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According to a recent report written by the BBC Health Inequality Gap ‘Widening' gap (2005) it is apparent that there is a continual problem with inequalities of health. As illustrated by the report the government advisory group revealed latest figures demonstrate that the gap between the poorest and the population as a whole has increased. The Group chairman Professor Sir Michael Marmot revealed that he would still like the health standard to be as good in the worst off groups as it is in the best, adding that the health standard has improved more rapidly in the best off group than it has in the worst off. The aim of this paper is to explore this in more detail with regards to how inequalities of health are related to social class, gender and ethnicity. To represent the reality of inequality of health studies and statistics will be addressed.
An individual's social class status tends to be classified within the material, cultural and social capital of the individual. There has always been a relationship between social class and health. Despite the intervention of the NHS there are still disturbing figures based on the irregularity of health between social classes. For example infant mortality rate was nineteen percent higher in 2001-3 between the general population, compared to 13% higher in 1997-9. BBC (2005) although, one uses this statistic it is worth mentioning that the population increase could be a contributory factor. However it remains an alarming statistic.
It is submitted that as a result of the lack of material gain of those of low social class status there is the likelihood of poverty, low educational attainment lack of resources in health and poor living conditions which relate to the inequality of health. Despite this as suggested by ‘Patient UK' in the article Health and Social Class(2008) ‘the difference in health between social classes is not simply a matter of disposable income'. However it is the general assumption that those who experience poverty in society are likely to be those from a low social class status. The Black Report (1980) and the Acheson Report (1998) titled Independent Inquiry into Inequalities in Health Report suggested that a reduction of the inequalities of income in societies may help eliminate some of the inequalities of health. Poverty remains a problem as it may result in the abuse of drugs alcohol which may contribute to social exclusion and mental health.
Another argument of the link between inequality and social class comes from the distinction on cultural views. It is argued that lower social classes practice a less healthy lifestyle, do less exercise in contrast to their middle class counter parts.(Batty GD 2006)
Moreover they are likely to drink and smoke more. This was evidenced by the Royal College of Physicians report onSmoking and Health(2008)where it revealed a huge distinction of those in lower social classes being more prone to smoking and drinking.
Earlier on reference was made between the link of inequality and social capital. This relates to the level of connection people have within their community through social organisations, clubs, family and work. It has been revealed that the social capital can have an impact on health an example of this is illustrated by self report studies which show those isolated in communities acquired poorer health than those employed.
Julian Tudor Hart(1971) made an interesting analysis on the failure of the NHS to provide a uniform standard of care. What she referred to as ‘The Inverse Care Law'. She emphasised that the “availability of good medical care tends to vary inversely with the need of the population served" She elaborated her point revealing that hospitals in poorer areas tend to have more ‘obsolete buildings and suffer recurrent crises in the availability of beds and replacement staff.'
There are apparent differences in the inequality of health and gender. Variations include the life expectancy and mortality, morbidity, health related behaviour and the socio-economic status. Independent Inquiry into Inequalities in Health Report (1998). One of the arguments raised as to the inequality of gender in health concerns the mortality and life expectancy. There is strong evidence which suggests that mortality rates are higher for men than women for all the major causes of death including cancer. Independent Inquiry into Inequalities in Health Report (1998) highlighted the variation of cancer for women and men. Whereas breast cancer was the main cause of death and lung cancer was second common, men mean lung cancer was the most common and prostrate cancer second common. The inquiry also revealed that life expectancy is five years longer in women than men.
With regards to morbidity osteoporosis is more prevalent in women. For example the life time risk of fracture of the hip in women is 14% more compared to 3% for men. (Acheson 1998)
There are also variations in health related behaviour which undoubtedly contribute to the inequality of health in gender. As illustrated by the Acheson Report (1998)almost 7% of men drink alcohol heavily - 50 units per week in contrast to 2% of women who drink 35 units per week. Women are more likely to eat consume healthier food than men.( Acheson 1998). However men's physical activity is greater to that women's which is due to men's higher levels of occupational activity.
The variation in women socioeconomic status also relate to the inequality of health in gender. Although women have increased in participation of paid employment they are more vulnerable to poverty as a result of their different occupational and domestic positions. It has been estimated that almost 66% of adults in the poorest households are women and 60% are dependant on income support. Moreover social isolation is more likely in women than in men most evident in the fact that older women are more likely to be widowed.
