Health inequality: an introduction

There is unequivocal evidence from across Australia of entrenched patterns of socio‐economic related health inequality. These patterns are seen in mortality, morbidity, health risk factors and access to preventive health services. Discussing the potential role of health promotion in addressing these health inequalities needs to be based on an agreed definition of health inequality and an understanding of the differences between health inequity and health inequality. This involves making value judgements on whether opportunities for health are fairly distributed. Health promotion practitioners need to be able to argue why they think health inequalities are important, have a clear understanding of what they think are the causes of health inequality and be informed on action that can be taken to reduce health inequality. The ever‐increasing level of information on patterns of health inequality within Australian society are likely to place increased pressure on health promotion policymakers and practitioners to ensure that their actions reduce health inequality – or at least not contribute to widening health inequality. The way in which these issues are approached will be strongly influenced by our values, the values of the organisations in which we work and the wider community. This requires each of us to be proactive in articulating our values and beliefs and being open to them being challenged.     

Women's Health in Israel

SUMMARY

This paper draws on feminist health scholarship to provide critically needed tools for conceptualizing women's health care and health status in Israel. It explores the links between inequities in gender roles and the health experiences of women, as patients and caregivers. The critique points to the consequences of defining women's health in relation to men. In an attempt to chart directions for fundamental change in the approach to women's health in Israel, the author underscores the relevance of sociocultural environments in accounting for female well-being and for women's illnesses. Women professionals, particularly in the social health sciences, are identified as a key to adapting health care to women's unique needs within a woman-centered and egalitarian delivery system.     

Health and inequality: Some applications of uncertainty theory

This paper applies to the Field of Health results of Stochastic Dominance Theory and expressions originally devised for the measurement of Income Inequality. In particular, use is made of Atkinson's inequality measure to compare health levels in England and Wales in the past century. It appears that the ‘inequality before death’ is less important today than it was in the past, this improvement being parallel to the increase in the average number of years lived (life expectancy). The analysis indicates also that both improvements were greater for women than for men during the period considered.     

Health inequality and population variation in fertility-timing

We estimate the impact of fertility-timing on the chances that children in poor urban African American communities will have surviving and able-bodied parents until maturity. To do so, we use census and vital statistics data to compute age- and sex-specific rates of mortality and functional limitation among prime-aged adult residents of impoverished African American areas in Harlem, Detroit, Chicago, and the Watts area of Los Angeles and for blacks and whites nationwide. Findings are consistent with the hypothesis that the early fertility-timing characteristic of poor urban African American populations mitigates some of the costs to families associated with excess mortality and early health deterioration in young through middle adulthood.     

Health reform in Mexico: the promotion of inequality.

The Mexican health reform can be understood only in the context of neoliberal structural adjustment, and it reveals some of the basic characteristics of similar reforms in the Latin American region. The strategy to transform the predominantly public health care system into a market-driven system has been a complex process with a hidden agenda to avoid political resistance. The compulsory social security system is the key sector in opening health care to private insurance companies, health maintenance organizations, and hospital enterprises mainly from abroad. Despite the government's commitment to universal coverage, equity, efficiency, and quality, the empirical data analyzed in this article do not confirm compliance with these objectives. Although an alternative health policy that gradually grants the constitutional right to health would be feasible, the new democratically elected government will continue the previous regressive health reform.     

Social workers' role in tempering inequality in healthcare in hospitals and clinics: a study in Israel

The paper presents an empirical examination of the role social workers play in tempering inequality in medical care. Data were collected in 2011 through face‐to‐face, semi‐structured, in‐depth interviews with 60 social workers employed in hospitals and clinics in Israel and selected through purposive sampling. The interviews probed the social workers' perceptions of the scope, causes and manifestations of inequality in health and healthcare and the actions they took to ameliorate it. The interviews were analysed using grounded theory. The findings show that all the social workers were acutely aware of the inequalities in their places of work, regarded reducing the inequalities as a major part of their role and made efforts to do so. They facilitated communication between doctors and patients of low socioeconomic status and advocated for such patients with medical staff and administration, as well as with the country's medical and social welfare bureaucracies. The paper details the means they used and the challenges they faced. The study highlights the important role that social workers play in reducing inequality in healthcare.     

Perception of Health Care Delivery in Israel: Women's Voices

In this article, we describe the results of nine focus groups in which women were asked to discuss their perception of the women's health care delivery system in Israel. The focus groups, held in Israel in 2001, included nearly 150 women with diverse demographic characteristics. This project solicited focused input from women of different ages from the periphery as well as highly populated areas. The responses were categorized into designated themes and are presented here to demonstrate the range of women's feelings toward health care. The qualitative findings of this research show that place of residence affects the women's sense of responsibility for their health and their use of private care. Age was found to affect knowledge and use of health information, the frequency of visits to the doctor, and the general level of satisfaction with the system. These findings are important to improve health care delivery and can serve as a basis for forging policy changes in Israel.     

