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A Powerful B2B Marketing Plan Template for Your Business. Get exclusive early access to unique content in the form of monthly, actionable lessons delivered straight to your inbox. Essay About. (UPDATE #2 (July 2017): This article, and our B2B Marketing Plan Template, have been significantly expanded to include a wider selection of marketing tactics and ideas. The blog post has also been expanded to include deeper, broader explanations of the principles behind successful marketing strategies. To get the Essay on Elizabeth "Wives and Daughters" expanded list and the complete, augmented B2B Marketing Plan Template, you#8217;ll need to The Celluar Phone download the Analyze Your Marketing 13 Steps to a Clear Marketing Strategy ebook, which not only includes the template, but has dozens of pages of explanations, tips, examples, and ideas that help you. Understand who you#8217;re targeting with your marketing Outline how the specific marketing tactics you#8217;ve chosen will resonate with your target markets and segments Build a brand from scratch or update an existing brand Tie your marketing strategies and tactics to Essay Threats Continent both specific audience(s)/market segments and business goals Ensure you#8217;re not wasting time on worthless marketing tactics while better opportunities pass you by.

You can still download an Essay about updated version (as of 2017) of the of transcontinental railroad free B2B Marketing Plan Template by scrolling to the end of this article, but the free version will not include. The expanded Brand Persona Template The expanded Customer Persona Template The comprehensive marketing goal-setting exercises Close to 80 pages of marketing explanations, examples of marketing strategies and tactics, and a wide variety of tools and about tips to havisham analysis help you reach your target customers and get those valuable accounts that make the difference between a fantastic year and squeezing by.) And now for the article#8230; Your Marketing Sucks Because You Don#8217;t Have a Plan, and You Can#8217;t Grow Based on Product, Price, or Customer Service Alone. Here#8217;s what I#8217;ve seen in case, after case, after case businesses have been coasting on the strength of their product, their customer service, and their price, for a very long time. They#8217;ve been successful because. They have a unique offering They got into The Celluar Phone, an industry early That have extensive industry expertise They#8217;ve cut costs drastically or are extremely efficient, leading to consistently competitive pricing They#8217;re impressive networkers and have powerful industry connections They provide products and services that meets an incredibly high standard of quality They#8217;ve shrewdly targeted a niche market and paired it with their niche expertise They#8217;re incredibly talented and have an incredibly talented team They provide amazing customer service and really care about their customers and what they do They#8217;re all around rockstars, and they were born to win. And while a business can grow to a certain point and be extremely successful in a limited way based on to the panic the above criteria, there#8217;s a hard business truth that every Business Superhero eventually butts their head against (often with disastrous consequences): None of that awesome stuff above will lead to infinite growth at about The Celluar Phone, some point, you will always need marketing to continue to grow. And a business that doesn#8217;t grow is a business that#8217;s doomed to fail.

Look, you#8217;re good at what you do, and your team is impact of transcontinental railroad good at what they do. Essay About The Celluar. You wouldn#8217;t be reading this if that wasn#8217;t the case. But sooner or later, every business has to implement a well-thought-out, specific, data driven, masterfully employed, and meticulously checked, rechecked, and adjusted marketing strategy (often quite a few of them, depending on the number of markets targeted) in order to break through their growth plateau and start competing with the big boys. Maybe you coasted on a wave of Continent growth based on one of those criteria above. Maybe you had some knowledge of marketing and were able to Essay The Celluar Phone implement a simple strategy for a while.

But now you#8217;ve reached a point where that can#8217;t be sustained, where you need to get serious, specific, and granular about the precise ways you#8217;re going to reach a variety of target markets and segments and then start converting them into analysis, customers. You#8217;ve eaten up all the low-hanging fruit you#8217;re ready to start the hard grind upward. The Celluar. You#8217;re ready to get serious. You need a serious marketing plan. Our B2B marketing plan template will help you get there we offer a free version at the end of this post, but if you want a robust plan, you#8217;re going to have to crack open the wallet and plunk down a few Washingtons to to hamlet get the Analyze Your Marketing ebook. Or, you know, just hire us #128578; Before we jump into the B2B marketing plan template, let#8217;s cover some of the about The Celluar Phone basics. For instance, what sets business-to-business marketing apart from African, business-to-consumer marketing (and why should we care)? B2B Marketing Basics Emotion Plays Less of a Role, but It Still Plays a Role.

The big difference that many people think exists between B2B marketing and B2C marketing is Essay about this: in B2B marketing, you#8217;re marketing to a business, and so your marketing needs to be targeting, basically, a robot. I swear, it#8217;s like some people literally think they#8217;re marketing to the brick and mortar location itself#8230; Instead of the people in the building. The truth is, every business is factor to the of 1819? run by people, and The Celluar even massive multinationals with layers of decision makers who supposedly keep emotion out of their decisions do anything but. The truth is, even CFOs and CEOs are emotional creatures, and they can be reached using many of the same marketing tactics that work so well on consumers. Threats Continent. The truth is, even high-powered C-suite veterans are only partially influenced by data, smart rhetoric, clever arguments, and Essay about The Celluar Phone demonstrations of quality, price, and high-end customer service.

The truth is (I swear it#8217;s the last time I#8217;ll say that), time is limited, and if your numbers and offering are right, the only thing that#8217;s going to stand between you and that big account you#8217;ve always dreamed of is a few competitors and the emotionally driven gut decisions of people with fancy letters after their name. Essay Threats Continent. If you can choose marketing tactics that appeal to the emotions of The Celluar these people, you#8217;ll likely be more effective than the stiff, stilted, overly professional competition. Why would I include this information in a blog post about building a marketing plan? Because too often I see unique, well-positioned brands fall to pieces as they grow. They start to miss havisham think they need to do too much (instead of focusing on about what they do best) and that they need to look and sound like everyone else. They focus heavily on to hamlet the logical side of every marketing tactic and Essay The Celluar Phone completely forget the emotional side of the equation. They go from unique to a faded grey, they blend in to hamlet with everyone else, and Essay about The Celluar they can#8217;t figure out why their rocketing growth suddenly plateaus (and starts heading backwards). Impact Of Transcontinental. So, as you consider your markets, your audience, the segments of Essay The Celluar Phone your market that you want to miss analysis target most, remembering that they are, at their very core, human beings. They#8217;re not robots.

They#8217;re not skyscrapers. They#8217;re not brands or logos. They#8217;re people and you can appeal to Essay about The Celluar them the same way you can appeal to miss the average consumer. And the about The Celluar average consumer, the average human, is Gaskell's influenced more powerfully by their emotions than their logic. They go with their gut more often than not. This is true for The Celluar, men and women, it#8217;s true across the Essay on Elizabeth "Wives and Daughters" board, it#8217;s just that, in B2B marketing, you need to Essay Phone have your ducks in a row before you start employing marketing tactics that have an Essay emotional basis. You Can#8217;t Rely on a Template to Plan for Essay Phone, Every Eventuality You Have to Continually Revise and Update Your Marketing Plan Based on Market and Business Conditions. There is to hamlet no one right way to write a marketing plan, and plans have a nasty tendency to Essay about The Celluar fall apart when they meet face-to-face with reality. However, if your plan is fluid and flexible, if you continually revisit, revise, and edit your plan to take into on Terrorism Threats African Continent, account how the tactics are working in practice basically, if your marketing plan is Essay The Celluar Phone a living document it#8217;s going to Essay on Terrorism to the African be effective.

You have to spend time on Essay your plan, but not too much time. Miss Analysis. If you spend tons of Phone time trying to come up with the Essay to the perfect plan, youll end up with a plan that was perfect for conditions 3 months ago but that may have no relevance to your business today. That fluidity is critical you dont want a static plan that looks forward an Essay about Phone entire year without wiggle room. Plans that might be effective in on Terrorism the first quarter can fall apart when the business environment changes, so you need a plan that#8217;s going to flow with the about Phone dynamic environment of business#8230; And the only way it can do that is if you#8217;re referring back to it constantly and making changes when necessary. We recommend you check your filled-out B2B marketing plan template at least every month make adjustments as you go, check when you can, look at the data, and go with your gut. Metrics dont do you much good if you dont apply changes when you have new information, so don#8217;t ignore what you learn. Miss Havisham. How to Use the about B2B Marketing Plan Template Most Effectively. A marketing plan is only as good as the troubles to hamlet planning that goes into it. Just choosing a handful of marketing tactics out of a hat and saying, #8220;Yeah, that seems good,#8221; is a good way to waste a bunch of money. A good marketing plan requires the following: SMART goals (explained below) Target audience(s) and a clear understanding of the target market/segments Defined brand(s), product(s), and service(s) Now, we have a variety of templates that help you define all of Essay about The Celluar Phone these things: Some of this stuff is included in the ebook, some of it isn#8217;t, so your best bet is to havisham analysis just download it all and work your way through it.

Some of it is paid, some of it isn#8217;t, but frankly, I#8217;m not too worried about the people who only want the free stuff people who are serious, the hard workers, they#8217;ll buy whatever they need to buy to succeed. You know which one you are. To use your B2B marketing plan template most effectively, you need to set goals, flesh out your brand, define your audience for each marketing strategy, thoroughly define your products and services#8230; all of it has to be worked out before you even begin to think about Essay about The Celluar, dropping some cash and to the panic of 1819? putting marketing tactics into motion. Your brand, your products, and your services are both informed by (and themselves inform) your target markets and the segments you choose to target. About The Celluar Phone. As your target audience shifts, grows, ages, and Treatment For Neurological changes, so too will your brand. Your goals will fluctuate from about, quarter to troubles quarter, year to about Phone year, and decade to decade. All of these things inform your marketing strategies. Which Factor Of 1819?. You might have dozens of Essay The Celluar strategies all centered around different products, services, markets, and business ventures, all of which are going to of transcontinental railroad change and The Celluar fluctuate over Gaskell's time.

To use our B2B marketing plan template most effectively, you need to realize this at a gut level and always be ready and willing to change your plan to Essay Phone meet new conditions. All factors must be taken into account if you want to which contributed to the panic of 1819? choose the most effective blend of tactics, combine them with business goals, and Essay form them into a variety of strategies. For Neurological Disroders. Marketing Tactics VS Marketing Strategy. Essay About The Celluar. Look, if you really want to miss havisham dive into the difference between marketing strategy and marketing tactics, you can read this blog post, but the difference can be summed up pretty simply with one sentence: Strategy is your plan to Essay about The Celluar Phone achieve a specific business goal your tactics are how you actually make that happen. This requires that you have clear business goals worked out from the outset. Your goals should be SMART: Now, our free B2B marketing plan template and Gaskell's the ebook both include a summary on SMART goals and a worksheet that teaches you how to create SMART goals in a meaningful way, but if you want to learn more about Essay about The Celluar, setting SMART goals and creating a SMART action plan, read this blog post. Troubles. Here#8217;s a simple example of a SMART goal: Our goal is to grow our business by 7% in the next year by increasing conversions by 15%, leads from our website by Essay about 50%, leads from our outdoor advertising campaigns by 12%, and by increasing the miss havisham analysis value of the average sale by Essay Phone 10%. This goal is contributed very specific, it#8217;s measurable, it#8217;s time-bound, and, for this particular business, it#8217;s both agreed upon and reasonable. Once you have a goal, it#8217;s time to create your marketing plan: thats your strategythe overarching plan to turn your goal into reality.

Tactics are the specific marketing methods you use within that strategy to Essay The Celluar Phone reach your goals. I#8217;ll give you a very simple example based on the SMART goal listed above: Our strategy to grow our business is as follows we will employ a combination of pay-per-click and miss havisham social media advertising to Essay The Celluar Phone increase our website leads. We will increase our outdoor advertising by 30% in our major markets and Essay Threats to the African begin outdoor advertising campaigns in Essay The Celluar Phone two new markets to generate more leads in impact of transcontinental those areas. We will also offer a series of promotions on our core products to increase conversions, and we will increase commissions on upsells and cross sells to encourage higher-value sales. What you see above is Essay a (simplistic) marketing strategy, based around a goal, that incorporates specific marketing tactics which should achieve that goal. Once you have your goals in mind and your strategy in place, you really need to think a great deal about each tactic.

Consider the following: The reason for choosing the to hamlet tactic why choose this tactic over another? How will it help me achieve my goal(s)? The audience/target market/market segment who are we targeting, why are we targeting them, and how will targeting them help us achieve our goal? Time frame is this tactic going to be effective in Essay Phone the time frame it needs to on Terrorism Threats African be effective in? Is short term what we need, or is long term better? Frequency how often are we going to Phone employ this specific tactic?

How many times will we try it before we retire it? Cost how much is this actually going to cost us? Are we going to get a measurable, reasonable return on railroad our investment? At what point does it become too expensive to continue? Let#8217;s dive into each of these. What#8217;s My Reason For Choosing This Marketing Tactic? You may have multiple reasons for including a tactic in your marketing strategy, so, as you work your way through your B2B marketing plan template, list them all.

Part of choosing a tactic is knowing why you are spending money on something, even if that reason is, Because someone who knows what theyre talking about Essay about The Celluar Phone, told me to do it. However, you still want to try to find better reasons that relate to the goals you are trying to achieve. Some reasons for choosing one tactic over to hamlet another might be to. Establish your brand as a thought leader Create brand awareness Generate new leads Nurture leads through the sales funnel Increase conversions Increase average sales value Support your sales force Improve/change brand image Acquire customers Retain customers Upsell/cross sell existing customers. If youre spending money on something, you need to know why youre spending that money and what you hope to Essay about The Celluar achieve as a result. Any tactic you use must be a good fit with your ideal customers. Factor To The Of 1819?. If the market won#8217;t support the tactic, if the The Celluar environment is wrong, if the segment doesn#8217;t respond (or worse, responds negatively), the tactic is wrong.

You wouldn#8217;t plan to factor contributed of 1819? attend a tradeshow where none of your potential customers (or other parts of your supply chain) will be in attendance. You wouldn#8217;t spend time on a social network that doesn#8217;t represent your market well. And if you#8217;ve built your customer personas, then this shouldn#8217;t be a problem you#8217;ll already have a pretty good idea of what will work on each audience (and what won#8217;t). You also need to figure out if you have multiple audiences. The Celluar. Whats effective for one audience may be totally ineffective for other audiences. If that#8217;s the impact case, then you need to Phone come up with multiple personas to make sure that you target each customer segment effectively. You want to make sure you#8217;re using your resources effectively. This is pretty important.

As you know, your resources are finite. You cant afford to waste time or money on miss havisham something that isnt working and Essay about Phone wont create a return on of transcontinental investment. Every minute is worth something in your business, and Essay about you want to spend your time as wisely as you spend your money, so make sure that the tactics you invest your time and money into are targeting your ideal customers and clients. What#8217;s the Timeframe for This Tactic? You need to figure out exactly when you#8217;re going to use each tactic.

When during the year is going to impact of transcontinental railroad be the best time to use each tactic? For instance, you may want to Essay Phone wait until the fall to start your email drip campaign, leading up to an industry event in Gaskell's "Wives and Daughters" the spring. Some tactics may only have a start date and aim to continue for the foreseeable future. With What Frequency Will I Employ This Tactic? You also need to consider how frequently youre going to employ each of your tactics. Essay The Celluar. How often will you deploy pay-per-click ads on Essay on Terrorism to the Continent social media? Will you run them constantly for 6 months, or only a few times a month? Are you going to about The Celluar Phone continue to spend money on radio and TV ads every week, or is it time to only do a few a year? Will you put out blog posts monthly? Bimonthly?

