Lecture notes for lecture 4 of the course WITH slides that she skipped in lecture (but covered following lec)

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13 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
Whitehall I
oSet up in 1967
oProspective study followed participants for 10 years
o18,000 British men in the Civil Service
oKey result: men in lowest grade of employment
(messengers/doorkeepers) were at least three times more likely to die
than men in the highest grades (administrators) The difference in
social standing (where you work) affect your health
oLower grades had higher risk factors (smoking, inactivity, blood
pressure, etc.)
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)
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Whitehall II
o10,000 men and women employed in the British Civil Service
o1985 to present
oResults: social gradient still exists for many diseases; SOCIAL CLASS
Explaining Inequalities in Health Outcomes
Different arguments arguing the inequalities of health
Programming hypothesis and Life Course hypothesis
oWhat happened before you were born; what is programmed 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: latency, 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 throughout the world
oIncreased sedentary lifestyle leads to higher rates of obesity
oSocioeconomic factors
Social and community influences
oThe more friends/community groups you are involved in, the better
your health
Working conditions and local environments
oLow social class working environments 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 money, employment
Complex sets of variables explain variation in health outcomes:
oStructure vs. behaviour, social position, psychosocial factors
oAll vary spatially at different scales
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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
oWith the growing need to provide health care to an aging population,
the issue of where to spend the money within health care is complex
(political, geographical, economic, etc.)
oImbalance between rural and urban health care availabilities
Efficiency, effectivity, and equity
oEfficient: providing maximum health benefits at minimum cost
oEffective: are we spending a lot of money on a treatment/service with
only a little benefit? With limited funds, money has to be spent
oEquity: are we providing services to populations uniformly? Equitable
access to care.
oBox 5.2
Health care need
oThe need for health care differs for developing and developed
oDifference in demand and need (i.e. sex change procedures, medical
use of marijuana)
Inequalities in Supply
Developing countries
WHO states that any health care system should:
oImprove the population of the health they serve
oRespond to peoples expectations
oProvide financial protection against the cost of ill health
Three stages of health care reform:
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