Module 2 Flashcards
What is socioeconomic position?
The social and economic factors that influences what positions individuals or groups hold within the structure of a society.
Called position rather than status as status is negative term.
What are determinants?
An event or characteristic that influences a health outcome/brings about a change for better or worse in health.
Types of determinants
Income, Education, Employment, Housing, Water/shelter/sanitation, social cohesion, Age, gender, ethnicity, crowded houses, access and deprivation.
Responses to determinants of health
- Encourage governments/agencies to improve living conditions.
- Increase social connections.
- provide opportunities to empower individuals.
- Reduce the barriers to health care/systems.
Difference between inequity and inequality
Inequity:
- Those inequalities that are deemed unfair or stemming from some form of injustice.
- Health inequities are different in the distribution of resources/services across populations which do not reflect health needs.
- Lack of fairness; there is a difference when there shouldn’t be.
- Both men and women get breast cancer but only mamagrams for women.
Inequality:
- Difference or variation in health.
- Differences in health experiences, and outcomes between different population groups according to SEP, gender, age, ethnicity.
- E.g women do not get prostate cancer.
- Social gradient
Measuring the socio-economic determinants of health
- Determinants must be objective, meaningful and measurable.
Socioeconomic position can also be known as…
Can also be recognised as socioeconomic status, social class, socioeconomic background and social stratification.
All have different theoretical bases and interpretations.
Why measure socioeconomic position (SEP)?
- Its used to quantify the level of inequality within/between societies.
- It highlights patterns over time which can be seen through census periods and even better generations (parents to children).
- Establishes the relationship between health and social variables (age,sex,ethnicity).
- Associated with health and life changes for as long as social groups have existed.
Measuring Income with surveys…
Income can either be given as a Personal income measure (sensitive) or as a household income measure (which is dependant on the family size- standardisation).
Personal income can be split into two…
- Absolute measures (exact annual figure)
2. Categorical measures (figure between two points)
Measures of income
- Have a Dose response associated with health.
- Have a cumulative effect- income builds up over the course of a life time.
- Have the greatest potential to change over a short duration.
- Most directly measures the material resources aspects of socioeconomic position.
Household income split up…
- Useful indicator for women, who may not be the main income earner.
- Should be ‘equivalised’ for comparisons between populations (requires information on family size/dependants).
Measures of Education
- Attempts to measure knowledge -related assets of an individual.
- Education can be measured as a continuous variable OR Education can be measured as a categorical variable.
- Capture transition from parents SEP to personal SEP .
- Are believed to be associated with our ability to respond to health promotion messages.
- Are easy to obtain, often have a good response rate and is relevant to all age groups.
- PROBLEMS: cohort effect- different standards of education in different countries.
Trend in Education
More education results in more likely to pick things up fast and stick with things e.g smoking campaigns and dedication therefore, to give up smoking.
How to measure education…
Education can be measured as a continuous variable:
- Years of completed education.
- Time in education (considered more important than achievements)
OR Education can be measured as a categorical variable:
- Educational attainment, milestones.
-Specific achievements are important in determining socioeconomic position.
Measuring occupation
- Jobs are grouped by potential income or SEP.
- (NZSEI) New Zealand socioeconomic index of occupational status (asks what is your job?)
- social class in the UK. - Head of house is transferable
- occupation of ‘head of household” for spouse or dependants. - Closely associated with income
- Reflects social standing
- possibly certain privileges resulting from SEP (lawyers, doctors) automatic respect that these people know their stuff. - The individuals experience occupational or social mobility over the course of a life time.
- Occupation influences/impacts on:
- social networks- cluster of people in same community resulting in break up foundations around better social connectiveness in the community.
- work-related stress = psychosocial effects
- occupational exposure to environmental risks.
NZSEI vs prevalence of smoking
Occupations that are more upper class generally have less people smoking while those in lower occupational groups according to NZSEI have more smokers. This shows a social gradient.
NEET - Not in education, employment or training
- A relatively new indicator of SEP, considering the ‘ideal pathways’ for school leavers at different levels of achievement.
- The term ‘NEET’ is NOT used to describe the identity of individuals or groups but their situation or official status. Where are they going after school etc.
Trend of life expectancy and education
Educational training after school results in higher life expectancy compared to those who do not go into extra educational training after school.
Difference between odds ratio and relative risk
- Where the data comes from.
