SOCIAL Health Inequality Flashcards
(23 cards)
What is the WHO definition of health?
Health as being ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’.
What is the biopsychosocial model of health:
-holistic model of health which brings together 3 areas that contribute to health.
1.Biomedical- e.g. genetics, viruses, bacteria, physical impairments.
2. Psychological-e.g. beliefs, behaviours, coping skills stress.
3. Social- e.g. social status, ethnicity, friendship group, family background.
=all these interact and impact health, so person + context needs to be taken into account as well as influence of biology.
=three factors interacting give rise to health inequalities at global level + in UK.
Outline life expectancy variations?
Japan-> highest 84.3 years.
Lesotho-> lowest 50.7 years.
Don’t have to look far afield to see such disparities. E.g. Glasgow, different parts of Glasgow have different life expectancies depending on neighbourhood. Cant take 15 years off life.
What are social determinants of health?
=circumstances which people born, grow up, live, work and age and the systems put in place to deal with illness. Circumstances shaped by wider set of forces: economics, social policies and politics.
E.g. income, education, unemployment, job security, working life conditions.
What is the difference between inequality and inequity?
Equality- everyone gets the same resources.
Equity- everyone gets same outcomes with resources distributed according to need.
Equal outcomes- through the removal of structural barriers.
List some examples of health inequalities between countries?
-infant mortality rate (risk of baby dying between birth + one year of age) is 2 per 1000 live births in Iceland + over 120 per 1000 live births in Mozambique.
-lifetime risk of maternal death during or shortly after pregnancy is only 1 in 17400 in Sweden but it is 1 in 8 in Afghanistan.
List some examples of health inequalities within countries?
-in Bolivia, babies born to uneducated women have infant mortality greater than 100 per 1000 live births, while infant mortality rate of babies born to mothers with at least secondary educations is under 40 per 1000.
-life expectancy at birth among indigenous Australians substantially lower than that of non-indigenous Australians.
-prevalence of long-term disabilities among European men aged 80+ years is 58.8% among lower educated versus 40.2% among higher educated.
What where some health inequalities surrounding covid?
report by Public Health England found factors other than underlying health status.
-age, male, country live in, minority ethnic background, born outside UK or Ireland, living in care home, certain jobs e.g. nurse, taxi driver.
What is HPV?
-human papillomavirus.
-sexually transmitted infection.
-more than 200 types:
-> 6 and 11- low risk types cause more than 90% warts.
-> 16 and 18- high risk types cause 70% of cervical cancer but other cancers as well.
80% sexually active individuals come into contact with HPV.
-condoms
-immune response
How does it affect health?
Genital warts (10% lifetime risk of males and females). HPV implicated in 5% of all cancers.
-cancers of the anus, tonsils, base of the tongue, penis, and head and neck.
Incidence of head + neck cancer in Europe attributable to HPV 16/18 is five-fold higher in men than women and increasing.
90% anal cancers
-50+ more women than men.
-20-49 more men than women.
-highest in men who have sex with men.
-higher in men living with HIV who have sex with men.
-cervical cancer.
What are the WHO targets for cervical cancer?
(WHO) defince cervical cancer eliminations as <4 cases per 100,000 women and has set ‘90-70-90’ targets for countries to reach by 2030.
-90% girls fully vaccinated by age of 15.
-70% women screened using high-performance test by age of 35, and again by age of 45 AND 90% of women pre-cancer treated.
-90% women with invasive cancer managed.
Detail cervical cancer in Uganda?
7th highest rate of cervical cancer worldwide.
-30 cases per 100,000 compared to 24.3 in Eastern Africa and 15.6 globally.
-6th highest cervical cancer mortality rate.
-cervical cancer is the most common cancer in the women aged 15-44yrs.
-6959 diagnoses and 4607 deaths each year.
Current screenings not routinely offered. Main approach is visual inspections.
Cervical screening variables across Uganda, one major barrier being access in remote or rural areas.
->35 million Uganda’s 44 million population live in rural areas.
->20th highest percentage rural population in world.
Screening rates between 4.8%-30%.
What did Black et al detail as cervical screening?
-embarrassment, fear of procedure or outcome.
-most frequent facilitators having a recommendation to attend screening
-small number of included studies limited a deeper understanding of district- specific barriers.
What is cervical screening in UK?
HPV primary screening:
-replaces cytology-based screening
-sample tested for HPV, if positive then sent for cytology
-opportunity for self-testing
What are dimensions of inequity?
Ethnicity, socioeconomic status, sexual minorities, age, sexual trauma, disability, etc.
-less likely to attend cervical screenings.
->ethnicity (bolarinwa & holt, 2023).
-at risk of worse adverse emotional response to testing HPV positive (O’Conner et al, 2018).
->lower attained education
->unemployed
->not married or cohabiting
-colposcopy attendance (Douglas et al, 2015)
->older women (45-64) likely to attend colposcopy within 4 months of referral than younger wome.
-> lower income area women have lower colposcopy attendance.
Disability in the UK?
16.0 million people (24% of pop) had disability in 2021/22.
Inequalities between disabled and non-disabled.
Women with disability find it hard to access health services.-> especially for cervical screening.
-some research exploring barriers to access for people with intellectual impairments.- indicates physically disabled adults higher risk of delayed, diagnosis + cancer mortality, cause of lower screening.
What is the link between cervical screening and physical disability?
->Edwards et al (2020): systematic review of barriers and facilitators to cancer care.
-identified 5 studies between 1997-2015 explored cervical screening for physically disabled women.
-all reported decrease in screening attendance associated with disability.
->Chan et al (2022): systematic review of factors influencing screening uptake- 9 studies 1997-2019.
-lack of knowledge of cervical cancer screening + how it can access.
-Difficulties and inconveniences in accessing cancer screening providers + undergoing screening procedures + uncomfortable experiences during screening procedure.
What is in the UK report from 2019 about disabled women and cervical screening?
2019 survey of 335 physically disabled women in UK.
-88% said harder for disabled women to attend or access cervical screening.
-63% had been unable to undergo cervical screening because of their condition.
-49% chosen not to attend cervical screening for reasons such as bad previous experiences related to their disability.
-20% reported they were assumed not to be sexually active.
=ppt chosen then asked to rate statements developed with patient and public involvement stakeholders. Statement included screening-related problems + solutions, questions about self-sampling and preferences for future screening.
Detail research into HPV self-sampling?
Asked questions e.g.: do you think you’d be able to do self-sampling yourself?- 63.5 said yes. Also said 21.1% would worry about doing it right. And 1% said would feel embarrassed doing HPV self-sampling.
How do HPV vaccinations work in the UK?
September 2008- school based vaccination programme introduced for girls aged 12-13.
April 2018 MSM up to 45 yrs could access vaccine.
September 2019- boys added to school based programme.
This has lead to: 88% reduction in CIN grade 2 or worse in young Scot women.
Do men need HPV vaccine?
Yes need to vaccinate boys as well as girls to:
-protect them and their partner.
-MSM- incidence of anal cancer is similar to estimated rate of CC without screening programme.
What are risk factors for Head and Neck Cancer?
Risk factors:
-excessive alcohol consumption
-smoking
-hpv
Brain cancer/ tumour is not HPC.
What are oropharyngeal cancers?
-rising incidences particulalry in men
-one of most rapidly rising incidences of cancer in high-income countries.
-an increasing incidence of this disease has been observed in UK, USA, across Europe, New Zealand, parts of Asia.
-both UK + USA, incidences of HPV + oropharyngeal cancer in men surpassed that of cervical cancer in women.
