To What Extent Do You Agree With The Claim That Social Injustice Is The Cause Of Health Inequalities?
Introduction
Health inequalities are the unfair and preventable differences in individuals, groups or population’s health status. These exist as a result of unequal distribution of economic, environmental and social conditions in the society. The conditions are involved in determining the chances of individuals becoming sick, ability to control sickness and chances to access better treatment.
Social injustice in the unfair distribution of resources such as employment and education in the UK influence the living conditions and health of a person. Smoking is one of the causes of death rate and inequalities in the UK. It is responsible for most of the premature deaths among the social classes.
The less advantaged group in the UK experience health discrimination because they do not have the economic power to access effective health care. Socioeconomic models like Whitehead and Dahlgren’s model of the social determinants of health inequalities highlight how an individual’s socio-economic lifestyle is dependent on their condition. If individuals from poor background contract tobacco-related diseases like lung cancer, they have a lesser chance to prolong their lives because they have limited ability to access medical attention. In contrast, if a smoker from a higher economic and social background similar tobacco related diseases, they have access to appropriate medical care.
The paper will look at such areas as social inequalities as a cause for health disparities, health inequalities for tobacco and the Whitehead and Dahlgren’s model of the social determinants of health inequalities. Based on this, the paper will provide some recommendations on the way forward for health inequality in relation to smoking.
Social inequalities as a cause for health disparities
Social inequalities as a cause for health disparities can be viewed in terms of alcohol consumption, smoking among others. People who wish to highlight the connection between social injustices and health inequalities state that health inequalities refer to differences in health between various social classes or groups who have different socio-economic advantage or disadvantage and different social hierarchy (Mcgillivray, Dutta & Lawson 2011, p. 254).
There is a connection between social economic groups and cigarette smoking. Smoking is a major cause of inequality. For example, in the UK, the rates of death emanating from tobacco are 2-3 times more among the disadvantaged social groups in comparison with the less disadvantaged social groups. Those who bear the greatest brunt are the long-term smokers as they are highly prone to diseases such as lung cancer. People living in social groups with a poor background tend to start smoking at an early age. Those from well up families will be preoccupied by other activities such as studies and therefore do not start very early. However, even they start early, their health does not deteriorate as they have access to better health care as compared to the long term smokers from poor background.
Socioeconomic research conducted in the UK to understand mortality differentials regularly use occupational social class as the major index of socio-economic position (Lynch & Kaplan n.d, p. 14). According to an analysis done on the decrease of mortality in Wales and England, it has emerged that the contribution of clinical medicine to the decline in mortality is small in comparison with the other influences (Marmot & Bell 2011, p. 73). Occupational socio-economic measures have also been used in these studies to show the association between mortality rates (Lynch & Kaplan n.d, p. 16) of people and socio-economic position (Blane et al 1998, p. 157).
Health inequalities for tobacco smokers
These are the differences experienced by disadvantaged groups such as women, the people, or racial minorities facing social discrimination in health care provision in comparison with the socially advantaged groups (Braveman 2006, p. 167). It refers to health disparities and pays attention to health differences among different social groups in the society (Braveman & Gruskin 2003, p. 254).
It is evident that the poor, ethnic minorities, racial, and other low class groups experience health discrimination. These health discriminations are reflected by high mortality and morbidity rates related to social class behavioral actions like smoking (Blane et al 1998, p. 157). Many European countries including the UK experience discrimination in the provision of health. Braveman & Gruskin (2003, p. 255) highlights that people belonging to the less advantaged social groups in terms of occupation, education, and income tend to die young due to smoking related diseases in addition to being vulnerable to health problems related to social class (Braveman & Gruskin 2003, p. 255). Smoking has been identified as the main cause of lung cancer, emphysema , chronic bronchitis, post-menopausal syndrome in women, and sudden infant death syndrome health issues (Blane et al 1998, p. 157), which is common in the less advantaged social class individuals as they cannot access effective health care (Braveman & Gruskin 2003, p. 255).
Whitehead and Dahlgren’s model of the social determinants of health inequalities
Whitehead and Dahlgren’s effort to highlight the social determinants of health provide a model that measures social inequities using socioeconomic position indicators (Braveman 2006, p. 179). This model includes health care as a component of an individual’s working and living condition because improvement and access to effective health care plays a significant part in reducing mortality rates (Whitehead & Dahlgren 2007, p. 24)
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The Rainbow model shows the way social determinants in health are interlinked and the way the factors are involved in influencing health care.
