Socio-Economic Factors and Their Effects on Health

This research explores the impact of socio-economic factors, specifically income and education, on individuals' health. It discusses the concept of social determinants, health challenges associated with socio-economic factors, and provides recommendations to overcome these challenges. The research methodology includes qualitative data collection and thematic analysis. The study aims to improve understanding of the effects of socio-economic factors on health and promote positive health outcomes.

SOCIO-ECONOMIC
FACTORS AND THEIR
EFFECTS ON HEALTH

TABLE OF CONTENTS
Research Proposal............................................................................................................................4
INTRODUCTION ..........................................................................................................................4
Aims and Objectives...................................................................................................................4
Research Questions.....................................................................................................................4
Literature Review........................................................................................................................5
Research Methodology...............................................................................................................5
RESEARCH METHODOLOGY.....................................................................................................7
Research Type: ...........................................................................................................................7
Research Approach: ...................................................................................................................7
Research Design: ........................................................................................................................8
Research Philosophy: .................................................................................................................8
Data collection: ..........................................................................................................................9
Research Strategy .......................................................................................................................9
Data Analysis: ............................................................................................................................9
Validity and Reliability: .............................................................................................................9
Ethical considerations: .............................................................................................................10
Limitations of the study: ..........................................................................................................10
LITERATURE REVIEW .............................................................................................................11
Concept of social determinants.................................................................................................12
Health Challenges associated with socio-economic factors .....................................................13
Solutions to deal with health challenges associated with socio-economic factors ..................16
Literature Summary..................................................................................................................18
Findings .........................................................................................................................................20
Theme 1: Socioeconomic Status and determinants of health ...................................................20
Theme 2: Health based in equalities in context to NHS health care in UK..............................23
Theme 3: Health conditions of low socio-economic population and initiatives by NHS ........25
CONCLUSION AND RECOMMENDATION.............................................................................29
Conclusion ...............................................................................................................................29
Recommendations.....................................................................................................................29

Alternative method: ................................................................................................................31
REFERENCES..............................................................................................................................32

