Social inequality and mechanisms of health inequality

Question 1

Define sex

Answer 1

Refers to physical differences between male, female or intersex.

-A person typically has their sex assigned at birth based on physiological characteristics, including genitalia & chromosome composition.
-This assigned sex is called natal sex.

Some people are assigned intersex- differences in sex development or variations in sex characteristics- 2%

Question 2

Define gender

Answer 2

How a person identifies themselves
- Cisgender, transgender, non-binary, genderfluid.
- Not made up of binary forms- broad spectrum.
- Person may identify at any point w/in this spectrum or outside it entirely.

Question 3

Define non-binary

Answer 3

-Not feeling that your gender identity fits naturally into the generic categories of male & female.

Question 4

Define transgender

Answer 4

People whose current gender identity or way of expressing their gender differs from the sex they were registered w/ at birth.

Some, but not all, transition socially or medically or both.

Question 5

Define sex assigned at birth?

Answer 5

Used when referring to trans health & gender dysphoria

Question 6

Define sexuality

Answer 6

Refers to individual experience of attraction (or lack thereof) that defines sexual identity

e.g. Lesbian, gay, bisexual, asexual & MSM

Helpful when obtaining health info & giving access to treatments they need e.g. sexual health services.

Question 7

Define ethnicity

Answer 7

An identification of genetic & cultural traditions that provide fluid boundaries between groups.

Genetic & cultural features of population that are considered stable & marks them out as different.

Fluid- not very precise

Contextual

Question 8

Define class

Answer 8

A system of ordering society based on perceived social or economic status

Question 9

What is the Equality Act 2010?

Answer 9

Identifies protective characteristic: sexual orientation, sex, disability, religion/ belief, race, pregnancy & maternity, marriage or civil partnership & gender re-assignment.

It becomes illegal to discriminate against anyone on these basis

Question 10

What social factors affect people’s health?

Answer 10

Access to free healthcare
Remoteness/ availability of transport.
Language barrier
Gender
Race
Education level
Access to healthy food
Immigration status
Financial stability
Mental Health
Employment status

Question 11

Social inequalities: How does gender affect health? Barriers?

Answer 11

Both biological & social gender important

HIV infection
-biological body puts women at higher risk for seroconversion during unprotected sex w/ male partner.
-Social relation of gender- women’s lack of control over sexual activity- puts women at risk of exposure to virus in first place.

14% of trans people refused GP care on account of being trans on at least 1 occasion
- 98% believed transition-related healthcare available on NHS is not completely adequate.
- Trans men not feeling welcome to get breast screening or cervical screening.
- Men who have sex w/ men have faced discrimination when donating blood in NHS- although guidance changed last year

Higher suicide rates in young men & LGBTQ+ people

Higher risk of substance misuse

Higher risk of mental illness

Barriers to effective healthcare:
1. Experiences or expectation homo-bi-transphobia from healthcare professionals.
2. Assumptions of heterosexicity
3. Concern’s about disclosing sexual identity - may stop honest convesations about sexual health.
4. Lack of knowledge or embarrassment of health professionals.

Question 12

Social inequalities: How does ethnicity affect health? What are the outcomes due to inequality?

Answer 12

Racial discrimination w/in society & healthcare settings.
- Language barriers, stigma & stereotypes, not having responses taken seriously

Poor job security

Stressful working conditions

Anti-social hours

^All affect outcomes of health

Black women 5 x more likely to die during childbirth than other women.

Patients who can’t speak English can struggle to access leaflets & GP care.

Lack of awareness about how different conditions e.g. rashes can present on dark skin.

Health outcomes:
- Higher incidence of mental health issues in BAME people
- Less accessible health care due to stigma and stereotypes

Question 13

Social inequalities: how does sex affect health?

Answer 13

Biological men more common research trials because they don’t get pregnant or have periods so fewer drugs are tested on women.

Endometriosis diagnosis takes approximately 7 years.

Lack of awareness about how diseases & illnesses can present differently in women e.g. the heart attack.

Females have better social networks

Females are better able to discuss medical problems w/ health professionals.

Females experience of motherhood & caring roles generates responsibility for their own health

Question 14

Social inequalities: how does class affect health?

Answer 14

Disparity in mortality rates between upper & lower social classes.

Richer people have access to private healthcare = shorter waiting times.

People who are less educated may have less knowledgeabout how to keep themselves safe during sex.

Working class people are disproportionately affected by limiting long term illnesses

Harder to afford good quality food

Can’t afford childcare

Lack of education & understanding about how to keep healthy.

Poorer housing, environment & access to health services

Question 15

What is social stratification?

Answer 15

Society’s categorisation into groups based on socio-economic factors e.g. wealth, income, education & occupation

Human society has always shown evidence of enduring hierarchy.

multi-dimensional.

Question 16

What are the different ways of conceptualising social stratification? I.e. how is social class classified?

Answer 16

• Karl Marx
• Max Weber
• NS-SEC
• A contemporary social pyramid perspective

Question 17

How did Karl Marx conceptualise social hierarchy?

