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Flashcards in Health equality and the third sector Deck (48)
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What is sociology?

The study of the development, structure and functioning of human society


The sociology of health and illness (Medical Sociology) applies which methods and theories of sociology to the health field?

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


What characteristics do medical profession have opposed to other occupations?

Systematic theory

Authority recognised by its clientele

Broader community sanction

Code of ethics

Professional culture sustained by formal professional sanctions


How can sociology be applied within the medical profession?

1) Sociology of the medical profession

2) Health promotion

3) The sick role

4) Social class

5) Ethnicity

6) Disparities of health

7) Housing

8) Education

9) Employment

10) Environment-Transport and health

11) Environment-Media and health


Sociology and health promotion?

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


Sociology and the sick role-patient?

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

Some individuals may adopt the sick role to receive benefits but are not engaged with the responsibility of the sick role


Sociology and the sick role-healthcare professional?

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


Sociology and social class, (National Statistics Socio-economic Classification (NS-SEC))?

1.1 Large employers and higher managerial and administrative occupations
Larger numbers of employees and who delegate some of their managerial and entrepreneurial role to salaried staff. Higher managerial role involves general planning and supervision of operations on behalf of employer. Service relationship with the employer

1.2 Higher professional occupations
Have a service relationship with their employer. Doctor, lawyer, scientist, clergy, teacher, OT, SALT, personnel officer, computer analyst, careers guide. This is regardless of whether employed, self employed or position of management

2 Lower managerial, administrative and professional occupations
Attenuated service relationship with employer – tend to act under positions above. e.g. sales managers, technicians, nurses, midwives, radiographers, welfare and community workers, ship’s officers and immigration officers

3 Intermediate occupations
Positions not involving general planning or supervisory powers, in clerical, sales, service and intermediate technical occupations civil service administrative officers and assistants, debt collectors, library assistants, secretaries, telephonists, medical technicians, dental nurses, flight attendants, driving instructors, data processing operators, routine laboratory testers, electrical engineers (not professional), installation and maintenance engineers.

4 Small employers and own account workers
Small employers who remain essentially in direct control of their enterprises e.g. restaurants, hairdressers, local retail outlets, builders, electricians. Also self employed tradesmen who do not employ others

5 Lower supervisory and technical occupations
Supervise others in same role e.g. foremen, reception supervisor
Opportunities for promotion, payment of a salary as opposed to a weekly or hourly wage, greater work autonomy e.g. electrical maintenance fitters, motor mechanics, cabinet makers, transport operatives

6 Semi-routine occupations
the work involved requires at least some element of employee discretion and contract typified by short term and direct exchange of money for effort. E.g. educational assistants, security guards, postal workers, hospital porters, cooks, hairdressers, builders, carpenters, dressmakers

7 Routine occupations
Even less opportunities for promotion, autonomy over work. These positions have the least need for employee discretion. E.g. Waiters and waitresses, bar staff, machinists, sorters, packers, railway station staff, road construction workers, building labourers, dockers, couriers, refuse collectors, car park attendants and cleaners

8 Never worked and long-term unemployed


Why was the National Statistics Socio-economic Classification constructed?

The NS-SEC has been constructed to measure the employment relations and conditions of occupations. These are central to showing the structure of socio-economic positions in modern societies and helping to explain variations in social behaviour and other social phenomena

It has also been reasonably validated both as a measure and as a good predictor of health, educational and many other outcomes


What does labour market situation equation to?

Labour market situation equates to source of income, economic security and prospects of economic advancement.


What does work market situation equation to?

Work situation refers primarily to location in systems of authority and control at work, although degree of autonomy at work is a secondary aspect


What are the social/socio-economic influences on our health?



Physical environment / housing



Income / social status / financial security

Health system

Social environment


What are the social/socio-economic influences on our health - gender?

Men have a higher mortality at every age:
- Higher risk cardiovascular disease
- Up to the age of 75, stroke incidence and mortality rates are higher for males
- Suicide rates three time higher)
- One in ten of all hospital discharges for men was estimated to be attributable to alcohol compared to one in 20 for women. 432 female alcohol-related deaths compared to 815 male deaths
- Higher rates of drug misuse in men versus women, accounting for almost three quarters of drug related deaths 429 (men) versus 155 (women) deaths

Women have a higher morbidity (Higher rates (twice as many) of depression and anxiety)

Women consult more frequently in General Practice settings

Women are over twice as likely to receive Carer's Allowance than males


Ethnicity and health?

1) South Asians living in Scotland have substantially higher rates of heart attacks than the general population, but they also have higher survival rates.

2) Prevalence of type 2 diabetes is higher in South Asian populations

3) Admissions for each ethnic group relative to the White Scottish group were lower among White Polish and Chinese groups, with higher rates in some Asian groups, White British and White Other. 

4) There is greater prevalence of sickle cell disease in African origin groups

5) Scottish data suggest that minority ethnic groups, with some exceptions such as Gypsy/Travellers, have better general health than the majority of the white population. These differences can vary by disease and ethnic group

6) Mortality in Scotland is higher in the majority ethnic (white) population than in the black and minority ethnic population


Ethnicity and alcohol overview?

