Health Inequalities Result From Social Inequalities

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Health inequalities are defined as the differences in health status or in the distribution of health resources among different population groups due to the social context in which individuals are born, live in and work. Health inequality is more rampant between individuals from financially poor backgrounds, as there are no adequate resources to treat them and when they are present, they are prohibitively expensive for them. This essay will discuss the social determinants of health and how the cause inequalities, providing points for and against the proposition that health inequality are as a result of social inequalities.

World health organisation has identified several social determinants of health that cause inequalities in the provision of health if not properly managed. The first social determinant of health is the social gradient; the social status of an individual determines his life expectancy with the more affluent people living longer than those from poor backgrounds do. This can be explained by the fact that individuals who are higher in the social ladder can be able to access quality health services such as medication and insurance when they are in need of them, however, this is not possible with those in the lower parts of the ladder since they cannot afford quality health services. However, this argument has not been without opposition since there are some individuals from the lower social classes who live much longer than those from upper social classes (UCL institute of health equity, 2013). This can be explained by the lifestyle of individuals from poor backgrounds who rely on the foods that nature provides freely or those available cheaply, coincidentally, those food that nature provides have been shown to have huge health benefits.

Using the neo materialist approach to understand social inequalities as causes of health inequalities emphasises on combination of negative exposures and lack of adequate resources at the disposal of an individual coupled with systematic under investment across a diverse human, political and cultural processes. These are both cumulative exposures of the individual to negative material circumstances and the lack of adequate resources to mitigate those negative impacts; this is made worse by the lack of government or the relevant authorities to invest in social and welfare infrastructures. Using this perspective, the neo materialists argue that it is the practical, tangible and economic circumstance facing the rich or poor individuals in the society that account for a large number of inequality cases in the health sector. For instance, the rich population in the society is able to access specialised medical attention for their ailments due to the high cost of such services; however, the poor population do not enjoy this privilege since they cannot afford the financial burden that comes with it. Other differences that contribute to health inequality according to the neo materialist approach include differences such as the risky or damaging type of employment opportunities that the poor work take, sub standard housing and living in polluted environments goes to show some of the differences that these two groups have which increase inequality in health.

Another aspect of neo material explanation in health inequality involve psychological explanations, which have been used in public health to promote strategies, which do little to reduce the levels of in equalities. A good example of this type of explanation is the focus on communities and the campaign to create social capital and enhance social cohesion while paying little attention to material inequalities, which are the main causes of the problem.

The neo materialistic approach however has some several challenges. One of them is that it is difficult to see how owning some goods as neo materialists argue has an effect on inequality levels in health directly or through primary means. For instance, owning more than one vehicle does not add any positive health benefit for a person, on the contrary, it may have a negative impact on his health since he will have less incentive to walk or take an exercise. Increase in levels of obesity in the developed countries in America and Europe can be attributed to the improved social and financial status of an individual since he is more likely to use a car for all his travelling.

This approach to health inequalities is more rampant in economies such as that of United States of America, which is funded locally, and there is weak legislation in health and safety at work and there is no universal access to free health care. This goes to show that there is more to health care inequality than the neo materialistic approach cares to explain.

Psychosocial explanations take into account other factors that the neo materialistic approaches do not. While psychosocial theorist acknowledge the role of access to good, adequate health and safety in explaining inequality in health care, controlled experiments involving all known material determinants account for only a third of the total inequality in health care. There are three aspects of psychosocial explanation that explain the harm caused to health by unequal societies which include social status, comparisons involving shame and respect, stress in childhood and lack of friends and social support.

For any human being, childhood encompasses critical and sensitive period where biological aspects that are important to the development of cognitive and emotional processes. The significance of childhood processes is such that the parameters that are developed during this phase are likely to develop into cumulative patterns, which affect their life in later stages; it has been proven that most of the children who grow in stressful environment are more likely to experience the same circumstances in their adulthoods. This happens when a child is deprived a certain factor to development, which in turn leads to another, for instance, a child who has been brought up in poverty, will most likely go to a low quality school, get low grades therefore employed in low paying jobs which are a health hazard. This theory in explaining social behaviour has however been disputed due to the fact that a large number of individuals who grew up with stressful childhoods are not disadvantaged in their adulthood, in any case they are more successful than those who were brought up in families with less childhood stressors.

