2. Mothers-to-be in deprived areas are more likely to have premature babies. Home care ‘’lottery’’ for the elderly. When the NHS was set up in 1948, one of its founding principles was to provide a universal health care service. n ‘ ’Everybody, irrespective of means, age, sex or occupation shall have the opportunity to benefit from the best and most up-to-date medical services available’’ (Beveridge) n In other words, a clear commitment to provide a service of equal quality for everyone.

3. Despite the advances in medical care and technology and a universal system of health care there is growing evidence that: inequalities in standards of health care provision exist throughout the UK inequalities in health still exist throughout the UK these inequalities are getting worse. …..65 years on

4. Mortality = death Morbidity = illness Factors which influence health n Different groups and categories of people have very different experiences of these determinants of health. n These different experiences can have an effect on a person’s chances of achieving good health. Also when these experiences overlap, they can have a “snowballing” effect. n However, the problem is complex - there is no simple explanation as to why differences in mortality rates and morbidity rates exist amongst individuals or groups.

5. Gender/biologicalfactors Hereditaryfactors Personallifestyle Ethnicorigin Socio- economic status Workingconditions Geographicallocation There are many influences on an individual’s health.

6. Health inequalities: hereditary illnesses n A degree of health problems are influenced by genes – Cystic fibrosis and sickle cell anaemia are two of the most common genetic conditions – 60% of all cancers (73% of breast cancers) linked to family history n BUT very few health conditions are purely genetic n Combination of genes and environment – lifestyle factors, such as diet, smoking, alcohol and exercise, and socio-economic status

7. Inequalities in Health: Age Success Criteria: You should be able to n Provide evidence for the existence of health inequalities according to age n Draw conclusions on the extent of these inequalities n Discuss possible explanations for these inequalities, linking, where possible, to other factors such as social class and lifestyle choices

8. Age and health: evidence n Poor health increases with age Percentage reporting long-standing illness or disability: Source: General Lifestyle Survey (2009)

9. Causes of age related ill-health n As part of the natural process of aging, in old age the body becomes increasingly less able to repair itself n Mobility problems increase and lifestyle habits change, with a reduction in physical activity n Physical frailty/susceptibility to the cold n Certain chronic conditions have a strong association with age: – Sensory problems (eyesight, hearing loss) – Arthritis – Dementia Heat or Eat

10. Report: Living Longer and Prospering (2011) n Poor health in old age is not inevitable n Lifestyle has the greatest impact on longevity, adding 4.6 years to male life expectancy after 65 followed by income, which adds 4 years n Conclusion: over a lifetime, our lifestyle choices take their toll and can result in an earlier death

11. Consequences of age related ill health n Greater demands on NHS – 75+ age group are more than twice as likely to visit a GP – 70% of those who require a hospital stay after a fall are aged over 70

12. For you to do n Read the BBC Article: Cold homes cost NHS more than a billion n http://www.bbc.co.uk/news/health- 20425364 http://www.bbc.co.uk/news/health- 20425364 n Analysis question: to what extent is age a cause of ill health?

13. Inequalities in Health: Gender Success Criteria: You should be able to n Provide evidence for the existence of health inequalities gender n Draw conclusions on the extent of these inequalities n Discuss possible explanations for these inequalities, linking, where possible, to other factors such as poverty and lifestyle choices

14. Gender and ill health: longevity n Life expectancy (England and Wales) *Men: 77 years *Women: 81 years n Pattern is consistent across all social classes but gap is wider amongst the poorest – 7 year gap in life expectancy between men and women in 10% most deprived areas – Explanations: manual work, male working class culture affecting lifestyle choices n BUT gap is narrowing – experts say by 2030 there will be no difference in life expectancy

15. Gender and ill health: Differing mortality/morbidity rates n Cancer – men are at greater risk of cancer (410 cases per 100,000 compared to 355 per 100,000 for women) n Heart disease n Respiratory diseases – see next slide 1 in 5 men will die from cardiovascular disease (CVD), 1 in 7 women)

