Section B – Social Issues in the United Kingdom Study Theme 2 – Wealth and Health Inequalities in the United Kingdom “Individual lifestyle choices limit good health more than any other factor.” Discuss.
“Pass” and better answers should feature developed, exemplified knowledge and
Lifestyle choices and their effect on health
Other factors which impact on health
Balanced comment/analysis on the impact of lifestyle choices on health.
Answers may refer to: • Evidence of health inequalities expressed in terms of life expectancy, mortality and morbidity rates, etc.
• Evidence may be drawn from wide range of reports eg ‘Equally Well: Report of
Ministerial Task Force 2008’ or ‘Inequalities in Health 1981-2001’ published in 2007, Scottish Household Survey, etc.
• Lifestyle choices: smoking, alcohol consumption, diet, use of illegal drugs, extent of exercise, uptake of preventative care services, etc., are factors that impact on health.
• Poorest groups/people in poorest areas tend to make worst life style choices ie smoke more and have higher alcohol consumption; more likely to use illegal drugs; take less exercise; have poorer diets and make less use of preventative health care.
• Other factors that affect good health:
- Local environment − quality of housing, community facilities, extent of crime, etc.
- Individual circumstances − income levels, unemployment, single parent, carer, age, etc.
- Social class
- Type/nature of employment − professional, labourer, stress of work, etc.
- Quality of, and access to, local health care services.
- Hereditary/biological factors.
• Even allowing for individual lifestyle choices, poorest groups still far more likely to die younger (between eight and ten years) and experience poorer health than those in wealthiest groups. Countries with lower income inequalities have a lower health gap.
To what extent have government policies reduced gender and/or ethnic inequalities? “Pass” and better answers should feature developed, exemplified knowledge and
• Government policies to reduce gender and/or ethnic inequalities
• Impact of government policies
Balanced comment on/analysis of the extent to which government policies have reduced
gender and/or ethnic inequalities.
Answers may refer to: • Equal Pay Act (1970); Sex Discrimination Act (1975) and Sex Discrimination Regulations (2008); Equality Act (2006); The Commission for Equality and Human Rights (2007); Gender Equality Duty Code of Practice (2007) places legal responsibility on public authorities to demonstrate that they treat men and women fairly; Women’s Enterprise Task Force (2006); Equality Bill 2008 includes provision that forces companies to publish pay rates.
• Work and Families Act (2006) extended the right to request flexible working; extended further 2009.
• CTC and Working Tax Credit. Government sees affordable childcare (‘wraparound childcare’) as crucial to narrowing the wage gap.
• Minimum Wage has disproportionately benefited women and minorities. Maternity and paternity leave.
• Skills Strategy (2003) to address the fact that over 50% of women in part time work are working below their skill level.
• Ethnic Minority Employment Task Force (2004) to tackle unemployment among black and Asian people.
• Women now make up 60% of the university population; success of women in reaching senior posts varies from place to place. Glass ceiling only cracked, not broken. Women make up 46% of all millionaires and are expected to own 60% of the UK’s wealth by 2010.
• Women make up only 19.3% of MPs, less than 10% of the senior judiciary, national newspaper editors and senior police officers; only 11% of directors in FTSE 100 firms are women despite accounting for over half of the UK population and 46% of the labour force.
• Sex and Power Report 2007.
• Gender pay gap: UK women in full time work earn 12.8% less per hour than men (2009). Gender pay gap has widened in some cases in recent years. Pay gap higher in the private sector than in the public sector. Higher women rise up the pay ladder, the greater pay gap becomes.
• Occupational segregation.
• In 2008 National Audit Office found the employment rate for ethnic minority population was 60% compared to 74% in general population. This gap had narrowed by only 1.3% in 20 years.
• Growing evidence of a ‘race pay gap’ which sees black and Asian workers earn up to 15% less than White counter parts.
• Only 4.3% of board members are from ethnic minority groups despite accounting for 8.5% of workforce (‘Race for Opportunity’).
• Women from Black Caribbean, Pakistani and Bangladeshi groups most likely to face a higher risk of unemployment, lower pay and have fewer prospects for promotion. EOC’s ‘Moving on up?’ report 2007.
• Credit references to health policies and success or otherwise in reducing gender and race inequalities.
15 marks Assess the impact of income on health. “Pass” and better answers should feature developed, exemplified knowledge and
The impact of income on health.
Other factors that impact on health.
Balanced comment on/analysis of the impact of income on health.
