This chapter describes the relationship between social and

economic conditions and poor health status. As early as in

1939 Faris and Dunham establish a link between schizophrenia

and social class. Link and Phelan in 1995 also noted lower

socio-economic status is associated with lower life expectancy,

higher overall mortality rates and higher rates of infant and

perinatal mortality. But opposite evidence was also noted

for example class differences were not found in the youngest

group in relation to chronic physical illness and mental health.

      In the Black report (DHSS 1980) for main factors which try

to explain the inequalities in physical and mental health were:

1)      Artifact explanations: there is artifact in official statistics

which results in inequalities. However, with new methods

currently there is sufficient evidence to confirm health

inequalities do exist.

2)      Selection explanations: the ‘social drift’ hypothesis,

where long term illness will make a person drop to a lower social class. 

3)      Cultural/behavior explanations: lifestyle and health

related behaviors result in inequalities.  

4)      Materialist explanations: a person’s social-economic

 position and material deprivation leads to poor health status.

       The behaviors and materialist explanations are more acceptable

 to me; because I believe health has a great proportion is

related to lifestyle and the environment. But the social drift

phenomenon is also observed in my clinical practice.

There was a large scale community survey of mental

health in the US in 1962 showed that lower class people

were more likely to have psychotic symptoms and middle-class

people were more likely to have neurotic symptoms. This may

be due to over-inhibition of behaviors (such as sexual and

aggressive impulses control) of middle class children. These

result in problems of anxiety and guilt appearing in middle

class group and fragmentation of their sense of self in

lower-class group.

Study also showed lower class people have fewer positive

experiences to buffer themselves against life stress, which

makes them more vulnerable to mental distress. This may

be due to the different stress of difference class and higher

social class members have better social support

both financially and emotionally. 

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