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Lecture 14 : Factors(4) Overview. EDUCATION HOUSING CONDITIONS MEDICAL SERVICES EXERCISE / STRESS FAMILY SIZE. Education. Life expectancy has been found in many studies to be directly related to education levels (i.e. the better educated on average live longer).
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Lecture 14 : Factors(4)Overview • EDUCATION • HOUSING CONDITIONS • MEDICAL SERVICES • EXERCISE / STRESS • FAMILY SIZE
Education • Life expectancy has been found in many studies to be directly related to education levels (i.e. the better educated on average live longer). • As with income, it is not clear whether education levels are an important factor in their own right, or just happen to be correlated with other social class related factors which may be more important.
Housing Conditions • Mortality and morbidity rates vary between housing types. • As before, it is not clear whether this is a function of housing quality per se, or other social class related factors associated with the people living in the houses. • A table in the UK Black report suggests that housing tenure (and by inference housing quality) may be an important factor it is own right. Variations are found between housing tenure types even when controlling for social class. (N.B. The private rented sector includes both luxury apartments and the worst slum housing. Mortality rates are higher in the latter than in council estates).
Mortality And Housing SMRs by Social Class and Housing Tenure Type (Source: Black Report)
Health Sevices • Access to the health services varies by social class, especially in countries where private medicine predominates. • Access varies within cities. For example, there are more GPs in Dublin’s southside than in the west of the city. • Access also varies between urban and rural areas. • Social inequalities in access and quality of treatment persist even if medical services are totally free – see quote by John Tudor Hart in reference to the British NHS even before it was decimated. • It is far from clear that inequalities in access to the health services have a major impact upon inequalities in health.
The Inverse Care Law 'In areas with most sickness and death, general practitioners have more work, larger lists, less hospital support and inherit more clinically ineffective traditions of consultations than in the healthiest areas; and hospital doctors shoulder heavier case loads with less staff and equipment, more obsolete buildings and suffer recurrent crises in the availability of beds and replacement staff. These trends can be summed up as the inverse care law: that the availability of good medical care tends to vary inversely with the need of the population served'. (John Tudor Hart, M.D.)
Stress • Stress causes the body to produce catecholamines (e.g. adrenaline) and the release of fats and sugar into the blood system to prepare it for ‘fight’ or ‘flight’. • It is hypothesised that stress without exercise, stress results in the fats accumulating on artery walls, resulting in atherosclerosis and hence an increased risk of heart disease or stroke.
Exercise • Regular exercise is recommended for good health. • Manual workers might be expected to get more exercise and have lower fewer heart attacks. In fact, they tend to have more heart attacks. This, however, may be due to other factors exerting an even greater effect than exercise. • Figures reported by Gatrell (2003) suggest that exercise is more common in the lower social classes. If correct, this would again run counter to the notion that exercise is good for you, as mortality rates are higher in the lower social classes.
Family Size • Family size is rarely considered as a health risk, but a Dublin study by Kent and Sexton found that children from large families tended to be smaller. • Studies elsewhere suggest that tall people tend to live longer than short people. • Family size would appear to be a more important determinant of size than social class.
