Mothers-to-be in deprived areas are more likely to have premature babies.

Home care ‘’lottery’’ for the elderly.

When the NHS was set up in 1948, one of its When the NHS was set up in 1948, one of its founding principles was to provide a universal founding principles was to provide a universal health care service.health care service.

‘’Everybody, irrespective of means, age, sex or occupation shall have the opportunity to benefit from the best and most up-to-date medical services available’’ (Beveridge)

In other words, a clear commitment to provide a service of equal quality for everyone.

Despite the advances in medical care and technology and a universal system of health care there is growing evidence that:

inequalities in standards of health care provision exist inequalities in standards of health care provision exist throughout the UKthroughout the UK

inequalities in health still exist throughout the UK

these inequalities are getting worse.these inequalities are getting worse.

…..65 years on

Mortality = death Mortality = death Morbidity = illnessMorbidity = illness

Factors which influence health

Different groups and categories of people have very different experiences of these determinants of health.

These different experiences can have an effect on a person’s chances of achieving good health. Also when these experiences overlap, they can have a “snowballing” effect.

However, the problem is complex - there is no simple explanation as to why differences in mortality rates and morbidity rates exist amongst individuals or groups.

GeographicalGeographicallocationlocation

Working Working conditionsconditions

Socio-economicSocio-economicstatusstatus

EthnicEthnicoriginorigin

Personal Personal lifestylelifestyle

HereditaryHereditaryfactorsfactors

Gender/Gender/biological biological

factorsfactors

There are many influences on an

individual’s health.

Health inequalities: hereditary illnesses

A degree of health problems are influenced by genes– Cystic fibrosis and sickle cell anaemia are two of

the most common genetic conditions– 60% of all cancers (73% of breast cancers) linked

to family history BUT very few health conditions are purely genetic Combination of genes and environment

– lifestyle factors, such as diet, smoking, alcohol and exercise, and socio-economic status

Inequalities in Health: Age

Success Criteria: You should be able toProvide evidence for the existence of health inequalities according to ageDraw conclusions on the extent of these inequalitiesDiscuss possible explanations for these inequalities, linking, where possible, to other factors such as social class and lifestyle choices

Age and health: evidence

Poor health increases with age

Percentage reporting long-standing illness or disability:

Source: General Lifestyle Survey (2009)

Age Percent0- 4 85-15 4 1216-44 4 1945-64 4065-74 5875 and over 66

Causes of age related ill-health

As part of the natural process of aging, in old age the body becomes increasingly less able to repair itself

Mobility problems increase and lifestyle habits change, with a reduction in physical activity

Physical frailty/susceptibility to the cold

Certain chronic conditions have a strong association with age:

– Sensory problems (eyesight, hearing loss)

– Arthritis – Dementia Heat or Eat

Report: Living Longer and Prospering (2011)

Poor health in old age is not inevitable

Lifestyle has the greatest impact on longevity, adding 4.6 years to male life expectancy after 65 followed by income, which adds 4 years

Conclusion: over a lifetime, our lifestyle choices take their toll and can result in an earlier death

Consequences of age related ill health

Greater demands on NHS– 75+ age group are more than twice as likely to

visit a GP– 70% of those who require a hospital stay after

a fall are aged over 70

For you to do

Read the BBC Article: Cold homes cost NHS more than a billion

http://www.bbc.co.uk/news/health-20425364

Analysis question: to what extent is age a cause of ill health?

