Social Class Differences in Health and Healthcare - Report Example

SOCIAL DIFFERENCES IN HEALTH AND HEALTHCARE by 20 July Social Differences in Health and Healthcare Since the beginning of healthcare systems in Britain, providing free and accessible care for everyone has been a top policy priority. The moment the National Health System was born, all elements of health care had to be unified around a common goal of providing free, superior quality medical and health care for everyone, irrespective of their social belonging and class. Introducing private healthcare options had to create an atmosphere of competition for the purpose of better quality and efficiency of healthcare in the country. Despite rapid advances in medical and healthcare policies, social class differentials in healthcare provision continue to persist. Social class as a complex reflection of individual professional, educational, and employment characteristics is integrally linked to individual health and wellbeing. This social class belonging also affects and alters the system of healthcare delivery, making it available and accessible only for those, who experience few social difficulties. As a result, lower social classes operate in a vicious circle of vulnerabilities, which negatively influence their health status and, simultaneously, create barriers to accessing quality healthcare options. Understanding and outlining social class differences in health and healthcare is impossible without understanding what means to be healthy and what exactly social disparities in healthcare mean for the broader community. Generally, health incorporates the state of physical and psychological wellbeing.1 Consequentially, healthcare is defined as a complexity of profoundly interrelated factors which are not limited to medical care but also involve other aspects – financing, quality, resource allocation, and others.2 Health determinants can be proximate and distant; the latter affect the quality and efficiency of health care through a long and sophisticated causal chain.3 In this sense, social class disparities are among the most essential healthcare determinants. “Social group health differences are considered to be the differences across subgroups of the population, which may be based on biological, social, economic or geographical characteristics”.4 Despite numerous policies and policy solutions, social class remains a crucial factor of healthcare disparities in Britain and the rest of the world. The relationship between socioeconomic status (SES) and care provision are extensively documented. It would be fair to say that the effects of SES on care are two-fold: on the one hand, SES always affects individual health and wellbeing. On the other hand, social class disparities in accessing and using even the basic healthcare services continue to persist. The former appear to be extremely stable over time, and even effective interventions on the main social risk factors of health and wellbeing fail to break this SES-health relationship.5 Notwithstanding the rapid advancement in social policies, individual social position (both absolute and relative) remains the most important variable of individual health and wellbeing.6 This social position justifies the validity of cross-social comparisons and groupings in the United Kingdom.7 It also makes the theory of health inequalities in light of socioeconomic class differences extremely legitimate. Individuals of lower socioeconomic position experience serious health difficulties and demonstrate higher rates of mortality/ morbidity.8 SES causes threshold effects on health, through poorer life conditions and malnutrition.9 In almost every single disease category, individuals lower in their SES experience “higher rates of mortality and morbidity than their better-off counterparts”.10 Not only do people of lower socioeconomic position suffer poorer health, but individuals at higher levels of SES always enjoy better health than those on the SES levels just below them.11 The question of how exactly SES affects individual health remains mostly unresolved. A belief persists, that health experiences within various SES strata are mediated by a variety of factors, including prenatal influences, family relationships and neighborhood characteristics.12 This is the social causation thesis, which is frequently used to explain the effects of SES on individual health status.13 Another, social drift explanation suggests that individual health status does contribute to SES.14 Whether or not SES contributes to poor health or vice versa is not clear, but it is obvious that social class differences further transcend to affect health care at the point of delivery. Numerous policies were developed to promote the sense of justice and fairness in the system of healthcare delivery. Nevertheless, social class disparities continue affecting the lives and wellbeing of healthcare recipients. Access to healthcare does contribute to social differences in many disease categories, including heart disease.15 Social disparities affect all aspects of healthcare delivery, like the choice of chemotherapy regimens.16 In the past 20 years, social disparities in British healthcare have dramatically widened, and these differentials are particularly threatening for the lives and wellbeing of the most deprived populations in Northern England and Scotland.17 The main question is why all these differences remain valid over time and do not change even under the pressure of social justice policies implemented in healthcare. The answer is rather straightforward: “differences in health care occur in the context of broader historic and contemporary social and economic inequality and persistent racial and ethnic discrimination in many sectors of social life”.18 Medical professionals hold numerous misconceptions and biases against individuals with a low socioeconomic status.19 As a result, while middle class people enjoy all healthcare privileges available to them, poorer layers with their health problems experience the lack of quality medical care and