Social determinants of health inequalities Flashcards
what did Semmelweis do?
1847 - Ignacz campaigned for hand washing after discovering a correlation between purpureal fever and dissection
what is the main determinant of population health?
not mean income, but extent of income division
what is the Gini coefficient?
a statistical representation of the nation’s income distribution amongst its residents - the lower the coefficient, the greater the equality amongst people
what is the Gini coefficient like compared to other countries?
high, compared to Scandinavian countries (e.g. Denmark)
what is the most powerful predictor of health experience?
socioeconomic model of health
what were responses to health inequalities?
black report, Acheson report, proportionate universalism
what is the Black Report?
1980
material: environmental causes, maybe mediated by behaviour
artefact: apparent product of how inequality is measured
cultural/behavioural: poorer people behave in unhealthy ways
selection: sick people sink socially and economically
what is the Acheson Report?
1998
income inequality should be reduced
give high priority to the health of families with children
what is Proportional Universalism?
focusing on the disadvantaged only will not help to reduce the inequality
action must be universal but with a scale and intensity proportional to the disadvantage
fair distribution of health is important
what are theories of causation?
psychosocial, neo-material, life-course
what is the psychosocial theory of causation?
stress results in inability to respond efficiently to body’s demands
impact on BP, cortisol levels and inflammatory and neuroendocrine responses
what is the neo-material theory of causation?
more hierarchal societies are less willing to invest into the provision of public goods
poorer people have less material goods, and the quality of these is usually lower
what is the life-course theory of causation?
combination of psychosocial and neo-material explanations
critical periods - greater impact at certain points in life course
accumulation - hazards and impacts add up -> hard work leads to injuries, -> disability
interactions and pathways - sexual abuse in childhood -> poor partner choice in adulthood
what are types of interactions and pathways that can affect life course?
sexual abuse in childhood -> poor partner choice in adulthood
what are the domains of public health?
health protection, improving services, health improvement, addressing the wider determinants of health
what are examples of health protection?
infectious diseases, chemicals and poisons, pollution, radiation, emergency response
what are examples of improving services?
clinical effectiveness, efficiency, service planning, equity
what are examples of health improvement?
lifestyles, family and community, education, employment, housing, surveillance, monitoring
what are examples of addressing the wider determinants of health?
seeing the big picture - making sense of data
what are ethical levels?
meta-ethics, ethical theory, applied ethics
what is meta-ethics?
exploring fundamental questions: right/wrong/defining good life
what is ethical theory? what are its categories?
philosophical attempts to create ethical theories
virtue, categorical, imperative, utilitarianism, 4 prinicples
what is applied ethics?
recent emergence of ethical investigation in specific areas (environmental, medical, public health)
what are ethical arguments?
deductive, inductive, considering what we believe in, ethical analogies
what are types of ethical fallacies?
ad hominem, authority claims, begging the question, dissenters, motherhoods, confusing necessary and sufficient, no true scotsman
what is ad hominem?
responding to arguments by attacking the person’s character rather than the content of their argument
what are authority claims?
saying a claim is correct because authority has said so
what is begging the question?
petition principii
assuming initial point of the argument
what are dissenters?
identifying those who disagree does not itself prove the claim is not valid
what are motherhoods?
inserting a soft statement to disguise the disputable one
what is the no true Scotsman argument?
modifying the argument e.g. “no true Scotsman would do that” “but this one did” “well, no true Scotsman would”
what are structural determinants of illness?
social class, material deprivation/poverty, unemployment, discrimination/racism, gender and health
what is the biomedical model?
mind and body are treated separately
body, like a machine, can be repaired
this privileges use of technological interventions
neglects social and psychological dimensions of disease
when is disclosure allowed?
if required by law (notifiable disease, regulatory bodies, ordered by judge/police)
patient consent
public interest (communicable disease, serious crime, research, education)
what are criteria for disclosure?
anonymous if practicable
patients consent (overrule?)
kept to necessary minimum
meets current law (data protection)
what happens to duty of confidentiality after death?
continues
what are the main notifiable diseases?
must be reported to WHO
cholera, yellow fever, plague
what are the types of health behaviour?
health, illness and sick role behaviour
what is health behaviour?
aimed to prevent disease (eating healthily)
what is illness behaviour?
aimed to seek remedy (going to the doctor)
what is sick role behaviour?
aimed at getting well (compliance, resting)
what are five lifestyle factors promoting mortality?
smoking, obesity, sedentary life, excess alcohol, poor diet
what are theories of behavioural change?
Health Belief Model, Transtheoretical model
what is the Health Belief model?