In addition to arguments that illustrate how gender inequalities link to health it is also worth demonstrating how cultural expectations of men and women impact on health. It has been submitted that ‘frustration hopelessness and low self -esteem' associated with unemployment are likely to be felt amongst men and if their female partner may also be out of work. This is relevant to the health as it may have a negative impact on health.
The Fourth National Survey of Ethnic Minorities (1993-94)(FNSEH) gave an insight into the relationship between ethnicity and health. In reaching their findings the socioeconomic status was taken into account. This was measured by material deprivation in relation to housing problems, and ownership of cars as well as consumer durables was considered. It demonstrated that socioeconomic inequalities contribute to the inequalities in health within ethnic groups, and may also contribute to the inequalities in health between ethnic groups.
Although the FNSEH (1993-94) measured socioeconomic factors to reach its findings it could also have considered other factors such as cultural issues and educational attainment in order to get a wholesome insight into the link between ethnicity and health. Furthermore the findings of the FNSEH (1993-94) was established a while ago indeed circumstances may have changed on the impact of health and ethnicity. The impact of the recession may be looked into as it is possible that the ethnic minorities may suffer the consequences of the economic downturn more. Ethnic migrants have increased due to expanding membership of the EU so it would be interesting include their relationships and links with health.
It has been suggested by the Acheson Report (1998) that the diversity of experience of health between different ethnic groups may reflect in the different causes of poor health. This includes differences between ethnic groups on the susceptibility of getting poor health and differential access to factors which ameliorate cause or susceptibility, such as, preventive health care services.
Poverty seems to be a contributory factor in the relation between ethnicity and health. It has been suggested that those from minority ethnic groups have higher than average rates of unemployment. (Maguire 1980). Furthermore there is a clear association between material disadvantage and poor health. This is most evident in the fact that according to studies of (Acheson D 1998) very high proportions of people from some minority ethnic groups are living on low levels of income, and are dependent on state benefits.
The impact of housing safety and surrounding environment are factors which contribute to the relationship of ethnicity and health. Although owner occupation is quite high in some minority ethnic groups, housing quality is often poor. (Acheson D 1998) Overcrowding has been found to be more common in some minority ethnic groups. With regards to safety the FNSEH (1993-94) found that more than one in eight people from minority ethnic groups had experienced some form of racial harassment in the past year with 25% of all respondents fearful of racial harassment. The British Crime Surveys have shown that South Asians and African Caribbean's are at greater risk of being victims of crime than whites. Such issues encountered by ethnic groups is likely to contribute to health negatively in particularly mental health. The impact of socioeconomic inequalities can be reduced however in saying this it may possibly marginalise ethnic groups implying that their problems are different to those of the majority. Despite this there is the risk of further inequality.
It is important to assess the evidence one has raised on this paper. With regards to the reports cited (The Black Report, The Acheson Report) it may be argued that the research sample used are not enough and so the findings may not be representative of the time. In addition to this the reports were conducted some over10 years ago and others 20 years ago and so inevitably circumstances may have changed. Therefore the findings may not be as applicable now. Despite this the main trends still exist.
Health inequalities are not reducing in the UK and the most socially and economically deprived areas continue to have those who suffer the worst health. There has always between a relationship between health and social class despite the intervention of the welfare state and the NHS. It appears that the economic, environment and cultural issues impact negatively on those with lower social class status in contrast to those in higher social class status. One is also sympathetic to the arguments laid out by Julian Hart on the ‘inverse care law' which highlight the failure of the NHS to offer uniform care. This undoubtedly may also impact on the link between health and social class. Arguments also suggest a link between gender and health. Research conducted by the DoH found that with regards to morbidity osteoporosis is more prevalent in women. In addition to this the variations in health related behaviour, which undoubtedly contribute to the inequality of health in gender Disturbing illustrations of this include higher mortality rates this should not be allowed to persist. As well as this the fact that women tend to be socioeconomically worse off is a negative factor. However cultural expectations of men and health related behaviour also lend a hand in finding the link of gender and health. As research and various statistics will highlight , there are indeed links to ethnicity and health. Most prevalent is the economic and environmental factors which highlight differences in health between the ethnic groups and the majority groups.