Lecture 14 : Factors4 Overview

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Lecture 14 Factors(4)Overview

• EDUCATION
• HOUSING CONDITIONS
• MEDICAL SERVICES
• EXERCISE / STRESS
• FAMILY SIZE

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Education

• Life expectancy has been found in many studies to
  be directly related to education levels (i.e. the
  better educated on average live longer).
• As with income, it is not clear whether education
  levels are an important factor in their own
  right, or just happen to be correlated with other
  social class related factors which may be more
  important.

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Housing Conditions

• Mortality and morbidity rates vary between
  housing types.
• As before, it is not clear whether this is a
  function of housing quality per se, or other
  social class related factors associated with the
  people living in the houses.
• A table in the UK Black report suggests that
  housing tenure (and by inference housing quality)
  may be an important factor it is own right.
  Variations are found between housing tenure types
  even when controlling for social class. (N.B. The
  private rented sector includes both luxury
  apartments and the worst slum housing. Mortality
  rates are higher in the latter than in council
  estates).

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Mortality And Housing
SMRs by Social Class and Housing Tenure Type
(Source Black Report)
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Health Sevices

• Access to the health services varies by social
  class, especially in countries where private
  medicine predominates.
• Access varies within cities. For example, there
  are more GPs in Dublins southside than in the
  west of the city.
• Access also varies between urban and rural areas.
• Social inequalities in access and quality of
  treatment persist even if medical services are
  totally free see quote by John Tudor Hart in
  reference to the British NHS even before it was
  decimated.
• It is far from clear that inequalities in access
  to the health services have a major impact upon
  inequalities in health.

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Distribution of GPs in Dublin, mid-1980s.
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The Inverse Care Law

• 'In areas with most sickness and death,
  general practitioners have more work, larger
  lists, less hospital support and inherit more
  clinically ineffective traditions of
  consultations than in the healthiest areas and
  hospital doctors shoulder heavier case loads with
  less staff and equipment, more obsolete buildings
  and suffer recurrent crises in the availability
  of beds and replacement staff. These trends can
  be summed up as the inverse care law that the
  availability of good medical care tends to vary
  inversely with the need of the population
  served'.
• (John Tudor Hart, M.D.)

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Stress

• Stress causes the body to produce catecholamines
  (e.g. adrenaline) and the release of fats and
  sugar into the blood system to prepare it for
  fight or flight.
• It is hypothesised that stress without exercise,
  stress results in the fats accumulating on artery
  walls, resulting in atherosclerosis and hence an
  increased risk of heart disease or stroke.

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Exercise

• Regular exercise is recommended for good health.
• Manual workers might be expected to get more
  exercise and have lower fewer heart attacks. In
  fact, they tend to have more heart attacks. This,
  however, may be due to other factors exerting an
  even greater effect than exercise.
• Figures reported by Gatrell (2003) suggest that
  exercise is more common in the lower social
  classes. If correct, this would again run counter
  to the notion that exercise is good for you, as
  mortality rates are higher in the lower social
  classes.

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Family Size

• Family size is rarely considered as a health
  risk, but a Dublin study by Kent and Sexton found
  that children from large families tended to be
  smaller.
• Studies elsewhere suggest that tall people tend
  to live longer than short people.
• Family size would appear to be a more important
  determinant of size than social class.

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Size Of Dublin Children