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The Unequal Distribution of Health Chances
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Social Inequalities in Health
In this course, Professor Michael Calnan (University of Kent) explores social inequalities in health. In the first lecture, we think about the unequal distribution of health chances and some examples of how this is mapped across a population. In the second lecture, we look at how to explain social inequalities in health, including the materialist, relative deprivation and cultural/behavioural/lifestyle explanations. Next, we think about equity and inequality in the context of the provision of and access to healthcare. In the fourth and final lecture, we think about how experiences and the prevalence of mental distress can be mapped socially, including by gender and ethnicity.
The Unequal Distribution of Health Chances
In this lecture, we think about the unequal distribution of health chances, focusing in particular on: (i) the fact that disease prevalence varies on both an individual and societal group level; (ii) the link between social hierarchy and health/life chances; (iii) social stratification, which results in social inequality; (iv) the three types of health inequality being the health status of a poor group, the health gap between a poor and non-poor group, and the gradient of illness/mortality rates across a population, defined by Graham in 2004; (v) the case that, while overall life expectancy improved from the 1970s to the 21st century, the gap between life expectancies in poor and rich groups remained stable; (vi) differentiating between life and healthy life expectancy, which are both influenced by income; (vii) the case that, while women still live longer than men on average, the gap in the last few decades has narrowed; (viii) the stalling of life expectancy improvement trajectories across all income levels in higher income countries, with older women from poor areas actually showing a decreased life expectancy; (ix) a potential link between austerity politics and life expectancy stalling; (x) Clare Bambra’s work, which found a North-South divide in life expectancy, with those living in the South of England having a higher life expectancy; (xi) Clare Bambra’s research, which found that life expectancy could be mapped across London based on district of residence; (xii) the link between being of a minority ethnic identity and having a lower sense of wellbeing; (xiii) intersectionality in health, which promotes the idea that factors such as area of residence, income, gender and ethnicity interact to produce health outcomes; (xiv) the fact that deaths by COVID-19 amplified these inequality outcomes, showing that individuals from deprived areas were much more likely to die from the disease than those from affluent areas, more so than with other conditions.
Hello? Uh, my name's, uh, Michael Call, and I'm a professor of medical
00:00:06sociology
00:00:11at the University of Kent.
00:00:13Today. I'm gonna be talking about social inequalities in health.
00:00:15The lectures are divided into three parts.
00:00:20Uh, and they are interrelated.
00:00:24So although they're parts, they do actually relate to each other.
00:00:26The first part is about the unequalled social dis
00:00:31distribution of health chances.
00:00:34Um,
00:00:36the second part is about inequalities in the provision of an access to health care.
00:00:37And
00:00:43the final part is about the nature
00:00:44and social distribution of mental illness and mental distress.
00:00:46Now they are interrelated. So,
00:00:51uh, although I'm going to talk about
00:00:53social patterning of
00:00:56physical illness and mental distress in, uh, separate parts,
00:00:57it's important that actually, they don't They aren't divorced from
00:01:02one another.
00:01:07The first thing I wanted to talk about
00:01:09is the social patterning of health and illness.
00:01:11Um,
00:01:15there is the idea that health and illness
00:01:17are not only experienced at the individual level,
00:01:18but that some diseases are more prevalent in some groups compared to others.
00:01:22So most groups are, uh uh, sorry.
00:01:28Most diseases are more prevalent in some groups than
00:01:30others,
00:01:33and it's related to social hierarchy as well.
00:01:35A person's social position or socioeconomic position.
00:01:39And their place in the social higher
00:01:43in the social hierarchy can influence their access to resources such as
00:01:45income, housing, employment, education,
00:01:52which in turn can influence their life chances and their, uh,
00:01:56health and life chances.
00:02:01This social hierarchy is linked to what's called the social,
00:02:04uh, the process of social stratification,
00:02:10which in turn result results in social inequality.
00:02:14Now the social
00:02:18social patterning
00:02:20tends to highlight and maps out
00:02:21the existence of such
00:02:24inequalities in health. And there's evidence of systematic,
00:02:26um,
00:02:31social inequalities in health by socioeconomic position and class,
00:02:32income, education,
00:02:38gender,
00:02:41ethnicity, religion,
00:02:43geographical place and a range of other
00:02:46social positions that Inter
00:02:50interact with one another.
00:02:53But let's focus
00:02:57principally on
00:02:59socioeconomic position
00:03:01and drawing on the work of Hillary Graham. It's possible to distinguish between,
00:03:04uh, different types, three different types of health inequalities.
00:03:09The first of that is the health status of a group defined as poor.
00:03:15So the focus is on those people, for whatever definition is used of poverty,
00:03:20uh, and their health status.
