Health Inequalities Flashcards
what typically determines health inequalities
determined by socioeconomic circumstances and determinants
what is used to measure socioeconomic factors that impact health inequalities
measured in epidemiology mainly by education, income, occupational social class, and area-measures.
equalities domains (equality act 2010)
protected characteristics - Age - Disability - Gender reassignment - Marriage and civil partnership - Race - Religion or belief - Sex - Sexual orientation
inequalities primary definition
socioeconomic SES measures: - Education - Income - Occupational social class - Housing - Area-based measures
SES means
socioeconomic status
SES measures
- Education - Income - Occupational social class - Housing - Area-based measure
5 class groupings in Registrar General’s Social Class Groupings
I. Professional II. Managerial and Technical III. N Non-manual Skilled III. M Manual Skilled IV. Partly Skilled V. Unskilled then unemployed
Registrar General’s Social Class Examples I. Professional
accountants, engineers, doctors, dentists
Registrar General’s Social Class Examples II. Managerial and Technical
teachers, journalists, nurses, managers
Registrar General’s Social Class Examples III. N Non-manual skilled
clerks, shop assistants, cashiers
Registrar General’s Social Class Examples III. M Manual skilled
carpenters, van drivers, cooks
Registrar General’s Social Class Examples IV. Parly Skilled
security guards, machine tool operators, farm workers
Registrar General’s Social Class Examples V. Unskilled
building and civil engineering labourers, cleaners
difference of Great British Class Survey 2011 BBC
161,400 web respondents, as well as a nationally representative sample survey, inc unusually detailed questions asked on social, cultural and economic capita thus three dimension of Class UK – Economic, Social and Cultural
new classes as defined by Great British Class Survey 2011 BBC 7
elite established middle class technical middle class new affluent workers traditional working class emergent service workers premarital, or precarious proletariat
new classes as defined by Great British Class Survey 2011 BBC ELITE
the most privileged group in the UK, distinct from the other six classes through its wealth. This group has the highest levels of all three capitals
new classes as defined by Great British Class Survey 2011 BBC ESTABLISHED MIDDLE CLASS
the second wealthiest, scoring highly on all three capitals. The largest and most gregarious group, scoring second highest for cultural capital
new classes as defined by Great British Class Survey 2011 BBC TECHNICAL MIDDLE CLASS
a small, distinctive new class group which is prosperous but scores low for social and cultural capital. Distinguished by its social isolation and cultural apathy
new classes as defined by Great British Class Survey 2011 BBC NEW AFFLUENT WORKERS
a young class group which is socially and culturally active, with middling levels of economic capital
new classes as defined by Great British Class Survey 2011 BBC TRADITIONAL WORKING CLASS
scores low on all forms of capital, but is not completely deprived. Its members have reasonably high house values, explained by this group having the oldest average age at 66
new classes as defined by Great British Class Survey 2011 BBC EMERGENT SERVICE WORKERS
a new, young, urban group which is relatively poor but has high social and cultural capital
new classes as defined by Great British Class Survey 2011 BBC PREMARITAL, or PRECARIOUSL PROLETARIAT
the poorest, most deprived class, scoring low for social and cultural capital
areas - rich (affluent) or poor (deprived)? People or place?
People - social environment, culture, community, networks, Physical environment - services, safety, transport, parks/recreation, safety, air quality,
SIMD
Scottish Index of Multiple Deprivation (2020) area-based index (6976 data zones – neighbourhoods of 800 people) range of domains inc data from a range of sources inc eg census: - employment - Geographic access to services - Income - Crime - Health - Housing Education, skills, training Deciles (tenths) or Quintiles (fifths) - 1 is most deprived (poorest) - 5 or 10 is least deprived (richest)
SIMD divisions in
Deciles (tenths) or Quintiles (fifths) - 1 is most deprived (poorest) - 5 or 10 is least deprived (richest)
most extreme SIMD difference Glasgow
Drumchapel (28th poorest) vs Bearsden 60th (richest) – out of 6976
Global inequalities can be
between countries (high, middle, low income) or within countries Relates to income of country (GDP) or distribution of income in country
how can countries reduce inequality?
Sweden – high tax, levels down society – more contribution from higher paid Japan – has fairer pay – less discrepancy
health inequalities in (3)
Access and uptake to health services – inverse care law [Tudor-Hart] Health behaviours – smoking, diet, alcohol, exercise, etc Health and disease outcomes thus life-expectancy
scotland health inequalities dental decay
dental decay levels in children in Scotland have improved overall - good news! But inequalities between those children in our most deprived communities and those in the most affluent have not budged to the same degree - bad news - The problem of dental decay seems increasingly and stubbornly polarised to the poorest in society.
scotland health inequalities mouth cancer
mouth cancer rates, over the past 10 years, have increased up to nearly 700 cases per year. And we have also seen widening inequalities which began in early 1980s but continue to this date. Such that the risk associated with low socioeconomic position is double that of higher positions and this risk remains when you take into account smoking, alcohol, and diet behaviours.
scotland health inequalites alcohol related facial injuries
GDH found that the risk of being admitted to hospital with an alcohol-related facial injury was seven times greater if you lived in the most deprived areas compared to the most affluent. This is a scar across the face of Scotland is a physical scar yes, but also a social one
trend of health inequalities
more deprived = poorer health outcomes
good guide to oral health indicator
number of teeth fewer teeth in most deprived
NDIP is
national dental inspection programme
oral cancer in health inequality
Widening socioeconomic inequalities Males and females age-standardised incidence rate of oral and oro-pharyngeal cancer by Carstairs deprivation least and most deprived quintiles 1976-2002. - highest in most deprived males - more deprived of both sexes higher than less deprived As you know descriptive epidemiology only goes so far – hypothesis generating
measurement of inequality
Absolute measures (difference) Relative measures (ratio / gradient) Simple measures Complex measures