Social class, poverty and health

Chapter 5. Social class, poverty and health

Ronnie Moore





Social differences and social strata



These are important markers and such labels carry a particular currency in terms of identity and belonging. This is not a local phenomenon either. If we look at other cultures in different parts of the world, we also see a tendency to differentiate people. The caste system in India provides a particularly good example of a complex and highly structured social system where a person’s caste position assigns their social position. This emphasizes strict social boundaries and is tied to religious practice and to how daily life is organized. The caste system not only stresses differences but importantly illustrates another phenomenon, that of social stratification (the dividing of a society into grades, levels or classes). This implies a layering in terms of hierarchy and status assigned at birth until death, where the person cannot chose to enter or leave their caste. The caste system is thus an extremely rigid form of social stratification.

When we look at Britain, we see that historically social stratification rested on a feudal system and on the ownership of land. The ruling elite (the nobility), were able to command power, status, privilege and wealth. This was maintained and socially reproduced through grace and favour and through the legal right of inheritance. The rise of industrialization however, meant that the basis of social stratification in Britain changed dramatically. The shift from an agrarian based economy to the modern, cash nexus (capitalist) economy comprehensively altered the nature of the social structure and the ancient order in Britain, and consequently people’s lives.

Within a developing and expanding industrial labour market, the basis of social stratification also came to rest increasingly on a social position in the workforce and on a market position in an economy based on exchanging labour for money. Much of the old ruling elite (hereditary aristocracy) still remained at the apex but important changes were occurring. The aristocracy had traditionally looked down on people who were in ‘trade’ but increasingly the new rich such as industrial or business entrepreneurs become part of the ruling elite. Inheritance however remained an important factor socially reproducing the elite. At the same time, the enclosure movement was forcing rural workers off the land into towns and cities to form the new industrial working class.

The initial phases of industrialization brought extremely harsh economic and social conditions. With virtually no regulation, the industrial workforce was vulnerable to unscrupulous employers and often forced to work long hours in very dangerous conditions (see Chapter 4). The very young, the infirm and the old did not escape these hardships; they worked in factories, mills and mines in a wretched industrializing world. Unrestricted (free market) commercial freedom meant that employment did not make people immune to suffering and poverty. Poor employment conditions meant that the majority of the industrial workforce was condemned to a life of misery and poverty. The labouring class lived in pitiable conditions, with overcrowding, poor nutrition and poor sanitation.


The growth of the middle classes


The industrial revolution in Britain and the development and expansion of an economically powerful British Empire were to have major social and economic consequences locally (and later globally). As industrialization attracted people to the large urban areas in search of work, it brought with it geographical and social mobility and cultural contact within and between nations. It constituted a reshaping of the geographical spread of the population of Britain and changed the way that the population was stratified. This changed the nature of family and social life (see Chapter 2) and gave rise to a more complex social order with a variety of different social groups or classes. The basis of one’s station or class was now linked to employment and position in the labour market.

As industrialization gathered momentum throughout the nineteenth century, jobs diversified. In the labour market, some skills were able to command higher levels of income and better conditions. Industrialization meant that new professions formed to organize and manage a developing capitalist economy, i.e. engineers, accountants. The expansion of the British Empire also fuelled the demand for new administrative occupations which expanded throughout the Victorian period including government officials, teachers, lawyers, doctors and clerks. Out of this emerged a very broad category of people who made up ‘the middling’ or middle class. Over the past century, this professional sector has expanded dramatically (Routh 1980).

The ethos driving the Victorian middle classes was the idea of individualism, independence, thrift and a moral and spiritual belief in hard work and merit. These virtues are embodied in what Max Weber (see Chapter 4) has described as the ‘Protestant Ethic’. Weber believed this ethic was a necessary condition for the growth of capitalism in certain parts of Europe (Bendix, 1966 and Hamilton, 2001). Underlying this ethos was the belief that the individual was responsible for his or her own actions and condition. Industrialization was believed to have created the possibility for upward social mobility into the middle and upper classes and this was seen as positive proof that a fair meritocratic system had replaced an inherently unfair system of nepotism and aristocratic privilege (Gunn and Bell, 2003 and Saunders, 1990). The focus was on the moral attitude of the individual and on their responsibility for their social class and economic condition. This ideology was not new. The ‘deserving’ and ‘undeserving’ were survivals of an older ethos.


