HL5 - Disparities in healthcare

Question 1

What are the different impacts of illness?

Answer 1

• Shock of diagnosis
• Frightening tests & treatments
• Physical changes in appearance
• Side effects
• Social disruption
• Existential issues (death & dying) - something that is not generally addressed in western culture

Question 2

What are the different stages of adjustment to illness?

Answer 2

• Illness
  
  • Presents challenges to individuals
  • Changes over time
• Required to deal with
  
  • Uncertainty
  • Disruption
  • Striving for recovery
  • Restoration of wellbeing
    
    • More & Johnson (1991) - ‘Generic model of emotional and coping responses)
• There is always something we can do to help mediate the illness (e.g. through talking)

Question 3

How can coping with illness impact friends and family differently?

Answer 3

Dealing with a broader context - can all be at different stages in dealing with the news

Question 4

What do we know about health differences between individuals?

Answer 4

• In Australia, the better-off live, on average, two years longer than the poor.
• Similarly, people who occupy minority roles in society as a result of ethnic or other factors may experience more illness or die earlier than the majority population.
• Findings that women live longer than men may be as much the result of social and psychological factors as biological ones.

Question 5

What does the Australian population look like?

Answer 5

Question 6

What are the leading causes of death in Australia?

Answer 6

Question 7

What are health differentials?

Answer 7

• Clear evidence of health differentials across whole populations both within and between countries
• WHO system for measuring life expectancy
  
  • equivalent of full health
• Richer the country = longer pop lives = longer health

Question 8

Can everybody read? How can this impact health?

Answer 8

Population has lower levels of literacy than we expect
Can impact survival rates

Question 9

What is the impact of poverty on health?

Answer 9

• People who live in developing countries live significantly shorter lives than those who live in more affluent countries (WHO 2000).
• Contributing factors are economic, environmental, and social – ;ack of safe water, poor sanitation, inadequate diet and poor access to health care.
• The problem now facing many developing countries in Africa is that of HIV infection and AIDS.

Question 10

How do health inequalities impact health?

Answer 10

• Found in rich & poor countries
• Consequence of social, economic and educational & environmental differences
• May be amenable to reduction by intervention at societal level
• Linear relationship between income and health
• Found income inequality was globally associated with less effective pandemic response across at least two pandemics

Question 11

What is homelessness like in Australia?

Answer 11

• 58% male, 42% female and 20% indigenous
• Increased by 13.7% in 5 years
• People stay in improvised dwellings, supported accommodation etc.

Question 12

What are Marmot’s eight principles of health equality?

Answer 12

Question 13

What is health inequality like within countries?

Answer 13

• 2010-12 life expectancy for:
  
  • Indigenous males 10.6 yrs lower than non- indigenous
  • Indigenous females 9.5 yrs lower than non- indigenous
• A problem within rich countries
• Failure of health care systems
• Technical problem to be addressed by improving access to services among those with poorer health
• Lifestyle/cultural differences between socio-economic or ethnic groups that can be solved through health education and promotion

Question 14

What are examples of differences between ethnic minorities?

Answer 14

• Significant variations both
  
  • between the overseas born groups
  • and between these groups and those born in Australia
• Migrants to Australia have lower rates of cardiovascular mortality than Australian born people.
• Deaths from lung cancer and breast cancer were higher in UK and Irish born residents than Australian born people but skin cancer was lower
• People born in Asia had significantly higher rates of mortality from infectious diseases, diabetes and homicide than the Australian born population

Question 15

What is health inequality like between countries?

Answer 15

• USA is below the OECD average for life expectancy
  
  • Some social groups have extremely poor health – more characteristic of poor developing countries rather than a rich industrialised one
  • The HIV epidemic caused a higher proportion of death and disability among young and middle-aged Americans than in most other advanced countries.
    
    • Lack of harm minimisation interventions
    • ‘War on drugs’
  • USA is one of the leading countries for cancers relating to tobacco.
  • The United States has high incidences of homicides compared to other industrial countries.

Question 16

What is an example of an Australian policy to minimise harm?

