The Impact Of Class On Health Outcome Sociology Essay

The aim of this essay is to provide a better understanding of how socio-economic class affects Health outcomes and how class issues compound the problems of social inequalities in healthcare. It will critically discuss the relationship between two concepts, health and class. After defining social class and health outcomes, it will discuss some social epidemiology from different countries, against the aspects that determines social class.

The World Health Organisation (WHO) defines health as follows: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This view offered by the WHO is contested; the holistic view of health incorporates the physical and mental, emotional and spiritual elements and encompasses the whole person. This holistic view bringing all these aspects together and is a more useful way to think about health (Ewes and Simnett, 2003) although the interaction of the different components is complex. It is important to address the holistic view since social policy needs to include the whole issue to be effective

Social class – An informal ranking of people in a culture based on their income, occupation, education, dwelling, and other factors [ii] – plays an important role in the level and expertise of the treatment that one receives and it influenced every aspect from the circumstances surrounding the health outcomes, to the level of care that is received. Class can also be defined as: “a large-scale grouping of people who share common economic resources, which strongly influence the types of lifestyles they are able to lead” (Giddens, 2006). Having discussed the contested ideas of class this essay will use the definition by Giddens.

Class is a persuasive force in health and longevity. The more education and income people have, the less likely they are to have and die of heart disease, strokes, diabetes and many types of illnesses.

When looking at health outcomes, there is more than just one factor that determines the health of a population. Income, social status, education, social environments, personal health practices, biological factors, genetic endowment, health services, gender, culture and sexual orientation all determine the overall health of a population. These can be subdivided into social determinates and biological determinates. This essay aims only to look at the social determinates, therefore only looking at class and the aspects that affect class. The social determinates of health underline that individuals of different socio-economic status show profoundly different levels of health and incidence of disease (Raphael, D. 2008).

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Job position is a very central characteristic of the discussion. It is directly affected by the level of education and intern; it directly affects the health status of the population. A very good way of understanding the health status of a given population is to study the life expectancy at birth, of the population. The life expectancy at birth tells us the number of years a new-born baby would live if, at each age it passes through, the chances of his/her survival were the same as they were for that age group in the year of his/her birth (WHO, 2011).

Graph : Life Expectancy at birth, by social class and sex, 1997-1999, England & Wales (Source: Statistics UK, 2001)

As we can see Graph One, there is a strong correlation between how long people live and the nature of their jobs. For the period 1997-99, life expectancy at birth in England and Wales for males in the professional group was 7.4 years more than that for those in the unskilled manual groups. The gap between the social classes was smaller for women than for men, at 5.7 years.

“Social class differences in mortality vary by cause of death. Key disease groups showing a difference are ischaemic heart disease, cerebrovascular disease, respiratory diseases and lung cancer. Between 1986 and 1999 partly-skilled and unskilled workers were 5.5 more times more likely than managerial, technical and professional workers to die from respiratory diseases.” (Office for National Statistics, Census 2001)

Thus we can now see the relationship between the social status (in this case, the nature of work) and health (life expectancy). In this first-world country which has a very comprehensive non-profit universal health care system (From movie Sicko, Michael Moore, 2007), the social inequalities are very prevalent in the health status of the population. This also has an effect on the risk factors.

Many risk factors for chronic diseases are now more common among the less educated than the better educated. Smoking has dropped sharply among the better educated, but not among the less educated. Physical inactivity is more than twice as common among high school dropouts as among college/university graduates. (Lewis, 2004)

The Transcript below from New York Times dated May 2005 by Janny Scott, gives a very detail story of three people, all affected by the same illness. All three suffered heart attacks during the same time period, but in the months to follow, their experiences differed drastically.

“Jean G. Miele’s heart attack happened on a sidewalk in Midtown Manhattan last May. He was walking back to work along Third Avenue with two colleagues after a several-hundred-dollar sushi lunch. There was the distant rumble of heartburn, the ominous tingle of perspiration. Then Mr Miele, an architect, collapsed onto a concrete planter in a cold sweat.

