patterns of health inequalities in UK

block 2 week 2 socpop

epidemiological transition

phase 1: pestilence and famine

• high mortality

• infectious disease

• malnutrition

phase 2: receding pandemics

• reduction in rate of infectious disease mortality

phase 3: degenerative and man-made disease

• more non-communicable disease

phase 4: declining CVD mortality, ageing and emerging disease

phase 5: aspired quality of life with persisting health inequalities

indicators of population health

• life expectancy

• infant mortality

  • correlates well with other measures but simple to measure

  • sensitive to social determinants of health

• healthcare use (hospital or emergency admission)

• public health or disease specific indicators

trend of life expectancy

trend of infant mortality

leading cause of death in England and Wales (2022)

1. dementia (11.5%)

2. ischaemic heart disease (10.3%)

3. chronic respiratory disease (5.2%)

4. cerebrovascular disease (5.1%)

5. lung cancer (5%)

social gradient

index of multiple deprivation (IMD): composite measure

• includes income, education, health, crime, living environment

health pattern by assigned sex

• females live longer than males

  • but spend more of their life in poorer health

health pattern by ethnicity: infant mortality

health pattern by geography

equality

• equal rights, treatment or opportunities that are of the same form, value, benefit

equity

fair and impartial rights, treatments or opportunities so everyone has the same overall benefit

vaccination example of equality vs. equity

• equality → available to all if you attend a central vaccination clinic

• equity → mobile vaccination clinic sent to remote, underserves areas

healthcare facilities example of equality vs. equity

• equality → all hospitals have same level of workforce, beds, equipment

• equity → areas with older, sicker people have more staff and better access to specialised services

inequality vs. inequity

• inequality → measurable differences in health between different groups

  • may be avoidable or unavoidable

• inequity → avoidable differences in health between different groups

  • may be due to systemic barriers or discrimination

  • subset of inequalities

examples of inequalities

• older people have more health needs than younger people (ageing is inevitable)

• life expectancy is different in those born male and female

examples of inequities

• geographical access → rural residents have more difficult access to facilities

• prevention → wealthier people have better opportunities for health and fitness

• chronic disease management→ lower availability of community support programmes in areas of deprivation

horizontal vs. vertical inequity in access to healthcare

• horizontal inequity → those with the same need to not have the same access

• vertical inequity → those with different needs are not provided with the level of resource appropriate for those needs

explanations for social gradient

• behavioural model

• materialist and neo-materialist model

• psychosocial model

• life course model

behavioural model

• inequitites result frm variations in lifestyle behaviours

materialist/neo materalist

• materialist

  • inequities from differences in direct access to material resources (housing quality, income, working conditions)

• neo-materialist

  • additional importance of access at a community level

    • access to good education, healthcare, nutritious food

psychosocial model

• stress leads to inequities in health

  • due to low income and poor material circumstances

  • due to relative lower position in social hierarchy

  • due to poor social capital

• can affect health

  • directly: neuroendocrine response to stress

  • indirectly: adoption of unhealthy behaviours

life course model

• describes interlinking of factors through life and accumulation of adverse factors to health