Health Inequalities

Socio-economic status has been consistently identified as an important factor in explaining the health of a population. This correlation has been documented in a large body of literature that reflects a clear incongruity between empirical reality and the values of justice and social cohesion. Health status results from the mutual interaction of multiple factors that act in different ways over the life of the individual. A study of social inequalities in health that centres on a specific phase of people's lives, such as old age, may contribute to a better understanding of the factors and mechanisms that define health, and help to generate a relevant framework for the development of social policies.

Health inequalities are central to current health policy internationally and in many nations. As health improvements have slowed, the extent and depth of health inequalities in the developed world have become too obvious to ignore. At the same time the profound differences in health between the developed and underdeveloped world, between obesity for some and starvation for others, has created a moral crisis. Yet, the often proclaimed solution to human problems, neo-liberal free-trade producing economic growth and improved human wellbeing, i.e., market fundamentalism, has proven a failure. The dogmatic application of neo-liberal doctrines perversely increases those social inequalities that are among the basic causes of health inequities. The issue then becomes one of creating conditions that would permit more variegated approaches to improving human well-being and reducing inequalities. Ironically, the dynamics of globalization, broadly defined as a view of human beings sharing the same planet and the same fate, has produced opposition to the untrammelled dominance of multinational corporations and the states they influence or control. If we know something about who and what the enemy is, we do not as yet know solutions other than doing something differently and more humanely. There are examples of countries and areas that do better than others at translating economic growth into improvements in human welfare. We can learn from them. Yet the onus remains on us to do whatever is within our capabilities to develop a more just and equal world.

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Health inequalities and inequities in healthcare are among the most significant problems in health systems and in today’s societies as a whole. They exist between and within countries, even in the most developed. Clarification of the concepts and fundamental principles is essential for studying the nature of inequalities and inequities and for establishing of adequate measures and policies to deal with them. This article aims to present the basic concepts of the essence of health inequalities and inequities in healthcare and to put the principles of health policy for solving these problems.

Bhatia R, Weintraub J, Farhang L, Yu K, Jones P. 2010. Using Our Voice: Forging a Public Health Practice for Social Justice. In: R Hofrichter, R Bhatia (eds.) Tackling Health Inequities Through Public Health Practice: Theory To Action. Oxford University Press, USA.

In questo libro il legame fra salute, medicina e società viene dapprima analiz-zato in prospettiva microsociologica, osservando, cioè, come salute e malattia si radichino nei corpi degli individui e nelle loro relazioni sociali. Si passa poi al livello delle organizzazioni sociali intermedie: dalla famiglia alle professioni sa-nitarie, all'ospedale, ai servizi territoriali e domiciliari e alle comunità locali. Da ultimo, vengono esaminati i processi sociali di più vasta portata, focalizzando l'attenzione sulle politiche sanitarie, sui sistemi sanitari e sulle disuguaglianze sociali di salute, e affrontando le problematiche venute più di recente ad emersione.

Drawing upon perspectives from across the globe and employing an interdisciplinary life course approach, this handbook explores the production and reproduction of different types of inequality, such as economic, gender, racial and ethnic inequalities, across a variety of social contexts, including health, education and the family. Combining quantitative and qualitative methods to bridge the gap between theory and practice and offer strategies and principles for identifying and tackling issues of inequality, this book will be indispensable for anyone interested in understanding and eradicating the processes of production, reproduction and perpetuation of inequalities.

