Individualisation and inequalities in health: a qualitative study of class identity and health

It has been argued that social class, if not dead, is at least a 'zombie category' in contemporary Western society. However, epidemiological evidence shows that class-based inequalities have either persisted or widened, despite overall improvements in the health of Western populations. This article presents an exploratory qualitative study of the individualisation of class identity and health conducted in a southern English city. Findings are presented in consideration of two competing argumentative positions around which participants worked to negotiate class identity and health. The first of these positions denied the significance of class for identity and health and was associated with the individualised heroic and stoic narratives of working class identity. The second position acknowledged the reality of class relations and their implications for health and identity, being associated with structurally and politically orientated narratives of middle class identity. In sum, resistance to class was associated with talk about individual, private experience whereas the acceptance of class was linked to discussion of health as a wider social or political phenomenon. This evidence lends qualified support to the individualisation thesis: inequalities in health existing on structural or material levels are not simply reproduced, and indeed in some contexts may even juxtapose, accounts of social identity in interview and focus group contexts. Class identity and health are negotiated in lay talk as participants shift argumentatively back and forth between competing positions, and public and private realms, in the attempt to make sense of health and illness. The promotion of greater awareness and interest in health inequalities within wider public discourse may well help support attempts to tackle these injustices. (C) 2004 Elsevier Ltd. All rights reserved.