Social Gradient In Health Health And Social Care Essay

Social Gradient In Health Health And Social heraldic bearing EssayThe current world is explicitly divided into developed world characterized by having ultra-modern technological advance custodyt, close to efficient communication system, better wellness manage and income opportunities and under developed region with completely opposite scenarios. This huge inequality among the countries depicted in huge differences in health and wellbeing of the populations.. According to the field Health Organization (WHO), there is a 36 old age renewing in the midst of the life foretaste among the countries. The life expectancy of Malawi is only 47 long time while in case of Japan it is 83 years. WHO has declargond that there is no biological or genetic reason for the alarming differences in health and life opportunity. The unequal scenario of health positioning, however, not only persists between countries, further too evident in spite of appearance countries, and surprisingly almos t all countries irrespective of generative or poor. on that point is a distinct differentiation in the health status among tidy sum of different socio-economic status (SES). Generally, muckle with higher SES tend to generate better health than that of lower SES (Whitehall Study). That is health status is directly think to cordial status. This fact is referred to as the mixer slope in health ( Kosteniuk and Dickinson, 2003). Since health inequalities are evident despite signifi quite a littlet improvement in everyplaceall health of the populace, it has become the pivotal agenda in the health policy supplying and management.Social Gradient in HealthThe social gradient in heath refers to the fact that inequalities in population health status are associate to inequalities in social status (Kosteniuk and Dickinson, 2003).The poorest of the poor, around the world, get down the worst health. Within countries, the evidence shows that in general the lower an individuals socioecon omic position the worse their health. There is a social gradient in health that runs from top to bottom of the socioeconomic spectrum. This is a global phenomenon, seen in low, middle and high income countries. The social gradient in health means that health inequities affect e rattling iodin.Health inequities, in particular, are avoid up to(p) inequalities in health between groups of people within countries and between countries. These inequities arise from inequalities within and between societies (WHO). Below are some examples of health inequities between and within countries extracted from WHOthe infant mortality rate (the adventure of a tike dying between birth and one year of age) is 2 per gigabyte live births in Iceland and over 120 per 1000 live births in Mozambiquethe life history risk of maternal death during or shortly after pregnancy is only 1 in 17 400 in Sweden but it is 1 in 8 in Afghanistan.Examples of health inequities within countriesin Bolivia, babies born to women with no education have infant mortality greater than 100 per 1000 live births, while the infant mortality rate of babies born to mothers with at least secondary education is under 40 per 1000life expectancy at birth among indigenous Australians is substantially lower (59.4 for males and 64.8 for females) than that of non-indigenous Australians (76.6 and 82.0, respectively)life expectancy at birth for men in the Calton neighbourhood of Glasgow is 54 years, 28 years less than that of men in Lenzie, a few kilometres awaythe prevalence of long disabilities among European men aged 80+ years is 58.8% among the lower ameliorate versus 40.2% among the higher educated.Measurement of Social GradientSES is generally categorized based on income, academic qualification, social position, occupation, etc. Each of these components is very associated with themselves. For example, better education tends to lead better job which again associated with better income. In UK, twain programifica tions exist. The Registrar-Generals Social Classes were introduced in 1913 and were renamed in 1990 as Social Class based on Occupation. The kindes are Professional occupations (Class I), Managerial and technical occupations (Class II), Skilled non-manual occupations (Class IIIN), Skilled manual occupations (Class IIIM), Partly-skilled occupations (Class IV), and Unskilled occupations (Class V).Office for National Statistics on the other hand classified social classes into eight categories. Table 1 depicts this classification.Table 1 Social classification of the Office for National StatisticsClassDescription1Higher managerial, administrative and maestro occupations1.1Large employers and higher managerial and administrative occupations1.2Higher professional occupations2Lower managerial, administrative and professional occupations3Intermediate occupations4Small employers and cause account workers5Lower supervisory and technical occupations6Semi-routine occupations7Routine occupatio ns8Never worked and long-term unemployedBased on the ii above social classification outcome variables (i.e., mortality and life expectancy) are analyzed. Results showed that those who belong to the upper social class tend to have better health in terms of less mortality rate and higher life expectancy than that of the lower class inhabitants. That is health status follows a social gradient. veritable Scenario UKThe figure 1 below depicts differences in male life expectancy within a small area in London. Travelling from Westminster, every two tube stops represent one year of life expectancy lost.CUsersazharDocumentsAcademicTheories Perspective of HPliteraturevital referencesD-Tube Map on LE 2004-08.jpgAlthough life expectancy has change magnitude in all London boroughs since 2000, there has been a widening in the gap between the boroughs with the highest and the lowest life expectancy. In 1999-2001, this gap was 5.4 years for men and 4.2 years for women. In 2006-2008, the gap had increased to 9.2 years for men and 8.5 years for women (ONS entropy sources).Regarding different social class mortality rate excessively varies significantly. From the data of the figure 2, we can see that mortality rate per 100,000 people increased to almost double from class I to class VII.This is a graph present age-standardised mortality rate by NS-SEC men aged 25-64, England and Wales 