What explanations have been offered for the existence of inequalities of health in the UK. In what way may health promotion activities address inequalities in health?

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                Student Number: 03970950

Inequalities In Health                Module Code: UZV 201 S1

  1. Inequalities In Health

  1. What explanations have been offered for the existence of inequalities of health in the UK. In what way may health promotion activities address inequalities in health?

Introduction

There are many and varied definitions of what health is, the Cambridge English Dictionary for example defines it as “A sound state of body or mind; freedom from disease" (Cambridge English Dictionary, p183) – but this rather simplistic definition does not wholly encompass the vast range of human experience which informs each individual’s definition of health. Definitions of health vary widely from person to person; as noted by Blaxter (1997), people have a desire to claim a healthy status, and may offer alternative explanations of their, or other peoples health experience rather than accept a state of ill health. Perhaps it is a western unease with the idea of ill health which leads to the disbelief many feel at the idea of the existence of inequalities in health (Blaxter, 1997).

Despite perhaps a conceptual discomfort with the idea of inequalities in health, there is information which suggests that there are inequalities in health, and that the inequality between rich and poor, termed the ‘health gap’, is continuing to grow (Smith et al., cited in Davidson, Hunt & Kitzinger 2003). The evidence for health inequalities is a matter of some contention however, with some suggesting that inequalities are simply an artifact of the interpretation of vast amounts of indifferent data (Gillespie & Prior, 1995). Certainly there is a high level of agreement within the lay public that health is dependent on individual behaviours rather than housing, environment or personal prosperity (Blaxter, 1997); furthermore there is the question of whether health inequalities are unjust or simply inequities caused by, for example, the prevalence of specific genes in certain socio-economic groups (which although leading to inequalities are not inherently unfair) (Whitehead, cited in Mackenbach & Kunst, 1997).

This essay will discuss what evidence exists for health inequalities, and the origins suggested for these inequalities. The impact of biological, social, environmental and psychological factors on health and how these factors interact to produce inequalities will be briefly considered. Finally, the question whether health promotion may act to reduce these inequalities will be discussed.

The evidence for inequalities & health affecting factors

In a study by Blaxter (1997), those who are traditionally considered to be disadvantaged in health terms, i.e. those in the social classes IV/V, were the only people to completely deny the existence of health inequalities, and would only attribute ill health to external factors (for example damp housing or pollution) as a last resort (Blaxter, 1997; Popay et al. 2003). An opinion which is perhaps reinforced by the popular media, in which the more right-wing papers emphasize the importance of individual health behaviour over and above the importance of  social environment (Davidson, Hunt & Kitzinger, 2003).

But this attitude is not supported by the evidence. In 1842, the then Home Department published a report entitled ‘Report to Her Majesty’s Secretary of State for the Home Department from the Poor Law Commissioners on an Inquiry into the Sanitary Condition of the Labouring Population of Great Britain’ (Chadwick, 1842) – this report brought into the awareness of the then government the relationship between the living conditions of the poor and high rates of illness and mortality. Since then there have been several seminal works which continued to highlight inequalities in health, most famously the ‘Black Report’ (Black et al., 1980) and more recently the Independent Inquiry into Inequalities in Health Report (Acheson, 1998) (also known as the Acheson Report).  

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The Black report (Black et al., 1980) argued that social and economic factors such as work, income, education, housing, environment and transport all affect health, and furthermore that the better off classes benefited from all of these factors being biased in their favour (Townsend & Davidson (eds), 1982). Not only that, but that manual classes make less use of the healthcare system despite needing it more. Although there is a lack of recent quantitative research in many areas, the research that does exist indicates some link between socio-economic status and use of healthcare facilities. A quantitative study correlating the ...

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