Bridging the Gap: A health inequalities learning resource

Poverty and Health Inequalities


Health Inequalities

 Poverty is defined relative to the standards of living in a society at a specific time. People live in poverty when they are denied an income sufficient for their material needs and when these circumstances exclude them from taking part in activities which are an accepted part of daily life in that society. Scottish Poverty Information Unit

As we have already highlighted health inequalities are as a result of a variety of inter relating and overlapping factors. In this section we look more closely at how some of these different factors relate to and impact on, one another.

Socio-Economic Factors

Socio-economic circumstances, in particular poverty and deprivation (Bailey et al., 2003), occupy centre-stage when we consider what creates health and social inequalities in Scotland.

Access and opportunity (SG, 2003) are inextricably linked to money and essentially to purchase power. Low income, whether due to unemployment, reliance on benefits or low paid work, limits access to adequate housing, education and other services or facilities, as well as to essentials such as food, fuel and clothing.

Socio-economic disadvantage impacts on opportunities for involvement, participation and contribution; and can result in feelings of hopelessness and despair. In turn this can emphasise and reinforce social exclusion (Palmer et al., 2006), affecting not only individual but families and community health (Kandirikirira, 2006).

And poverty does not exist in isolation, being associated with other factors, such as:

  • having a family to provide for
  • being unable to work due to incapacity or illness,
  • being geographically isolated from services or supports
  • as a young person leaving the care system
  • being a single parent,
  • living in sub-standard housing or experiencing homelessness
  • Lacking skills (such as literacy & numeracy or computer skills) or qualifications (Get Heard, 2006).

Adverse socio-economic circumstances have a cumulative effect throughout the life course. For example, low birth weight, which has a strong association with socio-economic deprivation - results in health and social disadvantage not only in childhood but also in adult life (SG, 2008a).

In turn children born into poverty and deprivation are less likely to make healthier 'choices' or progress in education.

Low levels of literacy and numeracy are strongly linked to socio-economic status (DES, 2003) and employability, while low levels of health literacy impact on the ability to access appropriate services, including preventative health programmes, both of which result in poorer health outcomes (Moser, 1999).

Other characteristics, such as sensory, physical or learning disabilities, mental health problems or race can also potentiate health and social inequalities.
Feelings of powerlessness (which may be real, perceived or a combination of the two) to be able to exercise some control over and manage our lives and our health are strongly associated with disadvantage and closely correlate with higher levels of stress.

Stress and Distress

Richard Wilkinson describes stress as a significant psychosocial influence on health and wellbeing, and  Equally Well (SG, 2008a) acknowledges the role of stress:

 There is a biological basis for this in the body's inflammatory system. People's responses to stress of all kinds can become "toxic" rather than positive or tolerable… (Scottish Government, 2008a p12)

This theme is developed further in the Equally Well 2010 review, which notes that:

 Poor health is not simply due to diet, smoking or other life style choices. We need to understand factors underlying poor health and health inequalities such as people's aspirations, sense of control and cultural factors. This is best understood as a 'sense of coherence', in which the external environment is perceived as comprehensible, manageable and worthwhile. Without this sense of coherence, people are likely to be subject to chronic stress and poor health as a result. Equally Well Review (2010a) Scottish Government

The Social Gradient in Health

Poverty and deprivation are major contributors to the health disparities that exist between the richest and poorest in Scottish society. However a straightforward rich-poor interpretation doesn't satisfactorily explain the social gradient of health, as McIntyre (2007, p2) explains

 …each successively more advantaged group (by socio-economic status) has longer life expectancy and better health. There is a gradient all the way up the social scale, rather than a threshold between the poor and the rest of society above which there are no social differences. For example, in Scotland death rates decrease even between the three least deprived categories.  

And nowhere is social gradient in health more evident than in relationship between poverty, deprivation and psychological distress.

Levels of psychological distress, Scotland 2003 

Phychological Distress graph

The graph above (McIntyre, 2007) shows levels of distress correlate strongly with social and economic positioning, affecting men and women.

Strikingly, the data also indicates that if those living in the most deprived areas in Scotland are almost twice as likely to exhibit levels of psychological distress, 'sufficient to indicate the need for treatment interventions'.

Meanwhile, those living in the most deprived areas are eight times more likely to be admitted to a psychiatric unit with an alcohol-related diagnosis.

Inequalities in Mental Health

The Equal Minds (Myers et al., 2005) report cast further light on this relationship. For example:

  • In Scotland twice as many suicides occur among people from the most deprived areas
  • UK-wide, only 24% of adults with long-term mental health problems are in work - the lowest employment rate for any of the main groups of disabled people.
  • One in four tenants with a mental health problem has serious rent arrears and is at risk of losing their home
  • People with mental health problems are nearly three times more likely to be in debt.
  • Poverty, unemployment and social isolation are associated with higher prevalence of schizophrenia, and rates of admission to specialist psychiatric care (for people with schizophrenia) are highest among those from deprived areas
  • In one study of people with a current or past experience of mental distress, 50% had been abused or harassed in public, while 25% felt at risk of attack inside their own homes.

Pause for thought…

Why do you think the social gradient is soevident in mental health?


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