Inequality Seminar

Question 1

What is sociology?

Answer 1

The study of the development, structure and functioning of human society

Question 2

How can we apply sociology to healthcare?

Answer 2

• Sociology studies peoples’ interactions with those engaged in medical occupations e.g. healthcare professional-patient relationships
• Sociology studies the way people make sense of illness e.g. illness versus disease
• Sociology studies the behaviour and interactions of health care professionals in their work setting e.g. professional values, interactions between health care professionals and other health care staff

Question 3

How is health promotion an example of sociology in medicine?

Answer 3

• Promoting healthy behaviour and preventing ill health is only possible if we understand the ways different groups in society operate e.g. men and women, rich and poor, young and old
• Sociology provides health promotion with an analysis of the different groups in society

Question 4

What do we mean by Social Class ?

Answer 4

In UK this traditionally has been based on income and position within employment (from UK Office for National Statistics 2001, increasing the previous five classes-from the 1911 population census-due to changes in employment)

Question 5

What are the social/socio-economic influences on our health?

Answer 5

A definition would be the collective set of conditions in which people are born, grow up, live and work. These include:

• gender
• ethnicity
• housing
• education
• employment
• financial security
• health system
• environment

Question 6

How can gender act as a social factor?

Answer 6

• Men have a higher mortality at every age
• Women have a higher morbidity
• Women consult more frequently in General Practice settings

Question 7

How can ethnicity play as a social factor?

Answer 7

• Britain is a multicultural society
• Ethnicity includes social and cultural influences as well as genetic
• Low socio-economic groups in ethnic communities have higher morbidity rates than their non ethnic counterparts
• There are differences between ethnic groups also
• Communication factors play a large part
• Stereotypes are a concern

Question 8

How can housing be a social factor?

Answer 8

• Excess winter deaths are almost 3x higher in the coldest quarter than in the warmest
• 1 in 4 adolescents living in cold homes are likely to have multiple health problems compared to 1 in 20 in warm homes

Question 9

How can education be a social factor?

Answer 9

Those with higher levels of education tend to be healthier than those of similar income who are less well educated e.g. better understanding of health, more effective engagement with health care services such as screening programmes

Question 10

How can employment be a social factor?

Answer 10

• Provides income and financial security; this obviously varies and relates in part to the previous slide on social class. (Deprivation is a major determinant of health inequalities)
• Provides social contacts
• Provides status in society
• Provides a purpose in life
• Unemployment is associated with increased morbidity and premature mortality

Question 11

What impact can the health system have?

Answer 11

• The WHO argues that governments should protect people against financial risk in matters of health, whether the system is publically or privately financed
• “And it should assure not only that the healthy subsidise the sick….., but also that the burden of financing is fairly shared by having the better-off subsidise the less well-off. This generally requires spending public funds in favour of the poor” (WHO 2000)

Question 12

What influence can general practice have on the general population?

Answer 12

• The distribution of GPs across Scotland does not reflect the levels of deprivation
• There is evidence that services designed to improve whole population health e.g. eye checks, cancer screening, may widen health inequalities if uptake is lowest in those who would derive the greatest benefit

Question 13

What affect can environment have on the general public?

Answer 13

• There can be adverse effects on health from the expansion of car use e.g. RTAs, pollution (often worse in deprived areas with poor urban planning)
• Active travel such as cycling and walking have a number of health benefits e.g. improved mental health, reduced risk of premature death, prevention of chronic diseases such as coronary heart disease, stroke, type 2 diabetes, osteoporosis, depression, dementia and cancer. Walking and cycling are also effective ways of integrating, and increasing, levels of physical activity into everyday life for the majority of the population, yet there has been a lack of investment in walking and cycling infrastructure.

Question 14

How can the media affect health?

Answer 14

• Shapes and stereotypes our views
• Shapes our expectations
• Consider the change in media attitude to mental health in recent years, aiming to reduce the previous stigma associated with mental illness

Question 15

How does WHO define health inequalities?

