HSCI130 Final

What is the healthy immigrant effect?

This construct describes the findings that immigrants to Canada arrive healthy and then their healthy deteriorate slowly over the years

Who is Bono?

A rock star who convinced Senator Jesse Helmes to change his position on AIDS funding

What is a false negative

The people who truly have a disease but test negative on a particular test

When did all Canadian provinces had adopted Medicare

1972

What is the proportion of the BC budget spent on health care

43%

What is the amount of people living with HIV/AIDS

39 million

This region has the highest per capita incidence of tuberculosis

Sub Saharan Africa

The number of children under 15 years living with turberculosis

1.5 million

What is the year of the establishment of the Canada Health Act

1984

What is randomized control trials?

A study design where exposure is randomized

What are antibodies

They neutralize pathogens and tag pathogens for destruction by the immune system

What is differential exposure hypothesis

The materialist explanation that the higher number of health problem among lower SES (socioeconomic status) group is a result of stress

What are CD4 t-cells

• HIV infects and kills these cells

• Rendering the entire immune system dysfunctional

Formula for incidence rate

Number of new cases / person time of observation

What is iatrogenesis

Describes illness caused by medical intervention

What is case control study

Type of study that helped epidemiologists discover that TSS was caused by tampons

5 principals of the Canada Health Act

• Comprehensiveness

  • health care plans cover ALL necessary health care services

• Universality

  • All insured person MUST receive care on uniform terms/conditions

• Portability

  • Health care follows you as you move around / travel across Canada

• Public Administation

  • Non-profit basis by a public administration accountable to the government/people

• Accessibility

  • Without FINANCIAL or “other barriers”

What is risk taking hypothesis

Hypothesis focused on explaining why men are more likely to die from accidents

What are hospitals

• Accounts for 25-30% of all spending in health care

  • 14% on doctors and drugs

  • Low amount on public protection (~5 - 10%)

Virchow concludes that this is the primary cause of the 1848 typhus epidemic in Upper Silesia

A lack of democracy

What is symbolic interactionism

The idea that we need to understand an individuals definition and understanding of a situation falls under this sociological paradigm

What is cumulative incidence

The proportion of a population who becomes diseased during a specific time period

Highly cited studies in England demonstrated that there is a social gradient in health

Whitehall studies

Antonovsky’s model that describes the factors that make populations healthy

salutogenic model of health

Raphaels term to describe macro-level factors like tax policies that indirectly influence health

Vertical structures

Who is John Snow

• famous epidemiologists who discovered the source of the 1854 Cholera outbreak

• Joseph Goldberger

  • Pellagra

• Hans Selye

  • Stress

The estimated number of British Columbians without a family doctor

• 17 - 22%

Medicare was born in this Canadian province

Saskatchewan

Total income of the top 1% of Canadian income earners in 2020, you need an income of.. (MCQ)

512, 000

Median income of Canadians in 2020

54,200

Concepts of health (details and describe at least 1)- short answer (6)

• normality : what s considered “normal health” in the population

• Balance : balancing all aspects of life

• Adaptability : able to deal with reasonable life challenges

• fitness : physical exercise

• Absence of illness / disease

• Physical / emotional / social

• Resource for life : necessary to maintain throughout life course

• Function : work, daily life

Biomedical model (MCQ)

• mind-body dualism

  • mind and body are separate, physical and psychological factors are separate, focus on biophysical factors

• Machine metaphor

  • Body is a machine (Western Science); body is made up of biophysical process (genes)

• Physical reductionism

  • Understanding phenomena by breaking down parts of a whole; examine parts individually to gain understanding

• Specific Etiology

  • Every disease has a cause; discovering causes allows us to intervene / provide treatment

    • With control (drug therapy)

    • By removal (surgery)

• Regimen / control

  • Fight / minimize disease through regimen and control

    • Assumption : we can disciple out bodies

      • Eating, exercising, managing stress

    • Individuals are responsible for care and maintenance of our bodies / machines

Paradigms p.1 (MCQ only)

