Exam 1 PDF

Multiple choice and short-answer questions ​ Bullet points/numbered responses are okay for short-answer questions ​ A few sentences, not a few paragraphs ​ About 50% of total points from multiple choice and 50% from short-answer questions ​ About 20 multiple choice questions and...

Multiple choice and short-answer questions ​ Bullet points/numbered responses are okay for short-answer questions ​ A few sentences, not a few paragraphs ​ About 50% of total points from multiple choice and 50% from short-answer questions ​ About 20 multiple choice questions and 5 short answer questions (Part A and Part B) ​ Material: Assigned readings, class lectures, class videos/assignments/exercises ​ 25% of final grade Study ​ Be able to reproduce your own lecture notes (by memory) ​ Pay attention to anything that we spent a lot of class time on ​ Review the PowerPoint slides on Brightspace ​ Be able to apply big concepts to specific examples ​ Think about in-class examples/activities ​ Know the main point(s) from each article Main Topics Epidemiological Transition & (Historical) Decline in Mortality Rates ​ Definition: A shift from high to low death rates over time ​ Shift from death due to infections/parasites to death from chronic, degenerative causes ​ Death risk shifts from young children to older adults ​ Results in large gains in life expectancy ​ Reasons for the Mortality decline in the 20th century? -​ Vaccines -​ Antibiotics -​ Hygiene -​ Hospitals -​ Sanitation -​ Food safety -​ Public health knowledge ​ Reasons for the Mortality Decline -​ Medical: Intro of medical treatments/interventions and or expansion of medical services. Ex: growth of hospitals, smallpox vaccines, antibiotics -​ Social: Rising standards of living (better diets, clean water, sewage disposal) improvements in hygiene and sanitation, Mainly reduces air, water, and food-borne infections ​ Example: Before Transition: High mortality from infectious diseases such as tuberculosis, pneumonia, and influenza. After Transition: As sanitation, vaccines, and antibiotics improved, deaths from infectious diseases fell. Chronic conditions like heart disease and cancer became the main causes of death. Medicalization ​ Definition: Defining a human problem or experience as a medical problem, usually in terms of illnesses, diseases, or syndromes ​ Specific example: ADHD -​ Pharmaceutical & Biotechnology Industries:Companies develop stimulant drugs (e.g., Ritalin, Adderall) to treat ADHD. Their goal is to expand the market by framing behavioral issues as medical conditions needing treatment. -​ Direct-to-Consumer Advertising: In the US, these drugs are advertised directly to parents and patients. This increases public awareness and demand for an ADHD diagnosis and treatment. -​ Consumer Demand: As awareness grows, more parents seek evaluations for their children’s behavior, further expanding the market for these medications. -​ Managed Care: Managed care organizations review and approve ADHD treatments, influencing what is considered medically appropriate. They help integrate these treatments into standard care, ensuring coverage and widespread use. ​ New “Engines of Medicalization” 1.​ Biotechnology -​ Pharmaceutical and biotechnology industries -​ Major goal: create and increase the market for their drugs -​ Direct-to-consumer advertising in the US (rather than (or in addition to) promoting drugs to doctors) 2.​ Consumers -​ Consumers increasingly vocal and active in their desire and demand for services 3.​ Managed Care -​ Approval required for medical treatments – largely in response to rising healthcare costs -​ Arbiter of what is deemed medically appropriate -​ Note: if a person isn’t paying 100% out of pocket for their treatment/care, managed care is likely involved Pros Cons Increased Awareness: Overmedicalization: ​ Consumers learn about treatment options and new drugs. ​ Can lead to unnecessary diagnosis and treatment. Empowered Patients: Biased Information: ​ Encourages patients to discuss symptoms and treatments with ​ Advertisements may emphasize  doctors. benefits over risks. Earlier Diagnosis: Increased Healthcare Costs: ​ May prompt individuals to seek ​ May drive demand for expensive medical advice sooner. medications regardless of need. Pressure on Providers: ​ Doctors may face requests for specific drugs, even when alternatives might be more suitable. The Social Determinants of Health ​ Key concepts -​ Distal (Upstream) vs. proximal (Downstream) factors: factors that indirectly influence health and mortality vs. factors that have more direct impacts on mortality -​ Upstream vs. downstream factors: Upstream factors refer to the social, economic, and environmental conditions. Like poverty, education, housing, and food access, these factors shape your overall health environment. Downstream factors are the individual behaviors and health outcomes, such as smoking, obesity, or chronic disease, that result from these conditions. Addressing