UNIVERSITY OF THE PEOPLE

HEALTH SCIENCE 2: PREVENTIVE MEDICINE AND SOCIAL

DETERMINANTS OF HEALTH.

WRITTEN ASSIGNMENT UNIT 2

INSTRUCTOR: JADE WILES

20TH SEPTEMBER 2023

Socioeconomic factors including gender and ethnicity, employment status, education, income level,

have a significant impact on a person's health. Whether a country is low, middle or high income,

there are notable gaps between the health statuses of the different social classes that make up that

country. An individual's socioeconomic status affects their likelihood of having poor health (WHO,

2018). Systematic disparities between the health statuses of different demographic groups are known

as health inequalities. Significant economic and social consequences are associated with these

injustices, for both individuals and nations. Health disparities refer to differences in health status or

health resource allocation between different demographic groups due to socioeconomic

circumstances surrounding birth, development, life, work and aging. Health disparities are

inequitable and can be reduced through the appropriate combination of legislative measures (WHO,

2018). Examples of health inequalities in Europe, especially in the UK, are:

• Educational inequality

• Social class inequality

• Inequality in health care and access to it

EDUCATIONAL INEQUALITY

Higher rates of infectious diseases, poorer self-reported health, and shorter life expectancy are all

associated with lower educational attainment. We can argue that education is central to an

individual's position in society because it is the fundamental determinant of both occupation and

income, although occupation or income may well reflect than the individual's socioeconomic

position.

The probability of unemployment is influenced by education, which is a frequently used index to

assess socioeconomic status and represents human material and immaterial resources. The extent of

disparities in health education varies across Europe and research has shown that although disparities
are smaller in West Germany, Spain, Switzerland and the Swiss welfare states, they still present in

the welfare states of Sweden, Norway and Denmark. For Finland, the United Kingdom, France and

Italy, intermediate positions were recorded. According to a Finnish study comparing Nordic welfare

states, the UK had the highest disparities in education and health in 1994. The extent of disparities in

education and health in each country countries are different, according to more recent international

surveys (Eikemo, 2008).

INEQUALITY IN HEALTH CARE AND ACCESS TO IT

Access to health care refers to the quality of services a health system provides to individuals.

Although the NHS has prioritized the idea of horizontal equity (fairness in access to healthcare) since

its inception, access to healthcare remains uneven. The Reverse Care Act states that: Within the

population served, the need for quality medical care tends to vary based on its availability (Steinbach

et al., 2016). The “hard to reach” or “rarely heard” classes are important. The data confirms their

health status is poorer and they use services less frequently for a variety of reasons. Black and

minority ethnic groups (BAME), homeless people, asylum seekers, young people with eating

disorders, NEET, older people, people with medically unexplained symptoms health care, people

with terminal cancer, people with sensory impairment, learning disabilities, people with mental

health or substance abuse problems. Consumer issues and older adults with physical, sensory,

intellectual, and mechanical disabilities are just a few examples of hard-to-reach groups (Steinbach et

al., 2016).

• For diverse communities to have equitable access, there must be equitable access to transportation

and communication services and comparable travel times to facilities.

• Patients are also informed about the accessibility and effectiveness of therapies and the same

waiting times.
• Fees are comparable (and dependent on ability to pay) (Steinbach et al, 2016).

Explaining differences in access to health care:

• Availability:

Even if they have the same needs, certain populations may not have access to certain health care

services or clinicians may treat patients from different populations differently different.

• Quality:

Depending on the population, there may be differences in the services provided to patients.

• Health care services may have costs (financial or other) that vary by demographic group.

• Information:

Healthcare organizations may not be able to ensure that all demographic groups are equally informed

about the services provided.

Social science research shows that social connections between individuals and within groups can

influence health outcomes through psychosocial mechanisms. The extent to which people own or

have access to a variety of social networks and set of shared social norms is thought to reflect the

quality of these relationships and the importance of the relationship between individuals. It includes

ideas for ethical support, practical support, information dissemination and self-assessment. However,

this concept can be somewhat ambiguous (Crinson et al., 2017).

SOCIAL CLASS (INCLUDING INCOME, WEALTH AND EDUCATION).