Weekly? How many tradeshows will you attend this year? Find a frequency thats reasonable (and doable) for each tactic. HINT: For some tactics, it may be wise to Gaskell's "Wives start small and increase frequency as you meet your goals. Start out with an overly aggressive task load, and you may never get your marketing plan off the ground. About Phone. How Much Will This Marketing Tactic Cost Me? Dont forget your costs! You need to make sure youre utilizing your resources effectively. Planning it all out and developing an to hamlet extremely detailed, specific strategy will force you to look at the costs as a whole. You won#8217;t get far with your marketing plan if your budget doesn#8217;t make sense, so go ahead and about Phone factor in those monetary costs now.

This will also make it easier to Disroders determine if you#8217;re getting a positive return on your investment when you check your progress later. Time is a part of your cost too Are you spending your (or your employees) time effectively? Is it worth it to Essay Phone keep paying someone to spend hours blogging when their time might be better spent writing marketing emails for you? Just looking at Essay Gaskell's, how much time you and Essay about Phone your employees are spending on various tasks can show you where you can make changes. What Are My Expectations And Goals? You can#8217;t launch into a new marketing tactic without having some sort of expectation of Essay on Terrorism Threats Continent outcomes, so spend some time thinking about your goals, but also spend time thinking, realistically, about The Celluar Phone, potential outcomes. Try to set attainable yet aggressive goals for your marketing, evaluate your progress, and be realistic about how it#8217;s working out.

Follow the SMART goals recommendations found here, and which contributed to the panic don#8217;t be afraid to Essay The Celluar reset your goals (and your marketing tactics!) along the way. And, at least once a month, you should be analyzing your progress in each area of your marketing plan and adjusting the plan and Essay on Terrorism Threats Continent tactics (and goals!) accordingly. Some Tactics We Recommend You Use When Filling out Our B2B Marketing Plan Template. Although there are quite a few tactics out there (and really, the The Celluar possibilities are almost limitless), here are a few that you might consider: SEO (Search Engine Optimization) SEM (Search Engine Marketing) PPC (Pay-Per-Click Advertising) Social Media Marketing Facebook Twitter LinkedIn Instagram Pinterest Snapchat Industry-Specific Social Media Sites Content Marketing Blogging Whitepapers Ebooks Checklists Webinars Video Tutorials Email Marketing Warm and Cold Emails Email Drips Direct Mail Affiliate Marketing Tradeshow Marketing Radio/TV Advertising Outdoor Marketing (digital and troubles physical billboards, posters, vehicle wraps, mobile billboards, window signs, and handheld signs) Point-of-Sale Marketing Press Releases Promotional Items SMS Marketing and Proximity Marketing Remarketing/Programmatic Marketing Telemarketing/Cold Calling Guerilla Marketing and Viral Campaigns. Remember, the about Phone important thing is to analysis meet your audience where they already are and to properly represent your brand in every tactic you plan. Choose your goals, develop a strategy, add in tactics, and Essay put it to work stay in budget, keep doing what works, and impact railroad stop the stuff that isn#8217;t working. As simple as it sounds, it#8217;s often more art than science.

Watch your metrics, track things carefully, but go with your gut. Trust yourself to Essay about The Celluar Phone know what#8217;s best and, if you just don#8217;t have the marketing chops to make it happen, click the Essay Gaskell's and Daughters" button to contact us. Essay. We#8217;d love to help you grow. Download the B2B Marketing Plan Template and the Ebook Now. If you#8217;re ready to get to work, then click the button to download our B2B Marketing Template. Or, if you want to stop screwing around and havisham get serious about increasing your commissions, generating leads, pumping up website traffic, and converting, buy the Analyze Your Marketing 13 Steps to a Clear Marketing Strategy ebook. Get exclusive early access to unique content in Essay The Celluar the form of monthly, actionable lessons delivered straight to your inbox. After almost a decade of marketing in which contributed to the panic a corporate setting, she tired of being a corporate cog and decided to go it alone, bootstrapping a business based on one simple principle:

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Black Report 6 Explanation of Health Inequalities. 6.1 Standardised death rates in about Phone, present day Europe have probably reached their lowest point in on Elizabeth and Daughters", the entire history of about The Celluar, human society. The twentieth century has witnessed a dramatic decline in the rate of troubles to hamlet, infectious disease, as well as the introduction of Essay, powerful therapies for troubles to hamlet its treatment. Common causes of about, death which have thus greatly diminished, such as TB and diphtheria were often linked to poverty and material deprivation. They have been replaced by panic, new diseases, some of which seem instead to be linked with affluence and about Phone, material abundance. On that account inequalities in health might have been expected to diminish.

The evidence which we have presented in earlier chapters suggests that this has not been the case. We must now address ourselves to the question of why social class should continue to exert so significant an influence on health in Britain, 6.2 There are a number of approaches to explanation of the relationship between social class and health, or at which factor least some aspect of it, in the present day. In our view none of Essay about The Celluar, these approaches provides a wholly satisfactory explanation of the which contributed relationship, or one that can account for life cycle differences in The Celluar Phone, the influence of social class on the risk of premature death. Indeed the variable of social class is in itself multi-faceted and its influence probably varies according to age or stage in the life cycle and according to the development sequence of a disease episode itself.

6.3 At the most fundamental level, theoretical explanations of the relationship between health and Treatment For Neurological Disroders Essay, inequality might be roughly divided into 4 categories:- i. artefact explanations; ii. theories of about, natural or social selection. iii. materialist explanations; and. iv. cultural/behavioural explanations. In some partial respect each one of these explanatory forms sheds some light on the observed relationships between class and health in present day Britain. We will first describe and discuss in of transcontinental, general terms the four approaches and then go on, by Essay about, reference to the problems of different age-groups, to show that a satisfactory explanation must build essentially on which, the ideas of the cumulative dispositions and Essay, experience of the Essay on Terrorism Threats African Continent whole life-time, and of multiple causation. 6.4 In this approach to the analysis of the relationship between health and social class, emphasis is placed on the artificial nature of the correlated variables. Both health and class are artefacts of the measurement process and Essay The Celluar, it is implied that their observed relationship may itself be an artefact of little casual significance. Hence the suggestion that continuities in the pattern of on Elizabeth Gaskell's, health inequality in the twentieth century may be more a reflection of changing trends in the occupational structure of British society than of a causal link between material welfare and health (see OPCS, 1978). Shifts in the occupational structure have led to Essay about Phone, the decline of certain traditional partly skilled and unskilled manual occupations (Registrar Generals Social Classes IV and V). Those men and women who continue to follow such trades tend therefore to be older on average than the rest of the active labour force because fresh entrants have been attracted to new job opportunities or they may be in residual occupations which have always had a poor health record. (This evolution in analysis, the social structure has of course been accompanied by some change in ethnic composition of the Essay about The Celluar Phone population.) 6.5 Thus the failure of health inequalities to diminish is believed to be explained to a greater or lesser extent by the reduction of the proportional the population in the poorest occupational classes (the implication being that the upwardly mobile either had better health than those who remained and that therefore the Disroders health of some of the latter could even have since improved; or that the health of the upwardly mobile subsequently improved).

6.6 One of the problems here is about The Celluar, that because of changes in occupational classification the change in recent decades in the distribution of population between the classes, and especially the troubles decline in the proportion in class V, has been believed to be larger than in fact it has been (see Table 3.16 above). Table 6.1 gives estimates by age as well as class of the distribution in 1951, 1961 and 1971. For men aged 25 and over the percentage in class V declined from about Phone, 11 to 8 and in impact of transcontinental railroad, class IV from 27 to 18 in Essay The Celluar Phone, the 20 years 1951 to 1971 (Most of the corresponding increase taking place in which factor panic of 1819?, class II, but also class I). However, the rate of change slowed down in 1961-1971 and Essay about, it can be seen that between a fifth and Threats, a quarter of those in the youngest age-groups continued to be found in classes IV and V. Overall, substantially more than a quarter of economically active men remained in classes IV and V in 1971. Table 6.1 Percentage of men aged 25 and over in five occupational classes in 1951, 1961 and 1971 (England and about The Celluar, Wales) according to 1960 (and 1970) classification of occupations. 6.7 Second, there are theoretical models which emphasise natural or social processes of selection.

In this approach, social class is relegated to the status of dependent variable while health itself acquires the greater degree of causal significance. The occupational class structure is seen as a filter or sorter of human beings and one of the major bases of selection is health, ie. physical strength, vigour or agility. It is factor contributed panic of 1819?, inferred that the Registrar Generals class I has the about Phone lowest rate of premature mortality because it is made up of the strongest and most robust men and women in the population. Class V by contrast contains the weakest and most frail people. Put another way, this explanation suggests that physical weakness or poor health carries low social worth as well as low economic reward, but that these factors play no causal role in the event of high mortality. Their relationship is strictly reflective. Those men and women who by virtue of innate physical characteristics are destined to live the shortest lives also reap the Essay most meagre rewards. Essay About The Celluar Phone? This type of miss, explanation has been invoked to explain the preponderance of individuals with severe mental disorders in social class V (a thesis which was reviewed critically in, for example, Goldberg and Morrison 1963). About The Celluar Phone? It is assumed that affected people inevitably drift to Threats to the, the bottom rung of the Essay about The Celluar Phone Registrar Generals occupational scale. Similar selective processes are thought to occur with other forms of disease even though the extent of drift may not be so great.

6 .8 Another problem to which this mode of reasoning has been applied is the distinct regional pattern exhibited by mortality rates. In this ease, the national economy is conceptualised as a mechanism of selection. Those parts of the UK with low rates of age-specific mortality and, by implication, apparently more fit populations are also believed to be regions where the economy is in a relatively healthy state and where job opportunities are better. This regional imbalance in economic vitality is associated with a trend in migration which systematically drains the contributed to the panic of 1819? depressed industrialised regions of their fittest men and women. The net result is believed to be reflected in the differential regional pattern of age specific mortality. Processes of selection may also influence the Essay about Phone distribution of Essay on Terrorism Threats to the, mortality between occupations.

In certain types of manual work, the Essay level of physical strength and stamina required may in itself act as a means of selecting or rejecting individuals. As a consequence although a given occupation might carry obvious hazards to the physical welfare of a worker, its tendency to attract and keep only the which panic physically robust may disguise these inherent dangers (cf Fox and Collier, 1976). Thus it may be misleading to infer, on Phone, the basis of death rates, the level of health risk attached to of transcontinental railroad, different occupations; to do so is to assume that the pattern of recruitment is random rather than systematically exclusive. 3. Materialist or structural explanations. 6.9 The third general type of explanation of the relationship between class and health emphasises the role of economic and associated socio-structural factors in distribution of health and well-being. There are many separate strands of reasoning within its explanatory rubric which can be more or less ordered according to the extent to which the primary causal significance is Essay about The Celluar, assigned directly or indirectly to the role of economic deprivation. Amongst explanations which focus on the direct influence of poverty or economic deprivation in the production of variation in rates of mortality is Marxs radical critique. Impact Railroad? This theory of political economy provides a theory of history linked to an explanatory account of the contemporary form and Essay The Celluar Phone, inevitability of economic exploitation.

6.10 Those associated with such a radical approach see health or the physical welfare of workers as a key dependent variable determined by the system of production which also gives a particular character to the culture and the ideology of society. Essay On Elizabeth "Wives? Not all follow Marx and Essay Phone, those who do risk interpreting modern problems in railroad, a way which he would not necessarily have approved. Crudely expressed in its original form, the about Phone argument was as follows. Capitalism is in to hamlet, essence a system of economic organisation which depends on the exploitation of The Celluar, human labour. The accumulation of profit, the guiding principle not only of the economic system, but of the whole form of capitalist social organisation, is the storing up in tangible form of the human effort and resources expended by individual workers over and above what they either require or have been allowed, to maintain their bodies in a fit and on Terrorism to the African, healthy condition. Marx did not use the modern concept of health in his analysis and Essay The Celluar Phone, was primarily concerned with the material welfare of Essay Gaskell's, human beings. This is reflected in his theory of immiserisation which assumes a minimum subsistence level which capitalist social organisation systematically violates through its greed for profit. In the process of immiseration the worker experiences economic deprivation on an ever increasing scale until finally he is left with insufficient resources to maintain bodily health.

6.11 Placed in its historical context Marxs analysis can be seen, at least in Essay The Celluar, part, as a counter critique to Malthusian theory which saw the relationship between death, disease and poverty as a natural phenomenon: the demographic safety valve of the fixed relationship between population size and the natural level of material wealth in the world. Marxs antidote to on Terrorism Threats African Continent, this naturalistic theory of social inequality stressed the about potential elasticity of material production under the capitalist mode of production, while at For Neurological Essay the same time drawing attention to its dependency on an unequal distribution of resources as well as its inherent tendency to promote material inequality in health as well as property between human beings. 6.12 Most modern proponents of Marxist theory do not interpret the Essay process of material exploitation in on Terrorism Threats African, terms of human bodily resources, and tend to measure surplus value in terms of wealth or property, the factors into which human labour is transposed. With the benefit of a centurys hind-sight the validity of much of this nineteenth century theory of the relationship between health and material inequality has been accepted today especially for the earlier phase of competitive industrial capitalism (G F Stedman-Jones 1971; Thompson, 1976). Essay About The Celluar Phone? Exploitation, poverty and miss, disease have virtually become synonymous for describing conditions of life in the urban slums of Victorian and Edwardian cities, as they are today for the shanty towns of the underdeveloped world. 6.13 What is the relevance of the materialist critique of capitalist society to contemporary health experience?

Can the premature mortality of the working class documented in Chapter 2 still be directly attributed to subsistence poverty and exploitation? It is true a relationship between material deprivation and Essay about Phone, certain causes of factor contributed to the, disease and death is Essay The Celluar Phone, now well-established, but then so is the capacity of the capitalist mode of production to expand the level of human productivity and to raise the living standards of working people. Economic growth of the kind most readily associated with the European style of industrialisation has in itself been credited with the decline in mortality from infectious disease during the nineteenth and twentieth centuries (cf McKeown: 1976; Powles: 1975). Troubles To Hamlet? Today death rates for all age groups in, Britain are a fraction of what they were a century ago and many of the virulent infectious diseases have largely disappeared, (cf Morris 1975; OPCS 1978), and the killer diseases of Essay about Phone, modern society accidents, cancer and heart disease seem less obviously linked to poverty. Against this background, the language of economic exploitation no longer seems to provide the to hamlet appropriate epithet for describing Life and The Celluar Phone, Labour in the last quarter of the twentieth century. Through trade union organisation and wages council machinery it is now argued that labour is paid its price and, since health tends to be conceptualised in optimum terms as a fixed condition of impact of transcontinental railroad, material welfare which, if anything, is put at risk by affluent living standards, it is assumed by about Phone, many that economic class on its own is no longer the powerful determinant of health that it once was. 6.14 The flaw in this line of on Elizabeth Gaskell's "Wives and Daughters", reasoning is the assumption that material subsistence needs can be uniquely and unambiguously defined in terms independent of the level of economic development in a society.

People may have too little for their basic physiological needs. But poverty is also a relative concept, and those who are unable to share the amenities or facilities provided within a rich society or who are unable to fulfil the social and occupational obligations placed upon them by virtue of their limited resources can properly be regarded as poor. They may also be relatively disadvantaged in about Phone, relation to the risks of illness or accident or the factors positively promoting health. 6.15 The structure of living standards has been slow to change in Britain. Personal wealth is still concentrated in the hands of a small minority of the population, as the reports of the Royal Commission on the Distribution of Income and Wealth have most recently shown (see Appendix 6, Table A6.1). 6.16 The question of whether the richest men and women in Britain have maintained their economic position at Essay "Wives the expense of less well endowed citizens eludes a categorical answer. The Royal Commission on the Distribution of Income and Essay Phone, Wealth has referred to the remarkable stability of the unequal distribution of of transcontinental railroad, income over the past 2 decades. (See also Appendix 6, Table A6.2). However there is no doubt that the proportion as well as number of the population dependent on a subsistence or near-subsistence income from the State has grown. The Celluar? For some groups, and especially manual groups, relative life-time resources will have been reduced.

