The Social Context of The Social Context of Health, Illness and Health, Illness and

RecoveryRecoveryLyn GardnerLyn Gardner

Lecturer,Lecturer, Centre for MentalCentre for Mental Health StudiesHealth Studies

NB this lecture is available at NB this lecture is available at http://shswebspace.swan.ac.uk/HNGardnerLD/http://shswebspace.swan.ac.uk/HNGardnerLD/

What is Sociology?What is Sociology?

‘‘Sociology offers a distinct and highly illuminating Sociology offers a distinct and highly illuminating perspective on human behaviour. Learning perspective on human behaviour. Learning sociology means taking a step back from our own sociology means taking a step back from our own personal interpretations of the world, to look at personal interpretations of the world, to look at the social influences which shape our lives.the social influences which shape our lives.Sociology does not deny or diminish the reality of Sociology does not deny or diminish the reality of individual experience rather, we obtain a richer individual experience rather, we obtain a richer awareness of our own individual characteristics, awareness of our own individual characteristics, and those of others, by developing a sensitivity and those of others, by developing a sensitivity towards the wider universe of social activity in towards the wider universe of social activity in which we are all involved.’ which we are all involved.’

Giddens, A., 1989Giddens, A., 1989

Thinking SociologicallyThinking Sociologically

• Published in 1990 by Zygmunt Published in 1990 by Zygmunt BaumanBauman

• ‘‘sociology is first and foremost a sociology is first and foremost a way way of thinking of thinking about the human world’.about the human world’.

THINKING SOCIOLOGICALLYTHINKING SOCIOLOGICALLY

‘‘Those human actions and interactions that Those human actions and interactions that sociologists explore have all been given sociologists explore have all been given

names and theorised about by the actors names and theorised about by the actors themselves.themselves.

Before sociologists started looking at them, Before sociologists started looking at them, they were objects of commonsensical they were objects of commonsensical

knowledge’.knowledge’.

Bauman, Z., 1990Bauman, Z., 1990

Meddlesome Sociologists….Meddlesome Sociologists….

• The questioning and critical stance taken The questioning and critical stance taken by sociology can sometimes be perceived by sociology can sometimes be perceived as intrusive and unsettling, or even as intrusive and unsettling, or even politically motivated (usually the left!)politically motivated (usually the left!)

• Bauman recognises this:Bauman recognises this:

‘‘In an encounter with that familiar world In an encounter with that familiar world ruled by habits…sociology acts as a ruled by habits…sociology acts as a meddlesome and often irritating meddlesome and often irritating stranger…’ (cited in Kirby et al. 1997:3)stranger…’ (cited in Kirby et al. 1997:3)

Cont.Cont.

Yet sociology adheres toYet sociology adheres to‘‘the rigorous rules of responsible the rigorous rules of responsible

speech’, argues Bauman.speech’, argues Bauman.Thinking sociologicallyThinking sociologically ’helps us to ’helps us to

understand other forms of life, understand other forms of life, inaccessible to our direct inaccessible to our direct experience’experience’ and accordingly we can and accordingly we can ‘understand more fully the ‘understand more fully the people around us’.people around us’.

Alan BennettAlan BennettThe well know English writer makes a similar The well know English writer makes a similar

point in his book point in his book Writing HomeWriting Home (1996) when (1996) when he comments on the usefulness of sociology he comments on the usefulness of sociology in providing insights into social life:in providing insights into social life:

‘‘I go to sociology not for analysis or I go to sociology not for analysis or explications but for access to explications but for access to experiences I do not have and often do experiences I do not have and often do not want (prison, mental illness, birth not want (prison, mental illness, birth marks)’.marks)’.

THE SOCIOLOGICAL THE SOCIOLOGICAL IMAGINATIONIMAGINATION

‘‘The ability to recognise that personal troubles The ability to recognise that personal troubles are in fact public ills – what we perceive as are in fact public ills – what we perceive as individual problems can be understood and individual problems can be understood and

explained only when we examine social, explained only when we examine social, economic and political factors.economic and political factors.

Sociology, then, is about understanding the Sociology, then, is about understanding the relationship between our own experience relationship between our own experience

and the social structures we inhabit.’and the social structures we inhabit.’

