Causes of Inequalities in Health: Socio-economic Status

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Causes ofInequalities in HealthSocio-economic
Status
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Inequalities in Health

• A number of studies have been carried out by
• various groups over the years.
• Their reports revealed
• the nature of health inequalities
• the scale of the health inequalities
• the causes of these inequalities in the UK.

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The following studies into health inequalities
have found a causal link between social class and
the incidence of ill health.
The Acheson Report (1998)
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Social Class
To understand the link between social class and
ill health, we need to be clear what is meant by
social class. A persons social class is based on
a mixture of factors
Occupation
Income level
Housing
Education
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Registrar Generals Classificationof Social Class
Categories
Class
Higher managerial, administrative,
professional. Accountant, bank manager, dentist,
doctor, solicitor.
I
Lower managerial, administrative,
professional. Farmer, librarian, sales manager,
teacher.
II
Non-manual Clerical and minor supervisory. Clerk,
police officer, shop assistant
IIIa
Skilled manual Clerical and minor
supervisory. Electrician, mechanic, plumber.
IIIb
Semi-skilled manual. Assembly line worker,
builder, lorry driver.
IV
Unskilled. Cleaner, labourer.
V
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The Black Report (1980)Remit

• To investigate the problem of inequalities in
  health in the UK.
• To analyse the lifestyles and health records of
  people from all social classes (based on the
  Registrar Generals categories).

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The Black Report (1980)

• Findings
• The health of the nation had improved generally
  but the improvement had not been equal across all
  the social classes.
• Gap in inequalities of health between lower and
  higher social classes was widening.

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The Black Report (1980)

• Findings
• Health standards were directly linked to social
  class.
• Ill health increased down the social scale.
• The problem had little to do with the NHS.
• Problems were linked with social and economic
  factors such as
• income
• unemployment
• poor environment
• poor housing
• education

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The Black Report (1980)Findings
Key causes of inequalities in health were
Low income
Sub standard housing
Unemployment
Poor education
Poor environment
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The Black Report (1980)Recommendations

• Report contained 37 recommendations which focused
  on two main areas

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The Black Report (1980)Reaction by Government

• When the Report was published there was a change
  of government. Conservatives were now in
  government and they criticised the Report.

Report did not explain inequalities in health.
Contrary to what the Report said, poor people did
use health services.
Spending more on health services would make no
difference to health standards.

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The Black Report (1980)
Problem was
They wanted to reduce public expenditure
Regarded the Report as old-fashioned,
socialist explanations of ill-health
Took the individualist approach people should
eat, drink and smoke less
Government disagreed
Argued that individual behaviour within
social classes shaped health
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The Health Divide (1987)Remit

• This Report, also called the Whitehead Report,
  concentrated on social class as one of the main
  causes of inequalities in health.
• The Report was commissioned by the Health
  Education Council (HEC) in 1987 and headed by
  Margaret Whitehead.
• Her remit was to update the evidence on
  inequalities in health and to assess the progress
  made since the Black Report six years earlier.

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The Health Divide (1987)

• The HEC was a quango a body set up by the
  government but able to work independently, in
  theory.
• Findings
• Revealed that the gap between health standards
  and social class had widened since the
  publication of the Black Report.
• Restated the direct link between health and
  social class.

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The Health Divide (1987)

• Government reaction
• Just when the Report was being commissioned, the
  government announced that the HEC was to be
  scrapped.
• HEC was campaigning on alcohol, tobacco and diet
  issues which upset some of the governments
  financial supporters tobacco manufacturers gave
  a lot to party funds.
• One week before findings were due to be made
  public, a press conference was cancelled with no
  explanation. Clearly pressure had been put on the
  Chairman of the HEC to cancel because of the
  controversial nature of the reports findings.

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Working Togetherfor aHealthier Scotland
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The Acheson Report (1998)

• This was an independent study into health
  inequality.
• It was commissioned by the new Labour government
  in 1997, under the chairmanship of a former Chief
  Medical Officer for England and Wales, Sir Donald
  Acheson.
• Remit to investigate health inequalities in the
  UK.

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The Acheson Report (1998)

• It was a very comprehensive survey of those in
  society described as disadvantaged.
• Its findings mirrored those of the Black Report.
• The root cause of inequalities in health was
  poverty.
• It concluded that in order improve the health of
  millions, the gap between the richest and poorest
  in UK society had to be reduced.

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The Acheson Report (1998)Findings

• Children from poor families weighed on average
  1.30gms less than those from wealthy families
• Infant mortality rates
• 7/1000 lower social classes
• 5/1000 upper social classes
• Long term illness
• 17 of profession men aged 45-64
• 48 of lower class men aged 45-64
• Income levels
• 2.2 million children live on income levels 50
  below the national average
• Health campaigns
• Higher uptake of screening amongst upper social
  classes widened health gap

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The Acheson Report (1998)Findings

• Poor men are 68 more likely to die in middle age
  than richer men.
• Poor women are 55 more likely to die young.
• Health inequalities start before birth
• A key factor in low weight babies is the mothers
  birth weight and her pre-pregnant weight.

Social class I
Risk increases
Coronary heart disease
Strokes
Lung cancer
Accidents suicides
Respiratory diseases
Social class V
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Scotland Health Survey 2003