SOC 2181 PDF - Race and Health Inequalities

Aug 29th Race - A group that is treated as distinct in society because of a certain perceived characteristics that have been defined as signifying superiority or inferiority Creation of race - The meaning of race is not based upon physical characteristics, BUT, the meaning that s...

Aug 29th Race - A group that is treated as distinct in society because of a certain perceived characteristics that have been defined as signifying superiority or inferiority Creation of race - The meaning of race is not based upon physical characteristics, BUT, the meaning that society gives to what is believed to make people different - Less biological differences, more about beliefs and treatment Creation of race (contemporary) - Race is a social construction - Racial formation: the social and historical process by which racial categories are created The Construction of the Racial Hierarchy The Puritains - Separate from the Pilgrims - Arrived in the United States in the 1630’s - Beliefs - Human hierarchy influenced by Aristotle - 그들은 남들보다 본인이 우위에 있다고 생각함. 피라미드로 치면 꼭대기층이라고 여김 Justifications Climate theory - Rooted in Christianity - “God ordained hierarchy” 1. Heavenly Master 2. Earthy Master 3. Enslaved - Shaped the views of slavery as the 1t slave ships arrive in 1609 to Virginia Curse of Ham - Genesis 9:18-29 - Ham is cursed by his father, Noah, after seeing his father naked - African Americans are believed to be the descendants of Ham - 신이 흑인들을 저주한다고 믿었다 - It lays the foundation for segregation and racism - Belief that Black people are genetically inferior Robert Boyle - Born in 1627 in ireland - Concerned with compiling a history of foreign lands andd their people - 1664: Pigmentation (Nature of Whiteness and Blackness) - Human pigmentation is skin deep,but Black skin is inferior - Work influences Sir Isaac Newton - White is the standard Cause of the Causes - Social factors, outside of medical care, shape health - The United States spends more than any other country, yet ranks near the bottom internationally on important measures of health - Medical care explains only 10-15% of preventable deaths - Roughly 50% of deaths are explained by behaviors and behaviors are shaped by social factors Sources of disparities Upstream - Focused on prevention - Preventing a health problem from occuring in the first place or stops the further worsening of a health concern - Examples - Screenings - Vaccines - Policies Downstream - Curative in nature - Treats a health problem - Examples - Antibiotics / Medicine - Surgery - Medical interventions Solutions to these disparities Upstream - Substantial investment and long-term funding - Coordination across various groups - Complicated and slow - Hard to measure and may take years to become apparent Downstream - More immediate and straightforward responses - Less focused on prevention - Easier to implement and immediate result - Easier to measure The gardener's tale Who is the gardner? - Government - Power to decide - Power to act - Control of resources - Dangerous when - Allied with one group - Not concerned with equity What is racism - A system of structuring opportunity and assigning value based on the social interpretation of how one looks, that… - Unfairly disadvantages some individuals and communities - Unfairly advantages other individuals and communities - Saps the strength of the whole society through the waste of human resources Institutionalized racism - Differential access to the goods, services, and opportunities of society, by “race” - Examples - Housing, education, employment, income - Medical access - Environmental toxins - Information, resources, advocacy Personally mediated racism - Differential assumptions about the abilities,motives, and intents of others, by “race” - Differential actions based on those assumptions - Prejudice and discrimination - Examples - Police brutality - Vigilance against people while shopping - Teacher devaluation Internalized racism - Acceptance by the stigmatized “races” of negative messages about our own abilities and intrinsic worth - Examples - Self-devaluation - Resignation, helplessness, hopelessness Relevant exam content - Theories to justify racism - The system that structure opportunity based on appearance - Causes of disparities - Important people in the creation of social categories - Upstream vs downstream factors - Levels of racism in the gardener's tale - Terms: racial formation, race, racism Sep 3rd Theories of Health Inequalities - In sociology, a theory is a way to explain different aspects of social interactions and social structures as well as create a testable proposition, called a hypothesis. Health inequalities - Systematic differences in the health of people occupying unequal positions in society - Income - Social class - race/ethnicity - Geography Social ecological model - Considers the relationship between individual, community, and societal factors to understand the different things that influences a person’s decision Artefact theory - Associations between markers of social status and health outcomes is a statistical artefact relating to the way in which a concept is measured over time Selection theory (reverse causation) - Health selection focused on reverse causation where poor health causes people to have lower socioeconomic status Intelligence theory - Intelligence is attributed to genetic endowment and this endowment determines health status - Intelligence and health are caused by an external factor Meritocracy theory - Idea that benefits should be given to the best performers - Higher positions are given according to merit alone - “More able” individuals born into lower socioeconomic status groups rise to a higher socioeconomic status group in