Essay: Do men and women in lower occupational groups had poorer health experiences?

The national health service was created to address the poor health of the nation, recent research suggests that its services may not be reaching those with the greatest need. In 1980 the Black report was published, it asserted that those in lower occupational groups had poorer health experiences and high mortality rates.
With the election of the new Labour government in the late 1990’s came more focus on and concern for reducing the health inequalities in Britain and as such the Acheson report was commissioned. The report found that the mortality rates between upper and lower income individuals and families had continued to widen and made recommendations to reduce these inequalities. The new Labour government continued to introduce policies in an attempt to address the health inequalities in Britain.
The governments approach to this was so far very materialistic or neo-materialistic. Wilkinson (1996) argued that to really tackle health inequalities the psychosocial reasons for it would also have to be taken into account and addressed.
The national health service (NHS) was created in 1948 to bring quality care to all, free at the point of use. The NHS is a very individualised service, based on cure rather than prevention. Godber (1998) argues that this is the NHS’s greatest failing, the slowness of government to look at preventative measures has resulted in great social costs as well as premature deaths. Shaw (2002) discuses how research suggests that NHS services may not be reaching those with the greatest need. A larger number of health resources go to higher income households rather than those in poorer households.
Hart (2000: 18-19) terms this as the ‘inverse care law’. He suggests that ‘the availability of good medical care tends to vary inversely with the need for it in the population served’. Hart argues that socio-economic deprivation leads to a greater incidence of coronary heart disease and those from lower socio-economic groups are less likely to be examined for illness and disease, be referred for tests or surgery and are generally given a lower priority so wait longer for any treatments. Good medical care depends on the population served, geographical differences, affluence, race and gender, which would imply that the NHS is not quality care for all.
In 1977 the Labour government appointed sir Douglas Black, former chief scientist of the department of health to head a group of researchers to asses the evidence on health inequalities and to help shape future policies. This report was an attempt to explain the reports of health inequalities that had been raised by health service workers and to find out why Britain’s mortality rates had failed to improve as fast as other countries (Townsend and Davidson. 1992). By 1980 the research group had concluded that both men and women in lower occupational groups had poorer health experiences, with mortality rates in occupation classes four and five worsening from 1950 to 1970, while occupational classes one and two had improved (Townsend and Davidson. 1992).
Explanations for these findings could have been that the data and statistics that were used for this research were biased, for example research tends to be male centric. Behaviour, choices and lifestyle can also affect health (Shaw et al. 2005). The group argued that the majority of the problems they had found lay within social and economic factors, such as income, environment, housing, transport and lifestyles and that all of these favour the health of the more affluent. Social position can affect health status. The group had thirty-seven recommendations, including more research and emphasis on prevention. The group recommended increasing benefits to improve material conditions of the poorest and ideas to improve working conditions and community services (Townsend and Davidson. 1992).
The Black report was submitted in 1980 to the new Conservative government who failed to adequately print and distribute it. They didn’t have a press conference or release it and only a few copies were given to select journalists on a bank holiday weekend, guaranteeing the lowest level of publicity. The report did not fit in easily with the ideology of the Conservative party (Townsend and Davidson. 1992).
The Conservative party’s secretary of state acknowledged the report by highlighting what he considered to be the reports flaws. He argued that there was no evidence that increasing benefits would help and that as the report failed to adequately explain the causes of health inequalities they could not accept its expensive recommendations. He also argued that there was new evidence to disprove the idea that working classes had less access to health services. The research group disputed these objections, going on to explain that the patterns of health inequalities could not be understood without looking at material deprivation as a factor (Townsend and Davidson. 1992).
In 1997, soon after the election of the new Labour government, Sir Donald Acheson, a former chief medical officer was appointed to head a small scientific advisory group to look at health inequalities and identify possible actions to be taken to improve them (Earwicker.2007) The Labour government had made known its concern about and intention of reducing health inequalities, this was a major difference to the previous Conservative government (Shaw. 2002).
The Acheson report was published in November 1998 and produced thirty-nine recommendations. The report asserted that over the previous few decades the mortality rates between the upper and lower ends of the social scale had continued to widen. The report identified three areas as crucial to improve the health of those less well off, beginning with steps to reduce income inequalities and improve housing conditions of the poorest households. It stated that the health of families with children should be given priority and that all policies that might affect health should first be looked at in terms of impacting health inequalities (Earwicker.2007)
The inquiry recommended policies to reduce income inequalities through a fairer tax system and argued that those with low incomes and at risk of health inequalities can be found in working or unemployed households, ethnic minorities, disabled people and pensioners. However, they stated that focusing on children could help with the problem of intergenerational transmission of poverty over time (Exworthy et al. 2003).
