The Inequalities in Health in Tayside Toolkit - Essay Example

?The Inequalities in Health in Tayside Toolkit Tamana Sayed Outline The Inequalities in Health in Tayside Toolkit The Reliability and Validity of Tayside Toolkit Data The Cultural and Structural Theoretical Explanations for the Inequalities in Health The Three Significant Factors That Influence the Health and Illness in Tayside The Three Policies to Employ to Lower the Level of Health Gap The Inequalities in Health in Tayside Toolkit Health condition is obviously not equal to each and every one among us, especially, between the rich and the poor people. This is for the reason that health condition among individuals is influenced by a wide array of factors. Some of these factors are biological while the others arise from the social and economic conditions (Farrell, McAvoy, Wilde and Combat Poverty Agency, 2008: 13). To lower the levels of inequality in health among the citizens of United Kingdom has been the priority concern of the National Health Service (NHS) and its partners (Tayside NHS Board 2002: 3). However, the problem of this health inequality is still not strategically addressed up to this date. Given this, the Health Inequality Toolkit is produced by the Tayside Health Inequalities Project Team to facilitate the development of a strategic approach to address the health gap in the local community (Tayside NHS Board 2002: 3). Basically, the Tayside Toolkit has focused on the characteristics of health inequalities which are believed to be not inevitable such as socio – economic status, ethnic origin and proximity to services (Tayside NHS Board 2002: 3). This is for the reason that these aspects can still be dealt with in reducing the health inequalities. In this regard, this paper primarily aims at assessing the Health Inequality Toolkit produced by the Tayside Health Inequalities Project Team. Specifically, its purpose is to answering four main points. Firstly, its objective is to evaluate the reliability and validity of the data provided in the Tayside Toolkit. Secondly, it targets to analytically explain and compare the possible cultural and structural theoretical explanations for the health inequalities as provided by the data. Thirdly, its aim is to identify three (3) factors which are highly important in affecting the health and illness within the said Toolkit. Lastly, its goal is to identify 3 policies that can be possibly used to lower the level of the health gap. The Reliability and Validity of Tayside Toolkit Data In the evaluation of the precision of the Tayside Toolkit Data, it is important to assess the reliability and validity of data. First of all, I can say that the data provided by the Tayside Toolkit is reliable for the reason that the gathered data reflects consistency when compared to other data based on other health inequality studies. The results are consistent across raters like that of having lower life expectancy for males than females, the number of deaths per specific ailment, and others. When compared to other studies, the data have similarities and can be suggested that it is stable. On the one hand, in terms of the other measure of precision, it can be suggested that the data provided in Tayside Toolkit is valid. That is to say, it has satisfied all the applicable types of validity. Though it is the case that the instruments (i.e. structured questionnaire) used is not presented, the data denotes that the content is representing the domain of factors towards health inequalities. Also, the instrument seems to be face valid because the data appears as if the questionnaire has measured what it has intended to measure. Besides, it has also determined the relationship of different factors or determinants to health inequality, or the criterion – related validity. In addition to that, it is a construct valid as well in a sense that it measures the theoretical constructs or aspect. Furthermore, the data can be used to predict other measures too. In that case, it can be said that it meets the standard of predictive validity. On the overall, it can be said that the data provided by Tayside Toolkit is reliable and valid. Though the data is not a hundred per cent perfect for of course, there is a margin of error in this research, I can say that the data is accurate. That means, it has its relevance which can be used for making generalisations about the sample of respondents. The results of this health inequality research have similarity with the others. In this manner, it can be said that the findings are consistent and stable, hence reliable. While in terms of validity, there does not appear any issue on the data which indicates that the instruments used in measuring the concepts are implemented well. In fact, the instrument has achieved what it has intended to measure and can be used to predict other measures too. Apart from that, the Tayside Toolkit Data has pointed out its own limitations enough for the data to be comprehended and addressed well. The Cultural and Structural Theoretical Explanations for the Inequalities in Health One of the possible theoretical approaches that can explain the existing health gap in Tayside is cultural theory. Cultural theory, also known as behavioural theory, suggests that the people’s cultural values that could affect the choices they make explain the health inequalities. That is to say, culture has its aspect which is potentially significant in shaping health inequalities in every individual (Sweeting and West, 1995: 163 – 175). In the Tayside Toolkit data, some of the cultural aspects that can explain the level of health gap are namely, sexual behaviour (unprotected sexual