Several factors affect a person’s health, many of which are outside the individual’s control. Certain economic, social and cultural factors have a significant effect.
Socially disadvantaged groups tend to have poorer health outcomes than more affluent groups.
As prominent sociologist John Germov put it, "the most underprivileged individuals in a society consistently suffer from shorter life expectancies and higher rates of illness compared to wealthier members who live longer and healthier lives".
Although some academics contest the idea that social classes exist in society, this article acknowledges the popular idea that social class exists and can help us analyse and explore drivers of inequality in our community.
For clarity, the definition of “class” used here will consider the three-class model commonly explored by social scientists. This model comprises the working class, middle class and upper class, combining aspects of Marxist and Weberian sociological perspectives. Analysing the effects of class on health through this viewpoint highlights how specific structures in society may contribute to health inequality between the classes. Moreover, it helps us understand how capitalism and the commodification of healthcare can bring health benefits to the upper class and simultaneously hinder health outcomes of the working and middle classes.
The notions of health and illness are inherently subjective. Regarded as social constructs formed by cultures and societies, the meanings of health and illness may change with time and place.
We know that smoking cigarettes contributes to lung cancer, and people consuming unhealthy diets often become malnourished and ill. We also understand that sedentary lifestyles contribute to obesity, coronary heart disease and a swathe of other health conditions.
By looking through a sociological lens that considers the stratification of society into classes, one can begin to analyse the profound question of ‘what are the causes of these causes?’
That is, what causes people to take up smoking? Why do certain groups consume unhealthy diets, and why do we increasingly live more sedentary lives.
A Marxist viewpoint sees capitalism as an economic and social system broadly designed to promote the private accumulation of wealth. Health sociologists like Germov warn that western capitalism has led to the commodification of healthcare which can drive health inequities across the community.
Healthcare commodification can be seen when governments promote privatisation through direct and indirect funding of organisations like private hospitals. The Medicare levy surcharge in Australia contributes to this commodification. This surcharge encourages individuals to purchase private health insurance, financially penalising taxpayers who choose not purchase private cover. Recent OECD reports also suggest that high levels of private health insurance in countries can contribute to healthcare access inequities.
Australians have access to both public and private healthcare systems. Medicare covers most of the public system and aims to provide free or low-cost healthcare to all Australians; it is publicly funded. The private system is a user pays system, with most patients relying on private health insurance to help cover the cost of procedures. To consumers, public health care costs are lower than the private equivalent, and there is a perception that the quality of care received in private care is superior to that of the public system.
Elective surgery is one area to consider where substantial discrepancies between the private and public sectors exist. For instance, before the 2020 coronavirus pandemic, a patient requiring knee surgery would have to wait around three months using the public system. The wait was significantly shorter if the patient could afford private healthcare.
Working-class patients are less likely to afford private hospital fees, so they are forced to wait months until a space is available in the public system.
In addition, knee injuries, for example, may restrict the patient’s ability to work, especially when one considers that members of the working class are more likely to be employed in manual labour roles than the middle or upper classes.
Working-class patients are also more likely to be casually employed without access to paid leave to utilise pre and post-surgery. Due to low job security, casual employees are more likely to lose their job if they can not work while waiting for surgery, further reinforcing their position as a member of the working class.
In contrast, a member of the upper class with private health insurance should have the funds to pay for surgery with a shorter wait time and is more likely to receive sick pay for their time off work after surgery. Furthermore, upper-class patients are more likely to afford better rehabilitative care, which helps transition the patient back to work.
Lack of education can also harm health. The working class generally achieve lower levels of education than the middle and upper classes.
In the United States, the New England Journal of Medicine reports that twelve per cent of adults have low literacy levels, to the point that they cannot read and interpret dosages and instructions on their medicine labels.
Therefore, it is not surprising that illiteracy has a range of profound negative implications for one’s health.
There are numerous ways to explore why working-class students are likelier to leave school earlier than middle and upper-class students. Prominent sociologists have long contended that from a structuralist perspective, our schools and education system do not promote economic opportunity equitably. Moreover, although today’s working-class may be more educated than previous generations, real incomes have decreased for the low-wage earners, and socioeconomic inequality continues to rise.
The working class are more likely to leave school earlier than the middle and upper classes. At times this has much to do with the intergenerational values on education. Studies have shown that working-class parents may be less likely to value formal education than middle- or upper-class parents.
The working class often encourage their children to leave school early to build a career in a trade or unskilled job. Working-class members may not appreciate the long-term financial benefits that tertiary education can help produce. In some cases, individuals who desire a tertiary education are forced into the workforce early to help pay household bills, preventing them from climbing the social ladder.
The working class are likely to be time-poor compared to the middle and upper classes. Many individuals require multiple jobs or work irregular hours to secure financial stability.
When people work long hours, they have less time to purchase and prepare nourishing meals for their families. As a result, unhealthy foods such as takeaway options are often bought out of necessity. On the other hand, the upper and middle classes are likely to have more time to prepare healthy meals and more disposable income to purchase nutritious ingredients.
In Australia, health experts recommend adults spend at least 150 minutes per week exercising to maintain their health, but only half of the population achieves this goal. But why are certain groups of people less active than others?
Most people know that they should be exercising more, but people clinging to the lower rungs of the social ladder are likely to be less active than those in the middle and those at the top.
Researchers from Victoria University discovered that people living in wealthy suburbs like Toorak or Brighton are much more likely to be physically active than those in less affluent areas, with the poorest suburbs faring worst when it comes to physical activity levels. As previously mentioned, the working-class are more likely to be time-poor than society’s middle and upper echelons. As a result, those working long hours or multiple jobs may not have enough spare time to start an exercise regimen, especially if they have children.
From a financial point of view, the wealthier you are, the more likely you can afford sporting equipment, sports club membership fees or gym sessions. As a result, social disadvantage affects the whole family. For example, if parents can’t afford to buy their child a $1,500 entry-level road bike, that child is unlikely to join the local cycling club with their schoolmates. The manual labour jobs that the working class tend to have are generally riskier than white collar workers. Workplace accidents disproportionately affect the working class more often than workers from other social classes. While there is often a degree of victim-blaming when workplace accidents occur, the social causes which lead to high-risk work environments need to be acknowledged. One such cause is the culture in many businesses where employers prioritise profit over workplace safety considerations, leading to increased risks of industrial accidents.
Although physically demanding jobs often have more workplace injuries, there are also risks associated with white-collar jobs. Problems like chronic postural or musculoskeletal problems are common across all classes. Still, the poorer workers are, the less likely they have the time and money to seek adequate treatment to improve their condition.
People from the working class smoke cigarettes more than wealthier workers. Several studies show that the number of tobacco retailers was significantly higher in areas of lower socioeconomic status. The same goes for access to healthy food.
People living in the outer suburbs have less access to healthy food options but much greater access to fast food, alcohol and pokie machines.
Viewing health inequality from a sociological perspective helps us examine some broad factors that drive ill-health. Furthermore, we can explore why the working-class have poorer health outcomes than the middle class, and the middle class have poorer health than the upper class.
The commodification of healthcare can be detrimental to the health of the poor and concurrently enhance the health of those with socioeconomic advantage.
The health burden that the working class carries is substantial. They often work longer hours for less money, have less time to live active lifestyles, are less likely to be as well-educated and will be subject to more dangerous working conditions than the middle and upper class. These factors must be carefully addressed with well-planned public health programs to stop the widening gap of health inequality in our society.