FPC3 Inequality Seminar (A&B Groups) Flashcards
(38 cards)
1
Q
What is Sociology?
A
The study of the development, structure and functioning of human society
2
Q
Application of Sociology to Healthcare:
The sociology of health and illness (Medical Sociology) applies the methods and theories of sociology to the health field in what ways?
A
- Sociology studies peoples’ interactions with those engaged in medical occupations e.g. healthcare professional-patient relationships
- Sociology studies the way people make sense of illness e.g. illness versus disease
- Sociology studies the behaviour and interactions of health care professionals in their work setting e.g. professional values, interactions between health care professionals and other health care staff
3
Q
how should health promotion in the society be done?
A
- Promoting healthy behaviour and preventing ill health is only possible if we understand the ways different groups in society operate e.g. men and women, rich and poor, young and old
- Sociology provides health promotion with an analysis of the different groups in society
4
Q
what is Medicalisation and some examples?
A
- The process where areas of behaviour or life become defined as medical problems, often with medical solutions
- Things that were previously seen as natural such as pregnancy and child birth are becoming more medicalised
- Problematic behaviours in relation to gambling, alcohol or sex become labelled as addictions and medically managed
- Normal responses to loss or adverse events requiring the intervention of doctors to legitimise them and manage them
5
Q
Stress - adverse reaction to excessive pressure. Common affecting 1 in 6 of those in work. Significant consequents for who?
A
- The individual – poorer physical and mental health, poorer health behaviours e.g. smoking, alcohol, poor diet
- Society – loss of productivity and work days
- The health service – increased use of health services due to stress or its consequences
6
Q
Work related stress associated with factors such as lack of power and control in the workplace, job security, low pay, changing job frequently or frequent redundancies
is work related stress medicalised?
A
- Often medicalised – person seen as unwell, encouraged to see a doctor or other expert (counsellor etc), sometimes signed off work
- But research suggests that organisational solutions that address the causes of stress e.g. workload, role clarity, support are more effective than those targeted at helping the individual cope better
7
Q
what does the sick role involve for the patient?
A
- The sick role exempts ill people from their daily responsibilities
- Patient is not responsible for being ill and is regarded as unable to get better without the help of a professional
- Patient must seek help from a healthcare professional
- Patient is under a social obligation to get better as soon as possible to be able to take up social responsibilities again
8
Q
What is the Sick role-healthcare professional role?
A
- Professional must be objective and not judge patients morally
- Professional must not act out of self-interest or greed but put patient’s interests first
- He/she must obey a professional code of practice
- Professional must have and maintain the necessary knowledge and skills to treat patients
- Professional has the right to examine patient intimately, prescribe treatment and has wide autonomy in medical practice
9
Q
What are the social/socio-economic influences on our health?
A
A definition would be the collective set of conditions in which people are born, grow up, live and work. These include:
- Gender
- Ethnicity
- Physical environment / housing
- Education
- Employment
- Income / social status / financial security
- Health system
- Culture and social environment
WHO – ‘There is ample evidence that social factors, including education, employment status, income level, gender and ethnicity have a marked influence on how healthy a person is. In all countries – whether low-, middle- or high-income – there are wide disparities in the health status of different social groups. The lower an individual’s socio-economic position, the higher their risk of poor health.’
10
Q
What are the social/socio-economic influences on our health - how does gener effect our health?
A
- In developed countries men have a higher mortality at every age; women outlive men by 4-5 years.
- Women have a higher morbidity:
- ?Just visit the doctor more
- ?due to living longer so more of the diseases of elderly
- Women may present differently but also some evidence that they are assessed differently e.g. receive poorer care for heart disease as assumed to be only common in men
•Women consult more frequently in General Practice settings
11
Q
how does gender affect presentation and diagnosis?
A
•Cardiovascular diseases have been the most investigated
- Younger women higher rate of mortality after first MI and CABG (bypass) but men in all age groups have higher risk of ischaemic sudden death
- Women experience a greater variety of symptoms – ‘atypical presentation’
- AF is a greater risk of stroke in women than in men
•But are not the only areas where there is a significant gender difference
- Higher incidence asthma in young boys but in young adulthood more women affected
- Women have a greater sensitivity to negative effects of tobacco
- Most autoimmune diseases are more frequent in women
12
Q
How is there Differences in Disease Management between gender?
A
- Women with MI receive less guideline based diagnosis and less invasive treatment than men
- Women with heart failure receive fewer guideline based diagnostic procedures and treatments, fewer implants and transplants but still have a better outcome than men
- Women obtain dialysis later than men and undergo fewer transplants
- Delay in referral of female patients with RA to clinic compared to men
- Osteoporosis and depression considered female diseases – both might be underdiagnosed in men
13
Q
how does ethnicity affect health?