Research Proposal
INTRODUCTION
Socio-economic factors are education, income, community safety and social supports that
directly impacts on individuals health and their well-being. Effect of socio-economic factors on
health has become one of the most discussing topic across the world because due to these factors,
there are wide number of people who unable to live their life prosperously. These factors also
impacts people's ability to make appropriate choice, afford medical care and housing, maintain
stress level and others (Queirós, Faria and Almeida, 2017 ). For example when people have
different socio-economic opportunities like good schools, secure job and strong social network
that automatically improves morality and achieves healthy and long lives. There are two major
socio-economic factors i.e. education and income that affects people's health positively and
negatively. This research topic has wide scope in future because still most of the people either
high class or low class are facing socio-economic factors which directly affects their health and
well-being. This research proposal provides high understanding to reader about impact of socio-
economic factors on people's health.
Aims and Objectives
Aim
“To evaluate effect of socio-economic factors i.e. income and education on health”.
Objectives
 To understand concept of socio-economic factors i.e. income and education.
 To identify health challenges associated with socio-economic factors.
 To recommend solution to deal with identified health challenges associated with socio-
economic factors and improves health of individuals positively.
Research Questions
 What do you mean by the concept of socio-economic factors i.e. income and education?
 What are the health challenges related with socio-economic factors?
 What are the solutions that can be recommended to overcome identified health challenges
related to socio-economic factors and leads positive effect on people's health?
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Literature Review
Theme 1: Understand concept of socio-economic factors i.e. income and education
As per the view of Cookson and et.al., (2016) socio-economic is the social science that
provides brief information about economic activity that affects and shapes by social processes.
Income and education are the two major factors that directly effect individuals health for
example employment that provides income through which individuals enable to shape choices
about housing, education, food, medical care etc. On the other hand, unemployment or illiteracy
limits choices and ability of saving and assets that supports in economic distress situations.
Theme 2: Identify health challenges associated with socio-economic factors
As per the view of Cavaliere, De Marchi and Banterle, (2018), socio-economic factors
i.e. income and education are the major factors that have raised wide health challenges. For
example more than 60 percent people are in low income families, so they enable to receive less
medical care such as treatment and screening that ultimately increases high death ratio. As same
there are 40 percent adults who are non-graduated because they did not have enough money to
take admission in higher school. Due to such illiteracy ratio, most of the people are unaware
about life threatening disease like cancer, neurological condition, diabetes etc. These are the
major health challenges that are properly related with socio-economic factors.
Theme 3: Recommend solution to deal with identified health challenges associated with socio-
economic factors
As illustrated by Heo, Fong and Bell, (2019), There are various solution to overcome
identified health challenges such as develop and conducts ongoing, automated recall programs
for the people in which aware them how they keep their health well-being. In this program
involves wellness visits, screenings and visits when they ill. With this initiative, UK's
government can deal with health issues and improves their morality rate.
Research Methodology
 Research Types: Research is referred to the study of available information and different
materials in order to find out appropriate outcomes of the problem of study. Qualitative
and Quantitative are the two research types that are used to collect data. In this research
will use qualitative research method for collecting data over the proposed research topic
because it maintains quality while collecting data (Calicioglu and et.al.,2019).
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 Research Approaches: It defines as a plan or procedure that properly consist with broad
assumptions in the context of reason of data collection, interpretation etc. There are two
research approaches i.e. inductive and descriptive. In this research will use deductive
research approach for collecting data over the research topic because it helps in choosing
right research method to conduct study.
 Research Design: It is a strategy that is selected to integrate different components of
study in logical way. There are three research designs exploratory, explanatory and
descriptive. Exploratory use for the research problem while explanatory uses to pick
better option in available data. In this research will use descriptive research design
because it gives proper understanding about the nature of demographic segment.
 Data Collection: There are two methods of data collection such as primary and
secondary. Primary data is collected through interview session while secondary data is
collected from available resources like magazines, research articles, Internet and social
media. Primary and secondary research methods will apply to collect information related
to proposed research topic.
 Data Analysis: It is process of understanding and interpreting gathered data in a way that
portray logical conclusion. Thematic method will use in this research assignment because
it helps to distribute data into themes that can be easily interpreted during training
session.
 Sampling method: Select number of people from wide population as sample size known
as sample population. There are two sampling methods probable and non-probable. In
this research will use random sampling method to select target population. 50 people will
be taken as sample population in the UK for the interview session so that logical
outcomes can be portrayed (Etikan and Bala, 2017).
 Ethical Consideration: According to ethical consideration, researchers should take
permission from authors before using published articles. They must maintain dignity and
respect of sample population while asking questions in the interview session. In this
research assignment will follow all guidelines related to ethical consideration by the
researcher.
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RESEARCH METHODOLOGY
Research methodology is structure, approach and techniques used to deliver the entire
study (Zangirolami-Raimundo, Echeimberg, and Leone, 2018). This is a systematic design of
how the data is collected, sampling is done and in what manner the data is analysed. The
philosophy and approach of the whole research is identified along with explanation of the
research design and type used to conduct the study.
Research Type:
There are primarily two kinds of research type, that is, qualitative and quantitative or a
combination of both. Quantitative research concentrates on focussing upon the testing and
measurement of the numerical data using statistical methods and in confirmatory in nature.
Qualitative research on the other hand focusses on collection and analysis of written data, spoken
data or textual data. It focuses on softer areas and the result is inductive with inclination towards
understanding perceptions (Mohajan, 2018).
Qualitative study is used to deliver this research. As the objectives and aim of study
allowed the researcher using this technique of study. Qualitative study will favour the researcher
to use all different models and theories to achieve the objectives behind the study.
Research Approach:
The research approaches that can be used for conducting the research are inductive or
deductive. Inductive reasoning is used for qualitative research and starts with theories and
observations. It uses patters, resemblances, regularities of experiences in order to derive to the
conclusion. On the other hand, deductive reasoning is coupled with quantitative research and
develops hypothesis from theory, collects and analyses data for testing the hypothesis and is
associated with scientific investigation (Liu, 2016).
This research uses inductive reasoning to study the concepts and effects of social
determinants and various patterns and experiences to conclude the impact on health. Unlike
deductive reasoning which takes a general premise and moves towards a particular observation,
the inductive approach to research will aim to draw general conclusion from the observations of
data and instances of responses (Averchenkova, Fankhauser and Finnegan, 2021). It has merits
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of flexibility, allows closer attention to the subject and context and is highly supportive towards
generation of new theories. Inductive reasoning is used to predict about the possibilities that
might be encountered.
Research Design:
This is the overall strategy of how the research is conducted and selected for integration
of various components of the study in a logical and coherent manner for efficiently addressing
the major research problems. It is the blueprint that determines collection, measurement and
analysis. In this research, the scholar has used a descriptive design which provides answers about
what, who, where and when of the research problems in relation to the variables present in
situations.
The research will narratively and accurately analysis the impact over health due to
education and income in UK. The effectiveness of this design in analysing non-quantifiable
issues and topics becomes the key reason behind choosing it. There is also a high possibility for
observing a phenomenon in entirely unchanged natural environment. It is also a time efficient
and quality efficient that would allow the researcher to gain the best level of outcomes against
the study conducted.
Research Philosophy:
The research philosophy refers to a system of thought that researcher follows and applied
during the whole process of conducting the research and analysing the data. Philosophies include
positivism, interpretivism, transforming and pragmatist. In this study researcher has adopted
interpretive-based philosophy which aims over integrating human interest to the study
(Dudovskiy, 2017). This philosophy is effective as it allows social constructions of shared
meanings, middle grounds, consciousness, language and instruments and is used in qualitative
analysis.
The major reasons for selection of this philosophy was the subjectiveness of the method
of interpretation and the extent and greater detain at which the research is conducted as the
theory represents what ought to be normative. Interpretive philosophy will allow researcher to
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interpret entire information in such way that researcher get to meet all different objectives behind
the study.
Data collection:
For conducting a research, collection of data is the initial step and refers to the process of
gathering and measurement of information through various sources on targeted variables in an
established system. The source of data collection used for this research is secondary sources.
Secondary sources for collection of data refer to already collected and published data from pre-
existing sources. This research has been done through the use of government reports, authentic
books, published journals and articles, internet, library database etc (Paradis and et.al., 2016).
Research Strategy
Research strategy is a pecise plan behind the study. This involves planning, strartegic
formation, implementation and controlling of the study. Entire study is conducted based on the
strategies designed by researcher. This involves strategic choices related to collection of data,
information, analysis, assesses and many other strategic direction.
Data Analysis:
Data analysis is the process of interpretation of collected data and modelling it for the
purpose of analysis and reaching to conclusions. Major data analysis tools and techniques
include using coding software, SPSS, text-based analysis, predictive analysis or thematic
analysis (Terry and et.al., 2017). This study has applied thematic analysis which is a popular
method to analyse the qualitative data and can be applied to in an inductive manner. It focuses on
interpreting the concepts and using existing knowledge, themes and patterns observed to
conclude the meaning of the data. The method is quite flexible and ideal of this exploratory
nature of research. The analysis is highly suitable for huge data bases and allows scholar to
expand the range of research past individual experiences and also helpful in interpretation pf
themes that is backed up by data.
Validity and Reliability:
The research conducted is extremely consistent in nature, highly dependable, applicable
to the situation or subjects and are highly transferable. The sources used in the research are from
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authentic a and published journals which are highly reliable for academic inferences and
purposes. The trust worthiness of all the articles, books and journals is high. The sources have
been taken from most recent developments and validity is positive. All the sources used are
highly relevant to the subject matter and address all the issues related to the study. Therefore, the
whole research can be understood as highly reliable and valid. The extent to which results can be
reproduced when repeated under similar conditions is moderate. The entire research accurately
measures what it is purposive to measure. All the outcomes have high correspondence to real
characteristics, values, properties and variations in the socio-economic world.
Ethical considerations:
All ethical principles are followed by the researcher. All information has been collected
with proper sources. There is not any not required modification has been coordinated in the
information collected through literature review sources.
Limitations of the study:
Time and financial resources were limited in number. Due to unavailability of proper
resources information collected was restricted in a certain limit. If there were more time
available than the study would have been very precise and reliable. The limitation of time and
money also allowed the researcher to only collect information through secondary sources.
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LITERATURE REVIEW
Introduction
The literature review for the research will aim at identification, evaluation and synthesis
of the relevant literature in the specific field of research aiming at assessing the impact of social
determinants and socio-economic factors on the health and well-being of individuals and society.
The literature overview helps in surveying the scholarly articles, books, published articles,
journals, websites, blogs and more other secondary resources. It also helps in providing the
description and the summary of the things learn from all the secondary resources (Oztemel and
Gursev, 2020). Literature review also critically evaluates the material studied from all such
sources which means all the objectives of the research will be seen from both the perspectives
which means negative as well as positive. This will help in gaining deep insight about the
specified topic. The main aim of the research will be divided into various themes. These themes
will in segregating the main objective so that the research can be done by focusing on all the
themes. These will be formed according to the research objectives. There are five major steps for
writing the literature review which are research which is for the literature and the theme (Poli
and et.al., 2017). Then the sources are evaluated according to the validity and the reliability as
well the needs of the researcher. After this, the themes and the debates are identified followed by
outlining the structure and then finally the literature review will be written.
The review will be conducted on a critical basis considering three primary themes in the
whole study. Analysis of the existing research by various scholars will be reviewed and
critiqued. The literature review contained credible, established and authentic published studies
and data. Various books, journals articles related to socio-economic topic are involved
(Bradbury, Murphy and Key, 2020). It also includes various key sources in context to main
debates and findings, new approaches and emerging trends, areas of conflicts among various
viewpoints of scholars and schools of thoughts, problems and challenges and extension of
research along with presence of literature gaps in this field of study.
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Concept of social determinants
According to Adler, Glymour and Fielding, (2016), social determinants of health refers to
those conditions or environment in which people are born, live, grow, work and age apart from
the wide range of systems and forces which shape their conditions and life. The systems and
forces consist of numerous economic policies, development agendas, social policies and norms.
The social determinants can be grouped into five major domains, that are economic stability,
access to education and quality, environment of the neighbourhood, access to healthcare and
quality and community and social context. In similar context Castrucci, and Auerbach, (2019)
elucidated that socio-economic status is a major social determinant which describes the social
standing and class of individual and groups and is measured collectively by three primary
elements, that are, education, occupation and income and is also used to depict the economic and
social difference as a whole in a society. The three levels of determining the socioeconomic
status of families, groups or individuals are low, middle and high. As per the author, education
level is an important factor on what kind of job the person will geta and the level of income they
may be able to attain (Adler, Glymour and Fielding, 2016).
In a study by Dursun, Cesur and Mocan, (2018), it was noted that increase in each level
of education directly increases the median earnings. Professional, doctoral and other higher
degrees lead to high income generation by the person in comparison to earnings with a high
school diploma which leads to less earning. Higher levels of education are associated with better
results in context to economy, psychology and health due to the fact that it would lead to better
networking, social support, higher control and income (Dursun, Cesur and Mocan, 2018). Apart
from that Education lead a significant role in development of skill sets, competencies,
knowledge, and acquiring jobs. Children from lower socio-economic backgrounds tend to have
slower academic achievements in comparison to children from higher socio-economic status.
They also tend to pertain to poor cognitive development, memory, language, socio-emotional
process which subsequently lead to poor income and health. However, Thomson, De Bortoli and
Underwood, 2017) describes in contradiction to this study that although there is a huge
difference in the margin of academic performance in both the classes, the disadvantaged
children, when provided basic opportunities, perform significantly better and show substantially
better educational achievements than children with higher status and concludes that the
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relationship between socio-economic background and education is very moderate and there is
gap in understanding the actual effect, which needs more extensive research.
According to Schmidt and et.al., (2015), income is another determinant which refers to
the amount of wages, rents, profits, salaries and other earnings received by people. An inequality
in income results in different lifestyles of people, where low income families have very less
chances of accumulating wealth or counter the immediate needs, which is further passed on to
future generations. In contradiction, people with higher incomes accumulate wealth which help
them in getting better medications, healthcare access and better nutrition (Schmidt and et.al.,
2015). When comparing countries, developed countries with higher Gross National Product and
per capita income show between sanitation, less pollution, easier access to healthcare, higher
living standard and lower mortality rates in relation to countries with lower per capita income.
When comparing individuals, income significantly determines ability to change occupation if
deemed unfit whereas people with low income tend to keep working in occupations with poor
working conditions as they have less alternatives. Although, short term impact of income upon
health remains elusive, income definitely matters for long-term health of people (Weida and
et.al., 2020).
Health Challenges associated with socio-economic factors
On the basic of views stated by O’Neil and et.al., (2020) the social determinants have a
major impact upon the quality of life of people which in-turn affects well-being and health.
These include requirements of safe housing, neighbourhood and transportation. Other
primary factors include job opportunities, nature of occupation, education level and quality
and income. Access to nutrition and healthy diet, opportunities and level of physical
activities, the level of pollution in water and air, literacy and language skills (Maria and
et.al., 2020). The determinants of poor health are health status and condition in early
childhood, unemployment and low-income levels, no basic support to acquire medical
facilitates, poor working conditions, lack of social support, poor transportation, poor
nutrition, low level of information and knowledge, higher substance abuse etc. Even in the
most affluent regions and countries like UK, the people who are less well off or facing
social constraints have substantially shorter life expectancies and higher tendencies to get
sick.
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According to a research conducted by Ucieklak-Jeż, (2018) education and Income
collectively impacted the areas of access to healthcare, prevention and treatment, and patient-
provider information. People of low-income group reported that their situation affected the
scheduling, type and number of diagnostic tests advised by the general physicians. Less services
were available for people due to high costs of the various diagnostic tests and lack of
information. Many of them experiences that the type of medications prescribed by the doctors
were not barned and generic. In relation to access to care, people with low-income experienced
multiple hindrances such as time, distance to healthcare facilities and cost of treatments
(Ucieklak-Jeż, 2018). In some situations, people were reluctant to hospitalisations which in turn
resulted in higher costs of healthcare as the situation worsened. In context to patient provider
information, communication barriers were noted as individuals felt their queries were not being
heard and were subjected to negative phrases.
In study by Kim and et.al., (2018), the impact of socioeconomic status was evaluated on
the health behaviours like chronic complications and metabolic control level in Korean patients
suffering from type 2 diabetes, which resulted in lower educational and income level being
closely related. Older men and women with low education and income possessed an increased
level of carbohydrate intake from food and lower intake of fat, while more educated men
lowered the chances of possessing uncontrolled hyperglycaemia and lowered the chances of
suffering from diabetic retinopathy (Kim and et.al., 2018). However, higher income level as
observed to be directly linked to obesity and a higher Body Mass Index (BMI). Contradictory to
this, in another study by Brunello and et.al., (2016) the causal effect of education upon health
was evaluated focussing on the area of health behaviours that are attributed. Two instrumental
variables were applied, that are, compulsory schooling reforms and a combination of aggregation
for addressing endogeneity of education and health behaviours. Education and awareness could
create positive impacts over the health care of people belong to age group of beyond 50 years.
When considering the health behaviours like drinking, smoking, exercising and body mass index,
the impact on health was accounted for short term while education affected the health on a long
term.
Marmot and Allen, (2014) elucidates that both income and health benefit the health of a
person as educated people are more likely to get better job opportunities and attain health
friendly benefits like Mediclaim, paid sick leaves, health insurance in comparison to people
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working in high-risk occupations which had few benefits. Higher earnings can increase the
availability and purchasing power to procure healthy food items, regular exercise, better
transportation and affording health services (Buheji and et.al., 2020). Conversely, low income
and education would lead to job insecurities, lack of assets, high vulnerability during tough
times, poor nutrition, unstable housing and unfulfilled medical needs (Adler, Glymour and
Fielding, 2016). People with higher income and education level also have positive psychological
and social benefits while those with less resources of social support, less sense of control over
life tend to showcase higher effects of stress. Lower income households pertain to poor living
conditions and higher pollution and population which tends to further impact health. Apart from
that people tend to suffer from a lack of primary healthcare services and other facilities (Newton,
Braithwaite and Akinyemiju, 2017.).
Furthermore, Foster, H.M. and et.al., (2018), elucidated that people who are having more
income, more education, more wealth and even more social standing suggests that those people
will tend to have longer as well as healthier lives. It is also reflected that relationship between the
socio economic factors and healthcare is very complex in nature. If there are differences in such
factors then there can be effects which are cyclical and compounding which can be accumulated
over the generations.
Building blocks to the above points, Cadar, D. and et.al., (2018), described that the
socioeconomic status also has the ability to impact the opportunities for the people which helps
in improving the health. If the income and wealth is greater, then this can help in gaining better
medical care, safe neighbourhoods and communities along with nutritious food. Through higher
income, Individuals can also gain the high quality education as well as more opportunities for
physical activity.
On the basis of views of Stormacq, Van den Broucke and Wosinski (2019), economic
development contain chances of reduction in health inequality. In some countries like Britain, it
was increases unlike the decrease. This was observed in the European countries and the Unites
states as well that if the socioeconomic status of individuals is higher, then the health condition
of the people is much better than the ones who have lower socioeconomic status.
In support of the above statement, Rizzuto and et.al., (2017), also highlighted various
theories as two different perspectives such as health selective theory and social causation theory.
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The difference in the Social Economic Status is considered as the most important and major
cause of the inequalities of health. This was suggested by social causation theory. On the other
hand, the health selective theory evaluates that people who are having good health can have
higher SES in most of the cases. This is how, it can be evaluated that there is a close relationship
between the influence of SES and the lifestyle of people. This is identified that proper health care
practices will improve health care of people even in old age. Proper diet, exercise, routine and
such related practices can provide the best level of health care nourishment.
Building blocks to the above point, Deepa, Anjana and Mohan (2017), also elucidated
that there is a strong relationship between Socio Economic Status (SES) and lifestyle. Individual
has the opportunity to choose a lifestyle from the existing choices, but the number of choices is
mostly determined by the social determinants and the SES. Lifestyle is also the most important
mechanism along with health and SES. The people who live a healthy lifestyle are found in
better mental and physical health. Between the relationship of health and SES, the lifestyle
becomes the mediator. SES affects the people’s health directly through the behaviours of
lifestyle. The personal routine whether negative or positive is even reflected by the lifestyle
(Geels, McMeekin and Pfluger, 2020).
According to Omidvar and et.al., (2018), the individuals having the higher income mostly
prefer the private organisations on the other hand, the people who are not much rich and are
having health insurance, they prefer to use public facility. The women, who have primary as well
as secondary education, prefer the facilities of private health. The people having middle or upper
income or moderate health status prefer public health services. There are also some differences
because of socio-economic inequities which states that the health facilities are not being used in
an optimal way (Khouja and et.al., 2020).
Solutions to deal with health challenges associated with socio-economic factors
Pons-Vigués and et.al., (2014) have illustrated that, multiple solutions for overcoming
various health challenges of prevention, treatment, access to healthcare and nutrition etc. have
been developed through ongoing, automated recall programs for individuals and families for
educating the on awareness of health, significance and maintenance health & well-being. The
programs involve wellness visits, screenings and visits as illness initiates. These policies and
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programs can be used by UK's government to deal with health issues and improve morality rate
of the people with low socio-economic status (Gopalan and Misra, 2020). The primary
determinants of health are healthcare, health behaviours and environmental exposure along with
chronic stress, morbidity and mortality. To counter these problems, addressing the link between
health and income equality by upgradation of tax and transfer benefits, subsidies, upgrading
pensions can be done.
As per Scott-Samuel and Smith, (2015), declared that elimination of health disparities
requires focus on all components of socio-economic status and address the pathways by which
they influence health. Steps like universal coverage for children, medical aids, health insurance
programs and implementation of national health policies. As education is considered key to
health inequalities, programs and policies for encouraging higher education and fostering early
childhood education have to be implemented by the governments of both emerging and
developed economies (Ozili, 2020). Apart from increasing access to health benefits, policy
makers need to debate on the merits of improving health of the population. Other aspects include
boosting productivity and increasing human capital, enhancing socialisation of future
generations, augmentation of lifetime earnings and attainment of education. Forster, Kentikelenis
and Bambra, (2018) state that in order to tackle health inequalities associated with low-income
levels, distribution of low-cost healthcare and generic medications have to be increased in the
existing healthcare policies in countries. Distribution of equitable income has to be focussed and
investment of more public goods and infrastructure, especially improving healthcare
infrastructure is necessary. Policies that are implemented have to reduce wealth inequalities,
increase availability of mortgage and loans, capital gain taxes, local financing options etc.
As per Nickel and vondem Knesebeck, (2020) other ways in which healthcare
professional and practitioners can assist in addressing socio economic factors are development of
policies and processes according to socio-economic factors and feasibility. Increasing frequency
of communication and accessibility is necessary for patients from different backgrounds.
Another way is to develop on going and automated recall programs as patients with low
education or income or both tend to not do regular visits to hospitals, to which nudges and
reminders might give them a push. Using multiple contact channels and being flexible on no-
show policies can reduce their reluctance in seeking health care by people.
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Various health promotional courses and programs can be further implemented by the UK
government to deal with health-related conditions to spread awareness regarding diseases and
make people self-sufficient. As per Taggart and et.al., (2018) DESMOND program or Diabetes
Education & Self-Management for Ongoing and Newly Diagnosed is quickly expanding across
UK via the National Health Service (NHS). This course is designed for supporting the patients
suffering from Type II Diabetes, empowering them to make their own decisions by educating
them. As per the author, there have been significant changes in the lifestyle outcomes of the
patients who attend the program but no biomedical outcome was noted. There is a gap in this
area of study and there is a need of an extensive discussion on self-management programs and its
effectiveness in dealing with socio-economic constraints of health.
Views illustrated by (Poli and et.al., 2017) indicate that United Kingdom is very
developed in economical context. Even after having a huge development and advancement socio
economic issues are rising in the region. The key reason identified is due to over stress, hectic
life schedule and irresponsible attitude and behaviour of people that could not guide them to give
emphasis over health care awareness. This could damage the life expectancy ratio of UK as well.
Well-being of people has also challenged due to this.
Literature Summary
The above literature review critically evaluated and summarises researches and studies
regarding the impact of social determinants on health of people and signifies the importance of
the topic. The whole review is divided into three themes. The first theme discussed regarding the
concept of social determinants and definitions from multiple authors was stated. The main socio-
economic determinants were evaluated to be education, occupation and income, which were
interrelated when impacting health. The second theme discussed regarding the health challenges
that these socioeconomic factors bring, which include lack of access to healthcare, lack of
patient-provider information, lack of access to healthy diet and nutrition, proper living
conditions, health behaviours, unmet medical needs and high vulnerability to sickness (Kamble,
Gunasekaran and Gawankar, 2018). The third theme discussed regarding solutions that
government and health practitioners can take to improve the health-related issues arising from
inequitable health and lack of education, such as investment on public goods and health
infrastructure, upgradation of tax and transfer benefits, subsidies, upgrading pensions can be
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done. Universal coverage for children, medical aids, health insurance programs, implementation
of national health policies programs and policies for encouraging higher education have to be
initiated. It was also observed from the literature overview that the people who are having high
income can get the best treatments at the private hospitals. Likewise, the people who got more
knowledge regarding the health, they will tend to eat healthier food as compared to what is eaten
by others (Poli and et.al., 2017). This can be recommended that the suggestions must be related
to the geographical locations, outcomes of health, studying about pollutants, involving the
communities, choice regarding the socioeconomic indicators along with the policy concerns. The
economic inequality can be connected to the poor mental health. Its disadvantage can be low
income, debt, housing, unemployment and many more. The people who are secluded socially
tend to have more deteriorated mental health. The more inequality between the society and the
economic recessions affects the mental health greatly. This does not end here, sometimes there
also comes the case of suicide due to the socioeconomic disadvantage. This relationship between
the mental health and educational inequality can be used in analysing the significance of the
employment for mental health and for this education is must (Oztemel and Gursev, 2020). The
disparities in the education and the income play the most important role for understanding the
racial difference in terms of mental health and health. The social class also helps in predicting
the health inequalities. The effect of economic inequality, deprivation and poverty can be seen in
the poor mental health in many countries.
19

