PH 102 Midterm

Population Perspective

-individual risk is not considered in isolation

-Rose = individual approach v. population approach

Individual Approach

-focusing on high-risk people

-why do some people have hypertension?

Population Approach

-focusing on the underlying distribution of the disease and targeting whole pop.s to change prevalence

-why do some pop.s have hypertension while in others it’s rare?

High Risk Approach (Individual)

-IDs risk factors in this pop.

-prescribe med.s or interventions specific to the high-risk pop.

-advantage = indiv. adherance to an individual-risk factor change is high

-disadvantage = not everyone at risk will go on to develop the disease

-does not change overall prevalence of a disease in the pop.

-focuses on the shape and placement of the risk curves

Population Approach

-what is driving the underlying distribution of the disease

-prevention activities should target whole pop.s reguardless of the variation in individuals’ risk status

-advantages = radical: attempts to remove the underlying causes that make the disease common = changes prevalence of the disease in the pop.

→root of problem = change prevalence

-disadvantage = very little advatage to single individual and poor motivation

Social Context of Behavior

-specific behaviors are not solely the result of individual choice but occur in a social context

-behaviors are socially patterned, cluster together, and are influenced by social context through:

1. shaping norms

2. enforcing patterns of social control

3. providing or not providing environmental opportunities to engage in certain behaviors

4. reducing or producing stress for which certain behaviors may be an effective coping strategy

Contextual Multilevel Analysis

-include both individual and group-level variables in analyses

- group-level variable = assessment of group, environ., or community-level characteristics

—based on group membership, all group members share them

ex: team, school, neighborhood, company, etc..

Development and Life Course Perspective

-events/exposures in childhood or early life matter to your current health

1. early development and childhood

2. accumulated exposures

3. influence adult social conditions

General Susceptibility to Disease

-social conditions create vulnerability to disease in general, rather than any specific disorder

General Susceptibility Hypothesis

-whether indiv.s developed one disease or another depended on their behavioral or environmental exposures as well as their bio. or genetic makeup

-became ill or died at earlier ages or whether specific socially defined groups had greater rates of disease depended on socially successful conditions.

Core Theoretical Models

share same goal = to explain how and why social factors and social conditions get “embodied” into physical and mental health outcomes

Bio-Psychosocial Theories

-stress and health

-focus on biological pathways between social environment, stress, and health

Stressors

-acute = dramatic, short-term

-chronic = ongoing, everyday hassels

Three Responses to Stress

1. psychological

2. behavioral = coping, potentially maladaptive

3. physiological = stress response

Physiological Response

-stress response

-immediate Fight or Flight = autonomic/sympathetic NS, adrenaline

-slower HPA axis response = cortisol

Allostatic Load Hypothesis

-damage arises from the chronic, repeated activation of neuroendocrine pathways

-”wear and tear”

-measured by composite set of clinical markers = BP, cholesterol, body comp., inflammatory measures

-patterned in pop. (not random)

Social Production of Disease

-contextualization of risks, is an alternative to exclusively proximal stress theories

-focuses on availability of resources by social satisfaction and the policies/strctures/norms that uphold it

Fundamental Causes (Link & Phelan)

-example of social production of disease theroy

-ex: SES, race/ethnicity, and gender

-SES diff.s in health are enduring bc:

→resources = money, knowledge, power, prestige, social support)

—> ability to avoid health risks, and eliminating any single pathways between SES and health NOT diff/s in health

Life Course Perspective

-study of long-term effects of physical and social exposures across lifespan

-critical life periods hypothesis

-accumulated exposure hypothesis

-social trajectory model (pathways/chains of risk)

Critical Life Periods Hypothesis

adult disease “programmed” suring critical developmental periods

Accumulated Exposure Hypothesis

Disease from lifetime of accumulated exposures

Social Trajectory Model (Pathways/Chains of Risk)

early life experiences influence adult social conditions (trajectories) → affect adult health outcomes

SES and Health

SES encompasses income and wealth, education attainment, occupational prestige

SES Gradient

-linear pattern showing heirarchies in health status by different levels of SES

Whitehall Studies

-demonstrate SES gradient amount British civil servants on employment grades.

-longitudinal data

Pathways between SES markers and health:

-education

-income

Education

-knowledge pathway (cog. skills, health literacy, abstract skills)

-occupational pathway (better jobs, benefits, income)

-psychosocial pathway (sense of control, social standing, social networks/support)

Income

-wealth and poverty

-access to health-promoting goods/services

-psychosocial effects (chronic stress, neighborhood violence)

-exposures over the lifecourse

Pros of Income as measure of SES:

-insight into quality of life

-can be applied to a family or household

Cons of Income as measure of SES:

-measured at single point of time = limited info about lifetime econ. advantage or disadvantage

-no guarantee that all income is available for use

-subject to reverse causation (health← →income)

Absolute Income

-income effects health result from access to tangible resources such as food, clothing, and shelter

Relative Income

-income effects health result from symbolic resources such as status, prestige, and control

Economic Inequality

-gap between the well-off and the less well-off

-income, pay, wealth

Pathways to Health

1. disinvestment in human capital

2. psychosocial pathway 1 = erosion of social cohesion

3. psychosocial pathway 2 = theory of social comparison

Erosion of Social Cohesion

-inequality encourages hostility, suspicion, and distrust, limiting social integration

-linked to homicide

-social isolation

Theory of Social Comparison

-negative emotions (shame, distrust) resulting from the perceived gap between one’s lifestyle and expected standard standard of living

-”dis-consonance”

-more inequality = unattainable acceptable standard of living

Race/ Ethnicity and Health

-race categories are NOT defined by distinct genetic markers that determine health

-embody HISTORICAL and CONTEMPORARY SOCIAL INEQUALITIES

-self-reported

-based on political and social meanings

Race and SES

-divide racial groups up by SES, there are still racial diff.s within SES groups

-diminishing returns/nonequivalence of SES

Diminishing Returns/Nonequivalence of SES:

Black Americans dont experience same health improvemnets with higher SES as white Americans due to factors like:

-high unemployment

-greater occupational hazards

-wealth disparity at equivalent education levels

Area-Based Differences (Racial Residential Segregation)

-physical separation of races in geographic location

-racial segregation of Black American

-pathway to health: segregation limits socioecon. mobility, creates barriers to high-quality education and health-promoting factors, and results in environmental toxins and institutional neglect

Interpersonal Discrimination

-directly perceived discriminatory interactions which act as uncontrollable and unpredictable stressor

-stress pathways → biopsychosocial model

Various Distrimination

-secondhand exposure to racial discrimination/prejudice directed at another individual

-interpersonal discrim.

-racism during COVID and high stress aong Asian American young pop.