exam 2014

Question 1

What is the relationship between SES and health?

Answer 1

SES is proportional to your health outcomes
linear relationship.
lower SES generally means poorer health outcomes.
-there is an inverse relationship

Question 2

What are two different ways to judge the fairness of a health ‘inequality’ when trying to determine whether it is an inequity?

Answer 2

Contemporary principles Respect for Autonomy- some people in society have an unfair inability to make informed decisions (e.g. Lower SES citizens, have lower education (making decisions)
Justice: is there a systemic disadvantage for a different group?
Beneficence or Maleficence: some groups have greater health benefits
Marmot approach

Question 3

What are the 4x contemporary principles?

Answer 3

Use contemporary principles of health ethics to judge inequalities. 
Justice
non maleficence
beneficence
respect for autonomy

Question 4

What is the Marmot approach?

Answer 4

inequality becomes an inequity when the disparity can be reduced by a reasonable means.
-don’t have to undergo huge structural and societal changes in order to reduce

Question 5

Why is youth depression an equity issue in NZ?

Answer 5

LGBT, Transgender/Rainbow youth, Maori, Youth in Alternative education have higher rates
-effected by depression more compared to other groups (NZ Pakeha)
higher risk of suicide(attempts) and bullying
No biological link
Unfair discrimination of health resources
Unfair distribution of burden of depression (which can be treated if treatments are readily available)
Systematic disadvantage

Question 6

What is Socioeconomic status?

Answer 6

A complex mix of social and economic circumstances of an individual or group of individuals
The position one holds in society based on things such as occupation, income, years of education

Question 7

What is the definition of Generation. What is an inequality that could be related to a generational difference and not a chronological difference?

Answer 7

Generation: people born around the same time/date range + with shared experiences of the world
Post Traumatic Stress Disorder from people in WWII
Generation I Internet generation more likely to be obese due to society change to sedentary lifestyle and poor diet

Question 8

What structural resource issues help us to understand the high rate of youth motor vehicle injuries and deaths in New Zealand?

Answer 8

Non-physical structural - young driving age. complicated traffic rules (increases risk)
Physical structural - poorly designed roads, lack of speed bumps (all encourages reckless driving)

Question 9

What are 2x non sex-specific health conditions more common in males and 2x sex-specific health conditions occurring primarily in females.

Answer 9

Males Non-sex specific: Heart disease, Cancer, Emphysema, Kidney Disease

Question 10

Why is ‘race’ is a socially constructed concept?

Answer 10

No genetic basis
based on skin colour, face shape, hair colour
cannot be objective measured anymore than ethnicity

Question 11

Describe the study, ‘On Being Sane in Insane Places’.

Answer 11

8 people put into mental hospitals
all bar 1 diagnosed with schizophrenia
all released “on remission” (still with the condition)
Diagnosis on mental health were subjective

Question 12

What are 5x options for dealing with the two types of scarcity discussed in class?

Answer 12

two types of scarcity - unavoidable scarcity and economic scarcity

1. Unavoidable scarcity: resource is finite, unable to redistribute (organ donors)
   a. capacity to benefit i.e. resources are given to those who would benefit most from them
   b. equal chances: everyone has equal chance at accessing health resources
2. Economic scarcity:
   a. market solution: giving all resources with free will of how they are delegated and used
   b. equal distribution - giving every individual the same amount of resource
   c. distributing the resources to reduce health inequities (fairer but probably unequal distribution)

Question 13

How do the material/structural and cultural/behavioural explanations help us to understand the outbreaks of measles recently in developed countries?

Answer 13

Material/structural - Low income= no vaccination due to access issues
-poor educational resources re value of immunisation
-poorly co-ordinated vaccination programmes
-indirect cost (e.g. transport, missed income)
Cultural/Behavioural- PI like to live together (overcrowding).
-Not culturally appropriate healthcare
-anti-vaccinations
-both parents working therefore reluctant to keep child home when sick

Question 14

Why is socioeconomic status often put forward as the primary cause of health inequalities and why is this problematic when trying to come up with solutions?

