Class and Social Determinants of Health

1. SOC108 – TOPIC 3
Class and Social Determinants
of Health

2. Learning and teaching objectives
• Differentiate between the main explanations
of health inequality.
• Understand the concept of class as a way of
making sense of health inequalities.
• Explain how class differences impact on health
inequalities in Australia.
• Outline the relationship between class and
workplace health and safety.
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3. The Unequal Social Distribution of
Illness
• Illness (and health) is unequally distributed in
society.
• The major socio-economic influences on
illness are:
– Occupation
– Income
– Diet
– Living conditions
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4. Major Explanations of Health
Inequality (Germov, 2014, pp. 87-93)
• Artefact explanations – health inequalities are due to statistical
anomalies.
• Natural/social selection explanations – social and health inequality
is a result of biological inferiority on the part of particular groups.
• Cultural/behavioural explanations – individual risk-taking or
illness-related behaviour (e.g., a poor diet) as the source of health
inequality.
• Materialist/structuralist explanations – key role of poor living and
working conditions in the production of health inequalities.
• Psychosocial/social capital explanations – widening income
inequality leads increased stress and insecurity, and impacts
negatively on health.
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5. Health Inequality:
A Sociological Approach
• Most sociologists favour
structuralist/materialist explanations of health
inequality.
• Why? This approach moves away from victim-
blaming/individualistic accounts and directs
attention to the broader social environment,
and the class structure of society, in shaping
health inequality.
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6. Class
• May be defined broadly as: ‘A position in a system
of structured inequality based on the unequal
distribution of power, wealth, income and status’
(Germov, 2014, p. 82).
• Not the same as socio-economic status (SES). SES
directs our attention to levels of inequality in
society but does not explain why such inequality
exists.
• Social determinants (epidemiologists) vs class
(sociologists).
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7. Class
Two main sociological perspectives on class:
• Marxist: focuses on the relationship between those
who own and control the means of production
(capitalist class/bourgeoisie) and those who have only
their labour to sell (proletariat).
• Weberian: argues that property is not the only thing
that determines one’s class position; the possession of
marketable skills is also important – this gives rise to a
more complex class structure which includes a middle
class whose position is based largely on education and
skills.
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8. Class and Health
• There is a clear relationship between patterns of morbidity,
mortality and social class.
• The living and working conditions experienced by the
working class contributes to health-damaging behaviours
(e.g., nutritionally poor diet; high rates of smoking) and
poorer health.
• The middle and upper classes experience generally better
health due to greater job autonomy and security, the
income to afford a healthy lifestyle as well as access to
good quality housing.
• However, it is important to keep in mind that class-based
health inequalities are also shaped by other group
distinctions based upon gender, age and ethnicity.
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9. Class and Workplace Health:
Applying your Learning
• Read pp.105-106 in the chapter by Schofield
and address the following questions:
– In what ways is class relevant to this issue?
– Which theoretical perspective(s) is most relevant
and why?
– Can you think of other recent examples in
Australia where there is a relationship between
work and illness?
– Why is the workplace often a cause of premature
death and illness?
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10. Further Reading
• Friel, S. (2014) “How social class affects health” The Conversation, 11th March
http://theconversation.com/how-social-class-affects-health-23366
• Victorian Health Care Association “Addressing the Social Determinants”
http://www.populationhealth.org.au/index.php/component/docman/doc_downlo
ad/5-social-determinants?Itemid=
• Marmot, M. (2005). “Social determinants of health inequalities”. Lancet,
365(9464), 1099-1104.
• World health Organisation (2012) : Social Determinants of health esp “Key
concepts” http://www.who.int/social_determinants/sdh_definition/en/
And watch…
• Richard Wilkinson 2011 “How economic inequality harms society” TED talks at
http://new.ted.com/talks/richard_wilkinson
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