An Analysis of the Social Gradient of Health Essay Example for Free

An Analysis of the Social Gradient of Health EssayThe demonstration of a social slope of thoroughlyness predicts that reducing discrimination itself has wellness benefits for all, non simply for the impoverished or deprived minorities within populations. (Devitt, Hall Tsey 2001) The above quote from Devitt, Hall and Tseys paper is a relatively good grounded and well researched statement which draws on contemporary theoretical sociological concepts to support the avowal that reducing inequality is the key to improving wellness for all.However the assertion that the demonstration of a social incline of wellness predicts that a reduction in inequality go out lead to health benefits for all is a quite a broad statement and requires closer examination. The intention of this essay is to examine the social gradient of health, whose existence has been well established by the Whitehall Studies (Marmot 1991), and, by focusing on those groups at the lower end of the social gra dient, determine whether initiatives to report inequalities between social classes will lead to health benefits for those classes at the lower end of the social scale.The effectiveness of past initiatives to address these social and health inequalities will be examined and recommendations made as to how these initiatives might be more effective. The social gradient draw by Marmot and others is inter link up with a variety of environmental, socio semipolitical and socio frugal factors which yield been identified as key determinants of health. These determinants interact with each other at a precise complex level to impact directly and indirectly on the health status of individuals and groups at all levels of association Poor social and economic slew affect health throughout life.People further down the social ladder usually run at least twice the risk of unspoilt illness and premature death of those near the top. Between the top and bottom health standards show a continual soc ial gradient. (Wilkinson Marmot 1998) In Australian society it is readily app arnt that the lower social classes are at great disadvantage than those in the upper echelons of society this has been discussed at length in several(prenominal) separate papers on the social gradient of health and its effects on disadvantaged Australian groups (Devitt, Hall Tsey 2001, Robinson 2002, Caldwell Caldwell 1995).Within the stage setting of the social gradient of health it can be inferred that natal groups, for example, are particularly susceptible to ill health and poor health outcomes as they suffer inordinately from the electr unitygative effects of the key determinants of health. A simple example of this is the inequality in distribution of economic resources Average innate household income is 38% less than that of non-Indigenous households. (AHREOC 2004). The seek and anxiety caused by insufficient economic resources leads to increase risk of depression, hypertension and heart dis ease (Brunner 1997 cited in Henry 2001).Higher social status and greater access to economic resources is concomitant with a reduction in stress and anxiety levels, as individuals in these groups pass water more cover over economic pressures which create this stress. This simple comparison proves that the social gradient of health accurately reflects how socioeconomic determinants affect the health of specific social classes at the physiological level. An computer address of the research into the social gradient and the determinants of health is the examination of the pathways through which specific social groups experience and respond to these determinants.These psychosocial pathways incorporate psychological, behavioural and environmental constraints and are virtually linked to the determinants of health Many of the socio-economic determinants of health have their effects through psychosocial pathways. (Wilkinson 2001 cited in Robinson 2002). These pathways have been demonstra ted by Henry (2001) in the conceptual baffle of resource influences (Appendix A), a model which illustrate the interaction between the constraints mentioned above and their impact on health outcomes.Henry states that a central differentiator between classes is the numerate of control an individual feels they have over their environment. Whereas an individual from a lower class group holds a limited sense of control over their well being and consequently adopts a fatalistic approach to health, those in higher classes with a stronger sense of control over their health are more possible to take proactive locomote in ensuring their future wellbeing.This means that both individuals will cope differently with the same health task. This is partly as a result of socioeconomic or environmental determinants relative to their situation, but it is also a result of behavioural/physical constraints and, most importantly, the modes of thought employed in rationalising their situation and acti ons. In essence these psychosocial pathways occupy an intermediate role between the social determinants of health and class related health behaviours.This suggests that, while the social gradient of health is a good predictor of predisposition to ill health among specific classes, it cannot predict how reducing inequality in itself will affect health outcomes or how a specific social class will respond to these changes. An examination of some initiatives aimed at reducing inequality in the indicators of health outcomes reveals this problem In 1996 merely between 5% and 6% of NT immemorial adults had any kind of post secondary school qualification compared with 40% of non-native Territorians. (ABS 1998).Within the context of the social gradient of health, education is an important indicator of health outcomes. It is evident from the quote above that there exists huge inequality within the Union land education system this suggests an increased likelihood of ill health for Aborigi nal people in later life. Even though there have been initiatives to address this inequality in one of the indicators of health outcomes (Colman 1997, Lawnham 2001, Colman Colman 2003), they have had single a minimal impact on Indigenous second level education rank (ABS 2003).This is partly due to the inappropriateness of these initiatives (Valadian 1999), but it is also due to the disempowerment and psychosocial malaise (Flick Nelson 1994 cited in Devitt, Hall Tsey 2001) which are a feature of Indigenous interaction and responses to the social determinants of health. Research has also been carried out into how effecting change in the inequalities in other indicators of health might affect health outcomes. Mayer (1997) cited in Henry (2001) examined the effects of two-bagger the income of low income families and concluded it would produce only modest effects.Henry believes that this points to the strong influence of the psychological domain in influencing health behaviours. Th is suggests that the key to better health for all lies not just in reducing inequality