Patterns Of Health & Health Inequalities In The UK

Question 1

Why is it important to understand population patterns of health and illness?

Answer 1

Patterns change over time
Differences between/within countries (i.e. due to income)
Key to understanding health inequality
Targeting of efforts to improve population health

Question 2

What is the population perspective?

Answer 2

Produces different view to looking at individuals; factors affecting the health of population equate to more than adding up the individual determinants

Question 3

What has been the epidemiological transition of the UK in terms of health trends?

Answer 3

• Social + economic development
• Transition in demographic + disease profile
• Deaths from acute infections + deficiency decline
• Deaths from chronic + non-communicable diseases increase
• > decline in death, birth rate + overall population health increase

Question 4

What is infant mortality?

Answer 4

Deaths within 1st year of child’s life

Important indicator of population health status as closely associated with living condition

Question 5

How has infant mortality changed in England + Wales?

Answer 5

There was a significant decline till about 2014/15 where there was a concerning increase so there is now some concern as West Midlands have one of highest rates

Question 6

What is child mortality?

Answer 6

Death of a child between the ages of 1-15 years

Important indicator of population health

Question 7

How has child mortality changed in England + Wales?

Answer 7

Steady decline but some concern now as we have a higher rate than other EU countries particularly for children under 5 years old (ranked 20/28 + 50% higher than Sweden)

Question 8

What is life expectancy at birth?

Answer 8

Average no. of years a newborn baby would be expected to live if mortality patterns at time of birth stayed constant (although they don’t; only way to predict this)

Important indicator of population health

Question 9

How has life expectancy at birth in the UK changed?

Answer 9

Increase since 1980s in both genders but concern because this increase has slowed down around 2011 +come to a halt around 2015/16 - this is a concern

Perhaps linked to austerity + difficult living conditions of some populations

Question 10

What parameter can we use instead of life expectancy at birth to better establish population health?

Answer 10

Healthy life expectancy at birth: average no. of years spent in good health

Question 11

What is shown in the UK for women and men’s life expectancy’s?

Answer 11

• Women have higher life expectancy although men are catching up
• Men have a better healthy life expectancy

Question 12

How is good health measured in the population? What has been found out via this method?

Answer 12

Measured using survey that asks people to rate their own health - subjective but shown to fit with more objective + medical measures too

> 20% of life not spent in good health so this is important for quality of life + demands on health service

Question 13

What are the leading causes of death (age standardised mortality rates) in England and Wales? List them from top to bottom.

Answer 13

Dementia/Alzheimer's 
IHD 
Cerebrovascular diseases
Chronic lower respiratory diseases
Lung cancer

Question 14

How was age-standardised mortality rates changed for England and Wales?

Answer 14

• Dementia overtaken IHD in last couple of years + still increasing (due to longer life expectancy)
• IHD, cerebrovascular disease, chronic lower respiratory disease + lung cancer decreasing year-on-year

Question 15

What are the differences in age-standardised mortality rates of men and women?

Answer 15

• Leading cause of death in men = IHD (although rates decreasing)
• Leading cause of death in women = dementia/Alzheimer’s (women live longer than men)

Question 16

In terms of cancer, what is the main cause of death in men and women?

Answer 16

Lung cancer for both

Question 17

What is the current long-term trend in the UK showing?

Answer 17

• Optimistic picture of health improvements over last century
• Undergone an epidemiological transition
• Increase life expectancy at birth but growth has slowed/halted
• Increase in disability free life expectancy
• Disease patterns changing

Question 18

How can be assess the distribution of health within a population?

Answer 18

Social epidemiology - concerned with social patterning of population health:

• Examines differential risks for social groups
• Looks at attributes of individuals within groups to try to explain pattern (not all individuals in group have all attributes/experience same outcomes)

Question 19

Define health inequality.

Answer 19

Marked social patterning -> systematic (not random) differences in health + illness between social groups i.e. gender, ethnicity, geography, socio-economic position, age + sexuality

Question 20

How is socio-economic status measured?

Answer 20

In a number of ways using occupation, income, education, access to or ownership of assets (housing, car) + index of multiple deprivation

Question 21

What is Registrar General’s socio-economic classification?

Answer 21

Most commonly used to look at health inequality + based on occupation

Proxy for status, income (generally), access to material resources + education

National statistics usually provided by this classification

Question 22

What are some examples of classes used in the national statistics socio-economic classifications?

Answer 22

• 1 = higher professional + managerial e.g. doctors

- 7 = unclassified e.g. students + never had a full time job like young people (big group)

Question 23

What is the social pattern evident across many indicators?

Answer 23

Clear social gradient i.e. stepwise/linear gradient in health -> with each step down the socio-economic ladder health becomes poorer

Evident across many indicators of general health + morbidity measures e.g. infant mortality rate, male/female life expectancy at birth

Question 24

What cancers are more predominant in groups with different socioeconomic status?

