2000 Health, healthcare and capitalism Flashcards
what are the 3 different ways to measure health?
Subjective / objective
Age / event
Cross-sectional / longitudinal
what does a subjective health measurement mean?
based on self report
what does an objective health measurement mean?
standardised measurements eg weight/height
what does it mean to measure health by age?
age when an event occurred eg age at first child
what does it mean to measure health by event?
when something occurs eg maternal mortality
what does it mean to measure health longitudinally?
asking as a cohort
what does it mean to measure health cross-sectionally?
asking over a length of time
what could be an issue with giving health details for a research project?
does the data end up in the hands of private companies?
what are some difficulties with collecting health data? (4)
- Hardest to collect data about older and vulnerable people
- Definitions and methods underlying indicators
- Problems with measurement tools
- Expectations with health? –
what technique is used in countries with little resources to collect health data?
focus on collecting objective routine vital data
why is objective routine vital data easy to collect in countries with little resources?
no need for much training, fairly simple to identify
what is an example of ‘easy to measure’ events?
death
why is it an issue that it is difficult to access health information about older and vulnerable individuals?
those are the ones who need it the most
what did Ferri et al find whilst conducting the global prevalence of dementia study?
the West was well covered with studies of good methodological quality, whilst South America, Africa and the Middle East had little to no studies on dementia
how can a post-colonial approach be seen in regards to dementia?
Dementia is a very Western idea, idea that the rest of the world needs to ‘catch up’
how is GDP per capita linked to infant survival within the first year?
within the developed countries there was a high infant survival rate compared to sub-saharan africa
what does the GDP per capita being linked to infant survival mean?
Health isn’t individual but based on the economy
what are some political/cultural influences on health? (6)
- Socio-economic status
- Gender
- Ethnicity
- Political power
- Cultural assets
- Social assets
what are 2 examples of influences on your socio-economic status?
education, employment
how can political power affect an individuals health? (3)
- Household authority
- Healthcare availability
- Safety and stability
how can cultural assets affect an individuals health? (2)
- Privileged lifestyles
* High status consumption practices
what are social assets?
social capital
how does rapid economic, political and social change impact mortality?
usually causes a sharp rise
why does rapid economic, political and social change impact mortality? (3)
- Embargos
- Armed conflicts
- Changes in government/policy
what are two contemporary UK examples of rapid economic, political and social change that impacted mortality?
- Austerity
* Brexit
how many excess deaths in 2015 are linked to cuts in health and social care in the UK?
30,000
how can Russia be applied to see how socio-political changes affect individuals health?
mid 80s, president keen to increase life expectancy, campaigns on excessive drinking, reversed in the mid 90s and so the life expectancy went down
what is an example of a government policy which isn’t explicitly about health but helps individuals health?
free bus pass for the elderly
how does gender affect health? (2)
- Sex selective abortions carried out
* Boy selected to get given healthcare once they’ve grown up if there isn’t enough money for both children
how many females were considered missing in 2008 worldwide?
4mil
how many ways did Blouin et al identify that trade policy affects health outcomes in a country?
4
how does material deprivation affect health outcomes?
mortality shifts due to nutrition, infectious diseases
how does acute psychological stress (economic insecurity) affect health outcomes? (3)
mortality changes in coronary heart diseases, cardiovascular diseases and violent deaths
how do unhealthy diets imported from Western countries affect health outcomes?
shifts in mortality due to chronic diseases
how does income inequality affect health incomes? (4)
chronic stress, mortality changes in coronary heart diseases, cardiovascular diseases and violent deaths
what are two examples of environmental risks to health?
Asbestos, pesticides
What generally explains health inequalities? (3)
- Material deprivation
- Psychosocial mechanisms
- Life course effects
How does psychosocial mechanisms affect health inequalities?
seeing what other people have and knowing you have no way to access those resources
How does life course effects affect health inequalities? (3)
latent (occurs during very early life, influences you for the rest of the life),
pathway (different pathways open up different opportunities eg university),
cumulative effects (all of these things start to add up, tipping point where your health is affected)
what transitions have occurred as a result of the global phenomenon of life extension?
Demographic and epidemiological transitions (ageing population, different types of diseases people suffer with when they’re older)
As a result of life extension, what has occurred? (3)
- Rationing of healthcare
- Withdrawal of the state
- Opening of new health markets (eg tele monitoring, home care services, medical devices)
what has occurred due to a rise of neoliberal policies?
decline of the welfare state
what is the neoliberal perspective on health?
•individualistic (eg responsibility for health, ‘cherry picking’ by service providers – prioritise cosmetic procedures over more complex, long term patients)
what are 3 examples of lifestyle choices which impact an individuals’ health?
