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HES > Health Care Inequalitues > Flashcards

Health Care Inequalitues Flashcards

1
Q

Possible reasons behind health and deprivation association

A

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

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2
Q

Aspects of healthcare use

A 
Recognising health need
Seeking and assessing advice (formal and informal) 
Diagnosis, treatment and support 
Screening 
Health promotion
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3
Q

Determinants of accessing care - whether to present

A

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

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4
Q

Ice burg of formal health care

A

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

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5
Q

Factors that affect whether someone seeks help

A 
Person- sex, age, ethnicity, previous health experience 
Nature and duration of symptoms 
Accessibility of formal health care 
-cost 
- convenience 
- attitude of staff
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6
Q

Access to healthcare:

A

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

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7
Q

Need

A

Ability to benefit

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8
Q

Need and demand can both increase

A

Increasing demand does not necessarily mean increasing need

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9
Q

Types of need - felt need

A

Subjective experiences

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10
Q

Expressed need

A

Demand

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11
Q

Normative need

A

Professional judgement of an individuals health state

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12
Q

Comparative need

A

Relative need usually at a population level

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13
Q

Ill health from ill health

A

Iatrogenic SE of medication

Psychiatric conditions more likely to smoke and drink

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14
Q

The inverse care law

A

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

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15
Q

Define equity

A

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

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16
Q

Define equality

A

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

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17
Q

How to reduce inequality and inequity

A

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

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18
Q

Explanations for lower survival in people living in more deprived areas

A

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

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19
Q

Progressive universalism in the NHS

A

Universal service but with different levels of intensity depending on need

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20
Q

Stereotypes vs generalisation

A

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

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21
Q

Values

A

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

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22
Q

World view

A

People’s assumptions about the nature of reality

Interpret things in a manner that is consistent with their beliefs

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23
Q

Emic

A

World views are the starting point bottom up

24
Q

Etic

A

Top down from the perspective of an outsider

25
Q

Ethnocentrism

A

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

26
Q

Cultural relativism

A

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

27
Q

Time orientation:

A

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

28
Q

Past time orientation

A

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

29
Q

Present time orientation

A

Now

30
Q

Future time orientation

A

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

31
Q

Hierarchical vs egalitarian cultures

A

Hierarchy vs equality

Class system

32
Q

Family of orientation vs family of procreation

A

Family you are born into vs family you make

33
Q

Models of disease

A

Medical, social, psychosocial

34
Q

Communication barriers

A

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

35
Q

Religion

A

Differences practices and symbols, spiritual beliefs and practices

36
Q

Cultural competence

A

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

37
Q

Ask 4 cs

A

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

38
Q

Define race

A

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

39
Q

Culture

A

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

40
Q

Ethnicity

A

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

41
Q

Acculturation

A

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

42
Q

3 distinct acculturation processes

A

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

43
Q

4 major influencing health factors

A

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

44
Q

Migrant health inequalities

A

Poorer housing

Poor paid work

45
Q

Many health inequality examples

A

CVD south Asians
Infant mortality differences
Mental health schizophrenia black people

46
Q

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

A

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

47
Q

Social selection theory

A

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

48
Q

Social constructivism

A

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

49
Q

Inequality in CVD

A

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

50
Q

INTERHEART study

A 
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
51
Q

British regional heart study

A 
Prospective study wider outcomes diagnosed CVD 
Focused on 3 risk factors
High bp
Blood cholesterol 
Cigarette smoking 
Above 80%
52
Q

Interstroke

A

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

53
Q

Target fur health care interventions

A

High risk vs whole population

Population shift larger effect then just those at high Risk

54
Q

NICE PHG 25

A

Addresses population v individual level

55
Q

Cancer inequalities

A

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

56
Q

Barriers to consulting

A

Emotional
Practical
Service barrier

HES (8 decks)

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