health psychology prejudice and health inequalities

Factors Influencing Health

  • Poll Engagement: Audience interaction on factors affecting health.

Health Inequality

  • Definition: Health inequity refers to avoidable inequalities in health between groups both within and between countries.

    • Causes of Health Inequity:

    • Economic and social conditions impact:

      • Risk of illness

      • Preventative actions taken

      • Treatment when illness occurs

Between-Country Inequalities

  • Examples of Inequality:

    • Maternal Deaths:

    • Sweden: 1 in 17,400

    • Afghanistan: 1 in 8

    • Infant Mortality:

    • Iceland: 2 per 1000 live births

    • Mozambique: Over 120 per 1000 live births

    • Survival Rate to Age 5:

    • Japan: 96%

    • Sierra Leone: 72%

    • Key Factors: Mother's access to water, food, and education.

Within-Country Inequalities

  • Infant Mortality in Bolivia:

    • Mothers with secondary education: under 40 per 1000 live births.

    • Mothers without education: over 100 per 1000 live births.

  • Life Expectancy in Australia:

    • Indigenous males: 59.4 years, females: 64.8 years.

    • Non-Indigenous males: 76.6 years, females: 82.0 years.

  • Disabilities in Europe:

    • Low educated men aged 80+: 58.8% vs. high-educated: 40.2%.

  • Life Expectancy in the UK (Glasgow):

    • Calton neighbourhood: 54 years.

    • Lenzie neighbourhood: 82 years.

Macro-Social Influences

  • Definition: Macro-social influences are large-scale social, economic, political, and cultural forces that impact life outcomes.

  • Examples of Macro-Social Influences:

    • Cultures

    • Historical legacies (e.g., colonialism)

    • Organised religions

    • Governmental and non-governmental organizations (NGOs)

    • Multinational corporations

    • Environmental events (e.g., earthquakes, droughts)

    • War, violence, terrorism

Social Determinants of Health

  • Definition: Circumstances in which people are born, grow up, live, work, and age, shaped by economic, social policies, and political forces (World Health Organization).

Social Determinants of Health Framework

  • Relevant concepts include: socioeconomic status (SES), gender, ethnicity, and health inequalities.

Neoliberalism

  • Definition: A political ideology that advocates for reducing state oversight, market opening, individual autonomy, capitalism, and globalization.

  • Reality of Neoliberalism:

    • Increased income inequality, poverty, and health inequalities.

Healthism

  • Definition: A belief system where health is seen as a moral good, and individuals are held responsible for maximizing it.

  • Key Implications:

    • Good vs. bad choices translate to good vs. bad people.

    • Illness is attributed to individual fault.

Micro-Social Influences

  • Definition: Micro-social factors that affect health at the individual or local level.

  • Examples of Interventions:

    • Health education campaigns

    • Nudge theory (encouraging preferred behaviours through subtle changes)

The Role of Government in Health

  • Healthy Lives, Healthy People (UK Department of Health, 2010):

    • Individuals make personal choices, but these choices are constrained by wider factors.

    • The government focuses on personal responsibility while acknowledging external influences.

    • Goals of Health Improvement:

    • Strengthening self-esteem and personal responsibility

    • Promoting healthier behaviours

    • Adapting environments for healthier choices.

Limitations of Individual Choices

  • Quote from Marks et al. (2021, p.76): “What individuals can do to change their lives is not simply a matter of personal choice; such changes are constrained politically, economically, and culturally.”

Life Outcomes and Determinants

  • Understanding Life Outcomes:

    • Individual health is a product of genetics and environmental experiences.

    • Macro-level factors influence micro-level outcomes.

Chief Medical Officer's Ten Tips for Better Health

  1. Don't smoke; if unable, reduce.

  2. Follow a balanced diet rich in fruits and vegetables.

  3. Maintain physical activity.

  4. Manage stress through conversation and relaxation.

  5. Drink alcohol in moderation.

  6. Protect from sun exposure.

  7. Engage in safer sexual practices.

  8. Participate in cancer screening.

  9. Adhere to road safety measures.

  10. Learn basic first aid: airways, breathing, circulation.

Alternative Tips for Better Health

  • Avoid poverty, and if in poverty, address it promptly.

  • Move from deprived areas.

  • Avoid disability or caregiving for disabled individuals.

  • Seek non-stressful work and adequate housing.

  • Ensure financial capability for social activities and holidays.

  • Access benefits available to you.

  • Improve socio-economic status through education.

Complex Interactions of Social Determinants

  • Lack of simple solutions and recognition of the role of political expediency.

