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<title>Inequalities in Health Care</title></titleStmt>

<publicationStmt><distributor>BASE and Oxford Text Archive</distributor>


<availability><p>The British Academic Spoken English (BASE) corpus was developed at the

Universities of Warwick and Reading, under the directorship of Hilary Nesi

(Centre for English Language Teacher Education, Warwick) and Paul Thompson

(Department of Applied Linguistics, Reading), with funding from BALEAP,

EURALEX, the British Academy and the Arts and Humanities Research Board. The

original recordings are held at the Universities of Warwick and Reading, and

at the Oxford Text Archive and may be consulted by bona fide researchers

upon written application to any of the holding bodies.

The BASE corpus is freely available to researchers who agree to the

following conditions:</p>

<p>1. The recordings and transcriptions should not be modified in any


<p>2. The recordings and transcriptions should be used for research purposes

only; they should not be reproduced in teaching materials</p>

<p>3. The recordings and transcriptions should not be reproduced in full for

a wider audience/readership, although researchers are free to quote short

passages of text (up to 200 running words from any given speech event)</p>

<p>4. The corpus developers should be informed of all presentations or

publications arising from analysis of the corpus</p><p>

Researchers should acknowledge their use of the corpus using the following

form of words:

The recordings and transcriptions used in this study come from the British

Academic Spoken English (BASE) corpus, which was developed at the

Universities of Warwick and Reading under the directorship of Hilary Nesi

(Warwick) and Paul Thompson (Reading). Corpus development was assisted by

funding from the Universities of Warwick and Reading, BALEAP, EURALEX, the

British Academy and the Arts and Humanities Research Board. </p></availability>




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<item n="speechevent">Lecture</item>

<item n="acaddept">School of Health and Social Studies</item>

<item n="acaddiv">ls</item>

<item n="partlevel">UG1/PG</item>

<item n="module">Health in the Community</item>




<u who="nf0262"><kinesic desc="projector is on showing slide" iterated="n"/> okay welcome to week six of health in the community <pause dur="2.8"/> just for reference # week six is outlined or the morning sessions are outlined on page twenty-one of your handbooks <pause dur="5.2"/> so as you all remember we've got a whole day's session in the university <pause dur="0.3"/> today <pause dur="1.6"/> before we <pause dur="0.3"/> begin this morning # <pause dur="2.3"/> this lecture and all the lectures this morning are being filmed for <pause dur="1.7"/> a research project <pause dur="0.2"/> # <pause dur="2.0"/> the aim <pause dur="0.4"/> of the lecture is is really to <pause dur="0.9"/> to video me <pause dur="0.7"/> but <gap reason="name" extent="1 word"/> also wants to have a camera on the audience as well <pause dur="0.5"/> so she's just going to come and explain about the <pause dur="0.3"/> research project and then seek your permission <pause dur="0.4"/> to film you as an audience <vocal desc="laughter" iterated="y" n="ss" dur="4"/> so </u><pause dur="4.9"/> <u who="of0263" trans="pause"> <event desc="taps microphone" iterated="n"/> is this working <pause dur="0.9"/> hello everyone <pause dur="0.3"/> can you hear me <kinesic desc="nod heads" iterated="n" n="ss"/></u><pause dur="0.8"/> <u who="sm0264" trans="pause"> shh </u><pause dur="0.3"/> <u who="of0263" trans="pause"> # hi my name's <gap reason="name" extent="2 words"/> and i'm a research assistant at the Centre for English Language Teacher Education <pause dur="0.3"/> CELTE <pause dur="0.4"/> and # this filming is being carried out as part of a <pause dur="0.2"/> part of two research