Becker (1974):
individuals must believe they’re susceptible to the condition
individuals must believe it has serious consequences
individuals must believe that taking actions reduces their risks
individuals must believe that the benefits of taking actions outweigh the costs
what is the Transtheoretical model?
pre-contemplation (no intention to give up smoking
contemplation (considering quitting)
preparation (getting ready to quit in near future)
action (engaged in quitting)
maintenance (steady non smoker)
relapse?
what are the key theories in ethics?
utilitarian/consequentialism, Kantianism, virtue ethics, four principles
what is morality?
concern with the distinction between good and evil or right and wrong (universal)
what is ethics?
system of moral principles and a branch of philosophy which defines what’s good for individuals and society (may differ in different culture)
what is utilitarian/consequentialism?
teleological
act evaluated solely in terms of its consequences
maximising good and minimising harm
greatest happiness principle of John Stuart Mill
what are the types of utilitarian/consequentialism?
hedonistic, rule, act, preference
what are the criticisms of utilitarian/consequentialism?
future consequences are difficult to predict
measuring and comparing the goodness of consequences is difficult
easy to bias in favour of particular groups
ignores intentions, past actions, character and fairness
doesn’t take account of fairness of result and may be inconsistent with human rights
what is utilitarianism?
states that people should maximise human welfare/well-being
what is hedonism?
states that people should maximise human pleasure
what is act consequentialism?
looks at every single moral choice anew
a particular action is morally good only if it produces more overall good than any alternative action
what is rule consequentialism?
bases moral rules on their consequences
whether acts are good or bad depends on moral rules
moral rules are chosen solely for basis of consequences
what rules should be adapted in rule consequentialism?
rules that would produce best results if they were adopted by most people
what is consequentialism based on?
whether an act is right or wrong depends only on the results of that act
the more good consequences an act produces, the better/more right the act
what is Kantianism?
features of the act themselves determine worthiness (goodness) of that act
following natural laws and rights
what are categorical imperatives of Kantianism?
set of universal moral premises from which duties are derived (e.g. do not lie)
what is deontological?
duty (from Greek)
focuses on rightness/wrongness of actions themselves, as opposed to wrongness of consequences of actions/character of actor
what is Kantianism founded on?
Kant’s view of rationality as ultimate good, all people being fundamentally rational
what is Kant’s main contribution towards ethics?
theory of Categorical Imperative
what is the Categorical Imperative?
one should act only in such a way that you’d want your actions to become a universal law - applicable to everyone in a similar situation
what are semi-Kantians? when did they arise?
1790s - altered features of Kant’s system that they saw as inadequate, unclear or wrong
Friedrich Schiller (1759-1805) Friedrich Bouterwek (1766-1828) Jakob Friedrich Fries (1773-1843)
when was the period of post-Kantianism?
1790 - 1835
German Idealists
what is idealism?
theory that fundamental reality is made up of ideas or thoughts and not physical matter
what is Rationalism?
knowledge could be attained by reason alone, a priori
dominant philosophical school of 18th century
what is Empiricism?
knowledge could be arrived at only through the sense, a posteriori
what is transcendental idealism? who proposed it?
Kant - we directly know of at least the possibility of noumena (things in themselves) - both empirically and transcendentally real even if they can’t be directly/immediately known
what are noumena?
things in themselves
who created Kantianism?
german idealist philosopher Immanuel Kant
when was Kantianism founded?
centred in Germany during Age of Enlightenment of late 18th and early 19th century
what are the criticisms of Kantianism?
Hegel - provide no specific info about what people should do as moral law is a principle of non-contradiction
Hegel - forces humans into an internal conflict between reason and desire
Schopenhauer - argues that ethics should be practical and offer a solution to real-world problem, whereas Kantianism is more idealised/perfect world-ish
Nietzsche - system benefits interests of people over others. Kantianism undermines his views of autonomy.
Mill - Kantianism can’t explain why certain actions without appealing to utilitarianism (bad reliance on reason, can’t explain why actions are right/wrong)
what is virtue ethics?
approach to ethics that emphasises an individual’s character as the key element of ethical thinking, rather than rules about acts themselves (deontology) or their consequences (consequentialism)
what are the three main strands of virtue ethics?
eudaimonism, ethics of care, agent based theories
what is eudaimonism?
classical formation of virtue ethics
eudaimonia: proper goal of human life. happiness/good life. can be achieved by lifetime of practicing virtues in everyday activities (phronesis - practical wisdom) to resolve any conflicts
what is a virtue?
habit/quality that allows individuals to succeed at their purpose
what is a teleological belief?
includes an account of the purpose or meaning of human life
when is virtue ethics only intelligible?
if it’s teleological
what are moral and intellectual virtues?
moral: prudence, justice, fortitude, temperance
intellectual: theoretical and practical wisdom
what did Aristotle argue about the moral virtues?
they’re each a golden mean (desirable middle ground) between two undesirable extremes
