07 soc in health.p65
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SociologyFactsheet
1
Social Differences in Health
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’.
Dubos and Pines extend this definition ‘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
equirements 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
ecognised 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.
Exam Hint: It is a good idea to show that you understand the
problems involved in defining health within and between
societies. Problems with defining health make it difficult to
measure it accurately.
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 XXXXXXXXXXBoth were
controversial as they identified failures of the NHS to seriously
address differences in health opportunities and claimed that the
est 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:
‘in the last twenty years extensive research literature…. has
shown continuing, and in some cases increasing differentials
in mortality and mo
idity rates between socio-economic
groups, men and women, regions of the country and ethnic
groups.’ (DHSS 1993)
Sociological explanations of differences in health between different
groups can be classified into four main theories.
Social constructionist
Natural and
Social Selection
Materialist-structuralist
Cultural-behavioural
This explanation claims that, for a
variety of reasons, the evidence on
which measurements are based is
largely invalid. It may be because of
methodological inadequacies or to do
with the socially constructed and
changing nature of key concepts.
Official health statistics must not be
taken at face value because the
processes by which they are
constructed may lead to distortion.
Natural selection interpretations are
applied particularly to gender and
ethnic groups and seek to explain
health differences in terms of alleged
genetic, biological or physiological
differences between groups. The
social selection explanation suggests
that rather than seeing ill-health as a
consequence of low social position,
it is instead a major cause of class
position. One of the main reasons fo
people being in a high social class is
their relatively good health.
This seeks to explain the rates of
mortality and mo
idity of different
classes, gender and ethnic groups by
focusing on their different material o
class circumstances and experiences
which result from this.
This attributes group differences to
members’ different norms, values,
knowledge and behaviours. Fo
example some have a better diet, some
are more liken to smoke.
There is widespread agreement among sociologists with Black’s
and Whitehead’s conclusions that structural and cultural factors
are the main contributors to health differences. However, in reality
these factors are intertwined, and constructionist and selectionist
explanations also play some part in the reported differences.
Exam Hint: These four explanations can be used to explain
differences in health for class, gender and ethnicity. If you
know these explanations you can use the evidence below
to support these explanations.
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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
ecause occupational classes are social constructions which
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 poo
health than those who were upwardly mobile.
Materialist-structuralist. These explanations emphasise 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 greater risk of accidents and
pollution. This explanation was the one most favoured 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 behaviours
of social classes and the knowledge, attitudes and values of people
in different social position. Lower social groups are shown to eat
more white
ead, smoke and drink more and watch more TV
compared to the middle classes who live a healthier life.
Social class V is a large group of people despite declining
proportion of the population.
Criticisms
Many factors influence mobility, not just health. Education is more
important than health in explaining mobility.
Social mobility cannot explain most of the differences as most ill-
health occurs in middle age when a person’s social class position
is established.
This explanation ignores the individual’s responsibility for thei
own health.
Class differences remain even when behavioural patterns are
accounted for.
Behaviour cannot be separated from social context.
Poor living and working conditions can influence people’s ability
to choose a healthy lifestyle.
This approach blames the victims of poor health for their difficulties
ather than focusing attention on structural inequalities.
Some argue that many middle class jobs can be stressful.
Exam Hint: In the exam you will be awarded marks for good understanding, appropriate evidence and evaluation.
To show understanding - clearly describe the different explantions.
• Evidence - use statistics/studies to support the explanations.
• Evaluation - use criticisms of the explanation or use the other explanations as an alternative.
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Health and Gende
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
ecause 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 gende
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 regula
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
occu
ence 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 oestrogen. 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 fo
good health and the different social positions of men and women.
Women are more likely to be in poverty as a result of thei
concentration in low paid employment and they are more often
eliant on state benefits as a result of old age or single parenthood.
This means they are more prone to illnesses resulting from poo
housing, inadequate diets and stress produced by insecurity.
Radical feminists emphasise that it is the housewife-mother role
which makes women sick.
Cultural-behavioural. Gender socialisation and societies role
expectations of males and females lead to differences in behaviours
which produce inequalities in health. Men are more likely to take
part in risk activities, like driving too fast, drinking alcohol and
smoking more and are more likely to be involved in violence.
According to Seligman XXXXXXXXXXfemales have traditionally been
socialised into being less able to cope with stress than males and
are therefore at greater risk from depression and other stress related
illnesses.
Criticisms
Health statistics may reveal more about behaviour processes than
eal differences in health.
Natural selection explanations can only provide limited answers
egarding gender inequalities and health. In the majority of cases,
differences resulting in biology can be ove
idden by social,
economic and environmental factors.
More women today are independent and choose to remain single.
Welfare state supports single parents.
More women today are becoming involved in ‘male orientated’
sports and occupations and are now drinking more and smoking
more. The issue of stress is highly debatable. Many argue women
cope better.
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Health and Ethnicity
Evidence