Padilla-Altamira, C. (2016). Solidaridad y cooperación. El surgimiento de la comunidad en torno a la enfermedad renal cónica. En F.J. Mercado-Martínez & E. Ibarra-Hernández (eds.), Crónica de la enfermedad renal. Voces de quienes viven y escuchan el padecimiento (pp. 85-111). Guadalajara: Universidad de Guadalajara.
El libro completo se puede consultar en: http://es.icphr.org/inicio/cronica-de-la-enfermedad-renal
En este capítulo abordaré tres temas que considero importantes para comprender la situación actual de las personas con enfermedad renal crónica y sus familias en Jalisco y México. En mi exposición pondré especial atención en las personas que carecen de seguridad social, que utilizan diálisis peritoneal y viven en comunidades alejadas de la capital del estado. Los tres temas en cuestión son: la formación de una comunidad en torno a la enfermedad renal y sus terapias; el surgimiento de una red de intercambios entre las personas que pertenecen a esta comunidad, a lo cual llamaré economía informal de las terapias de sustitución renal; y la influencia de la comunidad y de la economía informal en las vidas de las personas con enfermedad renal.

This article aims to improve the understandings of safety and risk in childbirth in Morocco from a critical medical anthropological perspective. It is based upon nine weeks' of fieldwork undertaken in the town of Ifli, an oasis in Eastern Morocco, on the border with Algeria. Ethnographic material stemmed mainly from participant observation and semi-structured interviews conducted between April and July 2009. This research sheds light on the interplay between the socio-cultural context and the broader political economy of health in shaping the knowledge and practices of childbirth. The core issues emerging from the fieldwork are the local concepts of risk in the birthing process through mothers’ and birth attendants’ experiences within medical pluralistic frames of reference. This article shall argue that ethnographic insights can play a crucial role not only in understanding socio-cultural dimensions of childbirth, but also in implementing novel approaches to reproductive health care in this area, such as the exchange of experiences between trained and local, non-trained midwives.

The recognition that certain characteristics (such as
poverty, disadvantage or membership of marginalised
social or cultural groups) can make individuals more
susceptible to illness has reignited interest in how to
combine universal programmes and policies with ones
targeted at specific groups. However, ‘universalism’ and
‘targeting’ are used in different ways for different
purposes. In this glossary, we define different types and
approaches to universalism and targeting. We anticipate
that greater clarity in relation to what is meant by
‘universalism’ and ‘targeting’ will lead to a more
nuanced debate and practice in this area.

Ensuring equitable access to high-quality healthcare constitutes a key challenge for health systems throughout Europe. Despite differences in health system size, structure and financing, evidence suggests that across Europe particular sections of the population are disproportionately affected by barriers to
accessing healthcare. Studies have also shown that difficulties in accessing healthcare are compounded by poverty and social exclusion, and that poverty and social exclusion compound difficulties in accessing healthcare.

At an EU level, access to healthcare is also a key issue. Listed as one of the common values for EU Member States agreed in June 2006 (Council of the European Union, 2006b), access for all to adequate healthcare and long-term care and tackling of inequities in access has also been proposed as a priority
objective for the new streamlined EU Open Method of Coordination for Social Protection and Social Inclusion. The Social Inclusion Strategy (European Commission 2006b) also emphasises a strong focus on reducing poverty and social exclusion for EU citizens.

Against this background, the European Commission (DG Employment, Social Affairs and Equal Opportunity) commissioned the European Health Management Association to undertake a study on “Quality in and Equality of
Access to Healthcare Services: HealthQUEST”. The study has had two key aims. The first has been to identify and analyse barriers to accessing healthcare, particularly for vulnerable people at risk of social exclusion. The study therefore looks at barriers to access at the supply side, problems experienced in this respect by certain groups of the population (demand side)
and also at the interplay between the two. The second aim has been to review policy initiatives taken by Member States to realise the objective of equitable access for all. This has included analysing evidence of the effectiveness of
policy initiatives and highlighting good practice.

This study is based on detailed analysis provided by studies on the situation of the following eight countries: Finland, Germany, Greece, the Netherlands, Poland, Romania, Spain, and the United Kingdom, - countries that represent different ways of organising and funding of health care across Europe. This was
complemented with findings from the literature, in particular recent European comparative studies.
The report falls into three principle parts. The first outlines the policy context and methodology of the project. The second looks at the specific barriers focused on in the study, including coverage, cost-sharing, health literacy and supply-side responsiveness. The third part moves on to analyse the specific problems affecting selected groups at particular risk of social exclusion. In each,
underlying factors have been analysed and policy initiatives and good practice identified.

