The black report on Inequalities in health care was introduced by the Department of health in the UK by Health Minister, David Ennals in 1977. It wanted to point out why the NHS had failed to reduce social inequalities in health and to investigate the problems. He would do this by analysing people's lifestyles and their health records from different social class backgrounds. It found that the overall health of the nation had improved but the improvement was not equal across all the social classes, and the gap in inequalities in health between the lower and higher social classes is widening. It seemed that some of the main causes of this were class and ethnicity.
The black reports main focus was centred on social class. The report stated that both upper and middle class individuals had a better quality and standard of living than lower class people. Below are four types of explanations the black report gave for the differences in illnesses and life expectancy within social classes.
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Artefact explanation studies the relationship between health and social class, age, profession, and views the relationships between social classes.
Natural or social selection: this explanation suggests that physical weakness and poor health conveys little social value as well as low economic.
Cultural explanation suggests lower social classes have less healthy lifestyles due to lack of exercise, eating unhealthy fatty foods and smoking. They have less money to provide themselves with healthier diets.
Material/structural explanation focuses on poverty, poor living conditions and environments. Studies in these areas confirm that social factors are the main causes which contribute towards ill health.
According to the 2001 census 8% of the UK's population is of an ethnic minority, which represented an increase by approximately 50% in the decade 1991-2001. The majority of the ethnic minority was Indians, Pakistanis and mixed ethnic backgrounds.
In many population groups, whether they are grouped by ethnicity or religion have many differences in ways of illness behaviour and seeking help with beliefs and health queries about an illness.
In some ethic groups, some diseases are more common than others, e.g. men from Indian backgrounds are more susceptible to cardiovascular illnesses. As a result of these statistics it has prompted further investigations into the detection of cardiovascular disease and the risk factors within ethic groups.
The two social groups that are being compared are social class and ethnicity. These two groups affect health related issues and explain sociological perspectives, patterns and trends.
Social class and patterns of health and illness
Social class is an intricate issue that comprises of status, wealth, culture, background and employment. The association between class and ill health is far from being straight-forward, there are many influences on health and one of them is social class. This is demonstrated by multilevel analysis (a method of assessing health inequalities using several different factors) which shows health inequalities even between households living in the same street.
Poverty and inequality in the social order have consequences on the social, physical and mental well-being of an individual. The following two factors are closely connected.
The infant mortality rate (IMR) children born to underprivileged parents are at more risk than that of a child born to more privileged parents. People from a higher social class are much less likely to die of illnesses such as cancer, heart diseases and strokes and would be likely to live longer compared to others.
The Black Report - which was introduced in 1980 - studied the health differences of people by dividing the population into five social classes and offers information on how social and environmental issues of health and illness and life expectancy are related to one another.
"There is overwhelming evidence that standards of health, the incidence of ill health or morbidity and life expectancy vary according to social groups in our society especially to social class". (Stretch, B, 2007, Pg361).
One possible explanation is that higher social classes can afford to pay for private healthcare. Their level of income is much higher which then also results in a better lifestyle and accommodation. People who were in less paid jobs meant they had poor housing and a reduced amount of money to provide food and heating.
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According to the above table from the Office of National statistics, life expectancy in the United Kingdom increased by approximately 20 years for both males and females between the periods of 1930-2009. Life expectancy in 1930 for males was age 58 and 63 for females, a 33% increase has occurred since then putting life expectancy up to age 78 for males and now a 30% increase for females to age 82. Life expectancy was at its highest in England between the periods of 2007-2009
The increase in life expectancy was mainly due to the decrease in infant mortality rates (deaths under the age of 1 year old). From the period 1930-2010 there was a 93% fall which was recorded as the lowest.
There is also a difference in health between different ethnic groups. According to the 2001 Census Pakistani and Bangladeshi men and women in England and Wales reported thehttp://www.publications.parliament.uk/pa/cm200809/cmselect/cmhealth/286/28608.gif
Age-standardised limiting long-term illness: by ethnic group and sex, April 2001, England and Wales
highest rates of 'not good' health.
Women were more likely to rate their heath as 'poor' compared to men across all the groups identified in the chart above, apart from white Irish and those from other ethnic groups.
Reporting poor health has been linked with the use of health services and mortality. Pakistani and white Irish females in England had higher doctor contact rates than females in the general population. Males from Bangladesh were three times likelier to visit their doctor than males from the general population after standardising for age.
According to the January 2007 report by the Parliamentary Office of Science and Technology, Black and Minority Ethnic (BME) groups generally have poorer health than the rest of the general population, it was proposed that the poor the position of socio-economic BME groups is the main reason which is motivating ethnic health inequalities. A number of strategies have aimed to challenge health inequalities in recent years, although to date, ethnicity has not been a continuous focus.
Race, culture, religion and nationality can have a major impact on an individual's identity. There are many different levels of identification within ethnic groups; many see themselves as British, Asian, Indian, Punjabi and more.
Health inequalities are differences in health status that are influenced by variations in society. Influential factors on health may include lifestyle, wealth, housing conditions, discrimination and health services. These factors over periods of time could be passed down through generation through maternal influences and could affect infant and child developments.
The Health Survey for England showed that BME groups are more likely to report ill health and that ill health starts at an earlier age than White British individuals.
Patterns of ethnic differences in health are varied, and connected with a lot of factors for example:
Some BME groups experience worse health than others. For example, surveys commonly show that Pakistani, Bangladeshi, and Black-Caribbean people report the poorest health, with Indian, East African Asian and Black African people reporting the same health as White British, and Chinese people reporting better health.
