Health equality and the third sector

Question 1

What is sociology?

Answer 1

The study of the development, structure and functioning of human society

Question 2

The sociology of health and illness (Medical Sociology) applies which methods and theories of sociology to the health field?

Answer 2

Sociology studies peoples’ interactions with those engaged in medical occupations e.g. healthcare professional-patient relationships

Sociology studies the way people make sense of illness e.g. illness versus disease

Sociology studies the behaviour and interactions of health care professionals in their work setting e.g. professional values, interactions between health care professionals and other health care staff

Question 3

What characteristics do medical profession have opposed to other occupations?

Answer 3

Systematic theory

Authority recognised by its clientele

Broader community sanction

Code of ethics

Professional culture sustained by formal professional sanctions

Question 4

How can sociology be applied within the medical profession?

Answer 4

1) Sociology of the medical profession
2) Health promotion
3) The sick role
4) Social class
5) Ethnicity
6) Disparities of health
7) Housing
8) Education
9) Employment
10) Environment-Transport and health
11) Environment-Media and health

Question 5

Sociology and health promotion?

Answer 5

Promoting healthy behaviour and preventing ill health is only possible if we understand the ways different groups in society operate e.g. men and women, rich and poor, young and old

Sociology provides health promotion with an analysis of the different groups in society

Question 6

Sociology and the sick role-patient?

Answer 6

The sick role exempts ill people from their daily responsibilities

Patient is not responsible for being ill and is regarded as unable to get better without the help of a professional

Patient must seek help from a healthcare professional

Patient is under a social obligation to get better as soon as possible to be able to take up social responsibilities again

Some individuals may adopt the sick role to receive benefits but are not engaged with the responsibility of the sick role

Question 7

Sociology and the sick role-healthcare professional?

Answer 7

Professional must be objective and not judge patients morally

Professional must not act out of self-interest or greed but put patient’s interests first

He/she must obey a professional code of practice

Professional must have and maintain the necessary knowledge and skills to treat patients

Professional has the right to examine patient intimately, prescribe treatment and has wide autonomy in medical practice

Question 8

Sociology and social class, (National Statistics Socio-economic Classification (NS-SEC))?

Answer 8

1.1 Large employers and higher managerial and administrative occupations
Larger numbers of employees and who delegate some of their managerial and entrepreneurial role to salaried staff. Higher managerial role involves general planning and supervision of operations on behalf of employer. Service relationship with the employer

1.2 Higher professional occupations
Have a service relationship with their employer. Doctor, lawyer, scientist, clergy, teacher, OT, SALT, personnel officer, computer analyst, careers guide. This is regardless of whether employed, self employed or position of management

2 Lower managerial, administrative and professional occupations
Attenuated service relationship with employer – tend to act under positions above. e.g. sales managers, technicians, nurses, midwives, radiographers, welfare and community workers, ship’s officers and immigration officers

3 Intermediate occupations
Positions not involving general planning or supervisory powers, in clerical, sales, service and intermediate technical occupations civil service administrative officers and assistants, debt collectors, library assistants, secretaries, telephonists, medical technicians, dental nurses, flight attendants, driving instructors, data processing operators, routine laboratory testers, electrical engineers (not professional), installation and maintenance engineers.

4 Small employers and own account workers
Small employers who remain essentially in direct control of their enterprises e.g. restaurants, hairdressers, local retail outlets, builders, electricians. Also self employed tradesmen who do not employ others

5 Lower supervisory and technical occupations
Supervise others in same role e.g. foremen, reception supervisor
Opportunities for promotion, payment of a salary as opposed to a weekly or hourly wage, greater work autonomy e.g. electrical maintenance fitters, motor mechanics, cabinet makers, transport operatives

6 Semi-routine occupations
the work involved requires at least some element of employee discretion and contract typified by short term and direct exchange of money for effort. E.g. educational assistants, security guards, postal workers, hospital porters, cooks, hairdressers, builders, carpenters, dressmakers

7 Routine occupations
Even less opportunities for promotion, autonomy over work. These positions have the least need for employee discretion. E.g. Waiters and waitresses, bar staff, machinists, sorters, packers, railway station staff, road construction workers, building labourers, dockers, couriers, refuse collectors, car park attendants and cleaners

8 Never worked and long-term unemployed

Question 9

Why was the National Statistics Socio-economic Classification constructed?

