Overview of Health Inequalities Flashcards
Describe the possible reasons behind the association between health and deprivation:
- artefact
- social selection
- behavioural
- psychosocial
- material
- access to healthcare
- artefact = observed associations not genuine, but exist because of the ways health and deprivation are measured
- social selection = health determines socio-economic status rather than socio-economic status determining health
- behavioural = people in deprived areas are more likely to smoke, eat poor diets, not take exercise
- psychosocial = the stress of working in poorly paid, low status jobs with little autonomy creates harmful biological effects
- materials = the direct effects of poverty
- access to healthcare = deprived population have poorer care
What are the 5 aspects of healthcare use?
- recognising health need
- seeking and accessing advice
- diagnosis, treatment and support
- screening
- health promotion
What factors impact on decision to consult?
person - age, sex, ethnicity, previous healthcare experience nature and duration of symptoms accessibility of formal health care - cost, convenience, attitude of staff
Why do poorer people have more need to health care?
- behavioural = people in deprived areas are more likely to smoke, eat poor diets, not take exercise
- psychosocial = the stress of working in poorly paid, low status jobs with little autonomy creates harmful biological effects
- materials = the direct effects of poverty
- access to healthcare = deprived population have poorer care
What are the aspects of access to healthcare?
- travel distance to facilities and transport
- communication servies (e.g immigrants)
- waiting times
- availability = not available to all e.g. IVF, clinicians touching e.g. male/female variation in statin prescriptions
- quality = provider, population groups
- charges (think of a non-UK environment)
Describe ‘ill health from ill health’
- using the example of psychiatric patients
Increased prevalence of IHD and DM in psychiatric patients
- iatrogenic - side effects of medication
- psychiatric condition predisposes them to e.g. smoking
- ill equipped to negative with NHS for physical care
What is the inverse care law?
‘the availability of good medical care tends to vary inversely with the need for it’
Describe equity vs equality
need equity not equality!
Equity = fairness
- recognises people have different needs
- tries to minimise the difference between the care of people with similar needs
- e.g. any means tested services such as prescriptions
Equality = uniformity
- everyone gets the same regardless of needs and ability to benefit
- e.g. buss passes for the elderly
What are the 5 ways to reduces inequalities and inequity?
- reviews
- guidelines
- targets and payments
- frameworks
- regulators
Possible explanation for the lower survival in people living in more deprived areas
Differences in:
- diagnosis (delays, advanced stage of disease)
- treatment (delays, poorer access to optimal care and lower compliance)
- general health (worse in more deprived)
- type of disease (histological type or more aggressive disease)
How did the Pay of Performance scheme (The UK quality and outcomes framwork QoF) affect inequalities int the following?:
- socioeconomic inequality
- age and sex
- ethnic inequalities
Socioeconomic = lower quality of care in deprived v nondeprieved but small magnitude - use of QoF narrowed the gap
Age and Sex = females generally worse off than men, oder worse than young - use of QoF lead to improvements but did not narrow the gap
Ethnic = black and south asian tend to do worse - QoF improved situation for all but did not narrow the gap e.g. in diabetes control
What does the National Service Framework do?
set clear quality quality requirements for care
based on best evidence of what treatments and services work most effectively for patients
e.g. in cancer
