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Modern Studies Conference

Modern Studies Conference

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Modern Studies Conference

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  1. Modern Studies Conference Website for overheads and handouts: http://www.abdn.ac.uk/pir/hmsc Health & Wealth Chris Wright – Dept. of Sociology School of Social Science University of Aberdeen

  2. Health & Wealth Relevance to the Higher Modern Studies curriculum Health and wealth not separate but interdependent Contexts:a) Global b) Modern economies c) USA d) UK e) Scotland

  3. Health Data - Definitions Mortality RateThe death rate of particular social groups. It provides a measure of health risk, improvements in the quality of health care and the comparative overall health of a group Morbidity RateStatistics used in the analysis of ill-health. They can be given in the form of either the number of sufferers from a particular condition or the proportion of the overall population with that condition Source: Oxford Dictionary of Sociology

  4. Health and Wealth- Global Context In general:As a society’s wealth (Gross Domestic Product) increases so does health. But: OECD (advanced) economies:Increases in these societies wealth have less effect on health outcomes (mortality and morbidity rates)than does the promotion of income equality within the society Source:Wilkinson in Gordon ‘Inequalities in health’

  5. "THERE IS A VERY STRONG ASSOCIATION BETWEEN INCOME INEQUALITY AND UNDER-FIVE CHILD MORTALITY AMONG THE WEALTHIER OECD COUNTRIES” OECD countries with the highest infant mortality rate: U.S., U.K. Canada Collison, D. et al "Income inequality and child mortality in wealthy nations" Journal of Public Health, 2007, Vol. 29, No. 2, pp. 114-117

  6. Health & Wealth: measuring ‘class’ and wealth • The welfare interest of the modern state in acquiring knowledge on citizens; official data gathering • Significance of infant mortality rates; registration of births and deaths • USA: Income measure – cut-off problem

  7. Health & Wealth - USA • Federal political system • Health outcomes among individual states are heavily influenced by the degree of income equality within states • Market based health provision but state provision through Medicare (elderly) and Medicaid(poor) is significant

  8. Health & Wealth: measuring ‘class’ and wealth UK: National data is typically analysed by Occupational Status, a ‘proxy’ (stand-in) for income and social class Local studies sometimes use a deprivation indexapplied to regions or cities e.g. the Scottish Index of Multiple Deprivation (SIMD)

  9. R-G Classification of Occupations • Professionals and Senior management • Middle management • a)Routine clerical work b)Skilled manual work • Semi-skilled manual • Unskilled manual

  10. Health & Wealth - UK • The significance of the establishment of the National Health Service, 1948. Health provision free at the point of delivery • Goal not only to improve overall health but to achieve greater equality of outcomes • Throughout 20th century general health has improved but class differences in health outcomes have widened

  11. Health & Wealth in UK- Black Report • Enquiry into the effects of the NHS, published 1980, chairmanship of Sir Douglas Black • Findings: General health had improved in UK since the introduction of the NHS, continuing a trend from the early years of the 20th century • However, the better health outcomes of higher occupational groups as measured by infant mortality rates, life expectancy and inequalities in the use of medical servicespersisted and may have increased

  12. Black Report Evidence of increasing health inequalities despite the NHS: Class 11930’s mortality rate = 90% of national average; 1972= 77% Class 51930’s mortality rate = 111% of national average; 1972= 137%. Steady ‘gradient’ from 1-5, i.e. increasing class differences Sources Black Inequalities in health Berridge Poor Health; inequalities in health before and after the Black report

  13. Health & Wealth in UK- Acheson Report • Report delivered in 1998; Sir Donald Acheson • Class inequalities had increased further since the Black report • Mortality rates among occupational groups showed persistent increase of differential outcomes, to the benefit of higher occupational groups, even over a relatively short period of time Sources: Acheson Independent inquiry into inequalities in health Gordon Inequalities in health: the evidence

  14. Acheson Report • Mid-1970’s: males in lower occupational groups had a death rate 53% higher than males in class 1 & 2; 10 years later it had risen to 68% • Mid-1970’s: females in lower occupational groups had a death rate 50% higher than females in class 1 & 2; 10 years later it had risen to 55%. • If all groups had the same death rate as groups 1 & 2 over this period, there would have been 17,000 fewer deaths per year in the early 1990’s • Inverse Care and Inverse Prevention “Laws”

  15. Accidents aren’t Random Audit Commission Report 2007: • Children of never unemployed/long term unemployed parents are: a) x13more likely to die from unintentional injury and b) x37more likely to die as a result of exposure to smoke, fire or flames than children of parents in higher managerial and professional occupations • Children in the 10 per cent most economically deprived areas are x3more likely to be hit by a car than children in the 10 per cent least deprived areas Better safe than sorry: preventing unintentional injury in children

  16. Childhood Road Traffic Accidents; Scotland 2008

  17. “Tackling Inequalities”: Dept of Health 2006 • Spearhead Initiative - areas of greatest health deprivation in England & Wales= 28% of the population • Response to official goal to reduce class-based health inequalities, infant mortality and life expectancy, by 10% by 2010. • February 2009. Official statement that only 19% of Spearhead sites would achieve their targets; in 66% of sites the gap with the national average was widening • Thus, in order to achieve the goal trends have to be reversed. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085307 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091414

  18. Current Situation However, whilst the health of all groups in England is improving, over the last ten years health inequalities between the social classes have widened—the gap has increased by 4% amongst men, and by 11% amongst women—because the health of the rich is improving more quickly than that of the poor. House of Commons Health Committee: Health Inequalities. Third report vol. 1. 15th March 2009 (emphasis added)

  19. Health & Wealth Scotland Deprivation Index: income, crime, employment, education etc As deprivation increases so health outcomes worsen. Instancesa) For both men and women death rate from heart disease is x2 in most deprived as in least deprived areas b) Cancer rates are highest and survival rates lowest in the most deprived areas. In least deprived areas the relationship is reversed c) Self-Assessment: 61% of residents of least deprived areas believed they were in good health compared to 45% in most deprived areas Equally Well : http://www.scotland.gov.uk/Publications/2008/06/09160103/3. Information Services Division (ISD) Scotland See also the work of S. MacIntyre

  20. Stroke and Deprivation: Scotland

  21. Heart Disease & Deprivation; Scotland

  22. All cancers: Scotland 2006

  23. Current Situation Scotland’s health is improving rapidly but it is not improving fast enough for the poorest sections of our society. Health inequalities… remain our greatest challenge Equally Well: report of the ministerial task force on health inequalities vol. 2 June 2008

  24. Explaining Health & Wealth Relationship Possible Explanation: Adapting arguments of a) M. Weber Life-chanceshow a person’s relationship to the ownership of property and scarce skills affects their ability to achieve their goals such as high quality education, good health, secure employment. Source: Sage Dictionary of Sociology

  25. Explaining Health & Wealth relationship b) P. Bourdieu Life chances are affected by access to: • Economic capital • Social capital • Cultural capital

  26. Explaining Health & Wealth relationship Economic capital:Resources that provide wealth Relevant to distribution of e.g. • Housing warm/dry versus cold/damp • Neighbourhood play areas versus street • Dietfruit, vegetables versus high-fat

  27. Explaining Health & Wealth relationship Social Capital: Resources that create social solidarity and access to valued networks Relevant to distribution of : • Support– Mutual assistance (Rosetto) (Glasgow) • Trust– Encouragement to be healthy (Aberdeen)

  28. Explaining Health & Wealth relationship Cultural Capital: Resources that give access to valued knowledge e.g. • Language– Doctor - Patient interaction • Education - capacity to understand health information

  29. The End Good Luck