3. Inequalities in Health

Question 1

What is a social class?

Answer 1

A segment of the population distinguished from others by similarities in labour market position and property relations.

Question 2

How is socioeconomic status measured/classified?

Answer 2

Individual - registrate general scheme, national statistic socio-economic classification.
Area-based - Townsend deprivations core.
Education - years/level reached.
Incomes - household.

Question 3

What is the Townsend deprivation score?

Answer 3

Data from census that considers four variables: unemployment, car ownership, overcrowded housing, housing tenure.

Question 4

What are the limitations of the Townsend deprivation score?

Answer 4

Heterogeneity and transient populations.

Question 5

How does socioeconomic status affect health?

Answer 5

Less deprived populations have higher life expectancy and higher disability-free life expectancies. Age standardised mortality rates are higher in lower socioeconomic groups.

Question 6

What is ethnicity?

Answer 6

The identification with a social group on the basis of shared values, beliefs, customs, traditions, language, and lifestyles.

Question 7

How does ethnicity affect cardiovascular disease?

Answer 7

Highest prevalence in men of South African origin.

Question 8

How is cancer affected by ethnicity?

Answer 8

Lower prevalence in Black Minority Ethnic (BME) groups.

Question 9

How is infant mortality affected by ethnicity?

Answer 9

Higher rates in women of Pakistani and Black Caribbean origin.

Question 10

How is mental health affected by ethnicity?

Answer 10

People from BME are less likely to be diagnosed with mental illness but highest reported poor mental health is in women of Pakistani and Black Caribbean origin.

Question 11

What are the differences in health according to gender?

Answer 11

Males have higher mortality rates and more suicide and violent deaths.
Women have higher life expectancy but higher reported mental health and rates of disability.

Question 12

What is the Black Report?

Answer 12

Report from department of health in 1980 that gave four theories for why health inequalities occur.

Question 13

What are the four theories from the Black Report?

Answer 13

Artefact explanation, social selection explanation, behavioural-cultural explanation, and materialist explanation.

Question 14

What is the artefact explanation for inequality?

Answer 14

Health inequalities are evident due to the way statistics are collected. It is concerned with quality of data and method of measurement.

Question 15

Why is the artefact explanation for inequality generally discredited?

Answer 15

More likely data collection leads to under-estimation of inequality rather than over-estimation.

Question 16

What is the social selection explanation for inequality?

Answer 16

Causation is from health to social position so sick individuals move down social hierarchy and healthy individuals move up hierarchy.

Question 17

What is the general view about the social selection explanation for inequality?

Answer 17

It is only a minor contribution to inequality but is plausible.

Question 18

What is the behavioural-cultural explanation for inequality?

Answer 18

Ill health is due to people’s choices/decisions, knowledge, and goals. So people from disadvantages backgrounds tend to engage in health-damaging behaviours and vice versa.

Question 19

What are the limitations with the behavioural-cultural explanation for inequality?

Answer 19

Behaviours are outcomes of social process, not just individual choice; choice is difficult to exercise in adverse conditions; choices may be ration if life is constrained by lack of resources.

Question 20

What is the materialistic explanation for inequality?

Answer 20

Inequalities in health arise from differential access to material resources, lack of choice in exposure to hazards, and accumulation of factors across life-course.

Question 21

What are the limitations of the materialistic explanation for inequality?

Answer 21

Further research is needed for how this precisely happens.

Question 22

What was the conclusion of the Black Report?

Answer 22

The materialistic explanation was the most powerful although there is some merit in the other explanations.

Question 23

What is the psychosocial perspective towards health inequality?

Answer 23

Psychosocial pathways associated with disadvantage act in addition to direct effects of absolute material living standards.

Question 24

What is the effect of income distribution on health?

Answer 24

Relative income affects health. Countries with greater income inequalities have greater health inequalities. So social cohesion is important in health.

Question 25

What is inequality?

Answer 25

What things are different, not equal.

Question 26

What is inequity?

Answer 26

Inequalities that are unfair and avoidable.

Question 27

How does socioeconomic status seem to affect access to healthcare?

Answer 27

Lower groups have a tendency to manage health as a series of crises so use event-base consultations to legitimise consultation, there is a normalisation of ill health, difficulty marshalling resources for negotiation and engagement with health services, use more porous services.

Question 28

How does ethnicity impact access to healthcare?

Answer 28

Higher use of primary care in some groups, higher use of mental health consultations in South African Female elders, lower receipt of specialist services in some groups. But variations between and within ethnic groups so can’t simply classify.

Question 29

What could be some reasons for why ethnicity impacts access to healthcare?

Answer 29

Language and social networks deter seeking help, stigmatisation and stereotyping, can be linked with socioeconomic status.

Question 30

How does gender impact access to care?

Answer 30

Women have higher use of primary care, possibly due to cultural expectations of what is gender appropriate.