Health Inequality All over the World - Research Paper Example

Inequalities and Health Name Presented by Department Institution Lecturer Health Inequality: Health inequality is the variation in the health status between groups within a population [1]. Also, health inequality is defined as the way the health determinants are distributed between different groups within a population [1]. For example, health inequality, with respect to variation in health determinants, may be expressed by the difference in mobility between young people and old people within a population. For instance, old people have a lower mobility than old people. [1] Health inequality, with respect to the variation in health status between groups in a population, may be explained, for example, by the difference in mortality rate between the poor and the rich people within a population. For instance, the mortality rate might be higher for the poor people than for the rich group in the population [1]. World Health Organization [2] indicates that there are various causes of health inequalities: biological variations, person’s free will, and the external environment. Health Inequity:  Health inequity is defined as the unnecessary variations in the health status between groups within a population [3]. In other words, health inequities are unfair and unjust health inequalities. [2] These variations are considered unnecessary because they are avoidable, making them unfair and unjust [4]. For example, health systems may be consistently unequal between the poor and the rich people in a population, such that they are more accessible to the rich people than to the poor people. This could lead to the provision of higher and more quality health services to the rich, who may not need much of the health services, than to the poor people, who may be in much need of the services but unable to access them. Equity in health: Equity in health is the lack of systematic variations or disparities in the health of people of different social groups within a population [4]. In addition, equity in health means that there are no disparities in the social factors that determine the health of people between different social groups within a population [5]. For example, ensuring that socially disadvantaged people, such as the poor, people in disenfranchised ethics, race or religious groups, or the females, are not disadvantaged in respect to their health ensures equity in health. This is possible through ensuring that such people can access health services the same way with the well up people in the society. Social Gradient: There are many factors that affect the health of an individual or a group in a society [6]. Income is one of the social determinants of the health of an individual or a group [6], which groups people according to their socioeconomic positions. This grouping leads to a social gradient [6], which ranks people depending on their income. For example, if one was to group households in a population with respect to income, there would be those whose income is the highest in the population these will be considered the richest in the population, and they will form their own social class. On the other hand, there will those whose income is the lowest. These will be considered the poorest, and they will form their own social class. In between, the two classes, there will be numerous other classes depending on their income. Arranging these social groups will result into a social gradient running from the richest to the poorest. Targeted Intervention: Targeted intervention is a health care approach that aims at specific people or group of people who have an elevated health risk, which helps in reducing the frequency at which the health issue occurs [7]. Targeted intervention is used as a secondary measure for preventing a health or behavior problem [7]. For example, it may be considered that Injecting Drug Users (IDUs) are at elevated risk of getting infected with HIV due to sharing of needles. In such a situation, healthcare providers, in the attempt to reduce the frequency at which HIV viruses are transmitted through sharing of needles, may decide to provide clean and safe needles to the drug users. This is a targeted intervention since it only targets such people, who are at high risk. Universal Intervention: Universal intervention is a health care approach, which is intended to address the entire population with respect to a given health problem [7]. In addition, [7] indicates that universal intervention is used as a primary measure for preventing a health or behavior problem. For example, vaccinating children, who are below five years old, against polio is a universal intervention. Such an intervention addresses all children under the age of five years in a population. Socioeconomic Status (SES): According to Hoffmann [8], status is the position that an individual or a group of people occupies in a socially inequality society. Therefore, socioeconomic status is the ability of a person or group to gain access to and control desired resources, which is determined by the financial, economic and social aspects of an individual [8]. The social aspect of an individual is the ability of the person to