What Is Social Class and How Does It Contribute to Our Understanding of the Social Determinants of Health?

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Introduction

Social class can be defined as a manifestation of structural inequality in the present day social system which creates different “classes” of individuals based on their economic status. This is commonly manifests as the following social classes:

Upper Class

This class within society is normally associated with individuals who have accumulated considerable amounts of wealth and social influence (Ritzer 2007). In most cases, this group consists of individuals who are business owners, land owners or have inherited their wealth through the endeavors of their parents.

This social class has the greatest amount of opportunities available to them in terms of wealth generation, health and education by virtue of their economic status and connections.

Middle Class

The middle class in society consists of individuals with more opportunities than the lower class but fewer opportunities than the upper class.

This section of the population normally consists of individuals with useful skill sets or levels of educational attainment that are valued by companies resulting in people from this class obtaining high paying jobs that allow them to maintain a relatively “well off” lifestyle in terms of wealth generation, health and the ability to provide opportunities for the same kind of life to their children (Ritzer 2007).

Lower Class

The lower class within society has the least amount of opportunities available to them due to a lack of economic means and social connections (Howarth, 2007). This class consists of individuals with low levels of education and they have fewer job prospects and opportunities for promotion due to a lack of skills and aptitude.

People belonging to the lower class, by virtue of their limited opportunities, have relatively little economic power and usually subsist on a “paycheck to paycheck” basis (Ritzer 2007). Unfortunately, the lower class is the largest portion of the current population in society and is commonly known as the “working class” since they are part of most manual labor operations (Howarth, 2007).

What is Structural Inequality and how does it impact social determinants of health?

Structural inequality, in essence, is an inherent bias within social structures which can provide some advantages to a select group of people within society while at the same time marginalizing others (Robert & Booske, 2011).

This can be seen in instances related to racism, education and discrimination wherein certain segments of the population are categorized and marginalized depending on their economic situation and their particular race (Baum et al., 2013). For example, the law involving illegal immigration passed by Arizona has in effect created a form of discrimination against many Mexicans living within the U.S. who are in fact there legally.

Structural inequality is one of the main reasons behind social determinants of health due to particular individuals having limited opportunities towards leading healthy life styles as a result of their economic class which leads to a limitation of opportunities (Keng-Yen et al., 2013).

What you have to understand is that the capacity to become healthy is based on an individual’s ability to be able to eat the right kind of healthy food and find enough time to exercise (Schofield, 2007). However, healthy food is often far more expensive than their fast food counterparts resulting in a limitation of the capacity to eat healthy based on how much money you can actually spend.

The same can be said for the need to exercise wherein a person needs to have sufficient time and the opportunity to do so (i.e. by joining a gym).

Such opportunities are often limited to people belonging to particular economic thresholds due to the fact that those belonging to the lower end of the spectrum simply cannot afford to buy healthy food or exercise due to their jobs while those belonging to the upper end of the spectrum can do so due to higher amounts of money and free time.

Other forms of structural inequalities which impact health can be seen in the form of community marginalization wherein particular types of races and economic classes are concentrated in certain communities (Obeng-Odoom, 2012).

What this causes is an imbalance in the distribution of wealth where money is consistently isolated in particular populations while minorities and people of low economic means are made to stagnate in their respective income niches. With fewer opportunities to obtain wealth, this causes stagnation in lower social classes wherein they have to subsist on cheaper types of food (normally junk food) in order to survive (Obeng-Odoom, 2012).

Other issues related to social class as a determinant of health is the inability of the lower class to access proper healthcare which severely limits their capacity to diagnose and treat a variety of possible conditions (Hunter et al. 2011).

Social Class leads to greater health risks

People belonging to the lower class of society are often considered less healthy than their middle class and upper class counter parts; however, the main reason behind this is connected to the type of food they consume which leads to detrimental health outcomes.

Junk food in the form of food from Mc Donald’s and Burger King have become a staple of the American diet for many decades, yet, despite its ubiquitous consumption there are considerable issues that need to be taken into consideration involving the nutritional value of the products being sold.

