AWA: Academic Writing at Auckland

According to Graham (2007), health inequalities are differences in health experienced amongst individuals, populations and disadvantaged groups. The focus of this essay will be health inequalities amongst population groups, as classified by age. Secondly, it will consider the influence of the social model on age related health inequalities. Finally, it will explore a couple of interventions aimed at addressing specific health issues which, arise as a result of age related health inequalities.

It can be argued that physiology changes as people age; thus allowing some age groups to be more susceptible to disease than others (Robertson & Campbell, 2008). Whilst this may be true to some extent, it must also be considered that as people age, different social factors impact on people in different ways (Christakis & Fowler, 2007). Thus the social model of health has a significant role to play in explaining health inequalities. For example, youth face different social pressures than middle aged adults and older people, and so different health outcomes are expected.

The social determinants of health, as proposed by the black report (1980, as cited in Asthana & Halliday, 2006) focus on how different societal factors can have an impact on health. These include four difference explanations. First, the material/structural explanation considers resources available to an individual or group, such as their level of access to health care (Asthana et al., 2006). Secondly the behavioural/cultural explanation discusses how behaviour and culture may impact on individuals and groups (Asthana et al., 2006). For instance, different age groups have varying codes of conduct, which may lead to a difference in health. The social determinants of health, also considers the impact of social selection- which investigates the degree of discrimination certain groups may face and how their health is effected as a result (Asthana et al., 2006). Finally, historical context is a social factor which can lead to health inequality, as it examines how things of the past affect the future. The latter two explanations will not be considered within this essay.

However, these explanations cannot be taken as standalone determinants, for they are interconnected, impacting one another in a variety of ways (Asthana et al., 2006). Still it is difficult to ascertain how much inequality is due to physiological difference and how much is due to social factors, because they occur concurrently in a variety of ways. Some examples of health issues related to age inequality include the high prevalence of; youth (15-24 year olds) experiencing mental illness (Ministry of Health [MOH], 2002), middle aged adults (24–64 year olds) living with chronic conditions (Ministry of Health [MOH], 2004) and the high incidence of falls elderly people have each year (Ministry of Health [MOH], 2006).

Youth (15-24 years old) uniquely produce the highest hospitalisation rate for self inflicted injury than any other age group (MOH, 2002). Up to 7.5 percent of 21 year olds have reported a suicide attempt (MOH, 2002). These health outcomes are likely when significant relationships have shattered either in romantic situations or amongst immediate family (MOH, 2002). Thus highlighting the importance youth place on material/structural resources. Furthermore, historical context indicates that an abusive past or disturbed childhood significantly increases the risk of mental health problems amongst adolescents (MOH, 2002). Also, some youth are more prone to a risk taking culture and associate themselves with others similar to them. Thus if unhealthy behaviour is the norm, for example, suicidal ideation, the situation is escalated for it is as though ‘everyone else is doing it also’ (MOH, 2002). Thus far, the social model has provided evidence of unique social factors youth are exposed to, which can lead to health inequality.

Another example of age related inequality is the high prevalence of obese middle aged adults. According to the MOH (2004), 26.5 percent of adults in New Zealand are obese. One explanation for this age related health inequality from the social model perspective is given by Christakis and Fowler (2007). As Christakis and Fowler (2007) explain, the social network individuals have (material/structural explanation) has a significant impact on one’s own behaviour. As middle aged adults tend to be fairly family orientated with a significant other, the state of the spouse is highly likely to determine the state of the other (Christakis et al., 2007). For if there are people within close proximity who are obese, it ameliorates the stigmatised severity of this condition, which then further impacts behaviours to induce a sedentary lifestyle (Christakis et al., 2007).

Finally, another example of an age related inequality is the rate of falling among older people. The MOH (2006) reported that falling was the predominant reason for hospitalisation of elderly people, which Biderman, Winkel, Fried and Galinsky (2002) support, revealing that 30 percent of older people will fall each year. Explanations for this lie partially in the social model as well as the biological model. For indeed, as one ages one becomes increasingly impaired in regards to the sensations (MOH, 2006). Robertson and Campbell (2008) allude to the severe risk factor a visual impairment may impose, a condition that commonly affects the elderly. However, in conjunction with this, the environmental structure must be considered. For objects which obstruct mobility may cause distress and reduce the space for the movement required (Robertson et al., 2008). Also, Biderman et al., (2002) provides evidence that there is a culture of fear of falling amongst elderly, which inhibit physical activity, resulting in an increased risk of fall. The reduction of physical activity can have a further adverse effect on elderly peoples’ risk of falling (MOH, 2006), in that it is a risk factor for reduced balance and gait.