Earlier retirement, unemployment and redundancies, single parent status and miss, disablement as well as the Essay Phone proportionate increase in the elderly population, all play some part in which contributed panic, this development. For recent years Table 6.2 shows the tendency for those at the lowest relative income standards to increase in number and proportion. Table 6.2 Numbers of persons in poverty and on the margins of poverty (Family Expenditure Survey) 6.17 A paradox has thus to be noted. About The Celluar Phone? While we would not wish to assert that the troubles to hamlet evidence is consistent and complete, the proportion of the population with relatively low life-time incomes (in the widest sense of income) seems to have increased in recent decades, just as the proportion assigned to classes IV and V seems to have decreased. People with low incomes are less able to Essay about The Celluar Phone, gain access to the facilities and the knowledge commanded by those with high incomes.

Thus whilst economic growth has improved the access of both groups to income and other resources, other groups have gained in proportion and Treatment For Neurological Disroders, since neither facilities nor knowledge is Essay about The Celluar Phone, a finite commodity, those with relatively low income (in increasing numbers) have remained relatively disadvantaged. 6.18 So it has been with health. Social class IV or V may in time catch up with the contemporary levels achieved by I and II but by that time, the latter groups will have forged even further ahead. Of Transcontinental Railroad? What is clear from all this is that there is Essay about, nothing fixed about impact of transcontinental levels of physical well-being. They have improved in the past and there is every likelihood that they will improve more in the future. Meanwhile class inequalities persist in the distribution of health as in the distribution of income or wealth and they persist as a form of relative deprivation. 6.19 The relationship between average means and descending occupational rank is well- established in the UK and also in other countries like the US. Reports of national surveys in both the UK and the United States for The Celluar Phone example, testify to For Neurological Essay, this relationship (GHS, 1972, pl88; FES reports; US, Vital and Essay Phone, Health Statistics Series 10, no 70, 1968-69). However there is controversy about trends in the relationship between skilled manual and miss havisham, the lower non-manual workers (as shown in about The Celluar, other income and earnings surveys).

In a national survey carried out in 1968 the latter worked fewer hours, had larger employer welfare benefits in kind and havisham, longer holidays, had larger capital assets, were more likely to be owner occupiers and had fewer dependents. The formers overall living standards tended to be lower. The highest earnings among skilled manual workers also tended to be temporary (Townsend, 1979, Chapters 10 and 18). 6.20 It is on the basis of knowledge of the Essay about The Celluar Phone relationship between occupational class and family income that inferences are made about impact of transcontinental poverty and health. Unfortunately the opportunities of examining directly the association between income and Essay about Phone, health are restricted. Relatively few data about factor contributed panic personal health can be related even to occupation and fewer still to income and to Essay The Celluar Phone, wealth. 6.21 More frequent adoption in studies of a more reliable measure of income is factor contributed of 1819?, desirable (as for example in The Celluar, the GHS) but such a measure will not always be sufficient as an analytic variable in explaining health. Of Transcontinental? Extension of the concept of income must be developed in 2 respects.

First, there is a substantial movement upwards and downwards in the social system. Goldthorpe and Essay about The Celluar, Llewellyn have shown just how widespread mobility is, not only between generations, but for an individual male moving through his work career (Goldthorpe and Llewellyn 1977). Troubles To Hamlet? For example, they found that those born to fathers in their classes VI and VII (roughly equivalent to the Registrar Generals III, IV and V) 43 per cent had by the time of the The Celluar survey (when they were adult) moved out of these classes. Looked at in another way, of Essay Threats to the African, those in The Celluar Phone, their classes VI and VII 31 per Gaskell's "Wives and Daughters", cent had been born into a different class. We would add that within occupational classes earnings can fluctuate very substantially. While many non- manual occupations are secure in the sense that there is career expectation of incremental annual increases of salary, independent of any promotion, many manual occupations are insecure by virtue of dependence on overtime, the Essay about Phone vicissitudes of trade and the economy generally and the tendency to move or be moved to railroad, lighter work in middle age. (see the evidence of substantial average loss of earnings during a three-year period on the part of the uppermost quartile of skilled manual earners, New Earnings Survey reports.) Some quantified estimates of lifetime income therefore need to be made in relation to occupational designation.

6.22 Second, during the decades since the war a growing fraction of family living standards has depended on benefits in The Celluar Phone, kind. These include employer welfare benefits (sometimes in terms of accommodation and havisham, subsidised accommodation), social service benefits and owner-occupation. Methods of Essay The Celluar Phone, comprehensively and reliably valuing such resources and relating them to which to the panic of 1819?, income have been devised but remain to be improved and accepted. The evidence relating financial poverty (causally) to Phone, ill-health is convincing, though only indirect. 6.23 The role played by material factors in the production and distribution of Treatment, health and ill-health in contemporary times is a complex one. It is complex because social class presents itself in a multi-faceted form in the advanced societies. Apart from the Essay about variables most readily associated with socioeconomic position, income, savings, property and housing, there are many other dimensions of social class which can be expected to exert an active causal influence on health status. These other dimensions are encountered in the world of work, in which factor contributed panic, the conditions under which men and Essay The Celluar, women earn their livelihood, in the level of danger and risk, in on Terrorism Threats, the degree of Phone, security and stability, in the scope for self fulfilment and job satisfaction and in the physical or mental character of the task itself. These dimensions of material inequality are closely articulated with another important determinant of health status education. 6.24 Educational attainment, or more fundamentally, the process of individual intellectual development, is closely linked to miss havisham, social class.

To a large extent, it is on the basis of success or the Essay Phone lack of it at school that children are selected for manual and non-manual work and as we have seen, this occupational distinction plays an important part in measured health status differentials. But we can go farther. Bernstein has argued that distinctive patterns of child rearing and of transcontinental railroad, socialisation such as those which tended to differentiate between working and middle class families, produce quite different linguistic capacities which are in turn correlated with quite different intellectual approaches to the social world (Bernstein, 1971). The working class child is rendered at a particular disadvantage on account of these differences because of the fit which exists between middle class norms of Essay about The Celluar Phone, socialisation and the dominant structure of the educational system. The outcome of Essay to the Continent, this is that children from middle class homes enter the school system already equipped with the appropriate mode of communication and as a result, they have more successful educational careers and leave school with a greater facility to manipulate their social and economic environment (which of course includes health services) to personal advantage. These ideas carry the variable of education far beyond the simple idea of the transmission of knowledge and Essay about Phone, skills. They imply that education and linguistic skill are amongst the troubles to hamlet most important sources of advantage and Essay about The Celluar Phone, disadvantage in both material and non-material spheres of of transcontinental railroad, human existence: determining the extent to which individuals are personally able to realise the level of human potential which advanced industrial civilisation has made possible. This dimension of class inequality in modern society brings us to the meeting point of the about Phone economic and the ideological in society.

Should we ascribe the deprivation of linguistic, cognitive and Essay on Elizabeth Gaskell's "Wives and Daughters", communicative skills to economic or cultural factors? Socialisation experience is seen to play a significant role in the transmission of the Essay Phone crucial modern form of deprivation (and may also play a role, for Essay on Elizabeth Gaskell's "Wives example, in explaining the association between smoking and educational levels [GHS 1976] but is the practice of socialisation an entirely voluntaristic feature of social life or is it constrained by economic and occupational life? This chicken and egg debate cannot be easily settled (cf Rutter and Madge 1976). 6.25 Two other lines of theoretical explanation require brief reference at this point. Each is The Celluar Phone, concerned with the effects on the health of the population of which factor to the panic, macroeconomic variables: levels of production and of unemployment, sectoral distribution of economic production, and so on. Studies of The Celluar, this kind were actually carried out by Morris and Titmuss in the 1940s, in contributed to the, the attempt to examine the effects of the Essay about The Celluar Phone violent economic fluctuations of the 1920s and 1930s upon a variety of health and Treatment For Neurological Disroders, mortality indicators (see eg Morris and Titmuss 1944a, 1944b). First, Brenner, making use of time series data trends in the US economy and fluctuations in rates of mortality purports to show that recessions and wide-scale economic distress exert and impact on a number of health status indicators including foetal, infant and maternal mortality, the national mortality rate especially deaths ascribed to: cardiovascular disease, cirrhosis of the liver, suicide and homicide rates, and also rates of first admission to mental hospitals (Brenner, 1973,1976, 1977).

In fitting the Essay about The Celluar Phone data on on Elizabeth Gaskell's "Wives and Daughters", economic trends (essentially unemployment) to that of health status indicators Brenner lags the latter between 2-5 years choosing the lag to obtain the best fit. By doing this, he purports to be able to estimate both the about Phone initial impact of recession on the dependent variable as well as the cumulative impact over the space of several years. Brenner posits time lags of varying numbers of havisham, years between economic change and changes in his various health indicators (on a purely empirical basis) thus establishing the about The Celluar Phone direction of causality in a temporal sequence as well as suggesting the length of time involved in the development process of disease. Railroad? The problem with such research is that of casual mechanism. How does unemployment increase mortality? Brenner makes use of the Essay about Phone somewhat ubiquitous concept of stress to link the two. 6.26 The second approach, in opposition to Essay on Terrorism Threats to the, Brenners. is concerned to disprove the common assumption (which Brenners work supports), that economic growth leads to an increase in general levels of about The Celluar Phone, health.

The basic theme which runs through the Essay on Terrorism Threats Continent materialist epidemiology approach is as follows. In the advanced capitalist societies, surplus value, ie the excessive extraction or exhaustion of human bodily resources and effort, in the productive process, is realised not through the depression of real wages as Marx argued during the The Celluar last century but through hazardous punishing and physically stressful work processes; human immiserisation is no longer manifested in terms of grinding poverty and deprivation, but finds expression in the spiritual and intellectual impoverishment of industrial workers. This situation is said to be the outcome of historical changes in capitalism itself. In the Treatment Disroders Essay advanced societies, the exploitation of human labour for profit has become rationalised. Wasteful competition between small firms has been displaced by the emergence of large scale monopolies whose profits are realised not through a penny pinching approach to workers wages but through a two-fold process: massive expansion in Essay, the production of Treatment Essay, commodities linked to the artificial stimulation of demand for them through advertising and the like. (cf- Stark, 1977). Here again it is argued that many of the commodities upon Essay Phone, which individual families as well as Western economies depend for their livelihood are either directly poisonous or potentially dangerous for human health. But in this theoretical approach, emphasis is placed more on the process of production than on what is produced. It is in of transcontinental, the actual process of commodity production therefore that disease is produced, through physical stress engendered by tense competitive work relations and routines and through social stress manifested in neglected or disrupted networks and relationships in the realm of domestic and community life.

As demonstration of this theory, epidemiologists working in about, this tradition have sought to show the way in which changes in the business cycle correlate with changes in mortality. But here, the correlation of time series data on employment and death are presented in such a way that high rates of mortality appear to follow on on Elizabeth "Wives, from low rates of unemployment and high levels of The Celluar, prosperity. (cf. Eyer, 1975, 1977a, 1977b). In periods of on Elizabeth Gaskell's "Wives and Daughters", high unemployment death rates are said to about The Celluar Phone, fall. This is said to result from the fact that the institutionalised pressure to consume is lessened, workers are relieved from stressful work routines, social solidarity increases, supportive relationships and networks are stimulated and human existence acquires a more varied and more elevated meaning. While not at all associated with this general theoretical approach Draper and his colleagues in Britain have been aware of the importance of certain elements within it, and have argued the negative consequences for health of indiscriminate economic growth, which can mean higher pollution, encouragement of impact of transcontinental, consumption of Essay about, commodities hazardous to health,, and so on. 6.27 Although we have so far interpreted materialist or structural explanations as being of a holistic, or macrostructural kind this is not wholly the case. Explanatory perspectives which draw attention to disparate dimensions or aspects of class do not necessarily embrace a holistic critique of economy and society. On Terrorism African Continent? Such approaches, which include that of social medicine, often stress (or empirically demonstrate) the significance of single causal variables such as insufficient income, poor or crowded housing, large families, insecure employment, manual occupations, inadequate diet or low levels of educational achievement. Such factors either singly or in combination with each other can be shown to exert an important influence on health status indicators like mortality so that they offer scope for the amelioration of inequality through special policy initiatives (Cf for example, Morris 1975; Townsend 1974; Zola and Koza 1967; Brennan and Lancashire 1978; Rainwater 1968; Cartwright and Dunnell 1972).

In our report we have made, and will continue to make, much of explanations of this kind. But is must be recognised that factors such as these can themselves be explained in macrostractura1 terms. At what point one chooses to stop the analysis ie what one accepts as an explanatory variable is a matter of intellectual preference and of the task at hand. 4. About Phone? Cultural/behavioural explanations. 6.28 Cultural or behavioural explanations of the which factor distribution of health in modern industrial society are recognisable by the independent and autonomous causal role which they assign to ideas and behaviour in Essay The Celluar, the onset of disease and the event of death. Such explanations, when applied to modern industrial societies, often focus on the individual as a unit of analysis emphasising unthinking, reckless or irresponsible behaviour or incautious lifestyle as the moving determinant of health status (cf. Fuchs, 1974).

These personal traits appear to be relevant causal agents in an historical context where the majority of African, premature deaths are caused by degenerative disease or motor accidents. What is implied is that people unwittingly harm themselves or their children by the excessive consumption of harmful commodities, refined foods, tobacco, alcohol or by lack of exercise [see tables 6.3, 6.4 and 6.5] or by Phone, their underutilisation of preventive health care, vaccination, antenatal surveillance or contraception. Some would argue that such systematic behaviour within certain social groups is a consequence only of lack of education, or of shiftlessness, foolishness or other individual traits. More theoretically developed as the basis for cultural/ behavioural explanations is the culture of poverty thesis which has much in common with the idea of transmitted deprivation. TABLE, 6.3 Food Consumption by Income Group (oz/person/week) GB1977. Table 6.4 Cigarette smoking by socio-economic Group (males and which contributed panic of 1819?, females aged 16+) 1975-6. Table 6.5 Participation in active leisure pursuits: ratio of rates for male non-manual to manual workers by Essay about The Celluar, age (males aged 16 or over engaging in each activity in the 4 weeks before interview) GB 1977. 6.29 As originally proposed by Oscar Lewis, an anthropologist who studied poor communities in Central American and, later, migrant groups in New York, the culture of poverty was intended to apply only to Essay Gaskell's and Daughters", market-organised social structure with poorly developed public systems of health, welfare and income maintenance (cf Lewis, 1967). Starting from a distinct cultural anthropological perspective, Lewis argued that human existence in any given environment involves a process of about The Celluar Phone, biological and havisham, social adaptation which gives rise to the elaboration of Phone, a structure of norms, ideas and behaviours. This culture over to the panic time acquires an integrity and a stability because of the supportive role it plays in helping individuals to Essay The Celluar Phone, understand and which factor panic of 1819?, cope with their environment but, through its influence on socialisation practices and the like, it also comes to have an important autonomous influence in the social consciousness of individuals.

The integrity of the Essay Phone culture ensures its autonomous survival even when the material base from which it emerged has changed or been modified. Essay "Wives And Daughters"? It is for this reason that people cling on Essay about The Celluar, to outmoded ideas or old-fashioned practices which do not seem to accord with the changed material realities of modern existence. In fact, the culture of poverty thesis has been widely criticised by British social scientists, eg Holman (1978, Chapter 3), Rutter and Madge (1976) and Townsend (1979, pp 65-71). 6.30 Consider, for example, the diffusion of acceptance of the idea of family planning. There is general agreement that this practice was first adopted by the professional classes, from whence it diffused to classes beneath (Banks and Banks, 1964). Troubles To Hamlet? Why should it have happened like that?

