Inequalities in Health Flashcards
How is socioeconomic status measured?
National Statistics Socio-Economic Classification (NS-SEC)
Calculation based on census data e.g. current and past work status, title, responsibility, etc.
e.g. 1 = higher managerial & professional (lawyers, economists), 7 = routine (cleaners, bus drivers)
Increased rate of ‘not good’ health with lower SES, increased rate of infant mortality with lower SES, etc.
Give some examples of how health is measured and compared in different groups.
Mortality & life-expectancy
No. of years in ‘good health’ = self-report on general health & effect of disease on activities of daily living
Admissions data
How is deprivation measured?
Calculation based on census data from 7 domains:
- income
- employment
- health & disability
- education skills & training
- barriers to housing & services
- living environment
- crime
Geographical areas ranked in terms of size of population
More deprived —> larger proportion of life in ‘ill health’ and increased mortality at a younger age
List the explanations for inequalities in health.
Black Report (1980):
- Artefact explanation
- Social Selection explanation
- Behavioural-Cultural explanation
- Materialist explanation
Whitehall studies e.g. Marmot 1991, 2010 = Psychosocial explanation
Wilkinson = Income Distribution explanation
Outline the artefact explanation for inequalities in health.
Health inequalities are evident due to the way statistics are collected, regarding measurement of class.
Concerns about quality of data and method of measurement
e.g. self-promotion of ill health in some classes, inaccurate recording of occupation in some classes
Numerator value = occupational distribution of those who die in a period of time
Denominator value = occupational distribution at most recent census
note: mostly discredited as an explanation - data problems lead to UNDERESTIMATION of inequalities
Outline the social selection explanation for inequalities in health.
Direction of causation is from health —> social position
- sick individuals move down social hierarchy
- chronically ill & disabled people more likely to be disadvantaged
note: only makes a minor contribution to differences in health and mortality
e. g. no difference between acute & chronic diseases, children cannot change social position
Outline the behavioural-cultural explanation for inequalities in health.
Ill health is due to people’s choices/decisions, knowledge, & goals.
People from disadvantaged backgrounds tend to engage in more health-damaging behaviours, people from advantaged backgrounds tend to engage more in health-promoting behaviours
Useful for health education
However, behaviours are outcomes of social processes, not simply individual choices
- ‘choices’ may be difficult to exercise in adverse conditions
- ‘choices’ may be rational for those whose lives are constrained by their lack of resources
Outline the materialistic explanation for inequalities in health.
Inequalities in health arise from differential access to material resources
e.g. low income, unemployment, work environment, low control over job, poor housing conditions
- lack of choice in exposure to hazards and adverse conditions
e. g. food deserts, increased crime, increased noise, poor air quality, increased road traffic collisions - accumulation of factors across course of UK
- limited by lack of research about precise route of how material deprivation causes ill-health
Outline the psychosocial explanation for inequalities in health.
Psychosocial pathways act in addition to direct effects of absolute material living standards
- social gradient of psychosocial factors e.g. stressors
- stress impacts on health directly and indirectly
Outline the income distribution explanation for inequalities in health.
Relative income affects health, not average income.
Countries with the greatest income inequality have greater health inequality: it is the most egalitarian societies with the best health, not the richest
Increased income inequality —> increased socio-evaluative threat (e.g. status, inferiority, judged) —> reduced health
Evidence for redistributive policies = reducing income inequality will improve social well-being and, in turn, other health and social factors
What is the difference between inequality and inequity?
INEQUALITY = when things are different; not equal
INEQUITY = inequalities that are unfair and avoidable, or not accounted for by clinical need
note: can have inequality without inequity
How can access to healthcare be measured? What are the limitations of this?
Utilisation studies = measure receipt of services
Limitations:
- does not include people who do not access care because they can’t/don’t know how
- evidence is contradictory and difficult to interpret
What patterns of healthcare access are associated with different levels of deprivation?
Increased deprivation —> increased rates of use of GP & emergency services, decreased rates of use of preventative & specialist services
- tendency to manage health as a series of crises, therefore use more ‘porous’ services
- event-based consulting may be required to legitimise consultations
- normalisation of ill-health
- difficulty marshalling the resources needed for negotiation & engagement with health services (e.g. missing work, transport, care of dependents, support system)
- may reflect lack of cultural alignment between health services and lower socio-economic status
- adjudication of technical & social eligibility by doctors affect referrals and offers of treatment
What is the difference between a positive and negative definition of health?
POSITIVE = health means living a healthy lifestyle; people with this view will engage in preventative interventions and be aware of the effect if diet and exercise on health
NEGATIVE = health means the absence of disease; people with this view are less likely to engage with preventative interventions in the absence of symptoms
