HEALTH Dr. J.E.

Griffiths
INEQUALITIES
LEARNING OUTCOMES
Students should be able to:
1) Discuss and explain the nature of health inequalities
2) Discuss the links between deprivation and poor health in community
settings
3) Discuss action-oriented approaches to health inequalities
WHAT ARE HEALTH Definition
Social locations & links with

INEQUALITIES? poverty
Physical & Mental Health
WHAT ARE HEALTH
INEQUALITIES?
Social group differences in health
In the United Kingdom, social groups have been defined using five
categories of occupation-based social class
Continental Europe - educational attainment or other occupational
USA - most research focuses on social categories defined in terms of
ethic/racial groups.
Common denominator - significant correlations between poverty and poorer
health have been widely observed
INEQUALITIES & MENTAL
HEALTH
Poor mental health as both cause & consequence
More common in areas of deprivation
Poor mental health associated with unemployment, less education, low
income or material standard of living.
Lone parents, those with physical illnesses and the unemployed = 20% of
the population, but contribute 36% of neurotic disorders, 39% of limiting
disorder and 51% of disabling mental disorders (Melzer et al 2004).
Higher national levels of income inequality linked to higher prevalence of
mental illness, but as countries get richer rates of mental illness increase
(Pickett et al 2006).
 HEALTH INEQUALITIES & SOCIAL
CLASS IN THE UK
Poverty tends to be  In the UK SOCIAL CLASS influential in determining
concentrated in your health.
particular geographical
 BLACK REPORT (1980) concluded that while the
areas – historical, social health of the nation as a whole had improved,
& economic reasons inequalities in health had not been eliminated.
 In fact, Black stated that the ‘Health Gap’ between
higher and lower social classes was widening.
Health inequalities have  He claimed that this was as a result of differences
continued to widen since in social and economic conditions.
the early 1980s  He said that people from lower social classes tend
Reflects a similar growth to drink and smoke more, exercise less and have
in economic inequalities. poorer diets than those in higher social classes.
 These poor habits can be traced back to POVERTY.
Link to lifestyles
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 ETHNICITY & HEALTH
INEQUALITIES
Ethnic minorities make up about 14% of the UK population
People from most ethnic By nearly all measures of
minority groups are health, the health of the UK’s
generally more deprived in minority ethnic populations is
terms of socio-economic poorer than that of the
status (SES)and poverty. majority White British
population.

In fact a person’s social location in terms of SES, ethnicity, and gender all tend to be interlinked when
it comes to patterns of health, illness and wellbeing
E.g. Persistent inequalities are seen in the health of Pakistani and Bangladeshi women. Their illness
rates have both been 10% higher than White women in 1991, 2001 and 2011.

Ethnic health inequalities may be reduced by improvements in the social status and living conditions
of disadvantaged groups
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 GENDERED HEALTH
INEQUALITIES
A newborn baby boy can expect to live 79.2 years and a newborn baby girl 82.9 years (O.N.S., 2016).

Gendered disparity reflected across the Western industrialised countries - much evidence to suggest
lifestyle and behavioural differences between men and women are implicated.

The current trend in the U.K. is actually for a narrowing of the gap in life expectancy by gender however;
in fact the differences peaked historically in the period 1965-69 at 6.25 years (Longevity Science
Advisory Panel, 2013).

However inequalities in male life expectancy by socio-economic circumstances have been increasing
despite the general improvement for all during this time (O.N.S., 2011).

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WHERE ARE HEALTH
INEQUALITIES?
 Health inequalities in Britain

Shaw, M., Smith, G. D., Dorling, D. (2005) Health inequalities and

New Labour: how promises compare with real progress, BMJ 2005;
330:1016-21
 ACTIVITY
Prof Danny Dorling Glasgow Salad

Write a list of factors responsible for the discrepancies in life expectancy in Glasgow
according to Dorling?
How are these factors related to health and communities?
https://www.youtube.com/watch?v=r0cJ7CX1lCA
SOCIAL CAPITAL & HEALTH INEQUALITIES - ENGLAND

