How useful is a ‘social approach’ in explaining differences in health amongst different social groups?

Introduced in the 1980s (Smith and Goldblatt,2004,p.70), social explanations emphasize the impact of socio-economic structures to create and maintain differences in health amongst different social groups.

In order to assess the usefulness of this approach, this essay will first outline the model’s main characteristics. Then, by focusing on ‘The Black Report’ and ‘The health divide’ analyses, the discussion will move on to identify the model’s strengths and weaknesses, also taking into account how some of the latter have been dealt by alternative approaches, such as the ‘complementary’ model and ‘the New Public Health’.

Social explanations focus on the overall health of society rather than individual health, by assessing and comparing the health of its populations, categorized according to socio-economic factors such as occupation, gender and ethnicity. Health is usually measured using statistical methods: data is collected for a representative set of health indicators (i.e.death rates) then figures are compared in order to find patterns which may suggest links between social groups and their social environments. Statistical data is sometimes backed up by qualitative evidence.

Two government reports on UK society, ‘The Black Report’ (1980) and ‘The health divide’ (1992), are examples of how the social approach could be employed. These reports included the mortality, morbidity and life expectancy statistics according to social class for 1978-79 and 1992.

Although improvements in health within each class were recorded between the two periods, class differential remained steady, with people on lower incomes still suffering from poorer health than those in the higher levels of the socio-economic scale, despite access to health services was made free since 1948 (Smith and Goldblatt,2004,p.52-54).

In contrast with restricting health and illness to the realm of human biology, as the dominant view of the time suggested drawing on the medical model, the reports highlighted the main strength of the social approach: its inclusion of socio-economic factors in explaining health differences.

By looking for associations between health variations and socio-economic factors, social explanations can also identify which of these structural forces might have the strongest impact on the health of different groups, thus directing governments in promoting targeted polices. For instance, the authors of the reports focused on material resources, such as poor housing, suggesting that a more equal distribution of resources was needed. This was also confirmed by a later experiment where relocating families from low income to richer areas resulted in an improvement in their health (Smith and Goldblatt, 2004, p.52-55).

The large use of statistical surveys to gather evidence, is also another strength of the social model, as claims can be backed up by the higher degree of objectivity and reliability accorded to such scientific techniques(Smith and Goldblatt,2004,p.71).

However, the social model does have some limitations .

Firstly, its highly focused analysis of social structures leads other structural forces, such as biological factors, to be overlooked. For instance, the association between high mortality rates and manual unskilled groups in the two reports was interpreted as the influence of low class position on health. Yet, it can be argued that if these groups had a higher percentage of old people, the impact of social class would have been less clear (Goldblatt,2004,p.30).

Secondly, the social approach fails to take into account the impact that individual agency has on health. Even if cultural explanations (Goldbatt,2004,p.31) within the social approach recognize a role to lifestyle, the individuals’ position in society may prevent them from making healthy choices, for example if economically unattainable (Smith and Goldblatt,2004,p.67). However agency can be exercised through collective action, by tackling socio-economic inequalities at the level of national policies (Smith and Goldblatt, 2004,p.70).

Another criticism to the social approach regards the danger of creating statistical artifacts. Even though evidence is gathered through scientific techniques, the acts of observation and data interpretation always involve a subjective component. Thus, an opposite interpretation of the two reports could suggest the influence of health on class position on the grounds that physical weakness may prevent access to the top jobs. Besides, figures may not represent accurately individuals’ mobility within the labour market nor they account for the class shrinkage occurred in the last years (Goldbatt, 2004,p.31-32).

For a more comprehensive explanation of health differences amongst different social groups, the Complementary and The New Public Health models could be considered.

Both approaches, whilst acknowledging the importance of biological and social factors, focus much more on individuals’ agency and prevention. Thus, they can help explaining health differences within and between social groups that can be related to individuals’ choices and clarify what control we have on our health.

The complementary model embraces an holistic view that sees body and mind as interlinked. Thus psychological and emotional factors are acknowledged and the responsibility on our health as well as the capacity for treatment is placed upon us. However, the effectiveness of the approach is hard to demonstrate because it relies on individual experience rather than scientific observation (Smith and Goldblatt, 2004, p.58-60).

By contrast, The New Public Health’s focus on lifestyle and risk assessment benefits from using techniques based on the scientific approach (Smith and Goldblatt, 2004, p.63-69). It also focuses on health promotion and prevention not only within the individual but also in the communities. For example, whilst the social approach could suggest that better housing conditions are needed in order to improve the health of people living in depressed areas, the New Public Health could highlight the need to facilitate people in making healthy choices, for example by offering health resources, such as sport facilities, in those areas (Smith and Goldblatt, 2004, p. 62).

