Lecture Notes on Inequality

8/14/2019 Lecture Notes on Inequality

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Social Determinants of Health

We are going to discuss health inequalities

(first 30 minutes)

We are going to play a game (The Last Straw)

on social determinants of health

This will be an Interactive Class


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The world is not an inn but a hospital


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Health Inequality and Inequity

Health inequality = differences in health

status or

Differences in the distribution of health

determinants between different population

groups.


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Differences in health status

Gross inequality exists across the world Gross inequality in health achievement exists

within New Zealand

Is this inequality unFAIR?


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Fairness is not the same as Equality

The difference between Equity and Fairness

is Important in Health Care

Inequalities in health are undesirable to the

extent that they are Unfair or Unjust

Unjust or Unfair or Avoidable inequaities are

inequities


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Some causes of ill health may be

avoidable


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Unnecessary, avoidable, unjust, unfair situations

resulting in health inequalities also lead to

inequity in health


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How does one tell if a population is

thriving?

Measure consumption patterns?

Measure average income? Measure economic wellbeing with measures

such as GNP?


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A better answer is to measure health

status.

If health of a population suffers it is an

indicator that the set of social arrangementsneeds to change.


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Social conditions powerfullyinfluence both the onset and

response to treatment of the major

killer infectious diseases


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How Do We Explain?


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Rawlsian Framework:

Socioeconomic disparities

in health status reflectunderlying inequities in

distribution of primary

goods


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Causes of the causes

Access to material resources is socially

determined

Material deprivation can account for high

DALY in some countries but

Poverty reduction is not a matter of just

providing clean water or better medical care.


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Spillover effects

Inequalities Affect everyone

Interventions to reduce social inequalities willhave other benefits, benefits other than or

more than just health Sanitary Reforms of 19th Century

Conditions that lead to marked health

disparities are detrimental to Everyone When Inequalities in health are reduced,

everyone benefits


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Achievement of Equity, Removal of

health inequity


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Utilitarian

principle:

maximize health

gain for all,

increase average

health for all


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Why health inequalities must be

reduced?

Public health programmes that are aimed to

reduce health inequalities can be cost

effective

Reducing social inequalities in health is an

issue of social justice.


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Should we strive to achieve a more

even share of good health, beyondimproving the average health status

of the population?


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What is meant by closing the

inequity

Health/Disability in Rich disability inpoor, after reduction, health/disability in rich that in poor, this sort of an intervention is

labelled as targetting to reduce health inequality It is possible to reduce inequality in health

without bringing down the overall health of thepopulation

Money Spent on Reducing health inequalitieslead to larger health gains than money spent onother kinds of health interventions


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What happens if the social situation is such that a

person may take a wrong step out of his free will

but there are situations in the society that makes iteasy for him to take a wrong step? Who is

responsible?


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When one is responsible for an unhealthy

decision that then leads to ill health, and in turn

health inequality, can that inequality be labelled asunfair?


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Strategies to reduce inequalities in health

across the world (Marmot, 2001)

Address and Relieve poverty

Develop health systems and

Improve the circumstances in which peoplelive and work

Structural and environmental interventions

affect the population more evenly than

educational programmes aimed at behaviour

change


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Address social determinants of health


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New Zealand Deprivation Index

NZDep2006 provides a deprivation score for each meshblock in New

Zealand

The NZDep2006 index of deprivation

ordinal scale ranges from 1 to 10, In the score, 1 represents the areas with

the least deprived scores and 10 the areas

with the most deprived scores


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Variables that Go Into NZDep Index

Lecture Notes on Inequality

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