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Summary: the Concept of Social Class

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 The concept of social class has long been linked to patterns of health in modern societies as health inequalities are clearly seen across the UK. According to The 1970-1972 Decennial Supplement of occupational Mortality (OCPS), figure 1 shows that men in social class V were 2.5 times as likely to die before the age of 65 than those in social class I (professional). Children in social class V families were also twice as likely to die as those in social class I. Thus, to fully understand the pattern of health and illness in modern societies, it is essential to find the link between social class, health and illness. Biological factors such as age, sex, or genetics are only few of many more factors that has an impact on health and the well being of an individual, as health can also be influenced by lifestyle factors that are often determined by their social and community relationships. These factors will determine whether or not an individual is vulnerable to poor health or developing an illness. Therefore, this paper will examine how social class as a structural influence has an effect on the many aspects of life regarding health, inequalities between socioeconomic groups, how food availability can lead to illnesses and its implications for health practitioners.

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According to The World Health Organisation, health is a state of complete well‐being not only physically but also mentally and emotionally. This shows the perspective of sociologists that being healthy is more than just not having a disease or falling ill, but instead being healthy is to be mentally stable and emotionally relaxed. According to Lay concepts of health these are the answers of different people when they are asked what is it like when they are healthy. Some are unable to answer as they only know when they are ill, while others say that being healthy is when they are able to walk about better or to be free of aches and pains. Some also say being healthy is when you are stable, energetic or just feeling happy. Being “unhealthy” or “sick” is simply a form of deviance in society. According to the functionalist model by Parsons, he argued that illness is not just a biological condition but also the social norms around the concept of illness and how sickness is portrayed in society. The functionalist model displays two rights and two obligations of an ill person. “The sick person’s rights are twofold: the first one is being exempt from normal social roles; the second one is not being responsible for their condition. Conversely, the sick person’s obligations included trying to get well and cooperating with the medical professionals”. Parsons concluded that illness is just a form of deviant in the society, as individuals who are ill are unable to complete their normal tasks leading to a dysfunctional impact on the society.

The health of people also differs according to their social class. This can be seen in different views of what is considered as healthy eating in different social classes. Conflicting ideas of what is considered a “balanced” or “squared ” meals can be related with the concept of modernity- as presented by Karls Marx. Marx focused on inequality between social classes and how it led to modernity. Marx identified two key social groups of early modernity which are capitalists/bourgeoisie and abourers/proletarians. Capitalists or bourgeoisies are individuals placed in the higher social class, individuals who fall under this category are property owners or business owners. Abourers or proletarians on the other hand, are placed in the lower social class and usually work as labourers and are propertyless. These two distinct social classes are what is considered to be the main emergement for modern society leading to the division of health between social groups. The difference in health is clearly seen as proletarians are paid low wages and thus can only afford less expensive foods which inturn, has less nutrition leading to lack of nutrition intake causing diseases such as vitamin deficiency and obesity. Also, they often live in poor conditions and far away from medical facilities, thus are often not able to access proper medical care. In addition to this, the difference in social class could also increase one’s risk of being exposed to environmental hazards and their access to health services. For example, individuals in lower social classes have less health insurance than the upper class as lower class occupations provide less care and benefits for workers. This means that for high socioeconomic classes, their healthcare is often funded for while for lower social classes costs for health care can be tremendously high as there are no insurances covered. Moreover, bourgeoisies who are property owners or business owners are often able to purchase more high quality food products and have more access to proper healthcare facilities. This can be seen in figure 2 which shows age standardised death rates per 100,000 population by major cause of death and social class in England and Wales. Individuals in lower socioeconomic classes have much higher rates of death in all disease categories compared to higher socioeconomic classes. However, the death rates for males are significantly higher than females in all categories. Thus, it can clearly be seen that an individual’s social class has a big impact on their physical health and well being as inequalities in occupation, income and availability of resources can make people’s daily lives more challenging. Therefore, leading to individuals being more vulnerable to declining health.

In recent years, the popularity of what is known as “clean” food or vegan options have been popularised. From supermarkets to upscale restaurants, the concept of healthy food options have been embedded everywhere. However, these options often come with a price tag. According to the NHS, healthy food options cost three times more than junk or processed foods. This evidence is based on research which looked at changes in the price of 94 food items in the UK in the decade from 2002 to 2012. It found that in this period foods classified as healthier such as fruit and vegetables were more expensive per calorie than foods high in fat or sugar. The main reason for this is likely to be due to the growing concerns and beliefs healthy eating which in turn causes more demand in fresh produce or wholesome food products, leading to suppliers increasing the market price. With fresh quality produce increasing its price, people who are not able to afford this opt for less expensive options like fast food chains and quick serving restaurants thus leading to weight gain and unhealthy eating habits. However, this is not the only case. Individuals who struggle with health problems are often from lower socioeconomic classes. One reason for this could be due to the lack of grocery stores as less wealthy neighbourhoods often have more fast food chains than grocery and healthcare stores. According to research briefings from the parliament in the United Kingdom, The Health Survey for England 2017 estimates that 28.7% of adults in England are obese and a further 35.6% are overweight but not obese. Even though this is not a big percentage compared to OECD countries such as America or Turkey , it is still considered a concern in the United Kingdom as these numbers could potentially rise every year as the demand for healthier food increases.

 Practical suggestions for health practitioners and policy makers include, encouraging public campaigns against illness-causing environments or products, making equity central to service organisation, highlighting occupation in research and everyday practice and making sure that inequality is a major focus of the European policy. Furthermore, good health can be achieved at low cost by having equitable distribution of primary health care, assuring there is adequate caloric intake for all and having a welfare-centered political system which ensures that there are stocks of food to prevent famine.

Social class is a strong social determinant of health as those in high socioeconomic classes are likely to have better health than those in lower socioeconomic classes. This is because individuals in higher social classes tend to have better occupations and incomes thus they are more able to provide themselves with better food options and healthcare services. Therefore socioeconomic inequality is a prominent feature of modern societies which clearly mirrors the society’s class structure as health inequalities are seen between households. This results in large health differences between different social classes and will continue to perpetuate across generations. Changing this unequal distribution of environmental hazards and access to health facilities between social classes will require significant policy changes for both social groups and health practitioners themselves.   

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