Module 3 Flashcards
SEP definition
The social and economic factors that influence what positions individuals or groups hold within the structure of a society
Determinants requirements
Must be objective, measurable, and meaningful
Measures of SEP
– Used to quantify the level of inequality within/between societies
– Highlight changes to population structures over time/between Census periods/ generations
– Needed to help understand the relationship between health & other social variables (age, sex, ethnicity)
– Have been associated with health & life chances for as long as social groups have existed
Measuring SEP for individuals
Education, Income, Occupation, Housing, Assets and wealth
Measuring SEP for pop
Area measures: Deprivation, Access
Population measures: Income inequality, Literacy rates, Gross Domestic Product (GDP) per capita
SEP
Individual lifestyle factors
- Education: higher education => pick up ideas/messages more easily
- Occupation: Status/social standing. Higher paid jobs => more power on social spectrum
- Income: Purchase material goods/services & health
SEP
Social and Community influences
- Your PARENTS education, occupation, income
– Commonly used to measure SEP in studies of children and adolescents
– Some evidence that your parent’s SEP is associated with own SEP
SEP
Living and working conditions
- Use area-based measures of SEP
- Most common in NZ is the NZ Index of Deprivation (NZDep)
- Index of Multiple Deprivation (IMD) allows you to drill down to explore the drivers of area deprivation
– Other measures include
Social fragmentation and
Accessibility indices
Social fragmentation
How well a society combines
Accessibility indices
Potential access to resources (not realized access)
Deprivation definition
State of observable/demonstrable disadvantage relative to the local community/wider society/nation to which an individual/family/group belongs
- Another way of measuring people’s relative position in society, but reports this based on where they live, not who the people themselves
- Measures focus on material deprivation
- Deprivation should be applied to conditions and quality of life that are of a lower standard than is ordinary in a particular society
What does living in poverty refer to?
A lack of income and resources to obtain the normative standard of living.
What is material deprivation?
Refers to what residents living in particular areas “don’t have”
Variables in NZDep2013
O CLIQuIEST
Communication Living space Income Income Qualification Employment Support Transport Own home
NZDep2013
Communication
People aged <65 with no access to the internet at home
NZDep2013
Living space
People living in equivalised households below a bedroom occupancy threshold
NZDep2013
Income x2
People aged 18-64 receiving a means tested benefit
and
People living in equivalised households with income below an income threshold
NZDep2013
Qualification
People aged 18-64 without any qualifications
NZDep2013
Employment
People aged 18-64 unemployed
NZDep2013
Support
People aged <65 living in a single parent family
NZDep2013
Transport
People with no access to a car
NZDep2013
Own home
People not living in own home
Use of NZ Dep2013
Planning and resource allocation. Research. Advocacy
Interpretation from NZDep2013
“People living in the most deprived neighbourhoods …”
Deciles are inverse scores to school deciles. 10 is worst. 1 is best.
General Socioeconomic, cultural and environmental conditions
- Group populations with similar SEP levels together
– Cross-sectional or longitudinal analyses
– The New Zealand Census Mortality Study
– Using the Integrated Data Infrastructure
Global determinants
– Income inequality
– National income • GDP
– Literacy Rates
– Free trade agreements
Preston curve
- Income & life expectancy not linear
- Countries with low GDP have low life expectancy
Population data purpose
- measuring trends in Births,Mortality, Morbidity, Migration
- more applied work Unemployment/benefit claimants/pensions, Crime, Health service utilisation, Voter turnout, Education pathways
Data sources for epidemiology
The Census (main), Estimated Resident Populations (ERP), Vital events, Health service utilisation and outcomes (HSU), Nationally representative surveys, Ad hoc surveys, The Integrated Data Infrastructure (IDI)
The Census
- Traditionally, to operationalise census data collection
- Enumeration officers’ to contact individual households
- Country divided into small areas “Meshblocks” ~100 people
- In 2018, online
ERP
Estimated Resident Populations
– An estimate of all people who usually live in NZ at a given date
– Does not typically break down by ethnic group
Vital events
– Births, deaths and marriages (Department of Internal Affairs maintain, but Stats NZ prepares reports)
HSU
Health service utilisation and outcomes
– Ministry of Health record and report publicly funded health information e.g. hospitalisations, blood tests, pharmaceutical dispensing
Nationally representative surveys
– e.g. the NZ Health Survey(~15,000 people/annum)
- MoH manages survey with key topics and ‘spotlight’ less common issues
- Self-reported health and health behaviours
Ad hoc surveys
– Student satisfaction survey, market research companies, etc - May not always be generalizable to the wider pop
IDI
– Large data repository that links de-identified data about people that have used Government services
- Uses routinely collected info from government (& other agencies)
- All information is de-identified & strict rules are in place to preserve confidentiality
- Data from many sources can be linked to create a pop based
- To be ‘counted’: have had an interaction with >1 of these agencies – i.e. health, education, tax, police, social development, ACC
- A large research database containing microdata about people and households.
