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Seeing social position: visualizing class in life and death

2003; Oxford University Press; Volume: 32; Issue: 3 Linguagem: Inglês

10.1093/ije/dyg176

1464-3685

Mary Shaw, Helena Tunstall, George Davey Smith,

Historical Studies on Reproduction, Gender, Health, and Societal Changes

There is a ‘magician’ Derren Brown who has recently been featuring on British television (www.derrenbrown.co.uk). One of his tricks is to stop a passer-by in the street and then, by using his apparently ‘psychic powers’, to guess their occupation. This produces an amusingly amazed reaction from the member of the public, but what Brown does is really a more extreme version of what we do many times a day—gauging social position from visual cues. When we look at an individual we quickly process visual information that denotes where they fit in the social world, and we do this predominantly without conscious thought. Visual indicators of class and wealth have played an important part in the historical development of the understanding of the relationship between class and health. Accounts of poverty and ill health in the 19th century frequently included descriptions of the physical effects of poverty upon the body. Death rates in British cities increased during the first half of the 19th century 1 and to contemporary commentators it was clear that the burden of ill health was concentrated on the poorest urban residents and that this was evidenced by their abject physical condition. 2‐4 In Frederick Engels’ The Condition of the Working Class in England in 1844 a Dr Hawkins is quoted as saying that visitors to Manchester were struck by ‘the lowness of stature, the leanness and the paleness which presents itself so commonly to the eye’ and in London Engels had seen ‘pale, lank, narrow chested, hollow eyed ghosts’ with ‘languid, flabby faces, incapable of the slightest energetic expression’. 2 The physical effects of the living conditions of the poor had their effects from early life: contemporary commentators pointed out that; the female factory operatives worked when pregnant until the hour of delivery (because otherwise they lost their wages) and their offspring were feeble. The appearance of these children showed their circumstances and neglect, which left ‘ineradicable traces which brings the enfeeblement of the whole race of workers with it’. 2 These characteristics—reflected in the short, scrawny, pale, and physically degenerate factory worker —were considered to be produced by long working hours, hot, damp, dusty, and overcrowded working environments, repetitive arduous work, physical abuse from overseers, poor food, lack of sleep, and inadequate exposure to sunlight. 2‐5 The resultant poor constitution increased susceptibility to disease and death. While there were some improvements in social conditions and standards of living from the mid 19th century onwards, 6 during the economic depression of the 1930s there was a resurgence of popular and academic interest in the effects of poverty on health. Again a particular focus was on the physical condition of the poor. In their well-known book Poverty and Public Health M’Gonigle and Kirby detailed shorter stature, lower weight, greater dental decay, greater prevalence of rickets and other bone diseases, worse posture, and greater prevalence of squint among the inadequately nourished children from poor households. 7,8 The social medicine movement of the period was concerned with social physiology; as John Ryle stated ‘The comparison of social class with social class in respect of height, weight, the routine clinical examination of systems, radiographic appearances, the common disabilities, and of mental and physical function tests ... should have much to teach us.’ 9