Health Inequality

Question 1

What is deprivation?

Answer 1

Unmet needs caused lack of resources of all kinds

Measured by THE INDEX OF MULTIPLE DEPRIVATION

Question 2

What is the definition of health inequalities?

Answer 2

Differences in health between groups of people within and between countries

Question 3

What may an association between two factors be due to?

Answer 3

CHANCE (random error) ~95% statistical significance
BIAS (systematic error) ~ problem with how study was done
CONFOUNDING (behavioural explanation)
TRUE (true explanation)

Question 4

What is the 1980 black report?

Answer 4

Looked at the association between social class and overall mortality. Showed that inequalities are widening.

Question 5

How does the Bradford-Hill criteria for causation determine whether an association is causative?

Answer 5

• strength (stronger = more likely to be causative)
• consistency (multiple populations, different study design and
  different times)
• specificity (1-to-1 relationship between cause and outcome)
• biological gradient (change in disease rate follows from corresponding
  change in exposure = dose-response)
• biological plausibility (presence of potential biological mechanism)
• coherence (does relationship agree with current knowledge of disease)
• experiment (does removal of exposure affect outcome)

Question 6

What does confounding mean?

Answer 6

An association is due to the effects of differences between study groups that alters their risk of developing the outcome of interest.
For a variable to be confounding it must:
1. Be independently associated with outcome (i.e. a risk factor)
2. Be associated with exposure being studied in the population
3. Not lie on the causal pathway between exposure and disease

Question 7

What are the four models of socioeconomic inequalities in health that lead to higher mortality rates?

Answer 7

Behavioural model:
Differences in health damaging or health promoting behaviours between socioeconomic groups (account for 1/3)

Materialistic model:
Poverty exposes people to health hazards
Black report identified this as the most significant model

Psychosocial model:
Social inequality results in psychological effects with physiological impacts, eg social support

Life-course model:
Health reflects patterns of social, psychosocial and biological advantages and disadvantages experienced by an individual over time