Lectures Advances in health and society
Lecture 1:
Health inequality – systematic differences in health status of different population groups
Differences in health status:
Life expectancy
Morbidity
Self-rated health status (Subjective health is correlated with life expectancy etc)
Different population groups:
SES (socio-economic status groups or position, position ethnically correct, status sounds
permanent and judgy)
We have this stereotypical ways of thinking of people of low SES, but with research
you need statistics
Indicators: income, education, occupation
Netherlands: education, but there is a devaluation of education because more
people get educated
US: ethnicity (more about the cultures)
UK: occupation
How you present the figures influences the way you think about it
Gender
Ethnicity
Sexual minorities
Disabled
Living in rural areas
Why focus on health inequality?
Global problem
Growing problem
No easy solution
It’s unfair (that people with lower income, or lower educated people die earlier or suffer
more diseases, it’s double punishment)
Health inequalities & health inequities
Health inequity = modifiable, considered unfair, hier kan je iets aan doen (access to covid vaccin)
Health inequality = older people are more sick than young people, women live longer, not
preventable
- Equality = concerned with sameness, refers to unavoidable social differences in health
- Equity = concerned with fairness. Where systematic differences in health are judged to be avoidable
by reasonable action they are, quite simply, unfair.
Aetiological pathways – looking at causes of health inequalities
Etiology – study of causes or origins
relevance – develop more effective approaches to improve health and reduce health inequalities
Introduction to the topic
, 1948 – free medical care in the uk, people noticed that health inequality exist, people with
more money don’t get as sick as people with low income, they first thought that people with
no money have no access to health services, you had to pay for the doctor, they thought it
was not fair, so they made the health system free access to improve health for the whole
population.
1970’s – health inequalities has increased, so the gap between poor and rich, so apparently
free access to health care doesn’t solve the issue
Why did free medical care not solve the problem? Environment, diet, access to clean water
1980: the Black report
o Social class statistics (health status and occupations reports to look for explanations)
o Explanations:
Selection correlation between income and health, if you are healthy you
are capable to work more and better and get promoted, causal so your
personal attributes make it
Artefact there is no correlation between health and occupation, it is not
true, they conclude that this is actually no explanation
Material/structural low paid job, unskilled job provide unhealthy
environment, with a lot of hazards, odor etc it is bad for you health, housing
conditions are worse
Behavioral-cultural lifestyle existing within communities of unskilled
workers, drinking, smoking
o Recommendations were not well received by the government, they didn’t like the
recommendations that much, political debate about the costs and no sufficient proof
o The black report became nevertheless a landmark document
1998: the Ancheson report
o Recommendations to reduce health inequalities
o They noticed social gradient effects
Not the poor and the rich, but health has improved in everybody but the
inequalities increased,
With each steps of the ladder health improved, so not only rich and poor but
different occupations had different levels of health so it was a gradient
Explanation: psycho-social causes, the richest have even more health than
the rich, so psycho-social causes could explain it, the lower on the ladder the
more psychological stress you experience about finances, housing etc and on
top of the ladder you have relatively little stress
2021:
o Still no decline in health inequalities
o Causes are still not fully understood
o Where do we put responsibility? Is unhealthy lifestyle a person’s responsibility or of
the environment they come from? Is it a matter of personal choice?
Identity
Stable identity vs. threatened identity
o Stable identity = loving environment and childhood, loving parents
o Threatened identity = violent childhood, tricky environment etc, you don’t manage
to think of yourself as a good person, not stable, people with threatened identity
may be more prone to prove their identity with buying stuff etc
Consumption as substitute (drugs, comfort foods etc)
Increase in identity threat because;
o Individual freedom (no religion, no rules, gender roles can make it more difficult for
identity)
, o Social media
Kate Pickett: consumerism
o More inequality leads to higher consumption, which is bad for the environment
o This is why we should do something about health inequalities
Lecture 2: Behavioral and cultural pathway to health inequality
Social class
How do I relate to health inequality?
Rutgers – kenniscentrum seksualiteit (mogelijke stage?)
