Excerpt
Table of Contents
Abstract
How to assess Inequalities in Health
Concept of Measuring Health
Concept of Inequalities
Concept of Social Class
Existing Inequalities
Life Expectancy
Infant Mortality
Life Satisfaction
Conclusion
Inequalities as a Social Problem
Table of Figures
Bibliography
Abstract
This essay is about inequities in health and to what extent they are seen as a social problem. In the first part the measurements for “inequalities” and “health” are clarified. Applying these measurements, the second part highlights currently existing inequalities in health in the UK today. The last part of the essay assesses the question why inequalities steam from social differences and what makes them problematic.
How to assess Inequalities in Health
In 1977, the working group of inequalities in health, known as the “Black Group”, was given the task to review information about differences in health status between the social classes;...,’ (Black, 1980: p.10). More than thirty years have passed since that first official assessment of the impact of social differences on the status of health. But still the question to reveal inequalities in health (the first part of the essay) is the same.
Concept of Measuring Health
Our understanding of what we perceive as health and ill-health is not a stable construct. It rather has varied throughout the past and according to experience, society and situational factors and each subgroups of the society will have a slightly different focus about how to understand health (Black, 1980: pp.12). In order to assess health and differences in health, our subjective constructs and understandings of health first need to be transferred into measurable, operational terms.
According to the Black report, the most common measurements of health are ‘mortality rate, prevalence or incidence morbidity rates, sickness-absence rates and restricted-activity rates’ (Black, 1980: pp.12). This essay will mainly focus on mortality rates which are in line with the Black report and a very familiar form of measurement. However each measurement has its own limitation and it should be mentioned that the major drawbacks of mortality rate is that it tends to underestimate the prevalence of chronic illness and other disease which influence human “well-being”. Therefore it is critical to keep in mind other forms of assessment and combine those, for example a reflection of social, emotional and physical functions (Black, 1980: pp.12) such as the measurement of life satisfaction included into this analysis.
Concept of Inequalities
The term inequality in health is not simply a question of assessment as clarified above. Once we have identified how to measure health, we need to clarify what is understood by inequalities.
The Black report differentiates between inequalities and differences. Differences such as in race, sex or age are naturally occurring and therefore not seen as problematic. Inequalities however are ‘brought about by social … organizations and … tend to be regarded as undesirable or of doubtful validity by groups of society` (Black, 1980: pp.16). Consequently it can be said that the Black report shapes the term both as resulting from socio-economic differences and as morally not neutral. This specific meaning should be carried in mind throughout the text. However not everybody appreciates the rather loaded and slightly ambiguous meaning of the term. Therefore the World Health Organization rather proposed the term `inequities` for inequalities which are unjustifiable and undesirable (Macintyre, 2002: p.210).
Concept of Social Class
Why is social class used as a measure and how is it constructed?
After assessing how to measure health we now need to define the second variable, a measure of inequalities. As the discussion on inequalities above suggests, it ought to be some kind of social-economic construct. In Britain, there has been a long tradition of measuring inequalities in health in terms of occupational class or status. This is dating back as long as the seventeenth century and was rather adopted by Black in 1980 then newly constructed (Macintyre, 2002: p.198). The widespread use of occupation can be accounted for by its comparable easy usage. As Black explains it, `inequalities are difficult to measure and trends in inequalities in the distribution of income and wealth, for example, cannot be related to indicators of health, except indirectly. Partly for reasons of convenience, therefore, occupational status or class (which is correlated closely with various other measures of inequality), is used as the principal indicator of social inequalities ….’ (Black, 1980: p.14).
Occupational status is therefore strongly related to a wide range of other factors associated with inequalities such as housing, education, income-level and life-style. It will hence be used in the analysis. The Registrar General's Social Class (RGSC) of socio-economic classification is applied, although since 2001 the new National Statistics Socio-Economic Classification (NS-SEC), with up to eight occupational categories, has been introduced. (Office of National Statistics, 2010: p.1)
However in order to ensure that past statistics are correctly incorporate into the analysis of long-term trends, the following “old” classification system is used:
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