An individual’s socio-economic life is dependent on their condition. An individual with a chronic smoking health issue in a poor neighborhood, poor living condition, and a poor working condition, is included in a disadvantaged social position (Marmot 2002, p.32). This class is characterized by social class habits like addictive smoking behavior as a way of displaying a person’s class position (Graham 2012, p. 84). The social environment determines smoking behavior when an individual reaches adulthood. Smoking behavior is determined by an individual’s occupational level at his adulthood, and is associated with age at leaving full time education (Galobardesr et al 2006, p. 10).
Health discrimination is regarded by U.S policy makers as an outcome of socio-economic injustices in health, and measures it at individual level characterized by an individual’s educational level and occupation (Levine & Munsch 2011, p. 83), or social level characterized by the neighborhood condition where they live (Aspen Health Law Center 1998, p.82). Education, economic income, and occupation are used in analysis to highlight the systematic difference at cross-national level (Galobardesr et al 2006, p. 9).
Smoking behavior is found to be associated with education. Occupational social class during adulthood is related to the age at which an individual leaves full time education. This suggests that health discrimination effects caused by smoking are linked to knowledge. Smoking behavior is linked to socio-economic indicators (Lynch & Kaplan n. d., p. 21), which confirms the suggestion that this health risk behavior is dependent on the social environment in which an individual lives (Blane et. al 1998, p. 159).
This model offers a starting point in understanding the social paths that lead to health discrimination. It provides insights that social factors are key in understanding the causal factors of health discrimination, which exist across interconnecting levels. In an attempt to understand and show how social process are connected to individuals’ discrimination in heath, researchers have identified that resources distributed across various social institutions such as workplaces (Macintyre 1997, p. 728), or education can significantly affect the life and health of a person (Lynch & Kaplan n.d, p. 22).
Lynch and Kaplan (n.d, p. 22) state that individuals in an advantaged social position have access to many resources, and consequently avoid risky social class behavior such as smoking, and consequences of these habits. High level of smoking and its consequences such as poor lung function, blood pressure were associated with early drop out of full time education, and manual/less advantaged social class (Galobardesr et al 2006, p. 8). This association between social class and high prevalence of smoking was found to be very strong in the educational strata.
It has been argued that different people differ from each other based on their different level of education. Studies have shown that education provides a person with favorable opportunities for employment with high levels of income, which can improve their living condition (Marmot 2002, p.32). Education has an impact on an individual’s health by influencing a person’s choice of health related lifestyle, which has the ability to reduce risks of mortality.
A comparison between mortality rates from three major death groups’ namely malignant diseases, cardiovascular health problems, and other diseases; and that from all death causes showed the same results that linked them to education and social class (Macintyre 1997, p. 736). Results based on all cause of death category revealed that people belonging to the manual or less advantaged social class, and those who dropped out of school while they were still young has a high death rate (Oliviere, Monroe & Payne 2011, p. 25). Deaths related to malignant diseases and cardiovascular health problems were found to be linked to education (Hamlin 1998, p.54).
The age at which people terminate full time education depends on various factors, which include a child’s aptitude, a family’s economic position, and opportunities for employment when an individual reaches the minimum age where they can leave school and be employed (Braveman 2006, p. 178).
The socioeconomic position of an individual is indicated using income, which measures material resources possessed (Marmot 2002, p.32). Similar to education, income is also associated with social health. It is undeniable that money has an influence and direct effect on health. Money and its related assets can be converted to health improving resources and services through expenditure. This is the concept of how money has an effect on health (Braveman 2006, p. 180)
There is emphasies in the United Kingdom’s national health policy to tackle the factors that influence the health, and health disparities of social minorities to achieve improvement of health for all. According to Link and Phelan (2009, p.87), this difference in access over social resources and socio-economic position underlies the relationship between social class and health because an individual social class determines access to health resources. It is from this reason that Braveman (2006, p. 181) identifies socioeconomic status as the cause of health discrimination.
