The Impact of Socio-Economic Factors on Health in the UK

This report, focusing on socio-economic factors and their effects on health in the UK, examines the interplay between income, education, and health outcomes. It explores the concept of social determinants, identifying health challenges associated with socio-economic disparities, such as unequal access to healthcare and the impact on chronic disease prevalence. The research methodology employs a qualitative approach, utilizing secondary data from government reports, academic journals, and other reliable sources. The report highlights the significant impact of socio-economic factors on health, including the role of employment, income, and education in shaping health-related choices and outcomes. It investigates the health challenges faced by low socioeconomic populations and explores initiatives undertaken by the NHS to address these inequalities, offering recommendations for future interventions. The report concludes with a discussion of potential alternative methods for addressing socio-economic health disparities, emphasizing the importance of targeted interventions and policy changes to improve health equity.

SOCIO-ECONOMIC
FACTORS AND THEIR
EFFECTS ON HEALTH
H1801219
TABLE OF CONTENTS

INTRODUCTION..............................................................................................................4
Aims and objectives......................................................................................................5
Research Question.......................................................................................................5
Rational........................................................................................................................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 Consideration: .................................................................................................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: Socio-economic status and determinants of health........................................20
Theme 2: Health-based inequalities in context to NHS health care in the UK.............23
Theme 3: Health conditions of the low socioeconomic population and the initiatives
by NHS.....................................................................................................................................25
CONCLUSION AND RECOMMENDATION...........................................................................29
Conclusion ................................................................................................................................29
Recommendations.................................................................................................................29

Alternative Method: .............................................................................................................31
REFERENCES..............................................................................................................................34

Chapter one: INTRODUCTION
Background:
From a historical point of view, it has been evident that the people belonging from lower
social class who received low education, worked in poor circumstances and blue collard
jobs, with substantial low earnings have always been subjected to poor health and
developed chronic health conditions. The social and economic opportunities like stable
jobs, robust social networks, education from good schools can be foundational for
shaping the choices of people regarding housing, food and dietary choices, education
and healthcare. But Unemployment limits these choices due to inability of accumulating
any savings or assets that acts as a cushion in times of distress and health related
emergencies (Sabir and Aziz, 2018).
Across the United Kingdom, there are notable differences between social and economic
opportunities being available to the residents of the communities that are being cut off
from investments or tend to experience discrimination. Most of the expenditure on public
health care is focused with people from financially marginalised backgrounds.
However, pro-rich inequality is present across the healthcare infrastructure and overall
indicators of clinical progress in the experiences of people (Blankenship and et.al,
2018). This research will lay evidences through and secondary methods regarding the
socio-economic inequalities in UK, how education and income directly and indirectly
affect health and how efficiently government bodies deal in countering the challenges.
Socio-economic factors are education, income, community safety and social supports
that directly impacts individuals health and their well-being. The effect of socio-
economic factors on health has become one of the most discussing topics across the
world. d-Due to these factors, there are a wide number of people who are unable to live
their life prosperously. These factors also impact people's ability to make the
appropriate choice, afford medical care and housing, maintain stress level among
others (Queirós, Faria and Almeida, 2017 ). For example, when people have different
4

socio-economic opportunities like good schools, secure job and a 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 a
deep understanding to the reader about the impact of socio-economic factors on
people's health.
Aims and Objectives
Aim
“To evaluate the effect of socio-economic factors i.e. income and education on
health”.
Objectives
 To explore the concept of socio-economic factors i.e. income and education.
 To identify health challenges associated with socio-economic factors.
 To recommend a solution to deal with identified health challenges associated
with socio-economic factors and improves the health of individuals positively.
Research Questions
 What are the impacts of socio-economic factors on health?
Rational
There have been multiple studies regarding the impacts and association of education
and income with health but there are limitations in understanding how they affect the
person at a fundamental level, The motivation of this study is to find out how closely and
direct social determinants affect the health of people and its deep impact upon areas
like access to health care and health policies. The research also aims to fill the gaps
between how the citizens from various ethnic and racial backgrounds in the UK
belonging to low economic status are affected in context to health as it is able to
mitigate the gaps between the different barriers of socio economic. The research aims
to understand the impacts of government involvement, the progress in context to
5

