Your health

What is social class?

Social Class can be defined by:

• economic factors (wealth, income, occupation)
• political factors (status, power)
• cultural factors (lifestyle, education, values, beliefs).

Despite arguments that the class system has changed over the past 50 years it is still the case that important differences in shared beliefs and values relate more obviously to class than any other social category.

Social class leads to inequalities of resources, whether that is income, education, housing or health.

People’s experience of class and poverty can lead to their views not being heard, being left out when decisions are being made, isolation and humiliation.

A recent poll showed that poor people in particular think that class, not ability, greatly affects the way they are seen.

In the last 25 years the number of people in the top two social classes has doubled in Glasgow. However while the city’s middle class has grown and prospered, other parts have seen little improvement. Many people are dependent on sickness or unemployment benefits or low paid work. This has led to growing inequality.

Social class discrimination can affect many areas of people lives; access to education, housing, social mobility and job opportunities and pay. Numerous studies have been carried out into the effect being working class might have on an individual’s working life. In 2017, the Social Mobility Commission found there was a class pay gap where professionals from working class backgrounds earn an average of £6,800 less than professionals from higher classes.

There is currently no specific protection within the Equality Act 2010 on the grounds of class; although the Fairer Scotland Duty does offer some protection.  

There is a strong link between social class and groups with other protected characteristics, as they are often denied access to power, wealth, status, resources and opportunities.

For example:

• Employment among all black/minority ethnic groups in Glasgow is 10% lower than for white Glaswegians
• 68% of disabled people have an income of less than £10,000
• Women are more likely to be poor than men due to lower paid jobs, part-time jobs and the fact that 90% of lone parents are women
• In Scotland today the pay gap between women and men can translate to a loss of over £330,000 in a woman’s working life – just because she is a woman.

Social class is not a protected characteristic in the Equality Act 2010 however it has close links to poor health and other forms of inequality. 

The Fairer Scotland Duty came into force on 1 April 2018. It places a legal responsibility on named public bodies in Scotland to actively consider how they can reduce inequalities caused by socio-economic disadvantage when making strategic decisions.

Scottish Government guidance (2021) Fairer Scotland Duty: guidance for public bodies provides a comprehensive explanation of the Duty together with useful tools to assess decision making processes.

Social class leads inequalities of resources, whether that is income, education, housing or health. This has led to widely varying but predictable life chances and health outcomes across Greater Glasgow and Clyde.

The link between social class and health was identified almost 40 years ago. In 1980, there was found to be a clear inequality in life expectancy between men in social class 1 (managers and professionals) and social class 5 (unskilled workers).

The reasons for the link between social class and health includes things such as health risks in low paid, unsafe jobs and stress caused by having low status and lack of power.

Upward and downward social mobility can improve or decrease people’s life chances. Certain events such as such as leaving home, becoming a parent, losing your job or bereavement can make us vulnerable to falling into a low income or low status in society.

Social class inequality has an impact on the whole of society. Research shows that more equal societies have better health rather than richer societies where there is a bigger gap between rich and poor.

NHS Greater Glasgow and Clyde is carrying out a range of work to tackle inequality as a result of income inequality, poverty and social issues.

These include:

• Monitoring the impact of the recession and welfare reform on health
• Increasing referrals to employability and money advice services
• The Healthier, Wealthier Children project which is exploring ways of tackling child poverty at local level 
• Measuring the health gap so that we know that specific programmes of work are making the gap better or worse

In ‘Turning the Tide through Prevention’, the Public Health Strategy 2018-2022, we can see that the determinants of health are well documented and many of them lie outside the direct influence of the NHS, such as relieving poverty, improving housing or education. A crucial element of this strategy is therefore the effectiveness of our influence on these factors through community planning partnerships and the way we work with Scottish and UK governments and the people who use our services.

Local health and social care partnerships mean that staff work together to give people support with health and social issues to reduce health inequality.

More information at:

Addressing Income Inequality, Poverty & Social Issues

Tina’s Story

Tina lives with her husband and two children. Two years ago she suffered a serious brain haemorrhage. The consequences of her illness, which was completely unexpected, were devastating.

In order to care for Tina and the children her husband had to leave his job. But when he tried to claim benefits he was told that he wasn’t entitled and would have to wait 10-16 weeks before they would be given any money at all. They said he had made himself voluntarily unemployed. This advice was wrong.

For four months the family had no income at all except for a small amount of Child Benefit and Tax Credit. They didn’t receive Housing Benefit, although entitled to it, and their rent wasn’t being paid. They sunk deeper and deeper into debt.

