Health Inequalities Flashcards

1
Q

What is sociology?

A

Sociology = the study of the development, structure and functioning of human society

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2
Q

What does medical sociology study?

A

Sociology of health and illness (medical sociology):

  • Sociology studies peoples interactions with those engaged in medical occupations
  • Studies way people make sense of illness
    • Illness vs disease
  • Studies behaviour and interactions of health care professionals in their work setting
    • Professional values, interactions between each other and patients
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3
Q

What are some examples of applications of sociology to healthcare?

A
  • Sociology of medical profession
    • Systemic theory
    • Authority recognised by its clientele
    • Broader community sanction
    • Code of ethics
    • Professional culture by formal professional sanctions
  • Health promotion
    • Promotion healthy behaviour and preventing ill-health is only possible if we understand how different groups operate
    • Sociology provides health promotion an analysis of different groups in society
      • Men/woman, old/young, rich/poor
  • Medicalisation
    • Process where areas of behaviour or life become defined as medical problems
    • Things that were previously seen as natural such as pregnancy and child birth are becoming more medicalised
    • Examples are behaviour in relation to gambling, alcohol or sex becoming labelled as addiction and becoming medically managed
  • Work related stress
    • Stress = adverse reaction to excessive pressure
    • Significant consequents for the individual (poorer physical and mental health and health behaviours), society (loss productivity) and health service (increased use of service)
    • Often medicalised but evidence suggests organisational solutions are better that address cause such as looking at workload, role clarity, support etc
  • The sick role
    • Sick role patient
      • Exempts people from daily responsibilities
      • Patient is not responsible for being ill
      • Patient must seek help from healthcare professional
      • Under social obligation to get better soon and be able to take up social obligations
    • Sick role healthcare professional role
      • Must be objective and not judge patients morally
      • Act not out of self-interest but in patients interest
      • Obey professional code of practice
      • Have and maintain knowledge and skills to treat patient
      • Right to examine patient intimately, prescribe treatment and wide autonomy in medical practice
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4
Q

Describe some aspects for the sociology of the medical profession?

A
  • Systemic theory
  • Authority recognised by its clientele
  • Broader community sanction
  • Code of ethics
  • Professional culture by formal professional sanctions
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5
Q

Describe some aspects for the sociology of health promotion?

A
  • Promotion healthy behaviour and preventing ill-health is only possible if we understand how different groups operate
  • Sociology provides health promotion an analysis of different groups in society
    • Men/woman, old/young, rich/poor
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6
Q

Describe some aspects of sociology for medicalisation?

A
  • Process where areas of behaviour or life become defined as medical problems
  • Things that were previously seen as natural such as pregnancy and child birth are becoming more medicalised
  • Examples are behaviour in relation to gambling, alcohol or sex becoming labelled as addiction and becoming medically managed
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7
Q

What is stress?

A
  • Stress = adverse reaction to excessive pressure
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8
Q

What are some consequences of stress?

A

Significant consequents for the individual (poorer physical and mental health and health behaviours), society

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9
Q

What are some socio-economic influences on our health?

