Modern Studies: Social Issues - Health and Wealth Inequalities in the UK

NATIONAL QUALIFICATIONS CURRICULUM SUPPORT

Modern Studies

Social Issues: Health and Wealth

Inequalities in the UK

[HIGHER]

George Clarke

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Acknowledgements

Learning and Teaching Scotland gratefully acknowledge this contribution to the National Qualifications support programme for Modern Studies.

The following sources are thanked for permission to use copyright material in this publication: text extracts on pp56/57 on Sure Start Scotland are from reproduced by permission; extracts on pp60/62 and 63/6 from ‘Changing Poverty Post-1997’ (2003) and ‘Routes into and out of Poverty’ (2004) are from Findings: Progress on Poverty 1997 to 2003/4, published by the Joseph Rowntree Foundation and reproduced by permission ( and ); text extracts on pp70/74 on the NHS are from and reproduced by permission.

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Contents

Section 1:Background4

Section 2:Changes in class structure8

Section 3:Causes of inequalities in wealth10

Section 4:Inequalities in health35

Section 5:Health care and social welfare: the political debate46

Section 6: Policies to deal with wealth inequalities48

Section 7:Policies to deal with health inequalities68

Resources:Useful websites85

HEALTH AND WEALTH INEQUALITIES IN THE UK (MODERN STUDIES, H)1

BACKGROUND

Section 1

Background

Why define social class?

150 years ago sociology sought to develop a scientific approach to the study of society. It needed methods of measuring society if it was to be accepted as a science. In the nineteenth century, Karl Marx and Max Weber pioneered models for defining class and structuring society so that it could be studied. In Britain in the twentieth century the government used three models: the Registrar-General’s Model of Social Class (RGSC), which was replaced by the Standard Occupational Classification and, from 2001, the National Statistics Socio-economic Classification.

Recently sociologists have developed alternative models. Two of the more widely used are Hutton’s 30:30:40 and the Runciman Scale.

Defining social class involves measuring economic, political and social factors, which is difficult. To simplify matters occupation has been used to group people. However occupation does not provide a precise method of measurement and at best only broad generalisations can be made from its use.

In contemporary Britain there are significant differences in life chances, living standards and the quality of life between different groups. For example the children of unskilled labourers are 4 times more likely to die in an accident, suffer from poorer health and higher infant mortality rates and attain lower levels of education compared with the children of professional people.

Therefore, although defining social class may be difficult, it is a useful tool for those involved in academic, business and government research. It provides a way to analyse the population, to understand how groups of people develop and change, and to help with planning for the future.

The Registrar-General’s Model of Social Class (RGSC)

UK governments used this model between 1911 and 1980. It placed people into a six-part hierarchy according to their occupation.

A–Professional etc. occupations

B–Managerial and technical occupations

C1–Non-manual skilled occupations

C2–Manual skilled occupations

D–Partly-skilled occupations

E–Unskilled occupations

The strengths of this model lay in the fact that it was simple to understand and use. Statisticians were able to compare health, work, poverty and family life through time, and this enabled governments to target resources for social planning. However, the model had several weaknesses. It used only occupation as a means of classifying people so it missed out millions of people such as those who were retired or unemployed or non-working spouses. It also made no provision for those living on investments and income from rent.

By 1980 another problem was that many jobs had changed in nature and importance to society. After 1980, the UK government used the Standard Occupation Classification (SOC). This had a classification based on nine major groups that were divided into hundreds of subgroups matching most occupations.

The nine major groups are:

1 Managers and Senior Officials

2Professional Occupations

3 Associate Professional and Technical Occupations

4 Administrative and Secretarial Occupations

5Skilled Trades Occupations

6Personal Service Occupations

7 Sales and Customer Service Occupations

8Process, Plant and Machine Operatives

9Elementary Occupations

The advantage of this system was that it was more logically grouped than the RGSC. Occupations were ranked according to the level of skill and the qualifications needed to do the job. The system was also more objective than the RGSC. However, it retained many of the weaknesses of the RGSC, such as still focusing on occupation, and therefore missed out large numbers of the population.

In 2001 the National Statistics Socio-economic Classification was introduced for all government statistics and surveys. It has eight classes, with the first one subdivided into two.

