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CHI Week 7. Inequalities in health: evidence and explanation. Lecture will cover. Transition to modern health patterns Evidence of inequalities in health Explaining inequalities. Transition to modern health patterns. The Decline of Mortality from Infectious Disease

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CHI Week 7

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Chi week 7

CHI Week 7

Inequalities in health: evidence and explanation


Lecture will cover

Lecture will cover

  • Transition to modern health patterns

  • Evidence of inequalities in health

  • Explaining inequalities


Transition to modern health patterns

Transition to modern health patterns

  • The Decline of Mortality from Infectious Disease

  • The Decline in Mortality of Children and Young People

  • The Rise of Mortality from Heart Disease, Strokes and Cancer

  • The Rise of (Female) Morbidity - Mental and Physical

  • Significant Social Inequalities in Health


Measuring social position

Measuring social position

  • Social class categories I-V

  • Income

  • Housing Tenure

  • Car ownership

  • Education (cultural capital)

  • Nationality (migration)

  • Gender

  • Ethnicity


Standard mortality rates

Standard Mortality Rates

  • Above 100 = higher chance of mortality

  • Below 100 = lower chance of mortality

  • National average is set at 100


Inequalities in health over time england and wales

Inequalities in health over time (England and Wales)

YearSMR by social class

IIIIIIIVV

1921-23829495101125

1949-538692101104118

1970-727781103114137

1981-836676100116165

1991-936672113116189


Evidence of social inequalities in health

Evidence of social inequalities in health

Whitehall Studies (Marmot)

  • Inequalities in health between grades of civil servants

  • Social hierarchy in disease

    • higher up the hierarchy you are, less risk of particular diseases/ill health


Evidence of social inequalities in health1

Evidence of social inequalities in health

Wilkinson (1996)

  • Social cohesion related to social gradient in health:

    • relative, rather than absolute, income levels related to higher social cohesion

  • Higher levels of social cohesion related to lower inequalities in health


Evidence of social inequalities in health2

Evidence of social inequalities in health

  • "We are becoming less equal in death. Where people live in the 1990s has become a more reliable guide to their chances of dying before they reach retirement age than at any time since the Second World War."

    Dorling, D (1997) Death in Britain: How local mortality rates have changed: 1950s to 1990s York: Joseph Rowntree Foundation.


Infant mortality rates uk 1991 95

Infant Mortality RatesUK 1991-95

Death rate per 10,000

Age01-4

  • Glasgow Baillieston80.46.3

  • Glasgow Maryhill72.64.1

  • Woodspring302.0

  • Buckingham382.9

    (Shaw et al, 1999)


Comparing constituencies

Comparing constituencies

Rate/1,000 having a long-term illness:

  • Glasgow Maryhill136

  • Buckingham42

    % not gaining 5 GCSEs A-C pass rate (1996):

  • Glasgow Maryhill70%

  • Buckingham48%


Comparing constituencies1

Comparing constituencies

Income levels (1991)

£6k – £10.5k£12.5 – £17k

  • Glasgow 91%9%

    Maryhill

  • Buckingham0%76%


Life expectancy england and wales 1996

Life Expectancy England and Wales (1996)

Life Expectancy by social class:

MenWomen

  • I77.783.4

  • II75.881.1

  • III7580.4

  • IV72.677.7

  • V68.277


Evidence of social inequalities in health3

Evidence of social inequalities in health

Blaxter, 1990 (Health and Lifestyles)

  • Role of Social Support/Social Capital ‘those who had the fewest family, friendship, working and community roles had the lowest psycho-social well being’ (105-6)

  • Lifestyle change had a more positive effect on the health of wealthier than poorer people.


Evidence of social inequalities in health4

Evidence of social inequalities in health

Nazroo (1997)

  • Reported health

    • Pakistani/Bangladeshi respondents 50% more likely to report ‘poor’ or ‘fair’ health than whites

  • Type II diabetes

    • Four times greater among South Asian ethnic minorities than among white population


Explanations

Explanations

Black Report:

  • Artefact: way that statistics collected bias results

  • Cultural/Behavioural: health inequalities due to lifestyle influences not caused by ‘structures’ of wider society as such


Explanations1

Explanations

Black Report:

  • Natural and Social Selection: social class position effect not cause of health status

  • Materialist/Structuralist: health inequalities directly caused by deprivation and other features of social inequalities.


Summary

Summary

  • Explanations for health inequalities :

    • Structural

    • Cultural

    • Natural

  • Evidence for structural explanation suggests inequalities related to wealth gap

  • Evidence of social hierarchy in ill health in Whitehall Studies.


Week 8

Week 8

Policy responses to health inequalities

  • In particular, please read:

  • S Illife and J Munro (2000), New Labour and Britain’s NHS’ International Journal of Health Services (IJHS), 30 (2)

  • M Powell (1999), ‘New Labour and the 3rd Way in the NHS’, IJHS, 29 (3)

  • Chapters 10 and 12 of course textbook Marmot and Wilkinson ‘Social Determinants of Health’

  • Government Policy docs - White Papers, The New NHS, Saving Lives and NHS Plan

  • BMJ searches on ‘The NHS Plan’ and ‘New Labour’


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