Social Class HEALTH Inequalities G672

Recap: How many can you explain? Objective & Subjective definitions of social class Registrar General Scale (RGS) NS-SEC Underclass Working class culture Means of Production Embourgeoisement Proletarianization Aristocracy & Super-Rich Ascribed/Achieved Statuses

Discuss Why is OCCUPATION a useful measure of social class? What are some problems with using OCCUPATION as a measure of social class? What are the problems with the NS-SEC?

Problems The majority of the population do not have an occupation The NS-SEC is generally based on the highest earner in a household, therefore ignores many people’s occupations. A classification based on occupation alone ignores other factors of inequality. Within a single occupation, there can be various levels of income, work-situation and lifestyle…

Social Class Health Inequalities: Activity In pairs, study the graphs on the hand-out and answer the questions provided. 10 mins

Social Class & Mortality Statistics Rate of stillbirths and premature infant deaths significantly higher for unskilled families than for professional families… …Children from poorer families are 5 x more likely to die in an accident than those from wealthier families. A person born into social class 1 lives (on average) about 7 years longer than someone in social class V. Around 90% of the major causes of death are more common in social classes IV and V than in other social classes.

Studies… The Black Report (1982) and The Health Divide (1992) show that members of the lower-classes continue to experience higher mortality rates. These studies suggest that a considerable number of deaths could be prevented each year if all classes shared the advantages of Class I…

Social Class & Mortality Stats Working-class people go to the doctor more often (and for a wider range of problems) than ‘professional’ people (Browne & Bottrill; 1999). In 2001, a health self-assessment question was added into the UK Census. The 2011 results are below… http://www.ons.gov.uk/ons/rel/census/2011-census- analysis/local-authority-variations-in-self-assessed- general-health-for-males-and-females--england-and- wales-2011/info-self-assessed-general-health.html

Social Class & Mortality Stats Self-assessments of health tend to worsen down the occupational hierarchy. Full-time and self-employed people are more likely to rate their health as “good”. Neurotic disorders are reported by 20% of unskilled manual workers, compared to 9% of professionals.

Discuss What additional problems might there be in explaining the relationship between health and class?

Potential Problems… Extraneous variables (“class” is an umbrella term that incorporates a range of variables e.g. diet, geographical location, ethnicity, gender etc.) Classes are changing – difficult to establish patterns of health as classes change Onset of disease is delayed – Some diseases appear years after exposure to them, making it difficult to establish patterns.

In Pairs Consider the different types of explanation. For each, decide on at least two explanations as to why people from lower social class backgrounds experience worse health and lower life expectancies: ARTEFACT CULTURAL/BEHAVIOURAL STRUCTURAL/MATERIAL

Artefact Explanations Researchers often focus on the differences between the highest and lowest classes. These are the extremes, ignoring everything in between… Artefact Explanations suggest that social class health inequalities are not real; they are just a product of statistics… …There is no convincing support for this view. Almost all researchers agree that class differences in health are both real and serious.

Social Selection Explanations Class does not effect health as much as Health effects class… …People with poor health fail to get good qualifications and/or good jobs and therefore are concentrated in the lower classes

Discuss (Pairs): List five ways in which people become upwardly mobile (e.g. improve on the position they were born into)? For each, explain how ill health could prevent this happening fully.

Social Selection Explanations Wealthier classes appear statistically healthier because healthy people are more likely to become wealthy… …Lower classes appear statistically less healthy because unhealthy people of all classes end up in the lower classes… So health influences the direction in which people move up or down the social scale.

Evidence in support of social selection Wadsworth (1995) claimed that boys who experience serious childhood illnesses are more likely to be downwardly mobile by age 26. Connelly & Crown (1994) claimed that schizophrenia is over-represented among homeless people because developing the illness puts a person at risk of homelessness.

Activity Complete the social selection activity on the worksheet provided.

Issues with Social Selection Explanations Illness does not always lead to downward mobility. Some people adapt to illness and continue with their careers… …Likewise, good health does not guarantee upward mobility. Appropriate qualifications and experience are much more important.

Cultural Explanations Inequalities in health are the result of differences in norms, values, attitudes, lifestyle and behaviour between social classes.

