Health Psychology

Discuss the evidence for the existence of social health inequalities in the UK and discuss why these inequalities may occur.

Definition of health varies depending on people’s approaches to their well-being. Some would have mainly medical approach; to say that, health is lack of disease or illness, whereas the others would have broader the approach to health, like “State of complete physical, mental and social well-being, not merely absence of disease or infirmity” (WHO, 1946).

For many years, the distribution of health state between populations was expressed in terms of ideas on “inequality”. The main core studies of inequalities in health have been referred to social and economic circumstances of individuals. A variety of factors can establish the socio-economic status (SES): income, wealth, type of housing tenure, education, style of consumption, mode of behavior, social origins, family and local connections. All this factors are interconnected and strongly correlate with illness and mortality. Moreover, not a single factor should be considered as adequate on its own. Therefore, more likely one of the influential factors on health would be behavioral, including consistency of diet, exercise, smoking and other individual life style factors. Second more influential factor is psychosocial, which includes such cognitive processes like self-efficacy, self- esteem and perceived control (Siegrist and Marmot, 2004).

One of the earliest studies in Britain in 1977, Black Report (Townsend and Davidson, 1982) summarized evidences of health social inequalities based on use of occupation as an indicator of social class. For the class stratifications, the (I-V) Registrar General’s categories have been used and they have been updated into I-VIII categories: 1) Higher managerial & professional; 2) Lower managerial & professional; 3) Intermediate; 4) Small employers & own accounts; 5) Lower supervisory, craft & related occupations; 6) Semi-routine; 7) Routine; 8) Never worked & long-term unemployed.

Best statistically available indicators of inequalities of health between different socio-economic groups, or more strictly occupational classes, are mortality rates. Mortality rates figures drawn from 1970s in Black Report show that man and women in occupational class V had almost double chance of dying than in class I, before reaching their retirement age. Figures from standardized mortality ratio on class and mortality in childhood (1970-72) indicate that at birth and in the first month of life nearly as much as twice infants die from unskilled manual parents then from professional parents. Furthermore, in the poorest class more than three times babes die before reaching their first year. In later childhood, the gap in mortality decrease to one and a half and two times, but increases again in early adulthood before falling again in middle and old age.

Similar evidence were presented in study by Kuh & Ben Shlomo, 1997, indicating that steepest social gradients in health are observed at early childhood and midlife, where less inequality appears in adolescence and in older age.

Some recent studies applied different asset-based measures, such as household income (Blaxter, 1990), or housing tenure and car ownership (e.g. Whitehead, 1988). There are believed to be predictive measures of health state, and a strong indicator that mortality and morbidity between socio-economic classes could characterized women as much as they do men ( e.g. Arber, 1989; Whitehead, 1988).

Convincing evidences, which present the gradient of mortality and morbidity in relationship between social classes, were found in British Whitehall studies (Marmot, Shipley, & Rose, 1984). As part of Whitehall I study of British public servants, Davey Smith, Shipley, and Rose (1990) examination indicates that occupational class and car ownership are strongly and independently related to mortality. A steep mortality risk gradient appeared between the highest occupational grade car owners and the lowest grade non-owners (the mortality rates per 1000 person years was 4.3).

While a number of researches shown evidences for a social gradient for mortality in general, some evidences were found for major causes of death, including coronary hear disease (CHD) and stroke (Marmot et al., 1984). More to say, according to Whitehall II study, several important risk factors of chronic degenerative diseases follow this social gradient (Marmot et al., 1991).

It should be noticed that occupational status still more frequently used measure of socioeconomic inequalities, which attributes to most relevant aspects of it. However, their application is limited to employed population (Fox, 1989; Lahelma, 2001; Marmot & Wilkinson, 1999).

There is no one single explanation as adequate but a large distribution of factors that contribute to explaining the SES impact on health.

In attempt to explaining health inequalities, Black Working Group suggested and examined four possible explanations of causes for differences in relationships between occupational classes and health. A multitude of studies and materials confirm, explore and provide further evidence and suggestions for explanations among social inequalities in health.

1. Artifact approach, supported by Illsley (1986) and Bloor et al. (1987), suggests that social class classification method of measurement is unreliable, and artificially overestimate the gradient of health inequalities. The arguments and evidences are concerning this explanation.

Firstly, the data from OPCZ Longitudinal Study indicates the existence of a clear occupational class gradient in mortality. Second, some recent studies have used different measurements to explain the relationship between social classes and health and conclude that whether social position is measured by income, housing tenure, household possessions or education, a similar pattern occurs on inequalities in health between the top and the bottom of social scale. Finally, results from different studies suggested that the Registrar General’s classification may be under-estimating the size of health gap rather than over-estimating it.

2. Theories of natural and social selection explain health inequalities through health selection process. Referring to these theories, people with a good health would move to a higher social class, whereas poor health would influence people to move down the occupational scale. Blane et al. (1993) and West (1991) argued that the possibility is that ill-health may lead to subsequent unemployment rather than unemployment leading to ill-health. According to inter-generational and intra-generational