Infant mortality and class

Posted: December 3, 2010 in Capitalism, Finance, Health

The infant mortality rate in poorer areas in the UK is much, much higher in deprived towns than affluent areas. Still. In 2010. More babies are being born prematurely and with congenital ‘defects’, which are causing their deaths.

The charity Bliss names obesity and smoking as key risk factors; other named factors include teenage pregnancy and increasing maternal age. Now, these seem to be the old chestnuts. There is no analysis of environmental factors likely to differ between deprived and affluent areas, or the problems of poverty in society. Pollution may be a factor. A lot of areas classed as deprived are in urban areas where cars are the main form of transport. Also, ‘deprived’ areas often do not have the leafy areas and front gardens as buffers from the street that help to counter the problem. And what about the stress of trying to get by on what is often an income that does not cover basic expenses? Or the stress of low-satisfaction, low-paid, routine jobs that demand much time and energy? Stress for the person carrying the baby does affect the baby.

  1. Dreki says:

    There’s also a race factor. I remember seeing a study that said that middle class women of color in their mid-20s had the same rate of infant mortality/miscarriages as lower class white teenagers. The class factor likely to be mixed with that- as people of color are more likely to be lower class than white people. It’d be nice if it’s just external problems, and not just discriminatory medical treatment, but I doubt that’s true- although the other factors are definitely likely to affect it. Although even if doctors just fail to take into concern that the other factors effect lower class people that don’t effect middle+ class people, that is also a problem there.

    • JKBC says:

      There was a mention in the article that discriminatory medical care didn’t appear to be a factor, but what they meant by ‘discrimination’ isn’t specified. Race is, as you say, also a factor which I should have mentioned, and discriminatory medical care may be more of a factor in that problem even if medical staff aren’t aware of it.

      • Dreki says:

        Yeah, “discriminatory” is all too often the subtle factors that you can’t really say were discrimination but were. (or the all too blatant factors that the people in power don’t want to accept are discrimination because it’s inconvenient)
        I don’t think doctors run around explicitly denying medical care or blatantly giving sub-par care to anyone who makes less than however much a year- that doesn’t mean that they don’t discriminate more subtly. It can be little things like putting a bit more pressure on a lower class patient to get a certain treatment or underselling the benefits/harm of certain treatments, which isn’t something you can really prove to be discrimination.

        I don’t know how it is in the UK, but in the US doctors generally hide between a wall of jargon to get patients to do what they want- middle+ class people are more likely to be able to have the time/education/resources to figure out what the jargon means and look up their health issues on their own, and also are more likely to be able to go to a different doctor if one isn’t treating them well. That’s not outright discrimination- okay, well, it’s classism but not discrimination on the part of specific doctors- but they all have an effect on quality of care.

        • JKBC says:

          Discrimination is often pretty hard to prove, but as you say that doesn’t mean it isn’t there. Unfortunately medical staff aren’t free of the kyriarchal bullshit that permeates society, and some of them may not even be aware they’re doing it although that doesn’t excuse any of it.

          I think the UK is pretty different because of the fact that we get healthcare under the NHS; class factors may be more similar to the US in England where in many cases there is a charge for prescriptions, although it is (I think) a flat rate. The jargon issue sounds like the sort of incidental and perhaps institutional classism that often gets ignored, and it also seems to be a bit of a consent issue; how can a person consent to treatment if what the treatment involves isn’t understood?

          • Dreki says:

            I wish that doctors were forced to be better than that, but it’s impossibel to do that in our society because no one is going to OKay making part of medical school ensuring that doctors are educated about privilege and having them check theirs regularly. (personally, I think that should be introduced in kindergarten…)

            There definitely is a classism issue with jargon, but consent is the bigger thing because it is a barrier to informed consent (which is also an issue of ablism, transphobia, interphobia, and a few other issues). Very possibly an intentional one- it’s much easier for the doctors to have patients unquestioningly do what they want (and harder for the patients to know if malpractice happened) then to have their opinions second-guessed at every step by someone who actually knows their stuff. Doctors make the “worst” patients for a reason.

  2. JKBC says:

    Yeah, no-one’s going to make privilege education compulsory in medical school because surprise, the folks in charge also have that privilege and desperately want to keep it. Privilege education should be compulsory, I agree, and it’s terrible that it’s not included anywhere in formal education, that people aren’t even aware of it.

    Consent-compromising jargon is very likely somewhat intentional, and it’s been swallowed by a bunch of people who really should know better outside the medical community – as an anecdote, I once knew someone who suffered from tiredness and a couple of other symptoms, which she thought were indicative of hypothyroidism having Googled it. She went to the doctor’s and asked for a test for it. I told one of my parents (great person, normally), who said, ‘You shouldn’t do that [do your own research], doctors don’t like it, you’re not qualified and it can throw off the diagnosis.’ Her results came back and she did have slight hypothyroidism.

