Causes and Impact of Health Inequalities

Causes and Impact of Health Inequalities Background In todays world, the advancements in medical technology and its expansion have improved the overall health of the population. However, inequalities persist within health care and not all people have equal access to it. Why do these disparities still exist in the present day? Understanding why these inequalities exist despite modern advancements has a significant importance in reducing health care inequalities. Aim Understanding health care inequalities and its challenges are the aim of this assignment. It seeks to explain and understand the mechanisms underlying the associations that can be found between the socio-economic statuses of population groups and their quality of health. It also explores life course pathways which mould and influence a persons chances of having a healthy life along with advantages and disadvantages that can affect health from an early age into adulthood. In addition, other factors such as gender, mental illness and disability and ethnicity will also be discussed since they also have a major contribution to inequalities in health. The assignment will focus on research led in the United Kingdom (UK). The United Kingdoms long tradition of research on health inequalities The UK is a high-income society, where greater prosperity and better overall health have been successfully attained without narrowing health inequalities, it can therefore be taken as an example for other societies that manifest similar trends in inequalities (Graham, 2009). Health Inequalities Health inequalities are differences between people or groups due to social, geographical, biological or other factors. These differences have a huge impact, because they result in people who are worst off experiencing poorer health and shorter lives (NICE, 2012). Affordable health care During the 19th century, inequality in health was mostly due to factors such as overcrowding, insufficient availability to local treatment facilities and poor sanitation (Morning 2015). Nowadays, in our industrialized society, these disadvantages have essentially disappeared. Modern hospitals and treatment centres are now commonly accessible across the UK. But not everyone can afford treatment. A study led in 2004 has shown that wealth is correlated with longevity, which demonstrates a strong link between the socio-economic status and mortality. For example, Figure 1 exhibits a pattern of health across income groups in England in 2004. As seen below, the proportion of men and women who deem their health as not good increases from around 15 percent in the richest fifth of English households to around 40 percent in the poorest fifth of households. This significant rise is not only manifested in the majority white population but also in other ethnicities in the UK (Graham, 2009). Figure 1: Proportion of women and men aged 16 and over assessing their health as not good by income quintile based on equivalized household income, England 2003. (Graham, 2009) This can be explained by considering the advantages that people in the higher socio-economic groups have. These advantages can lead to more knowledge about their health and the care available through improved education, or better continuity of care without issues of complying with treatment regiments such as expensive medication. For example, a man with higher income and education levels will have improved health insurance, increased information about the availability of treatments and will more frequently visit the doctor. This can translate into receiving more screenings such as screenings for colorectal cancer and diabetes. Differences between social classes and how they affect health       Landmark studies such as the Black report have shown that not only do social class inequalities still exist, they are also widening over time (DHHS,1980). Social class inequalities have been observed in all ages for all the major diseases. To try and describe social class inequalities in health, various models have been introduced into the UK such as the behavioural/cultural model, the materialist model, the psycho-social model and the life-course model (Steinbach,2009; Bartley and Blane, 2008; Bartley, 2004; DHHS, 1980). These models differentiate the characteristics affecting health that can be observed in different social classes over the whole period of their lives. For example, by describing the differences in behaviour that distinct social classes have, i.e. the behavioural model. Such as their dietary choices between healthy and unhealthy food, their prevalence to being in contact with drugs, alcohol and tobacco or the inclination to pursuing active leisure time such as hobbies in addition to their approach to healthy life choices such as immunisation, contraception and antenatal services (Steinbach 2009; Bartley, 2004; DHHS, 1980). Another model is the materialist model which describes the differences between