adulthood Behavioral theory - Differences in behaviors (smoking, drinking, substance abuse, physical activity) between groups are fundamental causes of health inequalities Structural theory - Differences in the socioeconomic status circumstances of social groups at all stages of the life course cause differences in health - Behaviors, cultures, and intelligence may be potential mechanisms linking determinants and health Fundamental Cause theory - Fundamental Cause a. Influences the likelihood of many diseases and health problems b. Affects disease via many types of risk factors c. Involves access to resources that help people avoid risk or limit the severity of a disease d. Effects on health persist over time even though intervening mechanisms may change Fundamental Causes Proximal Causes - Structural factors that shape access to - Responsible for generating a specific goods, services, and power outcome, but changes in these factors - Segregation: “Physical separation of don’t produce substantial changes the races in residential contexts” - Physical activity - shape s socioeconomic - Diet conditions for African Americans at the individual, household, and neighborhood levels - Determines access to education and employment opportunities influences economic mobility McKeown Thesis - Believed that population growth was caused by better standards of living (diet and nutrition not advances in medicine) and improved economic conditions - This theory was discredited because - McKeown misinterpreted his results - Clean water and milk supplies played a bigger role - Needed to emphasize the role of medical interventions and improved social conditions Exam content - Fundamental vs Proximal Causes - Able to identify and apply the different theories - Definitions: Theory Sep 5th Life Course Theory - The things you experience today influence your health tomorrow - Health trajectories are impacted during critical or sensitive periods - The environment that you are in impacts how healthy you can be - Health disparities are more than just genetic or behavioral choices - Gives the opportunity to identify cumulative experiences - Gives the ability to determine the timing of significant experiences in life that may shape health Life course model - Lifespan development - Human development and aging are lifelong processes not restricted to specific life stages - Agency - People have the capability to take actions and make choices that shape their lives within the constants of contexts - Time and place - Every individual life course is embedded within and influences by its specific historical time and place - Timing - The same vents and behaviors can have different effects depending on when they happen in the life course - Linked lives - People don't experience life alone, but influence each other through shared relationships Key concepts - Sensitive period model - Focuses on the differential effect of an exposure based on the timing - Early life exposures to certain events have stronger effects compared to later - Example: A child learning to crawl - Accumulation model - Focuses on the accumulation of exposures rather than their timing - Additive effect - Interventions should be aimed at preventing risk - Example: Exposed by salty food, and later when you eat something, it feels light - Pathway model - Focuses on the links between multiple factors - How events and circumstances at one point in the life course might indirectly impact later risks - Example: multiple factors combined causing traumatic behaviors in the later course of the life - Social mobility model - Focuses on the direction of change of an exposure - Used to look at socioeconomic status on health risk and behaviors Life course models Strengths Weaknesses  - Comprehensive perspective - Complexity - Longitudinal focus - Measurement issues - Considers contexts - Don't consider non normative events - Allows for interdisciplinary approaches - Predictive power Sep 10 Stress - Defined as a “general term describing the psychological and physical response to a stimulus that alters the boddy’s normal state” aka the “equilibrium: What is a stressor? - A stimulus that throw s the body’s equilibrium out of balance - Physical - Psychological - Social - Short-term - Chronic Allostasis - Process of adaptation to acute stres, involving the output of stress hormones Allostatic load - Price the body pays for being forced to adapt to adverse psychosocial or physical situations - Heart attack - Strokes - Death Adaptive stress response - More energy - Increased cardiovascular function - Suppressed digestion - Suppressed immune system - Sharpened cognition Stress-related disorder - Fatigue - Diabetes - Hypertension - Ulcers - Confusion Stress - Immune system - Immune suppression -> Natural killer cells - NK cells -> tumor cells - Cancer - Stress itself doesn’t cause cancer - Heart disease - Chronic stress - Higher blood pressure - More atherosclerosis - Heart attack or stroke - A person who has a lot of plaque buildup in their arteries, the body may cause a piece of the plaque to break - Blocks artery - Sleep - Helps to restore the body - Facilitates learning  - If don’t sleep - Interfere with certain types of learning - Hallucinations - Anxiety - Changes in metabolism - Hormone secretion Coping - Problem focused - Changing the environment itself - Active coping - Planning - Instrumental social - Support - Emotion focused - Changing the person’s emotional response to the stressor - Venting - Mental disengagement - Thought suppression - Intentionally trying not to think of the stressor - Rebound effect FFF alarm - Relieved through breathing exercises Sep 17th Social systems - The patterned network of relationships constituting a coherent whole that exists