Answers may refer to:
• Statistical evidence from both government-generated reports and independent health research identifies the link between income, morbidity and mortality.
• Adults in the poorest fifth twice as likely to be at risk of developing a mental illness as those on average incomes.
• Among those aged 45 to 64, 45% of men and 40% of women in the poorest fifth report a limiting longstanding illness or disability, compared with 10% and 15% respectively for those in the richest fifth.
• The rate of infant death among social classes 1 to 4 is around 4 per 1,000 live births, compared with 5.5 for those in social classes 5 to 8.
• Those at the lowest end of the social spectrum have the highest consumption of ‘junk food’ and lowest of fruit and vegetables.
• People on low incomes cannot afford, and seldom have access to, shops selling good food.
• Women on below average incomes are twice as likely to be obese as women on above average earnings.
• Unskilled men have a shorter life expectancy overall.
• Better off can afford better diets, leisure activities that promote good health, better housing and safer environments.
• Middle and professional classes more likely to consult health professionals, know how to get the best out of the system, and follow positive health promotion advice.
• Better off can afford the option of private health care.
• Almost half of all adults in the poorest fifth of the population have a limiting longstanding illness or disability (twice the rate for those on average incomes).
• There is a high incidence of heart disease in poorest areas of Scotland.
• Wealthiest area in Scotland (Bellsquarry) has life expectancy of 87.7 years while Glasgow is 54 for males – Shettleston Man as a personification of Glasgow’s ills.
• A child born in Calton, in the east end of Glasgow is three times as likely to suffer heart disease and four times as likely to be hospitalised than a child in the city’s prosperous suburbs.
• Difference in life expectancy between the best and worst areas in Edinburgh is 22 years (9 years in the Highlands).
• “Biology of poverty”: View that extreme poverty can make people more susceptible to diseases such as cancer; biological factors may also be important in explaining the gap
n health and lifespan between rich and poor as well as lifestyle and diet; people who are continually exposed to stress as a result of chronic social deprivation are more likely to suffer disease and cell malfunction.
• Women from ethnic minorities are twice as likely as white women to die during childbirth or soon afterwards (Maternity Alliance Report).
• Women have lower mortality but higher morbidity rates than men.
• Only 8.5% of those dying of cancer aged over 85 die in a hospice compared with 20% of all cancer deaths – illustrating inequalities in the way that care and support are made available to older people.
• Age, ethnicity, geography, lifestyle, social class, geography, the ‘postcode lottery’.
Critically examine the success of recent government policies to reduce poverty. “Pass” and better answers should feature developed, exemplified knowledge and
Recent government policies to reduce poverty.
The consequences of these policies to reduce poverty
Balanced comment on/analysis of the success of government policies to reduce poverty.
Answers may refer to: ‘Welfare to Work’
• 300,000 extra lone mothers have found employment – but these strategies have left behind large families or those with disabled children.
• Some five million women (20%) and four million men (18%) belong to households in poverty. This gap is half what it was in the mid-1990s. The fall reflects the decline in the poverty rates for two kinds of single adult households in which women predominate: lone parents and single pensioners.
• There are more poor adults in relative poverty since records began in 1961.
• Number of adults without children who live in poverty has changed little in a decade.
• Lifted lots of lone parents and families with children out of poverty.
• Things have improved in relative terms. Fewer children now live in what would have been called poverty a decade ago.
• If government had merely increased tax allowances and benefits in line with inflation since 1999 there would be 1.7m more poor children in the UK today.
• As the number of children helped by tax credits to escape poverty has increased, so too has the number needing tax credits to do so.
• Half the children in poverty are in families already doing paid work; this means that the key proposition behind the anti-poverty strategy – ‘work is the route out of poverty’ does not apply for many people. The underlying problem is low pay (despite
National Minimum Wage
• Target to halve child poverty by 2010 and end it by 2020 looks ‘unattainable’ as it would mean 300,000 children being moved out of poverty in each of the four years to 2010-11.
• 250,000 children in Scotland live in poverty.
• Most of the young adults aged 16 to 24 now in poverty were children when the Government first pledged to abolish child poverty in 1999. Two-thirds of them are single and without dependent children, many still living at home with their parents.
• UK child poverty is still above the EU average.
The [Means Tested] Minimum Income Guarantee and Pension Credit
• The big fall in poverty among pensioners, especially single pensioners, claimed as a major success of the anti-poverty strategy.
• These can have rapid and substantial effects on those with the lowest incomes but do not address the root of the problem.
