Title: Health Inequalities and Health promotion
1Health Inequalities and Health promotion
2Lecture plan
- Basics of inequalities - perspectives
- How is this linked to health promotion?
- What could be done to change the situation?
- Examples (inc from Scotland)
3Fundamentals
- Health and wealth linked - but how/why?
- Other inequalities
- - gender
- - race/ethnicity
- - age
- - disability, etc
- Inverse care law
4Fundamentals (cont)
- Inequalities often multiple not singular, e.g.
gender and age - In general the aging process affects women more
because - they live longer
- society has a gender-based view of older people.
- (Earl and Letherby 2008)
5Deprivation and health (1)
- Deprivation in itself is harmful
- People are trapped in health damaging
circumstances by poverty and low income, e.g., - housing, transport, diet, exercise,
- participation, empowerment
6Deprivation and health (cont)
- What else is intrinsic about health inequalities
that is linked with health promotion? - Poor response to health campaigns
- Potentially damaging social norms
7Lower socio-economic groups and health promotion
- Lower socio-economic groups less responsive to HP
campaigns, e.g. on - Smoking cessation
- Cervical smear campaigns
- Testicular cancer awareness
- campaign (inc Marks Spencer)
- Exercise
- Diet
8Lower socio-economic groups and health promotion
(cont)
- Culture as an influencing factor, e.g. food as
cultural identifier - In developed countries the poverty gap is
also a cultural one and food is one way that
people can feel isolated from the cultural
mainstream a family may be well nourished
nutritionally but still experience deprivation
through lack of access to valued foods, preferred
foods or consistent amounts of food (Crotty,
1999). (Caraher. 200248)
9Lower socio-economic groups and health promotion
(cont)
- Lay beliefs (and links with other types of
inequality) - Definitions of good diet
- Middle-class moderate and balanced
- Working-class meat, potatoes and greens
- Definitions of bad food
- Middle-class Processed and pre-packaged
- Working-class fatty (Povey et.al. 1998171)
10Lower socio-economic groups and health promotion
(cont)
- Cultural pressures vs realist needs
Breastfeeding among poorer rural Kenyan women. - Breastfeeding not socially acceptable, but
- Bottled milk too expensive
- (Ferguson 2007)
11Wider Inequalities issues Whitehall study
- 10,000 British civil servants, followed for 20
years. Much data produced. - age-standardised mortality over 10 year period
for males aged 40 to 60 - three and half times
higher in clerical and manual grades, as in
senior admin. Grades - Gradient in mortality
12Wider Inequalities issues Whitehall study (cont)
- However, no-one in the study was actually
deprived - So common interpretation that health and wealth
linked cannot explain all - Focus on poverty can block deeper understanding
13Smoking and Whitehall study
- Top people smoke less
- Death from smoking related diseases correlates
- But gradient also there for non smoking related
diseases (smoking therefore may be an effect as
much as a cause) - Is there some underlying causal process
associated with a hierarchy? (all societies have
hierarchy)
(Smith et.al. 1992)
14Whitehall Study II
- Looked at employment
- Stress and general ill health related
- Stress related to job positioning and lack of
control - (Marmot 1994)
15What is the problem?
- HP is not just health education and lifestyle
approach. However, HP message sometimes removed
from social context (e.g. relationship between
smoking and stress) - Responsibility for health is individual and
societal - HP must address broader inequalities?
-
16What is the problem? (cont)
- More facilities/education targeted at those who
need them - is this the answer? - Need to redistribute wealth and power, but how?
- Is inequality inevitable?
