Whose fault is it? People's own conceptions of the reasons for health inequalities

How do people themselves think about inequalities in health? The topic has rarely been investigated, and oblique evidence has to be drawn from research on general lay ideas about health and the causes of illness. Data from a large British survey are combined with a review of the extensive body of, more usually, qualitative research on attitudes to health in Western industrialised societies. One tentative conclusion is that social inequality in health is not a topic which is very prominent in lay presentations, and paradoxically this is especially true among those who are most likely to be exposed to disadvantaging environments. Possible explanations are offered in terms of the effects of widespread "health promotion" activities, and the way in which lay theorising incorporates relationships between the group and the individual. The methods used in asking people to talk about health are also relevant: accounts of health and illness are accounts of social identity, and it is unreasonable to expect people to devalue that identity by labelling their own "inequality".

Nematode spliced leaders--ubiquity, evolution and utility

Most nematode messenger RNAs (mRNAs) have at their 5' end a common 22 nucleotide leader sequence, the trans-spliced leader or SL1. The presence of this leader on some but not all mRNAs raises several questions: What is the role of the spliced leader in mRNA maturation, stability and translation? Why do some genes have a spliced leader and others not? What is the evolutionary origin of this trans-splicing mechanism? Recently, additional trans-spliced leaders (SL2, 3, 4, 5) have been described. What role do these variants play in nematode gene expression? While definitive answers to these questions remain elusive, it is clear that the spliced leader will significantly facilitate the cloning and sequence analysis of most nematode mRNAs.

Globin and globin gene structure of the nerve myoglobin of Aphrodite aculeata

The globin of the nerve cord of the polychaete annelid Aphrodite aculeata was isolated and purified to homogeneity. The native molecule has a pI of 6.3 and acts as a dimer of two identical Mr 15, 644.5 polypeptide chains as determined by electrospray mass spectrometry. It has an average affinity for oxygen (P50 = 1.24 torr) resulting from fast association (kon = 170 X 10(6) M-1 . s-1) and dissociation rates (koff = 360 s-1). The partial primary structure of this nerve globin was determined at the protein level and completed and confirmed by translation of the cDNA sequence. The globin chain has 150 amino acid residues and a calculated Mr of 15, 602.69 strongly suggesting that the amino terminus is acetylated. The absence of a leader sequence and the lack of Cys at the positions NA2 and H9 needed for the formation of the high Mr complexes found in extracellular annelid globins classify the Aphrodite globin with the cellular globin species. The Aphrodite nerve globin is unlikely to represent a separate globin family, as cDNA derived primers detect globin messenger RNA in muscle, gut, and pharynx tissue as well. The gene encoding this globin species is interrupted by a single intron, inserted at position G7.0. Comparison to other globin gene structures strongly suggest that introns can be lost independently, rather than simultaneously as a result of a single conversion event as suggested previously (Lewin, R. (1984) Science 226, 328).

Globins in nonvertebrate species: dispersal by horizontal gene transfer and evolution of the structure-function relationships

Using a new template based on an alignment of 145 nonvertebrate globins we examined several recently determined sequences of putative globins and globin-like hemeproteins. We propose that all globins have evolved from a family of ancestral, approx. 17-kDa hemeproteins, which displayed the globin fold and functioned as redox proteins. Once atmospheric O2 became available the acquisition of oxygen-binding properties was initiated, culminating in the various highly specialized functions known as present. During this evolutionary process, we suggest that (1) high oxygen affinity may have been acquired repeatedly and (2) the formation of chimeric proteins containing both a globin and a flavin binding domain was an additional and distinct evolutionary trend. Furthermore, globin-like hemeproteins encompass hemeproteins produced through convergent evolution from nonglobin ancestral proteins to carry out O2-binding functions as well as hemeproteins whose sequences exhibit the loss of some or all of the structural determinants of the globin fold. We also propose that there occurred two cases of horizontal globin gene transfer, one from an ancestor common to the ciliates Paramecium and Tetrahymena and the green alga Chlamydomonas to a cyanobacterium ancestor and the other, from a eukaryote ancestor of the yeasts Saccharomyces and Candida to a bacterial ancestor of the proteobacterial genera Escherichia, Alcaligenes, and Vitreoscilla.

