Psycological and Sociological Concepts 2

8/21/2019 Psycological and Sociological Concepts 2

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Psychological and Sociological Concepts1

Social contexts, ethical issues and inequalities in Health

The aim of this paper is to explore the relationship between social contexts and

ethical issues, mainly the implications for addressing inequalities in health status and

access to health care. Dimensions of inequality overlap and reinforce each other as

Graham !""#$ asserts, but while researchers debate about what predisposes

certain social groups to health inequalities, most researchers choose to accept that

health inequalities are a result of a combination of pathways %en&eval, !"'#$.

(ertain )ey terms will be used in the proceeding paper, which include health status,

health inequalities, access to health care, and social inequalities.

Health Status has a range of varying definitions. *ne definition can be defined as

+the impact of disease on patient function as reported by the patient or the +quality

of life as experienced and perceived by the patient -umsfeld, Health Status and

(linical ractice$. /nother definition of health status is that it +is a holistic concept

that is determined by more than the presence or absence of any disease. 0t is often

summarised by life expectancy or self1assessed health status, and more broadly

includes measures of functioning, physical illness, and mental wellbeing /ustralian

0nstitute of Health and 2elfare, Health Status$. 0t would seem then that health status

has a contextual relation to wellbeing as experienced by the individual, in addition to

it being a sub3ective measure of a certain quality of life. -egardless of the economic

status of a country, whether industrialised or poor, the 2orld Health *rgani&ation

2H*$ reports that indigenous people living in those countries en3oy a lower health

status in comparison to the overall population 2H*, 0ndigenous peoples4 right to

health status$.

The term health inequalities is usually used in the context of referring to differences

in the health of social groups who occupy disproportionate positions in society. 0n

other words, the term can be used to understand inequalities in the health of different

socioeconomic groups, where one group has an advantage over another and is

usually based on factors lin)ed to their access to economic resources Graham,

!""#$. 0n this context, health inequalities are lin)ed to an individual4s position on the

proverbial socioeconomic ladder. This means that socioeconomic positions of

individuals are based on social hierarchies usually built around factors of occupation,

education and income and will further predispose those individuals into falling within

Monique Mavronicolas


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socio groups based on these factors. These factors will in turn influence their quality

of life and standards of living. The higher up the socioeconomic ladder, will often

mean that the individual will have increased access to certain resources based on

the fact that they have disposable income and for example, the freedom to choose a

better quality of health care. Graham !""#$, moreover draws a distinction between

social inequalities and socioeconomic inequalities. The former usually refers to

ethnic inequalities in health, gender inequalities in health etcetera, while the latter

refers to the individual4s place in the hierarchies built around education, income and

occupation. 5urthermore, in the context of the 67, occupation is the single most

important measure of socioeconomic inequality.

(ertain ethical questions can be posed, such as8 should individuals of lower

socioeconomic status necessarily deserve fewer options when it comes to choosing

health care than say, an individual higher up the same ladder with an occupation

which affords greater financial rewards and associative benefits9 /fter all, despite

the 6nited States of /merica being a first world country, it is one of :; countries

whose constitutions do not guarantee their citi&ens any )ind of health protection

2heeler, !"' one highlighted as sometimes being +the single

most important obstacle > is one which 2H* identifies as being tied to the +gender

picture. The fact that men and women are different from each other, for example in

some cultures men wearing trousers and women wearing s)irts, means that the

practice in and of itself does not favour one sex over the over. However, the

distinction that gender norms and values give rise to gender differences, in certain

cultures, has the distinct possibility of translating into gender inequalities where menand women are viewed differently and are therefore treated disproportionately. The



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implications of these gender differences and inequalities mean that where there is a

difference in status among men and women, possibly giving more rights to one sex

over the other, within this context, could disproportionately affect their access to

health care 2H*, 2hy gender and health9$.

0n a !"'< report aimed at improving public health and compiled for local authorities

within the 6nited 7ingdom, nine )ey areas were identified in terms of improving

health and reducing health inequalities. These areas cover the local authority4s

statutory duties towards the following nine areas? (hildren and young people4s

services, supporting schools, helping people find 3obs and stay in wor), active and

safe travel planning, providing warmer and safer homes, access to green and open

spaces which include sports and leisure services, helping to develop strong

communities, wellbeing and resilience, effective public protection and regulatory

services and dood special planning to improve health. The 7ing4s 5und, !"'