Answer 9

The NS-SEC has been constructed to measure the employment relations and conditions of occupations. These are central to showing the structure of socio-economic positions in modern societies and helping to explain variations in social behaviour and other social phenomena

It has also been reasonably validated both as a measure and as a good predictor of health, educational and many other outcomes

Question 10

What does labour market situation equation to?

Answer 10

Labour market situation equates to source of income, economic security and prospects of economic advancement.

Question 11

What does work market situation equation to?

Answer 11

Work situation refers primarily to location in systems of authority and control at work, although degree of autonomy at work is a secondary aspect

Question 12

What are the social/socio-economic influences on our health?

Answer 12

Gender

Ethnicity

Physical environment / housing

Education

Employment

Income / social status / financial security

Health system

Social environment

Question 13

What are the social/socio-economic influences on our health - gender?

Answer 13

Men have a higher mortality at every age:

• Higher risk cardiovascular disease
• Up to the age of 75, stroke incidence and mortality rates are higher for males
• Suicide rates three time higher)
• One in ten of all hospital discharges for men was estimated to be attributable to alcohol compared to one in 20 for women. 432 female alcohol-related deaths compared to 815 male deaths
• Higher rates of drug misuse in men versus women, accounting for almost three quarters of drug related deaths 429 (men) versus 155 (women) deaths

Women have a higher morbidity (Higher rates (twice as many) of depression and anxiety)

Women consult more frequently in General Practice settings

Women are over twice as likely to receive Carer’s Allowance than males

Question 14

Ethnicity and health?

Answer 14

1) South Asians living in Scotland have substantially higher rates of heart attacks than the general population, but they also have higher survival rates.
2) Prevalence of type 2 diabetes is higher in South Asian populations
3) Admissions for each ethnic group relative to the White Scottish group were lower among White Polish and Chinese groups, with higher rates in some Asian groups, White British and White Other.
4) There is greater prevalence of sickle cell disease in African origin groups
5) Scottish data suggest that minority ethnic groups, with some exceptions such as Gypsy/Travellers, have better general health than the majority of the white population. These differences can vary by disease and ethnic group
6) Mortality in Scotland is higher in the majority ethnic (white) population than in the black and minority ethnic population

Question 15

Ethnicity and alcohol overview?

Answer 15

1) Most minority ethnic groups have higher rates of abstinence and lower levels of drinking compared to people from white backgrounds
2) Abstinence is high amongst South Asians, particularly those from Pakistani, Bangladeshi and Muslim backgrounds. But Pakistani and Muslim men who do drink do so more heavily than other non-white minority ethnic and religious groups
3) People from mixed ethnic backgrounds are less likely to abstain and more likely to drink heavily compared to other non-white minority ethnic groups
4) People from Indian, Chinese, Irish and Pakistani backgrounds on higher incomes tend to drink above recommended limits

Question 16

Ethnicity and alcohol potential emerging differences?

Answer 16

Frequent and heavy drinking has increased for Indian women and Chinese men

Drinking among Sikh girls has increased whilst second generation Sikh men drink less than first generation

Question 17

Ethnicity and alcohol higher risk of alcohol related harm by ethnic groups?

Answer 17

1) Irish, Scottish and Indian men (and Irish and Scottish women) have higher rates of alcohol related deaths than the national average in England and Wales
2) Sikh men have higher rates of liver cirrhosis
3) People from minority ethnic groups have similar levels of alcohol dependence compared to the general population, despite drinking less

Question 18

Ethnicity and alcohol, some hidden truths?

