3 Inequalities & Inequities in Health

Question 1

What is SES? What is NS-SEC? How can we measure SES?

Answer 1

Socio-economic Status.
NS-SEC is the National statistics- socio-economic classification.
It is a score between 1-8.
1= Higher managerial/Professional –> 8= Never worked
LOWER SCORE= BETTER SES

Question 2

What is the trend between SES & Health?

Answer 2

Worse SES (higher NS-SEC score)= Greater % of the population in worse health.

WORSE SES= WORSE HEALTH - indicative of INEQUITY

Question 3

How can we measure DEPRIVATION?

Answer 3

Using the INDEX of MULTIPLE DEPRIVATION or IMD

Calculated from census data in 7 domains e.g. income, health and disability, education, living conditions and crime.

It is the lives of the people, not the area that is deprived.

Question 4

What is the trend in infant mortality and SES?

Answer 4

Lower SES = Increased infant mortality

Question 5

What is the trend between deprivation and ill health?

Answer 5

More deprived a person is, greater proportion of life spent in ill health and decreased life expectancy.

Question 6

What EXPLANATIONS are there for HEALTH INEQUITIES?

Answer 6

Black Report offers 4 explanations:

1. Artefact
2. Social Selection
3. Behavioural-Cultural
4. Materialist

There is also a PYSCHOSOCIAL and INCOME DISTRIBUTION explanation.

Question 7

How does the ARTEFACT EXPLANATION explain health inequities?

Answer 7

Health inequities are present due to the way statistics are collected - they are artefactual.

The thinking is the error is because of a numerator/denominator error for OCCUPATIONAL EXPOSURE. The numerator is based on occupational exposure during the period of the study and the denominator for the most recent census.

This explanation is largely discredited. If anything, the artefactual explanation is thought to underestimate the inequalities.

Question 8

How does the Social Selection explanation explain the inequalities in health?

Answer 8

States that the direction of causation is from HEALTH –> SOCIAL POSITION
Sick individuals move down the social hierarchy. Rather than the social hierarchy position making people unwell.
Chronically ill people are thus more likely to be disadvantaged.

Question 9

How does the behavioural-cultural explanation explain the inequities in health?

Answer 9

Ill health is because of people’s life choices and decisions.
People from disadvantaged backgrounds tend to engage in more health-damaging behaviours, while people from advantaged backgrounds tend to engage in health-promoting behaviours.

Limitations include the concept CHOICES may be more difficult to exercise for some than others. e.g. they may lack resources to make the best choice. Not so easy to blame the individual as suggested.

Question 10

How does the materialistic explanation explain health inequalities?

Answer 10

Inequalities arise from differing access to material resources e.g. income, employment, work environment, adequate housing conditions.

The individual does not have the choice in exposure to hazards and adverse conditions.

Factors can ACCUMULATE over the lifetime.

This is the MOST PLAUSIBLE EXPLANATION

Question 11

How does the psychosocial explanation explain health inequities?

Answer 11

Some STRESSORS are DISTRIBUTED ON A SOCIAL GRADIENT. e.g. negative life events, social support, autonomy at work, job security are all worse for the deprived –> increased stressors for them –> DIRECT (physiological, immune) and INDIRECT (health related behaviours, mental health) effects on their health.

Question 12

How does the income distribution explanation explain inequities?

Answer 12

Relative income affects health. Countries with greater income inequality have greater health inequality.

Increased income inequality –> increased social-evaluative threat –> increased stress –> decreased health

IT IS NOT THE RICHEST BUT MOST EGALITARIAN SOCIETIES THAT HAVE THE BEST HEALTH

Question 13

Which is the most likely inequalities explanation

Answer 13

MATERIALISTIC

Question 14

What is the relationship between ETHNICITY and Health?

Answer 14

Inequity in infant mortality. Higher in BME

Inequity in cancer incidence. Lower in BME - thought to be due to health-related behaviours

Inequity in CVS disease - South Asian Males most affected

Question 15

How can the relationship between ethnicity and health be explained

Answer 15

1. SES
   Some ethnicities are linked to lower SES.
2. ACCESS
   ACCESS is the other major factor. BME have worse access to healthcare- language barriers or CULTURAL NORMS reducing GP presentation.
3. HEALTH RELATED BEHAVIOUR
   Some health-related behaviours are linked with specific ethnicities.

Question 16

What is the difference between INEQUALITY and INEQUITY?

Answer 16

Inequality= when things are different - not equal

INEQUITY= inequalities that are unfair and avoidable (not accounted for by clinical need)

It is possible to have inequality WITHOUT inequity.

Question 17

How can ACCESS to healthcare be measured. How can we use this to determine inequity in access?

Answer 17

UTILISATION STUDIES
Measure the RECEIPT of services.
Doesn’t account for those who can’t access care.

Question 18

What patterns are there in access and deprivation

Answer 18

The deprived tend to access emergency services and GP services more.

They tend to underuse preventive services and specialist services.

Ill health is NORMALISED

The deprived tend to manage health as a series of crises, not a positive state of being.

Question 19

Summarise the MULTIDIMENSIONAL MODEL of the links between Ethnicity and health inequity.

Answer 19

Culture –> exclusion or reduced access to services

Genetic factors may increase risks of certain diseases

SES factors lead to exposures to risks and access to the wrong type of care

Question 20

What are the patterns between gender and health?

Answer 20

Males= higher mortality rates, more suicide and violent death

Females = Higher life expectancy, worse mental health, higher rates of disability and morbidity.

Question 21

Why do inequalities exist between the genders?

Answer 21

BIOLOGICAL FACTORS (hormones, reproductive differences)

GENDER + SOCIAL FACTORS
Social norms, social roles and discrimination