Part 1 - Unit 3

Handouts

EXERCISE 2

HEALTH CHOICES

Questions

Are you able to:

• Go to night classes at your local College?
• Obtain life insurance?
• Expect sympathy from your GP when you are ill?
• Lead an active social life?
• Adopt a child?
• Obtain a mortgage?
• Plan 20 years ahead?
• Feel safe being out on your own after dark?
• Get support from society?
• Have a carer if you need one?
• Get access to information in a form appropriate to your needs?
• Pursue the work you want?
• Travel places whenever you want/need to?
• Plan a family?
• Treat yourself when shopping?
• Get access to contraception?
• Exercise your right to vote?
• Get repairs done to your house satisfactorily?
• Eat five pieces of fruit and veg a day?
• Walk down the street without fear of harassment or violence?
• Freely choose where you want to live
• Put money away into regular savings
• Talk about your issues without being judged negatively

EXERCISE 3

CONSTITUENCY HEALTH PROFILES

For those using the Internet, search for www.scotpho.org.uk. Then go to 2010 CHP profiles - select text only. Scroll down to find your area and choose sub CHP chart tool. A new page will open – click on intermediate spine zone chart and select the specific area you are interested in. Access the relevant profile from the geographical lists.

Additional information can be found on the following websites:

www.isdscotland.org choose a topic that is of interest from the a to z index.

www.scotland.gov.uk/topics/statistics/SIMD and use the interactive mapping tool.

www.sns.gov.uk and click on Standard Reporter or Advanced Reporter as appropriate.

Profiles for the greater Glasgow area are to be found on www.gcph.co.uk and click on community profiles.

Answer the following questions:

1. Which are the most significant figures in terms of health?

2. How does your constituency compare (generally) to the Scottish average?

3. Do you think there are direct links between any of the figures? If so, why?

4. Is there any information not included that you think would be useful?

Now search for details of another constituency that contrasts with yours. Participants may need help in determining how this can be done.

1. What constituency did you select and why?

2. What are the main differences between your constituency and the one you’ve selected?

3. Are there any similarities?

4. Are there any surprises?

EXERCISE 4

DEFINITIONS OF POVERTY

Absolute Poverty:
a standard of living so that someone cannot afford many things such as food, water, clothing, shelter, sanitation, education or health care, basic to survival. This is usually measure as those people living on less than 82p per day, a total of 1.4 billion people. Income in insufficient to obtain the minimum needed to survive.

Relative poverty:
a lower than average standard of living for a country or population. When come cannot afford to meet the general standard of living of most other people in their society. Their income is much less than the average for society as a whole so they are poor compared with others in society.

Individuals can be said to be living in poverty when they lack the resources to obtain the types of diet, participate in the the activities and having living conditions and amenities which are customary, or at least widely encouraged or approved in the societies in which they belong." Peter, Townsend, 1979, Poverty in the United Kingdom.

The basic definition JRF uses for its anti poverty strategy was broadly defined in the original Trustees paper in September 2014:

'When a person's resources (mainly material resources) are not sufficient to meet their minimum needs(including social participation).'

EXERCISE 4

LIST OF NECESSITIES

• New not second hand clothes.

• Enough bedrooms for every child over 10 of different sex to have his/her own.

• Presents for friends or family once a year.

• Three meals a day for children.

• Toys for children.

• A car.

• Public transport for one’s needs.

• A garden.

• A night out once a fortnight (adults).

• Damp-free home.

• A warm water-proof coat.

• Two hot meals a day (for adults).

• A telephone.

• A packet of cigarettes every other day.

• A ‘best outfit’ for special occasions.

• Meat or fish every other day.

• A hobby or leisure activity.

• Children’s friends round for tea or a snack once a week.

• A washing machine.

• Two pairs of all-weather shoes.

• Affordable heating for the home

• Refrigerator/freezer

• Bath/shower

• Digital TV

• Celebrations on special occasions such as Christmas or birthdays

• Outings at least once a month e.g. cinema or bowling

• Games console for teenagers

• A DVD player

• A computer with broadband connection

• MP3 players for the children

• Mobile phones for all members of the family

• Weekly allowance for young people

  (Adapted from: Mack J.,Lansley S. 1995. ‘Poor Britain’. Allen & Unwin. London. Taken from ‘A Community Development Approach to Health Issues in Northern Ireland’)

EXERCISE 5

Section 1

Inequality and the National Health Service

The NHS, once described as ‘an act of collective goodwill’, was set up specifically to reduce inequalities in health. Aneurin Bevan, Minister of Health 1945-51 and the main mover behind the legislation said:

‘The collective principle asserts that the resources of medical skill and the apparatus of healing shall be placed at the disposal of the patient, without charge, when he or she needs them; that medical treatment and care should be a communal responsibility and that they should be made available to rich and poor alike in accordance with medical need and by no other criteria.  It claims that financial anxiety in time of sickness is a serious hindrance to recovery, apart from its unnecessary cruelty. It insists that no society can call itself civilised if a sick person is denied medical aid because of lack of means.’

“In Place of Fear”, Aneurin Bevan (1978).  London.

Despite these intentions, evidence began to appear from the 1970s onwards that inequalities in health remained more or less the same as when the NHS was established.