Answer 16

• Needle exchange program
  
  • Exchange program for injecting drugs for users in Darlinghurst
  • Goal of achieving abstinence is valid but also the need to protect the health of individuals while using
  • It did not increase injecting drug use
  • Caused avoidance of 25,000 cases of HIV
  • Saved 2.4 billion dollars in healthcare

Question 17

What is the ‘healthy migrant’ effect?

Answer 17

Majority of people who migrate to Australia are healthy if not healthier than Australian population

Question 18

How does social class impact health?

Answer 18

• Lawson and Black (1993) found that marked differences in death rates according to social class exist
• If men of all social classes had the same mortality experiences as higher social class men the overall death rates for Australian men would be reduced by 60%
• They suggest that socioeconomic status is the most important indicator of health status among Australians

Question 19

What is social causation vs social drift?

Answer 19

• Social Causation Model– Low SES ‘causes’ health problems.– There is something about occupying a low socio-economic group that negatively influences the health of individuals.
• Social Drift Model– Health problems ‘cause’ low SES.– When individuals develop a health problem, they may not maintain a job or the levels of overtime required to maintain their standard of living. They therefore drift down the socio-economic scale

Question 20

What are health selection explanations?

Answer 20

• People are not sick because they are poor
• Rather poor health lowers income and limits learning potential
• Little empirical support for this

Question 21

What are statistical artefact explanations?

Answer 21

• The poorest in any society are usually the sickest.
• A society with high levels of income inequality has high numbers of poor and consequently will have more people who are sick.
  
  • There is little empirical support for this explanation

Question 22

How can we explain inequalities?

Answer 22

• It is impossible to decide how much each of these causes is contributing to the gradients in illnesses and deaths
• Understanding the material, behavioural and locality-based causes, and the interactions between them is a priority
• Behavioural, material, and local circumstances vary with SES
• Different types of health behaviour - more damaging or less damaging

Question 23

What are health risk behaviours?

Answer 23

• Poorer people doubly disadvantaged
• Health-compromising behaviour
  
  • Due to
    
    • Possess in sufficient knowledge
    • Lack of opportunities
    • Stress
• Environmental insult
  
  • Exposed to working in dangerous conditions
  • More accidents
  • Live in rented accommodation
  • Stress, strain and depression
    
    • Childhood
      – family instability
      – Overcrowding
      – poor diet
      – restricted educational opportunities
    • Adolescence
      – family strife
      – exposure to smoking and own smoking
      – leaving school with poor qualifications
      – experiencing unemployment or low-paid and insecure jobs
    • Older age
      
      • No or small occupational pension
      • inadequate heating
      • inadequate food

Question 24

What is Hobfoll & Lilly (1993) conservation of resources model?

Answer 24

• Mental and physical health are determined by the amount of resources available to the individual.– economic (e.g. job, income)– social (e.g. family support)– structural (e.g. housing)– psychological (e.g. coping skills, perceived control).
  • Indigenous Australians– Experience higher unemployment– State interference with family structures and support– poorer housing conditions– More likely to experience racism and stress– are less likely to have access to higher education (Australian Bureau of Statistics, 2005)
  – so their poorer health fits well into this model
• Hobfoll & Lilly (1993):
  • mental and physical health determined by the amount of resources available to the individual.– economic (e.g. job, income)
  – social (e.g. family support)– structural (e.g. housing) psychological (e.g. coping skills, perceived control).– High level of resources is health-protective.– Low levels of resources place an individual at risk for health problems.

Question 25

What impacts access to health care?

Answer 25

• Mediated by
  
  • availability of services, especially in rural and outer urban areas
    
    • cost of health care services, especially services to which patients are referred from primary care
  • waiting times especially allied health services
  • outpatient medical specialist services
  • elective procedures (Harris & Furler, 2002)
• Differences in response to unemployed patients with anxiety or depression
  
  • Being more likely to prescribe to
  • Less likely to refer or offer non-pharmacological interventions
• No problems in accessing some aspects of health care
• Low SES correlated with higher rates of admission for acute myocardial infarcation, also related to low intervention rates

Question 26

How should we reduce inequalities?

Answer 26

Tackling inequalities in health should involve different levels of intervention (Whitehead, 1995):
– Strengthening individuals
– Strengthening communities
– Improving access to essential facilities and services
– Encouraging macro-economic and cultural change