Behavioural and structural factors in the explanation of socio
structural conditions on lifestyle into consideration. Key words: socio-economic inequalities in health structural explanation
“As Natural as the Air Around Us”: On the Origin and Development of
and health inequalities in the Peruvian Amazon describe structural violence as. “a comprehensive framework to explain the mechanisms by which social forces.
Inequalities in Health: the Importance of Material/Structural Factors
27 Apr 2022 The material/structural explanation ... pothesis a part of the life course explanation of health inequalities
An assessment of the Black Reports explanations of health
assessment of the Black Report's four explanations of health inequalities. The artefact explanation. This approach to the problem urges us to look critically
Rethinking the relationship between socio-economic status and
This is a structural account of health inequalities. Psychosocial explanations focus on how social inequality makes people feel and the effects of the.
Persistence of social inequalities in modern welfare states
Although this may not be helpful for those who want to explain inequalities in health from the processes and structures involved in social inequality it could
CULTURE AND THE SOCIAL CONTEXT OF HEALTH INEQUALITIES
Thus Bourdieu connected macro-level constructs such as social structure to symbolic interactionism
Structural Stigma and Health Inequalities: Research Evidence and
Synthesizing this literature on the components of structural stigma Hatzenbuehler and Link. (2014) offered an initial working definition of this construct: “
The determinants of health: structure context and agency
However from the point of view of the development of a sociological analysis of health inequalities
Behavioural and structural factors in the explanation of socio
Key words: socio-economic inequalities in health structural explanation
The determinants of health: structure context and agency
However from the point of view of the development of a sociological analysis of health inequalities
Explaining socioeconomic inequalities in self-rated health: a
8 janv. 2016 explanation postulates that health inequalities are the result of worse material and structural condi- tions such as crowding
Reducing health inequalities: insights from theory and practice Gerry
Of all inequalities injustice in health is the Structural & political economy (i.e. politics and policy are ... Structural explanations fit best.
How do macro-level structural determinants affect inequalities in
The burden and prevalence of mental ill-health and mental illnesses are increasing [1]. Research shows that there are many explanations for this such as better.
Theorising Inequalities in Health: The Place of Lay Knowledge
address the relationship between human agency and social structure. We then rhetorical reasons explanations for inequalities in health have become.
Explaining Health Inequalities: Beyond Black and Barker: A
explanation of health inequalities is needed. The with structural; and to equate cultural with ... explanations into structural/materialist and.
Persistence of social inequalities in modern welfare states
Aims: Social–epidemiological explanations of health inequalities usually take the existence of the structure of society each of which represents a.
An assessment of the Black Reports explanations of health
structurally determined differences in the way the members of these assessment of the Black Report's four explanations of health inequalities.
A theoretical proposal for the relationship between context and
structural explanations of health inequalities. She suggests that there is a confusion between `materialist' and `material' explanations for these.
(PDF) Defining health and health inequalities - ResearchGate
Results: A definition of health as a structural functional and emotional state that is compatible with effective life as an individual and as a member of
(PDF) Inequalities in health: Definitions concepts and theories
7 mar 2023 · Different theories attempt to explain group-level differences in health including psychosocial material deprivation health behavior
Behavioural and structural factors in the explanation of socio
structural conditions on lifestyle into consideration Key words: socio-economic inequalities in health structural explanation behavioural explanation
[PDF] Reducing health inequalities: insights from theory and practice
On the causes of health inequalities • Structural explanations fit best • Behavioural and cultural theories are relevant but insufficient
[PDF] Defining health and health inequalities - CORE
Results: A definition of health as a structural functional and emotional state that is compatible with effective life as an individual and as a member of
A glossary for health inequalities
In this glossary the authors address eight key questions pertinent to health inequalities: (1) What is the distinction between health inequality and health
The Root Causes of Health Inequity - Communities in Action - NCBI
Health inequities are systematic differences in the opportunities groups have to achieve optimal health leading to unfair and avoidable differences in health
[PDF] Health inequalities fundamental causes and power
These structural inequalities operate through a wide range of social and economic path- ways including employment income housing and education to generate
[PDF] 1 Concepts Principles and Policy Approaches to Tackling Health
Health inequalities can largely be explained by the consequences of unequal access to good housing education adequate income and healthy food
Health inequalities—the need for explanation and intervention
1 août 2006 · Health inequalities understood as systematic differences in health between socio-economic groups have turned out to be much more persistent
What are the 4 explanations of health inequalities?
