1. Global Health Challenges Social Analysis 76: Lecture 5

2. Averages Do Not Tell the Whole Story Defining and Quantifying Inequalities in Health Health Inequalities Correlated with Income Reducing Inequalities Through Health or Other Sectors?

3. Three Examples Child mortality for rich and poor in developing countries Life expectancy across counties in the US Social class differences in the UK

4. Child Mortality: gap between rich and poor Poorest Quintile Richest Quintile

5. Trend for US overall life expectancy at birth, 1961-2000

8. I. Professional etc. occupations II. Managerial and Technical occupations III. Skilled occupations IV. Partly-skilled occupations V. Unskilled occupations Social Class Designation Based on Occupation in the UK

10. Why Are There Inequalities in Health?

11. Why Are There Inequalities in Health, even in a country like the United Kingdom with nearly 100% financial and physical access to healthcare?

12. Averages Do Not Tell the Whole Story Defining and Quantifying Inequalities in Health Health Inequalities Correlated with Income Reducing Inequalities Through Health or Other Sectors?

13. Social Analysis 76 Distribution of Healthy Life Expectancy

14. Inequalities vs. Inequities The term inequality simply refers to a quantity that is unequal across individuals or groups of individuals. Inequity invokes the concept of unjust inequalities.

15. 1. 1.Inequalities in healthy life expectancy due to living without clean water? 2. 2.Inequalities in healthy life expectancy due to tobacco consumption? 3. 3.Inequalities due to extreme sports? Inequities?

16. Total health inequality = Between Group Inequality + Within Group Inequality What Should We Measure?

17. “Inequality in the US has been increasing.” Relative and Absolute Inequalities

18. Distribution of child mortality

19. Averages Do Not Tell the Whole Story Defining and Quantifying Inequalities in Health Health Inequalities Correlated with Income Reducing Inequalities Through Health or Other Sectors?

20. Health and income at the national, community, and household level are highly correlated. Dual causality: poverty causes poor health and poor health causes poverty. Poverty to poor health has been the focus of social epidemiology for a century. More recently, recognize that health may be a key determinant of income growth. Income and Health Relationship

21. Source: Author’s calculations based on World Development Indicators 2003 (life expectancy and Penn World Table (GDP.) Note: Circles have diameter proportional to population size. The Millennium Preston Curve

22. The World Health Chart www.gapminder.org

23. Averages Do Not Tell the Whole Story Defining and Quantifying Inequalities in Health Health Inequalities Correlated with Income Reducing Inequalities Through Health or Other Sectors?

24. Strategies to Reduce Health Inequalities Major debate on the balance of intervention in sectors other than health such as improving educational opportunities or income distribution versus the role of public health and medical care.

25. Often the rich benefit from health system technologies more than the poor – this is true both for prevention and cure. Important agenda is to understand why interventions that might reduce health inequalities often do not reach the poor. Reducing Health Inequalities Through Health Systems

26. Coverage of glasses/contacts, Mexico 2005/6 by state

27. Intervention coverage by wealth quintile, Mexico 2005/6

28. What Determines Effective Coverage of Interventions? Price of health care Perceived need and knowledge Geographic proximity of providers - travel time Cultural and social acceptability of intervention - responsiveness of health systems Availability of necessary technology and resources Technical quality of providers Choice of an intervention Adherence Quality of providers Demand for health care