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Population Health 102 > Lecture 5 and 6 > Flashcards

Lecture 5 and 6 Flashcards

1
Q

What should we do about health inequalities?

A

Hard to argue we that we should do nothing
Also hard to see how we could remove all health inequities (enormous and not feasible easy to get rid of)
So we need to use our scarce resources to obtain the best outcomes (bang for buck/most efficient way)

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2
Q

What are the 3 reasons for better understanding health inequalities?

A

We will be better at/more able to:

  1. Justify the need for interventions
  2. Design more effective interventions
  3. Choose more efficient interventions
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3
Q

What sort of model is needed to explain the social inequalities in health?

A

Isn’t too general
Is focused on social factors(need to know range which influences), but not too detailed
Useful for developing solutions/interventions

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4
Q

What are examples of general social models?

A

Biopsychosocial Model
Dahlgren and Whitehead Social Model
- these are too general, don’t tell about the context, doesn’t tell how these things relate to each other

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5
Q

What are examples of specific social models?

A 
Foresight report (for obesity)
Mindmap overlap one
Not useful as a general model as it is too conditional/disease specific
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6
Q

How can we improve the biopsychosocial model?

A

Focus on social and expand(with 4 explanations): “social processes and context”
Collapse the rest into health + stress: “individual psychological, biological and cellular processes”

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7
Q

What are the 4x social factor explanations?

A

Social processes and contexts into 4x Factors/explanations:

  1. Resources (Material / Structural)
  2. Culture and Behaviour
  3. Historical Context
  4. Social Selection/Discrimination
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8
Q

What is the Black report?

A

1980
Showed enormous burden suffered by lower economic groups
Material/Structural (Phys and NonPhys) Resource
Culture and Behaviour (Victim blaming)
Natural/Social Selection
Artefact
Focus on reducing which ever one has biggest impact
-ve: Doesn’t take historical content into account

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9
Q

What are examples of Material Resources?

A

Required in order to be healthy:
income
food
shelter

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10
Q

What are examples of Physical structural resources?

A

Required in order to be healthy
access to health services
education
healthy environment (parks, shops etc.)

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11
Q

What are examples of Non-physical structural resources?

A

Required in order to be healthy
Social support/capital
Policies and Legislation/Regulation

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12
Q

What is the relevance of Material and Structural resources?

A

Being healthy requires material and structural resources (material, physical structural, nonphysical structural)
Potentially relevant to any health inequalities between social groups that have different levels of resources
This is usually seen as a CAUSE of health inequalities:
-but we’ll see how different levels of resources can be an EFFECT of health inequalities too
sick=less ability to work=labelled as lazy = but could also be sick due to lack of resources

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13
Q

What are examples of Cultural/Behavioural Factors?

A 
Social Norms
Peer Pressure
Social Expectations
In-group/Out-group effects
Obedience
Conformity
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14
Q

What is the relevance of Culture and Behaviour?

A

Different groups in society may have different cultures and behaviours, which may be more of less “healthy”
Relevant to inequalities in health that could be as a result of different cultures/behaviours between groups
This explanation has often been mistakenly interpreted as a victim blaming explanation (people’s bad choices) (we aren’t hardwired/genetically programmed to behave badly)
-but well see how culture and behaviour are highly related to the other explanations and should NOT be viewed independently
This is usually seen as a CAUSE of health inequalities
-but we’ll also see how cultural/behavioural differences can be an AFFECT of health inequalities
= less resources to be able to make better food choices

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15
Q

What are examples of Social Selection/Discrimination?

A

Racism
Sexism
Ageism
Disability-related discrimination

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16
Q

What is the relevance of Social Selection/Discrimination?

A

Relates primarily to discrimination
People with health problems are less likely to thrive in society(jobs, relationships) , and are more likely to face discrimination
Discrimination is the EFFECT of health inequalities
Discrimination (unrelated or related to health status) can also CAUSE health inequalities
=physical impairment = on health status or potential to have bad health problems = employment with chronic impairment
Some people with health impairments can end up with more impairments due to discrimination

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17
Q

What are some examples of Historical Context in social models?

