Using Conflict Theory, Research Paper Example

How are health and illness distributed across both domestic populations?

It is now largely recognized that a variety of social factors profoundly impacts various health outcomes outside of health care. The high variances in morbidity, mortality, and risk factors that scholars have documented between and within countries are depicted after classic social health determinants, such as income and education, as well as place-based traits of the social and physical environment in which people live and the macrostructural policies that form them.

A report published in 2013 from the National Research Council and Institute of Medicine quoted these socioecological factors, along with unhealthy deficiencies and behaviors in the health care system, as principal explanations for the “health disadvantage” of the U.S. In a comparison of 17 high-income countries, age-adjusted all-cause mortality rates for 2008 ranged from 378.0 per 100,00 in Australia to 504.9 in the United States (Hitchcock, 2003). The report documented a pervasive pattern of health disadvantages across diverse categories of illness and injury that existed across age groups, sexes, racial and ethnic groups, and social class.

Recent attention has focused on the substantial health disparities that exist within the United States, where life expectancy varies at the State level by 7.0 years for males and 6.7 years for females, but mortality and life expectancy vary even more substantially across smaller geographic areas such as counties and census tracts (Hitchcock, 2003). In many U.S. cities, life expectancy can vary by as much as 25 years across neighborhoods. The same dramatic geographic disparities can be seen for other outcomes, such as infant mortality, obesity, and the prevalence of diabetes and other chronic diseases.

Of the various social determinants of health that explain health disparities by geography or demographic characteristics (e.g., age, gender, race-ethnicity), the literature has always pointed prominently to education. Research based on decades of experience in the developing world has identified educational status (especially of the mother) as a major predictor of health outcomes, and economic trends in the industrialized world have intensified the relationship between education and health. In the United States, the gradient in health outcomes by educational attainment has steepened over the last four decades in all regions of the United States, producing a larger gap in health status between Americans with high and low education. Among white Americans without a high school diploma, especially women, life expectancy has decreased since the 1990s, whereas it has increased for others (World Health Organization, 2009). Death rates are declining among the most educated Americans, accompanied by steady or increasing death rates among the least educated.

Income is also another driving force behind the striking health disparities that many minorities experience. Although blacks and Hispanics have higher rates of disease than non-Hispanic whites, these differences are “dwarfed by the disparities identified between high- and low-income populations within each racial/ ethnic group.” That is, higher-income blacks, Hispanics, and Native Americans have better health than members of their groups with less income, and this income gradient appears to be more strongly tied to health than their race or ethnicity. Though it is easy to imagine how health is tied to income for the very poor or the very rich, the relationship between income and health is a gradient: they are connected step-wise at every level of the economic ladder. Middle-class Americans are healthier than those living in or near poverty, but they are less healthy than the upper class. Even wealthy Americans are less healthy than those Americans with higher incomes.

Poor adults are almost five times as likely to report being in fair or poor health as adults with family incomes at or above 400 percent of the federal poverty level, or FPL, (in 2014, the FPL was $23,850 for a family of four), and they are more than three times as likely to have activity limitations due to chronic illness. Low-income American adults also have higher rates of heart disease, diabetes, stroke, and other chronic disorders than wealthier Americans. Infant mortality and children’s health are also strongly linked to family income and maternal education. Rates of low birth weight are highest among infants born to low-income mothers. Children in low-income families are approximately four times as likely to be in poor or fair health as children in families with incomes at or above 400 percent of the FPL. Lower-income children experience higher rates of asthma, heart conditions, hearing problems, digestive disorders, and elevated blood lead levels. In 2006–08, the prevalence of asthma was 8.2 percent among nonpoor children but ii.7 percent among poor children and 23.3 percent among poor Hispanic children. Poor children also have more risk factors for disease, such as childhood obesity, which is a strong predictor of obesity as an adult.

The reported higher rates of risk factors to accompany higher rates of disease among low-income Americans. In 2011, smoking was reported by one out of four (27.3 percent) adults from families who earn less than $35,000 a year, three times the rate of those from families who earn $100,00 a year or more (9.2 percent). Obesity rates were also higher (31.9 and 21.2 percent, respectively), in part because of lower levels of physical activity. In 2oii, the proportion of adults who reported getting recommended levels of aerobic exercise was 36.1 percent for those living in poverty compared with 60.1 percent for those with incomes at least four times higher than the FPL. Income is also associated with mental health. Compared with people from families who earn more than $100,000 a year, those with family incomes below $35,000 a year are four times more likely to report being nervous and five times more likely to report sadness “all or most of the time”. Somatic complaints (i.e., the pain and other physical ailments that people experience due to stress and depression) also occur more commonly among people with less income.

