SOCIO-ECONOMIC STATUS AND HEALTH

However we define health, illness and prevention, it has to be said that health and disease are very unevenly spread throughout society. Put bluntly, people lower down the socio-economic scale have more disease and illness, and die younger, than those higher up. Analyses show that since 1910 those at the top of the social scale have consistently lived longer and are healthier, both mentally and physically. Not every disease is less common or causes less mortality among those better-off in socio-economic terms but this is generally so.

One of the best illustrations of health differences between socioeconomic groups is the infant mortality rate. In 1975-7 the infant mortality rate in the world was 99 per thousand live babies, ranging from 11-20 per thousand in advanced countries to 100-200 per thousand in less developed countries. Within advanced countries, though, the variation between the figures for different socio-economic groups is remarkable, with those lower down the scale having three times the infant mortality of those higher up. Whilst British and US statistics show a consistent overall fall in infant mortality the differences according to position on the socio-economic scale

still persist.

In the US socio-economic group is clearly related to racial composition since a large proportion of the non-white population lives in poverty. This is less true of the UK but there are close parallels. Infant mortality rates amongst the US black population are still double those amongst the white population-in fact the gap has widened over the last thirty

The crucial questions when thinking about prevention are to do with trying to understand why these discrepancies occur. Factors such as the mother’s age, nutrition, literacy and use of the health services greatly influence the risks for her baby. ‘High-risk’ mothers are more likely to be at the extremes of reproductive age, to be unmarried, to have had several babies, and to have had miscarriages and still-births. There is also a higher incidence of prematurity and low-birth-weight babies in the less advantaged socio-economic groups. These two conditions carry an increased risk of infant mortality and of physical and intellectual handicap in the baby. Women from these groups also have two behavioural factors that act against the best interests of their babies — they are more likely to smoke, and to have below-normal weight-gain during pregnancy.

I have used infant mortality as an example, but there are many other sets of statistics that show how much more commonly diseases occur in the jess advantaged sections of society. Infectious diseases are more common, possibly because the poor may be living in conditions which make infections more likely and lower their resistance to them. As recently as 1972 the mortality rate for ÒÂ among British men was ten times as great lower down the social scale as it was at the top. Better environmental conditions do not always act in favour of the rich though. People living in poor sanitary conditions acquire antibodies against poliomyelitis and hepatitis A virus early in life, whereas those living in clean conditions are vulnerable unless they are immunized.

When we look at chronic illnesses such as heart disease and cancer-the two biggest killers in the western world-the story is more confusing. The relationship between socioeconomic group and heart disease, for example, has changed with time. A position towards the bottom of the scale seemed to ‘protect’ men from heart attacks in 1960 but today this advantage has largely disappeared. One UK study found that the direct relationship between socio-economic status and heart disease (those at the top of the scale having more heart disease) disappeared when each category was analyzed for physical activity. Once, the kind of work a person did was what determined his or her level of physical activity, but with the coming of jogging, squash and other leisure-time sports this is no longer so.

There is also a relationship between socio-economic group and psychological well-being, whether one is rating subjective happiness, psychiatric symptoms, or first admissions to mental hospital. Studies show that certain neurotic conditions are commoner among those lower down the socio-economic scale. These groups are less likely to feel well in themselves, physically and psychologically. In a major US survey, groups lower down the socioeconomic scale (mostly members of racial minorities) were consistently (60 per cent) more likely than those higher up the scale to report their health to be ‘fair’ or ‘poor’. Reports of ‘excellent’ health increased with income-and people in the highest income group were more than twice as likely as those with the lowest incomes to report ‘excellent’ health. The factors influencing these differences are very complex and far from completely understood. It is clear, though, that the influences determining an individual’s health are many and varied, and are not always within his or her own control.

*14/72/5*

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