Session 3 - Inequalities and Inequities Flashcards
In what was can we measure the health of different groups?
Mortality and life expectancy
Self report - surveys and questionnaires
Admissions to hospitals
Diagnoses made at GP’s
In what ways can socio-economic status be calculated and measured?
- National Statistics Socio-economic classification -this is calculated using peoples current and past work status, title and responsibilities. They are then placed into a category 1-8 E.g the highest category is Higher managerial and professional (lawyers, architects, doctors) followed by lower managerial, with the lowest category being routine encompassing jobs such as bar staff, cleaners, labourers bus and lorry drivers
- Index of multiple deprivation. Uses 7 domains: Income, employment, health and disability, education skills and training, barriers to housing and services, living environment and crime. These are ranked and allow for comparisons.
What trends can be seen with socio-economic status?
These is higher infant mortally in lower socio-economic classes.
There is lower life expectancy and fewer disability free years in lower socio-economic groups.
Therefore the more deprived a person is the larger proportion of their life is spent in ill-health and they are more likely to die at a younger age.
Define inequality:
When things are different (not equal)
Define inequity:
Inequalities that are unfair and avoidable e.g. they are not accounted for by clinical need.
What are the patterns in usage of healthcare in lower socio-economic groups?
Higher rates of usage of GP and Emergency services
Underage of preventative services - e.g screening or asthma outpatients, and of specialist services e.g. CABG/cancer treatments.
What factors can explain the patterns in healthcare usage in lower socio-economic groups?
Tendency to manage health as a series of crises
Tendency to use more porous services
Event based consulting may be required to legitimise consultations
Normalisation of ill-health
Difficulty getting the resources needed to negotiate and engage with healthcare services e.g time of work/childcare/family support.
May reflect lack of cultural alignment between health services and lower SE groups.
Adjudications of technical and social eligibility by doctors affect referrals and offers.
Apart from socio-economic class what other factors affect access to and inequalities in healthcare?
Ethnicity Gender Age Disability Homelessness
What is the ‘artefact’ explanation of inequalities in health?
From the Black Report. Suggests that inequalities are simply due to the quality of the data and the method of measurement.
Numerator - based on the occupation of those who die during the period considered.
Denominator - occupational distribution at the most recent census.
This is a mostly discredited explantation and if anything underestimates the inequalities.
What is the ‘social selection’ explanation of the inequalities in health?
From the Black Report. Health status is related to social position. Sick individuals move down the social hierarchy and health individuals move up. Chronically ill and disabled people are more likely to be disadvantaged.
This is a plausible explanation but studies suggest that social selection only makes a minor contribution to SE differences on health and mortality.
What is the ‘Behavioural-cultural’ explanation of the inequalities in health?
From the Black Report. Ill health is due to people’s choices/decisions, knowledge and goals. People from disadvantages background tend to engage in health damaging behaviours and those in advantaged backgrounds tend to engage in health-promoting behaviours.
However - behaviours are outcomes of social processes they are not simply down to individual choice. Choices may be difficult to exercise in adverse conditions. And these choices may seem rational for those whose lives are constrained by their lack of resources.
What is the ‘Materialistic’ explanation of the inequalities in health?
From the Black Report. Inequalities in health arise from differential access to material resources e.g. lo income, unemployment, work environment, low control of job, poor housing conditions.
Lack of choice in exposure to hazards and adverse conditions. Accumulation of factors along life course. This is the most plausible explanation from the black report. However more research is required. As per…
What is the ‘Psychosocial’ explanation of the inequalities in health?
Psychosocial pathways act in addition to direct effects of absolute material living standards. e.g data from Whitehall studies showing a social gradient of psychosocial factors. Some stressors are on a social gradient e.g negative life events, social support, autonomy at work, job security. Stress has an impact on health via different pathways direct and indirect. The direct effects are physiological and also affect the immune system. The indirect effects include effects on HRB and mental health.
What is the ‘Income distribution and psychosocial pathway’ explanation of the inequalities in health?
Relative (not average) income affects health
Countries with greater income inequalities have greater health inequalities. It is not the richest by the most egalitarian societies which have the best health.
This is also associated with psychosocial explanation.
What are some of the inequalities between male and female health?
Males - higher mortality rates More suicide and violent death Females - higher life expectancy Higher reported (poor) mental health Higher rates of disability and limiting longstanding illness.