00:03:26The second approach actually looks at the comparison between
00:03:29the group that are poor in terms of their health status
00:03:34and how that is compared with another group. Maybe, uh, highly affluent groups
00:03:37and the third
00:03:44groups looks at the social gradient looks at the kind of social inequalities, um,
00:03:46and illness and mortality patterns across socioeconomic positions comparing,
00:03:53say,
00:04:00the very affluent with the moderately
00:04:01affluent with the poor.
00:04:04So it's the it's the social gradient of health, status and life expectancy
00:04:06that we're,
00:04:12um, interested in this concept. Now. The first two
00:04:13areas focus on absolute poverty or absolute absolute deprivation.
00:04:17The the third approach focuses on relative deprivation, and I'll talk about that
00:04:24in more detail when we talk about the explanations of social inequality.
00:04:30But next I'm gonna talk about, um,
00:04:38health chances and how that relates to socioeconomic
00:04:40position.
00:04:46And it's clear that, uh, between the 19 seventies and the 19
00:04:48and the early part of this century
00:04:53that, um,
00:04:56for each social economic group,
00:04:59uh, there was an improvement in life
00:05:02life expectancy. So over those 30 to 40 years,
00:05:04there was an improvement in life.
00:05:09It
00:05:12expectancy, particularly up to the kind of, uh, first part of this century.
00:05:14However,
00:05:20for each socioeconomic group Um Although there was an increase in life expectancy,
00:05:21there was the gaps in life expectancy between the,
00:05:28um higher and lower socioeconomic groups.
00:05:33The wealthy groups and the less wealthy groups stayed the same.
00:05:36So although there was improvements,
00:05:40there were still significant social inequalities across social class groups.
00:05:42There was also
00:05:50evidence of
00:05:51variation in life expectancy, according to what's called, UM,
00:05:53healthy life expectancy
00:06:00and life expectancy. Now, in terms of the concepts,
00:06:03um, life expectancy obviously is, um,
00:06:07the, uh,
00:06:11length of time that people live healthy Life
00:06:11expectancy is the length of time they live,
00:06:15uh, in a healthy state.
00:06:18And there's evidence that of income differences between
00:06:20not only life expectancy but healthy life expectancy,
00:06:25the most deprived
00:06:29groups actually have a lower life expectancy and a lower
00:06:31healthy life expectancy.
00:06:36What about trends
00:06:39by socioeconomic class,
00:06:41uh, which are related to gender?
00:06:44Well, there are differences in life expectancy between men and women.
00:06:46Women live longer than men.
00:06:51Um,
00:06:54and between 1982 and uh,
00:06:55the early part of this century,
00:06:59uh, within each socioeconomic group, males gain more life years than than females.
00:07:01Um, over that period.
00:07:08So, uh, men were catching women up
00:07:10in terms of their life expectancy, though, so the gap was beginning to narrow.
00:07:14There were many explanations for for that which, uh,
00:07:18we won't be able to
00:07:22address in this session.
00:07:23Female life expectancy in 2016
00:07:27was 3.6 years greater than for males in 2016.
00:07:31Male life expectancy
00:07:36is increasing faster than females clothing, closing the gap between the genders.
00:07:38So in a sense that although there is a difference between gender,
00:07:45the gap is closing.
00:07:49Of late, though,
00:07:51a different pattern has emerged and life expectancy
00:07:53has begun to stall.
00:07:57And this is occurring not just in the United Kingdom but
00:08:00in other high income countries such as the United States.
00:08:04Even people living in the most affluent areas have
00:08:09experienced slower improvements in life expectancy since 2011,
00:08:12so it's pre covid.
00:08:18Covid obviously had a
00:08:20major influence on life expectancy
00:08:21and excess mortality, but pre covid life expectancy began to stall,
00:08:24and for people living in the most deprived areas,
00:08:30improvement in life expectancy stalled for men and actually decrease for women.
00:08:33And this shows,
00:08:39even though life expectancy was stalling,
00:08:41it shows once again widening social inequalities.
00:08:44Now, there are lots of speculation about the the
00:08:49influences and causes of this, uh, slowing down
00:08:53in, uh, life expectancy,
00:08:58and it's stalling.
00:09:01Uh, but one of them is linked to the impact of government policy on
00:09:02austerity, the cuts in public expenditure
00:09:08since 2010.
00:09:12So that's actually been increasingly linked with, uh, life expectancy stalling.
00:09:14There's also,
00:09:21um, some work. And I'm drawing on the work of Claire Bam
00:09:23here about the relationship between life expectancy and where
00:09:26and where you live.
00:09:32Now there's the kind of, um,
00:09:34classic or simple finding is there is a north south divide.
00:09:37Life expectancy for people living in the South,
00:09:42on average tends to be longer than those living in the North.
00:09:46It's a bit more subtle than that because, as we all know,
00:09:51there are deprived areas in the south of England
00:09:54particularly, say, in the south west of England, such as Cornwall,
00:09:56where life expectancy is relatively low, at least compared with the South East.
