Health and illness in later life, inequalities – gender, ethnicity and end of life

Introduction
This Qualitative report outlines two interviewees later year’s experiences from two different cultural and ethnic backgrounds with the aim of examining the importance they attribute to their health status. A body of research reveal that there exist wide health inequalities between certain groups in the developed countries (Devaux & de Looper, 2012; U.S. Department of Health and Human Services, 2007 ; Van Doorslaer et al., 2003). These groups defining characteristics in include, ethnic, gender, age as well as economic status. Nonetheless, with all this definition of affected constituents by health inequality, the out come is a country where disadvantaged perish at the expense of the advantaged. This report takes a closer look at the intricacies involved with such classifications and the core issues leading to the rise in such deplorable conditions. It is in the light of these occurrences that this report aims at investigating health inequalities and health promotion taking into account gender, ethnicity and socio-economic as well as ageism and racism factors.
Methodology

The information collected for this study was from two interviews. The first one was with Ms B is a 69 year old woman. The interview took place in the front room of her home. The second interview was with Ms A is a 64 years old Black African woman; the Interview took place in her home.
The subjects were referred to as Ms A and B for confidential purposes; their real names were not used, but every other detail is as was during the interview. Prior to the interviews, the interviewees had to sign consent forms issued by the institution the interviewer is affiliated. The consent form is made available by the faculty under which the interviewer belongs and is mainly a legally binding document to ensure confidentiality of the contents of the interview.
The two first interviews were with elderly women and because of the generational gap; they were both handled with the utmost respect. However, there are instances that Ms A was referred to as ma’am because of her cultural background as a show of humility and respect.
Results/findings
A close examination of Ms A and Ms B interview reveal information relevant to the aims and objectives of this study. First, Ms B has a GP, who is 8 minutes walk from her residence and has been useful for medical issues such as surgery and other medical advice (12) while Ms A claims she does not need a GP. Ms A believes that her spirituality is an alternative to the help she can get from a GP (8) and does not even remember the last time she visited a GP(9). Ms B has a male Doctor (66) and has been with him for a long time. She claims that he is elder-ish and avoids women issue by referring to her to other female consultants (69). Despite having received several invitations, Ms A has never consulted a GP and claims she is fine (12). She does not remember the last time she visited a GP for any medical issue or advice (15). On the other hand, Ms B claims she has received much information from her local GP; there was a time she had trouble emptying her bowel freely (20) and she sort for advice from her GP, who asked her to take plenty of fruits and vegetables (21). She gets helpful information on other medical conditions freely such as Flu and Diabetes from pamphlets (24) as well as the nurse (25). Ms B receives helpful information from her doctor, such as, where to purchase blood pressure kits and how best to use it(27).
Both Ms A and B are very active and have plenty of activities to do around their houses. Ms B spends much of her time around the house re-arranging her kitchen cupboard (32). She cooks (39), prepares her skirting board and also spends time relaxing, watching TV while eating her lamb chops (40). Ms A also finds time to arrange her things though she does not seem to devote most of her time in household work as compared to her ministry, she is still yet to arrange the things that she move in with since she was re-housed in October(19). Ms A is very busy with ministry work and does not sit to rest (26). Ms B gets good nutritional advice from her GP and eats right, Weetabix and dry raisins for breakfast (47) and a cup of tea and crackers for lunch with 2 fruits (48). For dinner, she prefers lamb chops, broad beans and carrots (50). Ms B, on the other hand, claims she is a light eater with her diet consisting of predominantly fruits (30). She also goes sometimes without food during her fasting periods (31).
Ms B enjoys quality time with her children and grand children often (52); she also picks up her granddaughter from school (53). Ms A finds pleasure in God, her family both biological and spiritual (33). She is a spiritual person and delights in serving and worshiping all the time (36). Ms B finds time in her schedule to go shopping (56) when it’s quiet (57) and avoids shopping on Saturdays (58). In addition, she still drives, but does not do long distance (60), she only drives to the supermarket, and when there is no traffic (62), she avoids using the road because it is tiring and keeps her away from reckless drivers (63). Compared to Ms A, Ms B enjoys meeting people as part of her ministry than shopping (39) and uses public transportation, as opposed to private means (42). She enjoys bus rides regardless of whether it is school rush hour or not (45).
Ms B has friends she spends time with from time to time, they go shopping have snacks together (72). She also has a good neighbour at the end of the street that she spends time with visiting a local Nursing home (74). Ms B’s friends are good companions (80) they talk about family and engage in other activities such as making tea (82). She does not engage in community activities (85) as she used to in 2008(86). Ms A, on the other hand, socializes with everyone she meets in the course of her ministry (51); however she claims that her social life is in the church where she does volunteer work (52). She gets spiritual support from her ministry (55) and many refer to her as mummy (56). Unlike Ms A, she engages in community activities such as the Easter love fest (59) where she brings drinks and snacks and distributes leaflets to neighbours (60).
