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M Benzeval

Publications and source records attributed to M Benzeval.

11 recordsLinked to original sources
PubMed2001

Income and health: the time dimension.

It is widely recognised that poverty is associated with poor health even in advanced industrial societies. But most existing studies of the relationship between the availability of financial resources and health status fail to distinguish between the transient and permanent impact of poverty on health. Many studies also fail to address the possibility of reverse causation; poor health causes low income. This paper aims to address these issues by moving beyond the static perspective provided by cross-sectional analyses and focusing on the dynamic nature of people's experiences of income and health. The specific objective is to investigate the relationship between income and health for adult participants in the British Household Panel Survey from 1991 to 1996/97. The paper pays particular attention to: the problem of health selection; the role of long-term income; and, the effect of income dynamics on health. The results confirm the general findings from the small number of longitudinal studies available in the international literature: long-term income is more important for health than current income; income levels are more significant than income change; persistent poverty is more harmful for health than occasional episodes; and, income reductions appear to have a greater effect on health than income increases. After controlling for initial health status the association between income and health is attenuated but not eliminated. This suggests that there is a causal relationship between low income and poor health.

Causality↗
PubMed1998

The self-reported health status of lone parents.

A number of studies have shown that lone parents have poorer health status than the general population. However, what is missing from the existing literature is any systematic assessment of the contribution that lone parents' relatively poor socioeconomic circumstances make to their relative health disadvantage. This paper aims to fill this gap. It employs a large national dataset based on three consecutive years of the British General Household Survey (1992/1993 to 1994/1995) to assess the relative health status of lone parents in comparison to couple parents, and to evaluate the importance of different explanations for their health differences. The results confirm that lone parents, particularly lone mothers, have poor health status relative to parents living as couples. The observed health differences mirror variations in socioeconomic circumstances. However, even when a wide range of demographic and socioeconomic circumstances are included in multivariate models, lone mothers still have significantly poorer health than couple mothers for four out of five health variables. The paper concludes by discussing alternative explanations for the health differences between lone and couple parents--such as the absence of an intimate/confiding relationship, the stress and stigma associated with becoming a lone parent and health selection--and by highlighting future options for policy and research in this area.

Fathers↗
PubMed1996

Access to health care in England: continuing inequalities in the distribution of GPs.

BACKGROUND: One of the successes of the National Health Service is that the distribution of general practitioners (GPs) corresponds much more closely to the size of the local communities than it did before 1948. However, more should be done to reflect the fact that different populations have variable needs for GPs. The aim of this paper is to estimate the relative need for GPs by linking evidence from individual utilization data to the characteristics of small areas. METHODS: Statistical models of GP utilization were developed from household survey data on 12729 adults representative of the English population. The odds ratios derived from the models were combined with Census information for Family Health Services Authorities (FHSAs) to calculate a need indicator, which was used to estimate the number of GPs 'needed' in an area for comparison with the actual distribution. RESULTS: The utilization of GPs is associated with morbidity, demographic and socioeconomic variables. The needs indicator derived from the model of GP utilization varies from 1.66 to 2.40 with a mean of 2. Substantial changes in the distribution of Gans are required to reflect the relative need for them. For example, in relative terms, Cornwall and the Isles of Scilly has an excess of GPs of almost one-fifth whereas Rotherham has a shortfall of more than one-third. CONCLUSIONS: The findings in this paper suggest that there are still considerable inequalities in access to GP services in England in relation to need.

Adolescent↗
PubMed1995

Beyond class, race, and ethnicity: deprivation and health in Britain.

The concepts of class, race, and ethnicity figure prominently in health services research in Britain. Occupational class has been employed for nearly a century to investigate social inequalities in health and access to care. More recently, researchers have identified differences in health status and utilization between ethnic groups. This article examines how these constructs are defined in Britain and identifies some key research associated with them. It also draws attention to the considerable problems in using class and ethnicity to stratify the population. The authors conclude that a new approach that directly measures individuals' material and social resources needs to be developed.

Adult↗
PubMed1993

Health inequalities: new concerns about the children of single mothers.

