The Relationship Between Social Class and Health Essay Example

  • Category: Health, Health Care,
  • Pages: 8
  • Words: 1938
  • Published: 18 July 2020
  • Copied: 103


Michael Marmot has argued that the relationship between class and health is the major unsolved public health problem in the industrialised world. Critically assess explanations for this relationship between social class and health outcomes.

Sir Michael Marmot is a world-renowned epidemiologist who has spent his studies looking at the social determinants of health and how it can be interpreted when looking at the social gradient in terms of mortality and morbidity. Social class is a group of people of a similar status that commonly share commensurate levels of power and wealth. We should be careful not to get it mixed up with income level but rather see it from an occupational role or those who share a similar function that they take upon in society and where it ranks. As you go higher in ranks, there will be a shift in the levels of education, influence, and power that those with a low social class cannot identify with. It is seen that those with low to no social class tend to be the majority of the population and as we increase in class, the number of people decreases. This leads to the argument that Sir Michael Marmot makes when stating that the relationship between social class and health outcomes is the biggest unsolved public health problem in this day and age. 

The definition of health that will be central to this essay is from the World Health Organisation who have defined health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO, 1948). There has been an increased interest in looking at the relationship between class has when it comes to health outcomes. I will draw on previous studies that have looked at the relationship between social class and health and see whether they back up Sir Marmot’s argument.

This paper will heavily refer also to the social gradient of health which 'refers to the fact that inequalities in population health status are related to inequalities in social status.’ (ref). Social class has an important part when it comes to an individual’s physical health, ability to gain access to sufficient healthcare services, nutrition, and life expectancy. We can identify one’s socioeconomic status (SES) by seeing what the level of access to healthcare that individual is granted. People who identify in the lower spectrum of the gradient tend to face numerous health issues but are not able to access healthcare facilities when needed. When they do, the quality of service is low which is sad even though they face a higher risk of health problems that the rest of the population. Some of the health problems low SES have a higher risk of facing are; morality (especially infants), cancer, cardiovascular diseases (CVD), and disabling physical injuries (ref). 

Low Income Leads to Worse Health 

Studies have consistently informed us that having a low socioeconomic status is a disadvantage that alarmingly plays a role in ethnic inequalities in health. The health status of an individual is highly correlated to their socioeconomic status across the social gradient and it can be seen that the most advantaged have better health while those less advantaged deal with greater health consequences and risks. This can be examined by the neighbourhood in which we situate throughout our lives (from access to healthcare services, deprivation of infrastructure, stress, and lack of social support) may influence our health consciously and subconsciously. The environments in which we surround ourselves with can be backed up as there is evidence that claims that lower socioeconomic status groups tend to have poorer experiences than other classes. These backup Sir Michael’s argument that the relationship between social class and health outcomes is the biggest unsolved problem for public health across the world. 

In an article by Sir Michael Marmot ‘The Health Gap: The challenge of an unequal world’, he discusses the idea how our social and economic conditions mould the lives we are able to live which has led us to have inequities when it comes to health. Sir Michael Marmot has stated in his previous works that the social determinants of health look at the conditions in which people are born, grow, live, work and age in. The fact that there are inequities in power, money, and resources influence the conditions we face in our everyday lives. Sir Marmot makes an interesting statement in this article saying that ‘the perspectives of looking for ‘causes of the causes’ allow us to recognize the advantages/disadvantages there are which majority are of widespread and institutional discrimination’. 

The Impact of Social Class on the Child’s Early Life Development

Institutional discrimination is defined as the biased and ambiguous methods of treating an individual that is ingrained into our policies, laws, and/or objectives of big organizations. It truly supports Sir Marmot’s argument in relation to social class and health outcomes being a major unsolved problem in public health. He goes on to explain how an abnormal upbringing and being in poverty have a massively detrimental effect on a child’s early life development. There has been evidence to show that poor schooling does reduce the chances of getting a good job, a solid income, and healthy living conditions. Sir Marmot also states that a healthy lifestyle is not a priority for those that live in an environment where discrimination and crime are embraced as ‘the norm’ and only diminishes people’s social integration in life. He goes on to explain how the social gradient of health involves all of us and we all need to do our part in decreasing the disparity gaps between the rich and the poor. 

We are often been told that the rich are getting richer, while the poor are getting poorer. This can be seen from two perspectives, one is that the poor are to blame for not being accountable for their own health and choosing bad behaviours that don’t benefit them in any way, the other perspective is that we as a society creating opportunities for ourselves where consequently the poor are getting poorer and we don’t mind as long as it doesn’t affect us. Another aspect that Sir Marmot discussed was that social and economic conditions influence parenting which affects early child development. He discusses two strategies to tackle this issue; reduce poverty and support parents and families. 