policies and health programmes and courses, initiatives and solutions that have benefit
the situation.
Objectives
Understanding the concept of socio-economic factors i.e. income and education
According to Cookson and et.al.,(2016),socio-economic is the social science that
provides brief information about economic activity that affects and shapes social
processes. Income and education are the two major factors that directly affect
individuals health for example employment that provides income through which
individuals are able to shape choices about housing, education, food, medical care etc.
On the other hand, unemployment or illiteracy limits choices and the ability of saving
assets that supports in economic distress situations.
Identifying health challenges associated with socio-economic factors
In a study by 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 per cent of people are in low-income families, so they
enable to receive less medical care such as treatment and screening that ultimately
increases the high death ratio. As same, 40 per cent adults are non-graduated because
they did not have enough money to take admission in higher school. Due to such an
illiteracy ratio, most people are unaware of a life-threatening disease like cancer,
neurological condition, diabetes and so on. These are the major health challenges that
are properly related to socio-economic factors.
Recommended 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 related to ongoing, automated recall
programs for the people in which the awareness towards keeping health well-being.
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 mortality rate.
6

Chapter two: 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 are identified
along with an 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 nature. Qualitative research on the other hand focuses on the collection
and analysis of written data, spoken data or textual data. It focuses on softer areas and the result
is inductive with an inclination towards understanding perceptions (Mohajan, 2018). A
qualitative study is used to deliver this research. As the objectives and aim of the study allowed
the researcher to use this technique of study. A qualitative study will favour the researcher to use
all different models and theories to achieve the objectives behind the study. Research Types:
Research is referred to the study of available information and different materials to find out
appropriate outcomes of the problem of study. Qualitative and Quantitative are the two
research types that are used to collect data. This research will use a qualitative
research method for collecting data over the proposed research topic because it
maintains quality while collecting data (Caliciogluand et.al.,2019).
Research Philosophy:
The research philosophy refers to a system of thought that the 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, the researcher has adopted interpretive-based philosophy which aims over
integrating human interest into 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.
7

The major reasons for the selection of this philosophy were 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 the researcher to interpret the entire information in such a way that researcher
get to meet all different 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 patterns, resemblances, regularities of
experiences to derive 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 the 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 research approach will aim to draw a general
conclusion from the observations of data and instances of responses (Averchenkova,
Fankhauser and Finnegan, 2021). It has merits of flexibility, allows closer attention to
the subject and context and is highly supportive towards the generation of new theories.
Inductive reasoning is used to predict the possibilities that might be encountered.
Research Approaches: It defines as a plan or procedure that properly consist of broad
assumptions in the context of the reason of data collection, interpretation etc. There are
two research approaches i.e. inductive and descriptive. This research will use a
deductive research approach for collecting data on the research topic because it helps
in choosing the right research method to conduct the study.
8

Research Design:
This is the overall strategy of how the research is conducted and selected for
integration of various components of the study logically and coherently 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
that provides answers about what, who, where and when of the research problems with
the variables present in situations. The research will narratively and accurately analyse
the impact on health due to education and income in the 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 an entirely
unchanged natural environment. It is also time-efficient and quality efficient that would
allow the researcher to gain the best level of outcomes against the study conducted.
Research Design: It is a strategy that is selected to integrate different components of
the study in a logical way. There are three research designs exploratory, explanatory
and descriptive. Exploratory use for the research problem while explanatory uses to pick
the better option in available data. This research will use a descriptive research design
because it gives a proper understanding of the nature of the demographic segment.
Data collection:
For conducting research, the 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 the 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, the internet, library database etc (Paradis and et.al., 2016). Data Collection:
There are two methods of data collection as primary and secondary. Primary data is
collected through interview session while secondary data is collected from available
resources like magazines, research articles, the Internet and social media. Secondary
research methods will apply to collect information related to the proposed research
topic.
9

Research Strategy
Research strategy is a precise plan behind the study. This involves planning,
strategic formation, implementation and controlling of the study. The entire study is
conducted based on the strategies designed by the researcher. This involves strategic
choices related to the collection of data, information, analysis, assesses and many other
strategic directions. The methods like questionnaire technique has been used to collect
information under the primary research. As a part of the secondary research literature
review section has been conducted to deliver the overall study under this project.
Data Analysis:
Data analysis is the process of interpretation of collected data and modelling it for
analysis and reaching 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 inductively. 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 for
this exploratory nature of research. The analysis is highly suitable for huge databases
and allows the researcher to expand the range of research past individual experiences
and also helpful in the interpretation of themes that is backed up by data. Data Analysis:
It is a process of understanding and interpreting gathered data in a way that portray a
logical conclusion. The thematic method will be used in this research assignment
because it helps to distribute data into themes that can be easily interpreted during the
training session.
Sampling method:
Selected number of people from a wide population as sample size known as
sample population. There are two sampling methods probable and non-probable. This
research will use a random sampling method to select the target population.
10

