Differential mortality from tuberculosis (all forms) 1910-1912 and 1920-

The standardized mortality ratios (SMR’s) from tuberculosis of all forms among males in each occupational group for 1910-1912 and 1920-1922

are shown in Tables 3.10 and 3.11 respectively. Once again, a broad social

class gradient in mortality is observable from the SMR's of various occupational groups.

Table 3.9. Percentage unemployed in each occupational group, Australia, males, 1911 and 1921 Censuses

Percentage unemployed

Occupational Group 1911 Census 1921 Census

1. Professional 1.6 3.0

2. Domestic 5.6 9.8

3. Commercial 3.3 7.3

4. Transport and Communication 2.6 6.4

5. Industrial 6.4 16.2

6. Primary Producers 3.6 8.5

Total (1 - 6) 4.4 10.7

Source: Commonwealth Bureau of Census and Statistics (1917, p.390 and 1927, p.308).

Purdy (1924) has shown that overcrowding in the household was positively correlated with tuberculosis mortality in Sydney during 1909-1913. Cumpston

(1924) attributed the low tuberculosis death rates of rural occupations such as Agricultural Workers, Farmers etc., and of Transport and Communication Workers to the possible effects of cleaner environments in which these men worked. Further, Abbott (1952) showed that during 1910-1912, the overseas- born males exhibited higher mortality from tuberculosis than Australian-born males. In the light of these observations, the Primary Producers (a

majority of which are Farmers, Agricultural Workers etc.) appears to have had the advantage of containing a large proportion of Australian-born males

(Table 3.5), and also of living and working in the open. There is no information about density of population in households classified by occupational groups, but it may well be that the predominantly non­

metropolitan residence of Primary Producers could indicate their being less exposed to overcrowding c w - X

cross-infection.

Professional Workers, who showed about the average mortality level in 1910-1912 (Table 3.10), exhibited a significantly higher than average mortality in 1920-1922. This could be due to the effects of World War I. The total Australian population is reported to have recorded a temporary

increase in tuberculosis mortality between 1911 and 1917 as a consequence of the War (Cumpston 1924), and the Professional Workers appear to have borne the brunt of this increase. This occupational group contains Defence personnel, such as in the Army and Navy, Sailors, Marines and others. It

is also likely that war veterans could have been given preference in other public service jobs in the Professional occupation. In fact, if the

Table 3.10. Standardized Mortality Ratios (SMR's) from tuberculosis (all forms) and cancer (all sites). Males aged 15-64 years in each occupational group. Australia 1910-12

SMR

Occupational Group Tuberculosis^3^ Cancer

Professional 97 81*

Domes tic 142* 118

Commercial 103 88*

Transport and Communication 80* 84*

Indus trial 137* 148*

Primary Producers 5 7* 67*

All males^k^ 100 100

(a)

Refers to 1910-12, because the required data for 1910 are not available.

Standard Population, includes ’occupations not stated or undefined’ and ’Dependents'.

* SMR statistically significant (p < .05)

Source: Computed from Commonwealth Bureau of Census and Statistics (1911, 1912, 1913 and 1917).

Table 3.11. Standardized Mortality Ratios (SMR's) from tuberculosis

(all forms) and cancer (all sites). Males aged 15-64

years in each occupational group. Australia 1920-22

SMR

Occupational Group Tuberculosis Cancer

Professional 124* 86*

Domes tic 152* 106

Commercial 114* 98

Transport and Communication 81* 98

Indus trial 119* 131*

Primary Producers 61* 68*

All rnales^3^ 100 100

* SMR statistically significant (p < .05)

(a)

Standard Population, includes 'occupations not stated or

undefined' and 'Dependents'.

Source: Commonwealth Bureau of Census and Statistics (1921,

in 1920-1922, then the Professional, Clerical etc. Workers had the maximum proportion of males in the War Service^- (Table 3.12).

