Introduction
A person’s social circumstance significantly impacts their emotional and physical health. This conclusion is derived from many sociological researchers and theorists who have long studied the general health status of individuals and factions of society from a social perspective. Exploring the psychosocial mechanisms that link social location and health status provides ample evidence that those who are employed in low-end jobs or are less educated have lower incomes and therefore experience greater life stresses. They have little or no control of their employment or financial condition which leads to greater levels of stress thus poorer health on average than those of higher social circumstances. In addition, those of lower social status do not enjoy equitable access to quality health care. Social theorists from Karl Marx forward are not surprised that the disparity between elite and poor health circumstances falls predictably along the same lines that separate the elite and poor of society. The social conflict theory offers an explanation of the underlying causes regarding the health disparity amongst the social classes. The majority of this discussion provides evidence that proves Marx’s conflict theory within the context of the health advantage enjoyed by the upper class and looks at the ways in which student nurses might help to raise awareness of these issues.
Main body
Marx’s theories of labor value combined with his concepts of capitalism attempt to clarify how the revenue system operates to the benefit of the upper classes and the detriment of the lower classes. Conflicts will always persist because the upper class can never totally control the lower classes. The central concepts of Marxist economics include the theory of labor value, the disposition of production, and the inevitable conflicts between the classes. Lesser concepts of the theory include the idea of increased misery, the obsession with possessions, and the consequences of economic alienation. The Marxist conflict theory views capitalist production as an essential element of class struggle. Marxism theorizes that as capitalism persists, it exacerbates the misery level for working-class individuals (Marx & Engels, 1968). Marx blames the uneven distribution of wealth inherent in the capitalist system for spreading human misery which can reasonably be extrapolated to include inadequate access to health care for those of the working class. The conflict theory is proven every day if by no other measure than the consistent relationship between social stature and health condition.
It is not hard to understand how perceptions of subordination within the social context whether by a group or individual can yield excessive amounts of stress. An illustration of this concept can be found by examining subordinate animals. They must expend more energy to obtain food, face a greater chance of starvation, and are threatened more often by predators. Subordination within any social structure, whether human or animal, carries with it many psychological and physical stresses. The stresses emanate from feelings of hopelessness, the lack of autonomy and control over life choices in addition to the predictability of mundane existence. It is widely acknowledged by the medical community that persistent stress leads to and/or exacerbates harmful physical and psychological ailments. Studies have consistently demonstrated that the odds of poor health and earlier death rates are linked proportionately with lower social status (Adler et al, 1993). Theoretically, the reverse is true as well.
Health, whether good or bad can influence social and economic status. Certainly, bad health negatively affects a person’s ability to earn money. Social location can be an accurate predictor of health status. Individuals, their families, and groups in the higher social classes live longer on average. The life expectancy of children born to higher-income families today in Western societies is five years longer than those born to working-class families (Acheson, 1998). Until recent studies directed attention toward the sociological explanation for the inequality that exists in health status, a more direct link was thought to explain the disparity, a line of reasoning that merits serious consideration. Low-status jobs generally pay less. Lower incomes translate to restricted choices which means choosing food, housing, and health care based on budgetary constraints, not on which is the healthier choice (Marmot, 1984). This direct association, while valid, is only a surface view of the link between social class and health status. A more clearly defined view of this social phenomenon can be found only by examining the less obvious psychological and sociological aspects of the connection. Psychological concerns involve the extent to which levels of pessimism, optimism, and general feelings of self-esteem affect health (Hurst, 1997).
Social location more often than not is closely related to a physical location. Living in certain areas of the country and cities is a determining factor in projecting health outcomes. Lower-income people who live in the inner cities suffer what is commonly referred to as the ‘urban health penalty.’ This phrase illustrates the reality that health status is decidedly lower among lower-class neighborhoods. This faction of society doesn’t possess the political influence or financial means to effect change in their desperate circumstance. They are likely to remain poor and living in places that exacerbate their health problems. “Inner-city-bound populations, such as the poor and working poor often have heightened health risks because of smog, toxic waste dumping, noise, traffic, crime, violence, drug abuse, and crumbling infrastructures” (Short, 2001). The National Center for Children in Poverty released a report in 1997 that provided hard statistics that reproved the prevalent sociological theory. According to the report, nearly three million impoverished children in the U.S. are confronted by an increased chance of developing brain disorders as a result of being exposed to several ‘risk factors’ connected with living in such social circumstances (Short, 2001). These ‘risk factors’ comprise exposure to lead-based paint and asbestos, inadequate diet, and drug abuse and can be applied to any urban center. Those seemingly entrapped by their impoverished circumstances seldom seek preventative medical care or other health services until they require an emergency room visit.
Marmot (1991) cites perceptions of social status as having a larger impact on overall physical and psychological health than do other factors such as pay differentials. The vastly contrasting societies of the U.S., Cuba, and Japan were compared by the study to illustrate this finding. The gross domestic product (GDP) was balanced against the average life span in each country which proved higher incomes did not necessarily equate to healthier citizens. Social status, which is not automatically dependent upon financial status, determines the level of happiness and self-worth which translates into improved health outcomes. “Hierarchies are inevitable but how hierarchies are translated to differences in health is the crucial question. Social arrangements, education and social cohesion may be crucial factors” (Marmot, 1991). The Japanese society puts much emphasis on social arrangements and education and is universally acknowledged as cohesive when compared to all others. This cohesiveness is possible because, in this society, there exists less of a perceived gap in the social hierarchy. It models an ‘all for one and one for all type of mentality. The conflict theory is not applicable in Japan to the same degree as in other countries. The working class doesn’t experience similar internal or external psychological pressures to rise to a higher social class nor is ashamed and frustrated by their current social location to the same degree as those in other societies.
The people of Japan put greater importance on caring for the elderly, the crime rate is lower and industrial productivity is higher.
Conclusion
It would seem, given these overwhelming circumstances, that there is little a student nurse could do to alleviate the pressures and raise awareness of the dangers. However, within the social theories and psychological effects are hidden numerous places in which a student nurse might provide help, comfort, or at least understanding among individuals. For instance, by encouraging wellness check-ups, before emergency services are required, lower-income individuals might be able to avoid some of the more dangerous conditions prevalent for their segment of the population. Helping individuals discover low-cost nutritious foods can be integrated into the student nurse’s everyday life as they shop for themselves and discover new shops or marketplaces that offer reduced prices. Student nurses also may come into contact with individuals from higher social classes and can encourage these to take an interest in the well-being of the lower class children by donating quality food products to shelters and food kitchens. Perhaps most helpful, though, would be the student nurse’s treatment of those who seek assistance. The psychological impact of low social status, low income, or poverty has been proven in many cases to be more detrimental to an individual’s health condition than income or opportunity. By treating these individuals with respect and understanding, the student nurse may facilitate more open dialogue and encourage the individual in ways that will improve their self-esteem while empowering them to make necessary changes in their lives to break the sense of oppression many of these individuals experience as a result of their circumstances.
References
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Marmot MG, Smith GD, Stansfeld S, Patel C, North F, Head J, et al. (1991). “Health inequalities among British civil servants: the Whitehall II study.” Lancet. Vol. 337: 1387-93. [PMID: 1674771].
Marx, Karl & Engels, Frederick. (1968). “Manifesto of the Communist Party.” Selected Works. Moscow: Progress Publishers.
Short, Gail. (2001). “Perilous Places: Links Between Location and Health.” UAB Magazine. Vol. 21, N. 2.