What are health inequalities?
Health inequalities are the differences in health status across different population groups due to social, economic and political factors. One could argue that overall, people are living longer and more healthily now than they did in the past. However, there are many health inequalities that lead to certain population groups having better or worse health outcomes than others.
What factors affect health?
According to the Dahlgren and Whitehead rainbow, the determinants of health can be divided into five different categories:
- Constitutional factors such as age and sex.
- Individual lifestyle factors.
- Social and community networks.
- Living and working conditions such as unemployment, housing and work environment etc
- General socio-economic, cultural and environmental conditions.
What are the social determinants of health?
The term 'social determinants of health' is used to describe any non-medical factor that influences health outcomes. The following list has been provided by WHO and identifies various social determinants of health that can contribute to health inequalities.
- Income and social protection
- Unemployment and job insecurity
- Working life conditions
- Food insecurity
- Housing, basic amenities and the environment
- Early childhood development
- Social inclusion and non-discrimination
- Structural conflict
- Access to affordable health services of decent quality
Think about each of these, and consider how they relate to someone's health.
Let's look at an example.
It might be strange for working life conditions to be a factor that affects health, but if we dissect this further we can see how. People who are struggling financially are more likely to work jobs that have long unsocial hours, which will have a knock-on effect on their health. Their work conditions and hours may affect the quality of their sleep, their mental health, their ability to exercise or take an adequate lunch break. They may not be eating enough food or might be relying on cheap takeaways as they may not have enough time to make healthy meals. They may not be able to make a GP appointment if they need it because they are working from 9-5 and can't afford to take time off. As a result, they may be more tired, depressed, and overweight, which may, in turn, increase their risk of developing conditions like diabetes, high blood pressure, or high cholesterol.
What is the inverse care law?
The inverse care law states that the availability of good medical care tends to vary inversely with the need of the population served (Tudor Hart, 1971). This means that those with the poorest health who need medical care the most, are the least likely to receive it.
We know that the more deprived someone is, the more they are likely to suffer from health conditions. Let's look at two examples:
- In deprived areas where many people have poor health, there tend to be fewer doctors and healthcare professionals.
- This is because many doctors may find these areas unattractive to work in. The pay may not be as good as it would be in a more affluent area, or the crime levels may be high in that area so they may not feel safe living and working there. But is it fair that the population there don't receive good medical care? Should there be greater incentives (e.g. higher pay) to encourage more doctors to work in this area? How can we make sure the needs of that population are met?
- The rates of immunisations and screening for cervical and breast cancer are considerably lower in deprived areas, even though this is where cancer mortality is at its highest.
- What is stopping these people from getting screened or immunised? Are they just lazy? Are the programmes being run from 9-5, making them inaccessible to the working population? Should it be made more accessible for them (e.g. run the programme after working hours) or is it the responsibility of each person to put their own health first? These are all important questions to consider when trying to improve the health outcomes of the population.
Theories that explain health inequalities
Many theories have been put forward to try and explain why these health inequalities exist.
These include the following:
- Social Causation Theory
- This suggests there is direct causation between health and social status - the more healthy someone is, the more likely they will be able to earn more and work their way up the social class ladder. Therefore, it might appear that poverty leads to poor health, but the reality may be that poor health leads to poverty instead.
- Cultural-behavioural Theory
- This suggests that forms of culture (e.g. family, social class) influence our healthy or unhealthy behaviours. For example, some people may be more inclined to take up smoking or drinking if they are stressed, whilst others may take up yoga. It argues that unhealthy behaviours are often more socially acceptable in working-class populations. Do you agree with this?
- Materialist Theory
- This suggests that inequalities in health arise due to differences in resources that people have. This can be in terms of physical resources (e.g. money, living in a comfortable home, car ownership etc.,) or resources in the form of knowledge. The more resources someone has, the better their health will be.
- Psychosocial Theory
- This suggests that environmental stressors have a knock-on effect on people's mental and physical health. For example, lack of control at work or feeling inadequate because of low income may make someone feel inferior, and this in turn will affect their health. Therefore, this theory suggests that it is not the low income itself that causes poor health, but it is the way the low income makes someone feel that affects their health.
- The Artefact Theory
- This suggests that health inequalities are only evident due to the way statistics are collected. It argues that health inequalities are not real; if the way we measure health and social class are flawed, then the relationship between them must be flawed too.
These theories all try to explain why there are differences in health outcomes in different population groups. Which theory or theories do you agree with the most? Do you think only one is true, or is it a combination? Is there anything that is missing from these explanations?
Practice Interview Questions
- What can be done to reduce health inequality in the UK and around the world?
- Do you think the NHS is truly free for all? Who might someone disagree?
- Design a breast cancer screening programme for a deprived inner-city area. Consider how you would tell the community, where you would run it, what time you would do it, etc.
- Other factors that affect health are age, gender and ethnicity. How do each of these factors impact health?
Authors: Sana Khan & Latifa Haque
Editor: Latifa Haque