Nature And Extent
Nature and extent
The poorest of the poor, around the world, have the worst health. Socioeconomically disadvantaged people experience unjust impacts on their health status due to social, economic, environmental and cultural factors, otherwise known as health inequities. Research shows an evident link between inequities in socioeconomic status (SES) and inequities in health status, a pattern or phenomenon commonly referred to as the social gradient of health. SES refers to the status or position of an individual or group of people and is typically determined by measuring income, housing, education level and employment and how these influence where a person fits into a society over a period of time. Socioeconomically disadvantaged people are classified by their SES, and have handicapped access and opportunities to health care services, resources and financial stability. Research indicates that socioeconomic status may have the largest impact on health. It accounts for up to 40% of all influences on health (The British Academy 2014).
The extent of the health inequities experienced by socioeconomically disadvantaged people can be exemplified by a numerous variety of trends and statistics. To begin with, people with low SES commonly have higher rates of mortality, morbidity and infant mortality. The following statistics are a comparison of the health status found in areas classified as having the lowest SES against areas with the highest SES (Australia). High rates of mortality can be seen through the 652 deaths per 100,000 in areas with the lowest SES, compared with that of 449 deaths per 100,000 in areas with the highest SES. In other words people living in areas with the lowest SES have 1.5 times higher mortality rates than those living in areas with the highest SES. As for injury-related deaths, the low SES population are 2.1 times as likely to die from potentially avoidable causes. It is clear that premature death within the group could have been avoided with timely and effective health care. Lower SES groups also have lower life expectancy.
Chronic disease is one of Australia’s greatest health concerns going forwards, and socioeconomically disadvantaged people have poorer health outcomes in this area when compared to other Australians. The diseases this group are more likely to attain include CVD, diabetes, heart disease and lung cancer. For example people with low SES are 1.2 times as likely to die from CVD, 2.6 times as likely to have diabetes, 1.7 times as likely to have heart disease and 1.7 times as likely to be newly diagnosed with lung cancer.
Burden of disease is the impact of a health problem as measured by financial cost, mortality, morbidity, and several other indicators. Finally, the following statistics, which concern burden of disease, reinforce the evident health inequities experienced by people with low SES; when comparing areas of low and high SES, the burden of disease is 1.5 times as high for all causes, 2.3 times as high for diabetes, 2 times as high for lung cancer, 1.8 times as high for anxiety disorders and 1.4 times as high for stroke.
The sociocultural, socioeconomic and environmental determinants that may affect the inequity
Analyse→ identify components and relationship between them, draw out and relate implications
A range of interacting factors are influencing the health of all individuals, as seen through the sociocultural, socioeconomic and environmental determinants. While all determinants may have differing effects and levels of influence on the inequity, clearly socioeconomically disadvantaged people would be heavily impacted by socioeconomic determinants, including factors such as education, employment and income.
This population group commonly have lower levels of education and are less informed, affecting their ability to make healthy choices and decisions – this is referred to as lower health literacy and reduces the options for health care and healthy behaviours. This can be seen through the group’s lower usage levels of preventative measures. For example, the National Cervical Screening Program statistics show that participation rose with increasing socioeconomic status – from 52% in areas of lowest SES to 64% in the highest. Lower levels of education also leads to limited employment options, and have higher rates of hazardous work types. For example, a labourer is more likely to suffer an injury or develop skin cancer due to the work demands and frequent exposure to the sun. Higher rates of unemployment also affect mental health, as employment provides a sense of purpose. Generally socioeconomically disadvantaged people also have lower income levels, meaning they have less money to spend on their health. They may be forced to live in rural environments due to high housing costs in metropolitan areas, or have to eat packaged foods rather than fruits and vegetables, which can be more expensive. For example, an individual may not be able to afford private health insurance to pay for surgery on their knee, which can lead to potentially higher rates of disability.
