Session 3 - Inequalities in Health

Question 1

Give —- factors which effect health

Answer 1

Socioeconomic status
Ethnicity
Gender

Question 2

What is social class?

Answer 2

A segment of the population, distinguished from others by similarities in labour market position and property relations

Question 3

Give four different measurements of socioeconomic status

Answer 3

Individual
Area based
Education
Income

Question 4

Give two example measures of individual socioeconomic classification

Answer 4

Regitrar general scheme

National statistic socio-economic classification

Question 5

What is an area beased measure of socioeconomic status?

Answer 5

Townsend deprivation score

Question 6

What is the townsend depriviation score?

Answer 6

o	Census data
o	4 variables
     	Unemployment
     	Car ownership
     	Overcrowded housing
     	Housing tenure
o	Limitations include heterogeneity and transient populations

Question 7

Define ethnicity

Answer 7

The identification with a social group – membership of a collectivity – on the basis of shared values, beliefs, customs, traditions, language and lifestyles.

Question 8

Give four health factors associated with ethnicitiy

Answer 8

ardiovascular Disease
o Highest percentage prevalence in men of South Asian origin
o Cancer
o Lower prevalence in Black Minority Ethnic (BME) groups
o Infant Mortality
o Higher rates in women of Pakistani and Black Caribbean origin
o Mental Health
o People from Black Minority Ethnic (BME) groups are more likely to be diagnosed with mental illness
o Highest reported percentage of poor mental health is in women of Pakistani and Black Caribbean origin

Question 9

Compare three things about the life expectancies and health of men and women

Answer 9

Men - Higher mortality Women - Higher life expectancy
Men - More suicide and violent death Women - More mental health issues
Women - Higher rates of disability

Question 10

Give four theories for health inequality as outline by the black report

Answer 10

Artefact explanation

Social selection explanation
Behavioural - Cultural explanation
Materialist explanation

Question 11

What is an artefact explanation?

Answer 11

o Health inequalities are evident due to the way statistics are collected (measurement of class)
o Concern about the quality of data and method of measurement
o Mostly discredited as an explanation, as if anything data problems lead to under, not over estimation of inequalities.

Question 12

What is a social selection explanation?

Answer 12

o Direction of causation is from health to social position
o Sick individuals move down social hierarchy, health individuals move up
o Chronically ill and disabled people are more likely to be disadvantaged
o Plausible explanation but contribution only minor

Question 13

What is a behavioural-cultural explanation?

Answer 13

o Ill health is due to people’s choices/decisions, knowledge and goals
o People from disadvantaged background tend to engage in health-damaging behaviours, where people from advantaged backgrounds tend to engage in health-promoting behaviours.
o Useful explanation – e.g. Health Education
o Limitations of Behavioural-Cultural Explanation
 Behaviours are outcomes of social processes, not simply individual choice
 Choice may be difficult to exercise in adverse conditions
 Choice may be ration for those whose lives are constrained by their lack of resources

Question 14

What is a materialist explanation?

Answer 14

o Inequalities in health arise from differential access to material resources
o Low income, unemployment, work environments, low control over job, poor housing conditions
o Lack of choice in exposure to hazards and adverse conditions
o Accumulation of factors across life-course
o Most Plausible
o Limitations of Materialist Explanation
o Further research needed as to precise routes through which material deprivation causes ill-health

Question 15

Which is the most powerful of the four black report explanations?

Answer 15

The materialist

Question 16

Define inequality

Answer 16

When things are different

Question 17

Define inequity

Answer 17

Inequalities that are unfair and avoidable

Question 18

Give two features of the healthcare of more deprived groups?

Answer 18

o Lower rates of use of Preventive (e.g. screening, asthma) and Specialist Services (e.g. cancer treatments)

Question 19

Outline how low socioeconomic status can affect access to healthcare

Answer 19

o Tendency to manage health as a series of crises
o Normalisation of ill health
o Event-based consulting may be required to legitimise consultations
o Difficulty marshalling the resources needed for negotiation and engagement with health services
o Tendency to use more ‘porous’ services
o Doctor’s judgements of technical and social eligibility affects referrals and offers

Question 20

Outline how being a member of an ethnic minority afffects access to healthcare

Answer 20

o Higher use of primary care (some groups)
o Higher use of mental health consultations (South African Female Elders)
o Lower receipt of specialist services
o Variations between and within ethnic groups; be careful to avoid simplistic classifications

o Language and Social Networks may deter help-seeking
o Stigmatisation and Stereotyping
o Association between ethnicity and socioeconomic status

Question 21

How do women access healthcare differently to men?

Answer 21

o Women have higher use of primary care

 Cultural expectations of what is gender appropriate