1. Class and Health

2. Income and health Research demonstrates that wide disparities in wealth are connected with the health of a population. The greater the level of income inequity, the poorer the population health Those with the lowest incomes have the worst health outcomes, but the negative impact of inequity is felt among all.

3. Poverty & Child Health The after-taxes poverty rate is significantly higher in Canada (14%) than in countries such as Sweden (3%), the Netherlands (6%), France (7%), Germany (7%) and the United Kingdom (10%). One in four children lived in poverty in 1996 compared with one in eight in 1981.

4. Risk factors, poverty, child health Living in a lone-mother family is a risk factor for poverty. Children who are from visible minority groups are at elevated risk of living in poverty. Aboriginal children are at increased risk of poverty.

5. Inequity and child health Children who live in poverty encounter more hurdles to healthy development and are, consequently, at an elevated risk for a wide range of negative health outcomes. Babies born to low income parents are at an increased risk for low birth weight. Males from birth to 19 years of age in the poorest quintile had an injury death rate of 22/100,000 compared to 15/100,000 for male children in the richest quintile. The poorest 20% of children are at greater risk of dying in a fire or a homicide than other children. Children living in households with incomes less than $20,000 per annum are at considerably elevated risk of “hyperactivity” and “delinquent behaviours”.

6. Low Income and Child Health Low birth weight, prematurity, low income – Indicators of child health? – Indicators of relationship of class and health Health problems of poor children begin before birth Infant morality rates and distribution in social stratification

7. Canada, Health, & Inequalities

8. Deaths of Children In all provinces, younger children are at greater risk of poverty than older children. The national poverty rate for children under the age of 7 climbed to 25% in 1996 – From 13% in 1981 and 21% in 1991. For children between the ages of 7 and 17, the poverty rate in 1996 was 19%. Canada continues to have one of the highest infant mortality rates in the developed world trend that has held since the 1990s Canada recorded five deaths for every 1,000 live births in 2006, placing it 15th out of 17 peer countries

9. Beyond Income as variable: housing Mortality rates among homeless and marginally housed people were substantially higher than rates in the poorest income groups, with the highest rates seen at younger ages. higher mortality and shorter life expectancy than could be expected on the basis of low income alone the importance of considering housing situation as a marker of socioeconomic disadvantage.

10. Cultural Capital & Health

11. Working Conditions, Class and Health Occupation and well-being Top injuries: sprains and strains Body part affected: hands and back High risk groups: Blue collar men Injury rates decrease when lower physical demands

12. Open Class System facilitates mobility Open & closed class systems – the extent to which mobility occurs allowing people to pass through inequalities Closed system – No mobility – tend to persist across generations Open system – ease of social mobility permitted individual achievement & personal merit determining social rank hierarchical social status is achieved on the basis of people's efforts ascribed status (family background, ethnicity, gender, religion, skin color) less important blurred class lines & wide range of status positions

13. class societies Unequal access to all 3 advantages, economic resources, power, prestige – Potential for inequities How to define class? What variables do we use? – Occupation, income & wealth, prestige, education, residence, ethnicity, gender, age, ?

14. Social class The adjective “Class” – descriptive – collectively organized actors – people become identified independently of kinship as a constituent of class – for example, biological differences or functions as defined in the culture rather than social identities become increasingly important Class formation – the formation of collectively organized actors Class consciousness – the understanding of actors of their class interests Class struggle – the practices of actors for the realization of their class interests – In contest Interrelationships of all these

15. How do we know social classes exist? Social stratification the unequal distribution of goods and services, rights and obligations, power and prestige all attributes of positions in society, not attributes of individuals there are significant breaks in the distribution of goods services, rights, obligations, power prestige as a result of which are formed collectivities or groups we call strata or “class”

16. Popular Imagination of Social Class in Canada The Upper Class – Perhaps 3-5% of Canadians fall into this class. – Much of their wealth is inherited. – children go to private schools and they exercise great power in occupational positions. – Although this group has historically been primarily of British origin, it is now more widely distributed. – Lower-Upper Class The remaining 2-4% fall into the lower-upper class and depend more on earnings than inherited wealth. They are, for the most part, the "nouveau riche." The Middle Class – 40-50% of the Canadian population – $50,000 to $100,000 earned from upper managerial or professional fields. – rest of the middle class (average middles) typically works in less prestigious white-collar occupations or highly skilled blue-collar jobs The Working Class – about one-third of the population and has lower incomes than the middle class and virtually no accumulated wealth. The Lower Class – remaining 20% of our population is identified as the lower class. – In 2001 roughly 16% of the Canadian population were labelled as poor – supported entirely by welfare payments – others are among the "working poor" whose incomes are insufficient to cover necessities like food, shelter, and clothing. – typically live in less desirable neighbourhoods-often racially or ethnically distinct – children are often resigned to living the same lives of their parents.

17. Social Class Redefined Three general approaches to the conceptualization of social class can be identified in the public health literature: social class is equated with socio-economic status, i.e., income, educational attainment and/or occupational prestige, social class is a social group defined primarily by the nature of its relationship to the economic mode of production social class is a social group defined relationally in social space by its possession and utilization of various capitals such as economic, cultural and social capital

18. Neoliberalism, Class, and Health Neoliberalism – move from a bureaucratic welfare-based society toward a meritocracy – in the interests of business – based on individual and economic liberty Health & health care consequences – Individual centric – Achieved health Class analysis and achieved status

19. The “Hospital” and the Imagined communities of class Transformation of image and activity of hospital – from secular charity for indigent and working poor – To modern workplace for the production of health Redefinition of the relationship of middle class to the general public hospital The new economics of medical “progress” Changes in local health care system

20. Change in historical identity Hospital as charitable enterprise – durable disposition Transformation of hospital from one-class custodial care to temple of scientific medicine for all social classes – Safe hospitals offering professional care – Comfort and privacy – middle class consciousness – Metropolitan institutions Hospitals growing dependence on income from patients’ fees Transformation to “centres for the treatment of disease” (not class; not social categories) But institution embedded in open class society in spite of erasure of social class

21. Contemporary Hospitals The largest component of Canadian health care system – Employ 2/3 of all health care workers Large, bureaucratized, technological complex industries – “Health Factories” Transition from normative to utilitarian organizations Early history -- Total institutions for staff Social stratification – development of hospital class system – open class system Classes of institutions – Ownership groups – public (96% of bed capacity), proprietary (profit; corp. owned), federal – Hospitals – general, specialty, rehabilitation, extended care, long term psychiatric

22. Three “castes” of hospital workers Occupational def., status and mobility Docs, technicians & nurses, non-professional workers (dietary, laundry, housekeeping etc.) – Labor pools in class society at large Indications that the social class situation in hospital settings resemble “non-clinical areas” (society)