A

Migration (e.g. Pacifica 1992)
Colonisation (Maori)
Conflict (not so big in NZ)
Natural Disasters (Chch earthquake health problems)

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18
Q

What is the relevance of Historical Context?

A

Some historical events leave lasting effects on social groups
Colonisation/Migration: groups who have migrated to another country (particularly one that is dissimilar to their own) or who have be colonised (particularly where land and other resources have been lost) tend to have more health problems
This is usually seen as a CAUSE of health inequalities
Not effect as you can’t take away all the impact/influence of history

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19
Q

What does the more Realistic model contain?

A

Links between
Resources and Culture/Behaviour
Culture/Behaviour and Social Selection/Discrimination
Social Selection/Discrimination and Resources
Historical Context and Social selection/Discrimination

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20
Q

What is the definition of Socio-economic Status?

A

No real consensus about what it is
A complex mix of social and economic circumstances of an individual or group of individuals
Measures of SES often include indices of social class, income, occupation, employment statue, area of residence, housing quality, household composition and social integration - National Health Committee 1998

21
Q

What is the Consensus surrounding SES?

A

No really connects about what it is:
1. Some view it as a class (economic position)
2. Some view it as a social status (prestige)
3. come view it as a combination of class and social status
Is also called SEP (socioeconomic position)

22
Q

What is SES related to?

A

concept of “capital” (social and economic)

23
Q

Why is there such a emphasis on SES?

A

Magnitude of the difference
Statistics consistently show that social groups with generally lower SES experience worse health and lower life expectancy than those with higher SES (Black Report, Acherson Report, Our health our future, Decades of disparity)

24
Q

What are measures of SES?

A

Occupational based measures

Non occupational based measures

25
Q

What are examples of occupational based measures of SES?

A

British Registrar General Scale
Elley Irving Scale
NZSCO- NZ Standard Classification of Occupation
NZSEI- NZ Socioeconomic Index

26
Q

What are examples of non occupational based measures of SES?

A
  1. Income(poverty) - e.g. individual income, household income, poverty line
  2. Deprivation - e.g. NZDep
  3. Living Standards - e.g. ELSI
27
Q

What are the 5 stages of the registrar general scale?

A
  1. Professional (accountant lawyer doctor)
  2. Intermediate (manager, teacher, nurse)
    3N. Skilled Non-manual (clerk, secretary, shop assistant)
    3M. Skilled Manual (bus driver, carpenter, coal miner)
  3. Semi-skilled Manual (farm worker, bus conductor)
  4. Unskilled Manual (labourer, cleaner)
28
Q

What are the 8 major groups in the Australian and NZ standard Classification of Occupations?

A
  1. Managers - now get paid more therefore have moved up rank
  2. Professionals
  3. Technicians and Trade Workers
  4. Community and Personal Service workers
  5. Clerical and Administrative Workers
  6. Sales Workers
  7. Machinery Operators and Drivers
  8. Labourers
29
Q

What is the NZ Dep?

A

Area-based, not individual
More than just income, education and occupation
Still very economically focused rather than socially
Deprivationally based

30
Q

What are the Eight domains/ 9 variables of the NZDep?

A 
Income x2
Communication access - internet
Employment
Transport access - car
Qualifications
Living Space
Home Ownership
Support - single parent
31
Q

Why is SES related to health?

A 
The debate about causes has often centred on the four explanations outlined in the Black Report (1980)
Artefact
Material/Structural
Cultural/Behavioural
Natural/Social selection
(+ historical context)
32
Q

What is an artefact?

A

It has been suggested that there relationship between SES and health is not real
Said that is an artificial relationship created through the use of inappropriate measures of SES

33
Q

What are the suggestions that SES has an artificial relationship with health?

A

Problems with the data being used for the numerator and denominator for different ropes
-ethnicity recording, classification and coding difference/changes in census and mortality data
Problems with changing classification systems over time
-registrar general scale, Elley Irving scale, NZEIS
Reporting Bias for health problems between social classes
-reluctance of low SES youths to report health problems (tend to underreport)

34
Q

What is Evidence for an Artefact?

