Health Care Inequalitues

Question 1

Possible reasons behind health and deprivation association

Answer 1

Artefact: not genuine but exist due to the way health and deprivation is measured
Social selection: health determine socioeconomic status rather than the other way around
Behavioural: people in deprived areas are more likely to smoke, eat poor diets and not take exercise
Psychosocial: the stress of working in poorly paid, low status jobs with little autonomy creates harmful biological effects
Material: the direct effects of poverty - poorer access to healthcare

Question 2

Aspects of healthcare use

Answer 2

Recognising health need
Seeking and assessing advice (formal and informal) 
Diagnosis, treatment and support 
Screening 
Health promotion

Question 3

Determinants of accessing care - whether to present

Answer 3

Symptoms every 3-6 days but rarely present
Only If interferes with daily activities
Time on it - recovery time not achieved seek help
Informal advice from lay person
Self treatment

Question 4

Ice burg of formal health care

Answer 4

Under the ice burg are the healthy and those not seeking help
Above the iceburg are those awaiting care and receiving care

Question 5

Factors that affect whether someone seeks help

Answer 5

Person- sex, age, ethnicity, previous health experience 
Nature and duration of symptoms 
Accessibility of formal health care 
-cost 
- convenience 
- attitude of staff

Question 6

Access to healthcare:

Answer 6

Travel distance to facilities and transport
Communication services - immigrants
Waiting times
Availability - IVF clinicians vary in their prescribing
Quality of providers - Staffordshire hospital
Charges - non U.K. Environment

Question 7

Need

Answer 7

Ability to benefit

Question 8

Need and demand can both increase

Answer 8

Increasing demand does not necessarily mean increasing need

Question 9

Types of need - felt need

Answer 9

Subjective experiences

Question 10

Expressed need

Answer 10

Demand

Question 11

Normative need

Answer 11

Professional judgement of an individuals health state

Question 12

Comparative need

Answer 12

Relative need usually at a population level

Question 13

Ill health from ill health

Answer 13

Iatrogenic SE of medication

Psychiatric conditions more likely to smoke and drink

Question 14

The inverse care law

Answer 14

The availability of good medical care tend to vary inversely with the need for it

Question 15

Define equity

Answer 15

Fairness it recognises people have different needs and tries to minimise the difference between the care of people with similar needs
Means tested services

Question 16

Define equality

Answer 16

Uniformly everyone gets the same regardless of need and ability to benefit

Question 17

How to reduce inequality and inequity

Answer 17

Reviews
Guidelines -NICE
Targets and payments - pay for performance scheme QoF
Frameworks -national service framework- quality requirements for care
Regulators

Question 18

Explanations for lower survival in people living in more deprived areas

Answer 18

Differences in diagnosis- delayed so they are at the more advanced stages of the disease
Treatment - delays, poorer access to optimal care and lower compliance
General health - worse in the deprived
Type of disease - histologically more aggressive

Question 19

Progressive universalism in the NHS

Answer 19

Universal service but with different levels of intensity depending on need

Question 20

Stereotypes vs generalisation

Answer 20

Difference is not in the content
But is in the usage of the info
Stereotypes is an ending point
Generalisations is the beginning point

Question 21

Values

Answer 21

What we hold as important - exist at an individual and cultural level
Understanding values is key to understanding behaviour
Value system examples
Independence and autonomy
Privacy
Health and fitness
Physical appearance
Values can cause conflict and misunderstandings in health care

Question 22

World view

Answer 22

People’s assumptions about the nature of reality

Interpret things in a manner that is consistent with their beliefs

Question 23

Emic

Answer 23

World views are the starting point bottom up

Question 24

Etic

Answer 24

Top down from the perspective of an outsider

Question 25

Ethnocentrism

Answer 25

Judging someone's own culture based on the views of your own. Most humans are ethnocentric Western healthcare mainly ethnocentric

Question 26

Cultural relativism

Answer 26

Principle that all cultures are true in their own right, have to judge according to the views of their own culture

Question 27

Time orientation:

Answer 27

Focus of a person regarding time is different in different cultures Whether last, present or future is focused on

Question 28

Past time orientation

Answer 28

Laid back view on time - focus on tradition and long term relationships

Question 29

Present time orientation

Answer 29

Now

Question 30

Future time orientation

Answer 30

Run their life by the clock time is perishable and they have a shorter perspective

