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Social Inequalities and Health – The Black Report

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The term health inequalities describe the fact that health varies between individuals: the term refer to the systematic differences in the health of groups occupying unequal positions in society (socioeconomic groups).

In 1977 a committee was set up by the Labour Government headed by Sir Douglas Black to research the health chances of the population of Britain. Sir Douglas Black and his team came out with a report on inequalities health with emphasis on social class differences in health. This report is referred to as “The black report”.

The black report confirmed that there is a class gradient to Health, thus the inequalities associated to social class.

The report however, used four theories to explain social class differences in health, which are:

The behaviour / cultural theory – this explains self negligence among the lower class group, e.g. Irregular or no medical check-ups, poor / wrong dieting, insufficient exercise, irregular visit to the dentist. It also emphasized that the lower class engage in activities detrimental to health, e.g. smoking, Alcohol consumption. This argument sees the individual as bearing primary responsibilities for poor health (Anthony G. 2001). These habits are transcended to their children therefore transmitting ill health across the generations. I t is also explained that such behaviours are embedded in the social context rather than individual control which describes lifestyle and consumption as causes of poor health.

Another theory is the Structural / material theory; sees a number of factors that influences poorer health in the lower social class group, e.g. Inadequate housing (overcrowding), low income, poor diet, dangerous working environment (exposure to asbestos causes cancer), stress and depression. These factors in turn leads to immediate gratification (smoking, drinking and use of drugs), reducing access to quality health care. It also linked material deprivation to health inequalities between classes (Anthony G. 2001)

Natural and Social selection theory- it explains that people are in the lower social group as a result of their poor health, which prevents them from obtaining and maintaining high ranking jobs. It further describes that lower class group as a consequence rather than the cause of poor health. Peter T. (1988) further explained that people with poor drift to the bottom of the Registrar General occupational scale (Peter, T. 2001). This can be argued against because the lower social class group rely on the public health insurance which provides the minimal quality of care while the upper social class have private insurance which provides maximal health care.

However, the artefact theory argues that health inequalities are not real but are consequence of the use of inappropriate statistics and definition of social class

This approach suggests that both health and class are artificial variable and the widening gap between classes is the shrinking size of the poorer class (Peter, T. 2001).

The Black report also contained suggested measures to improve social class inequalities in health. The Conservative Government headed by Mrs. Margaret Thatcher however disregarded this reports as inappropriate thereby calling for another phase of research.

In 1997 an enquiry board headed by Sir Donald Acheson, was set up to look into the Health Inequalities and produce a report as well as recommendations to reduce inequalities.

The Acheson report had similarities with the black report in health inequalities with

Different approach like:

1. to review the latest available information on inequalities in health, and identify trends;

2. identify priority areas for future policy development likely to offer opportunities for beneficial, cost effective and affordable interventions to reduce health inequalities

3. the report will be published.

The Acheson report (1998) was able to identify and relate social gradient to poor health and made recommendations for interventions to reduce these inequalities.

The table below shows the social scale according to employment status;

Socioeconomic position refers to an individual’s place in the social hierarchies built around education, occupation and income. These three components of socioeconomic position are determining influence on an individual’s life chances and living standards. Each can be used to provide a hierarchical classification of socioeconomic position: from no qualifications to degree-level qualifications, from unskilled manual jobs to professional jobs, and from low income to high income.

A northwest-southeast divide in social class inequalities existed in Great Britain at the start of the 21st century, with each of the seven social classes having higher rates of poor health in Wales, the North East and North West regions of England than elsewhere. The widest health gap between social classes, however, was in Scotland and London, adding another dimension to the policy debate on resource allocation and targets to tackle the health divide.

The following table shows death rates by sex and social (occupational) class in those aged 15 to 64 years in rates per 1000 population. It relates to England and Wales 1971 and males refer to all males but females refer to married women only and classify them by their husband’s social class.

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