Three groups at particular risk of social exclusion and where there are important gaps in research (and sometimes also in policy action) were chosen for in-depth study:
− Migrants (including asylum seekers and illegal immigrants);
− Older people with functional limitations;
− People with mental disorders (studied as a special case study under the project).
For these groups the study looked across the eight countries to find out what issues they face and the interaction between the difficulties they experience. An in depth review in the form of a case study was undertaken on the access of people with mental health problems on access to mainstream (somatic) healthcare services."

By portraying the circumstances of people living with chronic conditions in radically different contexts, from Alzheimer’s patients in the UK to homeless people with psychiatric disorders in India, Managing Chronicity in Unequal States offers glimpses of what dealing with medically complex conditions in stratified societies means. While in some places the state regulates and intrudes on the most intimate aspects of chronic living, in others it is utterly and criminally absent. Either way, it is a present/absent actor that deeply conditions people’s opportunities and strategies of care.

This book explores how individuals, groups and communities navigate uncertain and unequal healthcare systems, in which inherent moral judgements on human worth have long-lasting effects on people’s wellbeing. This is key reading for anyone wishing to deconstruct the issues at stake when analysing how care and chronicity are entangled with multiple institutional, economic, and other circumstantial factors. How people access the available informal and formal resources as well as how they react to official diagnoses and decisions are important facets of the management of chronicity.

In the arena of care, people with chronic conditions find themselves negotiating restrictions and handling issues of power and (inter)dependency in relationships of inequality and proximity. This is particularly relevant in current times, when care has given in to the lure of the market, and the possibility of living a long and fulfilling life has been drastically reduced, transformed into a ‘reward’ for the few who have been deemed worthy of it.

Cette recherche s’inscrit dans le cadre des travaux de l’Observatoire international sur les impacts sociétaux de l’IA et du numérique (OBVIA) sur les effets des systèmes d’intelligence artificielle et des outils numériques déployés pour lutter contre la propagation de la COVID-19 sur les sociétés soutenus par les Fonds de recherche du Québec (FRQ). Ce chantier de recherche, mené d’avril à aout 2020, s’intéresse plus précisément aux effets différenciés de ces mesures sur les groupes en situation de marginalisation historique.

Se destaca la importancia de la historia antropométrica entre las ciencias preocupadas por la nutrición y la salud. La evolución del estado nutricional y de la desigualdad en España medida por indicadores antropométricos es el principal objetivo de un conjunto de 18 contribuciones presentadas y discutidas en el IV Workshop de Historia Antropométrica celebrado a comienzos de 2018, publicados ahora con una introducción en la revista Nutrición Hospitalaria (Extra 5, 2018)

Después de mostrar la capacidad de la estatura humana como representación del impacto de los procesos socioeconómicos y de los cambios ambientales en el estado nutricional durante los últimos siglos, se presentan las principales aportaciones y avances realizados en el taller. Las contribuciones abordan distintas facetas de la desigualdad de la salud nutricional y de sus determinantes desde finales del siglo XVIII hasta 2015. Además de la talla y del peso a diferentes edades (principalmente adultas), se incluyen otros indicadores antropométricos, como el dimorfismo sexual y el bajo peso al nacimiento. Los resultados reflejan graves problemas de malnutrición y de desigualdad en el pasado que persisten con otra naturaleza en la actualidad: retraso en el crecimiento hasta la década de los sesenta y creciente prevalencia de obesidad desde 1980.

Se concluye que los determinantes del estado nutricional y de la desigualdad de la salud requieren un enfoque multidimensional y de diálogo entre las ciencias sociales y las biomédicas. Conocer su dimensión en el pasado y su evolución proporciona un valioso aporte de conocimiento para entender con mayor perspectiva los problemas actuales y poder intervenir con atino en las políticas futuras.