social classes to the exposure to health hazards. This encompasses hazards such as air pollution, mold, cold, infestations and respiratory hazards that can arise from bad housing for example. The Black report (DHHS,1980) claims that this model is the most decisive factor leading to health inequalities. But many experts outline that since, in the UK, somewhat disadvantaged people receive various kinds of state aids, therefore it can be argued that housing and other materialistic issues are insufficient to account for major inequalities in health outcomes (Steinbach, 2009; Barley, 2004, DHHS, 1980). The psycho-social model on the other hand describes the principle that what people feel can determine changes in the physiology of the body. For example, a stressful social environment produces an emotional response which alters the state of the body through biological changes and can lead to serious conditions such as heart diseases (ODonnell, 2008). Areas affected can be the social interaction that an individual has every day, the work environment and the balance between home and work paired with their efforts and rewards. It has been shown that people with better relationships with their family and friends and who engage in social activities have better prospects to a healthier lifestyle than those who are rather isolated (Campbell, 2010). The last model focuses on patterns of social, psychological and biological advantages and disadvantages that can occur during the lifetime of a person. Factors that can influence a persons life can arise as early as in-utero and in early childhood. These disadvantages can ultimately accumulate and worsen through childhood and adulthood (Steinbach, 2009; Bartley, 2004). For example, individuals who have experienced differences in autonomy or, on the other hand, shame and doubt in childhood will react differently throughout their adult life (Graham, 2009). These models are represented by landmark studies in social class inequalities in health in the UK such as the Black Report (DHHS, 1980), the Whitehall study of British civil servants (spans over 10 years starting in 1967) and the Acheson report (Acheson, 1988). How gender affects health inequalities Many studies and researches have proven that, in industrialized countries such as the UK, women live longer than men but present more prevalence to ill health (Scambler, 2008). Although men have a greater chance of mortality due to injury and suicide in earlier stages of adulthood coupled with common single causes of death in adulthood such as cardiovascular diseases and cancers, more women than men go through stages of disabilities, notably in older ages. Mental disabilities have mostly been commonly correlated to anxiety and depressive disorders (Steinbach, 2009; Bartley, 2004; Acheson, 1998). The World Health Organisation (WHO) in 2008 suggested that gender differences in health are a result of both biological factors and social factors such as employment, risk taking behaviour, smoking and alcohol (Campbell, 2010). How ethnicity affects health inequalities Unfortunately, the information on death certificates in the UK do not display ethnicity, and mortality data uses country of birth as a defining factor, therefore ethnical minorities born in the UK cannot be determined. But regular documented studies on ethnical inequalities in mortality (Kelly, 2008) have explained that factors such as, migration processes, defined socio-economic disadvantages and genetic and biological differences between ethnic populations account for differences in mortality. Inequalities in the accessibility to health care The access to health care is a supply concern which describes the quality and quantity of services provided to a person and are defined by the health care system itself. In the UK, the health care system is the National Health Service (NHS), a system that was founded on the principle of fairness, meaning people should get the care they need, not the care they can afford (Steinbach, 2009; Cookson, 2016). The inverse care law, first described by Julian Tudor Hart in 1971, states: The availability of good medical care tends to vary inversely with the need for it in the population served (Hart, 1971). Equality of access to health care can be achieved by communities by meeting certain requirements. Factors such as the distance travelled, the transport facilities and communication used, the hospital waiting times, the patient information and knowledge about available treatment and its effectiveness and the costs of all these are considered to contribute to a health care system which is equal to all (Steinbach, 2009; Cookson, 2016). Availability is a determining factor of inequalities in accessibility in health care. Some health care services have been shown to treat population groups differently, denying services to some people and preferring others for a certain treatment. For example, clinicians might have a bias in treating different