Chi week 7
Sponsored Links
This presentation is the property of its rightful owner.
1 / 19

CHI Week 7 PowerPoint PPT Presentation

  • Uploaded on
  • Presentation posted in: General

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

Download Presentation

CHI Week 7

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript

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

  • 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

  • Social class categories I-V

  • Income

  • Housing Tenure

  • Car ownership

  • Education (cultural capital)

  • Nationality (migration)

  • Gender

  • Ethnicity

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)

YearSMR by social class







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 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 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 RatesUK 1991-95

Death rate per 10,000


  • Glasgow Baillieston80.46.3

  • Glasgow Maryhill72.64.1

  • Woodspring302.0

  • Buckingham382.9

    (Shaw et al, 1999)

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 constituencies

Income levels (1991)

£6k – £10.5k£12.5 – £17k

  • Glasgow 91%9%


  • Buckingham0%76%

Life Expectancy England and Wales (1996)

Life Expectancy by social class:


  • I77.783.4

  • II75.881.1

  • III7580.4

  • IV72.677.7

  • V68.277

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 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


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


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.


  • 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

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’

  • Login