Weeks 2-3 (inequality)

Question 1

what is evidence based practice?

Answer 1

integration of individual clinical EXPERTISE with the BEST AVALIABLE clinical evidence from SYSTEMIC research

Question 2

why is evidence based practice (EBP) important?

Answer 2

for best interventions and maximise effectiveness

Question 3

how is EBP carried out?

Answer 3

systemic reviews (collect and draw conclusion from multiple papers)
and
meta-analysis (statistical methods)

Question 4

pros of EBP?

Answer 4

1. helps highlight gaps in research / poor quality research
2. generalisable and up-to-date conclusion (as you can use latest research papers)
3. 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)

Question 5

what is meta-analysis? example?

Answer 5

statistical methods of combining multiple studies

e.g. forest plots

Question 6

what are the 2 branches of critiques of EBP?

Answer 6

practical

philosophical

Question 7

what are practical critiques of EBP?

Answer 7

1. impossible to create and maintain systematic reviews across all specialities (too many specialties)
2. challenging and expensive to distribute and implement findings
3. RCT not always feasible / necessary
4. required ‘good faith’ in pharmaceutical companies (pharma companies like their drugs to work - biased)
5. outcomes are biomedical

Question 8

what are philosophical critiques of EBP?

Answer 8

1. doesn’t align with doctors’ modes of reasoning
2. population outcome may not apply to individual
3. ‘unreflective rule followers’
4. undermining doctor-patient relationship and NHS
5. professional responsibility / autonomy

Question 9

what are difficulties of getting evidence into practice? (EBP)

Answer 9

1. evidence exists but doctors doesn’t know them
2. dr knows evidence but doesn’t use it (ignore)
3. organisational systems can’t support innovation (new idea / change)
4. commissioning decisions reflect different priorities (limited funding - have to sacrifice something)
5. resources not avaliable to implement changes

Question 10

describe the relationship between health and variables including social class

Answer 10

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)

Question 11

where is socio-economic status information gained from?

Answer 11

census data

Question 12

describe the relationship between health and variables using ethnicity: what is ethnicity?

Answer 12

identification with a social group on the basis of shared values, beliefs, customs, traditions, language and lifestyle

Question 13

describe some explanations for health inequalities

Answer 13

the black report:
artefact explanation
social selection explanation
behavioural-cultural explanation
materialist

NOT black report:
psychosocial
income distribution

Question 14

what is the black report?

Answer 14

report of the expert committee into health inequality chaired by Sir Douglas Black by DoH

Question 15

evaluate ‘artefact explanation’ for health inequalities: the black report

Answer 15

health inequalities are evident due to the way statistics are collected
reality: data problems actually UNDERestimate health inequalities

Question 16

evaluate ‘social selection explanation’ for health inequalities: the black report

Answer 16

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)

Question 17

evaluate ‘behavioural-cultural explanation’ for health inequalities: the black report

Answer 17

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

Question 18

what does ‘behavioural-cultural explanation’ for health inequalities: the black report support?

Answer 18

health education

Question 19

what are limitations of ‘behavioural-cultural explanation’ for health inequalities: the black report?

Answer 19

– 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

Question 20

evaluate ‘materialist explanation’ for health inequalities: the black report

Answer 20

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

Question 21

what does the materialist explanation explain about health inequalities?

Answer 21

• Lack of choice in exposure to hazards and adverse
conditions
• Accumulation of factors across life-course

Question 22

limitation of materialist explanation?

Answer 22

Further research needed as to precise routes through which material deprivation causes ill-health

Question 23

evaluate ‘psychosocial explanation’ for health inequalities: the black report

Answer 23

• Some stressors are distributed on a social gradient
– e.g. negative life events, social support, autonomy at work; job security
increase stressors = decrease health

Question 24

how can Stress impact on health? (think health psych)

Answer 24

different pathways:
– Direct (physiological, immune system)
– Indirect (health related behaviours, mental health)

Question 25

evaluate ‘income distribution’ (Wilkinson’s) for health inequalities: the black report

Answer 25

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)

Question 26

what are redistributive policies?

Answer 26

reducing income inequality in a society can improve social well-being, and in turn many other health and social factors

Question 27

what do utilisation studies measure?

Answer 27

• receipt of services (people who utilise the service)
• Evidence about UTILISATION is contradictory and
difficult to interpret

Question 28

cons of utilisation studies?

Answer 28

– What about people who don’t access care because

they can’t / don’t know how ?

Question 29

what is inequality in access to healthcare?

Answer 29

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)

Question 30

what is inequity in access to healthcare?

Answer 30

inequality which are UNFAIR and unavoidable

type of inequality

Question 31

what does inequality (+/- inequity) in healthcare lead to?

Answer 31

increase use of primary care and preventative / specialist services in those of higher socioeconomic classes