Week 9

Question 1

What do we mean by health inequalities

Answer 1

Health inequalities are avoidable, unfair and systematic differences in health between different groups of people. There are many kinds of health inequality and many ways in which the term is used. This means that when we talk about ‘health inequality’ it is useful to be clear on which measure in unequally distributed and between which people. (Kings fund 2020)

Question 2

Health inequalities

Answer 2

Preventable and unjust differences in health status across the population and between specific population groups
Avoidable differences do not occur randomly or by chance
Socially determined circumstances often beyond control of the individual
Limit opportunities and healthy life expectancy

Question 3

Health inequality factors that policy often considers

Answer 3

Socio-economic factors, for example, income
Geography for example, region or whether urban or rural
Specific characteristics including those protected in law such as sex, ethnicity or disability
Socially excluded groups for example people experiencing homelessness
(Kings fund 2020)

Question 4

Intersectionality

Answer 4

People experience different combinations of factors
The way different health inequality factors interact with each other is called intersectionality

Question 5

Life expectancy at birth

Answer 5

Key measure of health inequality
Linked to peoples socio economic circumstances
Deprivation is a common measure of socio economic circumstances
Index of multiple deprivation

Question 6

Deprivation and health

Answer 6

Index of multiple deprivation :
-level of income
-employment
-education
-levels of crime
Social gradient in health is the systematic relationship between deprivation and life expectancy
Males living in least deprived areas live 9.4 years longer thank males in most deprived areas
Gap is 7.4 years for females

Question 7

Healthy life expectancy

Answer 7

Good health is another key measure of health inequality
2 important measures:
-healthy life expectancy
-disability free life expectancy

Question 8

Inequalities in avoidable mortality

Answer 8

Some deaths are avoidable
Dependent on the getting help with illnesses and disease

Question 9

Long term health conditions

Answer 9

Major causes of poor quality of life
Is a barrier to amount of type of work
Correlated with lower socio economic groups
Tend to be more severe in those in lower socio economic groups
Deprivation linked to having more than one LTC

Question 10

Prevalence of mental ill health

Answer 10

Difficulties with accuracy of figure
Being in a protected characteristic linked to mental ill health
Women more likely to experience CMD, 1/5 and 1/8
Young women in particular
Psychotic disorders and ethnicity
People who identify as LGBTQ+ experience higher rates of poor mental ill health and lower well being than those who do not identify
Among working age adults suicide rates among the most deprived were consistently double the rates than those who were the least deprived

Question 11

Wider determinants of health

Answer 11

These are social, economic and environmental conditions
-income
-access to green space
-access to healthy food
-nature of work
-home you live in

Question 12

Behavioural risk factors

Answer 12

A persons behaviour is a major determinant of how healthy they are
4 principal behavioural risks to health are:
-smoking, poor diet, physical inactivity and high alcohol consumption
These risk are higher in disadvantaged groups
Circumstances can make it harder to move away from unhealthy behaviours

Question 13

Access and experience of health services

Answer 13

Refers to services that are timely appropriate and easy to use
Full range access refers to access to preventative interventions, social services as well as primary and secondary care
Inequitable access means a groups faces barriers accessing these services that they need

Question 14

Interactions between factors

Answer 14

We can see a complex interaction between a
number of factors
-Quality of health and care services
– Individual behaviours
– The places and communities people live in
– Wider determinants like education, housing and access to green space

Question 15

The inverse care law

Answer 15

Those who need care the most are least likely to get it and those who least need it tend to use health services more

Question 16

Access and equity

Answer 16

Marmot review fair society, health lives 2010
Health equity in England: the marmot review 10 years on
The health gap has grown between wealthy and deprived areas
The amount of time people spend in poor health has increased across England since 2010

Question 17

Impact of COVID-19 and health inequalities

Answer 17

Mortality rates higher in more deprived areas
2.6 times higher for the most deprived decile
Ethnic minority groups have experience higher mortality
Highest being bangladeshi, Pakistani and Caribbean groups also mortality rates from all causes were higher in these groups

Question 18

Covid-19 and disabled people

Answer 18

Greater risk of dying from COVID
Risk of death 1.6 and 1.4 times greater for disabled women and men respectively (those who consider their daily life to be ‘limited a lot’)

Question 19

Marmot 10 years on

Answer 19

As Marmot notes “if health has stopped improving it is a sign that society has stopped improving” what is government for it not to act on that (Marmot 2020)

Question 20

Cultural blindness

Answer 20

Claiming not to see differences in race, culture, ethnicity
‘Treating everyone the same way’
-this one size fits all approach
-does not represent personal care
-does not give equal chance

Question 21

Culture

Answer 21

What is culture:
-beliefs and behaviours that are learned and shared by members of a group
Cultural trait or personal idiosyncrasy?
Sub cultures- nursing and medicine are examples of 2 subcultures

Question 22

The cultural iceberg

Answer 22

Visible aspects
Non visible aspects

Question 23

So what is cultural competence and how am I going to get it?

Answer 23

Understanding your own culture and biases
Becoming sensitive to the cultures of others
Appreciating differences
Acquiring knowledge and understanding of others cultures especially values and beliefs
Applying your knowledge
Remember cultural competence care is patient centred care

Question 24

Asking the right questions

Answer 24

Principles of culturally competent care should apply to all patients
Learn to ask the right questions the 4 Cs
-what do you call your problem
-what do you think caused your problem
-how do you cope with your condition
-what concerns do you have regarding your condition

Question 25

Stereotypes vs generalisation

Answer 25

Difference lies not in the content
But in the usage of the information
Stereotype is an ending point
A generalisation is an beginning point.

