APA 3142- Sociology of Health and PA in Canada PDF

Exam 50% MC & 50% SA / MA Definitions & examples What is Sociology? Sociologists, like other scientists, aim to identify laws or patterns of human actions, and experiences, and to uncover the principles that govern them ○ Why don’t people behave randomly or think random...

Exam 50% MC & 50% SA / MA Definitions & examples What is Sociology? Sociologists, like other scientists, aim to identify laws or patterns of human actions, and experiences, and to uncover the principles that govern them ○ Why don’t people behave randomly or think random ideas? ○ Why do individuals and groups act in certain ways? ○ Why does the social world unfold in a particular way and not another? Sociology as a science: ○ Sociology is grounded in the scientific method (ex. verifiable, falsifiable) Critical thinking: ○ Sociological inquiry challenges common-sense assumptions by maintaining a critical distance Research methods: ○ Employs rigorous methods to analyze social phenomena Boy short hair and girl long hair example Systematic study of the functioning, organization, development and types of human societies Sociology is the study of social life, social change, and the social causes, and consequences of human behavior ○ Sociologists investigate the structure of groups, organizations, and societies, and how people interact within these contexts A science that focuses on the structure and functioning of societies and examines their historical evolution or ‘social change’ ○ It enables the description and explanation of observable differences in practices, attitudes, judgements, and ways of thinking, feeling, and acting among individuals Aims to contextualize and historicize human action ○ Contextualizes an action within past and present actions ○ Forges connections between central issue (which we seek to understand) and a series of issues drawn from the surrounding reality that frames and gives meaning to it ○ Composed of theories, concepts, and methods ○ Look at where they live, their availability to resources, their background Sociology in Practice - Why Do We Draw on Sociological Findings in Health Field Evaluate the effects of social policy on health and physical activity  Develop policies or programs aiming to reduce health inequalities, improve access to healthy lifestyles, and promote physical activity in underserved populations Promote health and healthy behaviors (physical activity and diet) through social networks Create culturally relevant interventions Challenge stereotypes and reduce stigma to improve access to healthcare Adapt health interventions and programs to aging populations Create healthy environments for people with disabilities Understand the role of sex and gender in health outcomes Address health problems by drawing on biopsychosocial approaches to health Improve health literacy by creating accessible education materials and communication strategies tailored to different population groups Sociology & Psychology Similarities ○ Both social sciences centered on study of human thought processes and behaviors ○ Dedicated to improve people’s lives and bettering society ○ Draw an empirical observation and analytical, communication, problem solving, and research skills ○ Both degrees can lead to variety of career paths Differences ○ Sociology focuses on human interactions Psychology emphasizes human emotions and cognition ○ Sociology studies human behavior in the context of group associations like age, class, gender, race, religion, and sexuality Psychology studies individual’s behavior as it’s shapes by the mind’s cognitive and emotional processes ○ Sociologists receive a foundation in social theory and public policy Psychologists learn basic aspects of medical science - neurological processes of brain ○ Outside of the academia, sociologists are typically drawn to social work within social justice and social service organizations Psychologists often work in health clinics and other medical fields A Brief History of Health & Illness The Social Significance of Covid-19 Health Institutions in Canada Social Gradient in Health Social Causes of Health & Illness: Social Capital Social Causes of Health & Illness: Gender (Women) Social Causes of Health & Illness: Gender (Men) Epidemiological Transition: Aging & Chronic Illness Stigma Disability, Impairment, and Human Rights in Context of Scarcity of Resources September 12th Introduction to SHI Questions on the Reading Questions help for exam Introduction  Go on strike - not working anymore, fed up, stomach stop working and end everyone dies ○ No nutrients, food, energy ○ Material bodies, flesh bodies, emotional beings ○ Environment to flourish or constrain and fend alone ○ Environment - everything outside our body Metaphor that reminds us ○ Solidarity with a common goal Responsible for sadness, obligations ○ Solidarity based on complementary expertise and functions Metaphor psychological and sociological - cost of living then vs now and value of money and how we pay for stuff and we have / need phones now, can’t just be individual problem, students going to professor about what to do with money for school ○ Social integration (too little or too much) and social regulation - 2 factors for suicide ○ Happy in life we meet individual expectations - fall short = sad and depressed The Biopsychosocial Approach Ecological models If have eating disorder may need psychologists, nutrients, physiologists, sociologists Determinants of health ○ Human biology - genes from our ancestors (diseases, conditions, etc) ○ Social and physical environment - how they influence us ○ Lifestyle habits - eating, drinking, exercise, work ○ Health care organizations - health care units Social Skeleton - Health, Illness, Structure Agency  Shows complexity of sociology How culture / belief systems / values are in line with social institutions / work place / school / family / education Impact our conception of groups - gender, class, ethnicity Effects our lifestyles and eventually health Stress / chronic stress impacts lifestyle - independently from lifestyle but directly impacts health Health indicators - blood sugar, pressure, genetics HK had increase of important but also shows that PA does not solve all problems but may have benefits Structure - helps explain society Structure agency model ○ Structure - creativity, autonomy, ability to change way we socialize, change better or worse in society ○ Enduring aspects in history that we see in society - public health and military and education not new ○ Born into existing structures Relational structures - social networks, social relations, how economy forces us to have social relations, school needs teachers - we depend on each other, hard to be alone or independent Institutional structures - linked to our belief systems, values, tied to institutions, learn value through family / school / politics Structure and agency connection - structure influences what you do in your agency, impacts behaviors / ability to manifest our agency ○ Behavior reproduce structures that socialized in See it like spiral - spiral like history in the world Major revolution - changes can be quite big General movements hard to change - iraq example What is Sociology? Sociologists like other scientists aim to identify laws or patterns of human actions and experiences and to uncover the principles that govern them ○ Why don’t people behave randomly or think random ideas ○ Why do individuals and groups act in certain ways  ○ Why does the social world unfold in particular way and not another Bad job ○ Psychologist give tools to cope ○ Sociologists tell you to leave Sociology as a science ○ Sociology is grounded in the scientific method (verifiable, falsifiable) Critical thinking ○ Sociological inquiry challenges common sense assumptions by maintaining a critical distance Research methods ○ Employs rigorous methods to analyze social phenomena Systematic study of the functioning, organization, development, and types of human societies Sociology is the study of social life, social change, and the social causes and consequences of human behavior ○ Sociologists investigate the structure of groups, organizations, and societies, and how people interact within these contexts A science that focus on the structure and functioning of societies and examines their historical evolution, or ‘social change’... it enables the description and explanation of observable differences in practices, attitudes, judgments, and ways of thinking, feeling, and acting among individuals Aims to contextualize and historicize human action ○ Contextualizes an action within past and present actions ○ It forges connections between a central issue (which seek to understand) and a series of issues drawn from the surrounding reality that frames and gives meaning to it ○ Composed of theories, concepts, and methods ○ Contextualize in time and space for human interactions Sociology in Practice - Why Do We Draw on Sociological Findings in Health Field Evaluate the effects of social policy on health and physical activity Develop policies or programs aiming to reduce health inequalities, improve access to healthy lifestyles, and promote physical activity in underserved populations Promote health and healthy behaviors (physical activity and diet) through social networks Create culturally relevant interventions Challenge stereotypes and reduce stigma to improve access to healthcare Adapt health interventions and programs to aging populations Create healthy environments for people with disabilities Understand the role of sex and gender in health outcomes  Address health problems by drawing on biopsychosocial approaches to health Improve health literacy by creating accessible education materials and communication strategies tailored to different population groups Common Sense to Sociology as Science Common