Discussion
Woodwarda and Kawachib (2000), reiterate a well known fact that health inequalities are socially, culturally and economically instigated. This paper aims at exposing evidence in health inequalities and the need for health promotion, as well as highlight gender,, ethnicity and socio-economic factors, Ageism and racism in the healthcare sector.
Adequate access to healthcare has been cited as a key factor determining a country’s commitment to reducing health inequalities and promotion. Devaux and de Looper (2012), explain that the need for General Practitioners can be analysed using variables such as age, gender and health status. In the current study, Ms B has a General Practitioner, who is 8 minutes walk from her residence, while, on the other hand Ms, A sees no need for one. Devaux and de Looper (2012) reveal in their study that people who are financially stable are more likely to visit a GP than those in the lower income level. Ms B in the interview is presented as more stable than Ms A financially. Ms B has time for shopping, cafes with friends, and she can also afford a healthy meal at the end of the day. She even has access to private transportation. Compared to Ms A, who is housed by the council (Shelter, 2013). Van Doorslaer et al. (2003) assert that income related health inequalities are persistent in Europe regardless of the fact that many countries have established easy access to physician services. They further posit that there is unequal opportunity in accessing health services across income groups. Ms A seems to be in the lower income category and much marginalized in regard to access to health services. This is a common trend in most developed economies especially in North America and Europe. In an examination of such inequalities, in self reported health and their impact on individual risk factors in the United States and Canada, McGrail et al.(2009), found that income distribution was responsible for more than 50 percent of income-related health inequalities. The same can be said of the United Kingdom where life expectancy is as high as in both the USA and Canada as a result of great preventive measures against killer diseases, yet the ubiquity of health inequality is constant (Graham & Kelly, 2004). They reveal that while the health of the general population seems to improve, those in the lower income bracket are far from this reality, and this has been a point of challenge to policy makers.
In addition, gender is one of the key causes of health inequalities.Ostrowska (2012), explains that notable differences between male and female health status is a common topic and has become a subject of increasing interest of researchers. According to them, researchers have recorded these differences in a bid to understand them within a bio-medical framework. Health inequalities in regard to gender divergence are indicative of the differences in social roles and status engraved in culturally created perception of femininity and masculinity. It is most likely that Ms A has continually ignored invitations to GP because of cost. It is most likely possible that she could be fine now, but the future is uncertain and more so in regard to her age. Health insurance coverage has become one of the key issues as far as women access to healthcare is concern. According to Kaiser Family Foundation (2013), health insurance coverage is a motivational factor for women and is effective in improving their health status by enabling access to preventive, primary, as well as, speciality healthcare. This could represent the case with Ms A, with medical cover; she would most likely at least visit her GP for a check up.
Racism has been one of the key issues associated with health inequality. Generally, it is said that Native and African American, as well as Pacific Islanders, have a shorter lifep and dismal health outcomes including high infant mortality rates, diabetes, HIV/AIDS, stroke, deteriorating life expectancy compared to their white and Asian American counterparts (U.S. Department of Health and Human Services, 2007). The United Kingdom is also faced with this challenge as explains Nazroo (2003 ), who posit that there is high health inequality across ethnic groups in the US and UK, and this has been documented. Woolf et al.(2004), in reference to a study by Dr. David Satcher and Dr. Adelwale Troutman, close to 900, 000 of the deaths of African Americans would have been prevented if their health matched that of their white counterparts. Racial identity is not pathogenic, but is a social issue in many countries that are the basis of profiling. While it is true that not all people from these minority groups both in the US and UK are poor, most of them are and according to Smedley et al. (2003), health follows a pattern that the more the wealth, the better the health. Most of them work in jobs that are in the lower status and are also less educated than their white counterparts. This is a key reason why this population is persistent in the lower socio-economic strata compared to the other ethnic groups. Ms A is a black woman who is more concern with her spiritual condition than her health condition. She seems not to take cognizance of the fact that one she might need medical attention given her age, “health by choice.” Nonetheless, this could be none of her fault, as an African American, she is disadvantaged, she might not be able to afford the cost or even fail to take on appropriate medical cover (Nazroo, 2003 ). It has been noted in Britain that immediate action is needed to reform the pension plans to match in regard to the disparity between the rich and the poor, a state that could lead to thousands of poor people dying before they reach retirement (Copper, 2013).
