Inequalities of Health Care.
Foundations of Health
September 2003 Cohort
Student Number: 03970336
Inequalities of Health Care
There can be many definitions of health; it is all in accordance with what the individual defines it as. Seedhouse (1987) and Blaxter (1990) suggest that it will mean many different things to many different people.
"The definition of health is a contested issue, however in the late twentieth century there has been a development in health promotion work". (www.sunderland.ac.uk/~hs0bgr/enlec/enlec1)
A persons own definition is very important as this is how you interpret your own and others health. One outlook on health by Antonovsky (1987) is that "health can be viewed as the opposite to illness in a traditional sense or it can be interpreted as being a continuum between health/ease and dis/ease".
This essay will be outlining some of the inequalities of health and what has been done to improve them, also what can be done in the future to combat the inequalities.
Health inequalities can and are directly caused by differences in "socio-economic status, ethnicity and ability and ultimately related to differences in income, education, employment, material environment and lifestyle" (www.nhsdirect.nhs.uk, 2004). These inequalities also coincide with the biological and psychological factors, which will be covered as part of this essay.
Health promotion is a large area associated with health and health inequalities and the government is always looking to extend and improve such promotions including breast cancer awareness, smoking and alcohol awareness. Although there are many health promotion activities, which are and will be taking place, this essay will be concentrating on health promotion through education and schooling and how they can help to tackle the many inequalities in health. Education is a prime example of how to address inequalities in health and covers issues such as nutritional needs, sex education and life skills, which are vital necessities combined together to promote good health.
The best-known literature, which has looked into reducing inequalities of health, is the Black Report written in 1980 by Douglas Black. Authorized by the government, the report was produced in order to explain trends in inequalities in health. These trends were to be examined and related to policies intended to promote and restore health. The report was primarily concerned with looking to reduce child poverty and economic inequality in general and focused its aims on promoting community health. Although the report recognized a link between socio-economic inequality and health inequality, which other reports have failed to do so, the Black Report was dismissed with the explanation of it being unrealistic.
The 1998 Acheson report chaired by Sir Donald Acheson (Independent Inquiry) supported the findings of the Black report in that poverty leads to poor health and made a recommendation that there be three main areas which need to be tackled in order to achieve improvements in health inequalities. The report stated that priority should be given to the health of families with children, improvements in the standards of poor households and that there should be steps taken to reduce income inequalities. (Www.archive.officialdocuments.co.uk, 2004)
Since the government accepted the links between life chances, deprivation and poor health, there have been policies put in place to support specifically targeted groups including: the 18-25's welfare to work programme, pension reform and minimum income guarantee and child support reform and working family tax credit.
There has also been a twenty-year programme launched by Tony Blair in response to the report, which aims to tackle and eradicate child poverty.
Although these reports have tended to focus on welfare, which is mainly the cause of inequalities in health, there are also other factors, ...
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Since the government accepted the links between life chances, deprivation and poor health, there have been policies put in place to support specifically targeted groups including: the 18-25's welfare to work programme, pension reform and minimum income guarantee and child support reform and working family tax credit.
There has also been a twenty-year programme launched by Tony Blair in response to the report, which aims to tackle and eradicate child poverty.
Although these reports have tended to focus on welfare, which is mainly the cause of inequalities in health, there are also other factors, which have an influencing affect. "Saving Lives: Our healthier Nation" is the most recent public health strategy for the U.K, it was a publication in 1999 which aimed to improve health and to reduce the health gap. The strategy established a "three way deal for health", meaning that individuals, communities and government all have a key part to play, and will all be encouraged to play their parts if the strategy is to be a success.
Also established in the strategy were four national targets for the year 2010 which every local area is to concentrate on; cancer; coronary heart disease and stroke; accidents and mental health, each local area is also expected to set additional local targets - inequalities of health being one of them. Health authorities will be working in conjunction with local authorities through the development of local health improvements to achieve the set targets. (OHN, 2002)
When looking into inequalities in health, there are close connections with the amount of wealth, power and participation an individual has. This connection is quite often a reflection of the individuals' SES (Socio-Economic Status) which refers to their position within society and can be in terms of their wealth, occupation, education and housing and in accordance of Healy (1998), wealth is of substantially higher importance. There is a strong correlation between social class and long-term health conditions such as diabetes and epilepsy and "a fundamental and consistent link between poverty and poor health". (www.dh.gov.uk, 2004) People who carry a lower SES tend to eat less fruit and vegetables, and less food which is rich in dietary fibre, as a direct consequence, they have lower intakes of anti-oxidant and other vitamins, than those who carry a higher SES.
Individuals who carry a high SES are able to afford private health care, suitable housing and substantial nutrition which all link together to provide a healthy lifestyle.
The wealth of a person can also have an effect on an individual's psychological state. Generally, people who have good wealth are content with their lifestyle and tend not to become depressed. They also have good social networks, which have a positive effect on an individual's health. Another psychological factor attached to the SES of an individual is the amount of stress that can be caused as a result of poor wealth. Healy in 1998 speaks about the damaging effects that an individual who lives in an affluent society who is considered to be living in poverty or deprivation may suffer, compared with an individual who lives in a less affluent society who lives in absolute poverty and found that the first individual suffers greater detrimental effects.
People living in neighbourhoods where the levels of crime are high can often suffer with ill health such as depression, this can lead to a greater incidence of smoking, alcohol consumption and also the misuse of drugs.