2001-03Figure 2 Age-standardised mortality rate by NS-SEC men aged 25-64, England and Wales 2001-03Explanations for InequalitiesIn order to explain why these inequalities exist, a number of explanations have been offered. These are briefly explained belowArtefactThe relationship between social class and health is probably an artefact of measuring stick systems used to determine social class as well as health status. Mortality ratios calculated on basis of number of deaths per social class divided by number from each class determined by census returns may be inaccurate reporting of social clas s.However, this explanation can be questioned in way that inequalities have been demonstrated using a number of different systems of measurement of social class. For example, occupation, property ownership, educational status and opening to social resources. Nonetheless, still there is room for improvement in the measurement system by which classification and health status are determined.Downward header (Darwinian selection)Based on the Darwins assumption, this explanation suggests that the illness go out slide down the social class while the healthier people will have a greater chance of social advancement.However, the fact that many health problems only seen in adulthood, often once career choices have been made and social class has been determined. Now, if illness causes downward shift then the explanation of healthy rise class is less apparent be true.Cultural explanationsHealth damaging behaviours are differentially distributed across social classes and contribute to observ ed gradients. This suggests that the lower social classes prefer less healthy lifestyles, eat more(prenominal) fatty foods, smoke more and exercise less than the middle and upper classes.Using the Canadian National Population Health (NPH) Survey (1994-1995) data of 7720 men and 9269 women 15 to over 80 years of age, (Kosteniuk and Dickinson, 2003) found higher household income, being retired, and aging are associated with better physical health and lower genial distress when accounting for their mathematical function in lowering stressor trains and bolstering control, self-esteem, social support, and social involvement. This evidence can partly be of supportive with the cultural explanations. However, more investigation is needed why this variation in behaviour of different social class.The material explanationPhysical and psychosocial features associated with the class structure influence health and contribute to observed gradients. This indicates that poverty, poor hold condi tions, lack of resources in health and educational provision as well as higher risk occupations for the poor determines the gradient in health. No dubiousness poverty impacts negatively in the health outcomes. However, only improving materialistic access might not lead better health and less social gradient.Consider the example of Bangladesh, India and Pakistan. Having around double income per person than that of Bangladesh in last decade, India and Pakistan left behind in almost all the health indicators (see Figure 3). look expectancy at birth increase for Bangladesh is 17% while the figures for India and Pakistan are 12% and 6.56% respectively. In case of infant (ageFigure 3 Health and income status of Bangladesh, India Pakistan from 1990 to 2011 (extracted from The Economist, 3rd November 2012)Social class is a complex construct that may involve status, wealth, culture, background and employment. It would therefore be naive to look for a uncomplicated causal relationship bet ween class and ill health. Each individual will experience a number of different influences on their health, some of which also come under the umbrella of social class.Actions to combat social gradient in healthMarmots review (2010) noted The implications of the social gradient in health are profound. It is tempting to focus limited resources on those in most need. Although social gradients in health affecting almost everyone, interferences however are very crucial for people in need most. But so far the policy, programmes and interventions aiming to reduce social gradient in health mounted a dole out and itself create problems for the root level personnel. A report from the Audit Commission says there has been too much policy and accompanying guidance issued by of import government for people working in the field to keep up with. It is also critical that trusts and local authorities have often faced strange demands from central government and calls for a more consistent and las ting set of policy statements to aid implementation on the ground.We are un presumable to be able to eliminate the social gradient in health completely, but it is possible to have a shallower social gradient in health and wellbeing than is currently the case for England. This is evidenced by the fact that there is a steeper socioeconomic gradient in health in some regions than in others, as shown in Figure 2.To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. We call this proportionate universalism. Greater intensity of action is likely to be needed for those with greater social and economic disadvantage, but focusing solely on the most disadvantaged will not reduce the health gradient, and will only tackle a small part of the problem.Potential area of intervention Unhealthy behaviourPotential target group group at in riskConclusionUnhealthy behaviourSmokingPoor nutr imentLess physical activityAlcoholismDeterminants of healthIn todays debates, the determinants of health include all the major non-genetic and non-biological influences on health. The term therefore covers individual risk factors, such as smoking, and what are often called wider determinants (Hilary Graham* and Michael P Kelly, Health inequalities concepts, frameworks and policy)Smoking is responsible for one in half a dozen deaths in the UK. It is overall the one area where behavioural change would make the greatest impact on health inequalities. A clear divide remains in smoking levels between manual and non-manual groups, and there are also significant differences between different ethnicities and genders. Over 40% of Bangladeshi men smoke, compared to around 5% of Bangladeshi women, and more than one in four women of Irish descent are smokers.Smoking is the largest recognised cause of premature death and disability, and