Answer 18

1) Minority ethnic groups are under-represented in seeking treatment and advice for drinking problems
2) Problem drinking may be hidden among women and young people from South Asian ethnic groups in which drinking is proscribed
3) Greater understanding of cultural issues is needed in developing mainstream and specialist alcohol services

Question 19

Dealing with disparities of health?

Answer 19

1) Identify the potential barriers to the use of health services:
- Patient level – language concerns, understanding the system, beliefs
- Provider level – understanding of the differences due to ethnicity, provider skills and attitudes
- System level – organisation of appointments and referrals

2) Culturally Competent Care:
- Combination of attitudes, skills and knowledge that allows an understanding and therefore better care of patients with a different backgrounds to our own.

3) Recognising when we are being culturally incompetent!

Question 20

Housing as a social factor?

Answer 20

1) 1 in 4 adolescents living in cold homes at risk of multiple mental health issues compared to 1 in 20 in warm homes
2) Children in cold homes are more than twice as likely to suffer from a variety of respiratory problems
3) Excess winter deaths are almost 3x higher in the coldest quarter than in warmest

Question 21

Education as a social factor?

Answer 21

Those with higher levels of education tend to be healthier than those of similar income who are less well educated e.g. better understanding of health, more effective engagement with health care services such as screening programmes, better engagement with health related advice and are better able to navigate health services

Also important to remember the effect that poor health can have on education.

Question 22

Employment as a social factor?

Answer 22

Provides income and financial security; this obviously varies and relates in part to the previous slide on social class. (Deprivation is a major determinant of health inequalities)

Provides social contacts

Provides status in society

Provides a purpose in life

Unemployment is associated with increased morbidity and premature mortality

Question 23

The WHO stance on financial restriction to health care?

Answer 23

The WHO argues that governments should protect people against financial risk in matters of health, whether the system is publically or privately financed

“And it should assure not only that the healthy subsidise the sick….., but also that the burden of financing is fairly shared by having the better-off subsidise the less well-off. This generally requires spending public funds in favour of the poor” (WHO 2000)

The WHO report judged each country’s health system against the most that it estimated could be achieved with its level of health service expenditure. It was possible for a relatively poor country to achieve a better result than a comparatively rich one

WHO summary – ‘Many countries need to use available funds more efficiently and raise more funds from domestic sources, but these measures would be insufficient to fill the current gap in the poorest countries. Only an increased and predictable flow of donor funding will allow them to meet basic health needs in the short to medium term.’

Question 24

Influence of health system: General Practice?

Answer 24

The distribution of GPs across Scotland does not reflect the levels of deprivation

There is evidence that services designed to improve whole population health e.g. eye checks, cancer screening, may widen health inequalities if uptake is lowest in those who would derive the greatest benefit

Access to other primary care services reflects higher levels of need in deprived areas. The effect of incentives (Paying dentist/doctors extra in deprived areas to increase the amount of healthcare professionals within these areas)

Question 25

Environment-Transport and health?

Answer 25

There can be adverse effects on health from the expansion of car use e.g. RTAs, pollution (often worse in deprived areas with poor urban planning)

Active travel such as cycling and walking have a number of health benefits e.g. improved mental health, reduced risk of premature death, prevention of chronic diseases such as coronary heart disease, stroke, type 2 diabetes, osteoporosis, depression, dementia and cancer. Walking and cycling are also effective ways of integrating, and increasing, levels of physical activity into everyday life for the majority of the population, yet there has been a lack of investment in walking and cycling infrastructure.

Combining public transport and active travel can help people achieve recommended daily activity levels. Public transport is the most sustainable for longer journeys, yet it can be more expensive and less convenient. In rural areas travel infrastructure and public transport may present challenges

Question 26

Environment-Media and health?

Answer 26

Shapes and stereotypes our views

Shapes our expectations

Consider the change in media attitude to mental health in recent years, aiming to reduce the previous stigma associated with mental illness

Question 27

WHO definition of Health Inequalities?

Answer 27

The WHO states that health inequalities can be defined as the differences in health status or in the distribution of health determinants between different population groups

Question 28

Health inequalities in Scotland overview?

