Introduction just a moral danger, but a mortal



In the last decade, public
health has had an increasing impact on the way we view our well-being, focusing
less on how disease relates to the individual health and more on how social
inequalities does. This change in focus on health has determined how much of an
impact social, economic and political factors play in the cause of illnesses
and disease around the world. Through stereotypical societies, individual
behaviours and prolonging hierarchies, the lack of health care available for
those compromised by social inequality is detrimental for their life expectancy
as they are not provided with the health care they require. ‘The rising social
inequalities that can be seen in nearly every country in the world today
present not just a moral danger, but a mortal danger as well.’ The relationship
between social inequalities and public health is an undeniable one that is
intensifying with the notion that poor health is more and more becoming due to
social inequalities. Undoubtedly income is the overall factor that ties public
health to social inequalities as fundamentally, the distribution of income is
what creates social inequality. The term income however can be divided in to
the following five models: behavioural model, materialist model, psycho-social
model, life course model and educational model. Each of these models will be
deeply analysed to assess the extent to which social inequality caused by
income, triggers poor public health.

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1.     Behavioural


The behavioural model looks
at how public behaviour changes towards their health depending on their social
status. There are many social class differences which either help to promote or
damage health behaviours such as active lifestyle, dietary choices, consumption
of alcohol, tobacco and drugs. Long-term studies have found that health
behaviour caused by social class differences have had an impact on mortality
rates over many years. This is because differences in social position help create
a perception of health for the future, whether it be good or bad. Those who are
more affluent, tend to be more confident about their future aspirations and
will therefore invest in a healthier lifestyle for themselves. In the last two
years, the prices of gym memberships and healthy foods have increased due to
the sudden craze for ‘healthy living’. However, this kind of healthy behaviour
is not affordable for many, highlighting a correlation between public health
and social inequality.



2.     Materialistic


Whilst the behavioural model
looks more towards a person’s personal ambition to have a healthier lifestyle
and how social status affects this decision, the materialistic model
illustrates how income can cause physical problems which lead to either greater
or poorer health choices. Poverty undoubtedly exposes people to various health
hazards. This can include their living situations, most often than not, the
locations for renting or buying accommodation at a cheaper price tend to be
areas that are more exposed to harm such as damp housing and air-pollution.

There are many specific proofs that confirm materialism to be the cause for
health issues. For example, ‘many studies have associated higher rates of
childhood respiratory disease with damp housing’. Whilst the full impact of
living standards can only be determined over a whole life period, the
regularities and similarities of these kind of examples show how much materialist
differences cause health inequalities. One key example is ‘The Black Report’, a
document published on how ill-health and death was unequally distributed among
the population of Britain in 1980 by the the Department of Health. “The Report
concluded that these inequalities were not mainly attributable to failings in
the NHS, but rather to many other social inequalities influencing health:
income, education, housing, diet, employment, and conditions of work” (McIntosh
Gray, 1981). Overall, the report found materialist explanations to be the most
important in explaining social class differences in health. However, when
looking at the UK specifically, income and social inequality can be questioned when
determining cause for poor public health. This is because in the UK, relatively
disadvantaged people receive various kinds of government help i.e. (NHS, government
housing, school meals etc). This goes to show how lack of health care systems
or poor housing would unlikely account for all social disparities in health
outcomes. Though this may be the case in the UK, many third world countries
around the world do not receive these kind of benefits from their government
and are therefore suffering in health due to social inequality caused by


3.     Inequalities
in health care and its access


After analyzing the
materialistic model, it was interesting to note that whilst the UK provides a
free national health service, most countries do not receive availability to this
kind of treatment. The inequalities towards the access for health care are key
in understanding the impact of social differences on public health care. Within
the ‘The Inverse Care Law’, Julian Tudor Hart in 1971, stated “The availability
of good medical care tends to vary inversely with the need for it in the
population served” (The Lancet). Research shows that ‘hard to reach’ groups
suffer the worst outcomes and access health services the least. These groups
include ‘Black and minority ethnic (BAME) groups, the homeless, asylum seekers,
adolescents with eating disorders, the unemployed, the elderly, people with
advanced cancers, people with learning disabilities and other people with a
variety of physical, sensory, intellectual and mental health difficulties’. For
a fair distribution of health care “equality of access is required for
different communities.” (Wonderling et al, 2005). There are many ways in which
health care can become more accessible such as:


Making transport
and communication services equal.

Ensuring the travel
distance to hospitals and other medical facilities are equal.

Having equal
charges (with equal ability to pay).

Patients being
equally told about the availability of treatments and it effectiveness.

Allow waiting
times for appointments to be equal.  


Goddard and Smith (2001)
suggests how engaging with socially excluded and marginalised populations
presents a major challenge but increasing flexibility of services, working with
voluntary sector organisations and user involvement can be effective mechanisms
for reducing inequalities in access to healthcare.


4.     Educational


The Educational model is an
interesting and detailed topic that can question whether social inequalities in
terms of access to health care, materialism, health behaviour would even affect
public health if one had a better education. An enhanced education would not
only provide knowledge on how to maintain a healthier lifestyle but would also
create a greater chance of achieving a high quality job that provide a better
income. Aside from countries with free health insurance, someone with a higher
education would more likely be employed and gain a job that provides
health-promoting benefits such as health insurance, paid leave, and retirement.5
Additionally, people with a poorer education would most likely end up working
in a high-risk occupation with fewer benefits.


Additionally, it has almost become
a global fact that a higher education would lead to higher earnings, therefore
a higher quality life and health. Whilst considering differences of income as a
social inequality, it is important to know that “in 2012, the median wage for
college graduates was more than twice that of high school dropouts and more
than one and a half times higher than that of high school graduates”.6 By
simply achieving a better education, one can not only obtain a better income
but a better healthcare and safer future, disregarding social inequality.


Furthermore, as previously
stated, those with more education tend to experience fewer economic hardships,
attain a higher social rank and better prestige whilst also obtaining access to
resources for superior health care. “A number of studies have illustrated how a
higher education and income is among the main reasons for a greater health
service.”1 Looking at income alone, annual earnings have risen dramatically for
someone with a university or advanced degree. Based on data from 2006-2008, “the
lifetime earnings of a Hispanic male are $870,275 for those with less than a
9th grade education but $2,777,200 for those with a doctoral degree.” These
examples are pivotal as the social inequality gained from these two different
education backgrounds can determined someone’s income and therefore the quality
of health care they are able to receive.  

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