Social Inequalities Flashcards
Topics
1) Social Determinants of Health
2) Deprivation & Mental health
3) Early Life
4) Class
5) Unemployment
6) Social Drift vs Social Causation?
7) Macro-economic context
8) Inequality & Mental Illness
9) Social Inequalities in Mental Health (EU contribution to World Mental Health surveys)
10) Age
11) Age discrimination in Mental health Treatment
12) Disability
13) Urban Environments
14) Rural environments
15) Implication for interventions
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Names and Years
2
Social Determinants of Health
This essay will discuss how inequalities caused by factors such as poverty and class, race and ethnicity, age, and geography impact mental health and illness.
Social Inequalities play an important role in mental health and illness. Life expectancy is shorter and most diseases are more common further down the social ladder in each society (Bartley & Plewis; 2002). It is important also to note that it is not only at the bottom of subhierarchies, for example middle class staff members of lower positions in middle or upper class work environments (Donkin et al., 2002).
Macroeconomic Context
Both poverty and socioeconomic class contribute to mental health and illness. Poverty correlates strongly with mental illness as it comes with financial burden of healthcare, stress, unemployment or underemployment, poor material living conditions, poor nutrition, can lead to substance abuse, strained relationships, marginalisation and can contribute to impaired self-worth (Wilkinson & Marmot, 2003). In Ireland the lowest occupational class has 3-4 times higher rate of mental disorder than higher occupational classes. This notion wa further extrapolated by Concoran and colleagues (2015) who showed that recent recession caused a 58% increase in the male suicide in Ireland. There were 476 more male and 85 more female suicides between 2008-2012 than expected if trends continued as they were before the recession. There were also significant and large increases in self-harm hospitalisations for both sexes during the same time frame. These findings coincide with the notion that there is a correlation between poverty and mental illness. However. it is important to note that although absolute wealth is important for one’s mental health, the equality or inequality of wealth is a more important factor (Wilkinson & Pickett, 2006). Further supportive evidence for this is the strong correlation between high income inequality in a country and poor index of health and social problems; overall wealthy countries that have large uneven distributions of wealth such as the USA have poor index of health and coail problems, while wealthy countries such as Sweden who have a more even distribution of wealth, have good index of health and social problems (Wilkison and Pickett, 2010).
The various resulting from economic differences prevent the affected people in society from focusing on achieving long-term goals that can build future and promote healthy lifestyle behavior. With the same understanding, the significance of unethical behaviour such as cigarette abuse and lack of exercise on human health has been linked to significant causes of death and lower socioeconomic status. Due to a lack of enough economic recourses to live a better life, poor lifestyle remains a significant point of concern for patients suffering from mental comorbidity. Nonetheless, studies showcase that the gaps in life expectancy for people at the lower economic level are significantly associated with mental challenges and negative health behaviours.
Also, society’s poor is linked to limited access to medical services, income despair, and worse conditions in the labour frontier. On the contrary, increased levels of inequality among women have resulted in dire implications, including increased cigarette use rates, high rates of stress, poor nutrition, inadequate prenatal care, and violence, consequently impacting babies both short and long-term durations.
Socioeconomic differences have severe implications and increase the risk of mental illness among society, a phenomenon that is not new to the study. According to research by national comorbidity survey, it was concluded that social inequalities related to low levels of education and income increased the chance of three or more mental disorders among the low-class income group (Price et al., 2018).
Race
Ethnic minorities seem to be a group that are more vulnerable to mental illness such as schizophrenia. Examples of these are Afro-Caribbeans in the UK and Afro-Americans in the US (Mangalore & Knapp, 2012). Ethnic minorities seem to under-use mental health services, have suboptimal routes of passage through services, be detained involuntarily and have poorer treatment outcomes. These issues are largely due to cultural misunderstandings which create gaps in understanding these minorities and in turn leads to providing suboptimal treatment in both clinical and societal regards (McLean et al., 2003). In Ireland, Irish travellers, a minority group, have considerably lower life expectancies relative to settled population; men having a 15 year lower than average, and women a 12 year lower than average. 11% of traveller death are due to suicide, which is 6-7 times higher than the settled population. These minority groups usually also suffer from stigma, are prone to substance abuse, domestic violence, and early parenthood, which are all a form of stress and contribute to the wide array of mental issues these groups grapple with with (Brunner, 1997).
Low quality of psychiatric care and the absence of mental health support for the low working class, minority, and immigrants trigger more concerns concerning the effects of economic differences in treating mental conditions (Vella & Pai, 2013). According to Muntaner et al. (2007), the public health view of psychiatric treatment and efforts on minority people on economic discrepancies is pragmatic. In the same context, pursuing public medical health care principles, the overall objective is to promote better services and ultimately reduce suffering among the marginalised people. Nonetheless, mental health has a significant influence on disability among disadvantaged ethnical groups and the minority poor. As a result, many individuals suffering from it become disabled (Bennett et al., 2019). In the same context, mental illness are among the leading cause of disability among minority marginalised groups, with more forecast projecting that by the end of 2020 it will be the leading cause of years/time lost to disability (Friederich 2017). Generally, the significance of economic discrepancies about psychiatry arises from the strong bond between mental disorders and racial inequality; also, it relates to the dire implications that economic differences have o the overall quality of life of patients suffering from psychiatric morbidity.
