The Social Patterning of Health and Illness

The Social The Social Patterning of Patterning of

Health and IllnessHealth and IllnessWeek 6.Week 6.

OverviewOverview The social patterning of health and The social patterning of health and illness. illness.

Problems with measuring data on health, Problems with measuring data on health, illness and disease. illness and disease.

Researching health and illness Researching health and illness Inequalities in health, Inequalities in health, mental illness. mental illness. Gender, ethnicity, age, social class and Gender, ethnicity, age, social class and health. health.

The ‘racialization’ and ‘feminization’ of The ‘racialization’ and ‘feminization’ of mental and physiological illness.mental and physiological illness.

Problems in researching Problems in researching Health and IllnessHealth and Illness

relativity of health concepts relativity of health concepts Concepts and understandings vary Concepts and understandings vary enormously from culture to culture. enormously from culture to culture.

Eg. depression recognized in some Eg. depression recognized in some cultures and not others cultures and not others

Dubos and Pines ‘the meaning of Dubos and Pines ‘the meaning of health also varies widely according health also varies widely according to all kinds of statuses’. to all kinds of statuses’.

'Good health may mean different things to an 'Good health may mean different things to an athlete and to a road sweeper, to a tree surgeon athlete and to a road sweeper, to a tree surgeon or an insurance broker, their lifestyles or an insurance broker, their lifestyles necessitate very different degrees of physical necessitate very different degrees of physical activity, their food requirements and activity, their food requirements and environmental stresses vary, they may have very environmental stresses vary, they may have very different understandings and experiences of different understandings and experiences of their own physiology, they may have different their own physiology, they may have different levels of access to information about health and levels of access to information about health and disease’.disease’.

Problems in researching Problems in researching Health and Illness 2Health and Illness 2

Increased sensitivity to health issues for those who Increased sensitivity to health issues for those who read about it alot read about it alot

Those who do not may over-estimate their own levels Those who do not may over-estimate their own levels of health of health

self assessment questionnaires a poor indicator of self assessment questionnaires a poor indicator of actual levels of health due to these wide variations actual levels of health due to these wide variations in awareness and understanding. in awareness and understanding.

research that uses interview techniques may be research that uses interview techniques may be problematic for the same reasons.problematic for the same reasons.

Problems in finding objective measurements of levels Problems in finding objective measurements of levels of health and illness. of health and illness.

health records compiled by doctors and hospitals??? health records compiled by doctors and hospitals??? Some suggest patient diagnosis is often distorted by Some suggest patient diagnosis is often distorted by

all kinds of prejudices that the doctor or health all kinds of prejudices that the doctor or health care professional may not even realize he or she care professional may not even realize he or she has. has.

Some Problems With Some Problems With Statistics. 1Statistics. 1

Under-reporting and Over-reporting Under-reporting and Over-reporting of illness.of illness.

What constitutes illness varies from What constitutes illness varies from culture to culture.culture to culture.

Depression not recognised in some Depression not recognised in some cultures.cultures.

Some illnesses not deemed serious Some illnesses not deemed serious enough for medical intervention.enough for medical intervention.

Traditional or ‘folk medicine’ or Traditional or ‘folk medicine’ or self medication often used first.self medication often used first.

Certain groups less Certain groups less willing or able to visit willing or able to visit

the doctor. Why?the doctor. Why? Stigmatisation of certain kinds illness.Stigmatisation of certain kinds illness. Cultural Taboos.Cultural Taboos. Some illnesses dealt with in the family.Some illnesses dealt with in the family. Gender issues.Gender issues. Racism and discrimination.Racism and discrimination. Marginal Groups i.e. Gypsies and Marginal Groups i.e. Gypsies and Travellers Travellers

Problems with access to services.Problems with access to services. Language problems.Language problems.

Certain Groups more Certain Groups more willing to visit the willing to visit the

doctor.doctor. Structural factors.Structural factors. Cultural factors.Cultural factors.


Misdiagnosis and misunderstanding. Can be due to Misdiagnosis and misunderstanding. Can be due to a number of Factors.a number of Factors.