Behavioral and cultural explanations for health inequality
Behavioral explanation = behave in a reckless, irresponsible way, unthinking, irresponsible behavior
or incautious lifestyle as the moving determinant of poor health status, you put a lot of responsibility
within the people
Health behavior health inequality
Lung cancer deaths: people with primary education (elementary education) die 3 times more from
lung cancer than people with tertiary education (HBO, WO)
Dutch population smoking: 20 % of Dutch population smokes, but there is a decrease in the number
of people smoking, there has been a lot of policy for it
Males smoke more than females
people with higher education smoke less than people with lower education
In 2014 26% of Dutch population smoked
How can we explain that people with lower education smoke more than people with higher
education?
behavioral-cultural explanation (3 explanations):
1. Individualized behavioral explanation (a way of thinking, not based on evidence)
Individual behavior
People with lower income and status don’t do well enough in school and have less
self-control, have shorter time perspective (not able to plan ahead), less endowed
intelligence, coping skills, or personal resilience, they have certain types of jobs
(worse working conditions and less money, lower status), other norms, it all leads to
more health risk behaviors, see figure next page
Downward thinking, happens a lot
Having interactions with people maybe could change this view
, Evidence socioeconomic status and smoking (as opposed to the individualized behavioral
explanation):
Smoking prevalence is higher among disadvantaged groups
Quit attempts are less likely to be successful among people with low SES, because
(cumulative effects):
Reduced social support
Low motivation
Stronger addiction
More likely to not completing interventions
Psychological differences (low self-efficacy)
Vulnerable for tobacco industry marketing
Smoking reduction interventions among lower SES groups
Evidence of smoking reduction interventions that work among lower SES groups is sparse
Disadvantaged smokers often perceive smoking as a coping mechanism to deal with stressful
lives
Combination of measures is required, delivered in conjunction with wider attempts to
address inequalities in health
o Raise price of tobacco products – most potential to reduce health inequalities
resulting form tobacco
o Mass media interventions
o Targeted cessation programs
2. Behavior as a result of culture
Culture as a social distinction
o We od things to show our status and distinguish ourselves from others
Leisure activities ‘people like us don’t go to the gym’
Lifestyle choices, like diet and smoking
o Limited evidence: shared culture or lifestyle may influence social differences in
health
Groups can influence people to smoke to be a part of a group
Underlying: the need to belong (Maslow)
3. Conflict between people’s needs (Maslow)
Lecture 1:
Health inequality – systematic differences in health status of different population groups
Differences in health status:
Life expectancy
Morbidity
Self-rated health status (Subjective health is correlated with life expectancy etc)
Different population groups:
SES (socio-economic status groups or position, position ethnically correct, status sounds
permanent and judgy)
We have this stereotypical ways of thinking of people of low SES, but with research
you need statistics
Indicators: income, education, occupation
Netherlands: education, but there is a devaluation of education because more
people get educated
US: ethnicity (more about the cultures)
UK: occupation
How you present the figures influences the way you think about it
Gender
Ethnicity
Sexual minorities
Disabled
Living in rural areas
Why focus on health inequality?
Global problem
Growing problem
No easy solution
It’s unfair (that people with lower income, or lower educated people die earlier or suffer
more diseases, it’s double punishment)
Health inequalities & health inequities
Health inequity = modifiable, considered unfair, hier kan je iets aan doen (access to covid vaccin)
Health inequality = older people are more sick than young people, women live longer, not
preventable
- Equality = concerned with sameness, refers to unavoidable social differences in health
- Equity = concerned with fairness. Where systematic differences in health are judged to be avoidable
by reasonable action they are, quite simply, unfair.
Aetiological pathways – looking at causes of health inequalities
Etiology – study of causes or origins
relevance – develop more effective approaches to improve health and reduce health inequalities
Introduction to the topic
, 1948 – free medical care in the uk, people noticed that health inequality exist, people with
more money don’t get as sick as people with low income, they first thought that people with
no money have no access to health services, you had to pay for the doctor, they thought it
was not fair, so they made the health system free access to improve health for the whole
population.