projects actually on <pause dur="0.4"/> academic spoken English <pause dur="0.5"/> so # we'd just like to have your permission just to make sure that nobody objects strenuously to being filmed <pause dur="0.6"/> is is that okay with you <pause dur="1.6"/><kinesic desc="nod heads" iterated="n" n="ss"/> any objections <vocal desc="laughter" iterated="y" n="ss" dur="1"/><pause dur="0.9"/> <vocal desc="laughter" iterated="y" dur="1"/><pause dur="2.4"/> all right thanks very much </u><pause dur="2.2"/> <u who="nf0262" trans="pause"> <gap reason="inaudible" extent="1 sec"/> thanks <pause dur="2.2"/> well the only advantage from my point of view is that i'll have on camera those of you that have fell <trunc>as</trunc> fallen asleep <pause dur="1.0"/><vocal desc="laughter" iterated="y" n="ss" dur="1"/> okay <pause dur="0.5"/> so let's # <pause dur="0.3"/> let's set off <pause dur="0.6"/><kinesic desc="changes slide" iterated="n"/> okay <pause dur="0.2"/> so the timetable for this morning it's quite a heavy timetable this morning we're going to start off by <pause dur="0.5"/> # having # a a a a <pause dur="0.2"/> short thirty minute lecture on inequalities in access to care <pause dur="0.6"/> then after probably just a two minute stretch <pause dur="0.4"/> and # <pause dur="0.2"/> <trunc>ti</trunc> a comfort stop we'll then <pause dur="0.2"/> follow it by another thirty minutes looking at how inequalities can be tackled <pause dur="0.9"/> then we've got a coffee break <pause dur="0.2"/> and then we'll finish off the morning looking # further at the theme of tackling inequalities in health <pause dur="0.4"/> and looking at <pause dur="0.3"/> the

policies and initiatives that have been put in place <pause dur="0.4"/> to tackle health inqualities <pause dur="1.7"/> are there any questions about that before we start <pause dur="1.3"/> so the learning outcomes of this morning's session are outlined on <pause dur="0.3"/> page twenty-one <pause dur="1.8"/><kinesic desc="changes slide" iterated="n"/> so we're beginning then by looking at inequalities in health care <pause dur="1.3"/> what i should say is because of the difficulties of accessing <pause dur="0.3"/> the Powerpoint slides on the learning environment which seems to be a continuing problem <pause dur="0.7"/> # the slides for <pause dur="0.2"/> all of today's lectures will be <pause dur="0.2"/> photocopied <pause dur="0.3"/> and put in your pigeonholes <pause dur="0.3"/> because i'm aware that you need # the slides from today's session <pause dur="0.4"/> to help you to write your formative assignment which is due in on Friday <pause dur="0.5"/> so that's also a reminder <trunc>t</trunc> that your first formative assignment your essay plan <pause dur="0.3"/> <trunc>i</trunc> <pause dur="0.3"/> is to be handed in by four o'clock on Friday <pause dur="1.6"/> okay but let's begin then by talking about inequalities in health care <pause dur="3.8"/> so to <pause dur="0.6"/> first of all i just want you to think about what we mean by the terms <pause dur="0.2"/> equality <pause dur="0.2"/> and equity <pause dur="4.2"/><kinesic desc="changes slide" iterated="n"/>

we've been looking at <pause dur="0.9"/> over # a period of weeks <pause dur="1.3"/> the fact that <pause dur="0.2"/> there is substantial evidence that documents that we have wide <pause dur="0.4"/> inequalities in health in in terms of inequalities in health status and health experience <pause dur="0.3"/> between different social groups <pause dur="2.9"/><kinesic desc="changes slide" iterated="n"/> but the evidence suggests that lack of access to health care <pause dur="1.1"/> only makes a minor contribution <pause dur="0.3"/> to the overall difference in mortality and morbidity <pause dur="3.1"/> but having said that <pause dur="0.8"/> it's also widely acknowledged that health services do have an important role to play <pause dur="0.5"/> in ameliorating and helping people cope with <pause dur="0.3"/> the damage to their health caused by poor material <pause dur="0.3"/> and social conditions <pause dur="0.4"/> so having said that lack of access or unequal access to health care <pause dur="0.4"/> isn't the cause of health inequalities <pause dur="0.3"/> that's not to say that they aren't an important issue <pause dur="4.9"/> but we need to bear in mind that <pause dur="0.5"/> equitable <pause dur="0.2"/> health care provision <pause dur="1.0"/> # <pause dur="2.4"/> is important <pause dur="0.6"/> rather than equality in health care provision <pause dur="0.5"/> so if we're talking about # <pause dur="0.7"/> providing people with

