Class differences in mortality

Comparison between Spain and Belgium 1999/2009

Manuel Len Mndez

SOCIOLOGY MASTER PROGRAM- SEMINAR IN SOCIAL DEMOGRAPHY ERASMUS EXCHANGE PROGRAM GHENT UNIVERSITEIT LECT.: BART VAN DEPUTTE

Death is an equall doome To good and bad, the common In of rest.

Edmund Spenser

Men fear death, as children fear to go in the dark; and as that natural fear in children is increased with tales, so is the other.
Francis Bacon

Table of contents:
DEVELOPING THE RESEARCH QUESTION
TYPOLOGY OF WELFARE STATES

1
4

LITERATURE OVERVIEW
NUTRITION OCCUPATION EDUCATIONAL LEVEL AVAILABILITY OF MEDICAL SERVICES AND THE MODEL OF LIVING URBANISATION AND GEOGRAPHICAL POSITION INCOME LEVEL STATUS MARITAL CONDITION RETHINKING SOCIAL CLASS SOME POSSIBLE EXPLANATIONS HYPOTHESES MAIN HYPOTHESES SECONDARY HYPOTHESES

6
8 9 11 11 12 14 15 15 15 17 17 17 18

FACTUAL INFORMATION DISCUSSION AND CONCLUSION BIBLIOGRAPHY WEBGRAPHY

19 27 A B

II

Developing the research question

The Death is the elder well-known partner of humanity. Biologically speaking, dying only takes a few seconds or minutes. It begins with the failure of one organ and so on this situation spreads all along the rest of the organs as if they were light bulbs, just switching off forever. When the time of dying arrives, is the same to everyone, no matter gender, religion nor social class. But the way in we die is so different if we look again thought the previous typology. My willingness to study the death and the dying has several reasons from the will to gain intellectual resources to became more self-reflective about the feeling we develop about the death and the dying and all of the feelings, reactions or opinions associated with them, passing through the desire to know about death, types of deaths, and the management and control of the pain associated to it, and ending up with the understanding of the changes produced in life expectancy and mortality rates. In the present research I am going to try to find an accurate theoretical explanation to the different ways of dying if we approach to them from the social class cleavage. More specifically I am going to do an attempt to figure out which differences and similarities exists in the death between social classes, but besides I am going to do a comparison of the most meaningful facts between two different countries and consequently cultures, such as Spain and Belgium. The choosing of these two countries have a very easy explanation, as Emile Durkheim postulates in his renowned essay, The rules of the sociological method, the investigator are able to interpose its values, beliefs and will at the moment of start a research. As I am an exchange student from Spain, and I was very well received by one of the oldest universities in Belgium, I decide to do the comparison of the ways of dying in these countries, of such different culture and social behaviour, in order to understand a little bit more the cultural trends of these so different societies in the last action that a man do, die. 1

In order to justify the willingness of that comparison between these countries I am going to do a briefly overview remaking the most meaningful facts of them both to enhance the differences and similitudes between them. Spain

Form of government

Parliamentary monarchy

Total population Total Density

Rank 27 47.150.800 (2010) 93,17 hab./km

GDP (nominal) Total(2009) GDP per capita

Rank 12 $1.438.356 millions $29.595 0,863 (20) Very High

HDI (2010)

Member of: European Union, NATO, UN, OECD, OSCE, UL, CIN, OEI, ABINIA, AED, EBRD, COE, G20

Kingdom of Belgium

Form of Government Total Population Total Density GNP (nominal) Total (2007) GNP per capita HDI (2010)

Federal parliamentary monarchy Rank 72 10.827.000 354.6 hab./km Rank 19 $ 530.613 million $ 49,430 (2008) 0,8671 (18)Very High

Member of: European Union, NATO, UN, OECD, OSCE, Benelux, COE

We can notice than these two countries have very similarities despite its great differences in matter of population and distribution of the GDP (Gross Domestic Product) per capita. Despite Belgium is a smaller country than Spain and consequently produces less benefit in whole numbers, Belgium has better distribution of that benefits being in the 19th position an 29th position in nominal GDP respectively according to the list provided by the Wold Bank in 2010. That factor influences consequently the position of both countries in the ranking of the Human Development Index (HDI) provided by the United Nations (UN). Then, as it is possible to see after the reading of the basic socioeconomic data, Belgium and Spain are so close in the HDI holding the 18th and 20th ranks respectively. As the HDI is calculated by three indicators such as Health, represented by the life span at birth, Wealth: measured by GDP per capita PPP 3