1970’s – health inequalities has increased, so the gap between poor and rich, so apparently
free access to health care doesn’t solve the issue
Why did free medical care not solve the problem? Environment, diet, access to clean water
1980: the Black report
o Social class statistics (health status and occupations reports to look for explanations)
o Explanations:
Selection correlation between income and health, if you are healthy you
are capable to work more and better and get promoted, causal so your
personal attributes make it
Artefact there is no correlation between health and occupation, it is not
true, they conclude that this is actually no explanation
Material/structural low paid job, unskilled job provide unhealthy
environment, with a lot of hazards, odor etc it is bad for you health, housing
conditions are worse
Behavioral-cultural lifestyle existing within communities of unskilled
workers, drinking, smoking
o Recommendations were not well received by the government, they didn’t like the
recommendations that much, political debate about the costs and no sufficient proof
o The black report became nevertheless a landmark document
1998: the Ancheson report
o Recommendations to reduce health inequalities
o They noticed social gradient effects
Not the poor and the rich, but health has improved in everybody but the
inequalities increased,
With each steps of the ladder health improved, so not only rich and poor but
different occupations had different levels of health so it was a gradient
Explanation: psycho-social causes, the richest have even more health than
the rich, so psycho-social causes could explain it, the lower on the ladder the
more psychological stress you experience about finances, housing etc and on
top of the ladder you have relatively little stress
2021:
o Still no decline in health inequalities
o Causes are still not fully understood
o Where do we put responsibility? Is unhealthy lifestyle a person’s responsibility or of
the environment they come from? Is it a matter of personal choice?
Identity
Stable identity vs. threatened identity
o Stable identity = loving environment and childhood, loving parents
o Threatened identity = violent childhood, tricky environment etc, you don’t manage
to think of yourself as a good person, not stable, people with threatened identity
may be more prone to prove their identity with buying stuff etc
Consumption as substitute (drugs, comfort foods etc)
Increase in identity threat because;
o Individual freedom (no religion, no rules, gender roles can make it more difficult for
identity)
, o Social media
Kate Pickett: consumerism
o More inequality leads to higher consumption, which is bad for the environment
o This is why we should do something about health inequalities
Lecture 2: Behavioral and cultural pathway to health inequality
Social class
How do I relate to health inequality?
Rutgers – kenniscentrum seksualiteit (mogelijke stage?)
Behavioral and cultural explanations for health inequality
Behavioral explanation = behave in a reckless, irresponsible way, unthinking, irresponsible behavior
or incautious lifestyle as the moving determinant of poor health status, you put a lot of responsibility
within the people
Health behavior health inequality
Lung cancer deaths: people with primary education (elementary education) die 3 times more from
lung cancer than people with tertiary education (HBO, WO)
Dutch population smoking: 20 % of Dutch population smokes, but there is a decrease in the number
of people smoking, there has been a lot of policy for it
Males smoke more than females
people with higher education smoke less than people with lower education
In 2014 26% of Dutch population smoked
How can we explain that people with lower education smoke more than people with higher
education?
behavioral-cultural explanation (3 explanations):
1. Individualized behavioral explanation (a way of thinking, not based on evidence)
Individual behavior
People with lower income and status don’t do well enough in school and have less
self-control, have shorter time perspective (not able to plan ahead), less endowed
intelligence, coping skills, or personal resilience, they have certain types of jobs
(worse working conditions and less money, lower status), other norms, it all leads to
more health risk behaviors, see figure next page
Downward thinking, happens a lot
Having interactions with people maybe could change this view
, Evidence socioeconomic status and smoking (as opposed to the individualized behavioral
explanation):
Smoking prevalence is higher among disadvantaged groups
Quit attempts are less likely to be successful among people with low SES, because
(cumulative effects):
Reduced social support
Low motivation
Stronger addiction
More likely to not completing interventions
Psychological differences (low self-efficacy)
Vulnerable for tobacco industry marketing
Smoking reduction interventions among lower SES groups
Evidence of smoking reduction interventions that work among lower SES groups is sparse
Disadvantaged smokers often perceive smoking as a coping mechanism to deal with stressful
lives
Combination of measures is required, delivered in conjunction with wider attempts to
address inequalities in health
o Raise price of tobacco products – most potential to reduce health inequalities
resulting form tobacco
o Mass media interventions
o Targeted cessation programs
2. Behavior as a result of culture
Culture as a social distinction
o We od things to show our status and distinguish ourselves from others
Leisure activities ‘people like us don’t go to the gym’
Lifestyle choices, like diet and smoking
o Limited evidence: shared culture or lifestyle may influence social differences in
health
Groups can influence people to smoke to be a part of a group
Underlying: the need to belong (Maslow)
3. Conflict between people’s needs (Maslow)