Question 31

Hierarchical vs egalitarian cultures

Answer 31

Hierarchy vs equality | Class system

Question 32

Family of orientation vs family of procreation

Answer 32

Family you are born into vs family you make

Question 33

Models of disease

Answer 33

Medical, social, psychosocial

Question 34

Communication barriers

Answer 34

Idioms, terms of speech, names Difference in terms even in English speaking countries Negative test result is good but may be confused as a bad test result Pain - expression differs in different cultures

Question 35

Religion

Answer 35

Differences practices and symbols, spiritual beliefs and practices

Question 36

Cultural competence

Answer 36

Understanding your own culture and biases Sensitive to others cultures Appreciating differences Knowledge of the cultures of others Apply knowledge Being culturally competent is patient centred care

Question 37

Ask 4 cs

Answer 37

What do you call your problem What do you think caused your problems How do you cope with your condition What concerns do you have regarding your condition

Question 38

Define race

Answer 38

Characterised by physical appearance and is determined by genetic ancestry and is usually permanent

Question 39

Culture

Answer 39

Set of behaviours/attitudes of a group and S usually determined by upbringing and choice and is changeable

Question 40

Ethnicity

Answer 40

Is defined as a sense of belonging and is a group identity, is determined by social pressures and psychological need and is partially changeable

Question 41

Acculturation

Answer 41

Process a person goes through when they arrive in a new country and may have begun before they arrived. Acculturation refers to the process of taking on the cultures of the host country in which you arrive

Question 42

3 distinct acculturation processes

Answer 42

Assimilation: fully integrated into a new country - language and culture resemble new country Integration: person takes on cultural norms of the new country but also maintains their original culture and that if their parents Separation: where a person maintains their original culture and rejects the country to which they have emigrated Marginalisation: it is when a person rejects their original culture and the new culture Integration most beneficial

Question 43

4 major influencing health factors

Answer 43

Genetic factors: skin colour can determine vulnerability the certain skin disease- cancer Social factors : drinking, smoking, unhealthy food determines vulnerability to obesity and other conditions Environmental factors: climate cooler- stockier build, warmer climates - leaner, different climates interaction with different microbes Human discovery factors - farming, drug discovery

Question 44

Migrant health inequalities

Answer 44

Poorer housing | Poor paid work

Question 45

Many health inequality examples

Answer 45

CVD south Asians Infant mortality differences Mental health schizophrenia black people

Question 46

Higher mental health in migrants and the poor Theories Social causation theory

Answer 46

Poorer people are more vulnerable to adversity and stress thus in turn makes them more vulnerable to developing psychiatric illness

Question 47

Social selection theory

Answer 47

Postulated those who are mentally ill have impaired upwards social mobility and therefore drift into lower socioeconomic status and neighbourhood

Question 48

Social constructivism

Answer 48

Deviant behaviours have become pathologised Given labels creating stigma for those people Society highlights the deviant behaviours and categories them as a set of symptoms - they are then seen as 'other' and take on the 'sick' role in order to cope with their treatment

Question 49

Inequality in CVD

Answer 49

Geography, age, gender, socioeconomic status, ethnicity, religion, disability, sexual preference, Health inequalities arise due to inequalities in health care

Question 50

INTERHEART study

Answer 50

``` Study 52 countries, case study control of acute MI Found 9 factors account for 90% of risk for MI Smoking Fruit and legumes Exercise Alcohol Hypertension Diabetes Abdominal obesity Psychosocial factors Lipids ```

Question 51

British regional heart study

Answer 51

``` Prospective study wider outcomes diagnosed CVD Focused on 3 risk factors High bp Blood cholesterol Cigarette smoking Above 80% ```

Question 52

Interstroke

Answer 52

22 countries Hypertension, current smoker, waist hip ratio, diet, physical activity, diabetes, alcohol, psychosocial stress, depression, cardiac causes/apolioproteins

Question 53

Target fur health care interventions

Answer 53

High risk vs whole population | Population shift larger effect then just those at high Risk

Question 54

NICE PHG 25

Answer 54

Addresses population v individual level

Question 55

Cancer inequalities

Answer 55

Age inc cancer 75+ cancer not treated as much spuds to overall negative effects Childhood cancers are difficult to identify Sex - men diagnosed more more women live with cancer Ethnicity - awareness lower in BME groups Disability- screening lower Sexual preference- lesbians delay seeking help, gay men higher incidence of anal cancer Geography- inc tracel costs no public transport

Question 56

Barriers to consulting

Answer 56

Emotional Practical Service barrier