• structural functionalist

  • Harmonious social system, social roles and institutions

  • Parsons sick role

    • Rights

      • Exempt from blame

      • Temporality exempt from regular roles / responsibilities

    • Duties

      • Try to get better to resume responsibilities

      • Seek competent help/treatment and cooperate on getting well

    • Criticisms of sick role

      • Focused on acute illness (rather than chronic)

      • Focused on physical factors than psychosocial

      • Medico-centric bias (POV of medicine than self care practices

      • Doesn’t consider social factors like gender / social class/ age

• Conflict theorist

  • Who has power, who makes decisions, who decides what’s medically necessary

  • Competing interest groups, medical profession = authority

• Symbolic interactionist

  • How people conceptualize health, people’s perspective

  • Interactions of individuals health/illness is socially constructeD

Paradigms p.2

• Feminist

  • Female POV on historical oppression of women in patriarchy

  • Androcentric

    • Focus / centered on men (MCQ on MT1)

    • Intersectionality gender, social class, ethnicity, age

• Sociology of the body

  • Embody societal structures

    • How does this experience of racism gets under peoples skin

      • embodiment of structure ; influences understanding of what society looks like

  • Bodies ; socially constructed (not just biological)

  • Embodiment : human perceptions / experiences through our bodies

  • Medical gaze : human body is object of study (focus on symptoms)

    • Biopower ; power = knowledge over people’s bodies

Ottawa Charter vs. Individualized Health Promotion

• health promotion

  • Ottawa charter : not everything is based on lifestyle, social circumstances matter

  • Individualized health promotion

    • Raising health consciousness

    • Health behaviour

Upstream / Downstream

• Down

  • Focus on people who ALREADY have the thing (ie. diabetes)

• Upstream

  • How do they get diabetes in the first place

  • Provide education to people at risk / healthy

• what is upstream approach? What is the downstream approach?

Salutogenic model of health (Antonovsky)

• concept model to provide a guide for identifying and understanding salutary factors that makes the populations healthy

• Contributes to an improved understanding of the origins of good health and social conditions that facilitate health protective behaviours

• Salutogenesis :

  • Antonovsky’s term describing the origins of the positive health

  • Introduced to encourage researchers to pay attention to the factors that protect and enchanted good health

Prevention paradox (MCQ)

• can’t focus on high risk people

• Majority of the cases come from people who are low / moderate risk

• Missing vast majority at moderate risk

  • Including low/moderate risk people → better chances of reducing risk

Ottawa Charter - Short Answer, MCQ, T/F

1. health Public policy

   • beyond health care; easiest choice = healthiest choice

   • Some policies make it harder to commit unhealthy behaviours

     • Eg. taxing smoking, vapes, drugs, etc

2. Create supportive environment

   • taking care of each other

   • Communities and natural environment can help with healthy choices

     • Eg. shaded area’s for kids, worksafe insentives

3. Strengthen community action

   • empowerment of communities

   • Dynamic group of people in common space, identities nearest

     • Eg. Community health centres, recreational centres

4. Build personal skills

   • individuals need support to change health

   • Increase available options for more control over health

   • Increase life skills and enable coping

     • Eg. Cooking classes, clubs, sports, gardening

5. Reorient health care system

   • shift some of the emphasis in health care to health promotions

   • Increase attention to health research and changes in professional education and training (UPSTREAM)

   • Curative services → preventative health promotions avoids biomedical model

     • Eg. Doctors incorporating dietary advice during consultations, prescribing exercise

Prevalence → calculations short answer

• prevalence % of total population = cases (DO NOT INCLUDE DEAD)

• Ignore immune because they are still in the population

• Include cases in the beginning at the start

  • 150 cases + cases in specific time period

• Report as a percent

• Write the correct equation

• PREVALENCE = PIE!!

