Explaining the Social Class-Health Link.

1. Explaining the Social Class-Health Link. Dr Dominic Upton.

2. The four explanations. • Artefact • Social selection • Behavioural/Cultural • Materialist

3. Artefact explanation. • The process by which mortality/morbidity and social class are measured results in an inaccurate representation. • No evidence for such a position given the consistency of the findings.

4. Social selection. • Health determines social class through a process of health-related mobility in which the healthy are more likely to move up the social hierarchy and the unhealthy move down. • Some evidence, but unlikely to be the complete picture.

5. Behavioural explanation. • Social class differences in behaviours that damage or fail to promote health and, which at least in principle are subject to individual choice.

6. Behavioural explanation. • Suggests that those in social class V smoke more (demonstrated), drink more (evidence variable), exercise less (only in leisure time), and have a poorer diet (probably accurate).

7. Evidence for the behavioural explanation. • Smoking: Those in social class V smoke more than those in social class I. • Exercise: Those in social class I exercise more in their leisure time than those in social class V. • Diet: Social class V have worse diet than those in social class I. • Alcohol: Worse drinking habits in social class V.

8. Choice and lifestyle. • People smoke, drink and eat poorly because it is easy and relatively cheap way of dealing with stress. • Not individual choice, but are forced to because of their lives and circumstances.

9. How much does lifestyle explain? • Studies suggest that 25% of the variance is explained by the lifestyle choice differences between the classes. • Major explanation must be some other factor.

10. Materialist explanation. • Hazards which are inherent in society and to which some people have no choice but to be exposed given the present distribution of income and opportunity cause the health inequalities. • This is the explanation the Black report favoured.

11. Materialist explanation. • Housing. • Income. • Stresses of living.

12. Other explanations. • Cultural compatibility • Use of health service • Social skills of patient and health care professional • Bias and expectations of the health care professional • Outcomes of the medical consultation

13. Conclusion. • Carroll et al (1996):"The SES-health gradients might be regarded as a key test of the frequently evoked but imperfectly articulated biopsychosocial model of health championed by the newly formalised discipline of health psychology" (p. 36)