access to care then we need to make sure <pause dur="0.2"/> thak ik that it's equitable according to need <pause dur="0.5"/> rather than # <pause dur="1.5"/> having it distributed equally <pause dur="0.6"/> amongst the population <pause dur="6.7"/><kinesic desc="changes slide" iterated="n"/> an equity of access to health care is a central objective <pause dur="0.4"/> of the U-K National Health Service and it has been since its inception <pause dur="0.3"/> in the mid-nineteen-forties <pause dur="2.5"/> there's strong evidence that those in <pause dur="0.2"/> poor material and social circumstances <pause dur="0.2"/> low income groups <pause dur="0.4"/> # are <trunc>li</trunc> # in particular are likely to experience <pause dur="0.5"/> the <trunc>w</trunc> poorest health status <pause dur="0.5"/> suffer <pause dur="0.2"/> # a greater number of and more serious conditions <pause dur="0.3"/> than those in better social and material circumstances we've been looking at that evidence <pause dur="0.2"/> and it's been very clear <pause dur="2.2"/> so this suggests then <pause dur="0.2"/> that # those in low income groups those in the poorest social and material conditions <pause dur="0.6"/> need would need to use health care services more than those who are better off <pause dur="2.9"/><kinesic desc="changes slide" iterated="n"/> so a key question that we need to examine and try to answer <pause dur="0.3"/> is do those with the greatest health care needs <pause dur="0.3"/> have <pause dur="0.5"/> equitable access

to health care services do they have access <pause dur="0.4"/> # <pause dur="0.2"/> # to to services according to their needs <pause dur="4.9"/><kinesic desc="changes slide" iterated="n"/> so a large number <pause dur="0.2"/> of research studies have looked at this question <pause dur="0.8"/> and they have documented that there are inequities in access to health care <pause dur="1.6"/> but when we look at the evidence it shows quite a complex picture <pause dur="1.5"/> these studies show that in many areas and i mean both areas in terms of geographical areas as well as areas of service <pause dur="0.5"/> those with the greatest health needs # do have # poorer access to health care <pause dur="0.4"/> # than those who are better off <pause dur="0.2"/> and this was identified very clearly in nineteen-seventy-one by Julian Tudor Hart <pause dur="0.4"/> who identified that an inverse care law applies <pause dur="0.3"/> # to Britain <pause dur="0.8"/> and Tudor Hart said that <reading>the availability of good medical care <pause dur="0.4"/> tends to vary inversely with the need for it in the population served <pause dur="1.9"/> and the empirical evidence for this law has accumulated steadily over time</reading> <pause dur="1.2"/> but as i said <pause dur="0.5"/> the evidence is quite <pause dur="0.2"/> is complex and # <pause dur="1.0"/> there is evidence for

inequities in health care in some areas but not in others but we're going to start off by looking at some of that <pause dur="4.0"/><kinesic desc="changes slide" iterated="n"/> so what <pause dur="0.2"/> the evidence shows us overall is that there are inequities in access to some services not all services <pause dur="2.4"/> and there's inequity in access to facilities and <pause dur="0.2"/> to treatment and care <pause dur="5.2"/> there are also inequities in the utilization of some services <pause dur="1.4"/> so the way that services are used whether they're underused and overused <pause dur="2.6"/> and there are also inequities in the availability of responsive services <pause dur="1.0"/> because it's it's important not only to have services that are there for people <pause dur="0.4"/> but for people with # substantial health care needs it's important to have services <pause dur="0.4"/> that # <pause dur="0.2"/> that they feel able to use <pause dur="0.4"/> that are accessible <pause dur="0.3"/> but also that are responsive in terms of targeted to addressing <pause dur="0.3"/> and meeting those <pause dur="0.3"/> their particular health needs in a form that are acceptable to them <pause dur="0.7"/> and that's an issue we'll be going to be talking much more about this afternoon when we look

