Inequalities in Healthcare

11 Key excerpts on "Inequalities in Healthcare"

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  Pharmacy Practice

  • Geoffrey Harding, Kevin M. G. Taylor, Geoffrey Harding, Kevin M. G. Taylor(Authors)
  • 2017(Publication Date)
  • Taylor & Francis

    (Publisher)

  Several commentators, notably Wilkinson (1996), have 155 Inequalities in Health and Health Care sought to explain the persistent social class gradient in health inequalities. Wilkinson examined the degree of income inequality in various countries and concluded that the overall level of wealth (or poverty) was not a significant factor in explaining health inequalities, but rather the difference between the richest and poorest was such an explanatory factor (Wilkinson and Pickett 2010). Thus, income inequali-ties are related to health inequalities. Moreover, those societies with lower income inequalities had higher levels of ‘social capital’, which translated through unspeci-fied mechanisms into the level of health. Others have sought to operationalize Wilkinson’s thesis by examining the mechanisms of social capital within societies. Social capital refers to the social solidarity between citizens, promoting feelings of well-being and social cohesion or inclusion – the systems and processes by which individuals feel part of society. This may be manifest in terms of turnout at elections, participation in social groups (e.g. sports clubs), voluntary organizations or church attendance or donations to charity (Putnam 2001). One problem of the social capital thesis is establishing the precise connection between health and these multifarious types of social capital; the causal mechanisms are not very clear-cut. TACKLING HEALTH INEQUALITIES Inequalities in health and health care are complex and deep-rooted phenomena that lie beyond the scope of health care systems alone, and thus are not simply amenable to remedy by government interventions or practitioners. Indeed, the social determi-nants of health lie well beyond any health care interventions.

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  Health, Disease and Society

  A Critical Medical Geography

  • Kelvyn Jones, Graham Moon(Authors)
  • 2022(Publication Date)
  • Routledge

    (Publisher)

  CHAPTER 6 Inequalities in health care

  Introduction

  There has been considerable interest in recent years in what has been termed inequality in health care. We take this as our theme in broadening our discussion of health care away from the relatively narrow issues which are covered in the previous chapter.

  As a context for the chapter the words of a Government White Paper published prior to the founding of the British National Health Service (NHS) are instructive:

  The Government wants to insure that in future every man, woman and child can rely on getting all the advice, treatment and care which they may need in matters of personal health; that their getting these shall not depend on whether they can pay for them, or any other factor, irrespective of need. (HM Govt, 1944 , quoted in Le Grand, 1982 , p. 23)

  Today, some thirty-seven years after the creation of this ‘model’ health service, the evidence from the Black Report indicates continued inequalities in health care in Britain (DHSS, 1980 ). The situation is similar elsewhere.

  The chapter will start by examining the social context of equality and inequality. We will then proceed to show how these social constructs can be linked to a spatial consideration of health care. Empirical evidence for both social and spatial inequalities will then be identified at the international, regional and local scales.

  Equality and inequality

  The term ‘equality’ may mean different things to different researchers. It is essential for us to recognise, at the outset, at least five distinctive conceptualisations (Le Grand, 1982 ):

  1. Equality of public expenditure;
  2. Equality of final real income;
  3. Equality of use;
  4. Equality of cost;
  5. Equality of outcome.

  Equality of public expenditure argues that expenditure from the public purse should be allocated to each individual on a per capita basis. Each and every individual should therefore receive the same proportion of available resources. The surface appearance of this form of equality is that it is just; however, different individuals will have different needs and so equality of public expenditure may, in reality, be inequality. Table 6.1 illustrates this point with an example, taken from Le Grand (1978) , using data from the 1976 British General Household Survey (see Chapter 2

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  Crash Course Medical Ethics and Sociology Updated Edition - E-Book

  Crash Course Medical Ethics and Sociology Updated Edition - E-Book

  • Andrew Papanikitas, Daniel Horton-Szar(Authors)
  • 2015(Publication Date)
  • Mosby Ltd.