ONS: Statistical bulletin: Inequality in Healthy Life Expectancy at Birth by National Deciles of Area Deprivation:
Males in the most advantaged areas can expect to live 19.3
years longer in ‘Good’ health than those in the least
advantaged areas. For females this was 20.1 years.
Males in the most deprived areas have a life expectancy 9.2
years shorter than males in the least deprived areas, they also
spend a smaller proportion of their shorter lives in ‘Good’ health
(70.9% compared to 85.2%).
Females in the most deprived areas have a life expectancy 6.8
years shorter than females in the least deprived areas they also
expect to spend 16.9% less of their life in ‘Good’ health (66.5%

England, 2009-11
compared to 83.4%).
 Poorer health often
concentrated in
particular (deprived)
residential
communities
Manchester is one of
the most deprived
areas in the UK

The indices are based on a basket of indicators grouped into seven domains of deprivation relating to ‘income’, ‘employment’, ‘health deprivation and disability,
‘education, skills and training’, ‘barriers to housing and services’, ‘crime’ and ‘living environment’, each with their own ranks and scores. There are two supplementary indices:
Income Deprivation Affecting Children Index (IDACI) and Income Deprivation Affecting Older People Index (IDAOPI).
HEALTH INEQUALITIES WITHIN
GREATER MANCHESTER
Life expectancy at birth indicates the number of years a baby born in an area
can expect to live if they experience the mortality rates of that area for the
whole of their life. These figures 2011-13
Miles Platting and Newton Heath 73.2
Didsbury East 83.6
i.e. 10.4 years difference
 COMMUNITIES &
HEALTH INEQUALITIES
ADDRESSING HEALTH
INEQUALITIES
Addressing health inequities has become a worldwide priority.
The WHO’s CSDH (2008) - call for action to governments, civil society, the
voluntary and private sectors to address health inequities.
But addressing health inequalities means taking action to improve the health
of the poor & socially excluded
This may mean taking action to reduce the inequalities in wealth that
correlate – inevitably a political element to this goal & subject to other
priorities of governments
i.e. there are issues of power, social justice, economic inequality & social
exclusion which are linked with health inequalities
COMMUNITIES & HEALTH
INEQUALITIES
Conceptually important in design of health improvement approaches globally
(Morgan, 2001)
Social model of health - engagement & empowerment of ‘communities’ are
recognised as social determinants of health
Fundamental components of bottom-up approaches to improving health &
health inequalities (Laverack and Labonte, 2000)
 WHY DO DEPRIVED COMMUNITIES
SUFFER POORER HEALTH?
Residence in a disadvantaged area = increased risk of ill health
Several factors may explain this apparent effect.
1) Poorer facilities and services - e.g. sub-standard housing, poor planning, and
underinvestment (SEU, 1998; JRF, 1999).
2) Worsened job prospects - increases risks to physical and psychological health
(Wadsworth et al., 1999; Linn et al., 1985).
3) Increased exposure to stresses produced by higher levels of crime, violence,
and incivilities
WHY DO DEPRIVED COMMUNITIES
SUFFER POORER HEALTH?
4) Fewer opportunities for social interaction and community participation –
e.g. fewer places and settings in which people can meet.
5) Feelings of exclusion, stigmatisation, segregation and abandonment
(e.g. JRF, 1999), all of which may affect mental health.
Wilkinson (1996) - constant reminder “of the atrophy of any sense of having
a place in a community, and of one's social exclusion and devaluation as a
human being” (p. 215).
Research suggests that inequitable social arrangements impact people via stigma,
stress, loneliness, low self-esteem, powerlessness, poor quality social relationships
(Bolam et al, 2003)
Reflected in discussions of the role of social capital, social support & social networks
LIFESTYLES & HEALTH
INEQUALITIES
LIFESTYLES & HEALTH
INEQUALITIES
Health-related behaviours are patterned according to socio-economic
gradients
Health-promoting behaviour and the avoidance of risk -- higher social strata.
In contrast, higher rates of smoking, poor diet and exercise cluster with
social disadvantage.
The underlying causes of the relationship between class, geography, lifestyle
and behaviour & health outcomes are still poorly understood
(Jones et al, 2011)
LIFESTYLE AND SES
E.g. Strong association between cigarette smoking and socio-
economic position.
Cigarette smoking is more prevalent among ‘manual’ social groups
than among ‘non-manual’ groups - lowest among higher managerial
and professional classes.
In 2006, 29% of men and 27% of women in ‘manual’ households
smoked compared to 18% of men and 16% of women in ‘non-
manual’ households (GHS, 2007).

