Health Psychology. Michael Murray
excess deaths for black females (Williams and Collins, 1995). Similar findings exist in other countries. Analyses of three censuses from 1971 to 1991 have shown that people born in South Asia are more likely to die from ischaemic heart disease than the majority of the UK population (Balarajan and Soni Raleigh, 1993).
There are many possible explanations for these persistent health differences between people of different races who live in the same country and are served by the same educational, social, welfare and health care systems (Williams and Collins, 1995; Williams et al., 1997). First, the practice of racism means that minority ethnic groups are the subject of discrimination at a number of different levels. Such discrimination could lead directly or indirectly to health problems additional to any effects related to SES, poverty, unemployment and education. Discrimination in the health care system exacerbates the impacts of social discrimination through reduced access to the system and poorer levels of communication resulting from language differences.
Second, ethnocentrism in health services and health promotion unofficially favours the needs of majority over minority groups. The health needs of members of minority ethnic groups are less likely to be appropriately addressed in health promotion, which in turn leads to lower adherence and response rates in comparison to the majority population. These problems are compounded by cultural, lifestyle and language differences. For example, if interpreters are unavailable, the treatment process is likely to be improperly understood or even impaired and patient anxiety levels will be raised. The lack of permanent addresses for minority ethnic group families, created by their high mobility, makes communication difficult so that screening invitations and appointment letters are unlikely to be received.
Third, health status differences related to race and culture are to a large extent mediated by differences in SES. Studies of race and health generally control for SES, and race-related differences frequently disappear after adjustment for SES. Race is strongly correlated with SES and is even sometimes used as an indicator of SES (Williams and Collins, 1995; Modood et al., 1997).
Fourth, differences in health-protective behaviour may occur because of different cultural or social norms and expectations. Fifth, differences in readiness to recognize symptoms may also occur as a result of different cultural norms and expectations. Sixth, differences can occur in access to services. There is evidence that differential access to optimal treatment may cause poorer survival outcomes in African-Americans who have cancer, in comparison with other ethnic groups (Meyerowitz et al., 1998). Seventh, members of minority ethnic groups are more likely to inhabit and work in unhealthy environments because of their lower SES. Eighth, there are genetic differences between groups that lead to differing incidences of disease, and some diseases are inherited. There are several well-recognized examples, including sickle cell disorder affecting people of African-Caribbean descent; thalassaemia, another blood disorder that affects people of the Mediterranean, Middle Eastern and Asian descent; and Tay–Sachs disease, which affects Jewish people.
Other possible mechanisms underlying ethnicity differences in health are differences in personality, early life conditions, power and control, and stress (Williams and Collins, 1995; Taylor et al., 1997). Research is needed with large community samples so that the influence of the above variables and the possible interactions between them can be determined. Further research is needed to explore the barriers to access to health care that exist for people from different groups. We will return to this topic in other chapters.
Future Research
1 The causes of poverty and interventions to ameliorate poverty should be the priority for economic and social policy and research.
2 Studies in psychology and sociology are necessary to understand humanitarian values, altruism, oppression, fear, aggression and cross-cultural issues.
3 Possible mechanisms underlying ethnicity differences in health, such as differences in early life conditions, racism, power, control and stress, must be explored.
4 Research is needed with large community samples so that the influence of the above variables and their possible interactions can be determined.
Summary
1 The world population is increasing dramatically. From 1 billion in 1800, it is expected to climb to 9 billion by 2050, while the amount of drinkable water available per person over the same period will fall by 33%. The increasing shortage will affect mainly the poor in countries where water shortage is already chronic. Conflict about water will become as prominent as the conflict about oil today.
2 The consumption of tobacco, alcohol, ultra-processed food, drink and other unhealthy commodities is increasing throughout the low- and middle-income countries and is driving a huge increase in the prevalence of non-communicable diseases.
3 The greatest influence on health for the majority of people is poverty. Half of the world’s population lacks regular access to treatment of common diseases and most essential drugs. Globally, the burden of death and disease is much heavier for the poor than for the wealthy.
4 In developed countries, life expectancy is increasing by three months every year. If this trend continues, life expectancy will approach 100 years by 2060, placing social, health and pension systems in a perilous position.
5 Economic growth does not reduce disparities in wealth across a society. ‘Trickle-down’ is a myth. Health gradients remain a universal feature of the health of populations in both rich and poor countries.
6 Gender differences in health, illness and mortality are significant and show striking interactions with culture, history and socio-economic status.
7 The health of minority ethnic groups is generally poorer than that of the majority of the population. Possible explanations include racial discrimination, ethnocentrism, SES differences, behavioural and personality differences, cultural differences and other factors.
8 ‘Doom and gloom’ is not inevitable. Prospects can significantly improve if policy makers intervene. The future health of populations depends upon actions taken by governments, corporations and opinion leaders supported by improved education about the social, political and economic determinants of health and illness.
5 Social Justice
‘To love life is to risk it,
to live it fully
means being ready always
to lose it
giving it over entirely to solidarity.’
Miguel D’Escoto Brockmann (1933–2017)
Outline
There is substantial evidence linking poor social conditions with ill health. The explanations for this include material, behavioural and psychosocial factors. In this chapter we consider health inequalities in the context of social justice, the competing explanations and the role of health psychologists in creating a healthier society. The explanation of health inequalities creates many important challenges for theory and research in health psychology.
Social Inequalities and Health
As shown in Chapter 4, substantial evidence from dozens of countries has linked social inequalities with health. Consistently, these studies show that people of lower socio-economic status (SES) have more illness and lower longevity than those in higher socio-economic groups. There is a gradient such that those one step down the ladder are unhealthier than those above. This persistent gradient is often referred to as a ‘health gradient’. When mortality is the measure, a more apposite term would be ‘mortality’ or ‘death gradient’. ‘Death gradients’ have been observed in all human societies in both rich/developed countries and poor/developing countries (Marks, 2004). Such gradients are normally continuous throughout the range of economic variation. If the gradient were stepped or flat at one end of the range and steep at the other, it could be inferred that the causative mechanism(s)