(Purchasing Power Parity) in international dollars and Education measured by the adult literacy rate and combined gross enrolment in primary, secondary and higher education, as well as year of compulsory education, I think these are quite good indicators to realise the levels of the countries in revision in the economic, social and cultural level related to the educational level field. Although, in order to define in a precise way about those indicators I am going to use the welfare state typology postulated by Gsta Esping-Andersen where we can see that Belgium remains in the Continental group characterized by one of the highest levels of social protection and its main feature is the universal provision based on the principle of citizenship, i.e. that is a wider access with fewer conditions, social benefits and higher proportion of expenditures in pensions. It is based on the principle of "assistance" (help) and insurance system, with a partial subsidy system that is not conditioned on employability. In the other hand Spain is situated in the Mediterranean group characterized by its later development (seventies and eighties decades) and with lower social costs and heavily based on a lower pension and social assistance costs.

TYPOLOGY OF WELFARE STATES

LIBERAL/RESIDUAL OR ANGLO SAXON LIBERAL COUNTRIES (LCS) In the welfare states of these countries (UK, USA, Canada, Australia and Ireland), state provision of welfare is minimal; social transfers are modest and often attract strict entitlement criteria; and recipients are usually means tested and stigmatised. In this model, the dominance of the market is encouraged both passively, by guaranteeing only a minimum, and actively, by subsidising private welfare schemes. Also minimises the decommodification effects of the welfare state and a stark division exists between those, largely the poor, who rely on state aid those who are able to afford private provision. In these countries the parties of liberal persuasion (LPs) have governed for the longest periods of time. CONSERVATIVE/CORPORATIVE/BISMARCKIAN OR CHRISTIAN DEMOCRATIC COUNTRIES (CDCS) These kind of welfare state comprehends countries as Germany, France, Austria, Belgium, Italy and Netherlands and are distinguished by its status differentiating welfare programs in which benefits are often earnings related, administrated through the employer and geared towards maintaining existing social patterns. The role of the family is also emphasised and the redistributive impact is minimal. However, the role of the market is marginalised. These countries, historically have been ruled by Christian Democratic and Judeo-Christian traditional parties (CDPs)

SOCIAL DEMOCRATIC/SCANDINAVIAN COUNTRIES (SDCS) This kind of countries are characterised by universalism, comparatively generous social transfers, a commitment to full employment and income protection and strongly interventionist state. The state is used to promote social equality through a redistributive social security system. Unlike the other welfare state regimes, this regime promotes an equality of the highest standards, not an equality of minimal needs and it provides highly decommodifying programs. These countries have been governed by social democratic parties or labour parties (SDPs) for the longest periods of time and include Sweden, Norway, Denmark, Finland and Austria. SOUTHERN/LATIN OR EX-AUTHORITARIAN OR EX-DICTATORIAL COUNTRIES ( EDCS) These states comprehend countries as (Italy, Greece, Portugal and Spain and comprise a distinctive southern welfare state regime. This kind of welfare state is described as rudimentary because they are characterised by their fragmented system of welfare provision, which consists of diverse income maintenance schemes that range from the meagre and generous welfare service, particularly, the healthcare system, that provide only limited and partial coverage. Reliance on the family and voluntary sector also a prominent feature. These countries the authoritarian or dictatorial parties have governed for the longest periods of time.
SOURCE: OWN MAKING MIXING INFORMATION OF RAMBA AND NAVARRO et al. PAPERS

A priori is difficult to determine out a strong cultural-socio-economic differences, due to the closest position of both countries in the raking of de HDI, which shows a very huge similarity in the aspects considered to make that index. In other way the big difference is noticed in the kind of welfare state that exists in each country and its political tradition, and that could be the path to follow in the research in order to find the differences in mortality rates between social classes. Due to the explained above and taking advantage of the actual tessitura of world economic crisis, I wonder to know if there are differences or similarities in mortality rates between social classes between Belgium and Spain during the period comprehended 1999 and 2009.