La desigualdad en salud configura un problema estructural en América Latina. Estas desigualdades se manifiestan tanto desde el acceso a los servicios e insumos de salud dependiendo la configuración institucional de los sistemas, como desde los resultados y su relación con los determinantes sociales. Con avances y retrocesos, este fenómeno siempre ha estado presente en la región y la pandemia del coronavirus no ha hecho más que mostrarnos su peor cara.

The considerable evidence base linking social conditions to population health has spurred many in public health to call for political action. Most of these conditions fall outside the purview of health departments, meaning that advocates are increasingly calling on other government sectors to improve health. Whether levelled at the whole-of-government or individual departments these calls seek a paradigm shift in governmental goals. Paradigmatic political change is an essentially normative process – one based upon ethical, rather than empirical, reasoning. Successfully achieving political change requires that public health advocates improve their normative justification for change and reduce their reliance upon evidence-based arguments. evidence-based policy • social determinants of health

The task of studying the impact of social class on physical and mental health involves, among other things, the use of a conceptual toolbox that defines what social class is, establishes how to measure it, and sets criteria that help distinguish it from closely related concepts. One field that has recently witnessed a wealth of theoretical and conceptual research on social class is psychology, but geographers' and sociologists' attitude of diffidence toward this " positivistic " discipline has prevented them from taking advantage of this body of scholarship. This paper aims to highlight some of the most important developments in the psychological study of social class and social mobility that speak to the long-standing concerns of health geographers and sociologists with how social position, perceptions, social comparisons, and class-based identities impact health and well-being.
DOI: https://doi.org/10.1016/j.socscimed.2017.11.037

According to Abraham Maslow’s Hierarchy of Needs(1) a person has an undeniable potential to seek out and fulfil as many self-actualising goals as possible at each level of their wellbeing. Given that basic physiological needs such as nutrition are present in ample and steady amounts; such a person may progress to more developed stages such as acquiring economic safety, prestige, intimacy, kinship etc. Children in particular desire to be safe or at least perceive an environment of safety under adult supervision. In the setting of poverty and inequalities in general, therein lies the unjust burden of existence on poor children in poor backgrounds.

Health Inequalities: Biographical Differences Carved into Bodies.
ABSTRACT

European studies of the relationship between social class and health bring out two contradictory tendencies: a general rise in life expectancy and the persistence (or even the growth) of health inequalities. This essay critically reviews the main explanations of health inequalities, grouped into three classes: naturalistic explanations; lifestyle explanations; explanations focused on social interaction. Naturalistic explanation represent health status as a cause instead of a consequence of individuals’ social position. A naïve version of these explanations ascribes the health inequalities to genetic diversity; a more sophisticated one recognizes in social mobility processes the mechanism which translate health resources into social resources. Lifestyle explanations describe health inequalities as the aggregate effect of the different propensity of individuals to adopt unhealthy behaviors. Explanation based on social interaction maintain that health inequalities are determined by differentials in exposure to health-related stressors which distinguish individual according to their social position. The essay concludes with a focus on the Italian context, describing the level of health inequalities in Italy and presenting the main data bases that can be used to study this phenomenon.

The purpose of this evidence review is to explore the independent effect of racialized status on health and access to health care. The task is difficult because other factors such as immigration and SES can affect or confound its independent effect (Laveist et al., 2009). Toronto Public Health has already explored the relationship between income inequality and health in a 2008 report The Unequal City: Income and Health Inequalities in Toronto and immigrant health in a more recent report in 2011, The Global City: Newcomer Health in Toronto, conducted in partnership with Access Alliance Multicultural Health and Community Services. Both reports called for further investigation of the impact of racialization on health. Thus, this report endeavours to disentangle the effects of immigration and SES to complement previous and future work, while contributing to the wider evidence-based discourse on health inequalities among racialized groups.

