Weeks 2-3 (inequality) Flashcards
what is evidence based practice?
integration of individual clinical EXPERTISE with the BEST AVALIABLE clinical evidence from SYSTEMIC research
why is evidence based practice (EBP) important?
for best interventions and maximise effectiveness
how is EBP carried out?
systemic reviews (collect and draw conclusion from multiple papers)
and
meta-analysis (statistical methods)
pros of EBP?
- helps highlight gaps in research / poor quality research
- generalisable and up-to-date conclusion (as you can use latest research papers)
- save clinicians locating and appraising studies themselves (as their practice standards have already been reviewed by people looking at the papers and setting the standards)
what is meta-analysis? example?
statistical methods of combining multiple studies
e.g. forest plots
what are the 2 branches of critiques of EBP?
practical
philosophical
what are practical critiques of EBP?
- impossible to create and maintain systematic reviews across all specialities (too many specialties)
- challenging and expensive to distribute and implement findings
- RCT not always feasible / necessary
- required ‘good faith’ in pharmaceutical companies (pharma companies like their drugs to work - biased)
- outcomes are biomedical
what are philosophical critiques of EBP?
- doesn’t align with doctors’ modes of reasoning
- population outcome may not apply to individual
- ‘unreflective rule followers’
- undermining doctor-patient relationship and NHS
- professional responsibility / autonomy
what are difficulties of getting evidence into practice? (EBP)
- evidence exists but doctors doesn’t know them
- dr knows evidence but doesn’t use it (ignore)
- organisational systems can’t support innovation (new idea / change)
- commissioning decisions reflect different priorities (limited funding - have to sacrifice something)
- resources not avaliable to implement changes
describe the relationship between health and variables including social class
social-economic status:
a segment of the population
distinguished from others by similarities in labour market position (job title) and property relations (socio-economical relationship)
where is socio-economic status information gained from?
census data
describe the relationship between health and variables using ethnicity: what is ethnicity?
identification with a social group on the basis of shared values, beliefs, customs, traditions, language and lifestyle
describe some explanations for health inequalities
the black report: artefact explanation social selection explanation behavioural-cultural explanation materialist
NOT black report:
psychosocial
income distribution
what is the black report?
report of the expert committee into health inequality chaired by Sir Douglas Black by DoH
evaluate ‘artefact explanation’ for health inequalities: the black report
health inequalities are evident due to the way statistics are collected
reality: data problems actually UNDERestimate health inequalities
evaluate ‘social selection explanation’ for health inequalities: the black report
Direction of causation is from health to social position:
sick people move down and healthy people move up social hierarchy
Chronically ill and disabled people - disadvantaged
(minor contribution)
evaluate ‘behavioural-cultural explanation’ for health inequalities: the black report
Ill health is due to people’s choices/decisions, knowledge
and goals:
People from disadvantaged backgrounds tend to engage in more health-damaging behaviours, while people from advantaged backgrounds tend to engage in more health-promoting behaviours
what does ‘behavioural-cultural explanation’ for health inequalities: the black report support?
health education
what are limitations of ‘behavioural-cultural explanation’ for health inequalities: the black report?
– Behaviours are outcomes of SOCIAL PROCESSES, not simply individual choice
– “Choices” may be difficult to exercise in adverse conditions (less choice)
– “Choices” may be rational for those whose lives are constrained by their LACK of resources
evaluate ‘materialist explanation’ for health inequalities: the black report
Inequalities in health arise from differential access to
material resources
– Low income; unemployment; work environments (e.g. paints / exhaust); low control over job; poor housing conditions
what does the materialist explanation explain about health inequalities?
• Lack of choice in exposure to hazards and adverse
conditions
• Accumulation of factors across life-course
limitation of materialist explanation?
Further research needed as to precise routes through which material deprivation causes ill-health
evaluate ‘psychosocial explanation’ for health inequalities: the black report
• Some stressors are distributed on a social gradient
– e.g. negative life events, social support, autonomy at work; job security
increase stressors = decrease health
how can Stress impact on health? (think health psych)
different pathways:
– Direct (physiological, immune system)
– Indirect (health related behaviours, mental health)
evaluate ‘income distribution’ (Wilkinson’s) for health inequalities: the black report
relative income affects health (linked to stress, more inequality = greater stress)
countries with greatest income inequality = greatest health inequality
egalitarian societies have the best health (equal rights)
what are redistributive policies?
reducing income inequality in a society can improve social well-being, and in turn many other health and social factors
what do utilisation studies measure?
• receipt of services (people who utilise the service)
• Evidence about UTILISATION is contradictory and
difficult to interpret
cons of utilisation studies?
– What about people who don’t access care because
they can’t / don’t know how ?
what is inequality in access to healthcare?
when things are different and not equal due to need (fair)
e.g. require a treatment for MI etc.
(can have inequality without inequity - fair)
what is inequity in access to healthcare?
inequality which are UNFAIR and unavoidable
type of inequality
what does inequality (+/- inequity) in healthcare lead to?
increase use of primary care and preventative / specialist services in those of higher socioeconomic classes