have most of their health needs unmet. People of lower SES have lower quality of life, experience the lack of financial resources, and live in poorer housing conditions; as a result, they need a longer period of care but cannot access and use available healthcare opportunities in their entirety.20 The main reasons of the existing social class inequalities in health and healthcare have little to do with the social class status per se. The core of the social class differentials in healthcare is in the state’s inability to guarantee fair and just provision of healthcare services for everyone. These differentials are rooted in historic and social realities that used to guide the evolution of healthcare systems in Britain and the rest of the world. Only considerable improvements and support of social justice policies can help to improve the situation. Competition with private healthcare players will only aggravate the situation, leaving the most disadvantaged beyond the boundaries of quality healthcare. Only broad social interventions can help the country to cope with the existing social class disparities in healthcare. The Royal College of General Practitioners has sent a written petition to David Cameron, asking him to reconsider the proposed Healthcare Reform Bill in light of potentially negative effects it may cause on the current system of healthcare. The healthcare system must provide poor and working class families with full access to the basic healthcare services and support their striving to improve the conditions of life and wellbeing. It is important to note that successful social policies have to be regularly updated, to fit in the changing conditions of social performance. Previous experiences suggest that social policies aimed at dealing with social and healthcare controversies alone cannot give poor individuals what they really need. Not only do social patterns of various diseases tend to persist over time, but the character and specific features of poverty and low SES gradually shift. Back in the 19th century, founders of healthcare and medical systems clearly observed a strong association between poverty and health problems.21 This link between low SES and illness was also attributed to the lack of appropriate living conditions, the absence of effective sanitation systems, and poor workplace conditions.22 All those factors caused multifaceted effects on the state of health among poorer populations. Advances in healthcare policymaking helped to reduce the gap in medical care, decreasing the incidence and eradicating the risks of such diseases as diphtheria, typhoid, and measles.23 Those policies also increased and expanded available medical care opportunities for poor populations. As a result, by the middle of the 1960s, most factors that caused healthcare problems among working class individuals had been eliminated; yet, the gap in accessing and using healthcare continues to persist.24 So, why are social class differences in healthcare so enduring? The answer is simple: factors that tended to intervene between health and socioeconomic status were addressed; in the meantime, new factors emerged, increasing the gap between the poor and the rich in the healthcare system. Diphtheria and typhoid are no longer threatening, but they gave place to other health risks, including malnutrition, smoking, diabetes, and stress. This is why successful SES healthcare policies must be regularly updated. Regular community assessments will help to identify the most dangerous factors of poor health and healthcare under-coverage in Britain. One social policy document can never suffice to bring the British system of healthcare to the desired end. Socially vulnerable populations must be constantly monitored, to give them better healthcare opportunities and a chance to meet their health needs. Bibliography ADLER, N.E. & J.M. Ostrove, ‘Socioeconomic Status and Health: What We Know and What We Don’t’, Annals New York Academy of Sciences, vol.896, 1999, p.3-15. BRAVEMAN, P.A., ‘Monitoring Equity in Health and Healthcare: A Conceptual Framework’, Journal of Health Population and Nutrition, vol.21, no.3, 2003, p.181-92. BRITTON, A., M. Shipley, M. Marmot & H. Hemingway, ‘Does Access to Cardiac Investigation and Treatment Contribute to Social and Ethnic Differences in Coronary Heart Disease?’, British Medical Journal, 5 July, 2004, p.1-10. CARTWRIGHT, A., ‘Social Class Differences in Health and Care in the Year Before Death,’, Journal of Epidemiology and Community Health, vol.46, 1992, p.54-57. CHEN, E., K.A. Matthews & W.T. Boyce, ‘Socioeconomic Differences in Children’s Health: How and Why Do These Relationships Change with Age?’, Psychological Bulletin, vol.128, no.2, 2002, p.295-329. GRIGGS, J.J., E. Culakova, M.E. Sorbero, M.S. Poniewierski, D.A. Wolff, J. Crawford & D.C. Dale, ‘Social and Racial Differences in Selection of Breast Cancer Adjuvant Chemotherapy Regimens’, Journal of Clinical Oncology, vol.25, no.18, 2007, p.2522-2527. JOHNSON, R.L., S. Saha, J.J. Arbelaez, M.C. Beach & L.A. Cooper, ‘Racial and Ethnic Differences in Patient Perceptions of Bias and Cultural Competence in Health Care’, Journal of General Internal Medicine, vol.19, 2004, p.101-110. MURRAY, C.J., E.E. Gakidou & J. Frenk, ‘Health Inequalities and Social Group Differences: What Should We Measure?’, Bulletin of the World Health Organization, vol.77, no.7, 1999, p.537-44. NELSON, A., ‘Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care’, Journal of the National Medical Association, vol.94, no.8, p.666-68. SUSSER, M., ‘Editorial: Understanding Sociodemographic Differences in Health – The Role of Fundamental Social Causes’, American Journal of Public Health, vol.86, no.4, 1996, p.471-73. WHITEHEAD, M., M. Evandrou, B. Haglund & F. Diderichsen, ‘As the Health Divide Widens in Sweden and Britain, What’s Happening to Access to Care’, BMJ, vol.315, 1997, p.1006. WILLIAMS, D.R. & C. Collins, ‘US Socioeconomic and Racial Differences in Health: Patterns and Explanations’, Annual Review of Sociology, vol.21, 1995, p.349-386. Read More