The Overwhelming Issues Of Health Inequalities Sociology Essay
Health is overwhelmingly unequal in society due to the many social processes which exist within it. In contemporary society health is often understood to be only biological, with people being led to believe that diet and exercise are the sole causes of ill health, and that medicine is how all ill health should be treated. However health may often be out of the control of the individual. Throughout history there have been distinct patterns of inequality which have been present over time. Medical Sociology looks at these patterns and attempts to decode them to try and understand what these inequalities are and why they exist. Within contemporary society there are roles and ideas which exist around social class, ethnicity and gender, all of which are bound up with health inequalities. Within high-income societies health inequalities are more prevalent than ever before, meaning it is more important than ever for Medical Sociology to try and understand these patterns and processes.
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Another approach to health was that of Medieval Islam. They had some of the same ideas as before, however, had advanced towards opening bodies up, discovering that things within the body could cause ill health. This was much more advanced than Northern Europe at this time due to a cultural break as the Catholic Church was opposed to any such experimentation, however much of the information which was gained here was lost over time due to its experimental nature which was branded as demonic at the time.
Medicine as we know it now began with Modernity and the Enlightenment which saw a movement away from understanding health in terms of religion, supernatural and environment and towards a secular understanding of health emphasising rationality (Barry and Yuill 2008). This allowed new explanations of disease and ill-health to be formulated based on science and evidence and is part of what we call the bio-medical model of health. This model has many advantages over the previous models discussed as it is informed by scientific research and evidence, and has a much better understanding of what causes ill-health and how it can be treated. Like all models of health, it also has disadvantages as it has a very constricted perceptive of what health is. It is often criticised for being mechanical, assuming that is something goes wrong in the body that it should be repaired or replaced similarly to a machine which has broken down. This model focuses on one causal factor of ill-health and the treatment of that factor. This model is reductionist as it fails to recognise that there may be more than one reason for ill-health including psychological or social influences. Medical Sociology takes these factors into account, looking at health and illness in relation to the social context in which one lives.
Because the bio-medical model is the one of dominance within contemporary society, almost all avenues of life have been 'medicalized' in some way, with the medical profession taking over everyday life issues and defining them as medical in nature. Conrad (2007) emphasises that there were no such thing as antidepressants, Viagra, elective serotonin reuptake inhibitors (SSRIs) and many other forms of medicine in the past, all of which are now widely used as treatment for certain 'disorders' which themselves were not actually classified as medical conditions until relatively recently. This has led to many areas of life being dominated by medicine. A major example of this is that of pregnancy and child-birth. According to Teijingen, Lowis, McCaffery and Porter (2004) all pregnancies are looked at in terms of being risky until they have been examined and given the green light by medical professionals. This attitude has led to medical professionals being consulted at every stage of pregnancy, birth, and onwards into the beginning of a child's life, to make sure everything is 'normal' and 'healthy.' In the past, and throughout other cultures around the world, pregnancy is looked at as healthy and natural and medical professionals would only be consulted if a problem is suspected.
This is a good example of the way the medical profession has taken over many areas of everyday life. Due to the nature of the bio-medical model and the way it seeks to heal ill-health it does not take into consideration why people with ill-health tend to have common characteristics like being in an ethnic minority, or being from a working class area. The bio-medical model does not attempt to explain health inequalities; it only looks at causes and cures for ill-health. Medical Sociology, on the other hand, looks at patterns of inequality and tries to understand why they exist. We will now go on to look at health inequalities in relation to social class and ethnicity, examining relevant attempts at explaining those inequalities.
Empirical evidence from the Office of National Statistics (ONS 2005) shows that within social class, there are disparities within life expectancy. People of lower social class backgrounds have a lower life expectancy than their higher class counterparts, with those from working class backgrounds having much lower survival rates after being diagnosed with cancer than people from a middle-class background. Nevertheless, this does not explain why these differences exist. In relation to social class, there are two opposing perspectives on health inequalities, the psycho-social approach and the neo-material approach, both of which will be looked at here.
