Inequalities in Healthcare

5 Key excerpts on "Inequalities in Healthcare"

• 

  eBook - ePub

  Healthcare System Access

  Measurement, Inference, and Intervention

  • Nicoleta Serban(Author)
  • 2019(Publication Date)
  • Wiley

    (Publisher)

  Braveman and Gruskin (2003) defined inequity in health as the presence of systematic disparities in health (or in major social determinants of health) between population groups with different levels of social advantage/disadvantage. Two distinctive facets of disparities are implied in health inequity as introduced by this definition. First, differences are systematic not at random. Secondly, the comparison across population groups is needed to infer who is benefiting the most or the least from policies affecting health, and therefore, how best to target interventions. Therefore, a health disparity between more and less disadvantaged population groups constitutes an inequity not because we know the proximate causes of that disparity and judge them to be unjust, but rather because the disparity is systematically associated with unjust social and economic structures (Morrison 2009). However, systematic association does not imply causation. For example, the underlying causality of a health disparity could be in factors associated with income rather than in income itself; equalizing income would not necessarily be effective in reducing that particular disparity. Because the overarching objective is to reduce inequities, both distinctive facets of disparities need to be rigorously incorporated in measuring and making inference on healthcare access

  Sign up to read

  Learn more about book
• 

  eBook - ePub

  Medicine, Health and Society

  • Hannah Bradby(Author)
  • 2012(Publication Date)
  • SAGE Publications Ltd

    (Publisher)

  Another approach to making sense of the preoccupation with inequality in health, points out that the term ‘inequality’ has taken on a specific meaning in the context of the study of health and society. Observations of inequality in health are more than simply mapping a set of naturally occurring differences, given that health conditions differ between groups and individuals arising from genetic inheritance, gender, geography and chance in a potentially infinite array of combinations. Evidence with regard to social hierarchy and health shows ‘a continuous gradient in health from the least to the most advantaged’ such that the phrase ‘“inequality in health” has come to mean a special sort of difference’ (Blaxter, 2004: 104), which can be recognized by the following characteristics:

   

  • Socially determined – that is arising largely from social factors;
  • Felt to be unjust – while some differences between groups are chosen or trivial, there is a sense that health inequalities are inequitable, immoral, and, importantly, potentially subject to change;
  • Not inevitable – given our current technology and knowledge, these inequalities are thought to be avoidable and as further research suggests mechanisms of causation and maintenance, new reforms suggest themselves (Blaxter, 2004: 105).

   

  Another way of expressing this would be to distinguish between ‘inequalities in health’ and ‘inequities in health’. While ‘inequality’ refers to difference between groups without comment on the source of that difference, ‘inequity’ refers to a normative principle of social justice which considers the differences to be unfair and unjust to the extent that they are avoidable (Siegrist and Marmot, 2006: 5). If equity in health is an ideal whereby everyone has a fair opportunity to reach their full potential health, then social gradients in health contradict this principled distribution of human life chances. A problem with drawing this precise distinction between inequity and inequality in health is that we do not yet know the extent to which inequalities between individuals or between groups are avoidable and therefore iniquitous. Until we have a better sense of the extent to which the major chronic diseases are socially determined, the lack of precision in attributing their inevitable or avoidable nature encapsulated by the term ‘inequality’ is an appropriate description of the dimensions of the problem (Siegrist and Marmot, 2006: 5).

  Sign up to read

  Learn more about book
• 

  eBook - ePub

  Health Policy and Economics

  Strategic Issues in Health Care Management

  • Manouche Tavakoli, Huw Davies, Mo Malek(Authors)
  • 2017(Publication Date)
  • Routledge

    (Publisher)

  The chapter is divided into three main sections. The first deals with the current policy context in the UK as it applies to HI and inter-agency working. It employs the conceptual models of policy windows (Kingdon, 1995) and policy failure (Wolman, 1981). The second presents empirical evidence from three case studies collated between September and December 1999. It presents empirical evidence of the ways in which three health authorities have been translating national policies into local action and engaging with local agencies in implementing such policies. The third section concludes by making assessments of the value of the models used and the lessons that can be learnt from health authorities’ strategies. As such, it also assesses the impact of current government policy.

  Background Health Inequalities Policy

  The term ‘health inequalities’ refers to health status and health care. Health (status) inequalities are a persistent feature of all societies for which data are available. The pattern is one in which men and women in higher socioeconomic groups enjoy better health across longer lives than those in lower socioeconomic groups. The evidence for the UK suggests that these inequalities are widening (Shaw et al., 1999). Health care inequalities are also evident in terms of the distribution of expenditure, staffing, access and provision (among others) according to need; equity is thus often defined as equal access for equal need.