1.1Large employers and higher managerial occupations: company directors, senior managers, senior civil servants, senior police officers

1.2Higher professional occupations: doctors, lawyers, teachers and social workers

2Lower managerial and professional occupations: nurses, journalists, actors, musicians, lower ranks in the police and armed forces

3Intermediate occupations: clerks, secretaries, driving instructors, telephone fitters

4Small employers and own account workers: publicans, farmers, window cleaners, painters and decorators

5Lower supervisory and technical occupations: printers, plumbers, television engineers, butchers

6Semi-routine occupations: shop assistants, hairdressers, bus drivers, cooks

7Routine occupations: couriers, labourers, waiters, refuse collectors

8Never worked and long-term unemployed: non-working spouses, unemployed for various reasons

This system overcame some of the problems of the RGSC and the SOC. It included large numbers of people who had been previously ignored such as the unemployed, retired, spouses and students. It was also a more refined way of categorising people. ‘Class’ now depends on a combination of the type of job and a person’s status within the job, such as an employer, self-employed, a manager, a supervisor or an employee. So a self-employed joiner would be in a different class from a joiner with 15 employees, and both would be in different classes from an employee joiner, who in turn would be in a different class from a supervisor of joiners. However, the system is still heavily based on occupation and this remains a weakness.

Sociologists have also developed different ways of defining social class. Will Hutton’s ‘The 30:30:40 society’ is based on Weber’s theory and argues that modern society has created a two-tiered labour market. There are those workers who are in full-time, well-paid and secure employment with high job status. There is a second group consisting of part-time and casual workers, who have little job security, low pay and low job status. Finally there are those who are at the bottom of the hierarchy; they are unemployed and on low incomes for a variety of reasons.

Finally there is the Runciman Scale. The Runciman Scale combines the class analysis of both Marx and Weber. It measures economic power, ownership and control and includes an estimate of a person’s status based on their marketability. The scale is based on economic power which has three elements. First there is ownership. Does a person own a company? The second is control. Does the person direct others in the workplace? Finally there is marketability. What skills does a person have and to what extent are these skills valued by society?

The strength of the Runciman Scale is that it uses several factors to analyse class. Also it makes economic and status distinctions within the middle class, to show the clear distinctions that exist within this class, and because this class is extensive in modern society. Finally it attempts to define an underclass to show that it is separate from the working class.

Activities

Make notes on social class in relation to the following themes:

•why it is difficult to define

•why trying to define it is necessary

•the value of a working definition for governments and sociologists.

This is necessary for understanding social class but it will not be examined.

HEALTH AND WEALTH INEQUALITIES IN THE UK (MODERN STUDIES, H)1

CHANGES IN CLASS STRUCTURE

Section 2 Changes in class structure

There was significant structural change in occupational social class during thetwentieth century. The percentage of the workforce involved in manual occupations was 75% in 1911 but this fell to around 38% in 1991 and has continued to fall ever since. Manual occupations were replaced by a growing number of managerial, professional and clerical jobs, and this upwards drift in occupational mobility has continued since 1991.

Women have grown as a proportion of the workforce from 29% in 1900 to 46% in 2000. 5 million women were working in 1900. This increased to 13 million in 2000. This is one of the most significant changes in the occupational class structure since 1900.

The diagram shows that the current class structure has over 50% of females in work in the top three class categories with approximately 47% of males in these categories. Fewer women are likely to be in manual jobs. Only 8% of women are skilled manual workers compared with 27% of males, whereas 32% of women are employed in skilled non-manual compared with only 11% of males.

Note that reasons for changes in class structure may be further explained in the section on causes of unemployment, which examines various reasons for structural changes to the economy.

Activities

1.In what ways has class structure changed over the twentieth century?

2. Describe and explain the current trends in class structure.

HEALTH AND WEALTH INEQUALITIES IN THE UK (MODERN STUDIES, H)1

CAUSES OF INEQUALITIES IN WEALTH

Section 3 Causes of inequalities in wealth

Income and wealth

Income is the money a person earns in a given period. Income is in the form of wages or salaries from employment, as well as interest from savings, dividends from shares, profits from business, and rent from land and property. Wealth is made up of the assets that are owned by people living in a country. Wealth is in the value of a house, the value of a pension, shares and savings.

How wealth is held in the UK:

•Housing

•State pensions

•Private pensions

•Savings

The main sources of income in the UK:

•Employment

•Pensions

•Benefits

•Self-employed income

•Rent, dividends, interest

•Others

How wealthy is the UK?

The total value of all goods produced and services provided in a country in one year is called the Gross Domestic Product (GDP). In order to compare different countries, the GDP is divided by the number of people living in the country at the time. This is the GDP per head.

In 2003, the UK’s GDP per head was $25,500 (£17,340). This makes the UK a very wealthy country. It is ranked 19th of 29 countries in the Organisation

for Economic Co-operation and Development (OECD) and 24th in the world overall (out of 192 countries).

Poverty in the UK

Absolute poverty is based on subsistence, a minimum standard needed to live. UNICEF describe a person as living in absolute poverty if they are deprived of two or more of the seven basic needs: clean water, sanitation, shelter, education, information, food and health. If the household or individual does not have access to a particular basic need, they are defined as ‘deprived’.