Literature overview
First of all I am going to try to find out what is said about the topic, looking into scientific literature. In order to start focusing in our question and having a clearly image of what I am referring to. To do so is necessary to choose one of the many concepts of social class. The social class is a status of membership to a specific social structure, but this status can be given by several factors. These factors can be cultural or educational, given by bloodline, kinship or castes, or given by the law made by men under certain prerequisites, or, and it is the well-known cleavage explained by Karl Marx in the modern occidental societies, the factors that can determine the membership to a social class can be given by the relationship of the individual with the ownership of the means of production, the production of goods or the consumption of these. But despite that is our main cleavage, the factors which influence the disparities that surround the act of dying are very disparate, in fact as Benjamin says: different elements in the environment influences the process of adaptation (to death): i.e. the mode of employment, working conditions, intelligence and educational levels, level of living, including this, nutrition, clothing, housing, medical care access and other kinds of wellbeing access and also is influenced by the cultural background as the religion, social customs, art forms and different modes of emotional expression(Benjamin, 1965:5). One way to approach to our issue, as I said is the historically way that tries to separate the effects of mortality of social changes by successive generations or cohorts as something related to the genetics and the environmental thus as an issue of our Zeitgeist, understood as the cultural spirit and values of our times. The human being, historically has had very heterogeneous ways of confront the death, but this is no reason because all that traditions had to soak in the common conscience. Thus, we can say, just climbing on the shoulder of giants, the act of dying is an amalgam of that traditions plus a succession of factors specifically of our contemporary Zeitgeist.

The study of the mortality related to the social class is a long recognized issue through the history, in fact there are several studies and comparisons between the total population death and high class population death rate during the preindustrial age, and those did not find any significant mortality differences between social classes. But lately with the spread and use of the demographic discipline by the Nation/States in order to take account of the army and the population, these gathered a lot of information about born an deaths and thus i.e. in 1835 A. Quetelet synthetized that kind of data for the first time in his study of Sur lhomme et le developpement de ses faculties ou Essai de physique sociale establishing with it the first bigger differences between social classes. In the second half of the XIX century and the first half of the XX, the social differences increased in a dramatically way, due to the industrial revolution, and bringing into play a variety of new variables to consider. For that reason has become so difficult to isolate only one factor that affects in a significant way to the death and the many of them usually overlap themselves removing clarity of perception. As is explained to exemplify this in the research of Benjamin, the presence of a small group of low status and high mortality might have more effect on mortality than for the social index of a specific area, leading to a departure from the normal inverse relationship between social status and mortality. And this can lead to sociological artefacts (Stockwell in Benjamin 1965:8). But despite on that confusion, one thing appears to be constant by doing an historical review of the issue, and is that the hygiene and the health changes interfere in the mortality rates, and the inequality of access to that cares depending of the social class based in economic aspects may be a reason for the difference in the act of dying. But in the recent ages where the technologies of hygiene have reached the mass is needed to look for more indicators which can lead us to a more causal answer of our initial question.

Another possible approaching way may be to look at the act of dying as a lack of health, as they are two sides of the same coin they have always appeared to be closely related, despite the historic discontinuity that marks a huge change in the boundaries of the quality of life in the modern societies, splitting the mortality rates of the per capita growth and relating it to the social inequalities, that is a better indicator that also embraces the per capita growth (Extracted from
Wilkinson 1984:61).

So in that ways of thinking the next step will be an attempt to find the more important of these factors and try to explain briefly how they work and how can be used in future researches. In order to do that Im going to enumerate the most used indicators used by sociological theory and after that pick the ones which fits better with the approach to the issue I want to do, namely differentials in social class mortality rates taking in account the welfare state of each country.

