Determinants of Health Inequities in Stormlands

Discuss about the Cross Cutting Review on Health Inequalities.

Health inequalities are widespread all over the world. This report provides a perfect synthesis of the health inequality audit carried out in Stormlands that was divided into 16 subzones. According to HM Treasury (2002) about the Cross-Cutting Review on Health Inequalities, the obligations of the government were stipulated to minimize inequities in the health sector and recognize that sustainable action on the broader contributing factors of health inequities is necessitated if the generation cycle of poverty and health is to be shattered.  According to Graham (2002), national policy and strategy indicate a collection of clarifications and interpretations of the meaning of tackling health inequities.

This report discusses four significant determinants of health inequities in Stormlands. These contributing factors are general socioeconomic and environmental conditions, gender, ethnic identity, and geographic place of residence. For instance, general socioeconomic and environmental  conditions, that is, the status people have in the society regarding education and incomes can affect the ability of a person to access health services (HFA, 2000).

In the following report, health inequity is conveyed in three ways:

• Health outcomes: – where the mortality (life quantity) and morbidity (life quality) are considered.
• Health risks: – where behavioral, biological, and environmental factors are considered.
• Utilization of health services: – where the rehabilitation, prevention and treatment measures are put into consideration.

Taking into consideration the failure to minimize inequalities in the health sector, we decided to carry out an audit in Stormlands, primarily to identify what more the local government could ensure to improve the outcome.  Our focus was the input the NHS and Department of Health have made in securing health equity. The following were our terms of reference:

• Whether the government, through the Ministry of Health, has met its public service targets in respect to health inequalities ;
• The accomplishment of NHS organizations to co-coordinate activities with local authorities and other relevant organization in handling the issue of disparities;
• The efficiency of the Department of Health in co-coordinating policies and strategies with the local government departments, in an attempt at minimizing health inequalities;
• The quality and distribution of GP services and their impact on health inequalities, and how the outcome and quality structure might be applied to reduce disparities in the health sector; and
• The efficiency of public health services in minimizing health inequalities by aiming at the leading causes of disparities such as smoking in local areas.

Health inequities in Stomlands society are documented in several aspects. Health and other relevant agencies usually collect health statistics, and available in a range of source documentations which we immensely relied on. There are limitations in the available data regarding methods of collections, interpretation, and quality.  However, regardless of the restrictions, the information evidently indicates health inequalities across the subzones of Stormlands in the stated measures: gender, socio-economic status, cultural uniqueness, and geographical dwelling place.

Health and possibilities of untimely deaths are caused by socioeconomic factors prevailing throughout the life and across the generation (Davey-Smith et al., 1997). Therefore, health in the middle or old age is subject to the previous socioeconomic status along with the current situation. In Stormlands, the subzones have registered a group of people with low level of education. This always results in underpaid jobs which are vulnerable and expose them to chemical and physical menaces, and inadequate housing.

There are several reasons behind the social-economic disadvantaged people in these zones to less likely embrace the beneficial health demeanors (Marmot & Bell, 2013). First, the relevant information as a guide on how they should healthily behave is not reaching them.  Moreover, they lack the necessary resources that can enable them to live healthily, furthermore, the environment (swampy and infested with mosquitoes) where they live negatively affect their health. It is also apparent that demeanors such as smoking are characterized and more inbuilt in those people with low socio-economic status.

Health in Stormlands is improving, however, over the last decade inequalities in health between the social classes have become widespread. The gap has increased by 11% among women, and by 3% among men (Jelfs, 2016). Figure 1 below illustrates the employment rate in Stormlands. Subzone 06 records the lowest rate of unemployment of about 7% among females and 8% among males. Subzone 16 marks the highest percentage of unemployment of about 23% among females and 25% among males. This scenario explains the inequalities in health across the subzones which are as a result of unemployment.

Health Inequity in Stormlands

Figure 1: Unemployment rate per subzone of Stormlands

Source: Victorian Department of Health (2012)

Where people live, place of residence plays a significant role in creating health inequalities. It is the management , local and social environments of the people. The acknowledged characteristics of people’s place of residence that create inequalities in health are (Pearce, Mitchell, & Shortt, 2015):

• The difficulty in accessing the place for the health services to be provided;
• The difficulty in accessing the place for educational facilities, employment and societal activities;
• An unavailability of  food choices which are healthy and affordable;
• Lack of safety factors on roads, lack of recreational facilities, and the shortage of public transport systems;
• Lack of suitability and better quality of the housing stock; and
• In-built negative views of other neighborhoods and low level of societal unity.

Some zones in Stormlands that are poverty-stricken experience features that make them unhealthier compared to those who live in wealthier zones. Therefore, life expectancy in poverty-stricken subzones is lower compared to the life expectancy of those people in wealthier subzones.  Moreover, some subzones in Stormlands are very marshy denying the accessibility of health services.  Subzones within Stormlands have negative perceptions and low level of cohesiveness with other subzones making it difficult for health services to be provided equally. Figure 2 below illustrates life expectancy at birth in different subzones of Stormlands.

Figure 2: Subzones of Stormlands Life Expectancy at Birth

Source:  Victorian Department of Health (2012

Averagely in Stormlands, men have shorter life management expectancy than women. Differences in gender health are illustrated in figure 3 below.

