Health inequality in the United Kingdom

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There are various factors affecting the health of ethnic minorities in the UK due to health inequalities. [1] The term "BAME" is often used however, the use of this term can be problematic for various reasons, such as an indicating power relations and also having a focus on skin colour. [2] Therefore, this article will use the term ethnic minorities. [2]

Contents

Furthermore, there are numerous factors that may be the cause for these inequalities. [1] Amongst these factors are various social determinants which include living in socio-economic disadvantaged neighbourhoods which impacts on having a lack of finances and resources and poor-quality housing. [1] Additionally, psychosocial determinants also have an impact. [3] This includes impact on mental and physical health. [3]

Diet

Early investigation into inequality in the UK centred on the role of diet. The work of John Boyd Orr was influential. In Food, Health and Income he examined diet in relation to income. His conclusion was that "as income increases, disease and death rate decrease, children grow more quickly, adult stature is greater and general health and physique improve." [4]

Socio-economic status

A gradient of inequalities in society exists, there is a relationship between health in England and Wales for those who have socio- economic status in comparison to those who do not. [1] The better a person's position in society, regarding a person's occupation, housing condition and education, the better their health is likely to be. [1] Unemployment has been associated with rates of morbidity and mortality as well as poor work settings. Health inequalities are influence by finances and resources. Inequalities in income impact on health inequalities. [5] The financial situation of a person influences choices that impact on their health, food that they buy as well as choices that they make regarding their lifestyle, such as fitness and exercise. [5]

Individuals living in poorer areas are likely to experience health inequalities which impacts on life span, not only is it likely to impact on life expectancy but it also has an effect on quality of life. [1] Housing and neighbourhood conditions are also crucial determinants of health [6] Factors including pollution and living in damp conditions contributes to respiratory health conditions [7]

Psychosocial determinants

There are also direct and indirect effects of stress that contribute to health inequalities [3] High income countries and the social hierarchy is linked to health outcomes [3]

Individuals who experience poor quality of education, low paid occupations in poor settings, poor housing are more likely to suffer from stress. [1] The longer they are in these situations of disadvantage the more likely they are to suffer mentally. [1]

In contrast to this, there is also research conducted within the UK indicates that in fact ethnic minorities have better mental well-being due to cultural factors that enable individuals to have more support, including strong family relations. [8]

However, due to vast research indicating the impact of social structural determinants on mental wellbeing and due to recent the social inequalities within the UK being further exacerbated due to the COVID-19 pandemic this research is ongoing [9]

COVID-19

The spread of the COVID-19 virus has impacted the lives of ethnic minority groups in the United Kingdom. Ethnic groups have been found to be at a higher risk of certain health conditions and, according to the 1999 Health Survey for England, minorities are more likely to report unfavorable health status in comparison to the majority population. [10] In addition, minorities have a higher risk of contracting the virus due in part to living and working in more dangerous conditions than the White population in the UK. [11]

These factors indicated an increased chance of ethnic minorities having worse reactions after being infected with COVID-19 than other ethnic groups. This conclusion was confirmed and reflected in mortality studies that reveal ethnic groups have up to a 50% greater chance of dying from the virus in comparison to the White British population. [11]

At lower-level occupational fields that are more likely to have contact with infected individuals, 20% of the workers are part of a minority. [11] Ethnic minorities were also at a greater risk of losing their job, leading to financial struggles. When comparing the living condition of minorities versus the majority population, it has been reported that minorities are living in more crowded homes. [12] Overcrowded homes make it easier for COVID-19 to spread among the community, which increases the negative impact and outcomes of the virus within minority groups.

The previous encounters of minorities with the health system in the UK have also impacted the lives of many during the pandemic. Further study has proven that minorities have claimed to have unpleasant experiences with public healthcare as opposed to other ethnic groups. [12] The Unfavorable experiences of ethnic groups have led to a decrease in the presence of ethnic minorities in hospitals. Overall, the pandemic has had a negative measurable effect on the ethnic minorities in the UK.

Interventions

England aimed to introduce interventions to reduce health inequalities, the strategy was based on two steps. [13] In 1999, the first step which involved the Department of Health publishing "Reducing health inequalities: an action inequalities in Health", which was the governments response to recommendations made in the "independent inquiry into inequalities in Health". [13] This included various government policies such as introducing "Health Action Zones", higher pensions, urban housing regeneration and national minimum wage. [13] This was followed by the second step of reducing health inequalities in 2003, "Tackling health inequalities: a program for Action" was published which consisted of targets that were aimed to be achieved by 2010. [13] This programme included various interventions which were aimed at improving the quality of housing and managing risks of poor health by introducing interventions focusing on diet and physical activity. [13] The interventions were effective however the health inequalities were not reduced in terms of infant mortality or life expectancy. [13] Amongst some of the issues were that the interventions were not conducted on a large enough scale to have this impact. [13]

Related Research Articles

Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequities, and face worse health outcomes than those who are able to access certain resources. It is not equity to simply provide every individual with the same resources; that would be equality. In order to achieve health equity, resources must be allocated based on an individual need-based principle.

