Modern Studies ConferenceModern Studies Conference

Website for overheads and handouts:Website for overheads and handouts:

http://www.abdn.ac.uk/pir/hmsc

Health & WealthHealth & Wealth

Chris Wright – Dept. of SociologyChris Wright – Dept. of Sociology

School of Social Science University of AberdeenSchool of Social Science University of Aberdeen

Health & WealthHealth & Wealth

1.1. Relevance to the Higher Modern Studies Relevance to the Higher Modern Studies curriculumcurriculum

2.2. Health and wealth not separate but interdependentHealth and wealth not separate but interdependent

3.3. Contexts:Contexts: a)a) Global Global b)b) Modern economies Modern economies c)c) USA USA d)d) UK UK e)e) Scotland Scotland

Health Data - DefinitionsHealth Data - Definitions

Mortality RateMortality Rate The The death ratedeath rate of particular social of particular social groups. It provides a measure of health risk, groups. It provides a measure of health risk, improvements in the quality of health care and the improvements in the quality of health care and the comparative overall health of a groupcomparative overall health of a group

Morbidity RateMorbidity Rate Statistics used in the analysis of Statistics used in the analysis of ill-ill-healthhealth.. They can be given in the form of either the They can be given in the form of either the number of sufferers from a particular condition or number of sufferers from a particular condition or the proportion of the overall population with that the proportion of the overall population with that conditioncondition

Source: Oxford Dictionary of SociologySource: Oxford Dictionary of Sociology

Health and Wealth- Global ContextHealth and Wealth- Global Context

In general:In general: As a society’s wealth As a society’s wealth (Gross (Gross Domestic Product)Domestic Product) increases so does health increases so does health. . But:But:

OECD (advanced) economies:OECD (advanced) economies: Increases in Increases in these societies wealth have less effect on these societies wealth have less effect on health outcomes health outcomes (mortality and morbidity (mortality and morbidity rates)rates) than does the promotion of income than does the promotion of income equality within the societyequality within the society

Source:Source: Wilkinson in Gordon Wilkinson in Gordon ‘Inequalities in health’‘Inequalities in health’

"THERE IS A VERY STRONG "THERE IS A VERY STRONG ASSOCIATION BETWEEN INCOME ASSOCIATION BETWEEN INCOME INEQUALITY AND UNDER-FIVE CHILD INEQUALITY AND UNDER-FIVE CHILD MORTALITY AMONG THE WEALTHIER MORTALITY AMONG THE WEALTHIER OECD COUNTRIES”OECD COUNTRIES”

OECD countries with the highest infant mortality rate: OECD countries with the highest infant mortality rate:

U.S., U.K. CanadaU.S., U.K. Canada

Collison, D. et al "Income inequality and child mortality in wealthy nations" Collison, D. et al "Income inequality and child mortality in wealthy nations" Journal of Public HealthJournal of Public Health, 2007, Vol. 29, No. 2, pp. 114-117, 2007, Vol. 29, No. 2, pp. 114-117

Health & Wealth: measuring ‘class’ and wealthHealth & Wealth: measuring ‘class’ and wealth

1.1. The welfare interest of the modern state in The welfare interest of the modern state in acquiring knowledge on citizens; acquiring knowledge on citizens; official official data gatheringdata gathering

2.2. Significance of infant mortality rates; Significance of infant mortality rates; registration of births and deathsregistration of births and deaths

3.3. USA:USA: Income measure – Income measure – cut-off problemcut-off problem

Health & Wealth - USAHealth & Wealth - USA

1.1. Federal political systemFederal political system

2.2. Health outcomes among individual states Health outcomes among individual states are heavily influenced by the degree of are heavily influenced by the degree of income equality within statesincome equality within states

3.3. Market based health provision but state Market based health provision but state provision through provision through Medicare Medicare (elderly) and (elderly) and MedicaidMedicaid (poor) is significant(poor) is significant

Health & Wealth: measuring ‘class’ and wealthHealth & Wealth: measuring ‘class’ and wealth

UK:UK: National data is typically analysed by National data is typically analysed by Occupational StatusOccupational Status, , a ‘proxy’ (stand-in) for a ‘proxy’ (stand-in) for income and social classincome and social class

Local studies sometimes use a Local studies sometimes use a deprivation deprivation indexindex applied to regions or cities e.g. the applied to regions or cities e.g. the Scottish Index of Multiple Deprivation Scottish Index of Multiple Deprivation (SIMD)(SIMD)

R-G Classification of OccupationsR-G Classification of Occupations

1.1. Professionals and Senior managementProfessionals and Senior management

2.2. Middle managementMiddle management

3.3. a)a) Routine clerical workRoutine clerical work

b)b) Skilled manual workSkilled manual work

4.4. Semi-skilled manualSemi-skilled manual

5.5. Unskilled manualUnskilled manual

Health & Wealth - UKHealth & Wealth - UK

1.1. The significance of the establishment of the The significance of the establishment of the National Health Service, 1948. Health National Health Service, 1948. Health provision provision free at the point of deliveryfree at the point of delivery

2.2. Goal not only to improve overall health but Goal not only to improve overall health but to achieve greater equality of outcomesto achieve greater equality of outcomes