Will L. Wilson’s heart attack came four days earlier in the bedroom of his brownstone in Bedford-Stuyvesant in Brooklyn. He had been regaling his fiancée with the details of an all-you-can-eat dinner he was beginning to regret. Mr Wilson, a Consolidated Edison (Electrical Company) office worker, was feeling a little bloated. He flopped onto the bed. Then came a searing sensation, like a hot iron deep inside his chest.

Ewa Rynczak Gora’s first signs of a heart attack came in her rented room in the noisy shadow of the Brooklyn-Queens Expressway. It was the Fourth of July. Ms Gora, a Polish-born housekeeper, was playing bridge. Suddenly she was sweating, stifling an urge to vomit. She told her husband not to call an ambulance; it would cost too much. Instead, she tried a home remedy: salt water, a double dose of hypertension pills and a glass of vodka.”

The article above shows how class affects health. By reading the above transcript, one can clearly see the diverse socio-economic conditions of these three individuals. By closely examining the socio-economic conditions of the patient’s one will see why each one received a different level of treatment.

Jean was an architect (professional, wealth, and upper-class) who lived in Manhattan (upper-class suburb) and had just eaten an expensive (wealth) meal which consisted of sushi (high risk foods). He received the needed emergency care on the scene and was treated at a private hospital.

Wills, an office worker (middle working class), who lived in Brooklyn (working class suburb) had just eaten an “all-you-can-eat” dinner (bad life-style choice) when his heart attack occurred. He was taken to a public hospital immediately.

Ewa, a Polish (immigrant) house keeper (lower class) was in her rented room by the Brooklyn-Queens Expressway (poverty). When she experienced symptoms of a heart attack her first thoughts were about money, the expense of an ambulance. She turned to home remedies coupled with her hypertension pills (illness and stress).

As we can see, the job position, and therefore the wealth status of these individuals guided their decision making process.

Lifestyle has a role to play in the health of a population. The rich will have diseases and illnesses that are associated with a particular lifestyle that their wealth permits and the poor will live exhibit symptoms of illnesses associated with a lack of means, including malnutrition and water-borne diseases. A factor affecting the types of illnesses that are dominant amongst specific groups of people is the diet of particular classes, which affects their state of health (Nobel, 2004). One example is that the rich in many developed countries generally eat more unhealthy, rich and convenience foods which can lead to obesity and related health risks on the one hand and to eating disorders such as anorexia and bulimia on the other. On the reverse side of the coin, poor people who have a monotonous protein-deficient diet may suffer from malnourishment as a result of their daily diet being deficient of the recommended dietary allowance for certain vitamins and other essential nutrients.

Another study from New Zealand “Unacceptable and intolerable inequalities exist between Māori and non-Māori across a range of social, economic and many major health measures”, definitely shows a trend based on the Ethnicity of the population. The inequalities in this case were the central influence to the socio-economic class of the Māori population.

Graph 2: Life expectancy at birth, by ethnic group and sex, 1950-1952 to 2005-2007

Source : Statistics New Zealand

In Graph Two, one can see that there are marked ethnic differences in life expectancy. In 2005-2007, male life expectancy at birth was 79.0 years for non-Māoris and 70.4 years for Maoris, a difference of 8.6 years. Female life expectancy at birth was 83.0 years for non-Māoris and 75.1 years for Māoris, a difference of 7.9 years.

The pace of improvement in life expectancy has varied by ethnic group. For non-Māoris, there was a fairly steady increase in life expectancy at birth over the period from 1985-1987 to 2005-2007, with males gaining 7.6 years and females 5.6 years. For Māoris, there was little change during the 1980s, but a substantial improvement in the 10 years to 2005-2007 (a gain of 3.8 years for both sexes). This exceeded the improvement for non-Māoris over the same period (3.6 years for males and 2.4 years for females). However, the overall gain in Māoris life expectancy from 1985-1987 to 2005-2007 (5.5 years for males, 4.6 years for females) was less than that for non-Māoris.

