HLTH200 Lecture Notes - Lecture 2: Free Hand, Asean Free Trade Area, Zoonosis
28 May 2018
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HLTH200 Lecture 4: Inequality, Inequity and Social Gradient
Infant mortality rates:
• High in Mozambique, cote d’lvoire, india, Bolivia
• Associated with low SES environment
• Low in Australia, America etc.
• Developing countries infant mortality:
o Broken down by the richest 20% to the poorest 20%
o Poorest 20% = has the WORST health in developing countries
o Lowest infant mortality rate amongst richest 20%
• Australia – infant deaths
o Same pattern; highest SES has lowest infant deaths compared to lowest SES (much
higher)
→ We refer to this pattern as the SOCIAL GRADIENT – this refers to the fact that inequalities in
population health status are related to inequalities in social status
Understanding the social gradient:
• Social status is
o Education
o Income
o Employment status
o Area of residence
o Social connectedness
o Social class of family of origin
o Social class of spouse
• Co-occurring factors make it difficult to identify the causes
Socioeconomic status and mortality:
• Death rates vary across countries according to socioeconomic conditions
• Death rates vary within countries according to socioeconomic status
• The extent to which death rates vary across socioeconomic status varies across countries,
depending on the cause of death and social conditions
The SOCIAL determinants of health (health inequality/inequity):
• ‘The social determinants of health are mostly responsible for health inequities’
• Health inequities → the unfair and unavoidable differences in health status seen within and
between countries (arising from poor governance, corruption or cultural exclusion)
VS.
• Health inequality → the uneven distribution of health/health resources as a result of genetic or
other factors or the lack of resources
Clear inequities in determinants:
• Nairobi 2010 – transport overflowed with people sitting on top and around it, hanging off it
(unsafe)
• Vancouver 2015 – new advanced technology train
Inequality vs. inequity:
• Inequalities that are not inequitable may arise from
o Free choice
o Genetics
o Life stage
• Inequalities that are inequitable arise from
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o Unjust distribution of resources
▪ Medical services
▪ Education
▪ Healthy environments
• But value judgements can always be challenged – do the poor deserve to be poor? Do they
deserve fewer services than the rich?
A clear example of inequity –
• Three medications provided by drug companies
• Cost of medications for treatment
o People in Norway costing almost $200-$500
o People in lower income countries are charged close to $1000 in Kenya, same pattern
in Tanzania & Uganda
• Is this fair?
o To be considered ‘below the poverty line’, a family of four needed to be surviving on
less than $841 a week and a single adult on less than $400 a week
o 1 in 6 children living in poverty
→ Widening gaps between rich and poor
Inequality vs. inequity – the global picture:
• If health was just related to wealth, we would see lower life expectancy rates where there was
less health expenditure
• But we are not seeing that:
o China, Sri Lanka compared to Mozambique, Zimbabwe – there is no clear line
Absolute vs. relative differences?
• Is it where we stand in the pecking order, or the size of the difference, that matters?
• Societies differ in the slope of gradient - the absolute level of difference between rich and
poor
• Average measures of health and longevity within nations are correlated with the slope of the
gradient
• E.g. average incomes of lowest vs. highest 10%:
o Hungary – average income is $40,000 (flat slope) compare this to
o Brazil – richest 10% had much higher incomes (slope is much steeper)
• Income inequity
o The ratio between the average incomes of top and bottom tenths of families in these
nations
o Thus, a higher number indicates a country with greater income inequality
• Greater discrepancy between rich and poor (through life expectancy):
o Life expectancy declines as the discrepancy increases
Health and Social Problems:
• Made up of
o Life expectancy
o Math proficiency/literacy
o Infant mortality
o Homicides
o Obesity
o Mental illness
o Imprisonment
o Teenage births etc.
• Still found more health and social problems as the discrepancy/inequality within a country
increases between rich and poor
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find more resources at oneclass.com
Income inequality and healthy life expectancy:
• Life expectancy rates better in Pakistan and India, compared to Mozambique
• Similar amount of money spent on health expenditure
• But still difference between measure of inequality between rich & poor
→ As inequality gets worse, there is a decrease in life expectancy
What is driving health inequity?
• The benefits of the economic growth that has taken place over the last 25 years are unequally
distributed
o In 1980, the richest countries containing 10% of the world’s population, had gross
national income 60 times that of the poorest countries, containing 10% of world’s
population
o By 2005, this ratio had increased to 122
• International flows of aid – grossly inadequate in themselves, and well below the levels
promised – are dwarfed by the scale of many poor countries’ debt repayment obligations
o The result is that in many cases there is a net financial outflow from poorer to richer
countries – an alarming state of affairs
What does this mean for health?
• Massive inequalities in health and there is no threshold for good/bad health. It falls on a
GRADIENT.
• Inequities
o Prices of medicine
o Income inequality (gap between rich/poor) is widening
• Widening inequality (relative powerlessness?) is associated with overall declines in health
• The burden rests with those at the top and middle levels of the gradient (those with power) to
ensure the gap does not continue to widen
Lecture 5: Globalisation and Health
Public health:
• Social and environment determinants of health
• Prevention/health promotion
• Interaction between social wellbeing, education, SES and health
• National focus
International health:
• Prevention and clinical care
• Usually bi-national (or small group of countries)
• Aid – low and middle income countries
GLOBAL health:
• Responses to emergence of new transboundary health issues that pose acute challenges to
existing forms of international health cooperation
• Economic globalisation
• Social environmental determinants:
o Infectious and non-communicable diseases
o Injuries
• Global health governance
o Proliferation of institutional arrangements
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Hlth200 lecture 4: inequality, inequity and social gradient. We refer to this pattern as the social gradient this refers to the fact that inequalities in population health status are related to inequalities in social status. Understanding the social gradient: social status is, education, income, employment status, area of residence, social connectedness, social class of family of origin, social class of spouse, co-occurring factors make it difficult to identify the causes. The social determinants of health are mostly responsible for health inequities": health inequities the unfair and unavoidable differences in health status seen within and between countries (arising from poor governance, corruption or cultural exclusion) Vs: health inequality the uneven distribution of health/health resources as a result of genetic or other factors or the lack of resources. Clear inequities in determinants: nairobi 2010 transport overflowed with people sitting on top and around it, hanging off it (unsafe, vancouver 2015 new advanced technology train.
