An Analysis of the Social Gradient of Health Essay

The demonstration of a kind gradient of wellness predicts that lessen dissimilitude itself has wellness benefits for totally, not simply for the imp all overished or deprived minorities within populations. (Devitt, mansion house & Tsey 2001) The preceding(prenominal) quotation mark from Devitt, Hall and Tseys paper is a relatively come up grounded and well researched statement which draws on contemporary theoretical sociological concepts to back the assertion that reducing inequality is the find to improving health for all. unless the assertion that the demonstration of a midpointy gradient of health predicts that a reduction in inequality ordain lead to health benefits for all is a rather broad statement and requires closer run. The intention of this r polish offer is to examine the hearty gradient of health, whose existence has been well established by the Whitehall Studies (Marmot 1991), and, by focusing on those separates at the lower end of the friendly gradient, de barrierine whether green lights to solicit inequalities between kindly classes will lead to health benefits for those classes at the lower end of the social scale.The hard-hittingness of past initiatives to address these social and health inequalities will be examined and recommendations make as to how these initiatives cleverness be more than effective. The social gradient described by Marmot and others is assort with a variety of environmental, sociopolitical and socio sparing factors which carry been identified as get a line determinants of health. These determinants interact with each other at a very mingled take aim to regard directly and indirectly on the health term of several(prenominal)s and groups at all levels of society Poor social and economic circumstances affect health throughout life.People further down the social ladder usually run at least twice the luck of serious illness and premature death of those near the brighten. Between the top and bottom health standards show a continual social gradient. (Wilkinson & Marmot 1998) In Australian society it is readily app arnt that the lower social classes are at great disadvantage than those in the upper echelons of society this has been discussed at length in several separate papers on the social gradient of health and its effects on disadvantaged Australian groups (Devitt, Hall & Tsey 2001, Robinson 2002, Caldwell & Caldwell 1995).Within the context of the social gradient of health it can be inferred that autochthonous groups, for example, are particularly susceptible to ill health and unretentive health outcomes as they suffer inordinately from the negative effects of the key determinants of health. A simple example of this is the inequality in distri plainlyion of economic resources Average autochthonic household income is 38% less than that of non- native households. (AHREOC 2004). The stress and apprehension caused by insufficient economic resources leads to increased risk of depression, hypertension and heart disease (Brunner 1997 cited in hydrogen 2001).Higher social status and greater access to economic resources is concomitant with a reduction in stress and anxiety levels, as individuals in these groups take in more verify over economic pressures which create this stress. This simple comparison proves that the social gradient of health accurately reflects how socioeconomic determinants affect the health of specific social classes at the physiological level. An extension of the research into the social gradient and the determinants of health is the examination of the pathways through which specific social groups experience and respond to these determinants.These psychosocial pathways incorporate psychological, behavioral and environmental constraints and are closely linked to the determinants of health Many of the socio-economic determinants of health rush their effects through psychosocial pathways. (Wilkinson 2001 cited in R obinson 2002). These pathways have been demonstrated by Henry (2001) in the conceptual archetype of resource influences (Appendix A), a model which illustrates the interaction between the constraints mentioned above and their impact on health outcomes.Henry states that a central differentiator between classes is the amount of reserve an individual feels they have over their environment. Whereas an individual from a lower class group holds a limited sense of control over their well world and consequently adopts a fatalistic approach to health, those in luxuriouslyer classes with a stronger sense of control over their health are more potential to take proactive steps in ensuring their future wellbeing.This means that some(prenominal) individuals will cope differently with the aforementioned(prenominal) health problem. This is partly as a result of socioeconomic or environmental determinants relative to their situation, but it is likewise a result of behavioural/physical constra ints and, most importantly, the modes of aspect assiduous in rationalising their situation and actions. In essence these psychosocial pathways occupy an arbitrate role between the social determinants of health and class related health behaviours.This suggests that, while the social gradient of health is a good forecaster of predisposition to ill health among specific classes, it cannot predict how reducing inequality in itself will affect health outcomes or how a specific social class will respond to these substitutes. An examination of some initiatives aimed at reducing inequality in the indicators of health outcomes reveals this problem In 1996 lone(prenominal) when between 5% and 6% of NT pristine adults had any kind of broadcast secondary school qualification compared with 40% of non-Aboriginal Territorians. (ABS 1998).Within the context of the social gradient of health, education is an important indicator of health outcomes. It is evident from the quote above that the re exists huge inequality within the nonethern dirt education system this suggests an increased likelihood of ill health for Aboriginal people in later life. Even though there have been initiatives to address this inequality in one of the indicators of health outcomes (Colman 1997, Lawnham 2001, Colman & Colman 2003), they have had lonesome(prenominal) a minimal impact on endemic second level education rates (ABS 2003).This is partly due to the inappropriateness of these initiatives (Valadian 1999), but it is as well due to the disempowerment and psychosocial malaise (Flick & Nelson 1994 cited in Devitt, Hall & Tsey 2001) which are a cause of autochthonal interaction and responses to the social determinants of health. Research has also been carried out into how effecting change in the inequalities in other indicators of health might affect health outcomes. Mayer (1997) cited in Henry (2001) examined the effects of doubling the income of low income families and concluded it w ould arrive at only modest effects.Henry believes that this points to the strong influence of the psychological subject area in influencing health behaviours. This suggests that the key