The family were struggling to survive on less than £50 a week. Through social services they were put in touch with the Family Support Unit (FSU) who helped with food parcels and Home Start, who were able to offer some support.

Tina’s situation has improved now. Her husband is back in work and they still receive support from Home Start, but the debt is still a major concern and the family still has some way to go before it’s back on track.

Courtesy of Joseph Rowntree Foundation www.jrf.org.uk

• Glasgow Centre for Population Health

‘Lesbian’, ‘gay’, ‘bisexual’ and ‘heterosexual’ are better described as ‘sexual orientation towards people’, rather than ‘sexual attraction to’. This reflects the fact that people build committed, stable relationships and it is not purely a focus on sexual activity.

Everyone has a sexual orientation. Sexual orientation is a combination of emotional, romantic, sexual or affectionate attraction to another person.

In other words, it’s about who you are attracted to, fall in love with and want to live your life with.

For the purposes of this sexual orientation web page, we have looked at lesbian, gay, bi-sexual and heterosexual issues only, as the term transgender does not relate to sexual orientation but rather the gendered identity of an individual. For more information on transgender issues go to our page

• ‘What is Gender Reassignment?‘.
• Stonewall’s glossary of terms

Discrimination on the grounds of sexual orientation can take several forms – from blatant abusive behaviour (1 in 3 gay men and 1 in 4 lesbians have experienced violent attacks) to more subtle forms that may go unnoticed by many.

Discrimination on the basis of sexual orientation is a crime under current Scottish Law.

Some examples of discrimination include:

1. Refusing to employ someone because of their sexual orientation. A case recently heard how a gay man was ‘advised’ not to follow a career in paediatrics – based on the belief that gay men are a risk to vulnerable groups. This is at odds with all evidence, which clearly shows that sexual orientation does not influence the likelihood of carrying out sexual abuse or a sexual assault.
2. Refusing accommodation. A recent survey showed that 70% of people living in rural areas of Scotland supported the right to refuse holiday accommodation on the grounds of sexual orientation.

Following is a short film by the Equality & Human Rights Commission titled ‘What is sexual orientation discrimination?’.

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Any sexual orientation other than heterosexual often receives negative responses from parts of our society and this can be made worse when combined with other equality issues.

Disabled lesbians and gay men face the same challenges experienced by many disabled people who live in poverty or on very low income. In addition, lack of money means that many disabled lesbians, gay men and bisexuals are excluded from the LGB social scene, often based in pubs and clubs, which can result in increased isolation. Even if money were not an issue, many venues would be inaccessible to some disabled people.

There may be tensions between sexual orientation and other protected characteristics. For instance, someone who identifies as being LGB but also belongs to a particular faith group may experience negative attitudes from other members of that faith group. It may be that some members of a faith group act in a way that might discriminate against LGB people. Recent high profile media coverage has centred on people with faith beliefs refusing to provide goods and services to LGB people in terms of holiday/leisure accommodation.

Examples of how sexual orientation can affect health include:

1. Research looking at mental health suggests gay men and lesbians report more psychological distress than heterosexuals. This can often be associated with a lifelong exposure to bullying and abuse. Surveys have shown extremely high percentages of young lesbian, gay and bisexual (LGB) people reporting verbal and physical abuse. It has also been found that young LGB people are up to six times more likely to attempt suicide that heterosexual youth.
2. Drug use amongst gay men has been found to be significantly higher than for heterosexual men. Research suggests that drug use is in part due to low self-esteem, and also due to the attitudes of society towards this group.
3. Lesbians have specific health issues relating to fertility, pregnancy, sexual health and mental health. However, there is evidence that lesbians are afraid to tell their GP of their sexual orientation in case they experience discrimination.
4. Figures show that gay men and men who have sex with men are generally at higher risk of contracting HIV/AIDS than heterosexual people. In 2006, 38% of all new cases of HIV/AIDS were found within this population group. Gay men and men who have sex with men are also at higher risk of contracting Ghonorrea, with 81% of all new cases diagnosed in 2006 found within this group.

Routine Data Collection

NHSGGC wants to get better at understanding both its workforce and the people who use our services. We know that our sexual orientation can affect health. However, at the moment we do not routinely collect information on sexual orientation from the people who use our services. Without this, it is difficult to deliver services that meet everyone’s needs. We are therefore going to introduce the collection of routine information relating to sexual orientation and will support this with a Sexual Orientation E-Learning module for all staff.