To pose this question, is, in essence, to question the applicability of the culture of poverty thesis. One answer is surely that men and women who felt secure and in Essay The Celluar, control of their material lives were most reluctant to leave reproduction to the will of God when a means of personal control was available. The question which must be posed a century later is why some young men and women, especially in the lower occupational classes, continue to leave the procreative dimension of their lives in divine hands? Is it lack of knowledge, outmoded ideas, or lack of access to the means of contraception or is it due to an underdeveloped sense of personal control or self-mastery in the material world? It can certainly be argued that what is often taken for cultural variation in cognition and behaviour is merely a superficial overlay for differing group capacities of self-control or mastery, which are themselves a reflection of material security and advantage. B. TOWARDS EVALUATION OF THE EVIDENCE ON HEALTH INEQUALLTITIES.

6.31 Seeking to troubles to hamlet, apply, and to choose between, such complex approaches to Essay The Celluar Phone, explanation (some of which, like that we have labelled materialist or structural themselves include competing approaches) when applied to evidence as complex at that which we have assembled, is Treatment For Neurological Disroders Essay, a daunting task. Intellectual honesty demands that we make clear our belief that it is in some form or forms of the materialist approach that the Essay about best answer lies. But there can be little doubt that amongst all the evidence there is much that is more convincingly explained in other terms: cultural, social selection and miss analysis, so on. Moreover it may well be that different kinds of factors, or forms of explanation, are appropriate to different stages of the life cycle. This possibility has guided our presentation of data for about explanation. 6.32 The beginning of the human lifetime, birth itself and the first year of Treatment For Neurological, life, has witnessed amongst the most spectacular declines in mortality of all age groups during the last century (cf OPCS 1978). Essay The Celluar? Between 1846 and 1976, death rates for infants of less than one year fell by more than 90 per cent and yet at the beginning of the 1970s the ratio of deaths for infants in social class V compared to troubles, social class I was between 4 and Essay about The Celluar, 5 to 1. How can this inequality amidst so much improvement be explained? 6.33 In the troubles to hamlet present day the cases of childbirth involving the greatest risk are those where the mother is older and Essay The Celluar, where she has already produced several children. Factor To The Panic? Such eases were, of course, more prevalent in Victorian society where knowledge about birth control was scant and where rather different ideologies about about The Celluar Phone family size existed. In recent years the percentage of mothers in classes IV and V having a fourth or fifth child has decreased, but remains higher than in classes II and III.

Class I produces a relatively large number of 4 and 5 child families. It may be that higher rates of contributed to the panic, stillbirth, or perinatal death, are a consequence of differences in Essay about, maternal age and parity between the Continent classes. Table 6.6 Still births and Essay about Phone, post-neonatal mortality rates by occupational class, age and parity, 1975-6. 6.34 However, as table 6.6 indicates, class inequalities in rates of death at birth and troubles, throughout the first year of life are found even when parity and maternal age are held constant. While age and parity exert an important influence on the risk of all stillbirths, the about Phone significance of these variables is much more evident among the wives of semi-skilled and unskilled manual workers. Gaskell's "Wives? The risk of stillbirth for the wives of professional and managerial households is lower no matter what their age or their previous record of about, pregnancies. Treatment Essay? (Similarly for perinatal death rates: at all ages and Essay about, parities the class differentials remain.) Rates of post neonatal mortality differ somewhat. Once again the variables of age and parity are more significant sources of differentiation among underprivileged women, but the pattern is different.

Class differences are now greater among young mothers under the age of 25 years except at higher parities, ie three or more previous births where the relationship between class disadvantage and increasing age reasserts itself. The conclusion which must be drawn from Table 6.6 is that occupational class differences are real sources of difference in the risk of infant mortality and not merely proxies for the variables of maternal age and parity. 6.35 Also to be explained are similar differences in the class incidence of low birth weight for, as we shall see, this is a handicap which (except under the most advantageous conditions) has long-term implications for the health and development of the neonate. 6.36 Examining the historic decline in perinatal mortality rates Hellier (1977) has established that over half can be attributed to such factors as mothers health and Essay Continent, quality of Essay about Phone, obstetric care. Essay On Terrorism Continent? Similarly, Doll, Hill and Sakula (1960) suggest that variations in the incidence of congenital malformations can largely be attributed to the nutritional status of the mother and the presence/absence of viral infections in pregnancy (eg influenza). In the light of the evidence which we have presented there can be no doubt that mothers health, nutrition, and obstetric care received (given differences in date of about The Celluar, presentation) are all class related.

6.37 Other explanations of early death, low birth weight, and congenital abnormalities which the troubles to hamlet literature yields are more complex. Lawrence, Carter, and Essay, David (1968), for example, suggest that genetic factors play a Predisposing role in which factor contributed to the panic of 1819?, giving rise to congenital defects adverse environmental factors acting as a trigger. Janerich (1972) comes to a similar conclusion. Illsleys work shows a mechanism for about The Celluar such genetic predisposition to become class-related. 6.38 Class differences in infant mortality have been ascribed to selective processes in factor contributed of 1819?, mating and marriage. About Phone? Illsley (1955) carried out a study of infant deaths in which he investigated patterns of hypergamy and hypogamy in which factor of 1819?, relation to The Celluar, the physical characteristics of the mothers. Treatment For Neurological Essay? He found distinctive patterns in relation to variables like height. Essay About Phone? Tall women showed a marked propensity to For Neurological Disroders Essay, marry hypergamously (ie to The Celluar Phone, be upwardly mobile at marriage, short women showed the opposite tendency to marry below their fathers social class. These inherent physical characteristics of women were then translated into differential rates of infant mortality; the mothers of greater stature having lower rates of For Neurological Disroders Essay, infant death. Illsley concluded that social class differences in infant mortality had a physical component: higher class men appeared to be recruiting as wives the most efficient child-bearing women. 6.39 Bairds thesis of transmitted nutritional deprivation offers another variant on the explanatory theme of selection (Baird, 1974).

He suggests the existence of a vicious cycle of nutritional deprivation which leads to low birth weight and congenital malformation. Essay The Celluar? This cycle is difficult to break because it originates in Essay on Elizabeth "Wives and Daughters", the nutritional deprivation of the mother, not at the time of giving birth, but at the time of her own birth. By this account perinatal death and low birth weight are seen as caused by the effects of nutritional deprivation upon the reproductive capacity of female infants. These explanations are based upon data accumulated on the childbearing population of Aberdeen over many years and they offer important insights into the mechanisms and processes whereby social class differences in mortality are produced and perpetuated. 6.40 If the relative importance of factors such as all of these in determining rates of The Celluar, perinatal death (and of handicap among survivors) is For Neurological Essay, controversial, the situation is somewhat clearer in the post-neonatal period. When we look at The Celluar Phone the causes of death in infancy which exhibit the steepest class gradients, there seems to be much evidence to suggest that the important causal variables are contained within the contemporary socioeconomic environment and which panic, therefore subject to human intervention in Essay The Celluar, the short term. As Figure 2 in Chapter 2 clearly indicates, the causes of infant death which are most likely to be associated with the stature or the nutritional status of the mother have the shallowest of gradients, whereas respiratory disease and accidents show steep class gradients. These observations lead us directly to consider the role of material deprivation on the life chances of the newborn. 6.41 Below the age of one year, class differences in survival are at their greatest during the post neonatal phase of life. This clearly represents a point of development when the individual is in need of Treatment For Neurological Disroders, almost continuous care and total attention from its parents and we may hypothesise that any factors which increase the parental capacity to provide adequate care for an infant will, when present, increase the chance of survival, while their absence will increase the risk of premature deaths The most obvious such factors fall within the sphere of material resources: sufficient household incomes a safe uncrowded and unpolluted home, warmth and hygiene, a means of rapid communication with the outside world, eg telephone or car, and an adequate level of man or woman power (ie two parents would normally provide more continuous care and protection than one). In addition to these basic material needs must be added other cognitive and motivational factors which are not independent of the distribution of material advantage.

Those factors would include knowledge, certain skills and resources in verbal communication and a high level of motivation to provide continuous and loving care. When all these factors are present the infants chance of survival is very good indeed. When some or even many of these are absent, then the outlook is less propitious. Moreover it should not be forgotten that these very same factors play a part in determining the development of the infants own cognitive/linguistic and Essay about Phone, other skills. Competences acquired at this stage of life can profoundly influence later intellectual (and hence educational) achievement. Health Inequality in Childhood (1-14 years) 6.42 The evidence for troubles health inequality between children in the different social classes presents something of a paradox. Rates of The Celluar, mortality throughout childhood form quite steep class gradients when parental occupation is used as a basis of presentation and yet, as the evidence in Chapter 2 shows, self-reported rates of morbidity for this age-group display a rather less consistent picture of disadvantage. Of Transcontinental Railroad? This recorded divergence demonstrates to some extent the gap between age-specific mortality and morbidity as substitutable measures of the same phenomenon, and we must deal separately with each. 6.43 The most important causes of death amongst all children aged 1-14 were (in descending order): accidents poisoning and violence; respiratory disease; neoplasms; congenital abnormalities; and Essay The Celluar, infections. Among 1-4 years olds, and troubles to hamlet, this we wish to Essay, stress, almost all the miss differences in mortality rate between social classes I and V is due to: accidents, poisoning and violence; respiratory disease; and congenital abnormalities (which of course play a more important role at younger ages).

Among older children, deaths from accidents, poisoning and violence remain highly class related (Table 6.7 gives the accidents data) though deaths from respiratory disease become less so. Table 6.7 Fatal accidents in childhood by sex and social class (1-14 years) 6.44 Since a great deal of the class differential in Essay The Celluar Phone, mortality among 1-4 year olds is due to just two causes: respiratory disease, and accidents and violence one approach to explaining this inequality is by unraveling those aspects of social situation, of way of living, responsible for respiratory disease and accidents/violence and which may then prove to be closely associated with social class. There are a number of epidemiological studies which enable us to do this. 6.45 Reviewing clinical examinations of the 1946 birth cohort up to the age of 15, Douglas and Essay on Terrorism Threats African, Waller (1966) found that the principal correlate of respiratory symptoms was the extent of air pollution in the childrens area of residence. There was no tendency for working class children to be more concentrated in high pollution areas, and social class had a small independent effect. A study of 2000 children living in Harrow (which did not permit consideration of a range of air pollution levels) concluded (Leeder, Corkhill, Irwig, Holland and Colley, 1976): illnesses occurred much more commonly in infants born to families which had several other children already, and in those families where the parents had respiratory disability or were smokers. When all relevant variables were taken together in a logistic model, the most important proved to Essay about, be: 1. bronchitis/pneumonia in siblings. 2. parental smoking.

3. number of siblings. 4. parental history of "Wives and Daughters", asthma/wheeze. Social class had no effect independently of these factors. It may thus be that much of the class gradient in morbidity (if not mortality) from respiratory disease can be explained in terms of parental smoking (ie secondary inhalation of smoke) and size of family (and the likelihood of infection by siblings). Essay? Both smoking and family size are clearly related to class. 6.46 Colley and Reids (1970) study of over 11,000 children aged 6-10 in a number of Essay Gaskell's "Wives and Daughters", urban environments was concerned with the interplay of social class and physical environmental variables. Here too, a past family history of Essay, respiratory disease was associated with chronic cough in the 6-10 year olds (who were examined by For Neurological Disroders, school medical officers). There was a clear class gradient (though family size and parental smoking was not considered). There was a rather complex relationship with air pollution levels. About The Celluar? Thus, age-adjusted morbidity ratios for chronic cough were calculated for social classes I/II, III and IV/V for each of three kinds of area differing in air pollution levels (Newcastle and Bolton; Bristol and Reading; and a number of rural area).

It was found that for class IV/V children, but not for classes I/II or III, morbidity rose with increasing air pollution; ie only for classes IV and V was pollution an exacerbating factor. (For all classes, morbidity was distinctly higher in Wales, even in rural Wales where pollution was lower, This was felt to railroad, require explanation in genetic terms or in terms of about, selective emigration). Colley and Reid argued that geographic variations within classes IV and V could not be explained by domestic circumstances such as differing levels of crowding (which were not great). 6.47 Finally we might refer to analysis of data from the US National Health Survey (which, like the GHS, is impact of transcontinental railroad, based on self-reporting). Speizer, Rosner and Taget (1976) found a strikingly higher prevalence of reporting asthma and bronchitis in children over 4 years residing in the same household as a parent with CNSLD (chronic non-specific lung disease).. [this] is not due to confounding by age, sex or smoking. Essay About? Occupational differences are also unlikely to be important since 76% of the children aged 16 or below. Of Transcontinental? Their conclusion is Essay The Celluar, that the principal factor is a familial (household) aggregation of disease.

This they take to be due to a combination of which factor, genetic and environmental factors. Essay About Phone? Evidence for the relevance of the Essay on Terrorism to the African Continent former was the six-fold excess of disease in children with both parents having CNSLD compared to those with only The Celluar Phone, one. Higgins and impact of transcontinental railroad, Keller (1975) provide further evidence for some genetic factor in transmission. The Celluar Phone? [In general, evidence on the genetic contribution to health inequalities tends to be indirect: little is really known of the importance of genetic factors]. 6.48 The general implication of these studies seems to be that the class gradient in bronchitis among children is largely a consequence of Essay Gaskell's "Wives, parental smoking, family size (and the about Phone increasing likelihood of infection by contributed to the panic, siblings), and a parental history of lung disease (which may to some degree genetically place the child at Essay The Celluar Phone risk). Parental history of lung disease is also, as shown independently, a function of type and of transcontinental railroad, severity of occupation. The Celluar Phone? Environmental pollution is also implicated, and may be a particular danger for impact those children (from classes IV and V) rendered prone through other factors. TABLE 6.8 Causes of death from accidents of children aged 1-14 years 1968-84.

6.49 The second condition responsible for much of the gradient in child mortality at ages 1-4 was accidents and violence of which, as Table 6.8 shows, accidents were the principal cause of death. The increased risk of death faced by lower class children in ordinary everyday activities such as playing at Essay Phone home or in impact of transcontinental railroad, the neighbourhood or (among older children) travelling to school by about The Celluar Phone, foot or bicycle, has to be viewed in terms of impact of transcontinental, differences in the environment to which children from different classes axe typically exposed. Among child pedestrians for Essay about The Celluar example, the risk of death from the impact of a motor vehicle is multiplied by 5-7 times in passing from class I to class V; for accidental death caused by fires, falls and drowning, the gap between the classes is even greater. These differences demonstrate the non-random nature of accidents as a collective class of events. While the death of an individual child appears as a random misfortune, the miss havisham overall distribution clearly indicates the social nature of the phenomena. How is it to be explained? 6.50 From among the different modes of explanatory reasoning outlines above, we may quickly dispense with those which attribute causality to the influence of selection or which reduce the problem to an artefact of the measurement process. Accidents have two primary causes: either environmental hazard, or dangerous behaviour reflecting carelessness, adventure or irresponsibility. These primary causes involve both material and cultural factors and indeed full explanation of inequalities in the risk of death in about The Celluar, childhood implicates each of them. 6.51 As Table 6.7 shows, while boys in miss analysis, all social classes bar I experience double the risk of about The Celluar Phone, a fatal accident of girls, the gap between the social classes is much more striking most especially for boys. When the two extremes of the occupational spectrum are compared it can be seen that children in the lowest social class are almost five times more likely to die before reaching school leaving age.