17How to address inequalities
- Government national policy
- some countries do much better than UK with less
money - Income Distribution Rising incomes can mean
poorer health, if wealth is more concentrated - Money is like muck - not good unless it is
well spread (Sir Francis Bacon)
18How to address inequalities (cont)
- local policies
- reduce stress - support the vulnerable
- Increase/improve coping skills
- empowerment, participation
- - voluntary sectors, self help groups
19Scotland
- Report of Scottish Royal Colleges Working Party
on Inequalities in Health 2000 - Refers to White paper Towards a healthier
Scotland 1998 - - a three level national government strategy to
reduce inequalities in life circumstances,
lifestyles and loss of health
20Three Level National Government Strategy
- Improving Life Circumstances Social inclusion,
job, income, housing, education, environment. - Tackling Lifestyles Poor diet, lack of exercise,
tobacco, alcohol/drugs misuse - Tackling what can be prevented Heart disease,
cancer accidents, improving child, mental, oral
and sexual health.
21Scotland (cont)
- Uptake of breast cancer screening 20 lower in
Depcat 7 than Depcat 1 - Rural issues
- Recommendation that extra efforts should be made
to achieve greater uptake and use of services by
those whose health is worse (see Acheson 1998)
22Scotland (cont)
- Time taken to achieve measurable changes is long
- governments change - - effective education to influence lifestyle
changes can take 10 years to have visible impact - But single most important strategy to reduce
heart disease will be integrated and local
initiative to confront relative deprivation
(SNAP 1998)
23Public Health Institute of Scotland
- Established following the recommendations of the
Review of the Public Health Function in Scotland - To protect and improve the health of the people
of Scotland by working with the relevant agencies
and organisations to increase our understanding
of the determinates of health and ill health
24Evans and Stoddart model
25Cure or sticking plaster?
- No redistribution of wealth
- still takes lifestyle approach, albeit based on
settings programme - GPs to give opportunistic advice - further
burden on them - focus on medical education re. inequalities
26References
- Acheson, D. 1998. Independent Inquiry into
Inequalities in Health Report. London HMSO. - Caraher, M. 2002. Food and Health national and
international policy perspectives. in Adams, L.,
Amos, M., and Munro, J. (eds) 2002. Promoting
Health. London Sage. - Earle, S, and Letherby, G. (eds). 2008. The
Sociology of Healthcare. Basingstoke Palgrave
MacMillan. - Ferguson, J. 2007. Dilemmas in infant feeding for
HIV positive mothers in a resource poor setting
views from above and below BSc Dissertation
University of Aberdeen.
27References
- Macdonald T. 1998. Rethinking Health Promotion.
Routledge. - Marmot 1994. Marmot MG. Social Differentials in
Health Within and Between Populations. Daedalus
123197-216. - Povey, R., Conner, M., Sparks, P., James, R., and
Sheperd, R. 1998. Interpretations of health and
unhealthy eating, and implications for dietary
change in Health Education Research. Vol.13
No.2. 171-183. SNAP. 1998. Coronary Heart
Disease. PHIS publications. - Smith, G. D., Shipley, M. J., Marmot, M. G.,
and Rose, G. 1994. Plasma cholesterol
concentration and mortality. The Whitehall
Study. JAMA Vol. 267. No. 1.
28Recommended Reading
- Adams, L., Amos, M., and Munro, J. 2002.
Promoting Health Politics and Practice. London
Sage. (Part 4) - Doyal, L. 1997. Gendering health Men, women and
wellbeing in Sidell, M., Jones, L., Katz, J.,
and Peberdy, A. (eds) 1997 Debates and Dilemmas
in Promoting Health A Reader. Milton Keynes
Open University press. -
- Leon, D., Morton, S., Cannegieter, S., and McKee,
M. 2003. Understanding the Health of Scotlands
Population in an International Context. London
London School of Hygiene Tropical Medicine. - Macintye, S. 2007. Inequalities in Health in
Scotland What are they and what can we do about
them? Glasgow Medical Research Council. - Stafford, M., Nazroo, J., Popay, J.M., Whitehead,
M. 2008. Tackling inequalities in health
evaluating the New Deal for Communities
initiative. in Journal of Epidemiology and
Community Health 200862298-304. - Â