Just as the ethnic minorities in the developed countries, the older generation is currently one of the constituencies with rising health challenges. It is a population that is experiencing health inequalities (Grundy & Sloggett, 2003 ). In England alone, there are 10 million people aged 65 and over (Thorpe, 2011). In this population, most of the are either sick or with some disability, thy account for 60 percent of hospital admissions (Thorpe, 2011). Grundy and Sloggett (2003 ), in their research used information from three rounds of the English Health Survey to understand the variations in wellbeing of those aged between 65-84 years. In their study, they used indicators based on self reports and data collected by a medical practitioner. The study revealed that socio-economic indicator and most prominent, income, was related to the increasing odds of diminishing health outcomes (Grundy & Sloggett, 2003 ). Ms B in the current study has already started experiencing the effects of aging and conscious of what is expected of her. She is 69 years and seeks regular medical advice from her GP and takes every precaution in order to live a healthy and rewarding life. Ms A, on the other hand, is 5 years younger than Ms B, she might not feel the impact of age on her, but as seen in the above paragraphs, she is bound to feel some of these effects, it is just a matter of time (Grundy & Sloggett, 2003 ).
The examination of gender, ethnicity, socio-economic, as well as ageism and racism variables as factors associated with health inequalities,, it is important also to consider the promotional aspect. Health promotion empowers people to consider and sustain healthy lifestyles thereby becoming better health managers (Family Health Teams, 2006). There needs to be promotion strategies that when implemented uses structural solutions that support change in behaviour. One of the areas needing work is for governments to focus on closing narrowing of the gap between the rich and the poor. However, it is not just the closing of the gap, but making available services that would positively impact the poor. Such remedies include; empowering and mobilizing the people to resort to healthier choices, such as making available healthy food for the masses (Shircore, 2009). In addition, the vulnerable populations need to be supported to change their behaviour, Shircore (2009), explain an important point that both physical and mental health are integral parts of quality of life and that evidence is clear that a healthy diets are beneficial to the both.
On the other hand, poor housing coupled with poor income adversely affect physical and mental health. In this regard, the need for effective social marketing is imperative in achieving the desired change with both the public and with decision-makers. To achieve this, one of the most effective ways as seen in the current study is to involve the GP in health promotion strategies (Family Health Teams, 2006). Ms B compared to Ms A had been receiving critically needed useful medical procedures because of her awareness of her health status. While Ms A, claimed, she did not need a GP and did not even remember the last time she visited a GP (9). Ms B had a Doctor (66) and had been with him for a long time. On the other hand, Ms B claims she has received much information from her local GP; there was a time she had trouble emptying her bowel freely (20) and she sort for advice from her GP, who asked her to take plenty of fruits and vegetables (21). She gets helpful information on other medical conditions freely such as Flu and Diabetes from pamphlets (24) as well as the nurse (25). Ms B receives helpful information from her doctor, such as where to purchase blood pressure kits and how to use of it in checking her blood pressure (27). The focus on patient education, counselling and support is an important health promotion strategy and should be given to every vulnerable person in the categories examined in this study.
Conclusion and recommendation
As explained by Ms A and Ms B’s economic and health conditions, there are wide disparities between minority groups and dominant populations, more so in developed countries. As an African woman, Ms A was oblivious to the fact that she would need medical at one point in life; such is the attitude that some people in minority groups face life. Nonetheless, there are others who regardless of what they know, are restricted by their economic state. As a matter of fact the common denominator across all this classification whether ethnic, gender, age, is economic stability or sustainability. It is the responsibility of the government and the entire stakeholder to ensure that necessary steps are taken to provide for the needs of these vulnerable groups so as to reduce the effects of such health inequalities. As seen above, certain subsidies can be given to the vulnerable groups to mitigate the effects of health inequalities as discussed.
The current study used two case studies to explain several variables. Further research is needed to zero in on specific details as it fails to do justice to all the variables presented, for depth and breadth of the issues investigated, the case studies fail to examine fully within the real-life context all the variables presented. On the gender issue, it would have been helpful if one of the interviewees was a male or in that case have more than two interviewees, the third of a different gender.
Bibliography
Copper, C., 2013. Britain’s poor ‘will die before they retire’ if pension reforms aren’t matched by health improvements. The Independent , 06 December.
Devaux, M. & de Looper, M., 2012. Income-Related Inequalities in Health Service Utilisation in 19 OECD Countries, 2008-2009”. OECD Health Working Papers.
