Inequalities In Health The wider socio-economic context of health behaviours

1. Inequalities In Health The wider socio-economiccontext of health behaviours

2. Source: Dahlgren & Whitehead (1991)

4. Source: Acheson Report (1998)

5. The Black Report (1980) Examined how health varies by: • Occupational status • Gender • Area of residence • Ethnic origin • Housing tenure

6. 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

7. Material conditions: • Income • Housing • Work environment • Education level The Black Report (1980) Material conditions were the predominant cause,followed by lifestyle factors

8. 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/economicallydeprived in the usual sense, and certainly not‘poor’

10. 1991 1998 2001 Most Affluent 161.36 98.04 79.54 Most Deprived 295.81 223.30 186.19 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)

11. 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 one’s circumstances Places the onus on government to provide socio-economic conditions in which people can thrive

12. Dead Poor 16:45-20:25 26:55-32:10 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?

13. Dead Poor Learned helplessness Alan’s story: • “My self-esteem went” • “What more can I do?” • “You don’t want to get out of bed in the morning”

14. Dead Poor The issues Stress

15. Bruce Alexander’s 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

16. Laboratory rats kept incramped, isolated conditionswith no opportunity to engagein normal rat behaviour

17. 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.

18. 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

19. 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)

20. 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)