Findings
Data analysis involves the interpretation of secondary data observed and gathered using
various authentic journals, government reports, articles, journals, business reports, internet,
libraries and other secondary sources. The method used will be thematic analysis for the study od
qualitative data from the above-mentioned secondary sources and all relevant themes in relation
to the effect on income and education on health will be studied and interpreted from the
organizational point of view of NHS UK.
Theme 1: Socioeconomic Status and determinants of health
According to Adler, Glymour and Fielding, (2016), socio-economic status is a class of
individual group in which people are differentiated in terms of their education, income,
occupation. Researchers are trying to develop link between socio-economic status and relative
incidence. It is related to multiple diseases to avoid high socio-economic status and risks it
spread protective strategies. These protective strategies such as identified money, knowledge etc.
help to overcome risk of socio-economic status. Socioeconomic status possess many
disadvantages to the risk factors for deteriorating the health of people and are characterized by
social circumstances for the entire life course and is a robust predictor of health. Inequalities in
health persist across regions, ethnicity, genders and socio-economic positions in respect to
getting access to health care and becoming major causes for ill health. The distribution of health
is determined by various factors such as individual, community and geographical and national
factors. There has been a growing evidence that documented inequalities in health-based
outcomes/ distribution of health as well as gaining access to healthcare in government
institutions like NHS in the UK and also internationally. Although ability to use and approach to
healthcare is a issue on the supply side which indicates the level of service of which is offered by
the healthcare system to the individuals with ill health in respect to the socio-economic status. It
is also known as a fundamental reason of diseases. As per the view of Adler, Glymour and
Fielding, (2016), people who are poor and powerless their health are worse compare too others.
People with lower socio-economic status face more issue in society. It also has various policy
points such as poor and socially disadvantaged people are more focused on their health because
20