C. Wright MillsC. Wright Mills, 1954, 1954

USING A SOCIOLOGICAL USING A SOCIOLOGICAL IMAGINATIONIMAGINATION

‘‘The worker may have exploited a The worker may have exploited a sociological imagination to question sociological imagination to question

commonsense understandings of commonsense understandings of poverty…leading to a poverty…leading to a

conceptualisation of poor people as conceptualisation of poor people as victims of a social system predicated victims of a social system predicated

on inequality.’on inequality.’

Sullivan, 1987Sullivan, 1987

The Social Model of Health, The Social Model of Health, Illness and RecoveryIllness and Recovery

• This model, or approach, suggests that social This model, or approach, suggests that social factors influence health: from mortality rates factors influence health: from mortality rates to recoveryto recovery

• Accordingly, it is important to look at the Accordingly, it is important to look at the significant structural factors which may significant structural factors which may influence health, illness and recovery: social influence health, illness and recovery: social class/socio-economic status, gender and class/socio-economic status, gender and ethnicity, and the impact of poverty and ethnicity, and the impact of poverty and mental illnessmental illness

HEALTH INEQUALITIESHEALTH INEQUALITIES

• Social circumstances across the entire life-Social circumstances across the entire life-course – from birth to late adulthood – course – from birth to late adulthood – influence people’s health and well-being.influence people’s health and well-being.

• Different Different socio-economic indicatorssocio-economic indicators – – income, wealth, educational attainment and income, wealth, educational attainment and occupational group – are all related to and occupational group – are all related to and help explain people’s health status.help explain people’s health status.

• Health inequalitiesHealth inequalities are produced by the are produced by the clustering of disadvantage – in opportunity, clustering of disadvantage – in opportunity, material circumstances and behaviours related material circumstances and behaviours related to health – across people’s lives.to health – across people’s lives.

Social determinants of health (Acheson, 1998)Social determinants of health (Acheson, 1998)Interaction of structural factors and individual Interaction of structural factors and individual

behaviourbehaviour

SOCIAL STRATIFICATION SOCIAL STRATIFICATION

THE RICH MAN IN HIS CASTLETHE RICH MAN IN HIS CASTLE

THE POOR MAN AT HIS GATETHE POOR MAN AT HIS GATE

GOD MADE THEM HIGH AND LOWLY,GOD MADE THEM HIGH AND LOWLY,

AND ORDERED THEIR ESTATE.AND ORDERED THEIR ESTATE.

All Things Bright and Beautiful,All Things Bright and Beautiful,

Mrs. C.F. Alexander, 1848.Mrs. C.F. Alexander, 1848.

STRATIFICATIONSTRATIFICATION

• DIVISION OF SOCIETY INTO DIVISION OF SOCIETY INTO HIERARCHICALLY ORDERED LAYERSHIERARCHICALLY ORDERED LAYERS

• MEMBERS OF EACH LAYER BROADLY MEMBERS OF EACH LAYER BROADLY EQUAL, BUT INEQUALITY BETWEEN EQUAL, BUT INEQUALITY BETWEEN

LAYERSLAYERS

SOCIAL CLASSSOCIAL CLASS

‘‘A large scale grouping of people who A large scale grouping of people who share common resources which share common resources which strongly influence the type of strongly influence the type of lifestyle they are able to lead.’lifestyle they are able to lead.’

(Giddens, 2001, p.282)(Giddens, 2001, p.282)

LIFE CHANCESLIFE CHANCES

• ‘‘The chances of obtaining those The chances of obtaining those things defined as desirable and things defined as desirable and avoiding those things defined as avoiding those things defined as undesirable in society.’ undesirable in society.’

(Haralambos, 1995)(Haralambos, 1995)

‘‘Inequality in health is the worst Inequality in health is the worst inequality of all. There is no more inequality of all. There is no more serious inequality than knowing you’ll serious inequality than knowing you’ll die sooner because you’re badly off.’die sooner because you’re badly off.’

Frank Dobson, Secretary of State Frank Dobson, Secretary of State for Health, 1997for Health, 1997..