Answer 15

The WHO states that health inequalities can be defined as the differences in health status or in the distribution of health determinants between different population groups

Question 16

Please explain: Health Inequalities in Scotland-Audit Scotland, December 2012

Answer 16

• The Scottish Government allocated around £170million (1.5% of overall NHS Scotland budget) to NHS boards to directly address health related issues associated with inequalities in 2011/12, and in its spending review of 2012/13 reiterated its commitment to addressing health inequalities. As yet it is not clear how NHS boards and councils allocate resources to target local areas with the greatest need
• Overall health has improved over the past 50 years, average life expectancy and healthy life expectancy has increased, but average life expectancy is lower than any other part of UK for men and women. Women tend to live longer than men but have more years of living in poorer health. People living in rural areas tend to live longer than those in urban areas
• Deprivation is the key determinant of health inequalities although age, gender and ethnicity are also factors
• Deprivation in Scotland is concentrated in the west but health inequalities vary widely within local areas

Question 17

Please elaborate on health inequalities among scottish children:

Answer 17

• Children in the most deprived areas have significantly worse health compared to children living in the least deprived areas; they are more likely to have lower birth weight, poorer dental health, higher obesity and higher rates of teenage pregnancy
• There is a mixed picture of progress in tackling health inequalities. For some indicators e.g. deaths from coronary heart disease, inequalities have decreased, but others such as mental health, smoking, alcohol and drug misuse remain significantly worse in the most deprived parts of Scotland. Addressing issues affecting children can improve long term health outcomes in adult life

Question 18

Please give some facts on homeless people:

Answer 18

• Average age of death of longer-term homeless is 47 years for men and 43 years for women
• Death by unnatural causes has been found to be four times more common than average amongst rough sleepers, and suicide 35 times more likely
• Rough sleepers are more likely to be assaulted than the average person
• Alcohol and drug problems are very high amongst rough sleepers, and people being resettled from the streets are more likely to face problems sustaining a tenancy if they have these problems
• The prevalence of infectious diseases, such as tuberculosis, HIV and hepatitis C, is significantly higher than in the general populations
• This population experiences poorer oral health than the general population.
• Access to health care for this population is different to that of the general population: one third of rough sleepers are not registered with a GP; attendance at accident and emergency is at least eight times higher than the housed population.

Question 19

What does FOPC team say about vulnerable groups?

Answer 19

People with a learning disability have worse physical and mental health than people without a learning disability. On average, the life expectancy of women with a learning disability is 18 years shorter than for women in the general population; and the life expectancy of men with a learning disability is 14 years shorter than for men in the general population (NHS Digital 2017).

Question 20

What are some barriers that stop people with a learning disability from getting good quality healthcare?

Answer 20

• a lack of accessible transport links
• patients not being identified as having a learning disability
• staff having little understanding about learning disability
• failure to recognise that a person with a learning disability is unwell
• failure to make a correct diagnosis
• anxiety or a lack of confidence for people with a learning disability
• lack of joint working from different care providers
• not enough involvement allowed from carers
• inadequate aftercare or follow-up care

Question 21

What are challenges for refugees arriving in a new country?

Answer 21

• Family integrity and social adjustments trump medical issues for most arriving refugees
• Competing demands of distinct services such as: social welfare, education, housing, transportation, public health, mental health, primary care, and specialty care encountered by refugees may overwhelm them and limited resources
• Language barriers impede the adjustment process
• Some refugees with urgent and complex medical conditions are unable to establish care and specialty referrals in a timely manner
• Underdeveloped or eroding health care systems in the countries of origin or first asylum leave many refugees with poorly controlled or undiagnosed chronic medical conditions
• Most refugees are unfamiliar with the biomedical practice of preventive medicine and primary health care
• Public health’s infectious disease screening results are not communicated to those providing ongoing medical care
• Exposure to violence, torture, warfare, and internment is common, even among children
• Loss upon loss is the nature of refugee life and so depression, PTSD, and anxiety are prevalent and often unrecognized
• Anti-immigrant sentiments further burden refugee life in the U.S.

