Social class has long contributed to health inequalities in the UK. People from lower social classes typically have less access to resources, poorer living conditions, and less healthy lifestyles, making them more vulnerable to illness and early death. This is evidenced by several historical artifacts, including a picture showing the wealth gap in Georgian Britain and Michael Marmot's Whitehall Study of civil servants which found higher mortality among lower-grade workers. The 1980 Black Report also documented increasing health inequalities between social classes in Britain and their social determinants like income, education, housing, and occupation rather than flaws in the healthcare system.

1. Answers: Introduction The purpose of this paper is to illustrate
Answers:
Introduction
The purpose of this paper is to illustrate the impact of social determinants of health (SDOH)
on health inequality using the three different artifacts. Social determinants of health such as
gender, social class, education, and economic status contribute to the health and wellbeing
of people, also there is a link between these SDOH such as social class and health
inequalities. Considering the fact that social equity is essential for the social health and
wellbeing of the community government has been optimistic and focuses on improving the
wellbeing of the population by reducing the gaps of social class, and unequal access to
resources (Preda, and Voigt, 2015). Differences in social calls and health inequality were
there before the existence of NHS, and HNS believed that health inequality can be reduced
by eliminating the social inequality and reducing the difference of social class. Thus, this
paper explains how different artifacts explain the relationship between social class and
health inequality (Goldblatt, 2016).
Impact Of Social Class On Health Inequality
Social class includes economic factors such as housing, access to resources, and living
conditions with physical factors. All these factors are linked with the health and wellbeing
of the population and cause health inequality based on the different social classes. For
example, people living with low income and lack of resources have complicated lifestyles
and they are often found suffering from obesity, and other cardiovascular diseases due to
unhealthy diet and lifestyle that increase the morbidity and mortality compared to the
people who have better living conditions and high social class (Bartley, 2016). Research
shows that morbidity and death statistics widely depend on the social class, people with low
social class are more vulnerable to wellbeing concerns. Social class is not only concerned
with housing and resources; however, it also includes the environment of the workplace
and education. Those who belong to the higher class tend to live more and have a better
working environment than low social class, hence it shows a relationship between the
occupation and health of individuals (Scambler, 2019).
Michael Marmot who originally investigated the impact of SDOH on the health and

2. wellbeing of workers found a strong relationship between the working class and the
mortality of people, and the working class is also linked with the lower socioeconomic
status (Marmot, 2017). In Whitehall, Study Marmot have revealed that Individual workers
with lower social class tend to receive low-grade jobs with low income, while people with
high standards received higher grade job as they have resources and opportunities and
higher education. The social class and living condition for low-grade workers does not
change and they become vulnerable to health issues by living in vulnerable situations,
hence, social status, income, and job affect the wellbeing of people. The Whitehall Study of
Marmot can be considered as an artifact explaining the social class and health inequality
who have received lots of recognition for his significant contribution to SDOH and wellbeing
(Lahelma aet al., 2015).
“From Ancient Rome to 20th Century Britain every historical age has experienced health
inequalities based on the wealth or social class of the population (BBC History, 2021)."
similarly, this problem also exists in the present UK. This pattern can be explained by a
pyramid structure, for example, people with low social class and low economic status are at
the bottom of the pyramid and are high in number, hence they have prone to health and
wellbeing challenges while numbers of people who have high social class are less and there
is the top, furthermore, the number reduces as the class of people increase, and they tend to
have low risk compared to the people who are at the bottom. “The 19th century has been
more unusual than it has left the mark on history. In the early 19th century, life expectancy
for middle-class people in London was higher than the working class, the middle class
expect to live 44 while the working-class only 22 (BBC History, 2021).”
How Artifacts Present Social Class And Health Inequality
There are various historical documents, images, and texts that have received significant
recognition, some of these artifacts can be used as evidence to explain the relationship
between social determinants of health and health inequalities. For example, the following
image shows the gap between rich and poor in Georgian Britain (Smith, 2013). It shows the
condition of the population in Britain from the early 18th century to the 19th century who
also experienced health inequalities due to the gap between poor and rich class people. This
artifact shows the history of social and health inequalities. Compared to the ancient times,
or Middle Ages, the modern world is only a little more equal to these times. Children
growing up today in the most deprived areas of Britain can hope to live between 85% and
90 percent as long as those at all denied regions. Maybe that extent is pretty much
consistent (BBC History, 2021).
Rich and Poor Gap, Georgina Britain, Source: (BBC History, 2021)
The second Artifact that explains the role of social status class in the health and wellbeing of
people is Michael Marmot’s White Hall study for civil servants of the UK. This has been one
of the oldest researches in the UK that explain the role of social determinants of health. “The