activity) which leads to unplanned pregnancies and even sexually transmitted infections (STIs); alcohol consumption which result to a number of diseases in particular, the liver disease, and also leads to accidents; physical activity; nutrition and diet; illicit drug misuse; breastfeeding; and smoking which has been identified as a major contributor to ill health (Tayside NHS Board 2002: 23 – 26). For example, smoking can be explained by cultural approach through saying that this could be a result of the environment in which they have grown up. The more the individual sees how smoking is practiced in their environment, the more likely this person would engage in smoking. This is because the individual is exposed in an environment where smoking is practiced. On the one hand, the materialist or structural theory can also justify why health inequality exists. Basically, this theoretical approach argues that the material conditions or the factors like class or distribution of wealth and income have direct influence on health. However, it is the case that there remains a confusion on the materialist or structural theory in terms of its version of material conditions (Macintyre, 1997: 723 - 745). According to Macintyre (1997: 723 - 745), the hard version of material conditions is the physical aspects of environment in which are viewed to be the key determinants of health while the soft version is the social and economic capital like education are viewed to be the incorporating psychosocial mechanisms. The inclusion of social capital in this theoretical approach is owed mainly to the Marxist point of view. In relation to the cultural or behavioural explanation, it is the case that the ‘hard’ view of the ‘soft’ version of material conditions would forget about the role of culture altogether due to the point that all values as well as health behaviours are outcomes of the underlying class structure. Smoking, for example, is explained by the structural theory as a result of the political and economic reasons like that of having low income. That is to say, the deprived individuals are more likely to smoke than those individuals in wealthy areas (Tayside NHS Board, 2002: 25). On the whole, smoking as a factor that affects health is explained by cultural theory through stating that the cultural reasons affect individuals’ choices on their smoking habits while the structural approach explains that economic reasons like having low income are reasons for the habit of smoking. The Three Significant Factors That Influence the Health and Illness in Tayside Health condition differs from each and every one as it is shaped by different factors. While some factors are biological, Farrell, McAvoy, Wilde and Combat Poverty Agency (2008: 13) consider also the social and economic factors that may possibly cause the health and illness in Tayside. The health inequality in Tayside is definitely triggered mainly by particular factors producing complex results. On the whole, the first factor that has significantly influenced the health and illness in Tayside Toolkit is smoking. According to Tayside NHS Board (2002: 25), smoking is the main contributor to ill health in Tayside for it intensifies the risks of a number of diseases, especially that of cancer and coronary heart disease. As a matter of fact, BBC suggested that smokers in their 30s and 40s are five times more probable to experience heart attack than their non – smoker counterparts. Apart from those effects of smoking in health, it also accounts to lung diseases (Farrell, McAvoy, Wilde and Combat Poverty Agency, 2008: 53). On the whole, cigarette smoking is the single greatest reason of avoidable illnesses and premature death (Farrell, McAvoy, Wilde and Combat Poverty Agency, 2008: 53; DHSSPS, 2002). It affects the unborn baby through having low birth weight or even the possibility of miscarriage. Also, despite the effects and risks of smoking, the deprived people in Tayside are engaged in smoking by almost twice prevalence than the people in better off areas (Tayside NHS Board, 2002: 25). This indicates a strong association between cigarette smoking and deprivation (Tayside NHS Board, 2002: 25) in which this claim is supported by Farrell, McAvoy, Wilde and Combat Poverty Agency (2008: 53) as they have suggested that smoking is commonly practiced especially in the lower socio – economic groups. On the sad note, it is not only the smokers who are affected by their smoking habits but also those who happen to be exposed on it. One among the effects to those who are subjected to second hand smokes is the 60 per cent increased risk of heart disease (Stop Smoking Program, 2012). Secondly, poor diet or poor nutrition is the second factor of health inequalities in Tayside. According to Farrell, McAvoy, Wilde and Combat Poverty Agency (2008: 52), the essence of a good diet is that it does not contribute to risks of raised blood pressure, heart disease, cancer, diabetes, dental decay, as well as obesity. Meanwhile, it is found out by the Scottish Health Survey that there is a decreased amount of fresh fruit and vegetable consumption as deprivation increases (Tayside NHS Board, 2002: 24) and this is not healthy for the rest of Tayside community. In this regard, poor diet is associated with deprivation. Diet, as a social factor in health behaviour, suggests that healthy lifestyles may not be easily accessible and practiced by the low income individuals in society (Farrell, McAvoy, Wilde and Combat Poverty Agency, 2008: 54). Those deprived individuals would rather choose to eat the unhealthy foods for they are not aware of its health advantages among people. Furthermore, education