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The psycho-social approach was first developed by Richard Wilkinson, a social epidemiologist who spent his life focussing on the study of health inequalities. This theory identifies that society being wealthy overall does not mean that people are healthier, as it is more to do with where one perceives themselves within society. For example, America, a very individualistic country, is the wealthiest country in the world. The wealth that America enjoys is however distributed very unequally within society, which mirrors health inequalities which also exist. In more economically equal countries, with closer knit communities, such as Japan, Sweden and Korea, health is more equal (Wilkinson and Pickett 2009.) This could also be seen in relation to the increase in income inequalities since the 1960's. America, for example had become very individualistic, and at this time, rates of employment were higher than ever and they had gone through their longest ever period of uninterrupted economic growth. However, many people were in very low paid jobs, and the growth in the economy benefitted those who were already economically well off. As a result, there was more inequality between social classes than there had been previously. There were also more inequalities in health amongst the classes.
This has been explained by some theorists such as Richard Wilkinson as being partly due to a biological function in the body, the fight or flight mechanism. This mechanism once was very useful to the human race as it allowed them to escape dangers in the past. These dangers are not present in contemporary society, but the mechanism still exists within us. This causes a problem within health as contemporary society has become faster paced and stressful in recent years. People from lower class backgrounds tend to face more social problems than in the past, status disparities are much more apparent on an everyday basis due to a move towards consumerism within society, making people more aware of their social status, and feel inferior as a result, in Wilkinson's (2009) words, 'Consumerism reflects social neuroses and insecurities fanned by inequality and increased competition for status.' Anyone who cannot compete and achieve higher status will feel inferior, creating a reason for them to become stressed. It has been suggested that the more in control you feel over your life then the better your health will be. This is because those who perceive themselves to have little control are more likely to be stressed and therefore be affected by the negative impacts of biological processes such as the fight or flight mechanism as such biological processes shut down the nervous system and other important processes, leaving the body more vulnerable to infection, which begins to explain why those from lower social class backgrounds have more health problems. As well as affecting processes inside the body, they also affect how an individual acts in society. Humans are social beings who are at their happiest and most content when they have strong bonds with others. People with strong social networks around them tend to be happier and healthier as they have people around them who care for them and can help them when they need it. If someone feels that they lack this type of support they may feel inferior according to Wilkinson and Pickett (2009). This is much more likely to happen within contemporary high-income societies as they have become individualised, meaning that there tends to be much less social cohesion within societies than in the past. Feelings of inferiority, according to Lynch, Smith, Kaplan and House (2002), can cause a person to participate in anti-social behaviour and also lack social cohesion through reduced participation within society. Feelings of inferiority can also cause a person to be more likely to smoke, drink, take drugs or eat unhealthily.
Elstad (1998) also points towards this idea that health-related behaviour such as smoking, drinking, exercise and diet are not always completely the choice of the individual, yet are often blamed for bad health. So even if this direction of thinking is taken, class inequalities still have an impact on this. As Elstad (1998) puts it, 'health damaging behaviour . . . is usually overrepresented among lower social strata.' This demonstrates further this particular reason for health inequalities between different social classes.