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ethnicity. These three categories have been briefly referenced and contextualised at

the outset of this paper. 0n terms of gender, the aspect of gender inequality was

highlighted as giving disproportionate rights to one sex over the other. 2H* further

highlighted this as potentially being the single most important obstacle, albeit in

terms of access to healthcare9 /s far as environmental determinants are concerned,

gender would more accurately be categorised as socio1cultural in nature. Gender

however can also contribute to access to health services where gender norms place

an embargo on women driving. 0n certain cultures for example, it is forbidden for

women to drive and in terms of access to healthcare this would in turn affect their

own as well as those dependant on them for care. -egarding social class or

socioeconomic factors, it was established that income, occupation and education

affected the distribution and access to healthcare. @astly, in terms of ethnicity, 2H*

identified indigenous people, regardless as to whether they existed in industrialised

or poor countries, as having a comparatively lower health statuses compared to the

overall population.

2hen there is diversity in healthcare practice over a broad scale of patient

demographics, given the absence of proper leadership and team wor)ing, this

potentially creates a variation in care standards which can negatively impact qualityand safety. Through clinical governance, efforts have been made to create a practice

culture, focusing on meeting patient needs and being accountable for the standard of

patient care provided. This in turn provides accountability to the public. 5or example,

one of the three essential features incorporated into the core competencies of the

G training curriculum of the 674s =ational Health Service, is that of attitudinal

features. 2hat the attitudinal features centre around are values, feelings and ethics

and the impact this will have on patient care between the practitioner and the patient.

Specifically, this could include the practitioner admitting when an error has occurred

and apologising for failings in the delivery of care -oyal (ollege of General

ractitioners, !"'"$.

Staff wellbeing has to do with care infrastructure and demands on staffing, where

healthcare staff report high demands on their time, which in turn has a negative

causal relationship between staff delivery and patient care and affects the perceived

quality of that service delivery both from the professional4s perspective and from thepatient$. The outcome of the !"'! study suggests that for a good patient experience,



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there needs to be enhanced staff wellbeing. The higher the demand on the staff, the

more stress they experience which is coupled with exhaustion and a decrease in 3ob

satisfaction. (ontextually, to use one example from the study surrounding the area of

elderly care, in this specific setting, staff members were found to have poor relational

care and failing to +connect with individual elderly patients =ational 0nstitute for

Health -esearch, !"'!$.

@anguage barriers in terms of cultural1environmental factors affecting quality of

patientAhealthcare professional interaction, language barriers will briefly be

discussed. 0n particular, language barriers which affect access to healthcare as

experienced by migrants and asylum see)ers within the 67. Buantitative evidence,

although limited, suggests that notwithstanding the mental and physical impact of

war which some asylum see)ers settling in the 67 have experienced from their own

countries, language barriers attribute to reduced access to health on the following

levels? inadequate information, unfamiliarity with the healthcare systems in the 67,

insufficient support in interpreting and translating for people with limited Cnglish

fluency, confusion around entitlement, and cultural insensitivity of some front line

care providers. Cven something as seemingly unimportant as regional accents, could

create a barrier for the migrant in understanding the healthcare practitioner andtherefore have a negative impact on health delivery. Buantitative information from

these studies also revealed that certain ris) factors for maternal mortality also

increased and was particularly high among mothers of /frican1(aribbean and

a)istani ethnicity ayaweera, !"'#$.

0n the next section of the paper we will focus on -ole and impact of social

inequalities around8 health beliefs, lifestyle and ris), class, gender, culture and

ethnicity, ageing, family and poverty, in view of the social contexts of inequalities of

health, the impact and role around the following determinants will be described and

discussed? health beliefs, lifestyle and ris), class, gender, culture and ethnicity,

ageing, family and poverty.