Dean (2017) suggesterd a close correlation between the degree of differences and mental morbidity rates in the US. Moreover, he further reiterated that communities with the higher inequality are more likely to have higher cases of health challenges, including mental problems, fishability, and obesity. Social differences have led to people in lower economic groups to get trapped in declining social injustices. Similarly, subjective social positions have inversely been associated with mental challenge disorders in many countries. Social inequalities lead to poverty within the turn, which introduces economic stress, which subsequently results in impairing the cognitive functions of an individual (Price et al., 2018).
Age
Just as there were interrelated factors that contributed to the inequality of minorities, there are such factors for people of age as well. Depression and anxiety increase for those over 80, due to being isolated, fear of death and being alone. Post-retirement elderly people are more likely to suffer from financial insecurity, bereavement and loss of status and identity, or the adoption of maladaptive identity which can all be detrimental to their mental health. Elderly are also somewhat marginalised. The majority of research and treatment is aimed at younger adults. What could be considered symptoms of mental illness such as confusion and low mood are often written off as by-products of getting older.
Cases of bias against age are pervasive in the community and are well-linked to adverse health result. Young people mostly carry out age discrimination against older seniors of society or against young children who are helpless in most cases. There has been increasing interest concerning age inequality as significant risk factor in the medical field of mental health and psychiatric epidemiology. Traditionally, mental well–being and age factor has been a subject of social inequalities within societies (Cockerham, 2014). Researchers have established that social class and mental health have an inverse relationship and contribute to social inequity in preventing, managing, and treating psychiatric cases. With the same understanding, psychiatric epidemiologists are recognised as the first researchers to showcase that poor people in society displayed higher mental illness rates than their well-off counterparts (Vella & Pai, 20013). Besides, mental health studies have inspired more research on economic differences in inequality and mental challenges while reflecting on psychiatrists’ humanistic concerns. The desire to improve human lives, living standards, and well-being of various poetry has inspired the drive for studies in mental health and inequality.
Geography
The environment is also a contributor to one’s overall mental health. Just as stressful prenatal environment or violent upbringing environment can have negative consequences on one’s mental health, so can stressful current living environment. High population density is strongly related to the onset psychosis and cities are linked to reduced wellbeing and higher pathology (Oher et al., 2004). A hypothesis as to why this is, is that our endocrine system - one of the systems responsible for the stress response - is simply not suitable for today’s modern world. In more primal ages, our bodies would only experience high levels of stress when hunting or when a predatory threat was in sight. however, in today’s age, out bodies perceive things such as jobs, exams, workload, traffic, and much more trivial things as stress activators and these tax people’s bodies, making them more susceptible to mental illness and physical illness (Lederbogen et al., 2011). White and colleagues (2013) conducted longitudinal research and found that green spaces played a very important role for mental health; allowing people to unplug from daily stressors and mimicking the sort of environment the more primal parts of the brain are more suitable for. The area one lives in also determines the mental health services that are easily accessible to people, therefore more likely to use. People whom live in more remote areas or that are older don’t have the same accessibility to mental health services as people who live in more urban environments or those that are part of a higher socioeconomic class.
Furthermore, the rates were doubled for those people living in the city. In the same context, Peen et al. (2010) confirmed that city residents had an increased probability of suffering from mood disorders, and more we are prone to experience anxiety challenges of different degrees. Additionally, the study established that city dwellers born and raised in the urban town had a higher prevalence (more than double) of suffering from schizophrenia in similar studies in the UK.
Kirkbride et al., (2012) established that population density, economic inequality, and income deprivation significantly raised the risk of non-affective mental conditions. Also, migration woes increased the rates of schizophrenia by up to three times, a rate that is greater than prevalence linked to winter birth, genetic causes, or obstetric factors. Nonetheless, research studies have positioned the risk factor of schizophrenia at 35% for genetic causes and 250% for environmental factors (Kirkbride et al., 2012). Similarly, more studies that look into the prediction of risk associated with polygenic risk score (PRS) highlighted that psychosis was the same as that from social detriments at one year before the onset of the comorbidity.
Implicatio/Complex intervention
When creating laws and policies to help improve situations, it’s important to consider two key factors: 1) Does lower socioeconomic class lead to poor mental health or does poor mental health lead to lower socioeconomic class and; 2) Interventions need to be multidimensional. The consensus is that there is a two-way relationship between socioeconomic status and poor mental health, however it doesn’t take away from the fact that inequalities are detrimental to mental health and do contribute to mental illness. When proposing and creating new policies to help with these issues, it is important to consider that disadvantaged categories don’t exist in isolation and they can interact in complex ways and that there are no universal solutions.