• Recent research has proved it to be both popular and on track.
• Critics claim that it is ill-targeted (particularly failing ethnic minority groups), poorly implemented and a colossal waste of money.
Scottish Government initiatives
• Free school meals, reduction and phased elimination of prescription charges, the “Equally Well” agenda, A Curriculum for Excellence, 3-18 (to improve life skills and employability).
• When more than 10% of income has to be spent on keeping warm.
• Government policy aims to eradicate fuel poverty among the elderly, disabled, children and long-term sick by 2010.
• Claim that there has been a significant reduction in the number of fuel-poor homes.
• Many households have been helped with cost of installing insulation and central heating.
• UK Government proposal (2008) that data identifying poorer families could be shared with companies to ensure they pay cheaper rates. (Most of the energy companies have “social tariffs”.)
• Agreement reached with the power companies to increase the amount of money they spend in helping people get on to lower tariffs and helping people insulate their homes.
• Energywatch claims more than 4 million households in fuel poverty (2.5m officially).
• Median income rises most years, so meeting any poverty reduction target is like “running up and down an escalator” according to Beverley Hughes (Minister for Children).
• Overall improvements in health (increased health expenditure) or educational achievement (“Education, Education, Education”) have sometimes left the most disadvantaged lagging even further behind.
• Well-meaning anti-poverty measures have nurtured a “why bother” society.
• The clawing back of benefits as people find better-paying jobs has undercut incentives for people to strive to improve their lot.
• The Tax Credits ‘fiasco’.
• Those moving from the minimum wage to one of two thirds of average earnings can take home as little as 11p of every extra pound they earn as a consequence of the high marginal tax rates created by the benefits system.
• A growth in means-testing or other forms of targeting has allowed limited resources to be focused on those in greatest need but may have led to problems of take up and of widening disincentives to work or save.
• Complexity of claiming means tested benefits.
• 40% of ethnic minorities live in poverty. This is double the proportion for whites. Even Indians and Chinese are much likelier than whites to be poor despite outperforming them at school.
• The 30% poverty rate amongst disabled adults aged 25 to retirement is twice the nondisabled rate AND higher than a decade ago.
• View that the UK is now a nation of greater income inequality (more people now in relative poverty than since records began in 1961), in which the plight of the very poor has worsened.
• Of 56 poverty indicators tracked by the Joseph Rowntree Foundation (2008), three quarters have stalled or are getting worse – a position being made all the more fragile with the onset of recession.
• View that government fuel poverty measures won’t fix the problem – people will still be left out in the cold.
Assess the effectiveness of government policies to reduce gender and ethnic inequalities. “Pass” and better answers should feature developed, exemplified knowledge and
Government policies to reduce gender and ethnic inequalities
Balanced comment on/analysis of the effectiveness of government policies to reduce
Answers may refer to:
• Child Tax Credit and Working Tax Credit.
• Government sees affordable child care as crucial to narrowing the wage gap.
• Minimum Wage and Statutory Pay Obligations.
• Maternity and Paternity leave.
• since 2003 companies have had to give serious consideration to employees (both genders) with children under six who request flexible working hours: one in five working women and one in ten men have taken up this ‘right to request’.
• Skills Strategy (July 2003) to address the fact that over 50% of women in part time work are working below their skill level.
• 2004: government set new Public Services Agreement targets for under-represented groups in senior management (two of which relate to women) for 2008.
• Equality Act (2006).
• Women’s Enterprise Task Force.
• Work and Families Act (2006) extended the right to request flexible working.
• Gender Equality Duty Code of Practice (from April 2007) places legal responsibility on public authorities to demonstrate that they treat men and women fairly. (implications for delivery of health care to both genders).
• Public Service Agreement Targets:
37% women in the Senior Civil Service (SCS);
30% women in top management posts (Pay Bands 2&3);
4% ethnic minority staff in the SCS;
• the Commission for Equality and Human Rights (2007).
• Race Relations (Amendment) Act, 2000.
• Ethnic Minority Employment Task Force (2004) to tackle unemployment among black and Asian people.
• Education and Training policies.
• One Scotland.
• strategic review of local race equality work in Scotland (2004).
• gender pay gap between 2005 and 2006 at its lowest value since records began.
• women now make up 60% of the university population.
• success of women in reaching senior posts varies from place to place. Glass ceiling only cracked, not broken.
• women make up 46% of all millionaires and are expected to own 60% of the UK’s wealth by 2010.