- De-identified data from a range of government agencies, Statistics NZ surveys (inclu 2013 Census), and non-government organisations.
- Holds over 166 billion facts, using 1.22 terabytes of space (continually growing).
- Researchers use the IDI to answer complex questions to improve outcomes for NZders
IDI Pros
- Deidentified
- Linkable, enabling wide insights
- Accessed in a data safe haven
- View longitudinal/life long information
- Identify risk/protective factors
- Predictive risk modelling
- Evaluate effectiveness of particular interventions
- Identify characteristics of groups with positive/negative outcomes
- Tailor interventions to people based on these characteristics.
IDI cons
- Definition of resident population varies
- IDI is only as good as the data in it
- Inherent selection biases from the choice of sources of data
- Can’t perform case management
- Can’t identify specific individuals at risk or for a specific intervention
- Can’t identify specific individuals who are abusing systems and enforce law.
Data considerations
- Ethics & data privacy/confidentiality
- Purpose of data collection vs use in analysis
- Population vs population samples
- Are the participants representative of the NZ population?
- Objective vs subjective measures of health
Population structure
Age & sex: male / female (biological)
Population composition
Other attributes ethnicity, level of education
Pop pyramids
X axis
male = left female = right
Pop pyramids
Y axis
Age: young to old bottom to top
Pop pyramids
Bars
count or % of people
Events determine pop structure
- Age-sex structure is a function of previous patterns/trends of fertility, migration & mortality events e.g. # of women aged 40-45 today determined by births 40-45 years ago (depleted by deaths ±migration)
- Vital events affect structure in different ways/extents
• Changes in fertility rates, can be dramatic but will have a time lag - Changes in infant mortality rates have similar effect
• Changes in adult mortality rates less dramatic & less variable over time - spread over wider age range - Migration can have dramatic effect, especially if the trend is age & sex specific e.g. post Christchurch earthquakes
Pop structure affects events
- Fertility, mortality and migration are not evenly distributed across the population by age and sex
• Fertility: women only, concentrated in young adult ages
• Mortality: highest among the very young and the elderly
• Migration: varies with sex and stage in the life cycle - Age-sex structure has a crucial influence on the rates at which these events occur in the pop
Dependency ratios
Child
0-14 years /working age x 100
Dependency ratios
Elderly
Elderly ≥65/working age x 100
Dependency ratios
Total
(Youth +elderly)/working age x 100
What is the working age?
15-64 years
What does the denominator (population structure) influence?
Analysis
Ethnic composition of NZ depends on?
– Data sources for numerator and denominator: Census, HSU, IDI, National Health Survey
– Ethnicity coding protocol used: Total Response, Prioritised, Sole/Combination
Numerical ageing
Absolute increase in the # of elderly (-Reflects previous demographic patterns
– Improvements in life expectancy)
e.g. High fertility rates 60yrs ago = larger # of elderly today
Structural ageing
Increase in the proportion of the pop that is elderly
– Driven by decreases in fertility rates – Began occurring in the 1800s
How does Numerical and structural aging occur?
independently but usually converge
Natural decline
When deaths > births (combo of absolute + structural ageing). More elderly = more deaths
Absolute decline
When there is insufficient migration to replace the decreased births and increased deaths - Not expected to happen in NZ for 70+ years – Happening in some European/Asian countries
Inequalities
Measurable differences/variations in health. Differences in health experience/outcomes between diff pop groups (social gradient)
Inequities
Those inequalities that are deemed to be unfair/unjust. Relations of equal and unequal power (political, social and economic, justice and injustice)
Health inequities:
Differences in the distribution of resources/services across pop which do not reflect health needs.