Social relationships are one of the key ingredients of well being of an individual such that lack of friend and low social status leads to chronic stress which is a common phenomenon in most of the developed countries currently. Social status is a central phenomenon in shame where an individual compares himself or herself with other people who are more socially advance than him or her where he feels a shameful discomfort if the values that he cares about or the opinions of others are such that they make him feel inferior. Shame can also be viewed as a social emotion, and with humans being evaluative beings, it is a threat that can cause exclusion from the social circles that an individual belongs to. Wilson and Picket (2009) says that “Larger inequality seems to increase people’s social estimation concerns by increasing the significance of social standing. (Wilkinson & Pickett 2009 p.43-44)

The psychosocial explanation of inequality is usually based on the biology of stress response where certain types of stress can be linked to bodily responses such as raised or blunted Cortisol. These stressors operate through the sympathetic adrenal medullary and the hypothalamic pituitary adrenocortical systems, which produce signs and symptoms similar to those of aging therefore increasing the psychological costs of mitigating the changes. This has the effect of causing medical complications especially chronic illnesses such as stroke and heart diseases therefore increases mortality rates especially in the developed countries in America and Europe. Increase in mortality and morbidity ratios is mostly common in the most unequal countries, this is attributable to a sense of control over ones responsibilities and a sense of autonomy, which in turn relate to the position that one occupies in the social hierarchy. In addition, the demands from an individual and the level of remuneration in relation to the amount of work that he does also influences the health status where presence or absence of social support. Stress that is linked to hierarchical working condition cannot be used to explain the whole extent of the inequality in health since there are very few organisational settings that use hierarchical model. Most of the organisations especially in the civil servants do not have hierarchies in employment and stress among employees working in such organisations can only be explained by other factors such as the normal ‘wear and tear’ of life.

In order to reduce inequalities in health, several measures should be taken depending on the source and extent of inequality (Jones & Douglas, 2012, 98). For material sources of health inequality, governments should be ready to enact policies that ensure income disparities are reduced, these includes ensuring the most underprivileged members of the society have access to basic goods and services such as food, clothing, quality education and quality health care. In addition, lawmakers should target policies that reduce unemployment levels, as this will increase the income available to pay for quality health care services (BBC, 2013). Policies that guarantee employees their safety while in their jobs should also be implemented since most of the risky jobs are taken by the less privileged in the society.

The government should also aim at encouraging healthy living among the citizens that include trying to avoid stress at all costs. In addition, individuals should be encouraged to foster healthy social relationships since they have been found to reduce stress and promote health among the people in those relationships. Health inequality brought about by the circumstances that people are born and brought up in should be addressed by improving those circumstances to ensure children are brought up in environments that will encourage them to be live healthy lives by not looking down on themselves and striving to improve themselves.

Reducing inequalities in health will involve several steps and actions will bring several ethical issues in to focus. One of the ethical issues that is likely to come up is discrimination in improving health between rich and the poor; while some disease such as obesity may be more common among the rich, others are more common among the poor. The ethical dilemma comes on which of the diseases affecting the two groups should be addressed first and through which methods since the two groups have equal rights and none should be treated favourably at the expense of the other. In order to reduce the income disparities, the government will need to enact measures to ensure that the poor benefit more and sometimes at the expense of the rich, this causes the conflict as some of the poor that the government want to help may be poor as a result of being lazy while the rich worked for their money. This may demoralize the rich from working harder since some of the incentives to working harder are taken away from them. Enacting policies that require organisations to ensure safety standards of their employees to some extent goes against the principle of free markets since the employees are aware of the risks that they are exposing themselves to when they took those job, however, , the government is also responsible for protecting its citizens from of harm (Douglas et al, 2009, 65).

Inequality in health is usually caused by materialistic factors, which include disparities in income and living conditions, and psychosocial factors such as stress and upbringing of individuals since childhood, which includes the conditions that they were brought up in. Government intervention is required to ensure that these causes of inequalities are reduced which include measure to reduce income disparities and encourage healthy living.

References

“Young jobless are ‘public health time-bomb’ warns WHO”, BBC News UK. 13th October 2013. Accessed on 13th Nov, 2013. HYPERLINK “http://www.bbc.co.uk/news/uk-24757807” http://www.bbc.co.uk/news/uk-24757807.

Douglas, J., Earle, S., Handsley, S., Jones, L. J., Lloyd, C. E., & Spurr, S. (Eds.). 2009. A Reader in Promoting Public Health. Sage.

Jones, L. J., & Douglas, J. (Eds.). 2012. Public Health: Building Innovative Practice. SAGE.

UCL institute of health equity. 2013. Poverty and income inequalities accessed on 13th Nov 2013 HYPERLINK “http://www.instituteofhealthequity.org/themes/poverty-and-income-inequalities” http://www.instituteofhealthequity.org/themes/poverty-and-income-inequalities.

Wilkinson, R. & Pickett, K. 2009, The Spirit Level: Why More Equal Societies Almost Always do Better, Penguin Books Ltd., London