In this relationship between class and health outcomes, one can see the marked increases that the population experienced. Class and inequality are directly affected by the socio-political situation in a country. Where previously the Māori population experienced discrimination, with the advent of democracy, freedom of movement (access to better health care) improved. This had a direct positive impact on the health statistics and outcomes.

As we can see in the above example, race and culture do play a role in health outcomes. A very good example of this is the discrimination of the native population in South Africa during the apartheid regime. During apartheid, health was used as a tool to lower the status and morale of the native Black population (Max Price, 2006).

Therefore based simply on phenotypic differences, the black population were marginalized in many areas, including health. The World Health Organization (WHO) publication, “Apartheid and Health,” is both the most authoritative and the most damning indictment of the mental and physical aspects of the health and health care of South Africans (Dommisse, 1988). It is a painstakingly documented account that shows apartheid to be the cruellest governmental assault on the health of a people ever known to man. The works of people like Dr Seedat and BM Magubane, both exiles during the apartheid era, show that from a situation in which the African people were a proud, healthy, and energetic people before the Europeans arrived, they were systematically impoverished, and both physically and mentally weakened to the point that most of them lived under some of the most miserable circumstances in the world (Magubane BM, 1979). The words “systematically impoverished” brings one to realise the detracting social conditions that lead to poor or reduced health outcomes based on the race of the population.

The liberal critique of apartheid health, exemplified by Benatar,(chair of the Department of Internal Medicine at the University of Cape Town) said, “Racial discrimination, the creation of economically unviable ‘homelands’ with rapidly increasing populations, the inadequate development of primary health care services and community hospitals, the inadequate allocation of resources to health, the misdistribution of medical personnel, and other political regulations and injustices combine to contribute to the prevailing disparity in health and access to medical care among the people of South Africa.”

The apartheid regime it is a very good basis on which one can develop a true understanding of the link between social class (here determined solely on skin colour, phenotype) and health care. During the apartheid era, social class was determined by race (Dommisse, 1988). In many places around the world, race, religion, and political support still play a significant role in determining the class of the individual. Current examples may be studied in such diverse societies as Palestine, Zimbabwe, Nigeria, India and China.

The new post-apartheid South Africa suffers from a triple burden of ill health – infectious diseases, non-communicable diseases, and injury and violence (Badshaw, 2006). Despite the denialism among some political leaders and lack of political will by socio-political organisations, HIV/AIDS is the main cause of premature death, accounting for 39% of years of life lost. This is causing a direct impact on health outcomes. Other infectious diseases and diseases of poverty, such as tuberculosis, diarrhoea and malnutrition, also impose a major burden. (Bradshaw D, South African National Burden of Disease Study 2000, Medical Research Council of South Aftrica.)

Some two decades since the introduction of HIV/AIDS in the general population, the epidemiological situation is characterized by very large numbers of people living with HIV and a disproportionate effect on particular sectors of society, (young women, the poor, and those living in underdeveloped areas in the country). Gender, poverty and place of residence are all the social determinates of class that are affecting the health outcomes of the population. HIV and AIDS, however, affect the lives of all people who live in South Africa in different ways.

Poverty – caused by discrimination (both past and present) as well as corruption and failure in national policy – is directly associated with ill health and a shorter life expectancy (Benzeval, 1995). We can also determine from statistical data that the poor are the most affected by HIV/AIDS. This does not suggest that only poor people are affected by HIV, but rather that they are the most affected by the epidemic and the diseases that are prevalent amongst its victims. This is due to their vulnerabilities that they are predisposed to due to culture, lifestyle and behaviour. Their situation is further exacerbated by the fact that they have to travel long distances to get the correct care, or they travel to facilities far from home for fear of being ostracised, else they do not receive the correct care. The link between HIV/AIDS and poverty has a myriad interrelations, including unequal income distribution (Gia, 1993), economic inequalities between men and women which promote transactional sex, relatively poor public health education and inadequate public health systems. Poverty related stressors arising from aspects of poverty in townships such as poor and dense housing; inadequate transportation, sanitation and food; unemployment; poor education; violence; and crime; have also been shown to be associated with increased risk of HIV transmission (Mitton, 2000). (HIV & AIDS and STI Strategic Plan for South Africa, 2007-2011)

In 1980, The Black Report was published. Its aim was to examine the differences in health by social class in the United Kingdom. It was found that the difference in health between the wealthiest and the poorest in the population is widening, and people in the UK from ethnic minority groups have poorer health as a whole. Homelessness and social isolation influence health adversely (Benzeval, 1995). This shows that social conditions heavily impact on health status.