3.8 Differential mortality from cancer (all sites) 1910-1912 and 1920-1922

The association between cancer of various sites and occupations which exposed the men to carcinogens, has been described by Benjamin (1965, p.35). It has also been found that cancers of particular sites, such as lungs and stomach, were higher among the lower social classes (Graham 1969,

pp.287-297). A more detailed discussion of the correlates of various types of cancer is given in Chapter 8. Available data for the present analysis are, however, inadequate to explore such associations among Australian males in various occupations. Nevertheless, the high SMR of Industrial Workers from cancer of all sites, indicates the possible exposure of these workers to carcinogenic materials at work, and also the higher

susceptibility of the lower social classes to the disease (Tables 3.10 and 3.11). Conversely, Professional Workers' low SMR from this disease probably reflects the lower susceptibility of the upper social class, while the

Primary Producers could possibly have the advantage of less air pollution.

3.9 Discussion and conclusion

The health and longevity of a person depends upon his ability to adapt to the stresses of the external environment. The most important factors which influence this process of adaptation are mode of employment and working conditions, education, various other elements of levels of living such as nutrition, housing, access to medical care, and other services which foster well-being, such as recreation and sport. Because of strong

intercorrelations between them, it may become misleading to treat any one of them separately; on the other hand it may not be practicable to study

1

Statistics on War Service were collected for the first time at the 1933 Census.

Table 3.12. Percentage of males aged 30-64 years in each occupational group who served in the 1914-18 war, Australia 1933

Census

Occupational Group Percentage

Agriculture, Pastoral, Dairying,

Fishing Forestry 14

Mining and Quarrying 13

Indus trial 17

Transport and Communication 18

Commerce and Finance 16

Public Administration, Professional,

Clerical 23

Entertainment and Sport 13

Personal and Domestic 15

Labourers 16

Total* 17

* Includes males of ill-defined occupations and those not gainfully employed.

Source: Computed from Commonwealth Bureau of Census and

Statistics (1937, pp.1536— 1616; 1937a, pp.1096- 1105).

their effects simultaneously. However, many researchers have found it economical to deal with a single indicator of the general living standards with which all other factors are associated in the same general direction. This indicator is occupation, which is most commonly and most easily recorded of all socio-economic characteristics (Benjamin 1965, p.5 and p.58). In many countries, including Australia, occupation is the only item recorded on the death certificate which can throw light on the socio­

economic status of the deceased.

In this chapter, the underlying objective of analysing occupational group differentials in mortality is to deduce the mortality differentials by social class. In the course of examining the differentials by broad occupational groups, reference has been made to the possible associations of birthplace (Australian-born versus overseas-born), metropolitan or non­ metropolitan residence, effects of World War I. Information on some other attributes such as living conditions, education or income among the

occupational groups in Australia is not available for the period under study, therefore it was not possible to discuss their roles on the observed differentials in mortality.

Antonovsky (1967), after reviewing a large number of studies from different populations, came to the conclusion that social class influences one’s chances of staying alive - the lower the social class, the smaller are the chances. People in the higher social classes always appear to take more advantage of the emerging methods of combating illness. Postponement of deaths is dependent upon the knowledge, technique or social organization required for fighting disease. This was as true when control of infectious diseases started, as it is now, when the fight is on to check the chronic diseases. Antonovsky concluded that in terms of such factors as access to good medical care, preventive medical action, knowledge of health care, and

the limitation of delay in seeking treatment, the lower class people may

well be at a disadvantage. Further, with regard to general living and working conditions, such as chances of cross-infection or vulnerability to

occupational hazards, people in the lower social classes are likely to be unfavourably placed. Studies conducted by the Registrar-General of England and Wales have shown that social class differences in mortality compare well with such differences in morbidity; and in terms of general and

specialist medical care, a man in the lower social class consults a doctor less often per illness than a man in the higher social class (Blaxter 1976). Although it may not be true of all diseases, occupational rank is, in general, inversely associated with illness and it has been suggested that in addition to being better equipped to deal with ill health, members of higher occupational ranks preserve their good health by virtue of

feelings of achievement and self-esteem derived from successfully performing an absorbing job. "Thoroughly enjoyed, and highly rewarded, they apparently enjoy a zest for life that is health promoting" (Wilson 1970, p.91).

