Health Inequalities Flashcards
What is the inverse care law?
The availability of good medical care tends to vary inversely with the need of the population served.
Is there an association between deprivation and ill health?
Yes.
More deprived a person, the larger the proportion of their life will be spent in ill health and the more likely they will die at a younger age.
Describe the difference between inequality and inequity.
Inequality: things are different/not equal
Inequity: inequalities that are unfair and avoidable
(You can have inequality without inequity)
What are health inequalities?
Avoidable inequalities in health between groups of people within countries and between countries
State some of the social determinants of health
Social determinants of health are the circumstances in which people are born, grow up in, live in, work in and age in
State the 6 theories regarding why we see inequalities in health.
- Artefact
- Social selection
- Behavioural-cultural
- Materialist
- Psychosocial
- Income distribution
Describe the artefact theory regarding why we see inequalities in health.
State whether it is plausible or not.
Health inequalities are due to the way statistics are measured; concerns about quality of data and method of measurement.
LEAST PLAUSIBLE EXPLANATION- data actually leads to an underestimation of inequalities.
Describe the social-selection theory regarding why we see inequalities in health.
“Direction of causation is from health to social position”; idea that sick individuals move down social hierarchy, healthy individuals move up social hierarchy.
PLAUSIBLE.
Describe the behavioural-cultural theory regarding why we see inequalities in health.
State whether it is plausible or not.
Ill health is due to people’s choices/decisions, knowledge and goals.
PLAUSIBLE but with limitations such as: person may not have another choice, behaviour is consequence of social processes.
Describe the materialistic theory regarding why we see inequalities in health.
State whether it is plausible or not.
Inequalities in health arise from differential access to material resources. This includes: lack of choice in exposure to hazards, accumulation of factors throughout life.
MOST PLAUSIBLE but further research needed to prove precise routes.
Describe the psychosocial theory regarding why we see inequalities in health.
State whether it is plausible or not.
Idea that social circumstances can cause stress and therefore have an impact on psychological health.
Health is influenced more by differences in income as oppose to actual income. Some stressors are distributed on social gradient. Stress impact on health via different pathways.
PLAUSIBLE.
Describe the income distribution (Wilkinson) theory regarding why we see inequalities in health.
State whether it is plausible or not.
Idea that countries with greater income inequalities have greater health inequalities. The most egalitarian societies have the best health.
PLAUSIBLE.
Explain how the income distribution (Wilkinson) and psychosocial theory (for inequalities in health) can be associated together?
Large income inequalities -> increases social-evaluative threat -> increase stress -> decrease stress.
What is the aim of redistributive policies?
To reduce income inequalities in a society to improve social wellbeing and in turn improve health.
State the four theories, suggested by Whitehead, that can used to reduce health inequalities.
- Strengthening individuals
- Strengthening communities
- Improving living and working conditions
- Promoting healthy macro-policies
(Actions you take depend on what caused the inequality)
State five factors associated with inequalities in health.
- Ethnicity
- Gender
- Age
- Disability
- Homelessness
Out of males and females, which gender has highest rates for:
- Mortality
- Suicide
- Reported poor mental health
- Disability and long standing illness
- Higher life expectancy
Males have higher rate for: mortality, suicide
Females have higher rate for: reported poor mental health, disability & long standing illness, higher life expectancy
State some issues faced by patients who are homeless or vulnerably housed
- Risk to health
- Physical e.g. increased risk infection, malnutrition, hypothermia etc…
- Mental health
- GP: need an address to see a GP
- Medications (access, storage e.g. insulin needs a fridge)
*Vulnerably housed means they live in unsafe, unstable or unaffordable housing
Define poverty
Cannot afford the basic needs of life e.g. food, shelter, clothing etc…
State and describe two types of rationing
Explicit rationing- based on defined rules of entitlements. (The use of industrial procedures for the systemic allocation of resources within health care system) Implicit rationing- care is limited but neither decisions, nor the bases for those decisions, are clearly expressed. (Allocation of resources through individual clinical decisions without criteria for decisions being explicit)
State four issues with implicit rationing
- lead to inequities - open to abuse - decisions based on perceptions - doctors appear increasingly unwilling to do so
State five disadvantages of explicit rationing
- very complex - heterogeneity of patients and illness - patient and professional hostility - impact on clinical freedom - some evidence of patient distress
State four advantages of explicit rationing
- transparent/accountable - opportunity for debate - more clearly evidence based - more opportunities for equity in decision-making
Explain the difference between implicit & explicit bias
- Implicit: implied (i.e. not expressed directly but still understood)
- Explicit: stated directly and fully (often no room for misunderstanding/misinterpretation)