Subjectivity and self assessment.Subjectivity and self assessment. Subjectivity and diagnosis.Subjectivity and diagnosis. Subjectivity and comparative understandings.Subjectivity and comparative understandings. Time constraints.Time constraints. Patient reporting Influence of gender, social Patient reporting Influence of gender, social

class and ethnicity.class and ethnicity. Cultural ‘misunderstandings’ and ‘cultural Cultural ‘misunderstandings’ and ‘cultural

deficit’ models.deficit’ models. Cultural Stereotyping- particularly with regard Cultural Stereotyping- particularly with regard

to mental illness.to mental illness. Negative stereotyping, cultural misunderstanding Negative stereotyping, cultural misunderstanding

and Marginal Groups i.e. Gypsies and and Marginal Groups i.e. Gypsies and Travellers.Travellers.


Problems with how the statistics are Problems with how the statistics are compiled.compiled.

Sample group.Sample group. Ensuring demographic and geographic Ensuring demographic and geographic

representation.representation. Low participation of practices in inner Low participation of practices in inner

citiescities Problems with categories- particularly Problems with categories- particularly

class and ethnicity.class and ethnicity. Generalisability. Age, gender, ethnicity Generalisability. Age, gender, ethnicity

and social class.and social class.

Illsley and Le GrandIllsley and Le Grand Illsley and Le Grand- Criticised Illsley and Le Grand- Criticised studies based on Under 65’s- studies based on Under 65’s- proportion of deaths in this age proportion of deaths in this age range has changed significantly range has changed significantly in last 70 years.in last 70 years.

Many deaths now take place over Many deaths now take place over age of 65, findings/ results from age of 65, findings/ results from under 65’s not generalisable to under 65’s not generalisable to older age groups.older age groups.

Objections to this:-Objections to this:-1. Although deaths under 65 are a minority, they 1. Although deaths under 65 are a minority, they

are usually premature deaths, premature death are usually premature deaths, premature death an indicator of disadvantage as it is often an indicator of disadvantage as it is often preventable.preventable.

2. New evidence on health of people over 65 tends 2. New evidence on health of people over 65 tends to confirm patterns of inequality found among to confirm patterns of inequality found among younger people.younger people.

General problems with ‘Official Statistics’- General problems with ‘Official Statistics’- How? Where? When? Who By? Who For? For What How? Where? When? Who By? Who For? For What Purpose?Purpose?

No Universalisable Concepts.No Universalisable Concepts. Problems with comparing studies.Problems with comparing studies. a number of problems here, some of them a number of problems here, some of them

relating to interpretation and detection and relating to interpretation and detection and the recording of H & I and others relating to the recording of H & I and others relating to access and participation. access and participation.

Problems with disease Problems with disease labels 1labels 1

Disease labels not created in a vacuum Disease labels not created in a vacuum (Foucault, Turner etc). (Foucault, Turner etc).

The interpretation of disease and Disease The interpretation of disease and Disease labels arise within a particular socio-labels arise within a particular socio-political contextpolitical context

different contexts produce different different contexts produce different conceptions of causes and what counts as conceptions of causes and what counts as normal and pathological states. normal and pathological states.

Foucault interested in the way that certain Foucault interested in the way that certain kinds of behaviours came to be defined as kinds of behaviours came to be defined as 'normal' while others came to be defined as 'normal' while others came to be defined as

Medical struggles around the individual bodyMedical struggles around the individual body


bio-politics of populations in bio-politics of populations in modern societies. modern societies.

Medical knowledge not an objective Medical knowledge not an objective science for Foucaultscience for Foucault

direct relationship between the direct relationship between the discourse of scientific knowledge discourse of scientific knowledge and the exercise of professional and the exercise of professional power. power.

Linked to social controlLinked to social control


Link between between knowledge and exercise of Link between between knowledge and exercise of power power

disease entities the product of mediacl disease entities the product of mediacl discourses discourses

Brian Turner uses example of anorexia- Brian Turner uses example of anorexia- depending on the dominant discourse within a depending on the dominant discourse within a society in which anorexic conditions are society in which anorexic conditions are present it could be viewed as a behavioural present it could be viewed as a behavioural disorder of the hormonal system of young women, disorder of the hormonal system of young women, or a spiritual quest foe perfection etc or a spiritual quest foe perfection etc

job of sociology to determine how these socio-job of sociology to determine how these socio-historical processes have given rise to certain historical processes have given rise to certain sets or ideas and perceptions that have been sets or ideas and perceptions that have been taken to count as knowledge.taken to count as knowledge.

