PASS S2 - Health inequalities

Question 1

What is the definition of health inequalities?

Answer 1

Health inequalities are defined as “unfair and avoidable differences in health across the population, and between different groups within society. Health inequalities arise because of the conditions in which we are born, grow, live, work and age. These conditions influence our opportunities for good health, and how we think, feel and act, and this shapes our mental health, physical health and wellbeing.” (NHS England)

Question 2

What is the relationship between deprivation and ill health?

Answer 2

The more deprived a person is, the larger the proportion of their life will be spent in ill health, and the more likely they will die at a younger age

Question 3

What are some explanations for health inequalities?

Answer 3

Black Report
Psychosocial explanation
Income distribution

Question 4

What are the four explanations in the Black report?

Answer 4

Artefact explanation
Social selection explanation
Behavioural-cultural explanation
Materialist explanation

Question 5

Explain what the Artefact explanation is

Answer 5

Health inequalities are evident due to the way statistics are collected
Concerns about the quality of data and method of measurement
Mostly discredited as an explanation

Question 6

Explain what the social selection explanation is

Answer 6

Direction of causation is from health to social position
Sick individuals move down social hierarchy, healthy individuals move up
Chronically ill and disabled people are more likely to be disadvantaged

Question 7

Explain what the Behavioural-cultural explanation is

Answer 7

Ill-health is due to people’s choices/decisions, knowledge and goals
Useful explanation

Question 8

Name some limitations of the Behavioural-cultural explanation

Answer 8

Behaviours are outcomes of social processes, not simply individual choice
‘Choices’ may be difficult to exercise in adverse conditions
‘Choices’ may be rational for those whose lives are constrained by their lack of resources

Question 9

Explain what the Materialist explanation is

Answer 9

Inequalities in health arise from differential access to material resources
Lack of choice in exposure to hazards and adverse conditions
Most plausible

Question 10

Name a limitation of the Materialist explanation

Answer 10

Further research needed as to precise routes through which material deprivation causes ill-health

Question 11

Explain the psychosocial explanation

Answer 11

Psychosocial pathways act in addition to direct effects of absolute material living standards
Data from Whitehall studies
Stress impacts health via different pathways: direct and indirect (think back to biopsychosocial model !)

Question 12

Explain the income distribution explanation

Answer 12

Relative income affects health
Countries with greater income inequalities have greater health inequalities
The most equal societies have the best health
Associated with the psychosocial explanation (greater income inequality -> greater social-evaluative threat -> greater stress -> worse health)

Question 13

How can we measure access to healthcare?

Answer 13

UTILISATION
Studies measure receipt of services
Evidence about utilisation is contradictory and difficult to interpret

Question 14

What is the pattern of access to healthcare like for the most deprived?

Answer 14

Higher rates of use:
GP services
Emergency services
Under-use of:
Preventative services
Specialist services

Question 15

What is the Dahlgren-Whitehead rainbow model?

Answer 15

Maps the relationship between the individual, their environment and health.
Individuals are at the centre, surrounded by the various layers of influences on health - including individual lifestyle factors, community influences, living and working conditions, and more general social conditions