some research suggests that these inequalities are as great as ever, despite the overall improvements within the education system. From the discussion above we could agree on the hypothetical that, the higher the social class background; the more likely the pupil would succeed.
The government has identified that the gap between the rich and poor is immense and those who live in areas surrounded by high rates of poverty, unemployment, poor housing and poor education are most likely to suffer, hence the hypothesis ‘The poorer you are, the more likely you are to be ill and or die younger’. There is a clear relationship between ill health and low income, so the government propose to introduce benefits that enable people with a low income to have a level of security. Social security is increasing child benefits so that children have better security. Mothers who have a low income or are unable to work will be introduced to affordable childcare. The elderly are vulnerable to poverty, especially those with a low pension. The government has provided free eye tests and reduced transport fares to ensure they too have some level of security. Housing is another form of security; if the home is unsafe, it can lead to bad health through damp or cold conditions. The government are aiming to offer more opportunities for people to have safe housing.
Correlation between social class and health status has long been recognised by governmental organisations and academic communities; however, agreements as to the mechanisms driving this inequality are still contested. There is a general consensus among sociologists based on evidence from the Black Report, Acheson and The Joseph Rowntree Trust that structural and cultural factors are the main contributors to health differentials between classes, and that in reality these factors are interrelated. There is also evidence that material and structural factors, such as housing and income can in fact affect health. The discussions above have shown that unfavourable social conditions (poor education, poor diet, morbidity) limit the choice of an individual’s life style and it is this set of studies, which illustrates most clearly to many sociologists that behaviour, and attitudes cannot be separated from its social environment. As social and economic life have major influences on the patterns of illness and death, this essay has shown that many inequalities of wealth, income, education, occupation and social privilege continue would impinge on the lifestyle of people in lower social classes thereby resulting in health equalities.
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