This course is designed to apply the field of sociology (the study of social interaction, human behavior, and social organization) to a host of contemporary social problems through examination of sociological perspectives, major concepts and current debates. The course will demonstrate how social problems are embedded in social institutions such as family, education, and criminal justice. In this course we will 1.) examine the nature and characteristics of social problems, 2.) examine the strengths and weaknesses of various sociological theoretical frameworks for understanding these social problems, 3.) apply sociological thought to current examples of social problems, and, 4.) familiarize ourselves with the various 'sides' of these debates.

Americans live three years less than their counterparts in France or Sweden. Scottish men survive two years less than English men. Across Europe, women in the poorest communities live up to ten years less than those in the richest. Revealing gaps in life expectancy of up to 25 years between places just a few miles apart, this important book demonstrates that where you live can kill you. Clare Bambra, a leading expert in public health, draws on case studies from across the globe to examine the social, environmental, economic and political causes of these health inequalities, how they have evolved over time and what they are like today. Bambra concludes by considering how health divides might develop in the future and what should be done, so that where you live is not a matter of life and death. Danny Dorling provides a foreword. - See more at: https://policypress.co.uk/health-divides#sthash.Y9Veeiqv.dpuf

Este trabajo compara la evolución de las tallas regionales entre Italia y España durante las fases de crecimiento económico moderno. Consta de varias partes. Tras la introducción, compara la evolución del bienestar económico medido por la renta per cápita en el largo plazo y revisa la historiografía sobre las disparidades regionales en ambos países. A continuación, muestra la tendencia del bienestar biológico con estaturas masculinas provenientes de los reemplazos militares y se adentra en el análisis de la desigualdad y la convergencia regional con una metodología basada en datos de panel para obtener la velocidad de convergencia. Los resultados demuestran que, partiendo de las tallas promedio más bajas de Europa a mediados del siglo XIX, ambos países registraron un notable incremento en el largo plazo, más intenso para el caso italiano desde antes de la Gran Guerra europea, mientras España lo hizo desde la década de 1950. Hubo divergencia en la primera mitad del siglo XX y una firme convergencia al final de la centuria. La desigualdad regional ha sido siempre más significativa en Italia. Aunque ambos países muestran procesos de convergencia regional durante la segunda mitad del siglo XX, la desigualdad es menor al final del periodo en España que en Italia. Los datos sugieren la importancia de explorar los efectos de la descentralización sanitaria y de otros servicios públicos de acceso al bienestar para conocer los determinantes de la dimensión regional de los niveles de vida biológicos.

Bu çalışmanın amacı 2009-2010 yılları arasında Eskişehir’de yapılan bir alan araştırmasının verilerine dayanarak algılanan sağlık statüsünün ve sağlığa ilişkin algı, tutum ve davranışların sosyal ve ekonomik statüye göre farklılaşıp farklılaşmadığının, farklılaşıyorsa ne şekilde farklılaştığının incelenmesidir. Nicel yöntemi izleyen araştırmanın verileri 229 yapılandırılmış görüşme ve 126 anketle toplanmış, SPSS yardımıyla çözümlenmiş, 6 derinlemesine görüşme ve 2 odak grup görüşmesi ile desteklenmiştir.  Araştırma bulgularına göre sağlığın ve hastalığın tanımlanma biçimi, sağlık bilgisinin elde edildiği kaynak, sağlık kurumlarına başvurma ölçütü, geçirilen gebelik sayısı, doğumdan önce sağlık bakımı alma ve doğumu hastanede yapma oranları gelire, eğitime ve yaşanan yere göre anlamlı bir farklılık göstermektedir. Algılanan sağlık statüsü ve doktor muayenesinden utanma tutumu gelire, eğitime, yaşanan yere ve cinsiyete göre anlamlı bir farklılık göstermektedir. Hastanelerin tek çatı altında birleştirilmesine ve Türkiye'deki sağlık hizmetlerinin yeterliliğine ilişkin değerlendirmeler ile sağlık personelinin davranışlarından duyulan memnuniyet düzeyi de gelir ve eğitim düzeyine göre anlamlı bir farklılık göstermektedir.  Bulgular sağlık risklerinin, sağlık hizmetlerine erişim düzeyinin ve sağlık hizmetlerini alma biçimlerinin toplumda eşitsiz bir şekilde dağıldığını, sağlık kurumlarına, sağlık personeline ve genel olarak sağlık hizmetlerine ilişkin değerlendirmelerin de buna bağlı olarak farklılaştığını göstermektedir. Genel Sağlık Sigortası yasası ile sağlık kurumları tek çatı altında birleştirilmiş olsa da bulgular sağlık alanındaki hiyerarşik yapının sadece sağlık kurumlarının mevzuatla birbirinden ayrılmasından kaynaklanmadığını, farklı ekonomik ve sosyal statüye sahip olan grupların kurumsal tıp ve sağlık personeli ile ilişkilerinin birbirinden farklı olduğunu, sağlık alanındaki hiyerarşik yapının çoklu etkilerle şekillendiğini göstermektedir. Bu çerçevede toplumsal eşitsizlikler birikimsel bir desen izlemekte, ekonomik, bölgesel ve cinsiyete dayalı eşitsizlikler açısından dezavantajlı olan gruplar sağlık riskleri ve sağlık hizmetlerine erişim açısından da devazantajlı olmaktadırlar.

The aim of this thesis is to examine whether social and economic status cause significant difference on health-related perceptions, attitudes and behaviors and self reported health status. It also tries to examine how these variables differ if a significant difference occurs. The research depends on fieldwork conducted in Eskisehir, Turkey in 2009 and 2010.  The research is a quantitative one and has both descriptive and explanatory aims. The data was gathered by 229 structured interviews and 126 questionnaires, analyzed by SPSS and reinforced by 6 depth and 2 focus group interviews. The findings reveals that the way of defining both health and illness, the source of health related knowledge, the criteria of application to health institutions, number of pregnancies, ratio of received health care prior to birth and ratio of hospital births show significance difference according to income and education levels and the characteristic of living place (rural/urban).  Self reported health status and the level of embarrassment feeling in medical examinations also shows significance differences according to income and education levels, gender and the characteristic of living place. The evaluation towards some recent developments in health care system and the general adequacy of the health care system in Turkey and the satisfaction from health care staff’s behaviors show important differences according to the level income and education. The findings show that the distribution health risks, level and form of access to health care services are distributed unequally in society and the evaluation towards health institutions, health care staff and adequacy of health care services in general differ according to the unequal distribution. Although health institutions have been uniformed and thus legal hierarchy has reduced, findings point out that the hierarchical structure in health area does not exclusively depent on the legislation that formerly used to distinct health care institutions. People with different economic and social status have dissimilar relations with institutional medicine and health care staff and the hierarchical structure in health area is shaped by a wide range of factors.  Social inequalities display a cumulative pattern, the groups who are disadvantaged due to economic, regional and gender inequities continue to remain disadvantaged groups in regard to health risks and access to health care services.

This book explores societal vulnerabilities highlighted within cinema and develops an interpretive framework for understanding the depiction of societal responses to epidemic disease outbreaks across cinematic history. Drawing on a large database of twentieth-and twenty-first-century films depicting epidemics, the study looks into issues including trust, distrust, and mistrust; different epidemic experiences down the lines of expertise, gender, and wealth; and the difficulties in visualizing the invisible pathogen on screen. The authors argue that epidemics have long been presented in cinema as forming a point of cohesion for the communities portrayed, as individuals and groups "from below" represented as characters in these films find solidarity in battling a common enemy of elite institutions and authority figures. Throughout the book, a central question is also posed: "cohesion for whom?", which sheds light on the fortunes of those characters that are excluded from these expressions of collective solidarity. This book is a valuable reference for scholars and students of film studies and visual studies as well as academic and general readers interested in topics of films and history, and disease and society.