Figure 3:  Gender health inequalities on SF36 Scales

Source: Australian Medicare Locals Atlas PHIDU (2011)

Both gender and sex impact the disparities in health outcomes of women and men. Sex is the biological differences recognized between women and men, while gender is the social classification that describes the cultural and social structure of masculinity and femininity in the social order, indicating the difference in allocating supremacy and resources (Ostlin, 2002).

Gender inequalities cause particular morbidity and mortality suggesting that the involvements with the aim of minimizing differential wellbeing amongst men should have a focus distinct from interventions that reduce women health inequalities (Smith et al., n.d.). The gender health inequalities in outcomes are as a result of differential gender risk factors, for instance, differential labor exposure segregation both at home and workplace, and the difference in accessing economic and social resources. The health of both women and men is affected by gender policies and gender roles.  Awareness programs need to be established in Stormlands to sensitize the influence of roles which expose gender to health hazards, utilization of available health services and health outcomes.

The lifestyle factors which impact inequalities in health are also referred to as the ‘proximate’ causes of inequalities in health since they are the direct originators of illnesses as opposed to the ‘broader determinants ‘such as socio-economic factors (Kristenson, 2006). These factors are smoking, nutrition, exercise, alcohol consumption, drug use, and sexual behavior. In Stormlands, the statistic shows that higher percentage of men smoke than women.

Figure 4 indicates levels of smoking among adults in the subzones of Stormlands.  Amongst male adults, daily cigarette smoking varies from an estimate of 17% to in Subzone 07 to 47% in Subzone 05 in Stormlands.  Females recorded the lowest and highest percentage in cigarette smoking; 8% in Subzone 07 and 26% in Subzone 12 respectively.

The Australian government should bring into notice national indicators to particularly to observe and control the progress of minimizing inequalities in health both nationally and locally. Besides, NHS together with Australian government should assess the geographical spread of primary care services to make sure that the requirements related to higher deprivations levels are sufficiently resourced.

Furthermore, the NHS boards and councils should ascertain things that they jointly employ in reducing inequalities in health sector locally, and work together to make sure that the targeted resources are those resources with the highest demand. The NHS should as well observe and control the usage of hospital services by the diverse group of people, and apply the gotten information to find out whether a particular line of action is necessary to help a specific group of people to access health services.

Conclusion

All the evidence indicated an apparent relationship between deprivation of socio-economic, poverty, and higher levels of morbidity and shorter life expectancy.  Health inequities mirror broader inequalities that result from the social divisions in our societies. There are measures that local authorities of Stormlands can take through benefits schemes to aid in reducing economic disparities which eventually would influence iniquities in health. The existent of health inequalities in Stormlands is indicated by various indicators of the state of wellbeing: morbidity, mortality, and life expectancy management .

Acronyms and terms used in the report

WHO   World Health Organisation

ABS     Australian Bureau of Statistics

NHS      National Health Service

SF36      This is a measure of health status

References

Australian Bureau of Statistics (2011). 3218.0 Regional Population Growth (2001-2010), Australia.

Davey-Smith G, Hart C, Montgomery S. 1997. Lifetime Socioeconomic Position and Mortality.Prospective Observational Epidemiology. British Medical Journal 314: 547–52.

Department of Health (2011). The health and wellbeing of Aboriginal Victorians: Victorian Population Health Survey 2008 Supplementary report, State Government of Victoria, Melbourne.

Graham, H. (2002) ‘Tackling inequalities in health in England: remedying disadvantage, narrowing gaps or reducing gradients?’ Internal discussion paper. Health Development Agency, London.

HFA. (2000). Striking a Better Balance: A Health Funding Authority response to reducing inequalities in health. Wellington: Health Funding management.

HM Treasury (2002) The Cross Cutting Review on Health Inequalities. Summary Report. HM Treasury, London.

Jelfs, P. (2016). The Australian Bureau of Statistics’ Aboriginal and Torres Strait Islander enumeration and engagement strategies: challenges and future options. Indigenous Data Sovereignty. doi:10.22459/caepr38.11.2016.15

Kristenson, M. (2006). Socio-economic position and health. Social Inequalities in Health, 127-152. doi:10.1093/acprof:oso/9780198568162.003.0006

Marmot, M., & Bell, R. (2013). Socioeconomically Disadvantaged People. Social Injustice and Public Health, 21-41. doi:10.1093/med/9780199939220.003.0002

Ostlin P. 2002. Gender perspecitive on socioeconomic inequalities in health. In J Mackenbach, M Bakker (eds). Reducing Inequalities in Health: A European perspective. London: Routledge Press.

Pearce, J., Mitchell, R., & Shortt, N. (2015). Place, space, and health inequalities. Health Inequalities, 192-205. doi:10.1093/acprof:oso/9780198703358.003.0014

Public Health Information Development Unit, Medicare Locals Instant Atlas, University of Adelaide

Smith, G. D., Hart, C., Upton, M., Hole, D., Gillis, C., Watt, G., & Hawthorne, V. (n.d.). Height and risk of death among men and women:. Health inequalities, 233-250. doi:10.2307/j.ctt1t8955q.27

VicHealth (2004). The Health Costs of Violence. Measuring the burden of disease caused by intimate partner violence. VicHealth, South Carlton.

Victorian Department of Health (2012). Mornington Peninsula (S) and Frankston (C) 2011. Local Government Area Profiles, Modelling, GIS and Planning Products Unit, Melbourne.

World Health Organization (2017) ‘Gender, equity and human rights’, https://www.who.int/genderequity-rights/understanding/gender-definition/en/