Approaches to Health Inequalities

HEALTH INEQUALITIES AND SOCIAL DIVISIONS

Introduction

Today, it seems to be an obvious truth that “social and environmental factors account for a substantial portion of health inequalities between and within countries.”^[1] The ubiquitous nature of economic and social inequalities is noted by all scholars.^[2] This is a truth that seems well-enough established both in the professional literature and in the consciences of the laity. The questions that occupy scholars’ time, therefore, have centrally to do with what might be done about such health inequalities and whether social divisions are more the causal origins of the inequalities or whether they are the result.^[3] As the literature reflects an ongoing investigation into all the matters addressed within this paper, definitive conclusions will have to wait until more is positively settled by the broader research community. But, certainly several pertinent issues can be explored at this time and the ongoing questions raised.

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The Realities of Inequality, Poverty and Societal Issues

As is widely acknowledged, there is a relation between relative poverty and social issues. Regarding social ways in which it is difficult for those in relative poverty to be like others around them, it is often found to be difficult for an impoverished person to “participate fully in the social life of a community or country,” which will often lead to feelings of powerlessness.^[4] Such social issues lead naturally into considerations of health inequality, as those who are impoverished often experience a great lack in education and access to resources normally available to those who are not in a state of relative poverty (e.g., healthcare, clean water, good nutrition, shelter, etc.).^[5] It has also been noted that these types of relative health inequalities (i.e., between social groups) may be getting worse.^[6]

Health Inequalities

There are at least two ways in which the discussion of health inequality can be broached. First, there can be shown to exist an inequality in healthfulness between classes. That is, one social group exhibits more health than does another, whatever the causal origin of this may be. Regarding the connection between a lack of healthfulness and social division, it has been noted that “A social class gradient is most pronounced for long-standing illnesses that limit activity.”^[7] That is, such illnesses occur within certain social classes. Second, it is possible to explore the relation between being socially challenged and not having access to healthcare. This latter issue may be the simplest to deal with as the reasons for it are more readily seen. If one simply does not have access to that which will provide him with health, then clearly inequity between his group and those of another will be readily apparent.

What Can Be Done about Access to Health?

In their editorial, Jeanette Vega and Alec Irwin explore some possible responses to such health inequalities. They note that in the past there has been enacted, what might be called a “Pro-Poor” approach. This takes into account the fact that the poor often simply do not have the means in terms of finance or education to bring it about that they have access to much in the way of health resources or medicine. So, interventionist groups are formed in order to try and ensure that they have some access to medicine and health care. These types of interventionist methods are important, write the authors. But, they are inadequate by themselves. First, they only tend to focus on providing access to one type of group, and this is merely an issue of inequity in unfairness. Second, and perhaps more importantly, they do not attempt to address many of the core reasons why such inequalities arise in the first place, which include “gender and ethnicity” among other reasons.^[8]

A more comprehensive approach is both necessary and desirable in the effort to combat health inequalities. More must be done to combat the social divisions that exist, both along monetary lines and other ethnic lines.^[9] There has been some progress made in a few countries, like Sweden wherein the approach has been comprehensive and on the cooperation between government agencies on high levels. Sweden has developed a national health policy that focuses on what determines health at the “societal level.” In this model, government agencies work alongside significant social sectors (e.g., education, transportation, environmental protection) and they are all required together to work toward the improving of “population health and narrowing health equity gaps.”^[10] Also, in the United Kingdom recent efforts at accomplishing these same goals have seen success in targeting, not an ethnic or social group, but an age group. That is, collaborative efforts have been engaged which have targeted mothers of children in early education and child care and have attempted to integrate these services with those of assistance to families and that of general health.^[11]

