Download MC-Medical_Sociology_chapter_3

Medical Sociology
Twelfth Edition
William C. Cockerham
Chapter 3
The Social Demography of Health:
Social Class
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
Introduction
• In the United States, the poor face substantial
barriers in life:
– Typically have worse health than the affluent
– Are treated within the framework of welfare
medicine
– Live in disadvantaged urban and rural locales
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
Introduction
• Socioeconomic status or social class is the
strongest and most consistent predictor of a
person’s health and life expectancy across the
life course regardless of access to health care
or health care delivery system
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
The Components of Social Class
• A social class is a category or group of people
who have approximately the same amount of
wealth, status, and power in a society
• Different models exist:
– Five-class model used in the U.S.:
•
•
•
•
•
Upper class
Upper-middle class
Lower-middle class
Working class
Lower class
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
The Components of Social Class
• Europeans tend to focus more on occupational
differences as the chief component of class
position
• American sociologists usually rely on
socioeconomic status (SES)
– Influenced by theories of Karl Marx and Max Weber
– Wealth an important component but Weber also
included social status and power
– Measured by three variables:
• Income
• Occupational prestige
• Education
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
The Components of Social Class
• Education appears to be the most important
component of SES in predicting health
outcomes
• Influences:
– Knowledge about healthy lifestyles
– Seeking preventive care or medical treatment for
health problems when needed
– Likelihood of having better income and satisfying
jobs
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
The Components of Social Class
• Importance of individual components of SES
and their impact on health varies over the life
course
– Education influences the onset of chronic diseases
– Income becomes more important later in life;
determines how health problems progress
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
The Components of Social Class
• The poor have the greatest exposure to risk
factors that cause ill health:
– Physical (poor sanitation, poor housing)
– Chemical (pollution)
– Biological (bacteria, viruses)
– Psychological (stress)
– Economic (low income, unhealthy jobs)
– Lifestyle (poor diets, smoking, lack of leisure-time
exercise)
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
Modern Diseases and the Poor
• Chronic diseases are most associated with
modernization and were associated with
upper classes
– Lifestyle changes among the affluent have
reduced their risks of chronic diseases
• Poor more likely to suffer from:
– Infectious diseases
– Chronic diseases
– Mental illness
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
Modern Diseases and the Poor
• Richard Wilkinson’s “income inequality
hypothesis”
– Blames degree of inequality among classes within
a society for health inequalities
– Society’s overall level of wealth less important
– Compelling argument but thus far findings in
other research have not supported his position
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
Equality of Care in Britain
• After World War II, socialized medicine was
introduced in Great Britain
• Provides the lower classes with the same
medical care available to the upper classes
• Only access to health care was equalized –
social class differences unchanged
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
Equality of Care in Britain
• Equalization of health care alone has not
reduced the disparity in health between social
classes
• Black Report in 1980 sponsored by British
government
– Assessed trends in population health
– Demonstrated health inequalities were not
decreasing among different social classes despite
increased welfare services
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
The Social Gradient in Mortality
• Whitehall studies conducted by Marmot
– Showed social class differences in mortality
among British male civil government employees
– Regardless of the cause, those with the highest
occupational rank had the lowest percentage of
deaths
– Mortality increased across each job category
– Lowest-ranked occupations had the highest
percentage of deaths
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
The Social Gradient in Mortality
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
The Social Gradient in Mortality
• Social gradient observed even among
relatively high ranked groups, where poverty
was not an issue
• Differences in mortality were linked to
hierarchy rather than deprivation
• Observed in numerous countries, regardless of
the specific variable used to indicate social
position
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
The Social Gradient in Mortality
• Possible reasons for gradient include
differences between classes in:
– Self-esteem and stress levels
– Effects of income inequality
– Deprivation through life course
– Health lifestyles and social support
– Socioeconomic environment
– Use of preventive health services
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
Neighborhood Disadvantage
• Five features of neighborhoods that can affect
health:
1)
2)
3)
4)
5)
Physical environment
Surroundings at home, work, and play
Services provided to support people
Sociocultural aspects of the neighborhood
Reputation of an area
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
Neighborhood Disadvantage
• Orderly neighborhoods are clean and safe,
houses and buildings are well maintained, and
residents are respectful of each other and
each other’s property
• Disorderly neighborhoods reflect a breakdown
in social order, as there is noise, litter, poorly
maintained houses and buildings, vandalism,
graffiti, fear, and crime
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
SES as a Fundamental Cause
of Sickness and Mortality
• SES can be described as a direct cause of poor
health because it:
1) Influences multiple diseases
2) Affects these diseases through multiple
pathways of risks
3) Is reproduced over time
4) Involves access to resources that can be used to
avoid risks or minimize the consequences of
disease if it occurs
Copyright ©2012 by Pearson Education, Inc. All rights reserved.
SES as a Fundamental Cause
of Sickness and Mortality
• The degree of socioeconomic resources a
person has or does not have, such as money,
knowledge, status, power, and social
connections, either protects health or causes
premature mortality
Copyright ©2012 by Pearson Education, Inc. All rights reserved.