2hile loo)ing at culture and ethnicity, within the context of health in the 6nited

7ingdom, studies have shown that blac) and minority ethnic %EC$ groups are

disadvantaged to the extent that they are far more li)ely to live in poverty, with an

income of less than ;" per cent of the median household income, compared to that



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of white %ritish people. 2hat the implications of these statistics reveal, is that when it

comes to health, these %EC groups are more li)ely to be affected by ill health and

be affected earlier$ than white %ritish people by comparison. This evidence draws on

socioeconomic inequalities which impact these minority groups, but what it also

draws on are determinants lin)ed to access to healthcare, which the reports also

indicate are lin)ed to barriers facing %EC groups 0nstitute of -ace -elations,

overty Statistics$. (ontinuing with the topic of ethnicity, earlier in this paper,

attention was also drawn to studies which highlighted the plight of asylum see)ers

and immigrants where %EC groups were shown to be more susceptible to maternal

mortality which faces mothers during childbirth. Given these examples, it is worth

drawing attention to a point which was noted at the outset of this paper, which is that

dimensions of inequality overlap and reinforce each other. The interconnectedness

of these inequalities are all the more evident and can be shown to overlap culture,

ethnicity, family and poverty.

Cthnicity is lin)ed to health beliefs. Cthnic diversity can lead to issues of ethnic

inequality which will directly impact health and the delivery of healthcare. 0t was

noted earlier that cultural insensitivity of some front line health wor)ers towards

migrants and asylum see)ers, were reported in studies. Ta)ing a closer loo) athealth beliefs and the religious views which drive these beliefs, it is worth exploring

the social contexts of certain health beliefs which may include, blood transfusion and

organ transplantation, termination of pregnancy, contraception and circumcision.

=HS staff are required to be trained and cognisant of the fact that ehovah

2itnesses a small (hristian sect$ deem it unacceptable for one of their own to

undergo a blood transfusion and organ transplantation. 0n this cultural1religious

setting, these health beliefs could impede the first priority of a physician, which in an

emergency situation, is to save a life. Should the life of a child of a ehovah 2itness

be in peril, and the parent refuse a life1saving blood transfusion or an organ

transplant for their child, it is possible to have the child made a ward of the court to

give the court the right to ma)e that decision. /bortion or termination of pregnancies

is something which is strongly opposed in certain religions. Healthcare professionals

need to be aware that it is ethically not acceptable to impose their own beliefs or

views on these patients who hold such health beliefs. /nother example of a religious

group who hold health beliefs is that of -oman (atholics who are strongly opposed



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to contraception. -oman (atholics do not permit barrier methods of contraception

which include condoms, hormonal contraception or 06(Ds. 2hen it comes to

circumcision, which forms part of some faiths such as udaism and 0slam, there is

sometimes some ethical concern among doctors that the child cannot give informed

consent to the procedure and especially if the procedure is performed for non1

medical reasons outside of the =HS, the ris) of potential complications

atient.co.u). Cthnic Eatters$. These few factors which were briefly discussed, not

only pertain to health beliefs, but potentially also to lifestyle and ris). Since the term

belief is also meant to include religious and philosophical belief, it should technically

also affect one4s life choices and the ris)s which accompany these life choices. The

protected characteristics of the Cquality /ct which was brought into force in !"'",

brings together a number of existing laws with the aim of ma)ing %ritain a fairer

society. These specific protected characteristics are protected by law and include

age, disability, gender reassignment, marriage and civil partnership, pregnancy and

maternity, race, religion and belief, sex and lastly sexual orientation Cquality and

Human -ights (ommission, rivate and ublic Sector Guidance$.

Despite legislative protection, many ethnic minority groups still experience social and

health inequalities imposed by their own religious leaders and families, while beingciti&ens of or resident in the 6nited 7ingdom. /n example of one such cultural and

religious context, specifically where culture and religion overlaps with a lifestyle ris)

and at the same time being in conflict with legislative protection, is that of female

genital mutilation 5GE$. 5GE is a procedure which intentionally alters or causes

in3ury to the female genital organs for non1medical reasons. 6nli)e circumcision in

boys or men, there is reportedly no health benefit for either girls or women. 0t is a

practice which is mostly carried out on young girls between infancy and the age of

fifteen and carries severe health complications and ris)s which include severe

bleeding, later potentially developing cysts, problems urinating, infertility,

complications in childbirth and potentially and increased ris) in infant deaths at birth.

