Determinants of Health Inequity and Significance to Public Health

The move to promote social justice extends that of public health service in what we now deem as eradicating ‘health inequity. ’Contemporary public health has now evolved such that the scope not only covers merely that of sanitation, diet regulation, disease treatment and quarantine/control but also, on the deeper scope, finding roots of the socioeconomic problems associated with morbidity, mortality and the likes and eliminating or targetshooting the cause. Such resolution would necessitate finding out the fundamental causes of the differential health determinants along the scope of social gradient.

Cohort studies on mortality and ‘deprivation’ used to analyze the relation on conditions between populations with different socioeconomic statuses and Chalmers and Capewell (2001) reveals that deprived people die from the same conditions as affluent people but earlier in terms of years or lifespan. But is deprivation merely a way of reducing the elements of health inequity?Scott (2005) illustrated the “layman” analysis on health inequity in the US. As a first world country, the economic state is considerably well-off compared to other states but there exists disparities in health care which is embedded both in the concurrent social system and the economic and health care policies.

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Scott exemplified the ‘disparities’ using three persons from different social strata with heart disease. It is not known if the ‘personas’ used by Scott were ‘real’ or ‘factual’ but the personas—John Miele (upper class Manhattan architect), Will Wilson (middle class office worker), and Ewa Rycnzac (lower class housekeeper) —do illustrate a window of social ladder and take us deeper into retrospective of the degree of health care accession and social approach these ‘personas’ are receiving.Classes predetermine the fate of health of the members of the state. The differences between accessions of health care are blatant; upper class John would have more chances of being healthy or, on the least, more liable to have the best of health care compared to Wilson and Ewa. Several elements are directly associated with the role of class in the health circumstances, ‘heart attack’, of the three personas: (a) location and accession to the best and afforded health service available; (2) education and income associated to health care accession; and (3) stress based on job types and control(4) social and networking and support of families and relatives. The ‘advantageous’ state is directly related to health outcomes and probability of survival.

Herein, the high socioeconomic status enjoyed by Wilson gives him the capacity to act on his disability. In retrospect, there would be depreciation of ‘capacity’ or ‘advantage’ as the individual climbs below the social ladder.We note here that socioeconomic status and social gradient denotes ‘relativity’ (Lynch 2000) in health equity. Thus, we can say that there is an empirical element in this particular social injustice. Scott (2005) merely enunciated perceptions of health inequity and did not dwell deeper into the structural causes of inequality. What is exactly the linkage between socioeconomic statuses (SES) and social gradient on public health?According to Lynch (2000), the causal relation between income inequity and health can be best explained by neomaterial interpretation —differential accumulation of exposures and experiences that have their sources in the material world—and differences in individual income. Herein, the neomaterial interpretation dabbles on a the thought that the conglomeration of ‘negative exposures’ and ‘lack of resources’ held by individuals, along with systematic underinvestment across a wide range of human, physical, health, and social infrastructure.

Lynch’s explanation reveals not only the an explanation of health inequity but also the aggravation of several social dilemmas which, naturally, pulls social justice down. Additionally, it is also noted here is that Lynch (2000) disposed the idea of psychosocial effect to explain the social crux.Marmot (2002) the epidemiological perspective on health inequity and Lynch (2000), he also stipulated the role of ‘income’ or ‘resources’ in health inequity. He added that:…income is causally associated with health through a direct effect on the material conditions necessary for biological survival, and through an effect on social participation and opportunity to control life circumstances (p. 31)He attributed the health inequity to poor material conditions and lack of social participation. Poor material conditions have been atypified above in the case of Scott (2000) and the different personas that he used to illustrate ‘dis/advantages’ within the social ladder.

Marmot (2002) explained this ‘resource availability’ in terms of threshold; an individual and his ability to become a recipient of health care [services] indirectly depends on the range of resources. A typical resource is the income of the individual. Incomes relatively determine the amount of ‘spending’ or investments individuals attribute to health care.Poverty is, again, not the cause of health inequity.

Other factors like ignorance, condition/type of the immediate community, and other exogenous factors (e.g. disease-related factors) correlate directly to health inequity. Although Marmot (2002) refused to acknowledge that it may also stem from ‘deprivation’, I contend that it is affected by it.

Suffice it is to say that the standard of living is indirectly affected by resources then ‘deprivation’ affects public health.What the government, the public and all the individuals concerned should accomplish is to utilize the knowledge on fundamentals of health inequity, to create intervention tactics to combat the problem. In an attempt to reduce the effects of the destructive social gradient pre-existing within the community, Marmot (20002) exaggeratedly suggested ‘income redistribution.’ The approach was obviously non-feasible and non-pragmatic and would defy the economic and political foundations of the state. What would be more feasible is creating policies that would, on the least, reduce the gaps between the advantageous ‘higher income’ strata and the lower echelons of the society.

Author: Raul Wells


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