Inequalities in health have many factors but these can be argued against as to whether they are the actual cause. Social class is a factor, along with region, age, gender, ethnicity etc. Measuring the impact of social class is difficult because social classes have changed over the years, eg) working class living conditions have changed, and there is a delay in the onset of diseases, eg) Asbestos related illness. (NICE 2009) However the Black Reports (1980) finding was that the death rate for men in the lower social classes was twice that for men in the higher social classes, and the gap between the two was increasing not reducing.
It also showed that some people in the lower classes were experiencing worse health than in the 1950s, maybe giving evidence that the change in working class living conditions wasn’t such a contributory factor. The report showed that British rates of infant mortality were in some cases higher than those in many developing countries, which doesn’t point towards a class inequality. The Black Report identified four explanations of health inequalities, the artefact explanation, natural or social selection, the cultural/behavioural explanation and materialist or structural explanation.
The artefact explanation stated that the relationship between class and health is artificial rather than real, arising either through the inadequate measurement of social class and health, or in the measurement of the relationship between the two. (UCEL 2003) The natural and social explanation involved the idea that health was a cause of social class position rather than a consequence, and that individuals are selected into higher classes, while the weakest go down the social scale to occupy the lowest position.
The cultural/behavioural explanation defined culture as a set of specific behaviours (smoking, excessive drinking, unhealthy diet and physical inactivity) which have consequences for health. These behaviours were regarded as cultural because of the understanding that they are within the control of individuals. The materialist or structuralist explanation explained the role of economic and structural factors in the distribution of health and well being. Research was conducted to provide evidence for the materialist/structuralist explanation.
It found a link between low birth weight and high blood pressure in adulthood which leads to increased coronary heart disease. (UCEL 2003) The Inverse care law stated that working class people receive poorer treatment from the health service. It stated that in poorer areas, qualified doctors are less likely to set up practices so people in lower classes are less like to receive efficient healthcare, when in fact they may be the ones that need it most due to bad living conditions & housing etc. The postcode lottery refers to this suggesting postcodes in richer areas tend to have more money to spend on health care than poorer areas. (DH 2011)
The Acheson Report (1998) showed many similarities with the Black Report. It found that there are still inequalities in different class groups, with evidence it is still growing. The report put forward several solutions including policies to reduce stress at work, improved access to health services for all classes, improve nutrition in schools, improved benefits and access to benefits for the most needy families. (DH 2011) In summary the evidence shows there are social class based health inequalities, however there are problems in measuring class and health.
The issue of social change, and delay in the onset of diseases should be taken into account when looking at this inequality. Evidence shows life expectancy is lower in poorer, less developed countries. The Acheson Report is in depth, but prefers to advise how funds should be allocated and not what should be done to solve the problems. Some evidence for social class health inequality is more conclusive than others, however social class can involve status, wealth, culture, background and employment. There is not a simple relationship between class and ill health. Everyone will experience a number of different influences on their health.
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