<span class="mw-page-title-main">Population health</span> Health outcomes of a group of individuals

Population health has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group". It is an approach to health that aims to improve the health of an entire human population. It has been described as consisting of three components. These are "health outcomes, patterns of health determinants, and policies and interventions".

The social determinants of health (SDOH) are the economic and social conditions that influence individual and group differences in health status. They are the health promoting factors found in one's living and working conditions, rather than individual risk factors that influence the risk for a disease, or vulnerability to disease or injury. The distributions of social determinants are often shaped by public policies that reflect prevailing political ideologies of the area.

Diseases of poverty are diseases that are more prevalent in low-income populations. They include infectious diseases, as well as diseases related to malnutrition and poor health behaviour. Poverty is one of the major social determinants of health. The World Health Report (2002) states that diseases of poverty account for 45% of the disease burden in the countries with high poverty rate which are preventable or treatable with existing interventions. Diseases of poverty are often co-morbid and ubiquitous with malnutrition. Poverty increases the chances of having these diseases as the deprivation of shelter, safe drinking water, nutritious food, sanitation, and access to health services contributes towards poor health behaviour. At the same time, these diseases act as a barrier for economic growth to affected people and families caring for them which in turn results into increased poverty in the community. These diseases produced in part by poverty are in contrast to diseases of affluence, which are diseases thought to be a result of increasing wealth in a society.

Multimorbidity, also known as multiple long-term conditions (MLTC), means living with two or more chronic illnesses. For example, a person could have diabetes, heart disease and depression at the same time. Multimorbidity can have a significant impact on people's health and wellbeing. It also poses a complex challenge to healthcare systems which are traditionally focused on individual diseases. Multiple long-term conditions can affect people of any age, but they are more common in older age, affecting more than half of people over 65 years old.

<span class="mw-page-title-main">Social medicine</span> Understanding how culture and larger groups of people shape health procedures

Social medicine is an interdisciplinary field that focuses on the profound interplay between socio-economic factors and individual health outcomes. Rooted in the challenges of the Industrial Revolution, it seeks to:

  1. Understand how specific social, economic, and environmental conditions directly impact health, disease, and the delivery of medical care.
  2. Promote conditions and interventions that address these determinants, aiming for a healthier and more equitable society.
<span class="mw-page-title-main">Food desert</span> Area that has limited access to affordable and nutritious food

A food desert is an area that has limited access to affordable and nutritious food. In contrast, an area with greater access to supermarkets and vegetable shops with fresh foods may be called a food oasis. The designation considers the type and the quality of food available to the population, in addition to the accessibility of the food through the size and the proximity of the food stores.

Race and health refers to how being identified with a specific race influences health. Race is a complex concept that has changed across chronological eras and depends on both self-identification and social recognition. In the study of race and health, scientists organize people in racial categories depending on different factors such as: phenotype, ancestry, social identity, genetic makeup and lived experience. "Race" and ethnicity often remain undifferentiated in health research.

Racial inequality in the United Statesof America identifies the social inequality and advantages and disparities that affect different races within the country. These can also be seen as a result of historic oppression, inequality of inheritance, or racism and prejudice, especially against minority groups.

The social determinants of health in poverty describe the factors that affect impoverished populations' health and health inequality. Inequalities in health stem from the conditions of people's lives, including living conditions, work environment, age, and other social factors, and how these affect people's ability to respond to illness. These conditions are also shaped by political, social, and economic structures. The majority of people around the globe do not meet their potential best health because of a "toxic combination of bad policies, economics, and politics". Daily living conditions work together with these structural drivers to result in the social determinants of health.

<span class="mw-page-title-main">Family homelessness</span> Socioeconomic phenomenon

Family homelessness refers to a family unit who do not have access to long term accommodation due to various circumstances such as socioeconomic status, access to resources and relationship breakdowns. In some Western countries, such as the United States, family homelessness is a new form of poverty, and a fast growing group of the homelessness population. Some American researchers argue that family homelessness is the inevitable result of imbalanced “low-income housing ratio” where there are more low-income households than there are low-cost housing units. A study in 2018 projected a total of 56,342 family households were recognized as homeless. Roughly 16,390 of these people were living in a place not meant for human habitation. It is believed that homeless families make up about a third of the United States’ population, with generally women being the lead of the household.