relate with others [8]. Socioeconomic status has a significant effect on the health of an individual [9]. For example, Berkman and Epstein [9] indicate that death rates are higher for people of low socioeconomic status than those in high socioeconomic status. This difference results from the difference in accessing healthcare between the two statuses. Life course perspective: Life course perspective is a way of explaining how human behavior relates with time from the time a person was born to death time [10]. Life course perspective provides a meta-theoretical framework, for which a person can have a clear understanding of human development [11]. It involves studying how the lives of people are shaped by social change, common life transitions, and chronological life [12]. Life course perspective has a significant impact on the health of individuals [11]. For example, the functional capacity of various biological systems are high during the early life of an individual, but their performance declines after an individual reaches early adult hood [11]. This decline in functionality makes aged people more prone to diseases that young people [11]. Explaining differences between: Health equity and health inequality: Health inequality brings about differences in the health conditions of people of different social classes within a population [2] while health equity ensures that there are no such variations [4]. In other words, health inequality is the opposite of health equity in terms of farness and just in the provision of healthcare. For example, poor people in a population may not have access to quality healthcare, leading to increased mortality rate than the rich people. This is a health inequality. To ensure health equity in the above case, the government can provide quality health to the poor people at an affordable rate so that healthcare services are available to everybody. This would ensure health equity. Targeted interventions and universal interventions: First, universal interventions address the entire population while targeted intervention aim at specific people or group of people whose health is at high risk [7]. For example, vaccinating children, below the age of five years, against polio is a universal intervention since it addresses all children under the age of five years. On the other hand, administering antiretroviral drugs (ARVs) to HIV cero-positive patients with CD4 cell count lower than 350 is a targeted intervention since it only addresses those with an elevated risk. Secondly, the impact of universal intervention on an individual is smaller than the impact of a targeted intervention on an individual [7]. However, universal interventions, through the use of various communication means, can reach more people in a population than targeted interventions [13]. For example, a health provider may use schools to provide universal intervention since it would be possible to reach all the students. There will be those who might not respond quickly to the interventions due to the low individual impact of universal interventions, which would require the provider to offer an intensive care through targeted intervention [13]. The health care system has no role in addressing health inequalities as they are caused by policies and circumstances that we cannot control: Whenever poor people live, they experience worse health, and they are subject to more suffering than the affluent people from any form of ill health [14]. In order to determine whether the health care system has any role in addressing health inequalities, it is exceedingly essential to understand the cause of health inequalities. The healthcare system would, of course, assume the responsibility of addressing the issue if the issue emanates from the system and/or the healthcare system has a capacity of dealing with the causes. Lynch and Kaplan [14] points out that health inequality arises from poverty, a condition that is beyond the control of healthcare systems. This implies that the health system has no role in addressing health inequalities, considering that they are caused by poverty. In fact, it would be the responsibility of labor administration to deal with the issue. Smith [15] indicates that dealing with income inequalities (reducing them), which is not the responsibility of healthcare systems, is an excellent method of combating the health inequalities in a society. Smith [15] further dissociates healthcare systems from the responsibility of dealing with health inequalities by recommending that respective governments should improve living standards of low income households through giving them social security benefits in order to combat the health inequalities. Moreover, governments should be committed towards dealing with unemployment, which is not the responsibility of healthcare systems, in order to deal with health inequalities. [15] This would involve establishing policies that work towards improving the skills of jobless people through training and education [15]. These recommendations serve to shield healthcare systems from the responsibility of addressing health inequalities issues since health inequalities are caused by inequalities in the living standards of people