Health Inequalities Flashcards
outline health inequality in terms of life expectancy
huge inequality across england - a boy born in Blackpool can expect to live until 74 whereas a boy born in westminster can live to almost 85
outline health inequality in terms of disability free life
people living in wealthiest areas have almost twice as many years of disability free life ahead of them at 65 as those in poorest
how is health inequality defined
systematic variations in health outcomes experienced by different groups of people within the population
how are inequalities typically grouped in the UK
- socioeconomic factors e.g income, occupational level, education, area-based deprivation
- specific personal characteristics - age, sex, ethnicity
- geography - rural vs urban
what is INEQUITY?
those inequalities which are unnecessary and avoidable - potentially modifiable and can be considered unfair and unjust.
how do we study health inequalities in epidemiology
need to think about what drives the inequalities we want to study and how to measure these drivers in datasets and whether this is adequate
how do we measure socioeconomic position?
using individual level indicators
childhood - parents education, occupation and income
young adulthood- education
active professional life - first employment, income, household conditions, partners SEP
retirement - household income, wealth, household conditions and assets for transfer across generations
what are area based indicators
used in absence of individual data
e.g IMD (index of multiple deprivation)
each area is given a composite score based on a range of demographic factors
other measurements include - Jarman, Carstairs
what is the IMD
index of multiple deprivation part of indices of deprivation IoD
official measure of relative deprivation in england
follows framework - people may live in poverty if they lack financial resources to meet needs, and deprived if they lack any kind of resources
what are the 7 domains of the IMD
income
employment
education
health
crime
barriers to housing and services
living environment
summed to create an overall score
how can hte IoD be used
compare small areas across england, identify most deprived small areas, explore domains of deprivation, look at changes in relative deprivation between iterations
what are some limitations of using area-based measures of SEP to study health inequalities
they are ecological measures
where we reside is only one component of ‘place-based’ exposure
often not accompanied by good quality data on confounders
health is one of domains of IMD so risk of ‘endogeneity bias’
in diverse areas like London suburbs area may be particularly poor indicator of aspects of SEP relevant to health risk
what type of factor is socioeconomic position
distal factor that acts across life via many different proximal factors on complex pathways to influence health outcomes
why is mapping out SEPs in a life course framework helpful
see if effects are cumulative, if there are any sensitive periods,
do people who experience changes in SEP have similar or different risk to those who stay the same?
what factors lie on the causal pathway?
what factors may lie on the causal pathway?
behavioural risk factors
environmental risk factors - air pollution, occupation
reproductive characteristics
infection risk
patterns of health seeking behaviour
health literacy