0t is a procedure which is not carried out by =HS staff, but instead by traditional

circumcisers 2H*. 5emale genital mutilation$. Despite protection afforded to

individuals living in the 67, 5GE practices still occur within minority groups. 2ith

enough education and awareness, the impact of health inequalities li)e 5GE has

received enough attention to warrant F


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the problem. 0nternationally, combined efforts have also received similar

endorsement Department for (ommunities and @ocal Government, 5unding to

prevent female genital mutilation and forced marriage$.

/nother social inequality determinant which merits reference and one which is

incidentally also protected by the Cquality /ct of !"'", is that of age. 2hen buying

goods or using services, the Cquality /ct includes protective provisions which cover

direct discrimination, indirect discrimination and harassment related to age. The aim

is to provide older people with equal rights as that afforded to a younger person,

whether this may be with regards to gaining access to a gym or a nightclub, buying

goods or simply protecting the older person from offences 3o)es or remar)s.

Social inequalities also pertain to class. *therwise )nown as the great class divide,

the term ties in economic status and a related social hierarchy, which already

referenced earlier in this paper, includes occupation, education and income. The

increasing social class divide has been an issue observed by government and local

authorities. The =HS for example, which draws its statistics from the 7ing4s 5und

research studies, observes health among the social classes in the 67 and purports

that the so1called middle class is ma)ing more informed health decisions and

refraining from certain negative health habits which the lower socio1economic

classes are failing to implement. The data further suggests that negative health

habits such as smo)ing, sedentary lifestyle and excess alcohol consumption, which

can lead to disease and early death, is more li)ely to be practiced by social groups

lower down the social ladder. The more educated a person was, the more li)ely they

were to have better financial resources and the more li)ely to also engage in a

healthier lifestyle Hope, !"'!$.

0n conclusion, this paper has successfully explored social contexts addressing

inequalities in health status and access to health care. 0n addition, it has managed to

establish that socioeconomic positions of individuals are based on social hierarchies

usually built around factors of occupation, education and income. 2hile the scope of

this paper was not to provide answers to ethical questions around social and health

inequalities, it managed to establish certain principles, for example that ethnicity is

lin)ed to health beliefs, that the quality of interaction between professional and



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Psychological and Sociological Concepts

patient is influenced by factors such as the quality of the healthcare, staff wellbeing

and language barriers and that class inequalities are directly lin)ed to lifestyle habits.

-eferences

/ustralian 0nstitute of Health and 2elfare. Health Status. /vailable at

http?AAwww.aihw.gov.auAmale1healthAhealth1statusA accessed '! anuary !"'

%en&eval, E. et el. !"'#$. How does money influence health9 /vailable at

http?AAwww.3rf.org.u)ApublicationsAhow1does1money1influence1health accessed '!

anuary !"'

Department for (ommunities and @ocal Government, 5unding to prevent female

genital mutilation and forced marriage. /vailable at

https?AAwww.gov.u)AgovernmentAnewsAnew1funding1for1female1genital1mutilation1and1

forced1marriage1prevention accessed '! anuary !"'

Cquality and Human -ights (ommission. rivate and ublic Sector Guidance.

/vailable at http?AAwww.equalityhumanrights.comAprivate1and1public1sector1

guidanceAguidance1allAprotected1characteristics accessed '! anuary !"'

Graham, H. !""#$. Socioeconomic 0nequalities in Health in the 67? Cvidence on

atterns and Determinants. /vailable at http?AAdisability1

studies.leeds.ac.u)AfilesAlibraryAgraham1socioeconomic1inequalities.pdf accessed '<

anuary !"'

Hope, . !"'!, /ugust !


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Psychological and Sociological Concepts1!

=ational 0nstitute for Health -esearch. !"'!$. Cxploring the relationship between

patients4 experiences of care and the influence of staff motivation, affect and

wellbeing. Southampton, 6nited 7ingdom? Eaben, . et el. /vailable at

http?AAwww.netscc.ac.u)AhsdrAfilesApro3ectASD*I5-I":1':'1!'

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Psycological and Sociological Concepts 2