The sons of other manual workers carry over twice the impact risk of accidental death. The loss of these lives so early in the lifetime, surely reflects the interaction of both material and cultural factors. 6.52 The consistency of the sex differential in about Phone, each social class is a measure of differences in the way in which boys and girls are socialised. Patterns of child-rearing for all social classes with the exception of professional households, appear on the basis of Table 6.7 to sanction, encourage or merely tolerate a greater range of careless risk-taking behaviours among boys, the outcome of which is recorded in a higher incidence of fatal accidents. 6.53 Health inequalities in childhood expressed in the form of mortality rates can therefore be seen to be at which of 1819? least in part the reflection of cultural practices in socialisation. In the modern world there is nothing obligatory about the Essay The Celluar Phone different preferences which parents show towards the behaviour of their sons and daughters: a fact which is perhaps reflected in the reduced sex ratio of miss havisham analysis, social class I and which offers some scope for a reduction in this specific form of inequality. Class differences between children in the risk of accidental death, too, may appear in Phone, part as a manifestation of Threats African, distinctive patterns of child-rearing on the part of parents in the different occupational classes. But such patterns have to be seen in about The Celluar Phone, the light of the great differences in the material resources of and Daughters", parents, which may place significant constraints on the routine level of care and about The Celluar Phone, protection that they are able to provide for their children. Children of miss havisham analysis, parents in social classes IV and V are amongst the Essay Phone poorest members of For Neurological Essay, their age group in the population. Their opportunities to The Celluar Phone, play safely within eye or earshot of their parents are far fewer than those of their better endowed peers higher up the social scale. Furnishings, including forms of heating in the home, are likely to be less safe, as are the troubles to hamlet other domestic appliances which they encounter.

6.54 These manifestations of the Essay about Phone differences in the material resources of households mean also that the children of semi and to hamlet, unskilled workers are more likely to be thrown onto their own devices during holidays and out of schools hours and this alone would be sufficient to increase the Essay about The Celluar probability of their being involved in an accident. In reflecting upon these forms of health inequality in childhood and adolescence it is impossible to escape the troubles conclusion that the physical welfare of children is closely linked with material resources, and that the distribution of the about The Celluar former is a reflection of the distribution of the latter. In the context of childhood therefore, the most straightforward of Treatment For Neurological, materialist explanations is capable of Essay The Celluar, providing a simple chain of causation by which the pattern of health inequality is illuminated. Analysis? Households in social classes IV and Essay The Celluar, V simply lack the means to provide their children with as high a level of on Elizabeth and Daughters", protection as that which is found in the average middle class home. These resources consist of income, property and territorial space but they may also take an associated non-material form. As Brown and Harris concluded on the basis of their research in Essay, Camberwell, one of the reasons for greater prevalence of accidents in working class homes is the higher incidence of analysis, stressful life events experienced by mothers. Such women, who lack the means to resolve the Essay about The Celluar Phone recurrent setbacks which dominate their domestic lives, are less well equipped to provide continuous and vigilant protection and troubles, care to their children: The mothers psychiatric state and about The Celluar, the presence of a serious long-term difficulty or a threatening life event were related to increased accident risk to children under 16. These factors were more common among working class children, and in analysis, so far as they are causal, they go a long way to explain the much greater risk of accidents to working class children. (Brown and Harris, 1978). Because Brown seeks to link aetiological factors back to social structural differences which both generate them and determine the severity of their impact, his work provides a unique link with the about The Celluar second approach to the explanation of health inequalities. 6.55.

The second, methodologically distinct approach, which also enables us to make sense of differences in morbidity among children (including self-reported data on both morbidity and GP consultations), focuses upon characteristics of life in the deprived household. A valuable recent such study has focused upon 6-7 and 10-11 year old boys from Disroders Essay, severely deprived large families in Birmingham, known to the social services department. Children were compared with a control group of similarly aged children, living in the same area but not under social service department supervision. The study fell into, and was published in, two parts. 6.56 In the about first Brennan focused upon medical characteristics (Brennan, 1973), but interpreted broadly. Havisham Analysis? She found that both sample and control children were below national age norms in height the sample children more so. There was a high degree of visual impairment again more marked among the sample children. (Moreover, out of 20 sample children having visual impairment (out of 46) only one wore spectacles). There was a higher degree of hearing loss among children.

Finally 78.2% of Essay, sample children (and 58.9% of control children) were diagnosed as having some illness on clinical examination (far higher than indicated for havisham analysis the city as a whole from school health records): the most important were respiratory disorders, orthopaedic defects, speech defects, skin disorders, and chest complaints. 6.57 The second study (Wilson and Herbert, 1978) considered also the Essay about 3-4 year old siblings of those older brothers, and made extensive Use of interviews, observation over a long period, and psychological test data. This study vividly illustrates the nature and the effects of considerable poverty on family life and on child development. It suggests that ill-health, inhibited cognitive development, and behaviour problems are associated in on Elizabeth "Wives and Daughters", a general poverty syndrome. For example, of the 3-4 year olds in a specially established experimental play group: The pervading impression of the group is one of bewildered, lost children, who did not know what to expect, who continued to be worried, and who seemed unable to relax; an impression which was reinforced by their very poor clothing, unkempt appearance and smell (p64). 6.58 Accidents to Essay The Celluar Phone, the children were common: 34 out of 56 families had experienced severe accidents (1 child had lost an eye, 16 suffered burns or scalding needing skin grafts ). Particularly striking (once again) is the extent to which ill-health was found to cluster in families.

Of the 56 families studied:- In forty families all, or most, members of the impact of transcontinental railroad family were reported (ie by themselves) as having had much illness, or as suffering from Essay about The Celluar, defects or conditions which affected their activities. Respiratory diseases were most frequently mentioned, followed by gastric conditions and impact railroad, skin conditions. Moreover, only 4 among the 16 fitter families can be truly said to be healthy; and obstetric problems were frequently mentioned. 6.59 The following quotations illustrate how these authors make sense of their findings: Thus the children, in Essay about, the process of growing up, have many shared experiences. They live in overcrowded conditions, being members of large families; their homes are inadequate by current standards; the neighbourhoods are rough and disliked by most who have to live in them. They experience poverty, by which we mean that they go short of things considered essential or normal by others around them.

Most, if not all, the children have first hand knowledge of illness, disability, accidents and mental stress expressed in a variety of symptoms (p104). The objective is survival, the operative unit is the family. The needs of individuals must take second place. Decisions were made at family level and related to the main wage earner or recipient of benefit rather than to the needs of individual children. (pl86) 6.60 The GHS shows that acute disorders are, on on Terrorism Threats to the African Continent, the whole, more prevalent amongst the The Celluar Phone sons of non-manual parents, a pattern which is reflected in the distribution of GP consultations in havisham, childhood. Essay About The Celluar Phone? An approach like that illustrated above may enable us to make sense of this divergence from mortality data. Self-reported sickness is not a standard health indicator and it might be expected to vary between socioeconomic groups as much on on Terrorism to the African, account of variation in cultural values, in the meaning of Essay, everyday experience, and on the degree of behavioural flexibility available to men and women in different socioeconomic groups, as on the more obvious manifestations of sickness or disorder. Consultation is obviously easier for non-manual households. They are more likely to have a telephone readily to hand to make enquiries or arrange appointments and on Terrorism Threats to the, access to private motor cars means that a visit to the GPs surgery causes less trouble and inconvenience. These sorts of differences represent inequalities in the distribution of opportunities to consult and, given that the act of consultation itself is likely to make an episode of sickness seem more concrete, certainly more memorable, that might even make an important difference to the incidence of remembered ie self-reported-sickness.

Since self reports of sickness amongst children are generally provided by parents, the much higher rate among boys in non-manual households may reflect greater accuracy of Essay, recall on the part of their mothers or fathers. Perhaps professional parents might be more likely to Essay, remember or to acknowledge episodes of acute sickness among children because their own daily activities may be more flexible, making it easier for them to care for a sick child or attend for medical consultation. For the opposite reasons a working class parent would be more prone to scepticism of childrens complaints. If keeping a child at home presents greater disruption to the income generating activities of a household then parents might be expected to The Celluar Phone, have a higher tolerance for minor disorders amongst their children. 6.61 At various points in this report we have indicated the importance which we attach to the promotion of health in its positive sense. In childhood this may reasonably be interpreted in developmental terms, and it is relevant to which factor to the panic of 1819?, consider finally research evidence relating to physical, behavioural and cognitive development in children.

6.62 In a series of studies over about The Celluar 2 decades, Pasamanick and his associates in the USA found associations between prematurity and birth complications and on Elizabeth Gaskell's and Daughters", a subsequent history of cerebral palsy, epilepsy, mental deficiency, behaviour disorders, reading disabilities, strabismus, hearing disorders, and autism (see eg Pasamanick et al 1956: Pasamanick and Knobloch 1960). Douglas in an analysis of IQ, tests administered to children from the Essay about The Celluar Phone 1946 birth cohort aged 8 and 11 matched premature babies (who had had birth weights of Threats African, 5 ? lbs or less) with controls similar in terms of sex, ordinal position in about The Celluar, the family, mothers age, social group, and degree of crowding in the home (Douglas, 1960). Essay Threats To The? The low birth weight babies scored significantly lower than their controls. They also did less well in the ll+ examination. Douglas attributed this to significant differences, which he also found, in social and educational backgrounds of parents and grandparents, parental interest in school progress, etc. In other words, he attributed both prematurity and poor achievement to adverse home conditions. Drillien, however, found that children of birthweight less than 4 ? lbs contained a high proportion of dull, retarded, and Essay Phone, grossly defective children. Below 3 lbs birthweight only 13% were of average or above average intelligence (Drillien, 1959).

Illsley (1966) found a clear association between birthweight and IQ within each social class at age 7: the effects of troubles, low birthweight being greater for children born into Essay about Phone, the lowest classes. Illsley does not feel it is Treatment For Neurological Disroders Essay, possible to distinguish the possible routes by which this may come about: the parallel effects of environmental influences on Essay Phone, reproductive health and cultural background; organic impairment in utero; and genetic inheritance. 6.63 Birch and Gussow (1970), reviewing numerous studies from many countries, conclude that whilst a good postnatal environment can compensate for the perinatal stress associated with prematurity, an environment which is not satisfactory can represent a cumulative hazard. They argue that for troubles children born into poverty the circumstances surrounding their development in utero and their birth may be significantly responsible for minor disorders of The Celluar Phone, perception and cognition, an increase in impulsivity or distractability, a delay in the mastery of certain bodily functions 11 (p67). 6.64 One aspect of the postnatal environment to which these authors attach special significance is nutrition. There is which factor contributed to the panic of 1819?, circumstantial evidence that nutritional deprivation can affect not only external physical growth, but also the brain and central nervous system. Eichenwald and Fry (1969), amongst others, have related nutrition to learning. Birch and Gussow suggest that the effect of malnutrition upon the brain during the period in which this is growing fastest (first 6 months after birth), unlike the effect on Phone, other growth, is not fully compensateable. Whilst in the case of contributed panic of 1819?, humans there is Essay about The Celluar Phone, no direct evidence that effects observed are due to malnourishment rather than other aspects of deprivation, laboratory studies of which factor to the of 1819?, animals provide some confirmation. Here an effect of malnutrition during the period of about Phone, rapid brain growth upon brain size and number of brain cells has been demonstrated, and an effect which cannot fully be made good later. To The? Malnutrition appears also to produce abnormal EEG patterns, in both animals and human infants.

Birch and Gussow conclude (p2l2): Thus the evidence would seem to indicate that severe undernutrition during, the early months of Essay The Celluar, a childs life may reduce the number and size of cells in his brain as well as the extent of myelination, and that nutrition imbalance of a severe degree may produce structural changes in the brain and Essay on Terrorism to the African Continent, spinal cord, abnormal electrical activity, and pathological lesions of the central nervous system However the relationship between these findings and childrens mental development is an about, open question, because we know too little at present about the functional implications of most of what we can learn by Essay on Terrorism Threats to the African, looking at the brain, weighing it, or its constituents, or reading the about The Celluar pattern of electrical activity on its surface. 6.65 It is, of course, less controversial to troubles to hamlet, point out that a hungry child is unlikely to be alert during lessons, (DHSS Eating for Health 1978; 43). There is, it must be reiterated, ample evidence for the association of adequate nutrition with achievement of full potential for physical growth. The importance of milk in about Phone, the nutrition (and hence growth) of children has been shown in a number of studies reviewed by the Sub-Committee on factor to the panic of 1819?, Nutrition Surveillance (Report, 1973). Moreover, the Essay about The Celluar lessons of the food policy introduced during the Second World War, to ensure fair shares for all, and which resulted in one of the most rapid falls in perinatal mortality rate (between 1940 and 1948) should not be forgotten. 6.66 Social scientists, of course, have stressed the effects of different aspects of the impoverished early environment on intellectual development, including patterns of parenting (themselves relatable to the effects of economic stress, housing, and family size). Wilson and Herbert (1978), for example, refer to to hamlet, the effects of delegation of mothering to older siblings; early severance of Essay Phone, mother-child contact and play in the unsupervised stress play-groups, scarcity or absence of toys for the training of the young child in the achievement of age-appropriate behavioural standards language development the Treatment For Neurological Disroders development of creative activities, power of Essay about Phone, concentration, manipulative skills etc (p184-5).

6.67 It seems clear, therefore, that cognitive development in early childhood has important implications for subsequent educational experience, and that inhibited or inadequate cognitive development is associated with those same factors of deprivation responsible for ill-health and inadequate physical development. On Elizabeth Gaskell's "Wives? Moreover, it thus becomes possible to trace a link (all too often reinforced by social processes) to occupational ascription/attainment. At the same time, too, child ill-health has important implications for adult health (in the The Celluar Phone negative sense), as research shows. 6.68 Evidence that conditions (such as lower respiratory tract disorders) contracted in early childhood may place the individual continuously at risk, or may persist, derives principally from longitudinal studies. The study of 1,000 Newcastle families illustrates dramatically how repeated respiratory infections in the first 5 years, if inadequately treated, can lead to contributed panic of 1819?, some degree of disability at age 15 (Miller, Court, Knox and Brandon, 1974: pp 94-128). This is sometimes due to permanent damage caused to about The Celluar Phone, the respiratory tract. In the Newcastle study 208 children aged 14 were identified as being at risk of respiratory infection, on the basis of severe illness in the first 5 years and Essay Threats Continent, other indications, and compared with a group of 97 controls of similar age.

Out of these 305 children clinical examination, cytological and other tests showed that 119 experienced respiratory symptoms. Essay Phone? Of these 107 came from the high risk group. In 45 cases disability was substantial. 6.69 Studies such as these (and there are many more) suggest, as the Court Committee put it, that inadequately treated bouts of childhood illness cast long shadows forward. Health Inequalities in Adult Life. 6.70 The rate of mortality in Britain today, once it has been standardized to take account of to hamlet, trends in The Celluar, the age composition of the population, continued to troubles to hamlet, exhibit the steady pattern of decline which has been in evidence for the last 70 years, (though, as we showed in Chapter 3, this is Phone, not the case for men in certain social classes or age groups). Respiratory disease, which, among the major causes of death, has the steepest and which contributed, most linear of class gradients has declined substantially for all age groups over the last two decades (Opcs, 1978: 11). Standards of health have continued to The Celluar Phone, improve in post-war Britain, but differences between occupational classes have remained or even widened. The phenomenon is of transcontinental railroad, principally one of relative deprivation the maintenance of a gap in life chances, against the dynamic background of Essay The Celluar Phone, improved prospects.

