Health Inequalities –

Explaining the
Social Class – Health Link.
 Objectives
The student will be able to:-

• Define the term social class and its

context.

• Discuss possible explanations

• Understand and discuss case studies.

 Background
• Always been an association between health
and social class.

• Includes all aspects:- expectation of life, infant

and adult mortality and general level of health.

• Remains marked differences in all social classes

with health, with significant geographical
variation and gender.
• Sigerist, 1943
“The task of medicine is to promote health, to
prevent disease, to treat the sick when
prevention is broken down and to rehabilitate
the people after they have been cured. These
are highly social functions and we must look at
medicine as basically a social science.”

• The greatest influences on the improvement in

health with longer expectancy of life, lower
infant mortality, etc., has not been so much
medical discoveries as improved social
conditions.
 What is Social Class?
• Often determined and measured by an
individual’s:-
occupation
sex
class
race
employment.
Registrar Generals Classification
Level Classification
I Professional
II Intermediate
III NM Skilled non - manual
III M Skilled manual
IV Partly skilled
V Unskilled
 Explanations
There are four possible explanations:-

• Artefact

• Social selection

• Behavioural / Cultural

• Materialist
 Artefact
• Suggests that it is difficult to measure health and
social class. Is it possible to show any link
between the two?

• There is a consistent relationship with poorer

health in the lower social classes.

• There is always a relationship between how

social class is measured and health: income,
education, housing etc.

• Unable to account for all the different studies.

 Social Selection
• Determines social class through the process of
health-related mobility.

• Suggests that the healthy are more likely to

move up and the unhealthy move down.

Example
Individual – chronically sick or disabled, unable
to find employment or are under-employed,
may move down the social scale.
 Points of view
• Do the sick belong to lower classes?

• Is it due to illness that they are unable to

climb up the social classes?

• Is an individual’s position in the social class

the cause of disease?
Schizophrenia studies
Tended to belong to the lower social classes.
Not shown with their fathers – shows the disease
causes the low social class not the vice versa.

• Most chronic diseases tend to develop later on

in life, after careers have been decided,
association with social class is not found.

• Not likely to be the complete picture.

 Behavioural / Cultural
• Differences in behaviours that damage or fail
to promote health.

• Suggests that lower social classes prefer less

healthy lifestyles.

• Someone who has been on their feet all day,

is less likely to seek activity in the evening or
want to spend a lot of time cooking a
balanced meal.
• Differences in health occur in the lower social
groups because they adopt more dangerous
and health damaging behaviour.

• Suggests that the lower social class choose to

smoke and drink more, not to exercise and
do not eat healthily.
 Evidence for Behaviour
• Diet
Social class V have a worst diet than social class I

• Exercise
S.C. I exercise more in their leisure time than S.C. V

• Smoking
S.C. V smoke more than S.C. I

• Alcohol
Worse drinking habits in S.C. V
 Materialist
• Concentrates on the hazards which are apparent
in society. Some have no choice but to be
exposed to them, lower social classes are
exposed to more unhealthy environments.

• Dangerous work, poorer housing, unable to use

health service.

• Housing – poor living conditions - damp, lack of

heating, pollution.
• Income – rent comes first, so if money is short
food is the first to go.

• Trying to overcome stresses of living on low

wages – smoking, sweets for children,
abandoning breast feeding etc.

• The Black report adopted the materialistic

approach.
 Points of view

• Is it a person’s choice?

• London housing estate gang crime

• Unemployment
 Other Relevant Factors
• Cultural compatibility
Middle class are more likely to visit their GP, to
place a medical explanation on their ill health.

• Use of Health Services

Middle to upper class more likely to use their GP
than lower class (i.e. unable to get time off
work).
• Social skills
Middle / upper class more confident, more wiling
to indulge in their symptoms and ask questions.

• Influence of the health worker.

Health care professionals may make assumptions,
can influence the outcome of the consultation.

• Outcome of consultation
Higher the social class, more likely to be referred
to a specialist.
• Medical consultations

Consultation times last longer for the higher

social classes an average of 6.1 minutes for
class I compared to social class V which lasts
for 4.7 minutes.

