Inequalties Flashcards
What are inequalities
Measurable differences or variations in health
What is the social gradient
Inequalities
Differences in health experience and outcomes between different populations groups according to SEP, area, age, disability, gender, ethnic group/
What are inequities
Inequalities that are deemed to be unfiar or stemming from some form of injustice
What are health inequities
Differences in the distribution of resources/services across populations which do not reflect health needs
Why reduce inequalities
- They are unfair
- Unavoidable
- Affect everybody
- Reducing inequities can be cost effective
Describe Maori health status using key indicators
Maori ehalth is exemplified by what systematic disparities
- Health outcomes
- in exposure to the determinants of health
- in health system responsiveness,
- in representation in health workforce
What does structural interventions refer to from the lessons from the titanic
More lifeboats and no barriers
Social interventions from lessons from the titanic
- rights based approach, commitment to review and ‘level playing field’
- not aimed at individual behavior
three
What are the determinants of ethnic inequities in health
- differential access to health determinants or exposures leading to differences in disease incidence
- differential access to health care
- differences in quality of care received
Structural contribution in Maori health
That the power, resources and opportunities of NZ society are organised by ethnicity
Societal contribution in Maori health
There are values and assumptions widely held in NZ society about the deservedness of different groups of people
What are downstream determinants
A determinate of health that is proximate or near to the change in health of status
What is an upstream determinate
A determinate of healht that is either distant in time and/or plae from the change in health status
What is the difference between upstream and downstream determinants
Upstream - what cases people to smolke
* interventions operate at the macro (proximal) level including treatment systems and disease management
Downstream - what causes exposure to cigartte smoke
* interventions operate at the macro (distal) level such as the government
What are the four capitals
Intergenerational wellbeing relying on growth, cultural and environmental conditions. They are interdependent and workd together
What is natural capital
Refers to all aspects of the natural environment needed to support life and human activity
e.g land, soil, water, plants
What is social capital
The norms and values that underpin society
* includes trust, the rule of law, the Crown-Maori relationship, cultural identity and the connections between the people and the communities
What is human capital
- people’s skills, knowledge and physical and mental health
- things that enable people to partake fully in work, study, recreation and society more broadly
What is financial capital
- Inclues things like houses, roads buildings
- make up the countries physical and financial assets which have a direct role in supporting incomes and material living conditions
What is structure in population health
- Social and physical environment conditions/pattersn (sometimes refered to as social determinants) that influence chouss and opportunities available
What is agency in population health
The capacity of an individual/community to act independently and make free choices
What is the purpose of the Dahlgren and Whitehead framwork
Identify determinants of health (risk or protective factors of disease) and consider levels of intervention
What does it mean when there is permeability between the factors of the D&W model
- No arch operates in isolation from the others
- Events at one level may impact on factors at another
What is social-economic position
The social and economic factors that influence what positions individuals or groups hold within the structure of society
What three things must the determinatns of SEP be
Objective, measurable and meaningful
Why do we measure SEP
- quanitify the level of inequality within or between our socities
- highligh changes to population structures over time
- understand relationship between health and other social variables (age, sex, ethnicity)
What factors do we look at when measuring SEP for individuals
Education, income, occupation, housing and assets and wealth
What do we look at when measuring SEP for populations
Area measures: deprivation, and access
Population measures: income inequality, literacy rates, GDP per capita
SEP on living and working conditions
Using area based measures of SEP, other measues include social fragmentaion, and accessibility indices
What is the definition of deprivation
A state of observable and demonstrable disadvantage relative to the local community of the wider socity or nation to which an individual, family or group belongs
Where should deprivation be applied to
Conditions and quality of life that are of a lower standard that is ordinary in a particular society
What are the variables included in NZDep2013
- Communication
- income
- employment
- qualification
- owned home
- support
- living space
- living conditions
SEP on the general socio-econimic, cultural and environmental condotions
- Group populations with similar SEP levels together and compare
- cross sectional or longitudinal analyses
Advantage of prioritised output
- ensures that where some need exists to assign people to a single ethnic group
- produces data easy to work with as each individual appears once. sum of ethnic group will add up to total NZ population
Disadvantage of prioritised output
- Places people in specific ethnic groups which simplifies yet biasses the resulting statistics as it over-represents some groups at the expenes of others in ethnic group counts
- externally applied single ethnicity which is inconsistent with the concept of self-identifcation.
Advantage of total response output
Potential to represent people who do not identify with any given ethnic group, depending on the level of detail reported
Disadvantages of total response output
- Create complexities in the distribution of funding ased on population numbers or in monitoring changes in the ethnic composition of a population in health
- create issues in interpretation of data reported by ethnic groupings where comparisons between groups include overlapping data.
What is numeral ageing
The absolute increase in the population that is elderly
* reflects previous demographic patterns
* improvements in life expectancy
What is structural ageing
The increase in the proportion of the population that is elderly
* driven by decreases in fertility rates
What is a natural decline of the population
Occurs when there are more deaths than births in a population
* combination of absolute and structural ageing
* more elderly = more deaths
What is absolute decline of the population
Occurs when there is insufficient migration to replace the ‘lost’ births and increased deaths