A
- South Asians living in Scotland have substantially higher rates of heart attacks than the general population, but they also have higher survival rates
- Prevalence of type 2 diabetes is higher in South Asian populations
- Admissions for Polish and Chinese groups are lower than white Scottish counterparts with higher rates in some Asian groups, white British
- There is greater prevalence of sickle cell disease in African origin groups
- Scottish data suggest that minority ethnic groups in Scotland, with some exceptions such as Gypsy/Travellers, have better general health than the majority of the white population
- Mortality in Scotland is higher in the majority ethnic (white) population than in the black and minority ethnic population
14
Q
how does ethnicity relate to alcohol?
A
There is diversity both within and between ethnic groups:
- Most minority ethnic groups have higher rates of abstinence and lower levels of drinking compared to people from white backgrounds
- Abstinence is high amongst South Asians, particularly those from Pakistani, Bangladeshi and Muslim backgrounds.
- People from mixed ethnic backgrounds are less likely to abstain and more likely to drink heavily compared to other non-white minority ethnic groups
- People from Indian, Chinese, Irish and Pakistani backgrounds on higher incomes tend to drink above recommended limits
15
Q
ethnicity and alcohol: Over time generational differences may emerge such as what?
A
- Frequent and heavy drinking has increased for Indian women and Chinese men
- Drinking among Sikh girls has increased whilst second generation Sikh men drink less than first generation
16
Q
ethnicity and alcohol - People from some ethnic groups are more at risk of alcohol related harm, what are some examples?
A
- Irish and Scottish men and women have higher rates of alcohol related deaths than the national average in England and Wales
- Sikh men have higher rates of liver cirrhosis
- People from minority ethnic groups have similar levels of alcohol dependence compared to the general population, despite drinking less
17
Q
ethnicity and alcohol - Is there is more to it than the numbers would suggest?
A
- Minority ethnic groups are under-represented in seeking treatment and advice for drinking problems
- Problem drinking may be hidden among women and young people from South Asian ethnic groups in which drinking is proscribed
- Greater understanding of cultural issues is needed in developing mainstream and specialist alcohol services
18
Q
Dealing with disparities in health relating to ethnic and cultural differences
A
•Identify the potential barriers to the use of health services:
- Patient level – language concerns, understanding the system, beliefs
- Provider level – understanding of the differences due to ethnicity, provider skills and attitudes
- System level – organisation of appointments and referrals
- Culturally Competent Care - Combination of attitudes, skills and knowledge that allows an understanding and therefore better care of patients with a different backgrounds to our own.
- Recognising when we are being culturally incompetent!
19
Q
how is housing a social factor?
A
- Indoor air quality is determined by levels of both outdoor and indoor pollutants. Sudden increases in air pollutants are most detrimental to the elderly and asthmatics
- Mould spores and the faecal pellets from house dust mites are the most common domestic allergens. Although the health effects of mould and house dust mites are poorly defined, limiting exposure to and proliferation of these allergens is recommended.
- The elderly and the very young are particularly at risk from both low and high indoor temperatures. Excess winter deaths may be prevented by providing affordable domestic heating.
- Lead exposure in children leads to physical, mental and intellectual problems. Lead exposure among children may stem from lead-based paint, which is found mainly in older, poorer housing, and mainly among poor families.
- Secure home ownership has been linked to improved health, which may be due to better housing quality and feelings of security. This link may vary from country to country according to the rates of home ownership and the meaning attached to it.
20
Q
does housing improvement help mental health?
A
Improvements to mental health have been consistently reported following housing improvements, regardless of whether they involved medical priority rehousing, energy efficiency improvements, refurbishment, or rehousing and area regeneration. In addition, the degree of mental health improvement was directly related to the extent of the housing improvement and was sustained for up to five year
21
Q
How might Education Influence Health?
Rates of major circulatory diseases, diabetes, liver disease, and several psychological symptoms (sadness, hopelessness, and worthlessness) show higher rates among adults with lower educational attainment
A
•Psycho-social environment:
- Effects social standing, sense of control and social support
- Bolsters individual capacity and autonomy / agency
•Access to different employment:
- Improves income – housing, environment, diet
- Improves benefits – sick pay, pension, holidays
- Improves working conditions – exposure to hazards and risk, improved autonomy and power in the work place
- Healthy knowledge - Benefits of lifestyle change, awareness of risk associated with health behaviours, capacity to negotiate the system.
- Direct effect – unexplained by above or by innate intelligence or other confounding factors.
22
Q
how is employment a social factor?
A
- Provides income and financial security (Deprivation is a major determinant of health inequalities)
- Provides social contacts
- Provides status in society
- Provides a purpose in life
- Unemployment is associated with increased morbidity and premature mortality
- But employment can also be a source of adverse health depending on the work place situation, risks, sense of autonomy and relative power.
23
Q
Does distribution of GPs across Scotland reflect the levels of deprivation?
A
- The distribution of GPs across Scotland does not reflect the levels of deprivation
- There is evidence that services designed to improve whole population health e.g. eye checks, cancer screening, may widen health inequalities if uptake is lowest in those who would derive the greatest benefit
24
Q
environment - how does transport relate to health?