In broad agreement with other commentators (Brotherston, 1975; Cartwright, 1982), it isolates four possible types of explanation of class differences in health: measurement artefact; natural or social selection; materialist; and cultural/behavioural differences.What is the sociological explanation of health inequalities?
Health inequalities are avoidable, unfair and systematic differences in health between different groups of people. There are multiple factors which influence health and well-being, including social, cultural, political, economic and environmental factors.What are the structural determinants of inequality?
Structural determinants are the socioeconomic and political processes that structure hierarchical power relations, stratifying societies based on class, occupational status, level of education, gender, etc.- The behavioural explanation asserts that health inequalities are the result of clustering of health-compromising behaviours in lower socioeconomic groups.
Reducing health inequalities: insights from
theory and practiceGerry McCartney
NHS Health Scotland
Reducing health
inequalities: insights from theory and practiceGerry McCartney
NHS Health Scotland
Of all inequalities, injustice in health is the
most shocking and inhumaneMartin Luther King
ͻPremature mortality
ͻMental wellbeing
ͻFirst heart attack <75y
ͻHeart disease mortality
45-75y
ͻCancer incidence <75y
ͻAlcohol first admissions
<75yͻAlcohol deaths 45-75y
ͻMortality 15-44y
ͻLow birthweight
ͻHealthy birthweight
ͻSelf-assessed health
ͻLimited long-term
conditionsMortality rate for those aged under 75 years
Mortality rate for those aged under 75 years, 2015Absolute inequalities -the gap
Slope Index of Inequality (SII)
Mortality rate for those aged under 75 years, 2015 Relative inequality (RII) = Absolute inequality / average= 1.33Ratio, or how many times worseMortality rate for those aged under 75 years
Trends in absolute and relative inequalities
Decline in heart
disease and alcohol- related mortality inequalitiesMortality rate for those aged under 75 years
Blakely T, Disney G, Atkinson J TengA, MackenbachJP. Typology for Charting Socioeconomic Mortality Gradients͗ ͞Go
Southwest". Epidemiology 2017; 28(4)͗ 594-603.
Current situation:
Absolute inequalities
Relative inequalities
Ideal future situation:
Absolute inequalities
Relative inequalities
What causes health inequalities?
4 theories have been proposed:
1.Artefact(i.e. we aren't measuring it well enough)
2.Selection theories (i.e. poor health causes social slide)
3.Behavioursand culture (i.e. poor people behave badly)
4.Structural & political economy (i.e. politics and policy are
the cause)Artefact
ͻUndermined by inequalities demonstrated using different statistical measures of social status ͻVery difficult to sustain a theory that such outcomes are unrelated to social status ͻHowever, improved measures of social status, or, perhaps would still be helpfulSelection
ͻThe zombie hypothesis
ͻSelection -reverse causation argument (i.e. poor health causes social slide) ͻLongitudinal studies which measure social status early in life amongst healthy people and track people over time for health problems show little social slide1 21 Smith G. D., C. Hart, D. G. Watt, D. Hole, V. Hawthorne. 1998. Individual social class, area-based deprivation, cardiovascular
disease risk factors, and mortality: the Renfrew and Paisley study. J EpidemiolCommunity Health 52: 399-402.
2 Power C., S. Matthews. 1997. Origins of health inequalities in a national population sample. Lancet 350(9091): 1584-9.
Behavioural and cultural
ͻImportant, but partial, theory
ͻAdvocates suggest that the prevalence of behaviours (e.g. smoking, alcohol & diet) cultures or skills (e.g. parenting) are the root causes of health inequalities ͻUnhealthy behaviours are more prevalent in lower socio-economic groups, however: ͻThe same behaviours generate higher mortality amongst working class ͻIt ignores why particular social groups adopt unhealthy behaviours1 2 ͻThe patterning of health behaviours is explained by socio-economic circumstances ͻWhere unhealthy behaviours have equalised, mortality inequalities have not3 ͻChanges over time in the causes of death responsible for inequalities suggest that removing one particular exposure (e.g. unclean drinking water) only changes one high cause-specific mortality rate for another4 51 Nettle D. Social class through the evolutionary lens. The Psychologist2009; 22(11): 934-7.