their health is not well, Rich and socially advantage people forced on there present health, and
they take precaution in earlier stage.
As per Bartley and Blane, (2008) the inequalities in the determination of health can be
documented on the basis of social class, ethnicity and gender in context to UK and all the
inequalities have been assessed by using different results on the basis of infant death rate,
morbidity, mortality rate, presence of disabilities in individuals and the overall life expectancy.
When it comes to social class which includes wealth, education and income, the UK has a long
history in the presence of inequalities. For more than a century, the medical officers were
concerned regarding the health-based outcomes and it was noted that the health outcomes started
to worsen with the rise in the economic and social disadvantages. It is important to make sure
that there has to be higher health care which is being provided and that is going to be good for
the overall operations as well which would be a great factor for the overall development of this
industry. After taking so many scoring and tests there is going to be a negative impact which is
going to be present and there is going to be an improvement which is going to be required by the
end of it. Bartley and Blane, (2008) also stated that the entire population was divided into five
categories of social classes according to the work, that is, professional occupations(I), Technical
and management operations (II), Manual and non-manual skill operations (III), Semi-skilled
occupation (IV) and Unskilled Occupation (V). The report by the government showed that the
occupational based mortality resulted in men who belonged to the social class V or unskilled
being two and a half times more likely to be dead before the age of 66 than the ones that
belonged to the social class I. It was also found that children who belong to the social class I
were twice as likely as safer from mortality than the children who belonged to the social class V
family (The National Statistics Socio-economic classification, 2020). These five categorize are
further discriminated in socio-economic status. Almost all information on inequalities in the
discovery of health care data is included privately funded and survey data.
Newton and et.al., (2015) interpreted the study of social class and health and stated that
when it came to the number of still death in children for social class V ranked at 8 while the
children from social class, I ranked at 4. When it came to infant mortality rate, the
underprivileged children had a higher rate of 8 while social class I children ranked at 4. As per
the mortality rate of children aged between 1 and 15 years of age ranked at 42 while children
aged 1 to 15 in the social class, I ranked at merely 18. While growing up there is a lot of change
21