Question 26

Values

Answer 26

Values are things we hold important. Values exist at the individual and cultural level
Understanding values is the key to understanding Behaviour
Some examples of different values system:
-independence and autonomy
-privacy
-health and fitness, what is considered healthy
-physical appearance

Question 27

Values and healthcare culture

Answer 27

Conflicts and misunderstandings can occur in health care between the values of the health care culture and that of the patient population
Autonomy and independence
Efficiency
Self control

Question 28

Worldview

Answer 28

Second most important concept in understanding people’s behaviour is understating their world view
World views consists of peoples assumptions about the nature of reality
People often interpret events in a manner that is consistent with their beliefs

Question 29

Emic and Etic perspectives

Answer 29

Emic account comes from within the culture
Etic account comes from the observer and tries to be culturally neutral

Question 30

Prejudice and discrimination

Answer 30

Evidence from studies that those individuals and communities that have had experience of institutional discrimination and racism may distrust the health care system

Question 31

Communication

Answer 31

Language issues:
-idioms
-differences in language terms even in English speaking countries
-for example the use of the terms negative and positive as applied to tests can be confusing
Names:
-when someone else answers for the patient
Interpreters:
Non verbal communication

Question 32

Ethnocentricism and relativism

Answer 32

Refers to attitudes
Ethnocentrism
Cultural relativism
Most humans are ethnocentric
Western health care systems tend to be ethnocentric

Question 33

Time orientation

Answer 33

A person focus regarding time varies in different cultures
Focus on past, present and future
Past time orientation
Present time orientation
Future time orientation

Question 34

More key concepts

Answer 34

Hierarchical versus egalitarian cultures
Family of orientation versus family of procreation
Models of disease:
-biomedical model
-magico-religious model
-holistic model
Disease etiology

Question 35

Pain

Answer 35

Expression of pain
Pain medication

Question 36

religion and spirituality

Answer 36

Religious practices
Sacred symbols
Spiritual beliefs and practices

Question 37

Family

Answer 37

Decision making
The role of the family

Question 38

Men and women

Answer 38

Sex roles
Gender preferences
Female purity

Question 39

Birth

Answer 39

Ante partum
Labour and delivery
Postpartum

Question 40

End of life

Answer 40

Dying
Death

Question 41

Race, culture and ethnicity

Answer 41

Race is seen to be characterised by physical appearance and is determined by genetic ancestry and is usually permanent
Culture is a set of behaviours and attitudes of a group and is often determined by your upbringing and choice and is changeable
Ethnicity is defined as sense of belonging and is a group identity determined by social pressures, psychological need and is partially changeable

Question 42

Acculturation

Answer 42

When a person arrives to a new country they will begin a process of acculturation they may have already started this process before they’ve even arrived
Acculturation refers to the process of taking on the cultures of the host country in which you arrive

Question 43

Assimilation

Answer 43

It’s a process where a person becomes fully integrated into a new country where their language and culture resemble that of host community

Question 44

Integration

Answer 44

It’s a process where a person takes on the cultural norms of the new country but also maintain their original culture or that of their parents

Question 45

Separation

Answer 45

It’s where a person maintains their original culture and rejects that of the country to which they have migrated

Question 46

Marginalisation

Answer 46

It’s when a person rejects their original culture and the new culture

Question 47

Factors of health of populations

Answer 47

Genetic factors
Social factors
Environmental factors
Human discovery factors

Question 48

Social causation

Answer 48

Stipulates that poorer people are more vulnerable to adversity and stress and this in turn makes them more vulnerable to developing a psychiatric illness

Question 49

Social selection

Answer 49

Postulates that those who are mentally ill have impaired upward social mobility and therefore they drift into a lower socioeconomic status and neighbourhood

Question 50

Social constructivism

Answer 50

This approach takes the view that reality of society is socially created and so are the labels that we assign people and the definitions that we create for behaviours that do not fit into what society defines as acceptable behaviour
Unacceptable deviants (termed as deviants) become noticed and pathologised and given labels which creates stigma for individuals
Under a label, will be set of stereotypical behaviours typical of a person with this label, the person who is labelled begins to internalise these expected behaviours and behaves in the expected way. These labelled deviants are rewarded by society for playing the stereotyped deviant role. Under this theoretical framework the concept of “lay appraisal” has emerged, this is the term given to the general population’s understandings about mental illness. A person who might display certain behaviours that are not deemed as “normal” will come to the attention of their family and friends who will appraise these signs and make decisions about symptoms and treatment even before the person has come to the attention of the clinician. It is argued that societies hostility towards the mentally ill by seeing them as “other” leads to stigma and prejudices and leads the person to take on the “sick” role to cope with such a hostile environment.

Question 51

Critical theory/anti-psychiatry

Answer 51

Thomas Szasz is one of the main contributors to critical theory also sometime called anti- psychiatry. Szasz believed that the term “mental illness” was socially created in the same way as social constructivism states above. He argued it is a metaphor that describes a behaviour or action that other don’t like and come to describe it as an illness and go on to give it a label such as schizophrenia. He saw labels given as “fake” diseases. He proposed that these labels were given to support the use of power by psychiatric authorities to detain and treat people sometimes against their will. He also argued that drug addiction was not a disease but a social habit. Critical theory highlights the problem of coercion in psychiatry and how in other fields of medicine, coercion is rare and in psychiatry it is used on a daily basis. It also highlights the lack of control the patient has and the paternalistic role the doctor takes as having the right to treat the patient. These debates are still currently alive and well in mental health services and similar discussions are held in local mental health user groups who aim to improve mental health services and their own experiences.