upstream factors targets the root causes of poor health outcomes rather than merely treating the symptoms that appear downstream. -​ Social determinants of health: “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affects a wide range of health, functioning, and quality-of-life outcomes and risks” -​ Life choices (People have control over many things in life, including choices about healthy lifestyle; e.g. health-related behavior) vs Life chances: Schemas/structures that shape what choices are available to people -​ Domains which Contribute to Early US Deaths: -​ Genetic and gestational endowments -​ Social Circumstances -​ Environmental Conditions -​ Toxic agents in homes and workplaces; other safety factors -​ Behavioral Choices -​ Diet, physical activity, drug use -​ Medical Care -​ About 5 of the 30 years of increased life expectancy in the 1900s are due to better medical care  -​ Medical errors account for 2-4% of all deaths -​ “Even if the entire population had timely, error-free treatment, the number of early deaths would not be much reduced” -​ Goals: -​ Improve the health of populations, not a single person -​ Change systems, not individuals -​ Prevent illness, not treat after fact -​ Why don’t we devote more money to prevent health problems? -​ Hard to document cost-effectiveness -​ Power of interest groups (Tax & profit) -​ Involve complex intervention -​ Usually not quick solutions Including “drivers of the conditions of life” ​ Key concepts -​ Drivers: industries and corporations, race and class based organization of society, and government policies -​ Health outcomes: the conditions of life -​ Drivers of the conditions of life: -​ Industries and corporations: Health insurance companies, social media organizations, oil/gas companies, food industry -​ Race/ethnic and class-based organization of society: inequality in neighborhoods, income inequality, racial residential segregation, inequalities in schools -​ Government policies: zoning, property tax, environmental regulations, taxes, government spending ​ How do the determinants of health contribute to a person’s risk of obesity? -​ Come up with at least one example for each determinant -​ Social Circumstances: When surrounded by family members who are obese, people can get shamed for trying to get help -​ Neighborhood -​ Food desert -​ Crime -​ Family -​ Simply the norm for those families -​ Income -​ Unable to afford food/no time to cook -​ Behavior: Mental Disorders, Eating disorders -​ Environment: Areas with a lack of grocery stores “A Food desert,” areas with a lack of sidewalks or parks,  -​ Medical Care: Surgeries for people with obesity to treat them might not always be covered by health insurance ​ Helpful examples, figures, tables, etc. ​ Specific Example 1: Big Tobacco a.​ Attack the science documenting the health risks of smoking b.​ To fund research… that supports their argument/comes to a different conclusion c.​ Ex: Lung cancer is actually caused by genes, nutrition, environmental factors, etc. d.​ Emphasize “Freedom of choice” ​ Specific Example 2: Big Soda a.​ Paid doctors and medical professionals for research to a different conclusion b.​ Bringing in the grocery industry c.​ “Fighting for the working class” d.​ Market items like “Diet Coke” U.S. (International) Health Disadvantage ​ Key Features of US Health Disadvantage 1.​ Americans have higher mortality and morbidity than in other high-income countries -​ Gains in life expectancy have been smaller in the US compared to most high-income countries 2.​ Disadvantage begins at birth and extends across the life course ​ The lag in life expectancy is particularly large for US women ​ Disadvantage most pronounced for Midwest and Southeast regions of the US ​ Reasons for the “U.S. Health Disadvantage”? -​ Medical Care: access to insurance -​ Individual Behaviors: tobacco use -​ Physical: physical inactivity -​ Environment Social Policies: food environment, transport, urban design -​ Social & Economic Inequalities: poverty, racial segregation, redlining State-level Policy Contexts and Health ​ Why Growing Geographic Variation within US? -​ Devolution of policy-making authority from federal to state level (e.g., block grants) -​ State preemption laws (state>localities) -​ Overall, more state authority=hyperpolarization of policies across states ​ Devolution and Policymaking Power ​ States can: -​ choose to enact policies -​ choose how to run existing programs (fiscal and regulatory control) like Medicaid, SNAP, TANF, etc. -​ States decide their own policies related to abortion, campaign finance, criminal justice, education, civil rights/liberties, gun control, immigration, health and welfare, housing, labor, LGBT rights, taxes, voting, etc. ​ Preemption Examples -​ Preemption often related to: anti-smoking laws (1980s), gun control laws (1990s), minimum wage, paid leave, anti-discrimination laws -​ Example: We saw this play out during the COVID-19 pandemic, States preempting local governments rulings on mask mandates and shelter-in-place orders ​ Thinking about preemption & devolution: -​ Benefits of authority at the state level? States tailor policies to their unique populations. They can adjust programs like Medicaid, SNAP, and TANF based on local needs. They can test new ideas without federal constraints. State governments can react quickly to local issues. They reflect community values in diverse areas like education, health, and criminal justice.  -​ Cons of authority at the state level? Policies can vary widely across states, deepening regional divides. Some citizens may have less access to services and protections depending on their state. State laws may override local measures, limiting community-specific responses (e.g., mask mandates during COVID-19). variations in policy can confuse citizens and complicate cross-state issues. ​ American Legislative Exchange Council (ALEC) -​ Drafts model bills that benefit members (donors, businesses politicians) and offers to state policymakers -​ Easier to change state policies vs. federal policies (few people pay attention to state policies) -​ States tend to be more responsive to business demands ​ How do state policies shape health? -​ Educational attainment Ex: state expenditures for primary/secondary schooling -​ Economic circumstances: Minimum wage, paid leave -​ Access to medical care: Medicaid eligibility rules, access to abortion -​ Behaviors: Taxes on cigarettes and/or vaping products, marijuana legalization, firearm regulations -​ Support economically disadvantaged individuals ​ Need to focus on structural, macro-level factors such as state policies because: 1.​ Interventions that focus on individual behavior are costly and ineffective -​ Successful example: smoking reduction efforts; focus on policies, physical environments, values, and behaviors 2.​ Focusing on individual behaviors can widen disparities 3.​ Individual behaviors are usually symptoms of a bigger issue 4.​ Health problems are disproportionately caused by wealthy individuals, large corporations, and policy/legal structures, not by poor, less educated, marginalized adults Stress, Health, and the Life Course ​ Definition: When environmental demands tax the adaptive capacity of a person. In other words, stress is a biological and psychological response when encountering a threat we feel we do not have the resources to deal with ​ Types of Stressors -​ Chornic -​ Life events -​ Daily hassles ​ Biopsychosocial & Behavioral Model of Stress -​ This is the overarching model for understanding how stress gets under the skin to affect health -​ Responses to stress include:  -​ Biological – Sympathetic nervous system (SNS) arousal & upregulation of the hypothalamic-pituitary- adrenocortical axis (HPA) -​ Psychological – Depression, anxiety, PTSD, lack of personal control, self-esteem -​ Social – Relationship strain, isolation -​ Socioeconomic – educational attainment, income, job opportunities -​ Behavioral – Smoking, overeating, alcohol misuse, drug misuse -​ Note: These are just a few examples for each category -​ These also have direct effects on physiology ​ Main findings -​ Finding 1: Stress -> Health Inequalities in Health -​ Finding 3: Minority groups are additionally burdened by discrimination-related stress. Major events and everyday experiences -​ Finding 4: Stress proliferates across the life course and generations -​ Finding 5: Stress -> Health can be mitigated by mastery, self-esteem, support (others) Life Course Perspective ​ TWO main tenets for the exam (pathways in relation to time, importance of timing of events) -​ Timing: Some experiences have strong effects on health when they occur at specific periods of the life course. Early life conditions and childhood experiences matter for social and biological development -​ Sequencing: Adversities often give rise to additional adverse experiences. Idea that “rich get richer, poor get poorer” ​ How/why are there long-term consequences of exposures -​ Stress responses involve the hypothalamic-pituitary-adrenal (HPA) axis, which, when overactivated, leads to increased levels of cortisol and inflammation. -​ These changes contribute to conditions such as heart disease, diabetes, depression, and immune system dysfunction.  -​ Adverse Childhood Experiences (ACEs) can perpetuate cycles of poverty and poor health across generations. -​ Children raised in stressful environments are more likely to develop unhealthy coping mechanisms, such as substance use, obesity, and risky behaviors. -​ Overwhelms a child’s ability to cope, leading to chronic activation of the stress response system. This alters brain architecture, particularly in the prefrontal cortex (decision-making), hippocampus (memory), and amygdala (emotional regulation), increasing risks of mental illness, substance abuse, and chronic diseases. ​ Toxic stress in early life as example -​ Examples: Material deprivation/poverty; Experiencing violence, abuse, or neglect; Witnessing violence in the home/community; Parent with substance misuse -​ Biological consequences of toxic stress -​ Permanent changes in brain structure and function -​ Disruption of cardiovascular system, immune system, metabolic regulatory controls, and more -​ Additional consequences of toxic stress: Affects learning, educational attainment, health behaviors (e.g., alcohol, drug use), mental health, physical health, and more Place and Health ​ 4 questions -​ How could neighborhoods affect health?