• POINT prevalence :

  • Cases in period - deaths - lost / total population - deaths - lost

• PERIOD prevalence :

  • Total cases in period / total population @ start

Sensitivity / Specificity (fill in the blank)

• draw table

• Find false negative (FN) and false positives (FP)

• Increasing sensitivity = decreasing FN

• Increasing specificity = decreasing FP

Prevention

• primordial = health education

• Primary = vaccines

• Secondary = screening

• Tertiary = rehabilitation / medication

  • Preventing further complications

Cumulative incidence (MCQ)

• new cases / population @ risk @ beginning of period

• AKA attack rate (AR)

• Uses

  • Quantify the proportion of people with disease

  • Estimate probability that an individual will have the disease during a point in time

  • Project healthcare and other policy needs / issues

  • Estimate the costs associated with a disease

Incidence rate (MCQ)

• new cases / person time

• Uses

  • Research on causes, prevention and treatment

• Reported : ____ cases per ___(eg.1000) person ___ (day, month, etc)

Disease terms (MCQ)

• endemic

  • Cases are continueally occurring in the population

• Epidemic

  • Outbreak of a disease in a localized group of people, spread by

    • Vectors

    • Carriers

• Outbreak

  • Introduction of new pathogens = higher cases than expected / usual

• Pandemic

  • Epidemics that have spread beyond their local region and are affecting people in various parts of the world

Age-standardized rates

• weighted avg of age-specified rates are used to modify rates to a standard population

• Why

  • Different AGE STRUCTURES

    • Some populations are older while some are younger

    • Older = more likely to die / get sick than younger

Materialist explanations (MCQ)

• Materialist explanations

  • emphasizes the material conditions under which people live

    • Aspects of social structures (powerful determinants of health)

      • Finances, stress, housing

    • Influenced by political economy persecptive of the conflict paradigm

      • Differential exposure hypothesis

        • Greater exposure to psychological stressors from financial problems, neighbourhood issues and social isolation

          • Experience of positive and negative exposures in life is an indicator of advantages and disadvantages that can influence health

• Neo-materialist

  • Health is affected not only by differential access to social and economic resources

  • Affected by level of funding invested in social infrastructure

    • What is the structure / funding in the structure

      • Eg. How close are superstores, libraries, gyms, etc to the neighbourhood / house

Cultural behavioural explanations (MCQ)

• Cultural behavioural explanation

  • Bad coping

• Differential vulnerability hypothesis

  • All have stressors

  • Position in social gradient can make some worse than others

  • How can we learn to behave in society

    • Lower (SES - socioeconomic status) individuals are less healthy as a result of engaging in health-related behaviours such as smoking, poor eating habits, etc

      • Assumption

        • These individuals don’t cope very well with environmental stressors = experience worse health

Psychosocial explanations (MCQ)

• Psychosocial

  • Comparing self to others; Inequities

    • People’s interpretation of their standing in social hierarchy matters

    • Sense of relative deprivation can generate feelings of low self-esteem, shame, envy

    • Strive and fail = consequences

      • Social comparasion

        • Perception and understanding of where people are in social structure

        • Perception of hierarchy leads to stress comparisons → shame, envy, etc

Gender explanations (MCQ + pos. Short answer) p.1

1. Risk taking hypothesis

   • men are more socialized to take risks = more risky behaviour

   • Woman are more socialized to be more cautious / concerned for their health = self care / seek treatment

   • Hengemonic Masculinity

     • The culturally dominant idea of what it means to be male and how masculine men are supposed to behave within a patriatrical society

2. Role accumulation hypothesis

   • More roles result in better health because they provide more benefits

     • Greater self-esteem, life satisfaction, sources of social support, improved financial resources

       • Eg. Women having 3 olds (wife, mother, worker)

         • Wife → social/financial support from husband/marriage

         • Mother → financial support to provide for children

         • Worker → independence/increased self-esteem, income to provide for family

Gender explanations (MCQ + pos. Short answer) p.2

3. Role strain hypothesis

   • harmful effects of women’s roles

   • Women with multiple roles = overload and role conflict

     • Trying to live up to nurturing expectations and keeping up with work = stress and ignoring own health

   • Increased stress and excessive demands

     • Increase psychological distress / worse health for women

4. Social acceptability hypothesis

   • women

     • Socialization into patriartical roles

       • Women are more willing to adopt the sick role (admit to being sick and getting treatment)

       • More likely to report experiencing symptoms

       • Tendency to seek help and get a diagnosis

   • Men

     • Socialized to deny that they are experiencing symptoms of illness

     • Reluctant to adopt the sick role

     • Reluctant to seek help for health problems until it is impossible to ignore

   • Woman will admit to experiencing ill health and may live longer than men due to the willingness to take health action and seek early treatment

