Lecture_5_2006

Lecture_5_2006 - Global Health Challenges Social Analysis...

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Unformatted text preview: Global Health Challenges Social Analysis 76: Lecture 5 Averages Do Not Tell the Whole Story Defining and Quantifying Inequalities in Health Health Inequalities Correlated with Income Reducing Inequalities Through Health or Other Sectors? Three Examples Child mortality for rich and poor in developing countries Life expectancy across counties in the US Social class differences in the UK under-five mortality rate C 100 150 200 250 300 350 50 ol om bi a P er u D om N Bra i n ic a z il ic an rag R ua ep G ub ua lic te m a B la Z ol iv im b ia ab w e G ha n K a en S ya en U .R eg ep a .o T l f T og a o nz a C am ni a er oo n B en G in C ot uin e e d' a Iv o M i re al aw Z M a i oz m am bi a B ur b k i i qu na e F as o M al N i ig er Child Mortality: gap between rich and poor 0 Poorest Quintile Richest Quintile Trend for US overall life expectancy at birth, 1961-2000 85 80 75 e0 at birth 70 65 60 55 1961 1963 1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 males females County life expectancy, males 1999 78.8 to 80.4 76.9 to 78.8 75.0 to 76.9 73.1 to 75 75.0 71.2 to 73.1 69.3 to 71.2 67.4 to 69.3 65.5 to 67.4 63.6 to 65.5 61.7 to 63.6 Trends in life expect ancy at birth for the eight best and eight w orst counties, males 85 80 75 70 65 60 55 1980 Life expectancy at birth 1985 1990 Year 1995 2000 Social Class Designation Based on Occupation in the UK I. Professional etc. occupations II. Managerial and Technical occupations III. Skilled occupations IV. Partly-skilled occupations V. Unskilled occupations Age-standardized death rate, adult males, England and Wales, 1911-1991 1,400 1,200 I II V III 1,000 per 100,000 800 600 400 200 0 1910 1920 1930 1940 1950 1960 1970 IV 1980 1990 Based on ONS UK Health Inequalities Decennial Supplement Why Are There Inequalities in Health? Why Are There Inequalities in Health, even in a country like the United Kingdom with nearly 100% financial and physical access to healthcare? Averages Do Not Tell the Whole Story Defining and Quantifying Inequalities in Health Health Inequalities Correlated with Income Reducing Inequalities Through Health or Other Sectors? Social Analysis 76 Distribution of Healthy Life Expectancy Inequalities vs. Inequities The term inequality simply refers to a quantity that is unequal across individuals or groups of individuals. Inequity invokes the concept of unjust inequalities. Inequities? 1. Inequalities in healthy life expectancy due to living without clean water? 2. Inequalities in healthy life expectancy due to tobacco consumption? 3. Inequalities due to extreme sports? What Should We Measure? Total health inequality = Between Group Inequality + Within Group Inequality Relative and Absolute Inequalities "Inequality in the US has been increasing." Distribution of child mortality 0.50 0.45 % population 0.40 0.35 0.30 0.25 0.20 0.15 0.10 0.05 0.00 A B C 0 20 40 Child mortality 60 80 100 Averages Do Not Tell the Whole Story Defining and Quantifying Inequalities in Health Health Inequalities Correlated with Income Reducing Inequalities Through Health or Other Sectors? Income and Health Relationship Health and income at the national, community, and household level are highly correlated. Dual causality: poverty causes poor health and poor health causes poverty. Poverty to poor health has been the focus of social epidemiology for a century. More recently, recognize that health may be a key determinant of income growth. The Millennium Preston Curve Source: Author's calculations based on World Development Indicators 2003 (life expectancy and Penn World Table (GDP.) Note: Circles have diameter proportional to population size. The World Health Chart www.gapminder.org Averages Do Not Tell the Whole Story Defining and Quantifying Inequalities in Health Health Inequalities Correlated with Income Reducing Inequalities Through Health or Other Sectors? Strategies to Reduce Health Inequalities Major debate on the balance of intervention in sectors other than health such as improving educational opportunities or income distribution versus the role of public health and medical care. Reducing Health Inequalities Through Health Systems Often the rich benefit from health system technologies more than the poor this is true both for prevention and cure. Important agenda is to understand why interventions that might reduce health inequalities often do not reach the poor. 20% 40% 60% 80% 100% 0% Oax Chis Tlax Mich Tab Gro Gto Hgo Pue Ver Slp Mor Nay Camp Dgo Sin Jal Qroo Zac Ags Col EUM Yuc Qro Bcs Son Chih Mex BC Coah Tamp NL DF Coverage of glasses/contacts, Mexico 2005/6 by state Crude Coverage Effective Coverage Intervention coverage by wealth quintile, Mexico 2005/6 100% Composite Effective Coverage 80% 60% 40% 20% 0% 1 2 3 Quintile of Wealth 4 5 Maternal and Child Health Other Interventions All Interventions What Determines Effective Coverage of Interventions? Price of health care Perceived need and knowledge Geographic proximity of providers - travel time Cultural and social acceptability of intervention - responsiveness of health systems Availability of necessary technology and resources Technical quality of providers Choice of an intervention Adherence Demand for health care Quality of providers ...
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