Considering these various health issues within the different age groups, it becomes quite evident that age related health inequalities occur. Nevertheless, there are several interventions which aim to reduce age related health inequalities.

One such intervention, which was quite successful, was the ‘Sources of Strength Suicide Prevention Program’ (Wyman et al., 2010). The goals of this program addressed primarily the community material/structural influences amongst youth, in that it aimed to increase the social connectedness students had within school, by increasing the communication between adults and students (Wyman et al., 2010). It also aimed to disseminate peer groups’ perceptions of ‘normal’ mental health behaviour and increase awareness of positive coping behaviours (Wyman et al., 2010), thus addressing the culture/behaviour of different youth social groups. This was done by training students to be able to identify and apply a variety of positive coping techniques.

The intervention was conducted within a random sample of high schools (Wyman et al., 2010). Since, the intervention environment is one which youth are already familiar with and constantly exposed to, access to this resource would only be limited by their attendance.  Student leaders, from different social groups were randomly selected to be trained in increasing social connectivity of adolescents by identifying trust worthy adults they may talk with (Wyman et al., 2010). Also, by reinforcing the idea that it is acceptable to ask help for a friend- and so decrease silent suicide acceptability, the potential to establish a positive youth culture is enabled (Wyman et al., 2010). The student leaders then had the role of transferring these messages throughout their circles of influence by any means they saw fit (Wyman et al., 2010). All the while, they received support from adult mentors.

The results of this programme were very encouraging. Schools which had participated in the Sources of Strength intervention saw a decrease of suicide ideation from an average of 8.8 percent to an average of 4.38 percent (Wyman et al., 2010). Furthermore, students with the most antisocial behaviour, lowest academic results and least positive adult communications achieved the best outcomes (Wyman et al., 2010), as it was found that, Sources of Strength also addressed the risk factors associated with these behaviours. The successful prevention of the occurrence of aversive effects due to intervention was credited to the fact that student leaders were trained with a diverse range of people and received adult mentoring (Wyman et al., 2010).

This simple design of the intervention allows for the easy application within a New Zealand setting. Because youth already have the resources to communicate with others in their social groups, such as via means of text messaging, Facebook, speeches at assemblies and distribution of posters (Wyman et al., 2010), the positive health messages can be portrayed in a way that would be culturally appropriate to them, and at not much cost. Additionally, student leaders are able to communicate with their peers in a non intrusive, informal, interpersonal way. Furthermore, training and mentoring of student leaders can be done by staffing positions in New Zealand schools which already exist- such as the school counsellors or the school chaplain.  A training program will have to be designed and constructed either at a national or individual level.

The Sources of Strength Suicide Prevention Program, which is driven by student leaders, is powerful in that it allows for youth to reach youth, in a way that addresses material/structural and cultural/behavioural risk factors that is culturally meaningful (Wyman et al., 2010).

Alternatively, an intervention which addresses age related inequalities is identified by Robertson and Campbell (2008). Home safety assessments and modifications are a primordial prevention measure, in that it addresses risk factors of the environmental structure- which are distally connected to the actual event (Robertson et al., 2008). It has been shown to be effective in reducing the rate of falls among elderly people, up to a quarter, with a total of 913 falls prevented per 1000 participants (Robertson et al., 2008). Additionally, falls were also reduced in the other environments participants were exposed to. This suggests that when elderly people have their homes assessed, they are educated in recognising environmental risks thus gain an increased awareness of movement (Robertson et al., 2008).

