Lecture 1_Health inequalities Flashcards
What is the biopsychosocial model of health?
- examines the medical and psychosocial aspects of health
- the fundamental assumptions is that health and illness are consequences of the interaction between biological, psychological and social factors
- multiple factors that lead to multiple effects
Why is health psych needed?
- mortality (death) rates primarily caused by “lifestyle” diseases of heart disease and cancer.
- predictions from WHO globally - heart disease main cause of death and disability by 2020.
Why we need to be aware of health inequalities?
- variations are pervasive and of a great magnitude
- continuation into better-off social groups, i.e. INEQUALITIES BECOMING PROGRESSIVELY WORSE (not just financial)
- socioeconomic HEALTH INEQUALITIES have INCREASED in recent years
- to effectively TARGET INTERVENTIONS to address these variations in health, it is important to understand the underlying psychosocial and behavioural mechanisms.
- need BROADER PERSPECTIVE
What is the impact of health variations/health inequalities?
- income inequalities within affluent countries is associated with POORER HEALTH OUTCOMES
- greater % share of income, the greater the life expectancy.
What were the findings of the magnitude of socioeconomic inequalities in mortality study?
- magnitude of socioeconomic inequalities in mortality differs between countries
- Eastern and Southern European countries (Hungary, Czech republic, lithuania etc.) have greater inequality, with these disparities becoming even worse over time.
- between-country variations in inequalities in mortality are partly attributable to variations in inequalities in smoking, excessive alcohol consumption, and poverty.
- countries with higher national income, higher quality of government, higher social transfers, higher health care expenditure and more self-expression values have SMALLER INEQUALITIES IN MORTALITY
What were found to be determinants of the magnitude of socioeconomic inequalities in mortality?
Between-country variations in inequalities in mortality are partly attributable to variations in inequalities in:
- smoking
- excessive alcohol consumption
- and poverty
Countries with: - higher national incomes -higher quality of government - higher social transfers -higher health care expenditure - more self-expression values HAVE SMALLER INEQUALITIES IN MORTALITY
What did Kaplan et al (1996) find consistently for states with more equitable income distribution?
- HIGHER spending on EDUCATION/library books per capita
- HIGHER rates of HEALTH INSURANCE
- LOWER rates of violent CRIME
- LOWER proportions of their population in jail
- relative poverty
Does poverty lead to health status inequalities (findings from the Whitehall -study II)
- what we've found is that lower paid ppl have higher death rates, particularly in countries in which there is greater inequity between income and health Poverty more likely to lead to: - lower grades (i.e. lower-level jobs) - less regular exercise in leisure time - ate less wholesome foods - consumed more alcohol - were more likely to be obese
What were findings about working conditions for individuals in lower grades (Whitehall - study II)?
- fewer lower grades report having control over their working lives, having varies work, or having to work at a fast pace
- fewer lower grade workers were satisfied with their work situation
What were findings about working conditions for individuals in lower grades (Whitehall - study II)?
- fewer lower grades report having control over their working lives
- fewer lower grades report having varied work, or having to work at a fast pace
- fewer lower grade workers were satisfied with their work situation
What were findings about psychosocial factors - social networks and social relations in the whitehall - study II?
- more lower grade employees reported visiting relatives once a month or more
- more high grades visited friends
- fewer lower grades involved in hobbies or received practical support (i.e. weren’t seeing friends, weren’t exercising, felt like they had no control over their jobs) –> unsurprising that they have higher rates of lifestyle influenced disease
- more lower grades report negative reactions from people around them.
What were the findings regarding psychosocial factors - health locus of control in the Whitehall studies?
- lower grades tended to show a lower perceived control over health outcomes than higher grades
What did the findings of the two Whitehall studies suggest as important determinant for health disparities?
- the combined results of the two whitehall studies are strongly suggestive of psychosocial factors as determinants of the social health differential evident in these data
45 and up study:
How are health lifestyle clusters associated with:
- Biological & psychological states
- Socio-economic indices
AGE:
- smokers cluster (youngest members)
GENDER:
- non screeners cluster (greatest number male)
- two non-smokers clusters (least number of males)
MARITAL STATUS
- smokers cluster (highest proportion of single members)
SOCIO-ECONOMIC STATUS :
- smokers clusters (lowest average SES)
- non-screeners and active non-smokers clusters (highest education and income)
- sedentary non-smokers (highest average SES)
WORK STATUS:
- smokers cluster (highest proportion of sick/disabled members)
- higher risk ex-smokers cluster (highest proportion of retirees)
- non-screeners cluster (highest proportion FT workers)
BIOLOGICAL MARKERS:
- higher risk ex-smokers cluster (poorest biological markers: highest bmi, lowest physical functioning)
- active non-smokers cluster: best outcomes on predictors (BMI, Physical functioning, quality of life, and psychological distress)
What were the conclusions of the 45 and up study?
CLUSTERS CHARACTERISED BY HARMFUL BEHAVIOURS LIKELY TO INCLUDE: - men - people living alone - people with lower income - people with lower SES MEMBERS OF CLUSTERS MORE LIKELY TO REPORT: - lower quality of life - being more distress
