• Subject Code : HSBH1013
  • Subject Name : Microeconomics

Society And Health

1a. The cultural and behavioural explanations of health highlight that health disparities arise due to indulgence in risk-taking behaviour. These involve actions like alcohol consumption, use of tobacco and following a poor diet. Theories centred around cultural and behavioural ideologies have been criticised on the grounds of victim-blaming, being too oversimplistic and exhibiting social bias (Germov, 2014). Victim blaming endorses the idea that individuals are solely responsible for the choices they make, irrespective of environmental, psychological and cultural factors. It is unfair to ignore external factors as well as psychological factors and state that a person is completely responsible for his ill health, based on the poor choices they make. A person’s choices are influenced by environmental factors (for instance, societal pressure) as psychological factors (how they deal with the pressure). Hence, cultural explanations have been accused of being too oversimplistic and biased.

1b. The cultural and behavioural approach provides insight into the social location as well as class identity and how these factors contribute to health disparities. They provide an economic and social perspective on the problem. Individuals from a lower socioeconomic status tend to indulge in more risk-taking behaviours as compared to those coming from a higher socioeconomic background. According to the economic perspective, individuals hailing from a lower socioeconomic background have lower incomes and earnings. This creates a lack of interest and willingness in them to invest in and save for the future, as they believe they will suffer a premature death due to their poor socioeconomic conditions. As a result, they focus on living in the present and enjoying themselves by indulging in risky behaviours (Pampel et al., 2010).

According to the social perspective, people who enjoy higher socioeconomic status are most likely to make healthy lifestyle choices and participate in activities involving fitness, avoiding activities that include alcohol or tobacco use. This is not only because they earn more and can afford such a lifestyle, but they believe that such a lifestyle differentiates them from other socioeconomic classes (Pampel at al., 2010). It acts as a distinguishing factor and sets them apart from those belonging to the lower socioeconomic groups. Also, the higher socioeconomic groups are more invested in the idea of adding years to their lives and avoiding premature death. This has more to do with the idea that risk-taking behaviours are associated more with those from lower socioeconomic backgrounds.

2a. The material and structural factors are factors such as poverty, lack of accessibility to quality medical care, discrimination, deprivation and lack of adequate opportunities. All of these issues are faced by people from the lower socioeconomic status. As a result, they add to lower life expectancy. Individuals from lower socioeconomic groups, usually involve the indigenous communities, migrants and unskilled workers (Germov, 2014). They do not get adequate educational opportunities or exposure, which leads them to work jobs that require more manual efforts. This increases their mortality rate. Due to inadequate educational resources, they also lack awareness about proper health and hygiene practices, causing them to be more susceptible to illnesses. There is also the problem of unemployment which adds to feelings of social isolation, inadequacy, anxiety and excessive stress. This goes on to create health-related problems for the unemployed, as stress and other factors have physiological implications as well. Adding to this there is the problem of discrimination which acts as an obstacle and prevents people from lower socioeconomic groups to get access to the same opportunities as the ones from higher socioeconomic groups. As, a result they are deprived of quality resources, which further adds to their health issues and increases the inequality gap.

Class analysis has been inadequate in explaining health disparities, as concepts such as social justice and welfare for the underprivileged have not been implemented successfully (Germov, 2014).

2b. The materialistic and structural approach does come with its own set of limitations. This approach is not able to explain the role of risk factors in the social gradient of health. According to the iconic Whitehall Study, the focus was only on the individuals above and below the poverty line. While highlighting the relationship between health and income groups, risk factors were completely ignored. This approach disregards risk factors and produces an oversimplified and incomplete picture of the problem of health inequality. The Whitehall studies show that higher-order civil servants also suffered from health issues (Marmot, et al., 1991). If the material was the only determinant of health, the disparities would have disappeared after the war, when the standard of living increased. Hence material factors do not show any effect after a certain threshold level and so, psychosocial factors were focused on due to these limitations (Elstad, 1998).

3a. The psychosocial capitals explain how psychological factors and social factors together have an impact on an individual’s health. This approach provides a more holistic and clearer picture as it takes into consideration various risk factors of health which the other theories have ignored. The psychosocial approach highlights how psychological risk factors, such as stress affects one’s physiological health systems, such as the cardiovascular system as well as lowers one’s immunity (Seeman et al., 2010). This approach also gives weightage to empirical evidence, which further enriches and adds more meaning to the materialistic as well as the cultural approaches (Elstad, 1998). Healthy behaviours can be encouraged through all spheres and backgrounds. As already highlighted by the Whitehall Studies, by merely stating that job status and income affects poor health among individuals is not enough (Marmot et al., 1991). Healthy lifestyle choices are affected by factors such as willingness to make the change, motivation and awareness. All of these being psychological factors have not been highlighted in the other approaches to health disparities. Also, there is no concrete evidence on higher income groups being devoid of health problems; not all those who are rich and have high status and incomes enjoy good health and not everyone who comes from lower-income groups suffers from poor health. Making such generalisations shows gaps in information, which is filled with psychosocial theories and factors.

