A teenage pregnancy is said to be any pregnancy experienced by a female in her teenage years below the age of 20 years (Teen Issues, 2009). Teenage pregnancy rates in the United Kingdom (UK) have been a public health concern and have come significantly into the limelight again because of the recent increase in rates. Among Organisation for Economic Co-operation and Development (OECD) developed countries, Office National Statistics (ONS) recorded that United Kingdom and United States are now the highest in terms of teenage pregnancy, while Japan and South Korea have the lowest (ONS, 2009). Table 1 below shows that the number of births per 1000 women in the United Kingdom between 15 and 19.
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This model is based on the theory that the behaviour of individuals determines their health status and also how behaviour or culture influences teenage pregnancy which ultimately leads to the equalities of health i.e. social differences in health-related behaviours due to ignorance and poorly informed choices/information. Income (Bartley, 2004) plays a big role for the choice of behavioural for teenage pregnancy. The question then arises on why unhealthy behaviour such as “early sex” or “unprotected sex” should be affected by low income? A cultural factor which was showed by Stronks et al (2007) plays a very important role in the contribution to unhealthy behaviour.
A multitude of studies suggests that teenage pregnancy is associated with disruption of schooling, social disadvantage and ongoing cycle of poverty, with many teenage mothers having themselves been the child of a teenage mother. Culture is increasingly been seen as a collection of behaviours that occur within defined domains in a community such as the family or institution (Bartley, 2004). In some societies, early marriages and traditional roles are also key factors that could cause teenage pregnancy. In some African countries such as Nigeria where i come from especially the Northern region of the country where teenage pregnancy is practised or as a tradition, it is a sign of fertility and a good thing or a blessing to the young girl and her family. It is also practised in India but it is more practised not only in the urban cities but more in the rural places of the country.
According to information available from the Guttmacher institute (2009) showed that in England, about 55% of women aged 20-24 had their first sexual encounter as teenagers in which teenage pregnancy is normative in some communities in England (Arai, 2007). Countries with a culture that is open about sex and teenage pregnancy always turn out to have low teenage pregnancy such as Holland (Weyman, 2003). The behavioural model is a simplistic way of viewing this situation and Blaster (1990) explained that behaviour only begins to have a protective effect on health when prevailing socioeconomic circumstances are good.
This model has been shown to be associated with material inequality or how material deprivation causes health inequalities such as bad housing (defined as living in temporary accommodation currently or in the past year, living in an over-crowded accommodation and/or living in unfit accommodation), poor/mal-nutrition, environment etc leads to poor health outcome (Barnes et al., 2008; Lynch J. W and Smith G. D et al., 2000). Becoming a parent as a greater impact on women’s employment and earnings (Graham, 2007), and women are also more likely to become a lone parent and devote a larger part of their lives to caring for children alone. Teenage mothers disproportionately comes from economically disadvantaged backgrounds as shown by HM Revenue and Customs in figure 3 which shows that there are more claims for child benefits in the most deprived super output areas.
Inequalities associated with poor housing (damp and mould) has higher rates of asthma, meningococcal infection, and respiratory tract diseases, particularly in teenage pregnancy. Brooke (2009) said that females whose parents are unskilled/manual workers are 10 times more likely to get pregnant as teenagers than females whose parents are professionals.
Material deprivation leads to a reduced ability (Townsend et al, 1988) to purchase items and services and to access amenities. Exposure to one form of material deprivation increases the risk of exposure to others and poor childhood circumstances set children on pathways which bring further exposure to disadvantage in later life. The health inequalities that arise as a result of material deprivation and ultimately teenage pregnancy could be better understood using the life course approach (Smith G. D, 2003). He explained that a health inequality is the result of effects of accumulation over an individual’s life and health outcomes. Reducing teenage births offer an opportunity to reduce the likelihood of poverty and of its perpetuation from one generation to the next.
This model focuses on the psychological effects of stressful conditions at home/work or of low self esteem. It also has come to the fore to help explain contemporary patterns of health. R. G Wilkinson (1996) argued that income inequality has a big effect on health which could lead to depression of the mind and also cause all sort of unhealthy lifestyle to the community such as teenage pregnancy, smoking, drugs, violence, rape, etc. There are 3 observations that showed the existence and importance of psychosocial pathways:
The existence of a gradient in health (between the rich and the poor; between the average person and the rich)
Due to the health gradient in a population (e.g. wealthy countries), there is a tiny relationship between an average income and life expectancy.
The strong existing relationship between income inequality and mortality. A country with a high income inequality would have a low life expectancy when compared to a country with a low income inequality (Marmot and Wilkinson, 2001).
Reckless behaviour by young teenage girls such as smoking, binge drinking and unprotected sex can lead to teenage pregnancy which is strongly related to psychosocial well-being (Christofferson, 2004). The psychosocial model has a way of interpreting an attention in respect to personal psychological thoughts such as maintenance, support, belief and trust. Wilkinson’s work was also supported by Brunner E (1997) in explaining stress and its biological effects with regards to health inequalities. A study which was conducted by Harver and Springer (2005) among female high schools showed that there is a higher level of stress among sexually active females than those that are not sexually active. The effects of relative deprivation, anxiety, social isolation and depression have been observed to have negative influences on the health and health-related behaviours of individuals (Kawachi et al., 2000).
