Module 2 Flashcards
Does measures of income have the greatest potential to change over a short duration?
Yes
Define Determinants of health For individuals
“any event, characteristic or other definable entity, that brings about a change for better or worse in health”
Define Acceptability
(Psychosocial Barriers)
The relationship between clients’ and providers’ attitudes to
what constitutes appropriate care.
I didn’t feel comfortable with the person is an example of
Acceptability
“I couldn’t get an appointment (e.g. the appointment times or service opening hours were not
convenient)” is an example of
Accommodation
What are the implications of (income) inequities?
An unequal society Less social cohesion Less trust between groups Increased stress Reduced economic productivity Poorer health outcomes
How can you attempt to measure knowledge-related assets of an individual?
Measure of Education
How can you measure inequites?
Relative measures
– Risk Ratio (EGO/CGO)
– Extremal Quotient (highest rate/lowest rate)
– THESE MEASURES HAVE NO UNITS
• Absolute Measures
– Risk Difference (EGO – CGO)
– Range (highest rate– lowest rate)
– THESE MEASURES HAVE UNITS
How can we allow for equity in society in terms of these major health determinants?
Encourage governments/agencies to improve living and working conditions
• Provide opportunities to empower individuals
• Increase social connections
• Reduce barriers to health care/systems
What is a unique characteristic of Measuring Neighbourhood Deprivation?
Tends to use a ‘deficit’ approach to describing population health
– Describes populations in relation to what they ‘don’t have’
What is the Most direct measure of the material resources aspect of SEP?
Measure of income
Define Agency
the capacity of an individual to act independently and make free choices
What are the important distinctions between the impact on individuals and populations?
o Single gene disorders = rare among the population
o Polygenic inheritance = influences likelihood of offspring
developing a disease
Define Accessibility
(Geographic Barriers)
The relationship between the location of supply and thelocation of clients, taking account of client transportation
resources and travel time, distance and cost.
Define Deprivation
“Deprivation is a state of observable and demonstrable disadvantage relative to the local community or the wider society or nation to which an individual, family or group belongs”
Because asking for personal income can be a personal question what sort of bias can this lead to?
reporting bias
What diseases are associated with environments that favour more sedentary lifestyles and/or poor nutrition?
Chronic diseases such as CVD and obesity
determinants
“any event, characteristic or other definable entity, that brings about a change for better or worse in health”
What is level 2 of the Dahlgren & Whitehead model?
Social and community networks & Living and working conditions
What is level 1 of the Dahlgren & Whitehead model?
Age, sex, constitutional factors & individual lifestyle factors
The determinants must be
objective, measurable, and meaningful
Define Social mobility
the movement of individuals, families, households, or groups of people within or between social strata in a society
What is a healthy environment?
The physical, social or political setting(s) that prevent disease while enhancing human health and well-being
“I couldn’t get in touch with the health professional or the person I usually see” is an example of
Accommodation
Examples of determinants include
• Water, shelter, sanitation • Income • Employment • Education • Housing and neighbourhoods • Societal characteristics e.g. racism, attitudes to alcohol or
violence, value on children • Autonomy and empowerment – social cohesion
What factors can affect household income?
how many people in the family earn money
family size
Define Affordability
(Financial Barriers)
The cost of provider services in relation to the client’s ability
and willingness to pay for these services.
Why measure SEP?
– are used to quantify the level of inequality within or between societies
– May highlight changes to population structures over time, between Census periods or even between generations!
– Are needed to help understand the relationship between health and other social variables (age, sex, ethnicity)
– Have been associated with health and life chances for as long as social groups have existed
What is asking for the household income useful for?
useful for women who may not be the main income earner in the family.
Define The ecological fallacy
• The error that arises when information about groups of people is used to make inferences about individuals
Define Inter-generational mobility
refers to the change in socioeconomic position between a parent and their children
Define Intra-generational mobility
refers to the movement up or down the social ladder in an individual’s lifetime
I couldn’t be bothered is an example of
Acceptability
What does a persons occupation affect?
