Areas populated by poorer people experience more hazards such as environmental pollution, traffic pollution, traffic volume and accidents. These areas are less resourced when it comes to public transport, shops and primary health care services. According to Whitehead (1988) children from lower social groups have more accidents, this may be explained by their reckless, risk-taking behaviour and inadequate care by their parents. A materialistic view would be of unsafe play areas, lack of space to play in high rise housing coupled with the inability to supervise their behaviour.
He concluded that the environment dictated the behaviour of both mother and child. In this scenario the whole family will be affected by inequalities in health. Mary’s elderly parents both suffer from illness. Her father suffers from asthma after working in the coal mines all his life, and her mother from arthritis. Her father is also at risk from COPD (Chronic obstructive Pulmonary Disease) as a result of working in the mines. This is a progressive disease that causes an obstruction of the airways.
According to the National Statistics (2004) circularity disease was the highest single cause of death during 2001, averaging 378 per 100,000 for the United Kingdom. The scenario does not say if Mary’s husband is obese, however if he is this significantly heightens his risk of ill health and chronic diseases. In winter the weather will affect both of them. Mary’s mother has arthritis, inflammation of the joints which can be very painful and restricts movement. It is estimated that over 20 million people in the UK have a rheumatic disease (Weller 2000).
With both parents illness restricting them to their own environment they could be at increased risk of becoming trapped in their own homes. With crime rates higher in poorer areas this could also have an affect on their quality of lives. Older people especially women are more likely to be the victims of theft. Fear of crime can cause mental stress and social exclusion. Older people tend to worry more about becoming victims, this may prevent them from attending local social events (Acheson 1998). Both parents present more stress to Mary’s already stressful life.
Neither can offer her any financial help, and with transport costs to consider childcare is not an option. Mary’s support is vital to them. This will put increased stress on Mary who is already struggling to stay in her part time job. With less money when she leaves work to visit her parents together with fatigue, this may prove to be detrimental to her health. Mary may have an increased risk of premature birth as preterm labour occurs in up to 10% of all births and accounts for more than 80% of infant death and disability (Mc Guire & Fowlie 2005).
Therefore Mary’s midwife should help her gain as much information and help as she can, involving as many agencies as the family permits. The midwife should also make sure that she has up to date knowledge on maternity benefits, help Mary and her family through the knowledge of other professionals claim all that they are entitled to. They must also discuss contraception. If Mary’s husband does not consent to a vasectomy then an alternative form of contraception is needed to ensure that there is not another unplanned pregnancy.
For the immediate future Mary must draw upon all the support around her. Her midwife must be aware of her circumstances, be observant for any deviations from the “normal” in her pregnancy and support Mary as much as she can. Poorer people may have poor health because they have to live in places which are health damaging. Unhealthy homes suffer from other social and economic disadvantage (Alcock 2003). Lack of access to gardens, parks, shopping facilities pollution from noise, dirt and litter.
Tenants’ usually have no choice in the fuel that heats their homes. The cost of fuel is often high due to damp conditions and lack of insulation. This creates a major source of debt (Jones & Pickett 1993). Poverty also increases the number of stressful life events. Poverty causes lack of control over events which can increase depressive illness. The coping mechanisms people use to overcome this stress may lead to worse problems. For example, drug abuse, alcohol abuse and smoking (Jones & Pickett 1993).
In Mary’s case she is at increased risk of developing post-natal depression, or even psychosis and twice as likely as men to suffer depression (Mc Guire & Fowlie 2005). One in four is likely to suffer from a serious depressive episode. However her husband is also likely to suffer from depression and low self esteem (Palmer et al 2006). According to Professor Nicholas Emler, a social psychologist, relatively low self-esteem is a risk factor for suicide, depression and victimisation (Palmer et al 2006). Certain groups face high risks of poverty, 69% of those families are where the breadwinner (s) are unemployed.
26% of families that are also at high risk are those with an adult in part time work (Thomson et al 1998). Mary and her family fall into this category and will be at risk of a higher level of poverty when she ceases her part time job. Research has shown that there is a definite link between unemployment and ill-health, these include long-standing illness, mortality rates, disability and psychological disturbances (Jones & Pickett 1993). Although there are many Social factors that affect Mary’s health there are also many physical conditions that she may suffer.