One thing that understands about health inequalities is that it can only be reduced, or tackled if things are done differently because it is persistent, stubborn and will continue to widen its causes. Addressing only the short terms won’t be of help but the long term causes of avoidable ill health. It is very important to identify and understand the effects of the types of pathways/models which all contribute to the existence of health inequalities. It is quite difficult to tell which of the models is the most important but an interesting part of it is that they are all interrelated to each other. However health-related behaviour alone can only partially explain inequalities in health and above all, experience has emphasized how important health inequalities works at the service delivery with an attention on disadvantaged or less well to do groups. There is a saying that says “one size doesn’t fit all” and that all national standards need to be supported to mix with local services in order to meet all diversity of different and local needs.
TACKLING HEALTH INEQUALITIES
Word Count: 2000
Tackling Health Inequalities: Teenage Pregnancy
Socioeconomic inequalities in health have moved up the policy agenda and rather than one approach in tackling teenage pregnancy. These approaches can be understood by ensuring an improvement to the health of the poorest of the poor ones, through narrowing the gaps between those in the poor society and the rich ones that are to do well, to addressing the association between socioeconomic position and health across the population (Graham, 2004). Public health policy in older industrial countries is in a process of change. A narrow concern with promoting population health is giving way to a broader vision of the goals of policy. The broader vision combines a focus on health gain with a commitment to reducing inequalities in its social distribution.
This commitment is the cornerstone of the United Kingdom new public health policies because England’s new strategy seeks ‘an improvement to the health of the lowest class in society and also narrow the gap. ‘Tackling health inequalities’ is a core driver of policy (Secretary of State, 1999). Development in the UK is in step with that elsewhere in Europe. Here, the goals of public health policy have been redefined to give greater emphasis (Gadikou E. E, Murray C. J and Frenk J, 2000; Chang W. C, 2002) to tackling systematic differences in the health of advantaged and disadvantaged of us that are ill, and some of us that are not. In so many studies about tackling health inequalities (Braveman A, Krieger N and Lynch J, 2000; Marmot M, 2001), it has been said that health inequalities are more widely understood to refer, not to variations between individuals, but no differences between social groups.
In most countries, including the UK, health inequalities are shorthand for socioeconomic inequalities in health, whether measured at the individual or are level. Health inequalities which relate to other structures of inequality like gender or ethnicity are typically labeled in these terms as gender inequalities in health, ethnic inequalities in health etc. to tackle health inequalities is therefore to tackle unfairness (Milburn A, 2001). To tackle health inequalities in teenage pregnancy, then good health is the way forward to every individual and not just a particular group or set of people. Decreasing health disadvantages, narrowing health gaps and decreasing health gradients can be used to tackle health inequalities (Graham, 2004)
Tackling Health Inequalities
There has been a very large amount of research on the causes of health inequalities in the world but less evidence on how to reduce, tackle or bring it to a stop. The major aim of tackling health inequalities is to build a more equal distribution of health between the social groups so that every individual gets to benefits. Health inequalities were known in the UK after the Black Report was published. The Black Report showed that there had been an improvement in health across social classes with the help of National Health Scheme (NHS). It is clear that the simplest way to tackle health inequalities is to improve on the social determinants of health in which the World Health Organization (WHO) defined the social determinants of health as ‘the condition in which people are born, grow, adapt, work and age including the health system. The figure below shows a summary of these conditions as proposed by Dahlgren and Whitehead (1991).
Dahlgren G. and Whitehead M. (1991)
In UK in the year 1980 when the Black Report was first produced on the issues of health inequalities. Sir Michael Marmot who is an epidemiologist at University College London, published an article on the relationship between health and poverty on the Fair Society, Healthy Lives. He described his article Fair Society as a social gradient in health. Michael Marmot said that the causes of health inequalities includes lifestyles such as smoking which remains more common, drug abuse, obesity, is increasing fastest, teenage pregnancy, amongst the poor in England on the study The Economist. Tackling health inequalities is described as a commitment ‘to break the link between poverty and ill health’ and ‘also improve the health of the lowest class’ (Millburn A, 2001).
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Reducing Health Disadvantages
At one end of the continuum, health inequality describes the poor health of poor groups and communities. Hansard (1998) said health inequality is the link between poverty and ill health. In this perspective, health inequality is a concept which captures the health consequences of poverty. Health inequalities are the health disadvantages which result from social disadvantage. It is an understanding of health inequalities which is in line with the government’s commitment goal ‘to make health better to the poor’. It is an important policy goal in which poor groups and poor communities endures rates of morbidity and mortality which the rest of the population has left behind (Townsend and Davidson, 1982; ONS, 2001).
