Inequalities Flashcards
How can we measure the health of different groups?
Measuring mortality and life expectancy
By self-report (e.g. survey)
Census 2011 - Q13 how is your health in general?
How can we measure the health of people in different socioeconomic positions?
National Statistics Socio-Economic Classification
(NS-SEC)
Calculated from Census data - complex calculation
How do we measure deprivation?
Index of Multiple Deprivation
Calculated from census data
On 7 domains: Income, Employment, Health and disability, Education skills and training, Barriers to housing and services, Living environment, Crime)
Small areas ranked to allow comparisons
What does the social patterning of health show?
That in the UK, health inequalities are evident between and within regions
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 some of the explanations of why there is an inequality of healthcare?
Artefact Social selection Behavioural-cultural Materialist ^these were the reasons the black report gave^
Psychosocial
Income distribution
What is the artefact explanation of health inequality.
Health inequalities are evident due to the way statistics are collected.
Mostly discredited as an explanation - if anything it would lead to underestimation of inequality
What is the social explanation of health inequality?
Direction of causation is from health to social position
Sick individuals move down the social hierarchy, healthy individuals move up
Chronically ill and disabled people more likely to be disadvantaged
Plausible explanation but studies suggest that at most Soc-Selection makes only a minor contribution to S-E differentials in health
What is the behavioural-cultural explanation for health inequalities?
Ill health is due to people’s choices/decisions, knowledge and goals
People from disadvantaged backgrounds tend to engage in more-health-damaging behaviours, while people from advantaged backgrounds tend to engage in more health promoting behaviours.
It’s a useful explanation
BUT it has limitations:
- Behaviours are the outcomes of social processes, not
simply individual choice
- “Choices” may be difficult to exercise in adverse
conditions
- “Choices” may be rational for those who loves are
constrained by their lack of resources
What is the materialist explanation for health inequalities?
Inequalities in health arise from differential access to material resources
Low income; unemployment; work environments; low control over job; poor housing conditions.
Lack of choice in exposure to hazards and adverse conditions
Accumulation of factors across life-course
Most plausible
But further research needed as to precise routes through which material deprivation causes ill-health
What are the psychosocial explanations for health inequalities?
That people from lower socioeconomic backgrounds have more stressors and less buffers for stress
less variety in work choice, more life events etc…
When we are stressed we engage in more health damaging behaviours.
What is the income distribution explanation for health inequalities?
Relative income affects health
Countries with greater income inequalities have greater health inequalities
It is not the richest but the most egalitarian societies that have the best health
Increase in income inequality > increase in social evaluative threat > increase in stress > decrease in health
How can we measure access to healthcare?
Utilisation studies measure receipt of services
But evidence about utilisation is contradictory and difficult to interpret.
What is the difference between inequality and inequity?
Inequality - when things are different (not equal)
Inequity - inequalities that are not fair and avoidable (or not accounted for by clinical need)
You can have inequality without inequity
What are the patterns of deprivation and access to healthcare?
More deprived groups seem to have:
- Higher rates of use of GP services and emergency
services
- Under use of preventive services (screening, etc…)
and specialist services (cancer treatments, etc..)
Why is there a difference in access to healthcare?
In deprivation:
Tendency to manage health as a series of crisis
Tendency to use more “porous” services
Event-based consulting may be required to legitimise consultations
Normalisation of ill-health
Difficulty marshalling the resources needed for negotiation and engagement with health services
May reflect lack of cultural alignment between health services and lower SES (socioeconomic status)
Adjudications of technical and social eligibility by doctors affect referrals and offers
