Flashcards in Topic 6 - Determinants of Hauora Deck (23):
Define social determinants of health?
Conditions in the environment that affect a wide range of health, functioning and quality of life outcomes and risks
Define health equity?
Attaining highest level of health for all people; every person equal; on going societal efforts to address avoidable inequalities, injustices and elimination of disparities
Define health disparities?
Differences in health outcomes and their determinants between segments of the population
Define health inequalities?
Used interchangeably with health disparities, summary of measures of population health, usually income, education, ethnicity
Subset of health inequalities that are modifiable, associated with social disadvantage, considered ethically unfair
What are some specific health inequalities in New Zealand?
1. Mortality - Maori 2-3 times higher than non maori
2. Mortality - SUDI - maori babies 5 times more likely
3. Bronchiolitis - deprived neighbourhoods 6 times more likely hospitalised
4. Teenage suicide - highest in OECD
5. Mental illness - higher among deprived groups
6. Infectious disease - rheumatic fever, rickets, tuberculosis, whopping cough (crowding and poverty)
With regards to social cohesion what effects does inequalities in New Zealand have on a community?
Encourage competition - loss of empathy
What are the causes of health inequalities?
1. Behavioural and cultural influences - eg social class and lifestyle theory
2. Materialistic and structural influences - eg social class impacts access to good resources (health, housing, education)
3. Inequality causing inequality
5. Social capital/trust
6. Social exclusion/participation
What is racism?
Ideology of superiority
What is interpersonal discrimination?
Racist assault (verbal and physical)
What is institutional discrimination?
Discriminatory practice/policy embedded in organisational structures
What is the neoliberal perspective on inequalities?
Health is a personal choice
Inequality is both inevitable and undesirable
Market distribution of reward/burdens is not deliberate therefore is not unjust
Socioeconomic conditions can be fixed by growth in the economy
What is the egalitarian perspective on inequalities?
Health is more than personal choice
Disadvantage accumulates over a lifetime
Health behaviour is influenced by the social environment
Factors beyond an individuals lifestyle have significant impact
What are three main pathways that contribute to ethnic inequalities in health?
1. Exposure to determinants that lead to disease
2. Access to health care
3. Quality of care received
How has Maori health been affected through colonialisation?
1. Loss of Maori land
- Flawed land acquisition by crown
- Harmful to maori social and economic development
- some redress through treaty
What are some instances of disparity in health care services for Maori?
Unmet need in primary care
Lack of screening
Reduced cancer services
In hospital more likely to have an adverse event
Reduced urgency for surgery despite higher need
What is the distribution gap?
Maori residing in lower deciles in greater numbers
What is the outcome gap?
The effect on Maori during/after treatment.
Eg increased hospitalisation with increased deprivation
Eg Maori have worse outcomes than non maori of the same socioeconomic status
What is the gradient gap?
Describes the relationship between ethnicity and increasing deprivation
Why are the gaps in distribution, outcome and gradient a breach of the Treaty of Waitangi?
Part of treaty was to protect maori from marginalisation as a result of colonisation
What are some solutions to counter inequality?
Policies that target:
1. Structural (underlying social and economic determinants)
2. Intermediary pathways (behaviour, environmental and material resources)
3. Health and disability support
4. Impact of ill health on socioeconomic position
What is an example of a solution to inequality?
He korowai orange - Maori health strategy 2002