NUTRITION
I am going to start paying attention to the nutrition habits as an environmental factor that has changed amongst the times in several ways, in the quantity of calories consumed, the quality of the food and the access to them as a basic good. The existence of a relationship between nutrition and mortality is widely accepted but for epidemiological analyses better than for demographic ones that dont take so much in account about that relationship. Anyway that relationship is difficult to establish because the effect of the nutrition over the mortality can be both positive and negative. Omram hypothesised in 1977 that the high nutritive foods were part responsible of the diminution of mortality and of the epidemiological transition occurred between the Age of Pestilence and Famine and the Age of Degenerative and Man-Made Diseases following the timeline specified by Abdel R. Omran. The few researches done looking after the direct relation between nutrition and mortality rates had hypothesised that the nutrients of food rather than the changes in the diet are a determinant of the distribution and variation in the age 8

patterns of mortality among populations, and economic factors, as income, has only an indirect relationship. The research made by Cage and OConnor (1994) states that if the caloric consumption is not the only factor that affect to the mortality rates, the study of the different nutrients present in regular food as fats, carbohydrates and protein may lead us to a better knowledge of how the good or the bad nutrition can affect to the mortality. In a deep research guided by quantitative methodology, these three aspects must be crossed with the mortality rates during any specific lapse of time in order to find any correlation between them. A hypothesis can be that the reduction of the major illness and diseases can be reduced by these nutrition habits guided by more a bigger caloric ingest in the diet. Namely to a better nutrition a better health and due to that a lower chance of death.

OCCUPATION
In order to establish a relation between the mortality rates and the occupation is needed to know the number of deaths for each previously stipulated cause of death by age and sex in each type of occupation. And as it is recommended in the essay on Benjamin, standardise the occupations by ages because there are significant differences of when the jobs are reached. But anyway we can find incongruences in the input data because the actual grade of occupation taking from the contracts often do not coincide with the occupation grade given at the moment of register the death. A good initiative in order to start getting some perspective could be look at the occupations with highest and lowest mortality rates, and compare them to a previously specified social class rank where has to fit all the occupations. There is a very simplistic but clearly cleavage made by the British Decennial Supplement of the Registrar General, made from occupation positions, which can help us to put the individuals in not so many groups in order to generalize our explanations:

I. II. III.

Upper and middle class-professional occupations. Intermediate class-managerial and technical, intermediate occupations. Skilled occupations count since 1971 with two sub-classes. IIIN. Skilled non manual workers.

IIIM. Skilled manual workers. IV. V. Partly skilled occupations, as agricultural workers Unskilled occupations.

(Benjamin 1965:59 and Gadeyne 2006:39)

Source: Kunst, A. E., Groenhof, F. & Mackenbach, J. P. (1998), Occupational class and cause specific mortality in middle aged men in 11 European countries: comparison of population based studies, British Medical Journal, 316, 1636-1641

As example of that, the research made by Erikson and Torssander (2008), after the standardization of the and the ages by occupation as Benjamin suggest, notes that he hazard of dying in wide largest in unskilled working class than in white collar workers, despite this approach is quite vague and the researchers encourage to do a more accurate typology, they charge the highest level of mortality in manual workers because the highest hazard of exposure to dangerous situations, the exposition to harmful work environments and bad health consumption habits as smoking, drinking or the use of drugs.

10

EDUCATIONAL LEVEL
This indicator can help to define in a better way the main relationship between occupation, income and mortality, used in a lot of sociological studies. The study of Benjamin assure than those in professional and managerial employment have lighter mortality than unskilled workers, also are better educated in health and other matters due that education plays an important part in deciding whether people cloths or feeds themselves adequately, what they do about fresh air, exercise or relaxation or in the other hand whether they avoid the massive alcoholic consumption, or tobacco or other harmful habits . (Benjamin
1976:50)

In some studies is assert that the cultural and educational level is a clue indicator to understand the relation between the socioeconomic class and the health-related behaviour.