MEASURING SOCIAL CLASS:MEASURING SOCIAL CLASS:The Registrar General’s ScaleThe Registrar General’s Scale

In Britain, government statisticians In Britain, government statisticians have measured social class with the have measured social class with the Registrar General’s Social Class Registrar General’s Social Class (RGSC) scale since 1911(RGSC) scale since 1911

R.G. SCALER.G. SCALE

I I Professional Professional e.g. lawyer, e.g. lawyer, doctor.doctor.

II II Intermediate Intermediate e.g. teacher, nurse.e.g. teacher, nurse.

IIINIIIN Skilled non-manual Skilled non-manual e.g. typist, shop e.g. typist, shop assistant.assistant.

IIIMIIIM Skilled manual Skilled manual e.g. carpenter, miner.e.g. carpenter, miner.

IV IV Partly skilled manualPartly skilled manual e.g. farm e.g. farm worker.worker.

V V Unskilled manual Unskilled manual e.g. cleaner, e.g. cleaner, labourer.labourer.

REGISTRAR GENERAL’S REGISTRAR GENERAL’S SCALESCALE

• MEN ALLOCATED ON BASIS OF MEN ALLOCATED ON BASIS OF OCCUPATIONOCCUPATION

• MARRIED/COHABITING WOMEN ON MARRIED/COHABITING WOMEN ON BASIS OF PARTNER’S OCCUPATIONBASIS OF PARTNER’S OCCUPATION

• CHILDREN ON BASIS OF FATHER’S CHILDREN ON BASIS OF FATHER’S OCCUPATIONOCCUPATION

• SINGLE WOMEN ON BASIS OF OWN SINGLE WOMEN ON BASIS OF OWN OCCUPATIONOCCUPATION

MEASURING SOCIAL CLASS II The MEASURING SOCIAL CLASS II The National Statistics Socioeconomic National Statistics Socioeconomic Classification (NS-SEC)Classification (NS-SEC)

In use since 2001 censusIn use since 2001 census

Reflects:Reflects:

• growth of middle-class occupationsgrowth of middle-class occupations

• changing mature of kinds of work changing mature of kinds of work that people dothat people do

• levels of social esteem that these levels of social esteem that these jobs attractjobs attract

NS –SEC social class classification systemNS –SEC social class classification systemSocial ClassSocial Class OccupationOccupation

1Higher managerial & 1Higher managerial & professionalprofessional

Doctor, lawyer, professorDoctor, lawyer, professor

2 Lower managerial & 2 Lower managerial & professionalprofessional

Teacher, nurse, police Teacher, nurse, police sergeantsergeant

3 Intermediate3 Intermediate Secretary, fire fighter, Secretary, fire fighter, HCSWHCSW

4 Small employer & self 4 Small employer & self employedemployed

Builder, hairdresserBuilder, hairdresser

5 Lower supervisory & 5 Lower supervisory & technicaltechnical

Craftsman, supervisorCraftsman, supervisor

6 Semi-routine6 Semi-routine Shop assistant, postal Shop assistant, postal workerworker

7 Routine7 Routine Bus driver, cleanerBus driver, cleaner

8 Never-worked or long-term 8 Never-worked or long-term unemployedunemployed

Students, unemployedStudents, unemployed

Following an extensive review of the Following an extensive review of the evidence, MacIntyre (1986) concluded thatevidence, MacIntyre (1986) concluded that

““occupational class (whether of self, father occupational class (whether of self, father or husband) has repeatedly been shown to or husband) has repeatedly been shown to be associated with a diverse collection of be associated with a diverse collection of health measurements, including death from health measurements, including death from all causes or from specific causes, physical all causes or from specific causes, physical or mental illness, height, weight for height, or mental illness, height, weight for height, birth weight, blood pressure, dental birth weight, blood pressure, dental condition, ability to conceive and self condition, ability to conceive and self perceived health.” (p.395)perceived health.” (p.395)

THE BLACK REPORTTHE BLACK REPORT

• Commissioned at end of 1970s by Labour Commissioned at end of 1970s by Labour government, chaired by Sir Douglas Black.government, chaired by Sir Douglas Black.