between the classes but also in changing those elements of the psychological domain which influence health behaviour. Another example of the gap between initiatives to reduce inequality and their impact on those inequalities is evident in an examination of economic constraints experienced by Indigenous Australians on social welfare.Price and McComb (1998) found that those in Indigenous communities would spend 35% of their every week income on a basket of food, compared to just 23% of weekly income for those living in a capital city for the same basket of food. To combat this inequality it would seem logical to reduce the price of food in Indigenous communities or else increase the amount of money available to those living in remote communities, i. e. a socioeconomic approach.It has already been established that increasing income has only modest effects and in combination with the fact that smokin g, gambling and alcohol account for up to 25% of expenditure in remote communities (Robinson 2002), how can it be guaranteed that the extra funds made available through either of the two suggestions above would be employed in achieving a desirable level of health? One possible suggestion is that a socioeconomic approach must be complemented by a psychosocial approach which addresses those abstract modes of thought, cultural norms and habits and health related behavioural intentions which dictate healthful behaviours.Culture and culture conflict are factors in Aboriginal health. But instead of the emphasis being placed on Aboriginal failure to assimilate to our norms, it should rather be put on our failure to devise strategies that accommodate to their folkways. (Tatz 1972 cited in Humphrey Japanangka 1998) Any initiative which hopes to thaw inequality in health must incorporate a sound understanding of the influence of the psychosocial pathways relative to the class level and cul tural orientation of that group, otherwise its succeeder will be modest at best.Using Henrys model of resource influences provides a framework for understanding how addressing these psychosocial pathways can lead to greater uptake of initiatives designed to address these inequalities. An analysis of the subject area Tobacco Campaign (NTC 1999) reveals how this initiative failed to impact significantly on Indigenous smoking rates. This was a stringently educational initiative which aimed to raise awareness of the effects of smoking on health.One of the primary flaws of its design was its failure to even acknowledge those Indigenous groups at the lower end of the social scale it also failed to communicate the relevance of its message to Indigenous people The only thing is that when it comes to Aboriginal people, they will not relate to Quit television advertisements because they dont see a black face. Ive heard the kids say Oh yeah, but thats only white fellas. They do. (NTC 1999) Not only did this initiative fail to connect with Indigenous people, it also failed to influence the elements of the psychological domain which legitimate such high rates of smoking.Within Indigenous culture smoking has become somewhat of a social practice, with the emphasis on sharing and borrowing of cigarettes (Gilchrist 1998). It is ineffectual to put across messages about the ill effects of smoking if the underlying motivation of relating to others is not addressed. In a report conducted on Indigenous smoking (AMA APMA 2000 cited in Ivers 2001), it was suggested that one of the key themes of an initiative aimed at reducing indigenous smoking rates should be that smoking is not a part of Indigenous culture.The Jabby Dont Smoke (Dale 1999) is an example of an initiative whose design attempted to influence accepted social norms. Its focus was primarily on children, thereby acknowledging the importance of socialization and the instillment of cultural norms at an early age. Unfo rtunately no data is available detailing its impact on smoking rates. As mentioned earlier in this essay, other feature of the psychological domain which has an effect through the psychosocial pathways is the modes of thought employed in rationalising actions and responses to various determinants and constraints.Self efficacy or the amount of perceived control over ones situation is an important contributor to health status Empowered individuals are more likely to take proactive steps in terms of personal health, whilst disempowered individuals are more likely to take a fatalistic approach (Henry 2001) Examples of initiatives which have strived to empower Indigenous people in being responsible for their own health include The Lung Story (Gill 1999) and various health promotion messages conveyed through song in traditional language ( Castro 2000 cited in Ivers 2001, Nganampa Health Council 2005).By encouraging Indigenous people to address these issues in their own way, the amount of perceived control over their own health is increased thereby facilitating a greater degree of self efficacy. The intention of this essay has not been to deny that the social gradient of health does not exist or that it is not an effective tool in creating understanding of where social and health inequalities lie. Unfortunately programs and initiatives which have been guided by the social gradient of health and have been purely socioeconomic in their approach have failed to have a significant, sustainable effect on health inequalities.In the US, despite socioeconomic initiatives to resolve inequality, the gap between upper and lower class groups has actually widened in recent times (Pamuk et al 1998 cited in Henry 2001). The scale of the intervention infallible to ensure a sustained impact on health inequalities has been discussed by Henry (2001), he also highlights the need to garner substantial political will in order for these changes to happen and makes the point that those in the upper classes are relatively content with the present status quo.This essay has attempted to demonstrate that in an environment where well grounded, evidence based socioeconomic initiatives are failing to have the desired out comes, it is perhaps time to focus more on altering those strongly held health beliefs which not only dictate responses to social determinants of health but also dictate responses to initiatives designed to address these inequalities Healthful behaviours are due to more than just an inability to pay. A mix of psychological characteristics combines to form distinctive behavioural intentions.(Henry 2001) In the current environment of insufficient political will and finite resources it would be prudent to use every tool available to ensure initiatives aimed at reducing inequality between the classes will have the maximum amount of benefit. This approach is not a long term solution, but until it is possible to achieve the large scale social remodelling necessar y to rightfully remove social inequality, and consequently health inequality, it is the most viable solution available. REFERENCES. ABS, 2003. 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