AVAILABILITY OF MEDICAL SERVICES AND THE MODEL OF LIVING

Is well checked that the higher economic development the higher health care has a country and this leads to a decreasing of the mortality rates caused by the lesser diseases like smallpox, diabetes, tuberculosis or diphtheria. We can find a variety of managing the public health care system depending if exists or not a welfare state and if already exists is also possible to match differences depending on the type of these. in conditions of universal accessibility of these medical services

understanding by any economic barriers, social and economic differentials in mortality are highly reduced (Benjamin, 1976:53) The way of living, also influence in the mortality rates, in the study of Benjamin is said that the health care and a careful way of living leaded to a decrease of the elder men mortality rates and in a reduction of the mortality of the woman of all ages. Also was noticed that the lung cancer and heart disease was reduced too due to the good living As concludes Charlotte Van Tuyckom,, lecturer of the, Department of Sociology at Ghent University, another factor to observe is the relationship between social inequality and health which happens to be very consistent. 11

One of the more used indicators to observe the social inequality is the Gini index made from the Lorenz curve and based in the economic distribution of one specific society, where 0 is full equitable distribution or equality of income and 100 is the highest inequality possible. Gini Index by years in Belgium and Spain Belgium Spain 26.92 Missing data 33.0 35.0 28.0 32.0

1992 2000 2005

SOURCE: COMPILED FROM GAPMNIDER, UNITED NATIONS DEVELOPMENT PROGRAM WEBPAGE AND NATION MASTER WEBPAGE.

URBANISATION AND GEOGRAPHICAL POSITION

The migration from the town to the cities might be another good indicator of social class, due as it is known the lowest classes of the towns the mostly of the times they migrate is to try improve its socio-economical level. Thus, and taking this in account, it could be very informative to check the mortality rates from those migrants from the town to the city, spread by borrows since they can be easily classified by social class. Another possible approach is the geographical placement of the individual, which can determine itself the social class and can give information about the mortality rates due to the inequality of that distribution, where the lower social classes may live in non-secure or harmful environments that affect negatively to his health status and can shorten the lifespan And both approaches can be crossed at the same time with the GDA per capita of each country, or to handle better the amount of information, each country can be divided in its main administrative regions, doing the comparison easier due to the more comparable data on one single region at the time. (Shaw et al. 2000). The evidence shows that health levels decrease dramatically in socio-economic disadvantaged areas and consequently the mortality rates rise up. In fact the World Health Organization (WHO) states that social distribution in health status, and indeed mortality rates, is underlain by the unequal distribution of fundamental resources and opportunities for a healthy life, such wealth education, employment, access to health care and the environment in which people live (WHO Commission on Social Determinants of Health 2008). 12

Source : Shawn M. et al. 2000

The main concept the researchers of that field are working on is the environmental justice, which studies de disparities in access to beneficial health environments and the protection of that deprivation by considering the socioeconomic status of an area. Unfortunately there is a lack of research in that field. Concluding is has been postulated but not so much proved that a better access to healthy environments (pollution-free, with open green spaces etc.) influences in a positive way to the health of the population and indeed in its mortality rates. The researchers also noticed that the access to the better places is strongly correlated with the socio economic level. I.e. research in Hamilton, Canada found thatr socio economic status modified the relationship between air pollution exposure and mortality (Jerrett et al 2004 in Pierce et al 2010).

13

INCOME LEVEL
The level of money that a regular individual earns, operationalized as income per capita, is another variable to considerate and to relate with the others to realise what is social class an thus find the causality between social class and mortality rate, due that from the income are extracted the taxes paid to the state, that could be one of the best indicators at the time to relate the information with the type of welfare state of the country observed.

Evolution of life expectancy depending on the Income level per capita in Belgium and Spain between 1991 and 2009.

At the time of operationalize that variable the gap can be chosen freely by the researcher but its highly recommended to make a likert scale of five or of seven steps, due to its statistical utility and making each of the steps equidistant, starting from the lowest amount of income and finishing with the highest.

14

STATUS
The concept of status is wide used in social sciences and specifically if it is wanted to find any kind of correlation or causality with the mortality rate, but, is also a concept who can allow a lot of facets in it. Thus Im going to define what I am going to use as the status indicator. Social status can be both acquired and determined by the main cultural values of a specific society. In ours the status can be understood as a combination position, gained by the marriage with equals o higher individuals in terms of power. The power itself understood as the possibility of oblige to do something to another person against its will and the specific occupation in the labour market, that also gives to the owner certain amount of power. MARITAL CONDITION Torssander and Erikson (2009) describes the Status variable as the measure based on the occupational structure of marriage or cohabiting, considering the general advantage or disadvantage that these provides reflecting the combined rates of both material an social inequality. The construction of that variable is based on the presumption that individual tends to relate and marry its equals in socio-economic level an education level.