Conflict theory

Conflict theories are perspectives in social science that emphasize the social, political, or material inequality of a social group, that critique the broad socio-political system, or that otherwise detract from structural functionalism and ideological conservatism. Sociologists in the tradition of conflict theory argue that the economic and political structures of a society create social divisions, classes, hierarchies, antagonisms and conflicts that produce and reproduce inequalities. Certain conflict theories set out to highlight the ideological aspects inherent in traditional thought. The conflict theory applies to this study since it will help to explore the social inequalities within the society. Since the research concerns a social phenomenon, it will relate well in explaining the health status in the society and the disparities thereof.

The conflict theory, suggested by Karl Marx, claims society is in a state of perpetual conflict because of competition for limited resources. It holds that social order is maintained by domination and power, rather than consensus and conformity. According to conflict theory, those with wealth and power try to hold on to it by any means possible, chiefly by suppressing the poor and powerless. A basic premise of conflict theory is that individuals and groups within social work to maximize their benefits.

The conflict theory has been used to explain a wide range of social phenomena, including wars and revolutions, wealth and poverty, discrimination and domestic violence. It ascribes most of the fundamental developments in human history, such as democracy and civil rights, to capitalistic attempts to control the masses rather than to a desire for social order. The theory revolves around concepts of social inequality in the division of resources and focuses on the conflicts that exist between classes. Many types of conflicts can be described using conflict theory. Some theorists, including Marx, believe that inherent societal conflict drives change and development in society.

Marx’s conflict theory focused on the conflict between two primary classes. Each class consists of a group of people bound by mutual interests and a degree of property ownership, often supported by the state. The bourgeoisie represents the members of society who hold the majority of the wealth and means. The proletariat includes those considered working class or poor. With the rise of capitalism, Marx theorized that the bourgeoisie, a minority within the population, would use their influence to oppress the proletariat, the majority class. This way of thinking is tied to a common image associated with models of society based on conflict theory; adherents to this philosophy tend to believe in a “pyramid” arrangement in which a small group of elites dictate terms and conditions to the larger portion of society, as a result of outsized control over resources and power.

Uneven distribution within society was predicted to be maintained through ideological coercion where the bourgeoisie would force acceptance of the current conditions by the proletariat. The thinking goes that the elite would set up systems of laws, traditions and other societal structures to further support their dominance while preventing others from joining their ranks. Marx further believed that as the working class and poor were subjected to worsening conditions, a collective consciousness would bring inequality to light and potentially result in revolt. If conditions were subsequently adjusted to address the concerns of the proletariat, the conflict circle would eventually repeat.

How Wealth and Income Influence Health

To some extent, income and wealth directly support better health because wealthier people can afford the resources that protect and improve health. In contrast to many low-income people, they tend to have jobs that are more stable and flexible; provide good benefits, like paid leave, health insurance, and worksite wellness programs; and have fewer occupational hazards. More affluent people have more disposable income and can more easily afford medical care and a healthy lifestyle—benefits that also extend to their children.

People with low incomes tend to have more restricted access to medical care, are more likely to be uninsured or underinsured, and face greater financial barriers to affording deductibles, copayments, and the costs of medicines and other health care expenses. Conditions may change under the Affordable Care Act, but as of 2011 the probability of being uninsured before age 65 was 28.4 percent for those living in poverty, 16.5 percent for those with incomes two to three times the FPL, and 5.2 percent for those with incomes four or more times the FPL.

Partly because of reduced access to care and reduced affordability, low-income patients are less likely to receive recommended health care services, such as cancer screening tests and immunizations. For example, in 2012 the proportion of adults ages 5o to 75 who reported never having been screened for colorectal cancer was 19.5 percent for those with annual household incomes of $75,000 or more but 42.5 percent for those with incomes below $15,000 (National Research Council, 2010). In 2011, almost one-quarter (23.3 percent) of adults with family incomes under $35,000 per year had no usual place of medical care, compared with 6.0 percent of those with incomes of $100,000. Similarly, 22.6 percent reported not having seen a dentist in more than five years, compared with 4.3 percent of adults with family incomes over $100,000 (National Research Council, 2010).

