According to the World Health Organisation (WHO), health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity: Social differences in Health, Assignment, UOB, UK

Defining Health

According to the World Health Organisation (WHO), health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.

‘Good health may mean different things to an astronaut and to a fashion model, to a lumberjack and to a member of the stock exchange. Their ways of
life require different levels of physical activity; their food requirements and stresses vary, and they are not equally vulnerable to all diseases’.

As health is a relative concept, what it means and how it is recognized varies both between and within societies. Therefore, within any one society individuals differ in their thresholds of discomfort and their tolerance of pain, in their readiness to define certain symptoms as indicative of sickness, and in their ideas about ‘appropriate’ responses to a particular sickness.

The same applies cross-culturally. Societies differ in the levels of discomfort and pain which are accepted as normal. Different societies may also interpret similar symptoms very differently.

The chance of a long and healthy life is dependent upon an individual’s social characteristics. These characteristics include social class, ethnicity, gender, age, and where you live.

Two significant pieces of research into health inequalities in the UK were the Black Report (Department of Health and Social Security 1980) and the Health Divide (Whitehead 1987). Both were controversial as they identified failures of the NHS to seriously address differences in health opportunities and claimed that the best explanations for such differences lay in the structure and unequal nature of British Society. A report by the Department of Health in 1993 showed a greater willingness to accept the significance of social factors, highlighting that:

Sociological explanations of differences in health between different groups can be classified into four main theories.

Health and Social Class

Evidence

• Life expectancy for men in professional and managerial occupations is 7 years more than those who are unskilled.
• Infant mortality in social class 1 is half that of social class V.
• In 65 out of the 78 categories of disease, males in higher social classes were least likely to suffer the condition.
• For women, this is the case for 62 out of 82 disease categories. Only skin cancer shows some reversal of this pattern.
• Young men aged 25 to 44 in unskilled occupations have 4 times the risk of dying from lung cancer, stomach cancer, and heart disease than professional workers.

Explanations

Social constructionist

Most researchers accept that class differences in health are real but it is difficult to make valid comparisons of different occupational groups’ health over time because occupational classes are social constructions that
change. Social class V is shrinking and therefore has a disproportionate
number of older members when compared with the expanding, and more youthful middle classes. By comparing social class V with the other classes, what is being revealed is health differences by age and not by social class.

Social Selection

In this view poor health is seen as the selector of social class. If you are frail and weak then you are less likely to be able to hold down a good job and are more likely to be unemployed.

In the National Child Development Study, Power found that young people who were downwardly mobile compared with the occupational class of their parents were more likely to have poor health than those who were upwardly mobile.

Materialist-structuralist: 

These explanations emphasize the ‘real differences in living conditions between social groups that may contribute to differences in their health experiences’ (MacIntyre 1986). Inadequate income leads to inadequate diets, poor quality housing, lack of space for children to play, and other material
disadvantages which affect health.

Lower-class jobs are likely to have a greater risk of accidents and pollution. This explanation was the one most favored by the Black Report and the main reason it was politically unpopular.

Cultural-behavioural

This explanation interprets differences in health primarily as reflecting the different lifestyles and behaviors of social classes and the knowledge, attitudes, and values of people in different social positions. Lower social groups are shown to eat more white bread, smoke and drink more and watch more TV compared to the middle classes who live a healthier life.

Health and Gender

Evidence

• Life expectancy at birth in 1994 was 78 years for women and 72 for men.
• Male babies are more likely to die before birth or in the first year of life. In 1993 the infant mortality rate was 7.8 for boys and 6.2 for girls.
• Heart disease is the major killer of both men and women, although the rates are significantly higher for males.
• Two-thirds of disabled people are women.
• On average women see the doctor six times and men four times a year.
• Women form 57 % of admissions to mental hospitals and are more likely to be diagnosed as suffering from depression, dementia, and psychotic illnesses

Explanations

Social Constructionist

Female illness is more likely to be recorded than male illness. Males consult doctors less and report less illness because of their greater need to appear self-reliant and tolerant of pain. Macfarlane questions whether the greater use of medical services by women really indicates worse health. She argues that
once consultations for contraception, pregnancy, childbirth, and genito-urinary disorders are excluded the health gap by gender virtually disappears. The health of women may appear to be worse than that of men because their longer life expectancy increases the risk of chronic illness, and senile dementia, and therefore regular use of medical services.

Natural Selection

There are obviously differences in the health experiences of men and women that can be attributed to biology. Hormonal differences can account for some variation in the occurrence of particular illnesses e.g. the higher rate of heart disease amongst men before the age of 50 can partly be accounted for by
the lack of protection provided by the hormone estrogen. Also, males suffer more malformations and genetically transmitted disorders.

Materialist-structuralist

Gender differences in health are accounted for by inequalities in the resources which make for good health and the different social positions of men and women. Women are more likely to be in poverty as a result of their concentration in low-paid employment and they are more often reliant on state benefits as a result of old age or single parenthood. This means they are more prone to illnesses resulting from poor housing, inadequate diets, and stress produced by insecurity. Radical feminists emphasize that it is the housewife-mother role that makes women sick.

Cultural-behavioural

Gender socialization and society’s role expectations of males and females lead to differences in behaviors which produce inequalities in health. Men are more likely to take part in risky activities, like driving too fast, drinking alcohol, and smoking more, and are more likely to be involved in violence. According to Seligman (1975), females have traditionally been socialized into being less able to cope with stress than males and are therefore at greater risk from depression and other stress-related illnesses.

Evidence

Ethnicity

• People from minority ethnic groups have a higher mortality rate when compared to the white population.
• Some diseases are strongly associated with ethnicity e.g. the blood disease sickle cell anemia mainly affects people of African and Caribbean descent.
• People of African and Caribbean descent are more likely to be admitted to psychiatric institutions, particularly as compulsory admissions

Explanations

Social constructionist

There are particular difficulties in the way ethnicity is recorded and categorized. Before the 1991 census, researchers largely relied on birth and death certificates which do not record a person’s country of birth. This meant that information was limited to people born outside the UK and ignored the British-born black population. The reliability of the census as a source of
information for the differences in health and ethnicity is also questioned by Raleigh and Balarajan (1994). Fewer census forms were returned from the lower classes and ethnic minorities form a larger proportion of this group.

Natural selection

Genetics does seem to influence the higher rates of heart disease and high blood pressure found amongst people born in the Caribbean and the Indian subcontinent. However, although certain diseases do have particular ethnic associations,  sociologists largely reject genetic explanations in preference of
those which emphasize social and economic factors.

Materialist-structuralist

Most male employees with origins in the Asian subcontinent and Caribbean, are concentrated in low-paid manual work and particularly in industries that are hazardous to health. This means that they are more likely to lack the material conditions linked to good health e.g. decent housing.

Cultural-behavioural

This explanation identifies inadequacies in the lifestyles of ethnic groups as causing health disadvantages. The higher heart disease rate of Indians, Pakistanis, and Bangladeshis in Britain has been blamed on the excessive use of ghee, a cooking fat. The failure of Asian and Caribbean women to use Western medical services adequately has been blamed for the higher risks their babies face during pregnancy and in the first year.

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