Over the past century, cigarette smoking in the UK has radically changed. During the early decades of the twentieth century, smoking prevalence was very high because of high production and promotion of tobacco products (Graham 2012, p. 83). Currently, cigarette-smoking rates associated with behavioral smoking have decreased. This downward trend is popular in high income or more advantaged socioeconomic groups (Anderson 2004, p. 47). Studies on behavioral smoking rates conducted in UK showed that in less advantaged socioeconomic groups, behavioral smoking and its consequent health impacts rates were double compared to high-income socioeconomic groups: 50% of the lower social economic groups have high chances of contracting heart diseases (Petra, 2013, p1). The assessment of these rates show that smoking is associated with social class and related to a less advantaged or low-income socioeconomic groups.
Research conducted in the UK have showed that pathways related to disadvantaged groups starting from poor living conditions during childhood, termination of full time education early, and disadvantaged adulthood circumstances, are directly associated with health discriminated smoking risks (Kagawa-Singer 1996, p. 38). Domestic trajectories relating to women have also been identified to matter in these circumstances related. Smoking among women in low-income socioeconomic groups during motherhood increase health discriminated risks over pathways related to childhood, educational, and adulthood circumstances disadvantage. According to Graham (2012, p. 86), smoking rates among women in less advantage pathways in the UK who experienced poor childhood circumstances, left school at an early age, became mothers in their teenage years, and currently live in a less advantaged environment on a low income is about 70 per cent.
Reduction in smoking rates in developed countries such as the UK is associated with policies aimed at controlling smoking and social movement away from smoking, which are seen to play a significant role in smoking rates reduction. These social moves and policies are identified as important efforts to protect the public health by creating a social environment where behavioral smoking is stigmatized (Lambert, Gordon & Bogdan-lovise 2006, p.72).
Public health related policies have had a significant effect in increasing public awareness, and transforming people’s perception towards smoking. Campaigns conducted in the UK were targeted at health risks that smokers face when they engage in smoking (Lynch, Kaplan & Shem 1997, p. 73). Social class risk associated to smoking specifically to pregnant mothers and unborn children were integrated in the mid 1970s UK government campaigns (Lambert, Gordon & Bogdan-lovise 2006, p.76). Currently, tobacco control policies have taken a focal place in reducing non-smokers exposure to tobacco smoke. These policies target the non-smokers who are mostly in the high-income socioeconomic group through warnings found on the cigarette pack, regulations, and media information campaigns. Legislation control of smoking is seen as a social injustice to the less advantaged groups. Smoking is not allowed in selective places where the advantaged group individuals frequent, but it is less controlled in public places where less advantaged individuals frequent.
Recommendations
Evidence shows that oppression, exploitation, poverty, and other social injustices negatively affect health. George & Krieger (2008, p. 530) provide three effective recommendations, which offers a guideline to ensure an equality oriented society.
Improvement of living conditions is necessary starting from birth to old age. Equality in the workplace, social protection, and a universal health care system can effectively alleviate health outcomes caused by inequality. This reduces social injustice and promotes equality in health.
The government should ensure that all work places are smoke free zones so as to create a culture of not smoking hence control health impacts. High tax should be imposed on cigarettes to increase their prices, reduce their availability. This deters most of the people from the aspect of smoking. Advertisements on smoking should be reduced or banned and in place of these, labeling on the packs done with warnings to encourage individuals stop smoking. This reduces the chances of smoking on the side of people from poor backgrounds who are not able to access better health care.
It is important to effectively look at the way money, resources, and power are distributed. This refers to equality in policymaking, gender equality, responsibility and accountability in the economic market, political empowerment, and good governance. This will ensure that economic and social needs of development are balanced with health equity.
Finally, there is need for a local and national monitoring system of inequalities in health, assessment of current policies to reduce health discrimination, and training health experts in social health determinants to ensure accountability and galvanize action. This will ensure equality in health.
According to George & Krieger (2008, p. 530), there is need for both a top-down and bottom-up action in the national health sector. Regardless of an individual’s ability to pay for health services, social and basic human needs such as clean water should be provided to everyone. Participatory and democratic approaches are crucial in integrating multispectral agencies because they pay attention to the consequences of negative effect of social exclusion, discrimination, and gender inequality to health.