More affluent people can more easily afford regular and nutritious meals, which tend to be more expensive and less convenient than less nutritious, calorie-dense, high-carbohydrate options and fast foods. People on low incomes face higher rates of food insecurity. Their difficult living circumstances often preclude active recreational opportunities for regular exercise, and the cost of gym memberships or exercise equipment is often prohibitive. They may also face financial and other barriers to obtaining assistance with lifestyle changes, such as smoking cessation or assistance with alcohol and drug dependence.

People with higher incomes are more likely to experience place-based health benefits, meaning that the conditions and assets positively influence their health in their living environment. In other words, even after adjusting for income and other attributes of individuals and households, health benefits appear to be associated with where people reside. Ellen and Turner (1997) identified six ways in which neighborhood conditions can influence the health of individuals: (1) quality of local services, (2) socialization, (3) peer influences, (4) social networks, (5) exposure to crime and violence, and (6) physical distance and isolation. Low-income neighborhoods and areas of concentrated poverty tend to expose their residents to higher rates of unemployment, crime, adolescent delinquency, social and physical disorder, and residential mobility.

The socioeconomic status of individuals and neighborhoods are intertwined with individual and population health because the local economy determines access to jobs, commerce, schools, and other resources that enable families to enjoy economic success and place-based health benefits. For example, one study found that “healthy adults residing in socioeconomically deprived neighborhoods died at a higher rate than did people in relatively less deprived areas, even after accounting for individual-level socioeconomic status, lifestyle practices, and medical history.” Smoking, diabetes, and other conditions are more common for people living in poor neighborhoods, independent of their income (Graham, 2009).

Population health is influenced not only by the economic well-being of individuals and households but also by the civic and economic vitality of their communities. People unable to afford to live in healthier, more desirable areas often struggle with challenges related to a variety of community-level health-related factors:

• Access to healthy food: Residents of low-resource neighborhoods often have limited access to sources of nutritious food, such as supermarkets that sell fresh produce and other healthful food options. They are more likely to live in neighborhoods with food deserts; an overconcentration of fast-food outlets, convenience stores, corner stores, bodegas, and liquor stores; and a shortage of restaurants that offer healthy food choices and menu labeling.
• Built environment: Low-income communities tend to have limited access to green space, recreational programs, and facilities for regular exercise and active living. Their neighborhoods are often less conducive to walking or cycling to school, work, or shopping.
• Advertising: Low-income and minority communities are more frequently targets for advertising of tobacco, alcohol, and high-calorie foods, often targeted to youth.
• Housing: People with limited resources experience higher rates of inadequate and unstable housing (and homelessness) and exposure to indoor pollutants (e.g., lead-based paint, asbestos, and dust mites). They often experience barriers to moving to a better neighborhood with healthier housing stock.
• Transportation: Public transportation is often inadequate to enable residents to commute to employment, to find a better job, or to reach a supermarket, a reliable childcare provider, or health care services.
• School systems: People with low incomes are more likely to live in poorer neighborhoods with a weaker tax base, thus reducing local resources that support public schools and social services. Cash-strapped schools in low-income neighborhoods may have inferior resources and deteriorated buildings.
• Jobs and health care: Low-resource neighborhoods often face a shortage of employment opportunities, as well as primary care providers and high-quality clinical facilities.
• Environmental pollution: Low-income residents are less likely to be able to afford living in neighborhoods that are free of pollutants and may of necessity live near busy highways with vehicle emissions, factories with billowing smokestacks and water emissions, bus depots, and other sources of air and water pollution.
• Disinvestment: Low-income residential neighborhoods reflect urban design legacies that discourage pedestrian activity and such practices as redlining, which served to isolate and segregate minority populations. Entrenched patterns reflecting long-standing disadvantage often perpetuate cycles of socioeconomic failure and an inability for low-income neighborhoods to recover. Public policies have historically led to disinvestment in these neighborhoods, causing persistent segregation, fewer economic opportunities, and increasing crime.