in a population [15]. World Health Organization (WHO) [2] indicates that it is sometimes difficult to avoid health inequalities since they are caused by factors that are beyond the control of the concerned individuals. For instance, health inequalities may be caused by differences in the biological aspects of different people [2], which healthcare systems cannot address. In addition, WHO [2] indicates that health inequalities are caused by environmental factors, which healthcare systems may not alter in the effort to address health inequality issues. For example, some religions or societies may prevent certain members from seeking healthcare services, which leads to health inequalities [16]. Accordingly, healthcare systems do not hold the responsibility of addressing health inequality issues. On the other hand, healthcare systems are not entirely shielded from taking the responsibility of addressing health inequalities since they can address some causes of health inequalities. In addition, health inequalities may be attributed to health systems. For instance, health care systems can provide interventions and improve health care access by those who are disadvantaged. This can have a significant impact on reducing health inequalities [17]. Secondly, Dowler and Spencer [18] explicate the importance of monitoring and evaluating health inequalities. This is exceedingly essential in providing tangible data regarding health inequalities [18]. In addition, updated data arising from the monitoring and evaluation activity would assist health care systems to advising the government in how to address health inequality issues accordingly, and it would aid in reducing cases of inequalities [18]. It is the responsibility of healthcare systems to conduct the monitoring and evaluation activity, which is exceedingly essential in addressing health inequalities [19]. Therefore, the healthcare systems have a role to play in addressing health inequalities. Enhancing accessibility of healthcare systems can have a significant impact on addressing health inequalities [18]. If health care systems are build equally in all areas, barrier to access them would be eliminated and a health system that is equity oriented would be created [18]. As a result, everyone would be able to access health care thus eliminating health inequalities associated with in access to health system [18]. Availability of health care systems that are functioning and have sufficient quantity can play an essential role in fighting health inequalities [18]. This would be possible if all healthcare systems functional, which ensures that they are accessible to all people. Woodward and Kawachi [20] indicate that disparities in giving out crucial information regarding healthcare contributes to health inequalities. Healthcare systems have a role in ensuring that such information is accessible to every person in a population regardless of his/her social class. To ensure that every person has the required information regarding healthcare, healthcare systems should devise effective methods of giving out such information. For instance, not every person will have access to a newspaper, and if healthcare systems choose to use the media for giving out such information, health inequalities will arise. Accordingly, healthcare systems should use effective methods that reach every person. To conclude this debate, we cannot say that the health care system has no role in addressing health inequalities as they are caused by policies and circumstances that we cannot control. The various relevant bodies should collaborate in addressing health inequalities and health equity. It is evident that health care systems have a role in addressing health inequalities, as well as other government bodies. The role of any stakeholder should not be undermined. For instance, it is the role of labor administration or any other such body to ensure social equity by addressing joblessness and poverty, and the health consequences arising from them. On the other hand, it is the role of health care systems to ensure that there is no discrimination in healthcare, which can result into health inequality. For instance, healthcare systems should ensure that health care services are equally available to everybody. In addition, healthcare systems lead in addressing these issues so that relevant bodies can take the role. Finally, healthcare systems should come up with methods of availing affordable healthcare services so that the financially disadvantaged people are not locked out. Measurement Issues: Table 1: Health Inequality-Infant Mortality among Aboriginal and General Population. [21] 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 Aboriginal Population males 10.2 11.9 11 10.4 9.5 8.4 8.8 7.9 Females 10.5 11.7 10.8 8.6 7.6 8.6 7.9 7 Persons 10.4 11.8 10.9 9.5 8.6 8.5 8.4 7.5 General Population Persons 5.1 5.1 5.4 5 4.8 4.6 4.7 4.8 Figure 1: Health Inequality-Infant Mortality among Aboriginal and General Population [21]. Infant mortality refers to the death of a baby who was born alive, but within the first year from the time of birth [21]. Infant mortality rate, therefore, is the number of such deaths in every 1000 live children [21]. The