Inequalities in health and disease (Epidemiology)

Question 1

Define health inequalities

Answer 1

Systemic differences in the health of groups and people according to

Social position - both individually and neighbourhood

Geographic - wider such as by country and smaller scale such as by postcode

Ethnicity - the group a person belongs to as a result of cultural factors such as language, diet, ancestry

Gender - mortality rates in men are higher at all stages of life, no difference in morbidity

Question 2

Why and how is social position measured? (Re. health inequalities)

Answer 2

Usually Occupation
Due to
-Training and skills
- Education
- Responsibility
- Income
- Social standing

Registrar Generals classification of occupation I) professional V) unskilled

National Statistics socioeconomic classification 1 (high managers) -8 (unemployed)

Information from:
Census
Death certs
Index of multiple deprivation - assess neighbourhood measures

Question 3

Inequalities seen in healthcare on basis of social position/employment?

Answer 3

Higher managers/professionals ——–> Unemployed

Increasing mortality rate (inc. infant and perinatal)

Decreasing life expectancy

Increasing morbidity (stroke, lung cancer, suicide, T2DM and obesity)

BUT

Decreasing morbidity of breast cancer and skin cancer

Question 4

Inequalities seen in healthcare on geographic basis?

Answer 4

Wider scale - Mortality rates lower in SE England than NW

Small scale- Life expectancy decreases as you travel east on the Jubilee line

Follows smilier pattern to social inequalities

Question 5

Inequalities due to ethnicity

Answer 5

Measure using place of birth as proxy

Assessed using census, death certificate, decennial supplement

Higher risks of certain disease in people of certain origins, e.g. CVD in Caribbean and African origin

Due to place of origin environment

Stress of migration process

Host environment - often end up living in unfavourable conditions

Question 6

Inequalities due to gender

Answer 6

Mortality rates high in men at all stages of life

Women have a longer life expectancy

No real difference in morbidity

Due to: Differences in genetics/hormones

Employment hazards

Risk taking behaviours

Difference in health service uses

Question 7

Potential reasons for health inequalities (social class and geographic)

Answer 7

a) artefact - differences are artificial (POOR EVIDENCE)

b) social selection - poor health results in decline in social position (POOR EVIDENCE)

c) Health behaviour differences - due to cultural and advertisement differences (PARTIAL EVIDENCE)

d) Psychosocial pathways - inequalities –> feelings of unfairness –> emotional distress —> bio and physiological effects (PARTIAL EVIDENCE)

e) Material circumstances - directly via employment conditions and indirectly via income (GOOD EVIDENCE)

f) Health service provisions and use - health service provision tend to be worse in locations of greatest need due to poor availability and lower uptake (GOOD EVIDENCE)