at <trunc>woi</trunc> working with <pause dur="0.3"/> disadvantaged # <pause dur="0.5"/> # <pause dur="0.9"/> patients and disadvantaged communities <pause dur="3.6"/><kinesic desc="changes slide" iterated="n"/> but let's <pause dur="0.2"/> first of all look at inequalities in access to primary health care <pause dur="0.6"/> and what we're going to see is a bit of a mixed bag <pause dur="4.6"/><kinesic desc="changes slide" iterated="n"/> the reviews # of <trunc>r</trunc> of that have looked at # <pause dur="0.4"/> the breadth of research in <trunc>d</trunc> <trunc>i</trunc> <pause dur="0.2"/> in in # <pause dur="0.6"/> access to primary care <pause dur="0.5"/> suggest that there probably now is a pro poor bias in G-P consultations and that's to <trunc>ex</trunc> <pause dur="0.3"/> to some extent what <pause dur="0.3"/> what you would expect <pause dur="0.9"/> there are higher consultation rates # <pause dur="0.2"/> for those people who are ill amongst disadvantaged groups <pause dur="2.5"/> and that this occurs even when need is controlled for <pause dur="2.5"/> but there is still continuing evidence that <pause dur="0.7"/> some <pause dur="0.2"/> marginalized groups have difficulty # accessing primary health care <pause dur="1.1"/> in particular if you think about it the kinds of groups that have difficulty in accessing primary health care <pause dur="0.3"/> are groups like asylum seekers <pause dur="0.7"/> # <pause dur="0.7"/> people who are homeless <pause dur="0.6"/> # who because they don't have # a place of residence <pause dur="0.3"/> may

find it <trunc>ax</trunc> # difficult to get on to G-P lists <pause dur="0.8"/> travellers <pause dur="0.4"/> # <trunc>s</trunc> many # G-Ps are # <pause dur="0.9"/> don't register travelling families <pause dur="0.4"/> and and as <trunc>tr</trunc> families are travelling round they often find when they <pause dur="0.3"/> they settle for a short period it's difficult <trunc>t</trunc> to get access to G-P services in particular areas <pause dur="3.4"/> some <pause dur="0.3"/> trusts and # <pause dur="0.2"/> and groups of G-Ps # have come together to provide specialized health services for these groups <pause dur="0.3"/> to try and # <pause dur="1.0"/> get round the difficult issue that some of these groups may have <pause dur="0.3"/> in terms of registering with a G-P <pause dur="0.4"/> so for example <pause dur="0.4"/> Coventry # <pause dur="0.6"/> <trunc>i</trunc> in Coventry <trunc>tr</trunc> <pause dur="0.2"/> Coventry Primary Health Care Trust has a particular <pause dur="0.2"/> # <pause dur="0.5"/> # specialist service to provide health care to asylum seekers and refugees <pause dur="4.2"/> but there's also evidence of inequitable access to particular services <pause dur="0.4"/> so for example there's some evidence that # <pause dur="1.1"/> there are inequities in access to health visiting services for people in disadvantaged groups <pause dur="0.5"/> and Reading and Allen in <trunc>nineteen-ni</trunc> ninety-seven looked at access # for

those with the poorest health needs to health <pause dur="0.2"/> health visiting services <pause dur="0.5"/> and although they found that <pause dur="0.2"/> some account had been taken of the fact that <pause dur="0.3"/> # those in # living in disadvantaged areas had greater health needs and there had been some attempt <pause dur="0.5"/> to # provide extra health visiting services in those areas <pause dur="0.4"/> the additional # resources that had been put in were nowhere near <pause dur="0.3"/> adequate enough to meet the substantial needs <pause dur="0.4"/> # and <pause dur="0.3"/> # health needs # and care needs of those families in those areas so although there were additional health visitors <pause dur="0.3"/> there weren't enough health visitors to meet <pause dur="0.3"/> the service requirement <pause dur="3.8"/> there's also evidence of underutilization of preventive services in primary care <pause dur="1.5"/> so there's a # people like McCormick # Majeed and Goddard and Smith <pause dur="0.5"/> have looked at the utilization of services in primary care <pause dur="0.3"/> and show and and their work suggests that manual social groups are less likely to attend their G-P practice <pause dur="0.3"/> for preventative care <pause dur="0.5"/> so although we've