Statistics using the Human Development Index (HDI) of a country as well as the life expectancy at birth index, give a good indication of the relationship between class (wealth aspect) and health outcomes (life expectancy) on a more universal level. The Human Development Report introduced a way of measuring development by combining indicators of life expectancy, educational attainment and income into a composite human development index. The aim was to create a single statistic that represented both the social and economic development. The HDI sets a minimum and a maximum for each dimension, called goalposts, and then shows where each country stands in relation to these goalposts, expressed as a value between 0 and 1 (United Nations Development Program – Human Development Reports).

The Gini coefficient is the most common measurement for inequality in a particular population. It is from a scale of 0 to 100, where 100 reflect total inequality.

The Life Expectancy at birth index is the expected (in the statistical sense) number of years of life remaining at birth (Sullivan A, Steven M, 2003). The reason why a simple life expectancy index was not used is that Life expectancy at birth is highly sensitive to the rate of death in the first few years of life; therefore one can see the state of a given country’s health care system much more accurately.

The Gross Domestic Product (GDP) has been added so that one can get an accurate idea of the economic fitness of the countries surveyed. The GDP gives the value of all the goods and services produced within a country during a set time period. It indicates the countries’ respective standard of living (O’Sullivan, A. 2003).

In tables 3a, 3b and 3c, one can see the relationship between the GDP and Life expectancy and equality between populations from different countries. These countries were chosen as they represent Developed, Developing and undeveloped countries. We can see from the above bar graph that HDI, GDP and Life expectancy at birth and equality all interrelate. There are some strong correlations between the equality in wealth distribution and the life expectancy at birth. If we look at Zimbabwe and Japan, one can see a drastic variation in the figures – this could mean that Zimbabwe is a relatively under-developed country when compared to Japan which is developed.

Thus we can conclude that the economic state, standard of living and health (here represented by life expectancy), all correlate. This allows us to understand how different social classes (here represented by wealth in an international setting) can negatively impact the health of a population.

In our discussion of class and health outcomes, class is just one of the factors that contribute to a nation’s, group’s or individual’s health outcome. When looking at health outcomes, there is more than just one factor that determines the health of a population. The determinates for health can be categorised into social determinates and biological determinates. This essay looked only at the social determinates, that is that individuals of different socio-economic background show different levels of health and incidence of disease (Raphael, D. 2008). Therefore, this essay cannot make conclusive deductions from the research provided, as the biological determinates and other factors have not been taken into consideration.

This essay however shows that there is a direct link between the social status of a population and the health outcomes. Going back to the transcript from the New York Times, one can see how the different social standing of these three individuals who suffered the same outcome, had different levels of treatment.

Life expectancy amongst the population who had stable jobs was much higher. This shows that with better job position, one can live longer. Using that, one can bring in the fact that job position is related to education. One of the impacts of better job position is better pay, therefore more wealth. So from just looking at the data provided for job position versus life expectancy at birth, one can see that job position determines life expectancy, thus a positive health outcome. Although life expectancy at birth is a very good indicator of health outcomes, it is very important to note that this is a broad-based generalization because of the many other factors that have not been accounted for.

In the examples which look at race and health outcomes, we see that in the ethnic groups of both South Africa and New Zealand much lower health outcomes were noticed for indigenous groups. It can be said that the population groups that were previously discriminated against based on their race had negative health outcomes.

If we look at the very broad picture, using the GDPs and human development index (which is based on, amongst other factors, life expectancy), we can see that poor countries generally have lower life expectancy.

So we can draw very limiting conclusions in saying “the social class of a population or group will directly affect the health of that population.”