patients based on individual characteristics even though they have identical needs. The equality in the costs of health care can also be disrupted by imposing costs which differ between people. Or even the information given to different populations can impact the patients outcome. For example, health care organisations who neglect or fail to ensure that everyone is equally conscious to the services available (Goddard and Smith, 2001). The NHS and current health inequality challenges The NHS regularly comes top of international league tables of fairness in health care but it is not perfectly fair. There are inequalities in the volume, quality and outcomes of NHS care received by rich and poor people. These inequalities could get worse as financial austerities start to bite more severely into NHS budgets and may contribute to wider health inequalities in society. These inequalities raise serious concerns about social justice and unfulfilled potential for disadvantaged people to live longer and healthier lives. A research project lead by Richard Cookson in 2012 focused on monitoring fairness of the NHS to make sure inequalities dont get worse and if possible get better. In 2012, the NHS still didnt monitor how inequalities were changing. And NHS decision makers knew that inequalities existed, but they had no way of telling if inequalities were getting better or worse or what influence their decisions were having on inequalities. By monitoring the fairness of the NH S, the results will make sure that everyone, rich or poor, can receive the care they need to live a long and healthy life (Cookson, 2016). Recently, research projects have provided methods of comparing the performance of local NHS areas in tackling inequalities in health care. Alongside similar indicators for wider determinants of health, such as the regularly updated marmot indicators (UCL, 2015). Which review the key areas that need to be improved to make a significant impact on health care inequalities such as strengthening the role and impact of ill health prevention. The methods will assess how well the NHS is tackling inequalities across a broad range of issues (Buck, 2016). An outcome from the Health Equity Indicators for the English NHS: Longitudinal whole-population study at small area level research project showed a great improvement in patient health care by monitoring key stages of the patient pathway (See Figure 2) (Cookson, 2016). Figure 2: Monitoring health care access, quality and outcomes at key stages of the pathway (Cookson, 2016). For example, Figure 3 shows that GP supply increased in all social groups, and the largest increases were in the most deprived areas. As seen below, the pro-rich inequality gradient was eliminated by 2011/2012 (Asaira, 2016). Figure 3: Equity of primary care supply, Patients per full time equivalent GP, excluding registrars and retainers, adjusted for age, sex and health deprivation (Asaira, 2016). Conclusion Health care inequalities most commonly arise from socio-economic conditions and are shaped by political, social and economic forces that can create or destroy a persons health and wellbeing. These problems are now seen as health problems that must be addressed to ensure everyone has an equal chance of a healthy life. Factors such as the costs of healthcare, social class, gender, ethnicity and accessibility to health care all contribute to the quality of life. Recently, projects have been undergone to help improve healthcare in the UK, for example, by monitoring the fairness of its services. In my opinion, the UK is one of the leading health care services in the world despite existing inequalities, but can be improved by further understanding and improving these inequalities, who have been only recently assessed. Total word count: 1966 References: -Acheson D (1998). Independent inquiry into inequalities in health report. London: The Stationary Office. -Asaria M, Ali S, Doran T, ferguson B, Fleetcroft R, Goddard M, goldblatt P, Laudicella M, Raine R, Cookson R. (2016). How a universal health system reduces inequalities: lessons from England. Epidemiology community health. 0 (1), 1-7. -Baker M, Mawby R, Ware J (2015). Health Inequalities. Engalnd: Royal college of general practitioners. 2-16. -Bartley M, Blane D (2008). Inequality and social class in Scambler G, Sociology as applied to medicine. Elsevier Limited. -Bartley M (2004). Health inequality: an introduction to theories, concepts, and methods. Cambridge: Polity Press. -Buck D (2016). The role of the NHS in reducing health inequalities: moving beyond fair access to care. Available: https://www.kingsfund.org.uk/blog/2016/03/reducing-health-inequalities. Last accessed 1st Feb 2017. -Campbell F (2010). The social determinants of health and the role of local government. England: Investor in People. 