Answer 24

Low: larynx + non-melanoma skin cancer

High: malignant melanoma (more holidays + UV exposure) + breast (fewer children + later births)

Question 25

How does geography affect health patterns in the UK?

Answer 25

• Variations in health between regions/neighbourhoods
• Morbidity/mortality rates higher in North (East + West), West + in urban areas
• Substantial inequalities in morbidity + mortality rates within local areas (e.g. in Coventry)

Question 26

What are the 3 explanatory models for health inequalities?

Answer 26

1. Behavioural + cultural
2. Social inequality (material + neo-materialist)
3. Psychosocial model

Question 27

Explain the behavioural/cultural model.

Answer 27

Proposes that health inequalities are as a result of variations in health behaviours + lifestyles e.g. smoking, diet, exercise etc.

Health behaviour choices seen as result of individual choices OR knowledge OR culture

Question 28

What is the evidence for the behavioural/cultural model?

Answer 28

Most important health behaviours follow social gradient e.g. smoking, lack of physical activity + poor nutrition higher in lower socio-economic groups (doesn’t mean everyone in these groups has unhealthy behaviours though)

Question 29

Why is there a social gradient seen for health behaviours?

Answer 29

Knowledge + attitudes not shown to have strong association for e.g. in smoking so:

Differences in social groups explained by social factors like socio-economic circumstances, education, gender + culture/ethnicity

Question 30

How does social inequality affect health behaviours?

Answer 30

Social inequality = strong determinant of health behaviour

People with low incomes under increased cognitive load, find it difficult to make decisions for future as have enough problems e.g. just want to feed kids, let alone look after health or too stressed to quit smoking

Question 31

Explain the material explanation of the social inequality model.

Answer 31

Proposes that health inequalities result from socio-economic differences in access to material resources -> access to material health resources shaped by broader structural factors e.g. place in society, policies etc.

= health inequality direct effect of poverty + material deprivation

Question 32

What is the evidence for the material explanation of the social inequality model?

Answer 32

Lower socioeconomic status associated with poorer access to material health resources

Material resources: income, food, fuel, heating, housing, transport, healthy environments + exercise facilities

Question 33

Why does social inequality of material resources affect diet?

Answer 33

Higher income associated with better diet - more purchase of fruit/veg, more fibre + less sugar

Lower income groups spend more income on food leaving less for other things - high calorie, low nutritional value foods cheapest -> social security benefits inadequate for healthy diet

Question 34

What are the consequences of poor diet/nutritional status?

Answer 34

Elevated risk of:
CHD
Type 2 diabetes
Childhood obesity
etc.

Question 35

Where do we see poorer access to material health resources?

Answer 35

• Individual level
• Community level: underinvestment in physical, social + health infrastructures affects lower socioeconomic groups most (neo-materialist approach)

Question 36

Many of richest countries have greatest __ + __ ___.

Answer 36

Social + health inequality

Question 37

Why do the models of health inequality not work as explanations on their own?

Answer 37

Health related behaviours alone cannot account for all of the current patterns of health inequalities + the social gradient is not associated with absolute poverty so likely that health is impacted by behavioural, material + psychosocial pathways

Question 38

What is the psychosocial explanation of social inequality?

Answer 38

Health inequality linked to psychosocial environment i.e. way people’s environment makes them feel

Psychosocial stress affects health:

• Directly - ‘allostatic load’ theory links environment to physical disease through neuroendocrine pathways
• Indirectly = adoption of unhealthy behaviours e.g. smoking

Question 39

What are some examples of psychosocial stress?

Answer 39

Money + other worries associated with low income + poorer material circumstances

Stress associated with position in social hierarchy

Question 40

How do psychological stress and material circumstances interact?

Answer 40

People lower down social structure face stress more frequently

Stress of everyday living due to low income + poorer material environments explain poor health

Question 41

What are the psychosocial effects of relative poverty?

Answer 41

Strong relationship between inequality distribution within countries + health

More about income inequality then amount of money

Poorer health outcomes associated with stress related to feeling less well-of than others

Question 42

What are the psychosocial effects of low social control?

Answer 42

Higher stress levels when their is lower social control at work

Poor health outcomes associated with lower social control over life

Question 43

Define lifecourse effects.

Answer 43

Material, behavioural + psychosocial (& biological) processes that operate independently, cumulatively + interactively across an individuals life course, or across generations, to influence development of disease risk

Question 44

What are examples of unhealthy behaviours?

Answer 44

Smoking
Poor nutrition
Alcohol consumption
Moderate physical activity
Vigorous physical activity

Question 45

How can social + economic circumstances come together to affect health?

Answer 45

Can be the causes of the causes affecting health directly or indirectly

Socioeconomic position (SEP) -> affects material + psychosocial factors -> directly affects general + mental health

OR

Material + psychosocial factors -> adopt unhealthy behaviours -> indirectly affecting general + mental health

Question 46

What models seem to have a bigger effect on health inequality between socioeconomic groups?

Answer 46

Material + psychosocial explanations explain more of health inequality than behavioural explanations