Answer 14

1. Easy to measure i.e.: income based SES. (don’t have to pull it apart) how not helpful as it doesn’t take into account the different sub-groups within (e.g. Asian and Pacifica)- need to focus on sub group to identify the cause
2. SES has a linear relationship to health outcome (social gradient) and is largely prevalent and seen amongst countries, between countries, within ethnic groups and between ethnicities.
   But 30-50% consistent evidence that there is JUST a relationship with SES and health inequalities (ethnic disparities), but 50-70% evidence that these health inequalities are SES isn’t not the soul factor of disparities
3. a. Disparities gap (higher amount of Maori in High deprivation, Low SES. b. Outcome gap (has more of an impact than it does for Pakeha). c. Gradient Gap (steeper)
4. SES may be a major component to health disparities, however not the majority. There are other factors such as material/structural resources, culture/behaviour, social selection and even historical context that contribute to health disparities between different groups, so this may be problematic to come up with solutions because there are many things we could change

Question 15

What are the 3x gaps which illustrate that health inequalities are affected by more than just SES?

Answer 15

a. Disparities gap (higher amount of Maori in High deprivation, Low SES.
b. Outcome gap (has more of an impact than it does for Pakeha).
c. Gradient Gap (steeper)

Question 16

How do the medical and social models of disability differ in the way they view the relationship between disability and impairment?

Answer 16

Medical:
Individual is the problem
Disability results in an = Impairment = loss of function
Dependant (on society)
Needs to be cured and cared for
must ADAPT to society in order to function
(doesn’t change society to be a more accessible environment) the individual must change to accommodate society
–
Social:
Impairment =Loss of function
Disability is caused by society not being constructed in a way that accommodates for a person’s disability
Understands the impact society has on someone’s ability to function
Physical, Organisational and attitudinal barrier to living a normal life
Fixing society> curing the individual
Society disables people through its beliefs and structures in place

Question 17

In relation to disabled people, discuss the benefits of the ‘functional diversity’ perspective, compared to the social model perspective?

Answer 17

Functional diversity is the idea that people have different levels of function and refers to the change in functionality that we experience in our life course. (function will change over people’s lives)
Lifespan of gaining and losing function as our function changes throughout our life, e.g. breaking limbs, illnesses.
It causes us to challenge the idea that loss of function is a bad thing.
It causes us to realise that a loss of function is not the end of our life and to be more accepting of ‘disabled’ people
A perspective change from being labelled to being either “common” or “unique”.
Benefit’s disabled people as it makes the differences that they have a normative part of society.
The normative way: that some people have function and some people don’t.
‘Disabled’ people whose loss of function may not be any more of an impairment than someone else’s, it is just more easily seen.
Social model still classes people as ‘disabled’ in society. Focuses on how to make them less impaired in society rather than a part of society.
Social model’s labelling doesn’t promote much self-efficacy/constantly labelled

Question 18

What are some key aspects of discrimination people with mental health issues face AND give ONE example of how we might reduce this problem?

Answer 18

Stigma:
common misconceptions held
e.g. that people with mental health problems are violent and unpredictable, resulting in people being judged straight away.
Not being able to perform well or hold a job well –> unemployment rates
Way of reducing these misconceptions. Programme “Low down”’. Sir John Kerwin, recognisable for rugby, become face of the campaign
His fame/status meant everyone recognised him and him willingly saying he had depression, expressing his troubles and active increasing awareness of the Low down mental health programme Reduced the stigma

Question 19

What is the social capital and how does it relate to health inequalities?

Answer 19

degree of social cohesion within communities
can be both positive or negative
Increased social cohesion within populations enhances population health (generally higher levels of social capital are more beneficial (e.g. if you get sick a greater social capital can take the stress away)
A diverse social network is negatively correlated with getting a cold.
Negative - social capital with everyone having negative health behaviours/risk tasking
# people that cant be trusted in your life is positively correlated with poor health. Social capital can have negative effects too e.g. gangs and the KKK who do harm to others.