5-68. -Cookson R (2016), Health Equity Indicators for the NHS, presented at Maximising the impact of the NHS in tackling health inequalities, London, 2016. -Cookson R (2016) Health equity indicators for the English final report to the NIHR HSDR Programme. HSDR -Cookson R, Propper C, Asaria M, raine R. (2016). Socio-Economic Inequalities in Health Care in England. The journal of applied public Economics. 37 (3-4), p371-403. -Department of Health and Human Services (DHHS) (1980). Inequalities in health: report of a research working group. (The Black Report). HMSO, London. -Graham H (2009). Understanding Health Inequalities. 2nd ed. England: Open University Press. 1-20. -Goddard M, Smith P (2001). Equity of access to health care services: theory and evidence from the UK. Social Science and Medicine 53:1149-62. -Hart T J. (1971). The inverse care law. The Lancet. 297 (7696), p405-412. -Kelly M, Nazroo J (2008). Ethnicity and Health in Scambler G Sociology as applied to medicine. Elsevier Limited. -Morning, Roberts, Phelan (2015), Social inequalities in health, presented at Social Inequalities in Health, Behavioral and Social Sciences Research Lecture Series, Bethesda, 2015. -ODonnell, K.; Brydon, L.; Wright, C.; Steptoe, A. (2008). Self-esteem levels and cardiovascular and inflammatory responses to acute stress. Brain, Behavior, and Immunity. 22 (8): 1241-1247 -Scambler A (2008). Women and Health in Scambler G Sociology as applied to medicine. Elsevier Limited. Steinbach R. (2009). Inequalities in the distribution of health and health care and its access, including inequalities relating to social class, gender, culture and ethnicity, and their causes. Available: http://www.healthknowledge.org.uk/public-health-textbook/medical-sociology-policy-economics/4c-equality-equity-policy/inequalities-distribution. Last accessed 1st Feb 2017. -The National Institute for Health and Care Exellence. (Oct 2012). Health inequalities and population health. Available: https://www.nice.org.uk/advice/lgb4/chapter/introduction. Last accessed 1st Feb 2017. -UCL Institute of Health Equity. (2015). Marmot Indicators 2015. Available: http://www.instituteofhealthequity.org/projects/marmot-indicators-2015. Last accessed 1st Feb 2017.

Recording Product Value Added Tax

Nama:Fajar Suryanegara Program Studi:Ilmu Administrasi Fiskal Judul Skripsi:Tinjauan Terhadap Penetapan Dasar Pengenaan Pajak Nilai Lain Atas Produk Rekaman Skripsi ini membahas penetapan Nilai Lain sebagai Dasar Pengenaan Pengenaan Pajak atas produk rekaman ditinjau dari asas-asas pemungutan pajak produktivitas penerimaan, kepastian hukum, dan kesederhanaan. Penelitian ini adalah penelitian kualitatif dengan desain deskriptif analisis.Hasil penelitian ini jika ditinjau dari asas produktivitas penerimaan ketetapan ini menimbulkan potential loss bagi negara yang terlihat dari selisih PPN terutang antara harga pasar dengan harga jual rata-rata. Berdasarkan asas kepastian hukum ketetapan ini kurang memberikan kepastian hukum karena kesalahan penggunaan pasal 1 angka 17 Undang-undang Pajak Pertambahan Nilai. Akhirnya, berdasarkan asas kesederhanaan ketetapan ini sudah memberikan kesederhanaan baik bagi wajib pajak atau Direktorat Jenderal Perpajakan karena pajak hanya dibebankan pada sat u level pemungutan.Kata Kunci: Dasar Pengenaan Pajak, Produktivitas penerimaan, kepastian hukum, kesederhanaan. ABSTRACT Name:Fajar Suryanegara Study Program:Fiscal Administration Title:Review for The Other Value Tax Base Quotition of Recording Product The focus of this study is the quotition other value as tax base for recording product reviewed from revenue productivity, certainty and simplicity tax principle. This research is qualitative with descriptive analysist design.The result for this research reviewed from revenue productivity principle caused potential loss for our country which can be seen from the deviation between market price and average sale price. Based on certainty principle this quotation gives less certainty because the misinterpretation of article 1 number 17 Indonesian Value Added Tax law. Finally, based on simplicity principle this quotition has given simplicity whether for tax payer or Tax General Directorate because the imposition is levied only to one level . Key words: Tax Base, Revenue productivity, certainty, simplicity

The Tragedy of Julius Caesar - Free Essay Example

