Social Inequalities In Health

11.1105

Health divide within countries - compared with affluent counterparts, people experiencing poverty tend to…
• Have shorter lives - 5-year gaps.
• Suffer more years of disability before they die - 13-year gap.
• Higher sickness and disease.

• Differences/variation versus inequalities/inequities.
• Inequality/inequity in health has ethical dimension: implies differences that are both avoidable and unfair/unjust.

How do inequalities rise?
• Main determinants of health - Dahlgren and Whitehead, 1991.
-Many determinants of health.
-Health service very important, but many other factors.
-Interaction between different factors.
• Different groups of population exposed to different things.

Eg. how does unemployment and poverty cause poor health?
• Lack of financial resources.
-Lack resources for food, housing, healing.
-Sub-nutrition.
• Psychosocial stress.
-Stress, stigma, social exclusion.
-Anxiety, depression, suicide, physical effects (chronic heart disease).
• Behavioural change.
-Caused by social isolation/coping in hardship.
-Tobacco/alcohol use, less exercise.

What does this mean for planning and delivery of health services?
• Increased need for health care.
• Because of higher levels of morbidity in certain groups and areas.
• Because deprivation makes access to and uptake of services difficult.
• Because poorer living/working conditions may make recovery more difficult.

Inverse care law = "Medical care is least available where it is most needed." Tudor Hart, 1971.
Applies to: access; uptake; quality of care.

Reflect on implications of observed social inequalities in health in:
• Dealing with individuals and people.
• Planning services for population groups.
• Reforming systems.
• Society's response.