Social Inequalities and Health Part 2 PDF

Social Inequalities and Health – PART 2 MED-110 MD6/Y1 2024-25 Dr Eirini Kampriani Assistant Professor of Medical Anthropology & Medical Ethics [email protected] This presentation partially includes material...

Social Inequalities and Health – PART 2 MED-110 MD6/Y1 2024-25 Dr Eirini Kampriani Assistant Professor of Medical Anthropology & Medical Ethics [email protected] This presentation partially includes material adapted from C.S. Constantinou 2019 Social Inequalities in Health Part 1 Social class and health Part 2 Explanations of the relationship between social class and health Summary of lecture 1 People have different social positions in society - social classes Social class is associated with both mortality and morbidity Working-class people are more likely to have higher mortality and morbidity rates Why are these differences observed? How can we account for them in sociological terms? LEARNING OBJECTIVES PART 2 Explain the reasons why social class is associated with high mortality and morbidity rates Apply the sociological principles to explain a case of cardiovascular disease Lecture Outline Case scenario Sociological theories & approaches Health policy Applying to the case Summary points & considerations  1. CASE SCENARIO Antonis Markou is 54 years old and had a heart attack a few days ago. The heart attack was attributed to coronary disease (narrowed arteries). Antonis had been having chest pains on regular basis which he ignored. When friends tried to alert him, he told them it was Based on Antonis’ experiences, because he was tired. can you identify any potential social reasons behind developing a Antonis did not have higher education and is a cardiovascular disease? low-income worker at a bakery in Nicosia. He likes soccer a lot, he smokes about 25 cigarettes per day and enjoys drinking whiskey with his friends. Though he has friends he feels stressed with low sense of life control. 2. Explanations of the Relationship Between Social Class and Health Social Social Class & Selection Health Social selection Social selection focuses on biological reasons individuals are biologically vulnerable to diseases This is the reason why these people do not move up in the social strata So it is not low socio-economic status that negatively affects health but instead health determines social class If people fall ill, they are unable to secure employment, esp in the lower classes downward social mobility tends to occur Social selection Limits of the social selection model Not sufficient to account for the whole of differences in health by social class (Papanikitas 2015) Social mobility tends to occur before serious diseases become prevalent Incapacity does not always lead to downward mobility Scambler G, Blane D. Inequality and social class. In: Scambler G, ed. Sociology as Applied to Medicine (5th Edition). London, Saunders 2003: 107-123 Explanations of the Relationship Between Social Class and Health Social Selection Social Class & Health Materialist model Materialist model The Materialist model argues that access to materials (resources) and control of (material resources) influences people’s health 1. Material possessions 2. Access to resources: education, healthcare services, proper housing People from lower socio-economic status are less likely to have access to healthy environments and healthcare Poverty and unemployment expose people to greater health hazards, e.g. poor housing, air pollution, insufficient or unhealthy food are associated with chronic stress and a lost sense of control Materialist model following improvements in living standards for the majority post-war, Life expectancy increased Social inequalities in health persisted Studies suggesting association between poor housing and poor access to education/health ‘inverse care law’ concept by Tudor Hart (1971) Healthcare is least available where it is most needed Even if available, healthcare and other services may be less accessible and thus under-utilized Reasons for variation in access to healthcare; availability; quality; costs; information Goddard and Smith (2001) Equity of access to health care services: Theory and evidence from the UK Social Science & Medicine 53(9):1149-62 Explanations of the Relationship Between Social Class and Health Social Selection Social Class & Health Behavioural Materialist Model model Behavioural model Behavioural models focus on individuals and how they behave health-damaging or health-promoting behaviours: Smoking Alcohol abuse Unhealthy diet Physical exercise Health literacy Health beliefs BUT – Long-term studies (eg. The Whitehall study of British Civil Servants) suggest that differences in health behaviour explain only one-third of social class differences in mortality Behavioural model Cultural explanations; middle and working class people have different cultures implications of Cultural explanations health inequalities may not be reduced by economic equality Is it morally right to try and change people’s values/integral components of their group lifestyle and culture? Explanations of the Relationship Between Social Class and Health Social Selection Social Psycho-social Materialist Class & Model Health model Behavioural Model Psychosocial model How psychological stress is generated by society’s inequality structures the effects of social inequality may cause stress Poverty can result in both stress and isolation. Social inequalities may make people feel subordinate and disadvantaged Control and autonomy Imbalance between home and work, between efforts and rewards Social support Evidence shows that people who have good relationships with family/friends and participate in the community have longer life expectancy than those who are isolated. Psychosocial model Two pathways from stress to poor health: a direct effect on disease development (mental illness/somatic disease) an indirect pathway when stress is expressed by health-damaging behavior(s) Stress-related mechanisms Lower socioeconomic groups experience a greater number of stressful life events, negative stereotyping, stigma, and social isolation lack of social relationships leading to maladaptive coping strategies, eg consuming alcohol to cope Affluent individuals may have a beneficial network of social connections/a social ‘buffer’ against stressful life events Jon Ivar Elstad (1998) The psycho-social perspective on social inequalities in health. Sociology of Health and Illness 20(5), 598–618 Explanations of the Relationship Between Social Class and Health Social Selection Lifecourse Materialist model Social model Class & Health Psychosocial Behavioural Model Model Lifecourse model This model has to do with one’s experiences with social conditions and social positioning across time Disadvantage at one time associated with disadvantage at a different time. Example: disadvantage in childhood (poverty) is associated with disadvantage