which comes in the thinking and that needs to be considered and that is going to make the
performance level be increased and that would be a better operations which would be present. As
per the standardized mortality rate of men aged between 29 and 65 years was observed high
among the social classes IV and V with 116 and 189 respectively while men from social classes I
and II ranked at 66 and 72 respectively. Newton and et.al., (2015) has interpreted that social
class-based inequity persisted for every age group in the UK all major diseases like
cardiovascular diseases, respiratory diseases, mental illness, arthritis, diabetes etc. There is a lot
of work load which is present, and they have a very systematic lifestyle as well with the same
objective which is to get in more money. This lifestyle is not healthy, and they need to do
activities and other involvement in events so that they are going to have higher understanding
which is going to be present.
As per Feigin and et.al., (2016) in another analysis conducted by the Global burden of
Diseases resulted in males who lived in the impoverished regions in England in the year 2013
showcased a life expectancy of an astonishing 9 years shorter 8.3 years shorter than the male’s
population residing in the least disadvantaged regions, and can be concluded as a large
difference. Female and male have a different way of living and a different take on life which has
to be considered so that there is going to be higher functioning and operations which are going to
take place. When, it comes to the life expectancy of female population who resided in the most
impoverished regions in the England was 6.7 years shorter than that of women who lived in the
least disadvantaged regions. In the study an inverse relationship between health deprivations and
health-based results was established (Health and social care, national archives, 2020). In current
times the health expectancy of the men at birth in UK is 63.5 years while the health expectancy
for women is 65.7 years. There is a lot of work load and pressure which is present on the men
society which is present in the females as well nowadays which is why the expectancy rates for
women has dropped down. It is according to the surrounding and thinking of the society as well
which si going to be considered in this situation which has to be present. Interrelationship of all
the individuals has to be studied in order to make sure that there is good understanding and
standards which are going to be present.
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Theme 2: Health based in equalities in context to NHS health care in UK
According to Cookson and et.al., (2016), national health service or NHS is the
comprehensive term for the public sector health care system of United Kingdom which is being
publicly funded from the general taxation since 1948. The organization was founded for the
purpose of provision of healthcare access which is always demanded by the clinical needs of the
people of the UK. But the major issues are that the use of services of the NHS is not solely
determined by clinical needs. Various individuals who have the same health needs tend to
receive different mount of care as per their socio-economic status. As per this empirical
investigation of variation in the NHS among various education and income groups in the
outcomes resulted in individuals being differing in their needs and requirements for health care.
It was also noted that the people that had received higher formal education on a n averaged tend
to be in better health and therefore distinct patterns of use was observed.
As per Bolger and Morago, (2020) in another study on NHS and the access to healthcare,
considering education as a proxy for socioeconomic status, when it came to low or no formal
qualifications, there was a high number of such persons being affected by poor health in contrast
to people with higher educational levels of degree and equivalent tend to have very good health
status. When other categories were studies, it showed that low soc-economic status people had
higher longstanding illness while the mean number report suggested high difficulty with
mobility, ADLs and IADLs. It is noted that the NHS focusses on three kinds of healthcare,
accident and emergency departments for unplanned treatments, outpatient care where the patients
are referred to the institution and don’t stay over night and inpatient or admitted patients who
split between emergency and pre-planned admissions or electives. Bolger and Morago, (2020)
observed in the study that people with low socio-economic status has reported to higher number
emergency and accident visits that people with higher education levels. It was also observed that
the outpatient visits were almost equal across all educational levels while the emergency
inpatient admissions were higher for people with low educational level. It was also noted that the
elective inpatient admission rate for people with no education was higher than the people with
high level of education.
However, in another study by Love-Koh and et.al., (2020) the authors observed that when
it comes to social and economic inequalities in the use of care provided by NHS in England, the
proportion of patients that spent more than 10% of their income for such charges which required
23

