Social Inequalities, Health Determinants, and Government Initiatives

In this assignment I will start off by analysing how social inequalities influence the life chances and health status of individuals. I will do this by referring to Dahlgreen and Whiteheads (1993) social determinants of health theory. I will choose a number of social determinants displayed within the case study provided and discuss how these have impacted on the life chances and health of the people within the case study. I will also include reports and statistics that discuss the social inequalities that come from these determinants. I will then move on to critically discuss how government and local initiatives aim to improve the quality of life for service users with a specific long term heath condition, the health condition chosen will again be one that is present within the case study.

Main body 1

Dahlgreen and Whitehead (1993) believe that there are a number of social factors that determine and influence an individual’s health (Annex A). They are known as Social Determinants of Health and they can range from a number of factors that are inherent in an individual including their own behaviours and choices, as well as community and national and socioeconomic factors (Dahlgreen and Whitehead 2003) In 1980, a report was published stating that there were major inequalities regarding health due to the variance in social determinants between different communities in society (Townsend, 1980).

Throughout the case study there are a number of social determinants that can be identified. One of them is unemployment with the UKs unemployment rate estimated to be around 4.8% (Office for National Statistics, 2021). Marmot (2008) states that unemployment has a significant impact on life expectancy and the quality of health that an individual has as many factors such as good nutrition, participation in social activities, environmental surrounds and some aspects of healthcare and education rely on financial status and income, consequently disadvantaging those in financial poverty. Eisenberg (1938) and Rueda (2012) revealed that continued unemployment can cause an individual to become more emotionally unstable and generate a decline in health. This can be seen within the case study in regards to Jack as he is showing signs of depression due to his ill health and unemployment. Those who are unemployed are more likely to have impaired mental health such as depression, anxiety and stress (Dean, 2009), whereas evidence shows that there is a positive correlation between employment and a better quality of physical and mental health as well as having more self-confidence, a better self-esteem and generally being happier (Ross, 1995). Studies show that higher levels of depression are a result of unemployment (Montgomery, 1999) (Frese, 1987), as well as poor mental health contributing to the difficulty of becoming employed (Butterworth, 2012), this can be demonstrated by Anika, as she has struggled to maintain work due to her poor mental health. Unemployment is more predominant within the younger generation with 7.7% of 16-19 year olds and 6.8% of 20-24 year olds being unemployed, this compared to only 3% of those aged between 25-34 years (Health Foundation, 2021). Anya may also be affected by her parents’ unemployment as it shown that children growing up in workless households are almost twice as likely to fail their education and developmental needs compared to those raised in working families (Department of Work and Pensions, 2017).The loss of or lack of income for those unemployed may result in individuals reducing the quality of their living standards, which can again, consequently have a negative impact on ill health and poor mental health (Bjorklund, 1985).

This leads onto another social determinant present which is the quality of housing in regards to Jack and Anika. Housing is determined as an important social determinant of health as it is recognised that a lack of housing or a poor quality of housing can negatively impact on an individual’s health and wellbeing (WHO 2008). Low-income households face both housing and social inequalities due to both high housing costs and location of area (Kelly, 2013). Evidence shows that those living in a lower income household are less likely to uphold the quality of their living standards due to the financial burden and are more likely to live in areas of deprivation resulting in social inequalities such as lack of access to services, fewer employment opportunities and potentially higher crime rates (The European Foundation for the Improvement of Living and Working Conditions, 2008) (Poortinga, 2008). Poor housing conditions are known to be associated with a number of health conditions such as asthma and respiratory infections (Kreiger, 2002). These health conditions are commonly associated with damp, mould and inadequate heating (Fisk, 2010) (Braubach, 2011) all in which are displayed within Jack and Anika’s home. Jack has had asthma since the age of 14 which is progressively getting worse, this could be due to the conditions in which he is living. Damp conditions within a household are closely associated with poor mental health such as depression and anxiety (Hopton, 1996). 29% of the lowest income quartile households within the EU have damp or leaks compared to the 8% of those within the highest quartile (The European Foundation for the Improvement of Living and Working Conditions, 2008).

Education is an important factor regarding social determinants as it is strongly linked with health behaviours and outcomes. Individuals with a better education are less likely to suffer from long term diseases or suffer from poor mental health (Cutler, 2006), this is due to those with a higher education being more likely to make better health related decisions regarding both themselves and those who surround them (Dewalt, 2004). Education is strongly associated with determining life expectancy and morbidity as well as playing an important role in shaping opportunities, employment and income, with those in education experiencing lower rates of unemployment (Lancet, Public Health, 2020) (Bartley, 2002). Children from poorer backgrounds are much less likely to do well at school and further their education, thus, affecting their employment opportunities and income later in life (Jerrim, 2015).

Amanda has Down syndrome and will therefore progress slower regarding her development. Annex (B) shows some of the difficulties that Amanda faces due to her condition. Research shows that not only do children with Down syndrome take longer to learn new skills, but they also learn differently in areas, meaning that their teaching may need to be altered to benefit them and their needs (APPGDS, 2012). An individual with Down syndrome will have some degree of learning disability, however the extent in which this will affect the individual varies from person to person (Mencap, 2021) Despite their additional learning needs, evidence shows that individuals with Down syndrome progress and learn better in a mainstream setting compared to those in segregated settings (Buckley, 2006). 82% of children and young people living with a learning disability are bullied (Department for Education, 2003). Studies show that individuals who are bullied are more likely to suffer from poor academic achievements due to the interference of concentration and psychological trauma (Glew, 2008) (Beren, 2009). Amanda also suffers with sleep apnoea. This is a common problem in children with Down syndrome due to the anatomy of their body, as well as those who are overweight (Marcus, 1991). Sleep apnoea can be associated with lack of concentration and poor academic performance caused by the deprivation and interruption of sleep (Primhak, 2005).