3.3. Throughout 20th century general health has Throughout 20th century general health has improved but improved but classclass differences in health differences in health outcomes have widenedoutcomes have widened

Health & Wealth in UK- Black ReportHealth & Wealth in UK- Black Report

1.1. Enquiry into the effects of the NHS, published Enquiry into the effects of the NHS, published 1980, chairmanship of 1980, chairmanship of Sir Douglas BlackSir Douglas Black

2.2. Findings:Findings: General health had improved in UK General health had improved in UK since the introduction of the NHS, continuing a since the introduction of the NHS, continuing a trend from the early years of the 20trend from the early years of the 20thth century century

3.3. However, the better health outcomes of higher However, the better health outcomes of higher occupational groups as measured by occupational groups as measured by infant infant mortality rates, life expectancymortality rates, life expectancy and and inequalities in inequalities in the use of medical servicesthe use of medical services persisted and may persisted and may have increasedhave increased

Black ReportBlack Report

Evidence of increasing health inequalities despite Evidence of increasing health inequalities despite the NHS:the NHS:Class 1Class 1 1930’s1930’s mortality rate = mortality rate = 90%90% of national of national average; average; 19721972 = = 77%77%Class 5Class 5 1930’s1930’s mortality rate = mortality rate = 111%111% of national of national average; average; 19721972 = = 137%.137%.Steady ‘gradient’ from 1-5, i.e. increasing class Steady ‘gradient’ from 1-5, i.e. increasing class differencesdifferences

Sources Black Sources Black Inequalities in healthInequalities in healthBerridgeBerridge Poor Health; inequalities in health before and after Poor Health; inequalities in health before and after

the Black reportthe Black report

Health & Wealth in UK- Acheson ReportHealth & Wealth in UK- Acheson Report

1.1. Report delivered in 1998; Report delivered in 1998; Sir Donald AchesonSir Donald Acheson

2.2. Class inequalitiesClass inequalities had increased further since the had increased further since the Black reportBlack report

3.3. Mortality rates among occupational groups Mortality rates among occupational groups showed persistent increase of differential showed persistent increase of differential outcomes, to the benefit of higher occupational outcomes, to the benefit of higher occupational groups, groups, even over a relatively short period of even over a relatively short period of timetime

Sources: Acheson Sources: Acheson Independent inquiry into inequalities in healthIndependent inquiry into inequalities in health

Gordon Gordon Inequalities in health: the evidenceInequalities in health: the evidence

Acheson ReportAcheson Report

1.1. Mid-1970’sMid-1970’s: males in lower occupational groups : males in lower occupational groups had a death rate had a death rate 53%53% higher than males in class higher than males in class 1 & 2; 1 & 2; 10 years later10 years later it had risen to it had risen to 68%68%

2.2. Mid-1970’sMid-1970’s: females in lower occupational : females in lower occupational groups had a death rate groups had a death rate 50%50% higher than higher than females in class 1 & 2; females in class 1 & 2; 10 years later10 years later it had risen it had risen to to 55%.55%.

3.3. If all groups had the same death rate as groups 1 If all groups had the same death rate as groups 1 & 2 over this period, there would have been & 2 over this period, there would have been 17,00017,000 fewer deaths per year in the early 1990’s fewer deaths per year in the early 1990’s

4.4. Inverse CareInverse Care and and Inverse PreventionInverse Prevention “Laws” “Laws”

Accidents aren’t RandomAccidents aren’t Random

Audit Commission Report 2007:Audit Commission Report 2007:1.1. Children of never unemployed/long term Children of never unemployed/long term

unemployed parents are: unemployed parents are: a) a) x13x13 more likely to die from more likely to die from

unintentional injury andunintentional injury andb) b) xx37 more likely to die as a result of more likely to die as a result of

exposure to smoke, fire or flames than children of exposure to smoke, fire or flames than children of parents in higher managerial and professional parents in higher managerial and professional occupations occupations

2.2. Children in the Children in the 10 per cent most economically 10 per cent most economically deprived areasdeprived areas are are x3 x3 more likely to be hit by a car more likely to be hit by a car than children in the than children in the 10 per cent least deprived areas10 per cent least deprived areas

Better safe than sorry: preventing unintentional injury in childrenBetter safe than sorry: preventing unintentional injury in children

Childhood Road Traffic Accidents; Scotland 2008Childhood Road Traffic Accidents; Scotland 2008

““Tackling Inequalities”: Dept of Health 2006Tackling Inequalities”: Dept of Health 2006

1.1. Spearhead Initiative Spearhead Initiative - areas of greatest health - areas of greatest health deprivation in England & Wales= deprivation in England & Wales= 28%28% of the population of the population

2.2. Response to official goal to reduce class-based health Response to official goal to reduce class-based health inequalities, infant mortality and life expectancy, by inequalities, infant mortality and life expectancy, by 10%10% by by 20102010..

3.3. February 2009. February 2009. Official statement that only Official statement that only 19%19% of of Spearhead sites would achieve their targets; in Spearhead sites would achieve their targets; in 66%66% of of sites the gap with the national average was wideningsites the gap with the national average was widening

4.4. Thus, in order to achieve the goal Thus, in order to achieve the goal trends have to be trends have to be reversed.reversed.