OBJECTIVES: To show that the exclusion from conventional class based analyses of child mortality of children whose parents are classified as "unoccupied" produces a misleading picture of health inequalities. DESIGN: Reanalysis of data published in the childhood supplement of the registrar general's decennial supplement on occupational mortality in England and Wales, which compares numerator data for registrations of deaths in children over the age of 1 but below their 16th birthday in 1979, 1980, 1982, and 1983 with data about children aged 1-15 who were enumerated at the 1981 census. RESULTS: Parents who are classified as "unoccupied" largely consist of economically inactive single mothers. Their children are estimated to represent 89% of the 614,000 aged 1-15 classified as "unoccupied" in the childhood supplement. They have the worst mortality record of all social groups--an age specific death rate of 68.8/100,000 a year, 42% worse than in social class V (48.4/100,000) and worse than that of social class I (22.8) by a factor of 3. At older ages (10-15 years) these children have a relative risk of death of 4.14 relative to classes I and II; the risk is 2.58 in children 0-4 and 2.56 in those 5-9. Relative risks of child mortality in social classes I and II in comparison to classes IV and V suggests a progressive shallowing from 2.08 at ages 1-4 to 1.37 at ages 10-15. When unoccupied parents were combined with classes IV and V and compared with classes I and II, however, inequalities seemed to be pervasive throughout childhood; the relative risks were 2.21 for those aged 1-4 and 1.98 for those aged 10-15. CONCLUSION: Children classified as unoccupied are almost certainly living in poverty as well as experiencing relatively high risks of mortality. Class based analyses which exclude them therefore produce a misleading picture of inequalities in child health. The implications for health policy are profound. Strategies to promote the nation's health should acknowledge the importance of material and social deprivation more explicitly.

Adolescent↗
PubMed1991

Utilisation by homeless people of acute hospital services in London.

OBJECTIVES: To estimate the numbers and distribution of homeless people in London; to quantify the utilisation of acute inpatient services by homeless people in two health authorities; and to predict the total numbers of admissions in homeless people in district health authorities across London. DESIGN: Data were collected from various sources on the distribution of homeless people across London boroughs. All unplanned acute inpatient admissions during November 1990 to relevant hospitals were identified. SETTING: Bloomsbury and Paddington and North Kensington, two former inner London district health authorities. SUBJECTS: Homeless people in London residing in bed and breakfast and private sector leased accommodation, residing in hostels, and of no fixed abode. MAIN OUTCOME MEASURES: Number and cost of acute unplanned admissions in homeless people in two health authorities in November 1990; predicted number of such admissions each year in district health authorities in London. RESULTS: There were at least 60,000 homeless people in London in March 1990. The majority were housed in temporary accommodation (55,412). There were at least 3295 hostel dwellers and 651 people sleeping rough. Homeless people accounted for 105 (8%) of the 1256 acute unbooked admissions in residents of Bloomsbury and Paddington and North Kensington health authorities in November 1990. Considerable variations in the pattern of acute unplanned admissions in homeless people were observed in the two districts with respect to housing status and specialty of admission. The total number of acute unplanned admissions in homeless people across London each year was estimated at 7598, ranging from 38 in Bexley to 1515 in Parkside. CONCLUSIONS: The results have fundamental implications for resource allocation across London. Allocation must take better account of the heterogeneity, uneven distribution, and extra health needs of homeless people.

Adolescent↗
PubMedDate not supplied

The determinants of hospital utilisation: implications for resource allocation in England.

Since 1976 various attempts have been made to ensure that NHS resources available for hospital and related services in England are allocated in proportion to the health care needs of different areas. The current method is based on analyses of the links between observed patterns of in-patient utilization and the characteristics of the populations of small areas. There are a number of practical difficulties with this approach, however, and so the search continues for new analytical techniques. The purpose of this paper is to explore how household survey data about 12,729 English adults could be used to inform resource allocation decisions. Health care need indicators can be developed based on Census information and odds ratios derived from logistic regression analyses of the relationships between hospital utilization, health status, socio-demographic characteristics and area indicators of supply. The results suggest that health status is the most important determinant of hospital utilization, although demographic and socio-economic factors also have some influence. In addition to the personal characteristics of individual respondents, area correlates of health care supply are also positively associated with reported utilization. The final part of the paper illustrates how weighted population estimates might be calculated on the basis of empirically-derived indicators of health care need.

Adult↗
PubMedDate not supplied

Income inequality and population health.

A number of studies have suggested that inequalities in the distribution of income may be an important cause of variations in the average level of population health among rich industrial nations. However, what is missing from the debate so far is any systematic review of evidence about the relationship between different measures of income distribution and indicators of population health. This paper aims to bridge that gap. First, it summarizes the recent English language literature on this topic and illustrates the methodological problems that weaken the inferences that can be derived from it. Secondly, it presents new empirical estimates of the relationship between different measures of income distribution, infant mortality and life expectancy based on the most authoritative data published to date. In contrast to most earlier studies, we find very little support for the view that income inequality is associated with variations in average levels of national health in rich industrial countries. Some possible explanations for these differences are outlined.

Developed Countries↗