Family Health Teams, 2006. Guide to Health Promotion and Disease Prevention. [Online] Ministry of Health Available at: HYPERLINK “http://www.health.gov.on.ca/en/pro/programs/fht/docs/fht_health_promotion2.pdf” http://www.health.gov.on.ca/en/pro/programs/fht/docs/fht_health_promotion2.pdf [Accessed 10 December 2013].
Graham, H. & Kelly, M.P., 2004. Health inequalities: concepts,frameworks and policy. [Online] Health Development Agency Available at: HYPERLINK “http://www.nice.org.uk/niceMedia/documents/health_inequalities_concepts.pdf” http://www.nice.org.uk/niceMedia/documents/health_inequalities_concepts.pdf [Accessed 10 December 2013].
Grundy, E. & Sloggett, A., 2003. Health inequalities in the older population: the role of personal capital, social resources and socio-economic. Social Science Med, 56(5), pp.935-47.
Kaiser Family Foundation, 2013. Women’s Health Insurance Coverage. [Online] Kaiser Family Foundation Available at: HYPERLINK “http://kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage-fact-sheet/” l “footnote-89006-14” http://kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage-fact-sheet/#footnote-89006-14 [Accessed 10 December 2013].
McGrail, K.M., Van Doorslaer, E., Ross, N.A. & Sanmartin, C., 2009. Income-Related Health Inequalities in Canada and the United States: A Decomposition Analysis. American Journal of Public Health, 99(10), pp.1856–63.
Nazroo, J.Y., 2003. The Structuring of Ethnic Inequalities in Health: Economic Position, Racial Discrimination, and Racism. American Journal of Public Health, 93(2), pp.277–84.
Ostrowska, A., 2012. Health inequalities–gender perspective. Przegl Lek., 69(2), pp.61-6.
Shelter, 2013. Who gets priority for council housing. [Online] Available at: HYPERLINK “http://england.shelter.org.uk/get_advice/finding_a_place_to_live/council_housing/who_gets_priority” http://england.shelter.org.uk/get_advice/finding_a_place_to_live/council_housing/who_gets_priority [Accessed 10 December 2013].
Shircore, R., 2009. Guide for World Class Commissioners Promoting Health and Well-Being: Reducing Inequalities. London: RSPH RSPH.
Smedley, B., Jeffries, M., Adelman, L. & Cheng, J., 2003. Race, Racial Inequality and Health Inequities: Separating Myth from Fact. [Online] Available at: HYPERLINK “http://www.unnaturalcauses.org/assets/uploads/file/Race_Racial_Inequality_Health.pdf” http://www.unnaturalcauses.org/assets/uploads/file/Race_Racial_Inequality_Health.pdf [Accessed 10 December 2013].
Thorpe, T., 2011. Healthy Lives, Healthy People: Our strategy for public health in England. [Online] Available at: HYPERLINK “http://www.bgs.org.uk/index.php?option=com_content&view=article&id=1443:healthylivesstrategy&catid=14:consultations&Itemid=110” http://www.bgs.org.uk/index.php?option=com_content&view=article&id=1443:healthylivesstrategy&catid=14:consultations&Itemid=110 [Accessed 10 December 2013].
U.S. Department of Health and Human Services, 2007. Health Inequalities. [Online] Available at: HYPERLINK “http://search.hhs.gov/search?q=African+Americans%2C+Native+Americans+and+Pacific++Islanders+live+shorter+lives+and+have+poorer+health+outcomes&btnG=Search&entqr=3&ud=1&sort=date%3AD%3AL%3Ad1&output=xml_no_dtd&oe=UTF-8&ie=UTF-8&lr=lang_en&client=HHS&proxys” http://search.hhs.gov/search?q=African+Americans%2C+Native+Americans+and+Pacific++Islanders+live+shorter+lives+and+have+poorer+health+outcomes&btnG=Search&entqr=3&ud=1&sort=date%3AD%3AL%3Ad1&output=xml_no_dtd&oe=UTF-8&ie=UTF-8&lr=lang_en&client=HHS&proxys [Accessed 10 December 2013].
Va Doorslaer, E., Koolman, X. & Jones, A.M., 2003. Explaining income-related inequalities in doctor utilisation in Europe:a decomposition approach. [Online] Available at: HYPERLINK “http://www2.eur.nl/ecuity/public_papers/WP5v4.pdf” http://www2.eur.nl/ecuity/public_papers/WP5v4.pdf [Accessed 10 December 2013].
Woodwarda, A. & Kawachib, I., 2000. Why reduce health inequalitiesJournal of Epidemiol Community Health, 54, pp.923-929.
Woolf, S.H. et al., 2004. The health impact of resolving racial disparities: An analysis of US mortality data. American Journal of Public Health, 94(12), pp.2078-81.