Sociocultural determinants including family, peers, religion, culture and media also affect the inequities experienced by those groups with low SES. Arguably, family plays the largest role of all these factors in determining inequities, as seen through “the cycle of poverty”. In 2011–12, people living in areas of lowest socioeconomic status were 2.3 times as likely to smoke as those living in the highest. This means people brought up in families were exposed to high amounts of second-hand smoke, therefore being more likely to take up smoking. Socioeconomically disadvantaged people were 1.7 times as likely to report having 4 or more risk factors. Unhealthy eating habits are a common risk factor found in this group, which are evident through the high levels of obesity. Other risky behaviours in socioeconomically disadvantaged households include: higher rates of drinking at levels that could cause lifetime harm, and lower rates of physical activity. The neighbourhood “gang” culture commonly found in low SES areas can be linked to high levels of racism or discrimination, which leads to repression of religious beliefs and also can negatively affect mental health. Gang culture is also linked to peer pressure, which is known to encourage risk behaviours, especially in young men. Socioeconomically people may have a higher prevalence of risk behaviours due to their lack of access to media, as they may not have the technology, resources or income to access media that can educate them on healthy behaviours and decisions.
Access to health services
Socioeconomically disadvantaged people can be heavily affected by the environmental determinant, which is mostly classified as a non-modifiable health determinant due to factors including location, access to health services and technology. This population group tends to have higher rates of homelessness. A lack of shelter and living on the street or in someone else’s house affects physical and mental health. Homelessness also limits access to health services, as large amount of benefits through Centrelink require a living address. There are also higher rates of socioeconomically disadvantaged people living in rural and remote areas when compared with urban areas, meaning socioeconomically disadvantaged people have poorer access to health services and greater distances to travel for medical care and health related services or technology.
The roles of individuals, communities and governments in addressing the health inequities
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A table listing responsibilities and an example for each responsibility
To improve the equity and overall health of people living in low SES areas individuals, communities and governments must take on certain responsibilities and commitments. Individuals, communities and governments need to work collaboratively to provide an intersectoral approach to the health of socioeconomically disadvantaged people. An intersectoral approach based on partnerships between people and agencies at many levels and in a variety of sectors. Intersectoral collaboration is the best approach to the health inequities in this group as they are present throughout every area of Australia, and therefore provides the best chance of success of reducing health inequity.
At a more personal level, individuals from socioeconomically disadvantaged backgrounds can also play a substantial role in addressing their health inequities by taking responsibility for their own health and the health of those around them. Learning better health practices and passing these behaviours on to their children can break the cycle of poverty. The importance of educational health is evident through the improved health and increased socioeconomic status of those with higher education. Actions such as remaining in school, or seeking to attend university improve ones SES and provide further information to help individuals make informed choices about their health and health care used. With the knowledge provided by educational institutions, individuals must take responsibility for their dietary choices and exercise habits, to empower them to live healthier, better quality lives. By discontinuing participation in risk behaviours such as drinking, smoking and drug use individuals can help to address the health inequities.
The community should encourage the efforts of individuals by providing a range of government-funded, supportive initiatives, such as relevant health care and support services. The success of government strategies rest upon the effective transmission of information and services to the most disadvantaged communities. Childcare, community healthcare, primary care, education, employment training and migrant services are all examples of programs that can promote good health behaviours, relieve low SES individuals of economic strain and address the health inequities. Current programs such as PCYC, provide physical activity programs and welfare support for youth in socioeconomically disadvantaged areas. Another example is ‘Youth of the Streets’ who aim to improve health outcomes for socioeconomically disadvantaged people. The development of an increasingly community-based health workforce that focuses on prevention of disease and the management of illness is a vital and relevant strategy, as it is preferred over the use of hospitals.
At the highest level is the role of the government, which aims to supply subsidies and funding to reduce the high costs of health education and promotion. The government must recognise that the costs associated with both negative health and improving lifestyle behaviours may be limiting for individuals. Consequently, a large number of government programs – public housing, pension cards, concession cards, Centrelink and the mandatory PDHPE curriculum – must be continued and improved to lessen the pressure on low SES groups. Initiatives like the Pharmaceutical Benefit Scheme and Medicare were created for this exact purpose; to decrease the gap between low and high SES groups by providing funding for free or reduced cost health care. Medicare is the most obvious example, as it allows access to a range of health professionals and funds hospitals, medical services and pharmaceuticals. A government initiative in which an intersectoral approach is exemplified, is the NSW State Health Plan, in which the government, NGOS and the private sector work together to bridge the gap between health inequities, including health inequities experienced by those with low SES. The goal of these initiatives is to provide all Australians with sufficient and affordable health care, despite their SES.