RETHINKING SOCIAL CLASS

But despite all the indicators listed above the mainstreams of the written sociology related to the understanding of mortality and social class, argue that none of them itself are fully relevant in the results. For that cause I am going to redefine the social class concept and try to fit it into the different social politics of each specific welfare state our object study countries.

15

For an easy understanding of what I want to explain I will display a schematic graphic of the idea.

Education

Social politics WELLFARE

Income

Social Class
Status

STATE

MORTA LITY RATES

Source: Selfmade

The Education indicator may be constructed as is explained below, as so can be the Income indicator, but in the case of the Status indicator I suggest it can be a typology created from the correlation between the achievement of the socio-cultural values of the specific society plus the power held by the individual, that is closely related to their occupation and finally the social position determined by formation of a family nucleus with one partner of the same education and income as the individual or not. The graphic above wants to illustrate that in the way how are articulated the education, the income and the Social status, determines a specific a specific configuration of social class and a specific kind of social politics which in turn shapes a specific kind of welfare state, determining largely but not entirely the mortality rates by social class. Coincidentally all the papers used in this research hold that none of the indicator had a fully explanation capability and often they overlap themselves. That table can be read in a bidirectional way.

16

SOME POSSIBLE EXPLANATIONS

So, following the premises explained before we can start thinking about the relationship between social class and mortality as a possible bidirectional causality between Mortality rates and Social Class or, and this is a causation of less weight because of its deterministic component, the genetic factor has could had an important role in the cause both mortality and social class having between those last a bidirectional relation of causality.

HYPOTHESES
Taking in account all the explained above is possible to look for an answer from that proposed hypothesis, after, doing the right correlations and statistical analysis, starting from a good data base who contains all the variables we determine. MAIN HYPOTHESES 1. All the variables are directly interdependent, named the higher will be the health level the higher will be the educational level and thus, the higher will be the educational level and the higher will be the income, etc. both in Belgium and Spain. 2. Higher socioeconomic status brings a lower mortality. 17

3. Mortality rates, in the entire hypotheses listed above are highest in Southern well fare state countries than in Conservative countries namely higher in Spain than in Belgium. 4. Persons of higher socioeconomic status (social class) possess a wide range of broadly serviceable resources including money, Knowledge, prestige, power and beneficial social connections, which can be used as an advantage both in Belgium and Spain to preserve and enhance their health. 5. Younger people, due to a highest educational level which brings the to a better health habits, has les mortality rates. SECONDARY HYPOTHESES 1. The kind of welfare state does not make a real difference in mortality rates by social class. 2. The reduction of the major illness and diseases can be reduced by these nutrition habits guided by more a best ingest of calories in the food. 3. The change in mortality rates associated with the social class only is noticed in individuals of 45 years onwards. 4. Mortality rates and social class differences it will be noticed between allochthonous and autochthonous. 5. Mortality rates are higher in blue-collar workers than in white collar workers.

18

Factual information
To give support to the exposed above Im going to attach some statistical tables of the main Statistical Institutes of each country studied, and do a brief comment of the data.

Source: Self-made with data of the Instituto Nacional de Estadistica (INE)

As is possible to see in the first chart the mortality rates were going down over the years in both countries (despite the lack of information for Belgium in the Spanish database for the years beyond the 1999) is presumably that the trend of the Belgium people is to decrease the mortality rates. In the chart is also noticed the high hazard of mortality by ischemic disease bigger in Belgium than in Spain, is at least 3 times bigger than the non-natural mortality causes, as car accident or suicide which have a minimal representation in both countries, in the other hand the death by mental illness produced by drug or alcohol consumption remains as the mean cause of mortality within these tree specific causes of dead. it can be seen the polarized behaviour of the people of those countries, in the death by mental illness by drugs, which in Belgium is wide bigger that in Spain and in the other hand the death produced by mental illness by alcohol consumption is much bigger in Spain that in Belgium, this behaviour could be explained by cultural traditions. 19

