18 Healthcare disparities and adjustment to illness

Question 1

What are the adjustments to illness?

Answer 1

Presents challenges to individuals

-changes over time

Question 2

What is an adjustment to illness required to deal with?

Answer 2

• Uncertainty
• Disruption
• Striving for recovery
• Restoration of wellbeing

Question 3

What are the stages in adjusting to illness?

Answer 3

• Initial response e.g. disbelief, denial and shock
• Dysphoria e.g. coming to terms with the diagnosis
• Adaptation e.g. lasts a varying period of time

Question 4

What do we know about health differences in Australia?

Answer 4

• Similarly, people who occupy minority roles in society as a result of ethnic or to her factors may experience more illness or die earlier than the majority population
• Findings that women live longer than men may be as much the result of social and psychological factors as biological ones

Question 5

What are the leading causes of death in Australia?

Answer 5

1. Coronary heart disease
2. Dementia and Alzheimer disease
3. Cerebrovascular disease
4. Lung Cancer
5. Chronic obstructive pulmonary disease

Question 6

What are all the leading illnesses impacted by?

Answer 6

Lifestyle factors

Question 7

What are the health differentials either within countries and between countries?

Answer 7

In general, the richer the country, the longer its population lives and the longer it’s equivalent of full health is

Question 8

Explain the assumption that everyone can read and the study involved

Answer 8

• Majority of people in Australia are in level 3 (minimum required for an individual to meet the complex demands of everyday life)
• A third of the population is less than level 3

Question 9

How does the impact of poverty on health affect life span?

Answer 9

People who live in developing countries live significantly shorter lives than those who live in more afficient countries

Question 10

What are the contributing factors on the impact of poverty on health?

Answer 10

They are economic, environmental and social lack of safer water, poor sanitation, inadequate diet and poor access to health care

Question 11

What is the problem that developing countries are facing?

Answer 11

HIV, infection and AIDS

Question 12

Explain the health inequalities

Answer 12

This can be found in both rich and poor countries
- Are likely to be the consequence of social, economic, educational land environmental differences e.g. lack of safe water

Question 13

Can health inequalities be changed?

Answer 13

• Maybe amenable to reduction by intervention at a societal level
• Must have the will to change it

Question 14

What is the impact of poverty on health?

Answer 14

• In industrialised countries, richer people live longer and have less illness than the economically less able
• There is a linear relationship between income and health
• If we look at the underlying structural determinants the inequalities in moving about: how you transport places

Question 15

What are some subtle differences may also impact health in what ways?

Answer 15

Marmot, Davey-Smith * Stansfield (1991): middle-class executives who own one care are more likely to die earlier than equivalent earners with two cars

Question 16

Has homelessness increased/decreased in Australia?

Answer 16

It has increased by 13.7% in 5 years

• 58% male, 42% female
• 20% Indigenous Australians
• 30% born overseas

Question 17

Where do people stay in terms of homelessness in Australia?

Answer 17

• Improvised dwellings, tents or sleeping out 7%
• Supported accommodation for the homeless 18%
• Staying temporarily with other households 15%
• Boarding houses 15%
• Other temporary lodgings 1%
• Severely overcrowded dwellings 44%

Question 18

What are the social determinants of ill health?

Answer 18

Recent evidence has three components, mostly linked

• Improvement in life expectancy, going for 100 years, has slowed since 2010
• Health inequalities, which probably become smaller during the 2000s, have grown again since 2012

Question 19

What is the life expectancy within countries in 2010-12?

Answer 19

• Indigenous males 10.6 years lower than non-indigenous

- Indigenous females 9.5 years lower than non-indigenous

Question 20

What is the explanation for the USA which fares badly on the expectancy being the exception to the rule?

Answer 20

USA is below the OECD average for life expectancy.

• Some social groups have extremely poor health
• Leading country for tobacco
• High incidences of homicides compared to other countries

Question 21

Explain the health inequalities within countries?

Answer 21

This is a problem within rich countries and a failure of health care systems. It is a technical problem to be addressed by improving access to services among those with poorer health. Lifestyle, behavioural or cultural differences between socio-economic or ethnic groups that can be solved through health education and promotion - possibly also genetic differences between groups

Question 22

Explain the variations of ethnic minority groups?

Answer 22

• Deaths from lung cancer and breast cancer were higher in UK and irish born residents but skin cancer was lower
• People born in Asia had significantly higher rates of mortality from infectious diseases, diabetes and homicide than the Australian born population

Question 23

With the exception of indigenous Australians, in what ways are minority groups in Australia different to minority groups in the UK or USA for example

Answer 23

A very controlled approach to migration

Question 24

What is the ‘Healthy Migrant’ effect?