Validity and Reliability:
The research conducted is extremely consistent, highly dependable, applicable
to the situation or subjects and are highly transferable. The sources used in the
research are from authentic and published journals which are highly reliable for
academic inferences and purposes. The trustworthiness 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 that has been
coordinated in the information collected through literature review sources. Ethical
Consideration: According to ethical consideration, researchers should take permission
from authors before using published articles. They must maintain the dignity and
respect of the sample population while asking questions in the interview session. This
research assignment will follow all guidelines related to ethical consideration by the
researcher.
Limitations of the study:
Time and money both the resources were limited in number. Due to the
unavailability of proper resources information collected was restricted to a certain limit. If
there were more time available, then the study would have been very precise and
reliable. The limitation of time also allowed the researcher to only collect information
through secondary sources.
11

Chapter Three : LITERATURE REVIEW
Introduction
Socio economic is a concept associated with the different areas of the socity.
The aim of the concept of socio economic is that society contribute immensely in the
overall growth and success of the business. In against to the contribution made by
society this is the responsibility of the business entity to give bacj to the society of
whatever i has earned from the society itslf.
This part of the study involve different views and opinions stated by the authors,
writers over the topic of study will be presented. The socio economic as a concept will
be understood under this section from the point of views of researchers and scholors.
This part of the research study will collect the precise knowledge and information over
the topic of study. The critical evaluation will be designed so that all aspects of the topic
and information could have been summarises as a part of this study. Under this section
based on different themes information published in researches, study, article and many
other secondary sources will be collected and present.
Concept of social determinants
According to Adler, Glymour and Fielding, (2016), social determinants of health
isare 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, which are economic stability, access to education and quality, the
environment of the neighbourhood, also get access of the health care facilities,
education and different other element of socio economy. In a 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
12

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 socio-economic status of families, groups or
individuals are low, middle and high. As per the author, education level is an important
factor to determine what kind of job the person will get, 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 an 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 the economy, psychology and
health because 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 the 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, a socio-emotional
process that subsequently leads 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 relationship between socio-economic background and
education is very moderate and there is a gap in understanding the actual effect, which
needs more extensive research.
According to Schmidt and et.al., (2015), income is another determinant that
refers to the number of wages, rents, profits, salaries and other earnings received by
people. Inequality in income results in different lifestyles of people, where low-income
families have very few 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 helps them in getting better medications, healthcare
13

access and better nutrition (Schmidt and et.al., 2015). When comparing to developed
countries who has higher Gross National Product and per capita income provides better
sanitation, less pollution, easier access to healthcare to people and it also provides
higher living of standard and lower mortality rates to countries with lower per capita
income.When comparing individuals, income significantly determines the 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 fewer alternatives.
Although the short-term impact of income upon health remains elusive, income matters
for the long-term health of people (Weida and et.al., 2020).
Health Challenges associated with socio-economic factors
Based on views stated by O’Neil (2020), the social determinants have a major
impact upon the quality of life of people which in turn affects there well-being and
health. These include requirements of safe housing, neighbourhood and transportation.
Other primary factors include job opportunities, nature of the 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. There is no basic support to
acquire medical facilitates, poor working conditions, lack of social support, poor
transportation, poor nutrition. Also the low level of information and knowledge, higher
substance abuse etc. Even in the most affluent regions and countries like the UK, the
people who are less well off or facing social constraints have substantially shorter life
expectancies and higher tendencies to get sick.
According to 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 the low-income group reported that their situation
affected the scheduling, type and number of diagnostic tests advised by the general
physicians. Fewer services were available for people due to the high costs of the
various diagnostic tests and lack of information. Many of the experiences that the type
of medications prescribed by the doctors was not barned and generic. Concerning
14

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 a study by Kim and et.al., (2018), the impact of socio-economic 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 a 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, are compulsory schooling reforms and a
combination of aggregation for addressing the endogeneity of education and health
behaviours. Education and awareness could create positive impacts on the health care
of people belong to the 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 in the short term while education affected the health in athe
long term.
Marmot and Allen, (2014) elucidate 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 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 et.al.,
2020). Conversely, low income and education would lead to job insecurities, lack of
15