More information is given to individuals in

higher social classes I and II compared to
those in social classes IV and V.
 Mortality Rates
Social
(Occupational) Males Females Ratio M/F
Class

I 3.98 2.15 1.85

II 5.54 2.85 1.94
III NM 5.80 2.76 1.96
III M 6.08 3.41 1.78
IV 7.96 4.27 1.87
V 9.88 5.31 1.86
Ratio V / I 2.5 2.5
 Adult Mortality Rates (SMRs)
Males Social class
Cause of Death I II IIINM IIIM IV V

Heart disease 69 81 102 106 110 137

Lung cancer 42 62 78 117 125 175
CVA 61 70 88 105 114 171
Bronchitis 34 49 84 109 134 208
Car accidents 64 75 79 101 114 175
Suicide 86 78 94 84 110 190
Females            
Heart disease 41 55 69 106 119 152
Breast cancer 107 103 105 100 99 94
CVA 61 70 88 105 114 171
Bronchitis 33 54 71 100 119 165
Car accidents 76 89 102 63 94 114
Suicide 77 81 99 55 76 84
 Baby Birth Weight
Birth Social Social Social No father
Weight Class Class Class Acknowledged
% I & II III IV & V

Less than
2500g 4.5 5.6 8.2 9.5

More
than
3000g 81.0 76.3 72.7 66.7
 Infant Mortality
Social Class Still Births Infant Deaths

I 3 6

II 3 5

III NM 4 6

III M 4 6

IV 6 8

V 6 11
 Mortality
• Measurement of deaths in a given area.

• Life expectancy has increases for both sexes –

still higher for women.

• Women live for an average of 81.6 years (2006)

• Men live for an average of 77.4 years (2006)

 Gender and Health
• Throughout the industrial world men live
shorter lives than women.

• Used to be due to working environment and

conditions.

• Men were more likely to die at any specific

age than a woman
 Points of view
• Why are men under-represented in health
statistics?

• Women are more likely to suffer high morbidity

rates than men.

• Women are more likely to go and visit their G.P

than men, if something is wrong.

• As a result men are often under-represented in

health statistics.
 Morbidity
• The measure of sickness in a given area.

• Women have higher rates of chronic disease:-

strokes
rheumatoid arthritis
diabetes etc.

• Women are more likely to be hospitalised.

• Major causes of death for men:-
heart disease
lung cancer
bronchitis
violent deaths

• Major causes of death for women:-

breast cancer
cervix cancer
uterus cancer
 Education
• Key to improving health inequalities.

• Need a change in attitude.

• Knowing or risks and noting of risks are two

completely different matters.

• Attitudes form early in children, need to be

influenced at an appropriate but early stage.
 Points of view
• How can education change an individual’s life
expectancy?

• Can it change the outlook?

• Increase social status or class?

• Can how an individual is educated, affect the

path they take later on in life?
• Attitudes towards food.

• A healthy diet from the outset is likely to

reduce the craving for food that is rich in fat,
salt and fast sugars.

• Eating less meat and more vegetables is

cheaper.

• Taste is acquired.
 Poverty
• Must not be equated with social class.

• What is seen as poverty in Britain is very

different to poverty in third world countries.

• Only those on the very lowest incomes can be

regarded as living in poverty.

• Those most likely to be affected by poverty

are the elderly and young children.
• May be a result of:-
substance abuse
drugs or alcohol
Leading to social exclusion including mental health.

• Prince’s Trust – disenfranchised youth.

• Takes a person from a very privileged background

to do something about the failings of society.
5 minute comfort break
 Case Study
• Herceptin - is not a drug but a monoclonal
antibody (a type of biologic therapy).

• It is very effective in women who have a

particular type of breast cancer.

• The drug has caused controversy because it has

created a 'post-code lottery' for treatment.

• While some Primary Care Trust's say all early-

breast cancer patients are eligible for the drug,
others only grant funding for "exceptional cases".
Patricia has been diagnosed with early stage breast cancer. She has
been told a number of treatment options by her attending physician
– surgery, radiotherapy and chemotherapy.

She went home and did some research herself, and found
alternative treatments which were less invasive, and was
particularly interested in the Herceptin treatment.

The next appointment she brought these treatments up with her

doctor, to be told she could not have them due to NHS cut backs
within her local health area.

If she wanted this treatment she could go to a private clinic, or

move to another area where this treatment was currently available.