• EOC research shows women make up less than 10% of the senior judiciary, senior police officers, top business leaders, national newspaper editors and 0.8% of senior ranks in the armed forces, despite accounting for over half of the UK population and 46% of the labour force.
• higher women rise up the pay ladder, the greater pay gap becomes; 23% at director level.
• gender pay gap: UK women in full time work earn 17% less per hour than men. (new laws urgently needed to tackle this according to EOC recommendation, September 2007.)
• pay gap higher in the private sector than in the public sector.
• 155% increase in equal pay cases being lodged with tribunals between 2006-2007.
• occupational segregation: 70% of women with qualifications in science, engineering and technology do not work in those professions.
• state pension not ‘gender proofed’.
• ‘wraparound’ state childcare policy, from 8am to 6pm unlikely to be in place before
• women from Black Caribbean, Pakistani and Bangladeshi groups (despite ‘stellar’ GSCE performance, likely to face a higher risk of unemployment, lower pay and fewer prospects for promotion.
• the CRE says that local government and the criminal justice system (including the police) have made good progress. However Whitehall departments, NHS trusts, further education colleges, district council and the Olympic Delivery Authority have fallen short.
• whereas there are 3, 460 white members of the senior civil service, only 70 are Asian and
20 black. Overall, just 4.1% of the top ranks come from a black or minority ethnic background.
• a study by the Joseph Rowntree Foundation, reveals that ethnic minorities suffer twice the level of poverty of white Britons, as discrimination and disadvantage blight their life chances.
• the study finds that many Pakistanis and Bangladeshis are paid so little they are still classed as poor. ‘Income poverty’ traps 1 in 9 whites, but 6 out of 10 Bangladeshis, 4 out of 10 Pakistanis and 3 out of 10 Britons of black African heritage.
• “We have helped an additional quarter of a million people from ethnic minorities move into work over the last few years and the employment rate has risen to 60% in the last three years. But we are aware that more needs to be done.” (Jim Murphy former minister for employment and welfare reform).
Critically examine the view that government, not individuals, should be responsible for health care and welfare provision. “Pass” and better answers should feature developed, exemplified knowledge and
the collectivist and individualist approaches to health care and welfare provision Government
health and welfare provision policies
Government health and welfare provision policies
Balanced comment on/analysis of the view that government, not individuals, should be
responsible for health care and welfare provision.
Answers may refer to:
• Collectivist emphasis on responsibility of government to invest in health and welfare to counteract inequalities borne by those who are victims of an exploitive system.
• original Beveridge principles of the welfare state; funded by social insurance and taxation, with citizens being provided for ‘from cradle to grave’, specifically with regards to health, housing, employment, education and poverty.
• public health care should be funded from taxation.
• Individualist emphasis on a reduced role for government, ‘lifestyle choices’ and greater individual responsibility.
• view that there is no such thing as society, only individuals.
• individuals should provide for their own health care through the private sector.
• view that the collectivist approach encourages a ‘dependency culture’.
• affordability of the welfare state dependent on getting even more people off benefit and into work.
• link between unemployment among lone parents and child poverty.
• Labour’s ‘Third Way’ – the welfare state exists for those in genuine need, but individuals have to be encouraged to become more self-sufficient.
• promotion of ‘social inclusion’ through ‘welfare to work’ policies with private sector involvement.
• welfare provision governed by ‘rights and responsibilities’/‘a hand up, not a hand out’.
• targeting and means – testing of benefits.
• Government response to the Turner Report on pensions.
• proposals for benefit reform.
• NHS continues to be supported from taxation; with mainstream clinical services staying public but the advantages of private sector involvement to meet targets is welcomed (less so in Scotland when Labour administered).
• emphasis on ‘healthy lifestyles’.
• Labour’s ‘holistic’ approach to health and welfare: health is not seen in isolation – its relationship to social class is acknowledged.
• Government has achieved success in lowering unemployment but there are still concerns about the high number of, for example, 1B claimants.
• the numbers in absolute poverty have gone down, but relative poverty has increased as the income gap between rich and poor has widened.
• health inequalities still a cause for concern.
To what extent are the founding principles of the Welfare State being met? “Pass” and better answers should feature developed, exemplified knowledge and understanding of:
The founding principles of the Welfare State
Government Welfare State/State welfare policies
Balanced comment on/analysis of the extent to which Government policies enable the founding principles of the Welfare State to be met
Answers may refer to: (Be flexible and accept a variety of approaches)
• solution to the problems of want, disease, ignorance, squalor and idleness seen in the “traditional” collectivist approach
• benefits to provide social security to protect the population from cradle to the grave.
