Variations in Health, Illness and Health Care-Seeking Behaviour of Those in the Upper Social Hierarchies in a Caribbean Society

Abstract

Background: Little research exists in the Caribbean, and in particular Jamaica, on the upper class, and no study emerged from a search of the literature examining health, illness, and health care-seeking behaviour of this group. Aims: To provide pertinent information on the upper class in regards to their general health status, illnesses, typology of illnesses, health care seeking behaviours and factors which determine their (1) moderate-to-very good health status, (2) illness, and (3) health care seeking behaviour in order to make available to policy specialists and public health practitioners information on this group, to be used as a guide in their decision making policies. Methods and materials: A sample of 2,734 respondents from the wealthiest 20% and second wealthy social hierarchies was extracted from a cross-sectional survey of 6,783 respondents. An administered questionnaire was used to collect the data, which were stored and analyzed using SPSS for Windows 16.0 (SPSS Inc; Chicago, IL, USA). The questionnaire was modelled on the World Bank’s Living Standards Measurement Study (LSMS) household survey. Results: The majority of the sample stated at least good health status (83.3%), with 0.5% indicating very poor health status, and 15.3% who indicated an illness in the last 4-week period. Four variables emerged as statistically correlated with moderate-to-very good health status of those in the upper class (i.e. second wealthy and wealthiest 20%) - Model fit χ2 = 57.54, P < 0.0001. The model explained 33.2% of the variance in moderate-to-very good health status, and that the model is a good fit for the data. Three variables emerged as statistically correlated with self-reported illness - Model fit χ2 = 1087.7, P < 0.0001. The significant variables (i.e. health care-seeking behaviour, good health status, and marital status) accounted for 72.4% of the variability in self-reported illness. Three variables emerged as statistically significant correlates of health care-seekers - Model fit χ2 = 995.45, P < 0.0001. The statistically significant correlates (i.e. good health status, self-reported illness, marital status) accounted for 76.4% of the variance in health care-seeking behaviour of the upper class. Conclusion: Rural residents continue to have lower moderate-to-very good health status when compared to the general population, and the second wealthy and the wealthiest 20% in Jamaica. Although only 4 percent of the upper social hierarchy utilize the public health care system, there is still a demand for public health services for this group, and it must be taken into account as a part of the general planning for the health care system of the country.