The Importance of SES to Health
`What Can We Do?
- Advocate policies that encourage medical and health promoting advances while breaking the link between the advances and SES resources - May be accomplished by reducing disparities in SES resources or developing interventions that are more equally distributed
The Importance of SES to Health
Regardless of what country poor people live in, what type of health insurance they receive, the poor still have the worst health of all. This finding persists across all diseases with few exceptions and throughout the life span.
Smoking behavior
The poor are twice as likely to smoke as people from high incomes
Bubonic Plague & SES
The poor disproportionately more affected. - Difference in sanitation - Wealthy could move to the countryside
Models of class for US medical sociologists
UC: extremely wealthy top corporate execs UMC: affluent well educated professionals and high-level managers LMC: office and sales workers, small business owners, teachers, managers WC: skilled and semi-skilled, lower level clerical workers LC: semi and unskilled, chronically unemployed
Difference between wealth and status
Whereas wealth is an objective dimension, status is subjective related to the esteem accorded by other people - status indicates person's social prestige, which may or may not correspond to wealth
Historical changes of poor and medical care
Years ago were less likely to seek medical care but systemic reasons were found for this (high charges, long waits, poor relationships) and this is changing (Medicare and Medicaid)
Social class
a category or group of people who have approximately the same amount of wealth, status, and power in a society
Difference between Weber and Marx
source of class more than just wealth alone - status and power were important too
Similarity between Weber and Marx
the basic source of class distinction was unequal distribution of goods and wealth
Simplest model of class
upper, middle, lower
SES as a "Fundamental Cause" of Mortality
Enduring association of low SES with illness, disability and death has led Link and Phelan to propose SES as a "fundamental cause" of mortality
How are the poor especially disadvantaged in relation to positive health lifestyles
Less access to health information and resources Less control over sleeping hours and food choices More likely to live in a social environment where unhealthy eating, smoking and heavy drinking are normal, making risky lifestyle formation more probable
Can Access to Healthcare Solve the Class Problem?
No - medical care alone cannot counter the adverse effects of class position on health. Even in Britain, where everyone has access, there remains a significant gap in health and life expectancy. Medical care is unable to overcome adverse effects of things like living conditions and negative lifestyles.
Socioeconomic Status (SES)
income, occupational prestige, and level of education
SES is the most important factor in
lifestyle selection and participation
Occupation
measures status, responsibility at work, physical activity, and health risks
Importance of SES as a fundamental cause of mortality
most in the past viewed SES as a contributing factor to poor health and mortality but not as a direct cause and because diseases and risk factors that appeared to account for inequalities seen in earlier periods have been virtually eradicated in the developed world
What does class help determine
personal opportunities and life experiences
Education and health
postpone the onset of poor health, but without income, it does little to slow the deterioration of health for people already in poor health
Education
reflects a person's skills for acquiring positive social, psychological and economic resources such as good jobs, nice homes, health insurance, access to quality healthcare, and knowledge about healthy lifestyles
Income
reflects spending power, housing, diet, and medical care
Four Essential Features of the Theory (Phelan)
1. Influence multiple diseases (not limited to only one or a few diseases or health problems) 2. Affects disease outcomes through multiple pathways of risk (risk factors) 3. Involve access to resources that can be used to avoid risks or minimize the consequences of disease if it occurs 4. Be reproduced over time by replacing intervening mechanisms - SES meets all four criteria
Britain's models of class
began using a 7-tiered model in 2001 based on differences in employment relationships (decision-making autonomy and job security) and work conditions (promotion opportunities and influence over planning); since moved to ten-class model
American model of class
focuses on a broader measure of SES derived from ideas about social stratification put forward by Max Weber
European model of class
focuses on a person's occupation