L5: Inequalities and inequities in health

Question 1

Why is inequality and social determinant of health so important?

Answer 1

Life expectancy: difference between richest and poorest wards is nearly 8 years
Infant death: 3.4 death per 1000 live births in Hampshire and 8.6/1000 in Birmingham and Black country
Morbidity: rates of limiting longstanding conditions in professional/managerial occupations is half that of people in routine/manual occupations
Disability: people in most deprived areas are more than twice as likely to have one or more disability compared to those in least deprived areas of Britain

Question 2

How does access to health care vary within Britain?

Answer 2

Inverse care law→ availability of good medical care tends to vary inversely with the need of the population served
e.g.
Area of most sickness→ GP more work, larger lists, less hospital support, inherit more clinically ineffective traditions compared to healthiest ares
→hospital Drs, heavier case loads with less staff and equipment, more obsolete buildings, suffer lack of beds and replacement staff

Question 3

How does health vary across the country?

Answer 3

Inequalities between regions and within regions

Question 4

Is there a link between deprivation and health?

Answer 4

Deprivation is strongly associated with ill health

More deprived a person= larger proportion of life spent in ill health and die at a younger age

Question 5

Why are there links between deprivation and ill health?

Answer 5

People are able to make choices
Only make choices on what is available to them
Not necessary ‘bad’ choices but best choice of a bad bunch of choices

Question 6

What are some of the explanations, theories and pathways for the inequalities in health?

Answer 6

6 different ideas

1. Artefact
2. Social selection
3. Behavioural-cultural
4. Materialist
5. Psychosocial
6. Income distribution

Question 7

What is the artefact explanation for health inequalities?

Answer 7

Inequalities are evident due to the way statistics are collected
Concerns about the quality of data and method of measurement
Most discredited
If anything likely an underestimation of inequalities

Question 8

What is the social selection explanation?

Answer 8

Direction of causation is form health to social position
Sick individuals move down the social hierarchy
Healthy individuals move up
Chronically ill and disabled people are more likely to be disadvantaged
Plausible explanation

Question 9

What is the behavioural-cultural explanation? What are the limitations?

Answer 9

Ill health due to peoples choices, decision, knowledge and goals
Useful explanation for health education BUT
- 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

Question 10

What is the materialist explanation? What are the limitations?

Answer 10

Inequalities arise from differential access to material resources
Lack of choices in exposure to hazards and adverse conditions
Accumulation of factors across life-course
Most plausible
- Further research needed

Question 11

What is psychosocial explanation?

Answer 11

Health is influenced more by difference in income than actual income
Some stressor are distributed on a social gradient (negative life events, social support, autonomy at work, job security)
Stress then impacts on health in different ways
- Direct (physiological, immune system)
- Indirect (health related behaviours, mental health)

Question 12

What is the income distribution explanation?

Answer 12

Relative (not average) income affects health
Countries with greater income inequalities have greater health inequalities
Its not the richest but the most egalitarian societies that have the best health

Question 13

Why does income distribution have such an impact on health inequalities?

Answer 13

Linked to the psychosocial explanation

Increase income inequality→ increased social-evaluative threat→ increased stress→ decreased health

Question 14

What is meant by redistributive policies?

Answer 14

Reducing income inequality in a society can improve social well-being and in turn many other health and social factors

Question 15

What actions can be done to improve health inequalitites?

Answer 15

Depends on what theory(ies) caused them
4 categories
1. Strengthening individual
2. Strengthening communities 
3. Improving living and working conditions 
4. Promoting health macro-policies

Question 16

What is the difference between inequality and inequity?

Answer 16

Inequality- when things are different (not equal)

Inequity- Inequalities that are unfair and avoidable

Question 17

What inequalities are there in access to health care?

Answer 17

most deprived groups seem to have
- Higher rates of use of GP services
- Emergency services
Under-use of
- preventive services
- specialist services

Question 18

What are the differences in who accesses health care in deprived areas?

Answer 18

• Often functional or negative approach to health therefore they often manage health as a series of crisis
• Ill health is normalised in these communities
• Consulations are usually attended after an ‘event’ has happened (e.g. they become more ill etc…)
• Often lack of resources for patients and patients are less able to speak up for what they want and need from health services
• Use service that are not necessarily secure
• Often lack of cultural alignment between health services and lower socio-economic groups
• Adjudications of technical and social eligibility by doctors affect referrals and offers

Question 19

What else affects access to health care leading to inequalities?

Answer 19

Diversity
e.g. ethnicity, gender, age, disability, homelessness etc…
Health is related to socioeconomic status as well as this

Question 20

What is the difference in health care between genders?

Answer 20

Males- Higher mortality rates, more suicidal and violent death
Females- Higher life expectancy, higher reported (poor) mental health, higher rates of disability and limiting longstanding illness