When investigating biological inequalities in health, there are uncontrollable differences in the gender of an individual, which can have an affect in later life. With an increased level of suicide attempts in males rather than females, there has been recent evidence suggesting that males find it more difficult to deal with stress. An article published in May 2000 by the New York Times attempted to investigate the differences in how males and females respond to stress, the article highlighted the fact that males tend to suffer more than females with stress related illnesses and effects such as hypertension and drug and alcohol abuse. (www.frogpond.com/articles, 2004) Research has been undertaken into the relationship of social ties and the ability to cope, it has been found that because females generally have more friendships where they are able to discuss their problems, reduce their stress load and are able to cope better, they have an increased chance of prolonging their lives through reducing their blood pressure, heart rate and cholesterol.
Having explored the differences that can arise through the gender of an individual, the biological inequalities on health also occur in age. An irreversible process of life, the age of an individual can have an affect on ones life. The older an individual becomes, the more susceptible they are to age related illnesses such as osteoporosis, which is the loss of bony tissue resulting in brittle bones. Although this is more prevalent in females than males due to the menopause, it is still common throughout both sexes.
When concentrating on health inequalities and health promotion, schools have a major role in diminishing any that may arise throughout childhood. Education plays a number of roles in influencing inequalities in health, if health is viewed in its widest sense. Education can be a childs' opportunity, with the support of their parents to create a healthy lifestyle and hopefully avoid many inequalities that children and adults will face throughout their lives. There can be a strong link between the education a child receives and the effect it will have on their SES status in later life, the level of qualifications achieved through school will create the individuals future career, lifestyle and financial position.
Schools have the vital role of influencing how the individual child will grow up. With education contributing towards the practical, social and emotional knowledge and skills essential for life, schooling provides a firm base needed for the achievement of a healthy life. Preparation for life is a key issue, which individuals will learn whilst in education, skills in developing relationships and how to deal with conflict against others will be part of this preparation including the practical skills such as budgeting and cooking. These skills and knowledge will help the individual learn to recognize possible detrimental affects of health and to avoid health related bad behaviour such as violence.
Education can provide an extensive role in helping the individual to achieve a satisfactory social network, children can learn a lot through social play and the special friendships built in early life give them a healthy start to these social networks. An important aspect of social groups within school is the way in which cultural differences are dealt with, the attitudes of individuals when considering multi-cultural races are more often than not established within the school environment. Education has provided the foundation for recent generations to become more socially accepting of individual differences, this is highlighted by a recent introduction of a variety of different religious curricular, steering views away from ignorance and favouring acceptance. This has an important health promotion role, one that can only be improved for further generations to combat any health inequalities such as discrimination, which may arise within the multicultural society.
Another health inequality, which is addressed within school, is inequalities in the diet, children who are from families receiving income support or on income-based job seekers allowance are entitled to receive free school lunches. "About 15 per cent of pupils in England receive a free lunch and about a further 27 per cent pay for it." (www.archive.official-documents.co.uk, 2004) There is evidence, which demonstrates individuals who are from disadvantaged families have poorer nutritional intake, as there can be a lack of fruit and vegetables essential for a healthy diet, school lunches therefore are an important component of the diet for these individuals.
With the improvements of nutritional intake through school, there should be an increased reduction of child hood health problems such as obesity and nutritional deficiencies which will help to diminish the risk of "chronic degenerative and other diseases of adult life, without increasing the risk of other conditions" (www.archive.official-documents.co.uk, 2004)
Obesity, if not tackled in the early years can have dire consequences including an increased risk of premature mortality. Many obese children have high cholesterol and blood pressure levels, which are risk factors for heart disease. With child hood obesity being an increasingly worrying contribution towards creating health inequalities, there have been nutritional initiatives introduced to the schooling system through the government. These initiatives include compulsory nutrition standards for school lunches, the teaching of food preparation, cooking and hygiene which forms part of the National Curriculum for school children up to the age of eleven and also the NSFS (National School Fruit Scheme) which entitles all school children of the ages four to six to receive a free piece of fruit each day. (www.nih.gov/news/WordonHealth/jun2002/childhoodobesity)
There are many inequalities in health which can be investigated and also many health promotion activities and initiatives which are in place. Hopefully this essay has given an insight into the inequalities in health and highlighted what is being done at present and what the ideas and plans for the future are. It has been demonstrated that biological, sociological and psychological factors all have an influencing effect on one another and can all be a contributing factor towards the detriments in health. With the involvement of the government and the support of local authorities, there is hope that these inequalities can be reduced.
This essay has concentrated on health promotion within education and schooling - the subject can be considered as a major starting block for the eradication of any health inequalities that may arise in early childhood. Children are considered to be our investment for our future and need to be well cared for and if generations to come are to be free from health inequalities then the current education system needs to be increasingly improved. There will always be some minor inequalities in health such as gender and age but these are permanent factors, which cannot be controlled.
Word Count: 2159
References
Independent Inquiry into Inequalities in Health Report, (1998), Reducing Inequalities in Health (on-line) UK: University of the West of England. Available from www.archive.official-documents.co.uk (accessed 22/02/04)
Frogpond, (2004), Men, women and stress, (on-line) UK: University of the West of England. Available from www.frogpond.com/articles (accessed 20/02/04)
Our Healthier Nation, (2004), Health Inequalities, (on-line) UK: University of the West of England. Available from (www.ohn.gov.uk/ohn/inequ.htm
Parliamentary Office of Science and Technology, (2003), Childhood Obesity (on-line) UK: University of the West of England. Available from www.parliament.uk/post (accessed 2/03/04)
NHS Direct, (2004), Inequalities in Health, What are the? (on-line) UK: University of the West of England. Available from www.nhsdirect.nhs.uk (accessed 2/03/04)
Department of Health, (2002), Tackling Health Inequalities: 2002 Cross-Cutting Review (on-line) UK: University of the West of England. Available from www. doh.gov.uk
Bibliography
Heath, H B M (1995), Potter and Perry, Foundations in Nursing Practice. UK edition, London: Mosby
Student Reg: 03970336