The Inverse Care Law

A GP called Tudor Hart wrote a paper in 1971 claiming that the areas with the most need had the worst services, and the areas with the least need had better services. He called this the ‘Inverse Care Law’ - the opposite of what you would expect. However, he also pointed out that improved medical services were not the only answer, and that other services such as housing, should also be improved in poorer areas.

The Health Divide

A report published in 1987 called “The Health Divide” by Margaret Whitehead, produced evidence that despite the NHS, there were still enormous differences in the health between different social classes.  Richer people lived longer and had less illness from the cradle to the grave.

More recent evidence shows that a child with parents in an unskilled occupation is twice as likely to die before the age of 15 as a child with professional parents.

This does not happen in all countries. The child death rates in Sweden, for example, are similar across all social classes. Therefore, it seems that although a free, accessible health service is important, other factors continue to cause inequalities in health.

The Scottish Parliament: January 2015

Despite significant investment in tackling health inequalities in Scotland since devolution, the gap between rich and poor remains persistently wide, according to an inquiry by the Health and Sport Committee.

The Committee found that most of the primary causes of health inequalities lie outside the health field – being income and deprivation related. It also heard that Government investment in public health campaigns; for example, to tackle smoking, alcohol, poor diet and lack of exercise, often led to disproportionate uptake and could widen health inequalities rather than narrow them.

Given the link between poor health and income inequalities, the Committee was also concerned that the implementation of welfare reform is reducing the income available to the poorest and most vulnerable individuals and families and may further impact on health and wellbeing inequalities.

The Committee made a number of recommendations, including:

• The primary causes of health inequalities are complex and although Scotland’s health is improving, attempts to address inequalities, have so far, met with only limited success;
• All the evidence pointed to very clear linkages between socio-economic deprivation and poverty and poor health and wellbeing, raised morbidity levels and lower life expectancy; 
• There are measures that could be taken through the taxation and benefits system to help reduce income inequalities. Other policy measures within the Parliament’s devolved powers, for example in education and housing, could have an impact;
• The traditional response of the NHS has been to treat diseases once they have arisen or seek to change behaviours that are known to give rise to ill-health, like smoking, alcohol and drug misuse, poor diet, lack of exercise and so on. The Committee heard repeatedly that the effect of these “lifestyle” public health campaigns was to widen inequalities rather than to narrow them.
• If real progress is to be made, significant efforts will have to be made across a raft of policy areas and by different agencies collaborating and working more effectively together;
• The Committee also wants to challenge Parliament and its Committees to consider what action they should take in order to help to develop policy and scrutinise Government activity across a range of portfolios. 
• The least well-off and most vulnerable individuals and communities often have the poorest access to primary health services and this remains an issue that the NHS will need to make efforts to improve.

http://www.scottish.parliament.uk/newsandmediacentre/85009.aspx#sthash.XelSPiXg.dpuf

Contains information licenced under the Open Scottish Parliament Licence V2: http://www.scottish.parliament.uk/Fol/OpenScottishParliamentLicence.pdf

- See more at: http://www.scottish.parliament.uk/newsandmediacentre/85009.aspx#sthash.XelSPiXg.dpuf

 
Section 2

Social Justice and Health

Research in 1996 appears to demonstrate that health is not simply to do with the amount of money people have.  In that case, all poor countries would have a much worse health record than rich ones.

Richard Wilkinson, through articles in the British Medical Journal and in his book entitled “Unhealthy Societies” says it is the gap between the rich and the poor in a country that is more important.  He noted that if there was less of a gap between incomes at the top and the bottom of the scale, as in Japan, then there was a higher life expectancy - that is, people can expect to live longer. He argues that the actual amount of money appears to be less important than the effects on social cohesion of a large gap between the rich and the poor. Such a gap appears to have an adverse effect on adult and infant mortality rates.

Source: Wilkinson, R.G. (1996).  Unhealthy Societies.  Routledge.

This is reinforced by Bartley et al in “Understanding Health Inequalities” when they point out that, ‘above a certain level of average income, it is not the amount of income but the way it is distributed that seems to matter.’

Their research also shows that:

‘In countries where income is more equally distributed, even those with lower incomes may have more control over their lives, and be less likely to be forced to take subservient work, or to feel that they are going to be ‘looked down on’ by others.’

Source: Bartley et al, ‘Dimensions of inequality and the health of women’ in Graham, H.(ed)(2000).Understanding Health Inequalities. Open University Press.

How a country distributes income and decides on levels of benefit indicates how much a society cares about such differences. How a society treats different groups living there indicates how much it cares about social inclusion and social justice.

POVERTY, INEQUALITY AND HEALTH

1. What I learned today about poverty and inequalities.

2. Is there anything you learned today that has changed your attitude towards your own health (Please give an example if you did)

2. Ideas or issues that were new to me.

3. Notes on ideas I have for the group presentation.

4. Ideas from today that link with that topic.

5. Community Health Profiles

Think back to the exercise where you searched for health information in relation to your own area and others. What were the key areas of inequality that were highlighted and can you say why you think this is the case?

Give 3 examples of inequalities and the reasons for this:

1.

2.

3.