Answer 24

The majority of people who migrate to Australia are as healthy if not healthier than the Australian born population

Question 25

What effects do social class have in mortality rates?

Answer 25

- Lawson and Black (1993) found that marked differences in death rates according to social class exist - If men of all social classes had the same mortality experiences as higher social class men the overall death rates of Australian men would be reduced by 60%

Question 26

What is the most important indicator of health status among Australians?

Answer 26

Socioeconomic status

Question 27

What are health inequalities?

Answer 27

Differences in health status or in the distribution of health determinants between different population groups -> designate differences or variations in the health achievements of individuals and groups.

Question 28

What is the evidence of health inequalities?

Answer 28

- Clear health inequalities between and within countries -> the richer the country, the longer its population lives, longer its equivalent full-time health

Question 29

Explain the effects of socioeconomic status on health outcomes and name the models related to this

Answer 29

- Poverty linked with poorer health outcomes – lower deprivations have higher years of healthy life expectancy Social Causation Model and Social Drift Model

Question 30

What is the Social Causation Model?

Answer 30

Low SES causes health problems -> there is something about occupying a low socioeconomic position that negatively influences the health of people

Question 31

Which model does evidence tend to support and why?

Answer 31

Evidence tends to support this model more strongly because health status does not predict SES, but SES measures predict subsequent health status

Question 32

What is the Social Drift Model?

Answer 32

Health problems cause low SES -> when people develop a health problem they drift down the socioeconomic scale

Question 33

What effect does the environment have on SES?

Answer 33

People of lower SES more likely to be exposed to health-damaging environments e.g. working in dangerous environments have more accidents, lower quality houses (mould, dampness, lead exposure), high levels of air pollution

Question 34

What are the different health behaviours for lower SES?

Answer 34

People of lower SES more likely to engage in some health risk behaviours e.g. smoke more, eat a less healthy diet, less exercise However, these differences do not provide the whole explanation for the health differentials

Question 35

What are the psychosocial factors of lower SES on health?

Answer 35

Experience more stress than people of higher SES and often have fewer personal resources to help them cope with stress -> which can impact health

Question 36

What type of stress, strain and depression could be happening at the childhood stage? (Carrol, Davey-Smith & Bennett, 1996)

Answer 36

- Family instability - Overcrowding - Poor diet - Restricted educational opportunities

Question 37

What type of stress, strain and depression could be happening at the Adolescence stage? (Carrol, Davey-Smith & Bennett, 1996)

Answer 37

- Family strife - Exposure to smoking and own smoking - Leaving school with poor qualifications - Experiencing unemployment or low-paid and insecure jobs

Question 38

What type of stress, strain and depression could be happening at the Adulthood stage? (Carrol, Davey-Smith & Bennett, 1996)

Answer 38

- Working in hazardous conditions - Financial insecurity - Periods of unemployment - Low levels of control over work or home life - Negative social interactions

Question 39

What type of stress, strain and depression could be happening at the Older age stage? (Carrol, Davey-Smith & Bennett, 1996)

Answer 39

- None or small occupational pension - Inadequate heating - Inadequate food

Question 40

What is Hobfoll & Lilly (1993) conservation of resources model?

Answer 40

Mental and physical health is determined by the number of resources available to the individual - Economic (e.g. job, income) - Social (e.g. family support) - Structural (e.g. housing) - Psychological (e.g. coping skills, perceived control)

Question 41

How are indigenous Australians affected by this?

Answer 41

- Have higher unemployment - Poorer housing conditions - Are less likely to have access to higher education

Question 42

What does the conservation of resources model explain?

Answer 42

- High levels of resources are health-protective | - Low levels of resources place an individual at risk for health problems

Question 43

Access to health care services in Australia is mediated by several factors, what are they?

Answer 43

- Services availability - Access to health care services - Elective procedures

Question 44

Name some ways of reducing inequalities in health

Answer 44

This should involve different levels of intervention (Whitehead, 1995) - Strengthening individuals - Strengthening communities - Improving access to essential facilitites and services - Encouraging macro-economic and cultural change

Question 45

What type of impact can minority status have on health?

Answer 45

Can impact variety of issues e.g. language, religion, migration, culture, ancestry, forms of identity (should not be considered one entity as there are variations within that group) -> healthy migrant effect in Australia – migrants are as healthy or healthier than Australian-born population which are different to refugee minorities or aboriginal and Torres Strait islanders.