S2 - Health Inequalities

Question 1

why is measuring socioeconomic status straightforward

Answer 1

can be measured in different ways:
- individual occupation
- the area in which people live

also challenging to measure and compare health eg
- life expectancy
- infant mortality

Question 2

how is deprivation measured

Answer 2

index of multiple deprivation, calculated from cencus data from 7 domains:
- income
- employment
- health and disability
- education, skills and training
- barriers to housing and services
- living environment
- crime

… more complex and nuanced way of understand the way in which people live

Question 3

social patterning of health in UK

Answer 3

• in UK, health inequalities are evident between those from different socio-economic groups
• deprivation is strongly associated with ill health…

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 4

explanations for inequalities in health

Answer 4

covered in Black Report
- artefact
- social selection
- behavioural-cultural
- materialist

others
- psychosocial
- income distribution

Question 5

explanations for inequalities in health: artefact explanation

Black report

Answer 5

health inequalities are evident due to the way statistics are collected
- concerns about quality of data and method of measurement
- mostly discredited as explanation
- if anything, data problems lead to an underestimation of inequalities

Question 6

explanations for inequalities in health: social selection explanation

Black report

Answer 6

direct of causation is from health to social position

• health status → social position, (not social position → health status)
• sick individuals move down social hierarchy, whereas healthy individuals move up
• chronically ill and disabled people are more likely to be disadvantaged
• plausable explanation, but studies suggest that social selection makes only a minor contribution to the socioeconomic differentials in health and mortality

Question 7

explanations for inequalities in health: behavioural-cultural explanation

Black report

Answer 7

ill health is due to people’s choices/decisions, knowledge and goals
* poeple from disadvantaged backgrounds tend to engage more in health damaging behaviours (eg smoking)
* people from advantaged backgrounds tend to engage more in health-promoting behaviours
* explanation eg health education and access to services

limitations
- 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 contrained by their lack of resources

Question 8

explanations for inequalities in health: materialist explanation

Black report

Answer 8

inequalities in health arise from differential access to material resources
eg low income, unemployment, work environments, low control over job, poor housing conditions

• lack of choice in exposure to hazards and adverse conditions
• accumulation of factors across life course (unlikely to have only one of these exposures in isolation)
• most plausible explanation
• limitation is that further research is needed to understand precise routes through which material deprivation causes ill-health

Question 9

explanations for inequalities in health: psychosocial explanations

Answer 9

• psychosocial pathways act in addition to direct effects of absolute material living standards
• data from Whitehall studies (eg Marmot 1991) showed social gradient of psychosocial factors
• some stressors are distributed on a social gradient (eg negative life events, social support, autonomy at work and job security) ie people from lower socioeconomic background are more likely to have negative life events

stress impacts on health via different pathways
* direct (eg physiological, immune system)
* indirect (health related behaviours, mental health)

Question 10

explanations for inequalities in health: income distribution

Wilkinson

Answer 10

• relative (not average) income affects health
• countries with greater income inequalities have greater health inequalities
• it is not the richest, but the most egalitarian societies that have the best health
• egalitarian = fairer

associated with psychosocial explanation:

increased income inequality → increased social-evaluative threat→ increased stress → decreased health

☞ redistributive policies eg tax and min wage
… reducing income inequality in a society can improve social well-being, and in turn, many other health and social factors

Question 11

how can we measure acces to healthcare

Answer 11

utilisation studies measure reciept of services
☞ what about people who don’t access care because they don’t know how or can’t?

evidence about utilisaiton is contradictory and difficult to interpret

Question 12

deprivation and patterns of access to healthcare

Answer 12

more deprived groups seem to have
* higher rates of use of GP + emergency services
* underuse of preventative services (eg screening and outpatients) and specialist services (eg cancer treatment)

this could be due to…

☞ tendency to manage health as a series of crises
☞ normalisation of ill health
☞ difficulty marshalling resources needed for engagement with health services
☞ tendency to use more pourous services (eg services that are readily accessible, eg GP and A+E as these don’t require an appointment)