6.71 This feature of contemporary trends suggests that there is nothing natural about class inequalities in health. Men and women in social class V do not die before their fellow human beings in social class I as a matter of on Elizabeth Gaskell's and Daughters", biological fate. Indeed, they are quite capable of collectively achieving the low rates of mortality achieved by social class I, the only difference being that it takes longer and by the time it is achieved, social class I has moved on to record an even lower rate, thereby ensuring the Essay maintenance of the health gap. 6.72 Explanations of Gaskell's and Daughters", this failure to distribute the health benefits of Essay about, social and economic progress evenly and contemporaneously among the occupational classes have taken a number of forms. 6.73 The twentieth century has witnessed and will continue to witness a series of revolutionary changes in the structure of occupations. To date these changes have resulted in a contraction in the size of the semi and Gaskell's and Daughters", unskilled manual labour force and an expansion in non-manual occupations (see Table 6.1). These changes have given rise to alterations in the age composition of each occupational class, older workers tending to be found in the contracting areas though not as emphatically as some people suppose younger and more recent recruits to Essay Phone, the work force tending to be found in the expanding area. Besides making comparisons between the occupational classes over miss havisham analysis time somewhat difficult, these shifts in the occupational structure in themselves offer an analytical solution to Essay The Celluar, the continuing pattern of health inequality, for it is on Elizabeth Gaskell's "Wives, argued that the higher death rates of social class IV and V are at least, in part, a reflection of the older age structure of these occupational groups. Essay About The Celluar? The same argument can be used conversely to explain the troubles to hamlet relatively low death rates of about Phone, social class I. This explanation which reduced class differences to an artefact of measurement has a certain plausibility. It is true that while social class V is impact of transcontinental, today made up of workers who are older on average, social class I has a larger than average share of younger men. Nevertheless the grounds for asserting that age is the primary causal determinant of the higher mortality of Essay about The Celluar Phone, social class V are weakened when class differences are examined for each age group.

Figure 6.1 shows the relationship between age and occupation for some of the major causes of death. For all causes except malignant neoplasms class gradients are steepest in early adulthood and most shallow in the decade before retirement. The artefact explanation does not throw light on these observed patterns of fatal disease incidence amongst younger men. Mortality Ratios by troubles to hamlet, Occupational Class, Age and cause of Death (men 15-64; England and Wales) 6.74 These same distinctive trends also highlight the limitations of the thesis that the health gap is caused by age-related processes of social mobility. Essay The Celluar? Occupational drift throughout the analysis span of working life may help contribute to class differences among the over-fifties but it cannot be said to be the cause of Essay about, class inequalities between the ages of 15 to 45 years. Among these age groups health inequality reaches a peak which it makes little sense to attribute to processes of social selection. In addition lack of continuity between children and adults in the class related incidence of fatal disease gives very limited plausibility to the idea of to the Continent, natural selection as an explanatory form. 6.75 The limitations of these paradigms especially among the male workforce of 45 years and under leads to a consideration of the direct role of material life on the production of health differentials.

The most obvious starting point in the search for relevant causal relationships within a materialist perspective is the division between manual and non-manual occupations. About Phone? Men engaged in manual occupations routinely confront a much higher degree of risk to health and physical well-being in Essay Threats, their work task than their non-manual counterparts. These risks are manifold. They may result in direct loss of life either suddenly in the form of accidents or in an attenuated manner through long-term exposure to dust, dirt or poisonous substances in the workplace. The same eventualities may also entail antecedently, physical injury, disability and chronic illness. The direct risk of physical disability in manual work presents itself in a variety of forms.

Amongst these, accidental injuries are the most obvious but other forms of physical impairment affecting vision, hearing and breathing are also common accompaniments of productive processes involving manual employment which it must be said, are in no way compensated for by way of financial reward or wages. 6.76 But significant as is occupational hazard in about The Celluar, the production of broad differences in which factor of 1819?, health between manual and non-manual workers and between men and women, it is not a sufficient explanation. 6.77 The influence of material deprivation in the aetiology of Essay The Celluar Phone, modern degenerative disease processes is poorly understood in the present day especially amongst workers below the For Neurological Essay age of 45. In the past poverty was an obvious antecedent in mortality associated with starvation, infection, and respiratory disorders but its possible influence in deaths traced to, for example, cancer or circulatory disease is less clear-cut. These causes of death, because they dominate the Essay Phone disease profile of the wealthy advanced industrial nations have been dubbed the diseases of affluence and, although their aetiology is in general poorly understood, it is thought that they have their origins in overindulgence rather than poverty and in behaviour which abuses and misuses the human body.

The modern diet, with its emphasis on highly refined foods, and modern sedentary patterns of work and leisure are prime targets in the search for causes of premature death in the twentieth century and, at a rather more specific level, the mass consumption of tobacco products is blamed for the early onset of some diseases (eg lung cancer) (see Tables 6.3, 6.4 and 6.5). 6.78 This association between disease and death on the one hand, and the consumption of tobacco products on Essay on Terrorism to the Continent, the other, provides an example of the way in which threats to health and The Celluar, well-being continue to be tied up with the productive activities of human beings on which they depend for material subsistence and on which, in the long run, social progress tends to contributed to the, be judged. The mass production and consumption of commodities (including cigarettes) is at the heart of economic life in the advanced societies, and cigarette production is a source of government revenue as well as industrial profits. About? Governments have been unwilling to bring in to hamlet, legislation to Essay about The Celluar Phone, ban the production and the sale of tobacco despite the Treatment For Neurological Disroders almost irresistible case that has been built up against The Celluar, it on health grounds in recent years. 6.79 The habit of cigarette smoking therefore provides a convenient focus around which to explore the causal relationships in patterns of health inequalities among adult men and women. This is so because of social life and specific patterns of behaviour which are often attributed to Essay on Terrorism to the African, culture. 6.80 Among heavy smokers in Britain men outnumber women and, following trends over the last decade or so, manual workers have increasingly come to Essay about Phone, outnumber their non- manual counterparts.

6.81 This demographic picture of on Elizabeth Gaskell's and Daughters", cigarette consumption reinforces the clinical view that smoking is damaging to health, since the statistical characteristics of Essay about The Celluar, heavy smokers are the same as those of the people who are most likely to lose their lives before retirement. 6.82 Can this demographic coincidence help us to understand the underlying cause of the Threats African Continent health inequalities that have been observed among adult men and women? Given that cigarette manufacturers are now obliged to Phone, warn their customers of the dangers of smoking it would seem on the face of it that smoking is havisham analysis, a wilful, self-destructive habit and Essay about The Celluar Phone, that those people who fail to take heed of the risks have only Treatment For Neurological Essay, themselves to blame if they forfeit their health as a result. Such a conclusion assumes that smoking is an entirely voluntaristic behaviour, the indulgence of the irresponsible. This idea does not square with the fact that the consumption of cigarettes depends on a multi-million pound industry, is sanctioned by Parliament, treated as an important source of taxation income, and freely permitted in public places, even on premises owned by the National Health Service. As health educationalists are fond of pointing out, tens of millions of pounds are spent every year in Britain on the promotion of smoking through advertising and The Celluar, sports sponsorship while only a fraction of this amount goes on publicity about the For Neurological attendant health risks. 6.83 These facts about tobacco and about Phone, its role in the economy are an indication that smoking remains part of material and cultural life in Britain. But changes are taking place and not surprisingly the avant garde of culture change are drawn from Essay on Elizabeth "Wives and Daughters", people in the higher social classes. If cigarette smoking is a major contributory cause of deaths due to cancer or heart disease, then the uneven response in the population to the news that it is dangerous is likely, in the future years, to The Celluar, make class differentials in health even wider than they are at present. 6.84 Moreover, in on Terrorism Threats African Continent, recent years sex differences in the pattern of smoking have begun to even out, perhaps a reflection of the increased earning capacity of about, women and their claims for which contributed to the of 1819? equality with men. But the overriding characteristic of people who have continued to be heavy users of tobacco products despite the adverse publicity is about The Celluar, manual work.

Why is this so? 6.85 In general it seems likely that people who have the scope within work and leisure relationships and activities to find compensatory means of fulfilling the needs which smoking satisfies, will be more likely to take the warnings about Gaskell's and Daughters" cigarettes seriously and to amend their behaviour in Essay about, favourable directions. This inference serves as both reminder and reflection of the fact that the structure of Treatment For Neurological, work opportunities and the associated levels of financial rewards (what sociologists term the social division of labour) remains fundamentally unequal in present day Britain. This structure of Essay The Celluar, inequality which discriminated, between men and women, between races, regions and social classes, has many dimensions. Income, wealth, job security, pension rights, credit-worthiness, are among the most obvious, but equally significant, especially in their implications for health are education as a continuing lifelong process, and protection from threats to which contributed to the panic, physical well-being.

These characteristics of the work that people do and the context in about, which they do it, are reflected in the quality of the lives they lead. From this perspective smoking behaviour cannot be taken as a fundamental cause of ill-health, it is rather an epiphenomenon, a secondary symptom of deeper underlying features of economic society. 6.86 The drift of this section has been to argue that it is from the realm of the materialist perspective that the most plausible explanation of health inequality between adults in Britain is to be found. It has also been argued that it is not possible to distinguish clearly between cultural and impact of transcontinental railroad, material influences in human behaviour. It is no good treating cigarette smoking as an aberrant or irresponsible behavioural response while society as a whole permits, even depends on, the widescale production and Essay about, promotion of For Neurological Disroders Essay, tobacco goods.

Human health is a part of the organisation of material existence. It is Essay The Celluar Phone, both produced and endangered by the work which men and troubles to hamlet, women do in order to earn their livelihood. About Phone? The manufacture and consumption of tobacco products and its effects on Essay on Elizabeth "Wives, health provides a very clear example of the limitations of conventional health policy as a means to reduce health inequality. The prematurely lost lives of about The Celluar Phone, working class men and women will not be saved in the acute hospital or in the GPs surgery. 6.87 The classification of elderly men and women into factor contributed to the of 1819?, occupational classes is made more difficult by the fact of retirement. Occupation becomes a less centrally point of retired persons social identity and, in consequence, it is often forgotten, ignored or treated superficially in the process of collecting survey data. These tendencies feed into the processes of generating statistical, rates, making it rather more difficult, for Phone example, to compute class based rates of mortality. Essay On Elizabeth "Wives And Daughters"? There is little doubt, however, that the Essay about Phone class-based mortality gradients which follow the population from impact of transcontinental, birth, through youth to middle age not suddenly disappear after retirement.

6.88 The new longitudinal survey being produced in the OPCS will, in about The Celluar Phone, time, provide a sound picture of class inequalities in rates of mortality among the retired. Factor Contributed Of 1819?? The early returns for this survey suggest that observed gradients will be more shallow for this age group. This trend is not unexpected. The Celluar? In adult life class inequalities in mortality become reduced in late middle age as the risk of death increases; the expected trends for old age merely complete this already established pattern. 6.89 If we were to argue along the lines of a Selection of the Fittest theory we might conclude that the flattening out of gradients amongst the elderly was the result of a filtering process which preserved only the most robust of social classes IV and troubles to hamlet, V for survival into retirement. It is difficult either to prove or discount this inference but the data of morbidity differentials in old age do not support it. Chronic or longstanding disorder is more prevalent among retired manual workers and their wives suggesting, if anything, that the link between relative material deprivation and poor health is sustained throughout the whole lifetime. Essay The Celluar? At the same time it is likely that some men or women engage in semi or unskilled manual work in the years immediately before retirement may well have arrived at their present jobs because poor or failing health caused them to forfeit a more demanding but better paid skilled manual occupation. In such cases, the descent into the lowest occupational classes on account of troubles to hamlet, ill-health may well be a portent of an earlier than average age of death. 6.90 After retirement the appropriateness of mortality rates to Essay about The Celluar Phone, health status measurement is to hamlet, increased by the fact that health may literally become a matter of life and death for The Celluar the over sixty-fives.

At the end of the lifetimes use, the body begins to exhibit the effects of wear and tear and sooner or later the manifestations of degeneration in disease are a natural outcome. In general, it is reasonable to Treatment, conclude that these processes occur sooner rather than later in men rather than women, and in manual workers rather than non-manual workers. An equally reasonable conclusion is that the timing of these outcomes are the end product of inequalities in the use made of, and the demands upon the human body earlier in the lifetime. In practical terms what is implied is that men in our society lead lives which are more punishing to the human frame, and that among men, manual work involves greater use of sheer physical resources and hence more wear and tear on Essay about, the body. Appropriate forms of redistribution between the sexes and the occupational classes might be expected to introduce a greater degree of evenness in these lifetime processes of physical growth, maturation and decay. 6.91 This interpretation stems from a materialistic model of explanation.

It suggests that inequalities in troubles, health are the direct reflection in a dynamic sense of inequalities in the social division of Labour. In the collective effort of social production, some workers literally give more of themselves than others and hence their bodies wear out first. The Celluar? But inequalities in health at the end of the lifetime also emanate from the Essay and Daughters" distribution of rewards associated with the social division of labour. Old age is about, a time of poverty, albeit poverty expressed in the form of relative deprivation. But relative deprivation among Britains aged can mean material scarcity in very real terms (as deaths from hypothermia among the old reveal in on Elizabeth Gaskell's "Wives and Daughters", severe winters). Essay The Celluar Phone? A recent DHSS Report estimated malnutrition at 7% among a sample of the elderly who were studied (DHSS 1980 p3).

In old age the relationship between income and the capacity to protect personal health is stronger perhaps than at any other time in the life cycle, and in general it is fairly certain that individuals who are well endowed through generous or index linked pension schemes will lead the healthiest, the on Terrorism most comfortable, and the longest lives after retirement. Essay The Celluar Phone? These material fortunes or misfortunes of old age are closely linked with occupational class during the working life. To have secure employment and an above average income when one is at work is to be better able to provide for ones retirement. It is in this way that continuity in havisham, the distribution of material welfare is sustained, and inequalities in health perpetuated, from the cradle to the grave. This consideration, seriatim, of different stages of the life cycle leads to several conclusions. In the first place, although different kinds of explanation have to be combined, and although cultural explanations and a genetic contribution of importance to early childhood conditions have their place (although knowledge, of the latter is inadequate), nevertheless we feel that more of the relevant evidence is explained by what we call materialist or structural explanations than by any other form of explanation. However this rubric, it will be recalled, covered many subsidiary approaches which need to be remembered and carefully set out. 6.93 The second important conclusion we wish to draw is this. Some of the evidence on class inequalities in health is adequately understood in terms of specific features of the socioeconomic environment: features (such as accidents at work, overcrowding, smoking) which are strongly class-related in Britain and about The Celluar, also have clear aetiological significance.

Since such features are recognised objectives of various areas of havisham analysis, social policy we feel it sensible to offer them as contributory factors to be dealt with in their own right and Phone, not to go on to explain their incidence further in social structural terms. The same is true of other aspects of the For Neurological Disroders Essay evidence which we feel show the importance of measures related to the health services. Antenatal care, for about The Celluar example, is of clear importance in havisham analysis, preventing perinatal death, and the international evidence presented in Chapter 5 shows that much can be done through improvement of antenatal care and of its uptake. The international evidence also suggests the importance of preventive health within health policy, despite studies (to which we have alluded earlier) which suggest that little of the differences in mortality either between nations, or between British regions can be explained in terms of health care provision. But beyond this there is undoubtedly much which cannot be understood in terms of the impact of so specific factors. Much we feel, can only be understood in terms of the more diffuse consequences of the class structure: poverty, work conditions (and what we termed the Essay about Phone social division of impact railroad, labour), and deprivation in its various forms. 6.94 It is this acknowledgement of the complex nature of the explanation of health inequalities involving access to and use of the health services; specific issues in other areas of social policy; and more general features of about Phone, class, material inequality, and deprivation which informs and structures the recommendations we make in Chapters 8 and9. 6.95 These recommendations draw in another way upon Essay on Elizabeth, our interpretation of the evidence It is our view that early childhood is the period of life at which intervention could most hopefully break the continuing association between health and class.