Relative poverty is when people do not get access to products and services that society considers to be necessary for basic living. This type of poverty varies significantly as society changes.

How do we measure poverty in the UK?

In Scotland the most commonly used definition of poverty is taken from the low-income statistics produced annually by the Department of Social Security in the Households Below Average Income (HBAI) publication. The HBAI definition of poverty is 60 per cent of median income level. The median income level is an average income measured as follows. The level of income of each household is taken after direct taxes and benefits, adjusted for household size; the median income level is the middle value, with half the population above that level and half below it.

In 2003–04, according to the Department of Work and Pensions (DWP) statistics, the median weekly income (before housing costs) for a single person with two children was £359, and for a couple with two children it was £490, so the poverty line for these two family groups was £216 and £294 respectively.

Another method for measuring poverty is to use Income Support levels. Income Support is paid to people in the UK who are not working and who do not have to attend a Job Centre regularly. In 2005, the weekly Income Support for a couple with two children was around £178; for a single parent with two children it was £147.

In 1999, thePoverty and Social Exclusion (PSE) Survey identified those items that the majority of the population thought were necessities. The researchers chose 35 items considered by 50% or more of the people surveyed as being necessary for modern living: for example, beds and bedding for everyone in the household, two meals a day, the ability to celebrate a birthday or Christmas. The researchers then identified how many people had these items and how many were unable to afford them. If a household could not

afford two or more of these things then they were classed as poor. The PSE survey found that 26% were ‘poor’ because they lacked two or more items.

The extent of poverty in the UK

In 1979, 5 million people in the UK were classed as poor. Poverty grew significantly through the 1980s and peaked in the mid 1990s at just over 14 million in 1996. Since then there has been some reduction to 12.4 million in 2003, but it has remained persistently high.

Today just less than 1 in 4 people in the UK – nearly 13 million people – live in poverty. This includes nearly 1 in 3 children (almost 4 million) – using the HBAI definition.

Which groups are vulnerable to poverty?

In 2002/03, 22% of the UK population (12.4 million people) were living in low-income households. The trend is downwards from the 14 million in 1996/97. The reduction has been in low-income households with children and low-income households with pensioners. In 1996/97, 4.3 million children were in low-income households but this fell by 700,000 to 3.6 million in 2002/03 as a consequence of government policies on tax and benefits. The number of low-income pensioner households fell during the same period by 500,000 from 2.7 million to 2.2 million.

In contrast, the number of working-age adults without dependent children in low-income households was higher in 2002/03 than in 1996/97: 3.9 million compared with 3.6 million. This group now accounts for a third of all people in low-income households.

Who are the poor in Scotland? (average 2000/03)

Since the mid 1990s, three groups – pensioners, children and working-age adults with children – have all seen a fall in poverty rates. However, working-age adults with no children have increased their likelihood of poverty and this group now forms the largest group experiencing poverty in Scotland.

Activities

Make notes on:

•how wealth is held in the UK

•the main sources of income in the UK

•to what extent is the UK a wealthy country?

•absolute poverty

•relative poverty

•the level of poverty in the UK

•the main groups vulnerable to poverty in the UK.

Practice essay

To what extent is poverty a problem in the UK?

(15 marks)

Poverty and social exclusion

Social exclusion embraces a variety of problems that lead to poverty. Social exclusion describes the impact of the economic, industrial and social changes that have taken place over the last 20 to 30 years. These include long-term or repeated unemployment, family instability, social isolation and the decline of neighbourhood and social networks. Social exclusion is a result of shortcomings and failures in the systems and structures of family, community and society.

Social exclusion occurs when people are separated from employment by being unemployed, having poor skills or low income. It also involves separation from social relationships, caused by the breakdown of the family, which has led to an increase in single-parent families and more elderly people with no family to care for them. Finally it involves alienation from social systems such as education, decent housing and health services.

To gain a clearer understanding of the concept of social exclusion, we shall examine each of the main causes of poverty in turn, while examining the interaction of education, health and housing and the overarching role that government plays in these.

The main causes of poverty in the UK are:

•Government policy

•Unemployment

•Low-income employment

•Gender

•Age

•Race

Government policy as a cause of poverty

Government policy can have a significant impact on the levels of poverty and also on the groups who are poor.

Between 1979 and 1997, Conservative governments made significant changes in the structure of society and increased the gap between rich and poor, thereby increasing relative poverty in the UK. Employment laws made it easier for employers to dismiss workers and created higher levels of unemployment. Union laws made it more difficult for trades unions to defend workers’ wages and conditions.