Mental health inequality refers to the differences in the quality, access, and health care different communities and populations receive for mental health services. Globally, the World Health Organization estimates that 350 million people are affected with depressive disorders. Mental health can be defined as an individual's well-being and/or the absence of clinically defined mental illness. Inequalities that can occur in mental healthcare may include mental health status, access to and quality of care, and mental health outcomes, which may differ across populations of different race, ethnicity, sexual orientation, sex, gender, socioeconomic statuses, education level, and geographic location. Social determinants of health, more specifically the social determinants of mental health, that can influence an individual's susceptibility to developing mental disorders and illnesses include, but are not limited to, economic status, education level, demographics, geographic location and genetics.

Healthcare disparity in Massachusetts refers to the issues in access to, and treatment of, the residents of the state of Massachusetts. Many factors contribute to healthcare disparity, including access, behavioral risk factors, family history, social determinants of health, social and cultural factors, and discrimination in the clinic. There is also a distinction between health disparity, otherwise known as health equity, and health inequality. If one population dies young as a result of genetic or a non-controllable factor, that is known as health inequality. If a population dies young as a result of lack of access to preventative treatment or care once they get sick, that is known as health inequity.

The weathering hypothesis was proposed to account for early health deterioration as a result of cumulative exposure to experiences of social, economic and political adversity. It is well documented that minority groups and marginalized communities suffer from poorer health outcomes. This may be due to a multitude of stressors including prejudice, social alienation, institutional bias, political oppression, economic exclusion and racial discrimination. The weathering hypothesis proposes that the cumulative burden of these stressors as individuals age is "weathering," and the increased weathering experienced by minority groups compared to others can account for differences in health outcomes. In recent years, the biological plausibility of the weathering hypothesis has been investigated in studies evaluating the physiological effects of social, environmental and political stressors among marginalized communities. This has led to more widespread use of the weathering hypothesis as a framework for explaining health disparities on the basis of differential exposure to racially based stressors. Researchers have also identified patterns connecting weathering to biological phenomena associated with stress and aging, such as allostatic load, epigenetics, telomere shortening, and accelerated brain aging.

<span class="mw-page-title-main">Mental health during the COVID-19 pandemic</span> Psychological aspect of viral outbreak

The COVID-19 pandemic has impacted the mental health of people across the globe. The pandemic has caused widespread anxiety, depression, and post-traumatic stress disorder symptoms. According to the UN health agency WHO, in the first year of the COVID-19 pandemic, prevalence of common mental health conditions, such as depression and anxiety, went up by more than 25 percent. The pandemic has damaged social relationships, trust in institutions and in other people, has caused changes in work and income, and has imposed a substantial burden of anxiety and worry on the population. Women and young people face the greatest risk of depression and anxiety.

<span class="mw-page-title-main">Impact of the COVID-19 pandemic on children</span> Overview of the impact of the COVID-19 pandemic on children

A systematic review notes that children with COVID-19 have milder effects and better prognoses than adults. However, children are susceptible to "multisystem inflammatory syndrome in children" (MIS-C), a rare but life-threatening systemic illness involving persistent fever and extreme inflammation following exposure to the SARS-CoV-2 virus.

<span class="mw-page-title-main">Impact of the COVID-19 pandemic on African diaspora</span>

The COVID-19 pandemic has revealed race-based health care disparities in many countries, including the United States, United Kingdom, Norway, Sweden, Canada, and Singapore. These disparities are believed to originate from structural racism in these countries which pre-dates the pandemic; a commentary in The BMJ noted that "ethnoracialised differences in health outcomes have become the new normal across the world" as a result of ethnic and racial disparities in COVID-19 healthcare, determined by social factors. Data from the United States and elsewhere shows that minorities, especially black people, have been infected and killed at a disproportionate rate to white people.

The COVID-19 pandemic has had an unequal impact on different racial and ethnic groups in the United States, resulting in new disparities of health outcomes as well as exacerbating existing health and economic disparities.

Biological inequity, also known as biological inequality, refers to “systematic, unfair, and avoidable stress-related biological differences which increase risk of disease, observed between social groups of a population”. The term developed by Centric Lab aims to unify societal factors with the biological underpinnings of health inequities – the unfair and avoidable differences in health status and risks between social groups of a population - such that these inequalities can be investigated in a holistic manner.

The social determinants of mental health (SDOMH) are societal problems that disrupt mental health, increase risk of mental illness among certain groups, and worsen outcomes for individuals with mental illnesses. Much like the social determinants of health (SDOH), SDOMH include the non-medical factors that play a role in the likelihood and severity of health outcomes, such as income levels, education attainment, access to housing, and social inclusion. Disparities in mental health outcomes are a result of a multitude of factors and social determinants, including fixed characteristics on an individual level – such as age, gender, race/ethnicity, and sexual orientation – and environmental factors that stem from social and economic inequalities – such as inadequate access to proper food, housing, and transportation, and exposure to pollution.