    (Publisher)

  Inequalities in health and healthcare provision 9 This chapter is co-authored with Elizabeth Morrow, PhD Student, Dept of Political Economy, King’s College London. This chapter considers inequalities in health and healthcare provision by social class, gender, ethnicity and age. IMPACT OF SOCIAL CLASS There is a long tradition in Britain of analysing national statistics to shed light on the nature and causes of social inequalities in health (Figs 9.1, 9.2). In 1837, William Farr set up the General Register Office. Farr, as the first Superintendent of Statistics, clearly believed that it was the responsibility of the national office not just to record deaths, but to uncover underlying linkages which might help to prevent future disease and suffering. In the nineteenth century, the associations between various occupations and health were put down to: specific work-related hazards and variation of income – which affected the provision of nutrition and housing. In 1942, the Beveridge Report set out a national programme of policies to combat the ‘five giants of Want, Disease, Ignorance, Squalor and Idleness’. In 1977, the Research Working Group on Inequalities in Health, chaired by Sir Douglas Black, was established. The result- ing ‘Black Report’ presented in 1980 attempted to explain trends in inequalities in health. It argued that inequalities in health were a result of inequalities in society. While the recommendations of this report had a significant effect in academic circles, it arguably failed to produce meaning- ful change in political policies (health inequalities grew throughout the 1980s). In 1997, the recently elected ‘New Labour’ govern- ment set up an independent inquiry chaired by Sir Donald Acheson. The Acheson Inquiry, published in 1998, identified the following as areas where policy could redress health inequalities by tackling socio- economic factors: 1. Poverty, income, tax and benefits 2. Education 3. Employment 4.

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  Medicine, Health and Society

  • Hannah Bradby(Author)
  • 2012(Publication Date)
  • SAGE Publications Ltd

    (Publisher)

  Another way of expressing this would be to distinguish between ‘inequalities in health’ and ‘inequities in health’. While ‘inequality’ refers to difference between groups without comment on the source of that difference, ‘inequity’ refers to a normative principle of social justice which considers the differences to be unfair and unjust to the extent that they are avoidable (Siegrist and Marmot, 2006: 5). If equity in health is an ideal whereby everyone has a fair opportunity to reach their full potential health, then social gradients in health contradict this principled distribution of human life chances. A problem with drawing this precise distinction between inequity and inequality in health is that we do not yet know the extent to which inequalities between individuals or between groups are avoidable and therefore iniquitous. Until we have a better sense of the extent to which the major chronic diseases are socially determined, the lack of precision in attributing their inevitable or avoidable nature encapsulated by the term ‘inequality’ is an appropriate description of the dimensions of the problem (Siegrist and Marmot, 2006: 5).

  Another common criticism of the health inequalities literature is the difficulty of translating research findings into measures that tackle the inequalities being described. Reducing inequalities in health outcomes between social classes is a national policy issue and, despite declared good intentions, the actual efforts towards the reduction of inequalities have been modest, with only a few countries reaching ‘a stage of policy development in which serious efforts can be, and sometimes are, considered’ (Mackenbach, 2006: 245). Thus, there is inadequate evidence of the application of good policy to tackle health inequalities to be able to come to a judgement on the feasibility of such a task.

  MEASUREMENT OF INEQUALITY

  Health inequalities by various social divisions, including class, gender, ethnic group and occupation, have been measured in a number of ways, including the assessment of: longevity or life expectancy; experience of disease; experience of symptoms; dimensions of fitness; and the functional ability to perform daily tasks. Since health is a multi-dimensional quality, in which the balance of dimensions varies according to social context, one’s state of health and across the life-course, there are a huge number of means of rendering a measurement. In theory, a full assessment of health would be a composite measure, in which case the weighting of the various components becomes subject to debate: is health most appropriately measured by individual self-assessment of ‘wellness’, self-reporting of symptoms, the uptake of general or specialist health services or rates of sick days away from work? The demonstration of inequality in rates of morbidity, the quality of health service provision and rates of service use are beset by difficulties in defining and consistently measuring appropriate variables – for example, good quality service provision in places and at times that suit patients attract higher rates of use than poorer services at inconvenient times and in inaccessible locations, but the higher service use does not necessarily indicate poorer health. The great difficulty in measuring the many dimensions of health in a way that is comparable across populations means that univariate summary measures are very appealing.