is considered to be the third factor that has an effect on the health and illness in Tayside. Based on the data, it can be suggested that Dundee, with almost three times as many children are excluded from school, has lesser educated population than the rest of the Tayside (Tayside NHS Board, 2002: 5). Apart from this, gross disparity in health such as higher rate of teen pregnancies is experienced by Dundee (Tayside NHS Board, 2002: 5). Through this, it can be suggested that education also is a significant factor that affects health. This is because the teens are not aware and informed of the use of contraceptives when they engage in sexual practices. According to Farrell, McAvoy, Wilde and Combat Poverty Agency (2008: 41), the relationship between poorer levels of education and poorer health has been frequently shown in research on health inequalities. While the effects of education as a factor may be complex, it is crucial to define the importance of educational system in providing individuals an edge of understanding health better through having greater knowledge. According to Robert Wood Johnson Foundation (2009: 2), educational attainment is associated with children’s health as well in the beginning of early life. Aside from that, it influences individual’s health to avoid and detect serious illnesses early (Robert Wood Johnson Foundation, 2009: 5). Education also affects the individual’s access to health professionals in three pathways: first, health knowledge and behaviour; second, employment and income; and third, social and psychological (Robert Wood Johnson Foundation, 2009: 5). That is to say, education is a key to a healthy life style because it affects the choices of people like knowing the benefits of breastfeeding, the advantages of exercise and diet, and other stuffs. Fundamentally, cigarette smoking, poor diet and lack of education can be said to be the main contributors of ill health in Tayside. These factors are most common in Tayside, especially in its low income groups, which are considered to be influential in the health and illness Tayside. The Three Policies to Employ to Lower the Level of Health Gap In order to lower the level of health gap in Tayside, different policies have been recommended to the local organisations. Nonetheless, the top three policies which I consider to be the most effective in reducing the level of health inequality include the following: first, the level of involvement of NHS staff in social justice initiatives; second, positive discrimination or directly targeting those sectors in greatest need; and third, the focus of educational programmes for the schools and localities to be conducted by the partnership of NHS and local authorities. First of all, according to Tayside NHS Board (2002: 34), Tayside organisation has pushed for a number of initiatives aiming at narrowing the health gap such as Social Inclusion Partnerships and New Community Schools, though nonetheless, it is the case that the degree of involvement as demonstrated by the NHS is still little relative to other parts of Scotland. As we may see, the Tayside is lagging behind in terms of health and because of this fact, the efforts and involvement needed to be exerted by the NHS staff must still be advanced. Despite the fact that NHS has initiated to narrow the gap in health, Tayside remains to be poor in terms of health as compared to the rest of the areas in Scotland. This only implies that their efforts are still lacking to improve health equality. Given this, the no. 1 policy that should be given importance is the level of involvement of NHS staff in social justice initiatives. That indicates that the NHS staff should have more trainings and immersion to help the communities in need. In every strategic approach, the level of involvement in pursuing a goal, in this case, to cut down the health inequalities by the NHS, should not be overlooked. That is because, in every plan, successfully achieving the main aim could not be obtained without the exerted degree of involvement. In case the level of involvement is not high enough, efforts in reducing the inequalities in health will not be achieved successfully given the lacks in efforts. Health inequality in Tayside only reflects that the efforts exerted by NHS are still not enough. Secondly, it is also operational for the local organisations of Tayside to employ positive discrimination. To prioritise in the third place the sectors with poorer health conditions or let’s say, prone to deteriorated health status, is to directly address the population whose needs on health are the greatest. To focus on them more can be backed up by the fact that this population have the greatest needs on health. Once they are neglected, chances are, their conditions are to even get worsen. Instead of lowering the health gap, we have done otherwise. So, if the aim is to really cut down the level of health inequalities, the focus should be given more to the sectors of Tayside whose health are at risk. In order to positively discriminate, first, the focus should be put more weight on the two significant factors affecting health mentioned earlier, smoking and poor diet. The rationale of prioritising first the smokers and communities with poor diet is because implementing the policy has different considerations like funds in particular. Also, there should be a starting point in which those at risk should be given much more attention as compared to others because the aim is to stop their risky behaviours and attitudes towards health. On the one hand, this is to be done by both the partnership of NHS and local authorities which would benefit the majority as a