  Health inequalities have been recorded since long before the NHS. However, it is recognised that the NHS has neglected its role in seeking equity (Klein, 1988) and that equity should be a more explicit priority in the future (Saltman, 1997). This is part of the Labour government’s policy for the NHS. The government’s strategy for the NHS (The New NHS in England and other documents for Scotland, Wales and Northern Ireland, published in 1997/98) emphasised the need to tackle HI. One of the key principles which underpinned Labour’s proposals was the renewal of the NHS as a genuinely national services, characterised by ‘fair access’ to services, ending the ‘unfairness’, ‘unacceptable variations’ and ‘two tierism’ of the Conservative internal market (1991–97). Strategies to promote this equity agenda included national service frameworks, new institutions (e.g. National Institute for Clinical Excellence (NICE)) and health action zones (HAZs). HAZs will have certain flexibilities not enjoyed by other areas and reflect the emphasis placed upon inter-agency partnerships (see Joined-up Government, below).

  The performance of NHS agencies would be measured according to an indicator of ‘fair access’. The five other indicators used by the government are efficiency, health improvement, patient/carer experience, health outcomes, effective delivery of appropriate health care.

  Sign up to read

  Learn more about book
• 

  eBook - ePub

  Social Work, Health and Equality

  • Paul Bywaters, Eileen McLeod(Authors)
  • 2012(Publication Date)
  • Routledge

    (Publisher)

  Oppression in bodily form

  DOI: 10.4324/9780203069530-2

  Introduction

  In this chapter we underline the case that inequalities in health should be a central concern for social work. We give evidence of the extent of this major social problem and the complex ways in which health inequalities are linked with multiple dimensions of social inequality. We argue that oppression is physically embodied in the suffering involved in ill health and premature death. We present evidence of widening inequalities across the UK population and show how these inequalities are woven into the fabric of people's daily lives as they work to secure and maintain health for themselves and those close to them. We discuss the economic and policy backdrop to this daily labour of lay health work and argue that inequalities in health are not simply the visible outcome of a particular economic system but are part of the process through which the economic and political system is sustained. We focus on policy relating to health care as an example of the wider reconstruction of welfare.

  This chapter prepares the ground for a detailed examination across Chapters 3 to 7 of the actual and potential role of social work in reducing health inequalities. It is not concerned with inequalities in the experience of illness, which are also the focus of later chapters, but primarily with inequalities in ‘health chances’: people's chances of staying well, getting ill or dying prematurely (Moore and Harrison 1995 ).

  The production of health: Social, economic and environmental factors

  In Britain, the Black Report on Inequalities in Health (Department of Health and Social Security (DHSS) 1980) proved to be a landmark study, demonstrating that the NHS and social services had been ineffective in closing the gap in health between rich and poor (

  Davey Smith et al. 1990

  and 1998a ). Since then an extensive body of evidence on the association between social inequalities and inequalities in health has been developed (Whitehead 1987 ;

  Davey Smith et al. 1990

  ; Smaje 1995 ; Watt 1996

  Sign up to read

  Learn more about book
• 

  eBook - ePub

  Global Health

  • Brian Nicholson, Judy McKimm, Ann K Allen(Authors)
  • 2015(Publication Date)
  • SAGE Publications Ltd

    (Publisher)

  Differences in access to services, as well as the quality of the services provided, can be an important cause of inequalities in health within countries. Health facilities and staff are often concentrated in urban and wealthier areas and the costs of services or transportation may prevent people from accessing the care they need. In Nigeria in 2008, only 8 per cent of women from the poorest fifth of households gave birth with the help of a skilled health professional; 86 per cent of women from the wealthiest fifth of households did so (WHO, 2014). People also need to be able to access a range of other services that affect health, such as environmental or social services and, critically, education.

  Although many countries have achieved universal coverage of health services, they still have social gradients in health. Inequalities in infant mortality persist in the UK, despite the universal National Health Service. Differences in access and quality of services are unlikely, on their own, to explain the gradient in health.

  Social status and psychosocial causes

  In the 1970s, the first of several studies of health among civil servants in London – the Whitehall studies – observed that there was a gradient in coronary heart disease by employment grade (Marmot et al., 1978). Indeed, employment grade explained more of the differences in health than conventional risk factors, such as smoking. Yet, civil servants do not lack the material means necessary for health, nor are they exposed to physical occupational hazards. This research led to suggestions that people's position in the social hierarchy relative to others, rather than in absolute terms, is an important cause of health inequalities. In high-income countries (HICs), people may be relatively wealthy in absolute terms by global standards, yet have a low status (in terms of income, education, occupation or other markers of status) relative to others in their society.

  Sign up to read

  Learn more about book