Answer 17

Said two classes exist:
- Bourgeoisie- owners of capital
- Proletariat- wage labourers

Marx theorised that this class antagonism would lead to revolution

Question 18

How did Max Weber conceptualise social hierarchy?

Answer 18

Emphasised the importance of
-class-based life-chances
- Honour
- Party (political organisation for change)

Question 19

What is the NS-SEC?

Answer 19

National Statistics Socioeconomic classification:
- Formulated in 1980s- somewhat outdated
- Measures employment relations
- Used in research domain as a proxy for social class
- Differentiates occupations in terms of reward mechanism, promotion prospects, autonomy & job security

E.g. 1 to 7
1. Higher managerial & professional e.g. doctors, lawyers, architects
2. Lower managerial & professional e.g. nurses, teachers, journalists
7. Routine e.g. labourers, lorry drivers

Question 20

What is the contemporary social pyramid?

Answer 20

Newer model- 2019

At the top of pyramid:
1. The 1 % class- multimillion business owners
2. The salaried elite- having luxuries of salary- pensions, sick-pay
3. The precariat- people who have good level of education- self employed, free-lancers, 0 hour contracts
4. The working poor- people who have salaried employment, but no opportunity to advance

Question 21

What models are used for social health inequality?

Answer 21

Behavioural model

Materialist model

Psychosocial model

life-course model

*the models interact & work together

Question 22

What is the behavioural model?

Answer 22

Individual lifestyle differences e.g. smoking, diet, exercise.

Influenced by personal characteristics & level of education.

Suggests that lack of knowledge & long term goals = less use of health services & lack of preventative health measures.

Amongst manual groups:
- Higher rates of smoking, contributing to ill health.
- fibre w/ higher consumption of saturated fats.
- Less exercise compared w/ non-manual groups.

Question 23

What is the Psycho-social model?

Answer 23

Focuses on the way social inequality makes people feel, & how these feelings may themselves alter body chemistry.

I.e. effects of stress on body

Influenced by home, workplace & community

Risk factors:
1. social support
2. control & autonomy at work
3. balance btw home and work
4. balance btw efforts & rewards

Psycho-social work hazards leading to poor health:
- High workload combined w/ lack of control over work tasks may negatively affect the immune system.
- Poor social support from family may produce high levels of stress → impaired health.
- Stigma - how we percieve barriers to health, determines how we act & if we seek help.

Question 24

What is the materialist model?

Answer 24

Role of economic & socio-structural factors e.g. labour & housing markets.
- Idea that there is permanent social & economic inequality which exposes individuals to different probabilities of illness.
- i.e. hazards that are inherent in the present form of social organisation & which some people have no choice to be exposed to.

Poor-quality & damp housing = higher respiratory disease in children.
Low income =worse diet.
Mortality related to income

i.e. lack of choice e.g. being exposed to chemicals at work.

Question 25

What is the life-course model?

Answer 25

Adult health outcomes are associated w/ earlier life experiences i.e. disadvantage adds up through life.

Health determines one’s social class of destination.
People in better health more likely to ascend in society but people in poor health are more likely to descend in society.
- E.g. low birth weight & health problems in childhood predict low socio-economic status throughout childhood.
- E.g. disadvantaged material circumstances w/in childhood = highest health risks

The highest health risks are found in those that grow up & remain in disadvantaged material circumstances.

E.g.
Those who experienced poor home conditions are more likely to go on & experience occupational disadvantage.
- Lower paid jobs mean that these are likely to be the same people who have worse housing in more polluted and unfriendly areas.

Question 26

How has sociology tried to help reduce health inequalities in the UK?

Answer 26

GOV reviews - e.g. the Marmot Review, favour a mixture of the materialist & behaviouralist approaches.
- Reduce income inequality through social security provisions (universal credit).
- Reduce poverty, especially for families w/ children e.g. free school meals & childcare vouchers.
- Role of doctors - doctors can ensure people are claiming the benefits they are entitled to.
- Health campaigns - there have been efforts by Marcus Rashford to teach people to cook = changing behaviour.

Large scale quantitative resreach- can demonstrate associations btw phenomena.
- e.g. Wilkinson & Pickett (2009) The Spirit Level - demonstrates that more equal societies exhibit better average health outcomes.

Small scale qualitative research- can tell us about the lived experience of health inequality.
-E.g. how stigma affects motivation to visit the GP & how access to services affects lives.

Question 27

What are Macro, Meso & Micro barriers?

Answer 27

Macro = institutional barrier

Meso = regional barrier

Micro = individual barrier

Institutional barriers include legislations e.g those around immigrants accessing healthcare

Regional barriers include economic status

Individual barriers = religious & cultural beliefs

Question 28

Give some reasons why transgender people do not report hate crime.

Answer 28

Mistrust in police

Feeling that nothing can be done

Fear of being outed

Feel that incidence wasnt serious enough