Mc Guire & Fowlie (2005) suggest that women from poor socioeconomic backgrounds are more likely to endure preterm labour. However, some studies have shown that interventions such as better antenatal care, increased social support and a healthier diet during pregnancy does improve the outcome of preterm delivery ( Taylor & Field 2003). Most women are aware of specific hazards in the area that they work. The most important time for teratogenic influences are in early and late pregnancy. As Mary works for a hairdresser she is at risk of chemical hazards.
There are special codes of practice for certain toxic chemicals which safeguard pregnant women and their unborn child, Mary should consult her employer regarding the chemicals that she uses (Chamberlain & Morgan 2002). Mary may also be affected at work by passive smoking as there are no laws in force at present to avoid this. Mary has to stand for long periods of time, some studies have shown that this can increase preterm labour. Travelling to work can cause stress especially where there is heat, noise, fatigue and other people’s tobacco smoke.
Studies in Spain have showed that the likelihood of preterm labour increases with the duration of stressful public travel (Chamberlain & Morgan 2002). Nutrition is also a key factor as it plays a crucial role in the growth and development of an infant. In June 1991 the National Children’s Home charity commissioned a survey on the eating habits of low income families in Britain. The results showed that one in five parents regularly denied themselves food and one in ten children under five went without enough to eat at least once a month (Oppenheim 1993).
Blincoe (2006), states that maternal nutrition is a contributing factor in the rise of prematurity and retarded growth. It is well noted that women who have poor diets, tend to give birth prematurely, and of low birth weight. A baby born at full term weighing less than 2. 5kg is likely to suffer illness and may have difficulty feeding (Skeoch & Galea 1987). Studies have shown that pregnant women in low social classes are more likely to deliver early and have a low birthweight baby that will need special care (Brooke et al 1989).
A healthy pregnancy is aided by a diet providing calories and nutrients, with a supplement of folic acid in the early weeks of pregnancy. Proper nutrition during pregnancy plays a vital role in determining the health of the newborn child. Through the quantity and quality of what a pregnant woman eats, she provides the nourishment necessary to begin and maintain the growth and development of the fetus (Blincoe 2006). If Mary wishes to breastfeed successfully she will need support from her midwife. A survey by The Office of national Statistics showed that in 2000 there was only a 2% rise in breastfeeding from the figures taken in 1995.
The lowest rates for breastfeeding are found in socio-economically deprived families (Nicoll & Williams 2002). It is advisable therefore that as Midwives interact with parents during pregnancy labour and birth, they are best placed to give as much information to them as possible. With Mary’s family there will be many forms of care and information that a number of professionals can give them. The NMC code of conduct (NMC 2004) states that midwives should promote the interests of clients, including helping them gain access any healthcare relevant to their needs (NMC 2004).
In conclusion, the Black Report followed by the Acheson Report brought inequalities in health and the mortality rates among the lower social classes to the forefront. Areas for the development of policies to reduce the inequalities suffered by lower social classes were proposed and some implicated. Unfortunately it also showed that some inequalities in health have risen, not declined and that there is a continual link between poor health and social class. The children in the scenario are growing up in a home of disadvantage. This may affect their chances of a good education and their future prospects as they mature to adulthood.
They are likely to be undernourished and be growing up in cramped conditions that will affect their health. This will have a greater impact on them with another sibling joining their family, being another mouth to feed. The inability to travel between her parent’s house and her own on a regular basis with a new baby and low income will have a considerable effect on Mary. There is a high risk of Mary becoming stressed and unable to cope at her inability to carry on caring for her parents as she has been doing. Mary’s parents will also find this hard as they rely on her so much and may themselves become more socially disadvantaged.
It is clear that people from the lower socio-economic groups are disadvantaged. They are more likely to be living in poverty, be unemployed or their partner may be out of work. These families may live in cramped conditions, dependant on state benefits and undernourished. As midwives interact with families during pregnancy, birth and the postnatal period they are best placed to give parents information. Historically, midwives have focussed on maintaining good health within their remit of normal birth and the detection of any complications.
However, the increasing shortage of midwives in the United Kingdom makes it more and more difficult to care properly for these socially disadvantaged women. The only way to change this situation is through legislation that pulls these women up from the lower social classes by giving them a decent amount of money to live on, and the chance to work if they want to by providing them with cheap, safe care for their children, or the chance to return to education to train for a career that may well see them promoted to the higher end of the social class scale.