How social class affects health

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The Conversation is organizing a series, Class in Australia, to identify, illuminate and discuss its many manifestations. Here, Sharon Friel considers the points where class and health interact.


The unequal distribution of power, money and resources also creates inequalities in health. Nowhere is this clearer in Australia than in the fact that the wealthiest 20% of the population can expect to live an average of six years longer than the poorest 20%.

Australians who are socially disadvantaged in terms of income, employment status, education and location, and Indigenous Australians, also have a higher risk of chronic diseasessuch as diabetes, heart disease and cancers, and depression.

Things don’t have to be like this. Differences in health outcomes at the population level are not explained by genetic variation or mythical deviant behavior particular to people in lower social class groups.

Indeed, the existence of systematic social differences in health outcomes shows that there is something in our society that creates an unequal distribution of opportunities for good health. These health differences are both avoidable and unfair.

Embrace complexity

People need the basic material conditions for a decent life, they need to have control over their lives and they need to have a say in decision-making processes and in the implementation of policies and programs that affect them.

Economic and social policies generate and distribute political power, income, goods and services. And who you are will affect your access to quality and affordable education and health care, sufficient nutritious food, good working and leisure conditions, among others.

Together, these factors are what determine your health and social status. health inequalities.

At first glance, the “social determinants of health” approach suggests that health inequalities are produced (and prevented) by policies and actions within the health sector. The possible co-payment of $6 for a doctor’s visit touted by the Minister of Health, for example, would undoubtedly affect low-income groups more than others.

But much of the blame for the social inequality that leads to different health outcomes lies elsewhere. Health is affected by policies in other sectors, such as education, taxation, transport and agriculture as well.

Education, for example, gives people the resources they need throughout life to earn a secure income, support their families and cope with illness. Children from economically disadvantaged backgrounds are more likely to perform poorly in school and drop out early.

They typically grow up to be adults with lower incomes and are less able to provide quality health care, nutrition and stimulation to their own children. This is how the disadvantage is transmitted from generation to generation.

Decent work, including wages that reflect the real cost of living, is also important for health. work can provide financial security, social status, personal development, social relationships and self-esteem, and protection against physical and psychosocial risks.

In Australia, the salary of a worker belonging to the lowest paid 10% has increased by 15% since 1975, while the salary of those belonging to the richest 10% has increased by 59% during the same period. In 2009, Australia’s top 20 CEOs earned more than 100 times the average salary.

Moreover, the number of factors affecting health may actually increase. Because we live in a rapidly globalizing world, we must now also take into account the effects of trade on life and health. We have to make sure Exchange Policy does not compromise the ability of governments to regulate for health;

And that the deregulation of working conditions does not widen the gap between good and bad quality jobs, which can be worse for your health than no work at all. Australian data shows that adverse working conditions (high job demands and complexity, low job control, job insecurity and unfair pay) are worse for mental health than being unemployed.

Create change

One way to look at this is that it’s too complex and difficult to do anything about it. Another is to recognize the many entry points and opportunities for improving health and quality of life.

For people who are unconvinced by the argument that health inequities are unethical, the fact that they are also incredibly inefficient should spur action to reduce them. Preventing Health Inequalities would save $2.3 billion in hospital expenditures; and 5.3 million fewer drug benefit plan scripts would be completed each year, resulting in annual savings of $184.5 million.

Clearly, reducing health inequalities does not happen overnight. This requires a long-term vision and sustained political will.

The cross-sectoral nature of the determinants of health inequalities requires a holistic response. It requires ministers across all policy areas to each consider the impact of their decisions on the social wellbeing and health of all Australians.

But the current political climate does not bode well for health inequalities in this country. The apparent emphasis on productivity at all costs and the control of public discourse by a powerful business elite suggest that we still have a long way to go before we can create economic and social conditions that help everyone realize their potential.


See the other articles in the Class in Australia series here.


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