A

Studies have adopted alternative methods of measurement to try and overcome the potential for creating an artificial relationship
-More recent work with linked data has shown that the numerator/denominator bias is not an issue
-some issues with changing measures of SES and health remain (is now a clear relationship)
Despite these issues, there is still a persistent direct relationship between health and socioeconomic status
Conclusion: Does not seem an adequate explanation - should always be considered though during studies

35
Q

What does Material/Structure suggest about SES?

A

Suggests that health difference between social classes are the result of material deprivation and structural inequality
It is the most logical and has been one of the most popular explanations for SES-related inequalities
-SES is all about resources after all
-BUT well also see how this explanation is related to the other explanations

36
Q

What is the Evidence for Material/Structural in relation to SES?

A 
Huge difference in health outcomes between groups with different levels of income, education and occupation
Evidence from many areas including
1. Intrauterine development
2. Physical environment
3. Environmental stress
4. Opportunity structures
37
Q

What are examples of Intrauterine Development?

A

Low/high birth weight = more health problems later - bp, obesity, diabetes
Poor maternal nutrition = low/high birth weight
Poverty = poor nutrition
Therefore lack of MATERIAL resources is main case of this gradient

38
Q

What are examples of Physical Environment?

A

Damp housing = more health problems
Poverty = afford only damp housing/poor insulation
therefore lack of MATERIAL resources is the cause

39
Q

What are examples of Environmental Stress?

A

Stress= more health problems
Less control over work conditions = stress
Lower SES = less control over work conditions
Therefore the lack of STRUCTURAL resources is the cause (less ability to make decisions in workplace)

40
Q

What are the Origins of the Executive Stress Myth?

A

Bradys experiment was poorly designed -over anxious monkeys therefore already hellish problems
Subsequent studies have shown that “executive stress” is a myth
Uncontrollable situations ARE more stressful that controllable situations
BUT doing too much coping in a controllable situation may also damage your health
Executive mangers are under less stress due to having more control

41
Q

What are examples of opportunity structures?

A

Sedentary Behaviours = health problems
Less availability of safe recreational areas/facilities in lower SES area= more sedentary
Therefore STRUCTURAL resources are the cause

42
Q

What could be some of the cases of the Obesity Epidemic?

A 
Culture around eating
Culture around Physical activity
Food supply
Wealth - money to have a healthy diet
Resource related issues
Historical context - culture's eating
Pacifica corn beef from colonisation which has now become part of the culture
43
Q

What are 5 statistic significant reports on SES?

A 
Black report (UK) 1980
Acheson Report (UK) 1998
Social Inequalities in Health (NZ) 1999
Our Health Our Future (NZ) 1999
Decades of Disparity (NZ) 2003,5,6
44
Q

Wat is the Social Gradient?

A

LINEAR process
Lower Social economic scale have much poor Health outcomes
in-between is gradual and fairly liner increase/improvement in health outcomes as you increase social economic class (even between top and very top)

45
Q

What could change in health outcomes be due to?

A

Change in the way things are measured

Change in genuine health outcomes

46
Q

What are the benefits of using individual income as a measure of sex?

A 
Really easy to access
Good/Easy to know
from stats NZ
-ve = don't know social context, #family members, stress etc
Household income = more complicated
47
Q

What is the relationship of NZDep and Hospitalisations?

A

Very linear relationship

Even more so than just gradient for income

48
Q

What are general conclusion about SES?

A

Material/structural facts play a significant role in the relationship between health and SES
And it is not just material resources and wealth that are causing the inequality, it is structural resources too
But its not the only cause and it highly related to other explanation which will be discussed later
There are also other components to material/structural explanation
-absolute and relative poverty
-social support and social capital

49
Q

What should the four explanations enable us to do?

A

understand the social causes and effects of health inequalities
identify the best targets for interventions

Population Health 102 (14 decks)

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