316 week 1 (intro)

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Health disparity

A measurable difference in health outcomes population between groups. Purely descriptive term, (often interchangeablewith health inequality).

ex; urban kids having more asthma

Health equity:

The goal state. Everyone has a fair opportunity to achieve their full health potential, meaning that avoidable and unjust health gaps have been eliminated.

( example- mobile health;th clinics in areas w no hospital

Health inequity (Coburn)*

avoidable differences in the social, environmental and political conditions that shape health outcomes such as sickness and mortality

ex; unequal access to dental care driven by insurance and income gaps.

Upstream determinants*

are the wide scale structural, social, economic, and environmental factors that shape health long before an individual ever walks into a doctor’s office. They dictate the conditions in which people are born, grow, live,work, and age.

ex; minimum wage leading to stress

Concentrated disadvantage*

Concentrated disadvantage is the geographic clustering of extreme poverty, underfunded infrastructure, and environmental toxins that creates compounding chronic stress and independently worsens health outcomes.

EX; housing next to highways with no nearby facilities

Allostatic load (Coburn)

The cumulative physiological cost of chronic stress-response activation. Cortisol, blood pressure, inflammatory markers, worn down by repeated exposure rather than a single event.

Life-course perspective

 the principle that health outcomes reflect exposures and conditions accumulated across a person's entire life, not just their current circumstances.

ex; housing instability as a child leading to allostatic load

Social gradient

health follows a graded slope, not a rich/poor binary, every step down the income/status (not just the poorest 5-10%) ladder corresponds to worse health ex; people in canada with higher SES live longer and report better self rated health than those with lower incomes (marmot) 

The 6 Action Domains (Marmot) (P.U)

• 1. Give every child the best start in life.

• 2. Enable all people to maximize capabilities and exercise control over their lives.

• 3. Create fair employment and good work for all.

• 4. Ensure a healthy standard of living for all (minimum income for health).

• 5. Create and develop healthy and sustainable places and communities.

• 6. Strengthen the role and impact of ill-health prevention within social contexts

Proportionate Universalism (PU) (marmot)

The primary policy solution for addressing social gradient . Interventions must be universal across all of society, but delivered with an intensity proportionate to the level of disadvantage

Glasgow paradox (psychosocial example; health inequality)

Despite having identical deprivation levels to Liverpool and Manchester, Glasgow’s higher mortality rates are driven by psychosocial factors like a low sense of self-control, efficacy, and self-esteem.

Relational Urban Governance (Corburn)

The policy solution for urban health equity. Replaces single-issue fixes with multi-sector policy (Health Equity in All Policies) co-designed directly with marginalized communities.

6 Intersecting Nodes (Coburn)

1. People: Community culture, local knowledge, and social networks.

2. Physical Features: Built infrastructure (housing, streets) and natural environments.

3. Interpretations & Narratives: Perceptions, meanings, and feelings attached to a place.

4. Political Systems: How institutions distribute resources across geographic areas.

5. Governance: Rules, laws, and policies shaping public participation and decision-making.

6. Power Relations: Structural dynamics determining who benefits from public investments.