sense / fake trust / my truth ○ Is not preoccupied with logical answers and doubt Scientists - extreme doubt - ‘is this true’ ○ Is based on personal experience - beliefs, opinions, and judgments Women stay at home and take care of kids cause they make babies Women don’t vote - goes against their husband idea ○ Often based on false premises - normative or ideological ○ Generalize to all members of social groups The white community, the black community - all the same cause of skin color Sociology ○ Questions what happens to be natural ○ Systematizes their observations - selection, categorization ○ Deepens one’s knowledge of particular domain ○ Follows a systematic and progressive learning method ○ Theories Obstacles to Scientific Enquiry Common sense disguised as scientific work - peer reviewed articles Seductive power of legends, myths, and stories - read something that fits what your bias/think, anti scientific The convincing arguments of rhetorical writing and talking The temptation of intellectual routine and mental laziness Previous socialization Social Imagination Sociological imagination - C.Wright Mills ○ *A state of mind that enables us to grasp the connection between history and biography, and the relations between the two within society History in widest sense - 1950s, 1500s that type History in personal sense - your biography & eventually they meet Teen in 2024 vs 2000 vs 1950  Come back to time and space for wondering about things - why is it same or different, why now, etc ○ Sociologists need to think what it’s like to be young today - put themselves in the young shoes - dynamics, needs, relate to each other, race, sexual identity Challenge for sociologists ○ Understanding the impact of modern societies on our life (technological progress) Positively or negatively impact Electric bike - not peddling anymore, long term impacts? Impact genetics ○ Situate human experience in time and space ○ How does social structures impact experience If individuals are the architects of their own future, they do so within certain constraints Tools used to link personal troubles with public issues ○ It’s not always an individual issue A template for analysis ○ Historical factors - what changed and how, does it impact today ○ Cultural - western, ethnic, personal ○ Structural - income, organizations (school, church), sports ○ Critical - come to question specific issues to improve society and wellbeing Scarcity - air not scarce, scarce as respirators - need to have principles of cueing or hierarchies to manage scarcity (ex. Medical technology) Rarity - becomes resource ○ Not enough of it ○ Poisonous snakes are rare but not scarce because not wanted Sociology & Psychology Similarities ○ Both social sciences centered on study of human thought processes and behaviors ○ Dedicated to improve people’s lives and bettering society ○ Draw an empirical observation and analytical, communication, problem solving, and research skills ○ Both degrees can lead to variety of career paths Differences  ○ Sociology focuses on human interactions Psychology emphasizes human emotions and cognition ○ Sociology studies human behavior in the context of group associations like age, class, gender, race, religion, and sexuality Psychology studies individual’s behavior as it’s shapes by the mind’s cognitive and emotional processes ○ Sociologists receive a foundation in social theory and public policy Psychologists learn basic aspects of medical science - neurological processes of brain ○ Outside of the academia, sociologists are typically drawn to social work within social justice and social service organizations Psychologists often work in health clinics and other medical fields Sociology of Health & Illness High status in sociology Sociology of health ○ A sub discipline of sociology that focuses on the social distribution of health practices, the social construction of health and on health institutions Factors explaining its growth ○ Health is important in our society - healthism (values health above things) ○ A lot of money involved in health - sociology more money making now than before, funding for research / science ○ Post war period - WWII generated lot of suffering / disability / STI / gynecology issues / baby boom Main research themes ○ Professions and occupations - patient interactions ○ Disease monitoring and treatment - planning medical care ○ Experiences of health and illness ○ Lifestyle - health inequality, why is there more smokers / more diseases in lower income brackets Traditions ○ Individualistic / therapeutic approach More and more we work in this sector Doctor and patient relationship ○ Collective / public health / preventive approach More so us now Research program ○ Micro - social interactionism (doctor-patient interaction)  ○ Macro - political economy of health, power relations (social inequalities, demographic change, power) Interface between institutions and experience 3 levels of analysis ○ Societal level - population, demography, epidemiology Aging ○ Institutional / normative level - socio cultural conventions that structure our lives What is normal aging or priority in aging, who takes care of the elderly ○ Experiential level - emotions, feelings Grandparent living with children and makes feel safe and happy and is benefiting from them Understanding how many of our personal troubles are linked to social structure ○ Immigrants who lived period of crisis Development of SHI Classic studies ○ R. Virchow’s (1844) work on typhus fever The Prussian gvt wanted to understand the outbreak of fever and proposed a study to understand the causes of illness Findings - poor health was a result of poverty, lack of education, absence of social rights & the expansion of democracy was a fundamental condition of good health ○ E. Durkheim’s (1897) work on suicide Suicide was not only a psychological issue Connected suicide with social context Father of the notion of social capital Classic studies ○ T. Parson’s concept of sick role - 1951 ○ E. Goffman’s concept of stigma - 1963 ○ H. Becker’s Boys in White - 1961 ○ M. Foucault’s work on the power - 60’s/80’s ○ P. Bourdieu’s work on lifestyle - 70’s/90’s Definitions of Health Definitions of health ○ Have changed over the years ○ Have political, economic, and social consequences ○ Tend to evaluate a person’s condition according to a standard (conformity/deviance) Idealist vs functional definitions  ○ Idealist - state, balance, harmony, and realization of potential broad often philosophical understanding of health, including mental, emotional, and even spiritual dimensions Health happiness with absence of disease Horizon - never really get there (state of perfect) Gives direction, standard of achievement ○ Functional - health as the ability to function and adapt in daily life, with an emphasis on practical, social, and environmental determinants (focus on capacities to cope with the environment) Capabilities to function within environment Resources have to be happy or go to school or feel insecurity SHI As Critical Discipline Highlights the consequences of unregulated economies Identifies the causes of social inequality Provides a different point of view on the body Challenges the medical model Provides a critique of medicalization **Medical & Social Model Table in reading with info Importance of different viewpoints Domains for fields and types of work Both models exist together - might not be one or the other ○ Aware of each even though they work in one or the other Medical model - care model, doctors, physiotherapists Social model - preventive, social, people who are in area of prevention, social policy Use table to study ○ Medical model - focus on individual and to find treatment for person Individual, risk factors, responsibility to individual, in charge after receiving information Cause accident / trauma / genetic / exposure / lifestyle Criticism - blaming individual, taking away social responsibility of disease, can lead to stigma / victim blaming ○ Social model - focus on societal factors, social factors, living conditions, policy, programs Collective responsibility, social responsibility, what should / shouldn’t we tolerate as a society Inequalities - class, gender, generational - tools to help us find patterns of health and wellness  Political / economical / cultural / poverty / unemployment problem Seen as very euotopia - over emphasis on society to the expensive of one’s personal responsibility, undermine psychological issues that aren’t really social issues, have depression because susceptible to depression ○ Curing vs preventing disease Focus Assumptions Key indicators of illness Causes of illness Intervention Goals Benefits & criticism Leading Causes of Death by Model Medical model - find why person has heart attack; eating, obesity ○ Social - low education lead to increase tobacco consumption, bad habits, need social measures, not just increasing education about smoking but will improve a lot of health measures Medical Model Why challenge the medical model? Because it: ○ Accepts ideological assumptions about the individual, not the social nature of disease ○ Neglects the holistic (social & psychological) needs of patients ○ Does not answer many chronic illnesses ○ Medical model to fix them then send them back to condition they got it from - need both models to help September 19th Brief History of Health & Health Care Outline From traditional to contemporary societies Health care institutions in canada  Case study on covid 19 Introduction 3 types of societies ○ Traditional - before science ○ Ancient - renaissance (17 century ish) See beginning of science / scientific method (rene descartes, founder of science) ○ Contemporary 3 themes ○ Health and medicine ○ Body ○ Allopathic and social medicine History of H&I ○ Doesn’t develop itself linearly Big developments come at specific periods of time Years with