LGBTQ+ Staff Forum

The NHSGGC LGBTQ+ Staff Forum is a group of staff members made up of those that identify as lesbian, gay, bisexual, transgender, queer inclusive (LGBTQ+) and our allies. The group aims to create a safe and welcoming space for staff members within our LGBTQ+ community though our social activities, programme of events, formal and informal meetings.

For more information about the group and how to join, visit our web page.

NHS Scotland Pride Badge

The NHS Scotland Pride Badge promotes inclusion for LGBTQ+ people and makes a statement that there’s no place for discrimination in NHS Scotland.

Over 9,200 of our NHSGGC staff have already made the Pride Pledge and are wearing the badge with pride.

For more information, visit our campaign web page

A young lesbian woman was taken into hospital suffering from Leukemia. The treatment was lengthy and painful, both physically and mentally.

While in hospital, the young woman suffered homophobic bullying from another patient to the point where she felt it was difficult to have her partner visit her on the ward.

The nurses noticed how upset she was and that her partner was no longer visiting, so asked what was wrong. The young woman explained the situation and was immediately supported by staff, including the consultant in charge of her care, who challenged the other patient’s behaviour. They made it very clear that NHS services should be free of all types of discriminatory behaviour – including homophobia.

Publications

• National LGBT+ Health Needs Assessment 2022 – short films explaining the process and outcomes – Full summary of findings   Wish list
• Don’t look back?
• Fair For All – The Wider Challenge – Good LGBT Practice in the NHS
• Gay and Bisexual Men’s Health Survey Scotland
• Getting Equalities Monitoring Right
• Halt Hate Crime
• Hate Crime – What You Need To Know
• Hidden Lives
• Inclusive Language in the NHS
• LGBT In Scotland – Health Report
• Life in Scotland for LGBT Young People
• Not Just A Friend
• Protecting Patients – Your rights as LGB people
• Social context of LGBT people’s drinking in Scotland
• The Needs and Experiences of LGBT People in Glasgow
• Your Services, Your Say

Websites

• LGBT Helpline Scotland
• Stonewall – information pages
• LGBT Health
• Healthy Gay 
• LGBT Youth Scotland
• The Sandyford Initiative

Discrimination with a focus on religious belief and religious difference is not a new phenomenon. For many years the West of Scotland has been characterised by sectarianism which continues today. Religious discrimination, and suspicion of religions, has come to the fore again due to a rise in Islamophobia – particularly after September 11th and the July 7 bombings in London.

In the past there was no specific protection against discrimination for most religious groups. There was, however, protection for people from Sikh and Jewish communities who were protected under the Race Relations Amendment Act as an ethnic group. Religion is often woven in with race and culture to form personal or group identity. Black/Minority ethnic communities, who can be on the outskirts of society, have often used religion to express and to sustain their identity.

There is now greater protection from religious discrimination through the Equality Act 2010. Religion & belief is a protected characteristic and everyone who is protected under law from discrimination, harassment or victimisation is afforded the same level of protection.

For some people, their religion is important to their health yet often the cultural and practical dimensions of religion are not assessed and taken account of when individuals attend for health care. This can be considered as a form of discrimination, can cause distress and as a result can have a negative impact on the effectiveness of diagnosis and treatment. In the same way that other examples of equality categories often remain invisible to health care organisations and therefore in the way that services are planned, there is lack of data on patients for whom religion is significant to their wellbeing. In addition, strong views on any particular form of religion can lead to prejudice and discrimination against other beliefs – often referred to as sectarianism. This too can have an impact on the physical and psychological wellbeing of individuals.There can also be assumptions that everyone has a faith of some description despite of a large percentage of people who consider themselves to be atheist. Any assumptions about faith can lead to experience of discrimination.

Following is a short film by the Equality & Human Rights Commission titled ‘What is religion or belief discrimination?’.

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There may be examples of poor health resulting from the disharmony between some followers of religion and other equality groups. For example, people within the LGBT communities who practice or follow a religion may face additional health issues such as mental health problems or feel isolated, perhaps due to discrimination within their faith community.

A person’s value system, sense of purpose and inner strength, whether resulting from religious or other sources, has been linked to how they respond to illness and treatment. Our approach in NHSGGC focuses on ‘spiritual care’ and ‘spiritual needs’ as outlined in the Spiritual Care Policy. This recognises that all people, whether religious or not, have spiritual needs that may or may not include aspects of formal religion or belief. People will gain comfort and strength to face illness from being allowed to practice their religion while in hospital.