got <pause dur="0.4"/> # high <trunc>cons</trunc> consultation rates when people are ill when it comes to <pause dur="0.3"/> attending for preventive health care <pause dur="0.3"/> then <pause dur="0.2"/> uptake # is much much lower <pause dur="2.3"/> and also # <pause dur="1.6"/> there's <pause dur="0.7"/> also evidence of uptake of poor uptake for things like # screening services and particular preventive care like immunization rates <pause dur="1.1"/> child health screening and cervical screening <pause dur="4.7"/><kinesic desc="changes slide" iterated="n"/> let's <pause dur="0.9"/> move from primary care then to look at secondary care and what happens when we look at access to secondary care <pause dur="2.1"/> well <pause dur="2.8"/> the studies that have looked at access to secondary care <pause dur="0.5"/> suggest that # the systematic reviews that have been done suggest that there's no evidence of inequities in <pause dur="0.3"/> the total number of referrals <pause dur="0.2"/> or referrals for <pause dur="0.2"/> for medical conditions that are made <pause dur="0.4"/> # <pause dur="0.2"/> # <pause dur="0.4"/> to clinicians in secondary care <pause dur="0.5"/> so <pause dur="0.4"/> that's when clinical need is controlled for <pause dur="1.0"/> so the total number of of referrals <pause dur="0.3"/> and referrals <trunc>com</trunc> # medical <pause dur="0.4"/> conditions seem to be according to need <pause dur="2.3"/> but when you look at # referrals for some specific

conditions <trunc>ref</trunc> requiring surgery <pause dur="0.4"/> then there's some strong evidence that those with the greatest needs have the poorest access <pause dur="0.8"/> and Chaturvedi and <trunc>bensh</trunc> Ben-Shlomo's <trunc>s</trunc> study <pause dur="0.2"/> # <pause dur="0.3"/> they've looked at several areas of access to care <pause dur="0.5"/> # they've looked at # access and surgery for arthritis of the hip and their work showed <pause dur="0.4"/> that # <pause dur="0.3"/> if you were disadvantaged <pause dur="0.4"/> # then you were less likely to be referred for surgery <pause dur="0.3"/> <trunc>th</trunc> # # <pause dur="0.7"/> <trunc>f</trunc> for <pause dur="0.3"/> hip surgery than those who were better off <pause dur="1.5"/> regardless of need <pause dur="3.6"/> there <trunc>als</trunc> also evidence for inequalities in access to inpatient treatment <pause dur="1.6"/> and again there's a number of studies that have documented this <pause dur="1.4"/> disadvantaged patients are less likely to be investigated # with <pause dur="0.2"/> # using <trunc>coro</trunc> coronary angiography <pause dur="0.5"/> and less likely to be referred for coronary artery bypass grafts <pause dur="0.2"/> than those who live in more advantaged area <pause dur="0.5"/> and again this is quite well documented in research by Ben-Shlomo <pause dur="0.4"/> and Chaturvedi <pause dur="0.2"/> in nineteen-ninety-five and Payne and

Saul in nineteen-ninety-seven <pause dur="2.1"/> there's also evidence that # <pause dur="0.5"/> patients from disadvantaged areas <pause dur="0.3"/> wait longer for cardiac surgery once they have been referred and once they have been identified as having a clinical need <pause dur="0.5"/> # than those who were better off and this is because they're less likely <pause dur="0.3"/> to have their operations # identified <pause dur="0.3"/> classified as of urgent priority <pause dur="0.4"/> and the wait was something like three or four weeks longer <pause dur="3.5"/><kinesic desc="changes slide" iterated="n"/> so we've documented <pause dur="0.2"/> # <pause dur="0.5"/> a complex pattern of inequalities in access to <pause dur="0.2"/> to care both in primary care <pause dur="0.3"/> and to secondary care <pause dur="2.2"/> so how do we explain <pause dur="0.2"/> inequalities in health care <pause dur="2.3"/> well again <pause dur="0.5"/> the reasons for # <pause dur="0.4"/> inequities in health care again quite complex and <trunc>muls</trunc> multifaceted <pause dur="4.5"/><kinesic desc="changes slide" iterated="n"/> there's little doubt that those who are <trunc>disad</trunc> materially and socially disadvantaged <pause dur="0.4"/> # <trunc>ec</trunc> experience particular barriers to seeking and receiving health care <pause dur="0.5"/> and these barriers are both financial <pause dur="0.7"/> geographical <pause dur="0.4"/> social <pause dur="0.4"/> and cultural barriers <pause dur="4.4"/> and these <trunc>we</trunc> <pause dur="0.3"/> this afternoon we're going