Answer 28

The Scottish Government allocated around £170million (1.5% of overall NHS Scotland budget) to NHS boards to directly address health related issues associated with inequalities in 2011/12, and in its spending review of 2012/13 reiterated its commitment to addressing health inequalities. As yet it is not clear how NHS boards and councils allocate resources to target local areas with the greatest need

Overall health has improved over the past 50 years, average life expectancy and healthy life expectancy has increased, but average life expectancy is lower than any other part of UK for men and women. Women tend to live longer than men but have more years of living in poorer health. People living in rural areas tend to live longer than those in urban areas

Deprivation is the key determinant of health inequalities although age, gender and ethnicity are also factors

Deprivation in Scotland is concentrated in the west but health inequalities vary widely within local areas

Question 29

Health Inequalities in Aberdeen?

Answer 29

There are substantial variations in life expectancy estimates in different areas of Aberdeen City (based on Intermediate Zones).

• For males, life expectancy at birth ranges from a low of 68.2 years in Woodside to a high of 84.9 years in Braeside, Mannofield, Broomhill & Seafield – a difference of 16.7 years.
• For females it ranges from a low of 74.9 years in Woodside to a high of 87.0 years in Balgownie and Donmouth East – a difference of 12.1 years.

Question 30

Health Inequalities in Scotland-Audit Scotland, December 2012 key facts least deprived versus most deprived?

Answer 30

1) Life expectancy of women:
84. 2 vs 76.8

2) Life expectancy of men:
81. 0 vs 70.1

3) Alcohol related admission per 100,000:
214 vs 1621

4) Percentage adults smoke:
11% vs 40%

5) GP consultation foe anxiety per 1000 patients:
28 vs 62

6) Exclusive breast feeding rates:
40% vs 15%

7) Low birth weight:
13% vs 31%

8) Children who attend dentist:
81% vs 54%

9) Obesity:
18% vs 25%

10) Teenage pregnancy per 1000:
3 vs 14

Other facts:

• £11.7 billion total amount spent by the NHS in 2011/2012
• £170 million allocation to the NHS for schemes related to health inequalities

Question 31

The Scottish Burden of Disease Study 2016 Deprivation Report?

Answer 31

The disease burden in the most deprived areas in Scotland was more than double that found in the least deprived areas (14.1% v. 6.7%), and the burden increased with each level of deprivation

In deprived areas, early death contributed more burden than living with ill health (57.9% of burden due to early death)

In the least deprived areas people were more likely to live with ill health (45.4% of burden due to early death) but there were still fewer people living with, or dying early from, ill health in the least deprived areas than there were in the most deprived areas

The fatal burden rate was three times higher in the most deprived areas in Scotland compared with the least deprived area

The rate of burden increased with age

Increased levels of disability caused by different conditions within more deprived areas

Question 32

What are the leading causes of disease burden in Scotland?

Answer 32

The overall burden was greater in the most deprived areas compared with the least deprived areas,

1) Drug use disorders (17.0 times higher) - DALYS 8.1%
2) Alcohol dependence (8.4 times higher) - DALYS 3.9%
3) Chronic liver disease (7.2 times higher)- DALYS 3.7%
4) Chronic obstructive pulmonary disease (COPD) (6.2 times higher) - DALYS 4.7%
5) Lung cancer (4.3 times higher)- DALYS
6) Higher rates of self-hame and suicide

Question 33

10 diseases contributing to burden in the most deprived areas of Scotland?

Answer 33

1) Drug use disorders
2) Ischaemic heart disease
3) Depression
4) Lung cancer
5) COPD
6) Alcohol dependance
7) Low back and neck pain
8) Storke
9) Anxiety
10) Chronic liver disease

Question 34

10 diseases contributing to burden in the least deprived areas of Scotland?