• To review evidence on inequalities in health To review evidence on inequalities in health & suggest policy recommendations.& suggest policy recommendations.

• Published in 1980 at start of Thatcher's Published in 1980 at start of Thatcher's new Conservative administration.new Conservative administration.

• Not widely disseminated – only 260 copies Not widely disseminated – only 260 copies printed.printed.

THE HEALTH DIVIDETHE HEALTH DIVIDE

• Subsequent edition published by Subsequent edition published by Penguin in dual volume with Penguin in dual volume with Whitehead’s Whitehead’s The Health DivideThe Health Divide (1987) which updated the findings, (1987) which updated the findings, edited by Peter Townsend and Nick edited by Peter Townsend and Nick Davidson.Davidson.

• This publication made the findings This publication made the findings widely available and made for a widely available and made for a shocking indictment on the state of shocking indictment on the state of the nation’s poor.the nation’s poor.

THE ACHESON REPORT THE ACHESON REPORT (1998)(1998)• An independent inquiry into An independent inquiry into

inequalities in healthinequalities in health

• Commissioned by the Labour Commissioned by the Labour GovernmentGovernment

• Access via internet: Access via internet: www.archive.official-documents.co.ukwww.archive.official-documents.co.uk

EXPLANATIONS FOR EXPLANATIONS FOR INEQUALITIESINEQUALITIES• ARTEFACTARTEFACT

• SOCIAL SELECTION THEORYSOCIAL SELECTION THEORY

• CULTURAL/BEHAVIOURALCULTURAL/BEHAVIOURAL

• MATERIALISTMATERIALIST

ARTEFACTARTEFACT

• Relationship between social Relationship between social inequality and health chances has inequality and health chances has been created by researchers - an been created by researchers - an artefact being something made by artefact being something made by people.people.

• Official mortality and morbidity Official mortality and morbidity statistics are unreliable and invalid.statistics are unreliable and invalid.

SOCIAL SELECTION SOCIAL SELECTION EXPLANATIONEXPLANATION

• Argues that health status influences Argues that health status influences social statussocial status

• i.e. healthy people - upwardly mobile i.e. healthy people - upwardly mobile and unhealthy drift into lower social and unhealthy drift into lower social classes.classes.

CULTURAL/BEHAVIOURALCULTURAL/BEHAVIOURALEXPLANATIONSEXPLANATIONS

• Suggests that different social classes Suggests that different social classes behave in different waysbehave in different ways

• i.e. the poorer health of lower social i.e. the poorer health of lower social classes is caused by behaviour that classes is caused by behaviour that damages healthdamages health

• the culture of higher social classes the culture of higher social classes leads to better health and longer life leads to better health and longer life expectancyexpectancy

LIMITATIONS TO LIMITATIONS TO CULTURAL/BEHAVIOURAL CULTURAL/BEHAVIOURAL

THEORYTHEORY

• Behaviour is often a result of Behaviour is often a result of economic circumstanceseconomic circumstances

• Lifestyle/behaviour make a bigger Lifestyle/behaviour make a bigger contribution to health for the contribution to health for the affluent than for the pooraffluent than for the poor

ALSOALSO

• There are significant cultural There are significant cultural variations variations withinwithin each social class each social class

• There is considerable cultural overlap There is considerable cultural overlap between different social classesbetween different social classes

• Impact of other social factors such as Impact of other social factors such as ethnicity, gender, location and ageethnicity, gender, location and age

MATERIALIST/STRUCTURAL MATERIALIST/STRUCTURAL EXPLANATIONEXPLANATION

• Social class differences in health are Social class differences in health are caused by the different caused by the different workingworking and and livingliving conditions of the different conditions of the different social classessocial classes

WORKING CONDITIONSWORKING CONDITIONS

• Manual occupations associated with Manual occupations associated with higher rates of morbidity and higher rates of morbidity and mortality.mortality.

• Unemployment associated with Unemployment associated with higher rates of morbidity and higher rates of morbidity and mortality.mortality.

LIVING CONDITIONSLIVING CONDITIONS

• Blackburn (1991) suggests that low Blackburn (1991) suggests that low income damages health in 3 waysincome damages health in 3 ways

• 1. Lack of resources (for food and 1. Lack of resources (for food and shelter) can make one vulnerable to shelter) can make one vulnerable to physical illness.physical illness.