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 fewer 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 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
the relationship between socio-economic factors and healthcare is very complex. If
there are differences in such factors then there can be effects that are cyclical and
compounding which can be accumulated over the generations.
Building blocks to the above points, Cadar and et.al., (2018), described that
socio-economic status also can impact the opportunities for the people which helps in
improving the health. If the income and wealth are greater, then this can help in gaining
better medical care, safe neighbourhoods and communities along nutritious food.
Through higher income, Individuals can also gain high-quality education as well as more
opportunities for physical activity.
Based on the views of Stormacq, Van den Broucke and Wosinski (2019),
economic development contains chances of reduction in health inequality. In some
countries like Britain, it was increased, unlike the decrease. This was observed in the
European countries and the United States as well that if the socio-economic status of
individuals is higher, then the health condition of the people is much better than the
ones who have lower socio-economic status.
In support of the above statement, Rizzuto et.al., (2017), also highlighted various
theories as two different perspectives such as health selective theory and social
causation theory. 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
16

social causation theory. On the other hand, the health selective theory evaluates that
people who are having good health can have higher Socio economic status (SES) in
most 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 the 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. The 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 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 private organisations, on the other hand, the people who are not much
rich and are having health insurance, prefer to use a 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
state 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 et.al., (2014), have illustrated that multiple solutions for overcoming
various health challenges of prevention, treatment, access to healthcare and nutrition
and so on. They have been developed through ongoing, automated recall programs for
17

individuals and families for educating them on awareness of health, significance and
maintenance health & well-being. The programs involve wellness visits, screenings and
visits as illness initiates. These policies and programs can be used by UK's government
to deal with health issues and improve the mortality rate of 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 up-gradation of tax and transfer benefits, subsidies, upgrading
pensions can be done.
Scott-Samuel and Smith, (2015), declared that, the elimination of health
disparities requires focusing 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 the 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 to tackle health inequalities associated with low-income
levels, the 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 on and investment of more public goods and infrastructure,
especially improving healthcare infrastructure is necessary. Policies that are
implemented have to reduce wealth inequalities, increase the availability of mortgage
and loans, capital gain taxes, local financing options etc.
As illustrated by Nickel and VondemKnesebeck, (2020) other ways in which
healthcare professional and practitioners can assist in addressing socio-economic
factors are the development of policies and processes according to socio-economic
factors and feasibility. Increasing frequency of communication and accessibility is
18

necessary for patients from different backgrounds. Another way is to develop ongoing
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 (Nickel and
VondemKnesebeck, 2020).
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 the 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 for an extensive discussion on self-management programs and their
effectiveness in dealing with socio-economic constraints of health.
Views illustrated by (Poliand et.al., 2017)indicate that the United Kingdom is very
developed in an 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 overstress, hectic life schedule and irresponsible attitude and behaviour of
people that could not guide them to emphasize health care awareness. This could
damage the life expectancy ratio of the UK as well. The well-being of people has also
challenged due to this.
Literature Summary
The above literature review critically evaluated and summarises research and
studies regarding the impact of social determinants on the health of people and signifies
the importance of the topic. The whole review is divided into three themes. The first
theme discusses the concept of social determinants and definitions from multiple
19

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 discusses the health challenges that these socio-economic 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 discusses 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 in public goods and health infrastructure, up-gradation of
tax and transfer benefits, subsidies, upgrading pensions can be 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 people who are
having a high income can get the best treatments at private hospitals. Likewise, the
people who got more knowledge regarding health will tend to eat healthier food as
compared to what is eaten by others (Poli 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, the choice regarding the socio-economic indicators along policy concerns.
Economic inequality can be connected to 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 mental health greatly. This
does not end here, sometimes there also comes the case of suicide due to the socio-
economic disadvantage. This relationship between mental health and educational
inequality can be used in analysing the significance of employment for mental health
and this education is a must (Oztemel and Gursev, 2020). The disparities in education
and income play the most important role in understanding the racial difference in terms
of mental health and health. Social class also helps in predicting health inequalities. The
effect of economic inequality, deprivation and poverty can be seen in the poor mental
health in many countries.
20

Chapter Four Results and discussion
Data analysis involves the interpretation of secondary data observed and
gathered using various authentic journals, government reports, articles, journals,
business reports, the internet, libraries and other secondary sources. The method used
will be thematic analysis for the study of qualitative data from the above-mentioned
secondary sources and all relevant themes concerning the effect on income and
education on health will be studied and interpreted from the organizational point of view
of NHS UK. The themes designed above project about the different elements of the
society and its economic aspects. This is essential that all areas of the society get
proper growth oriented opportunities that can provide the proper support and
development opportunities to the society as a whole.
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 the link between socio-economic
status and relative incidence. It is related to multiple diseases to avoid high socio-
economic status and risks related to spread of protective strategies. These protective
strategies such as identified money, knowledge and so forth. help to overcome the risk
of socio-economic status. Socio-economic status possesses 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 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 the ability to use and approach to healthcare is an issue on the supply side
which indicates the level of service which is offered by the healthcare system to the
21

individuals with ill health in respect to the socio-economic status. It is also known as a
fundamental reason for diseases. As per the view of Adler, Glymour and Fielding,
(2016), people who are poor and powerless in their health are worse compare to 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 their health is not well, Rich and socially advantage people forced on
their present health, and they take precaution in an earlier stage.
According to Bartley and Blane, (2008), the inequalities in the determination of
health can be documented based on social class, ethnicity and gender in context to the
UK and all the inequalities have been assessed by using different results based on the
infant death rate, morbidity, mortality rate, presence of disabilities in individuals and the
overall life expectancy. When it comes to the 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 that 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
22

