Lecture 5

Lecture 5 - Health inequalities Inequality vs inequity Inequity Inequality A measurable difference or variation in size amount rank etc

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Unformatted text preview: Health inequalities Inequality vs. inequity Inequity Inequality A measurable difference or variation in size, amount, rank etc. “Objective” statement How different are we? Lack of justice; unfairness Value judgment; political concept Who should we be like? (other group) What should we be like? (target) What is unequal is not necessarily inequitable EXAMPLES? http://www.cdc.gov/nchs/ppt/hpdata2010/apha02/disparities11jeff.ppt Horizontal and vertical equity Horizontal equity Equal access on the basis of medical need, regardless of gender, social status, religion, political views, etc. Vertical equity Those with greater need should get care first Determining need Kevin cannot climb stairs or do other physical activities because of his condition. He is able to carry the groceries and do some light household work. Rob is able to walk distances of up to 200 metres without any problems but feels tired after walking one kilometre or climbing more than one flight of stairs. He has no problems with day-today activities, such as carrying food from the market. Determining need Kevin is a professor And a single dad of a 2year old And he owns a car Rob is a professional athlete And 50 years old And he lives on the third floor of a walk-up in the plateau From a policy perspective (Whitehead 2000), determinants can be considered… Unavoidable -> Inequalities in health Natural biological variation Behavior – “freely” chosen. Ex: skydivers deliberately engage in an (expensive) activity that carries a higher risk of mortality and injury Transient health advantage Avoidable -> Inequities in health Home & work environment Behavior that is restricted socially or materially Access to care Health-related social mobility http://web.archive.org/web/20040519165304/www.who.dk/Document/PAE/conceptsrpd414.pdf The aim of policy for equity and health (Whitehead 2000) “[…] Not to eliminate all health differences so that everyone has the same level and quality of health, but rather to reduce or eliminate those which result from factors which are considered to be both avoidable and unfair. Equity is therefore concerned with creating equal opportunities for health and with bringing health differentials down to the lowest level possible.” (p.7) Limitations Idea of unavoidable determinants disputed Identification of all / or important determinants ?? Avoidability / unavoidability may be continuous rather than categorical Measuring determinants is inexact…at best. Ethical – Inequity judgment is subjective Sick individuals and sick populations (Rose 1985) Aetiology (or etiology): the cause of a disease or abnormal condition Causes of cases (individual) vs. causes of incidence (rate of occurrence) Why is this person hypertensive? Why does population A tend to have higher levels of hypertension than population B? Individual and population determinants Stage I hypertension: treatment with medication recommended On genetics and the environment Genetics dominate the explanation of individual susceptibility, but not of populations There tends to be much greater genetic variation within populations than between them In contrast, environmental exposures tend to be homogenous within populations, but to differ a lot between populations Individual and population determinants Between-population variation Within-Kenyan pop variation Within-London pop variation Limited potential for population Incidence of Down syndrome by maternal age Women under 30 individually have very low risk, but because they have so many births, they generate half the cases Women over forty have the highest individual risk, but only generate 13% of cases “A large number of people at a small risk may give rise to more cases of disease than the small number who are at a high risk” High-risk vs. population strategy approach High-risk vs. population strategy approach Limitations of the population strategy approach for inequalities in health © Louise Potvin, 2006 Université de Montréal © Louise Potvin, 2006 Université de Montréal © Louise Potvin, 2006 Université de Montréal © Louise Potvin, 2006 Université de Montréal © Louise Potvin, 2006 Université de Montréal © Louise Potvin, 2006 Université de Montréal Historical Product: Concentration of Vulnerabilities Concentration of advantages Mean effect © Louise Potvin, 2006 Université de Montréal Concentration of vulnerabilities Health Outcome © Louise Potvin, 2006 Université de Montréal TIME © Louise Potvin, 2006 Université de Montréal ...
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This note was uploaded on 03/23/2012 for the course SOCI 309 taught by Professor Smith during the Fall '10 term at McGill.

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