out of the pocket health care expenses was least in the UK as compared to other developed
countries. The number of people who skipped the medical consultation due to the reasons of cost
in UK was around 4 persons in a population of 100, which is still low as compared to other
countries like USA. NHS has even tried to incorporate need for care with the general practice
since 2014-15, although it has still a long way to go despite its efforts in many years in terms of
supply of primary health care to be well aligned with need. When it comes to payments of
general practice in most deprived areas was quite less and receive 7% less funding per patient
than the least deprived regions, there are fewer GPs serving the most deprived areas. However,
practices in the most deprived areas having more nurses while the number of appointments is not
very different in the most deprived and least deprived regions. Although, it was also observed
that one is more likely to see a practice nurse in the least deprived area than witnessing a general
practitioner. It was also inferred from the data in the study that the most deprived regions had a
face to face appointments compared to the least deprived areas which preferred to have
appointments by phone. The patient satisfaction has also seen a major drop in the most deprived
regions in comparison to least deprived regions.
As per Chouhan and Nazroo, (2020) there are major inequalities in health care and its
access in UK. Health care access is indicated by the supply side issue which infers that the level
of service that healthcare system offers to individuals. NHS has made the equity in healthcare
access as its central objective since its inception, there are various inequalities that still persist. In
an inverse care law, it is also stated that the availability of better medical facilities varies
intensely with the requirement for the population that has to be served. As per the study, the
authors emphasized that the groups of people who are hard to reach and seldom heard tend to
suffer from more health-based outcomes and receive less healthcare service for multiple reasons.
In the study, the heard to reach groups were categorised by the black and minority ethnic groups,
asylum seekers, the homeless people, adolescents and teenagers with eating disorders, people
with no employment, people with lack of education and any other skill-based training. Chouhan
and Nazroo, (2020) state that along with this people with sensory impairments and those with
certain unexplainable medical symptoms, patients who suffered from advanced cancers, people
who underwent substance abuse, those who had learning disabilities, people with mental health
issues and old people who suffered from a variety of sensory, physical and mental health
problems were also treated with inequality.
24