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 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 operation 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 workloads 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 a higher understanding of which is going to be present.
A study byFeigin 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 9 years but the real statistics are 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 the female population who resided in the most impoverished regions
in 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
23

archives, 2020). In current times the health expectancy of the men at birth in the UK is
63.5 years while the health expectancy for women is 65.7 years. There is a lot of
workload 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 is
going to be considered in this situation which has to be present. The interrelationship of
all the individuals has to be studied to make sure that there is a good understanding and
standards which are going to be present.
Health-based inequalities in context to NHS health care in the 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 the United Kingdom
which is being publicly funded from the general taxation since 1948. The organization
was founded for the 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 different in
their needs and requirements for health care. It was also noted that the people that had
received higher formal education on an n averaged tend to be in better health and
therefore distinct patterns of use were observed.
Bolger and Morago, (2020) in another study on NHS and the access to
healthcare, considering education as a proxy for socio-economic 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
studied, it showed that low socio-economic status people had higher long-standing
illness while the mean number report suggested high difficulty with mobility, ADLs and
IADLs. It is noted that the NHS focuses on three kinds of healthcare, accident and
24

emergency departments for unplanned treatments, outpatient care where the patients
are referred to the institution and don’t stay overnight 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 a higher number of emergency and accident visits than 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 a 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 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 the UK was around 4 persons in a
population of 100, which is still low as compared to other countries like the USA. NHS
has even tried to incorporate the 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.
Patient satisfaction has also seen a major drop in the most deprived regions in
comparison to the least deprived regions.
25

According to Chouhan and Nazroo, (2020), there are major inequalities in health
care and its access in the UK. Health care access is indicated by the supply side issue
which infers that the level of service that the healthcare system offers to individuals.
NHS has made equity in healthcare access its central objective since its inception,
various inequalities 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. In that 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,
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.
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
health care based on availability, quality, costs and information. Many health care
services might not be present for certain population groups or even clinic practitioners
as they have a distinct propensity for offering treatments to people from other population
groups, despite 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
26

health care institutions tend to 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 and more. 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 to engage 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 patient involvement, and
can be deemed an effective mechanism to reduce the inequalities of health care.
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 was 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 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 were 60,946.
Across all 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, cardiovascular diseases like ischemic heart
disease, respiratory diseases like chronic obstructive pulmonary diseases and
27

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 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 about improving the
health and well-being of the disadvantaged population specifically related to social
determinants like education and income. NHS has started a 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.
According to Alderwick and Dixon, (2019) the institute has also tried to improve
the social identity of health by initiates in terms of 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 the healthy child
program. The practices to support healthy behaviour among people has been started
which describes how certain groups who may have higher possibilities of possessing
poor health behaviour will be supported for positive results. NHS has also partnered up
for increasing the awareness and reach of its programs and policies and focusing on
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 explain sociological and economic factors, which put an
impact on dealing with health challenges. These factors consist of income level, or
group of people who are not having any income, unemployment, citizenship and so on.
28

People having low income have to face issue during the treatment of their health issues,
as it puts a 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 have the 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 peopledon'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 the education gap, improper facility of staff and hospitals
and health professionals, owing to this many people especially those who are from slum
area are lagging 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 a regular campaign for the people who are living in 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 emphasized 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 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 unhygienic area, chances of getting
the 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
29

affect their family member, society and those who fall under their contact. Government
should take some steps to protect the lives of poor people
Chapter five CONCLUSION
Introduction
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. 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
30

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.
As identified in the research, 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. This is why; these points must eb
considered while making specific recommendations which can help in meeting the challenges
and improving the health of the individuals. The socio-economic factors such as education,
employment, income etc. can also affect the quality of life the individuals live. Therefore, at the
time of making the health choices, managing stress and also affording the medical care and
housing, these must be addressed.
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
31

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
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.
32