Source: Self-made with data of Statistics Belgium

Due to the lack of information in the Spanish database I have addressed to the Belgian Institute of Statistics and only appear to be fragmented information about the causes of death, both specific and general. In the graphing of the data it can be noted that from 1998 to 2006 in intervals of one to three years maximum the trend is to stabilize the mortality rates with a slightly deceleration of the rhythm except for the tumors which experiments a minor increasing of cases. As I had asset before the general trend of the Belgian mortality is a decreasing one. It remains to check why this general decreasing is produced by. Checking only the All

cause standarized death rates taking as reference the spanish population in 2009, it is possible to check the similar behavior of both countries but with a higher level of Belgium.
Source: self-made with Eurostat data

20

Source: Eurostat

As I said before, a good way to compare the deaths is not by whole country but by administrative delimitation, in the preceding map the mortality rates of both countries can be appreciated in whole numbers divide in quintiles and coded by colours to have a more visual perception of death rates in 2011. In the following charts is possible to compare the number of deaths of the countries divided by regions in two different years, 2000 and 2009 in the same way as in the other graphics it can be noticed that behaviour is very stable, just with minor changes upward or downward

21

Source: Eurostat

The following representations are related to the main indicators used in the construction of the variable, Social Class, as is explained before, it could be built by combining Educational level, Income per capita, and Status, the later based upon the Marriage between equals. I have to say that in the databases requested, no crossing with other variables were allowed, and is a job that has to be done by the researchers, to be able to include some kind of typification of Social Status.

22

The next chart shows the educational level of both the Belgians and the Spanish students in percentages from the lowest level, Pre-Primary education to the highest one, Tertiary education. Is needed to say that the data is not standardised and the percentages show are related to the whole population of each country, as is well known Spanish population is larger than Belgian, so the graphic shows this disparity. It can be noticed that the spanish 3 to 6 levels are quite simile while in Belgium the difference between them is more substantial, being smaller the percentage of 5th and 6th level of education. These data can be correlated with the mortality rates, a typificated to be able of build the early said indicator Social Class.

Soure: Self-made with data of the Eurostat.

23

Other of the indicators needed to make the Social Class dataset is Income. Just to have a brief idea of how is distributed the money in our countries, I present a coloured map indicating the gross earnings in the secondary and tertiary sector of production, as is clearly visible, Belgium has highest benefits than Spain, but they are so close because only have one gap of difference.

24

As can be appreciated in the next map, also the minimum inter-professional wage is higher in Belgium than in Spain. This can be because of the different kind of welfare state present in each country, maybe taxes revenue data, and social policies information will be needed to round up the role of that welfare state plays in the relationship with the social class.

Source: Eurostat

Finally to complete the new proposed Social Class concept the marital status is observed in the next pictures in a four category typification for both countries, the graph shows the different behaviour two societies, ruled by a different religious/moral precepts. While the majority of the population of both countries marry for the first time without having been in another institutional legitimated 25

relationship or maybe they came from a former civil state In Spain few divorce occurred in comparison with Belgium, the case of the widowed is minimal an could not be relevant for the research. Again correlation with Income and Education level will be needed to find a proper Social Class categorization.

Source:Self-made with Eurostat data

26

Discussion and conclusion

The primal conclusion if any, without doing any analysis at all, and following the always present conclusive pattern in almost every paper used to document mine, is that there is not a unique variable which determines in a strong way the mortality rate in general. So find a single variable for any of the two countries under observation could be a titanic job. Following the read, if one of the considered factors must have a special treatment for its a, priori, inextricably relation with the others, is the Educational Level. It is fundamental to focus and thresh it, because a higher Educational level leads to another sight of view about the world, which could lead itself to the individual to take care about its health, to achieve a better job which gives more money to get certain social status which at the same time could lead to the owner the chance to get married with a person of the same status. And if the main hypotheses are corroborated a higher social class leads to a better health that prevent from death prematurely. Income is the other main indicator to study about, because it permits access to material objects that can prevent a deterioration of the health, as well as permits to move along to healthy environments. As the money is not always achieved by a high educational level, it is necessary to take a closer look on it. I suggest the Nutrition indicator as one that can be used as an external factor to the social class and the mortality rate, cue to its deepness as concept and its many operationalization possibilities. In other hand, due to the lack of continuity of the data recollected, it could be reasonable to reduce the period studied or look for more detailed data for the proposed period. Finally, and looking at the raw mortality cyphers, the different welfare state of each country do not seems to be apparently influent, as it is possible to see, the standardized ratios are very similar. Correlations following the proposed model will be needed.

