Introduction
Society is unequal and some social groups have poor health as a result of these social inequalities. The
individuals with disabilities experience prejudice, a negative attitude towards others based on a
prejudgment about those individuals based on little or no knowledge or experience for example, all
disabled people are stupid, and they can do nothing without someone’s help. This type of views can lead
to negative stereotyping where, someone believes that all members of a certain group share the same
negative characteristics, such as referring to them all as ‘the disabled people’. This is called labelling,
where differences are ignored and it believed that all disabled people cannot learn or carry out any task
without considering their cognitive ability, even if a person with a disability has achieved something in
their life. These views then lead to discrimination where someone is treated unfairly because of their
association with or perceived connection to a group. For example, a wheelchair user is not given a job
because the company would have to make changes to the building. This can, therefore, cause individuals
to feel excluded and feels if their left on the edge, unwanted and feel marginalised, which can cause the
individual to develop mental illness. The proportion of disabled people who reported feeling lonely
“often or always” was nearly four times that of non-disabled people. In the year ending March 2018,
13.3% of disabled people reported that they felt lonely “often or always”, compared with only 3.4% for
non-disabled people. (ONS, 2019) The people with disabilities have linked problems such as lack of
socialization, feel marginalized, discriminated, ignored, trouble finding a job, therefore, have low
income, poor health and develop mental illness. This can lead to social exclusion, where society does no
longer see them as part of the society, which leads for their health needs to go unnoticed. Around one in
five (19%) people in the UK is thought to live with a disability, but little is known about their access to
healthcare services and what barriers they might face. Men with disability were more than 7 times as
likely to have an unmet healthcare need because of the cost of treatment, and more than 5 times as
likely to face a problem because of the cost of prescribed medicines as were men with no disability.
(BMJ, 2017) 96% of UK areas are missing their target to supply all wheelchairs within the 18 weeks
guaranteed by the NHS constitution. That’s paraplegics stuck in bed as they wait for a wheelchair, and
disabled children left using unsafe equipment. (The Guardian, 2017)
The Black Report (1980) was chaired by Sir Douglas Black and it provides detailed and comprehensive
explanations of the link between social classes and environmental factors and health, illness and life
expectancy. This report demonstrated the significant differences in the levels of health and illness
between different social classes, in which it explains the differences in the levels of illness and life
expectancy experiences by different social classes. This means that these differences in health and
wellbeing were an impact of the level of people’s income, the quality of their housing and the
environment in which they live and work. The Black Report gave four possible explanations of class
differences in health:
Statistical artefact – suggests that it not social class but the age structure and patterns of
employment of people in lowest social classes that explain the differences. It said that statistics
produced a biased picture where, they still find a link between low social class, high levels of
illness and lower life expectancy for example, people in lowest social classes had higher
numbers working in traditional dangerous industries and so it would be expected that they
would have higher rates of illness. Nine years is the age gap between the life expectancy of men
in some of the poorest and wealthiest areas in the UK according to official statistics. The gap is
seven years for women. (C. Milne, 2016)
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Natural or social selection – suggests that people are in the lower classes because of their poor
health, absenteeism and lack of energy needed for success and promotion. However, this has
been rejected by sociologists because there is evidence to show that ill health is caused by
deprived circumstances rather than causing them. For example, healthy people are more likely
to get promoted while unhealthy people are more likely to lose their jobs.
Cultural or behavioural choices – focuses on the behaviour and lifestyle choices of people in the
lower social classes. People in the lower closes smoked more, drank heavily, were more likely to
eat junk food and take insufficient exercise, which link to such major causes of death as
coronary heart disease, lung cancer chronic bronchitis and diabetes. However, some argue that
this behaviour is a consequence only of lack of education, shiftlessness, foolishness or other
individual traits. For example, there were 25% male professionals and 59% unskilled manual
males who are current smokers. (Social Health Association, 1980)
Material or structural – emphasises the role of economic and associated socio-structural factors
in distribution of health and well-being. It claims that disadvantaged people with shorter life
expectancy and higher mortality rates, suffer poorer health than other groups because of
inequalities in wealth and income. For example, higher rates of childhood respiratory disease
have been associated with damp housing. However, the full impact of living standards can only
be understood over the course of the life term. Also, in the UK, relatively disadvantaged people
receive various kinds of state help such as rent, free school meals which, some argue, makes
diet or poor housing unlikely to account for all inequalities’ health outcomes. (Social Health
Association, 1980)
The Marmot Review 2010 and 2018 again looks at the differences in patterns of ill health between social
groups and describes how the ‘social gradient’ on health inequalities is reflected in the social gradient on
educational attainment, employment, income and housing condition, which means that health improves
as social status goes up. There has been no sign of a decrease in mortality for people under 50. In fact,
mortality rates have increased for people aged 45-49. It is likely that social and economic conditions
have undermined health at these ages. The Marmot Review has recently confirmed an increase in the
north/south health gap, where the largest decreases were seen in the most deprived 10% of
neighbourhoods in the North East, and the largest increases in the least deprived 10% of
neighbourhoods in London. (Institute of Health Equity, 2020)
The Marmot Review fits with the four explanations of the Black Report as it suggests that taking action
to reduce health inequalities will have a positive effect on society in many ways for example, bringing
economic benefits by reducing population illness and increasing productivity. It suggests that the policy
to reduce health inequalities must give every child the best start in life, such as school meals, education
and free health educational programmes, create fair employment and good work for all. (Health
Knowledge, 2016) Half of the minority ethnic groups, mostly black, Asian and mixed ethnic groups, had
significantly lower Disability Free Life Expectancy at birth than white British men or women. The lowest
DFLEs observed were for Bangladeshi men and Pakistani women. DFLE was highest for Chinese men and
women. Among older people aged 60 years and over, minority ethnic groups are more likely than white
British people to report limiting health and poor self-rated health. (Institute of Health Equity, 2020)
Inequality and patterns of ill health
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