Lecture notes for lecture 4 of the course

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6 Jun 2011
Lecture 4
VIDEO 1 – Bill Davenhall, Your health depends on where you live.
Genetics + lifestyle + environment = health
Food, water quality – not considered when doctors inquire about your health and health history
Geography is destiny in medicine.Jack Lord
Geographic information can keep you healthy
Patterns of Health Inequality
oRegional and class divides (spatial, social, ethnic)
oSmall scale variations
Explaining Inequalities in Health Outcomes
oDeterminants of Health
Fixed factors (age, gender, genetics)
Social networks
Living/working conditions
Whitehall Studies
Whit ehall I
oSet u p in 1 9 6 7
oProspe c tive stu d y followed p articipants for 1 0 ye a rs
o18 , 0 0 0 British men in the Civil Servic e
oKey result: men in lowest g rade of employ ment
(mes s en g ers/doorke e pers) were at le a st thre e ti mes more likely to die
than men in the hig h est g rades (administrators) The difference in
oLower grades h ad hig h er risk factors (smo king, ina c tivity, bloo d
oThe level of control you have over your job affects your risks of heart
disease (those who have lower job control, perhaps more stressed,
have a higher risk of heart disease)
Whit ehall II
o1 0 , 0 0 0 men and women employ ed in the British Civil Servic e
o19 8 5 to present
oResult s: social g radient still exists for man y dise a ses; SOCIAL CLASS
Explainin g Ineq u alities in He alt h Outcomes
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Different arguments arguing the inequalities of health
Program m ing hypothesis and Life Course hypothesis
oWhat happened before you were born; what is program med into you,
your mothers health is one of the reasons that you could have inequal
health outcomes
oMothers health when carrying child affect the childs long term health
oExperiences the individuals have over their lifetime, factors exposed to
during lifetime i.e. pollution
oLIFE COURSE: latenc y, cumulative, pathway
Behavioural (lifestyle) factors
oIf you participate in life damaging activities, your health will suffer
oThe higher social class, the better you tend to eat (because you have
that choice)
oResearch/relationship is consistent throughou t the world
oIncreased sedentary lifestyle leads to higher rates of obesity
oSocioeconomic factors
Social and com m unity influences
oThe more friends/com m unity groups you are involved in, the bet ter
your health
Working conditions and local environments
oLow social class working environ ments tend to have more hazards
oLocal environments: living close to highly polluted areas, highly
industrial areas, the neighbourhood you live in are all important to your
Material deprivation and health
oPoor health can result from lack of services
oLack of participation in society
oLack of mone y, employment
Complex sets of variables explain variation in health outcomes:
oStructure vs. behaviour, social position, psychosocial factors
oAll vary spatially at different scales
oDifficult to separate place and health they are very linked
Health Service Delivery
Primary Health Care: first layer of access to medical system GP, family
doctor, nurse practitioner, preventative health care
Secondary Health Care: hospital setting, specialized place of health care,
treatment of health
Tertiary Health Care: health specialists who work in a designated centre i.e.
cancer centre
Different models of medical care exist
Other issues for Discussion
Health conundrum ” and rationing
oSituation where people are living longer, therefore = higher stress,
more needs
oCost of providing health care to this system is also increasing
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