health of a child is usually at a very high risk at the time of birth and during the first year of the child [22]. Socioeconomic factors have been established to have a significant contribution towards infant mortality in a population [22]. In addition, access to quality healthcare services by the mother during the time of giving birth, and the child during his first year of living, determines the infant mortality rate in a population [22]. Racism is a widely recognized factor that determines the health of indigenous people, such as aboriginal people [23]. Racism involves stereotypes, discrimination, beliefs, or prejudices, and these can range from insults and threats to rejection in a social structure [23]. Racism has also been pinpointed as one of the factors that limit the aboriginal people from seeking quality healthcare services, which is crucial in addressing infant mortality [23]. The standard of living of a population of a household, especially during the first year of a child, is also a major determinant of the mortality rate in a population [24]. There has been much controversy regarding the health of these people. Such controversies revolve around the adequacy, availability, effectiveness, accessibility and quality of health services in meeting the needs of the community [23]. In addition, the aboriginal people of Australia are generally known to be poorer than the non-aboriginal people [25]. This implies that their living conditions are generally poorer than those of the non-aboriginal people. These factors, when combined, lead to increased mortality. This explains why the infant mortality in the aboriginal population is higher than in the non-aboriginal population (figure 1) However, the graph in figure 1 indicates that the condition has been improving for the aboriginal population in that the infant mortality rate is reducing with time since the year 2000. Waldram, Herring and Young [25] point out that, since recently, the health status of aboriginal people is becoming better since the government has been taking initiatives on improving their living conditions. This involves providing better quality water, sewage disposal systems, electricity, and housing [25]. In addition, there have been significant efforts to address racism with the aim of eliminating health inequalities in the aboriginal population [23]. This implies that access to quality healthcare by aboriginal people is enhanced. These factors serve to explain the continuous reduction in the infant mortality rate among the aboriginal people. NSW Males 60 76.4 NSW Females 65.1 81.9 Victoria Males 60 77.1 Victoria Females 65.1 82.3 Queensland Males 58.9 76.4 Queensland Females 62.6 81.9 Western Australia Males 58.5 76.9 Western Australia Females 67.2 82.6 South Australia Males 58.5 76.6 South Australia Females 67.2 82.3 Northern Territory Males 57.6 70.3 Northern Territory Females 65.2 75.2 Australia Males 59.4 76.6 Australia Females 64.8 82 Figure 2: life expectancy of aboriginal and non-aboriginal people [21] Life expectancy of an individual is the length of time (in years) that the person will most probably live provided that life conditions, such as mortality rate, do not change [21]. Access to quality healthcare services has a significant impact on life expectancy of an individual since it affects the mortality rate of the individual’s group in the society [14]. This implies that the groups of people who do not have access to quality healthcare services have a higher mortality rate than those who have access to the same. Racism is a widely recognized factor that determines the health of indigenous people, such as aboriginal people [23]. In addition, living conditions of a person or a group of people has a significant impact on the life expectancy of a person or the group of people [24]. For instance, a population having poor living conditions have a higher mortality rate than those under improved living conditions. Since quality of life is dependent on the poverty of a person or a group of people, it follows then that life expectancy is also affected by the poverty (income level) of an individual or a group of people. A comparative analysis of the mortality rates of aboriginal and non-aboriginal people, as shown in figure 2, indicates that the mortality of aboriginal people is far much less (about 17 years) than that of the general population. This shows that there exist health inequalities between the aboriginal and non-aboriginal populations. In Australia, there is substantial inequality in the wellbeing and health of the aboriginal people [23]. Contemporary and historical racism, oppression and colonization have been identified as key factors leading to the inequalities. Research studies indicate that racism leads to poor mental health among the aboriginal people [23]. Mental health issues include anxiety, depression and psychological distress. Little research has been conducted on the impact of mental health on the life expectancy of the aboriginal population. However, research indicates that poor mental health, especially depression, leads to suicide among American young individuals, including children [26]. In addition, mental health problems lead to substance