• 2. Lack of control over one’s 2. Lack of control over one’s circumstances can be circumstances can be psychologically damagingpsychologically damaging

• 3. Coping strategies adopted by 3. Coping strategies adopted by those on low income may lead to those on low income may lead to behaviour that damages healthbehaviour that damages health

EvidenceEvidence

Most sociologists conclude, as did the Most sociologists conclude, as did the authors of the Black Report and authors of the Black Report and Acheson Report, that differences in Acheson Report, that differences in material circumstances are the main material circumstances are the main determinants of inequalities in healthdeterminants of inequalities in health

POVERTY, HEALTH AND POVERTY, HEALTH AND SOCIAL EXCLUSIONSOCIAL EXCLUSION

What contribution can What contribution can sociology make to an sociology make to an

understanding of poverty understanding of poverty and its impact on health?and its impact on health?

DEFINING POVERTY

‘‘Poverty means going short materially, Poverty means going short materially, socially and emotionally. It means spending socially and emotionally. It means spending less on food, on heating, and on clothing less on food, on heating, and on clothing than someone on an average income. Above than someone on an average income. Above all, poverty takes away the tools to build the all, poverty takes away the tools to build the blocks for the future – your blocks for the future – your life chanceslife chances. It . It steals away the opportunity to have a life steals away the opportunity to have a life unmarked by sickness, a decent education, unmarked by sickness, a decent education, a secure home and a long retirement’.a secure home and a long retirement’.

Oppenheim and Harker, 1996:4.Oppenheim and Harker, 1996:4.

Income inequalities lead to lower levels Income inequalities lead to lower levels of of social capitalsocial capital, largely through:, largely through:

‘‘feelings aroused by social comparisons to feelings aroused by social comparisons to do with confidence, insecurity and fears of do with confidence, insecurity and fears of inadequacy. Social hierarchy induces inadequacy. Social hierarchy induces worries about possible incompetence and worries about possible incompetence and inadequacy, feelings of insecurity and inadequacy, feelings of insecurity and feelings of inferiority’ feelings of inferiority’

(Wilkinson, 1999, p.262).(Wilkinson, 1999, p.262).

SOCIAL CAPITAL, Wilkinson (1996)SOCIAL CAPITAL, Wilkinson (1996)

• A high degree of income inequality in a A high degree of income inequality in a rich country:rich country:

• Makes social divisions worseMakes social divisions worse

• Reduces levels of trustReduces levels of trust

• Increases social anxiety and stress Increases social anxiety and stress levellevel

DEFINING POVERTYDEFINING POVERTY

Absolute PovertyAbsolute Poverty

Families are in poverty when their Families are in poverty when their incomes are ‘insufficient to obtain the incomes are ‘insufficient to obtain the minimum necessities for the minimum necessities for the maintenance of physical efficiency’ maintenance of physical efficiency’ B.S. Rowntree, 1941.B.S. Rowntree, 1941.

Relative PovertyRelative Poverty

‘‘Individuals, families and groups in the Individuals, families and groups in the population can be said to be in poverty population can be said to be in poverty when they lack the resources to obtain when they lack the resources to obtain the types of diet, participate in the the types of diet, participate in the activities and have the living activities and have the living conditions and amenities which are conditions and amenities which are customary, or at least widely customary, or at least widely encouraged or approved, in the encouraged or approved, in the societies to which they belong.’societies to which they belong.’Townsend, 1979.Townsend, 1979.

SOCIAL EXCLUSIONSOCIAL EXCLUSION

Refers to the ‘dynamic process of Refers to the ‘dynamic process of being shut out, fully or partially, from being shut out, fully or partially, from any of the social, economic, political any of the social, economic, political and cultural systems which determine and cultural systems which determine the social integration of a person in the social integration of a person in society.’society.’

Walker and Walker, 1997.Walker and Walker, 1997.

