HaDSoc Week 3 Flashcards
How can we measure and compare the health of different groups (ethnic, gender, culture, socioeconomic) in England ?
Mortality and life expectancy Self report - surveys - e.g. Census Other - Patient records, admissions, hospital appointment records
What patterns exist when comparing the health of people living in different regions of England?
Different life expectancies across different regions of England Healthy life expectancy - much bigger gradient Related to economic standing of area e.g. Poor areas - healthy life expectancy 54 years, affluent ares - healthy life expectancy 70 years
How can we measure and compare the health of people in different socioeconomic positions?
Based on individual occupation - NS-SEC - calculated from census data - complex calculation Based on geographical residential area - Index of multiple deprivation - calculated from census data - small areas ranked to allow comparisons
What patterns exist between the health of people in different socioeconomic positions in the UK ?
% of population who self-identified as “not good health” increases with more manual/routine jobs Infant mortality increases with more manual/routine jobs Age of life expectancy and disease-free life expectancy increase, the less deprived the area
What can we conclude about inequalities in the UK?
In the UK, health inequalities are evident between and within regions - Deprivation is strongly associated with (ill) health: the more deprived a person is, the larger the proportion of their life will be spent in ill health, and the more likely they will die at a younger age.
What explanations did the Black report offer for inequalities in healthcare in the UK?
Artefact Social selection Behavioural-cultural Materialist
Describe the artefact explanation
Health inequalities are evident due to the way statistics are collected (re measurement of class) Concerns about quality of data and method of collection - numerator based on based on occupational distribution of those who die during the period considered – Denominator - occupational distribution at the most recent Census People could be self promoting their class in the census - Mostly discredited as an explanation - If anything, data problems lead to underestimation of inequalities - Whitehall studies
Describe the social selection explanation
Direction of causation is from health to social position Sick individuals move down social hierarchy, healthy individuals move up Chronically ill and disabled people are more likely to be disadvantaged Plausible explanation, but studies suggest that, at most, Soc-Selection makes only minor contribution to S-E differentials in health and mortality - Whitehall Because: Health related social mobility not possible in children And if Soc Selection was the case, the biggest differences would be seen in diseases that take longest time to kill but the difference is the same across all illnesses
Describe the Behavioural-cultural explanation
Ill health is due to people’s choices/decisions, knowledge and goals: People from disadvantaged backgrounds tend to engage in more health-damaging behaviours, while people from advantaged backgrounds tend to engage in more health-promoting behaviours Useful explanation - e.g. for health education Limitations: – Behaviours are outcomes of social processes, not simply individual choice – “Choices” may be difficult to exercise in adverse conditions e.g. Access to health food – “Choices” may be rational for those whose lives are constrained by their lack of resources - Not taking into account social context - victim blaming
Describe the materialist explanation
Inequalities in health arise from differential access to material resources – Low income; unemployment; work environments; low control over job; poor housing conditions - Lack of choice in exposure to hazards and adverse conditions - Accumulation of factors across life-course - Most plausible - Limitations: – Further research needed as to precise routes through which material deprivation causes ill-health
Describe the psychosocial explanation for inequalities in healthcare (Whitehall)
Psychosocial pathways act in addition to direct effects of absolute material living standards Data from Whitehall studies (e.g. Marmot 1991) security Social gradient of psychosocial factors Some stressors are distributed on a social gradient e.g. negative life events, social support (resource to cope), autonomy at work; job Stress impact on health via different pathways: – Direct (physiological, immune system) – Indirect (health related behaviours, mental health) – (Recall Health Psych. – biopsychosocial model)
Describe the income distribution explanation for inequalities in healthcare (Wilkinson)
Relative (not average) income affects health Countries with greater income inequalities have greater health inequalities It is not the richest, but the most egalitarian societies that have the best health Trend shown between income inequality and health and social inequality Why? – Associated with psychosocial explanation: Income inequality –> Social- evaluative threat (self-esteem, devalued) –> Stress–> Health Redistributive policies: reducing income inequality in a society can improve social well-being, and in turn many other health and social factors - e.g. more equal salaries before tax
How can we measure access to healthcare?
Utilisation studies measure receipt of service - cant measure how many people would like to access service but cant Evidence about utilisation is contradictory and difficult to interpret
What patterns exist between deprivation and access?
More deprived groups seem to have: – Higher rates of use of • GP services • Emergency services – Under-use of • Preventive services (e.g. screening, asthma, outpatients) • Specialist services (e.g. CABG and cancer treatments)
What are the theories behind the pattern between deprivation and access?
Tendency to manage health as a series of crises - lower preventative measures - as and when Normalisation of ill-health - see a lot of ill people Event-based consulting may be required to legitimise consultations - reluctance to take on ill identity - only when something visibly/clearly wrong with you Difficulty marshalling the resources needed for negotiation and engagement with health services - harder to find resources in deprived circumstances Tendency to use more “porous” services - easily accessible May reflect lack of cultural alignment between health services and lower SES Adjudications of technical and social eligibility by doctors affect referrals and offers - assumptions and stereotypes
What are the potential explanations for the patterns between ethnicity and health?
The patterns of health and ethnicity appear to be quite complex; many minority groups do worse on some indicators, but better on other indicators.
SES: Perceived health of people in some BME groups is hugely affected by their SES - these groups are more likely to be in SES disadvantage. Material deprivation is more common in some minority ethnic groups (e.g. many Pakistani and Bangladeshi groups)
but other BME groups are associated with less deprivation (e.g. many Chinese and Indian groups.)
Poorer reported health in these groups cannot be attributed only to SES disadvantage, i.e. there are other factors at work here too.
Access Patterns of access that are associated with cultural norms in the ways in which people in different BME groups access and receive services. One example is evidence of higher GP consultation rates by people from some South Asian groups and lower GP consultation rates by people from some Chinese groups; these rates may reflect different cultural norms in dealing with illness, for example use of Chinese herbalists.
Services may not be meeting the needs of people from certain groups and cultures, i.e. a lack of cultural alignment in service provision. Potential discrimination in service provision, diagnosis and treatment
Health related behaviour: Some health‐related behaviours do vary by ethnicity. However, there is significant heterogeneity in lifestyle within ethnic groups. Also, many minority groups do ‘better’ than the majority WB group in relation to key health risks (i.e. there are patterns of lower smoking rates, lower alcohol consumption and healthier diet in many minority ethnic groups)
People’s behaviours are heavily shaped by socioeconomic structural and contextual factors. Significance of particular behaviours for health varies depending on the health system’s response, i.e. behaviours that are regarded as more common in a minority group may be viewed as deviant and receive a less adequate response than those behaviours regarded as typical of the majority population. Some apparent differences in behavioural patterns may be due to the indirect effects of discrimination. It is important to avoid engaging in ‘victim blaming’ when considering associations between certain minority ethnic groups and health