MI-Environment: Geospatial patterns and inequality of relative heat stress vulnerability in Michigan

Heat stress causes morbidity and mortality and is increasing with climate change. Heat stress can pose particular challenges in northern regions not well adapted to heat. To assist decision makers, we identified the relative vulnerability of census tracts within Michigan to factors that increase exposure to heat stress or reflect susceptibilities in the population based on a California heat vulnerability index. In the MI-Environment assessment, we used a Geographic Information System (GIS) to combine future ensemble climate model projections to create a total of 9 geospatial and demographic variables. As part of a broader planned cumulative environmental exposure assessment, the statewide heat vulnerability index (HVI) maps display the location and relative magnitude of exposure on three metrics: built environment (Place), future expected long-term temperature averages (Temperature), and population susceptibility (People). We observed varied and distinct patterns for each of the three component indices. We assessed how equitably those exposures are distributed by racial and socioeconomic factors. This analysis showed that each of the component indices and the aggregate HVI are disproportionately distributed along racial and socioeconomic lines in Michigan. Census tracts with higher percentages of people of color had larger exposure to HVI factors with a deviation from equity of -0.115 [95% CI -0.108, -0.122]. Similarly, for census tracts with higher percentage of people experiencing poverty, the deviation from equity was -0.101 [95% CI -0.094, -0.107]. The MI-Environment visualization tool can help communities prepare for climate change and resolve inequities by identifying census tracts with the most vulnerable residents and highest potential exposures.     

Health and family planning services in Bangladesh: a study in inequality

The development of health and family planning services in Bangladesh is examined in the context of the country's political economy. Inequities of power, influence, opportunity, and the ownership and distribution of assets and income are seen to lie at the root of the "Bangladesh crisis." In this, the country is not unlike many others in the Third World, only more so. The internal and external pressures which have contributed to a coercive attitude toward the problem of too rapid population growth are discussed. The allocation of Bangladeshi health service resources is examined in terms of expenditure, manpower, and facilities; they are found to be both inequitably distributed and inefficiently applied. Some alternatives to present patterns of development are touched upon. It is concluded that despite the country's poverty, most people do not have to go without basic primary health care (including family planning), which can be afforded even by countries as economically impoverished as Bangladesh.     

Health inequality among Estonian women

In Eastern Europe, in post-Communist countries, transformations during the past 10 years have considerably affected the life of women. Our aims were to (a) examine health status and socioeconomic inequalities among Estonian women, and (b) study the relationships between women's social roles and health. A group of 659 women, aged 18-45, completed the Health Questionnaire for Adults (HQA) and the General Health Questionnaire (GHQ). Income had the largest effect on self-related health and psychoemotional health ratings. The second important indicator was education. Women's additional social roles (marital status, parental role) were not detrimental to their health in our study.     

Changing practice patterns of school-based occupational therapists in Israel

Following the enactment of the Special Education Law in Israel in 1988, school-based occupational therapists (OTs) were expected to modify their practice patterns by, providing services within the classroom or other educational settings, increasing collaboration with other team members, and implementing indirect intervention models such as monitoring and consultation. The purpose of this study was to examine the intervention patterns of school-based OTs in Israel. The study sample included 77 school-based OTs. The survey was carried out through a questionnaire which included: (1) background information, (2) implementation and perceptions towards intervention models, and (3) team-work practices of the OTs. The findings indicated that most of the time (76.9%) OTs still implement the 'direct therapy' model, working outside the classroom and focusing on improving performance components. These findings imply that school-based OTs in Israel are still in the process of changing their practice patterns, and are mostly applying the medical model. However, due to the relatively small sample, it is important to repeat this survey using a larger sample of OTs who work in different settings and with various age groups.     

Demographic and socio-economic patterns of hospitalization for infectious diseases in Israel

Hospitalization rates in Israel for five common enteric communicable diseases were computed according to age, sex, religion, origin and place of residence. Higher rates were found for non-Jews of both sexes and males of all origins. Higher rates were also found for settlements inhabited by new immigrants of low socio-economic classes. These findings suggest that more emphasis should be placed upon sanitary improvements and education for better health, rather than on merely improving the health delivery system.Corresponding author.     

Health literacy in health systems: perspectives on patient self-management in Israel

Health systems will face new challenges in this millennium. Striking the balance between the best quality of care and optimal use of dwindling resources will challenge health policy makers, managers and practitioners. Increasingly, improvements in the outcomes of interventions for both acute and chronic patients will depend on partnerships between health service providers, the individual and their family. Patient education that incorporates self-management and empowerment has proven to be cost-effective. It is essential that health care providers promote informed decision making, and facilitate actions designed to improve personal capacity to exert control over factors that determine health and improve health outcomes. It is for these reasons that promoting health literacy is a central strategy for improving self-management in health. The different types of health literacy--functional, interactive and critical health literacy--are considered. The potential to improve health literacy at each of these levels has been demonstrated in practice among diabetics and other chronic disease patients in Clalit Health Services (CHS) in Israel is used as an example to demonstrate possibilities. The application of all three types of health literacy is expressed in: (i) developing appropriate health information tools for the public to be applied in primary, secondary and tertiary care settings, and in online and media information accessibility and appropriateness using culturally relevant participatory methods; (ii) training of health professionals at all levels, including undergraduate and in-service training; and (iii) developing and applying appropriate assessment and monitoring tools which include public/patient participatory methods. Health care providers need to consider where their patients are getting information on disease and self-management, whether or not that information is reliable, and inform their patients of the best sources of information and its use. The improved collaboration with patient and consumer groups, whose goals are to promote rights and self-management capabilities and advocate for improved health services, can be very beneficial.