– Social networks
– Work-related stress = psychosocial effects
– Occupational exposure to environmental risks
The determinants of health may vary at different life-stages. What are these life stages?
o Pre-birth o Childhood o Adolescence o Adulthood o Older-age
Define Structure
social and physical environmental conditions/patterns (social determinants) that influence choices and opportunities available
What is level 3 of the Dahlgren & Whitehead model?
General socioeconomic, cultural and environmental conditions & Living and working conditions
What is At the core of the Dahlgren & Whitehead model?
factors that are sometimes referred to as ‘non-modifiable’ determinants: genes and biology
What is Socio-Economic Position?
“The social and economic factors that influence what positions individuals
or groups hold within the structure of a society”
What does NEET stand for?
Not in Education, Employment or Training
‘I didn’t know how to (e.g. you didn’t know where to go or who to call for help or advice)’ is an example of
Availability
Cost too much is an example of
Affordability
What are the Three levels of influence?
Person
Community
Environment
Define Downstream interventions
Downstream interventions operate at the micro (proximal) level, including treatment systems,
and disease management
Why should we reduce inequalities?
- They are unfair
- They are avoidable
- They affect everybody
- Reducing inequities can be cost effective
What are the three ways in which life course events can
interact to influence long term health and wellbeing?
- Cumulative (e.g. the ‘poverty trap’)
- Multiplicative (e.g. CVD risk factors)
- Programming (e.g. foetal stimulus/disruption affecting later life)
Give examples of how Education can be measured as a categorical variable
– Educational attainment, milestones
– Specific achievements are important in determining SEP
What are examples of some major health determinants?
Age • Gender • Ethnicity • Income • Education
• Occupation • Housing tenure • Crowded houses • Access • Deprivation • Racism
What are the 5 As
Availability Accessibility Accommodation Affordability Acceptability
The staff were unfriendly is an example of
Acceptability
Define the The ‘Inverse Care’ Law
“The availability of good medical care tends to vary inversely with the need of the population served”
How can reporting bias be reduced when asking about personal income?
Use categorical measures as opposed to absolute measures.
“I had no transport to get there” is an example of
Accessibility
I was hoping that the problem would go away or get better with time is an example of
Acceptability
What is an example of inequities in health?
Those inequalities that are deemed to be unfair or stemming from some form of injustice.
Health inequities are differences in the distribution of resources/services across populations which do not reflect health needs
• Relations of equal and unequal power
• political, social and economic as well
as justice and injustice
What is an example of inequalities in health?
Measurable differences or variations in health
differences in health
experience and outcomes between different population groups - according to SEP, area, age, disability, gender, ethnic group
i.e. ‘the social gradient’
How is occupation measured?
• Can be measured as:
– Current or longest held occupation
– Parental occupation in studies of younger populations
• Occupation is transferable
– Occupation of “Head of household” for spouse and dependents
Give examples of how Education can be measured as a continuous variable
– Years of completed education
– Time in education considered more important than achievements
Define Upstream interventions
Upstream interventions operate at the macro (distal) level, such as government policies and international trade agreements
Define Availability
(Existence of Services Barriers)
The relationship of the volume and type of existing services
(and resources) to the clients’ volume and type of needs
The built environment can be defined as:
‘all the buildings, spaces and products that are created, or at least significantly modified by people’.
What does NZSEI stand for?
The New Zealand Socioeconomic Index of Occupational Status
Elements of healthy environments include:
– Clean air and water – Appropriate housing – Access to wholesome food – Safe community spaces – Access to transport – Opportunities to incorporate exercise as part of daily life
Define Accommodation
(Organisational Barriers)
The relationship between the manner in which supply
resources are organised and the expectation of clients.
Define Equality of opportunity
everyone has the same chance of moving up the social ladder.