Kmietowicz, (2020) states that equality in the access and reach to healthcare for various
communities needs to inculcate travelling distance facilities being equal, better healthcare
infrastructure in local areas, better transportation and communication services, waiting time and
appointment facilities being equal, patients being equally informed regarding the presence of all
required and effective treatments and equal cost and charges to consultation, medications and
other medical facilities.
Richardson and et.al., (2020) have outlines the major reasons for variations in the health
acre on the basis of availability, quality, costs and information. Many health care services might
not be present for certain population groups or even clinic practitioners as they have distinct
propensity for offering treatments to people from another population groups, in spite of them
having similar needs. The quality of the health care services that are offered to patients tends to
vary among various population groups. The costs involved in health care services that are
provided to the patients in either financial terms or otherwise tends to vary among various
population groups. Apart from these, the health care institutions tend too fail in ensuring that the
entire population groups have been made equally aware regarding the services being available
and educate them regarding diseases, treatments, preventions etc. Richardson and et.al., (2020)
has explained the reasons why this happens as the hardship to reach communities where the
patients face multiple barriers like culture, language, education level, income problems, general
medical literacy and other barriers like being reluctant in engagement with these services. It is
difficult for NHS to engage with such social excluded and even marginalised communities and is
therefore a major challenge. Although, NHS has been increasing its facilities’ flexibility and also
partnering up with voluntary organisations and non-government organisations to increase the
patient involvement, and can be deemed an effective mechanism to reduce the inequalities of
health care.
Theme 3: Health conditions of low socio-economic population and initiatives by NHS
It was estimated in the study by Kivimäki and et.al., (2020) that the socio-economic
factors led to many disadvantages in terms of diseases. In the study a sample size of 109,246
people were taken within the age group of 17- 77 years of age. The socio-economic status was
calculated using the regional deprivation, occupational position, income and education as the
baseline. All the participants have followed up for diagnosis of health-based conditions as per the
25

standards of WHO international classification of diseases and the generalizability of the findings
were tested. The findings inferred that in 110,831 person-year at risk, it was recorded that the
corresponding numbers for the UK that were taken under hospitalizations was 60,946. Across al
the socio-economic indicators and after removing constants and adjusting the lifestyle factors,
when compared with the group of advantaged people, it was observed that the low socio-
economic status people were associated with higher risks for 18 among the total 56 health
conditions studied. The 16 diseases would be attributed to the inter-related health-based issues
where the hazardous ratio was higher than 5. Kivimäki and et.al., (2020) describe that this
consequently started with the psychiatric and mental health disorders, self-harm and high amount
of substance abuse which subsequently resulted in liver and kidney diseases, cardio vascular
diseases like ischemic heart disease, respiratory diseases like chronic obstructive pulmonary
diseases and bronchitis, cerebral infraction, cancers of the lung and Alzheimer’s and other forms
of dementia. Therefore, it can be interpreted from the review that Healthcare policies and
practices can effectively address the psychological and other health problems in the social
contexts, and if done in the early years of the life cycle development, this could prove to be an
effective strategy for reduction of health inequalities.
Currie and et.al., (2019) elucidates that NHS has initiated various policies in dealing with
the health-based inequalities and is still striving to achieve the goals. NHS has involved local
systems in taking actions to reduce the inequalities through clinical commission groups and local
authorities who share responsibilities to address the priorities and the outcomes using the health
and well being strategies and commissioning innovations. NHS has started provision of
resources in relation to improving the health and wellbeing of the disadvantaged population
specifically related to the social determinants like education and income. NHS has started
reduction in the variation of quality of services that are provided and the variations observed in
the access for diseases like diabetes- DESMOND program, atrial fibrillation, psychological
therapies and hypertension.
As per Alderwick and Dixon, (2019) the institute has also tried to improve the social
identifies of health by initiates in terms od employment welfare advice and programs and
housing. NHS has increased the engagement of the local staff who conduct national and local
interventions through programs like healthy child program. The practices to support healthy
behavior among people has been started which describes how certain groups who may have
26