Income and wealth are part of a complex web of social and economic conditions that affect health (and each other) over a lifetime. These conditions include education, employment, family structure (e.g., single motherhood), neighborhood characteristics, and social policies, as well as culture, health beliefs, and country of origin. Educational achievement is an especially strong predictor of health independent of income. There is also evidence that when people are exposed to economic disadvantage—especially at critical developmental stages of life—and to other harmful life conditions they become more vulnerable to disease processes and experience harmful physiological reactions to toxins in their environment (Graham, 2009). The stress associated with financial adversity is believed to have harmful biological effects on the body. Stress is thought to affect hormones and the health of the immune system (a phenomenon called allostatic load), causing damage to organs and increasing the risk of disease over time.

Health and income affect each other in both directions: not only does higher income facilitate better health, but poor health and disabilities can make it harder for someone to succeed in school or to secure and retain a high-paying job. Scientists call this phenomenon reverse causality or selection effects. The role of reverse causality is not entirely clear, as much of the evidence linking income and health consists of studies that show an association but are not designed to prove the direction of causal relationships. There is, however, a small but more compelling body of prospective evidence about the protective effects of income on health.

Health and Education

Among the most obvious explanations for the association between education and health is that education itself produces benefits that later predispose the recipient to better health outcomes. We may think of these returns from education, such as higher earnings, as subsequent “downstream” benefits of education (later in the chapter we will discuss “upstream” factors that may influence both education and health throughout the life course, especially before children ever reach school age). Following the socio-ecological framework presented in the introduction, we describe a range of potential downstream impacts of education on health, starting with the ways individuals experience health benefits from education. Afterwards, we discuss the health-related community (or place-based) characteristics that often surround people with high or low education, and closing with the larger role of social context and public policy.

Education can impart a variety of benefits that improve the health trajectory of the recipient. Below we discuss its role in enhancing non-cognitive and cognitive skills and access to economic resources, and we highlight the impacts of these on health behaviors and health care usage. Although this section focuses specifically on the health benefits of education, we do so in full knowledge that education is impacted by health, development, and a host of personal, community, and contextual factors. Education contributes to human capital by developing a range of skills and traits, such as cognitive skills, problem-solving ability, learned effectiveness, and personal control. These various forms of human capital may all mediate the relationship between education and health. Personality traits (also known as “soft” or non-cognitive skills) are associated with success in later life, including employment and health. The ‘Big Five’ personality factors include conscientiousness, openness to experience, extraversion, agreeableness, and neuroticism/emotional stability (Bartos, 2002). Roberts et al. postulate three pathways whereby personality traits may impact mortality: through disease processes (e.g., response to stress), health-related behaviors, and reactions to illness. They suggest that the strength of association between the ‘Big Five’ personality traits and mortality is comparable to that of IQ and stronger than socioeconomic status. Although enduring, these skills are also mutable, and research indicates that educational interventions to strengthen these skills can be important, especially among children in disadvantaged areas, who may find it more difficult to refine these skills at home and in their social environments.

Personal control, also described in the literature in terms of locus of control, personal efficacy, personal autonomy, self-directedness, mastery, and instrumentalism, is another soft skill associated with educational attainment. According to Bartos (2002), “Because education develops one’s ability to gather and interpret information and to solve problems on many levels, it increases one’s potential to control events and outcomes in life. Moreover, through education, one encounters and solves problems that are progressively more difficult, complex, and subtle, which builds problem-solving skills and confidence in the ability to solve problems.”

Personal control can impact individuals’ attitudes and behaviors, potentially including health behaviors. Furthermore, an individual’s sense of mastery and control may mediate stress, possibly by facilitating better coping mechanisms. Lack of personal control, on the other hand, may provoke physiological responses, leading to suppression of the immune system. Achieving positive health outcomes in today’s health care environment requires a variety of factors to come together that may be affected by educational attainment and a combination of soft and hard skills. Patients benefit from the ability to understand their health needs, follow or read instructions, advocate for themselves and their families, and communicate effectively with health providers. A systematic review of health literacy and health outcomes found that individuals with lower health literacy had poorer health-related knowledge and comprehension, ability to demonstrate taking medications properly, and ability to interpret medication labels and health messages. They also had increased hospitalizations and emergency care, decreased preventive care, and, among the elderly, poorer overall health status and higher mortality. For example, low literacy and low levels of other basic skills such as listening and numeracy have been associated with greater difficulty in asthma care in adults.

