This is the Chapter 2 of the book Introduction to Health Psychology (Val Morrison_ Paul Bennett) 4th Edition. Which is content for the exam of the component Health Psychology of Module 5 (Health Psychology & Applied Technology) of the University of Twente, in the Netherlands. 

Ch. 2: Health inequalities

Health differentials: 

Environmental and social factors influence on health

• Socio-economic status (SES): measure of social class
• Health differential: differences in health status and life expectancy across different groups

Evidence:

• Lower respiratory tract infections: infections in parts of the respiratory system. It's the most common cause of death among poverty
• Health USA: they scored badly in the WHO, because of:
  • Native Americans/inner-city poor
  • HIV
  • Cancers relating tobacco use
  • Violence

Socio-economic health inequalities:

• It is defined as health-behaviour choices, availability such choices, and the social context
• Does SES influence health, or does health influences SES?
  • Social causation model: low health causes health problems --> more predictable of SES
    • Coronary heart disease (CHD): narrowing blood vessels that supply blood and oxygen to heart --> Individuals with low SES, more than twice as likely to develop CHD
  • Social drift model: when people develop health problem --> they are unable tp maintain the workload, the levels of overtime required to maintain that standard of living.

Different health behaviours:

• Premature mortality: death before age that is normally expected (65 years) --> Behaviours of people of low SES are more health-damaging and less health-promoting than behaviours of people of high SES

Access to health care:

• USA:
  • 18%: with health insurance --> they report financial barriers that prevent them from appropriate care
  • 13%: accessed to appropriate medication
• UK: economic barriers less stark
• Coronary artery bypass grafts: surgical procedure, to improve blood flow (CHD) --> although high percentage in SES received it, poorer population remined relatively deprived of this health care
• Statins: drug to reduce cholesterol levels --> High SES are more likely to be prescribed statins

Environmental factors:

• Low SES is exposed to health damaging environments:
  • Working in dangerous settings
  • Low-quality housing --> respiratory health damaged and high levels of stress hormones
    • Atheroma: fatty deposit in intima (inner lining) artery
    • Renting: more at risk of developing CHD
      • Experience more damp
      • Earn less
      • Psychological consequences of living in differing accomodation
• Psychological pathways: illustrates the differences of exercise facilities, traffic safety, and poor environment conditions, in low SES and high SES.

Stress hypothesis:

• Childhood: family instability/overcrowding/diet/education
• Adolescence: family/exposure smoking/poor qualifications/unemployment or low-paid
• Adulthood: working conditions/financial insecurity/unemployment/control work or home life/social interactions
• Older age: occupational pension/heating system/food
• Hierarchy-health hypothesis: states that when someone is aware of their position in the socioeconomic hierarchy --> influence on health
• Wealth disparities in society, wider wealth disparities when there are low levels of social cohesion and of social capital: feelings social cohesion and trust in the neighbours 

Work and stress:

• Karasek and Theorell (1990) model: work environment contributes to stress and illness

1. Demand job
2. Degree freedom decisions on how to cope with demands
3. Social support

• Classic “stressed executive”: defines stress as an outcome of the demands, instead of as the demands combined with the degree of job autonomy and social support
• Ambulatory blood pressure: blood pressure measured at certain period of time --> showed significantly higher blood pleasure when individual is at work
• Model of work (Siegrist et al., 1990): effort --> reward

• High levels work stress -->
  • High workload
  • Low social support
  • High effort-reward imbalance

Work-life balance:

• Work-home spillover: continuation of responsibilities at home after work

Unemployment:

• Financial insecurity

Minority health status:

• Prevalence of different diseases varies across ethnic groups
  • Afro-Caribbean population --> high rates of hypertension (blood pressure significantly above normal levels) and strokes (damage brain, either bleed into the brain tissue or blockage of the artery, which prevents oxygen from getting to the brain)

Health behaviours:

• Behavioural hypothesis: variations in health outcomes are explained by differences in behaviours across ethnic groups

Stress:

• Specific stressors: Psychological impact of being part of a minority status
  • Discrimination
  • Racial harassment
  • Demands maintain/shift culture
• John Henryism: stated that successful black individuals have to push harder than white equivalents to achieve same level of success --> higher blood pressure reflects such effort

Gender and health:

• Life expectancy: UK
  • Men: 77.4 years
  • Women: 81.6 years
• Differences in industrialised countries, in some countries women are more likely to get premature illnesses or to mortality due to pregnancy, and poor environment
• Risk ratios: compares probability of certain events occurring in 2 groups.
  • Risk ratio = 1: event equally likely in both groups
  • Risk ratio > 1: event more likely first group
  • Risk ratio < 1: event less likely in first group

Biological factors:

• Women grater resistance infections
• High levels testosterone, protective against CHD --> high testosterone associated with low levels of HDL cholesterol (good cholesterol)
• Physiological response to stress:
  • Men: greater increase stress hormone and blood pressure in response to stressors

Behavioural differences:

• Women less alcohol
• Men eat more meat
• Men less likely seek help
• Men engage more leisure exercise (health-promoting behaviour)
• Inequalities power à impact health women

Economical/social factors:

• Women economically inactive and with lower-paid jobs --> have problems associated with low SES