A
- Air pollution-related deaths and illness are linked most closely to exposures to small particulate matter. Small particulates bypass the body’s defences against dust, penetrating deep into the respiratory system
- An estimated 3.7 million premature deaths are attributed to air pollution, based on WHO data from 2012. Overall, higher urban air pollution concentrations increase the risk for cardiovascular and respiratory disease, cancer and adverse birth outcomes
- Another transport-related air pollutant that harms health includes ground-level ozone (O3) - a mix of urban air pollutants and key factor in chronic respiratory diseases such as asthma
- About 120 thousand people die due to motor vehicle accidents every year in the 51 countries of the WHO European region. Speed has a major effect on the frequency, severity and mortality from RTA. e.g. 5% of pedestrians will die if hit by a vehicle at 20mph, 45% at 30mph and 85% at 40mph
- Estimates of the health impacts and costs of transport strategies have tended to not include the health effects of increased walking and cycling and the health savings associated with this
- Active travel such as cycling and walking have a number of health benefits e.g. improved mental health, reduced risk of premature death, prevention of chronic diseases such as coronary heart disease, stroke, hypertension, type 2 diabetes, osteoporosis, depression, dementia and cancer.
- Walking and cycling are also effective ways of integrating, and increasing, levels of physical activity into everyday life for the majority of the population, yet there has been a lack of investment in walking and cycling infrastructure.
- Combining public transport and active travel can help people achieve recommended daily activity levels. Public transport is the most sustainable for longer journeys, yet it can be more expensive and less convenient. In rural areas travel infrastructure and public transport may present challenges
25
Environment - how does Media effect our Health
* Shapes and stereotypes our views
* Shapes our expectations
* Consider the change in media attitude to mental health in recent years, aiming to reduce the previous stigma associated with mental illness
26
Health Inequalities - what does WHO define it as?
The WHO states that health inequalities can be defined as the differences in health status or in the distribution of health determinants between different population groups
Or alternatively – the avoidable differences in health status seen within and between countries
27
what are some health inequalities in scotland?
* Overall health has improved over the past 50 years, average life expectancy and healthy life expectancy has increased, but average life expectancy is lower than any other part of UK for men and women.
* Women tend to live longer than men but have more years of living in poorer health. People living in rural areas tend to live longer than those in urban areas
* Deprivation is the key determinant of health inequalities although age, gender and ethnicity are also factors
* Deprivation in Scotland is concentrated in the west but health inequalities vary widely within local areas
28
Does deprevation effect health in scotland?
* The disease burden in the most deprived areas in Scotland was more than double that found in the least deprived areas (14.1% v. 6.7%), and the burden increased with each level of deprivation
* In deprived areas, early death contributed more burden than living with ill health (57.9% of burden due to early death)
29
do diseases differ in deprived and non-deprived areas?
30
what are all the different things contributing to a persons health?
* Education
* Homelessness / poor quality homes
* Unemployment
* Family breakdown
* Anti social behaviour
* Hopelessness
* Multi-morbidity
* Ambition / aspiration / opportunity
31
what is WHOs definition of vulnerability?
* Vulnerability is the degree to which a population, individual or organization is unable to anticipate, cope with, resist and recover from the impacts of disasters
* Particularly children, pregnant women, the elderly, those already unwell or malnourished or those living in poverty
32
what is the socttish gorvenments definition of vulnerability?
“Adults at risk” are adults who -
* (a)are unable to safeguard their own well-being, property, rights or other interests,
* (b)are at risk of harm, and
* (c)because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected
33
what are some vulnerable groups?
Some groups within society are more likely to have poorer health
* The homeless
* Those with a learning disability
* Refugees
* LGBTQ+
* Prisoners
34
what is the inverse care law?
In 1971, a GP Dr Julian Tudor Hart proposed the Inverse Care Law, published in the Lancet. This described that those who most need medical care are least likely to receive it and conversely, those with least need of health care tend to use health services more, and more effectively
35
what is the third sectors contribution?
The Task Force (Ministerial taskforce on health inequalities) has noted that Third Sector organisations can be very effective in addressing the wider factors underlying health inequalities. Where Third Sector services demonstrate that they contribute to meeting local outcomes and priorities, they should be given the resources by their funders and commissioners to allow services to be maintained, developed and made more financially sustainable
36
what is the role of Voluntary Sector Organisations?
* Provide a means of engaging effectively with communities and individuals
* Deliver a range of services which may help to reduce health inequalities, including:
- Promoting healthy living to groups of people who may not use mainstream services
- Supporting people to access relevant services NHS Health Scotland
37
What Range of Factors can Reduce Health Inequalities?
* Effective partnership across a range of sectors and organisations e.g. to promote health, improve patient education about health
* Evaluate and refine integration of health and social care
* Government policies and legislation e.g. smoking ban, Keep Well campaign
* Time to invest in the more vulnerable patient groups
* Improve access to health and social care services and professionals
* Reduction in poverty
* Social inclusion policies
* Improved employment opportunities for all
* Ensuring equal access to education in all areas
* Improved housing in deprived areas
38
look at the third sector seminary information at th end of the powerpoint and the case study