Appropriate recognition of religious practices and preferences, and consideration of the patient’s spiritual needs, are particularly important in the care of the dying and in dealing with the deceased and their family after death. This also has a relevance to the care offered in our Maternity Units at a time of peri-natal or neo-natal death. Consideration of spiritual needs equally applies to people who have a non-religious stance.

Religion or belief within a health care environment can also impact on

• Gender and choice of staff;
• Disclosure of sensitive information;
• Attitudes towards illness and health practices;

Religious views may also affect the way in which health promotion messages are received and acted upon. Some religious practices, such as not drinking alcohol or vegetarianism, may have positive links to health. Others may affect whether or not certain medications can be taken due to animal/alcohol by-products.

NHSGGC has a multi-levelled response in tackling inequalities associated within religion or belief.

• The organisation actively pursues the capture of religion / belief from its staff at recruitment stage as well during the course of employment (SWISS) to ensure that it doesn’t discriminate against one group of staff.
• We have developed a Spiritual Care Policy outlining the nature of spiritual care, the provision of spiritual care facilities in our hospitals, training and education, the role of all staff in delivering spiritual care and the importance of consultation with faith and belief groups.
• Healthcare Chaplaincy, as an NHS service, has a key role in responding to the spiritual and religious needs of staff, patients and visitors. Healthcare Chaplains function on a ‘generic basis’ whereby their service is for all people, regardless of faith or belief. They are a point of contact to draw in care and support from particular faith and belief groups.
• The organisation provides training to staff at induction level and during the course of employment on equality and diversity which includes religious/ belief issues. Training on subjects such as Loss and Bereavement include reference to the needs of those from faith communities.
• Our Equality Impact Assessment can identify whether services are actively addressing issues associated with religion and belief and put in place necessary actions.
• The Catering Service provides Halal, Kosher and vegetarian meals upon request. Work is being undertaken to meet the needs of other religious groups.

Baldeep’s Story

Baldeep is a baptised Sikh and follows the practice of wearing the 5 ‘Ks’ – this includes wearing the Kirpan. The Kirpan is a very small sword. As is the custom, Baldeep wears hers under her clothing in a cloth sheath. For her, and for all baptised Sikhs, it is a symbol of the commitment she has made to follow the Sikh way of life and carries a deep spiritual significance. She will never remove it unless absolutely necessary.

Unfortunately, one day Baldeep felt very unwell and had to go the nearest Accident and Emergency Department. Whilst she removed clothing to be examined the nurse asked what it was that she was wearing. The nurse became alarmed that Baldeep was carrying what looked like a knife and refused Baldeep any further assistance until the Kirpan was removed. Baldeep explained that the Kirpan was a sacred item in her faith and she could not remove it; was it absolutely necessary to remove it in order to be examined? The nurse said that on health and safety grounds no patient should be carrying a weapon. Baldeep argued that if treatment was denied to her because she was wearing this sacred symbol, it was tantamount to religious discrimination.

The nurse seemed unsure about this and consulted her ward manager. The ward manager came to meet Baldeep and enquired more about her faith and the Kirpan. It was clear that treatment could not be denied as Baldeep was observing the requirements of her faith in the wearing of the Kirpan. This had to be respected. It was agreed that she could be examined whilst wearing it but if an x-ray or any other sort of scan was required it would have to be removed. Baldeep understood this and before going to the x-ray her Kirpan was removed, along with the Kara (the steel wristband) and held by the nurse during the procedure. Baldeep then replaced it accompanied by the saying of a prayer.

Comment and Background Information:

The wearing of the Kirpan is permitted by UK law as it is an intrinsic part of the Sikh faith and Sikh religious observance. It is generally not visible. Legislation makes it clear that a service cannot be denied to anyone on grounds of the religion or belief and the ward manager above was correct to see this. The discussion that took place leading to an agreed solution was also appropriate and correct.

Further information about the Sikh religion can be found in the resources identified in section 6 – Support and Resources.

Publications

• A Multi-Faith Resource for Healthcare Staff
• Advice to British Hajjis
• Faith and Belief Communities Manual
• Information and Guidance on Visiting Hospitals for Faith and Belief Community Representatives
• Ramadan Health Guide
• Seen and Not Heard – Voices of Young British Muslims
• Spiritual Care Policy
• Values in Harmony

Websites

• Al-Khair
• Almeezan
• Central Mosque
• Glasgow Gurdwara
• Glasgow Unitarians
• Hindu Mandir Glasgow
• Methodist Church in Scotland
• Nil By Mouth
• Orthodox Church
• Salvation Army
• Scottish Baptist
• Scottish Lutherans
• United Reformed Church