is responsible for about one in six deaths (over 100,000 i n total) every year in the UK. Smoking prevalence has fallen dramatically in the most affluent sectors of society over the prehistorical 30 years, but much less so among the most disadvantaged. Women who smoke during pregnancy are more likely to have babies born prematurely, twice as likely to have low birth weight babies and up to three times more likely to die from sudden unexpected death in infancy (SUDI). Low birth weight babies experience increased risk of cardiovascular disease and diabetes.Long-term smokers bear the heaviest burden of death and disease think to their smoking and is disproportionately drawn from lower socio-economic groups. Smokers in poorer social groups tend to have started smoking at an earlier age 31% of smokers in managerial and professional households started before they were 16, compared with 45% of those in routine and manual households.Obesity and its risks are not experienced equally across society, in some cases this is related to particular behav iours. There is evidence that people whose ethnic background is Pakistani or Bangladeshi are much less likely to engage in high levels of physical exercise.There are marked differences in satisfaction with primary care services. People from black and minority ethnic groups report significantly worse access than white British people. Performance on access is worst for people from Pakistani and Bangladeshi backgrounds their satisfaction with their level of access is 10-20 voice points below that reported by people from white British backgrounds.It is clear that more needs to be done to address the needs of people with disabilities. Compared with people without disabilities, they are more likely to live in poverty, less likely to have educational qualifications, more likely to be economically inactive, more likely to experience problems with hate crime or harassment, and more likely to experience problems with housing and transport. These correlations appear to work in both directions people are also more likely to become disabled if they have a low income, are out of work or have low educational qualifications. accident is the single largest cause of disability in England.1 Approximately half of those who survive a stroke will be left with long-term disability problems six months afterwards and will be dependent on others.People with disabilities often experience multiple forms of labour market disadvantage more than 40% of people with disabilities are low-skilled around 25% of those of working age are over 50 and around 10% are from black and minority ethnic groups. unmatched study2 has estimated that people with learning disabilities or long-term mental health problems are 58% more likely to die before age 50 than non-disabled people. And studies of psychiatric patients in infirmarys show that up to 70% smoke.Access to care services has been reported as an issue. Around a quarter (24%) of deaf or hard-of-hearing people miss care appointments, and 19% miss mo re than five appointments, because of poor communication. Two-fifths (40%) of visually impaired people believe that their GPs are not amply aware of their needs, rising to 60% for other surgery staff. Disabled people are also four times more likely than the general population to find their dentists surgery inaccessible.Stigma and shame are barriers to the engagement and employment of people with mental illness. Negative media images add to this discrimination. Only 21% of people with long-term mental illness are employed, the lowest proportion of any disabled group.People with severe mental illness are 1.5 times more likely to die prematurely than others, often from preventable causes, and they are also less likely to access routine health checks.There are also differences in alcohol related deaths. There are now around 23,260 deaths related to alcohol every year in England. Every man dying of alcohol-related causes loses on average 21 years of life, and every woman loses 15 years. The prevalence of disability increases rapidly with age. Approximately 75% of men and women aged 85 and over are disabled.Alcohol is a particular problem in the mid years. Around 26% of adults in England are drinking at hazardous, harmful or dependent levels. The largest increase in the number of NHS alcohol-related hospital admissions is in the 35-49 age group. These include admissions where alcoholic liver disease, the toxic effect of alcohol or mental and behavioural disorder due to alcohol are identified as the primary or secondary diagnosis.The social pattern of problem drinking is complex, but more disadvantaged communities have higher levels of mortality, hospital admission, crime, absence from work, school exclusions, teenage pregnancy and road traffic accidents due to alcohol consumption. Within localities, the most disadvantaged individuals typically unemployed, low-income older smokers have 4 to 15 times greater alcohol-specific mortality and 4 to 10 times greater alcoh ol-specific admission to hospital than the most affluent.Alcohol has a serious effect on behaviour and relationships in the home, affecting the mental health and behaviour of children of alcohol-misusing parents.15 Furthermore, harmful drinking is link up to psychiatric morbidity including depression, and around a third of incidents of domestic violence are linked to alcohol misuse. Around one million children live in families where at least one parent misuses alcohol, and by the age of 15 young people in families with a parent who drinks at harmful levels have rates of psychiatric disorder that are between 2.2 and 3.9 times higher than those of other young people.16Since the mid-1990s, newly diagnosed cases of HIV have been increasing. Increased testing will have contributed in part to this, and also enables earlier intervention. Men who have stimulate with men continue to be disproportionately affected. By 2006, men having fire with men accounted for up to three-quarters of UK- acquired HIV infections, and they remain the behavioural group at greatest risk of acquiring HIV in the UK. An estimated 31% of men having sex with men aged 15-59 were unaware of their infection in 2006. Among HIV-infected men having sex with men, diagnosed late are 14 times more likely to die within one year of diagnosis than those diagnosedearlier.17