References

  1. 1 2 3 4 5 6 7 8 Scambler, Graham (2012). "Health inequalities". Sociology of Health & Illness. 34 (1): 130–146. doi:10.1111/j.1467-9566.2011.01387.x. ISSN   1467-9566. PMID   21929656. S2CID   22961473.
  2. 1 2 Milner, Adrienne; Jumbe, Sandra (1 August 2020). "Using the right words to address racial disparities in COVID-19". The Lancet Public Health. 5 (8): e419–e420. doi: 10.1016/S2468-2667(20)30162-6 . ISSN   2468-2667. PMC   7373398 . PMID   32707127.
  3. 1 2 3 4 Uphoff, Eleonora P.; Pickett, Kate E.; Cabieses, Baltica; Small, Neil; Wright, John (19 July 2013). "A systematic review of the relationships between social capital and socioeconomic inequalities in health: a contribution to understanding the psychosocial pathway of health inequalities". International Journal for Equity in Health. 12 (1): 54. doi: 10.1186/1475-9276-12-54 . ISSN   1475-9276. PMC   3726325 . PMID   23870068.
  4. ↑ Orr, John Boyd (1936). Food, Health and Income. London: Macmillan. p. 49. Retrieved 24 December 2021.
  5. 1 2 Cutler, David; Lleras-Muney, Adriana; Vogl, Tom (September 2008). "Socioeconomic Status and Health: Dimensions and Mechanisms": w14333. doi: 10.3386/w14333 .{{cite journal}}: Cite journal requires |journal= (help)
  6. ↑ Gibson, Marcia; Petticrew, Mark; Bambra, Clare; Sowden, Amanda J.; Wright, Kath E.; Whitehead, Margaret (January 2011). "Housing and health inequalities: A synthesis of systematic reviews of interventions aimed at different pathways linking housing and health". Health & Place. 17 (1): 175–184. doi: 10.1016/j.healthplace.2010.09.011 . ISSN   1353-8292. PMC   3098470 . PMID   21159542.
  7. ↑ Gibson, Marcia; Petticrew, Mark; Bambra, Clare; Sowden, Amanda J.; Wright, Kath E.; Whitehead, Margaret (1 January 2011). "Housing and health inequalities: A synthesis of systematic reviews of interventions aimed at different pathways linking housing and health". Health & Place. 17 (1): 175–184. doi: 10.1016/j.healthplace.2010.09.011 . ISSN   1353-8292. PMC   3098470 . PMID   21159542.
  8. ↑ Harding, Seeromanie; Read, Ursula M.; Molaodi, Oarabile R.; Cassidy, Aidan; Maynard, Maria J.; Lenguerrand, Erik; Astell-Burt, Thomas; Teyhan, Alison; Whitrow, Melissa; Enayat, Zinat E. (11 April 2015). "The Determinants of young Adult Social well-being and Health (DASH) study: diversity, psychosocial determinants and health". Social Psychiatry and Psychiatric Epidemiology. 50 (8): 1173–1188. doi: 10.1007/s00127-015-1047-9 . ISSN   0933-7954. PMC   4519637 . PMID   25861790.
  9. ↑ Aughterson, Henry; McKinlay, Alison; Fancourt, Daisy; Burton, Alexandra (29 November 2020). "The psychosocial impact on frontline health and social care professionals in the UK during the COVID-19 pandemic: a qualitative interview study". doi:10.1101/2020.11.25.20238766 . Retrieved 29 March 2021.{{cite journal}}: Cite journal requires |journal= (help)
  10. ↑ Alexander, Claire; Byrne, Bridget; Khan, Omar; Nazroo, James; Shankley, William (2020). Ethnicity, Race and Inequality in the UK: State of the Nation. Bristol, UK: Policy Press. pp. 73–92. ISBN   978-1-4473-5126-9.
  11. 1 2 3 England, P. H. "Disparities in the Risk and Outcomes of COVID-19 (2020)." Public Health England: London.
  12. 1 2 Public Health England. "Beyond the data: Understanding the impact of COVID-19 on BAME groups." London: Public Health England (2020).
  13. 1 2 3 4 5 6 7 Mackenbach, Johan P. (1 July 2011). "Can we reduce health inequalities? An analysis of the English strategy (1997–2010)". Journal of Epidemiology & Community Health. 65 (7): 568–575. doi:10.1136/jech.2010.128280. ISSN   0143-005X. PMID   21459930. S2CID   1061631.
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