to look at # these barriers in much more detail and look at some of the ways that these barriers to <pause dur="0.4"/> # seeking and receiving health care <pause dur="0.4"/> can <pause dur="0.2"/> be reduced for those who have the greatest health care needs so i'm not going to say any more about those things now <pause dur="4.4"/><kinesic desc="changes slide" iterated="n"/> another possible reason is the attitudes of health care workers <pause dur="0.5"/> certainly research that has looked at the attitudes of a of a number of of groups mainly health visitors <pause dur="0.2"/> # social workers <pause dur="0.3"/> # health promotion workers <pause dur="0.4"/> # has suggests suggests <pause dur="0.2"/> that <pause dur="0.3"/> there are particular views about # <pause dur="1.2"/> those with the greatest needs those in the poorest conditions that are held by health workers which may mean they're not offering <pause dur="0.3"/> the kinds of services and the level of services that those people need <pause dur="1.0"/> # there are notions that # of undeserving poor not all groups in in in <pause dur="0.5"/> # <pause dur="0.6"/> <trunc>socia</trunc> poor social material conditions are viewed in the same way <pause dur="0.3"/> some groups are seen as more deserving than others <pause dur="1.0"/> you can probably can anybody think

of those any groups that might be seen as particularly undeserving </u><pause dur="2.9"/> <u who="ss" trans="pause"> <gap reason="inaudible, multiple speakers" extent="1 sec"/> </u><pause dur="0.5"/> <u who="nf0262" trans="pause"> hear some mutterings </u><pause dur="1.9"/> <u who="sm0267" trans="pause"> smokers </u><pause dur="0.2"/> <u who="nf0262" trans="pause"> smokers might be one can you think of any more </u><pause dur="0.7"/> <u who="sf0265" trans="pause"> drug dealers </u><pause dur="0.4"/> <u who="nf0262" trans="pause"> pardon <pause dur="0.5"/> drug dealers yeah <pause dur="0.2"/> yeah </u><pause dur="3.7"/> <u who="sf0266" trans="pause"> prisoners </u><pause dur="0.4"/> <u who="nf0262" trans="pause"> pardon </u><pause dur="0.6"/> <u who="sf0266" trans="pause"> prisoners </u><u who="nf0262" trans="latching"> prisoners yeah <pause dur="0.2"/> maybe maybe some asylum seekers <pause dur="0.4"/> # <pause dur="0.2"/> those particular groups who don't behave in the way that # we might think they should behave <pause dur="0.4"/> # <pause dur="0.7"/> there's also possibly negative stereotypes for particular minority ethnic groups <pause dur="0.4"/> groups that are <trunc>li</trunc> more likely to be seen as deserving maybe groups like mothers with young children <pause dur="0.3"/> but there there # <pause dur="0.2"/> it's <trunc>proba</trunc> probable that the attitudes of health care workers <pause dur="0.3"/> # and the way that they perceive particular groups of patients <pause dur="0.4"/> # may mean that they don't offer services or the or appropriate services to specific groups of disadvantaged families <pause dur="4.7"/><kinesic desc="changes slide" iterated="n"/> also <pause dur="0.6"/> # an explanation is likely to be related to the

knowledge of health care workers <pause dur="1.1"/> first of all that workers may including <pause dur="0.2"/> doctors may <pause dur="0.8"/> fail to recognize or understand the health needs of disadvantaged groups why has it done that hang on <pause dur="0.6"/><kinesic desc="changes slide" iterated="n"/> let's go back there we go <pause dur="0.9"/> # <pause dur="2.5"/> because of <trunc>knowl</trunc> because of lack of knowledge that their their health needs <trunc>n</trunc> may be greater <pause dur="0.5"/> or <trunc>n</trunc> <trunc>n</trunc> knowledge and lack of understanding about their how their health care knowledge can be addressed and of course <pause dur="0.4"/> a key # learning outcome for this module <pause dur="0.4"/> is that both # <pause dur="0.2"/> both from your university based teaching and your <pause dur="0.2"/> your community based teaching <pause dur="0.4"/> is that you will develop a body of knowledge <pause dur="0.3"/> which will enable you to recognize and understand <pause dur="0.3"/> the health needs of those who have the greatest health needs in our society <pause dur="1.5"/> so it's <unclear>fairly</unclear> to recognize or or understand health needs but also lack of knowledge about how to address <pause dur="0.2"/> the specific health needs <pause dur="0.4"/> # through the development of responsive services <pause dur="0.4"/>