3. Whitehall investigation of British government employees started in 1967, showed a
precarious opposite relationship between social class, as surveyed by grade of business, and
mortality from a wide scope of infections (Marmot aet al., 1991).” “Somewhere in the range
of 1985 and 1988 Marmot examined the degree and reasons for the social angle in
bleakness in another partner of 10 314 government employees that included 6900 men, and
3414 females aged 35 to 55 (Marmot aet al., 1991).” The review has observed a relationship
between business-grade and commonness of angina, electrocardiogram proof of ischemia,
and indications of persistent bronchitis. Self-saw wellbeing status and side effects were
more regrettable in subjects in lower-status occupations (Tanaka aet al., 2018).
The black report was one of the very first documents published by the department of health
and social security in the UK that explain the relationship between social class, health, and
mortality. The black report was published in 1980 to show the health inequalities among
the working groups. The Report displayed exhaustively the degree to which infirmity and
deaths are inconsistently dispersed among the number of inhabitants in Britain and
recommended that these disparities have been augmenting rather than reducing since the
foundation of the National Health Service in 1948. “The Report presumed that these
imbalances were not principally owing to downfalls in the NHS, but instead to numerous
other social disparities affecting wellbeing: pay, instruction, lodging, diet, business, and
states of work (Gray, 1982).” As a result, the Report suggested a wide procedure of social
approach measures to battle imbalances in wellbeing. These discoveries and proposals
were essentially abandoned by the then Secretary of State for Social Services, not very many
duplicates of the Report were printed, and scarcely any individuals had the chance to
understand it. The Black Report is a significant archive that deserves wide attention and
discussion (Black, 1980).
Short Narrative
Social class has been selected as the social determinant of health for wide discussion as the
social class has been contributing to creating health inequalities in the United Kingdom for a
long time. Since the time of Georgian Britain, people living with low social-economic status,
and low social class have been facing various challenges such as lack of resources, poor diet,
and low income that affect their health and wellbeing and increase the vulnerability of
people.
Based on my personal experience in these areas, I can say that I have observed that people
with lower economic status are considered with lower class who often lives in areas where
they do not have proper resources such as rural or remote areas that also increase the
vulnerability of people. Furthermore, they are associated with a lifestyle and environment
that does not focus on a healthy diet, exercise and these people are often involved in
alcohol, drugs, and substance use that increase health problems.
The chosen SDOH (social class) has a huge impact on people. The important thing about this
SDOH is that it can predict the health and wellbeing of individuals or groups based on the
evidences. For example, people with high income and high social class are involved in
exercises, and have, more options for physical fitness, they regularly consult with doctors as

4. income is not a challenge to them, while low income is the main reason of lower-class
restrict them to access healthcare services, and leads to a typical lifestyle as discusses above
that increase the risk of morbidity.
Prior to this research, I have heard that social class is responsible for the challenges such as
health problems, education, and vulnerability, however, I have found that people living with
lower socio-economic status also have high mortality rate.
Conclusion
Based on the above analysis it can be concluded that SDOH such as income, education, and
socioeconomic status affect the health and wellbeing of a group or individual. It has been
found that lower social class makes people acquire various health problems that increase
mortality. The above-mentioned artifacts, a picture from Georgian Britain, Black Report, and
Whit Hall Study are the evidence that explain how socioeconomic status is linked with the
deaths and multimorbidity.
References
Bartley, M., 2016. Health inequality: an introduction to concepts, theories and methods. John
Wiley & Sons.
BBC History. 2021. Regency inequality: the gap between rich and poor in Georgian Britain.
[Online] Available at: https://www.historyextra.com/period/georgian/regency-inequality-
the-gap-between-rich-and-poor-in-georgian-britain/ [Accessed January 13, 2022]
Black, D., Great Britain Working Group on Inequalities in Health (1980). Inequalities in
health. Department of Health and Social Security.
Goldblatt, P.O., 2016. Moving forward monitoring of the social determinants of health in a
country: lessons from England 5 years after the Marmot Review. Global health action, 9(1),
p.29627.
Gray, A.M., 1982. Inequalities in health. The Black Report: a summary and
comment. International Journal of Health Services, 12(3), pp.349-380.
Lahelma, E., Pietiläinen, O., Rahkonen, O., Kivimäki, M., Martikainen, P., Ferrie, J., Marmot, M.,
Shipley, M., Sekine, M., Tatsuse, T. and Lallukka, T., 2015. Social class inequalities in health
among occupational cohorts from Finland, Britain and Japan: a follow up study. Health &
place, 31, pp.173-179.
Marmot, M.G., Stansfeld, S., Patel, C., North, F., Head, J., White, I., Brunner, E., Feeney, A. and
Smith, G.D., 1991. Health inequalities among British civil servants: the Whitehall II
study. The Lancet, 337(8754), pp.1387-1393.

5. Marmot, M., 2017. Social justice, epidemiology and health inequalities. European journal of
epidemiology, 32(7), pp.537-546.
Preda, A. and Voigt, K., 2015. The social determinants of health: Why should we care?. The
American Journal of Bioethics, 15(3), pp.25-36.
Smith, L., 2013. Lunatic Hospitals in Georgian England, 1750–1830 (Vol. 28). Routledge.
Tanaka, A., Shipley, M.J., Welch, C.A., Groce, N.E., Marmot, M.G., Kivimaki, M., Singh-Manoux,
A. and Brunner, E.J., 2018. Socioeconomic inequality in recovery from poor physical and
mental health in mid-life and early old age: prospective Whitehall II cohort study. J
Epidemiol Community Health, 72(4), pp.309-313.