Answer 34

1) Low back and neck pain
2) Sense organ disease** (Main difference with most deprived)
3) Ischaemic heart disease
4) Migraine
5) Depression
6) Alzheimer’s and other dementias
7) Stroke
8) Anxiety disorders
9) Lung cancer

10 ) Colorectal cancer

Question 35

Other burdens of most deprived?

Answer 35

Education

Homelessness / poor quality homes

Unemployment

Family breakdown

Anti social behaviour

Hopelessness

Multi-morbidity

Ambition / aspiration / opportunity

Question 36

Vulnerable groups-The Homeless?

Answer 36

Average age of death of longer-term homeless is 47 years for men and 43 years for women

Death by unnatural causes has been found to be four times more common than average amongst rough sleepers, and suicide 35 times more likely

Rough sleepers are more likely to be assaulted than the average person

Alcohol and drug problems are very high amongst rough sleepers, and people being resettled from the streets are more likely to face problems sustaining a tenancy if they have these problems

The prevalence of infectious diseases, such as tuberculosis, HIV and hepatitis C, is significantly higher than in the general populations

This population experiences poorer oral health than the general population.

Access to health care for this population is different to that of the general population: one third of rough sleepers are not registered with a GP; attendance at accident and emergency is at least eight times higher than the housed population.

Question 37

Vulnerable groups-Learning Disability?

Answer 37

People with a learning disability have worse physical and mental health than people without a learning disability. On average, the life expectancy of women with a learning disability is 18 years shorter than for women in the general population; and the life expectancy of men with a learning disability is 14 years shorter than for men in the general population (NHS Digital 2017).

Question 38

Barrier that stop people with a learning disability from getting good quality healthcare?

Answer 38

a lack of accessible transport links

patients not being identified as having a learning disability

staff having little understanding about learning disability

failure to recognise that a person with a learning disability is unwell

failure to make a correct diagnosis

anxiety or a lack of confidence for people with a learning disability

lack of joint working from different care providers

not enough involvement allowed from carers

inadequate aftercare or follow-up care

Question 39

Vulnerable groups-Refugees?

Answer 39

Family integrity and social adjustments trump medical issues for most arriving refugees

Competing demands of distinct services such as: social welfare, education, housing, transportation, public health, mental health, primary care, and specialty care encountered by refugees may overwhelm them and limited resources

Language barriers impede the adjustment process

Some refugees with urgent and complex medical conditions are unable to establish care and specialty referrals in a timely manner

Underdeveloped or eroding health care systems in the countries of origin or first asylum leave many refugees with poorly controlled or undiagnosed chronic medical conditions

Most refugees are unfamiliar with the biomedical practice of preventive medicine and primary health care

Public health’s infectious disease screening results are not communicated to those providing ongoing medical care

Exposure to violence, torture, warfare, and internment is common, even among children

Loss upon loss is the nature of refugee life and so depression, PTSD, and anxiety are prevalent and often unrecognised

Anti-immigrant sentiments further burden refugee life in the U.S.

Question 40

Vulnerable groups-Prisoners?

Answer 40

50% of prisoners surveyed stated that they were drunk at the time of their offence and 38% report that their drinking affected their relationship with their family. This is in contrast to 14% of men and 9% of women in the Scottish population saying they had an alcohol problem

76% of Scottish prisoners report being smokers compared to the national average of approximately 24%. However, 56% of those surveyed stated that they wished to give up

Prisoners surveyed reported ‘feeling interested in people’, ‘feeling loved’ and ‘feeling close to other people’ (57%, 43%, 56%) only ‘some of the time’ or ‘rarely’

44% of surveyed prisoners reported being under the influence of illicit drugs at the time of their offence and 39% reported that drug use was a problem for them on the outside

In general, prisoners, both before and on liberation from prison, live in the poorest areas of Scotland. Their health inequalities are further exacerbated by the even higher rates of premature death that ex-prisoners experience, related to violence, accidents, substance misuse and suicide. Those in and out of prison also experience poor continuity of health care.