More to Be Done on the Research Level

In a recent article Stuart Logan asked the hypothetical question of whether research was still important to be carried out in the area of child health inequality.^[12] If it is obvious to all, as he argues it is, that “the relationship between poverty and poor health has been demonstrated so often and for such a wide range of conditions,” then the question naturally arises as to why any such investigative research into the relationship between socioeconomic status and child health should be carried out. Logan believes there are two important reasons that this endeavor is crucial in the overall attempt to overcome health inequalities and social divisions. First, we must continue to advocate for those who cannot advocate for themselves, and children are the first that come to mind in this category. Furthermore, there is simply not a “differential in health outcomes between those who are poor and those who are wealthy.”^[13] Secondly, to continue such research may shed light on the crucial area of etiology, which, in medicine, is that branch that attempts to determine the causal origins of disease. An example of this latter would be the putative relation between the age of first pregnancy and the cause of breast cancer later in life.^[14] Without further research, this suggestion may remain indefinitely putative.

Robert Beaglehole agrees with these reasonable suggestions by Logan. Although everyone seems to know the general truth about health inequalities and a correlation with social distinctions, “an appropriate response is hampered by our poor understanding of their underlying causes.”^[15] This is a difficult reality, but it only seeks to illustrate and support the contentions made by Logan with regard to the specific case of child health inequality. Without the proper amount and type of research to be done, it seems difficult to see how this situation of inequality might be improved. Without knowing the prior causes that lead to various ill effects among some social classes, there would seem to be no good way of making forward progress in this regard.

Concluding Thoughts

As Beaglehole notes in his book review, health inequalities are plainly offensive. They may be most offensive to those who work in the medical profession who have the know-how and skills necessary to help any and all (if they could only access any and all), but who are frustrated by a lack of governmental efforts to improve the persistent situation involving a lack of health and access to healthcare. Some steps of various governments (notably in Europe) have been taken to improve the situation, as we have explored briefly in this essay. Yet, as the writers of the brief appearing in the World Health Organization note, more strategic planning and (more importantly) implementation on the parts of governments working alongside various other national organizations may go a long way yet toward improving the overall situation of health inequality. Without significant progress in this area, it is likely that social divisions between classes, races, and ethnic groups will persist.

Bibliography

Beaglehole, Robert. “The Challenge of Health Inequalities” (book review) in The Lancet, London, Feb. 18-24, 206, vol. 367, issue 9510, p. 559-60.

“Poverty and Health.” In Oxford Illustrated Companion to Medicine. Oxford: Oxford University Press, 2001.

Logan, Stuart. “Research and Equity in Child Health.” In Pediatrics. Vol. 12, no. 3, Sept. 2003.

Vega, Jeanette and Alec Irwin. “Tackling Health Inequalities: New Approaches in Public Policy.” In Bulletin of the World Health Organization (WHO), July 2004, 82 (7).

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Footnotes

^[1] Jeanette Vega and Alec Irwin, “Tackling Health Inequalities: New Approaches in Public Policy,” in Bulletin of the World Health Organization (WHO), July 2004, 82 (7).

^[2] Robert Beaglehole, “The Challenge of Health Inequalities” (book review) in The Lancet London, Feb. 18-24, 206, vol. 367, issue 9510, p. 559-60.

^[3] Or a third alternative is whether they could be reciprocal-mutually contributing to the origin and subsistence of each other over time.

^[4] “Poverty and Health,” in Oxford Illustrated Companion to Medicine, (Oxford: Oxford University Press, 2001), pp. 665-9.

^[5] Ibid., p. 665.

^[6] Robert Beaglehole, “Health Inequalities,” p. 559.

^[7] “Poverty and Health,” p. 665.

^[8] Vega and Irwin, “Tackling Health Inequalities,” p. 7.

^[9] Ibid.

^[10] Ibid.

^[11] Ibid.

^[12] Stuart Logan, “Research and Equity in Child Health,” in Pediatrics, vol. 12, no. 3, Sept. 2003, p. 759.

^[13] Ibid.

^[14] Ibid., p. 760.

^[15] Beaglehole, p. 559.