Main body 2

Throughout the case study, there a number of individuals that show signs or have diagnoses of poor mental health. Vos (2013) states that depression is the prime mental health disorder worldwide. With mental health being the leading cause of illness and disability (UK Department of Health, 1993) there has been an increase in the recognised need for initiatives and promotion into positive mental health and wellbeing (WHO, 2004). No Health Without Mental Health (2011) is a government initiative put in place to help local authorities implement change in regards to mental health. It sets out six main objectives in which they aim to tackle mental health. These objectives are; (1) More people will have better wellbeing and mental health and fewer people will develop mental health problems, (2) More people with mental health problems will have a good quality of life, (3) More people with mental health problems will have good physical health, fewer will die prematurely, and more people with physical ill health will have better mental health, (4) More people will have a positive experience of care wherever it takes place (5) Improved services will result in fewer people suffering avoidable harm, (6) Public understanding of mental health problems will improve and fewer people will experience stigma and discrimination as a result of negative attitudes and behaviours to people with mental health problems.

Despite there being clear objectives, the interventions suggested are optional to local commissioners to implement, therefore leaving some areas of society disadvantaged (Department of Health, 2011). However, if implemented effectively then it would not only positively impact on the mental health sector, but the physical side effects that are associated with mental health and wellbeing will be reduced (NICE, 2009). There are effective implementation strategies within the framework as a guide to achieve each objective effectively.(1) Increasing the quality of promotion and awareness in regards to mental health and well-being within schools and educational systems as it is shown that 1 in 5 individuals experiencing mental health are below the age of 25 with 50% being symptomatic by the age of 14 (Kessler, 2005), (2) encouraging primary care staff to help recognise and identify signs of mental health and deliver treatment within their care setting and (3) improving the access to health promotion interventions such as cessation services and screening programmes are all ways in which change can be made to help in reducing ill mental health and wellbeing (No Health Without Mental Health, 2011) (Department of Health, 2011). Screening strategies and early detection interventions allow healthcare and their pathways to be more effective as it allows room to take action before an individual’s health deteriorates or prevents the onset of ill health to begin with (Marmot, 2008).

Another government initiative is Time to Change (2007), unfortunately this initiative closed down in 2021, however their work has impacted on how mental health is perceived and what can be done to help. Their aim was to support leaders within communities, education and work to deliver a change on how mental health was perceived and taught as well as helping people through their own mental health problems to challenge stigma and discrimination. the initiative focused on 4 main points to improve. These were; (1) Improving public attitudes and behaviour towards people with mental health problems. (2) Reducing the amount of discrimination that people with mental health problems report in their personal relationships, their social lives and at work. (3) Making sure even more people with mental health problems can take action to challenge stigma and discrimination in their communities, in workplaces, in schools and online. (4) Creating a sustainable campaign that will continue long into the future.

The media is known to contribute to the stigma of mental health and illness by the exaggerated and inaccurate information and images that is advertised to represent psychiatric disorders (Wahl, 1995). The social learning theory (1997) suggests that learning is achieved through observation, therefore individuals will learn their behaviours and knowledge regarding mental health through what is advertised and portrayed by the media (Bandura, 1992). This initiative aimed to change and influence the messages being portrayed by the media by ‘running social marketing campaigns targeted at audiences that are ‘cooler’ towards mental health, focusing our ‘owned’ channels on supporting our ‘warm’ audience to take an active role in our social movement and working with the media to improve reporting on mental health problems and challenge stigmatising coverage’. Over the other sectors that the initiative targeted there was a common theme to encourage and empower individuals to talk about their mental health problems as well as educating people on the importance of being there for others. Time to Change proved to be an effective initiative as their work was able to improve the attitudes of 5.3 million people with discrimination within the workplace falling by 25% in 2015/2016 (Time to Change, 2016).

A local initiative is Hertfordshire Health Walks. The initiative was founded in 2001 and aims to help individuals of all ages to increase and sustain their physical health and remain active. There are various walks available to suit each individual’s ability and physical capability ranging from 20-90 minutes. More than 60 walks are offered each week with over 47,000 people taking part each year. Many of the walks take place at the same time and same place, in-keeping with a regular and consistent routine for those that may struggle.

The initiatives main aim is for individuals to be able to reap the health benefits of exercise and physical activity. By exercising regularly, people are generally at a lower risk of many long-term health conditions such as heart disease, cancer and stroke (Bouchard, 1994) (Blair, 2001). Although this initiative is not directly focused on improving mental health, evidence shows that exercise is effective in improving mental health by reducing feelings such as anxiety and depression whilst also boosting self-esteem and cognitive function (Callaghan, 2004). It has also been shown to help overcome social withdrawnness whilst encouraging more social interactions and providing a distraction from negative feelings (Guszkowska, 2004) (Peluso, 2005). Walking is a way of positively impacting and influencing both an individual’s mental and physical health and can also prevent and help manage with rehabilitation from illness (NHS, 2020). The initiative helps to promote the UK Chief Medical Officers Physical Activity Guidelines (GOV.UK, 2019) which states that adults should aim to be active every day and to do at least 150 minutes of physical activity over the course of each week.

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Annex A:

GOV.UK Research and analysis Chapter 6: social determinants of health. Published 13 July 2017 (https://www.gov.uk/government/publications/health-profile-for-england/chapter-6-social-determinants-of-health)

Annex B: