Health Inequalities and promotion

Question 1

Different types of need in healthcare

Answer 1

1. Felt need: Pt subjective desire for healthcare/ability to benefit
2. Expressed need: aka demand for healthcare
3. Normative need: Provider’s judgement of need for healthcare (supply)
4. Comparative need: Provider judgement of need relative to other groups

Question 2

Examples of social determinants of health

Answer 2

Play greater role than healthcare service provision (approx 60-80%)

Employment, living/working conditions, education, social situation

Housing, food, sanitation

Question 3

Sources of healthcare inequality

Answer 3

Poor service provision to deprived population

Limited ability to access services

Multiple external disadvantage that limits access to healthcare (e.g. educational, language, cost barriers)

Question 4

Explanations for socioeconomic health inequality by the Black report 1980

Answer 4

Artefact: Numerator not related to denominator (e.g. census and mid-census values)

Behavioural: Poor health is a result of poor lifestyle choices

Social selection: Poor health limits social mobility

Materialistic: Differential access/choice to material resources (beneficial and harmful)

Question 5

Components of unmet healthcare need

Answer 5

1. Unaware of problem
2. Not accessing service
3. Misdiagnosis/mistreatment
4. Poor compliance to treatment

Question 6

Components of formal health needs assement

Answer 6

1. What is the problem? - Epidemiology
   
   1. Definition of problemt to be addressed
   2. Evidence of unmet need from literature, routine health data –> defines scope
2. How will it be addressed?
   
   1. Clinical and cost effectiveness of solutions - Epidemiology
   2. Current service provision + relation to other populations - Comparative
   3. Key stakeholder data - Corporate
3. Action plan
   
   1. Recommendations (output)
   2. Re-appraisal (outcomes), esp. pt-reported outcomes

Question 7

What is a joint strategic needs assessment?

Answer 7

Commisioned by local authorities

Assesses current and future health/wellbeing needs of a population

Allows prioritisation of services

Question 8

What is a health impact assessment?

Answer 8

Assesses impact of intervention/policy OR population change/event on key outcomes of interest

Often studies policies not directly related to healthcare

Question 9

What isahealth equity audit?

Answer 9

Assesses:

health determinants

Access to services

Healthcare outcomes

within/across populations and distribution according to need

Question 10

Inverse care law in screening programmes

Answer 10

Deprivation positively correlated with increased incidence and negatively correlated with screening uptake - reduce screening efficacy

Also age and cervical screening

Question 11

Ottawa Health Charter Strategies

Answer 11

Enable: Allow individuals to make positive health choices

Mediate: Between differing interests in society to pursue health

Advocate: For favourable socio-economic, political, cultural, behavioural conditions to promote health

Question 12

5 action areas for health promotion

Answer 12

Create supportive environments for health

Strengthen community action for health

Develop personal skills

Re-orient health services towards preventing disease

Helathy public policy to hold it all together