Inequalities in Health: Gender

Success Criteria: You should be able toProvide evidence for the existence of health inequalities gender Draw conclusions on the extent of these inequalitiesDiscuss possible explanations for these inequalities, linking, where possible, to other factors such as poverty and lifestyle choices

Gender and ill health: longevity

Life expectancy (England and Wales) *Men: 77 years *Women: 81 years Pattern is consistent across all social classes but gap

is wider amongst the poorest– 7 year gap in life expectancy between men and

women in 10% most deprived areas– Explanations: manual work, male working class

culture affecting lifestyle choices BUT gap is narrowing – experts say by 2030 there will

be no difference in life expectancy

Gender and ill health: Differing mortality/morbidity rates

Cancer– men are at greater risk of cancer (410 cases per

100,000 compared to 355 per 100,000 for women) Heart disease

Respiratory diseases– see next slide

1 in 5 men will die from cardiovascular disease (CVD), 1 in 7 women)

Deaths from respiratory diseases England/Wales (2007-2009)

Explaining gender related health differences: physical differences

Physical differences account for vulnerabilities to different diseases– E.g. testicular, ovarian and

breast cancer– However 4000 men a year

are diagnosed with breast cancer

Explaining gender related health differences: health related behaviour

Women are, by most measures, healthier than men yet make, on average, 6 visits to their GP a year, compared to 4 for men

Potential to detect and treat illnesses before they become serious

Well-documented reluctance amongst men to visit GPs and other health professionals

Explaining gender related health differences: lifestyles

Diet and obesity– Men consume less fruit and vegetables than women– 69.2% men overweight compared with 59.6% of women

– 6% of men and 5% of women have diabetes– 16% of men and 14% of women have CVD

Smoking– Similar rates (24% of men and 22% of women) but this is a recent

phenomenon linked to rise in young women smoking Alcohol

– 25% of men are “hazardous harmful drinkers” compared to 18% of women

Exercise– 45% of men and 33% of women take enough exercise (at least 60

min daily)

Scottish Health

Survey 2011

For you to do

Read the articles: – Why are men reluctant to seek medical help– Obesity still a problem for Scots– Female binge drink rates ‘double’

You should take notes using the activity questions

http://news.bbc.co.uk/1/hi/magazine/8154200.stm http://www.bbc.co.uk/news/uk-scotland-glasgow-w

est-19713671

http://news.bbc.co.uk/1/hi/health/8034533.stm

Inequalities in Health: Race

Success Criteria: You should be able toProvide evidence for the existence of health inequalities according to raceDraw conclusions on the extent of these inequalitiesDiscuss possible explanations for these inequalities, linking, where possible, to other factors such as poverty and lifestyle choices

Race inequalities in health: infant mortality

Infant mortality rates higher for ethnic minorities as a whole

highest among mothers not born in UK

Causes of infant death differ– Half of all deaths of Pakistani

infants are due to congenital abnormalities, compared to 25% of all infant deaths

– 67% of the Caribbean group of deaths due to premature birth/low birth weight

Race inequalities in health: morbidity

Risk of suffering from particular diseases is different – Diabetes is most common among Pakistani (18%) and

Indian groups (14%) – three times Scottish average– Only 4% of Chinese suffer from CVD (15% Scottish

average), mainly diet related

Sickle cell anaemia, a congenital disease, is most common in Black Caribbean, Black African and Black British communities

Explaining racial differences: culture and lifestyle

Cultural considerations– Language barriers: limits access to health

services/health education– Role of women: some groups unwilling for females to

be examined by male doctors– First cousin marriages increasingly common in British

Born Pakistani groups: doubles chance of having a child with a congenital disorder from 2% to 4%

– Diet influences deaths from CVD Lifestyle choices and culture can be closely connected

– Alcohol: most British Muslims do not consume alcohol, 30% of Chinese men do not

– Physical activity: levels among female Pakistani and Bangladeshi groups are particularly low due to limited availability of “women only” sessions

Explaining racial differences: social class

As in the general population, income among ethnic groups has an important impact on health

Groups with incomes comparable to Whites show smaller differences in health

Bangladeshi groups, who record highest levels of poverty, have health levels 50% worse than whites

Caribbean/Pakistani/Bangladeshi more likely to dwell in inner cities where housing issues/social exclusion can affect health

For you to do

Read/highlight your summary sheet Analysis question:

– To what extent may racial inequalities in health be explained by social class differences?

– you will also need to use you notes on race from the wealth inequalities section of the topic to help you answer this