Inequality

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

“The world is not an inn but a hospital”

Health Inequality and Inequity

• Health inequality = differences in health status or

• Differences in the distribution of health determinants between different population groups.

Differences in health status

• Gross inequality exists across the world• Gross inequality in health achievement exists

within New Zealand

• Is this inequality unFAIR?

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

Some causes of ill health may be avoidable

Unnecessary, avoidable, unjust, unfair situations resulting in health inequalities also lead to inequity in health

How does one tell if a population is thriving?

• Measure consumption patterns?• Measure average income?• Measure economic wellbeing with measures

such as GNP?

A better answer is to measure health status.

If health of a population suffers it is an indicator that the set of social arrangements needs to change.

Social conditions powerfully influence both the onset and response to treatment of the major killer infectious diseases

How Do We Explain?

Rawlsian Framework: Socioeconomic disparities in health status reflect underlying inequities in distribution of primary goods

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.

Spillover effects

• Inequalities Affect everyone• Interventions to reduce social inequalities will

have 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

Achievement of Equity, Removal of health inequity

Utilitarian principle: maximize health gain for all, increase average health for all

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.

Should we strive to achieve a more even share of good health, beyond improving the average health status of the population?

What is meant by closing the inequity

• Health/Disability in Rich <———> disability in poor, 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 the population

• Money Spent on Reducing health inequalities lead to larger health gains than money spent on other kinds of health interventions

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 it easy for him to take a wrong step? Who is responsible?

When one is “responsible” for an unhealthy decision that then leads to ill health, and in turn health inequality, can that inequality be labelled as “unfair”?

Strategies to reduce inequalities in health across the world (Marmot, 2001)

• Address and Relieve poverty• Develop health systems and• Improve the circumstances in which people

live and work• Structural and environmental interventions

affect the population more evenly than educational programmes aimed at behaviour change

Address social determinants of health