• range of Government benefits available for those out of work, including Income Support and Jobseekers Allowance, becoming increasingly means tested
• the National Minimum Wage
• issue of paying for pensions
• launch of campaign against child poverty in 1999, child poverty in Scotland reduced by 25% (target) in 2005 (for UK by 23%).
• evidence of inequalities between social classes and gender/race
• New Labour’s “holistic” approach to health care; good-health promotion campaigns, bans on smoking; PPP; welfare to work strategies aims to improve the quality of life
• Government still provides care but asks individuals to take responsibility too
• issue of charges.
• recent public and privately channelled investment in education
• the welfare-to work (a hand up, not a hand out) strategy
• Tax Credits
• New Deals
• Pathways to Work
• the idea of universalism has faced substantial pressure in the past few years
• instead of universal benefits that are largely flat rate, the expansion of means-testing, (‘targeting’) has led to the creation of benefits like Pension Credit and also tax credits
• Tax Credits are near universal benefits directed at all but the richest 10% of families with children
• progressive universalism
• proposals for incapacity benefit
• contributory principle under threat
• the idea of a state monopoly has been tempered to some degree by greater involvement of the private and voluntary sectors
• UK has one of the highest child poverty rates in developed countries
• labour market polarised between the work-rich and work-poor households
• financial support for working parents is now amongst the most generous for low-paid employees in the OECD
• no set targets for reducing poverty in the population as a whole; work may reduce the risk of poverty but it does not eliminate it
• Government policy has been most successful in dealing with “blockbuster” poverty – the poverty suffered by the greatest number of people – by giving the poor more money
• Government would insist that changes are in keeping with the concept of ‘modern’ collectivism
To what extent do social and economic inequalities continue to exist in the UK? “Pass” and better answers should feature developed, exemplified knowledge and understanding of:
Inequalities in the UK
Government policies to reduce these inequalities and/or reasons for these inequalities
Balanced comment on/analysis of the extent to which inequalities continue to exist in the UK.
Answers may refer to: (Be flexible and accept a variety of approaches)
Social and Economic Inequalities linked to age, gender, race, social class, region;
• huge inequalities in the way that care and support are made available to older people
• continued evidence of “glass ceiling” (might be cracked, not yet broken). New “glass partition” – women concentrated in the less well-paid sectors of the professions
• women still earning less than men in part-time and full-time jobs; men in full-time employment now earning 18% more an hour than women
• extent of racism
• ethnic minorities find it difficult to get jobs; and many are more likely to be unemployed than white males of the same age and level of education
• the social class wealth and health gap
• claim that the “disadvantaged dying” become part of the “revolving door” system; labelled as “bed blockers” as if being ill and not getting treatment were their own fault
• North-South wealth and health divide
• gap in living standards between the well paid and those on benefits
• lone-parent families
• continued existence of poverty: view that the UK’s most troubled group, in both absolute and relative terms, is poor, white and British born
• expansion of the middle class has made it harder than ever for the working classes to get better high-earning professional jobs
• all groups have become more prosperous but the gap between the classes has not narrowed
• North-South split widening; difference within regions; Glasgow labelled “a swamp of poverty” because all ten of the most deprived areas in Scotland are in the city (Scottish Index of Multiple Deprivation); Northern areas of England have higher obesity rates, more smoking related deaths and lower life expectancies than Southern areas
• view that gender equality is no longer a live issue – girls are high achievers at school; high % of women MSPs; Solicitor General is a woman; opening up of medicine, the legal profession and the church (where there is an increasing demand for part-time clergy) to women
• General Household Survey analysis shows that UK born ethnic minorities seem to be doing the same jobs as similarly qualified Whites and earning similar amounts
• children of Afro-Caribbean and Indian immigrants have completely closed the earnings gap with Whites in both professional and blue-collar work
Government/local policies/strategies to reduce inequalities:
• candidates may select from a wide range of these and should demonstrate a link with the “wealth/health inequalities” features in their answer
• promise to end child poverty forever
• gender and race legislation
• Equalities Act (2006) − under the Act the Commission for and Human Rights (CEHR) will bring together the Disability Rights Commission and the Equal Opportunities Commission from October 2007. The Commission for Racial Equality will join in 2009, putting expertise on equality, diversity and human rights all in one place