Health PDF Past Paper

Module: Health Cerdeña et al. (2020) ​ Race-based Medicine ​ Race-based medicine involves using race as a biological determinant in clinical practice. It relies on the assumption that racial groups have distinct genetic and...

Module: Health Cerdeña et al. (2020) ​ Race-based Medicine ​ Race-based medicine involves using race as a biological determinant in clinical practice. It relies on the assumption that racial groups have distinct genetic and physiological traits, influencing diagnoses, treatments, and medical education. For example: ​ Black patients' renal function is adjusted based on presumed higher muscle mass. ​ Asian patients are screened for diabetes at lower BMI thresholds due to assumptions about visceral fat distribution. ​ Hypertension treatment guidelines recommend different algorithms for Black patients based on presumed ACE inhibitor efficacy differences. ​ What is Wrong with This Approach? ​ Race-based medicine is fundamentally flawed because: ​ Race is a Social Construct: It does not correspond to biological categories. Genetic variation is continuous and does not align with racial classifications. ​ Implicit Bias: It perpetuates stereotypes and systemic inequalities, misrepresenting health disparities as inherent racial traits rather than outcomes of structural racism. ​ Inaccuracy: Using race as a proxy oversimplifies complex factors like genetic ancestry, environment, and socioeconomic conditions. ​ Detrimental Impacts ​ Misinformed Care: Adjustments based on race can lead to delayed diagnoses or inappropriate treatments. For instance, Black patients may receive delayed dialysis due to higher eGFR thresholds. ​ Health Disparities: Racialized assumptions reinforce unequal care, such as inadequate pain management for Black patients due to biases about pain sensitivity.  ​ Scientific Stagnation: It discourages identifying precise biomarkers or understanding structural contributors to health disparities. ​ Race-conscious Approach to Medicine ​ This alternative focuses on acknowledging and addressing racism as a determinant of health, rather than using race as a biological marker. ​ What Does This Entail? ​ Avoidance of Race-based Adjustments: Replace race-adjusted tools with precise, individualized measures (e.g., using cystatin C for kidney function instead of race-based eGFR adjustments). ​ Education on Structural Racism: Teach that health disparities stem from systemic inequities, not racial biology. Highlight the role of socioeconomic and environmental factors. ​ Critical Research Practices: Use race to investigate structural barriers and explicitly define its context in research, avoiding race as a proxy for biology. ​ Inclusive Policymaking: Ensure diverse representation in guideline creation and leadership decisions to address systemic biases. ​ How is This Different? ​ Race-based Medicine: Treats race as an inherent biological factor, perpetuating stereotypes and inequities. ​ Race-conscious Medicine: Recognizes race as a social determinant, focusing on structural factors and individual context to promote equity and precision in care. ​ Cheah et al. (2020) ​ What Do the Authors Want to Explore? ​ The study examines the experiences of COVID-19-related racism and racial discrimination among Chinese American parents and their children, focusing on the associations between these experiences and their mental health. The authors explore multiple dimensions of discrimination, including online and in-person direct and vicarious discrimination, as well as perceptions of Sinophobia related to health and media portrayals. ​ What Did Their Survey Find? ​ High Rates of Discrimination: Nearly half of parents and youth reported direct COVID-19 racial discrimination online (parents: 31.7%; youth: 45.7%) and in person (parents: 50.9%; youth: 50.2%). ​ Vicarious Experiences: A large majority witnessed vicarious racial discrimination online (parents: 76.8%; youth: 76.5%) and in person (parents: 88.5%; youth: 91.9%). ​ Perceptions of Sinophobia: ​ 49.1% of parents and 71.1% of youth perceived health-related Sinophobia, with many believing that Chinese people were unfairly viewed as a public health threat. ​ Media perpetuation of Sinophobia was recognized by 50.4% of parents and 56.0% of youth. ​ What Did These Mental Health Issues Look Like? ​ Parents: ​ Psychological well-being was negatively associated with discrimination and perceptions of Sinophobia. ​ Anxiety and depressive symptoms increased with exposure to all types of discrimination and Sinophobia. ​ Youth: ​ Psychological well-being declined due to online and in-person direct discrimination, health-related Sinophobia, and media Sinophobia.  ​ Anxiety and internalizing problems correlated with all discrimination types and Sinophobia. Externalizing problems were linked specifically to Sinophobia. ​ Both parents and youth were negatively affected by the cumulative and intersectional impacts of direct, vicarious, and collective forms of racism. ​ What is Meant by the “Racialization of Disease”? ​ The "racialization of disease" refers to the association of specific diseases with specific racial or ethnic groups, leading to stigmatization and systemic bias. During the COVID-19 pandemic, Chinese Americans were unfairly blamed and viewed as carriers of the virus, perpetuated by terms like "Chinese virus" and stereotypes about Chinese culture and behavior. This framing reinforces xenophobia, perpetuates stereotypes, and has tangible mental health consequences for affected communities. ​ Lecture Concepts ​ Key findings of: In Sickness and in Wealth ​ Misconception: Our biology defines us ​ We develop and grow as we age, and we are capable of change ​ We carry our history in our bodies ​ America spends $2 trillion a year on medical care - nearly half of all the health dollars spent in the world ​ Yet we live shorter and sicker lives than most other developed countries ​ “A lack of healthcare is not the cause of illness and disease” ​ Economic status correlates with health status - a twin study showed that among identical twins who grew up together but separated later, if one twin was higher-class and the other was lower-class (compared to each other), the higher-class one tended to have a better health status later in life ​ Notion of excess death - should be able to predict how many people in each population will die in a certain time frame, any more than that prediction is “excess death” ​ Wealth of the top 1% of Americans is greater than the bottom 90% combined ​ Excess death is more of a problem in poorer areas ​ Whitehall studies (in the UK) prove that the lower the grade of employment, the higher the risk of major causes of death (even after controlling for health behaviors) ​ Similar findings when you look at data in America, including the gradient of risk as you go up the socio-economic ladder ​ College graduates live (on average) 2.5 years longer than high school graduates ​ Homeownership is a method of financial security for many families, and contributes to economic disparities and thus health disparities ​ Based on someone’s high school/college education, income, and a couple other factors, a person’s life expectancy can be predicted to a relatively high level of accuracy. That’s not right for society. ​ When we feel threatened or that we can’t control our lives, the “stress effect” is activated and we release cortisol. However, an excess of stress can cause these neural pathways to become overactive, which makes us more ill than we would have been ​ Neither chronic stress nor its side effects are equally distributed on a hierarchy ​ “Stress of social subordination” - increased, nonstop stress can lead to other illnesses ​ 1 in 5 American men works in a high demand, low control job and is more likely to experience both higher blood pressures AND higher resting heart rates and blood pressures than men with more control of their employment ​ Socio-economic status determines (for the most part) both the stressors you face and the resources you have to fight them ​ Most of the poor in America (at the time of the documentary’s release) are white, contrary to many stereotypes ​ Stressors interfere with the brain’s neural connections - basically chemical damage to the brain ​ A different study showed that the longer someone’s parents owned a home, the smaller that person’s chance of being able to catch a cold decrease. ​ African American health outcomes are going to be worse than their white counterparts ​ Racial discrimination can be a factor in many of these outcomes, but race itself is not a determinant ​ How can we reduce health inequality? ​ A century ago, social reforms like universal education, the 8-hour workday, and increased sanitation improved the health of many Americans. The average life expectancy in those days was in the 40’s. Today it’s about 30 years longer than that. ​ Things we can do tend to be nonmedical things, like those listed above. Doing things like addressing the wealth gap and making post-secondary education easier for everyone (financially) will help reduce the disparities in the medical field.  ​ What do racial health disparities look like? o African American rate for Hypertension or High Blood is higher than other races which is important because high blood pressure can lead to other health related issues o Mexican/Native Americans have higher rates for Diabetes which shows that they are in risk of heart disease, stroke, heart attack o White Americans have the last rate of diagnosed diabetes ​ Life expectancy gap o Which racial groups have the lowest life expectancy? ▪ ​ Between 2000-2019, Black-White Gap decreased from 5.8 years to 3.6 years ▪ ​ All groups saw improved life expectancy expect Native Americans ▪ ​ Native Americans now have the lowest life expectancy of any racial group in the United States o What does this look like in Wisconsin compared to other states? ▪ ​ Wisconsin has the highest life expectancy gap between racial groups compared to other states ▪ ​ Black-white gap: 6 years (2018) ▪ ​ Native American-White gap: 7.7 years (2018) ▪ ​ Wisconsin ranks 44th among U.S states in Native American life expectancy (One of the lowest) o Pregnancy Related Mortality: Very high pregnancy mortality rates for African Americans and Native Americans o Comparative COVID rates ▪ ​ African Americans and Hispanic Americans are 2 ½ times more likely to die from COVID compared to White Americans  ▪ ​ African Americans and Hispanics have