Readings for Week 8
1. Social Class and Health Inequalities by Julie McMullin and Loraine Davies
*SES was used as a proxy, or interchangeably for social class in this chapter
•social class is one of the many social structures that organizes and pattern social life in
•a sociological understanding of the social structure recognizes that individuals are not
disadvantaged because they are lazy, stupid, or lacking in ambition. To understand social
structure in this way acknowledges that individuals do not freely make decisions about
their lives, but rather that their decisions are constrained by structural factors.
•The alternatives that are available to people vary on the basis of the social structure.
•Social class acts as a social structure because it is a mechanism that organizes people in
terms of relative disadvantage and it represents a means through which patterns of
privilege and reward are distributed.
•the alternatives available to members of the working class are far fewer and more
restrictive than are the alternatives available to people of upper classes.
•Over the past century, while many proximal risk factors for specific diseases have been
successfully identified and often eradicated, the socio-economic status gradient in health
has not disappeared. This, it is argued, makes socio-economic status a “fundamental
cause of disease”
•The fundamental causal nature of SES is attributed to the fact that more privileged
individuals have more resources such as “knowledge, money, power, prestige, and social
connectedness,” which they can marshal in a variety of ways to protect their health.
•As risk factors for disease change, so too can the strategies to avoid the risk factors,
especially among those with more resources and therefore higher SES.
•More privileged individuals are less likely to experience the more preventable diseases
compared to the less preventable diseases in the U.S., but not in Canada. These findings
suggest that “Canadian social policies are more effective than U.S. policies in altering the
[SES] social conditions that affect the determinants of disease.”
•Social causation vs. social selection: it is not that lower education and income cause poor
health, but that those with poor health are not able to achieve high levels of income and
education. While it is generally agreed that social causation has a stronger effect than
social selection, selection factors do contribute to some of the SES variations in health.
For example, many individuals who experience health conditions also have trouble
securing stable employment and income.
•Socio-economic inequality results in the differential distribution of health-enhancing and
life-extending resources such as income, education, and social connections among
individuals in society
•When mortality rates are compared over a 25-year period between 1971 and 1996, we see
that although it has declined over time, an income gradient in mortality is evident, with
lower rates among the wealthiest income quintiles and the highest mortality rates among
the poorest income quintiles
•when Montreal is compared to Ottawa, Toronto, Winnipeg, Calgary and Vancouver, it has
the highest unemployment rate and poverty index; it is also at the bottom of most health