That is, not only may subsequent health (or propensity to Essay about The Celluar, ill-health) be to some degree determined in early life, but there may be some co-determination of subsequent educational (and hence to some degree occupational) achievement and Essay, future health status at that time. In our recommendations, therefore, we focus particularly (although not exclusively) upon Essay about Phone, measures directed towards reduction of railroad, health inequalities in childhood. REFERENCES CHAPTER 6. Abel-Smith, B and P Townsend The Poor and the Poorest (London: Bell, 1965) Banks, J and 0 Banks Feminism and Family Planning (London: Routledge, 1964) Baird, D. Epidemiology of congenital malformations of the central nervous system in (a) Aberdeen and (b) Scotland J. Biosooial Sci 6 (1974) 113. Baird, D. The epidemiology of low birth weight: changes in about Phone, incidence in Aberdeen, 1948-1972 J. Biosooial Sci 6 (1974) 323. Bernstein, B. Class.

Codes and Control (London: Routledge, 1971) Birch, H 0 and J D Gussow Disadvantaged Children; Health, Nutrition and Treatment For Neurological, School Failure (New York; Harcort. Brace and World, 1970) Brennan, M. E. Medical characteristics of children supervised by the local authority social services department Policy and Essay The Celluar, Polities 1(1973)3. 255. Brennan, M.E. and R Lancashire Association of childhood mortality with housing status and unemployment J Epidem and Comm.

Health 32 (1978) 28. Brenner, M H. Fetal, infant, and maternal mortality during periods of economic instability Int. J Health Services 3 (1973) 2 145. Brenner, M.H. Estimating the social costs of national economic policy: implications for mental and physical health and criminal aggression (Joint Economic Committee, U.S. Congress. U.S. Government Printing Office, Washington DC, 1976) Brenner, M. H. Health costs and benefits of economic policy Int. To Hamlet? J. Health Services 7 (1977) 4.

Brown, G and T Harris Social Origins of Depression (London: Tavistock, 1978) Cartwright, A and K Dunnell Medicine Takers. Prescribers. and Essay The Celluar Phone, Hoarders (London: Routledge, 1972) Colley, J. R. T. and D. D. Reid Urban and social class origins of childhood bronchitis in England and Wales BMJ 2 (1970) 213. Department of Health and Social Security First Report by the Sub-Committee on Nutritional Surveillance (Reports on Health and Social Subjects, No. 6, London; HMSO, 1973. Department of Health and Social Security and Department of Education and Science Prevention and Health (Cmnd 7047, London HMSO 1977) Doll, R., Hill, A. B. and J Sakula Brit.

J. Prey. Soc. Med. (1960) Douglas, J. W. B. Impact? Premature children at primary schools BMJ 1(1960) 1008. Douglas, J W B and R E Waller Air pollution and respiratory infection in children Brit. J Prev. Soc.

Med. 20 (1966) 1. Drillien, C. M. in Journal Obstetrics and Gynoecology of the British Commonwealth 66 (1939) 721. Eichenwald, H P and P C Pry Nutrition and learning Science 163 0969) 644. Eyer J Hypertension as a disease of modern society Int. J. Health Services 3 (1975) 4 539. Eyer J Prosperity as a cause of death Int. J. Health Services 7(1977)1 125.

Eyer J Does employment cause the death rate peak in each business cycle? Int. J. Health Services 70977) 4 625. Fox A.J. and P. P. Collier Low mortality rates in industrial cohort studies due to selection for work and survival in the industry Brit. J. Prev. Soc. Med. Essay About Phone? 30 (1976) 4 225. Fuchs V. Who Shall Live ? Health. Economics^ and Social Choice (N.

Y. Basic Books 1974) Golderg, E.M. and S. L. Morrison Schitzophrenia and analysis, social class Brit.J. Psychiatry 109 (1963) 785. Goldthorpe, J. and C. Llewllyn Class mobility Brit. J. Sociology 3 (1977) 269. Hellier, J.Perinatal mortality 1950 and Essay, 1973? Pop Trends 10 (Winter 1973)

Higgins and Keller Familial occurrence of chronic respiratory disease and familial resemblance in ventilatory capacity J Chronic Dis 28 (1975) .39. Holman RT Poverty; Explanations of troubles, Social Deprivation. ( Lond on , Robe rt s on , 1978) Illsley R Social class selection and class differences in relation to stillbirths BMJ (1955) ii 1520. Illsley R Early prediction of perinatal risk Proc. Roy. Soc Med. 59 (1966) 181.

Janerich D. T. Maternal age and spina bifida: longitudinal versus cross sectional analysis Am J Epidem 96 (1972) Kosa J. and I. K. Zola Poverty and Health; A Sociological Analysis (Cambridge Mass, Harvard Univ P., 1976. Lawrence, K. M., Carter, C. 0. and P. A. David Major CNS malformations in South Wales II Brit. J. Prev. Soc. Med. 22 (1968) 212. Leeder, S. R., Corkhill R., Irwig L. M., Holland, W. W. and J. R. T. Colley Influence of family factors on the incidence of lower respiratory tract illness during the first year of Essay about The Celluar Phone, life Brit. Essay Gaskell's? J. Prev. Soc.

Med. 30 (1976) 203. Lewis 0. The Children of Sanchea (N.Y., Random House, 1967) McKeown T The Modern Use of Population (London; Arnold, 1976) Miller P. J.W., Court, S.D.M., Knox, E.G. and The Celluar Phone, S. Brandon The School Year in Newcastle-upon-Tyne. 1952-1962 (Oxford Univ.P., 1974) Morris, J. N. Uses of "Wives and Daughters", Epidemiology (London, Churchill, 3rd ed 1975) Morris, J. N. Social inequalities undiminished The Lancet (13 January 1979) 87.

Morris J. N. and R. M. Titmuss Health and social change: I The recent history of rheumatic heart disease Medical Officer (26 August 2nd, 9 September 1944) Morris J. N. and R. M. Titmuss Epidemiology of peptic ulcer The Lancet 30 th December 1944) 841. O.P.C.S. The General Household Survey 1974, 1975, 1976, 1977 ( London, HMSO, annually ) O.P.C.S. Occupational Mortality 1970-72 (London, HMSO, 1978)

O.P.C.S. Social and Biological Factors in Infant Mortality (Occasional Paper No 12, 1978) O.P.C.S. The Demographic Review (London, HMSO, 1978) O.P.C.S Trends in Mortality (London, HMSO, 1978) Paeamanick, B. The Celluar? et al Pregnancy experience and the development of childhood speech disorders: an epidemiological study of the association with maternal and fetal factors Am. J. Diseases of the Child 91 (1956) 113.

Pasamanick, B. and H Knobloch Brain damage and reproductive causality Am. J Orthopsychiatry 30 (i960) 298. Powles, J. Health and industrialization in Britain (Proc. First World Congress on Env. Medicine and Biology, Paris, 1974) Rainwater, L. And Daughters"? The lower class: health, illness and medical inEtitUtiOflB in II PeVrischer and E. J. Thompson (eds) Among the Essay People; Encounter with the Poor ^N. Y. Basic Books, 1968)

Rutter, M and N. Madge Cycles of Disadvantage (London; Heinemann, 1976) Speiser, F.E., Rosner Band Tager I Familial aggregation of chronic respiratory disease: use of national health Interview Survey data for specific hypothesis testing Int. J Epidem 5(1976) 2 167. Stark, E. The epidemic as a social event Int J Health Services 7 (1977)4 681. Stedman-Jones, G. Outcast London (Oxford Clarendon Press, 197 1 ) Thompson, P. The Edwardians (London, Paladin, 1976) Townsend P Inequality and the health service The Lancet (1974) Townsend P Poverty and Britain (London Penguin Books 1979)

Wilson H and Herbert GW Parents and Children in the Inner City (London Routledge 1978) [The Socialist Health Association (SHA) regularly posts articles on its independent blog about the social determinants of health. Except where explicitly stated, these articles should not be taken as official statements of policy on such matters. Essay On Elizabeth "Wives And Daughters"? For example, this recent blogpost talks about the social determinants of dementia, and is unrelated to official SHA policy.]

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acadimic essay The Academic Essay. The academic essay is Essay about The Celluar Phone, merely a specific writing genre#150;as is the which contributed to the panic, love letter, newspaper editorial, or pop-fiction. As a genre, it functions within a set of norms, rules, and about The Celluar Phone, conventions. On Elizabeth "Wives? The purpose of this discussion is to make clear to you what those rules and norms are, and how to use them to The Celluar Phone, express your argument clearly. The purpose of the havisham analysis, academic essay is to persuade by reasoned discourse. The Celluar? Scholars use the essay amongst themselves to advance ideas. Its value as an instructional tool is to havisham, assist students in developing their critical thinking skills. As you recall, critical thinking is defined as: the ability to Essay The Celluar, read theory accurately, appropriate it meaningfully, apply it independently, generate results based on that application, analyze the results, and form a clear argument based on those results that can be defended with a specific line of reasoning. A good academic essay engenders this process and on Elizabeth Gaskell's, clearly demonstrates that the process has been performed successfully. With this in mind let's examine how to write an about The Celluar Phone academic essay. Do you frequently find yourself struggling with the introduction to your essays?

Do you not know how to troubles to hamlet, begin the essay? Do you find yourself searching for a generalizing statement that will get things going, and trying to Essay, find a delicate balance between BS'ing and saying something meaningful? If so, that's because you are not following the norms for the introduction to the academic essay. Following this norm actually makes introductions a piece of cake and gets you right into Treatment Disroders the body of the The Celluar Phone, essay. Here is the norm: The purpose of the For Neurological Disroders Essay, introduction is two-fold: 1. Phone? To introduce the troubles, theoretical framework that will guide your analysis. 2. To introduce the thesis statement that will organize your paper.

Following this norm allows you to Essay about Phone, cut to the chase. No more generalizing statements of philosophical speculation that you venture forth hoping that it won't get shot down. You know, crap like Hemingway was perhaps one of the most visionary authors of his time. or The Western is perhaps the most uniquely American of all the genres. Rather, if the Disroders, purpose of the essay is to demonstrate that you have appropriated a theory and applied it independently to produce results, then the function of the introduction becomes more focused: to introduce the theory#150;or theoretical framework#150;that you have decided to use. Hence you will find that many essays begin with such statements as In his book. Or, In her essay. IMPORTANT NOTE: One of the Essay about Phone, main reasons that the norm of the Introduction developed this way is because of an important rule of the Academic Essay: Avoid making statements that you cannot prove. The problem with the generalizing/philosophical/BS'ing statements like Hemingway. and The Western. is that they cannot be proven through reasoned discourse.

Moreover, to even try and do so would require voluminous amounts of discourse for something that is not even your thesis: what you actually ARE setting out to prove. Gaskell's "Wives And Daughters"? As a result, the genre of the Academic Essay has evolved into Essay about the above norm. It still meets an introduction's purpose of orienting the reader, it just does so in a very specific manner. Having accomplished that, the expectation for an essay is that you will introduce a thesis statement that is For Neurological Essay, directly related to that theoretical framework (or its application). As a result, a major convention of the academic essay is that: The introduction ends with the thesis statement. Having stated a thesis, you are expected to then go and Essay about, prove it through the body of the essay. That said, it is important to discuss what's at stake in making a thesis statement. There are four basic logical forms for a thesis statement:

#149; A banal thesis statement. #149; A simple thesis statement. #149; A complex thesis statement. #149; An impossible thesis statement. Let's discuss each of these quickly before moving on. A banal thesis statement is a statement that does not really say anything#150;it is in fact meaningless because it is either so overly general or so evident as to not be of significance. Here's an example from literature. A frequent argument students will make is This author used symbolism to make his point. Essay On Terrorism Threats? The statement, however, is meaningless precisely because it is not of Essay The Celluar, significance: every author writing literature uses symbolism of one kind or another, either using language metaphorically or metonymically. Thus, to attempt to on Terrorism Threats to the Continent, single out or make a distinction of a piece for using symbolism is to not say anything that even needs proving to begin with.

A simple thesis statement is not quite what it may sound like. A simple thesis statement means that only one main point or argument is Essay about The Celluar Phone, going to be proved. The term simple argument can thus be misleading because the argument itself can and frequently is very theoretically sophisticated. What makes them simple is that in terms of of transcontinental railroad, their logical structure, they only take on one line of proof, and hence, their organization of proof will be simple. One has to be careful, however, because sometimes one main argument may require SEVERAL supporting arguments. The example here would be the argument that Star Wars belongs within the Essay about Phone, Western Genre. Here the writer has only For Neurological, one thing to prove, but in order to do so will have to establish the elements that comprise the Western Genre and demonstrate how the film embodies them--not a small task. About The Celluar Phone? Simple thesis statements are eminently preferable in terms of writing an essay for a course. It allows you to focus on your points and your proofs rather than getting lost in the organization of your arguments. A complex thesis statement means that the thesis has more than one point to prove.

In this respect, the Treatment For Neurological, essay will have to organize more than one line of reasoning in so far that more than one thing has to be proven. Complex theses are not necessarily more theoretically sophisticated than simple thesis statements, they are only more difficult to organize clearly. In this respect, they are not worth what they entail and should be avoided. An example of about Phone, a complex thesis statement would be something like: Faulkner's novels critique the ideologies of patriarchy and racism. Essay To The African? This would be an appropriate analysis for the work of Faulkner, but I'm not sure it would be worth it. To begin with, it is not clear what the writer has to gain in terms of Essay The Celluar Phone, proving BOTH of troubles, these aspects of the about Phone, work rather than just the one. Instead, with this complex thesis, there are going to be long sections of the essay where half of what needs to be proved will be left suspended while the other half gets discussed. In addition, the thesis picks the work of Faulkner which necessitates discussing every book, rather than just one. Thus it is to the Continent, that an important convention of the academic essay is that: A complex thesis statement can usually be restructured into a more theoretically sophisticated (if not interesting) simple thesis statement. Making an Argument.

As stated earlier, the academic essay is an exercise in Phone reasoned persuasion. In this respect, the thesis statement is an important organizational structure insofar as it establishes how the rest of the essay will be organized. Classical logic maintains that there are 3 basic kinds of persuasive statements: statements of fact, statements of value (or evaluation), and statements of policy (or action, which argue what we should do). Unless otherwise specified, the first of these, the statement of fact, is the form that the thesis statement for an academic essay should take#150;the obvious exception being when you write evaluative criticism (which you will NEVER do in my course). Statements of fact can themselves be grouped into two basic forms: arguments of classification, and Essay on Elizabeth and Daughters", arguments of operation or function. It is possible to make other distinctions, like for example, arguments of Essay The Celluar, relationship (how to things relate to each other) but these distinctions can be readily subsumed into these two basic groups. Arguments of classification are when you establish some sort of criteria, and then argue that something meets or fails to meet that criteria.

The earlier example that Star Wars belongs within the Western Genre is an example of an argument of classification. Having established what comprises the Western Genre, the writer will then go on to prove how Star Wars embodies, contains, or possesses those elements. The writer will, in other words, prove that Star Wars meets that criteria. Arguments of operation or function argues in terms of what something does, or how it functions. The earlier argument that Faulkner's work critiques the ideology of patriarchy is an example of function. This statement argues that Faulkner's work DOES something: it criticizes the ideology of patriarchy. Note that unlike the argument of classification, the writer of this essay SEEMS to have to do more to on Elizabeth "Wives, prove their thesis.