Conclusion
This paper has shown clearly that social injustice is the main cause of health inequalities experienced by the less advantaged socioeconomic groups in UK. Social inequalities for example provision and equitable distribution of social resources such as access to education define the lifestyle and living condition of a person. This paper has successfully shown that social condition relates to health discrimination among different socioeconomic groups in UK.
It is evident that poor, ethnic minorities and low class groups are prone to health discrimination. This is shown by the increased mortality and morbidity rates which are in line with social class behaviors such as smoking. Smoking is one of the main causes of lung cancer, chronic bronchitis and other diseases. People from less advantaged communities tend to die while still young as a result of smoking related diseases. This is because they are not able to access better health care. The Whitehead and Dahlgren’s model of social determinants in health inequalities provides a model that measure social inequalities making use of social economic position indicators. The model includes health care as a component of individual’s living and working condition due to improvement and access of health care which helps in lowering mortality rates.
There is need for people to be made aware of effects of smoking where the government could ensure the products are highly taxed no advertisements and instead warnings are put in place. More funds should also be directed to health for all to ensure equality. Monitoring of health inequalities should also be enhanced. All this ensures good health and equality for all.
Reference List
Anderson, NB 2004, Encyclopedia of health & behavior, Thousand Oaks, Calif, Sage Publications.
Aspen Health Center 1998, Employment discrimination in the health care industry, Gaithersburg, Md, Aspen Publishers.
Blane D, Hart, CL, Davey, SG, Gillis, CR, Hole,DJ & Hawthorne, VM 1998, ‘Association of cardiovascular disease risk factors with socioeconomic position during childhood and during adulthood’, J Epidemiol Community Health, Vol. 52, Viewed 10 December 2013, pp. 153-160 HYPERLINK l “otherarticles”http://jech.bmj.com/cgi/content/abstract/52/3/153#otherarticles
Braveman, P 2006, ‘Health disparities and health equity: concepts and measurement’, Annu. Rev. Public Health, Vol. 27, pp. 167-19
Galobardesr, B, Shaw, M, Lawlor, DA, Lynch, JW & Smith GD 2006, ‘Indicators of socioeconomic position (part 1)’, J Epidemiol Community Health, Vol. 60, pp. 7-12
George, DS & Krieger, N 2008, ‘Tackling health inequities’, BMJ,pp. Vol. 337, 6 September, pp,525-530
Graham, H 2012, ‘Smoking, Stigma and social class’, Journal of Social
Policy, Vol. 41, pp 83-99
Hamlin, C 1998, Public health and social justice in the age of Chadwick. Britain:1800-1854. Cambridge: Cambridge University Press.
Kagawa-Singer, M 1996, Health issues for minority adolescents. Lincoln, University of Nebraska Press.
Lambert, H, Gordon, E & Bogdan-Lovise, A eds 2006, ‘Social science perspectives 2 on evidence-based health care’, Social Sci Med; Vol. 62, pp.2613-719
Lang, K 2007, ‘Poverty and discrimination’. Princeton, N.J., Princeton University Press.
Levine, LE & Munsch, J 2011, Child development: an active learning approach. Thousand Oaks, Calif, SAGE.
Link, B& Phelan, J 2009, ‘The social shaping of health and smoking’, Drug and Alcohol Dependence, Vol.104, no.1, pp.S6–S10.
Lynch, J & Kaplan, G n.d, ‘Socioeconomic position’.
Lynch, JW, Kaplan, GA & Shem, S 1997, ‘Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning’, N Engl J Med Vol. 337, p.1889–95.
Marmot, M 2002, ‘The influence of income on health: views of an epidemiologist’, Health Affairs, Vol. 21, no. 2, pp. 31-46
Marmot, MG & Bell, RG 2011, ‘Improving health: Social determinants and personal choice’, American Journal of Preventive Medicine, Vol. 40, pp. s73-s77
Mcgillivray, M, Dutta, I & Lawson, D 2011, Health inequality and development. Houndmills, Basingstoke, Hampshire, Palgrave Macmillan.
Oliver, D, Monroe, B & Payne, S 2011, Death, dying, and social differences. Oxford, Oxford University Press.
Petra, R. 2011. Low Income Individuals Have 50% Higher Risk Of Heart Disease. Medical news Today.
Whitehead, M & Dahlgren, G 2007, Concenpts and principles for tackling social inequities in health. Copenhagen, WHO, Regional Office for Europe.