The Social patterning of The Social patterning of Health and Illness Health and Illness

BackgroundBackground Mortality and Morbidity rates vary Mortality and Morbidity rates vary significantly between societiessignificantly between societies

Also variations between groups Also variations between groups within societies. within societies.

emphasis is usually on social emphasis is usually on social class, gender and ethnicity. class, gender and ethnicity.

also enormous variations between also enormous variations between societiessocieties

Health and Social Class.Health and Social Class. Key literature- Key literature- The Black report (1980) The Black report (1980) Updated and Updated and Republished (1992).Republished (1992). The Health divide (1988 The Health divide (1988

37 recomendations ranging from improving 37 recomendations ranging from improving information, research and organization so that information, research and organization so that more effective healthcare planning could be more effective healthcare planning could be instituted, redressing the balance of health instituted, redressing the balance of health care system so that greater emphasis would be care system so that greater emphasis would be palced on prevention, primary care and palced on prevention, primary care and community healthcommunity health

most importantly recommended improving the most importantly recommended improving the material conditions of life for disadvantaged material conditions of life for disadvantaged groups, groups,

conclusions of the two reports essentially the conclusions of the two reports essentially the same.same.

The Black report (1980)The Black report (1980) SummarySummary1. There remained a marked class 1. There remained a marked class gradient in health.gradient in health.

2. That such class differences 2. That such class differences were more marked in Britain than were more marked in Britain than in many other countries.in many other countries.

3. That in certain respects these 3. That in certain respects these class differences were increasingclass differences were increasing

The Black report (1980) contThe Black report (1980) cont gap between the classes had continued to widen.gap between the classes had continued to widen. words high mortality rates positively correlated words high mortality rates positively correlated

with poverty.with poverty. lower occupational groups more vulnerable to almost lower occupational groups more vulnerable to almost

all the killer diseases all the killer diseases Peter Townsend ‘mortality rates for working class Peter Townsend ‘mortality rates for working class

males were higher in 65 out of 78 disease categories males were higher in 65 out of 78 disease categories and for working class women in 62 out of 82’.and for working class women in 62 out of 82’.

Malignant melanoma rates higher among the higher Malignant melanoma rates higher among the higher occupational groups. occupational groups.

For women in higher social classes rates of cancer of For women in higher social classes rates of cancer of the brain and the breast were also greater. the brain and the breast were also greater.

Accidental death by violence, injury and accident Accidental death by violence, injury and accident higher among the lower social classes.higher among the lower social classes.

In 1980's this gap continued to widen as death rates In 1980's this gap continued to widen as death rates declined faster among the higher occupational groups declined faster among the higher occupational groups than the lower than the lower

The Black report (1980) contThe Black report (1980) cont In 1980's this gap continued to widen as death rates In 1980's this gap continued to widen as death rates

declined faster among the higher occupational groups declined faster among the higher occupational groups than the lower than the lower

lower socio-economic groups also experience more lower socio-economic groups also experience more sickness and ill health throughout the life cycle. Poor sickness and ill health throughout the life cycle. Poor children more likely to be born with low birth weightchildren more likely to be born with low birth weight

their mothers are more likely to suffer complications their mothers are more likely to suffer complications in pregnancy or childbirth. in pregnancy or childbirth.

Poor children more likely to suffer from a range of Poor children more likely to suffer from a range of health problems including obesity, cerebral Palsy, health problems including obesity, cerebral Palsy, hearing and visual impairment, accidents and higher hearing and visual impairment, accidents and higher rates of tooth decay.rates of tooth decay.

differences between socio-economic groups become differences between socio-economic groups become increasingly marked in adulthood increasingly marked in adulthood

Working class people more likely to deem themselves to Working class people more likely to deem themselves to be in poor health in self-assessment exercisesbe in poor health in self-assessment exercises

Illness also genderedIllness also gendered

Gender and Health.Gender and Health.BackgroundBackground

Throughout entire industrial world Throughout entire industrial world men live shorter lives men live shorter lives

Men more likely to die at any given Men more likely to die at any given age than women of the same age. age than women of the same age.