- a/EG = RR
- OR= (a/c) / (b/d)
However, interpretation is very similar in which the odds of …. being a smoker is 20x less likely than a particular group.
Major arguments for attempting to reduce inequalities in health
- They are unfair- inequality becomes unfair when poor health is the of unjust distribution of social determinants in health (unequal opportunities in education etc)
- They are avoidable- Making things accessible by changing the distributions those gaps are avoidable.
- They affect everyone- Some types of health inequalities have obvious spill over effects on the rest of society e.g spread of infectious disease, crime and violence.
- Reducing inequities can be cost effective
Odds ratio = 1.99
Smoking in maori vs non maori
Maori are 2 times more likely than non maori to be cigarette smokers.
Social Mobility defintion
The movement go individuals, families, households, or groups of people within or between social strata in society.
Intra-generational mobility
Refers to the movement up or down the social ladder in an individuals life time.
Inter-generational mobility
The change in socioeconomic position between a parent and their children.
Equality of opportunity
That everyone has the same chance of moving up the social ladder.
Social mobility trend - countries
The more income inequality, the less social mobility within that particular country.
The Lorenz Curve (Gini Coefficient)
Gini= (A)/(A+B) where A= line between perfect equal line and curved line. 0= very equal society 1= every unequal society
Implications of (income) inequities
- An unequal society- a gap between the rich and the poor.
- Less social cohesion (members of society coming together)
- Less trust between groups- People talking to people that are similar to them.
- Increased stress- to find money for food etc increases as gap between rich and poor increases.
- Reduced economic productivity
- Poorer health outcomes - damper homes results in increased sickness and parents have to take time off work to look after children resulting in less pay etc.
How to reduce inequities?
Redistribution of resources according to need. E.g not giving the same to everyone but giving the amount of resources dependant on the death rate etc.
- Using the best practise may be a possible way to improve performance of others and therefore, reduce inequity. E.g free 50 hours of child care increases child development.
Determinants of health vary at different life stages. Theses life stages are…
- Pre-birth
- childhood
- Adolescence
- Adulthood
- Older-Age
Three ways in which life course events can interact to influence long term health and well being…
- Cumulative- poor income results in poor diet, effecting education and therefore less advantaged in larger population. (POVERTY TRAP)
- Multiplicative- Increasing age accommodation of age and ethnicity. (CVD)
- Programming- what happens in the embryo may result in outcomes later in life. E.g lack of oxygen is related with diseases later on in life.
Downstream interventions
operate at the micro level, including treatment systems, and disease management. E.g own treatment
Upstream interventions
Operate at the macro level, such as government policies and international trade agreements. E.g sugar tax: reducing harm before it happens.
The dahlgren and whitehead model
Centre: Age, Sex and Constitutional factors e.g particular disease.
Individual lifestyle factors: choices the individual choices to do.
Social and community network: exposures to family and friends.
Living and working conditions: Occupational hazards and effects on the health of occupational group. Eg forestry workers- tags that determine blood pressure
General socioeconomic, cultural, and environmental conditions: international trade agreements, government policies.
Three levels of Influence:
The Personal
The community
The environment
The personal level of influence
Age, Sex, constitutional factors and individual lifestyle factors.
- Found at the core of the Dahlgren and whitehead model are factors that are sometimes referred to as ‘non-modifiable’ determinants.
- Genes are importants, but too is the influence of the environment. Therefore, the exposure to culture has an impact on our health seen by CVD prevalence and traditional Japanese vs non traditional Japanese upbringing.
- The choices you make as an individual impact on the likelihood that you will have good health outcomes. (social gradient).
- your choices as an individual impact the likelihood of having good health
- Habitus: Values installed by parents. Social gradient included in spectrum e.g wealthy environment resources to change- more likely too. From poorer environment- less likely due to lack of money.
The environmental level of influence
-cultural factors, physical environment and socioeconomic general factors
The important distinctions between the impacts on individuals and populations
- SINGLE gene disorder: rare amongst the population
- POLYGENIC inheritance: influences likelihood of offspring developing a disease. E.g diabetes
Social and community networks and living working conditions influences
- Family and friends allow normative behaviour development - attitudes formed.
- Attitudes and behaviours of people living and working in the local community influences the sense of what is normal and acceptable
- Social capital.
Social Capital
The value of social networks that facilitates bonds between similar groups of people.
“Its not what you know, its who you know”.
