Module 2

• Definition of Access - Andersen

  Access is the end result of a process flowing from predisposing characteristics and enabling resources ('Potential' access) through need (perceived and evaluated), to ultimate health outcomes (health status and satisfaction)
• Availability (Existence of Service Barriers)


  The relationship of the volume and type of existing services (and resources) to the clients' volume and type of need
• Accommodation (Organisational barriers)


  The relationship between the manner in which supply resources are organised and the expectation of clients.
• Acceptability (Psychological Barriers)


  The relationship between clients' and providers' attitudes to what constitutes appropriate care.
• Accessibility (Geographic Barriers)


  The relationship between the location of supply and the location of clients, taking account of client transportation resources and travel time, distance and cost.
• Affordability (Financial barriers)


  The cost of provider services in relation to the clients' ability and willingness to pay for these services.
• Commerical DOH - Freudenberg

  Structures, rules, norms and practices by which business activities designed to generate wealth and profits influence patterns of health and disease across populations
• Commercial DOH - Kosinka and Ostlin

  Highlight inherent tensions between commercial and public health objectives in consumption, accessibility and affordability of goods and services.
• Upstream or Downstream? Commercial DOH

  Upstream
• Shaping the evidence

  • Shaping research and funding priorities by;
  • Lobbying
  • Financing univeristy programmes and chairs
• Employing narratives and framing techniques

  • Focusing on youth, often directly in schools
  • Focus on individual problem behaviours
  • Being 'part of the solution'
  • Focus on corporate social responsibility
• Constituency Building

  • Promoting or sponsoring efforts beyond their core business
  • Partnership with charities or heath/education-related foundations
• Policy substitution, development and implementation

  • Partnership or voluntary agreement with government
  • Contributing to health policy consultations
• Lobbying


  Previous government positions influencing oncoming policies, despite not being part of the government anymore
• Equality


  Everybody getting the same thing
• Equity 


  Everybody getting something fit for purpose
• Inequalities 


  Measure differences or variations in health or social outcomes
• Differences in heath experiences and outcomes between different populations are according to social gradients. (SEP, area, gender, disability, gender, ethnicity)
• Inequities


  Differences are deemed to be unfair or stemming from some form of injustice.
• Heath inequities of differences in the distribution of resources/services across populations which do not reflect the health needs of the population.
• Relations of equal and unequal power - political, social, economic as well as justice and injustice.
• Equity defined by MOH


  People have differences in heath that are not only avoidable but unfair and unjust. Equity recognises different approaches and resources to get equitable health outcomes.
• P (PROGRESS)

  Place of residence
• R (PROGRESS)

  Race/Ethnicity/Culture/Language
• O (PROGRESS)

  Occupation
• G (PROGRESS)

  Gender/Sex
• R (PROGRESS)

  Religion
• E (PROGRESS)

  Education
• S1 (PROGRESS)

  Socioeconomic status
• S2 (PROGRESS)

  Social capital
• Rate difference - absolute measure

  EGO-CGO
• Ratio Ratio - Relative measures

  EGO/CGO
• Why reduce inequities?

  • They are unfair
  • They are avoidable
  • They affect everybody
  • Reducing inequities can be cost effective
• Inequities in heath outcomes result from inequities in opportunities
• Implications of inequities

  • An unequal society
  • Less social cohesion
  • Less trust between groups
  • Increased stress
  • Reducing economic productivity
  • Poorer health outcomes
• Socio-economic position

  The social and economic factors that influence what positions individuals or group hold within the structure of a society
• Determinants of socio-economic positions

  • Objective
  • Measurable
  • Meaningful
• Measures of SEP

  • Are used to quantify the level of inequality within or between societies
  • May highlight changes to population structures over time, between Census periods or even between generations (Change over time)
  • Are needed to help understand the relationship between heath and other social variables. (Age, Sex, Ethnicity)
  • Have been associated with heath and life changes for as long as social groups have existed
• SEP for individuals

  • Highest level of education
  • Income
  • Occupation
  • Housing
  • Assets and Wealth
• SEP for Population 1

  Area Measures

  • Deprivation (Deciles)
  • Access