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Lecture 8

Lecture 8.pdf

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Lorne Tepperman

Lecture 8-Illness and Stigmatization Effects of Social Inequality: (1) Illness and Stigmatization How does inequality harm people? Have discussed income (class) inequality, gender inequality, ethnic and racial inequality, age inequality, sexual inequality, and international inequality. Question: How does inequality translate into sickness, crime, and conflict? Answer: Inequality disempowers,disconnects, disinforms, and devalues people. What inequality does . Disempowers by depriving people of income, influence, and authority Disconnects by reducing social connectedness and depriving people of social contacts (or social capital) Disinforms by depriving people of useful informationabout opportunities Devalues by depriving people of self-esteemand self-worth These effects also lead to desperation, risk-taking Income inequality mediates these processes (and is well-measured),so we focus on income inequality Recent study at U of T finds that Patients from different income groups are hospitalized for different reasons And different hospitals serve different income groups, in different ways The researchers studied ALL hospital admissions in Toronto examined data on ALL patients admitted between 2008 and 2010 to 20 hospitals in the Toronto Central Local Health Integration Network Finding: Poor people get the most funding-starved care Very low-incomepeople (bottom quintile< $35,000per year) are using the parts of the health care system that are in greatest crisis," said Dr. Rick Glazier, a professor with the department of family & communitymedicine at the University of Toronto's Faculty of Medicine. Poorerpeople over-use emergencyservices, wait longer for suitable care Wealthier patients (top quintile>$101,000average) are morelikely to receive same-day surgery than low-incomepatients Poorerpatients are more likely to be hospitalized for mental health issues visit emergency departments for non-urgent issues, and remain in acute care hospital beds while waiting to be transferred to more appropriate care in the community,such as nursing homes. Poor patients are warehoused Patients waiting for an 'alternate level of care' occupy an acute hospital bed but do not require the resources or services provided These waiting patients are more likely to have low incomes than high incomes Class determinants of healthcare Glazier says the statistics point to class-based strains on the health system Wealthy groups enjoy health supports that those with lower incomes lack Glazier said, [including] access to primary health care by MDs the ability to pay for healthy foods and medicines ability to live in a healthy place where you can receive home care if you need it Social inequality = healthcare inequality Canada's public health-care system (Medicare): an umbrella term for 13 separate but linked health insurance plans are administered separately in each province and territory Gives Canada something close to equal, universal healthcare coverage However,the coverage is not perfect Coverage issues Coverage issues Medicare does not cover costs of prescription medicines most dental care most vision care non-physician health services (e.g., psychologists,physiotherapists) long-term home care services Current concerns Fast-growing cost of medicines currently, only drugs taken during in-hospital treatmentare covered by Medicare removalof non-essential services from Medicare coverage (adult eye exams, chiropractic care, etc.) greater strain on Medicare owing to aging of the population, greater longevity of chronically ill people Insufficient attention to preventivecare strategies Research on inequality illustrates the population health perspective A population health perspectivefocuses on how social variables influence the physical and psychological well-being of large groups of people Health is viewed as a societal problem, not a personal problem (though experienced personally) Differences in vulnerability Some groups are morevulnerable to health problems (including infectious diseases, obesity, and injuries) than other groups these different levels of risk are usually a result of economicand social inequalities We know this through our ability to measure precisely the effects of illness and disease Life Expectancy: a good general measure of population health the average number of years remaining to a person at a particular age, given current age-specific mortality rates varies geographically and demographically global life expectancy has increased dramatically in the past century However,significant disparities in life expectancies persist between equal and unequal nations More unequal nations have lower life expectancies Why the unequal health risks? To somedegree, these observed differences in health reflect health-related lifestyle differences: alcohol consumption smoking diet exercise the importance of these lifestyle behaviours is well documented But there is more to the story of inequality! The role of class inequality The most famous proof of an inequality effect is found in the Whitehall Studies Lifestyle differences were ruled out as causes Whitehall studies found higher mortality rates from all causes for men of lower employmentgrades especially for deaths from coronary heart disease (CHD) Class = job control = stress = coronary illness = earlier death People in low status jobs have less control over their work than people in higher status jobs = more stress = more heart attacks This was confirmed in Scandinavian research by Robert Karasek and Tores Theorell in 1990Tores Theorell in 1990 US and Canadian researchers re-confirmed this finding in 2010: Women with highest job strain are most likely to suffer heart attacks Other working conditions are also important Some jobs are just moredangerous than others industrial and environmentalpollution accidents at work physical risk of attack (e.g., journalists, taxi drivers, prostitutes) However,being a waitress is also dangerous to your health Or consider Infant and Child mortality rates two statistical indicators of population health that focus on society's most vulnerable members: the number of deaths of children under one year of age per 1000 live births the under-five mortality rate In the graph on the next page, note the slope and the outliers other kinds of inequa
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