    It’s a shame and a disgrace that the medical community can’t recognise these failings… I suppose it comes back to the privilege issue. Many of them are probably so used to being the ‘expert’ they react badly to people knowing their stuff and double-checking the facts.

    • Dreki says:

      The real reason is “Doctors can’t play God if you’re educated about things- and that makes them mad”. Not all are like that, but I think some are. The human body is just too complicated- yet we expect every single doctor to be an expert on all the ins and outs. It’s just not possible, even if you spend all your time studying and none of it treating patients you’ll forget some things, yet we seem to expect doctors to be experts on everything.

      I think it does come back to the privilege issue. To be able to be a doctor you have to be privileged enough to get yourself through 8+ years of schooling, and I’d imagine that having that much power would go to anyones head.

      • JKBC says:

        You’re probably right; it would probably be extremely tempting to think ‘well, I’m the doctor, I should know and they shouldn’t be doubting me’. About the privilege, I don’t know how it is in the US; I believe the UK has NHS subsidies for medical courses which means there are probably more people doing the courses who aren’t as class privileged. But that amount of schooling ends up meaning that there is an education and qualification power imbalance between doctor and patient, which is probably pretty intoxicating.

        • Dreki says:

          It’s good the NHS works like that. The US is kind of weird… recently there’ve been problems that school loans have gotten so out of hand (and, when you file bankruptcy, don’t get erased) that some people get out of medical school and end up with serious problems.

          The power balance makes me really uncomfortable. I know of a trans woman whose doctor refused to refill her hormone prescription because something was one point over what it should be, no “try to get this down” just “you can’t have this until that’s down”. That’s what makes this worse, it makes people who need medications, who are generally less privileged, the most vulnerable- because the doctor can just not write a refill on the prescription if you don’t feel like doing what the doctor wants. I’ve heard of some doctors who say they know their patients will sign consent forms they don’t want to sign because how else will the patient get the treatment they need? It’s disgusting. Even without bringing other privileges into it, the doctor/patient power imbalance disturbs the hell out of me.

          • JKBC says:

            That system about the loans sounds really… intimidating and overly capitalist at the expense of humanity.

            That’s absolutely terrible and really frightening. It’s pretty obvious that there isn’t any consideration of the ethics of consent and power, which could at least be addressed by a few classes at the training stage. And always it’s the marginalised who suffer… We’re trained to think of doctors as always in the right, especially those who are somewhat privileged in background and privileged in that they match cultural standards of ‘health’ and ‘ability’ (myself included in this), and the knowledge of that cultural training is almost certainly influencing doctors’ mindset.

          • Dreki says:

            Yeah… student loans scare the crap out of me, but you have to get them to go to school here unless you get REALLY lucky or have REALLY rich parents. Schools raise the cost of tuition every year as well- there are no protests, they’ve done it so long. It’s just what happens, even in this recession the price is steadily climbing. I don’t think they raise it as much each year as they’re going to in the UK, but I imagine that by steadily raising it they’ve raised it by way more over time.
            And because it’s a recession and people are having a hard time paying what they owe, some creditors ahve been getting creepy about trying to get the money they’re owed. And I think it can really screw you over in a lot of ways if you’re overdue on a loan…

            It is seriously frightening. Add to that things like that doctor who cut off the woman’s clitoris when he was only supposed to take a small growth and doctors have WAY too much power for their own good and seem to think they deserve it and there’s nothing wrong with it. The culture doesn’t help, but I think it may be shifting- people are starting to get warier of doctors now.

  3. JKBC says:

    I think the US fees are way higher than the UK ones, even after this big hike upwards; the steady rise has probably taken it a lot higher and removed a lot of the catalysing factors for protest. Loans are pretty much inevitable here as well, even now, (at least for the people I know, although the level of ‘rich’ one has to be to not need one is almost certainly lower) although I think student loans tend to be a bit more flexible than other loans. But it really is awful how the financial sector is taking out their recession troubles on people who had nothing to do with causing the recession.

    That case was horrendous on so many levels – it was obvious by the sadistic, sexist, ageist way he went about it that he meant harm, and his defence that it was in her best interests proves that he knows nothing about consent and ethics and probably had forgotten the Hippocratic Oath as well. I hope people are becoming warier, however hard; perhaps that could start to bring it home to doctors and medical staff that the attitudes they’re fostering aren’t okay. Although, we’ll still need healthcare…

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