Patterns of ethnic inequalities in health vary from one health condition to the next. For instance, BME groups tend to have higher rates of cardio-vascular disease than White British people do, but lower rates of many cancers.
Ethnic differences in health vary across age groups, so that the greatest variation by ethnicity is seen among the elderly.
Ethnic differences in health vary between men and women, as well as between geographic areas.
Ethnic differences in health may vary between generations. For example, in some BME groups, rates of ill health are worse among those born in the UK than in first generation migrants.
Sociologists try to describe how society ranks itself but there are many different philosophies for this, which often clash with one another. Some of these philosophies include Marxism, Functionalism, and Interactionism. Each sociological perspective has different views.
The Marxists theory is an explanation of how society works, how and why history unfolded and an account of the nature of capitalism. The theory believes that society is in conflict between two classes.
Functionalists argue that society is organised much like the Human Body. Everything must function correctly in order for society to work as a whole, just like every organ in the body must function correctly in order for the body to work as a whole.
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Another classic view is Interactionism. We can liken Interactionism to a play; everyone must play their respective roles in order to create a successful performance - in society everyone must do their jobs in order to create a successful society. This approach is much like the functionalism viewpoint.
The Biomedical Model is mainly used by physicians in diagnosing diseases. This approach concentrates on physical processes such as physiology, biochemistry and pathology of a disease. This model signifies freedom from any disease, infection, pain or defect is considered as being healthy although this model doesn't take into account social factors of an individual, and the diagnosis is a result of the doctor and patient negotiation.
The biomedical model considers the body as a machine and if a particular part of the body isn't functioning, it must be corrected in order for the body to continue to work properly.
The Social Model of health is based on how society and the environment affect everyday health and well-being. Influential factors may include social class, household income, education, occupation, poverty and poor housing could lead to ill health such as respiratory problems. The social model aims to encourage society to provide better housing and to fight poverty to help prevent future ill health in individuals.
The focus of these models is to explain why health inequalities exist and continue to be a problem. The key cultural explanation places emphasis upon extreme consequences of behaviour such as poor nutrition, excessive alcohol consumption, smoking, drugs or lack of exercise. Inequalities in health will be reduced when society make healthier personal and behavioural choices.
Socio- model of health is:
The state of health is socially constructed resulting historical, social and cultural influences that have shaped perceptions of health and ill health.
The root causes for diseases and ill health are to be found in social factors, such as the way society is organised and structured.
Root causes are identified through beliefs and interpretation for example, from a feminist perspective, root causes relate to patriarchy and oppression.
Knowledge is not exclusive but has a historical, social and cultural context as it is shaped by these involved.
The biomedical of health is:
The state of health is a biological fact and the norm.
The body is a machine and ill health results from dysfunction of that machine.
Ill health is a deviation from the norm.
Ill health is caused by biological factors such as viruses, bacteria, genetic characteristics or trauma.
The cause of ill health is identified through the process of diagnosis, considering the signs and symptoms.
Individuals play little or no part in the interventions to restore the body to health.
There is no consideration of the individual's interpretation of health and ill health or social factor that may contribute to ill health. Finding a cure is a greater concern than preventing ill health.
Culture plays an incredibly important role in the cause and reasoning of mental health. Cultural beliefs can shape the way people identify stress and the way in which they seek help. Indeed, in some cultures, people suffering from depression and anxiety disorders can also present with physical/psychosomatic symptoms.
As Britain becomes more culturally-enriched, striving for a melting pot of nations and ethnicities as opposed to a salad bowl of clearly defined ethnic groups, our society is slowly adapting.
There are many cultural factors which can influence mental health, for example, Asians; in particular immigrants, language, age and gender can be a contributing factor.
The knowledge of English is an important factor which influences access to care. Asian languages are not usually spoken outside of the ethnic group. Age is another factor, the younger a person is when they migrate the better chance they have of adapting to living in that particular country. Also gender contributes; men seem to have acculturated quicker than women though this may change as more women enter the working environment.
According to the traditional belief system mental illness is caused by a lack of harmony, emotions and sometimes caused by evil spirits. Social stigma, embarrassment, and 'saving face' often prevent Asians groups from seeking behavioural and professional health care help.
The table below shows the health beliefs and behaviours of Chinese, Korean, Japanese and Vietnamese cultures.
The term 'mental illness' was made more popular at the beginning of the 1900's by physicians, social reformers and former asylum patients. They wanted to reduce the stigma that was linked with the word mental illness; they felt that it caused prejudice against asylum patients because it implied isolation between the mentally sick and well, healthy patients.
The labelling of mental illness is stigmatising too many, it makes people think that mentally ill people are a completely separate group from 'people like us'. Society seems to overlook the fact that they are simply just ordinary people who have severe emotional difficulties which they are failing to cope with.
Misconceptions of this label can be fuelled by things such as the media and describe the mentally ill as being dangerous and violent people. Stereotypes like these seem to be contradicted by people's experiences of mental health, which than can affect not only themselves but their family, friends and even work colleagues.
The use of the word 'mental illness' could be very misleading, it could be seen that the majority of mental health problems are caused by biological or medical factors. Whereas, in fact, mental health problems result from complicated interactions of biological, social and personal factors. For example someone who is vulnerable to depression but has a strong social support could make them less susceptible to becoming severely depressed.
Reducing stigma that is attached to mental health issues has been a main focus for several groups, but in order to change this stigma, attitudes of the general public need to be changed first. The media could help this by reporting more positive aspect of mental illness, for example; peoples recovery and modern treatments which are available.
Delivering better care for patients could be helped by further training for mental health staff; this could lead to less negative attitudes from the public which would help patients to be a part of society giving them a better everyday life.