Topic 11: social inequalities in health Flashcards
Describe impact of social divisions on us
- E.g. Divisions of class
- Impact =
> Income
> Services we have access to
> Life opportunities available
Explain wealth and poverty in UK + Europe + N.America
- Wealth is distributed unequally
- Poor people = manual jobs + longer hours + dangerous conditions BUT earn less
- 1% of UK population = 21% total personal wealth
- Poorest 50% population = 7% total personal wealth
- Substantial number of households = no savings
Define absolute poverty
Poor = doesn’t have necessary resources to sustain life
Define relative poverty
- Poor = in relation to others
- Below 60% of median income
Describe social stratification
- Structured system = categories groups of people = creates unequal life choices
- Socio-economic classification = form of stratification
Describe working class
- Wages = weekly
- Jobs = routine manual jobs
- Residence = rented
- Children = expected to get jobs after school
Describe middle class
- Wages = monthly salaries
- Jobs = non-manual
- Residences = borrow money to buy own houses
- Children = encouraged to get higher education
Give the 5 classes based on occupation
1) Professional = doctors/lawyers
2) Intermediate = managers/nurses
3) Skilled non-manual = shop assistants/police
4) Skilled manual = electricians/miners
5) Semi-skilled manual = postman/farmer
6) Non-skilled manual = cleaners
Describe 21st century social class
- Using the Great British social class calculator
- By researchers from 6 UK unis + BBC
- Online survey = response by 161k people
Give the 7 21st century social classes
1) Precariat
2) Emergent service workers
3) Traditional working class
4) New affluent workers
5) Technical middle class
6) Established middle class
7) Elite
Explain the difference in health profile of people by social class
- Boys born in 2 lowest classes = like expectancy 70 = 5 years < than highest classes
- Men in manual classes = 40% more likely than non-manual to report chronic illness = limit activities
- Children from manual worker households = more likely to suffer chronic disease + tooth decay than non-manual
What causes the inequalities in health?
- Inequalities in wealth
- Leads to lifetime accumulation of disadvantages = poor health outcomes
- Cumulative differential exposure to health-damaging/health-promoting physical/social environments = variation in health/expectancy
What are the 3 ways suggested by Marmot where socio-economic position linked to health?
1) Money
2) Status
3) Power
Give the trends in monitoring social inequalities in health life expectancy + mortality + LT conditions
LIFE EXPECTANCY:
- Increased over the years male/female
- However decreases from class 1-7 male/female
MORTALITY RATES:
- Decreased over the years
- However increase from class 1-7
LONG TERM CONDITIONS:
- Prevalence increases from class 1-7
- Unskilled = 52% suffer compared to 33% in professionals
- Cancer + CVD increase from least to most deprived
Describe social selection
- Individuals biologically vulnerable to disease = reason why don’t move up social strata
- Therefore socioeconomic status doesn’t affect health negatively BUT health determines social class
- Illness> unable to get employment> downward social mobility
What are the limits of social selection model?
- Not sufficient = doesn’t account for differences in health by social class
- Social mobility usually before serious diseases prevalent
- Incapacity doesn’t always cause downward mobility
Describe the materialist model
- Argues = access to materials + control of resources = influences health
- Access to resources = education + healthcare + housing
- Lower socioeconomic status = less likely to access
- Poverty exposes them to greater hazards = poor housing + pollution + insufficent food = chronic stress + loss of sense of control
Explain the context and evidence of the materialist model
1) Post-war improvements =
- After WW2 living standards improved = increased life expectancy
- Social inequalities in health persisted
2) Research findings =
- Poor housing + limited access = associated with worse health outcomes
3) Inverse care law =
- Healthcare least accessible in most needed places e.g. impoverished
- If services available = costly + difficult to access
Give the barriers to healthcare access
- Availability = shortages + lack of facilities
- Cost
- Info = lack of awareness
Describe the behavioral model
- How individuals behave
- Health damaging/promoting behaviors
- LT studies suggest = differences in health behavior explain only 1/3 social class differences in mortality
Give health damaging/promoting behaviors
DAMAGING:
- Smoking
- Alcohol abuse
- Unhealthy diet
PROMOTING:
- Physical exercise
- Health literacy
- Health beliefs
What is the cultural explanation of the behavioral model/limitations?
- Middle + working class have different culture
- However even if economic disparities addressed = equal income/access = cultural factors still create health inequalities
- Practices + dietary habits = influence health outcomes
- Ethical question = even if cause poor health is it appropriate to encourage cultural change
- May be infringement of identity + autonomy
Describe the psychosocial model
- Society’s inequality structures = psychological stress
1) Social inequalities = feel subordinate + disadvantaged = imbalance between home + work
2) Social support = evidence that people withe good relationships + part in community = longer life expectancy than those isolated
What are 2 pathways from stress to poor health in psychological model?
1) Direct effect on disease development = mental illnesses
2) Indirect when stress expressed by health-damaging behaviors
Give some stress-related mechanisms
1) Low socioeconomic groups experience = more stressful life events + stereotyping + stigma + social isolation
2) Lack of social relationships = maladaptive coping strategies
3) Affluent individuals have beneficial social connections = buffer against stressful life events
Describe the life-course model
- Experiences with social conditions + social positioning over time
1) Disadvantage at 1 time associated with disadvantage at different time = research suggests poor home experiences in childhood more likely to experience occupational disadvantage as adult
2) Methodological + conceptual issues = timing/duration of exposure across life - Risk factors accumulate + interact over life-course
Describe class mobility
- Study showed class of origin + class of destination = both influence health
- Born working class = bad for health = moving up social ladder cannot compensate
- Worse health outcome = born + stay in working class as adult
Which model is most sufficient answer?
- Combination of materialist + behavioral + psychosocial models
- Working-class people more likely to =
> Limited access to resources
> Smoke + alcohol + unhealthy diets - Cause =
> Wage workers suffer from chronic stress = smoking/alcohol/food are coping mechanisms
> Working class has poorer literacy = more influenced by inequality culture
Define health policy
- Studies providing documentation of health inequalities + policy recommendations in UK
What are the 3 health policies in the UK?
1) Black report = clear difference in mortality + morbidity across social class
2) Acheson report = Mortality decreased in last 50 years BUT inequalities in health remain = unemployment + housing + education
3) Marmot review = health inequalities post 2010
- Addressed social justice + fairness
- View of social determinants of health
- Properly addressed levels of deprivation