There is a powerful moral argument for tackling these absolute health disadvantages. It is an argument which asserts that health is a basic need which no one should be unnecessarily denied. It is ‘a very elementary freedom in the sense that there should be an ability to survive rather than succumb or give way to death’. It is a moral position which puts the health of the (global) poor at the top of the policy agenda. World Health Organisation (WHO, 1999) reported that ‘first and foremost, there is a need to reduce greatly the burden of excess mortality and morbidity suffered by the poor’. In a country as rich as the UK, there are few who would not regard the poor health of poor communities as compromising the elementary freedom to survive. Average standards of health achieved two decades ago should be achievable by the poorest now.
Defining health inequalities as health disadvantages aligns public health policy with other elements of the government’s welfare programme. It provides a bridge between the public health and social exclusion agenda, steering both towards interventions targeted at groups vulnerable to social disadvantage. However, while offering policy advantages, defining health inequalities as health a disadvantage is not without its problems. It turns socioeconomic inequality from a structure which impacts on all to a condition to which only those at the bottom are exposed. It is the lowest socioeconomic groups and the poorest communities who are ‘suffer the outcome’, ‘health inequalities which is the lifestyle of the people and from low income, poor education, bad housing, poverty, pollution, low educational standards, and joblessness’ (DoH, 1998). Firstly, tackling health inequality is not a population wide strategy but it is one confined to sub-groups which make up a relatively small proportion of the population. Secondly, tackling health inequality does not extend to bringing levels of health in the poorest groups closer to the national average. In a society where overall rates of health are improving, absolute improvements in their health maybe sufficient to narrow the gap between the worst and better off. As a result, better health among the poorest group has been associated with a widening gap in life expectancy between the bottom and the top.
Narrowing Health Gaps
At the mid-point on the continuum is a position which focuses not only on the poor health of poor groups but also on their health relative to other groups. Here, health inequalities are defined in terms of health gaps. The Chief Medical Officer (CMO England, 2001) refers to health inequality in terms of ‘the gap in health between the best off and the worst off in the society’. The targets for tackling health inequalities, however, adopt a different formulation of the health gap in terms of the health differentials (DoH, 2001) those in the poorest circumstances and the average for the population. The health gap is a measure of health inequality widely used in research to compare the health of those at the extreme ends of the socioeconomic hierarchy. This concept of health inequality is an important driver for policy which draws attention to the fact that population averages mask wide differences in health between social groups. The moral case for addressing health gaps is enshrined in the constitution of the World Health Organisation (WHO). It suggests that, in any given society, those in the best health set a standard which all should be able to enjoy. If this is so, it is those in the poorest groups who face the most profound denial of their fundamental human right. This has been an important focus of equity-oriented public health strategies and in England, health inequality targets are health gaps targets (Botting, 2007).
Narrowing health gaps therefore represents a more ambitious goal than remedying health disadvantages. This measure/concept of health inequality is an important driver for policy making which magnets attention to the fact that the society averages mask wide differences in health between groups. As the national average improves, narrowing gaps requires special efforts to ensure that figures (DoH, 2002) are not only keeping up, but closing the inequality gap.
Reducing health gradients
To further the continuum, health inequalities as an issue in the UK and other European countries is not only about the differences in health between the good, the bad and the ugly but instead, the relationship between socioeconomic position and health in a systematic way. Reduction in health gradients have endured across epidemiological periods, proofs in the 19th century where infectious/communicable diseases were really the major cause of death but now, chronic or Cardio-Vascular disease (CVD) diseases has come to stay to take over.
Health inequalities follow a social gradient and to tackle this socioeconomic gradient in health is really a challenging policy (DoH, 2002). The moral case for tackling socioeconomic gradients lies in the moral equality of people with respect to health and just as World Health Organization constitution states, the highest attainable standards of health (WHO, 1948) should favour everybody regardless the colour, race, religion, belief, socio and economic conditions and this principle has long guided Public health in England. A socioeconomic differential has a focus compared to social disadvantages which widens the frame of health inequality policy in three ways:
The research for what causes health inequality in the society in a systematic difference in life chances, the kind of lifestyles they live and living standards with people’s unequal positions in the socioeconomic hierarchy
Tackling health inequalities becomes a population-wide goal to improving health which involves everybody.
Reducing health gradients provides a comprehensive goal to one that subsumes remedying disadvantages and narrowing health gaps within the broader goal across socioeconomic groups.
Reduction in socioeconomic gradient in teenage pregnancy, there should be an improve at a faster rate to health in other socioeconomic groups and policies to remedy health disadvantages, closing the health gaps and reduce health gradients need to be pursued in tandem.
The story of health inequality is clear because the poorer you are, the more likely you are to be ill and to die younger. The recent rise in teenage pregnancy rates calls for urgent action to reduce or stop the rise and also initiate a decrease in these rates. To effectively tackle teenage pregnancy, health inequalities related to teenage pregnancy need to be tackled; the root cause of these inequalities need to be tackled. Health inequalities affect everyone and are avoidable (Woodward & kawachi, 2000). The key factors for tackling teenage pregnancy are:
Engagement of delivery partners;
Sexual health advice service;
Prioritisation of sex and education in relationship.
Health inequalities are also increasingly been seen as an injustice (Graham, 2004). In other words, good health is the right of every individual and not just for a particular group or groups of people. These concepts which can be used to tackle health inequalities can be complementary rather than mutually exclusive.
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