There is no contemporary evidence for Australia which can show the use of health care facilities by occupational groups, neither are there any morbidity statistics for these groups, but one survey in Brisbane in the early 1960’s, showed that old people in poorer suburbs sought medical help less readily than those in better class suburbs, even though the former were pensioners who could go to a nearby free general hospital or to a local

general practitioner free of charge. Higher social classes in New York City were also found to seek medical care more readily than their lower class counterparts (Gordon 1976, p.78).

It may not be wrong to assume that a similar situation existed in Australia in the first three decades of this century. The introduction of

"Basic Wages"'*' in 1907 (Yearbook 1929, p.452-543), could have acted at least to partially dilute the social class differentials in medical care and standard of living, so far as income is concerned. This is not to say that there was no poverty. In fact, it has been found that the incidence of poverty was greater among low income earners with large families than among low income earners with small families or than among high income

earners with large families. There was an overall tendency of the families of Labourers, Factory Operatives and Truck Drivers to be somewhat larger

than the families of Accountants, Marketing Executives, University Professors or Dentists, and the take-home pay of the latter categories was consistently higher than that of the former (Williams 1974, p.89). Therefore, it may be stated that in Australia during the period before the Second World War, there were differences among social classes with respect to health care and income, the lower the class the more adverse the

situation was likely to be. The occupational groups studied in this chapter, though not forming counterparts to the defined "social classes" of England and Wales, show that Professionals etc. Workers who can be regarded as belonging to the higher social classes, exhibited lower SMR's from all causes of death and from tuberculosis and cancer during 1910-1912, 1920-1922, than did Industrial Workers, who belong to the lower social class. Agricultural, Dairy etc. Workers, who according to the study by Taft (1953) may be regarded as belonging to a lower social class than Professional Workers, however, show lower SMR’s than the latter. This could have happened because, as mentioned earlier, they ( Agricultural Workers) lived in relative isolation, that is, mostly in rural areas where mortality was low, and possibly adopted a healthier life-style.

”* It is the lowest wage which can be paid to an unskilled Labourer on the basis of the normal needs of an average employee.

Conclusions

The Australian society, which has sometimes been described as having no class distinctions, is indeed stratified according to class, status and power

(Encel 1970, pp.149-179). The analysis presented in this chapter has shown that there have been considerable differences in the mortality of various occupational groups. An occupational group associated with lower social class exhibited, in general, higher mortality than another group associated with lower social class. Since not enough information is available about life-styles of each occupational group, it is difficult to offer a definite explanation for the observed mortality differentials. Logan (1954) also encountered apparently similar difficulties in interpreting the observed social class differentials in mortality in England and Wales. Part of the problem of interpretation may be non-availability of information on

ancillary characteristics of the occupational groups or social classes. Further, although occupation is regarded as a simple, but fairly

comprehensive, indicator of socio-economic status (Benjamin 1965, p.58), it stands for a whole variety of life conditions affecting one's level of health and well being. Other problems related to the interpretation of occupational mortality data are discussed in Chapter 2.

However, from the available data relating to Australia in the early part of this century, the possibility of some association between the mortality of an occupational group and its ethnicity, residence in

metropolitan or non-metropolitan areas, participation in the First World War, and economic situation (percentage unemployed), has been suggested.

It may however, be mentioned that some of the factors mentioned above, may not be strictly regarded as causal factors, but they could be surrogates for more immediate factors affecting mortality, such as various aspects of life-style.

CHAPTER 4

DIFFERENTIAL MORTALITY AMONG MALES OF VARIOUS OCCUPATIONAL