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Socioeconomic status does not only have an affect on access to health care but on a person’s life expectancy as well. It is commonly agreed upon that people who are lesser off suffer from lower life expectancies. If we take a look at Sydney again, one can see that the gap between rich and poor, healthy and sick, has been widening over the past 25 years. The following map on changes of wealth in Sydney represents the increased division between rich and poor (Map 1).
Dr Lillian Hayes of Sydney University, recently conducted a study on socioeconomic differentials of mortality in Sydney from 1970-1994. In her research she found that, “For men there has been an increase in relative mortality differentials between the most and least socio-economic disadvantaged groups: 12 per cent in the Sydney region and 19 per cent in rural NSW. In women the differences have remained constant” [Crowe 2000]. Additionally, her analysis found that improvements to overall mortality had had greater impact on advantaged rather than disadvantaged groups. This supports the existence of an ever widening gap and provides impetus for improvements in the health status of disadvantaged people. Another interesting thing that came out of the Hayes report was that the predicators she suggests for lower socioeconomic status are the same characteristics that the Western Sydney Health Service Area describes as endemic to their community [SWSAHS 1998]. Some of these qualities included: unemployment or low income, being a single parent, lack of education, unskilled/no qualifications, leaving school early, and whether people rented or owned their own homes.
Environmental influences on health are also a predominate feature of low socioeconomic status or class and vary from type of dwelling, to work spaces, social relationships or even natural occurrences such as pollution or dampness. People most likely to suffer from negative environments include: public housing residents, manual labourers, industrial workers and those generally associated with a lower level of financial security. In a paper by Dr Paul Beggs on the Spatial Analysis of Dwelling Crowding and Disease in Sydney, it was found that morbidity from bronchitis and emphysema is related to dwelling crowding [Beggs 1999: pg9]. Furthermore, Dr Beggs research shows that higher levels of crowding are consistently associated with socioeconomic indicators. He explains these results by stating that people with higher socioeconomic status have an increased ability to buy larger homes and thus do not experience the effects of crowding. This point can be further substantiated by taking a look at MAP2 which illustrates the crowding index for each local government area in the Sydney statistical division. Among some of the higher rating scores lie; Fairfield, Auburn, Bankstown, Blacktown and Canterbury. If one then compares this data with maps of standardised morbidity rates for bronchitis and emphysema, and standardised morbidity rates for all causes, it is possible to draw a link between places with high levels of crowding (which Beggs largely attributes to socioeconomic forces) and higher levels of disease [Beggs 1999: pg9].
Beggs also alludes to the detrimental impact of infective agents and respiratory irritants such as tobacco smoke in areas that are deemed crowded. The Western suburbs of Sydney tend to suffer from much higher rates of people who smoke. Most concerning is the growing proportion of this percentage in teenagers and young adults – particularly that of females. Statistics of the overall portion of males (16-24 years old) and females (16-24 years old) who smoke do not show much variation, however the intention to quit does. About 44% of Males in South Western Sydney have expressed a willingness to quit whereas only 29% of females have [NSW Health 2000: smoking].
By and large, tobacco attributable mortality rates are higher in WSHSA residents than in NSW overall. In the table provided on smoking status by sex in WSHSA and NSW, the Western Sydney figures consistently show higher numbers of smokers. Perhaps of even more concern however are the quit rate figures. Between the years of 1989 and 1997, the percentage of people to quit smoking in NSW has risen 6.6% [EIRE 2001: pg11-12]. Alternatively, Western Sydney figures only show an increase of 2.4%. The data from this table tells us that while Western Sydney continues to have a larger percentage of its population classified as smokers, attempts to promote better health or to remedy this problem have been either non-existent or insignificant. Another possibility is that residents of the WSHAS can not afford to seek medical aid such as counselling, nicotine patches or the like. Opportunities for people living in underprivileged areas to quit smoking are needed and more attention should be focused on underage smoking.
This section has only looked at a couple of the health inequalities associated with socioeconomic status or class. Topics not covered, but perhaps alluded to, include: obesity, increased rates of cardiovascular diseases, higher instances of cancer, dental health, mental health, immunisation of communicable diseases and suicide.
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Marcus Bingemann
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