REFERENCES
Adler, N.E., Glymour, M.M. and Fielding, J., (2016). Addressing social determinants of
health and health inequalities. Jama, 316(16), pp.1641-1642.
Alderwick, H. and Dixon, J., (2019). The NHS long term plan.
Arshed, N.,Awais, A., Nabeela, K., and Samra, B., (2018). Education enrollment level
and income inequality: A case of SAARC economies. Social Indicators
Research, 140(3), pp.1211-1224.
Averchenkova, A., Fankhauser, S. and Finnegan, J. J., (2021). The impact of strategic
climate legislation: Evidence from expert interviews on the UK Climate Change
Act. Climate Policy. 21(2). pp.251-263.
Bartley, M. and Blane, D., (2008). Inequality and social class: Scambler G, editor.,
Sociology as applied to medicine.
Blankenship, K.M., Del Rio Gonzalez, A.M, Keene, D.E., Groves, AK., and Rosenberg,
A.P., (2018). Mass incarceration, race inequality, and health: expanding
concepts and assessing impacts on well-being. Social Science & Medicine, 215,
pp.45-52.
Bolger, J. and Morago, P., (2020). Health and health inequalities. Social Policy for
Social Work, Social Care and the Caring Professions: Scottish Perspectives,
p.183.
Bradbury, K. E., Murphy, N. and Key, T. J., (2020). Diet and colorectal cancer in UK
Biobank: a prospective study. International journal of epidemiology. 49(1).
pp.246-258.
Brunello, G., Schneeweis, N., and Winter-Ebmer, R., (2016). The causal effect of
education on health: What is the role of health behaviours?. Health
economics, 25(3), pp.314-336.
Buheji, M., Katiane da Costa Cunha., GodfredBeka., B. Marvric YL De Souza., S.
Sousa da Costa Silva., Mohmmed Hanafi., and T ChetiaYein., (2020). The
extent of the covid-19 pandemic socio-economic impact on global poverty. a
global integrative multidisciplinary review. American Journal of
Economics.10(4). pp.213-224.
Cadar, D.,Lassale, C., Davies, H., Llewellyn, D.J., Batty, G. D., and Steptoe, A.,(2018).
Individual and area-based socioeconomic factors associated with dementia
incidence in England: evidence from a 12-year follow-up in the English
longitudinal study of ageing. JAMA psychiatry. 75(7). pp.723-732.
Castrucci, B. and Auerbach, J., (2019). Meeting individual social needs falls short of
addressing social determinants of health. Health Affairs Blog, 10.
Chouhan, K. and Nazroo, J., (2020). Health inequalities. ETHNICITY, RACE AND
INEQUALITY IN THE UK, p.73.
Cookson, R., Carol, P., Miqdad, A., and Rosalind, R., (2016). Socio‐economic
inequalities in health care in England. Fiscal Studies, 37(3-4), pp.371-403.
33

Cookson, R., Carol, P., Miqdad, A., and Rosalind, R., (2016). Socio‐economic
inequalities in health care in England. Fiscal Studies, 37(3-4), pp.371-403.
Coster, J.E Turner, J.K., Bradbury, D., and Contrell, A., (2017). Why do people choose
emergency and urgent care services? A rapid review utilizing a systematic
literature search and narrative synthesis. Academic emergency medicine. 24(9).
pp.1137-1149.
Currie, J., Guzman, Castillo, M., Adekanmbi, V., Barr, B., and O'Flaharty, M., (2019).
Evaluating effects of recent changes in NHS resource allocation policy on
inequalities in amenable mortality in England, 2007–2014: a time-series
analysis. J Epidemiol Community Health, 73(2), pp.162-167.
Deepa, M., Anjana, R.M. and Mohan, V., (2017). Role of lifestyle factors in the epidemic
of diabetes: lessons learnt from India. European journal of clinical
nutrition. 71(7). pp.825-831.
Dudovskiy, J., (2017). Interpretivism (interpretivist) research philosophy. Research
Methodology.
Dursun, B., Cesur, R. and Mocan, N., (2018). The Impact of education on health
outcomes and behaviours in a middle-income, low-education
country. Economics & Human Biology, 31, pp.94-114.
Feigin, V.L., Gregory, A. R., Moshe, N., Priya, P., Rita, K., (2016). Global burden of
stroke and risk factors in 188 countries, during 1990–2013: a systematic
analysis for the Global Burden of Disease Study 2013. The Lancet
Neurology, 15(9), pp.913-924.
Forster, T., Kentikelenis, A. and Bambra, C., (2018). Health inequalities in Europe:
setting the stage for progressive policy action.
Foster, H.M., Carlos, A., Celis-Morales., Barbara, N, Fanny, Petermann-Rocha., Jill, P.
Pell, and Jason, M. R. Gill., (2018). The effect of socio-economic deprivation on
the association between an extended measurement of unhealthy lifestyle
factors and health outcomes: a prospective analysis of the UK Biobank
cohort. The Lancet Public Health. 3(12). pp.e576-e585.
Geels, F. W., McMeekin, A. and Pfluger, B., (2020). Socio-technical scenarios as a
methodological tool to explore social and political feasibility in low-carbon
transitions: Bridging computer models and the multi-level perspective in UK
electricity generation (2010–2050). Technological Forecasting and Social
Change. 151. p.119258.
Gopalan, H. S. and Misra, A., (2020). COVID-19 pandemic and challenges for socio-
economic issues, healthcare and national programs in India. Diabetes &
Metabolic Syndrome: Clinical Research & Reviews.
Illingworth, P., (2020). Global citizenship: an exploration of the relevance to UK health
and social care professions. British Journal of Nursing, 29(4), pp.242-244.
Kamble, S.S., Gunasekaran, A. and Gawankar, S.A., (2018). Sustainable Industry 4.0
framework: A systematic literature review identifying the current trends and
34

