Manana Maridashvili.

MD. PhD. Professor

Health and Society III

(Medical Sociology, Equality)

Topic 3

The social demography of health: social class.

What is social demography?

Social demography deals with questions of population composition and change and how they
interact with sociological variables at the individual and contextual levels. Social demography also
uses demographic approaches and methods to make sense of social, economic, and political
phenomena.

The social demography of health It describes the relationship between social class and health.
It also discusses how social factors can be fundamental causes of health and disease.

A social class is a category or group of people who have approximately the same amount of
wealth, status, and power in a society.

In 2001, social scientists in the United Kingdom adopted the National Statistics Socio-
Economic Classification (NS-SEC) scheme as their official measure of class position. This
approach was based on differences in employment relationships and work conditions that
commonly used a seven-class model. Yet, the term status groups did not replace social class
in sociology to signify a person's location in a social structure.

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 What are demographic factors in health?

A large and growing body of evidence shows that sociodemographic factors – age, race, ethnicity,
and language, for example – and socioeconomic status (SES), such as income and education, can
influence health outcomes.

A large and growing body of evidence shows that sociodemographic factors –

o age,
o race,
o ethnicity, and
o language,

and socioeconomic status (SES), such as

v income and
v education,

can influence health outcomes

How do demographic factors influence health?

Changes in age composition of the population will affect needs and demand for health and
social care. Care needs are not evenly divided among age groups in the population. Cost per capita
tends to rise sharply with age.

How does demographic changes affect health care?

The aging of the population affects the demand for all health care services, including hospitals,
and long-term care. Older persons use more health services than their younger counterparts
because they have more health problems. They are also hospitalized more often and have longer
lengths of stay than younger persons.

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 EPIDEMIOLOGY

Study of the determinants (“causes”) and distribution of disease in human populations.

Epidemiologists look for possible relationships between disease and these factors:

´ Social Class (“Class”)

´ Ethnicity (“Race”)
´ Gender (“Sex”)
´ Age
´ Region e.g. urban, suburban, rural

e.g. low income country, middle income

country, high income country

´ Other e.g. education, “illegal worker” status

UNEQUAL DISTRIBUTION OF DISEASE

´ Ethnicity: In Malaysia, Orang Asli have the worst health e.g. malnutrition is more
common, they experience more disability and higher rates of disease, and they die younger
´ Gender: Males are at higher risk of dying from certain health conditions. Females are at
higher risk for other health conditions.
´ Age: Young children and old people
´ Region: Rural people generally have poorer health than urban people. In the cities, slum
dwellers have poorer health than non-slum dwellers.
´

DISTRIBUTION OF DISEASES ARE AFFECTED BY SOCIOECONOMIC FACTORS

Other socioeconomic factors:

§ Education: Better educated people tend to have better health

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 § Illegal workers: They are at higher risk of developing occupational-related diseases

UNEQUAL ACCESS TO HEALTH SERVICES

Julian Tudor Hart’s “Inverse Care Law”:

People who need health services the most are the least likely to get them

Why? Because of barriers to access:

´ Financial barriers e.g. unable to pay, cannot afford to take time off from work to see the
doctor
´ Geographic barriers e.g. too far to travel
´ Cultural barriers

SOCIAL CLASS IS A VERY IMPORTANT FACTOR RELATED TO HEALTH

A person’s “social class” position is strongly linked to his or her health status.

Social Class is measured either by a person’s INCOME or OCCUPATION

Social Class Groupings:

1. Upper Class,
2. Middle Class,
3. Working Class,
4. Underclass

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 How does social class relate to health?
The Role of Social Class in Health

A person's social class has a significant impact on their physical health, their ability to receive
adequate medical care and nutrition, and their life expectancy

THE SOCIAL CLASS GRADIENT IN HEALTH

The social gradient in health means that health inequities affect everyone.
For example, if you look at under-5 mortality rates by levels of household wealth you see that
within counties the relation between socioeconomic level and health is graded.
People from lower social classes usually experience higher disability rates, higher morbidity
rates, higher mortality rates and have lower life expectancy (than people from the upper classes)
Thus,
“The lower the social class, the lower the health status of people”
It is NOT a statistical artifact:
No matter how “social class” is measured, the relationship between low social class and low
health status is found in every country where health statistics are collected.

REASONS FOR THE SOCIAL CLASS GRADIENT IN CLASS

1) Poverty e.g. not enough money to buy proper food, being forced to live in poor quality
housing in unhealthy or high crime areas
2) Lower class people are less well-educated and
3) have less knowledge of healthy lifestyles
4) Class differences in health-related behavior

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 5) More dangerous jobs of lower class people
6) More stressful lives of lower class people

SOCIAL CLASS AND HEALTH

A low social class position can have a negative effect on health.

But, poor health can also lead to a fall in social class position (the “Downward Drift” hypothesis)
e.g. people who become alcoholics or drug addicts, people who cannot work because of bad health
etc can fall into poverty.

CAN EQUAL ACCESS TO MEDICAL SERVICES ELIMINATE THE SOCIAL CLASS

GRADIENT?

In 1947-48, the British Government established the NHS (National Health Service) and made
access to medical services equal for all social classes.
However, the social class gradient continues to persist in Britain (documented by the “Black
Report”)
´ Thus, we conclude that good health depends on more than just access to medical services

What is Social Health?

Social Health is a term that refers to the ways in which people create healthy and positive
interpersonal relationships with one another.
Having good social health helps people improve their emotional wellbeing and feel supported in
their daily lives.

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 What are the 5 factors of social health?

SDOH
Social Determinants of Health

Social Determinants of Health can be grouped into 5 domains:

1) Economic Stability.
2) Education Access and Quality.
3) Health Care Access and Quality.
4) Neighborhood and Built Environment.
5) Social and Community Context.

Good social health looks like: Being engaged with others in your community. The ability to
develop and maintain friendships. Creating boundaries in friendships and relationships. Having a
supportive network of family and friends.

How can you improve social health?

To build healthy relationships:

1. Recognize how other people influence you.
2. Share your feelings honestly.
3. Ask for what you need from others.
4. Listen to others without judgement or blame. ...
5. Disagree with others respectfully. ...
6. Avoid being overly critical, angry outbursts, and violent behavior.

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