Socio-economic inequalities in health.
And future ones on health risks, health promotion and public health, and ethnicity and
health inequalities.
What are socio-economic inequalities in health?
● Systematic differences in health between different socio-economic groups within a
society between classes, socially produced – so avoidable and largely considered
unacceptable – Dame Margaret Whitehead.
● Different from global inequalities, that is differences between countries not within.
E.g. life expectancy between UK and Uganda.
o More interested in lack of healthcare, poverty, starvation, malnutrition. But
also the global spread of ‘unhealthy lifestyles’
▪ Many countries have dual burden of ‘infectious diseases’ (malaria, TB)
and ‘diseases of affluence’ (stroke, cancer, more to do with lifestyles)
▪ BUT many would argue that inequality is pathogenic, and we must
look at inequality across national borders
▪ = structural violence (Paul Farmer 2003: Pathologies of power)
Socio-economic status.
● Different ways to measure, depends on variables such as job, level of education,
place of residence (see slide for graph)
Social gradient in health
● Higher social position, better the health (tends to be).
● No one side of healthy rich people and unhealthy poor, just the rich tend to be a
little healthier – it is a gradient (see slide for graph) – deaths in a particular
population at a time, north east and south west. People in north west with good
jobs, mortality rate is 2 in 1000, for e.g. big differences.
● (marmot review 2010)
● North south divides – in US, southern states are worse, in UK, South is better (life
expectancy), differences from one place to another, not just south and north – see
‘railway’ line graph on slide for better view, but generally better in south (UK).
Health inequalities in England – examples (may not be up to date)
• Infant mortality rates are 16% higher in children of routine and manual workers as
compared to professional and managerial workers
• Deaths from cardiovascular diseases are 2.7 times higher in the 20% most deprived
areas compared to the 20% least deprived
• Smoking rates are 28% and 24% respectively amongst men and women routine and
manual workers as compared to 16% and 14% amongst men and women
professional and managerial workers
• Alcohol related hospital admissions are 2.6 times higher amongst men and 2.4 times
higher amongst women in the 20% most deprived areas compared to the 20% least
deprived areas
, • Obesity rates are 27% and 34% amongst men and women routine and manual
workers as compared to 21% and 14% amongst men and women professional and
managerial workers.
Area-based approaches
• Inequalities in health also map onto geographical divides
• North versus south
• But also neighbourhood-level differences
• Context versus composition? = is the area unhealthy (poor housing, crime, no fresh
food), or do unhealthy people end up there?
Why are they studied?
● Mainly studied in public health, and some sociologists.
● Public health = “The science and art of promoting and protecting health and well-
being, preventing ill-health and prolonging life through the organised efforts of
society”. Faculty of Public Health, 2014
● academic discipline which is concerned with public health = epidemiology: the study
of patterns of disease occurrence in populations and the determinants that influence
these patterns (epidemiology of coronavirus)
● Determinants of disease are factors or events that result in a change in health
(biological, social)
How is group membership (E.G. socio-economic status) linked to health? Agency vs
structure.
• Epidemiology is interested in this question to aid prevention
• Public policy has a wider interest in the fair distribution of health resources, not just
preventional ill health but that aid is spread through population equally.
• Health inequalities are studied to inform policy on how to reduce them = to design
policy interventions
Epidemiology versus sociology
• Different paradigms (model, how knowledge is ordered and how u think about it) :
sociologists are concerned with social interactions and processes (link between
people), epidemiologists are concerned with the characteristics of individuals which,
in aggregate, predispose them to certain diseases (Nettleton 2006 p. 171 quoting
Stacey, 1987)
• Social epidemiology assumes that the distribution of advantages and disadvantages
in a society reflects the distribution of health and disease and focuses particularly on
the effects of social-structural factors on states of health.
• social sciences can shed light on the role of social-structural factors in determining
health – e.g. race, class, gender = perennial debate on individual versus structural
explanations for health inequality (Nettleton 2006 p. 173)
• study in order to address and solve these inequalities for equal health
How do we explain them? What is causing them? (epidemiology explanations)
a) Behavioural/Cultural
b) Materialist
And future ones on health risks, health promotion and public health, and ethnicity and
health inequalities.