2 Lynch JW, Kaplan GA, SalonenJT. Why do poor people behave poorly? Variation in adult health behavioursand psychosocial characteristics by
stages of the socioeconomic lifecourse. Social Science and Medicine 1997; 44(6): 809-8193 StringhiniS, DugravotA, Shipley M, Goldberg M, Zins M, KivimaM, Marmot M, SabiaS, Singh-ManouxA. Health Behaviours, Socioeconomic Status,
and Mortality: Further Analyses of the British Whitehall II and the French GAZEL Prospective Cohorts. PLoSMed2011; 8(2): e1000419.
doi:10.1371/journal.pmed.1000419.4Link BG, Phelan J. McKeown and the idea that social conditions are fundamental causes of disease. American Journal of Public Health 2002; 92(5):
730-2.
5MackenbachJP. What would happen to health inequalities if smoking were eliminated? BMJ2011; 342: d3460.
Malnutrition
Inequalities
in mortalitySocio-economic inequalitiesLack of access
to clean waterSmoking
Environmental
toxins (e.g. asbestos)Alcohol and drugs
Unknown future
mechanismsStructural and political economy
ͻDifferences in income, resources and power between groups cause health inequalities: ͻHealth inequalities rise and fall with income inequalities ͻThe health of communities has improved when they have been given more resources by chance1 ͻThose with most resources are always the healthiest, regardless of their behaviours2 ͻEven when genetic factors are involved (such as cystic fibrosis) inequalities in mortality by social class are wide and vary depending on changing contextual factors31Costello EJ, Compton SN, Keeler G, AngoidA. Relationships between poverty and psychopathology. JAMA 2003; 290: 2023-9.
2 Commission on Social Determinants of Health. 2008. Closing the gap in a generation: Health equity through action on the social determinants of health.
Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization.3Barr HL, Britton J, Smyth AR, Fogarty AW. Association between socioeconomic status, sex, and age at death from cystic fibrosis in England and Wales
(1959 to 2008): cross sectional study. BMJ 2011; 343: d4662. Inequality in mortality between best and worst 10%of local authorities in Great Britain (sources: Thomas 2010 and Luxembourg Income Study) Inequality in mortality between best and worst 10%of local authorities in Great Britain (sources: Thomas 2010 and Luxembourg Income Study) Inequality in mortality between richest and poorest 5ths of the US population 1960-2000 (sources: Krieger 2008 and Luxembourg Income Study) Inequality in mortality between richest and poorest 5ths of the US population 1960-2000 (sources: Krieger 2008 and Luxembourg Income Study)On the causes of health inequalities
ͻStructural explanations fit best
ͻBehavioural and cultural theories are relevant, but insufficient. Blaming poor people for their behaviours, skills and cultures is damagingͻSelection theory doesn't edžplain much
ͻTherefore health inequalities are determined by political decisions and political priorities ͻHealth inequalities are not inevitable and have been lower in the past and are lower in other populations Least likely actions to reduce health inequalities Information based campaigns (mass media information campaigns)Written materials (pamphlets, food labelling)
Campaigns reliant on people taking the initiative to opt in Campaigns/messages designed for the whole population Whole school health education approaches (e.g. school based anti-smoking and alcohol programmes) Approaches which involve significant price or other barriers Housing or regeneration programmes that raise housing costsMost likely actions to reduce health inequalities
ͻStructural changes in the environment: (e.g. area wide traffic calming schemes, separation of pedestrians and vehicles, child resistant containers, installation of smoke alarms, installing affordable heating in damp cold houses) ͻLegislative and regulatory controls (e.g. drink driving legislation, lower speed limits, seat belt legislation, smoking bans in workplaces, child restraint loan schemes and legislation, house building standards, vitamin and folate supplementation of foods) ͻFiscal policies (e.g. increase price of tobacco and alcohol products) ͻIncome support (e.g. tax and benefit systems, professional welfare rights advice in health care settings) ͻReducing price barriers (e.g. free prescriptions, school meals, fruit and milk, smoking cessation therapies, eye tests) ͻImproving accessibility of services (e.g. location and accessibility of primary health care and other core services, improving transport links, affordable healthy food) ͻPrioritising disadvantaged groups (e.g. multiply deprived families and communities, the unemployed, rough sleepers and the homeless) ͻOffering intensive support (e.g. systematic, tailored and intensive approaches involving face to face or group work, home visiting, good quality pre-school day care) ͻStarting young (e.g. pre and post natal support and interventions, home visiting in infancy, pre-school day care)Summary
ͻHealth inequalities are due to politics and policiesͻBehaviours are only part of the story
ͻAddressing poverty, inequality and the social determinants of health is essential ͻThe evidence suggests that the most effective actions on health behaviours involve legislation, regulation and taxationquotesdbs_dbs10.pdfusesText_16[PDF] structural functionalism in family
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