Health inequalities

Joan Garrod

Health inequalities

Definition

The World Health Organization (WHO) defines health inequalities as

follows:

‘The differences in health status or in the distribution of health

determinants between different population groups.’

Health inequalities

Relevant groups in the UK

In the UK, the population groups showing differences in health and

health chances are based on:

Social class

Gender

Ethnicity

Region

These are not, of course, mutually exclusive — e.g. working-class

people tend to live in more deprived areas.

Health inequalities

Factors determining health

So, what factors determine our actual health and our health chances?

The WHO Commission on the Social Determinants of Health (2008)

took a holistic view. Their report said that health inequalities both

within and between countries are caused by:

• The unequal distribution of power, income, goods and services

which in turn leads to unfairness in people’s lives — namely:

• Their access to health care, schools and education

• Their conditions of work and leisure

• Their homes, communities, towns or cities

• Their chances of leading a flourishing life

Health inequalities

Factors determining health

The Royal College of Nursing (Policy Briefing January 2012)

summarises by saying that the social determinants of health are:

‘The collective set of conditions in which people are born, grow up,

live and work.’

• Some health conditions are the result of biology (e.g. inherited

genetic diseases) or lifestyle (e.g. smoking, excessive drinking).

• Other health inequalities are beyond the control of individuals and

groups, and could be avoided, and it is these on which sociologists

and others have focused.

Health inequalities

Models explaining social class inequalities in health (1)

Behavioural model: this suggests that the causes are health-damaging

or health-promoting behaviours, such as diet, drugs and alcohol

consumption. However, long-term studies have found that

differences in health behaviour explain only one-third of social class

differences in mortality.

Materialist model: poverty exposes people to greater health hazards,

e.g. poor housing, air pollution, insufficient or unhealthy food.

Health inequalities

Models explaining social class inequalities in health (2)

Psycho-social model: the effects of social inequality may cause stress

which can bring about biological changes that increase the risk of

heart disease. Evidence shows that people who have good

relationships with family and friends and participate in the

community have longer life expectancy than those who are

isolated. Poverty can result in both stress and isolation.

Life-course model: health reflects the patterns of all advantages and

disadvantages experienced by a person over the course of their life.

Disadvantages or advantages at birth and during early childhood

are likely to extend into adulthood.

Health inequalities

Social class

The average life expectancy for women is higher than that for men in

all social class groups. But, with each downward grade of a social

class (whichever measure of social class is used), average life

expectancy for both men and women decreases.

Men in the top social class can expect to live, on average, 7 years

longer than men in the bottom social class, and the gap is similar

for women.

Discussion point: What social factors can you think of to explain this

pattern?

Health inequalities

Life expectancy at birth for men and women by social class England and Wales 2002–5

Source: Office for National Statistics 2007, licensed under the Open Government License v3.0.

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Region(Remember that region/area is closely linked to social class.)

Statistics showing some UK regional patterns of health inequalities:

In England, the average difference in ‘disability-free’ life expectancy between

the poorest and richest areas is 17 years. (ONS 2009 Life Expectancy at Birth)

In Scotland, men living in the most deprived areas will die, on average, almost

11 years earlier than those living in the least deprived areas. (NHS Healthy

Life Expectancy in Scotland December 2011)

In Northern Ireland, men living in the poorest areas will die on average 8 years

earlier than men living in the wealthiest areas. (Northern Ireland Health and

Social Care Monitoring System 2013)

In England, primary school children from deprived areas are twice as likely to

be obese as those from wealthier areas. (HSCIC National Child Measurement

Programme December 2014)

Health inequalities

Ethnicity

Health inequalities are also seen among different ethnic groups:

• The White Gypsy or Irish Traveller groups, identified for the first time in the

2011 Census, have particularly poor health. Both men and women have

twice the White British rates of limiting long-term illness.

• 50% of all men aged 65 or older reported a limiting long-term illness, but

69% of Bangladeshi older men reported being ill.

• 56% of all women aged 65 or older reported a limiting long-term illness, but

this was reported by 70% of Pakistani and Bangladeshi women.

• Conversely, the Chinese group reported consistently better health: half or

under half the White British rate for both men and women.

(‘Ethnic Health Inequalities 1991–2011’, ESRC Centre on Dynamics of Ethnicity, October 2013)

Question: What reasons can you suggest for these differences? (Think of social

class, area and cultural differences.)

Health inequalities

Gender

In industrialised countries, women on average live longer than men, but appear

to experience more ill-health. Men have higher mortality rates for the more

common causes of death such as heart disease and lung cancer, but women

report higher incidences of complaints such as tiredness, headaches and

muscular aches and pains. Women also have higher rates than men for poor

mental health, particularly related to anxiety and depressive disorders.

The World Health Organization suggests that gender differences in health are

related to both biology and social factors. ‘Social factors’ refer to distinct

roles and behaviours for men and women in a given culture, dictated by that

culture’s norms and values for gender.

Health inequalities

Gender and social factorsSocial factors offered to explain the higher mortality rates in men:

Employment: men are more typically found in occupations involving direct risk to life,

such as operating dangerous machinery and exposure to environmental hazards

and toxic substances.

Risk-taking behaviour: men are more likely to engage in dangerous sports and are at

greater risk of road traffic accidents. They tend to drive longer distances than

women and to drive faster, and are more likely to drive under the influence of

alcohol.

Smoking: older men are more likely than women to be or to have been heavy

smokers, though the gender gap has narrowed and now girls below 15 are more

likely than boys to smoke.

Alcohol: men drink significantly more than women in all age groups.

(‘Women and Health’ A. Scambler, 2008)

Question: Can you suggest any other gender-related factors?

Health inequalities

Conclusion (1)In their book The Spirit Level (2009), Richard Wilkinson and Kate Pickett

argued that income inequality was linked to health and social

problems. Karen Rowlingson (2011) conducted an independent review

of the research into the effects of income inequality, with particular

reference to the arguments put forward in The Spirit Level.

Among the conclusions were:

• Evidence from a range of studies suggests that there is a correlation

between income inequality and health and social problems.

• Those with higher incomes do better on a range of outcomes. There is

a ‘social gradient’ in health, meaning that with every step up the

socio-economic ladder there is an increase in health.

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Conclusion (2)

There is less agreement among studies regarding whether income

inequality causes health and social problems, though some rigorous

studies provide evidence of such a relationship.

Some research suggests that inequality is particularly harmful after it

reaches a certain threshold. Britain was below this threshold up to the

early 1980s but rose above it in 1986–7 and has been well above the

threshold since 1998–9.

The most plausible explanation for inequality’s effect on health is ‘status

anxiety’. Inequality is harmful because it places people in a hierarchy

that increases status competition and causes stress, which leads to

poor health and other negative outcomes.(‘Does income inequality cause health and social problems?’ K. Rowlingson, Joseph Rowntree Foundation

report September 2011.)