In conclusion, the usefulness of the social model in explaining health differences amongst social groups draws upon its ability to address the impact that socio-economic factors have on health differences, using rigorous, albeit not entirely objective, evidence, to support its analyses.

However, the model’s primary focus on social structures risks to overlook other factors that influence health, with particular disregard to individual agency.

Thus, alternative, more rounded approaches, such as the complementary model and the New Public Health, could also be considered for a better understanding of health issues.

References

Goldblatt, D. (2004) DD121 Workbook 2, Milton Keynes, 2nd edn. The Open University.

Smith, B. and Goldblatt, D., (2004) ‘Whose health is it anyway?’, in Hinchliffe, S. and Woodward, K. (ed.) The Natural and the Social: Uncertainty, Risk, Change, London, 2nd edn. The Open University.

being an undegraduate: the interaction of agency and structure through social roles

The freedom and control to shape our own identities are influenced by personal, material and social structures.

The aim of this essay is to support this claim by showing the interaction between agency and some of these structural influences, taking as an example my role as an undergraduate IT student at Queen Mary College of London in 2004.

In particular, I will focus on three aspects of this experience: the influence of gender in subject choice (Information Technology), the economic and ethnic factors entangled with the choice of the institution (Queen Mary) and the collective identities built around the college societies.

Information technology is centered on the study of computer hardware and software. It belongs to the realm of the scientific subjects, which are generally considered as ‘masculine’, with male students outnumbering and outperforming female students. In my case, more than 80% of the students enrolled on my course were male (Davis, 2006).

In fact, gender-related patterns in subject choice and in academic performance are present since primary school, with girls performing better in humanities and boys prevailing in science and technology (Gove and Watt, 2004, pp.61-64).

Research has pointed at different causes to account for this phenomenon: biological differences between the two sexes (Kimura, 1992), social factors such as gendered activities and interests as well as teachers’ perception of gendered identities (Murphy and Elwood, 1998), have all been considered.

Nevertheless, the presence of female students in my course and the fact that none of us failed, clearly shows that we can actively challenge this gender gap in performance and subject choice, a gap that, according to statistics, is already narrowing in primary and secondary education (Gove and Watt, 2004, p.62-63).

My choice on which university to enroll in was largely influenced by economic factors. Coming from a low income background, Queen Mary College appeared to be the more convenient solution, as it offered me the highest grant.

However, I discovered that for some of my fellow students, who came from Asian countries, ethnicity also played an important role. For them, Queen Mary was an attractive option because of its large percentage in Asian students, as well as its location, which is in an area of East London were these communities have a strong presence (Tower Hamlets Research and Scrutiny, 2005). The university itself was clearly aware of this and its prospectus offered often images of cheerful, successful Asian students, seeking explicitly to interpellate this kind of audience.

An important aspect of the student life was also socialization by means of joining one or more

societies, voluntary groups funded and run by students within the university. Most societies at Queen Mary represented ethnic communities, while others were based on religion and a minority on leisure activities, thus suggesting a hierarchy of importance in the factors that influenced the creation of group identities within that institution.

Choosing to join a group was entirely voluntary, as long as prospective members shared the aims of the society. Therefore students were likely to be members of the societies they most identified with, shaping and taking up for themselves these collective identities.

Furthermore, there was no limit in the number of societies a student could be member of. For

example a Jewish student was also member of the Palestinian society, which shows firstly that

individuals have multiple identities, which may well be in conflict with each other, and secondly how agency can challenge stereotypes and assumptions, in this case the perceived incompatibility of being a Jewish who supports the Palestinian cause, thus promoting a change in the structures that impose such definitions.

In this essay I have described some of the most common ways in which structure and agency

interact in shaping our identities, with reference to my university experience.

Firstly, I have focused on the relationship between gender, subject choice and academic performance and how these are both being challenged. I have also pointed out how structures influence each individual differently, showing how income influenced my choice of university, while for other students this choice was based more on ethnic considerations.

With regards to university societies as sources of collective identities, I have stressed how joining a society is strongly based on the similarity among its members and that by joining different societies individuals can take up multiple identities, even though these may be perceived in contradiction with one another.

Thus, individuals exercise their agency in shaping their identity and may challenge the structural constraints imposed on them.