Lecture Notes on Inequality
Transcript of Lecture Notes on Inequality
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Social Determinants of Health
We are going to discuss health inequalities
(first 30 minutes)
We are going to play a game (The Last Straw)
on social determinants of health
This will be an Interactive Class
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The world is not an inn but a hospital
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Health Inequality and Inequity
Health inequality = differences in health
status or
Differences in the distribution of health
determinants between different population
groups.
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Differences in health status
Gross inequality exists across the world Gross inequality in health achievement exists
within New Zealand
Is this inequality unFAIR?
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Fairness is not the same as Equality
The difference between Equity and Fairness
is Important in Health Care
Inequalities in health are undesirable to the
extent that they are Unfair or Unjust
Unjust or Unfair or Avoidable inequaities are
inequities
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Some causes of ill health may be
avoidable
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Unnecessary, avoidable, unjust, unfair situations
resulting in health inequalities also lead to
inequity in health
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How does one tell if a population is
thriving?
Measure consumption patterns?
Measure average income? Measure economic wellbeing with measures
such as GNP?
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A better answer is to measure health
status.
If health of a population suffers it is an
indicator that the set of social arrangementsneeds to change.
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Social conditions powerfullyinfluence both the onset and
response to treatment of the major
killer infectious diseases
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How Do We Explain?
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Rawlsian Framework:
Socioeconomic disparities
in health status reflectunderlying inequities in
distribution of primary
goods
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Causes of the causes
Access to material resources is socially
determined
Material deprivation can account for high
DALY in some countries but
Poverty reduction is not a matter of just
providing clean water or better medical care.
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Spillover effects
Inequalities Affect everyone
Interventions to reduce social inequalities willhave other benefits, benefits other than or
more than just health Sanitary Reforms of 19th Century
Conditions that lead to marked health
disparities are detrimental to Everyone When Inequalities in health are reduced,
everyone benefits
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Achievement of Equity, Removal of
health inequity
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Utilitarian
principle:
maximize health
gain for all,
increase average
health for all
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Why health inequalities must be
reduced?
Public health programmes that are aimed to
reduce health inequalities can be cost
effective
Reducing social inequalities in health is an
issue of social justice.
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Should we strive to achieve a more
even share of good health, beyondimproving the average health status
of the population?
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What is meant by closing the
inequity
Health/Disability in Rich disability inpoor, after reduction, health/disability in rich that in poor, this sort of an intervention is
labelled as targetting to reduce health inequality It is possible to reduce inequality in health
without bringing down the overall health of thepopulation
Money Spent on Reducing health inequalitieslead to larger health gains than money spent onother kinds of health interventions
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What happens if the social situation is such that a
person may take a wrong step out of his free will
but there are situations in the society that makes iteasy for him to take a wrong step? Who is
responsible?
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When one is responsible for an unhealthy
decision that then leads to ill health, and in turn
health inequality, can that inequality be labelled asunfair?
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Strategies to reduce inequalities in health
across the world (Marmot, 2001)
Address and Relieve poverty
Develop health systems and
Improve the circumstances in which peoplelive and work
Structural and environmental interventions
affect the population more evenly than
educational programmes aimed at behaviour
change
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Address social determinants of health
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New Zealand Deprivation Index
NZDep2006 provides a deprivation score for each meshblock in New
Zealand
The NZDep2006 index of deprivation
ordinal scale ranges from 1 to 10, In the score, 1 represents the areas with
the least deprived scores and 10 the areas
with the most deprived scores
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Variables that Go Into NZDep Index