Explanations for Social Class Inequalities in Health (AQA A-Level Sociology): Revision Notes
Explanations for Social Class Inequalities in Health
Overview of health inequality explanations
Sociologists have developed several approaches to understanding why health outcomes vary so dramatically between social classes. Health inequalities refer to the systematic differences in health status and life expectancy between different social groups, particularly those from different socioeconomic backgrounds.
Shaw et al (2008) argue there exists an inextricable connection between poverty, inequality, wealth and health. Despite overall improvements in life expectancy, health inequalities persist, with the poor experiencing higher rates of illness and premature death whilst the wealthy enjoy better health and longevity. These researchers highlight that health inequalities encompass mortality, morbidity and disability, with their causes disputed between materialist, lifestyle and psychosocial factors operating across the life course.
Hilary Graham (2004) takes a different approach, arguing that the social factors influencing health and the social processes creating unequal distribution are not necessarily the same. She contends that governments genuinely committed to reducing health inequalities must examine how their policies affect the entire population, recognising that policies have different consequences for groups with unequal access to health determinants.
The health inequalities framework
Graham and Kelly's framework illustrates how health inequalities develop through a chain of interconnected factors. Social structure (including occupation, income and wealth) influences an individual's social position (determined by social class, gender, ethnicity and age group). This position then affects intermediary factors such as environmental conditions, cultural lifestyle choices, behaviours, and access to healthcare facilities. These intermediary factors ultimately determine health outcomes and wellbeing.
Four explanations for social class inequalities
Bartley and Blanc (2008) propose four distinct models to explain social class inequalities in health:
1. Behavioural model
This explanation focuses on damaging behaviours associated with cultural factors and lifestyle choices. These behaviours include smoking, poor diet, lack of exercise, and limited use of preventive services like immunisation, contraception and antenatal care.
However, long-term studies including Wilkinson and Pickett's research and the Whitehall II Study have demonstrated that differences in health behaviour explain only a small proportion of social class differences in mortality rates. This suggests that individual lifestyle choices alone cannot account for the scale of health inequalities observed.
2. Materialist model
The materialist explanation examines the impact of structural factors, particularly the experience of living in poverty. This model considers exposure to health hazards including poor-quality housing, deteriorating housing estates, inadequate diet, insufficient heating during winter, and elevated stress levels.
The influential Black Report (1980) identified materialist explanations as the most important factor accounting for social class differences in health. However, critics note that welfare provision such as free school meals and housing benefits can reduce some poverty-related problems, suggesting that material factors alone cannot explain all social class inequalities in health.
Feminists have contributed to this model by arguing that social class differences and women's longer life expectancy can obscure women's poorer health compared to men. Miller and Glendinning (1989) found that women experienced greater economic hardship than men, stemming from both biological and social factors.
3. Psychosocial model
This model argues that social inequality affects how people feel, which subsequently influences body chemistry and physical health. The Whitehall II Study (Ferrie et al, 2004) provides compelling evidence for this explanation.
Research Example: The Whitehall II Study
The study examined civil servants and found that an imbalance between effort and reward manifested in measurable biological factors:
- Lower-ranking civil servants had poorer blood quality compared to higher-ranking colleagues
- Elevated fibrinogen levels (making blood thicker and harder to circulate)
- More adverse blood fat profiles
Key Finding: Smoking, drinking, diet and exercise accounted for less than one-third of social class health inequalities. The remaining two-thirds were attributed to perceived inequalities and status differences within the civil service hierarchy.
The study concluded that "inequalities in health cannot be divorced from inequalities in society" and that addressing health inequalities requires understanding how social organisation affects health and finding ways to improve working and living conditions.
4. Life-course model
This relatively recent model suggests that disadvantages experienced in childhood create repercussions that extend into adulthood. Children from deprived backgrounds tend to achieve less success in education and consequently end up in lower-paid, lower-status employment.
Whilst this model requires longitudinal studies to provide empirical support, it makes sociological sense as a logical explanation for how health disadvantages accumulate over time. The model demonstrates how early life experiences can create lasting impacts on health outcomes.
Additional perspectives
Wilkinson and Marmot (2003) emphasise that regardless of individual genetic susceptibilities to disease, the most common causes of poor health across populations are environmental. They argue that both structural and cultural living conditions shape health outcomes, explaining why health has generally improved across Europe whilst also accounting for variations between countries and widening health differences between social groups in some nations.
There is also the artefact explanation, which suggests that the relationship between social class and health inequalities may be partly due to how data is collected and categorised rather than representing genuine causal relationships.
Key research: Victoria Cattell (2001)
Victoria Cattell conducted important research on 'poor people living in poor places', revealing that deprivation alone is less important for health than having a strong sense of community.
Research Example: Community and Health
Cattell's findings showed that within stable working-class communities, social capital provided good levels of support and emotional wellbeing.
However, in areas with weaker communities due to high population turnover, fewer social connections resulted in negative health factors including:
- Anxiety
- Depression
- Fatalism
Conclusion: This research highlights the importance of community cohesion and social support networks for health outcomes.
Contemporary application
Current estimates suggest that only ten per cent of the causes of health inequalities fall under the direct influence of the NHS. The remaining ninety per cent stem from social factors, particularly inequalities in income and education. This statistic underscores the importance of addressing broader social determinants rather than focusing solely on healthcare provision.
Recent evidence
Data from 2014 reveals the persistence and worsening of health inequalities in the UK:
- The London Health Observatory found a life expectancy gap of nearly 25 years between London's affluent and deprived wards
- The Equality Trust discovered that over the past 20 years, life expectancy gaps between different UK local authority areas increased by 41% for men and 73% for women
Research demonstrates that income serves as one of the greatest determinants of health. Whilst average income differences between countries show limited impact, within societies income inequality matters considerably. Ranking neighbourhoods from richest to poorest creates an almost exact match with health outcomes from best to worst.
However, the relationship extends beyond absolute poverty. Even neighbourhoods slightly below the richest areas demonstrate poorer health outcomes than the wealthiest areas. Income inequality, relative poverty, unemployment, under-employment, insecure incomes, and low-pay economies all negatively impact health. The daily struggle experienced by those at the bottom of the economic hierarchy creates substantial pressure on both physical and mental wellbeing.
Summary
Key Points to Remember:
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Multiple explanations exist: Behavioural, materialist, psychosocial, and life-course models each contribute to understanding health inequalities, with no single explanation providing a complete picture.
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Social factors dominate: Only 10% of health inequality causes relate directly to NHS provision; 90% stem from broader social factors like income and education inequalities.
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Evidence supports psychosocial factors: The Whitehall II Study demonstrated that workplace hierarchy and stress directly affect biological markers, with lifestyle factors explaining less than one-third of observed health differences.
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Community matters: Victoria Cattell's research shows that social capital and community cohesion can buffer against the health impacts of deprivation.
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Inequalities are widening: Recent UK data shows life expectancy gaps between rich and poor areas have increased substantially over the past two decades, highlighting the ongoing relevance of these explanations.