Lecture 3.1: Health Inequalities & Inequities

Question 1

What is Health Inequality?

Answer 1

Defined by WHO as all types of health variation
but generally used in UK and literature to refer
exclusively to variations that are avoidable and
“unfair.”

Question 2

The Inverse Care Law

Answer 2

The inverse care law states that the availability of good medical care tends to vary inversely with the need for it in the population served

Question 3

What is a Health Needs Assessment?

Answer 3

Identifying vulnerable populations with specific health
needs

Question 4

What is a Health Equity Audit?

Answer 4

Is a process that examines how health determinants, access to relevant health services, and related outcomes are distributed across the population

Question 5

What is a Health Impact Assessment?

Answer 5

A practical approach used to judge the potential health effects of a policy, programme or project on a population, particularly on vulnerable or disadvantaged groups

Question 6

What are the 4 Levels of Prevention of Health Inequality?

Answer 6

• Primordial Prevention
• Primary Prevention
• Secondary Prevention
• Tertiary Prevention

Question 7

What is done in Primordial Prevention?

Answer 7

Alter societal structures & thereby underlying determinants

Question 8

What is done in Primary Prevention?

Answer 8

Alter exposures that lead to disease

Question 9

What is done in Secondary Prevention?

Answer 9

Detect and treat pathological process at an earlier stage so that treatment can be more effective

Question 10

What is done in Tertiary Prevention?

Answer 10

Prevent relapses and further deterioration via follow up care and rehabilitation

Question 11

What is the High Risk Approach?

Answer 11

Proposes to intervene for prevention upon those with the strongest likelihood of developing disease

Question 12

What are the Strengths of the High Risk Approach?

Answer 12

• Effective (high motivation of individual and
  physician)
• Efficient (cost-effective use of limited resources)
• Benefit : risk ratio is favourable
• Appropriate to individual
• Easy to evaluate

Question 13

What are the Weaknesses of the High Risk Approach?

Answer 13

• Palliative and temporary (misses a large amount of
  disease)
• Risk prediction ± not accurate
• Difficulty and costs of screening
• Hard to change individual behaviours

Question 14

What is the Population Approach?

Answer 14

Begins with recognition that the occurrence of common diseases and exposures reflects the behaviour and circumstances of society as a whole i.e. mass drug administration

Question 15

What are the Strengths of the Population Approach?

Answer 15

• Equitable
• Can be cost effective in terms of identification
• Large potential for population benefit

Question 16

What are the Weaknesses of the Population Approach?

Answer 16

• Small perceived risk of dx and small benefit to
  individual may result in poor motivation
• Poor motivation leads to poor coverage
• Benefit: Risk may be questionable

Question 17

Axes of Inequity (5)

Answer 17

Geography
Income
Gender
Place of residence (rural/urban)
Ethnicity

Question 18

Levels of Analysis (4)

Answer 18

Global
Regional
National
Sub-national

Question 19

How do we investigate equity? (3 Steps)

Answer 19

▪ First need diagnosis
➢ Outcomes
▪ Then need to look at causes of inequity
➢ Upstream factors
▪ Design intervention to tackle causes of inequity

Question 20

How to measure inequity in health outcomes? (3)

Answer 20

• Life expectancy
• Mortality (e.g. infant mortality, child mortality,
  maternal mortality)
• Morbidity

Question 21

List the 4 wider determinants of health?

Answer 21

Economic Stability
Education
Neighbourhood & Built Environment
Social & Community Context

Question 22

Health Inequity Definition

Answer 22

Avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically (WHO)

Question 23

The quality of the services a patient receives can be
determined by…? (6)

Answer 23

• Gender
• Income level
• Mother tongue
• Ethnicity
• Religion
• Technology

Question 24

Barriers to Accessing Healthcare (5)

Answer 24

• Knowledge of need
• Knowledge of availability of services
• Perceived quality of services (inc patient treatment)
• Social norms
• Fear

Question 25

What can be done to reduce inequities? (7)

Answer 25

• End poverty!
• Identify levels and root causes of inequity
• Distribution of resources (by need)
• Financing strategy (by ability to pay)
• Training of health workers
• Health promotion and prevention (stagnant water,
  nutrition)
• Cash transfers

Question 26

What is Equity?

Answer 26

It is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically (WHO)