between individuals, groups, and institutions. Important things to note: - Addressing population health should focus on understanding these complex relationships - Social systems influence behaviors - Health risks are not evenly distributed throughout the population Socioeconomic status - An economic and social combined total measure of a person’s economic and social position in relation to others, based on income, education, and occupation - Living conditions - Access to goods and services - Environmental exposure risk - Educational resources - Occupational type and risk Employment - Defined as employed or unemployed - Unemployed are more likely to have - Fair or poor health - Higher stress-related conditions - No insurance coverage - Higher depression and anxiety Education - It is linked to  - Better jobs - More money - Access to information and social networks - Improved critical thinking skills - Enhanced personal growth and self-awareness - Greater civic engagement and participation - Better health outcomes - Increased cultural understanding and empathy Income - Linked to - Affording healthcare costs - Nutrition and diet - Lifestyle choices - More control in life=less stress - Better living arrangements The positive functions of Poverty (Herbert Gans) - If poverty exists and persists, it has a function - Spurs creativity - Social cohesion - Ensures that the most undesirable jobs are done - Creates a demand for products geared towards this demographic Policy suggestions - Increasing attention to the education system - Redistributing resources - Supporting early childhood programs - Creating a livable wage - Using a fundamental cause approach Sep 19th Medical sociology - The systematic study of how humans manage issues of health and illness, disease and disorders, and healthcare for all Disease - Any harmful deviation from the normal structure or functional state of an organism Illness - A person’s subjective experience of their symptoms or having a diagnosis of being sick Sickness - A term to describe events that can either be noted as a disease or an illness Social constructionism - Conceptual framework that emphasizes the cultural and historical aspects of phenomena widely thought to be exclusively natural Medicalization - The process by which non-medical issues become framed as medical problems Foucault “ medical knowledge and practices are intertwined with power structures, shaping how illness are defined and managed” Cultural meaning of illness - Illnesses have biomedical and experiential dimensions - Social response vs. the actural disease - Burden of managing the disease AND ddisease stigma - Contested illness - Sufferers claim to have a specific disease that many physicians do not recognize as medical - Chronic fatigue - Irritable bowel syndrome - Fibromyalgia Illness experience as socially constructed - Illness is socially constructed - Giving their illnesses meaning - Effort to manage illness and daily experiences - Can be useful for policy reforms Medical knowledge as socially constructed - Medical knowledge reproduces inequality - Pregnancy - Biological diseases are socially negotiated and interpreted Stigma - The co-occurence of labeling, stereotyping, separation, status loss, and discrimination in a context in which power is exercised 1. Stereotype a. A person or thing that conforms to an unjustly fixed impression or attitude 2. Prejudice a. A preconceived notion 3. Discrimination a. Unfavorable treatment based on prejudice - Functions of stigma - Exploitation / domination - Enforcement of social norms - Avoidance of disease - Addressing stigma - Raising awareness of the stigmatizing condition - Improving attitudes towards people with a condition - Increasing willingness to disclose or discuss a condition - Promoting behaviors associated with anti-stigma engagement Sep 24th Built Environment - Refers to human-made surroundings where people live, work, and play - Buildings - Streets and sidewalks - Homes - Infrastructure (transportation, utilities, etc.) - Open spaces Five features of place that affect health - Physical characteristics - Availability of healthy environments within - Publicly or privately provided support services  - Sociocultural features - Reputation of the area Brief historical content: Late 19th and Early 20th Century 1867 - San Francisco prohibits specific obnoxious uses in certain districts in the US (Beginning of land-use zoning) 1875 - Civil Rights Act (forbids racial segregation) 1880/90s - Jim Crow segregation / Plessy v. Ferguson 1910 - 1st Racial Zoning Laws adopted in Baltimore, MD Plessy v. Ferguson (1896) - Supreme court sustains constitutionality of providing ‘separate but equal’ accommodations for Black and White people - Ramifications - Segregation is allowed and becomes widespread - Segregation is further institutionalized now formally - De facto: segregation exists by voluntary association - De Jure: segregation exist by local laws mandating segregation Early 20th century 1920s - Industrialization of the US. BIPOC folks move closer to city central white folks move away from city center 1930s - redlining: home owners’ loan corporation created to refinance home mortgages and minimize foreclosures; loans denied on basis of race’ consequences in investment 1934 - National housing act of 1934: establishes federal housing administration’ accelerates decay and isolation of minority inner - city neighborhood via withholding of mortgage capital, and making it more difficult to neighborhoods to attract and retain families able to purchase homes Redlining - Federal government and lenders would literally draw a red line on a map around the neighborhoods they would not invest in based on demographics alone Late 20th century Late 