in adulthood For example, research suggests that individuals who experienced poor home conditions in childhood are more likely to experience occupational disadvantage. Methodological and conceptual issues timing and duration of exposures across the life span risk factors accumulate and interact synergistically over the lifecourse in complex ways  Class mobility A recent study (Präg P, Richards L. (2019) showed that class of origin and destination class both influence your health Being born working class is bad for your health, and moving up the social ladder cannot compensate for it The worst health outcomes expected by those who were born in working class families & belong to the working class in adult life Präg P, Richards L. (2019) Intergenerational social mobility and allostatic load in Great Britain J Epidemiol Community Health 73:100-105. DISCUSS Which model you think provides the most sufficient explanation? Social Selection Lifecourse Materialist model Social model Class & Health Psychosocial Behavioural Model Model Explanation Combination of Materialist, Behavioural and Psychosocial models Working class people are more likely to have access to limited resources smoke, abuse alcohol and have unhealthy diets Why? wage workers are more likely to suffer chronic stress – smoking, alcohol abuse, food consumption are coping mechanisms of stress and difficult life situations Working class people have poorer health literacy are more likely to be influenced by inequality culture; i.e. adopt a fatalistic view of life  3. Health Policy Marmot Review (2008) Studies providing documentation Health inequalities in England of Health inequalities and policy post-2010 recommendations in the UK The Acheson Report (1998) be addressed in terms of mortality decreased in the last 50 fairness and social justice years but inequalities in health be considered in view of all remained the social determinants of unemployment health housing be properly addressed educational achievement according to levels of child poverty deprivation The Black Report (1980) showed a clear difference in mortality and morbidity across social classes Health Policy and Socio-economic inequalities in health in the UK There has been some decrease in mortality and morbidity rates across all social classes but not in relation to one another Therefore, health inequalities persist While life expectancy is improving, healthy life expectancy (ie free from long-standing illness) is not improving at the same pace (Kelly et al (2000) Why do inequalities persist? Health service provision inequities vs social inequalities that lead to differential health outcomes over a lifecourse. inequality refers to unbalanced conditions. inequity refers to the state of being unfair/unjust inequities are avoidable; WHO - no matter the location, people of the lowest socioeconomic status experience the worse health. Why do inequalities persist? Need to address social dynamics than a limited focus on social categories Actions should focus on all determinants of health inequalities: resources, migration, gender, social support, stressful work etc Policy should focus on all aspects of life; income security, quality of healthcare, gender balance, social inclusion, healthy environments Policy has to be multi-layered; no single action can be effective People’s experiences are not confined to one determinant, i.e. their social class alone People are influenced by exposure to many other social experiences, identity practices, social location, historical and political forces  4. APPLYING TO THE CASE Antonis Markou is 54 years old and had a heart attack a few days ago. The heart attack was attributed to coronary disease (narrowed arteries). Antonis had been having chest pains on regular basis which he ignored. When friends tried to alert him, he told them it was What are the social explanations because he was tired. for Antonis’ condition? Antonis did not have higher education and is a low-income worker at a bakery in Nicosia. He likes soccer a lot, he smokes about 25 cigarettes per day and enjoys drinking whiskey with his friends. Though he has friends he feels stressed with low sense of life control. 4. Applying to the Case Socio-economic position Lifestyle associated with working class Education and recognition of symptoms Stress and social support 5. SUMMARY POINTS There is an association between social class and mortality/morbidity Sociological theories provide different perspectives of the relationship between social class and health The most sufficient explanation is a combination of materialist and behavioural models Individuals in lower socio-economic groups are more likely to smoke, abuse alcohol and have unhealthy diets as ways to cope from socially induced stress CONCLUDING CONSIDERATIONS Why does this all matter? How does this affect clinical practice? REVISIT POST-PART 1 ACTIVITY Reflecting on the documentary and material presented in the lectures, consider: How is social class associated with health? Why do you think these differences exist? How can we account for these differences in sociological terms? Documentary Unnatural Causes: Does inequality make us sick? The series aims to tackle questions around the causes of alarming socio-economic and racial inequities in health., in the US Follow the links below to watch video clips on issues relevant to this week’s topic; watching these will not take more than 7 minutes in total. Health in America - VIDEO EXCERPT, Unnatural Causes - Episode 1 https://unnaturalcauses.org/video_clips_detail.php?res_id=213 Arriving Healthy - VIDEO EXCERPT, Unnatural Causes - Episode 3 Wealth Equals Health - VIDEO EXCERPT, Unnatural Causes - Episode 3 https://unnaturalcauses.org/video_clips.php?vid_filter=Episode%203%20-%20Becoming%20American Barry, A-M and Yuill C (2016). Understanding the sociology of health (4th edition). Croydon: SAGE. Chapter 5: pages 77-86. --------------------------------------------------------------------------------------------------------------------------------- See also: Papamikitas A. & Morrow E. (2015) Inequalities in health and healthcare provision. In Medical Ethics and Sociology, chapter 9 pp 115-134. Elsevier-Mosby Sample SBA Antonis Markou is a 54 years old and had a heart attack a few days ago. The heart attack was attributed to coronary disease (narrowed arteries). Antonis did not have higher education and is a low-income worker at a bakery in Nicosia. He likes soccer a lot, he smokes about 25 cigarettes per day and enjoys drinking whiskey with his friends. Though he has friends he feels stressed with low sense of life control. Which combination of models better explain Antonis’ experience? a. Materialist, psychosocial, and social selection b. Lifecourse, social selection, and materialist c. Psychosocial, lifecourse, and behavioural d. Materialist, behavioural, and psychosocial e. Behavioural, social selection, and lifecourse