In a review of the impact of patient socioeconomic status on patient-physician communication, Sommerfeld concluded that communication is influenced in part by patients’ communicative ability and style, which depend largely on education and other personal attributes. Education contributes to more active communication, such as expressiveness and asking questions. In response, physicians tend to communicate less to patients who seem less educated and to provide care that is more directive and less participatory. in addition to its impact on soft skills, education has the potential to impart skills in reading, mathematics, and science/health literacy that could contribute to an individual’s health. Learners of English as a second language are helped to overcome language barriers that can interfere with the understanding of health needs.

Education may also improve a range of other skills, such as cognitive ability, literacy, reaction time, and problem-solving. Pathways from these skills to health outcomes may be indirect, via attainment of better socioeconomic circumstances or behavior, but they may also apply directly in clarifying the increasingly complex choices individuals face in understanding health priorities and medical care needs (Merrill, 2017). Skills such as higher cognitive ability and health literacy may also lead directly to improved health outcomes because of an enhanced “ability to comprehend and execute complex treatment regimens,” and better disease self-management. A strong education may be important in both navigating health care and making choices about lifestyle and personal health behaviors. Cutler and Lleras-Muney report that increased cognitive ability resulting from education contributes significantly to the education gradient in health behaviors.

Adults with higher levels of education are less likely to engage in risky behaviors, such as smoking and drinking, and are more likely to have healthy behaviors related to diet and exercise. Data from the National Survey on Drug Use and Health (NSDUH) indicate that in 2009-10, 35 percent of adults who did not graduate high school were smokers, compared to 30 percent of high school graduates and 13 percent of college graduates (Blas, 2010). The impact of education on health behaviors likely stems from education’s impact on skills as well as socioeconomic status. Examining competing explanations for the education gradient in health behaviors, Cutler and Lleras-Muney find evidence for the importance of resources, cognitive ability (especially how one processes information), and social integration.

Education offers opportunities to learn more about health and health risks, both in the form of health education in the school curriculum and also by giving individuals the health literacy to draw on, later in life, and absorb messages about important lifestyle choices to prevent or manage diseases. For example, people with more education are more likely to have healthy diets and exercise regularly. Analysis of several waves of data from the National Health and Nutrition Examination Survey (NHANES) found that intake of specific nutrients (e.g., vitamins A and C, potassium, calcium), as well as overall diet quality, are associated with education. Also, Behavioral Risk Factor Surveillance System (BRFSS) data for 2010 indicate that only 61 percent of adults with less than a high school education and 68 percent of high school graduates said that they exercised in the past 30 days, compared to 85 percent of college graduates (Lopez, 2006). It must be noted, however, that not all behavioral risk factors are higher among those with the lowest educational attainment. BRFSS data for 2011 indicate that the prevalence of binge drinking increases with higher levels of education (Blas, 2010).

Finally, adults with higher levels of education tend to have lower exposure to stress related to economic deprivation or relative deprivation, and may, therefore, be less inclined than those with lower levels of education to adopt unhealthy coping behaviors for stress. Individuals with more education tend to have greater socioeconomic resources for a healthy lifestyle and a greater relative ability to live and work in environments with the resources and built designs for healthy living.

References

Bartos, O. J., & Wehr, P. E. (2002). Using conflict theory. Cambridge: Cambridge University Press.

Blas, E., Kurup, A. S., & World Health Organization. (2010). Equity, social determinants, and public health programmes. Geneva, Switzerland: World Health Organization.

Graham, Hilary. (2oo9). Understanding Health Inequalities. Open Univ Pr.

Hitchcock, J. E., Schubert, P. E., & Thomas, S. A. (2003). Community health nursing: Caring in action. Clifton Park, NY: Thomson/Delmar Learning.

Lopez, A. D., & Disease Control Priorities Project. (2006). Global Burden of Disease and Risk Factors. New York, NY: Oxford University Press.

Merrill, R. M. (2017). Introduction to epidemiology.

National Research Council (U.S.)., National Research Council (U.S.)., & National Research Council (U.S.). (2010). Understanding the changing planet: Strategic directions for the geographical sciences.

Sommerfeld, B. E. (2011). Social determinants approaches to public health: From concept to practice. Geneva: World Health Organization.

World Health Organization. (2009). Global health risks: Mortality and burden of disease attributable to selected major risks. Geneva, Switzerland: World Health Organization.