Question 20

Why it is difficult to establish the proportion of a health inequality due to biological versus social causes? And how many of the social causes are due to the different explanatory factors?

Answer 20

There is a tendency for research to use either biological or social explanations but not both.
Different social factors are more or less important for different health issues in different age groups.
Relevance for both biological and social causes may change overtime.
Social causes can have a much bigger impact than biological causes.
However biological still needs to be taken into account
-all 4x factors are so interconnected,
e.g. disparity in material resources (e.g. relative poverty) are created in part by dubious structural resources (e.g legislation/policy). in turn molded from historical contexts (e.g colonization or apartheid).
Attributing proportionality to factors that are so convoluted is near impossible.
Recent changes in structural resourcing fail to address social selection (e.g institutionalized racism) that still exists as a result of all these factors.
-child health issues (anti immunisation)
-youth health issues (high rates of motor vehicle accidents in males),
-adult health issues (mental health)
-older people health issues (falls and unintentional injuries)

Question 21

What are 3x myths of globalisation?

Answer 21

1. Globalisation is new. Isnt. Product movement and transport has always been occurring. Throughout history people have moved and traded. people have migrate and traded globally over time
2. It is inevitable. We are able to change and manage it. But would do more harm (than good) to stop it.
3. Globalisation is a leveller. Economic benefits do not filter down to the people who most need it. doesn’t level instead disadvantages lower and middle income countries. China opened its boarders and the “rich get richer”
   Economic independacy vs dependancy on international business/trade
   -when you are at a position of benefiting you do not see the downfalls to global development

Question 22

Why are the cultural/behavioural explanation for ethnic inequalities often criticised as being a victim blaming explanation?

Answer 22

Often seen as victim blaming because behaviours are seen as choices (e.g. choose to eat negative food)
However those behaviours are ingrained in certain cultures
Therefore these are not choices as such, but more a CULTURAL NORM,- therefore offensive if they do not take part
-doesn’t take into account of why groups carry out behaviour, rather instead just points out that they have said unhealthy behaviour
For example it would be easy to say that a group has bad health outcomes due to unhealthy smoking habits, and to not ask why that group smokes.
-Therefore it is important to understand that most cultural norms are a construct of society and that those people are not “wired” that way. Thus it should not be viewed independently but alongside the other explanations eg Historical context.

Question 23

What is the impact of both absolute and relative poverty on health inequalities?

Answer 23

absolute poverty:
basic needs, foods, shelter
Relative poverty:
people in your society who can’t live in a socially acceptable way

Question 24

Use the explanatory model presented in lecture to explain the differences in obesity rates and obesity related conditions between different ethnic groups?

Answer 24

Ethnicity: a group of people you belong to, shared ancestry, social customs, traditions and languages that forge part of your identity
Obesity rates are higher in Maori and PI ethnic groups
Material and structural: over represented in Low SES - less access to healthy food, gyms, poor health literacy, no parks
Culture and Behaviour: eat at a mare, fundamental. high fat diet. Harder to change.
Social selection: culturally inappropriate doctors, discrimination, social stigma around being lazy workers
Historical: Colonisation, migration. Conflict. Natural disasters.
-migration into area of bad food, sedentary lifestyle, loss of income, low SES

Question 25

What is experiential diversity inc comparison to functional diversity?

Answer 25

Experiential diversity= the differences accumulated through different experiences
Functional diversity= the differing levels of function between people and the dynamic range of functions (we have or don’t have) throughout our lifespan.

Question 26

What is an example of justice?

Answer 26

unfair distribution of resources

applying laws that protect some groups more than others

Question 27

What is an example of beneficence and non-maleficence?

Answer 27

some groups getting more health benefits from something

unfair exposure to things which can harm their health

Question 28

What is an example of respect for autonomy?

Answer 28

unfair ability to make informed decisions