GGRB28H3 Chapter Notes -Telehealth, Ibm Officevision, Health Promotion

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21 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
oInternational (contrasts between countries in the developed and developing worlds - i.e.
mortality and morbidity data)
oRegional and class divides (spatial, social, ethnic) (within particular countries, within
social classes, gender differences, ethnicity)
oSmall scale variations
Explaining Inequalities in Health Outcomes
oHealth status can be pictured in terms of layers of influence (with a set of fixed factors
(age, genetics, sex) at the core)
Lifestyle (representing behaviour(s) that may or may not be conductive to good
Social networks (and community influences)
Living/working conditions (and access to local services and facilities)
Structural/policies (representing the influence of macro-economic and broad-
scale social conditions on individual health)
oprogramming hypothesis and the lifecourse: chronic diseases are biologically
programmed in the womb or in infancy (but it is argued that some factors may simply be
the result of being born into poor families; social may matter more than biological).
some argue that factors (social and biological) may accumulate throughout life
obehavioural (lifestyle) factors: people experience poor health because they are more likely
to participate in health-damaging behaviours which are socially patterned and therefore,
determinants of health inequalities; mainly deals with alcohol consumption, diet,
smoking, and lack of physical activity
osocial and community influences: social isolation and lack of engagement in local
community life contribute to poor health and early death; social networks provide social
support (i.e. tangible support/advice); social support has been expanded to social capital,
which accepts a variety of aspects of the social environment
oworking conditions and local environments: environments within which people work and
live; some work environments are hazardous and pose threats through exposure to
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dangerous machinery, chemicals, or poor practice; these environments can be sources of
omaterial deprivation and health: poor health can be linked to lack of services, amenities,
and resources in local neighbourhoods; material deprivation includes lack of income,
poor housing, and unemployment; striking relationship between death rates and poverty;
poverty may lead to dental decay which may lead to morbidity
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)
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 AFFECTS
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 mother’s 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
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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 health
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
oDifficult to separate place and health – they are very linked
Health Service Delivery
Primary Health Care: first layer of access to medical systemGP, family doctor, nurse
practitioner, preventative health care, in home, or in a clinic or health centre, basic medical
attention such as prescriptions, immunizations, nutrition counselling
opreventative medicine and health promotion
Secondary Health Care: hospital setting, specialized place of health care, treatment of health that
cannot take place in a health centre or clinic, access to secondary level may be through primary
because the patient needs further investigation, diagnosis, and treatment
omore specialized care that is more concerned with cures (not prevention)
Tertiary Health Care: health specialists who work in a designated centre i.e. cancer centre,
tertiary centres have facilities not available in smaller hospitals; patients are referred to tertiary
centres for investigation, surgery, or radiation treatment
Different models of medical care exist
Other issues for Discussion
Health “conundrum and rationing
oas life expectancies increase, so do the costs of the health care system; Situation 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.)
ounderserviced groups exist because of high provision costs to remote areas; Imbalance
between rural and urban health care availabilities (doctors are attracted to major urban
centres rather than remote rural areas) - government of Ontario implemented incentive
schemes to encourage redistribution of physicians to little effect
ogovernment constraints on health care expenditure mean that we cannot provide all the
care we want
Efficiency, effectivity, and equity
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