Inequalities in Health

Question 1

Where do social inequalities stem from?

Answer 1

Structured social divisions that exist within societies across history and cultures

Question 2

What do social divisions lead to?

Answer 2

Differential “life chances” in education, career and health

Question 3

How are social divisions identified today?

Answer 3

Difference in:
Socio-economic class
Gender
Ethnicity

Question 4

How is social class measured?

What is it based on?

Answer 4

Since 2001, the official classification measure has been the National Statistics Social Economic Class

Based on employment conditions and relations, but not assessed in relation to skill levels

1-8 with 1 being high managerial/professional and 8 being long term unemployed

Question 5

Outline the socio-economic model of health

Answer 5

Social inequalities in health outcome reflect differential risk exposure to the social and environmental factors impacting on health outcomes (‘social determinants’) across the lifespan

The risk in this instance being an individual’s socioeconomic class

Question 6

What is relative health risk primarily associated with?

Answer 6

An individual’s socioeconomic class position

Question 7

What are ‘social determinants of health’?

Answer 7

The broad social and economic circumstances that together determine the quality of the health of the population

Question 8

Examples of social determinants of health

Answer 8

Living and working conditions 
Water + sanitation
Education
Healthcare services 
Agriculture + food production 
Housing 
Social and community networks
Individual lifestyle factors 
Age, sex and constitutional factors

Question 9

Top 3 social determinants of health

Answer 9

Educational attainment
Employment
Living standards/income

Question 10

How does educational attainment impact health?

Answer 10

Low attainment may impact on many outcomes in later life including, quality of work, future earnings, involvement in crime, morbidity, and death

Question 11

How does employment impact health?

Answer 11

Effect of unemployment does not just affect individuals

Children growing up in workless households are almost twice as likely to fail at all stages of education compared with children growing up in working families

Question 12

How do living standards/income impact health?

Answer 12

Many health outcomes improve incrementally as income rises

A parent’s income may influence a child’s early development and educational opportunities, which in turn can affect a child’s employment opportunities and their income

Question 13

What did the Black Report (1980) do?

Answer 13

Examined the association between social class and health, and indicated the death rate of disease incidence (morbidity) and the rate of incidence of death were not randomly distributed throughout the population

Argued that it was primary material circumstances that were the primary cause of social inequalities in health (rather than lifestyle choices)

Question 14

Outline the main differences in health outcomes that currently exist between social classes in the UK

Answer 14

Life expectancy is increasing for every social class, however, it is increasing faster in higher social groups

􏰀Mortality and morbidity has decreased for every social class. However, mortality rates are much higher in lower classes than higher e.g. rates are 4x higher in lower 10% compared to upper 10%

􏰀The social class gradient of mortality and morbidity in Britain holds for most disease classifications

􏰀The gap in inequality has been reduced in terms of the absolute number of deaths involved.
􏰀
The gap in health equality has become larger. In 2001, a worker in a routine or manual occupation was twice as likely to die before the age of 65 than his manager,
but in 2008 that ratio had risen to 2.3 times

Question 15

How does income inequality affect social/health outcomes?

Answer 15

Social and material conditions pertaining within a particular society at a particular time serves to structure health outcomes

Question 16

How do health risks change over time?

Answer 16

Risks to health are associated with social disadvantage, which cluster together and accumulate over time/longitudinally

Inequalities in health should therefore be seen as manifested across a social gradient, rather than being an outcome of poverty alone

Question 17

What does ‘stress theory’ argue?

What does this mean in terms of inequality?

Answer 17

Social anxiety about status produces biological stress mediated by a range of psychological factors

If so, inequality is harmful because it places people in a hierarchy which increases competition for status, causing stress and leading to poor health and other negative outcomes

Question 18

What has happened to the social class gap in health inequality in recent years?

Answer 18

Has become larger in relative terms

i.e. number may have decreased, but ratio gap between groups has increased

Question 19

What did the Black Report find?

Answer 19

Health standards directly linked to social class

Ill health is increased down the social scale

Problems were linked with social + economic factors such as: income, unemployment, poor housing + education

Question 20

List the Acheson Report (1998) actions to reduce inequalities in health

Answer 20

Reducing income inequality
Reducing unemployment + improve employment opportunities
Reducing risk of poverty 
Improving housing conditions
Improving schooling 
Improving living environment 
Crime reduction

Question 21

Outline the two concepts of social inequality

Answer 21

Social inequalities do not reflect biological differences and therefore are not inevitable or unavoidable

Social inequalities stem from structured social divisions that exist within societies across history and cultures→ e.g. social classes

Social scientist use socio-economic class to see how it affects: Education, work and health outcomes

Question 22

How was the Registrar-General’s Occupational Classification (RGOC) used to measure social class until 2000?

Answer 22

Looked at the relative status of a person’s occupation on a scale of 1-6 with 1 being higher status/skill

1- Professional (doctors, lawyers, higher managers)

2 - Intermediate non-manual (nurses, middle managers)

3- Junior non-manual (secretary, technician)

4- Skilled manual (carpenters, electricians)

5- Semi-skilled manual (postman, farm worker)

6- Unskilled manual (hospital porter, cleaner, labourer)

Question 23

What did the Black Report (1980) find in terms of health outcomes in relation to socio-economic class?

Answer 23

Artefact/Error→ results are due to individual health behaviour and human error

Cultural factors→ Different health behaviours and beliefs in different classes e.g. lower class more likely to smoke, drink and have poor nutrition

Health selection→ Those with poor health are downwardly mobile

Material circumstances→ social difference in income, diet, housing and working environment

The report found that it was mainly material circumstances that caused the unequal distribution

Question 24

Describe the differences in health outcomes that currently exist between social classes in the U.K

Answer 24

Increased life expectancy in all classes

Decreased morbidity and mortality in all social glasses

Increased gap in health inequality