BUT females are more likely to BUT females are more likely to experience high morbidity rates experience high morbidity rates

women are far more likely to visit women are far more likely to visit the doctor than men the doctor than men

men generally underepresented in men generally underepresented in health statisticshealth statistics

Gender and Mortality.Gender and Mortality. over the last 100 years, in all contemporary over the last 100 years, in all contemporary advanced industrial societies, life expectancy advanced industrial societies, life expectancy has increased for both men and women has increased for both men and women

but higher for women. but higher for women. (1994) average female life expectancy was (1994) average female life expectancy was approximately 78 years compared to 72 years approximately 78 years compared to 72 years for men. for men.

Major causes of death among British men heart Major causes of death among British men heart disease, lung cancer, bronchitis, accidents disease, lung cancer, bronchitis, accidents and other violent deathsand other violent deaths

For women cancers of the breast cervix and For women cancers of the breast cervix and uterus are major causes of mortality. uterus are major causes of mortality.

coronary heart disease now a major cause of coronary heart disease now a major cause of female deathsfemale deaths

Gender and Morbidity.Gender and Morbidity. Women more likely to report both physical Women more likely to report both physical and psychological problems to their GP. and psychological problems to their GP.

higher rates of chronic disease such as higher rates of chronic disease such as strokes, rheumatoid arthritis, diabetes and strokes, rheumatoid arthritis, diabetes and varicose veins for women women also varicose veins for women women also constitute two thirds of those with a constitute two thirds of those with a disability. disability.

Women more likely to have been hospitalizedWomen more likely to have been hospitalized women constitute the majority of those women constitute the majority of those suffering from neurosis, psychosis, dementia suffering from neurosis, psychosis, dementia and depressive disorders. and depressive disorders.

women also more likely to suffer from women also more likely to suffer from Iatrogenic diseaseIatrogenic disease

Health and Ethnicity.Health and Ethnicity. Data seriously inadequate. Data seriously inadequate. Before the 1991 census researchers Before the 1991 census researchers had to rely on Birth and death had to rely on Birth and death certificates to identify ethnicity. certificates to identify ethnicity.

comparing the mortality rates of comparing the mortality rates of ethnic minorities born in the UK ethnic minorities born in the UK before 1991 is extremely problematic. before 1991 is extremely problematic.

still comparatively little known still comparatively little known about the health and morbidity of about the health and morbidity of British born ethnic minorities. British born ethnic minorities.

data is extremely limited and must be data is extremely limited and must be viewed cautiously.viewed cautiously.

Ethnicity, mortality and Ethnicity, mortality and Morbidity.Morbidity.

Despite the methodological difficulties a number of Despite the methodological difficulties a number of studies have provided generally consistent data on the studies have provided generally consistent data on the causes of mortality and morbidity among minority ethnic causes of mortality and morbidity among minority ethnic populations. Provisional findings suggest the following.populations. Provisional findings suggest the following.

Groups from India, Pakistan and Bangladesh - more likely Groups from India, Pakistan and Bangladesh - more likely than white population to die from heart disease.than white population to die from heart disease.

Groups from India, Pakistan and Bangladesh, Africa and Groups from India, Pakistan and Bangladesh, Africa and the Caribbean - more likely than white population to the Caribbean - more likely than white population to suffer from a stroke (esp Africans and Afro-suffer from a stroke (esp Africans and Afro-Caribbean's).Caribbean's).

Africans and Afro-Caribbean's suffer from very high Africans and Afro-Caribbean's suffer from very high rates of hypertension, liver cancer, TB, diabetes and rates of hypertension, liver cancer, TB, diabetes and maternal mortality.maternal mortality.

Afro-Caribbean's and 'Asians' (problematic category) Afro-Caribbean's and 'Asians' (problematic category) suffer disproportionately from accidental and violent suffer disproportionately from accidental and violent death, and poisonings.death, and poisonings.