Question 22

Stats of prisoners:

Answer 22

• 76% of Scottish prisoners report being smokers compared to the national average of approximately 24%. However, 56% of those surveyed stated that they wished to give up
• 44% of surveyed prisoners reported being under the influence of illicit drugs at the time of their offence and 39% reported that drug use was a problem for them on the outside

Question 23

Stats of LGBT:

Answer 23

• In a Stonewall survey which reported on the experiences and concerns of more than 6,000 lesbian and bisexual women respondents reported that: one in five respondents had deliberately harmed themselves in the last year, compared to 0.4 per cent of the general population and half of respondents under the age of 20 had self-harmed, compared to one in fifteen of teenagers generally
• In relation to the NHS half of the respondents reported that: they ‘are not out to their GP’, and of those who had attended a consultation with a partner, only 10% felt the partner had felt welcome
• A 2008 Scottish survey of over 70 transgender people in Scotland noted particular issues with mental health services e.g. lack of understanding

Question 24

What is inverse care law?

Answer 24

In 1971, a GP Dr Julian Tudor Hart proposed the Inverse Care Law, published in the Lancet. This described that those who most need medical care are least likely to receive it and conversely, those with least need of health care tend to use health services more, and more effectively

Question 25

Give some key points from: “Equally Well” Scottish Government 2008

Answer 25

• Health inequalities remain a significant challenge in Scotland
• The poorest in our society die earlier and have higher rates of disease, including mental illness
• Healthy life expectancy needs to be increased across the board to achieve the Scottish Government’s overall purpose of sustainable economic growth
• Tackling health inequalities requires action from national and local government and from other agencies including the NHS, schools, employers and Third Sector
• Priority areas are children, particularly in the early years, “killer diseases” such as heart disease, mental health and the harm caused by drugs, alcohol and violence
• Radical cross-cutting action is needed to address Scotland’s health gap to benefit its citizens, communities and the country as a whole

Question 26

What range of factors can reduce health inequalities?

Answer 26

• Effective partnership across a range of sectors and organisations e.g. to promote health, improve patient education about health
• Evaluate and refine integration of health and social care
• Government policies and legislation e.g. smoking ban, Keep Well campaign
• Time to invest in the more vulnerable patient groups
• Improve access to health and social care services and professionals
• Reduction in poverty
• Social inclusion policies
• Improved employment opportunities for all
• Ensuring equal access to education in all areas
• Improved housing in deprived areas

Question 27

What is equality vs equity?

Answer 27

Question 28

What is the contribution of the third sector?

Answer 28

Third Sector services demonstrate that they contribute to meeting local outcomes and priorities, they should be given the resources by their funders and commissioners to allow services to be maintained, developed and made more financially sustainable

Question 29

What are the contributions of voluntary sector organisations?

Answer 29

• Provide a means of engaging effectively with communities and individuals
• Deliver a range of services which may help to reduce health inequalities, including:
  
  • Promoting healthy living to groups of people who may not use mainstream services
  • Supporting people to access relevant services NHS Health Scotland

Question 30

And finally, what are some benefits of volunteering?

Answer 30

• Gain confidence. Volunteering can help you gain confidence by giving you the chance to try something new and build a real sense of achievement
• Make a difference. Volunteering can have a real and valuable positive affect on people, communities and society in general
• Meet people. Volunteering can help you meet different kinds of people and make new friends
• Be part of a community. Volunteering can help you feel part of something outside your friends and family
• Learn new skills. Volunteering can help you learn new skills, gain experience and sometimes even qualifications
• Take on a challenge. Through volunteering you can challenge yourself to try something different, achieve personal goals, practice using your skills and discover hidden talents
• Have fun! Most volunteers have a great time, regardless of why they do it.