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  Social work and global health inequalities

  Practice and policy developments

  • Bywaters, Paul, McLeod, Eileen(Authors)
  • 2009(Publication Date)
  • Policy Press

    (Publisher)

  Health, like wealth, is distributed in gradients (Gorin, 2000; Wilkinson and Marmot, 2003). Gradients in health closely parallel each society’s historically evolved form of distributing resources necessary for human development and well- being. Access to health care, while vitally important in the lives of individuals and families, does not significantly overcome inequality in the distribution of wealth or its impact on population health. Isaacs and Schroeder found that,‘Medical care has been estimated to account for only about 10 to 15% of the nation’s premature deaths.Thus, ensuring adequate medical care for all will have only a limited effect on the nation’s health’ (2004, p 1141). Further, Poulton et al (2002), studying the impact of children’s exposure to socio-economic disadvantage on adult health in the UK, concluded that there was a detrimental impact on physical, dental and mental health despite a universally accessible and subsidised health care system. The unequal distribution of material and psychosocial resources and their impact are also unveiled in the differential development and scope of various welfare state investments in human capital (Kawachi et al, 1999; Coburn, 2000; 2004). Societies with lower income inequality gaps have higher levels of investment in health and human services, entitlement programmes and support systems. Health at the population level reflects these interacting societal-scale forces. This conceptualisation of health is significantly influenced by the work of Krieger (Krieger et al, 1993; 1997; Krieger, 1994; 1999; 2001a; 2001b).

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  Social Sources of Disparities in Health and Health Care and Linkages to Policy, Population Concerns and Providers of Care

  • Jennie Jacobs Kronenfeld(Author)
  • 2009(Publication Date)
  • Emerald Group Publishing Limited

    (Publisher)

  ( Smedley et al., 2003 ). The elimination of disparities in health was a goal of Healthy People, 2010. Unequal Treatment extensively documented health care disparities in the United States and focused on those related to race and ethnicity. One weakness of the report was there was not a focus on disparities related to SES. The IOM report on Unequal Treatment also looked at factors related to providers of care and argued providers’ perceptions, and from that, their attitudes toward patients can be influenced by patient race or ethnicity ( Smedley et al., 2003 ). The National Healthcare Disparities Report (2003) did have a focus on the ability of Americans to access health care and variation in the quality of care. Disparities related to SES were included, as were disparities linked to race and ethnicity, and the report also tried to explore the relationship between race/ethnicity and socioeconomic position. There were a number of key findings from the report. First, inequality in quality of care continues to exist. These disparities often are particularly true for some more serious health care problems, such as minorities being diagnosed with cancer at later stages, less often receiving optimal care when hospitalized for cardiac problems, and higher rates of avoidable hospital admissions among blacks and poorer patients. Differential access to health care often leads to disparities in quality of care actually received. In addition, opportunities to provide preventive care are often missed. The report closes with a call for more data, more research and the linkage of those to policy within the United States. The knowledge about why disparities continue to exist is still limited, and data limitations may limit improvement efforts. Despite these concerns, improvement is possible, and some examples are provided using California subpopulation data that demonstrate how targeted some prevention efforts to specific groups can yield useful results.

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  Social Work, Health and Equality

  • Paul Bywaters, Eileen McLeod(Authors)
  • 2012(Publication Date)
  • Routledge

    (Publisher)

  Oppression in bodily form

  DOI: 10.4324/9780203069530-2

  Introduction

  In this chapter we underline the case that inequalities in health should be a central concern for social work. We give evidence of the extent of this major social problem and the complex ways in which health inequalities are linked with multiple dimensions of social inequality. We argue that oppression is physically embodied in the suffering involved in ill health and premature death. We present evidence of widening inequalities across the UK population and show how these inequalities are woven into the fabric of people's daily lives as they work to secure and maintain health for themselves and those close to them. We discuss the economic and policy backdrop to this daily labour of lay health work and argue that inequalities in health are not simply the visible outcome of a particular economic system but are part of the process through which the economic and political system is sustained. We focus on policy relating to health care as an example of the wider reconstruction of welfare.

