Health inequalities Flashcards
Name 3 responses to health inequalities
- The black report (1980)
- The Acheson Report (1998)
- Proportionate Universalism
What did the black report say? (1980)
The black report
a. Material (enviromental causes, might be mediated by behaviour)
b. Artefact (an apparent product of how the inequality is measured, Population information came from the decennial census while death and cause of death information came from death certificates. Furthermore, the report noted that the meaning of social class may have changed over time as some jobs disappear and others emerge.)
c. Cultural/behavioural (poorer people behave in unhealthy ways)
d. Selection (sick people sink socially and economically)
What was in the Acheson report (1998)
a. income equality should be reduced
b. families with children should been the highest priority
What is proportionate universalism?
a. focusing on the disadvantaged only will not help to reduce the inequality
b. action must be universal but with a scale and intensity proportional to the disadvantage
c. fair distribution of wealth is important
What are the theories of causation?
- Psychosocial
a. Stress results in inability to respond efficiently to body’s demands
b. this impacts bp, cortisol levels and on inflammatory and neuro-endocrine responses - Neo-material
a. more hierarchal societies are less willing to invest into the provision of public goods
b. poorer people have less material goods, quality of which is generally lower - Life-course
a. a combination of both psychosocial and neo-material explanations
b. critical periods - processes greater impact at certain points in life course (childhood)
c. accumulation - hazards and their impacts add up -hard work leads to injuries resulting in disabilities that may lead to more injuries
d. interactions and pathways - sexual abuse in childhood leads to poor partner choice in adulthood
What are the main domains of public health?
-Health protection (infectious disease, chemicals and poisons, pollution, radiation. emergency response)
• Improving services (clinical effectiveness, efficiency, service planning, equity)
• Health improvement (lifestyles, family & community, education, employment,
housing, surveillance and monitoring)
• Addressing the wider determinants of health (seeing the big picture - making sense
of data)
What are the different ethical levels?
Meta-ethics - exploring fundamental questions: right/wrong/defining the good life
• Ethical Theory - philosophical attempts to create ethical theories:
i virtue
ii categorical
iii imperative
iv utilitarianism
v 4 principles
• Applied Ethics - a recent emergence of ethical investigation in specific areas (environmental, medical, public health)
What are the main ethical arguments?
• Deductive (one general ethical theory -> all the medical problems)
• Inductive (settled medical cases -> generate theory or guides to medical practice)
• Considering what we believe in (General ethical theory -> institutions/feelings ->
medical problem)
• Ethical Analogies (removing a healthy limb of a BDD patient vs plastic breast
surgery)
What are some common ethical fallacies?
• Ad hominem - responding to arguments by attacking person’s character rather
than the content of their argument (Latin for: “to the man”)
• Authority claims - saying a claim is correct because authority has said so
• Begging the question - petitio principii - assuming the initial point of the argument
• Dissenters - identifying those who disagree does not itself prove the claim is not
valid
• Motherhoods - inserting a soft statement to disguise the disputable one: “All
humans are equal (so we shouldn’t stop PVS patient treatment)
• Confusing necessary & sufficient
• No true Scotsman - modifying the argument:
i “No Scotsman would do such thing.” ii “But this one did.”
iii “Well, no true Scotsman would.”
SOCIOLOGY
what are the structural determinants of illness
Structural determinants of illness: i social class ii material deprivation/poverty iii unemployment iv discrimination/ racism v gender and health
SOCIOLOGY
what is the biomedical model
Biomedical model
i Mind and body are treated separately
ii Body, like a machine, can be repaired
iii This privileges use of technological interventions
iv It neglects social and psychological dimensions of disease
When can confidentiality be compromised?
• Disclosure allowed if:
i required by law (notifiable disease*, regulatory bodies, ordered by a judge or police) (the 3 main, cholera, yellow fever, plague)
ii patient consent (can be overruled)
iii public interest (serious communicable disease, serious crime, research,
education)
What is the criteria for disclosure? -eg patient has the plague
• Criteria for disclosure: i anonymous if practicable ii patient's consent (overrule?) iii kept to a necessary minimum iv meets current law (data protection)
• After death: duty of confidentiality continues
Explain the meaning of health, illness and sick role behaviour
1) Health behaviour - aimed to prevent disease (eating healthily)
2) Illness behaviour - aimed to seek remedy (going to the doctor)
3) Sick role behaviour - aimed at getting well (compliance, resting)
Name five lifestyle factors that promote mortality
Five lifestyle factors promoting mortality: i smoking ii obesity iii sedentary life iv excess alcohol v poor diet