future perspectives. Process Safety and Environmental Protection. 117. pp.408-
425.
Khouja, J. N., Marcus, R.Munafo., Caroline, L. Relton., Amy, E. Taylor, and Suzanne, H.
Gage., (2020). Investigating the added value of biomarkers compared with self-
reported smoking in predicting future e-cigarette use: Evidence from a
longitudinal UK cohort study. PloS one. 15(7). p.e0235629.
Kim, S.H.,S.Y.Lee, Chei, WK., Young, JS., and Study Group., (2018). Impact of
socioeconomic status on health behaviours, metabolic control, and chronic
complications in type 2 diabetes mellitus. Diabetes & metabolism journal, 42(5),
pp.380-393.
Kivimäki, M., David, B., Martin, J.S., Joana, P., Pryry, N.S., Tuula, O., Sakari, B.S., and
Michael, G. Marmot., (2020). Association between socioeconomic status and
the development of mental and physical health conditions in adulthood: a multi-
cohort study. The Lancet Public Health, 5(3), pp.e140-e149.
Kmietowicz, Z., (2020). NHS launches Race and Health Observatory after BMJ’s call to
end inequalities.
Liu, L., (2016). Using Generic Inductive Approach in Qualitative Educational Research:
A Case Study Analysis. Journal of Education and Learning, 5(2), pp.129-135.
Love-Koh, J., Cookson, R., Griffin, S., and Claxton, K., (2020). Estimating social
variation in the health effects of changes in health care expenditure. Medical
Decision Making, 40(2), pp.170-182.
Maria, N., Zaid, Alsafi, CatrinSohrabi, Ahmed Kerwan, and Ahmed Al-Jabir., (2020). The
socio-economic implications of the coronavirus pandemic (COVID-19): A
review. International Journal of Surgery. 78. pp.185-193.
Marmot, M. and Allen, J.J., (2014). Social determinants of health equity.
Mohajan, H.K., (2018). Qualitative research methodology in social sciences and related
subjects. Journal of Economic Development, Environment and People, 7(1),
pp.23-48.
Mosquera, I., Gonzalez-Rebago., Bacigalupe, A., and Suhrcke, M., (2017). The impact
of fiscal policies on the socioeconomic determinants of health: a structured
review. International Journal of Health Services, 47(2), pp.189-206.
Newton, J.N., Adam, D.M.B., Christopher, J.L.M., Kyle, J.F., Daniel, D., Haidong, W.,
Elias, D., and Carme, B., (2015). Changes in health in England, with analysis by
English regions and areas of deprivation, 1990–2013: a systematic analysis for
the Global Burden of Disease Study 2013. The Lancet, 386(10010), pp.2257-
2274.
Newton, S., Braithwaite, D. and Akinyemiju, T.F., (2017). Socio-economic status over
the life course and obesity: Systematic review and meta-analysis. PloS
one, 12(5), p.e0177151.
35