Evidence on inequality in health from a national survey

The debate about social inequality in health in Britain has so far been based principally on mortality rates. A survey of morbidity and fitness in a large representative sample of adults living in private households in England, Wales, and Scotland reveals striking differences between social classes in self-defined health status, the reported incidence of illness, the prevalence of chronic disease, and measured physiological fitness. The disadvantage in health status does not simply relate to a minority in the poorest social circumstances but appears to be related in a very regular way to the social class structure.

Religion and attitudes towards alcohol use in the Western Isles

Research on religion and alcohol has produced conclusive results with regard to the relationship between religion and alcohol consumption but ambiguous findings with regard to more general attitudes towards alcohol use. This paper considers these issues in depth by a secondary analysis of data collected in the Western Isles of Scotland. It finds that differences between Protestants and Catholics do exist: Protestants are more likely to endorse an abstinent position, while Catholics are more permissive in their attitudes towards drinking. In terms of attitudes towards drunkenness, however, differences between the two groups are slight. The paper concludes by giving data on differences in attitudes towards alcoholism and service use and calls for future studies in the area to take the cultural context of these issues into account.

Equity and consultation rates in general practice

An attempt was made to distinguish different types of consultations and their variation by social class by a secondary analysis of the second national morbidity survey in general practice. The greatest difference in consultation rates, comparing patients in social classes IV and V with those in classes I and II, was for life threatening, urgent, chronic, or incapacitating conditions, thus matching the presumed difference in need. For more trivial conditions and for symptoms not specifically diagnosed the difference between social classes was less, and for married women in various ways consultation rates suggested less care seeking by patients in the lower social classes. The different uses made of primary care is more illuminating and more relevant to the question of equality in use of services than crude overall consulting rates by social class.

The causes of disease. Women talking

An analysis is presented of the concept of 'disease' and its causes, held by one group of middle-aged women brought up in poor social circumstances. The diseases which the women talked about, and their ideas of cause, are shown to be the products of a particular medical and social history. The categories of cause which were favoured were infection, heredity and family susceptibility and agents in the environment. The women preferred to reject natural degenerative processes or the idiopathic: inevitability and randomness were both found frightening. It is suggested that the women's models of disease processes (though often factually incorrect) were in principle no different to those of advanced medical science, and no less sophisticated. The most notable features of their talk, however, were the salience of knowing about cause, the strain towards rational explanation and the importance of linking together life events. It is suggested that these are common human traits, which have implications for the interaction between doctors and patients.

Health services as a defence against the consequences of poverty in industrialised societies

The purpose of this paper is to offer, as a basis for discussion, a review of the issues involved in a consideration of the role of health services as a 'defence' against the consequences of poverty. First, some general questions are asked: It is true that industrialised nations have reached a stage of development where health care is irrelevant to health? Is the issue inequality in health, or more narrowly the particular problems of a minority, the 'poor'? Are the causes of disadvantage in health to be seen as behavioural or structural, and if health systems concern themselves with social-structural issues, is this medical imperialism or the proper exercise of responsibility? The role of health services is considered in relation to primary prevention, secondary prevention (or curative medicine) and tertiary prevention (or rehabilitative medicine). It is concluded that (though the impact of any form of universally-available health service must not be minimised) health systems in industrialised societies are not in general successful in mitigating or preventing the health problems of poverty. Some socio-medical policy programmes and some health-care delivery initiatives have, however, produced measurable effects. It is suggested that, while health systems can never wholly compensate for social inequalities in health, 'community' programmes may perhaps most effectively combine the structural and the individual approaches.

Consulting behaviour in a group of young families

From data collected as part of a sociological study of the health care of children in a socially disadvantaged group, a description is given of all the illness perceived by the mothers, and the use of health services, in 139 children during six months. In some circumstances and for some conditions, the mothers of these families might be seen as 'underusing' services, neglecting potentially important symptoms. In other cases, they appeared to be 'overusers' for trivial conditions, especially of the services of their general practitioner. The reasons for their apparently inefficient behaviour are discussed, and suggestions are made about the possible implications for primary care among vulnerable families.