A
  • Gender
    • Men greater mortality
    • Woman higher morbidity
      • Maybe due to visiting doctor more or living longer
    • Evidence woman are assessed differently and receive poorer care
    • Gender affects presentation and diagnosis
      • Younger woman higher rate of mortality after MI and CABG but men in all age groups higher risk of ischaemic sudden death
      • Woman experience more atypical symptoms
      • AF greater risk in stroke in woman than men
      • Most autoimmune diseases are in woman
    • Gender effects disease management
      • Woman with MI receive less guideline based diagnosis and less invasive treatment than men
      • Woman obtain dialysis later than men and undergo fewer transplants
      • Delay in referral of woman with RA compared to men
      • Osteoporosis and depression considered female disease, both might be underdiagnosed in men
  • Ethnicity
    • South Asians have substantially higher rates of heart attacks and type 2 diabetes
    • Admission for Polish and Chinese groups lower than white Scottish counterparts
    • Greater prevalence of sickle cell disease in African origin groups
    • Mortality higher in white population than in black and minority populations
    • Ethnicity impacts alcohol
      • Most minority groups have higher rates of abstinence and lower levels of drinking, highest amongst South Asians
      • People from Indian, Chinese, Irish and Pakistani backgrounds on higher incomes tend to drink above limits
      • Over time generational differences may emerge, such as increased heavy drinking for Indian woman and Chinese men
      • People in some ethnic groups greater risk of alcohol related harm, Irish and Scottish men and woman have higher rates of alcohol related deaths than rest of UK
        • Stats may be impacted by minority ethnic groups being under-represented in seeking treatment and advice for drinking problems
      • Sociology describes and seeks to identify reasons, dealing with disparities in health relating to ethnic differences
        • Identify potential barriers to use of NHS
          • Personal – language, understanding, belief
          • Provider – understanding differences due to ethnicity, provider skills and attitude
          • System – organization of appointments and referrals
        • Culturally competent care is a combination of attitudes, skills and knowledge to allow for understanding and better care of patients with different backgrounds to our own
  • Physical environment / housing
    • Cold homes greater risk of mental and physical health problems
    • Excess winter deaths 3x higher than in warmest
    • Indoor air quality is determined by indoor and outdoor pollutants, most detrimental to elderly and asthmatics
    • Mould spores and faecal pallet from house dust mites
  • Education
    • Worse education level associated with poorer health
    • Effects of education persist throughout life
    • How education might affect health
      • Psycho-social environment
        • Effects social standing, bolsters individual capacity and autonomy
      • Access to different employment
        • Different employment improves income and benefits and working conditions
      • Healthy knowledge
        • Lifestyle changes, awareness of risk associated with behaviours
  • Employment
    • Provides: income and financial security, social contacts, status in society, purpose in life
    • Unemployment associated with increased morbidity and premature mortality
  • Income / social status / financial security
  • Health system
    • Greater spending per capita associated with less mortality and longer life expectancy
    • Distribution of GPs across Scotland does not reflect levels of deprivation, services designed to improve whole population health (such as screening) may widen health inequalities if uptake lowest in those who would get most benefit
  • Culture and social environment
    • Transport
      • Greater air pollution increases CVS and respiratory diseases, cancer and adverse birth outcomes
      • RTA, speed has a great impact in mortality
      • Increased walking and cycling benefits mental and physical
    • Media
      • Shapes our views and expectations, such as how has decreased previous stigma associated with mental health
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10
Q

Describe some aspects of gender influencing our health?

A
  • Men greater mortality
  • Woman higher morbidity
    • Maybe due to visiting doctor more or living longer
  • Evidence woman are assessed differently and receive poorer care
  • Gender affects presentation and diagnosis
    • Younger woman higher rate of mortality after MI and CABG but men in all age groups higher risk of ischaemic sudden death
    • Woman experience more atypical symptoms
    • AF greater risk in stroke in woman than men
    • Most autoimmune diseases are in woman
  • Gender effects disease management
    • Woman with MI receive less guideline based diagnosis and less invasive treatment than men
    • Woman obtain dialysis later than men and undergo fewer transplants
    • Delay in referral of woman with RA compared to men
    • Osteoporosis and depression considered female disease, both might be underdiagnosed in men
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11
Q

Describe some aspects of ethnicity influencing our health?

A
  • South Asians have substantially higher rates of heart attacks and type 2 diabetes
  • Admission for Polish and Chinese groups lower than white Scottish counterparts
  • Greater prevalence of sickle cell disease in African origin groups
  • Mortality higher in white population than in black and minority populations
  • Ethnicity impacts alcohol
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12
Q

What are some examples of ethnicity impacting alcohol intake?

A
  • Most minority groups have higher rates of abstinence and lower levels of drinking, highest amongst South Asians
  • People from Indian, Chinese, Irish and Pakistani backgrounds on higher incomes tend to drink above limits
  • Over time generational differences may emerge, such as increased heavy drinking for Indian woman and Chinese men
  • People in some ethnic groups greater risk of alcohol related harm, Irish and Scottish men and woman have higher rates of alcohol related deaths than rest of UK
    • Stats may be impacted by minority ethnic groups being under-represented in seeking treatment and advice for drinking problems
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13
Q

What are some potential barriers for people of various ethnicities using the NHS?

A
  • Personal – language, understanding, belief
  • Provider – understanding differences due to ethnicity, provider skills and attitude
  • System – organization of appointments and referrals
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14
Q

What are some examples of physical environment/housing influencing health?

A
  • Cold homes greater risk of mental and physical health problems
  • Excess winter deaths 3x higher than in warmest
  • Indoor air quality is determined by indoor and outdoor pollutants, most detrimental to elderly and asthmatics
  • Mould spores and faecal pallet from house dust mites
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15
Q

What are some examples of education influencing health?