Mortality rates for obstructive lung infections such as Mortality rates for obstructive lung infections such as bronchitis and many types of cancer esp. lung cancer bronchitis and many types of cancer esp. lung cancer lower among Afro-Caribbean's and 'Asians'.lower among Afro-Caribbean's and 'Asians'.

Ethnicity, mortality and Ethnicity, mortality and Morbidity. 2Morbidity. 2

All ethnic minorities have higher rates of All ethnic minorities have higher rates of still births, perinatal moralities (death still births, perinatal moralities (death within 1 week), and neo-natal mortality (within within 1 week), and neo-natal mortality (within 1 month).1 month).

Only Afro-Caribbean's and Pakistanis continue Only Afro-Caribbean's and Pakistanis continue to show 'excess mortality throughout infancy' to show 'excess mortality throughout infancy' (Whitehead 1992).(Whitehead 1992).

Children from Asian families have higher rates Children from Asian families have higher rates of rickets.of rickets.

Afro-carribeans more likely to be admitted to Afro-carribeans more likely to be admitted to mental health units, men more so than women mental health units, men more so than women and more likely to be sectioned. Once there and more likely to be sectioned. Once there they are more likely to receive harsh treatment they are more likely to receive harsh treatment e.g.- electro-shock therapy, anti psychotics.e.g.- electro-shock therapy, anti psychotics.

Explanations.Explanations. PovertyPoverty Stress of migration and racismStress of migration and racism Anomic explanationsAnomic explanations Cultural deficit modelsCultural deficit models

Gypsies, Travellers and Gypsies, Travellers and Health.Health.

not all Travellers are recognized in the eyes of not all Travellers are recognized in the eyes of the law as an ethnic the law as an ethnic

nomadic lifestyle compounds and intensifies the nomadic lifestyle compounds and intensifies the problems faced by other minority groups. problems faced by other minority groups.

Britains nomadic population is extremely diverse.Britains nomadic population is extremely diverse. Different problems for different groups Different problems for different groups considerable methodological problems associated considerable methodological problems associated

with researching Travellers health with researching Travellers health an invisible minority an invisible minority Gypsy and Traveller health research has usually Gypsy and Traveller health research has usually

been conducted separately to that of other been conducted separately to that of other minority groups less in the way of funding devoted minority groups less in the way of funding devoted to research for this group to research for this group

Traveller health needs are very different to those Traveller health needs are very different to those of other disadvantaged groups of other disadvantaged groups

Research Problems.Research Problems. Researcher Access.Researcher Access. Trust.Trust. Geographical isolation.Geographical isolation. Mobility.Mobility. Gypsies rejection of Gypsies rejection of officialdom.officialdom.

Truth.Truth. Negative stereotyping and Negative stereotyping and cultural insensitivity.cultural insensitivity.

Nomadism, Mortality and Nomadism, Mortality and Morbidity.Morbidity.

Poor dental health.Poor dental health. Increased susceptability to tetanus, polio, TB, whooping Increased susceptability to tetanus, polio, TB, whooping

cough M, M, R, Diptheria.cough M, M, R, Diptheria. Low birth weight.Low birth weight. High rates of infant mortality, miscarriageHigh rates of infant mortality, miscarriage Spread of infectious diseases, respirartory infections, Spread of infectious diseases, respirartory infections,

impetogo, other skin infections, lice, scabies, threadworm, impetogo, other skin infections, lice, scabies, threadworm, gastroenteritis, (Link to environment and large families gastroenteritis, (Link to environment and large families living in close proximity).living in close proximity).

High rates of diabetes (Gypsies and trad Travellers)High rates of diabetes (Gypsies and trad Travellers) High rates of alcohol related illness.High rates of alcohol related illness. Limb deformity form fractures (low rates of follow up Limb deformity form fractures (low rates of follow up

treatment).treatment). High rates of cardiovascular disease particularly among men.High rates of cardiovascular disease particularly among men. High rates of mortality among males as a result of Drug use High rates of mortality among males as a result of Drug use

and overdose ( 'New-Age' Travellers)and overdose ( 'New-Age' Travellers) High rates of drug induced mental illness ( 'New-Age' High rates of drug induced mental illness ( 'New-Age'

Travellers)Travellers)

Explanations. 1Explanations. 1 Cultural erosion (Gypsies and trad Travellers)Cultural erosion (Gypsies and trad Travellers) Dangerous environments.Dangerous environments. Poor uptake of preventative care, (smear Poor uptake of preventative care, (smear tests, breast screening, health checks, child tests, breast screening, health checks, child developmental screening, dental services, developmental screening, dental services, health education,health education,

Poor uptake of immunisations.Poor uptake of immunisations. Links to Poor access to health services Links to Poor access to health services (Temporary residents).(Temporary residents).