What are socio-economic inequalities in health?
● Systematic differences in health between different socio-economic groups within a
society between classes, socially produced – so avoidable and largely considered
unacceptable – Dame Margaret Whitehead.
● Different from global inequalities, that is differences between countries not within.
E.g. life expectancy between UK and Uganda.
o More interested in lack of healthcare, poverty, starvation, malnutrition. But
also the global spread of ‘unhealthy lifestyles’
▪ Many countries have dual burden of ‘infectious diseases’ (malaria, TB)
and ‘diseases of affluence’ (stroke, cancer, more to do with lifestyles)
▪ BUT many would argue that inequality is pathogenic, and we must
look at inequality across national borders
▪ = structural violence (Paul Farmer 2003: Pathologies of power)
Socio-economic status.
● Different ways to measure, depends on variables such as job, level of education,
place of residence (see slide for graph)
Social gradient in health
● Higher social position, better the health (tends to be).
● No one side of healthy rich people and unhealthy poor, just the rich tend to be a
little healthier – it is a gradient (see slide for graph) – deaths in a particular
population at a time, north east and south west. People in north west with good
jobs, mortality rate is 2 in 1000, for e.g. big differences.
● (marmot review 2010)
● North south divides – in US, southern states are worse, in UK, South is better (life
expectancy), differences from one place to another, not just south and north – see
‘railway’ line graph on slide for better view, but generally better in south (UK).
Health inequalities in England – examples (may not be up to date)
• Infant mortality rates are 16% higher in children of routine and manual workers as
compared to professional and managerial workers
• Deaths from cardiovascular diseases are 2.7 times higher in the 20% most deprived
areas compared to the 20% least deprived
• Smoking rates are 28% and 24% respectively amongst men and women routine and
manual workers as compared to 16% and 14% amongst men and women
professional and managerial workers
• Alcohol related hospital admissions are 2.6 times higher amongst men and 2.4 times
higher amongst women in the 20% most deprived areas compared to the 20% least
deprived areas
, • Obesity rates are 27% and 34% amongst men and women routine and manual
workers as compared to 21% and 14% amongst men and women professional and
managerial workers.
Area-based approaches
• Inequalities in health also map onto geographical divides
• North versus south
• But also neighbourhood-level differences
• Context versus composition? = is the area unhealthy (poor housing, crime, no fresh
food), or do unhealthy people end up there?
Why are they studied?
● Mainly studied in public health, and some sociologists.
● Public health = “The science and art of promoting and protecting health and well-
being, preventing ill-health and prolonging life through the organised efforts of
society”. Faculty of Public Health, 2014
● academic discipline which is concerned with public health = epidemiology: the study
of patterns of disease occurrence in populations and the determinants that influence
these patterns (epidemiology of coronavirus)
● Determinants of disease are factors or events that result in a change in health
(biological, social)
How is group membership (E.G. socio-economic status) linked to health? Agency vs
structure.
• Epidemiology is interested in this question to aid prevention
• Public policy has a wider interest in the fair distribution of health resources, not just
preventional ill health but that aid is spread through population equally.
• Health inequalities are studied to inform policy on how to reduce them = to design
policy interventions
Epidemiology versus sociology
• Different paradigms (model, how knowledge is ordered and how u think about it) :
sociologists are concerned with social interactions and processes (link between
people), epidemiologists are concerned with the characteristics of individuals which,
in aggregate, predispose them to certain diseases (Nettleton 2006 p. 171 quoting
Stacey, 1987)
• Social epidemiology assumes that the distribution of advantages and disadvantages
in a society reflects the distribution of health and disease and focuses particularly on
the effects of social-structural factors on states of health.
• social sciences can shed light on the role of social-structural factors in determining
health – e.g. race, class, gender = perennial debate on individual versus structural
explanations for health inequality (Nettleton 2006 p. 173)
• study in order to address and solve these inequalities for equal health
How do we explain them? What is causing them? (epidemiology explanations)
a) Behavioural/Cultural
b) Materialist