1) Most minority ethnic groups have higher rates of abstinence and lower levels of drinking compared to people from white backgrounds

2) Abstinence is high amongst South Asians, particularly those from Pakistani, Bangladeshi and Muslim backgrounds. But Pakistani and Muslim men who do drink do so more heavily than other non-white minority ethnic and religious groups

3) People from mixed ethnic backgrounds are less likely to abstain and more likely to drink heavily compared to other non-white minority ethnic groups

4) People from Indian, Chinese, Irish and Pakistani backgrounds on higher incomes tend to drink above recommended limits


Ethnicity and alcohol potential emerging differences?

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


Ethnicity and alcohol higher risk of alcohol related harm by ethnic groups?

1) Irish, Scottish and Indian men (and Irish and Scottish women) have higher rates of alcohol related deaths than the national average in England and Wales

2) Sikh men have higher rates of liver cirrhosis

3) People from minority ethnic groups have similar levels of alcohol dependence compared to the general population, despite drinking less


Ethnicity and alcohol, some hidden truths?

1) Minority ethnic groups are under-represented in seeking treatment and advice for drinking problems

2) Problem drinking may be hidden among women and young people from South Asian ethnic groups in which drinking is proscribed

3) Greater understanding of cultural issues is needed in developing mainstream and specialist alcohol services


Dealing with disparities of health?

1) 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

2) 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.

3) Recognising when we are being culturally incompetent!


Housing as a social factor?

1) 1 in 4 adolescents living in cold homes at risk of multiple mental health issues compared to 1 in 20 in warm homes

2) Children in cold homes are more than twice as likely to suffer from a variety of respiratory problems

3) Excess winter deaths are almost 3x higher in the coldest quarter than in warmest


Education as a social factor?

Those with higher levels of education tend to be healthier than those of similar income who are less well educated e.g. better understanding of health, more effective engagement with health care services such as screening programmes, better engagement with health related advice and are better able to navigate health services

Also important to remember the effect that poor health can have on education.


Employment as a social factor?

Provides income and financial security; this obviously varies and relates in part to the previous slide on social class. (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


The WHO stance on financial restriction to health care?

The WHO argues that governments should protect people against financial risk in matters of health, whether the system is publically or privately financed

“And it should assure not only that the healthy subsidise the sick….., but also that the burden of financing is fairly shared by having the better-off subsidise the less well-off. This generally requires spending public funds in favour of the poor” (WHO 2000)

The WHO report judged each country’s health system against the most that it estimated could be achieved with its level of health service expenditure. It was possible for a relatively poor country to achieve a better result than a comparatively rich one

WHO summary – ‘Many countries need to use available funds more efficiently and raise more funds from domestic sources, but these measures would be insufficient to fill the current gap in the poorest countries. Only an increased and predictable flow of donor funding will allow them to meet basic health needs in the short to medium term.’


Influence of health system: General Practice?

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

Access to other primary care services reflects higher levels of need in deprived areas. The effect of incentives (Paying dentist/doctors extra in deprived areas to increase the amount of healthcare professionals within these areas)


Environment-Transport and health?

There can be adverse effects on health from the expansion of car use e.g. RTAs, pollution (often worse in deprived areas with poor urban planning)

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, 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


Environment-Media and 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


WHO definition of Health Inequalities?

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


Health inequalities in Scotland overview?

The Scottish Government allocated around £170million (1.5% of overall NHS Scotland budget) to NHS boards to directly address health related issues associated with inequalities in 2011/12, and in its spending review of 2012/13 reiterated its commitment to addressing health inequalities. As yet it is not clear how NHS boards and councils allocate resources to target local areas with the greatest need

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


Health Inequalities in Aberdeen?

There are substantial variations in life expectancy estimates in different areas of Aberdeen City (based on Intermediate Zones).

- For males, life expectancy at birth ranges from a low of 68.2 years in Woodside to a high of 84.9 years in Braeside, Mannofield, Broomhill & Seafield – a difference of 16.7 years.

- For females it ranges from a low of 74.9 years in Woodside to a high of 87.0 years in Balgownie and Donmouth East – a difference of 12.1 years.


Health Inequalities in Scotland-Audit Scotland, December 2012 key facts least deprived versus most deprived?

1) Life expectancy of women:
84.2 vs 76.8

2) Life expectancy of men:
81.0 vs 70.1

3) Alcohol related admission per 100,000:
214 vs 1621

4) Percentage adults smoke:
11% vs 40%

5) GP consultation foe anxiety per 1000 patients:
28 vs 62

6) Exclusive breast feeding rates:
40% vs 15%

7) Low birth weight:
13% vs 31%

8) Children who attend dentist:
81% vs 54%

9) Obesity:
18% vs 25%

10) Teenage pregnancy per 1000:
3 vs 14

Other facts:
- £11.7 billion total amount spent by the NHS in 2011/2012
- £170 million allocation to the NHS for schemes related to health inequalities