There is a long history of socio-economic health disparities in the UK. Since the first reports by

health officials more than 150 years ago, disparities in health outcomes have been a cause for

concern. Greater socioeconomic deprivation is often associated with poorer health outcomes. The
British government added questions about occupations to the decennial census in the early 20th

century. Researchers were then able to study health outcomes based on social status (Steinbach et al.,

2016). Class-based inequalities exist in the UK for all major diseases and at all ages. In 2013, men

living in the poorest areas of England had a life expectancy that was 8.2 years shorter than those in

the least deprived areas, a difference as large as in 1990. According to a study of health outcomes

Health in the UK by Global for the Global Burden of disease research in 2013, the difference in life

expectancy between women living in the poorest and least poor areas was 6.9 years, down from 7.2

years the previous year (Steinbach et al, 2016). There are four main models used to explain social

class inequalities in health:

Behavioral Model:

There are social class differences in health-harmful or unhealthy behaviors, such as drug, dietary

habits, alcohol and tobacco use, contraception, active leisure activities and vaccines, and prenatal

care. However, longitudinal studies have shown that only one-third of mortality inequality between

social classes can be attributed to differences in health behavior (Steinbach et al., 2016).

Materialist model:

People living in poverty are at risk of health problems. People from disadvantaged backgrounds are

more likely to live in unsafe environments such as damp homes and polluted air (Steinbach et al,

2016).

Life cycle theory:

The social, psychosocial, and biological patterns of advantage and disadvantage that an individual

experiences over time are reflected in their health status. What happens to a child during pregnancy

and during the first years of life affects the chances of good or poor health, and disadvantages can

accumulate throughout childhood and adulthood. For example, people who experienced poor living
conditions as children are more likely to be at a disadvantage in their careers. Studies testing life-

cycle explanations require accurate longitudinal data because life-cycle models have only recently

been developed. However, many studies have demonstrated that health disadvantages accumulate

over time (Steinbach et al., 2016). Actions to eliminate health disparities must begin before

conception and last throughout the child's life. Only then can the strong link between childhood

deprivation and negative consequences later in life be broken.

Similarly, adverse childhood experiences influence the likelihood that people will adopt health-

harming behaviors later in life. ACEs are traumatic events that occur during childhood that either

directly harm a child (such as sexual or physical abuse) or affect their environment (such as growing

up in a home with domestic violence) (Steinbach et al., 2016). The psychological aspect of stress that

has received the most health attention is its relationship to work. Anxiety, despair and unmanageable

stress are estimated to affect one in six workers in England and Wales each year. Stress caused

British workers to lose 10.4 million working days in 2011-2012, an average of 24 days per person.

However, stress is a complex issue with many aspects. Stress can affect physical health, although its

impact on mental health is well known (Crinson et al., 2017).

In summary, there is compelling evidence that socioeconomic factors, including education,

employment status, income level, gender and ethnicity, have a significant impact on a person's

health. Whether a country is low, middle or high income, there are notable gaps between the health

statuses of the different social classes that make up that country. An individual's socioeconomic

status affects their likelihood of having poor health.

Reference

WHO.(2018, February 22). Health inequities and their causes, WHO. Retrieved from

https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes

Eikemo, T et al. (2008). Health inequalities according to educational level in different welfare

regimes: a comparison of 23 European countries. Wiley online library. Retrieved from

https://onlinelibrary.wiley.com/doi/10.1111/j.1467-9566.2007.01073.x

Crinson, I., Martino L. (2017). Section 10: The role of social, cultural, psychological and family

relationship factors in the aetiology of disease and illness. Faculty of Public Health. Retrieved from

https://www.healthknowledge.org.uk/public-health-textbook/medical-sociology-policy-economics/

4a-concepts-health-illness/section7/activity4/answers

Steinbach, R., Margaret,E.(2016). Inequalities in health (e.g. by region, ethnicity, soci-economic

position or gender) and in access to health care, including their causes. Faculty of Public Health.

Retrieved from https://www.healthknowledge.org.uk/public-health-textbook/medical-sociology-

policy-economics/4c-equality-equity-policy/inequalities-distribution