27

Bibliography
BAMBRA C., Health Inequalities and welfare state regimes: theoretical insights on a public health puzzle, J Epidemiol Community Health Vol. 65, pp. 740-745, Published Online, 2011. DRESSLER W. W., Social inequality and Health: a Commentary Medical Anthropology Quarterly, Vol. 24, Issue 4, pp.549-554, American

Anthropological Association, 2010. TORSSANDER J., ERIKSON R., Stratification and mortality A comparison of education, class, status, and income, European Sociological Review, Vol. 26, Number 4, pp. 465-474, 2010. PEARCE J.M., RICHARDSON E.A., MITCHELL R.J. and SHORTT N.K., Environmental justice and health: the implications of the socio-spatial distribution of multiple environmental deprivation for health inequalities in the deprivation for health inequalities in the United Kingdom, Transactions of the Institute of British Geographers, Royal Geographical Society, pp. 522-539, 2010. TORSSANDER J., ERIKSON R., Stratification and Mortality A comparison of Education, Status and Income, European Sociological Review, Vol. 26, Number 4, pp. 465-474, Oxford University Press, 2009. ESPELT A., BORRELL C., RODRIGUEZ-SANZ M., MUNTANER C., PASARIN M I., BENACH J., SCHAAP M., KUNST A. E., NAVARRO, V., Inequalities in health by social class dimension in European countries of different political traditions, International Journal of Epidemiology, Vol. 37, pp. 1095-1105, Oxford University Press on behalf of the International Epidemiological Association, 2008. ERIKSON R., TORSSANDER J., Social class an d cause of death, European Journal of Public Health, Vol. 18, pp. 473-478, 2008. AUGER J. A., Social perspectives on death and dying, Fernwood Publishing, Nova Scotia (Canada), 2007. KELLEHEAR A. A social history of dying, Cambridge University Press, Melbourne, 2007. A

GADEYNE S., The ultimate inequality: Socio-economic differences in allcause and cause-specific mortality in Belgium in the first part of the 1990s, Centrum voor Bevolkingns- en Gezinsstudie (CBGS), Brussel, 2006

NAVARRO V. et al., The importance of the political and the social in explaining mortality differentials among the countries of the OECD, 1950-1998 International Journal of Health Services, Vol. 33, pp. 419-494, Baywood Publishing, 2003.

PHELAN J. C., LINK B. G., DIEZ-ROUX A., KAWACHI I., LEVIN B., Fundamental causes of social inequalities in mortality: a test of the theory, Journal of Health and Social Behaviour , Vol. 45 (September), pp. 265-285, 2004.

SHAW, M et al., Widening inequality in mortality between 160 regions of 15 European country in the early 1990s, Social Science & Medicine, Vol. 50, pp. 1047-1058, 2000.

CAGE T.B., OCONNOR K., Nutrition and the variation in level and age patterns of mortality, Human Biology, Vol. 66, pp. 77-103, 1994. WILKINSON, R. G., National mortality rates. The impact of inequality, American Journal of Public Health, Vol. 82, No. 8, 1992. CARLSON, G., On mortality, inequality and social theory, Acta Sociologica, Vol. 19, No. 4, pp. 387-391, Sage Publications Ltd., 1976. BENJAMIN B., Social and Economic factors affecting mortality, Mounton &Co., The Hague, 1965.

Webgraphy
http://www.gapminder.org/

http://es.wikipedia.org/wiki/Estado_de_Bienestar#El_modelo_continental

http://es.wikipedia.org/wiki/Espa%C3%B1a

http://es.wikipedia.org/wiki/Belgica

http://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nominal)_per_ca pita

http://www.beta.undp.org/undp/en/home.html

http://www.nationmaster.com/graph/eco_gin_ind-economy-gini-index

http://www.nationmaster.com/graph/eco_gin_ind-economy-gini-index

http://en.wikipedia.org/wiki/Epidemiological_transition