3b. The biopsychosocial approach to health is one of the more contemporary approaches to health as it takes into account the physiological mechanisms, as well as the social and psychological factors. The physiological mechanism affected by social conflicts and status is the Allostatic load (Gustafsson et al., 2014). The allostatic load means the wear and tear our body goes through. The more we are affected by challenges and struggles, the more wear and tear our body goes through, due to prolonged exposure to stress. Dysregulation of biological mechanisms occurs when various status-related factors such as poverty, unemployment and inequality at the workplace affect a person. This has shown to have an impact on the allostatic balance, causing health morbidities to arise. Evidence also suggests there being a relationship between socioeconomic status and lowering of grey matter in one’s anterior cingulate cortex (McEwan & Gianaros, 2010). This results in an impairment of emotional control and neuroendocrine functioning.

References for Microeconomics

Adler, N. and Stewart, J. (2010). Health disparities across the lifespan: Meaning, methods, and mechanisms. Annals of the New York Academic of Sciences, 1186: 5-23.

Brunner, E. and Marmot, M. (2006). ‘Social organization, stress, and health’ in M. Marmot & R. Wilkinson (eds) Social Determinants of Health. Oxford: Oxford University Press.

Clougherty, J., Souza, K. and Cullen, M. (2010). Work and its role in shaping the social gradient in health. Annals of the New York Academic of Sciences, 1186: 102 - 124.

Connell, R.W. 1988, ‘Class inequalities and “just health”’, Community Health Studies, vol. 12, no. 2, pp. 212–17.

Elstad, J. (1998). The psycho-social perspective on social inequalities in health. Sociology of Health & Illness, 20(5): 598–618.

Germov, J. (2014) “The Class Origins of Health Inequality”, in Germov, J. (ed.) Second opinion: An introduction to health sociology, (5th edition), Melbourne: Oxford University Press: 81-102.

Gustafsson, P., San Sebastian, M, Janiert, U., Theorell, T., Westerfund, H. & Hammarstrom, A. (2014) Life-course accumulation of neighbourhood disadvantage and allostatic load: empirical integration of three social determinants of health frameworks. American Journal of Public Health, 104(5):904-10.

Kristenson, M., Eriksen, H., Sluiter, J., Starke, D. & Ursin, H. (2004). Psychobiological mechanisms of socioeconomic differences in health. Social Science & Medicine, 58: 1511–1522.

Lindsay, J. (2006). A big night out in Melbourne: drinking as an enactment of class and gender. Contemporary Drug Problems, 33: 29–61.

Marmot, M., Davey-Smith, G., Stansfield, S. Patel, C., North, F., Head, J., Brunner, E. & Feeney, A. (1991) ‘Health inequalities among British civil servants: the Whitehall II Study’ The Lancet, 337(8754): 1387-93.

Marmot, M. (2005) ‘Social Determinants of Health Inequalities.’ The Lancet, 365: 1099-104 Marmot, M. (2006) ‘Health in an unequal world.’ The Lancet, 368(9552): 2081-94.

McEwen, B. and Gianaros, P. (2010) Central role of the brain in stress and adaptation: Links to socioeconomic status, health, and disease. Annals of the New York Academic of Sciences, 1186: 190-222.

Pampel, Kreuger and Denney, J. (2010). Socioeconomic Disparities in Health Behaviors. Annual Review of Sociology, 36(1):349-370 Page 5 of 5

Pickett, K. & Wilkinson, R. (2009). Greater equality and better health: Benefits are largest among the poor, but extended to nearly everyone. BMJ, 339:b432.

Plumridge, E., Fitzgerald, L. and Abel, G. (2002). Performing coolness: smoking refusal and adolescent identities. Health Education Research, 17(2): 167-179.

Seeman, T., Epel, E., Gruenewald, T., Karlamangla, A. and McEwen, B. (2010). Socioeconomic differentials in peripheral biology: cumulative allostatic load. Annals of the New York Academic of Sciences, 1186: 223-239.

Stead, M., McDermott, L., MacKintosh, A. and Adamson, A. (2011). Why healthy eating is bad for young people’s health: Identity, belonging and food. Social Science & Medicine, 72: 1131-1139.

Walsh, J., Senn, T. & Carey, M. (2013) Longitudinal associations between health behaviours and mental health in low-income adults. Translational Behavioural Medicine, 3(1): 104-113.

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