RECAP FROM UNIT 2 AND INTRODUCTION TO UNIT 3 (15 minutes)

1. Give out session notes from the previous unit and recap on the main points. Clarify any points as necessary. Ask participants to refer to their learning logs and identify one topic they would like to know more about. These could be incorporated into the discussions in exercise 3.
2. Give out programme for Unit 3.
3. Poverty, inequality and health are often talked about in the news. This unit will look closely at the effects of income on health and will draw upon three different sources of information. One of these will be, if possible, the Internet, which can provide facts about the local area. If this is not possible, you will have to bring some facts and figures to the session. The second type of information will come from books - reading about how poverty has a major effect on the health of the population. The third source of information is the group’s own knowledge and experience and that is where you will be starting today.
4. You will also (if time permits) be spending time working on the Group Project.

BARRIERS AND CHOICES (30 minutes)

Prior to the session you will need to prepare some cards; each with a different role written on it. You can choose from suggestions listed below or change the roles to suit the group you are working with. However, make sure you keep the young homeless man and the middle-aged married man with a good job as they provide a basis for major contrasts.

• Young lone parent with three children under five.
• Young working woman, recently married and expecting her first baby.
• University student doing 2 part-time jobs to supplement his/her income.
• Elderly woman living on her own with no family nearby.
• A young homeless man.
• A woman living with a violent male partner.
• A 53-year-old man who is unable to work due to an arthritic condition.
• A 35-year-old gay man in a stable long-term relationship.
• A young woman who is disabled and confined to a wheelchair.
• A middle-aged married man with a good job.
• A 16 year-old who has left school and is struggling to find work
• A young married black woman with 2 children.
• A 22 year-old with an addiction problem.
• A 12-year-old girl with eating disorders
• A 53-year-old man with severe depression
• A 44-year-old asylum seeker

1. Give each participant a role card. Ask them to stand in a straight line, facing you. Ask them not disclose what is on their card. Read out each question on Handout A. If they can answer ‘yes’ they take one step forward. If ‘no’ then they should take one step back. If they are unsure or the question does not apply to them they should stay where they are. Stress that they should answer generally on behalf of their role.

2. Once all questions are asked invite participants one by one to disclose the role they assumed.

Discussion points

• How does it feel to be where you are?
• Who has the most choices and opportunities available to them?
• Who has the least?
• What are the barriers that exist? What can be done about them?
• How inequalities can be divisive and can cause resentment amongst different groups.  Can people think of examples of groups blaming others for their own difficulties?  (Unemployed people may blame black people for taking jobs; blaming incomers for the problems of a changing rural community; seeing elderly people as a drain on resources, and so on.)
• Does this distract us from looking more carefully at the causes of the problems?
• Different groups have different experiences. To what extent can they tackle problems on their own and how much do they need to work together in order to challenge discrimination? How can this be achieved?

FACTS, FIGURES AND PEOPLE’S STORIES (60 minutes)

This exercise is about using different resources to find information that expands our understanding of inequality due to differences in income. As the tutor, you will have made sure that all the information you need is available whether it is through the Internet, articles in the press/ magazines, pictures, local strategy documents etc. The only criterion is that the material should generate discussions on health inequalities caused by income inequalities.

The exercise works best, however, if you can use a mixture of facts and documented real-life experiences.

1. Profile exercise

• Explain that for this exercise you will be working in small groups to search for, read and distil information and feed back to the rest of the group.

• Split the group into 3s or 4s and give out Handout B. Check with each group that they understand what is required and allow them 15-20 minutes to complete it.

• Ask each small group to feed back their main findings. Are there similarities (or differences)? What are the common themes?

2. Reading exercise

Keep participants in their small groups and distribute the material you have brought with you. Ask the groups to go over the material and note down their thoughts on how income inequalities may result in health inequalities. Use the following questions to prompt discussion:

• Are people being denied their rights?
• What examples of inequalities have participants noticed?
• How much control do people have over issues of inequalities?
• What would the benefits of addressing these inequalities be?

What would the group’s recommendation for reducing inequalities be?

• Write up key points from their research on the flipchart sheet.
• Bring everyone together. Ask the group to look at the information on the flipchart. Round off the exercise by asking people if they’ve learned anything new. Were there any surprises? Has the exercise triggered more questions?

DEFINING POVERTY (45 minutes)

Explain that before looking at the links between poverty and health, we need to be clear about what we mean by ‘poverty’.

1. On a flipchart write ‘POVERTY IS …………’. Ask participants what immediately comes to mind when they hear/see the word ‘poverty’. Record key words quickly on the flipchart. Display flipchart sheet(s) where everyone can see the collective thoughts.
2. Give out Handout C and read through this, highlighting any key points. Do these definitions match yours? Is there anything you disagree with?
3. Split into small groups and give out Handout D. Ask participants to look over this list of necessities and try to agree what would be the 10 most necessary things in order of importance. Ask the groups to record these on a flipchart sheet. The lists should then be pinned up and compared.

INEQUALITIES IN HEALTH (30 minutes)

1. Give out Handout E. Read through this slowly with the group while participants underline or highlight parts they think are important.

Discussion Points:

• What do we understand by Bevan’s idea of the ‘collective principle’?
• Does the Inverse Care Law still exist?
• Why has free, accessible health care not had a major impact on reducing health inequalities?
• According to Wilkinson what is the most important factor in influencing health status?
• What, according to Bartley et al, are the effects of a more equal distribution of income?
• How does the Sottish Government publication of 2015 relate to previous thinking on the subject?
• What according to Jennifer Prah is the connection between health and society?

1. Bring out discussion of the key points and the links between relative poverty, social justice and health.

THE GROUP PROJECT – SESSION 2 (30 minutes)

1. Planning and getting started.

Decide

• Who is doing what.

Give each group a large sheet of flipchart paper and coloured felt-tip pens and encourage them to start getting their ideas down on paper - brainstorm ideas then begin to focus on one aspect. Each group can do their own thing or could cover one aspect of an overall theme, such as women’s health, mental health or the health service.

• What they might need to collect or organise.

Pictures or headlines from magazines/newspapers etc. Would they need paint/coloured paper/glue?  What are you able to provide?

• How they want to present their topic.

What ideas seem manageable?  What resources or hidden talents are there in the group? Sketches?  Photography?  Comics? Encourage people to be as creative as possible, within the time limitations.

• Who would course members like to invite to the Group Presentation?

As course tutor, you will be expected to write and invite people to this session. If friends or relatives are coming, that could be organised by the course members themselves, but you will need to coordinate this. About 10-15 guests is about right, but check this out with the group.

On the day, make sure there is enough time for last-minute preparation by inviting guests to come later than the participants.

RECAP AND SUMMARY (15 minutes)

1. Go over the main points you have covered in today’s session – refer to flipcharts if necessary.

• Barriers and choices
• Facts, figures and people’s stories
• Definitions of poverty
• Inequalities in health
• The group project 

1. This is optional:  inform the group that next session is the midpoint of the Part 1 course and that you will be conducting a focus group exercise to ensure that the course is on target in relation to learning outcomes and the group’s expectations. Be clear in your own mind why you would do this exercise.

2. Give out the Unit 3 Learning Log and give people time to fill this in before they go or encourage them to fill it in at home as soon as possible.