Part 2 ----3.Materialist Theory Materialist theory suggests that differences in the material circumstances of the social classes- such as income, housing, diet and working environment- are the key determinants of inequalities in health and the use of health care services. Both historical and contemporary evidence support this view. Socioeconomic inequalities are understood to be of key importance to the pattering of health behaviors and are the focus of much debate as they appear to be widening.

In other words, the inverse association between socioeconomic level and risk of disease is one of the most common and outstanding observation in public health. This association is found for most measures of socioeconomic level and is generally consistant across age, time and place. For example, housing that is cold, damp, or overcrowded creates well-known health hazards such as respiratory and parasitic diseases, stress-related diseases and depression.

Low income families are more likely to face hazards in the home and risks from traffic and industrial plant in their neighborhoods. Standards of diet are closely associated with income, with particular implications for levels of infant mortality. Opportunities for holidays, travel and leisure, which may relieve stress and facilitate recovery, are similarly related to financial circumstances. Unemployment is associated with particular health risks, due to the emotional, social and economic problems that being out of work brings.

Studies have shown that unemployed men and their families have increased mortality experience, particularly from suicide and lung cancer; or having lower income did increase the relative risk for lung cancer mortality. Work processes and working environments can pose very serious threats to health. People in manual occupations are at far great risk than others, particularly those involving contact with machinery, chemicals and industrial wastes.

Occupational disease can be very uncertain, developing gradually or lying inactive for decades. They include a range of cancers, skin diseases, infectious diseases and poisoning. Wives and children of workers may be at risk from chemical traces accidentally carried home on clothing or from pollution from local factories. Even the unborn may suffer as a result of genetic damage sustained by their parents.

The stress associated with low autonomy, repetitive tasks and close supervision at work can also cause health problems. Access to services also reflects income levels. People who use private health care are overwhelmingly of higher social groups. Thus, many researchers conclude that differences in material circumstances are the main determinant of class inequalities in health. However, there are some aspects of the health behavior of the poor that might seem difficult to explain in economic terms, for example high rates of cigarette smoking.

4. Cultural-Behavioral Theory This theory focuses on class differences in health beliefs and health behavior. It is argued that people in higher social class appear to have broader and more positive definition of health and they have higher expectations and more commonly explain illness in terms of individual actions rather than external forces. In contrast, research evidence suggests that people in the lower social class are more likely than others to equate being healthy simply with an absence of disruptive symptoms and they believe that good health is more a matter of luck or chance.

Cultural-behavioral theorists sometimes suggest that the poor are characterized by distinctive attitudes to life. There are rather two different versions of this argument. The culture of poverty thesis argues that poor are characterized by social disorganization and as a result, it is suggested, individuals become undisciplined, careless and self-indulgent. In contrast, the class subculture thesis argues that the poor live in cohesive and strong circular communities and said to support value system at odds with those of the wider society.

Cultural-behavioral explanations cannot be dismissed. There are differences in outlooks and behavior between the social classes that are relevant to health and health care. For example, the observation that children from lower social groups have more accidents than children from higher groups may be explained by the behavioral view as due to more reckless risk-taking behavior in this group and inadequate care by parent.

Also it has been shown that men and women in the lower social class are nearly four times more likely to be smokers than those in the higher social groups and therefore, they are more likely to die of lung cancer than their affluent counterpart. However, there is a danger of stereotyping and stigmatizing the lives of the poor. This approach can lead to the belief that individuals simply have to change their attitudes and if they do not, they are responsible for their own health problems.

(To be Contd)