Nickel, S. and von demKnesebeck, O., (2020). Do multiple community-based
interventions on health promotion tackle health inequalities?. International
Journal for Equity in Health, 19(1), pp.1-13.
O’Neil, A., and et.al., 2020. The impact of socioeconomic position (SEP) on women's
health over the lifetime. Maturitas.
Omidvar, S., Faramarzi, M., Hajian-Tilak, K., and Nasiri, Amiri, F., (2018). Associations
of psychosocial factors with pregnancy healthy lifestyles. PloS one. 13(1).
p.e0191723.
Ozili, P., (2020). COVID-19 in Africa: socio-economic impact, policy response and
opportunities. International Journal of Sociology and Social Policy.
Oztemel, E. and Gursev, S., (2020). Literature review of Industry 4.0 and related
technologies. Journal of Intelligent Manufacturing. 31(1). pp.127-182.
Paradis, E., Bridget, O., and Maria Athina., (2016). Design: selection of data collection
methods. Journal of graduate medical education, 8(2), pp.263-264.
Poli, S., Cella, A., Puntoni, M., Mussacchio, C., Torrigliani, C., and Pilotto, A., (2017).
Frailty is associated with socioeconomic and lifestyle factors in community-
dwelling older subjects. Ageing clinical and experimental research. 29(4).
pp.721-728.
Pons-Vigués, M., Elia Diez., and Carme Borell., (2014). Social and health policies or
interventions to tackle health inequalities in European cities: a scoping
review. BMC public health, 14(1), p.198.
Richardson, E., Lynda Fenton., Jane P., Andrew, P., Martin, T., Gerry, M., and Mark, R.,
(2020). The impact of income-based policies on population health and health
inequalities in Scotland: a modelling study. The Lancet Public Health, 5(3),
pp.E150-E156.
Rizzuto, D. Mossello, E., Fratiglioni, L., Santoni, G., and Wang, HX., (2017). Personality
and survival in older age: the role of lifestyle behaviours and health status. The
American Journal of Geriatric Psychiatry. 25(12). pp.1363-1372.
Sabir, S. and Aziz, N., (2018). Impact of Health and Education on Income Inequality:
Evidence from Selected Developing Countries. Business and Economic
Review, 10(4), pp.83-101.
Schmidt, W.H., Nathan, A.B., Pablo, Z., and Richard, T.H., (2015). The role of schooling
in perpetuating educational inequality: An international perspective. Educational
Researcher, 44(7), pp.371-386.
Scott-Samuel, A. and Smith, K.E., (2015). Fantasy paradigms of health inequalities:
Utopian thinking?. Social Theory & Health, 13(3-4), pp.418-436.
Setia, M.S., (2016). Methodology series module 5: Sampling strategies. Indian Journal
of Dermatology, 61(5), p.505.
36

Stormacq, C., Van den Broucke, S. and Wosinski, J., (2019). Does health literacy
mediate the relationship between socioeconomic status and health disparities?
Integrative review. Health promotion international. 34(5). pp.e1-e17.
Taggart, L., Truesdale, M., Carey, M.E., Martin-Stacey, L., and Scott, J., (2018). Pilot
feasibility study examining a structured self‐management diabetes education
programme, DESMOND‐ID, targeting HbA1c in adults with intellectual
disabilities. Diabetic Medicine, 35(1), pp.137-146.
Tan, S.S., Marta, M.P., Ann, LD. Boone., Graham, B., and Yves-Marie Pers.,(2019).
Evaluation design of EFFICHRONIC: the chronic disease self-management
programme (CDSMP) intervention for citizens with a low socioeconomic
position. International journal of environmental research and public
health. 16(11). p.1883.
Terry, G., Nikki, H., Victoria, C., and Virginia Braun., (2017). Thematic analysis. The
Sage handbook of qualitative research in psychology, pp.17-37.
Thomson, S., De Bortoli, L. and Underwood, C., (2017). PISA 2015: Reporting
Australia's results.
Ucieklak-Jeż, P., (2018). Income and education as a source of health inequality. New
UE countries case. PraceNaukoweUniwersytetuEkonomicznego we Wrocławiu,
(510), pp.181-192.
Weida, E.B., Pam Phojanakang., Falgini Patel., and Mariana, C., (2020). Financial
health as a measurable social determinant of health. PloS one, 15(5),
p.e0233359.
Zangirolami-Raimundo, J., Echeimberg, J.D.O. and Leone, C., 2018. Research
methodology topics: Cross-sectional studies. Journal of Human Growth and
Development, 28(3), pp.356-360.
Online
Health and social care, national archives, (2020). Available from:
https://webarchives.nationalarchives.gov/20160105163808/https://www.ons.gov.
uk/ons/taxonomy/index.html?nscl=Subnational+Health+Expectancies. (Accessed
on 20/04/21).
The National Statistics Socio-economic classification (NS-SEC), 2020. Available
through:
https://www.ons.gov.uk/methodology/classificationsandstandards/otherclassificati
ons/
thenationalstatisticssocioeconomicclassificationnssecrebasedonsoc2010#structu
re-and-flexibility (Accessed on 18/04/21).
37