Having both lower levels of child poverty and higher quality of services to support families improve the quality of early child development. Sir Marmot says that in order to decrease the health gap between rich and poor, we need to reduce any avoidable inequalities throughout our lifespan when it comes to our health. This starts with having equity from early child development all the way through to having better conditions for the elderly (ref). 

In another article by Sir Marmot titled ‘Social justice, Epidemiology, and Health Inequalities’, he goes on to discuss the importance of focusing on the social gradient when it came to health. 

Social Gradient in Health is a Major Health Problem

Sir Marmot explains that to ignore the social gradient in health is to ignore a major health problem across all societies which supports the argument of this essay. He uses Figure 1 to explain how that even though over time everyone’s health was improving, there is still a gap within the gradient. This suggests that we do not only need to improve the health of the populations, but we also need to decrease the inequalities within our populations. All societies have a health social gradient, but they vary. There is evidence that those from Scandinavian countries have a higher life expectancy rate as well as smaller inequalities. 

This is something that Sir Marmot says every country needs to be taking note of why they are so far ahead with tacking these public health issues compared to the rest of us. In this paper, health is seen as an outcome. Sir Marmot discusses how psychosocial influences are key when looking at the health inequalities that exist within societies. He elaborates how it contributes to our health inequalities, which are; early childhood development and education foreshadow the rest of an individual’s lifespan, behaviours influence health, stress pathways are an initiator to physical disease, and that social disadvantages consequently contribute largely to an individual’s mental health. Sir Marmot concluded this paper by saying that ignoring health inequalities that can be avoided yet aren’t is unjust and that we need evidence- based policies to achieve social justice for all. 

An article by David Matthews titled ‘Social class and its influence on Health’ highlights 5 main ideas that he drew from his study. They are; 1) there is a clear link between poverty and health, 2) being insecure and having a poorly paid job has detrimental effects on an individual’s health, 3) materialistic influences health (e.g. diet, housing, work conditions, etc), 4) Inequalities in health and wellbeing are stemmed off the inequalities of economics and social conditions that society has constructed, and 5) striving for wealth actually does more harm than good to your wellbeing. We can look at the social gradient again and see that health worsens as you progressively go down the scale. The relationship between social class and health can be seen when focusing on diet, housing, working conditions, and the urban environment.

The influence that social class has on an individual’s health when looking at the diet is that those with poor education will opt for less nutritious foods as they lack in money as well. Poor housing can be seen as a social class aspect that affects one’s health, this can be seen as it increases the risk of accidents happening with overcrowding, unsafe conditions, and can lead to respiratory problems as well. As for working conditions and its relationship with health is that worldwide, there are around 340 million occupational accidents and 160 million victims of work-related illnesses annually (ref). An individual’s job can affect their mental health very differently. This can be seen as those at the bottom of the social gradient may feel inadequate and lost making them feel isolated, whereas, on the other hand, those who are at the top of the social gradient may feel the pressure of always having to perform well which can lead to stress when has a negative impact on an individual’s health and wellbeing. 

One’s urban environment can influence their health as where one lives and poverty, play a major role in the access and availability of services, housing conditions, and crime rates. David makes a clear statement saying that health inequalities aren’t solely linked to income but also to the inequalities of wealth within society. This has caused a negative impact on the population’s health and we need to right our wrongs. One way we can truly diminish health inequalities by highlighting and focusing on individuals and the environments where deprivation, poverty, and economic insecurity has become a norm. It has been said time and time again that a healthy society lays a foundation built on; equality, social justice, and social cohesion. To have these three in action will reduce the social gradient gap in health that has become such an alarming concern due to Sir Marmot’s studies and theories. 

An article by McCartney and his colleagues titled ‘Theorising Social Class and Its Application to the Study of Health Inequalities’ explain that social class can be defined as “… people’s structural location with the economy”. There are many theories that can help illustrate social class relations, they are; Individual attributes, Habitus & Distinction, Discrimination, Intersectionality, Opportunity hoarding & social closure, exploitation & domination, power, and time (lifespan, intergenerational transmission, and social mobility). These theories are co-dependent of one another as well as being intertwined together. By looking at Wright’s model (shown beside), we can see that social classes process themselves and influence the power they have between classes. 

Depending on the exposure for each class, can explain the different health, social experiences, and outcomes. Poor health may influence the social class processes in relation to market position and occupation. By seeing all the diverse mechanisms that make up social class allow us to analyse them and their relation to certain health outcomes. When we are looking and health and using social class as a measurement,, we need to consider the roles of power relations and legal rules within society, the importance of social background (how someone is bought up), habitus and distinction, discrimination, social closure and opportunity hoarding, relative positions and power of social class in the markets – in regards to exploitation and domination. This way we can make fair and understanding findings in our future studies about the relationship between social class and health.