STRUCTURAL DETERMINANTS OF HEALTH

CLASS

Despite the services available from the N.H.S. and Welfare State, there are major differences in health existing between social classes. The socio-economic structure in Britain is still apparent. It is where you are in that table that can define your future and health. The higher you are in the table, the more access you will have to better wealth, housing, environment, education, job security, private medical care, power and influence.

A study carried out by the General Household Survey revealed that the lower down the social class hierarchy you moved chronic and acute sickness increased. On average a man living in social class I lives seven years longer than a man of social class V. Heart disease is one and a half times higher than average for a lower class man, compared to a man in a higher class.

EDUCATION

Education is a vital necessity for our future. Education increases the opportunities for a better income and job security; it also gives people a sense of control over their lives. This is a key factor which influences our health.

Up until 1944 children only had the opportunity to attend elementary schools. Very basic education was taught i.e. reading writing and arithmetic, this lead the individuals to working class employment. The secondary schools which were fee paying schools educated children using a far wider curriculum, leading to middle class employment. The fees attached with these schools were restricted mainly to the higher classes who had the funding to pay for it. The affect of so many children missing out on full time education became apparent in the Second World War. The majority of army recruits were illiterate. Although these individuals were fully able to fight for their country, they could not read or write. This was all down to the fact that their parents were unable to finance their children through secondary education. Alarm bells began to ring, and people were in fear that Britain’s industrial position would be threatened by such a poorly educated labour force. So in 1944 the Butler Education Act was introduced. This allowed every child from the age of five free secondary education until the age of 15 fifteen.

ENVIRONMENT

The environment in which we live in is a key factor to our health. These factors also include our housing, and working conditions. Poor housing conditions are usually the norm for a family living in the lower class structure. People living in inner cities are more likely to be faced with overcrowding and living in rented properties. These rented properties are often neglected by the tenants due to lack of income. Private landlords often ignore the state of the properties, thus leaving the families and their health to suffer. In some cases owner-occupiers may not have the funding and resources to maintain their houses, leading to a downward spiral in their health.

Another contribution to ill health is the natural environment, e.g. air and water quality. Inner cities are overpopulated causing high air pollution. A recent study chartered by the Trent Public Health Observatory showed alarming figures of health related problems caused by the affects of living in cities. In this report it was stated that people living in Lincoln, Leicester and Nottingham suffered with premature deaths, heart disease, strokes and other related diseases than those living in Rutland.

It is a no win situation for the lower class sector. The majority of them are unable to have the resources and leave the inner cities, to find a healthy environment in urban areas.

EMPLOYMENT

Employment deters where you are in status, thus affecting your health. The movement up through the social class hierarchy can improve your working terms and conditions.

A lower class worker could be faced with longer working hours for a very low pay. This has a spiralling affect on your health and well being. A loss of self esteem can result from working in dangerous and unhygienic conditions. The working class are undermined by supervision from the upper classes; this can result in a stressful workplace.

The poverty trap that a working class individual can be caught in can be very hard to escape from. The majority of working class people are living on the ‘bread line’ and are unable to afford the necessities, like food to stay healthy. This has a knock on affect for the whole family.

Unemployment can affect an individual’s health and lifestyle dramatically. The long term affects can lead to depression, loss of identity, self worth and loss of contact from social aspects. Mounting debts and hardship can create stress and anxiety in coping with their lives. This results in the person’s health suffering. 

GENDER

Our health is also affected by our gender. Evidence suggests that women live longer than men. Trends of women indicate that females are more likely to use the medical services provided, and are more health conscious than men. Men are generally brought up in society as the aggressive gender, and take more risks. It is normally men who do the hazardous jobs like climbing a ladder, construction work. They are also more likely to work more hours and do the dangerous jobs.  Women however are more socialized than men to take care of themselves.

In younger ages of gender the population is roughly the same, but the gap is evident when you compare the elder gender. In 1996 two thirds of people aged seventy five or over were women. This climbed to three quarters at the age of eighty five. The life expectancy rate for men and women has a gap of about four years.

ETHNICITY

Social inequalities are not only affected by our social class and gender, ethnicity can influence our health and well being also. The norms and values of an ethnic race can have an impact on their health.

Sickle cell is biologically more likely to affect Afro-Caribbean's than any other ethnic group. In an Asian community where they carry out their daily norms by covering themselves from head to toe they are more likely to encourage rickets, a vitamin D deficiency, due to lack of exposure to the sun. Their diet can also result in higher levels of obesity.

Racism plays a huge part in the ethnic minority. The high levels of abuse that occurs in the lower classes can affect the persons mind and self esteem, causing depression, stress or anxiety. Racism can also result in unemployment or working long hours for little pay.

Medical services could result in problems with the ethnic groups through the lack of being able to communicate. Literature which gives advice for a particular illness may still not have been translated into their ethnic minority language, causing confusion and a sense of not belonging.