Global Health and Social Class
15.01.2017
Social class is a function of socioeconomic status, a root cause and health determinant, which accounts for most of the health disparities seen in the world today. It is reflected in racial, gender and income differences between population groups both within and between countries. For example, the higher disease rates of African Americans in the United States when compared to Caucasians, have remained consistent despite many attempts to address them. This gap in morbidity among racial groups is widening in recent years for several causes of death. Specific minority populations have also shown higher rates for some health conditions just by being in their group, even when their social status is somewhat “equivalent” when compared to other groups. Factors that contribute to the differences in social status and negatively affect health by restricting socioeconomic opportunities include income, education, power, individual and institutional discrimination, gender, residence in poor neighborhoods, employment, bias in medical care, racism, and inferiority stigma. These factors, and their combinations constitute an individual’s social class.
Research has consistently proved that health is not only a function of genes and habits but is also influenced by class and status. The unequal distribution of power, money and resources also creates health inequities through a systematic and unequal distribution of opportunities to be healthy. Analyses of data from the German National Health Interview and Examination Survey showed that in the last decade, the proportion of people belonging to lower social class has decreased while middle and upper social classes have increased. Some risk factors attributed to the differences in social class were smoking, obesity and inactivity, which were mostly associated with people belonging to lower social class. Concurrently, hypertension and hypercholesterolemia were more often observed in men of the upper social class compared to those belonging to lower class. Regarding morbidity, diseases such as chronic bronchitis and gastric and duodenal ulcer were found to have higher prevalence in the lower social class while allergic rhinitis were observed more often in the higher class. Differences in social class are clear and many attributes are unique to people depending on which of the classes they belong. The contentment about life and health status was higher in the upper class while the level of complains and dissatisfaction about life and health status was higher in the lower class. Additionally, a study in Australia showed that the richest 20% of the population can expect to live an average of six years longer than the poorest 20%, just by belonging to then richer social class.
The British Epidemiologist, Michael Marmot, is a pioneer in this field of research. He studied English civil servants over some decades and found that irrespective of universal healthcare and race, people higher up the ladder (richer and upper status) lived longer and were less sick than those lower down (poorer and lower status)- even when behavior is accounted for. This effect or “social gradient” was consistent throughout the ladder as people just below the highest statuses tended to have shorter lives and be sicker than those just above them all the way down. Marmot discovered two variables that seemed to have a great impact on health and well being: a sense of autonomy or control over one’s life and work, and the ability to fully participate in the society. Naturally, people with higher incomes and education levels tend to have more control and power and contribute more to the society than those with fewer resources- a plausible explanation for the health differences. For example, a job loss may not really affect a rich educated man with multiple investments like Dr. K, but can trigger a disastrous chain of events including ill health for a low-wage worker.