whole because of the objective of making a healthier population. The positive discrimination or targeting directly the smokers can be done by allowing people to smoke only in such designated areas, hence smoking areas. This will be implemented together with a campaign that smoking is dangerous to one’s health and not just the smoker’s health for it also affects others through the second hand smoke. The NHS together with the local authorities should push for a no smoking campaign. Together with this action, they must also provide assistance and support to those who would like to quit smoking. On the one hand, directly targeting the individuals with poor diet will be done via feeding programs. The local community should also market healthy foods instead of unhealthy goods. The authority should promote the benefits of consuming the fresh fruits and vegetables as well. Apart from positive discrimination, thirdly, the rationale of prioritising next the focus of educational programmes for the schools and communities to be conducted by the partnership of NHS and local authorities is because lack of education is regarded as also a significant factor that influences health and illnesses. Education provides individuals an advantage of understanding health better. Via the means of educating the people in general, it is the case that the causes of negative health practices and situations can be prevented. Indeed, there is a saying that ‘prevention is better than cure’. Likewise, this idea of promoting education in order to close the health gap aims at making preventive measures that can aggravate the health condition of society. This is also similar with working on the origin of health inequalities first. It is important to initially correct the ideas on health among individuals so to not worsen the level of health gap existing as of today. Furthermore, the misconceptions on health and illnesses may be corrected once individuals are educated. The schools must also take part in this action as they need to teach students about knowledge on health through offering a specific subject or course that teaches the disadvantages of smoking and substance use, the importance of healthy diet and nutrition, the practice of safe sex, the advantages of breastfeeding, who to seek medical help, and others. Apart from this, given that the deprived communities are also deprived in education, the local authorities must hold educational programmes for the locals to be conducted by the staff. Once in a while, the NHS and local authorities must hold educational programs to educate people also about the disadvantages of smoking and substance use, the importance of healthy diet and nutrition, the practice of safe sex or family planning, the advantages of breastfeeding, who to seek medical help, and others. Apart from these, they must also be informed with any medical developments or issues so that they know what to do in times of health crisis. For example, educating people about breastfeeding will encourage the mothers to breastfeed their babies. Apart from this, the view of society on breastfeeding will change once they are educated on the health as well as the economic benefits of breastfeeding. Another case is through educating people about safe sex, chances are lesser cases of unwanted or untimely pregnancies, sexually transmitted infection and others. Likewise, informing people about the dangers of smoking in health will likely to discourage them from trying smoking. The aim is to educate these people on health so that their behaviour and attitudes towards health may possibly be changed. The level of involvement of NHS staff in social justice initiatives, the positive discrimination or directly targeting those sectors in greatest need and focus of educational programmes for staff are the top three priority policies that are in need to be implemented. The rationale for selecting each of these three policies are explained above though the reason for combining these three is because of the fact that these three aim at different specific goals that if combined, will surely yield effective results of lowering the health gap. First, the adequate degree of involvement in achieving an end goal is the most important. This is followed by educating the individuals as preventive measures of illnesses. Third is through working out on the sectors that are at risk. These will have to meet at a juncture which would surely narrow the health gap. In this case, health equality can be achieved little by little in this case. References: BBC. 2011. How does smoking affect your health [online] Available at http://www.bbc.co.uk/health/physical_health/conditions/smoking_health_effects.shtml [Accessed on 5 June 2012] Department of Health, Social Services and Public Safety. 2002. Investing for health. Belfast: DHSSPS Farrell, C., McAvoy, H., Wilde, J. and Combat Poverty Agency. 2008. Tackling health inequalities: An all – Ireland approach to social determinants. Dublin: Combat Poverty Agency/Institute of Public Health in Ireland. Stop Smoking Program. 2012. Smoking and pregnancy [online] Available at http://www.helpwithsmoking.com/smoking-and-pregnancy.php [Accessed on 5 June 2012] Macintyre, S.1997. The Black Report and beyond: what are the issues? Social Science & Medicine 44: 723-745. Robert Wood Johnson Foundation (2009). Education matters for health. Education and Health 6: 1-15. Sweeting, H. and West, P. 1995. Family life and health in adolescence: a role for culture in the health inequalities debate? Social Science & Medicine 40: 163-175. Tayside NHS Board, 2002. Health inequalities toolkit 2002 [pdf] Available at: [Accessed 22 May 2012] Read More