  This chapter prepares the ground for a detailed examination across Chapters 3 to 7 of the actual and potential role of social work in reducing health inequalities. It is not concerned with inequalities in the experience of illness, which are also the focus of later chapters, but primarily with inequalities in ‘health chances’: people's chances of staying well, getting ill or dying prematurely (Moore and Harrison 1995 ).

  The production of health: Social, economic and environmental factors

  In Britain, the Black Report on Inequalities in Health (Department of Health and Social Security (DHSS) 1980) proved to be a landmark study, demonstrating that the NHS and social services had been ineffective in closing the gap in health between rich and poor (

  Davey Smith et al. 1990

  and 1998a ). Since then an extensive body of evidence on the association between social inequalities and inequalities in health has been developed (Whitehead 1987 ;

  Davey Smith et al. 1990

  ; Smaje 1995 ; Watt 1996

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  Health Inequalities and People with Intellectual Disabilities

  • Eric Emerson, Chris Hatton(Authors)
  • 2013(Publication Date)
  • Cambridge University Press

    (Publisher)

  The data in Figures 2.1 to 2.6 illustrate variations in different measures of health status by geographical location (country or region (2.1–2.5), gender (2.3, 2.5, 2.6), age (2.6) and disability status (2.4)). The preceding sections also contained information on the association between health and neighbourhood wealth (Villermé), housing conditions (Engels) and intellectual disability status. However, these differences in health status between groups are not necessarily health inequalities. The term health inequalities refers to differences in health status between social groups ‘which are unnecessary and avoidable but, in addition, are also considered 36 Chapter 2: Health and health inequalities unfair and unjust’ (Whitehead, 1992). It is highly likely that many of the differ- ences we have used to illustrate the preceding section of this chapter are unnec- essary and avoidable and would be seen by many as also being unfair and unjust. For example, to the extent that the above differences reflect the impact of global, regional and within-country inequalities in the distribution of wealth and power, these differences are clearly unnecessary and avoidable and, hopefully to most people, unfair and unjust. But what about the shorter life expectancy of men, or of people with intellectual disabilities? To what extent are these differences unneces- sary, avoidable, unfair and unjust? The determinants of health and health inequalities We now have nearly two centuries of research evidence that has described the association between exposure to a wide range of environmental adversities and poorer health (Adler and Stewart, 2010; Black, Morris, and Bryce, 2003; Graham, 2007; Lund et al., 2010; Marmot, 2005; Marmot and on behalf of the Commission on Social Determinants of Health, 2007; Marmot and Wilkinson, 2006; Pickett and Wilkinson, 2007; The Marmot Review, 2010; Wilkinson and Pickett, 2009; World Health Organization, 2008).

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  Sociology in Practice for Health Care Professionals

  • Ron Iphofen, Fiona Poland(Authors)
  • 1998(Publication Date)
  • Red Globe Press

    (Publisher)

  Chapter 7 Equal and Unequal Opportunities In most societies some groups of people have more access to material resources, to health and to respect than others. Most health and care resources are taken up in dealing with disadvan-taged groups. As we have indicated inequality and the lack of political resources to remedy inequalities are central to meeting health care needs. Inequality and difference One of the many paradoxes of human experience is that we are, at the same time, similar but different. We share the fact that we are mortal human beings. This makes us all equal in one respect, but we are also unique. Each of us inhabits our own particular place in space and time. Only I have had my experiences and inherited my physical characteristics. Only you have had and inherited yours. However, we find it hard to handle complete difference or complete sameness. We like to think that some people are similar to us and some are different from us, and we organise our world according to those characteristics. In most societies people do not see each other as equals. To differentiate between their fellow creatures all human societies use criteria which are of importance in that society. Societies have different priorities over the things that are valued. The most common criterion for differentiating people is gender. People generally treat other people differently according to their sex because sex is something that matters to us. For the purpose of selecting a mate, reproduction or the pleasure of 109 R. Iphofen et al., Sociology in Practice for Health Care Professionals © Ron Iphofen and Fiona Poland 1998 Equal and Unequal Opportunities company, it is important that we can tell the difference between men and women. However, for most of human history females have been regarded as physically and intellectually inferior to males and have consequently not been treated equally.

