Social Class and Health Inequality (AQA A-Level Sociology): Revision Notes
Social Class and Health Inequality
Social class remains one of the most persistent factors shaping health outcomes in modern society. The relationship between social position and health demonstrates clear patterns of inequality that have been extensively documented through research and government reports.
The study of health inequality reveals how social stratification creates systematic differences in health outcomes, life expectancy, and quality of life across different social groups.
Key research evidence
Rowlingson's income inequality study
Research Study: Rowlingson's Income Inequality Analysis (2011)
Karen Rowlingson conducted a comprehensive review of existing data examining whether income inequality directly causes health and social problems. Her research addressed three critical questions:
- Whether a link exists between income inequality and health/social problems
- Who experiences the greatest impact from income inequality
- The broader consequences of income inequality on society and the economy
Her findings revealed a clear correlation between income inequality and poor health outcomes. While there was general agreement that this relationship exists, less consensus emerged about whether income inequality independently causes health problems beyond other contributing factors. The research highlighted several additional influences including individual poverty levels, cultural and historical factors, ethnicity, and welfare state policies.
Rowlingson's work suggested that inequality may create harmful effects through status anxiety within society. This competitive hierarchy places individuals under stress, potentially leading to deteriorating health. Although the independent effect of income inequality appeared modest in individual studies, the cumulative impact across entire populations proved substantial. Britain's inequality levels rose significantly during the mid-1980s and have remained elevated since.
Historical government reports
Three major reports have shaped understanding of health inequalities in the UK:
The Black Report (1980) provided the foundation for modern research into social class health inequalities. This government-commissioned study presented statistical evidence alongside an influential framework for interpreting health disparities across social classes.
The Acheson Report (1998) was commissioned by the New Labour government to examine health inequalities as a matter of social justice. It focused on the widening health gap between different social groups and proposed addressing inequalities through NHS partnerships with local communities, particularly in schools, workplaces, and neighbourhoods.
The Marmot Review (2010) offered evidence-based analysis of health's social determinants, examining how living and working conditions create health inequalities. It highlighted life expectancy gaps between the wealthiest groups and the rest of society, showing that disadvantaged groups not only die earlier but experience more years of poor health.
Theoretical perspectives
Marxist approach
Marxist analysis views health inequalities as an inevitable outcome of capitalism's unequal class structure. The working class (proletariat) experiences exploitation and alienation in work, while unemployed individuals face isolation, marginalisation, and greater deprivation through reliance on benefits. This economic system creates material conditions that directly impact health outcomes.
Weberian and postmodern perspectives
Some sociologists argue that traditional class analysis has become outdated for understanding health inequalities. They suggest focusing on market position and consumption patterns rather than traditional social class categories. This approach emphasises how market relationships and lifestyle choices shape health outcomes in contemporary society.
Mortality and social class
Mortality refers to death rates within populations and provides stark evidence of class-based health inequality.
ONS data from 2014 reveals striking differences in death rates across social classes:
Statistical Evidence: Mortality by Social Class (2014)
- One in five manual workers (approximately ) die before reaching the current retirement age of 65
- Only of professional and managerial workers die before retirement
- After retirement, working-class individuals enjoy 14 years of life compared to 18 years for professionals such as lawyers, teachers, and doctors
These statistics demonstrate how social class position fundamentally shapes life expectancy and the quality of later life.
Morbidity and social class
Morbidity describes illness rates within populations and shows how social class affects not just when people die, but how healthy they are while alive.
While illness generally increases with age, social class creates significant variations in when and how people experience poor health. Research indicates that health disparities stem from multiple interconnected factors. Beyond structural elements like poverty and material deprivation, cultural and lifestyle factors play important roles. Disadvantaged groups often engage in activities that increase their risk of developing serious illnesses.
Contemporary research
Research Finding: Buck and Frosini (2012)
Buck and Frosini's 2012 study identified 'four key damaging behaviours' more common among poorer populations:
- Smoking
- Excessive drinking
- Poor diet
- Lack of exercise
Conversely, higher social classes increasingly avoid these behaviours. This research suggests the health gap between richest and poorest groups will continue widening unless these behavioural patterns change.
Statistical context: In 2013, the UK lost million working days to sickness absences, averaging days per worker. This demonstrates the substantial economic impact of health inequalities.
Key sociologists and research
Wilkinson and Marmot (2003)
WHO Report: 'The Social Determinants of Health: The True Facts'
Their research emphasised health's sensitivity to social environmental factors. They concluded that improving health requires reducing educational failure, unemployment, and housing problems. Their work suggests that societies actively working to reduce inequalities achieve the best overall health outcomes.
Williams et al (1998)
Conceptual Analysis: The Meaning of Social Class
These researchers examined the meaning and usefulness of social class as a concept. They found ongoing debates about socio-economic status definitions, particularly regarding social class categories.
Their analysis revealed that social class involves two key components:
- A structural account of power relations, inequality, and exploitation
- Self-conscious group awareness and identity
However, Esping-Anderson (1993) argued that class categories may artificially group diverse individuals who don't share strong collective economic or social identities.
The concept has become more complex due to postmodernist theories about 'risk society' and changing social structures, yet social class remains prominent in health inequality discussions due to its continued explanatory power.
Understanding social class complexity
The relationship between social class and health outcomes is complex but demonstrates clear patterns. Health chances generally deteriorate as individuals move down the social hierarchy. However, health inequalities exist even within the same neighbourhoods and communities.
Current policy implications are significant. With state pension ages rising to 66 by 2020 and 70 within fifty years, a greater proportion of working-class individuals will experience illness and death before retirement compared to the current figure.
Summary
Key Points to Remember:
- Social class remains a powerful predictor of health outcomes despite debates about its definition and relevance
- Clear statistical evidence shows working-class individuals experience higher mortality and morbidity rates than professional classes
- Multiple factors contribute to health inequalities including income, lifestyle choices, material conditions, and structural inequalities
- Government reports consistently identify health inequalities as a social justice issue requiring policy intervention
- The health gap between social classes may widen unless behavioural and structural factors are addressed simultaneously