and again this afternoon we're going to look at <pause dur="0.3"/> # those issues in much more detail <pause dur="1.6"/> # <pause dur="2.3"/> an example of # <pause dur="1.3"/> this <trunc>i</trunc> of of <pause dur="0.3"/> of practitioners in a # failure to address specific health needs through the development of responsive services <pause dur="0.5"/> was thrown up by this study <pause dur="0.2"/> # which by is Feder et al in in two-thousand-and-two <pause dur="0.5"/> which looked at and it's this is # in the British Medical Journal where you'll find <pause dur="0.4"/> lots and lots of articles on inequalities and inequities in access to care so that's a very good <pause dur="0.4"/> place to go if you put in the terms <trunc>i</trunc> # <pause dur="0.3"/> inequality in access to care you'll throw up thousands and thousands of references <pause dur="1.2"/> but this study looked at # <pause dur="1.5"/> tried to identify # <pause dur="1.0"/> why there were lower coronary <trunc>o</trunc> <pause dur="0.2"/> or looked at coronary revasculize <trunc>revascu</trunc> <pause dur="0.9"/> revascularization <pause dur="0.2"/> for # <pause dur="0.9"/> different groups of patients <pause dur="0.6"/> so by revascularization we mean access to angioplasty and to coronary <trunc>art</trunc> coronary artery bypass grafts and this study showed <pause dur="0.4"/> that # <pause dur="1.1"/> people of South Asian origin had <pause dur="0.8"/>

lower <pause dur="0.9"/> # <pause dur="1.2"/> rates of <pause dur="0.2"/> of # angiopasty and coronary artery bypass grafts <pause dur="0.4"/> than white patients <pause dur="0.3"/> but this didn't appear to be explained by <pause dur="0.2"/> physician bias because <pause dur="0.4"/> the study # <pause dur="0.4"/> <trunc>look</trunc> asked groups of physicians <pause dur="0.2"/> to <pause dur="0.3"/> identify # <pause dur="0.2"/> groups of patients from the notes # without showing people's ethnic <trunc>stat</trunc> without showing the patient's ethnic status <pause dur="0.4"/> to <pause dur="0.5"/> from the clinical data to decide whether particular patients <pause dur="0.3"/> needed revascularization <pause dur="0.7"/> # so this wasn't explained by physician bias <pause dur="0.4"/> but may be explained but they were suggesting # <trunc>m</trunc> <pause dur="0.7"/> that <pause dur="1.6"/> it the lower rates were <trunc>ex</trunc> <pause dur="0.8"/> explained by the fact that <pause dur="0.3"/> South Asian <pause dur="0.2"/> patients were less likely to <pause dur="0.2"/> # go on to be <pause dur="0.5"/> to have <trunc>angio</trunc> angioplasties or coronary artery

bypass grafts <pause dur="0.4"/> possibly because of the culture and language barriers <pause dur="0.3"/> and that physicians <pause dur="0.3"/> that they they felt were there and that the physicians needed to find a way of <pause dur="0.4"/> # reducing these barriers so that <pause dur="0.2"/> patients this particular group of patients <pause dur="0.4"/> # would understand the need for <pause dur="0.3"/> and feel more able to # receive the <pause dur="0.3"/> # the kind of of # surgical procedures <pause dur="0.3"/> that # was being <trunc>idenif</trunc> identified as as as as clinically important for them <pause dur="2.5"/><kinesic desc="changes slide" iterated="n"/> okay <pause dur="0.8"/> we're going to have a two minute break now <pause dur="0.3"/> # before we look at how inequalities can be tackled <pause dur="0.3"/> so we'll just have a two minute stretch and comfort break