Poverty



THE POOR IN HISTORY


In great monarchies, and in early parliamentary democracies, the poor were regarded as an enduring problem. Historically, they were categorized into different groups including vagrants, paupers, migrants, the sick, the old and the able bodied poor. An important distinction arose between the ‘deserving’ and the ‘undeserving’ poor. As early as 1531, an Act of Parliament officially differentiated between the ‘able-bodied’ vagrant and those vagrants that could not help being in the position that they were in because of disability or sickness (Kumar 1984). This coincided with the expansion of towns and cities in which an earlier form of capitalism (described as mercantile capitalism) expanded from the sixteenth century onwards. The able-bodied poor were identified as ‘sturdy beggars’ and were seen as not wanting to work for a living. They were regarded as being a threat to the moral, religious and political order of the day. Begging for example, was considered a threat to public order and legislation made slothfulness a crime punishable by flogging. Ill-health was regarded suspiciously and seen as an excuse for laziness. Sir Thomas More for example, condemned the work-less as ‘Sturdy and valiaunte beggars cloaking their idle lyfe under the colours of some disease or sickness’ (Garraty 1978: 28). There was however, some recognition that, in certain circumstances, the able bodied might not be in a position to work because no work was available. Thus, for example, another Act was passed in 1572 recognizing some groups, such as redundant soldiers, as being genuinely unemployed, thus exempting them from the penalties of the extreme vagrancy laws.

Since the Elizabethan Poor Laws of 1597, official attitudes to the poor in Britain have been embodied in a series of Acts. Legislation reflected the general reluctance of government to take responsibility for the poor and infirm. It was widely held that official actions to help the poor would simply encourage idleness and thus make matters worse. Historically, relief from poverty was regarded as a matter for the family, sometimes with the assistance of the church. Rather than being seen as socially caused, poverty was seen as an individual matter, due to personal misfortune, or to character or moral defect.

Although the poor law provided basic relief from hardship and deprivation, its primary function was not charitable; rather it ensured that the poor were effectively managed. The legislation provided for a harsh system of public provision for the poor and destitute. The New Poor Law Amendment Act of 1837 marked a new approach to poverty coinciding with the growth of industrial capitalism (see Chapter 4). The aim now was to exert greater discipline on the able bodied poor by forcing them into workhouses if they wished to obtain relief.

It was these Acts that guided official attitudes towards the poor for the rest of the nineteenth century and arguably up to the present day ‘welfare to work’ policies (see Chapter 4). By the middle of the nineteenth century, workhouses were common throughout Britain. One of the effects of the harshness of this legislation was that it encouraged workers and their families to become geographically mobile in search of work. Official attitudes to the poor continued to link poverty to a pathology of the poor person; a moral defect rather than a defect in the social, political and economic environment in which that person lived. In other words, the focus was on the individual rather than the way society was organized and it was individual failings that were perceived as the cause of poverty.



DEFINITIONS OF POVERTY



Marx believed that these circumstances were the result of exploitation and uncontrolled capitalism where the poor were tied into cycles of poverty. Thus, poverty reproduced itself with successive generations. Marx and Engels viewed social class in terms of a theory of social change and also believed that it was important to understand society in order to change it.

Karl Marx (1818–1883)




One of Marx’s central ideas was the concept of alienation. In his earliest work, Economic and Philosophical Manuscripts (1844) Marx described the alienated nature of labour under capitalism and contrasted it with the idea of a communist society in which freedom and cooperation would prevail. He said of alienation: ‘Money is the alienated essence of man’s work and existence; the essence dominates him and he worships it’.

In the German Ideology (1845), he and Engels developed the idea of historical materialism. They believed that history could be understood by reference to material conditions rather than ideas and personalities. In particular, they believed that conflict and struggle between opposing forces was the motive force of history. They said ‘Life is not determined by consciousness but consciousness is determined by life’.

Marx joined the Communist League in Paris in the 1840s and he and Engels were invited to produce a succinct statement of Communist philosophy. They published the Communist Manifesto in 1848. It began ‘the history of all hitherto existing societies is the history of class struggle’ and concluded ‘Workers of the world unite. You have nothing to lose but your chains’.

Marx spent much of the rest of his life analysing the capitalist production process. He produced two major works Das Capital in which he developed the theory of surplus value and the Grundrisse, which was published after his death.

Marx developed many influential ideas and his ideas have extended beyond the Communist movement. His writings about economics and sociology have influenced many thinkers who do not share his political views.

Other important observers at the time also exposed the effects of urban life on the industrial poor. One of the most influential reformers of the period was the founder of the Salvation Army, Charles Booth, whose Life and Labour of the Peoples of London (1889) provided a bleak historical account of what the life of the poor was like. Booth showed that poverty, bad working conditions, low income and bad health were related. He defined poverty existing when income was not large enough to sustain physical health, otherwise known as the subsistence level. For Booth, poverty meant being in a constant state of want and struggling for the basic essentials to survive.

Thus, social reformers tried to identify a fixed point of income, beneath which it would be impossible for a person to live and work. This became known as the absolute definition of poverty. It regarded poverty as relating solely to the amount of income necessary for maintaining a person’s health and ability to function. This was an extreme distinction in that it defined a level of subsistence which was the absolute minimum for maintaining health. Those who had the bare essentials to survive were not categorized as being in poverty. Booth demonstrated that, even according to this minimal definition, large numbers of people in Britain were living in poverty. The sociological importance of this work was that it provided an important starting point for the subsequent debate on social conditions, poverty and health. By establishing measurable (albeit crude) levels of poverty and devising means whereby it could be defined and understood, Booth stimulated public and academic debate which would inform research into poverty and health.