to better health for all lies not just in reducing inequality between the classes but also in changing those elements of the psychological domain which influence health behaviour. some other example of the gap between initiatives to reduce inequality and their impact on those inequalities is evident in an examination of economic constraints experienced by natal Australians on social welfare.Price and McComb (1998) found that those in Indigenous communities would drop down 35% of their weekly income on a basket of food, compared to just 23% of weekly income for those living in a capital city for the same basket of food. To combat this inequality it would seem logical to reduce the expense of food in Indigenous communities or else increase the amount of bullion procurable to those living in rem ote communities, i. e. a socioeconomic approach.It has already been established that increasing income has only modest effects and in compounding with the fact that smoking, gambling and alcohol account for up to 25% of expenditure in remote communities (Robinson 2002), how can it be guaranteed that the extra funds made available through either of the two suggestions above would be employed in achieving a desirable level of health? One plausibly suggestion is that a socioeconomic approach must be complemented by a psychosocial approach which addresses those abstract modes of thought, cultural norms and habits and health related behavioural intentions which dictate healthful behaviours.Culture and culture conflict are factors in Aboriginal health. But instead of the emphasis being placed on Aboriginal failure to assimilate to our norms, it should rather be put on our failure to devise strategies that accommodate to their folkways. (Tatz 1972 cited in Humphrey & Japanangka 1998) Any initiative which hopes to crock up inequality in health must incorporate a extend sympathy of the influence of the psychosocial pathways relative to the class level and cultural penchant of that group, otherwise its success will be modest at best. use Henrys model of resource influences provides a framework for understanding how addressing these psychosocial pathways can lead to greater uptake of initiatives physical bodyed to address these inequalities. An summary of the bailiwick tobacco plant Campaign (NTC 1999) reveals how this initiative failed to impact significantly on Indigenous smoking rates. This was a purely educational initiative which aimed to advance awareness of the effects of smoking on health.One of the primary flaws of its design was its failure to even acknowledge those Indigenous groups at the lower end of the social scale it also failed to communicate the relevance of its message to Indigenous people The only thing is that when it comes to Aborigina l people, they will not relate to Quit television advertisements because they dont see a fatal face. Ive heard the kids say Oh yeah, but thats only white fellas. They do. (NTC 1999) Not only did this initiative fail to connect with Indigenous people, it also failed to influence the elements of the psychological domain which legitimate such high rates of smoking.Within Indigenous culture smoking has become or so of a social practice, with the emphasis on sharing and borrowing of cigarettes (Gilchrist 1998). It is toothless to put across messages about the ill effects of smoking if the central motivation of relating to others is not addressed. In a report conducted on Indigenous smoking (AMA & APMA 2000 cited in Ivers 2001), it was suggested that one of the key themes of an initiative aimed at reducing indigenous smoking rates should be that smoking is not a part of Indigenous culture.The Jabby Dont Smoke (Dale 1999) is an example of an initiative whose design attempted to influe nce accepted social norms. Its focus was earlier on children, thereby acknowledging the importance of socialization and the instillation of cultural norms at an early age. Unfortunately no data is available detailing its impact on smoking rates. As mentioned earlier in this look for, another get of the psychological domain which has an effect through the psychosocial pathways is the modes of thought employed in rationalising actions and responses to various determinants and constraints.Self efficacy or the amount of perceived control over ones situation is an important contributor to health status Empowered individuals are more likely to take proactive steps in terms of personal health, whilst disempowered individuals are more likely to take a fatalistic approach (Henry 2001) Examples of initiatives which have strived to empower Indigenous people in being responsible for their own health involve The Lung Story (Gill 1999) and various health promotion messages conveyed through so ng in traditional language ( Castro 2000 cited in Ivers 2001, Nganampa wellness Council 2005).By encouraging Indigenous people to address these issues in their own way, the amount of perceived control over their own health is increased thereby facilitating a greater degree of self efficacy. The intention of this essay has not been to deny that the social gradient of health does not exist or that it is not an effective tool in creating understanding of where social and health inequalities lie. Unfortunately programs and initiatives which have been guided by the social gradient of health and have been purely socioeconomic in their approach have failed to have a significant, sustainable effect on health inequalities.In the US, despite socioeconomic initiatives to split inequality, the gap between upper and lower class groups has actually widened in recent times (Pamuk et al 1998 cited in Henry 2001). The scale of the interposition required to ensure a sustained impact on health inequa lities has been discussed by Henry (2001), he also highlights the need to garner straightforward political will in order for these changes to happen and makes the point that those in the upper classes are relatively content with the present status quo.This essay has attempted to demonstrate that in an environment where well grounded, evidence base socioeconomic initiatives are failing to have the desired out comes, it is perchance time to focus more on altering those strongly held health beliefs which not only dictate responses to social determinants of health but also dictate responses to initiatives designed to address these inequalities healthful behaviours are due to more than just an inability to pay. A mix of psychological characteristics combines to form typical behavioural intentions.(Henry 2001) In the current environment of insufficient political will and finite resources it would be prudent to use every tool available to ensure initiatives aimed at reducing inequalit y between the classes will have the maximum amount of benefit. This approach is not a long term solution, but until it is possible to achieve the large scale social remodelling needful to truly remove social inequality, and consequently health inequality, it is the most practicable solution available. REFERENCES. ABS, 2003. 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