Could any of these lead to ill health? RECAP: What are the features of working class culture according to Willis (1977)? Could any of these lead to ill health? Why might the lifestyles of upper class people ensure they are healthier?

Cultural Explanations Annandale & Field (2007) claimed that working- class people have more negative definitions of health. They also have lower expectations of health, considering it in fatalistic terms. This can impact their health behaviours… Pairs: Identify a minimum of FIVE behaviours which might increase one’s risk of illness or premature death…

Studies tend to conclude that working-class people… Smoke More… Drink More… Eat less well… Exercise less…

From Cancer Research UK:

Cultural Explanations “Much ill health in Britain today arises from over- indulgence and unwise behaviour. Not surprisingly, the greatest potential and perhaps the greatest problem for preventative medicine now lies in changing behaviour and attitudes to health…” (The Labour Party – Prevention & Health - 1977)

Problems with Cultural Explanations Accused of blaming the victim (e.g. if the lower classes suffer worse health, it’s their own fault…) Townsend (1999) points out that some people have more freedom to ‘choose’ a healthy lifestyle than others. Poorer people adopt unhealthy behaviours as a response to their situation… Blackburn (1991) claims that improving the income for poorer families will improve their eating patterns…

Structural/Material Explanations Social class inequalities are caused by the structure of society and people’s different living/working conditions. Argue that some factors which appear to be cultural are actually due to other factors. For example, poor diets among the working classes is down to low income, not personal choice.

Ext: - Suggest one solution to each of the above! Discuss: How could the following material factors lead to ill-health? Long working hours? Dangerous working environment? Damp housing? Low income/unemployment? Stress? Ext: - Suggest one solution to each of the above!

Structural/Material Explanations Accident rates are higher amongst those in manual labour. Those who live in poorer housing have higher rates of respiratory diseases (Martin et al, 1987) The material effects of unemployment are significant, leading to stress, disruption and behavioural patterns that damage health (Morris et al, 1994) Lobstein (1995) found that healthy food cost less in affluent parts of London than it did in poorer areas.

THE WHITEHALL STUDY (Marmot) Asked why lower grade civil servants had higher rates of death from all causes and specifically coronary heart disease Even when controlling for factors such as smoking, obesity, leisure time, height etc. the lower grades still had a risk factor of 2:1 compared to highest grade. Concluded stress associated with lack of control was a significant factor. http://www.abc.net.au/science/slab/stress/whithall.htm

Discuss: Which would you prefer and why? A Sociology Exam in which you have to answer four essay questions in ninety minutes, following a precise structure for each question. A Sociology Exam in which you answer four unstructured essay questions from a choice of twelve in up to four hours. How does this relate to the Whitehall Study?

Discuss Do you agree that people of a lower social class are likely to have less control over their own work? Do you agree that this leads to stress? Are there any other factors that might mean people from the lower social classes experience more stress (and therefore more ill health in general)?

An Unhealthy Environment YouTube - Health Inequalities - Social Determinants of Health Film (Glasgow) Individually, while watching: Identify and explain the potential factors impacting health in this short film… Compare your responses to those of a partner.

Multiple Disadvantage Unemployment and low pay Inadequate housing Poor environment High levels of crime Poor health Poor education

Inverse Care Law (Hart,1971) Care is distributed in inverse proportion to need Deprived areas have fewer GPs People on low incomes are more likely to be dependent on public transport for getting to a surgery or hospital People in manual work are more likely to lose pay if they take time off work Poorly educated people are less likely to be knowledgeable about health and health services and to be assertive when dealing with doctors Do not have the money to jump NHS waiting lists by using private services

Social Class & Mental Health G672

Class & Mental Health Match these studies to explanations/studies already covered in this section: Rogers & Pilgrim (2005) agreed that poorer people are significantly more likely to experience mental health problems. Stansfield et al (2003) found that work is the main factor in depressive symptoms in men: Both lack of employment and inadequate employment. Ross et al (2001) believed that bad neighbourhoods were a key influence on mental health. Reading & Reynolds (2001) found that anxiety about debt was the best predictor of depressive symptoms in families.

Homework Identify and Explain TWO types of explanation for Social Class Inequalities [17] Due: Next Lesson