Lecture 3.1: Health Inequalities & Inequities Flashcards
What is Health Inequality?
Defined by WHO as all types of health variation
but generally used in UK and literature to refer
exclusively to variations that are avoidable and
“unfair.”
The Inverse Care Law
The inverse care law states that the availability of good medical care tends to vary inversely with the need for it in the population served
What is a Health Needs Assessment?
Identifying vulnerable populations with specific health
needs
What is a Health Equity Audit?
Is a process that examines how health determinants, access to relevant health services, and related outcomes are distributed across the population
What is a Health Impact Assessment?
A practical approach used to judge the potential health effects of a policy, programme or project on a population, particularly on vulnerable or disadvantaged groups
What are the 4 Levels of Prevention of Health Inequality?
- Primordial Prevention
- Primary Prevention
- Secondary Prevention
- Tertiary Prevention
What is done in Primordial Prevention?
Alter societal structures & thereby underlying determinants
What is done in Primary Prevention?
Alter exposures that lead to disease
What is done in Secondary Prevention?
Detect and treat pathological process at an earlier stage so that treatment can be more effective
What is done in Tertiary Prevention?
Prevent relapses and further deterioration via follow up care and rehabilitation
What is the High Risk Approach?
Proposes to intervene for prevention upon those with the strongest likelihood of developing disease
What are the Strengths of the High Risk Approach?
- Effective (high motivation of individual and
physician) - Efficient (cost-effective use of limited resources)
- Benefit : risk ratio is favourable
- Appropriate to individual
- Easy to evaluate
What are the Weaknesses of the High Risk Approach?
- Palliative and temporary (misses a large amount of
disease) - Risk prediction ± not accurate
- Difficulty and costs of screening
- Hard to change individual behaviours
What is the Population Approach?
Begins with recognition that the occurrence of common diseases and exposures reflects the behaviour and circumstances of society as a whole i.e. mass drug administration
What are the Strengths of the Population Approach?
- Equitable
- Can be cost effective in terms of identification
- Large potential for population benefit
What are the Weaknesses of the Population Approach?
- Small perceived risk of dx and small benefit to
individual may result in poor motivation - Poor motivation leads to poor coverage
- Benefit: Risk may be questionable
Axes of Inequity (5)
Geography
Income
Gender
Place of residence (rural/urban)
Ethnicity
Levels of Analysis (4)
Global
Regional
National
Sub-national
How do we investigate equity? (3 Steps)
▪ First need diagnosis
➢ Outcomes
▪ Then need to look at causes of inequity
➢ Upstream factors
▪ Design intervention to tackle causes of inequity
How to measure inequity in health outcomes? (3)
- Life expectancy
- Mortality (e.g. infant mortality, child mortality,
maternal mortality) - Morbidity
List the 4 wider determinants of health?
Economic Stability
Education
Neighbourhood & Built Environment
Social & Community Context
Health Inequity Definition
Avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically (WHO)
The quality of the services a patient receives can be
determined by…? (6)
- Gender
- Income level
- Mother tongue
- Ethnicity
- Religion
- Technology
Barriers to Accessing Healthcare (5)
- Knowledge of need
- Knowledge of availability of services
- Perceived quality of services (inc patient treatment)
- Social norms
- Fear
What can be done to reduce inequities? (7)
- End poverty!
- Identify levels and root causes of inequity
- Distribution of resources (by need)
- Financing strategy (by ability to pay)
- Training of health workers
- Health promotion and prevention (stagnant water,
nutrition) - Cash transfers
What is Equity?
It is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically (WHO)