higher possibilities of possessing a poor health behavior will be supported for positive results.
NHS has also partnered up for increasing the awareness and reach of its programs and policies
and focusing in strategic development in reduction of health care inequalities along with
redesigning and engaging communities and high prioritization of health care service and
healthcare infrastructure development.
The term socio-economic explains sociological and economic factors, which put impact on
dealing with the health challenges. These factors consist income level, or group of people who
are not having any income, unemployment, citizenship etc. People having low income have to
face issue during the treatment of their health issues, as it puts dramatic impact on the health. On
the other hand, those people of society who belongs to the upper class or known to be high net
worth they have quality of food take nutritious ingredients in their meal same as they spent on
their health and they can spend ample of money on their diseases and for the treatment as well,
but in opposite the low income group of people don't get proper nutrition in result they may face
illness and due to shortage of money they even can't get proper health care and treatment due to
lack of treatment many people lose their lives. So the socio-economic is responsible for the
health challenges of people. There are many hurdles in the accessibility of health care as well
which includes education gap, improper facility of staff and hospitals and health professionals,
owing to this many people specially those who are from slum area are legging behind to get
proper health care services. This is one of the biggest reason behind the increase in the mortality
rate. Government can do something for poor people by providing them free of cost health
services and necessary medicines and try to bridge the gap of lower and high class people by
providing them equal opportunities. By conducting regular campaign for the people who are
living semi-urban areas, in slum and backward areas to make them aware about the importance
of regular health care check-up so that they get to know about the various types of diseases apart
from this they should be taught numerous precautions so that they can protect themselves from
any kind of big diseases by taking proper precautions. Owing to having differences in the society
it put emphasis on the health of the people which should be accepted by anyone but this the bitter
truth of society and people are not thinking about the health of other persons just because they
are poor or not in the condition to get proper health care for them, besides this the gap between
upper-class and lower-class of the society is getting increases with the passage of the day.
Except this socio economic factor includes place of living, if the person is living in the pleasant
27

environment and atmosphere there is there are fewer chances of facing any health issue on the
other hand if somebody is living in the poor locality and in unhygienic area, chances of getting
illness is very high. Due to that they have to go hither and thither for treatment, and owing to
lack of money they don't get proper health facility as well in result they may affect their family
member, society and those who fall under their contact. Government should take some steps to
protect the lives of poor people
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CONCLUSION AND RECOMMENDATION
Conclusion
From the above research project, it can be concluded that low socio-economic status has
been linked to multiple health related issues and problems. The people who had lower income
levels tend to be more prone to situations and conditions like lack of healthcare, health
management problems, nutritional and dietary needs, emergency health treatments, health
behaviour of people, prevention opportunities, treatment opportunities etc. People with low level
of educations tend to lack health behaviours, health literacy, general communication and
understanding, health management etc. They also feel that lack of education can be associated
with health risk factors like obesity, unwanted pregnancies and drugs and substance abuse. Most
people from this lower socio-economic status tend to suffer from diseases like diabetes, cardio
vascular disease, arthritis, respiratory illnesses etc, while many people also have a psychological
health condition. It was also observed that ethnicity, religion, race, nationality, gender tend to
increase the health-based inequalities couple with low income and education that people face in
UK. It was also concluded that majority of the people are not at all aware about health promotion
activities and initiatives by the government and public healthcare institutions. And many are less
likely to get enrolled in educational courses related to health. Apart from that it can be concluded
that low socio-economic status in aggregate affected the lifestyle, emotional well-being and
physical health of the people. It was evaluated that NHS is facing a lot of issues in terms of
healthcare provision but is initiative various policies and programs to reduce the inequality of the
socio-economic determinants of health like education and income.
Recommendations
There are various healthcare policies such as global health policy, health foreign policy
etc. that has goal to provide care service to the people above concern of specific nation. For
example, global health policy comprises the global governance structure which creates
accordingly public health throughout the global. The main objective of the policy to give
healthcare support to the people beyond of boarder restriction so that healthcare governments
across the world can improve life expectancy rate of people (Coster and et.al., 2017). Ass same
many government and agencies across global has proposed foreign policy in health for those
people who have low income status and due to this they unable to get treatment on time. With
29

this policy government across the global provides healthcare support to the people and treats
their healthcare condition in efficient manner. There has a great example of WHO and NHS,
these are health and social care companies that provides both type services to those people who
have low economic and social status in society due to this they unable to take care of their health
and suffers from chronic disease. Even these companies are not only provided healthcare support
but also it provides accommodation and education facilities to such people so that they can make
their life better like other normal people. So, it is best option for those people who are socially
and economically are weaker. Apart from this, UK’s government should formulate other
healthcare policies to cover maximize people who are still unable o get advantage of healthcare
policies. Like NHS and WHO, there must have other healthcare companies which can take care
of their health. So, it is one of the best ways to deal with people’s health issues.
Healthcare campaigns is another strategy that can play significant role in UK such as UK is a
developed country among others wherein multicultural people lives their life. In UK, all category
peoples i.e. below poverty line (BPL), lower class, middle class and upper class. BPL is
considered one of the weakest categories of people wherein most of the people are suffering
from malnourishments and do not have enough money that they can spend on their food and
education. In other word, these people are too much weakest in respect of socially and
economically. There is two reasons for this situation such as first, these people do not have good
education background so that they can get good salary from their owners which makes them
economical level. Other is that they do not have proper food so most of the time they sleep
empty stomach. In this context, UK’s government must organize campaigns on such rural places
and remote areas across UK whereas they do not get any advantage of government policies and
facilities. In this campaign, doctors, registered nurse, teachers and some volunteers require to be
presented because they can understand needs to such people and can provide them healthcare and
financial support. UK’s government should organize health promotion interventions in different
areas to support them and aware them what food they must be taken in their diet through which
they can keep them healthy (Tan and et.al., 2019). In addition, UK’s government creates some
agencies and allocates them across the UK so that they can provide healthcare centres and
facilities to those people. Another is that UK’s government should provide employment
opportunity to the people so that they can earn good then they can buy food products for them.
Due to lack of employment opportunity, these people unable to live their livelihood. Thus, these
30

recommendations must be implemented by UK’s government it will help this category to live
their life like middle- and upper-class people as well as improves their socio-economic status in
society which ultimately reduces death ratio of people who belongs to this category.
Alternative method:
Qualitative method has been used for this research assignment to collect information over
the proposed research topic. But quantitative method is also a good option for collecting
information. This method allows researchers to collect information in numerical figure that can
be easily interpreted by the researcher. I have decided that next time I will use quantitative
method for the data collection if I get similar research project.
31

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thenationalstatisticssocioeconomicclassificationnssecrebasedonsoc2010#structure-and-
flexibility>
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