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