Inequalities In Health

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Inequalities In Health The wider
socio-economiccontext of health behaviours
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Source Dahlgren Whitehead (1991)
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Source Acheson Report (1998)
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The Black Report (1980)
Examined how health varies by

• Occupational status
• Gender
• Area of residence
• Ethnic origin
• Housing tenure

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The Black Report (1980)
Principal conclusion There were large
differentials in mortality and morbidity that
favoured the higher social classes and that were
not being redressed by health or social services
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The Black Report (1980)
Material conditions were the predominant
cause,followed by lifestyle factors
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The Whitehall Studies Marmot et al. (1991)
Whitehall civil servants
Lowest grades had 3 times mortality of
highestgrades Only partially explained by
differences inbehaviours and traditional
risk-factors
Participants were not socially/economicallydepriv
ed in the usual sense, and certainly notpoor
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Mortality Rates From Coronary Heart Diseasein
Males Under 75 per 100,000 Population
Ratio 1.83 2.28 2.34
Measuring Inequalities in Health Working
GroupScottish Executive (2003)
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Dead Poor
Competing Ideologies
Behavioural Health is a matter of personal
choice Places onus on the individual to
behave responsibly
Materialist Health is determined by ones
circumstances Places the onus on government to
provide socio-economic conditions in which
people can thrive
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Dead Poor
Think about

• Is health simply a matter of making choices?
• How do socio-economic circumstances influence
  the likelihood of making responsible choices?
• How do socio-economic circumstances influence
  people psychologically?

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Dead Poor
Learned helplessness
Alans story

• My self-esteem went
• What more can I do?
• You dont want to get out of bed in the
  morning

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Dead Poor The issues
Stress
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Bruce Alexanders radical rat park experiments
Rats will starve themselvesto death if given
theopportunity to helpthemselves to
opiates They will endure severeelectric shocks
in orderto access drugs Addiction is a
physiological inevitability if one
takesaddictive drugs
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Laboratory rats kept incramped, isolated
conditionswith no opportunity to engagein
normal rat behaviour
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Rat Park
Airy and spacious, 200 times the size ofa
standard laboratory cage, with a peaceful
forestscene, complete with lakes and mountains
paintedon its walls. Kept comfortably warm with
anabundance of food, there were empty tins
forburrowing, bright balls and wheels for play,
andlots of companionship 16-20 rats of both
sexesin residence, a special space for mating,
aromaticcedar shavings for nesting, and a
private placefor giving birth.
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In Rat Park
Rats preferred plain water oversweetened
morphinated water No matter how hard they
tried,they could not induce the rats totake
morphine Addicted rats kicked the habitwhen put
into Rat Park, with onlyminor withdrawal symptoms
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Psycho-social integration and dislocation
At the end of the twentieth century jobs
disappear on short notice, communities areweak
and unstable, people routinely changefamilies,
occupation etc dislocation plays havoc
with the delicateinterpenetrations of people,
society, thephysical world and values that are
neededto sustain psychological
integration. Alexander (2000)
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Psycho-social integration and dislocation
Without psycho-social integrationwe, like rats
in cages, turn tosubstitutes, not because
thesubstitutes are alluring in andof
themselves, but because ourcircumstances are
deficient. Slater (2004)