The Acheson report had mainly been accepted positively though two main criticisms were that it had failed to cost its recommendations as the Black report had and that it had failed to include targets. It has been argued that the ensuing debate over costings would have impacted on effective policy making and tackling health inequalities (Earwicker. 2007) The Acheson inquiry formed part of a wider approach to tackling health inequalities and social exclusion across government, indicating a new relationship between research and policy making (Exworthy et al. 2003.).
According to Earwicker (2007) the Acheson report inspired the development of a ten-year plan to update and improve the NHS and brought experts, practitioners and ministers together to develop ideas and tackle inequalities for the first time.
The Labour government appeared to recognise the more social and structural determinants of health and had put initiatives in place to try and tackle health inequalities, however its white paper ‘Choosing Health’ (DOH.2004) implied individual responsibility for ill health (Shaw et al. 2005). The ‘Saving Lives’ (DOH. 1999) white paper targets saw a shift towards the governments intent to begin tackling the social determinants of health and had two key aims. To narrow the health gap and to improve the health of the population as a whole, decreasing mortality and morbidity rates. The Labour government introduced many policies with the intent of addressing health inequalities, including introducing national minimum wage and working families and child tax credit (Shaw et al. 2002 and 2005).
Shaw (2002) argued that although Labour introduced many changes they had done very little towards reducing the massive inequalities in health and income in Britain and while they showed positive intentions they had not properly addressed the fundamental causes of health inequalities. Many of the initiatives that the government had put in place only effected England, whereas some of the highest mortality rates and poorest health were found in other parts of Britain (Shaw et al. 2005).
Though previous focus on health inequalities had been materialistic or neo-materialistic, individualised and the blame of lifestyle choice Wilkinson (1996) argued that in fact health inequalities stem from a mix of neo-materialistic and psychosocial causes and that health is affected by social position and the differences between income within a population. It had been commonly presumed that because of the wealth of some countries by the end of the 21st century health inequalities would have disappeared. Instead social position had remained an important factor in determining health, even in wealthier counties and there were huge differences in mortality rates between social classes (Wilkinson. 1996).
Wilkinson (1996) goes on to argue that rather than the wealthiest countries it is the more egalitarian countries that have the best health. They appear to have social cohesion, they have a good community life and with equalities in wealth all people are able to access the same social activities and organisations, with fewer incidences of anti-social behaviour reported. Their society appears more caring and cohesive and has fewer alcohol and drug related deaths or homicides.
Rowlingson (2011) discusses how income inequalities can be harmful to health as it places society in a hierarchy, increasing competition for social status, causing anxiety and stress, leading to ill health. Wilkinson (1996) suggest that there is a lot of evidence showing that psychosocial stress can influence mortality and illness rates and that chronic stress can affect cardiovascular, endocrine and immunological processes. The social life of society has one of the biggest effects on health alongside income inequality. ‘It is clear that the psychosocial burden we have identified is now the most important limitation of the quality of life in modern societies’ (Wilkinson.1996: 230).
Shaw et al (2005) suggests that there is data that shows increasing health inequalities in Britain, with mortality rates increasing in the poorest areas and decreasing in the most affluent and that income inequality remains at a very high level. They argue that this does not bode well for the future of the health of Britain. Though living standards have improved for some of the poorest it has not reduced inequalities in health or income and if this continues it is very likely to impact future generations.
There are many ideas and opinions about why Britain has health inequalities and how they could be reduced. Rowlingson (2011) suggests that policies could be put in place to redistribute wealth through taxation and benefits and that a larger emphasis on equality and better public services would help. Shaw et al (2005) agrees, stating that Britain’s level of benefits is low in comparison with EU poverty standards making it impossible to sustain good health.
Barnard (2015) argues that so far, the policies that have best addressed health inequalities are those that improve the incomes of the poorest rather than those that have sought to intervene in lifestyle choices, for example smoking. He suggests that future governments should focus on poverty reduction while working alongside the NHS and other public health teams and services to improve health.
The government appears to favour tackling income inequality by focusing on training and employment, however nothing can reduce unemployment if there are no jobs available. Moreover, a large amount of the population cannot work due to age, disability or caring responsibilities so tis government focus will do little to help them out of poverty. An anti-poverty policy needs to be implemented to provide income and services and to increase living standards. This type of policy will do the most to quickly impact health inequalities in Britain (Shaw. 2002).
Wilkinson (1996) argues that first the government and the public need to recognise the importance of income inequality and social cohesion in improving health. He states that all policies must be evaluated to find out their impact on social division and the economic focus must be on improving social cohesion and quality of life. Health inequality is affected by the structural features of society.
Numerous studies have shown that health differences are not confined to differences between the poor and the rest of society but instead run right across the population with every level in the social hierarchy having worse health than the one above it. Were the new Labour government correct when they stated that Britain was not ready for the steps of income redistribution and would only wish to eliminate health and income inequalities if it meant no higher taxes for them personally? If Britain were to move towards a more egalitarian society would this eliminate all health inequalities, or would some remain without the individualised focus on lifestyle choices suggested by previous governments?