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CHI Week 7

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

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CHI Week 7

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  1. CHI Week 7 Inequalities in health: evidence and explanation

  2. Lecture will cover • Transition to modern health patterns • Evidence of inequalities in health • Explaining inequalities

  3. 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

  4. Measuring social position • Social class categories I-V • Income • Housing Tenure • Car ownership • Education (cultural capital) • Nationality (migration) • Gender • Ethnicity

  5. Standard Mortality Rates • Above 100 = higher chance of mortality • Below 100 = lower chance of mortality • National average is set at 100

  6. Inequalities in health over time (England and Wales) Year SMR by social class I II III IV V 1921-23 82 94 95 101 125 1949-53 86 92 101 104 118 1970-72 77 81 103 114 137 1981-83 66 76 100 116 165 1991-93 66 72 113 116 189

  7. 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

  8. 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

  9. 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.

  10. Infant Mortality RatesUK 1991-95 Death rate per 10,000 Age 0 1-4 • Glasgow Baillieston 80.4 6.3 • Glasgow Maryhill 72.6 4.1 • Woodspring 30 2.0 • Buckingham 38 2.9 (Shaw et al, 1999)

  11. Comparing constituencies Rate/1,000 having a long-term illness: • Glasgow Maryhill 136 • Buckingham 42 % not gaining 5 GCSEs A-C pass rate (1996): • Glasgow Maryhill 70% • Buckingham 48%

  12. Comparing constituencies Income levels (1991) £6k – £10.5k £12.5 – £17k • Glasgow 91% 9% Maryhill • Buckingham 0% 76%

  13. Life Expectancy England and Wales (1996) Life Expectancy by social class: Men Women • I 77.7 83.4 • II 75.8 81.1 • III 75 80.4 • IV 72.6 77.7 • V 68.2 77

  14. 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.

  15. 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

  16. Explanations 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

  17. Explanations 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.

  18. Summary • 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.

  19. 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’

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