NİŞANTAŞI ÜNİVERSİTESİ HEALTH PSYCHOLOGY NİŞANTAŞI ÜNİVERSİTESİ © İktisadi, İdari ve Sosyal Bilimler Fakültesi iisbf.nisantasi.edu.tr

Chapter 5 Explaining health behaviour

Chapter 2 Health inequalities

Learning Outcomes By the end of this chapter, you should have an understanding of: the impact of poverty on health causes of variations in health between and within countries the impact of socio-economic deprivation on health and theories of why this occurs the relationship among work stress, unemployment and health the health impact of having a minority status in society the impact of gender on health

Health Differentials Clear evidence of health differentials across whole populations both within and between countries. WHO developed a system for measuring healthy life expectancy. In general, the richer the country, the longer its population lives and the longer its equivalent of full health is. Health differential – a term used to denote differences in health status and life expectancy across different groups. Healthy life expectancy – WHO provides a fairly vague definition of this phrase: the number of years that a person can expect to live in ‘full health’ (in contrast to life expectancy, which is how long one would expect them to live) by taking into account years lived in less than full health due to disease and/or injury.

Healthy Life Expectancy Table 2.1 Life expectancy in years for the highest and lowest ranked countries in 2013 Source: WHO (2013).

The Exception to the Rule USA in 29th place: average healthy life expectancy of 70 years Explanations include the following: Some social groups (e.g. Native Americans) have health more characteristic of developing countries rather than a rich industrialised one. The HIV epidemic caused a higher proportion of death and disability to young and middle-aged Americans than in most other advanced countries. USA is a leading country for cancers related to tobacco (i.e. lung). High incidence of homicide compared to other industrial countries.

The Impact of Poverty on Health People who live in developing countries live significantly shorter lives than those who live in the more affluent developed countries (WHO 2000). Contributing factors are economic, environmental, and social (e.g. lack of safe water, poor sanitation, inadequate diet and poor access to health care – i.e. Rahimi et al., 2007). The problems now facing many developing countries in Africa is that of HIV infection and AIDS. Within the industrialised countries, richer people live longer and have less illness than the economically less able.

Income and Health Figure 2.1 Years of healthy life expectancy according to Carstair’s deprivation scores in the UK Source: from ‘Inequalities in health expectancies in England and Wales: small area analysis from 2001 Census’, Health Statistics Quarterly, 34 (Rasulo, D., Bajekal, M. and Yar, M. 2007), © Crown copyright 2007; Crown copyright material is reproduced with the permission of the Controller, Office of Public Sector Information (OPSI), also reproduced with the permission of the author.

Social Causation vs. Social Drift Social Causation Model Low socio-economic status (SES) ‘causes’ health problems. There is something about occupying a low socio-economic group that negatively influences the health of individuals. Social Drift Model Health problems ‘cause’ low SES. After onset of a health problem, people may not maintain a job or levels of overtime required to maintain their standard of living. Thus drift down the socio-economic scale. Socio-economic status – a measure of the social class of an individual. Different measures use different indicators, including income, job type or years of education. Higher status implies a higher salary or higher job status.

Different Health Behaviours Lower SES groups engage in more health-damaging behaviours including: higher intake of alcohol; eat a less healthy diet; take less exercise. Why? less aware of risks; lack of opportunities; stress associated with living with poverty; coping; inhibit long-term consequences of health-damaging behaviour.

Differentials in Access to Health Care Figure 2.2 Health service use according to level of social deprivation in Scotland in 1999 Source: Scottish Executive (1999).

Environmental Individuals in low SES groups often have poor working and living conditions Woodward et al. (2003): male renters are at a 1.48 times higher risk of developing CHD than male owner- occupiers women renters are 2.6 times more likely to develop CHD than their owner-occupier counterparts. There are a number of explanations for these differentials: renters may experience more damp, poor ventilation, overcrowding; rented occupation may be further from amenities, i.e. leisure facilities; renters earn less than people who own their houses; the psychological consequences of living in differing types of accommodation may directly impact on health.

Conservation of Resources Hobfoll and Lilly (1993): Health determined by the amount of resources available to the individual. economic (e.g. job, income) social (e.g. family support) structural (e.g. housing) and psychological (e.g. coping skills, perceived control). Higher level of resources means health-protective. Lower levels of resources place an individual at risk for health problems.

Stress of Low SES Groups Carroll et al. (1996): Childhood: family instability, overcrowding, poor diet and restricted educational opportunities; Adolescence: family strife, exposure to others’ and one’s own smoking, leaving school with poor qualifications, experiencing unemployment or low-paid and insecure jobs; Adulthood: working in hazardous conditions, financial insecurity, periods of unemployment, low levels of control over work or home life and negative social interactions; Older age: small occupational pension, inadequate heating, food, etc.

Work and Health – SES Differentials Excess mortality in low SES groups may result from working environments: Bacharach et al. (2004): inconsistent social controls job alienation job stress work drink culture Kouvonen et al. (2005): lack of control over work long working hours poor social support

Work Stress Karasek and Theorell (1990) Three key factors that contribute to work stress: the demands of the job; the degree of freedom to make decisions about how best to cope with these demands (job autonomy); the degree of available social support.

Demand–Control Occupation Stress Model Figure 2.3 Some of the occupations that fit into the four quadrants of the Karasek and Theorell model

Minority Status and Health Prevalence of diseases varies across ethnic groups: Heart disease among British men from the Indian sub-continent is 36% higher than national average High rates of hypertension and strokes in Afro-Caribbean population High levels of diabetes among Asians Relatively low rates of lung cancer in people of Caribbean or West African origin Explanations for these differences mirror those for low SES Health behaviours, stress and access to health care Prevalence – the percentage or total number of people to have a disease in a given population at any one time. Prevalence is the number or percentage of existing cases. Hypertension – a condition in which blood pressure is significantly above normal levels. Stroke – damage to the brain either as a result of a bleed into the brain tissue or a blockage in an artery, which prevents oxygen and other nutrients reaching parts of the brain. More scientifically known as a cerebrovascular accident (CVA).

Gender and Health Women: Men: Expected to live four years longer (than UK men) Report more symptoms than men Report more long-standing illness Access health care more frequently Men: More likely to die from violence Engage in more health-risk behaviours Have less acute illness than women Are nearly twice as likely to die early due to heart disease