What we know
What information do we have about the Eastern Board area?
What is the result of this on our health locally?
Policies
What is happening in the Eastern Board area?
References

Poor social and economic circumstances affect health throughout life. People further down the social ladder usually run at least twice the risk of serious illness and premature death as those near the top. Nor are the effects confined to the poor: the social gradient in health runs right across society, so that even among middle class office workers, lower ranking staff suffer much more disease and earlier death than higher ranking staff. Both material and psychosocial causes contribute to these differences and their effects extend to most diseases and causes of death.

Disadvantage has many forms and may be absolute or relative. It can include having few family assets, having a poorer education during adolescence, having insecure unemployment, becoming stuck in a hazardous or dead-end job, living in poor housing, trying to bring up a family in difficult circumstances and living on an inadequate retirement pension.

These disadvantages tend to concentrate among the same people, and their affects on health accumulate during life. The longer people live in stressful economic and social circumstances, the greater the physiological wear and tear they suffer, and the less likely they are to enjoy a healthy old age.

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Social gradient and associated low income has a major impact on health arising not only from material deprivation but also from the social and psychological problems of living in poverty. The Northern Ireland deprivation measures highlight high levels of income deprivation in inner city Belfast but also demonstrate that local areas of income deprivation exist in different parts of the Board. A significant number of Board residents live in the least deprived areas of Northern Ireland.

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The majority of the evidence suggests that material conditions and socio-economic class are the underlying factors of ill health. Low social gradient imposes constraints on the material conditions of everyday life by limiting access to the fundamental building blocks of health such as adequate housing, good nutrition and opportunities to participate in society. The concomitants of poverty are often poor nutrition, overcrowded, damp and inadequate housing, increased risk of infection, and inability to maintain optimal hygiene practices.

The terms social class, social disadvantage, socio-economic status and occupation are often used interchangeably. The previous classification of social class derives from the Registrar General’s scale of five occupational classes ranging from professionals in class I to unskilled manual workers in class V. Because people were allocated to social classes on the basis of the occupation of the head of the household, the classification was more suited to men than to the elderly, the unemployed or women. The Office of National Statistics introduced eight new categories for the 2001 census to take account of changes in the labour market with a social class for the self-employed and one for people who have never worked or are long-term unemployed.

The Black Report (1980) found significant differences in death rates between socio-economic classes. Throughout Northern Ireland, health and disease are socially patterned with the more affluent members of society living longer and enjoying better health than disadvantaged social groups. This health gap may even be getting worse. Economic growth has been accompanied by widening income differentials, which is reflected in widening differences in mortality rates between the social classes.

The Institute of Public Health in Ireland was set up to promote co-operation for public health between Northern Ireland and the Republic of Ireland. It produced a report entitled Inequalities in Perceived Public Health (A Report on the All-Ireland Social Capital and Health Survey). One of the aspects the report studies was inequalities in perceived health and its findings are relevant to the Eastern Board area.

The report found that, compared to those with third level education qualifications, those with no formal qualifications (or primary qualifications) are 51% less likely to have excellent/very/good general health. Compared to those with the highest income people with the lowest incomes are less likely to have good health: they are 52% less likely to be very satisfied with their health and are 51% less likely to have a very good quality of life.

The link between higher educational attainment, social gradient and impacts on health are evident. Inequalities in Perceived Public Health indicates that, compared to those with third level education qualifications, people with no formal qualifications or primary qualifications) are more likely to feel very unsafe in their local area (24% compared to 12%); more likely to have fewer than three people to ask for a lift (70% compared to 64%); and more likely not to be involved in local organisations in the last three years (90% compared to 79%).

Compared to those with the highest incomes, people with the lowest incomes are more likely to have a low local services score (37% compared to 34%); more likely to feel very unsafe in their local area (31% compared to 10%); and more likely not to be actively involved in local organisations in the last three years (91% compared to 74%)

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