one model working then change almost over night because of findings ○ Medicine and body is very political My god said you’re dying because you didn’t follow the rules - could be very powerful Big change / tension when stop believing we are sick because of religious / kings ○ Embedded in power relations Religious and secular knowledge Individual vs social processes - individual intervention, social / collective interventions and policies, health care collective vs private, public vs private Tension between traditional and modern medicine ○ Related to understanding of the body How we see body and how works - has changed over time Is it smell or evil spirit - no knowledge of microbes / bacteria - why should we wash our hands for example; didn’t have scientific knowledge of what causes disease Why do some people get depressed, why are some people gifted at school, how does an athlete start a sport and become really good super quick ○ Tied into developments (a) health and medicine, (b) and conceptions of the body and (c) allopathic and social medicines Traditional Societies Understanding disease  ○ H & I were understood through a cosmology of good or evil - no secular knowledge of health and hygiene No scientific knowledge - it’s our spiritual or religious knowledge Cosmology - System of classification in which certain activities we do soon as good and bad and have connections with our health ○ Illness has been set in a theodicy A system of beliefs that attempts to explain and justify the presence of human suffering Such sacred understanding remains today More into religious / spiritual understanding to explain why we get sick or not If religion isn't strong wouldn't have so many religious people Tries to explain things that aren’t explainable - death, illness Health and illness are tied into classificatory systems that are linked to religious and moral views about the body ○ Sacred and profane - purity and danger book ○ Significance of taboos Ex.1 lifestyle and pork restriction; forbidden; pork didn’t fulfill significance need, don’t fit classification; cloven feet like cows but not ruminant; viewed as something different than natural order of things; wasn’t related to health another religion came out and wanted to stand out so said eat anything you want Ex.2 illness and menstrual blood; inuits had diff view of the world; men not allowed to approach women when she was on cycle, isolate them, brought bad aura, reason explained why people got sick, later associated with pms but not something in your head, hysterectomy and hysterical related ○ What is permitted or forbidden Early Societies Renaissance Obeying to the cosmos ○ Body (microcosm) reflects the world (macrocosm) and the astral influences ○ Brain to the moon; heart to the sun Climate change comets were used to explain the arrival of plagues Ancient medicine and humoral medicine (Hippocrates & Galen) ○ Humoral medicine - system linked human to wider cosmos - links body to the universe  ○ The body Health represents a harmonious balance between 3 humors; blood, phlegm, black bile and yellow bile Associated with an organ - liver, spleen, heart, brain Has 4 qualities - heat, cold, humidity, dryness Constitutes by 4 qualities - fire, water, earth, air ○ Sickness Reflected an imbalance between humors Involved bringing the body back into balance ○ Equilibrium, balance - work, family, rest after training Claudius Galen Physician (130-200 AD), greek doctor, popularized beginning of training methods for gladiators (humoral medicine, overtraining not good and need rest) ○ Important figure in development of sport medicine and exercise science ○ Believed in the virtues of exercise - opposed to glorification of athletes ○ Advocates the use of opposites and vigorous effort More balance life Humoral medicine by using the opposite ○ Important in kin and medicine Ideas finished around 16th century Early Societies to Renaissance 16th - 17th c. competing discourses within medicine due to dissection, anatomy, and physiology The erosion of humoral medicine marks the arrival of modern medicine ○ More science develops the more permitted it is to understand human body less traction theory of human body ○ End of theory of balance for balance sake - slowly replaced by more scientific understanding of body - starts with anatomy Need to dissect body to see how it works ○ Dissecting body is very sacred Not supposed to temper with human body or god's work ○ Trying to reveal masterpiece of god William harvey - figuring out circulation of body, why / how blood flows Modern Medicine Development of the concepts of health and illness ○ Increase secularization of society - religious slowly being replaced by scientific understanding with relations to medicine ○ Rise of theories of health ○ Separation between mental and physical health - mind / spirit / ideas and physical body  Birth of psychology and psychiatry Made sense at that time ○ Erosion of traditional therapies Hierarchy - more science take place, more see positive impacts, less attraction to rituals / spiritual beliefs / humoral medicine approaches More specialists of mind, liver, liver cells ○ Differentiation of categories Specialists / expertise - very precise Spread from Europe through colonization ○ French and english came and brought secular knowledge ○ Confrontation for ideas of world, indigenous vs europeans Secularization process brought by science ○ Classification and specialization of diseases ○ Increased status of medical professions, decreased status of traditional medicine - healers, medicine man, wise women, midwives Power relation ○ No neat point of separation; religious and secular mix The presence of religion remains present Anatomy Lesson of Dr Tulp - Rembrandt 1632 Painting anatomy lesson Always has to be done with authorization of religious organizations, king Famous anatomist - andreae vesalii ; showing drawings of human anatomy, correct mistakes from past, humans distinction as beings not animals, need to dissect to understand George chaeyne - english physician - nutrition, mental health, critical of youth who aren’t respecting religion lifestyle (not too much food, alcohol, etc) ○ Depressed and obese himself - lost weight by controlling lifestyle ○ Promotes being vegetarian ○ English malady - english depressed / gloomy ○ Sleep well, eat well, have fun ○ How to live to 100 years old book Moving from spiritual way to birth of scientific well being of health and lifestyle Modern Medicine Mind body dualism 17th c ○ *Rene Descartes - 1st big game seen in class Birth of scientific method  ○ Exclusion of religious conceptions of the body; establishment of mathematical laws governing the body - body as machine It was a physical and material body to separate from mind Is relationship between 2 but for study need to separate them (illness etc) Studying specific parts of body - specialists for categorization Believed in evidence - new in history; can’t believe in something if not proven ○ Clarified mind and body distinguished Founder of modern science Huge impact on experimental method and psychology Today say with ecological perspective, trying to bring back mind body together Physical environment impact on stress, stress impact physical body ○ Important foundation of scientific understanding of body Mechanical models of body Birth of medicine - discourse on method of rightly conducting one’s reason and of seeking truth in sciences, 1637 Heightened interest on mental illnesses - psychiatry Body-as-machine ○ Objectification of the body ○ Mechanistic representations of the body ○ Removal of the ‘thinking person’ / consciousness It’s the body of patients that are treated Pulleys, pressures, muscles ○ Like living organisms on earth ○ Anatomy marks the end of anthropocentrism Finding we get sick by different conditions - dirt, garbage, smell, taste, humidity are examples Two approaches ○ Medical intervention ○ Illness prevention Two types of medicine ○ Individualized medicine ○ Social medicine Two concepts of illness ○ Hygiene and contagion 17th and 18th c. discourse on illness based on miasma (effluvia and air mutations)  ○ Miasma - theory of miasma; toxic imminations that resulted from decomposition, contamination, stagnant water, dirty environments, fog also associated to vapors / toxic / contaminated air Bathing was not encouraged because it exposed pores of body to miasma Gets into our nose, mouth, pores and makes us sick Perfume had a protective / preventive value from odors Solution was to improve smell This belief created an obstacle in understanding of diseases Urban developments and architecture began to be concerned with air circulation (18th -19th c) ○ Densely populated areas, excess heat, humidity and air pollution were risky environments More dense = more risk for disease ○ Burials were beheld away from the cities ○ Bad Breath was perceived as carrying pathologies ○ Improved architecture - widening streets, opening windows, garbage outside cities, bury dead outside cities Good - focused on smell and community Microbiology brings a scientific revolution: germs theory (mid - end 19th c) ○ Pasteur, Tyndall, Koch Pasteur = pasteurization - boiling / heating up something to remove germs - vaccination Tyndall - sterilization Koch - sources of diseases like tuberculosis, know causes then can find how to prevent it - “focus on what we don’t see” Led to destigmatize populations like the poor, protect poor and rich cause poor may pass illness to rich You catch a disease All participate to same findings, hard to know who did what ○ Importance to the invisible Now know need to clean homes, water, tools ○ Discovery of vaccination Chickens don’t get sick when get small doses, adapt ○ Germ theory - birth of microbiology Power of microscope - developed 17th / 18th c Discovery world for infinitely small Know it’s not smell - now it's germs So far : Anatomy , humoral, miasma theory, germ theory Health education  ○ Personal health for collective health ○ Illness is avoidable ○ Identification of health measures Statement of the academy of medicine in France (1896). Germs are the enemy ! Increased connection between hygiene and the environment (proper housing, health insurance) Social contract, solidarity, screening ○ Between rich and poor - because protecting rich Increased connection between mental health and the environment (20th c) 3.2 Modern Medicine - Social Side Hygiene became important in management of society ○ State centralized statistics on health (end of 19th c) - social living conditions, profession, economy Began to reorganize territory ○ Air, earth, water ○ Classification of dangers - buildings, slums, cleaning of cities ○ Specific authorizations and systems of surveillance and sanctions (homeless, prostitutes, sailors) Gain knowledge with surveillance measures Age, how many died, dashboards saying stats about covid - economic and social 19th c. Infectious Diseases Social and biological aspect Continued debates between allopathic and social medicine ○ Treatment of patients through medical interventions VS actions on the social and physical environment Germs theory ○ Marks a move away from spontaneous illness pathogenic microorganisms ○ Generates new debates between AM: medical understanding of hygiene SM: control of town planning, water systems McKeown Thesis - Canadian Historian of Health - died from tuberculosis Rise of life expectancy in 19th and 20th c. and decrease on infectious disease (TB) were due to improved living conditions (nutrition, water)  ○ Medical intervention would only explain 1/10 of the problem Does this thesis still stand How can it be applied to policy related to covid-19 - yes ○ Once identify cause chronic diseases and say population have to be active avoid screens or eat better = reducing impact of many diseases without treating them Chronic - can’t cure it by definition; not a chronic disease but have arthritis and diabetes, have multi diseases ○ Try as society to prevent once we find cause - relevant today’s chronic diseases ○ Used to isolate instead of cure Debate between preventive social medicine vs care Once found vaccine almost no one died from TB ○ Little bit of people to no one had it Identify cause, adopted hygienic measures/public health measures What works more ○ Discovery of cause, prevention, or treatment ○ Obviously it’s both ○ Just by doing prevention have lot of work done Contemporary Times Health and wellbeing ○ Context - individualism, end of grand narratives, decrease in religious beliefs Importance of my wellbeing My society provides means for everyone to live lives as they want Can’t decide what everyone needs Idea of being happy so important - need social means to have resources to be happy in own way ○ Reinforce self control and body awareness Giving means to people to control their own life, aware of your body, being happy and aware ○ Self responsibility, prevention education (AIDS) Seen as normal The dilemma of normal life span. Is aging a disease? ○ What is a normal age span ○ Trying to find ways to slow down aging process ○ Normal don’t need to invest resources But if not normal need to find why ○ Seeing that is may be a disease  ○ Sharing of public resources Economic / political instability, risks and disasters ○ Environment, global warming, major outbreaks like covid Part 2. Health Care Institutions In Canada Institution ○ An association or organization with a structure in which the powers, roles, and functions of individuals are explicitly defined An institution includes standards, operating rules and sanctions Can also be organizations Doctors, nurses, lawyers etc ○ Components Higher level and community Prevention, care ○ Institutionalization process Way institutions functions Sanctions Medical errors Rules / prioritization subjected to sanctions if broken Canadian Context (17th - 18th Centuries) Explained well in reading State of knowledge in health ○ Colonization ○ Meeting between 2 worlds - indigenous groups (already here) and colonizers (europeans) Had belief system for health care - humoral ○ Preventive medicine - have knowledge ○ Starting to build state - to manage people (political) Roles of governing bodies - 18th c ○ Health authorities and quarantines for sick ○ Know impact of sickness Mortality rate ○ Infectious diseases Extremely common - major cause ○ Infant mortality 25% of kids died before age 1 (¼ didn’t reach age 1) Almost normalized Died cause of infectious diseases ○ Life expectancy at birth 30 years old before - now close to 88 (male vs female difference) Canadian Context (19th Century)  40-60% of deaths - infectious diseases ○ Pandemics - diseases appear sudden ○ Endemics - regular diseases that impact specific group or place (malaria) ○ Outbreaks occasionally - syphilis ○ Higher before especially in young kids Germ theory - same happened in NA ○ Knowledge from european transmitted to colonies 19th c (canadian state) ○ Context ○ Industrial revolution and urbanization More concentrated in cities From 18% to 50% of population now lives in cities - sewage, services, sanitary measures Doctors important / hospitals have teaching role to train not just fix people ○ Hospitals Status of medical doctors Medical schools First cooperation / association of doctors Around 7 hospitals then ○ Standardized Wasn’t rigorous training or standards before Toward end of century - document made to standardize care Flexnor who recommends # of medical schools to develop more expertise in each school & increase prereq for students, encourages scientific training, training not only in class but practical in hospital, increases / recommends create of corporations that manage quality of practice Doctors started working together - harmony ess system ○ Sharing of powers after confederation - 1867 Birth of canada as formal state Provinces and federal gov negotiate to have diff powers Health was given to provinces to manage Far from universal health care system Canadian Context (20th Century) Birth of public health (internationally speaking) WHO - developed after WWII ○ First public health school in NA - John Hawkins Knowledge of nutrition, vaccines, etc  Type of diseases/interventions - more related to accidents / chronic diseases, less to infectious ones ○ People living longer, have cancer/chronic/cardiovascular diseases now ○ New patterns of diseases because we live longer ○ Crisity of public health 20th century ○ Increase in health Scientific discovery, vaccination programs Increase of medical doctors ○ WWI & WWII Death and injuries - injured or traumatized Infectious diseases Political consequences Secret plague of soldiers - syphilis (STIs), shell shock (PTSD) Political and federal (in charge of army) interests - territory to act upon ○ Development of public health Growth of federal government Department of health Medical education norms Persistent problems ○ Canada vs US - Canada has gun control and universal health care Now in control of their hospital - municipal and city bits ○ Evolving canadian context Demographic and territorial issues Policy and politics ○ Structural conflict within health system ○ Access to health care Not always easy - waiting lines, prioritization of specific care, quality of care Seeing erosion / holes in universal health care system Wealthy people don’t want to wait, want quality care - use money to gain access, change system or system will change to meet their demands Scarcity - not responding to demand, people with power get what they want, find ways, some leave country to get care elsewhere but create problems for them there, impacting flux of resources around the world Institutionalization of health care ○ Emergence of universal access to health care  ○ Hospital insurance and diagnostic services act 1957 / medical care bill 1966 Universal access to health care Agreement between governments Administration of health care by the state Act - Parliament think seriously to have universal health care system, provinces mange own way but needs to be free and accessible to all 1970s all provinces have universal health care system - so new, nothing from historical perspectives, could change in upcoming years ○ Emergence of public health ○ Role of federal government Cost of provincial expenses covered half by federal government Problem - wasn’t optimal, didn’t encourage provinces to find optimal ways to spend money Change way we fund health care and base it on other measures - wealth, wasn’t based on expenses Now provinces manage health care system manage in better way cause no guaranteed Gov also going to develop info system CIHI and CIHR (funds professors in health, largest in canada) Need health info in digital age, fed gov controls it Way of participating in convo about health by funding researchers, creating info, modulating way we fund canadian health care system ○ Canada is diff country but doesn’t remove what happening in europe for ex Hospital is a process - didn't’ just appear, don't’ have research or standards of practice like today - all was created Complex healthcare system being threatened by privatization, creates 2 tier system right now Part 3. Case Study on Covid 19 Socio historical context of epidemics Sociology of catastrophe Social cohesion Post truth society ○ Lose trust in institutions ○ Large group of population don’t believe leaders, have problem with needing everyone help  If war breaks out how to convince everyone to work together Cohesion important when facing common enemy - our case disease/virus Lessons for future health crisis Impact Then vs Now Science has changed, some similarities and differences Social media - impact now, changes groups Music example ○ Radio ○ Concerts ○ Much music tv channel ○ Apple music find music you may like ○ Less common thread/influence ○ Translate with political expression ○ Share across world Impact of Pandemic - Class Discussion Change our lives ○ Rights / freedom to go around ○ Social distancing, preventing physical contact - safety practices ○ Mistrust in medical system / science ○ Political - different views of how to care for disease Freedom convoy in ottawa ○ Online work increases - school, work, pass/fail marking ○ Horizontal learning - late for assignments or didn’t do them, working with peers but online may be isolated ○ Spikes in teens being depressed, political divisions, wars Scientific impact ○ Did we see germ theory - extension of it In very advance level of theory Development of vaccination in small period of time Money and scientists doing this Authorized without ethics Sense of urgency - finding solution, coordination, competition Historical Epidemics  Economic exchange - impact from europe Circles represent impact size Relatively common in history Many thought pandemics were done Resort to similar methods - mask, social distancing, vaccinations ○ Working with science to find solutions/cures Daily Counts of Death by Covid 2020-2022 Standardized death rates - isolate/control for variable, remove effect of age Neighborhood that’s older population - cancer rates high there, not high because people are old, want to remove impact of being old to have measure that makes more sense for global population Have peaks for deaths - going down with time for some Covid 19 Social Inequality Income and death rates ○ Poor = more at risk for dying with covid Men more than women ○ Wealthy of neighborhood - people that share characteristics 2 lakes - rockcliffe in ottawa, don't’ see it because of houses Lower death rates ○ Accumulated death rates With time - being higher at poor level than rich ○ Death rates - undebatable Give indicator of what’s happening underneath ○ Work that can be done at home vs not ○ Having kids that want to play with others Deaths spread amongst provinces ○ Classification system different - did each province classify same way Social Consequences of Covid 19 Themes  ○ Social inequalities - physical and mental health, mortality, vaccination, employment, etc ○ Social institutions - healthcare, education, families, housing Quality of social organizations Polarized societies ○ Culture - relationship to risk, conspiracy theories, stigmatization, polarization Stigmatization of groups - ‘asians responsible for covid’, hispanic, older people took a lot of care ○ Social - social cohesion, isolation, religion/spirituality, etc Didn’t wanna get vaccinated for religious reasons ○ International politics - social policies, international relations, inequalities and humanitarian aid Human right issues, debate west should pay for vaccination in africa ○ Technological - working/school from home, social media, telemedicine, screens, etc Meeting friends only online ○ Ethical - management of scarce resources, vaccination, vaccine passport Varied between countries - ethics went all over the place Impacted freedom ○ Scientific - crisis of legitimacy, research topics, commercialization and knowledge sharing Research topics shifted right away Crisis is legitimacy - who is legit to impose measures on us / who to trust Quest for Meaning - Turner 2023 Many statistics and scientific explanations, but little discussion of our persona, social, and spiritual experiences Faced with major natural, social or political disasters, human beings seek to give these events a meaning that goes far beyond simple factual accounts Religions have often been used to explain suffering and misfortune? What about secular explanations ○ Identify extremism What will we do with these What to do with society that is very plural with perspective of immigration ○ Marginalization of immigrants, weakening of democratic powers, increasing individualism, erosion of citizenship / common good  White house gets attacked is something odd that’s happening, odd in canada to see violence but see physical imitation - appeared after pandemic Notion of citizenship / be a citizen - member of a nation, contributing member to nation, *member of nation have rights and responsibilities (both go together) - follow rules in exchange for being protected Citizenship - protection, education (educating children, making children to make society and have place to school and care for sick babies), economy (going to school and work & protected if lose job) Health is pivotal for all 3 pillars - not just for person but important for society and citizenship contract Don’t have healthy babies if don’t have health care : example Understudied for impacts and how ○ Increase in ‘toxic’ masculinity ○ Etc Pressure on healthcare system increases triage and hierarchical principles between individuals Social / economic impact ○ How will kids vote, take on formal institutions, way to live, army, citizenship Human have reflexes of trying to give it meaning even with scientific facts ○ Why should i get vaccinated / why does she have to be but not me ○ Is it fair to be protected because i get vaccinated and they don’t ○ Goes beyond factual evidence Sociology of Catastrophes - Turner 2023 Covid 19 as a social catastrophe ○ Increased mortality and disease Conditions they died in ○ Imposed quarantines, preventive measures (vaccination, masks), surveillance and punishment ○ Social upheaval ○ Weakening of our institutions charged with ensuring stability, security and health Education, family, law force What is a catastrophe  ○ Event or series of events that lead to a certain collapse of social and political institutions, results, among other things, in the advent of a new consciousness ○ Don't seem to be more polite - service industry more verbal abuse now, working in gyms and sport centers in lack of politeness seeing Will our elites have same legitimacy as before Creates instability in world Certainites less certain Trust in neighbors or government more eroded ○ Leads to instability where there is no clear recovery because there is social upheaval leading to a different society Bring instability - war, global warming/environment, pandemic, cost of living One of those things make chaos or stress but now we have many at once Sociology of catastrophe - important, not just a disaster/tragedy, it’s a disaster (much wider, implications, before/after) ○ Not to be confused with: crisis, disaster, risk, danger ○ Etymology ‘Related to a play’ ; ‘end, denouement’ happy or unhappy CATA = downwards STROPHE = rotation, turning point Social Cohesion During Health Crisis Impact of covid 19 pandemic on social cohesion - social connectedness / solidarity among groups in society ○ Increase of societal divides - how pandemic has magnified existing divides ○ Erosion of social ties - between peers, friends, siblings, kids to play at home, develop habits ○ Scapegoating and stigmatization ○ *Misinformation and distrust - disinformation also Misinformation - not intended to cause harm by giving false info Disinformation - consciously wanting to cause harm by giving false info ○ Fragility of social bonds Important friendships Historical examples ○ The plague - 14th century Jewish groups targeted for creation Bacteria on rats and mice  ○ Tuberculosis - 19th to 20th century Blame poor, marginalized groups Lack of democracy ○ HIV / AIDS Homosexual men, drug users, sex workers Immigration, people of color, africans ○ Something we don’t understand and can kill us - people try to find meaning and blame others Covid - not same society Post Truth Society - Fukuyama, 2022 A society where a significant portion of the population makes claims that lack factual basis, despite evidence to the contrary Reflects a broader decline in the authority of and trust in key institutions such as religious, educational, and medical organizations ○ Lack of confidence in authority ○ Trust in key institutions - scientific included Technology amplifies this phenomenon, as these institutions are continually scrutinized and evaluated by general public Example Post Truth, Distrust, & Erosion of Scientific Expertise Post truth ‘ trust and falsity have become matters of the power to persuade….it then becomes difficult to distinguish between news and sake news’ Impact on disinformation / misinformation ○ Emotions and beliefs increasingly override objective facts and scientific evidence Capacity to persuade people that is more important than facts ○ False information about vaccine safety, mask effectiveness, and covid 19 treatments Spread rapidly through media and social networks, amplifying their reach and influence Undermined public health efforts ‘Fake news’ When population believes you’re not transparent enough - reduces effectiveness of public health measures Trends already bubbling in society (distrust already present) ○ Erosion of trust in scientific expertise and skepticism towards public health authorities Weakened collective responses to the pandemic Led to polarization within communities, increasing social fragmentation, reducing the effectiveness of coordination efforts  Reach is much wider with media ○ Historical examples Anti vaccination movements in the 19th century exhibited similar resistance, driven by fear and mistrust of scientific authorities, mirroring today’s challenges Before social media - imagine it today with media following compulsory law How to adopt measures to health in context where divisions between classes / political parties / culturally / racially groups, sexual orientations / gender identities Lessons / Solutions For Facing Future Health Crisis Implementing evidence based interventions ○ In order to counter disinformation / misinformation Rebuilding trust ○ Do this in education setting ○ Having leaders to bring people together ○ Strengthening institutions that bring us together Family day in ontario Strengthening social cohesion Addressing disinformation and misinformation ○ Fact checking more - newer idea ○ Legal issues / cases of bringing people to court because misinformed culture consciously Balancing / strike a balance for individual rights and collective rights ○ Develop rhetoric to make more present in population / teach our society about rights and duties, individual vs collective rights ○ Sometimes both not compatible ○ Give little individual rights to promote collective rights The Optimist or Pessimist View Taking an optimistic or pessimistic view of disasters How to understand current instability (characterized by a combination of threatening conditions and political instability, environment, pandemics, wars, social polarization) ○ Tolkien and the eucatastrophe ‘good catastrophes’ - Lord of the Rings Triumph of ‘good over evil’ and hope for a better world Every catastrophe has to be linked with some positive outlook to give us more hope for future ○ International risk community Future wars, cost of living - generational project Three concrete optimistic avenues  ○ Better understand how social, cultural, and political factors can contribute to our development and security in relation to our shared vulnerability Threats to communities All vulnerable for different reasons ○ Continue our scientific studies on contagious diseases, prevention and protection ○ Maintain citizen education September 26th Inequality & Health Last Class Important theme ○ Secularism - secularity of our institutions ○ Less religious, less spiritual ○ Brought over by centuries - science Development of science Renaissance - bubbling of theories and scientists Rose the understanding of the body ○ 19th century shut down theories - germ theory - associated / development with microbiology and microscopes Sterilization - no knowledge of contamination Pasteurization - milk, cheese (raw cheese not pasteurized & not for pregnant women) Sanitization / hygiene - washing hands, cleaning desks Architecture / urban development - open windows for ventilating, narrow / small streets Developing cities, caring for sick ○ Theory before germ - miasma theories; created changes for wrong reasons Saw smell, humidity going into air - came into body pores/mouths to give disease, wasn’t smell but was bacteria Income, wealth intertwine with other sectors ○ Something about income, education, seems to be most important factor when talking about health ○ Eating habits, leisure, access to health services, healthy environment ○ Better to be rich than poor and educated vs not October 3rd Inequality & Health Status Syndrome By M. Marmot What is the status syndrome ○ Psychological experience of inequality-how much control you have over your life and the opportunities you have for full social participation-that has a profound effect on your health What is the social gradient in health and what are its principal causes ○ Social gradient - from poor people to wealthy people, everyone in between, see there is a gradient or ladder Why does the author suggest that people are not entirely responsible for their health ○ Individual or collective responsibility ○ Questions of social responsibility is key ○ You may believe that society has responsibility - as a taxpayer you have responsibility to ensure population is somewhat healthy Introduction Aim ○ To introduce the notion of social determinants of health ○ To understand the connection between social status and health (social gradient) ○ To understand the connection between social status and lifestyles A few questions ○ What expressions should be used - disparity, injustice, inequality, or inequity ○ What type of inequality (between individuals or between groups) ○ How to measure or operationalize health inequalities ○ What are the debates over individual and social responsibility ○ Can operationalize health inequalities be modified Take away lifestyle and can compare health Need to be coordinated with other interventions What diseases are more susceptible to class issues Social Structure & Health Sociology - look at society and social structure, enduring patterns that make society how it is, make gender and class differences, values and norms Social structure - system of relations between individuals; durable social patterns within a group, society or social organization How can we influence and change them to improve well being and health of population Social structure and health  ○ Social / socioeconomic inequalities Also referred to as class ○ Differences in our behaviors/life ethic (socialization) and inequalities of opportunity (structure) Personal ethics - why it’s ok to do this or why it’s not ○ Cumulative advantages and disadvantages ○ Social inequalities in health How do we intervene when there’s so much going on in someone's life ○ See the way we do and think as being the impact of cumulative advantages / cumulative disadvantages Chain of negative or positive events in our lives - creates these inequalities Determinants of Health Social determinants of health ○ The interaction of individual, social, environmental and political factors influencing people’s health status How do they affect health ○ Income, education, life expectancy, type of diseases we die from What are the strategies for improving health - global ○ Health care - easy one, sick and go see doctor and get cured, impact is limited from populational perspective Does not see much people, people who go see you are sick already ○ Collective action - how to encourage society or groups to take care of each others health Student rights, student dental health program ○ Lifestyles Ottawa charter of health promotion document Interaction of various factors, socioeconomic factors that influence our health ○ Very broad social determinants of health - housing, education, family, violence, community Hits on - education, unemployment, development as a child, relationship with food, type of housing, social exclusion, social  net in society (protective system), access to health care services, system related to color of skin/culture, disability Everything we are supposed to do - still end of unhealthy than our counterpart that does the same thing - affect our health in many ways (fetal programming, stress, lifestyle, health care access) Defining Health The changing definition of health ○ Previously defined as an absence of illness Was state of happiness, health, well being ○ Now includes physical capabilities, social and personal resources Looking at more relational - relationship between individual and their environment How can an individual relate more successfully with their environment, access to resources Have diploma and access to school to get education to get job - no access means no job Definitions often emphasize different values; most tend to describe the state of a person in relation to a norm (deviance) ○ The idealistic perspective ○ The functional perspectives Social Inequalities in Health Same society - 10 or 12 years later ○ Obstacles to overcome are larger than you ○ Role of society is so reduce the obstacles that people have in their lives ○ Common obstacles - one’s with most resources come out healthiest Covid for example ○ Lines of cars in america waiting for food bank, eating bad and not eating at all is same impact ○ Not investing in key resources in society to promote healthy lifestyles  Not looking in this at depth Analyzes impact of various aspects of society on health equity / equality Why is the gap wider or smaller in terms of health and well being ○ Material circumstances, behavior, biological/ psychological, social cohesion, occupation, education, class, gender, ethnicity, socioeconomic status, policies, values of country Built in the impact of the white hall studies held in UK Rely on models like this Inequalities of health and illness *Begins with economic and social policy and how this impacts the socioeconomic gradient - no health yet, just socioeconomic gradient Why are people poor and some wealthy - what’s the extent of this different ○ Measures for that ○ Redistribute wealth - give people money but may have huge taxes To share resources From economic / social policy to socioeconomic gradient (income, education) the to psychological aspects Physical environment - water we drink, place we live, drink same water even if poor or rich ○ Big difference but not big impact ○ Most share healthy environment ○ Same working environment but not same living aspects Genetic heritage - could explain health if someone in family had illness ○ No question that genetics are involved in health ○ Question now is it involved in health inequality What impact lifestyles ○ Mostly psychological dispositions, dispositions to adopt diff lifestyle / our taste Should i eat those chips or not  Stimulants to perform better Wealthy - have more control over lifestyle, can change situation, retire and travel and have long life ○ Willing to invest in health ○ More time and motivation ○ Less constraints in life To explain not health but health inequalities Socioeconomic position - not talking about income ○ Position implies hierarchy and income / education Wealth in comparison to people around you How it impacts health ○ Middle row explains ⅓ of difference ○ Stress or chronic stress makes up for 50% of health Result of not having control over our lives Control is key variable No control in another aspect like a student - working hard for exam and not getting grade expected Stress of job, home, family Not necessarily school stress Rich person eats chips and has other ways to get rid of it and stay healthy and has ways to help Not significant if we measure wide populations ○ Rich and poor both die if fallen off cliff Bouchard model Health Lifestyles Paradigm (W.J. Cockerham 2013) Explaining middle pathway from above diagram Structure of class is the start Socialization experience  ○ Raised in those families and get socialized in specific way (rich vs