MANIFESTATIONS OF MANIFESTATIONS OF EXCLUSIONEXCLUSION• SocialSocial – isolated, weak or limited social – isolated, weak or limited social

network.network.• EconomicEconomic – un/employment, insecure, – un/employment, insecure,

low paid work.low paid work.• PoliticalPolitical – links to above re.work, not – links to above re.work, not

registered to vote,no registered to vote,no voice/disempowered.voice/disempowered.

• Cultural Cultural – little opportunity to engage in – little opportunity to engage in varied range of cultural activities.varied range of cultural activities.

MEASURING POVERTYMEASURING POVERTY

• No official poverty line in BritainNo official poverty line in Britain

• Researchers use statistical indicators Researchers use statistical indicators such as benefit provision required to bring such as benefit provision required to bring people's income up to subsistence levelpeople's income up to subsistence level

• Most commonly used threshold of low Most commonly used threshold of low income is 60% of median (middle) income is 60% of median (middle) income.income.

SUBJECTIVE MEASUREMENTS SUBJECTIVE MEASUREMENTS OF POVERTYOF POVERTY

Opinion polls conducted on what Opinion polls conducted on what ordinary people considered to be ordinary people considered to be ‘necessities' for an ‘acceptable’ ‘necessities' for an ‘acceptable’ standard of living – producing standard of living – producing ‘‘deprivation indicesdeprivation indices’.’.

EXTENT OF POVERTY IN EXTENT OF POVERTY IN BRITAINBRITAIN• In 2002/3 In 2002/3 12.4 million12.4 million people on incomes people on incomes

below this income thresholdbelow this income threshold• This represents a drop of 1.5 million since This represents a drop of 1.5 million since

1996/971996/97• In 2002/3 In 2002/3 3.6 million children3.6 million children were living were living

in households below this income thresholdin households below this income threshold• The Black ReportThe Black Report concluded that ‘above concluded that ‘above

all, we consider that the all, we consider that the abolition of child abolition of child povertypoverty should be adopted as a national should be adopted as a national goal for the 1980s.’goal for the 1980s.’Townsend & Townsend & Davidson, 1988Davidson, 1988..

WHY ARE POOR PEOPLE WHY ARE POOR PEOPLE POOR?POOR?

Two main explanations:Two main explanations:

• Responsibility lies with the individual Responsibility lies with the individual or group – or group – ‘blame the victim’‘blame the victim’

• Structural forces in society shape Structural forces in society shape disadvantage – disadvantage – ‘blame society’‘blame society’

BLAME THE VICTIMBLAME THE VICTIM

• Poor people are poor because of the Poor people are poor because of the things they dothings they do and the choices they and the choices they make.make.

• Culture of povertyCulture of poverty into which poor into which poor children are socialised. Transmitted children are socialised. Transmitted across generations – people resign across generations – people resign themselves to their plight.themselves to their plight.

• Cycle of povertyCycle of poverty

BLAME THE VICTIM cont.BLAME THE VICTIM cont.

• Very popular theory – regard the Very popular theory – regard the poor as responsible for their own poor as responsible for their own poverty and are suspicious of those poverty and are suspicious of those living on welfare benefitsliving on welfare benefits

• Frequently voiced through tabloid Frequently voiced through tabloid presspress

CRITICISMS OF INDIVUALISTIC CRITICISMS OF INDIVUALISTIC EXPLANATIONSEXPLANATIONS

• Ignores wider issues – too simplisticIgnores wider issues – too simplistic

• Neither culture of poverty or cycle Neither culture of poverty or cycle of deprivation explain how people of deprivation explain how people came to be poor in the first placecame to be poor in the first place

BLAME THE SYSTEMBLAME THE SYSTEM• Emphasises wider social processes – political and economic Emphasises wider social processes – political and economic

factors – that produce conditions of poverty which are difficult factors – that produce conditions of poverty which are difficult for individuals to overcome.for individuals to overcome.

• For example – educational opportunities, employment For example – educational opportunities, employment patterns/opportunities e.g. Closure/relocation of manufacturing patterns/opportunities e.g. Closure/relocation of manufacturing industries.industries.

• Class, gender and ethnicity.Class, gender and ethnicity.

• Taxation policies that benefit the better off.Taxation policies that benefit the better off.