A
  • Worse education level associated with poorer health
  • Effects of education persist throughout life
  • How education might affect health
    • Psycho-social environment
      • Effects social standing, bolsters individual capacity and autonomy
    • Access to different employment
      • Different employment improves income and benefits and working conditions
    • Healthy knowledge
      • Lifestyle changes, awareness of risk associated with behaviors
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16
Q

Why does employment influence health?

A
  • Provides: income and financial security, social contacts, status in society, purpose in life
  • Unemployment associated with increased morbidity and premature mortality
17
Q

How does the structure of the health system influence health?

A
  • Greater spending per capita associated with less mortality and longer life expectancy
  • Distribution of GPs across Scotland does not reflect levels of deprivation, services designed to improve whole population health (such as screening) may widen health inequalities if uptake lowest in those who would get most benefit
18
Q

What are some examples of transport influencing health?

A
  • Greater air pollution increases CVS and respiratory diseases, cancer and adverse birth outcomes
  • RTA, speed has a great impact in mortality
  • Increased walking and cycling benefits mental and physical
19
Q

How does the media influence health?

A
  • Shapes our views and expectations, such as how has decreased previous stigma associated with mental health
20
Q

What is the WHO definition of health inequalities?

A

Health inequalities = differences in health status or in distribution of health determinants between different population groups (WHO)

21
Q

Summaries the latest health inequalities audit?

A
  • Health and life expectancy has improved over last 50 years, but lower than rest of UK
  • Woman live longer than men but have more years of poorer health
  • People in rural areas live longer than those in urban areas
  • Deprivation key determinant of health inequalities, although age, gender and ethnicity also factors
22
Q

How does disease burden corespond to level of deprivation?

A
  • Burden increases with each level of deprivation
23
Q

What are the top 3 causes of disease burden for:

  • most deprived areas
  • least deprived areas
A
24
Q

Other than disease burden, what are some examples of other issues associated with deprivation?

A
  • Education
  • Homelessness / poor quality homes
  • Unemployment
  • Family breakdown
  • Anti-social behaviour
  • Hopelessness
  • Multi-morbidity
  • Ambition / aspiration / opportunity
25
Q

What is vulnerability?

A

Vulnerability = degree to which a population, individual or organisation is unable to anticipate, cope with, resist and recover from the impacts of disasters (WHO)

26
Q

What groups of people are most at risk of being ‘vulnerable’?

A
  • Children, pregnant woman, elderly, sick, malnourished, those in poverty
27
Q

Describe the Scottish governments definition of vulnerability?

A
  • “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
28
Q

Who are some examples of vulnerable groups with poorer health?

A
  • Homeless
  • Learning difficulties
  • Refugees
  • LGBTQ+
  • Prisoners
29
Q

What is the ‘inverse care law’?

A

Inverse care law = those in most need of medical care are least likely to receive it and conversely, those with least need tend to use health services more

30
Q

What is the governments task force for inequality called?

A

Ministerial taskforce on health inequalities

31
Q

What are the 3rd sector organisations that tackle inequality called?

A

Voluntary sector organisations (non-government, non-profit)

32
Q

What kinds of services do voluntary sector organisations deliver?

A
  • Promotes healthy living to groups not using mainstream services
  • Supports people to access relevant NHS services
33
Q

What are some examples of voluntary sector organisations?

A
  • Citizens advice
    • Help people with negotiating difficult problems, such as debt, finances, benefits, consumer rights
    • Supports witnesses in court
    • Advocacy work
  • Alcohol and drugs action
    • 7 days support, advice and targeted interventions for anyone affected by substance misuse
    • Telephone helpline, drop in service, needle exchange, ongoing support
  • CLAN
    • Supports people affected by cancer
    • Aims to improve quality of life
    • Includes information and support, counselling, complimentary therapies, social and wellbeing activities, dedicated support for children and families
  • Somebody cares
    • Provides food, furniture, clothing and more to vulnerable and marginalised people
  • Penumbra
    • Mental health charity
    • Promotes mental health, prevents mental health issues for those at risk, supports people with mental health issues
34
Q

What are some examples of things that could be done to reduce health inequality?

A
  • Partnership across sectors to promote health
  • Evaluate and refine health and social care
  • Government policies and legislation
  • Invest in more vulnerable patient groups
  • Improve access to health and social care
  • Reduction in poverty
  • Social inclusion policies
  • Improved employment opportunities
  • Ensuring equal education
  • Improved housing in deprived areas