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The Neo-Material explanation criticises the above approach, stating that health inequalities are due to access to resources and also exposure to external stimuli. Put simply, this approach focuses on the contribution of access to education, health care, transport, food, accommodation and the type of environment the person occupies in relation to health inequalities. There is a close relationship between income inequality and access to resources (Lynch, Smith, Kaplan, House, 2000) which can then negatively affect health. The argument here is that the cause of inequalities in health between social class groups cannot be reduced to psychological reactions in the body, suggesting that the psycho-social approach underestimates the role of material resources in creating health inequality (Lynch, Smith, Kaplan, House, 2000). However, supporters of Wilkinson's thesis would argue, according to Elstad (1998), that if a lack of material resources was the main cause of inequalities, that those inequalities would have improved significantly during the post-war period when standards of living increased. However, this was not the case as health inequalities have actually increased between social classes indicating that the neo-material perspective is incorrect in its assumption in this case. It is important to also note in relation to Wilkinson's thesis, that although people generally benefit from living in cohesive societies, this rarely happens within contemporary society. Today's society has become very competitive, reality shows such as the 'X-Factor', 'Strictly Come Dancing', 'Big Brother', 'Britain's Next Top Model,' and 'The Apprentice' all advocate individualism, meaning social cohesion is very rare. This has also been affected by globalisation as villages have become towns, and towns have become cities, with more and more people populating each area. This makes social cohesion harder to achieve as people do not know one another anymore, whereas in the past you would know everyone around you in your day to day life. This indicates that Wilkinson's theory could be shallow in some ways as due to our political system, social cohesive societies are few and far between.
What is important in relation to social class and health inequalities is trying to identify the fundamental causes of such inequalities. Marxists would argue that capitalism inherently breeds inequalities as a small number of people control everything. This means that the foundations of our society are built around inequality, meaning that it goes much deeper than either Wilkinson's psycho-social ideas or the ideas of the neo-materialists, and that much more work needs to be done on both perspectives in order to ascertain the true reasons for patterns of health inequality in relation to social class.
Health inequalities not only exist between social class groups, they also exist between ethnic groups. Over the years the ethnic composition of Britain has changed enormously, and is more multicultural today than it has ever been in the past. Britain was always multicultural to some extent as the first black football player, Andrew Watson played during the late 1800's, and half-a-million non-British soldiers died fighting in the wars. Despite this, Britain was not thought of as multicultural until the 1950's.
People from ethnic minorities living in high-income societies such as Britain and the USA often have worse health that average. There is a link between this and social class as people from ethnic minorities are more likely to be in a lower class position. This means that they are affected by the points discussed previously in relation to health inequalities and social class. However, as well as these issues, people from ethnic minorities tend to have even worse health than their white counterparts in the same class position as them. Nazroo (1997) found that people from ethnic minority groups did experience poorer health, stating that they reported higher incidences of heart disease, hypertension and diabetes.
Traditionally, illness amongst ethnic minority groups was said to be biological, with people believing that genetic differences were the reason that ethnic minorities were more susceptible to some diseases and illnesses than their white counterparts. This could be said to imply white peoples genes were in some way superior, feeding into the racist ideas which have been around within society since the 1600's. However, this is not a supported argument as people from different ethnic backgrounds do not differ genetically, and therefore biology cannot be the cause of health inequalities amongst ethnic groups. This again points towards white supremacy ideas which have emerged from social ideas within society throughout history. Racism such as this has always been around, and in fact happens all the time.
According to Modood (1997), in England and Wales, one in eight people from ethnic minority backgrounds report experiencing racial harassment every year, with this often being something they experience repeatedly. Conversely, Karlsen and Nazroo (2002) suggest that the actual number may be much higher, as in some cases people may not want to discuss the racism they have experiences. They also suggest that the person may not perceive their treatment to be discriminatory when it in fact is (Karlsen, Nazroo 2002). Modood (1997) also found that many white people would openly admit to discriminating against people who were from a different ethnicity to themselves. Chahal and Julienne (1999) state that people from ethnic minority backgrounds face abuse and violence on a daily basis, emphasising that racism has major consequences on the health of the people affected, as well as 'reducing their quality of life' (Becares, Nazroo, Stafford 2008), with one quarter of people from ethnic minority groups surveyed admitting to being afraid of being racially harassed (Modood 1997).