1940s - urban renewal; privately owned properties are purchased and taken via eminent domain’ razed and developed for other uses 1949 - american housing act of 1949: federal financing for urban renewal projects; increase funding for public housing units 2956 - federal highway Civil Rights Movement - Brown v. Board of Education - Overturns Plessy v. Ferguson, laws establishing racial segregation are unconstitutional  - Fair housing Act of 1968 - Prohibits discrimination in sale, rental, and financing of housing based on race, religion, national origin sex, disability and family status Residential Segregation and Health - Neighborhood/housing - Medical care - Health - Education - Employment - Segregation Neighborhood design - Conventional development - Low density, low connectivity, single use and auto-dependent - Low density housing - Is more recent and typically features larger lot sizes and homes Neighborhood and housing quality - Disinvestment of economic resources - Lower quality of housing - Exposure to physical, chemical, and biological agents - Commercial enterprises avoid segregated urban areas - Tobacco and alcohol industries target poor minority communities Food environments - Food deserts - Geographic areas where residents have limited options for affordable and healthy foods - Impacts over 23 million people in the US - Food Desert and Food Apartheid linked with poorer diet, higher levels of obesity and associated illness - People eat whats convenient and affordable, which for some means fast food - Fast food is more likely to be concentrated in low income neighborhoods and communities of color - Economic issues - Catering to affluent buyers - De-retailing of the urban core Greenspace - Benefits - Reducing premature mortality - Improving cardiovascular risk factors - Improved air quality - ⅔ of children in the US ddo not live within walking distance to a park - Supply side approach - Disadvantages - Property values - Location Built environment measures associated with planetary health to consider - Effects of - Wildfires  - Flooding - Extreme heat and heat island Education and employment - Education: Schools often financed through property tax - Educational outcomes: Lower test scores, limited curriculum, less qualified - Employment: Spatial mismatch and skills mismatch - Spatial: Mismatch between where low-income households reside and where job opportunities are located - Skills: Mismatch between employees’ knowledge and skills and tasks for which they are needed Oct 1 Population health - An approach that focuses on interrelated conditions and factors that influence the health of populations over the life course, identifies systematic variations in their patterns of occurrence, and applies the resulting knowledge to develop and implement policies and actions to improve the health and wellbeing of those populations Population health (simplified) - A way of looking at how different factors affect people’s health over their lives. It studies patterns and differences in health across groups and uses this information to create and put into action policies that improve people’s health and well-being Rural - Discrepancies in how rural is defined - Pastoral landscapes, isolated areas, or farmlands away from large and noisy places - Census bureau defines rural as: all territory, population, and housing units located outside of urbanized areas and urban clusters - Rural health - - the health status of people living in rural areas and the policies that guide the healthcare delivery system that serves them Timeline - 1880s - The health status of people living in rural areas and the policies that guide the healthcare delivery system that serves them - 1946 - Hill-burton act - Goal to build hospitals where they were needed and where they would be sustainable one their doors opened - 1977 - Rural health clinic services act of 1977 - Goal to improve access to primary health care in rural, underserved communities and to promote a collaborative model of healthcare delivery - 1980s - Rural health research centers - established which led to the creation of centers focused on rural health research including the national rural health association - 1997 - Balanced budget act - aimed to improve access to healthcare and reduce the financial vulnerability of rural hospitals Environmental and community context - Positives  - Smaller amounts of particulate matter = better air quality - Less traffic congestion - Space and seclusion - Reduced noise - Negatives - Poorer water quality = waste management infrastructure - More susceptible to the impact of climate change - Limited internet access - Lack of infrastructure and road maintenance - Less access to medical care and first response - Food deserts/apartheid Economic landscape - People in rural areas are on average worse-off economically than in urban areas - Slower post-recession recovery - Slower job growth - Job availability Sociodemographic characteristics - Higher proportion of adults -> out migration of younger people to urban areas - Declining fertility rates and increasing mortality rates - Racial demographics Health behaviors - Context matters, so the environmental, neighborhood, and SES features are important for health behaviors - Rural residents have - Higher smoking rates - Less physical activity - Higher overweight or obesity rates - Higher deaths from motor vehicle incidents Healthcare - Although medical care does not contribute the most towards health, it is an important characteristic - Healthcare challenges and the quality of this care - Healthcare shortages and closure of facilities - Driving longer distances - Less likely to get recommended preventive care services - Financial barriers to care - Costs of running a facility