Poor ante-natal and post-natal care.Poor ante-natal and post-natal care. Lowuse of contraception (Esp Gypsies and trad Lowuse of contraception (Esp Gypsies and trad Travellers)Travellers)

Short birth intervals (Gypsies and trad Short birth intervals (Gypsies and trad Travellers)Travellers)

Explanations. 2Explanations. 2 Poverty.Poverty. Illiteracy (excepting New-Age Travellers).Illiteracy (excepting New-Age Travellers). Discrimination.Discrimination. Illness often dealt with within group (Folk Illness often dealt with within group (Folk remedies)remedies)

Suspicion of conventional medicine (esp Suspicion of conventional medicine (esp 'New-Age' travellers).'New-Age' travellers).

Poor sanitation.Poor sanitation. Large families living in close proximity Large families living in close proximity Low uptake of immunisation.Low uptake of immunisation. Poor hygiene re dogs and food prep.Poor hygiene re dogs and food prep. Drug use ( 'New-Age' travellers)Drug use ( 'New-Age' travellers)

Explaining Health Explaining Health Inequalities .1Inequalities .1

1 Social constructionist approaches.1 Social constructionist approaches. take issue with the nature of the take issue with the nature of the

data and evidence upon which studies data and evidence upon which studies of health inequalities are based. of health inequalities are based.

Labelling theorists ‘disease labels Labelling theorists ‘disease labels are not always applied in the same are not always applied in the same way to all groups in society’.way to all groups in society’.

doctors apply specific disease doctors apply specific disease labels more readily to some groups labels more readily to some groups than others. than others.

Variations in morbidity rates a Variations in morbidity rates a product of differential labelling product of differential labelling

Explaining Health Explaining Health Inequalities . 2Inequalities . 2

2. 2. Natural and social selection approaches.Natural and social selection approaches. evidence essentially valid. evidence essentially valid. often used to explain the health differentials often used to explain the health differentials among gender and ethnic groups, among gender and ethnic groups,

differences rest upon supposed biological or differences rest upon supposed biological or physiological differences. physiological differences.

ill-health a major ill-health a major causecause of low social position of low social position rather than a consequence of it. rather than a consequence of it.

social mobility can be explained by reference social mobility can be explained by reference to good health. to good health.

Based on false suppositions about ‘natural’ Based on false suppositions about ‘natural’ difference. difference.

Surprisingly feminist accounts of the ‘natural’ Surprisingly feminist accounts of the ‘natural’ body have been influenced by selectionist body have been influenced by selectionist approaches.approaches.

Explaining Health Explaining Health Inequalities 3Inequalities 3

3. 3. Materialist-Struturalist approaches.Materialist-Struturalist approaches. rates of morbidity and mortality linked rates of morbidity and mortality linked

to individual or group’s location in to individual or group’s location in the social structurethe social structure

This approach accused of being overly This approach accused of being overly deterministic deterministic

fails to take into account the meanings fails to take into account the meanings of the social actors themselvesof the social actors themselves

fails to acknowledge that health and fails to acknowledge that health and illness labels are negotiated on an illness labels are negotiated on an ongoing basis.ongoing basis.

Explaining Health Explaining Health Inequalities 4Inequalities 4

4. 4. Cultural- behavioural approaches.Cultural- behavioural approaches. differentials in health status linked to differentials in health status linked to

individual or group norms, values, attitudes, individual or group norms, values, attitudes, knowledge and behaviours. knowledge and behaviours.

cultural deficit models cultural deficit models deficit in knowledge or inappropraite deficit in knowledge or inappropraite

behaviours or cultural practices are said to behaviours or cultural practices are said to be the cause of unequal patterns of ill be the cause of unequal patterns of ill health. health.

