Health Inequalities

1
Health Inequalities
2
Poverty 1900

• That in this land of abounding wealth, during a
  time of perhaps unexampled prosperity, probably
  more than one fourth of the population are living
  in poverty, is a fact that may well cause great
  searchings of heart. There is surely need for a
  greater concentration of thought by the nation
  upon the well-being of its own people....
• (Rowntree, 1901, p 304 cited in Lloyd, 2006)

3
Poverty 2000

• The issue isn't in fact whether the very richest
  person ends up becoming richer. The issue is
  whether the poorest person is given the chance
  that they don't otherwise have ... the justice
  for me is concentrated on lifting incomes of
  those that don't have a decent income. It's not a
  burning ambition of mine to make sure that David
  Beckham earns less money.
• (Tony Blair, Quoted in Bromley, 2003, p 74)

4
Global inequalities

• half of world trade and more than half of
  global investment benefit just twenty-two
  countries accommodating a mere 14 per cent of the
  world's population, whereas the forty-nine
  poorest countries inhabited by 11 per cent of the
  world's population receive between them only a
  0.5 per cent share of the global product - just
  about the same as the combined income of the
  three wealthiest men of the planet. Ninety per
  cent of the total wealth of the planet remains in
  the hands of just 1 per cent of the planet's
  inhabitants. And there are no breakwaters in
  sight capable of stemming the global tide of
  income polarization - still ominously rising
  (Bauman, 20076)

5
Individual vs. Society
Health - individual health (medical
practitioners) bio-genetic causes
Societal Psychology
Community Psychology
- population health (epidemiology) social and
economic causes
6
Individual vs. society

• Psychology - bio-medical
• What makes one individual healthier than another?
• Psychology societal / community
• What makes one society healthier than another?

7

• A societys life expectancy is closely related to
  the scale of income inequality
• Life expectancy increases when income
  inequalities decrease due to increases in social
  cohesion.

8
The Epidemiological Transition

• The main cause of death in a society moves from
  infectious diseases (eg. cholera) to degenerative
  disease (eg. cancer)
• Following the transition, growth in the economy
  and further improvements in living standard have
  little effect on improving health

Inequalities and health
It is not the richest countries that have the
best health, but the most egalitarian.
(Wilkinson, 19963)
9
The missing link...

• Health and quality of life in modern societies
  is primarily dependent on distributional
  justice and level of what might be called social
  capital.
• (Wilkinson, 19969)
• E.g., Japans dramatic rise in life expectancy

10
Some surprising findings!

• .. Numbered among the healthiest countries in
  the world are countries with particularly high
  rates of smoking (Wilkinson, 199617)
• During the two world wars life expectancy for men
  and women in Britain increased by six and seven
  years - twice as fast as the average rate of
  improvement during the rest of the century
  (Winter, 1988, cited in Wilkinson, 1996, Ch6).

11
Changes in life expectancy in England Wales
12
But isnt improvement in health due to medical
advances?

• Bulk of the decline in infectious disease
  occurred before medical interventions were
  invented (McKeown, et al. 1975)
• Iatrogenesis
• One-quarter of all deaths in health care are now
  caused by treatments of one sort or the other.
  Doctors would find it very hard to function if
  forced to face up to all the damage they cause in
  their efforts to do good. (Healy, 2004 275)
• Conclusion
• Social and economic determinants are
  substantially more powerful than medical
  (biological) determinants of ill health

13
The magnitude of the problem

• In the 1980s death rates were four times as high
  in the poorest 10 of electoral wards in the
  North East of England as they were in the
  wealthiest 10 (Phillimore et al. 1994).
• Men in the most prosperous parts of London live
  11.5 years longer than men in central Glasgow
  (Office of National Statistics, 2005)
• Report available free from www.statistics.gov.u
  k/statbase/Product.asp?vlnk8841

14
Health inequalities are due to

• social mobility (social drift) - NO
• genetics - NO
• differences in medical care - NO
• differences in risk behaviours - NO

15
Not just a problem for the poor

• In societies with large income inequalities,
  levels of morbidity (illness) and mortality
  (death) are higher across all socio-economic
  groups, not just amongst the poorest.

16
People living on low incomes
17
Dramatic increase in UK income inequalities in
the 1980s were followed by

• a dramatic drop in reading standards among
  children
• a rapid increase in school expulsions
• an unprecedented rise in crime rates
• a 75 increase in suicide rates among young men
• Twice as much drug dealing
• 4 - 5 times increase in drug related deaths

18
Socio-economic interventions in health

• The crucial pathways leading to disease are
  psychosocial
• Modern health problems reflect peoples
  subjective experience of their personal
  circumstances
• Health is affected by our social arrangements
• Social support (individual level)
• Social capital (community level)

19
Psychosocial pathways

• Health inequalities result from peoples
  perception of their income relative to others.
  This produces negative emotions like shame and
  distrust which have a negative effect on health
  through psychoneuroendocrine mechanisms and/or
  health-damaging behaviours (Ellaway, et al.
  2001).

20
Cross cultural comparisions

• Low

• High

Standards of health Life expectancy Education
standards
USA Britain
Sweden Japan
Crime Prison populations Health inequalities
High
Low
True during 1980s
21

• We - at least in the developed countries - live
  undoubtedly in some of the most secure
  societies that ever existed. And yet it is
  precisely the cosseted and pampered we' of all
  people who feel more threatened, insecure and
  frightened, more inclined to panic, and more
  passionate about everything related to security
  and safety than people of most other societies on
  record.
• (Bauman, 200755)

22
Social capital, Economics Crime

• the most spectacular safety panics' and the
  loudest alarms about rising criminality, coupled
  with ostentatiously tough actions by governments
  and manifested among other ways in a rapidly
  rising prison population have occurred since
  the middle 1960s in the countries with the least
  developed social services (like Spain, Portugal
  or Greece), and in the countries where social
  provision was being drastically reduced (like the
  United States and Great Britain). the new focus
  on crime and on dangers threatening the bodily
  safety of individuals and their property has been
  shown beyond reasonable doubt to be intimately
  related to the pace of economic deregulation
  and of the related substitution of individual
  self-responsibility for social solidarity.
• (Bauman, 200716-17)

23
(No Transcript)
24
(No Transcript)
25
Human beings construct their realities in a
process of interaction with other human beings
(Meltzer et al. 1975)
it is always possible to take apart an
intellectual system and trace its component parts
to the interests of certain social groups
(Parker, 1999)
26
Choosing health making healthy choices
easier (White Paper, Nov 2004)
27
(No Transcript)