As well as the direct effect of interpersonal racism on the health of those from ethnic minority backgrounds, racism also has an indirect effect (Becares, Nazroo, Stafford 2008). Because people hold prejudices towards people from ethnic minority backgrounds, sometimes without realising, it means that those people will have less positive experiences within the health care service, the law enforcement service and so on. Institutional racism is a major problem with institutions such as the police, the army, the NHS and also many educational establishments being racist in certain cases, often unintentionally, which means that people from ethnic minority backgrounds may not get the quality of care they are entitled to within the NHS, they may be discriminated within law enforcement and so on. This again is detrimental to the health of people from ethnic minority backgrounds.
Within the area of ethnicity and health inequalities the debate boils down to biology versus racism, and from a sociological perspective it is clear that the biology debate does not hold up due to scientific evidence supporting the fact that there are not biological differences between people of different ethnicities, therefore the inequalities which are apparent between ethnic minorities are mostly down to the racism which still exists within contemporary society, but also effected by structural issues in terms of ethnic minority people tending to occupy the lowest paid occupations. However, again, it is not yet possible to give definitive reasons for these inequalities as much more research would need to be done within the area.
Throughout this essay we have seen how health inequalities emerge from social processes such as social class and ethnicity, and that health is more complex than the things which we ourselves control such as exercise and diet. Patterns of inequality have emerged throughout history in relation to health with people from lower social classes and ethnic minority groups often having poorer health within high-income contemporary society.
Although the bio-medical model of health is predominant in contemporary society due to the history of health and healing, Medical Sociology looks deeper at those inequalities within health and the reasons for them in order to get a more comprehensive idea of what is happening and also of how to successfully bridge the gap by understanding the underlying causes for those inequalities.
Within the area of social class, two approaches were looked at in order to gain an understanding of health inequalities which exist: Wilkinson's psycho-social approach and the neo-material explanation. The psycho-social approach concentrates on the stresses of everyday life and the lack of social cohesion within lower socio-economic groups, and attributes this to poorer health, whereas the neo-material explanation contests this idea, and instead emphasises the relationship between income inequality and access to resources necessary to stay healthy. Both of these approaches have received criticisms. The psycho-social approach is accused by supporters of the neo-material explanation of underestimating the role of material resources in relation to health (Lynch, Smith, Kaplan, House, 2000). However, Elstad (1998) argues that if this were the case then during the post-war period the gap between the health of social classes would have become far less due to the significant improvements in living conditions during this time. This is the main criticism of the neo-material approach. From looking at both perspectives it is clear that neither completely explain what causes such profoundly unequal health between social classes. Perhaps if more research was done and if both of these ideas were combined in some way we would then have a more comprehensive view of the causes of such health inequalities.
In terms of ethnicity, both the biological debate and the racism debate were looked at, however, due to scientific evidence in the area of genetics the biological debate is no longer relevant as it has been proven that there is no genetic difference between people of different ethnicities. This turns attention to the racism debate which has much more support in this area by researchers such as James Nazroo and Saffron Karlsen as well as many others.
As mentioned previously, racism has always existed, and although it is less predominant in society today, it does still exist. People from ethnic minority backgrounds within high-income societies such as Britain and America tend to have worse health than their white counterparts, which has been related to racism, either direct or indirect, by many researchers such as Nazroo (1997), Modood (1997), and Chahal and Julienne (1999). Also, with many white people admitting to discriminating against people on the grounds of their ethnicity (Modood 1997) then it has been suggested that this could contribute to the reasons why ethnic minority groups tend to occupy the lowest paid jobs. This, in turn, relates to the social class debate which we looked at previously, with people from ethnic minority groups tending to occupy the lower end of the spectrum in relation to their social class group.
Although it is not possible to give definitive answers as to why patterns of health inequality exist between social class groups or ethnic groups, it is clear that looking at the patterns through the eyes of Medical Sociology gives us much more answers than if we look at the bio-medical model. Through these perspectives which we have looked at we gain a more complete idea of what health inequalities exist within high-income societies and the patterns which have emerged throughout history and created them, and in turn this will hopefully allow us to bridge these gaps more successfully in future.
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