Define + Describe Availability
Definition:
Measures the extent to which the provider has the requisite resources (such as personnel and technology) to meet the needs of the client ā just means whether the volume and type of services needed by the community are available
E.g. Do we have enough GPās, do the GPās have enough of this, of that? Do we have to go to another branch/service because the first place you went to didnāt have the provisions/resources on hand?
Define + Describe Acceptability
Definition:
Cultural and social factors determining the possibility for people to accept the aspects of the service ( and for services to accept aspects of the patient) and the judged appropriateness for the persons to seek care ā Emcompasses ethnic background, gender, class, culture
E.g. is a woman is going in for a cervical screening, is there a female practitioner available? ā are our identity, gender, sex etc. reflected in the health care services?
Define + Describe Affordability
Definition:
The economic capacity for people to spend resources and time to use appropriate services
When mentioning affordability: Always state whether it is a direct or indirect cost ā Even if healthcare was āfree,ā it wouldnāt actually be free ā we would be paying elsewhere
E.g. wonāt seek out services due to cost / wonāt get their precription due to cost
Define + Describe Accommodation
Definition: T
Measures the extent to which the provider has the requisite resources (such as personnel and technology) to meet the needs of the client ā just means that the volume and type of services needed by the community are available
Reflects the extent to which the providerās operation is organised in ways that meet the constraints and precedences of the client ā includes structural aspects(how the health system is built)
E.g. Opening hours, Telephone services, How appointments are made
Define + Describe Accessibility (geographic)
Definition:
Measures the extent to which the provider has the requisite resources (such as personnel and technology) to meet the needs of the client ā just means that the volume and type of services needed by the community are available
E.g. People residing in rural areas could travel for hours to access certain health services (e.g. specialised services)
Which of the 5 Aās does the following statement refer to?
The relationship of prices of services
and the clientās ability to pay
Affordability - Penchansky & Thomas (1981) (1981)
Which of the 5 Aās does the following statement refer to?
How the patient feels about the
characteristics of the provider (and vice
versa)
Acceptability - Penchansky & Thomas (1981) (1
Which of the 5 Aās does the following statement refer to?
The relationship between the manner in
which the supply or resources are
organised to accept the client and the
clientsā ability to accommodate to these
factors
Accommodation - Penchansky & Thomas (1981) (1
Which of the 5 Aās does the following statement refer to?
The relationship between the location of
supply and the location of the clients
Accessibility (geographic) - Penchansky & Thomas (1981) (1
Which of the 5 Aās does the following statement refer to?
Volume and type of services relative to
client need
Availability - Penchansky & Thomas (1981) (1
Describe the impact of the SDoH on health
They dictate health opportunities / the opportunity to obtain and maintain healthiness of social groups based on their placements within these within hierarchies of power, prestige and SES ā where you sit in the hierarchy dictates what type of social determinants you have access to
SDoH dictate your health outcomes ā they dictate how exposed we are to them ā can be positive + negative ā is it the distribution of the SDoH that determine whether we are healthy or not
Define Prejudice
differential assumptions about the abilities, motives, and intentions of others according to their āraceā/ethnicity
What is Discrimination?
Differential action towards others according to race/ethnicity based on prejudicial assumptions
Includes acts of omission(excluding/leaving out someone or something) and commission (instruction/command given to a person).
How does Jones (2020) describe the Idea of Race?
Race (or ethnicity) is preceded by racism
āRaceā (or ethnicity) is not a biological construct that reflects innate differences, but rather, it is a social construct that captures the impacts of racism in a racialised-society
āRaceā was created to justify that actions of the European expansion and manifested in many different types of differences like oppression
What does Racism entail?
Differential access to goods and services of society
Structures that favour one group over another group (inaction in the face of need)
Discrimination (differential action towards others according to race/ethnicity based on prejudicial assumptions ) + Privilege
Produces inequities that manifest as a disadvantage for some groups and privilege for others
What are the 3 levels of Racism as described by Jones (2020)?
Institutional
Personally-Mediated
Internalised
Note: the levels are not equal ā just like in the TKHM Modified Williams model, we want to intervene in the structural, basic causes (i.e. donāt target personally-mediated & internalised)
Define Institutional Racism
Ā differential access to the goods, services and opportunities of society by ethnicity
Describe Institutional Racism
aka structural/social/systemic racism
Embedded in social norms, custom, laws (social)
Manifests itself in material conditions and access to power (structural)
Inaction in the face of need (systemic)
Because it is structural āmaintained by political and social institutions āĀ no identifiable perpetrator
Drives differences in SES by ethnicity
Manifests as inherited disadvantage
āWhen an entire network of rules and practices disadvantages less empowered groups while serving at the same time to advantage the dominant group/sā
Donāt provide equality or equity for all
Describe Personally-Mediated Racism
Prejudice (differential assumptions) and discrimination (differential actions) ā expressions of societal racism operating through individualsĀ
Acts of commission (doing) / omission (not doing)
Maintained by structural barriers + societal norms
Describe Internalised Racism
Taking on / accepting messages about inferiority or superiority of social groups in racialised hierarchies
Not believing in themselves or in others who look like themĀ
Manifests as helplessness, hopelessness, self-devaluation
Product of systemic/institutional racism
Acepting limitations to oneās own full humanity, including oneās spectrum of dreams, oneās right to self-determinations, and oneās range of allowable self-expression
Where people believe in the racial hierarchy ā you internalise that racism you have been exposed to, and then you believe it
Manifests as an embracing of āwhitenessā
Describe Privilege
A feature/product of racism where inequities manifest as a disadvantage for some and an advantage for others
The flip side of oppression.
Oppression confines and limits oneās opportunities, while privilege confers power, dominance, resources, and rewardsā(Schaefer, 2008)Ā
Unearned systematic and interpersonal advantage (Borrell et al, 2009)
True/False: If a group is being disadvantages, another is being privileged
True
True/False: We canāt have privilege in some areas of our lives, and be disadvantaged/oppressed in others
False
True/False: We can be unaware of our privilege, when it may be obvious to other people (we assume that everyone has the same as us)
True
āIt is hard for any of us to recognise a system of inequity that privileges usā (Camara Jones)
What are 3 ways racism impact health outcomes?
Differential exposure to the determinants of health (e.g. socioeconomic & environmental)
Differential access to and quality of health services
Direct effects of racism such as trauma and stress - intergenerational