00:10:00However, even in the Southeast, in the big in the big cities of the South East,
00:10:08the uh, district in which you live
00:10:15shapes the life expectancy.
00:10:18Um,
00:10:21shakes your life expectancy. And as as I said, I'm drawing on the work of Claire Bam
00:10:23here,
00:10:28and she looked at, um,
00:10:30life expectancy amongst the districts of London.
00:10:33And she said, If try travelling east on the tube from Westminster,
00:10:36every two tube stops represents more than a year of life expectancy lost.
00:10:40If you travel east bound between Lancaster Gate and Mile end,
00:10:4720 minutes on the central line,
00:10:51life expectancy decreases by 12 years.
00:10:53So even in the affluent southeast, in the in the big cities in London,
00:10:57and this is replicated in other cities throughout
00:11:02the UK,
00:11:06there are major variations in life expectancy,
00:11:07according to the area or district or ward in which you live.
00:11:10Now there is an issue. There is a kind of different explanations for this.
00:11:15Is it the place,
00:11:19or is it the social characteristics of the population who live there?
00:11:21Is it the context or composition effect?
00:11:26And the evidence suggests so far,
00:11:30it's mainly the composition or the social characteristics of the population.
00:11:33Moving on now, we talked about place.
00:11:39We talked about socioeconomic position and gender,
00:11:40and I just briefly want to talk about
00:11:43ethnicity and health ethnicity is a multidimensional concept
00:11:45with numerous links to health.
00:11:50While the major determinants of ill health are
00:11:53largely the same across all ethnic groups,
00:11:56ethnicity is important social identifier in modern Britain,
00:12:00shaping people's networks of association
00:12:06and their social economic
00:12:09opportunities.
00:12:11Furthermore, minority ethnic identities,
00:12:12uh, continue in many circumstances
00:12:16to be sub subject to social exclusion
00:12:19and sig stigmatisation,
00:12:23ethnicity and health. Well, just in terms of social trends,
00:12:27Um,
00:12:32black men have higher reported rates of
00:12:34psychotic disorder than men in other groups,
00:12:37and we talk about that more when we
00:12:41talk about social distribution of mental distress.
00:12:42Data suggests lower levels of reported well being amongst
00:12:47most minority ethnic groups than the white population.
00:12:50And there were large differences in infant mortality by ethnicity.
00:12:56Rates are highest among British, Pakistani, black,
00:13:01Caribbean and black African groups,
00:13:04so there is
00:13:08strong evidence of the relationship between
00:13:09ethnicity and health.
00:13:11But what this raises is an important notion of, from a sociological point of view,
00:13:13of interconnecting fact interconnecting factors
00:13:20or what's called intersexuality.
00:13:24And this is the idea that
00:13:29health is a kind of complex
00:13:31interaction of many factors,
00:13:33and we talked about socioeconomic position talk about gender and ethnicity.
00:13:36They all interact together to actually lead on to actually
00:13:41extra incremental effects on health.
00:13:48So in inequalities in these different
00:13:52social positions or indicators of social positions
00:13:55are interrelated.
00:13:59Disadvantages are concentrated in particular parts of the population
00:14:00and can be mutually reinforcing.
00:14:06Lower social economic groups, for example,
00:14:09tend to have high pre higher prevalence
00:14:11of risky health related lifestyle practises.
00:14:14Worse access to care,
00:14:17a less opportunity to live healthy life.
00:14:19People may find it difficult to move away from these unhealthy practises
00:14:24because of a range of a wider determinants of health.
00:14:28So the importance of interconnecting factors or the concept of
00:14:33intersexuality is crucial for understanding social inequalities in health.
00:14:38Finally, for this part, I just want to talk about
00:14:47COVID-19 and deaths by deprivation.
00:14:51COVID-19. Actually,
00:14:55um,
00:14:57the patterns of death and diagnosis mirrored
00:14:59or exacerbated
00:15:03the social inequalities in health that I've just talked about.
00:15:05People who lived in deprived areas have higher diagnosis rates and death rates
00:15:09for those living in less deprived areas.
00:15:15The mortality rates for COVID-19 in the most deprived areas are more than double
00:15:18the least deprived areas for both males and females.
00:15:24This is greater than the inequality seen in mortality rates in previous years,
00:15:28indicating greater inequality and death rates for COVID-19.
00:15:33So COVID-19 deaths actually exacerbated
00:15:38the social inequalities that went before,
00:15:42so let me finish there for part one.
00:15:47
Cite this Lecture
APA style
Calnan, M. (2023, June 07). Social Inequalities in Health - The Unequal Distribution of Health Chances [Video]. MASSOLIT. https://massolit.io/courses/social-inequalities-in-health
MLA style
Calnan, M. "Social Inequalities in Health – The Unequal Distribution of Health Chances." MASSOLIT, uploaded by MASSOLIT, 07 Jun 2023, https://massolit.io/courses/social-inequalities-in-health