• Lack of affordable childcare that reduces parent’s (especially Lack of affordable childcare that reduces parent’s (especially women and lone parents) ability to work.women and lone parents) ability to work.

STRUCTURAL FORCES SUCH STRUCTURAL FORCES SUCH AS:AS:• ClassClass

• EthnicityEthnicity

• GenderGender

• AgeAge

• Occupational positionOccupational position

• Educational attainmentEducational attainment

Shape the way in which resources are Shape the way in which resources are distributeddistributed

POVERTY IS BAD FOR YOUR POVERTY IS BAD FOR YOUR HEALTHHEALTH• Lack of resources (for food & shelter) Lack of resources (for food & shelter)

can make one vulnerable to can make one vulnerable to physical physical illnessillness

• Lack of control over one’s Lack of control over one’s circumstances can be circumstances can be psychologically psychologically damagingdamaging

• The coping strategies adopted by those The coping strategies adopted by those on low income may lead to behaviour on low income may lead to behaviour that that damages healthdamages health

POVERTY:THE IMPACT ON POVERTY:THE IMPACT ON CHILDREN’S MENTAL CHILDREN’S MENTAL HEALTHHEALTH• 1 in 10 children in the UK had a clinically 1 in 10 children in the UK had a clinically

recognisable mental disorder in 2004 recognisable mental disorder in 2004 (Office for National Statistics)(Office for National Statistics)

• Prevalence varied according to family Prevalence varied according to family characteristics:characteristics:

• More common among single-parent More common among single-parent familiesfamilies

• More common in families where both More common in families where both parents were unemployedparents were unemployed

• More common among children whose More common among children whose parents had no educational qualifications.parents had no educational qualifications.

HEALTH RELATED HEALTH RELATED BEHAVIOURS - SMOKINGBEHAVIOURS - SMOKING• Health-related behaviours – such as Health-related behaviours – such as smokingsmoking and and

diet – are strongly influenced by the social diet – are strongly influenced by the social environment in which people live. environment in which people live. People do not People do not have equal choiceshave equal choices about how they live theirabout how they live their lives. lives. (Shaw et al 1999).(Shaw et al 1999).

Surviving by Smoking, Hilary Graham, 1994.Surviving by Smoking, Hilary Graham, 1994.

• ‘‘Smoking is one of the ways women handle and Smoking is one of the ways women handle and diffuse the contradictory pressures that structure diffuse the contradictory pressures that structure their daily lives. It provides a way of keeping going their daily lives. It provides a way of keeping going when women have little going for them.’when women have little going for them.’

SMOKINGSMOKING

• ‘‘The habit identified as the major cause of The habit identified as the major cause of premature death and childhood ill-health in premature death and childhood ill-health in Britain is – paradoxically- one which many Britain is – paradoxically- one which many women identify as essential to their survival women identify as essential to their survival and to the survival of their families’and to the survival of their families’

• ‘‘Maternal smoking is a habit through which Maternal smoking is a habit through which the welfare of children is simultaneously the welfare of children is simultaneously threatened and protected’threatened and protected’

• Smoking can be ‘experienced as a Smoking can be ‘experienced as a preventive strategy for non-accidental injury’preventive strategy for non-accidental injury’

• Smoking has a clear ‘mood management Smoking has a clear ‘mood management function’function’

SPENDING ON SPENDING ON TOBACCOTOBACCO

• ‘‘Like food and fuel, spending on tobacco Like food and fuel, spending on tobacco is inversely related to income: more is is inversely related to income: more is spent proportionately on tobacco as spent proportionately on tobacco as household income falls’household income falls’

• ‘‘Tobacco spending has the hallmark of Tobacco spending has the hallmark of necessity’necessity’

• ‘‘Women recognise the contradictory kind Women recognise the contradictory kind of support that smoking provides…of support that smoking provides…smoking illuminates the toll that social smoking illuminates the toll that social divisions take on the welfare of women divisions take on the welfare of women and their children’.and their children’.

Poverty, Smoking and the Poverty, Smoking and the Health ProfessionalHealth Professional

‘‘how can they be poor when they how can they be poor when they always have money to spend on always have money to spend on cigarettes, a four pack, and they all cigarettes, a four pack, and they all have televisions and videos. I don’t have televisions and videos. I don’t know why they have children, they know why they have children, they can’t look after them, feed them, or can’t look after them, feed them, or buy then the things they need’buy then the things they need’

Cont.Cont.

