Social Change Week 6, Health and Mortality
Terms in this set (28)
What is Health?
The World Health Organisation in 1948 defined health as "A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".
In general health is determined by the context in which people are born, grow up, work and grow old. Genetics are important on the individual level but population health is largely driven by social, economic and cultural factors.
The most commonly used measure of population health and is calculated based on mortality rates.
The most frequently used approach is Period Life Expectancy which is the mean length that this cohort is expected to live assuming the mortality rates of a given year (the year of birth, or any other year in the life of a particular cohort).
Healthy Life Expectancy (HLE) combines health and mortality in a single indicator (HLE: average number of years that a person can expect to live in good health).
"Compression of morbidity" in its original form assumes life expectancy will reach its biological limits and the average onset of morbidity will be postponed so years of poor health are "compressed".
Life expectancy is still increasing, but compression of morbidity can still occur if healthy life expectancy increases faster than life expectancy, however this implicitly assumes that interventions outside the medical system will be effective (removal or major risk factors) for example, fewer people are smoking.
"Expansion of morbidity" assumes that due to medical advances that push down the mortality rates of the major drivers of death while their epidemiology stays the same, years with ill health at the end of life increase (expand).
"Dynamic equilibrium" suggests a continuation of the status quo, where the increase in life expectancy is accompanied by an equivalent postponement of the onset of morbidity/disability.
An alternative interpretation suggests that dynamic equilibrium occurs when the year spent with severe disability increase (expansion), but years spent with mild or moderate disability decrease (compression).
UK, Life expectancy
If we look at the UK as a case study, females have always had higher life expectancy than males.
UK, Mortality Rates
Females also have a lower mortality rate.
UK, Overweight and Obesity Rates
UK, Smoking rates
Epidemiological transition accounts for the replacement of infectious diseases by chronic diseases over time due to expanded public health and sanitation.
There are 3 stages to this process.
The Age of Pestilence and Famine
Mortality is high and fluctuating precluding sustained population growth 12000 years before the agricultural revolution.
Age of Receding Pandemics
Modernisation triggers a decrease in mortality, which accelerates as epidemic become less frequent or disappear. Life expectancy is increasing - sustained population growth.
Age of Degenerative and Man-Made(Non communicable) Diseases
Mortality continues to decline and eventually approaches stability at a relatively low level. Life expectancy continuous to increase reaching unprecedented levels. This stage started in the first half of the 20th century in the UK.
Mc Keown's Thesis
He emphasised the importance of economic growth, rising living standards, public health measures and improved nutrition as the primary sources of most historical improvements in the health of developed nations.
He pointed out that mortality rates for most serious infectious diseases, such as tuberculosis, plummeted long before there were any effective individual preventive or therapeutic medical measures and argued that such measures had little effect on mortality before around 1935.
The World at Large
The cross-sectional relationship between life expectancy and per capita income is known as the Preston Curve, named after Samuel H. Preston who first described it in 1975
Diminishing returns, from a level upwards national income not associated with life expectancy. If economic development was the only determinant of health, countries that get richer would just move along the same curve.
Social Determinants of Health
Social-Economic Predictor (SEP) indicators: income, wealth, education, occupational social class, housing tenure.
Health inequalities are defined as differences in the health status or in the distribution of health determinants between different population groups.
Reducing health inequalities is therefore about fairness and justice and promotes the "right to health" as described in the constitution of the WHO (1946).
Reducing or eliminating health inequalities will improve population health and offset the effects of population ageing.
In general, ill health and disability have an impact on the economy via reduced labour supply, reduced labour productivity, less education and training, fewer savings for investments in physical and intellectual capital, higher healthcare costs, and higher uptake of social security benefits.
The economic costs of socioeconomic inequalities in health are in the order of €1000 billion, or 9.4% of European GDP (Mackenbach, Meerding et al. 2011).
Sir Douglas Black
The Black Report (1980) was the report of the expert committee into health inequality.
Although overall health had improved since the introduction of the welfare state, there were widespread health inequalities.
The "Marmot" Curve
This inequalities between the rich and poor in terms of health spread far and wide.
The inequalities of Obesity
All of the areas and all of the classes are were you would expect them to be according to the theory.
Theories of health inequalities, Cultural-behavioural
The cultural-behavioural approach asserts that the link between SEP and health is a result of differences between SEP groups in terms of their health-related behaviour: smoking rates, alcohol and drug consumption, dietary intake, physical activity levels, risky sexual behaviour and health service usage - all these "risky" behaviours are thought of as a consequence of disadvantage.
Theories of health inequalities, Materialist
The (neo)materialist explanation focuses on income and what income enables access to goods and services and the limitation of exposure to physical, behavioural and psychosocial, risk factors.
The effect of income inequality on health reflects a combination of negative exposures and lack of resources held by individuals, along with systematic underinvestment across a wide range of human, physical, health, and social infrastructure.
An unequal income distribution is the result of historical, cultural and political and economic processes.
Theories of health inequalities, Psychosocial
Psychosocial factors many of which are associated with low social status, are known to affect health partly through direct physiological effects of chronic stress and partly through their influence on health related behaviour. Examples include control over life, job insecurity, anxiety, social isolation, socially hazardous environments, bullying, and depression.
Evidence shows that these factors influence health and that their prevalence is affected by the socioeconomic structure and by people's position within this. The socioeconomic class gradient is therefore largely explained by the unequal social and economic distribution of psychosocial risk factors.
Theories of health inequalities, Artefact
The artefact approach suggests that socioeconomic inequalities do not really exist but are a result of the data used and methods of measurement: that difference in health by socioeconomic class can be explained by differences in measurement and that the size of the inequalities observed is due to differences in data measurement tools.
Theories of health inequalities, Health selection
The health selection approach asserts that health determines socioeconomic class status rather than socioeconomic class determining health. Individuals who are 'fitter' are more likely to move up the social hierarchy. In contrast, people with ill health are downwardly mobile (or less upwardly mobile) and are therefore concentrated within the lower socioeconomic classes.
Evidence for the 5 theories
None whatsoever for the "artefact" hypothesis.
A lot for the neomaterial and psychosocial hypotheses.
Neomaterial (Lynch et al, 2004) psychosocial (Wilkinson & Picket, 2006).
Psychosocial interpretation more important for mental health (Layte 2011).
But a lot of evidence against the psychosocial explanation on mortality (Avendano, 2015).
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