Question 41

Vulnerable groups-LGBT

Answer 41

Studies have found higher rates of depression among gay men, lesbians, people who are bisexual or transgender than the general population. A study in Glasgow suggests that young LGBT people may be particularly vulnerable to depression and anxiety

In a Stonewall survey which reported on the experiences and concerns of more than 6,000 lesbian and bisexual women respondents reported that: one in five respondents had deliberately harmed themselves in the last year, compared to 0.4 per cent of the general population and half of respondents under the age of 20 had self-harmed, compared to one in fifteen of teenagers generally

In relation to the NHS half of the respondents reported that: they ‘are not out to their GP’, and of those who had attended a consultation with a partner, only 10% felt the partner had felt welcome

A 2008 Scottish survey of over 70 transgender people in Scotland noted particular issues with mental health services e.g. lack of understanding

In the First Out survey, 1 in 4 respondents had experienced ‘inappropriate advice or treatment due to sexual orientation or gender identity’ while 24% had experienced ‘homophobic staff’ in the NHS. Reluctance to disclose - due to a (real or perceived) fear that doing so may have unwanted repercussions - is an issue for too many LGBT people

Question 42

Vulnerable groups?

Answer 42

1) Homeless
2) Prisoners
3) LGBT
4) Refugees
5) Children’s

Question 43

Inverse Care Law?

Answer 43

In 1971, a GP Dr Julian Tudor Hart proposed the Inverse Care Law, published in the Lancet.

This described that those who most need medical care are least likely to receive it and conversely, those with least need of health care tend to use health services more, and more effectively

Question 44

Equally Well” Scottish Government 2008-Key Points?

Answer 44

Health inequalities remain a significant challenge in Scotland

The poorest in our society die earlier and have higher rates of disease, including mental illness

Healthy life expectancy needs to be increased across the board to achieve the Scottish Government’s overall purpose of sustainable economic growth

Tackling health inequalities requires action from national and local government and from other agencies including the NHS, schools, employers and Third Sector

Priority areas are children, particularly in the early years, “killer diseases” such as heart disease, mental health and the harm caused by drugs, alcohol and violence

Radical cross-cutting action is needed to address Scotland’s health gap to benefit its citizens, communities and the country as a whole

Question 45

What range of factors can reduce health inequalities?

Answer 45

Effective partnership across a range of sectors and organisations e.g. to promote health, improve patient education about health

Evaluate and refine integration of health and social care

Government policies and legislation e.g. smoking ban, Keep Well campaign

Time to invest in the more vulnerable patient groups

Improve access to health and social care services and professionals

Reduction in poverty

Social inclusion policies

Improved employment opportunities for all

Ensuring equal access to education in all areas

Improved housing in deprived areas

Question 46

Equally Well-Third Sector Contribution?

Answer 46

The Task Force (Ministerial taskforce on health inequalities) has noted that Third Sector organisations can be very effective in addressing the wider factors underlying health inequalities. Where Third Sector services demonstrate that they contribute to meeting local outcomes and priorities, they should be given the resources by their funders and commissioners to allow services to be maintained, developed and made more financially sustainable

Question 47

Voluntary Sector Organisations?

Answer 47

Provide a means of engaging effectively with communities and individuals

Deliver a range of services which may help to reduce health inequalities, including:
– Promoting healthy living to groups of people who may not use mainstream services
– Supporting people to access relevant services NHS Health Scotland

Question 48

The Benefits of Volunteering?

Answer 48

1) Gain confidence.
Volunteering can help you gain confidence by giving you the chance to try something new and build a real sense of achievement

2) Make a difference. Volunteering can have a real and valuable positive affect on people, communities and society in general

3) Meet people.
Volunteering can help you meet different kinds of people and make new friends

4) Be part of a community. Volunteering can help you feel part of something outside your friends and family

5) Learn new skills.
Volunteering can help you learn new skills, gain experience and sometimes even qualifications

6) Take on a challenge.
Through volunteering you can challenge yourself to try something different, achieve personal goals, practice using your skills and discover hidden talents

7) Have fun!
Most volunteers have a great time, regardless of why they do it.