Inequalities and Inequities in Health Flashcards
What is inequality?
When things are different (not equal)
What is inequity?
Inequalities that are unfair and avoidable, or not accounted for by clinical need
Can you have inequality without inequity?
Yes
How can health be measured?
- Mortality and life expentancy
- Self report
How can health be measured by self-report?
Surveys asking how their health is in general
How can socioeconomic position be measured?
Based on individual occupation
What measures socioeconomic position based on individual occupation?
The National Statistics Socio-Economic Classification
What is the National Statistics Socio-Economic Classification (NSSEC) calculated from?
Census data
What is class 1 of NSSEC?
Higher manegerial and professional
Give examples of jobs that would fall into class 1 of NSSEC
- Lawyers
- Architects
- Medical doctors
- CEs
- Economists
What is class 2 of NSSEC?
Lower managerial and professional
Give examples of jobs in class 2 of NSSEC
- Social workers
- Nurses
- Journalists
- Retail managers
- Teachers
What is class 3 of NSSEC?
Intermediate
Give examples of jobs in class 3 of NSSEC
- Armed forced up to sargeant
- Paramedics
- Nursey nurses
- Police up to sergeant
- Bank staff
What is class 4 NSSEC?
Small employers and own-account workers
Give examples of jobs in class 4 of NSSEC
- Farmers
- Shopkeepers
- Taxi drivers
- Driving instructors
- Window cleaners
What is class 5 NSSEC?
Lower supervisory and technical
Give examples of jobs in stage 5 NSSEC
- Mechanics
- Chefs
- Train drivers
- Plumbers
- Electricians
What is class 6 NSSEC?
Semi-routine
Give examples of jobs in stage 6 NSSEC
- Traffic wardens
- Receptionists
- Shelf stackers
- Care workers
- Telephone salespersons
What is class 7 NSSEC?
Routine
Give examples of jobs in class 7 NSSEC
- Bar staff
- Cleaners
- Labourers
- Bus drivers
- Lorry drivers
How can deprivation be measured?
Based on geographical residental area
What is the Index of Multiple Deprivation calculated from?
Census data
What allows for comparisons in the Index of Multiple Deprivation?
Small areas are ranked
Where are health inequalities evident in the UK?
Between and within regions
What is deprivation strongly associated with?
Ill health
Why is deprivation strongly associated with ill health?
The more deprived a person is;
- The larger proportion of their life is spent in ill health
- They are more likely to die at a young age
What did census data allow from 1911?
Occupation-based comparisons on death rate
What was the Black Report (1980)?
A landmark text that outlined 4 explanations for inequality in health
What explanations for inequalities in health did the black report outline?
- Artefact
- Social selection
- Behavioural-cultural
- Materialist
What did the Acheson report find in 1998?
Inequalities had widened since the Black Report
What did Whitehall studies in 1967, and 1985-present do?
Cohort study of civil servants
What was the Marmot report in 2010?
A review of evidence-based strategies for tackling inequalities
What are the explanations for health inequalities?
- Artefact
- Social selection
- Behavioural-cultural
- Materialist
- Psychosocial
- Income distribution
What does the artefact explanation for heatlh inequalities say?
Health inequalities are evident due to the way that statistics are collected regarding the measurement of class
What is the numerator based on in statistics regarding the measurement of class?
Occupational distribution of those who die during the period considered
What is the denominator based on in statistics regarding the measurement of class?
The occupational distribution at the most recent census
What has happened to the artefact explanation of health inequality?
It has been mostly discredited
Why has the artefact explanation for health inequality been largely discredited?
If anything, data problems lead to an underestimation of inequalities
What does the social selection explanation of health inequalities say?
The direction of causation is from health to social position
How can the direction of causation be from health to social position?
Sick individuals move down the social hierarchy, healthy individuals more likely to move up, therefore chronically ill and disabled people more likely to be disadvantaged
Is the social selection explanation for health inequality likely to be correct?
Plausible explanation, but studies suggest that at most it makes only a minor contribution to S-E differentials in health and mortality
What is the behavioural-cultural explanation of health inequality?
Ill health is due to peoples choices/decisions, knowledge, and goals, and people from disadvantages backgrounds tend to engage in more health-damaging behaviours, while people from advantaged backgrounds tend to engage in more health-promoting behaviours
Where is the behavioural-cultural explanation of inequality useful?
In health education
What are the limitations of the behavioural-cultural explanation of health inequality?
- Behaviours are the outcome of social processes, not simply individual choice
- ‘Choices’ may be hard 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 for health inequality?
Inequalities in health arise from differential access to material resources
Why may someone have differential access to material resources?
- Low income
- Unemployment
- Low control over job
- Work environment
- Poor housing conditions
What is the result of differential access to material resources?
Lack of choice in exposures to hazards and adverse conditions
What happens to factors in the materialistic explanation over the life course?
They accumulate
What is the advantage of the materialist explanation to health inequality?
Most plausible
What are the limitations of the materialist explanation of health inequality?
Further research needed as to precise routes through which material deprivation causes ill-health
What does the psychosocial explanation of heatlh inequality act in addition to?
The direct effects of absolute material living standards
What is the psychosocial explanation of health inequalities derived from?
The Whitehall studies
What does the psychosocial explanation for health inequalities say?
There is a social gradient of psychosocial factors, and some stressors are distributed on a social gradient
What stressors are distributed on a social gradient?
- Negative life events
- Social support
- Autonomy at work
- Job security
Via what pathways can stress impact on health?
- Direct
- Indirect
What are the direct pathways through which stress can have an impact on health?
- Physiological
- Immune system
What are the indirect pathways through which stress can have an impact on health?
- Health related behaviours
- Mental health
How does income affect health?
Relative (not average) income affects health
Which countries have the greatest health inequalities, regarding income?
Those with greater income inequalities- not the poorest
What is the effect of income distribution on health partly associated with?
The psychosocial explanation
Why is the effect of income distribution on health related to the psychosocial explanation?
Increase income inequity = increase in socio-evaluate threat = increased stress = decreased health
What do redistribution policies aim to do?
- Reduce income inequality
- Improve social well being
In turn, improve many other health and social factors