Obesity, ‘binge drinking’, drug abuse
how is obesity framed?
lazy, undeserving of healthcare
what is Cohen’s theory?
moral panics
when did Jeremy Hunt declare obesity as a national emergency?
2016
what does neoliberalism create according to Coburn?
higher income inequality and lower social cohesion
How has globalisation changed class structures?
Decline of the welfare state and rise of neoliberalism
what did Wilkinson find in 1996 related to GNP per capita?
After certain absolute levels of GNP per capita are attained (around 5,000 dollars), the major determinant of differing levels of health status amongst nations lies in their degree of income inequality
what did Putnam find in 1993 related to GNP per capita?
•Social cohesion/trust is one of the main mechanisms linking the national trust degree of income inequality with health
why does Coburn criticise studies on low-income children?
describes the belief that enriching their environments will help prevent health or others difficulties later in life however, there isn’t any discussion of the causes of socio-economic status differences themselves
why does Syme say research doesn’t focus on the causes of SES?
Research attention seen as supposed to focus on something we can actually change
how does Coburn update Wilkinson’s idea about social cohesion?
rather than income inequality producing lowered social cohesion leading to lowered health status, neo-liberalism produces both higher income inequality and lower social cohesion, partly due to its undermining of the welfare state
what are 3 characteristics of neoliberalism?
- that markets are the best and most efficient allocators of resources in production and distribution
- that societies are composed of autonomous individuals (producers and consumers) motivated chiefly or entirely by material or economic considerations
- That competition is the major market vehicle for innovations
how does neoliberals view inequality?
either a positive virtue or the best allocator of resources, and believe that what you put into the market one gets out
why is neoliberalism against intervention in markets?
they feel it damages the operation of the ‘invisible hand’ which most efficiently aligns production, consumption and distribution
how did Margeret Thatcher feel about society?
there is no such thing as `society’ only individuals or families
why does neoliberalism end up promoting suspicion about others intentions?
If everyone is legitimately seeking their own economics self-interest, as neo-liberalism implies, then there is reason for widespread suspicion of the motives and intentions of others rather than `trust’.
why does neoliberalism attribute social problems to individual failings?
•Since markets are just allocators of reward, then social problems are attributed to individual failings
what is Coburn’s main hypothesis?
The more market-oriented the society, the higher the social fragmentation and the lower the social cohesion and trust
in what 2 ways did Barley et al find that the welfare state affected individuals? why?
the welfare state has both material and psychosocial effects by preventing dramatic falls in living standards and by a wider effect on the degree to which citizens experience a sense of control of their lives
what did Smith find cross-nationally in relation to higher levels of both social expenditure and taxation as a proportion of GDP?
associated with longer life expectancy, lower maternal mortality, and a smaller proportion of low birth weight deliveries
how are higher degrees of inequality excused in a global era?
inevitable or inescapable due the `realities’ of international competition.
why is inequality seen as helpful to aid a productive economy?
a key motivational factor
what are 3 ways in which neo-liberal policies have changed politics?
an increased focus on means testing regarding various income support measures,
on reducing entitlements,
or on undermining the power of labor unions
how can discrepancies be seen between inequality in neo-liberal economies?
most social democratic' or even corporate’ welfare state regimes, such as the Scandinavian countries have been much less unequal than more neo-liberal regimes such as the United States, Britain, and the former British colonies
how can Coburn’s ideas be criticised? (3)
- prosperity rather than lowered inequality which is most highly related to improved health status
- No alternative to neo-liberal policies
- Under neo-liberalism, the welfare state has just changed not disappeared
how can the idea that it is prosperity rather than lowered inequality which is most highly related to improved health status be considered?
Definitely true up to GNP/per capita of $5000, afterwards there is no real relationship
why do some people argue that there is no alternative to neo-liberal policies?
Simply outcomes of increased global competition over which no single nation or political regime had much control
how can the idea that there is no alternative to neo-liberal policies be criticised?
by considering the differences in economic policy and in income inequality and health that exist amongst the developed nations, and, even amongst particular areas within nations
why do some people argue that now under neo-liberalism, the welfare state has just changed not disappeared?
Some authors contend that we now have, not a directly involved state but, `the regulative state’(Ruggie)
how can the idea that the welfare state has just changed not disappeared under neo-liberalism?
it is clear that entitlements under neo-liberalism have been reduced
why has there been a decline in working class power? (3)
by the domination of neo-liberal ideology and policies
by attacks on the welfare state, and by a dominance of employer interests in the market