Q – Why are poorer people more likely to smoke & better off people
less likely to smoke?

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LIFESTYLE & HEALTH
INEQUALITIES - SMOKING
Smoking causes a host of serious diseases
Thus, health inequalities inevitably develop between population groups with
different smoking rates.
The main focus in the UK has been on socio-economic differences in
smoking rates but there are also marked differences between ethnic groups.
Lower income groups are more likely both to smoke and not to have quit
(Flint and Novotny, 1997), and consume disproportionately high amounts of
tobacco (Whitlock et al., 1997).
 UNDERSTANDING SMOKING LEVELS
IN DEPRIVED AREAS – STEAD ET AL
(2001)
Place of residence associated with smoking - ‘area effect’ of living in a disadvantaged
neighbourhood.
Means of coping
Socialising
Normative influence
Feelings of strong local identity, resilience and support - but appeared to foster
smoking.
Poor in the factors which foster giving up – e.g. optimism
Few respondents motivated by economic burden of smoking - deepening financial
hardship intensified need for tobacco.
HEALTH PROMOTION
“any event, process or activity which facilitates the protection or improvement of the
health of individuals, groups, communities or populations.”
Marks et al, p.504
Aims -
Disease prevention (Upstream story)
Primary prevention: Detection high risk groups
Secondary prevention: Early diagnosis
Tertiary prevention: Limit disability, complications
HEALTH PROMOTION METHODS USING
BEATTIE’S TYPOLOGY (BEATTIE – 1991)

MODE OF INTERVENTION
Advice Legislation

Education Authoritarian Policy making and

implementation
Behaviour change
Health surveillance
Mass media campaign

Individual Collective
Focus of
intervention
Counselling
Lobbying
Education
Action research
Group work
Skills sharing and training
Group work
Community development
Negotiated
HEALTHY HOMES -
OUTCOMES
Community participation contributed to the project reaching intended targets
Successfully reduced asthma symptom days and urgent health services use
Improved caregiver quality-of-life score. Improvement was greater with a
higher-intensity intervention.

Krieger et al (2005) – evaluation study

Read More: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2004.042994
THE HEALTHY COMMUNITIES
MOVEMENT
A ‘Community Coalition’ - Brings together a broad range of citizens within a
locality to address a given problem (Kloos et al, 2012)
Aims to strengthen community participation & catalyse community change
Healthy Communities
“A healthy communities approach employs community development
strategies and involves a wide range of local institutions, community groups
and private citizens, as well as health professionals, in efforts to improve the
conditions that encourage and support healthy living.” (Wolff, 2015: online)
E.g. in Massachusetts (USA) developed a health outreach program for a low
income neighbourhood (Wolff, 2004)
THE COMMUNITY TOOLBOX
http://ctb.ku.edu/en
A widely employed internet-based resource for building healthier
communities.
 LIFESTYLES & GENDERED
HEALTH INEQUALITIES
• Poor lifestyles and preventable risk factors are some of the principal
causes of premature death and morbidity in men, with over 50% of
premature deaths being avoidable.
• Smoking – higher proportion of men smoke
• Poor diet – men more likely to eat fat, sugars, soft drinks (NHS, 2009)
• Heavy drinking – higher proportion of men exceed recommended daily
limits
• Also, those men in poorer material and social conditions eat less
healthily, exercise less, consume more alcohol, and are more likely to
smoke or misuse drugs.
(EC, 2011).
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MEN’S SHEDS – COMMUNITY-
BASED ACTION
Men’s Sheds are community-based organisations - a space for older men to participate in
meaningful occupation (such as woodwork).
Men's Sheds are contributing a dual health and social role for a range of male subgroups.
- outward social focus, supporting the social and mental health needs of men; health
promotion and health literacy are key features of Men's Sheds.
Cordier & Wilson (2014) - an important role to play in addressing the gendered health
disparity that males face.
Places where the aims of male health policy can be actualised

See also:
Melluish, S., & Bulmer, D. (1999). Rebuilding solidarity: An account of a men’s health action
project. Journal of Community and Applied Social Psychology, 9, 93–100.
SUMMARY
Nature of health inequalities – poverty, social class, gender, ethnicity
Links with lifestyle – community health psychology
Understanding how poverty & deprivation are translated into poorer health in
community settings
Community Psychology action-oriented approaches to health inequalities
Gendered health inequalities