poor), what your parents do, what you do for leisure, what to be when you grow up ○ Parents / peer fashion what’s important to you and choices made ○ Interaction between how we socialize and what is possible for me Life choices ○ Everyone in environment didn’t do well in school or dropped out - see parents out working hard, no help with homework, staying in school is important but what they do shows otherwise ○ Creates vision for world and what you are likely to adopt in terms of practices - what to do in lifestyle ○ Socialize, views, way of life, chances ○ Can’t always live in expectation Inequality Inequality is a violation of human dignity; it is a denial of the possibility for everybody’s human capabilities to develop. It takes many forms, and it has many effects: premature death, ill health, humiliation, subjection, discrimination, exclusion from knowledge or from mainstream social life, poverty, powerlessness, stress, insecurity, anxiety, lack of self-confidence and of pride in oneself, and exclusion from opportunities and life chances. ○ Inequality, then, is not just about the size of wallets. It is a sociocultural order, which (for most of us) reduces our capabilities to function as human beings, our health, our self-respect, our sense of self, as well as our resources to act and participate in this world. (Therborn, 2014) Education and income : Influence social position and influence way of life ○ Wealthy more secure and more confident ○ Take less chances ○ Die later ○ Less humiliated about home, way they talk, relationship with kid ○ Anxiety vs insecurity with poor - you’re a refugee, worried about getting fired, worried car won’t start next day Sociology of Health & Illness Operationalizing health inequalities according to three components of a human being - can blend together ○ Vital Need to study biological component relative to studying health Death rate, types of PA, weight, VO2max, diseases, stress levels, mental health ○ Existential Cycle aspect  Anxiety, happiness, flourishing, stress, security, subjection, discriminate Emotions we have - don’t feel like doing it, won’t do it ○ Resources Social aspect Networks, social resources, family, connections *Scarce - resource in high demand *Rare - resource limited and hard to find, important friends, be rich Start by giving definition of human being Biocycle social model Social Inequalities in Health Definitions of health inequalities / inequities Generic ○ Refer to differences in health associated with structural and social disadvantage that are systemic, modifiable, avoidable, and unfair Health inequities are rooted in social, economic and environmental conditions and power imbalances, putting groups who already experience disadvantage at further risk of poor health outcomes ○ Inequalities - are they different and why Something else added - add notion of resource, scarce resource When you don’t have, you’re without - creates handicap, loss Something in society if you don't have it places you at lost compared to others Sociological ○ Refer to the end product of wider social and structural inequalities that characterize a territory at a given moment in its history and economic development ○ Sociology enables us to understand the process by which a social order is translated into the body and health Helps us understand how determinants get translate into equalities Premature deaths ○ Standard established around world - establish here at age 75  ○ Never happen in history yet that someone didn't die ○ Death not important measure to study ○ Give benchmark ○ Classify # of people died from pmd we divide into 5 equal groups of income - female higher life expectancy (men are less likely to seek health, risk taking behavior, mining / wood / fishing community), women protected up to menopause from cardiovascular disease - more poor = suicide rate increase - canadian portrait site important Social Inequality & Health The role of the welfare state on health Health of population / inequality - not only people making decisions but also countries making policies that impact people's health and decisions State has role and impact on people’s health - cost for day care or tuition may be different in provinces The Black Report - 1980 ○ Assessing the health of the population ○ Praises and critiques (4)  (1) Was statistical problem / artifact of measure - not measuring to the thing, we think its policy but just measuring the fact poor people are sicker and can’t work, not policy that impact its health of people (2) natural selection - social darwinism, poor people are less intelligent, less likely to get good job, lot of responses that weaker members die earlier and give room to more stronger (can’t say that today, can’t prove it), show it varied between time and countries, unjust to compare human and animals (3) Lifestyle explanation - more lifestyle than healthcare issue (4) Material condition - environment, housing, etc ○ Last 2 created more debate - has the state a role in playing people’s lifestyle and involve environment different way then involved in universal healthcare system Need to go beyond investments in health care ○ Social, scientific, political impacts Are these inequalities preventable and how ○ Health care system important but insufficient when trying to reducing inequalities and illnesses / chronic diseases / death rates Social Gradient in Health - From Reading - **FOR EXAM Status syndrome - play on words talking about status determines diseases going to have ○ Low social status more chances of having lower health status Defining the social gradient in health ○ Stepwise patterns in health outcomes as one climbs through socioeconomic ladder the more healthy one is Why does M. Marmot refer to metaphors ○ Puccini’s La Boheme Horsing around and having fun, living the life Love of his life All greta tragedies someone dies Guy - Finish degree in english - go to paris, drink wine, don't’ pay rent, have fun, poor as heck Girl Mimi - born and stay very poor but embroidered, she dies in the end Both in love and both young - love is insufficient to make you healthy *health and illness - type of poverty or choice you have in life (girl always poor didn’t have control to get out of it, guy made  choice to have fun cause when fun was over he could get job and be more serious Poverty and health - aspect of control Social connectedness - girl was alone only had guy, guy had many friends Wasn’t just lifestyle, nutrition issue More status = more healthier - tricky saying what causes status, important to how you feel in community ○ The analogy with a parade Same experiment but instead of taking people will take their parents Classify people by parental education and income See same trends Killer - it’s unfair Depend on parent income - for him choose parents wisely, can’t choose them ○ Choosing your parents wisely If health is widely determined from something we just born into How can we blame individual if health already largely determined by parents Adjusting for specific variables Social, scientific, political consequences Consequences of low SES ○ Fewer means to face stress ○ Higher probability of socially excluded ○ Weaker self esteem; higher rates of distress ○ Lower control; higher dependency Social gradient in health  ○ Relational perspective ○ Health varies according to… Ex. captain scott As a general trend It’s not the countries that invest the most in health care that have the highest life expectancy Scarcity of resources ○ Above a certain threshold public investments in health care drain other resources, diminishes collective wealth, engenders more illness ○ The law of diminishing returns ○ The case of japan ○ Ted talk Richard Wilkinson Whitehall Studies Why the study of civil servants ○ The gradient in health in both sexes for a population of 18 000 people ○ Homogeneity of the physical environment ○ Highly stratified environments ○ Health as a classification system of social ranking 3 important conclusions on the relation between social position and health ○ Blood pressure ○ Psychological health and stress ○ Lack of economic and social resources Interaction Between Social & Biological The social environment affects the nervous system, which acts on other biological systems (endocrine, immune and blood) ○ L’hypothalamus affects the hypophysis that in turn affects the suprarenal glands, increases the level of glucocorticoids ○ Numerous effects on digestion, libido, energy, blood pressure, immune system  ○ Brings premature aging - death Studies on male baboons Type of society in fundamental ○ Personality A/VDocument - unnatural causes: in sickness and in wealth October 10th Unnatural Causes - Is Inequality Making Us Sick Midterm Exam Not random questions for readings and documentary ○ What we see in class related History pamphlet - discussed stuff in class too What is sociology / of health Pandemic History Canadian health institutions Class , inequalities, social determinants of health A lot of ‘why is the wrong answer’ Read question well Half to 2/3 MC and rest SA Questions Identify 3 reasons that explain why we are not entirely responsible for our own health Why is health care insufficient to increase the health of the population In what way can sociological and epidemiological approaches be complementary How are healthy lifestyles affected by wealth Provide 3 solutions to decrease health inequality Social Structure and Health Neighboring UK didn't have - rational important in canada and US and universal health care systems SCA Framework Cube Cons of model - social determinants of health ○ Depends on spot in social life ○ Way too wide - too much to act on at same time ○ Useful in terms of critique - answer lies somewhere there But hard to act on once decided How you react to model Defining Health  Have to refine so we don’t get lost Only act on small part of cube Researching - have to accept that collaboration of all health practitioners / teachers / policy makers to make a difference ○ As individual we act on individual slice Social Inequalities in Health Gradient ○ Black report ○ Whitehall studies ○ Importance - is there an in between, not just who health vs who isn't, not just rich vs poor but us in between ○ Gradient - income, education, classification system ○ Social gradient in health - tie people health to gradient Seeing clear connection - wealthier/educated you are more healthy ○ How health gradient can be steeper depends on types of obstacles place on society that affect people Tons of models listed last class ○ UN - widely used - looks at inequalities / gradients Outcome is inequality - not just looking at who is / isn’t health, our principle outcome / interest is inequality ○ Richard - data doesn’t lie, built to explain the health gradient Started with social and economic policy - influence social gradient or social living conditions that eventually will impact on inequalities in health and illness Health inequality perspective - genetic and physical environment and health care systems don’t have big difference in health care and inequality - already available to those living here - still inequalities remaining Genetic - shown it’s not the case, changes in time it’s not genetic, doesn’t change quickly and impact large number like canadian population Health care systems don’t actually have big impact anymore Ottawa - breath same air, drink same water no matter wealthy or not Shows indirect and direct way the socioeconomic gradient impacts socioeconomic gradient in health Indirect - lifestyle, not impacting directly health, impacts our psychology / priority systems / feelings of being capable to adopt  or change behaviors to affect our behavior ; smoking easy to quit when wealthy Direct - health and illness - low in social gradient / hierarchy - just being there impacts our health, most important factor is chronic stress (stress follows you all the time, work, get home, at home, bill to pay, kids to take care of, spouse is bad, it’s everywhere) Lower end of social hierarchy - more chronic stress than wealthy people Higher you are and in between impacts chronic stress differently (more wealthy, less impact etc) ○ Cockerman - change social lifestyles Social Gradient of Health Puccini’s ○ Control is important factor - control over one's life - important determinant of health ○ Explains relationship health education and ill health, lower and hierarchy and ill health ○ Money and education act a lot and are powerful resources Analogy with parade ○ Status with job, income, education etc - classification systems, measurable in large numbers ○ Each classification see a gradient with income, education, protege ○ Cannot do everything at once all at the same time like cube ○ Income gradient will be really useful to understand health problem or income and education or just one Moral implications - same classification system but use parents income; very much determined by our parents socioeconomic characteristics, don’t choose our parents we can’t blame individuals for their health, health dependent on what’s before their life ○ If we aren’t responsible for ehealth then who is - society does, future health pros Have to work on more than one lifestyle to change one's health - need to work on policy issues to change cycle and living conditions of people in community ○ Social perspective - not just 2 extremes, all people in between, person closer to poverty will live shorter lives statistically speaking, why should you be different; not just caring for poor / wealthy, also caring for us and people around us, everyone is in between  Rich alive and poor dead ○ Scientific - mortality or ill health or multimorbidity, causes extremely wide (stress, eating habits, pollution, vacations); not one single variable that impacts one's mortality, is cluster of variables and how they interact and when they interact (beginning / all / end of life) We study those more or less important Studies on policies / programs that impact health / lifestyles Women entering workforce - huge impact on their life, expectancy changed because of control over lives increases ○ Political - social gradients talk about economic policy, redistribution of wealth, big social universal programs, day care / health care programs, education programs, equal opportunities, increase general welfare of population that impact health Whitehall Studies - Civil Servants in UK Workers that went in morning and came at night - social measures, biological (blood samples), environmental measures, all working in same building but different position / pay Depending on job, mortality rate defer also Show social gradient One institution - thousands of people (2800 in study) ○ Wealthy / people at top - level 1, comparative number ○ Lower end - 80% more chances of dying 25 years later in poor group, also 2x as much ○ Take away impact of smoking, blood sugar, pressure, height, take risk factors away of common diseases (cardiovascular) - it reduced, still see good 50% difference when adjust for impact of poor lifestyles Not only lifestyles that impact health then what is it - back to determinants of health model Interaction between stress and lifestyle ○ Study important for around the world Social gradient - something else that was killer, 50% lifestyle, 50% something else related to stress People with phd live longer than masters / bachelor degrees Dead or alive Low SES Consequences  Fewer means to face stress - social connections Higher at being social excluded - less contact, less integrated Weaker self esteem, higher rate of distress Lower control, higher dependency Poverty and where i am compared to the other people in society - gradient ○ One thing to be poor but another to be poor amongst wealthy ○ Idea of social position - not just position of poverty or not education Part of society Lower end have less resources to work way up in life Captain Scott 1910 ○ Hero of kids long ago ○ Expeditions ○ Captain in UK army and explorer - wanted to be first person to put flag in antarctica ○ Left with 5 men, different levels of army ○ All end up dead ○ He was leader - last to die Had money, prepared, would get fame ○ Final letter - to widow, not happy ending, new he would die, in blizzard, all his partners died ○ Died according to rank Broken in brains - first to die Each had description ○ In front of something big (-40) all will die but not at same time - captain was leader and was prepared ○ Another norwegian team that beat them ○ Reward system is important - a lot of work / burnout, not just working hard but being rewarded in exchange Work like crazy and project gets moved and feel they are overwhelmed by bureaucracy - not in control of their work Brain as important organ to understand health and understand stress, live when at bottom or top of hierarchy Doing this all for leader and get nothing out of it ○ Control over life - the ones that followed captain because he was in control General trend ○ More country wealth, more wealth distributed, less gradient is steep, healthier society is ○ More redistributed well and rich country - canada redistribute fairly well and have good average health of population, gradient less steep  Country spend most in world on health care (US) Law of diminishing returns - to increase health of population ○ Country with healthcare systems - invest in more technology have better health ○ More invest in health care - the less who invest in social systems - all money in health care and less in health ○ To define sweet spot - what point investments and resources does it stop investing, more in doctors less in kinesiologists for example Difference in mortality with level of education - see gradient Whitehall Studies 1 18 000 vs 10 000 people (1st vs 2nd study) Focus on civil servants ○ Could measure large portion of population ○ Stratified environment, use health as classification system ○ Not extreme poverty ○ People who have good jobs - 2 week paycheck, employer government, pension ○ Still seeing huge differences Mortality rate between poorest and wealthiest within civil servant and UK Poorest live shortest lives Roughly 10 year difference between 2 groups Control for education drops about half - education and income are two big influences  Same job different level Age groups - predicted difference in gaps is with age Younger people affected in this graph 3 important conclusions ○ Cortisol in blood - higher in poor for longer period of time showing chronic stress ○ Blood pressure Morning to work everyone had high BP, stress Took same measures going home, wealthier people pressure went down, poor people remain high ○ Lack of resources being culprit / determinants explaining poor health Interaction Between Social & Biological More cancers etc has to be biological Studies on monkeys to show impact of stress, pressure, lack of control and environment on nervous system Brain is one in charge for feeling ○ Hypothalamus sensitive to stress and environment Glands, interns effects glands that produce cortisol Effects energy levels, immune system, libido, premature aging, cholesterol in arteries Put in same cage see if hierarchy makes different ○ Lower end have same symptoms / biological reactions that humans do ○ Shows how bodies are deeply connected to social structure, place in social hierarchy, not just lifestyle ○ Ones get addicted to drugs because of lack of control, stress - resort to be dispensary to alleviate stress Documentary - Unnatural Causes In Sickness & In Wealth https://www.kanopy.com/en/uottawa/search Social class important factor for determinant of health More income and education = less cortisol throughout day Economic policy is health policy Intervene or see world where we don’t eliminate hierarchy but constrain how they affect people