​ Neighborhoods impact health through their physical, social, and service environments, influencing behaviors, access to resources, and exposure to risks. -​ Are features of places really that important for health—or should we focus primarily on the individuals who live in them?​ Even after accounting for individual differences, neighborhood conditions independently affect health outcomes.  -​ Do all Americans have the opportunity to live in a healthy neighborhood?​ Access to healthy neighborhoods is unequal, with racial, ethnic, and socioeconomic disparities limiting opportunities for many. -​ Could public and private policies improve neighborhoods in ways likely to improve America’s health?​ Policy interventions can enhance neighborhood conditions and reduce health disparities by addressing environmental, social, and service inequalities. ​ 3 types of environmental factors 1.​ Physical Environment: Includes air quality, water quality, and exposure to toxins. 2.​ Social Environment: Refers to neighborhood social structures, safety, and community support. 3.​ Service Environment: Access to essential services like healthcare, education, and healthy food options. Relationships and Health ​ Social determinants of health in relationships -​ Which relate to relationships? -​ Neighborhood: social environment (quality of relationships among residents, trust, connectedness) -​ Social and community: relationships and interactions with family/friends/coworkers/neighbors; social support -​ Education quality: teacher-student relationships -​ Health care quality: doctor-patient relationships ​ Relationships can be beneficial for health 1.​ Behavioral Pathways -​ Social control of health habits, provide information and create norms 2.​ Psychosocial Pathways -​ Social support, personal control, symbolic meanings/norms (e.g., sense of responsibility to stay health), mental health 3.​ Physiological Pathways -​ Benefits immune, endocrine, and cardiovascular functions -​ Reduce allostatic load (wear and tear on body) ​ Sometimes relationships are harmful for health 1.​ Unhealthy social norms -​ Social contagion (social norms) 2.​ Relationship strain -​ Biopsychosocial and behavioral responses to stress 3.​ Caregiving demands (for spouse, child, aging parent, etc.) -​ Primary stressors: health status/behaviors of person caring for -​ Secondary stressors: Role conflict (with work, other family members) ​ An Example: Marriage  ​ Married people report better health outcomes than unmarried -​ Spouses monitor, inhibit, regular, or facilitate health behaviors (e.g., smoking, drinking, eating, medication use) -​ Spouses try to stay healthy for each other -​ More sense of personal control, improved mental health, beneficial physiological responses -​ Key source of social support -​ Pooling of economic resources ​ Are all marriages good for health? -​ If one spouse is pulling more weight -​ Marriages are both supportive and stressful Readings 1.​ “The Burden of Disease and the Changing Task of Medicine" -​ The article The Burden of Disease and the Changing Task of Medicine discusses the shift from infectious diseases in the 19th century to chronic conditions as dominant health challenges today. It emphasizes how disease is shaped by social, cultural, and economic factors, calling for a holistic approach that addresses both biomedical advances and social determinants of health. 2.​ "The Shifting Engines of Medicalization” -​ The article The Shifting Engines of Medicalization by Peter Conrad examines how medicalization has evolved, with biotechnology companies, consumer demand, and managed care now driving the process rather than the medical profession. This shift emphasizes the growing influence of market forces on healthcare, raising concerns about the social and economic impact of an increasingly medicalized society. 3.​ “The Case for More Active Policy Attention to Health Promotion” -​ The article The Case for More Active Policy Attention to Health Promotion argues that U.S. health policy prioritizes medical care over prevention, despite behavioral, social, and environmental factors being key determinants of health. It calls for stronger leadership, targeted policies, and increased funding for health promotion to reduce preventable deaths and shift focus toward population health. 4.