Sample details Pages: 2 Words: 622 Downloads: 6 Date added: 2019/03/26 Category History Essay Level High school Tags: Julius Caesar Essay Did you like this example? In life, people can change for the good or bad, or maybe the bad has always been in them and they finally let it out. All throughout history, you see groups of people conquering parts of the world, but yet to some, they are still good and to others, they are murderers, fugitives, and or vagabonds. Greed can change someone, wanting power can simply create a monster, like Christopher Columbus discovered America when he was a murderer inreality. Don’t waste time! Our writers will create an original "The Tragedy of Julius Caesar" essay for you Create order Everyone will pay for their sins, this is the way of life, the way God set things up but everything happens for a reason. What do you say about your friends or family who turn on you for power, or simply because they feel like its the right thing to do? Would you ignore the signs that God has sent you in ways you cant understand? In the Tragedy of Julius Caesar, we see how some people change or show who they really are or even the simple fact that some of us dont take heed to warnings at all. Luke 12:15 then said to them, Watch out! Be on your guard against all kinds of greed; a mans life does not consist in the abundance of his possessions. God said to watch out for greedy people much like Cassius. Cassius was a snake in the grass who presented itself like he was your friend. He was able to manipulate Brutus and changed him in a way he cant change or undo for his sins are with him. Cassius was okay with ruining others life because it shows that he barely even valued his own life. Proverbs 15:27 He who is greedy for gain troubles in his own house, but he who hates bribes will live During the story, everyone started to lose something or someone they loved because of their actions. Caesar was going to be king of Rome because he won the battle of Pompey. But did his big headedness bring death upon him? Fate has its way of revealing itself one way or another. 1 Peter 5:8 Be sober-minded: be watchful. Your adversary the devil prowls around like a roaring lion, seeking someone to devour. Caesar thought that he was immortal, as if he was a God and that no harm could come his way. People like that can become very dangerous or die. In this world, you have to keep both eyes open and keep your enemies close and your friends closer. People can turn on your no matter how long youve been friends. His bestfriend Brutus is a prime example of this, he killed Caesar. Sometimes, you can trust yourself because no one will have your back like you will. Friendship and loyalty is very important in this world. We need people in order to survive thats how it was set up. Brutus was a very loyal and honorable man, but someone broke him. He was manipulated into killing Caesar his bestfriend! He tried to keep the good in him, so he did it for the people of Rome, to save them. Everyone should be able to trust someone but people will always look out for themselves in their own way. The circle of life was present during this story there was a domino effect. Greed always ends up bad for it is a sin and your fate depends on your actions. Caesar was the reason he died because he was so immortal. The moral of this play is take heed and always be cautious. I will never let my guard down! Everyone knows what goes around comes back around, and this play has showed us this in the most brutal way. We learn from our mistakes or history will keep repeating itself.

The Genesis Of International And Intercontinental Adoption

This paper sees the sights the genesis of international or intercontinental adoption in U.S. martial intercession, predominantly the Korean War and its consequences. Keeping focus on the concealed statistics in Korean adoption research, the prostitute and her biracial kid, this article tends to recast armed camp-town in Southern Korea as the original situate of communal casualty, an essential situation that causes to be biracial children homeless and their respective Korean mothers attenuate mothers for adopting them. â€Å"One people, one nation† is the National philosophy of South Korea which has coupled with American geopolitical benefits in this Asian expanse shaped the primary thrust and draw reasons and causes for children of Korea to be†¦show more content†¦and South Korea. Representing biracial offspring whose existence diagnosis was precluded in Korea, on the other hand, the South Korean administration analytically introduced large scale adoption as the only practicable alternative for biracial progeny. But, this bio-political exercise was mitigating to all children at the limitations whereas encouraging worldwide adoption for the up-coming 50 years. Pearl Buck who is one of the significant American advocates of global adoption says as follows: â€Å"Hybrid Asian and American families created through adoption could eventually facilitate better political relations between the United States and Asia...Page 16 The metaphors and descriptions mentioned in this article unfold a fractional account regarding the genesis of the international adoption and portray themselves as confirmation of the US familial dominance and compassion. The chronicle of the Holts and their eight biracial Korean children is considered to be a prodigy amongst the adoptee society. It tempts us to believe the substantial circumstances and affinity attachments as of which biracial children were extorted. Most of the adoptees that were viciously hauled out from their unique kith and kin, but, have been brought up obsessed by the worries of their societal bereavement, as have