abuse among the young population, which ultimately leads to pre-mature death. It is highly possible that poor mental health, arising from racism, have similar consequences among aboriginal populations. This explains the low life expectancy for the aboriginal population as compared to that of the non-aboriginal people. The aboriginal people are considered to be the most disadvantaged group of people in the affluent Australian population [23]. This makes these people to be affected by poverty related health problems [23] as well as historically and socially related health problems [23]. According to Waldram, Herring and Young [23], studies indicate that the aboriginal population has a significantly lower income level than the non-aboriginal population. In addition, housing conditions for aboriginal people are, in general, poorer than those of non-aboriginal people [23]. This is another factor that contributes to the difference in life expectancy between the aboriginal and non-aboriginal people. The implication is that poverty and poor living conditions exposes the aboriginal people to more health problems than the non aboriginal people, increasing the mortality rate in the aboriginal people. Accordingly, the life expectancy for the aboriginal people is lowered compared to that of the non-aboriginal people. References 1. Gates, B., and Barr, O., (Ed). Oxford Handbook of Learning and Intellectual Disability Nursing. Oxford, New York: Oxford University Press. 2009. P 142. 2. World Health Organization (WHO). Health Impact Assessment (HIA). [Cited 14 Dec. 2011]. Available from: http://www.who.int/hia/about/glos/en/index1.html. 3. Kirch, W. Encyclopedia of Public Health. Springer Science+ Business Media, LLC. 2008, p.755. 4. Wilkinson, R. G., and Pickett, K. E. Income Inequality and Population Health: A Review and Explanation of the Evidence. Social Science & Medicine 2006, 62(7), 1768-84. 5. Braveman, P., and Gruskin, S. Defining equity in health, J Epidemiol Community Health. 2003. From retrieved 8 Dec.2011. 6. World Health Organization (WHO). Social Determinants of Health, the Solid Facts. From retrieved 9 Dec. 2011. 7. Kartikeyan, S., Bharmal, N. R., Tiwari, P. R., and Bisen, P. S. HIV and AIDS: Basic Elements and Priorities. Netherlands: Springer. 2007. P 10. 8. Hoffmann, R. Socioeconomic Differences in Old Age Mortality. Springer Science+ Business Media B. V. 2008. 9. Berkman, L., and Epstein, M. A. Beyond Health Care – Socioeconomic Status and Health. The New England Journal of Medicine. 358, 2509-2510. 2008. 10. Li, K. Life Course Perspective: A Journey of Participation in Physical Activity. Author. 2008. P 1. 11. Hutchison, D. E. A Life Course Perspective. 2003. 12. Stein, C., and Moritz, I. A Life Course Perspective of Maintaining Independence in Older Age. Geneva: World Health Organization. 1999. P 4. 13. Harris, E., Rose, V., Kemp, L., and Chavez, R. Strengthening The Effectiveness of “Whole of Government” Interventions to Break the Cycle of Violence in Disadvantaged Communities. NSW Public Health Bulletin. 18, 94-96. 2007. 14. Lynch, J., and Kaplan, G. Socioeconomic Position. Social Epidemiology. 2000, 13-35. 15. Smith, D. G. (Ed). Health Inequalities: Life course Approaches. Bristol, United Kingdom: The Policy Press. 2003, p xv. 16. Shaw, M., Dorling, D., Gordon, D., and Smith, D. The Widening Gap: Health Inequalities and Policy in Britain. Bristol, United Kingdom: The Policy Press. 17. Ashcroft, R., Dawson, A., Draper, H., and McMillan, J., (Ed). Principles of Health Care Ethics. West Sussex, England: John Willey and Sons Limited. P 590. 18. Dowler, E., and Spencer, N., (Ed). Challenging Health Inequalities: From Acheson to Choosing Health. Bristol, United Kingdom: The Policy Press. P. 1. 19. Exworthy, M., Stuart, M., Blane, D., and Marmot, M. Tackling Health Inequalities Since the Acheson Inquiry. Bristol, United Kingdom: The Policy Press. 2003, p 2. 20. Woodward, A., and Kawachi, I. Why Reduce Health Inequalities. Journal of Epidemiology and Community Health 2000, 54, 923-929. 21. New South Wales Department of Health (NSW). The Health of People of New South Wales-Report of the Chief Health Officer. Sydney: NSW Department of Health. From retrieved 9 Dec. 2011. 22. Freemantle, C., Read, A., Klerk, N., McAullay, D., Anderson, P., and Stanley, F., 2006. Patters, Trends, and Increasing Disparities in Mortality for Aboriginal and Non-aboriginal Infants Born in Western Australia, 1980-2001: Population Database Study. Lancet. 367, 1758-1766. 2006. 23. Williams, D., and Mohammed, A., Discrimination and Racial Disparities in Health: Evidence and Needed Research. J Behav Med. 32, 20-47. 2009. 24. Australian Bureau of Statistics (ABS). 4704.0 - The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples Canbeera: ABS. 2010. 25. Waldram, B. J., Herring, D. A., and Young, K. T., Aboriginal Health in Canada: Historical, Cultural, and Epidemiological Perspectives, Second Edition. Toronto, London: University of Toronto Press. 2006, p 1 26. Paradies, Y., Anderson, I., and Harris, R. The Impact of Racism on Indigenous Health in Australia and Aotearoa: Towards a Research Agenda Melbourne. Cooperative Research Centre for Aboriginal Health. 2008. Read More