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This essay will discuss the relationship between social inequalities and health care, and how these inequalities affect the quality and quantity of care provided. To begin with, this will be looked at in terms of poverty and its effect on health and then ways in which these inequalities can be challenged. Inequality has a profound effect on the standard of care provided and also the amount of services provided. Different social groups can often find a considerable variation in the services provided to them from others. Access to care is also greatly affected by social background.
Poverty is a way of describing people whose living conditions are poor due to the circumstances they are subjected to, these include: education, housing and employment. ‘People are said to be in poverty if they lack the resources for the diet, activities, living conditions and amenities that are usual for the society in which they live and are excluded from normal social activities' (Townsend 1979). This suggests poverty has a large effect on how people can interact within their community, and is very detrimental to there every day lifestyle. A lot of the factors that cause poverty are out of the individuals' control, or can no longer be changed, and they actually have no power to change their situation. This can cause an unbreakable cycle keeping them and their family trapped in poverty.
Employment status which will lead to families being in a poor financial state has a huge affect on the quality of health. ‘There is a strong relationship between how long people live and the nature of their jobs' (Office for National Statistics 2004). The data showed that there was a significant difference in life expectancy for those in ‘Professional' jobs to those in ‘Unskilled' jobs. This suggests physical health is greatly affected by low paid employment and unemployment. Low level employment will have an impact on their ability to improve their housing and won't support healthy living conditions, such as diet and cleanliness, resulting in a detrimental effect on health. Poverty will often also be seen by poor housing and living conditions, which is linked with employment status. ‘Those living with low income are more likely to suffer from poverty' (Borton 2009). Poor living conditions affect the standard of their housing and the community in which they are part of. Families will often be unable to afford proper amenities such as heating and children may have to share rooms. The crowded conditions and lack of heating will promote poor health as it becomes easier for illness to spread in these circumstances. Whereas those who don't live in poverty will be able to afford housing, food and decent living conditions and this means they are very likely to live a much healthier lifestyle than those in poverty.
Certain social groups can be more at risk of poverty and this can make it more difficult for them to escape. Age can have a large bearing on poverty and the elderly are generally at a higher risk. The elderly are already at a higher risk of health problems but living in poverty can increase this risk even further. Different ethnic groups are also seen to be at an increased risk of poverty. Poverty rates vary considerably between ethnic groups, Bangladeshis, Pakistanis and Black Africans have the highest whereas White British have the lowest (Palmer and Kenway 2007). These statistics are based on income poverty but suggest that being from a different ethnic background has a large effect on your chances of living in poverty. This is difficult to explain but could be to do with immigration and other things such as poor education and an inability to communicate effectively. Family structure and age are the most likely causes of these differences.
The impact of poverty on health can be quite profound. A poor living environment can impact nutrition and in the young could lead to malnutrition and certain nutrient deficiencies. Malnutrition becomes more apparent in areas that suffer from urban poverty (Amis 1995). Although this data is old the condition of malnutrition in areas of poverty is difficult to reverse. It would only be reversed if there was a change in income status or a reduction in living costs. Therefore poverty and employment status still has an impact on nutritional status. Unemployment may cause mental health issues for those it affects. The search for work can have lots of exclusion and rejection; this may lead to feelings of inadequacy and could cause depression. There is statistical proof that in the unemployed there is an increased rate of psychological symptoms that are medically significant (Montgomery, S. M. et al 1999). This means those who are unemployed are at a higher risk of developing mental health problems than those in steady employment. As employment is linked to poverty this shows that people in poverty will be at an increased risk of mental health problems. Relaxation is an important part of a person's life and is very important for healthy living. The stress of a life in poverty can make this all the more important. However due to financial circumstances the activities they chose will often be detrimental to health but are all they can afford. Leaving education early and a disadvantaged life course increase the rates of smoking (Graham, H. Et al. 2006). These are two of the aspects that cause poverty and are linked to increased rates of smoking this means that there will be an increase in long term illness in poverty caused by the effects of smoking and passive smoking. Alcoholism is also strongly linked with poverty and will also cause long term health issues, due to the abusive drinking and its' detrimental effects on the liver and other organs.