REFLECTION POINT



We have seen that in Victorian times, people tried to define a level of ‘absolute poverty’. This was the minimum that people needed just to stay alive; in other words just above starvation level. There has more recently been an attempt to replace this with the concept of ‘relative poverty’. This tries to define the level of income required to participate in society. It therefore involves an effort to establish what most people think are basic essentials for that society at the time. More than twenty years ago Mack and Lansley (1985) showed that there was public consensus about what were regarded as necessities at that time. Make a list of the things that you think are the necessaries of life today to which everyone should have access? Do you believe that this should include just the basics we need to survive such as food, clothing and shelter? Alternatively, do you think that this should also include things that enable people to participate in society and its customs (for example, the ability to buy family Christmas presents)?


Social class



DEFINING SOCIAL CLASS


Our discussion so far has illustrated the fact that social differentiation has existed throughout history but has been dynamic and changing. With the rise of modern capitalism, societies stratified into a hierarchical system, based primarily on economic status and social prestige. The consequences of such a dramatic reordering of British and other industrial societies intensified the harsh conditions of the poor, especially the ‘labouring poor’. Marx in particular was concerned with early industrialization and with its effects on social structure and social class.

Marx was particularly interested in the mechanisms that produced and reproduced class inequality and what he called ‘class consciousness’. He argued that a person’s chances of living, surviving and providing for themselves and their family were linked to the relationship to what he termed ‘the means of production’. Capitalists and industrialists appeared to profit under capitalism since they owned and controlled the means of production (i.e. the factories and mills that the workers laboured in, and the raw materials of production such as cotton and steel).

However, the working poor (who had only their labour to sell to survive) were exploited. For Marx the distinction was clear. There existed two social classes – those who own the means of production (the wealthy bourgeoisie), and those who must sell their labour to survive (the proletariat). His outlook was critical. He argued that the nature of the relationship was antagonistic and based on exploitation. For Marx, wealth determined life and health chances and an economic definition was therefore crucial as a measure of social position or class.

Marx believed that the rich would accrue more and more wealth since they not only owned finance but also controlled the mechanisms of finance. Marx predicted that this would eventually lead to a concentration of capital among the rich. This would ultimately lead to a class revolution since capitalism was based on exploitation and thus the interests of the bourgeoisie and the proletariat were diametrically opposed. The theory behind this was the idea of a dialectic (after the German Philosopher, Hegel). This was the idea that the struggle of opposites will eventually lead to progress and the creation of new conditions.

Central to Marx’s ideas was his theory of alienation (see also Chapter 3). Workers perceived themselves being subjected to market forces of supply and demand, i.e. constrained by the market which was beyond their control. The net result of this was that workers became alienated and estranged from what they produced. This is the sense of loss of control of one’s life and one’s destiny. Marx believed that only with the end of capitalism would humans be free to fulfil their truly social nature.


THE CHANGING NATURE OF SOCIAL CLASS


Marx believed his ideas to be central to a general understanding of social and class inequality and not bound by national borders. He believed that capitalism would only be overthrown by international revolution. In some ways, his vision foresaw the importance of international capitalism and what we now understand as globalization. For some, though, Marx’s theory was over-deterministic. It appeared to overplay the influence of structural mechanisms such as capitalism and underplay human ‘agency’. That is, the extent to which people are able to exercise personal choice as opposed to being subject to social forces beyond their control. For example, Marx talked of ‘economic capital’ but failed to recognize other forms of capital which later theorists suggest are important to life and social living. For example, more recently Pierre Bourdieu developed the notion of social or cultural capital (which is discussed later in this chapter).

Social stratification thus appeared to develop in a more complex way than Marx has predicted particularly through the expansion of the middle classes. Class conflict rather than increasing as Marx suggested, appears to have been contained, via trade union collective bargaining and the development of the welfare state. Marx’s prediction of a unified (and international) class consciousness ‘a class for itself’ did not emerge; rather, local and national identities and cultures continued to exert an important influence. The working class as defined by Marx have not developed a unified international consciousness.

Historical accounts of industrialization identify various stages of development. While Marxists talk about early and late phases of capitalism, non-Marxists have talked of early, mature, late and post-industrial phases and of modernity and post-modernity. The historical significance here is that the nature of work and the nature of our society has changed and is still changing. The social significance is that working and living practices are influenced by this and these epochs appear to mark distinct stages in the development of human society. Social classes appear to be more fluid and therefore more complex than Marx suggested. Rather than classes polarizing, the class structure in advanced industrial societies appeared to become more complex and differentiated.

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Feb 17, 2017 | Posted by in NURSING | Comments Off on Social class, poverty and health

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