In nearly every town and city, fast food restaurants carry some form of junk food that is rapidly consumed by a voracious public that enjoys the taste and convenience of such products. Unfortunately, the reason behind this consumption has been related to the fact that it is simply the most affordable means of feeding a family.

As noted by the Baum et al. (2013) study, the dollar menu seen in Mc Donald’s as well as the various cheap and instant foods that are available in most grocery stores, while affordable, are lacking in sufficient nutritional diversity which contributes to health problems amongst the population that normally consumes it which normally consists of the lower class.

Such types of food have considerable levels of sodium, fat and carbohydrates resulting in the development of high caloric contents. While this would seem perfectly fine for someone that is trying to feed their family on a budget, the fact remains that while the caloric density is high, the nutritional value is low.

The recommended daily allowance of nutritional calories that a body should have in a single day, as stated by the American Medical Association, is roughly 2,500 to 3,000 calories a day. The problem with junk food that is consumed by the lower class is that due to their convenience and serving size, most people are not aware that on average they consume more than 3,000 calories a day from the various forms of junk food they eat.

An average adult male in the U.S. should consume only 65 grams of fat and 2,500 calories in a single day yet a burger and fries combo meal with a large coke available at the local McDonald’s is equivalent to more than 50 grams of fat and 1500 calories in a single sitting.

This would not be a problem should that be the only large meal they eat however this meal is supplemented by various chips, sodas and various other unhealthy options throughout the day which brings the total calorie count to 4,000 calories or more.

While the most obvious solution would be to buy healthier types of food, the problem, as mentioned earlier, is the fact that healthier options are economically unfeasible for members of the lower class of society (Alexander, 2013).

As such, due to their limited access to money as a result of structural inequality, this prevents them from rising from their current positions inevitably creating a social system with social class based categories of health wherein people at the lower end of the social spectrum are normally unhealthy while those belonging to the upper end of the spectrum are fit (Germov, 2009).

Conclusion

Based on the given information, it can be seen that while junk food is behind the current health problems of people belonging to the lower class, it is not the only cause. The structural inequality that exists in society is actually a prime contributing factor towards the social determinants of health that society now faces.

The combination of higher prices for healthy food, the lower cost of unhealthy food, and the limitation of economic opportunities for the lower class brought about through structural inequality are actually the primary reasons behind the prevalence of problematic health cases among the lower class since they are not getting the types of food and the opportunity to exercise that they need in order to be healthy.

Reference List

Alexander, K. (2013). Social Determinants of Methadone in Pregnancy: Violence, Social Capital, and Mental Health. Issues In Mental Health Nursing, 34(10), 747-751.

Baum, F. E., Legge, D. G., Freeman, T., Lawless, A., Labonté, R., & Jolley, G. M. (2013). The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints. BMC Public Health, 13(1), 1-13.

Germov, J. (ed.) (2009) Second opinion: An introduction to health sociology (4th ed.), Melbourne: Oxford University Press, Chapters 1, 4, 5 and 6.

Howarth, G. (2007) Whatever happened to social class? An examination of the neglect of working class cultures in the sociology of death, Health sociology review, 16, 5, 425-435.

Hunter, B. D., Neiger, B., & West, J. (2011). The importance of addressing social determinants of health at the local level: the case for social capital. Health & Social Care In The Community, 19(5), 522-530.

Keng-Yen, H., Cheng, S., & Theise, R. (2013). School Contexts as Social Determinants of Child Health: Current Practices and Implications for Future Public Health Practice. Public Health Reports, 128(Supp 3), 21-28.

Obeng-Odoom, F. (2012) Health, wealth and poverty in developing countries: beyond the State, market, and civil society, Health sociology review, 21, 2, 156-64.

Ritzer, G. (ed.) (2007) Blackwell encyclopedia of sociology, Oxford: Blackwell, pp.2086 -91.

Robert, S. A., & Booske, B. C. (2011). US Opinions on Health Determinants and Social Policy as Health Policy. American Journal Of Public Health, 101(9), 1655-1663.

Schofield, T. (2007) Health inequity and its social determinants: A sociological commentary, Health sociology review, 16, 2,105-14.

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