Social inequalities and perceived health.

The association between morbidity and mortality indicators and low socio-economic status has been observed for many centuries. In 1980 the publication of the Black Report in Britain drew attention to the failure of the National Health Service to close the gap between rich and poor in relation to health status. The gradients of morbidity and mortality which are linked to social class have been observed throughout Europe, in the U.S.A. and Australia. However, information on how people feel, as opposed to how they become ill, and the cause of their death, is scarce. Measures of perceived need can provide important additions to routinely collected data because they give access to the experiential status of respondents and thus provide vital data on which to base planning, provision and evaluation of health services. A standard reliable and valid measure of perceived health, the Nottingham Health Profile, was used to conduct a postal survey of differential status in subjective health between social classes in England. The results showed statistically significant differences between social classes in the age group 20-44 years only. For both men and women these were in their experience of sleep problems, emotional problems and lack of energy. In all cases the lower the social class the greater the amount and severity of perceived distress. After the age of 45 these differences, although still present, were not so marked, perhaps because of the excess mortality rates in lower socio-economic groups and the lowering of expectations with age. It is suggested that younger people from unskilled and semi-skilled occupations and, of course, the unemployed, are more vulnerable than their better off compatriots because of a kind of psychic susceptibility which is a consequence of social circumstances and the inability to cushion the effects of ill health. A type of Marxian "immiseration' may occur whereby in contemporary society health status is undermined by spiritual and social impoverishment rather than by the gross poverty and grinding labour of the past. The results of this study indicate that changes in the allocation of health care resources may have only a minor influence on inequalities in health. Remedial action would, rather, need to take the more radical form of providing fulfillment for aspirations and enhancing well-being by introducing fundamental social, economic and environmental reforms.