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085307http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/

PublicationsPolicyAndGuidance/DH_091414PublicationsPolicyAndGuidance/DH_091414

Current SituationCurrent Situation

However, whilst the health of all groups in England is However, whilst the health of all groups in England is

improving, over the last ten years health inequalities improving, over the last ten years health inequalities

between the social classes have widened—the gap has between the social classes have widened—the gap has

increased by 4% amongst men, and by 11% amongstincreased by 4% amongst men, and by 11% amongst

women—women—because the health of the rich is improvingbecause the health of the rich is improving

more quickly than that of the poor.more quickly than that of the poor.

House of Commons Health Committee: Health Inequalities. House of Commons Health Committee: Health Inequalities.

Third report vol. 1. 15Third report vol. 1. 15thth March 2009 (emphasis added) March 2009 (emphasis added)

Health & Wealth ScotlandHealth & Wealth Scotland

Deprivation Index:Deprivation Index: income, crime, employment, income, crime, employment, education etceducation etc

As deprivation increases so health outcomes worsen.As deprivation increases so health outcomes worsen.InstancesInstances a)a) For both men and women death rate from For both men and women death rate from

heart disease is heart disease is x2x2 in most deprived as in least in most deprived as in least deprived areasdeprived areas

b)b) Cancer rates are highest and survival Cancer rates are highest and survival rates lowest in the most deprived areas. In least rates lowest in the most deprived areas. In least deprived areas the relationship is reversed deprived areas the relationship is reversed

c)c) Self-Assessment: Self-Assessment: 61%61% of residents of least of residents of least deprived areas believed they were in good health deprived areas believed they were in good health compared to compared to 45%45% in most deprived areas in most deprived areas

Equally Well Equally Well : http://www.scotland.gov.uk/Publications/2008/06/09160103/3. : http://www.scotland.gov.uk/Publications/2008/06/09160103/3. Information Services Division (ISD) ScotlandInformation Services Division (ISD) ScotlandSee also the work of See also the work of S. MacIntyreS. MacIntyre

Stroke and Deprivation: Scotland Stroke and Deprivation: Scotland

Heart Disease & Deprivation; ScotlandHeart Disease & Deprivation; Scotland

All cancers: Scotland 2006All cancers: Scotland 2006

Current SituationCurrent Situation

Scotland’s health is improving rapidly but it isScotland’s health is improving rapidly but it is

not improving fast enough for the poorest not improving fast enough for the poorest

sections of our society. Health inequalities…sections of our society. Health inequalities…

remain our greatest challengeremain our greatest challenge

Equally Well: report of the ministerial task force on healthEqually Well: report of the ministerial task force on health

inequalities vol. 2 inequalities vol. 2

June 2008June 2008

Explaining Explaining Health & WealthHealth & Wealth Relationship Relationship

PossiblePossible Explanation Explanation::

Adapting arguments of Adapting arguments of

a) a) M. WeberM. Weber

Life-chancesLife-chances how a person’s relationship to how a person’s relationship to the ownership of property and scarce skills affects the ownership of property and scarce skills affects their ability to achieve their goals such as high their ability to achieve their goals such as high quality education, good health, secure employment. quality education, good health, secure employment.

Source: Source: Sage Dictionary of SociologySage Dictionary of Sociology

Explaining Health & Wealth relationshipExplaining Health & Wealth relationship

b) b) P. BourdieuP. Bourdieu

Life chances are affected by access to:Life chances are affected by access to:

1.1. Economic capitalEconomic capital

2.2. Social capitalSocial capital

3.3. Cultural capitalCultural capital

Explaining Health & Wealth relationshipExplaining Health & Wealth relationship

Economic capitalEconomic capital:: Resources that Resources that provide wealthprovide wealth

Relevant to distribution of e.g.Relevant to distribution of e.g.

1.1. HousingHousing warm/dry warm/dry versusversus cold/damp cold/damp

2.2. NeighbourhoodNeighbourhood play areas play areas versusversus street street

3.3. DietDiet fruit, vegetables fruit, vegetables versus versus high-fathigh-fat

Explaining Health & Wealth relationshipExplaining Health & Wealth relationship

Social Capital: Social Capital: Resources that create Resources that create social solidarity and access to social solidarity and access to valued networksvalued networks

Relevant to distribution of :Relevant to distribution of :

1.1. SupportSupport – Mutual assistance (– Mutual assistance (RosettoRosetto) ) ((GlasgowGlasgow))

2.2. TrustTrust – Encouragement to be healthy – Encouragement to be healthy ((AberdeenAberdeen))

Explaining Health & Wealth relationshipExplaining Health & Wealth relationship

Cultural Capital: Cultural Capital: Resources that give Resources that give access to valued knowledge access to valued knowledge e.g.e.g.

1.1. LanguageLanguage – Doctor - Patient interaction– Doctor - Patient interaction

2.2. EducationEducation - capacity to understand - capacity to understand health informationhealth information

The EndThe End

Good LuckGood Luck