much higher rates of hospitalizations compared to White people during COVID ​ Five Models Racial Health Disparity Models (be sure that you can define each model): o Racial genetic model: Genetic or biological factors cause health disparities ▪ ​ Little empirical evidence for this model o Health behavior model: Behaviors voluntarily adopted by individuals cause health disparities ▪ ​ Little empirical evidence for this model o SES (Socioeconomic Situation) model: socioeconomic disparities cause health disparities ▪ ​ This model explains some, but not all, of the health gap ▪ ​ Significant component to health disparities but research that controls for socioeconomic indicates there are other reasons o Psychosocial stress model: stress associated with institutional and interpersonal racism causes health disparities ▪ ​ Good evidence supports this model o Social Constructivist model: casual connections between race and health are difficult to make because race is a social construction ▪ ​ Because race is socially constructed, race isn’t very consistent in categorizing people. The actual pigmentation of one’s skin color has no relation to high blood pressure. However, people who are categorized into Black racial group end up having higher blood pressure and larger health disparities o Which models are supported by scientific evidence? ▪ ​ Psychosocial Stress Model and Structural-constructivist model are supported by scientific evidence ​ Income and Life Expectancy  o High Income Americans are more likely to live longer than love income Americans o Early 1970s: 1.2-year life expectancy gap between 60-year-old in top half of income distribution and 60-year-old in bottom half of income distribution o 2001: that gap had increased to 5.8 years between top half and bottom half of income distribution o Men Born in 1920: 6-year difference in life expectancy between top 10% and bottom 10% of earners o Men Born in 1950: that gap had more than doubled to 14 years o Women born in 1920: 4.7-year difference in life expectancy between top 10% and bottom 10% of earners o Women born in 1950: gap grew to 13 years o Overtime, relationship between socioeconomic status and racial health disparities have grown o Race also plays a huge role for racial health disparities so race + income disparities lead to double jeopardy for some people in low income and marginalized racial groups ​ Interactions of Race and Socioeconomic Status o Minority Poverty Hypothesis: Predicts larger racial health disparities amongst the poor due to unique disadvantages ▪ ​ Not supported by health data ▪ ​ Ex: Found grocery store accessibility in terms of distance to being much larger for poor blacks and poor whites o Diminishing Returns Hypothesis: Predicts that POC don’t experience same returns that white people receive in highest economic bracket ▪ ​ Supported by health data o We can interpret that being poor will result in much health problems regardless of race ​ Psychosocial Stress Model  o Childhood trauma leads to increased risk for anxiety, depression, PTSD, suicide, alcohol, abuse, and drug abuse o Childhood trauma negatively impacts cognitive functions and academic performance ​ Racism is a public health Crisis o Pervasive racism leads to physical and mental health problems o People who support this declaration that racism is a public health crisis state that it is to change the institutional racism that exists everywhere in society ​ Racial Disparities in Access to Covid-19 Vaccinations o Anderson and Ray-Warren (2022): ▪ ​ Black and Latino neighborhoods less likely to have vaccination facilities ▪ ​ Black neighborhoods received fewer doses on average ▪ ​ Both patterns explained by existing lack of health infrastructure in those communities ▪ ​ Existing inequalities greatly grew during COVID since health infrastructure wasn’t very stable for Black and Hispanic people o Urban white residents go higher rates of vaccinations compared to Urban POC ​ Double Consciousness (W.E.B. DuBois) and the Looking-glass Self (Charles Cooley) o Looking-Glass self: a person views herself according to how she thinks others view her o Doubler Consciousness: a way of thinking about yourself through two pairs of eyes: those of the dominant group and those of your own racial/ethnic group ▪ ​ Black people must think about how white people see them and how Black people see them ​ Symbolic violence o The process by which members of a marginalized group internalize and accept negative views about the group  o A term that describes the subtle and often unconscious ways that dominant social groups maintain their power and privilege over marginalized group ​ Racial survival strategies for symbolic violence (what do these look like?) o Code-switching ▪ ​ Adjusting one’s style of speech, appearance, behavior, and expression in ways that optimize comfort of others in exchange for fair treatment, quality of service, and employment opportunities o Testing ▪ ​ The act of “feeling out” members of other racial or ethnic groups to evaluate their level of racial tolerance o Masking ▪ ​ Managing one’s self-presentation in a way that downplays aspects of one’s racial identity ▪ ​ Explicitly racialized concept that Black people have to control the way they are