They will not only about The Celluar, have to define what the ideology of patriarchy is#150;and thus establish criteria#150;they will also have to demonstrate that Faulkner's work DOES something with that criteria. The question of HOW leads to a discussion of the body of the essay. The Body of the Essay. From a conceptual standpoint, the function of the body of the essay is to prove the thesis statement laid out in the introduction. Easy enough. This section discusses how the writer accomplishes that proof. In the discussion of types of argument, I made the point that the writer will have to establish criteria that can be used to prove their argument. The body of the essay is the location where the writer accomplishes that. An introduction is precisely that: It INTRODUCES the theoretical framework and the thesis statement.

It does not DESCRIBE or DISCUSS these two things. Essay On Terrorism Threats To The African? This is about Phone, a fairly common mistake that beginning essay writers make. They fear that they have not said enough in the intro and as a result, go on which of 1819? to discuss aspects of their theory or elaborate on a thesis. The problem with doing so is that it screws up your organization. What comes next is no longer clear to the reader. If you keep it clear to Essay, yourself that the purpose of the of transcontinental railroad, introduction to your essay is to only INTRODUCE your theoretical framework, and your thesis statement, then the function of the Essay The Celluar Phone, body of your essay will also become evident to troubles, the reader. Essay About The Celluar? They will expect you to establish criteria so that you can prove your thesis.

As a result, another important norm of the Threats to the African Continent, academic essay is: A primary function of the body of the Essay The Celluar Phone, essay is to establish the criteria by Treatment For Neurological, which the Essay about, thesis statement will be proven. Thus it is that having argued that Star Wars is a Western, the Essay on Terrorism Threats, body of the paper is going to have to first establish the elements that comprise the Western#150;it will have to Essay about The Celluar Phone, establish the criteria by which the thesis can be proven. To argue that Faulkner's work criticizes thee ideology of patriarchy is going to require that the writer establish what the ideology of patriarchy is. Establishing the criteria by which the thesis statement will be proven leads to impact of transcontinental, the next logical step: demonstrating how the object under investigation meets those criteria. Clearly it is not enough for the Faulkner essayist to just define what the ideology of patriarchy is. Their thesis is that Faulkner's work criticizes that ideology. As a result, they will have to point to specific things within the Essay about Phone, text and Treatment Disroders, argue that they relate to those criteria IN A SPECIFIC WAY#150;in this case through a process of criticism. This process of relating the object of investigation back to the established criteria is another fundamental component of the body of the essay. Without it, the proof is not complete. As silly as that sounds, I kid you not that the most frequent mistake of beginning essay writers is a failure to relate their analysis back to the criteria they have established. Thus it is that another important norm for the academic essay is: Relate the analysis back to Essay about, the terms and concepts of the established criteria.

The Star Wars example brings up another fundamental logical task to this process. From the beginning you have probably thought the Star Wars thesis to to the, not be very feasible. The film is not set in the West, and it occurs in the future. The question becomes, however, whether these are ESSENTIAL criteria to the Western, and about The Celluar, if not, what is? In terms of proving that thesis statement, the writer is going to have to clearly establish what the elements of the Essay on Terrorism Threats to the, Western Genre are, and then relate aspects of the film back to ALL of those criteria. Herein lies the essential importance of completeness to that process. If the Star Wars writer establishes the criteria but can only point to the gun-fighting that occurs in the film, then their essay will fail to persuade. Their essay will fail to persuade precisely because it inadequately addresses the scope of the criteria. Thus it is that another important norm for this process is: Fully address the established criteria. It is very important to note that fully addressing the scope of the criteria does NOT mean that the object under discussion has to fully meet ALL the criteria.

To stick with the Star Wars example, the writer can not IGNORE the issue of setting and even remotely hope to persuade the audience. In some way, the writer is going to have to address the fact that both time and place are out of the bounds of the Western. This is the about Phone, point precisely. The author will have to to hamlet, ADDRESS that point#150;those criteria#150;not necessarily MEET those criteria. In this respect, the writer is going to have make a supporting argument about Phone how these criteria relate to troubles to hamlet, each other in terms of about, comprising the genre (or in troubles to hamlet a logical sense the Essay Phone, whole). The important point is that all criteria are addressed adequately. Failure to to the African, address any of the established criteria creates a gap in logic. Subsequently, the reasoning process (and its ability to persuade) fails. About The Celluar Phone? Fully relating the object of the thesis to the established criteria fulfills the logical requirements necessary to persuade reasonably and allows the writer to draw conclusions. Before that process is discussed, however, it is necessary to examine an important component of this relating back process.

The Role of Description. Relating the object of investigation or the object of the thesis back to the established criteria is miss havisham analysis, necessarily going to involve description. Description is frequently an unclear and Essay, thorny issue for writers of the academic essay#150;especially in terms of scope (how much is enough?). The purpose of description, however, clarifies the issue of to hamlet, scope. The purpose of Essay about Phone, description to is to make clear, or establish WHAT in the object of investigation (the film, the scene, the shot) relates to the criteria being used.

It therefore becomes important for to hamlet, the writer to use description in such a manner as to establish the basis of the relationship between the Essay, object and the criteria. Furthermore, the writer should LIMIT description to accomplishing only this task. Added description is not only to the African Continent, superfluous, but distracts from trying to Phone, prove your argument. As a result, another important norm for the body of the academic essay is: Subordinate description to the purpose of analysis. As stated above the process of fully relating the panic of 1819?, object of the Essay about The Celluar, thesis to the established criteria has the effect of fulfilling the logical requirements.

It is THAT task which ultimately persuades, not the conclusion itself. It is for this reason that, in some respects, the conclusion does not seem to have a FUNDAMENTAL role in the process of reasoned persuasion. That in itself probably accounts for how many dopey tips exist for what to do with a conclusion, like: repeat the thesis statement (like people have forgotten it despite the fact that you've been working to prove it the entire time) or some other such thing. What to do with a conclusion if the work of proof is already done? The most effective thing to do with a conclusion is to first signal that the to hamlet, work is coming to close, and then close off the discussion itself by Essay, stating something definitive about the work. Like the introduction, then, the conclusion has a dual role: to signal the transition to to hamlet, closure, and to Essay The Celluar, close the discussion with a definitive statement. The work of the conclusion should reference the thesis, without necessarily repeating the thesis (or the steps by which it was proven) It should then say something definitive that signals closure by pointing to the implications of what you've discussed, by amplifying what you've discussed, or by contextualizing what you've discussed. In each case, you are striving to close discussion by Essay on Elizabeth Gaskell's "Wives, being definitive, and you are taking caution not to violate rule #1 of the academic essay: avoid statements that you cannot prove. To stay with the running examples, the conclusion to the Faulkner paper could look something like this: . it therefore serves as an example of how literary texts structure their criticisms of dominant ideologies. Essay? (pointing to the implications of proving your argument).

Thus, far from being a portrait of impact railroad, its time Faulkner's work demonstrates that literary works actively engage ideologies. (amplifying your argument) Rather than a story centered exclusively on Essay about The Celluar Phone war, Hemingway's novel instead participates in factor contributed of 1819? the reinforcement of dominant ideologies with American culture. (Contextualizing the argument) Note that the similarity here is how definitive these statements are. They draw upon the work that has been done, but say something different and final that is logically based upon what has been discussed. There are, of course, variations on the genre of the Essay about The Celluar Phone, academic essay--some rather large difference exist, for example, between the social sciences and the humanites. This discussion is based on which factor contributed panic of 1819? the humanties approach. Other variations can result from the idiosyncracies of specific instructors. To the about The Celluar Phone, degree that what is written here sounds heavy handed and inflexible, I caution instead that such tone is trying to to the African Continent, reflect the manner in which your own analysis and writing will need to sound precise and rigorous#150;the standards by Essay, which the academic essay is evaluated. The precision and rigor with which these norms and to hamlet, conventions are applied should function only to demand that your own analysis and reason engender these standards. They are thus meant to Essay about, elevate your thinking, not control it. Railroad? The principles by which the Essay about The Celluar Phone, academic essay structures itself is designed to be a discipline that frees your thinking, not subjugate it. Within its conventions is unlimited creative potential whose only demand, ultimately, is that you say something meaningful that others can be persuaded of via your logic. What I have attempted to do here is make the norms and conventions of the genre explicit so that you can refine your skills working within it.

Mastering this genre has the Essay African, benefit of developing your skill to analyze situations using explicit criteria, and be able to make decisions based on that analysis. More than a few people have found that possession of such a skill is invaluable in life and professional endeavors.

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Free Essays on Essay The Celluar Rudeness At The Movies. Conclusion Final Draft Professor Kay Rudeness at the Movies On average, most Americans go out to public places to eat and for activities. Majority might agree that public outings are no longer as pleasant of an troubles to hamlet, experience. Going to the movies is becoming one of the Phone less appealing outings. Going to the movies has been a great pastime for Treatment For Neurological Disroders many people in our society, although the experience of going to Essay The Celluar, the movies in America has changed over the years. It seems like in of transcontinental railroad the past years, rudeness at about The Celluar the movie theaters has dramatically increased, making the movie theater experience worse for. What Used to Be a Great Past Time. to the movies has been a great pastime for many people in our society. The experience of going to the movies has changed over the years in Essay Threats to the America. It seems like the past years rudeness at the movie theaters has increased making the movie theater experience worse for everybody.

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should be deported and never allowed back into the US, or placed in jail. The majority of immigrants, are rude and miss disrespectful. I have experienced rudeness first hand in store lines, on the road and in public places. I hear the same type of complaints from other people all the time. They should not. Many people may go to the movies . The movies can be an escape into a fantasy world. The type of movie someone goes to see can give a hint to what kind of personality thye possess. Everyone has a different preference on what type of movie is Essay about Phone, best suited for them. There are many people that will classify. Rudeness of People on contributed of 1819? Cell Phones in Public.

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Why Do We Watch Scary Movies ? When reading To Kill A Mockingbird by Harper Lee, one aspect of the early story really bothered me. Why do Jem and Scout, even though they are deathly scared of the about Radley house dare each other to mess with the house? Evidently, the two children are fascinated by the fear. Does every Chinese know how to analysis, do Kung Fu? Every time I turn on the television and start surfing channels, I can find some action movies . Those Kung Fu kicks and punches on the screen really catch my attention. Naturally I think about the stereotype: Does every Chinese know how to do Kung Fu? A stereotype. Violence in Horror Stories or Movies. VIOLENCE IN HORROR STORIES OR MOVIES Violence in entertainment today: One of the most serious social problem in my mind is the violence in entertainment today.

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The Theme of Essay about, Love and Death in Woody Allen's Movies. The Theme of Love and Death in For Neurological Woody Allens Movies Banality of life is one the topics that never gets old. And it is a commonplace feature of the about view of the director who doesnt hesitate to borrow (from Chekhov to Bergman) but at the same time he manages to be very similar to himself. We already. the white stones started to melt away slowly here and there, there were small streams of melted water. That day we did not go anywhere. Of Transcontinental. We watched movies and stayed in the house since in the afternoon the weather changed and became chilly. In the about Phone evening my aunts cow gave birth to a male calf which. Lessons I'Ve Learned from Horror Movies. Lessons I've Learned from Horror Movies I am a movie buff and love pretty much any genre.

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nothing. One may be the most beautiful person anyone has ever laid their eyes on, but if that girl has an ugly heart and displays characteristics of rudeness , impoliteness, and bad manners, the girl is not pretty. These negative characteristics overpower the physical attractiveness. Inner beauty refers. China Upstream Media Market Research on Demand of Increasing Number of Movie Viewers, Latest Introduction of 4k Technology and Government Regulations for Domestic Movies. Media Market Research on Demand of Increasing Number of Movie Viewers, Latest Introduction of 4k Technology and Government Regulations for Domestic Movies China upstream media market is forecasted to grow over the next five years. Essay Phone. The following report provides information regarding the impact of transcontinental recent trends.

Ethics at about The Celluar the Movies Legally Blonde. Christy Leonard Dr. Of Transcontinental. Hendrix PHL 206 September 2010 Ethics at the Movies Legally Blonde Based on a novel by Essay about The Celluar Phone Amada Brown, Legally Blonde is a comedy starring Reese Witherspoon as Elle Woods, a bubbly, outgoing California sorority girl who has, surprisingly, outstanding morals and ethics in. Dracula This semester we watched a lot of different versions of which contributed of 1819?, Dracula. Movies such as Dracula are my favorite because I personally like watching vampire movies . The first version that we watched wasnt bad, but it wasnt as good either. It was by Bella Lugosi and was filmed in England. In this version. The Presentation of Women in Thrillers in the 1930s and Today a Comparison on the Basis of Two Movies: the Essay about 39 Steps the Bourne Identity.

Content Page 1. Introduction 3 2. The two movies and The Bourne Identity 4 2.1 The 39 Steps 4 2.2 The Bourne Identity 4 2.3 Pamela and Marie 5 3. Comparison of selected scenes in The 39 Steps and impact The Bourne Identity 5 3. Adam Levison Ancient Roman Attitudes Throughout the play Curcilio, I felt a theme of sleaziness and rudeness . The rudeness is portrayed in the first couple of scenes when Palinurus and Phaedromus are unusually rude to one another. As the about The Celluar play progresses we learn that Phaedromus is in For Neurological Essay love with. The Movies By John Bennett The birth and production of the about Phone commercial full-length movie, beginning in "Wives and Daughters" the very beginning of the Essay The Celluar Phone 20th century (The Story of the havisham Kelly Gang (1906, Australia), with a running time of about The Celluar Phone, between 60-70 minutes)([1]), up until today has changed dramatically. Before the advent. of living that does not involve much movement yet can still be entertaining. Two of the very famous forms of entertainment nowadays are Novels and Movies . Even though they are completely different they still share some similarities. And Daughters". Popularity and Essay The Celluar Phone their ability to deliver massages are two of factor contributed to the of 1819?, their similarities. Television, Radio, and the Movies are something we all as Americans participate in. About The Celluar Phone. However, is the way the media stereotypes a certain race really the belief that influences society today?

In the following paragraphs I plan to examine the history of of transcontinental railroad, African-Americans in Essay The Celluar the media and some of the Essay Gaskell's and Daughters" many. Movies and Their Impact on Society. Movies and Their Impact on about The Celluar Phone Society Im going to make a name for myself. If I fail, you will never hear of me again- Edward James Muggeridge. On Terrorism African Continent. True to about Phone, his words he succeeded in making a name for himself and he created the first movie or motion picture.

Now if you do not understand or know what a movie. Stereotyping in two of on Elizabeth Gaskell's "Wives and Daughters", my favorite Disney movies. Stereotyping in two of my favorite Disney movies Krista Tackebury SOCL202 8/26/2015 For this discussion board post I have chosen to write about two Disney Movies I grew up watching and loved through my childhood. The first Disney movie I chose to about The Celluar Phone, write. Movies shape the world around us and feed popular culture. Each film produced has a different message to convey. Railroad. Directors, writers and actors use film to reflect their message. The Wild One, released in Essay The Celluar 1953,starring Marlon Brando, directed by Laslo Benedek and of transcontinental railroad written by John Paxton, is a film filled. Watching Movies Is a Wasting of about Phone, Time.

Watching movies is a wasting of time. Movies or motion pictures have been around ever since man first discovered and invented cameras, and, in fact, even before that, through animate cartoons. It is a form of entertainment that is extremely popular in the world at large, thanks to dedicated filmmakers. usually go blank. There are so many great movies out there. There are different genres for different kinds of people.

Some people prefer comedy and impact of transcontinental horror, and Essay some people prefer drama and action. Me personally I like action, thriller, and sci-fi. My three favorite movies would have to be The Crow, Natural.