Health Inequalities
Health Inequalities…… Mind the Gap
7000PUBHEA: PUBLIC HEALTH: POLICY AND PRACTICE
STUDENT NUMBER: 777593
ASSIGNMENT 2, ESSAY 2
WORD COUNT: 3000 WORDS
INTRODUCTION
The World Health Organisation (WHO) defined the term Health Inequalities as differences in health status or in the distribution of health determinants between population groups (WHO, 2010). Inequalities in health have been identified by the United Nations (UN) as not only a key deterring factor of some countries achieving set global public health targets, but also a major reason for deterioration of overall health within countries (McDavid, 2009). According to WHO (2010), some inequalities are attributable to biological variation or free choice and others are identifiable with the external environment and conditions mainly outside concerned individuals control. Inequalities in the first case are unavoidable and maybe largely seen as acceptable whereas the other inequalities are avoidable, unjust and linked to health inequities. Health inequality is often used interchangeably with health inequity (Harris and Lloyd, 2017), a term defined by the Whitehead (cited in CDC, 2014) as outcomes in health that are avoidable and unjust. For the purpose of this essay, I will discuss lengthily the issues surrounding only the avoidable health inequalities that I will use in the same context as health inequities.
The health outcomes used to measure inequalities in health include mortality rates, life expectancy, disability and health status (Acheson, 1998). These outcomes demonstrate the growing inequalities between countries and within countries, including those inequalities between different races and groups (Smits and Monden, 2009).
The maternal mortality rate (MMR) in Sierra Leone being 1360 per 100000 live births in 2015, when in the same year in the United Kingdom (UK) it is 9 per 100000 live births (World Bank, 2016) is a manifestation of inequality between countries. Another example of ‘between countries’ inequality is the infant mortality rate (IMR) in Iceland being 2 per 1000 live births and over 120 per 1000 live births in Mozambique (WHO, 2013a). Sierra Leone and Mozambique are poorer countries ranked 181 and 180 respectively in the United Nations development index for 2014 (UNDP, 2015). A classic example of inequality within country is the case of Scotland where life expectancy at birth of men in the Calton neighbourhood of Glasgow is 54 years, and few kilometres away in Lenzie, the LE of men is 82 years (Reid, 2011). Similarly, in London the life expectancy of men in wealthy areas of Kensington and Chelsea is 88 years, while a man living few miles away in poorer Tottenham green is not expected to live more than 71 years (Ramesh, 2017). Calton and Tottenham are deprived areas in their respective cities.
Marmot (2005), pointed out that poverty and deprivation are not sufficient to understand these growing inequalities, but an added understanding of the relationship between the social determinants of health (SDOH) and health inequalities is required. I will discuss this relationship and the other different manifestations of health inequalities in different populations later in this essay.
Prior to Marmot linking Inequalities to social determinants of health, other commentators brought forth explanations for health inequalities (RCN, 2012). Such were seen in the Black report of 1980 and the 1998 Acheson inquiry. The theoretical explanations from the Black report: artefact, social or health selection, cultural or lifestyle and structural or materialistic explanations will be critically analysed further in the essay.
The problems with health inequalities have been noticed both globally and locally. Global actions taken to reduce inequality include the ‘health for all 2000’ initiative by the WHO (WHO, 2013b) and the Sustainable Development Goals (SDGs) by the United Nations (Nino and Alexovich, 2017). The new labour party recognised the dangers of inequalities in 1997 and set up a new independent inquiry into health inequalities headed by Sir Donald Acheson, as the previous government discarded the initial report on inequality (Smith, Morris, and Shaw, 1998). Some other initiatives in the UK against inequalities include ‘our healthier nation 1998’ and the National Health Service (NHS) plan 2000 (Wistow, Blackman, and Byrne, 2015). The ‘health for all 2000’, ‘our healthier nation 1998’ and the NHS plan 2000 will all be evaluated in their capacity to reduce health inequalities in this report.
AIMS AND OBJECTIVES OF THIS REPORT
- To examine the concepts of health inequalities
- To identify the relationship between SDOH and health inequalities
- To critically analyse theoretical explanations of health inequalities
- To critically evaluate key strategies in their capacity to reduce health inequality
SOCIAL DETERMINANTS OF HEALTH AND DIFFERENT MANIFESTATIONS OF INEQUALITIES
Social determinants of health are social and economic conditions and their distribution among the population that influences individual and group differences in health outcomes. According to WHO (2016), they are conditions in which people are born, grow, work, live and age. Some of the accepted SDOH are social gradients, stress, early childhood development, social exclusion, unemployment, addiction, food security and available transportation (Marmot and Wilkinson, 2003). Marmot (2010), explained in the marmot review that inequalities in the social determinants results in inequalities in health and consequently actions against health inequalities should involve actions against all social determinants of health. The Black report of 1980 and the Acheson report of 1998 also demonstrated the links between social determinants and health outcomes and inequalities and recommended fairer redistribution of resources to reduce economic inequality and improve social welfare of poorer households (RCN, 2012). I will now use some of the commonly accepted SDOH to examine the relationship between SDOH and inequalities, and manifestation of health inequalities among different groups.