​ “The Social Determinants of Health” -​ The article The Social Determinants of Health: Looking Upstream by Kathryn Strother Ratcliff highlights how societal, political, and economic factors shape health outcomes, emphasizing the need to address systemic drivers like power dynamics and policies. It critiques the focus on individual behaviors and biomedical models, advocating for upstream interventions to tackle health inequities and create a more just health system. 5.​ "Why Do Americans Have Shorter Life Expectancy and Worse Health Than Do People in Other High- Income Countries"  -​ The article Why Do Americans Have Shorter Life Expectancy and Worse Health Than Do People in Other High-Income Countries? highlights how the U.S. health disadvantage stems from social and economic inequalities, not just healthcare deficiencies. It emphasizes the role of social policies in shaping health outcomes and calls for policy changes to address broader determinants like education, income, and early childhood support. 6.​ “U.S. State Polarization, Policymaking Power, and Population Health” -​ The article US State Polarization, Policymaking Power, and Population Health by Jennifer Karas Montez argues that the decline in U.S. life expectancy is closely tied to state-level policies and increasing political polarization. It highlights how policy differences between conservative and liberal states have widened health disparities, with state governance playing a crucial role in shaping population health outcomes. 7.​ “Stress and Health: Major Findings and Policy Implications” -​ The article Stress and Health: Major Findings and Policy Implications by Peggy A. Thoits highlights how stress significantly affects physical and mental health, particularly among disadvantaged groups. It advocates for policy interventions that address structural inequalities, reduce stress exposure, and promote early-life support programs to mitigate long-term health disparities. 8.​ “Life Course Epidemiology” -​ The article Life Course Epidemiology by Kuh, Ben-Shlomo, Lynch, Hallqvist, and Power highlights how health outcomes are shaped by exposures throughout life, emphasizing the interaction between biological, social, and behavioral factors. It advocates for a life course approach to health research and policy, focusing on early-life conditions and cumulative risks to reduce long-term health disparities. 9.​ “The Lifelong Effects of Early Childhood Adversity and Toxic Stress” -​ The article The Lifelong Effects of Early Childhood Adversity and Toxic Stress by Jack P. Shonkoff, Andrew S. Garner, and the American Academy of Pediatrics highlights how early adversity and toxic stress disrupt brain development and increase lifelong health risks. It calls for early interventions and policies to reduce childhood adversity, promoting healthier development and breaking cycles of poor health and social outcomes. 10.​“Where We Live Matters for Our Health” -​ The article Where We Live Matters for Our Health: Neighborhoods and Health highlights how neighborhood environments shape health outcomes through physical, social, and service factors. It calls for policy interventions and community initiatives to reduce health disparities by improving living conditions, addressing racial and socioeconomic inequalities, and expanding access to resources. 11.​Pages 54-59 of “Social Relationships and Health: A Flashpoint for Health Policy”  -​ The article Social Relationships and Health: A Flashpoint for Health Policy highlights how social relationships influence physical and mental health through behavioral, psychosocial, and physiological pathways. It calls for policies to promote positive social ties and reduce social isolation, emphasizing the long-term health disparities caused by strained relationships and cumulative disadvantage 1. People in neighborhoods that lack social connection and trust often experience worse health than people in more connected neighborhoods. This is best considered an example of the: a. Physical environment b. Social environment c. Service environment d. All of the above e. None of the above Question 1. Companies comprising the vaping industry (e.g., JUUL) offered youth-friendly flavors and paid for e-cigarette ads on the internet and in stores. The vaping industry may best be considered: a. A driver of the conditions of life b. An industry immune to government regulation c. A social determinant of health d. A bad apple Example Short Answer Question (Application of Material) Choose one of the following stressors: divorce, death of a parent, unemployment. Part A) First, explain how you think this stressor might lead to worse health according to the biopsychosocial and behavioral model of stress. In your answer, label the four main components of this model (i.e., biological, psychological, social, behavioral) and provide an example/explanation for each. Part B) Then, add a life course perspective to this example by succinctly explaining the importance of the timing of this stressor. Tonight ​ Review notes ​ Recall ​ Quizlet ​ Answer class doc questions ​ Practice own questions ​ Practice short answer questions