‘‘we spend hours telling them how to we spend hours telling them how to eat properly. What food to buy, what eat properly. What food to buy, what is good for them and the baby. What is good for them and the baby. What do they do? Live on chips and fags. do they do? Live on chips and fags. It’s a waste of my time and effort. It’s a waste of my time and effort. They never breast-feed, don’t take They never breast-feed, don’t take iron and never take advice’iron and never take advice’

Hunt, S. 2004.Hunt, S. 2004.

‘‘Fags are good…Fags are good…

to relax. After a hard day with the to relax. After a hard day with the kids I like to curl up with a fag. I only kids I like to curl up with a fag. I only smoke when the kids are outside or smoke when the kids are outside or after they have gone to bed. I know after they have gone to bed. I know it’s not good for them, but it’s good it’s not good for them, but it’s good for me, it helps me unwind’for me, it helps me unwind’

Emma quoted in Hunt, 2004Emma quoted in Hunt, 2004

WOMEN, POVERTY AND WOMEN, POVERTY AND HEALTHHEALTH

‘‘Women bear the brunt of poverty, it is Women bear the brunt of poverty, it is women who manage poverty on a women who manage poverty on a daily basis and it is women who daily basis and it is women who struggle to feed, clothe and house struggle to feed, clothe and house themselves and their children’.themselves and their children’.

Hunt, 2004:23Hunt, 2004:23The burden of ‘managing poverty’ has The burden of ‘managing poverty’ has clear consequences for the health clear consequences for the health status of women.status of women.

WHY ARE WOMEN POOR?WHY ARE WOMEN POOR?

• MultifactoralMultifactoral• Women who are pregnant, women with small Women who are pregnant, women with small

children, women from ethnic minority groups and children, women from ethnic minority groups and those who have missed out on education are those who have missed out on education are marginalised and excluded (Walby, 1997)marginalised and excluded (Walby, 1997)

• Lone parent families – approx 21% of all families; Lone parent families – approx 21% of all families; 90% are mother-headed lone parent families.90% are mother-headed lone parent families.

• Women are more likely to be in low-paid workWomen are more likely to be in low-paid work• Women are more likely to have responsibility for Women are more likely to have responsibility for

child and other care, reducing their capacity for child and other care, reducing their capacity for employment, secure work and promotion.employment, secure work and promotion.

CONCLUSIONCONCLUSION

‘‘Poverty is best understood as a Poverty is best understood as a function of social, economic and function of social, economic and political structures and processes political structures and processes which create and perpetuate an which create and perpetuate an unequal distribution of resources unequal distribution of resources both within and, in a global context, both within and, in a global context, between societies’ (Lister, 2004).between societies’ (Lister, 2004).

Cont.Cont.

Reducing health inequalities requires Reducing health inequalities requires that the underlying causes of these that the underlying causes of these inequalities are tackled (Shaw, et al. inequalities are tackled (Shaw, et al. 1999)1999)

SEMINAR GROUPWORKSEMINAR GROUPWORK

• Why are poor people poor?Why are poor people poor?

• What is your response to the What is your response to the contradictory nature of health contradictory nature of health damaging behaviour?damaging behaviour?

• What are the implications of the What are the implications of the effects of health inequalities on the effects of health inequalities on the role of the nurse?role of the nurse?

RESOURCESRESOURCES

Blackburn, C. (1992) Poverty and HealthBlackburn, C. (1992) Poverty and HealthShaw, M. et al (1999) The Widening GapShaw, M. et al (1999) The Widening Gaphttp:www.jrf.org.uk (Joseph Rowntree http:www.jrf.org.uk (Joseph Rowntree

Foundation)Foundation)http://www.poverty.org.uk/intro/http://www.poverty.org.uk/intro/www.archive.official-documents.co.ukwww.archive.official-documents.co.ukwww.dh.gov.ukwww.dh.gov.ukwww.statistics.gov.ukwww.statistics.gov.uk