Case Studies and Research

  • Whitehall II Study:

    • Cohort study since 1985 involving over 10,000 civil servants.

    • Found that job demands and control influence health, with buffers like social support mitigating negative outcomes.

Health Equity and Empowerment

  • Statement from WHO:

    • Health equity relies on the empowerment of individuals to address and change the unequal distribution of resources to which they are entitled.

Roles of Psychologists in Health and Social Justice

  • Key Actions:

    • Strive for social change and justice.

    • Foster resilience and behaviour change.

    • Engage in participatory action research, emphasizing listening over prescribing.

Stigma as a Fundamental Cause of Health Inequality

  • Definition of Stigma:

    • A mark or label indicating membership in a devalued group.

  • Definitions Related to Stigma:

    • Prejudice: Negative attitudes towards a devalued group.

    • Discrimination: Unequal treatment based on group membership.

Dynamics of Stigma According to Link & Phelan (2001)

  1. Labelling: Assigning a devalued identity.

  2. Stereotyping: Associating negative traits with the group.

  3. Separation: Creating a divide (us vs. them), leading to dehumanization.

  4. Status Loss: Diminishing recognition and respect for the devalued individual/group.

  5. Discrimination: Both individual and structural forms affect access to resources and opportunities.

  6. Use of Power: Stigma is deeply rooted in power dynamics; powerful groups do not face stigma like marginalized groups.

Stigma and Health Outcomes

  • Impact on Population Health:

    • Stigma contributes to resource availability, social relationships, and psychological responses that affect health.

    • Pathways Through Which Stigma Affects Health:

    1. Resource Availability: Stigma impacts access to education, housing, healthcare, etc.

    2. Social Relationships: Increased stigma leads to social isolation which negatively affects health outcomes.

    3. Psychological Responses: Stigmatized individuals might experience maladaptive emotional regulation, leading to detrimental health behaviours.

    4. Stress Responses: Chronic stigma contributes to ongoing stress, which can lead to serious health consequences.

    • Allostatic Load Definition: Refers to the cumulative wear and tear on the body due to chronic stress, as described by McEwen & Stellar (1993).

Types of Stress

  • Biological: Illnesses and pollution.

  • Economic: Opportunities and hardships.

  • Social: Involves structural, interpersonal, and intrapersonal factors.

Social Stress and its Health Implications

  • Research Findings: Perceived discrimination correlates with increased risks of various health issues, including hypertension, heart disease, and Type 2 Diabetes Mellitus (T2DM).

Microaggressions

  • Definition: Brief, commonplace insults or indignities that communicate negative messages to targeted individuals or groups (Sue et al., 2007).

Examples of Microaggressions

  • Typically directed towards marginalized groups (race, sexual orientation, nationality, religion) but can affect any individual from a minority status.

Impact of Hostile Environments

  • Consequences of Hostile Environments: Anticipated stigma heightens stress responses, increasing risks for several health issues and poor psychological outcomes.

Quasi-Experimental Studies on Stigma

  • Study on Islamophobia and Birth Outcomes: Analysis highlighted poorer birth outcomes (low birth weight, pre-term births) for women with Arabic names post-9/11.

  • Same-Sex Marriage Legislation: Data indicated improvements in health outcomes post-legalization in Massachusetts, contrasting with states that enacted bans.

  • Media Influence on Weight Stigma: Studies show an uptick in anti-fat attitudes in response to significant media events.

Summary on Stigma and Health Inequalities

  • Health inequalities are rooted in stigma across various factors throughout an individual's life cycle.

  • Direct and indirect effects of stigma have profound implications for health and accessibility to necessary resources.

Intersectionality and Weight Stigma

  • Weight stigma interacts with other forms of marginalization, leading to compounded disadvantages across different social identities.

Internalised Weight Stigma (IWS)

  • Refers to self-directed anti-fat attitudes and is distinct from self-esteem.

Clustering of Negative Health Outcomes

  • Weight stigma correlates with poor mental health, reduced quality of life, increased mortality risk, and adverse physical health markers.

Weight Stigma in Healthcare

  • Bias of Healthcare Professionals: Evidence shows strong biases against overweight individuals amongst healthcare providers, manifesting in disrespectful treatment and inappropriate comments.

  • Patient Experiences: Many report feeling stigmatized, which impairs their willingness to seek care.

  • COVID-19: Misleading statistics and healthcare practices emphasized the prevalence of weight stigma among care providers, particularly concerning treatment and accessibility.