Chapter 3 The Social Demography of Health: Social Class

1. Medical SociologyTwelfth EditionWilliam C. Cockerham Chapter 3 The Social Demography of Health: Social Class

2. Introduction • In the United States, the poor face substantial barriers in life: • Typically have worse health than the affluent • Are treated within the framework of welfare medicine • Live in disadvantaged urban and rural locales

3. Introduction • Socioeconomic status or social class is the strongest and most consistent predictor of a person’s health and life expectancy across the life course regardless of access to health care or health care delivery system

4. The Components of Social Class • A social class is a category or group of people who have approximately the same amount of wealth, status, and power in a society • Different models exist: • Five-class model used in the U.S.: • Upper class • Upper-middle class • Lower-middle class • Working class • Lower class

5. The Components of Social Class • Europeans tend to focus more on occupational differences as the chief component of class position • American sociologists usually rely on socioeconomic status (SES) • Influenced by theories of Karl Marx and Max Weber • Wealth an important component but Weber also included social status and power • Measured by three variables: • Income • Occupational prestige • Education

6. The Components of Social Class • Education appears to be the most important component of SES in predicting health outcomes • Influences: • Knowledge about healthy lifestyles • Seeking preventive care or medical treatment for health problems when needed • Likelihood of having better income and satisfying jobs

7. The Components of Social Class • Importance of individual components of SES and their impact on health varies over the life course • Education influences the onset of chronic diseases • Income becomes more important later in life; determines how health problems progress

8. The Components of Social Class • The poor have the greatest exposure to risk factors that cause ill health: • Physical (poor sanitation, poor housing) • Chemical (pollution) • Biological (bacteria, viruses) • Psychological (stress) • Economic (low income, unhealthy jobs) • Lifestyle (poor diets, smoking, lack of leisure-time exercise)

9. Modern Diseases and the Poor • Chronic diseases are most associated with modernization and were associated with upper classes • Lifestyle changes among the affluent have reduced their risks of chronic diseases • Poor more likely to suffer from: • Infectious diseases • Chronic diseases • Mental illness

10. Modern Diseases and the Poor • Richard Wilkinson’s “income inequality hypothesis” • Blames degree of inequality among classes within a society for health inequalities • Society’s overall level of wealth less important • Compelling argument but thus far findings in other research have not supported his position

11. Equality of Care in Britain • After World War II, socialized medicine was introduced in Great Britain • Provides the lower classes with the same medical care available to the upper classes • Only access to health care was equalized – social class differences unchanged

12. Equality of Care in Britain • Equalization of health care alone has not reduced the disparity in health between social classes • Black Report in 1980 sponsored by British government • Assessed trends in population health • Demonstrated health inequalities were not decreasing among different social classes despite increased welfare services

13. The Social Gradient in Mortality • Whitehall studies conducted by Marmot • Showed social class differences in mortality among British male civil government employees • Regardless of the cause, those with the highest occupational rank had the lowest percentage of deaths • Mortality increased across each job category • Lowest-ranked occupations had the highest percentage of deaths

14. The Social Gradient in Mortality

15. The Social Gradient in Mortality • Social gradient observed even among relatively high ranked groups, where poverty was not an issue • Differences in mortality were linked to hierarchy rather than deprivation • Observed in numerous countries, regardless of the specific variable used to indicate social position

16. The Social Gradient in Mortality • Possible reasons for gradient include differences between classes in: • Self-esteem and stress levels • Effects of income inequality • Deprivation through life course • Health lifestyles and social support • Socioeconomic environment • Use of preventive health services

17. Neighborhood Disadvantage • Five features of neighborhoods that can affect health: • Physical environment • Surroundings at home, work, and play • Services provided to support people • Sociocultural aspects of the neighborhood • Reputation of an area

18. Neighborhood Disadvantage • Orderly neighborhoods are clean and safe, houses and buildings are well maintained, and residents are respectful of each other and each other’s property • Disorderly neighborhoods reflect a breakdown in social order, as there is noise, litter, poorly maintained houses and buildings, vandalism, graffiti, fear, and crime

19. SES as a Fundamental Causeof Sickness and Mortality • SES can be described as a direct cause of poor health because it: • Influences multiple diseases • Affects these diseases through multiple pathways of risks • Is reproduced over time • Involves access to resources that can be used to avoid risks or minimize the consequences of disease if it occurs

20. SES as a Fundamental Causeof Sickness and Mortality • The degree of socioeconomic resources a person has or does not have, such as money, knowledge, status, power, and social connections, either protects health or causes premature mortality