Health Inequalities Flashcards
What are the different ways socio-economic status can be measured?
- Individual occupation
- The area in which people live.
What are the common ways to measure and compare health?
- Life expectancy
- Infant mortality
What is used to measure socioeconomic position when looking at an individuals occupation?
- National statistics socio-economic classification
(NS-SEC)
Pg 3 (look at the different classification on the table).
How do we measure deprivation based on geographical residential area?
- Index of multiple deprivation
- Calculated from census data, looking at 7 domains
e.g. income, employment, health and disability, educational skills and training, Barriers to housing and services, living environment and crime
What patterns can be seen when comparing the health of people in different socioeconomic positions?
- Health inequalities are evident between those from different socio-economic groups
- Deprivation is strongly associated with (ill) health
- The more deprived a person is, the larger the proportion of their life will be spent in ill health, and the more likely they will die at a younger age.
What are the different explanations, theories & pathways for health inequalities?
- Artefact (Black report).
- Social selection (Black report)
- Behavioural-cultural (Black report)
- Materialist (Black report)
- Psychosocial
- Income distribution
What is the Artefact explanation (Black report)?
Health inequalities are evident due to the way statistics are collected.
- Concerns about the quality of data and method of measurement.
- Mostly discredited as an explanation
- If anything, data problems lead to underestimation of inequalities
What is the social selection explanation?
Direction of causation Is from health status to social position.
- Sick individuals move down the social hierarchy, healthy individuals move up.
- Chronically Ill and disabled people are more likely to be disadvantaged
- Plausible explanation, but studies suggest that social selection makes only a minor contribution
What is the Behavioural-cultural explanation (Black report)?
Ill is due to people’s choices/decisions, knowledge and goals - people from disadvantages backgrounds tend to engage in more health-damaging behaviours, whilst people from advantages backgrounds tend to engage in more health-promoting behaviours.
- Useful explanation - for health education
What are the limitations of the Behavioural-cultural explanation?
- Behaviour are outcomes of social processes, not simply individuals choice.
- Choices may be difficult to exercise in adverse conditions
- Choices may be rational for those whose lives are constrained by their lack of resources (?)
What is the materialist explanation ?
Inequalities in health arise from differential access to material resources
- e.g. low income, unemployment, work environment, low control over job, poor housing
- Lack of choice in exposure to hazards and adverse conditions
- Accumulation of factors across life- course
- Most plausible explanation out of the 4
What is the limitation of the materialist explanation?
- Further research is needed on the precise routes through which material deprivation causes ill health.
What is the psychosocial explanation?
- Psychological pathways act in addition to the direct effects of absolute material living standard.
- Social gradient
- Some stressors are distributed on a social gradient e.g. negative life events, social support and job security.
- Stress impacts on health via different pathways
1. Direct (physiological, immune system)
2. Indirect (health related behaviours, mental health)
What is the income distribution (Wilkinson) explanation?
- Relative (not average) income affects health
- Countries with greater income inequalities have greater health inequalities
- It is the must equal (egalitarian) societies that have the best health
What explanation can the income distribution explanation be used in association with?
- The larger the income gaps within a country, the worse the country performs on these health and social problems.
- This is because of the association with psychosocial explanation
- Increased income inequality leads to increased social-evaluative threat leading to increase stress and decreased health.
What is the redistributive policies (Income distribution explanation)?
- Reducing income inequality in a society can improve social well-being, and in turn many other health and social factors
E.g. The government may make decisions/changes about how they set up their tax system and things like minimum wage
How can we measure access to healthcare? And what about people who don’t access car because they can’t or don’t know how?
- Utilisation studies measure receipt of services
- Evidence about utilisation is contradictory and difficult to interpret
When it comes to access of care what is seen in more deprived groups?
- Higher rates of use of
- GP services
- Emergency services - Under-use of
- Preventative services (e.g. screening)
- Specialist services (e.g. CABG and cancer treatments
