reasons for inequalities in health

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marxist perspective

MARXISM- Marxist sociologists claim that the poor health of the working-class is caused by the organisation of capitalist society which has four effects:

(1)     Most wealth and income is concentrated in the hands of the capitalist upper class which means there is little wealth and income left to go around for everyone else which is the main cause of poverty. For example, 1% of the population own 22% of wealth whilst the bottom 50% has to share just 1% of the wealth.

(2)     Capitalist greed for profit is the cause of low pay and unemployment for the working-class, and consequently poverty. For example, many companies have closed down their British factories to open more profitable factories in the developing world.

(3)     About 500 workers are killed per year in the UK and thousands are injured in the workplace – 70% of these incidents are caused by employer negligence. Moreover, thousands of workers die or become ill after being exposed to toxic materials/fumes in the workplace.

The middle-classes have more spare income to invest in private health insurance and care which means they can leapfrog NHS waiting lists and receive treatment a lot quicker than the working-class.   

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THE INVERSE CARE LAW – Tudor Hart – he argues that those areas in greatest need (usually working-class areas in the North) get less funding than middle-class areas which generally enjoy good health.


These inequalities in funding mean that working-class areas have less new hospitals, nurses and GPS and have longer waiting lists for hospital beds,  operations and treatment services for diseases such as cancer. 

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PSYCHO-SOCIAL explanation

) The PSYCHO-SOCIAL explanation of Wilkinson is closely related to the materialist and Marxist explanations. He claims that poor health is caused by inequality and lack of social cohesion or community. He points out that there are many poor societies around the world that do not suffer poor health because they are characterised by a strong sense of community –people pull together to help one another because they are not divided by extremes of inequalities in wealth and income.


Wilkinson claims that the poor health of the working-class is caused by the lack of community spirit in the UK – the poorer sections of society feel  resentment, envy, hostility etc about  inequalities in wealth and income. This lack of community is very apparent in inner city areas in which daily life for poor people is characterised by unhappiness, anxiety, fear, insecurity, isolation & loneliness which are stress triggers for both physical and mental illness.

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There are no significant differences in mortality and morbidity between the working-class and the middle-class – the official statistics have been distorted and biased by the steep decline in the number of young people in working-class jobs.

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Blames the working-class and poor for making the wrong lifestyle choices with regard to


§  Diet – consume too much junk food, fried food, white bread, sugar & salt; not enough fruit and vegetables = obesity

§  Smoking – working-class 3X more likely to smoke than middle-class

§  Alcohol – working-class drink more than middle-class

§  Exercise – middle-class more likely to engage in sports and exercise such as walking and jogging , more likely to visit gym and health clubs


Steve Field suggests working-class parents need to take more responsibility for the health of their children by encouraging more sensible eating habits.


We need more health promotion campaigns to change children’s eating habits and get people involved in activities such as dance, sport and cycling.

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Middle-class people experience better health because they inherit a superior genetic predisposition to be healthy whilst the working-class are genetically inferior and get ill a lot more. 

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This is very critical of the culturalist theory because it fails to examine the economic and social environment of the working-class especially the impact of poverty on health.


·         Dobson notes that POVERTY is the main cause of ill health. Shopping for healthy food is restricted by low income. Processed food is cheap & although unhealthy, parents know their kids will eat it.  Organic healthy food is expensive. Buying unhealthy foods is a rational decision in the context of poverty.

·         Fast food chains target working-class areas with cheap attractive offers

·         Many working-class areas are food deserts – lack large supermarkets with choice of healthier food.

·         Working-class people are less likely to be able to afford health clubs, gyms, golf, tennis etc compared with the middle-classes.

·         Poverty means that people may be living in worse housing – poor quality run-down damp rented accommodation – in deprived inner-city areas.

·         Shaw notes that poverty is associated with premature death – 70% chance of dying before the age of 65. Glasgow Shettleston has a mortality rate of 234 compared with the middle-class area of Wokingham which has a mortality rate of 65.

Mitchell – getting rid of poverty could save 12000 lives a year.  

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