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  Health Psychology in Australia

  • Jill Dorrian, Einar Thorsteinsson, Mirella Di Benedetto, Katrina Lane-Krebs, Melissa Day, Amanda Hutchinson, Kerry Sherman(Authors)
  • 2017(Publication Date)
  • Cambridge University Press

    (Publisher)

  282 Learning outcomes After reading this chapter, you should be able to: • explain how society’s norms may contribute to health inequalities • critically evaluate different contributing factors to health inequalities • evaluate barriers to reduced health inequalities • identify limitations in the existing scientific research and how these impact on the generalisability of said research findings. Introduction There has probably never been a human society without health inequalities . Human societies tend to have a clear power-based hierarchy. With increased power comes increased influence and access to wealth generation and health expertise and services. Such human societies will have health inequalities. You can capture society’s health inequality by examining the profile of the ruling class. In typical Western societies, the ruling class tends to be Caucasian, heterosexual, male and well educated, with good social networks and a well-paid prestigious job. Clearly the ruling class has a high socioeconomic status (SES) and it certainly does not have any stigma associated with its status. Stigma is about perceptions and perceptions matter, as we will see in the present chapter. When it comes to your health, it all matters: SES, employment status, occupation, marital status, education, isolation (e.g. social support), sex (male, female), unemployment, culture, sexual orientation, religion or lack thereof, race (e.g. Indigenous), living in an urban versus rural community, and health literacy . Different factors that capture your standing in society affect your health but it can be difficult to discover exactly how they do so. These factors do not exist in a vacuum. If you are homeless, you are also likely to be poor with a low-paying job, if you even have a job, and it will likely be in a low prestigious occupation requiring low education levels.

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  Human Rights and Economic Inequalities

  • Gillian MacNaughton, Diane Frey, Catherine Porter(Authors)
  • 2021(Publication Date)
  • Cambridge University Press

    (Publisher)

  Lynch, Julia F. and Isabel M. Perera. 2017. “Framing Health Equity: US Health Disparities in Comparative Perspective.” Journal of Health Politics, Policy and Law 42(5): 803–39. MacNaughton, Gillian. 2009. “Untangling Equality and Non-Discrimination to Promote the Right to Health Care for All.” Health and Human Rights Journal 11 (2): 47–63. 360 chuan-feng wu MacNaughton, Gillian. 2015. “Human Rights Impact Assessment: A Method for Healthy Policymaking.” Health and Human Rights Journal 17(1): 63–75. Majette, Gwendolyn Roberts. 2012. “Global Health Law Norms and the PPACA Framework to Eliminate Health Disparities.” Howard Law Journal 55: 887–19. Markwick, Alison, Zahid Ansari, Mary Sullivan, Lorraine Parsons and John McNeil. 2014. “Inequalities in the Social Determinants of Health of Aboriginal and Torres Strait Islander People: A Cross-Sectional Population-Based Study in the Australian State of Victoria.” International Journal for Equity in Health 13(1): 91. doi: 10.1186/s12939-014-0091-5. Marmot, Michael. 2004. “Social Causes of Social Inequalities.” In Public Health, Ethics, and Equity, edited by Sudhir Anand, Fabienne Peter, and Amartya Sen, 37–62. New York: Oxford University Press. Maslow, Abraham Harold. 1943. “A Theory of Human Motivation.” Psychological Review 50(4): 370–96. Maslow, Abraham Harold. 1970. Motivation and Personality. New York: Longman. Matthew, Dayna Bowen. 2015. “Toward A Structural Theory of Implicit Racial and Ethnic Bias in Health Care.” Health Matrix 25(1): 61–85. McCoy, David. 2006. “Financing Health Care: for All, for Some, for Patients or for Profits?” In The Global Right to Health: Canadian Development Report 2007, edited by North-South Institute, 57–84. Ottawa, Canada: Renouf Publishing. McDowell, Ian and Claire Newell. 1996. Measuring Health: A Guide to Rating Scales and Questionnaires. New York: Oxford University Press. McKean, Warwick Alexander. 1983. Equality and Discrimination under International Law.

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