The home safety assessment and modification intervention involved having an occupational therapist assess the structural environment of the elderly person, with the specific purpose of reducing fall risk.  Peterson and Clemson (2008, as cited in Robertson et al., 2008) indicated that the assessment of the elderly person’s home must consider the personal fitness of the elderly person. For example, identifying potential tripping dangers and providing easier reaching environments may be more suitable for a frailer or sedentary person, as opposed to seeking safer climbing options. Furthermore, Peterson and Clemson (2008, as cited in Robertson et al., 2008) suggested that a home assessment intervention is unique in that the occupational therapist surveys the home with the client. In this way behaviours particular to the client can be identified and incorporated into the intervention. Similarly, unique risk behaviours may be indentified and protective measures put in place. Furthermore, part of the assessment- as suggested by Peterson and Clemson (2008, as cited in Robertson et al., 2008) may involve reorganising furniture of the elderly person in order to create the necessary space for impaired movement.

The home safety risk assessment and modification intervention focuses on preventative measures, toward an easily definable group in society. Although it is individual based, it does not necessarily mean that it is ineffective. To implement this individualised intervention into the New Zealand setting, Robertson and Campbell (2008) have identified several factors which need to be considered. For the government may be able to pass legislation that recognises the safety of the home as a significant risk factor to falling (Dyson, 2005), thus increasing the amount of people reached.  Another factor to be considered for implementation is that, occupational therapists must have an appropriate level of knowledge and skills to ensure quality and efficiency in the provision of the intervention (Robertson et al., 2008). Furthermore, the impact of this intervention is highly dependable on the level of rapport the occupational therapist is able to build with the client, as this will help with clear communication and adherence to adjustments made (Robertson et al., 2008).

Robertson and Campbell (2008) identified that the Accident Compensation Corporation will most likely be the funders of such an intervention, with the increased employment of occupational therapists necessary. However, the projected expenditure of this is to be up to $241,277 less than the current cost of treating those who will fall if this program is not implemented- thus highlighting the effectiveness and necessity of such a program.

Having an occupational therapist assess the home provides a personalised intervention, which will build on the existing behaviours of the elderly person. Additionally, the home safety assessment will increase the elderly person’s material and structural resources in the way of general education, which they may then be able to project into other situations (Robertson et al., 2008). In order to implement such a program, New Zealand must have a knowledgeable and skilled task force of occupational therapists.

It is evident that there are many different health issues arising from age related health inequalities. The social model explains many of these health differences (Asthana et al., 2006), by way of the material/structural explanation, cultural/behavioural explanation, social selection and historical context. The Sources of Strength Suicide Prevention Program was an intervention that proved to be successful in reducing health inequality amongst youth (Wyman et al., 2010), by delivering an intervention that was culturally significant. Home safety risk assessment and modification was another successful intervention in reducing health inequality amongst elderly people (Robertson et al., 2008).

References

Asthana, S., and Halliday, J. (2006). What works in tackling health inequalities: pathways, policies and practice through the lifecourse. Bristol: Policy Press.

Biderman, A., C, Wikel, J, Fried, A.V., & Galinsky, D. (2002). Depression and falls among community dwelling elderly people: a search for common risk factors. Journal of Epidemiology and Community Health, 56, 631-636.

Christakis, N.A., & Fowler, J.H. (2007). The Spread of Obesity in a Large Social Network Over   32 Years. The New England Journal of Medicine 357(4), 370-379.

Dyson, R. (2005). Preventing Injury from falls: The national strategy 2005-2015. Wellington: The Accident Compensation Corporation.

Graham, H. (2007). Health inequalities and inequities. In Unequal lives: Health and socioeconomic inequalities. (pp. 3-18). New York: Open University Press.

Ministry of Health. (2002). New Zealand Youth Health Status Report. Wellington: Ministry of Health.

Ministry of Health. (2004). The Health and Independence Report 2004: Director-General of Health’s annual report on the state of public health. Wellington: Ministry of Health.

Ministry of Health. (2006). Older People’s Health Chart Book 2006.Wellington: Ministry of Health.

Robertson, M.C., & Campbell, A.J. (2008).  Optimisation of ACC’s fall prevention programmes for older people: Final Report. Dunedin: University of Otago, Dunedin School of Medicine.

Wyman, P., Brown, H., LoMurray, M., Schmeelk-Cone, K., Petrova, M., Yu, Qin., Walsh, E., Tu, X., & Wang, W. (2010). An Outcome Evaluation of the Sources of Strength Suicide Prevention Program Delivered by Adolescent Peer Leaders in High Schools. American Journal of Public Health 100(9), 1653-1661.