Despite the advances in the national health care system, designed to reduce health inequalities these inequalities still persist and therefore, there is an ongoing debate as to how to explain these differences as a prelude to addressing the problem. The Black report (1982) evaluated Britain’s Health Service and its impact on the health of the population. It highlighted four different types of explanations for class differences in health. These four explanations are; 1. Measurement artefact. 2. Natural or social selection. 3. Cultural/behavioural differences. 4. Structural/materialists. The artefact approach challenges the statistics that link ill health to social class. This explanation argues that class- related health differences only appear because of the ways statistics are recorded and measured and therefore they are not real and do no exist.
Reasons why this may be the case are that certain measures of both class and of health are bias and imperfect validity. ”In calculating mortality rates the occupation of the deceased is taken from death certification of the decreased is taken from death certificates, while total number of people in each class are calculated from occupations rewarded in the ten yearly censuses. Misleading of occupation in either source introduces bias into the calculation.” ”Repeat reclassification of occupation at each census and since 1931 has made it difficult to compare occupational classes over such a time-span, unless adjustments are made to allow for the reclassification.”
”The proportion of the population in each social class has changed over time. In particular, this a smaller proportion of the population in class V and a large proportion in classes 1 and 11 because of an upward shift in occupations. The statics and lifestyle of the much smaller class 1 in 1921, may have been very different from the status of the expanded class 1 in 1981, so again the studies may not be comparing like with like.” (Whitehead, M (1992) ‘Inequalities in health, The health Divide chapter 3, ‘Recent Trends, London, Penguin Books).
There can be other problems with collecting statistics such as, the fact that statistics are not always accurate. Another point to be considered is how the questions are worded. It is easy, and often subs conscious for the questioner to word the questions in such a way as to lead to respondent to reply in a certain way. (Taflinger, R., ‘the problems with statistics’ 1996. http://www.wsu.edu/..taglinge/evistatis.html). Hospitals have been known to manipulate statistics so as to reach targets and all of this can interfere with the validity of the data findings.
The authors of the Black Report dismissed the artefact explanation as a reason for the inequalities. Consequently, it does not offer any better clarity to the complexities of health inequalities in society and so cannot be sustained.
There have been a number of studies that have used different measures of class and health and all have shown similar patterns. There is a consistent relationship with those in the lower social classes, always showing poorer health. This is the case; weather social class is measured by income, housing tenure, household possessions, or education. Further more, health has been measured according to mortality, morbidity (and thus itself has been measures in a number of different ways), and self-rated health. Again there is always a relationship. Therefore, the Artefact explanation cannot account for all these different studies (www.wic.ac.uk/shss/dom/…./scexplanations/artefact.htm).
National/Social selection. It could be argues that class differences are the result of human biological differences. The argument is that those who are fitter and in better health getter jobs. For example ”an individual who is chronically sick or disabled may move down the social scales since they are unable to either find employment or are than their current employment suggests) (www.uwic.ac.uk/shss/dom/…/scexplanations/artefact.htm).
Conversely those in poor health are more likely to be unemployed with resultant consequences which are likely to affect their health. The ethos of this explanation is similar to that of Social Darwinism which refers to varies ideologies based on a concept of competition among all individuals, groups and nations. National selection explains speciation in populations as the outcome of competition between individual organisms for lifted resources, popularly known as ”Survival of the fittest”.