MoH equity
In NZ, ppl have differences in health that are avoidable, unfair/unjust. Equity: Diff people with diff levels of advantage require diff approaches/resources to get equitable health outcomes.
Te Tiriti o Waitangi
- Mana whenua
- Mataawaka
PROGRESS
- Place of residence
- Race/ethnicity/culture/language
- Occupation
- Gender/sex
- Religion
- Education
- Socioeconomic status
- Social capital
RD
Rate Difference
– absolute measure – EGO-CGO
RR
Rate Ratio
– relative measure
– EGO/CGO
Why health inequalities should be reduced
- The equitable thing to do - unfair
- Health inequalities are avoidable
- They affect everyone
- There are economic benefits associated - cost effective
Where do inequities in health outcomes result from?
Inequities in opportunities
Lorenz curve - Gini Coefficient
The ratio of the area between the line of perfect equality and the observed Lorenz curve to the area between the line of perfect equality and the line of perfect inequality
Gini = (A) / (A+B)
Lorenz curve - Gini Coefficient
if Gini = 0?
A very equal society
Lorenz curve - Gini Coefficient
if Gini = 1?
A very unequal society
The implications of (income) inequities
- An unequal society
- Less social cohesion
- Less trust between groups
- Increased stress
- Reduced economic productivity
- Poorer health outcomes
Transport choices
Cost, Travel time/ability to wake up in the morning, Car parking, Bus/Train timetabling, Distance, Walkability, Access to car/bicycle, Cycleways/Footpaths, Connectivity, Safety, Availability of showers at destination,Convenience, Children, Weather, Hills, Stuff to carry, Exercise, Time outdoors, Peers, Bike storage, Age, Fitness level, Mobility, Gender, Habits, Society/cultural expectations
Promoting Sustainable Modes of Commuting
Northern Busway, City Rail Link, T2/T3/Bus Lanes, Northwestern Motorway, Dedicated Lanes for Cyclists, Dedicated Cycleway/Footpath – Grafton Gully, Queen Street-Walkability, Walking School Buses (big scale)
Cycling
Health benefits
Reduce stress, promote weight loss, builds stamina/muscle strength, increases cardiovascular fitness/longevity, boosts immune system, aids in heart disease prevention
Cycling
Health risks
Air pollution exposure & accidents
Impact of noise barriers on air pollution conc. adjacent to motorways
- 30% reduction on average in ultrafine particle exposure with barrier
More people will cycle in neighbourhoods with:
- Low traffic volume with low vehicle speed on residential streets
- Separate cycleways on high-traffic roads
- Mixed land use (residences, commercial entities and civic facilities all co-located) so that destinations are walkable/bikeable from home
IMD variables
CHAInwHEEl
Crime, Health, Access, Income, Housing, Education, Employment
IMD
Crime
The Crime Domain measures the risk of personal and material victimization (mostly theft, burglaries and assaults): damage to person or property
IMD
Health
Identifies areas with a high level of ill health (hospitalizations, cancer) or mortality
IMD
Access
Measures the cost and inconvenience of travelling to access basic services. Supermarkets, GPs, service stations, ECE, primary and intermediate schools
IMD
Income
Captures the extent of income deprivation in a data zone by measuring state funded financial assistance to those with insufficient income
IMD
Housing
Proportion of people living in overcrowded housing and the proportion living in rented accommodation
IMD
Education
Captures youth disengagement and the proportion of the working age population without a formal qualification
IMD
Employment
Measure the degree to which working age people are excluded from employment