Eg high incidence of rickets, caused by Eg high incidence of rickets, caused by vitamin D deficiency, among some Asian vitamin D deficiency, among some Asian cultures is a result of cultural norms and cultures is a result of cultural norms and values which dictate that ‘Asian’ women must values which dictate that ‘Asian’ women must cover their bodies in public (the body cover their bodies in public (the body produces vitamin D upon exposure to sunlight).produces vitamin D upon exposure to sunlight).

Global InequalitiesGlobal Inequalities

Life expectancy at global level, Life expectancy at global level, continues to improve – UK insurers continues to improve – UK insurers just had to make new calculationsjust had to make new calculations

In Africa average age of death around In Africa average age of death around early 40s – same level as UK was at early 40s – same level as UK was at in 1900in 1900

Russian males around 59 years of ageRussian males around 59 years of age BUT outliers pull figures downBUT outliers pull figures down WHO report details the global gap WHO report details the global gap Many health issues the result of Many health issues the result of undernutrition among the poor and undernutrition among the poor and overnutrition amongst the wealthyovernutrition amongst the wealthy

The AIDS PandemicThe AIDS Pandemic AIDS now fourth biggest cause of death AIDS now fourth biggest cause of death 70% of the 40 million with HIV/AIDS 70% of the 40 million with HIV/AIDS concentrated in Africaconcentrated in Africa

Life expectancy at birth in sub-Life expectancy at birth in sub-Saharan Africa is currently estimated Saharan Africa is currently estimated at 47 years at 47 years

without AIDS it would be around 62without AIDS it would be around 62 treatment not available to those who treatment not available to those who suffer mostsuffer most

Environment. Poverty and Environment. Poverty and HealthHealth

In both Africa and Asia, In both Africa and Asia, unsafe water, unsafe water, sanitation and hygiene,sanitation and hygiene, iron deficiency and iron deficiency and indoor smoke from solid fuels indoor smoke from solid fuels 10 leading causes of disease. All much more common 10 leading causes of disease. All much more common

in poor countriesin poor countries Link back to Gypsies and healthLink back to Gypsies and health 1.7 million deaths a year are attributed to unsafe 1.7 million deaths a year are attributed to unsafe

water, sanitation and hygiene mainly through water, sanitation and hygiene mainly through infectious diarrhoea.infectious diarrhoea.

Nine of ten such deaths among childrenNine of ten such deaths among children Many of diseases suffered by those in poverty Many of diseases suffered by those in poverty

strongly related to patterns of living, and strongly related to patterns of living, and particularly to consumption – too much or too particularly to consumption – too much or too littlelittle

Disease in the WestDisease in the West Overweight and obesity are important determinants of health Overweight and obesity are important determinants of health Increases in blood pressureIncreases in blood pressure Unfavourable cholesterol levelsUnfavourable cholesterol levels Increased resistance to insulinIncreased resistance to insulin Raises the risk of coronary heart disease, stroke, diabetes, Raises the risk of coronary heart disease, stroke, diabetes,

and many forms of cancerand many forms of cancer WHO say killing about 220,000 people in the US and Canada WHO say killing about 220,000 people in the US and Canada

alone, and 320,000 in 20 countries of Western Europealone, and 320,000 in 20 countries of Western Europe Tobacco – nearly 5 million attributable deaths in 2000, Tobacco – nearly 5 million attributable deaths in 2000,

mostly in Westmostly in West Alcohol – worldwide 1.8 million deaths, 4% of global disease Alcohol – worldwide 1.8 million deaths, 4% of global disease

burden, much of this in the West burden, much of this in the West (growing) Physical inactivity causes about 15% of come (growing) Physical inactivity causes about 15% of come

cancers, heart disease an diabetescancers, heart disease an diabetes lack of fruit and vegetables they say responsible for 3 lack of fruit and vegetables they say responsible for 3

million deathmillion death globalization of Western diseases of affluenceglobalization of Western diseases of affluence In developing those countries that are more urbanized see In developing those countries that are more urbanized see

‘Western diseases’ ‘Western diseases’

The Social Patterning of Health and Illness

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