16. Deaths from respiratory diseases England/Wales (2007-2009)

17. Explaining gender related health differences: physical differences n Physical differences account for vulnerabilities to different diseases – E.g. testicular, ovarian and breast cancer – However 4000 men a year are diagnosed with breast cancer

18. Explaining gender related health differences: health related behaviour n Women are, by most measures, healthier than men yet make, on average, 6 visits to their GP a year, compared to 4 for men n Potential to detect and treat illnesses before they become serious Well- documented reluctance amongst men to visit GPs and other health professionals

19. Explaining gender related health differences: lifestyles n Diet and obesity – Men consume less fruit and vegetables than women – 69.2% men overweight compared with 59.6% of women –6% of men and 5% of women have diabetes –16% of men and 14% of women have CVD n Smoking – Similar rates (24% of men and 22% of women) but this is a recent phenomenon linked to rise in young women smoking n Alcohol – 25% of men are “hazardous harmful drinkers” compared to 18% of women n Exercise – 45% of men and 33% of women take enough exercise (at least 60 min daily) Scottish Health Survey 2011

20. For you to do n Read the articles: – Why are men reluctant to seek medical help – Obesity still a problem for Scots – Female binge drink rates ‘double’ n You should take notes using the activity questions n http://news.bbc.co.uk/1/hi/magazine/8154200.stm http://news.bbc.co.uk/1/hi/magazine/8154200.stm n http://www.bbc.co.uk/news/uk-scotland-glasgow- west-19713671 http://www.bbc.co.uk/news/uk-scotland-glasgow- west-19713671 n http://news.bbc.co.uk/1/hi/health/8034533.stm http://news.bbc.co.uk/1/hi/health/8034533.stm

21. Inequalities in Health: Race Success Criteria: You should be able to n Provide evidence for the existence of health inequalities according to race n Draw conclusions on the extent of these inequalities n Discuss possible explanations for these inequalities, linking, where possible, to other factors such as poverty and lifestyle choices

22. Race inequalities in health: infant mortality n Infant mortality rates higher for ethnic minorities as a whole n highest among mothers not born in UK n Causes of infant death differ – Half of all deaths of Pakistani infants are due to congenital abnormalities, compared to 25% of all infant deaths – 67% of the Caribbean group of deaths due to premature birth/low birth weight

23. Race inequalities in health: morbidity n Risk of suffering from particular diseases is different – Diabetes is most common among Pakistani (18%) and Indian groups (14%) – three times Scottish average – Only 4% of Chinese suffer from CVD (15% Scottish average), mainly diet related Sickle cell anaemia, a congenital disease, is most common in Black Caribbean, Black African and Black British communities

24. Explaining racial differences: culture and lifestyle n Cultural considerations – Language barriers: limits access to health services/health education – Role of women: some groups unwilling for females to be examined by male doctors – First cousin marriages increasingly common in British Born Pakistani groups: doubles chance of having a child with a congenital disorder from 2% to 4% – Diet influences deaths from CVD n Lifestyle choices and culture can be closely connected – Alcohol: most British Muslims do not consume alcohol, 30% of Chinese men do not – Physical activity: levels among female Pakistani and Bangladeshi groups are particularly low due to limited availability of “women only” sessions

25. Explaining racial differences: social class n As in the general population, income among ethnic groups has an important impact on health n Groups with incomes comparable to Whites show smaller differences in health n Bangladeshi groups, who record highest levels of poverty, have health levels 50% worse than whites n Caribbean/Pakistani/Bangladeshi more likely to dwell in inner cities where housing issues/social exclusion can affect health

26. For you to do n Read/highlight your summary sheet n Analysis question: – To what extent may racial inequalities in health be explained by social class differences? – you will also need to use you notes on race from the wealth inequalities section of the topic to help you answer this