Access to health care is also affected by poverty, as deprived areas aren't very attractive areas to work for health care professionals. ‘For these populations access to preventative measures and medical or surgical treatments is very often delayed' (UEMO 2009). Decreased access to health care means certain treatment will be difficult to obtain. This will stop people in poverty being supplied with quality and appropriate care, causing an increase in illness and complications from minor problems.
A lot of social attitudes towards people who live in poverty are very negative. ‘Discrimination is sometimes based on views that people living in poverty are inferior or of lesser value' (Killeen 2008). These attitudes have led to the idea of ‘povertyism' (Killeen 2008). These are the attitudes that those who are in poverty are ‘unemployable' and ‘lazy'. These are very typical stereotypes and need to be challenged within communities. Attitudes can manifest within the health care setting and need to be removed to ensure all patients are being treated equally. To effectively help those living in poverty these attitudes need to be challenged. This can all start in a situation of professional practice, by ensuring all those in our care are treated equally. This requires us as professionals to supply access to services for all especially those at a disadvantage. Challenging attitudes in the community is more difficult as individual professionals but if any negative attitudes are voiced by patients these can be stopped, by explaining how some may find them offensive. As a team of professionals attitudes can be worked on as a unit by trying to change peoples' opinions. This can be done by creating services to tackle things such as unemployment in certain areas. Initiatives like this will work to change negative attitudes and change the way people are treated.
As a physiotherapist when working with people in poverty it is important to acknowledge the stress and strain this will have on a service user. When working with an individual listening to them can be a great help and allow them to relieve a lot of mental stress. The patient may voice certain issues that they may not have a full understanding of and referral to various services then becomes useful. Referral to these services may then allow them to find ways to improve their living conditions and circumstances. The problem of poor nutrition in children, for example, could be helped by referral to a paediatric dietician. This referral allows the parents of a family in poverty to become better educated and improve the health of their children in the short and long term. People who live in poverty will usually be part of a community in similar circumstances. When providing services as a professional this information can be used to help patients in their treatment by allowing them to interact in groups. In physiotherapy practice group work is often used in rehabilitation and other treatments. ‘It can be used in individual or group therapy' (Carlisle 2008). When using group therapy it would be beneficial to group people from similar circumstances together. The patients are then able to share situations and ideas with each other that are relevant. This could include recommending services to each other that are beneficial or just being able to socialise with other people who understand their situation better than the physiotherapist might. Group discussions will also benefit the mental states of patients as they can share and learn from each other's experiences. This will allow patients who are possibly feeling slightly depressed to feel hopeful and optimistic about their future by talking to somebody who has been through the same thing. These reasons make group treatment physiotherapy valuable for helping patients who suffer some form of social inequality.
By investigating social inequalities and linking those to certain health issues, the services that are provided can then be altered to suit local circumstances. When looking at service provision trends in illness relating to the community need to be considered. Using poverty as the example, these areas have higher rates of illness than those areas not living in poverty. Therefore accessible services should be directed at the areas in poverty. Poverty also shows strong links with poor mental health, so services like counselling should be readily available. Other issues like smoking and drinking are common in poverty and would also need service provision. The type of people who live in poverty also needs to be looked at when considering service provision, for example the number of elderly people. Their age would be a restricting factor for them accessing any services. These ideas can be applied to any social inequality, where investigation will allow the correct services to be provided in the correct areas. The services required will differ for different inequalities but the principal is the same for those who live in poverty.
Looking into social inequality it's clear that social exclusion can have a very negative on health care. This is caused by the attitudes of society as a whole and the services that are provided in areas of inequality and deprivation. Different inequalities affect different aspects of health care, but certain inequalities are also linked to each other. This can be seen by the links between poverty and age or ethnicity, and this again will alter the services that are required. Health professionals can help to change these inequalities by working with individual patients, groups of patients and community based initiatives. This will help with the overall aim of providing equal care to all aspects of our very diverse population.
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