Race / ethnicity explanations (MCQ)

• healthy immigrant effect

  • First 1 years they have better health, but then deteriorates

    • acculturation

      • Adopt unhealthy behaviours common in Canada (smoking, drinking, etc)

    • Resettlement stress (most evidence)

      • Psychological and structural challenges

    • Health care access

      • Limited access to or poor experiences with healthcare

• Impact of racism

  • People think race is biological

  • More variations within groups (ethnicity)

  • Structural racism

    • Who gets what job especially in education

• Racism and health — 4 marks open ended

  • People’s experience of racism, structural racism, embodiment

• Neoliberalism

  • Political philosophy about free market, how things operate in society

Horizontal structures vs. Vertical structures

• horizontal structures

  • Day-to-day public health strategies

    • Community heath interventions, family

• Vertical structures

  • Policy changes or initiatives further removed from direct individual impact

    • Tax policies, education policies

how do we measure health (list)

1. Levels of cortisol

2. Index of life events

3. Perceived stress score

4. Biological markers of stress → allostatic load

   • allostatic load : physical and mental health damage when the body is repeatedly exposed to stress

5. Mental health as a measure of stress

   • measures of depression

How do we target / reduce stress

• focus on mental health resources

• Individualized ways to manage stress vs. Structural approaches

  • Eg. Not having exams in the evening, less tuition fees

Why work matter explanations (short answer)

• 2 concepts : the gradient is steeper for men

1. Demand control

   • two dimensions

     • Psychological demands on the working person

     • Degree of control the person has over work schedules

   • High demand + low control = HIGH strain

     • Risk of psychological strain and physical illness

2. Effort reward balance

   • emphasized the importance of social reciprocity (give/take)

   • Time / effort doesn’t match rewards (income, job satisfaction, job security)

     • Leads to negative health effects

   • Individuals with effort-rewards imbalance at work have an increased risk of coronary heart disease

Income inequity hypothesis

• income inequity hypothesis

  • Greater inequity in income distribution within a population increases social problems including social gradient of health

• problems

  • Aggregate vs. Individual level measurement

    • Effect of within-country or community area policies

    • Timing of inequity and onset of health issues

    • Effect of average income level of country

    • Mechanisms

Ch.8 (short answer)

• stress reduction strategies

  • Individual

    • Activities like Pet therapy or relaxation spaces

  • Structural

    • Addressing stressors

      • High tuition, precarious employment, gender roles

• Premiers question — 8 marks

  • Recommend health promotion strategies

    • Evidence from social determinants of health

    • Improving access to affordable housing

    • Addressing systemic barriers

Features of Canadian health care — 3 marks

• health care is a provincial responsibility

• Health care is privately delivered and publicly financed

• Private providers and public not-for-profit hospitals

• Fee for service funding and global budgets

• Choice of practitioner

• Universal overage applies to less than ½ of total health care expenditures

Definitions from text book — more but didn’t cover

• hegemonic masculinity

  • The culturally dominant idea of what it means to be male and how masculine men are supposed to behave in a patriarchal society

• Androcentric

  • A way of thinking that privileges the masculine perspective when trying to understand social life

• Neoliberalism

  • Political philosophy about free market

  • How things operate in society

    • Educate people → better choices

• Latrogenesis

  • Sickness / injury caused by the healthcare system

Pac-Man arguement

• health care taking up resources — spending a large budget on healthcare

  • Pac-Man : heath care eating up resources

  • Challenge : the pie has shrunk, revenue is going down

  • Decreasing revenue, decreases corporate taxes

  • People don’t want cuts in healthcare

  • Decreasing budget = health care takes up more % and cuts into other %

Key trends

• amount we spend on health care = 334 billion

• % of BC budget spent on healthcare = 43%

• How do we spend the money = 14% drugs and doctors, 25% hospitals (largest categories)

  • 5 - 10% on public health + prevention

• Provincial / territorial per capita health expenditures vary

  • Provinces/ territories is responsible for health care

• Comparing provinces/territories

  • Top 3 higher than BC : Nunavut, Northwest territories , Yukon territories

  • Top 3 lower than BC : Ontario, New Brunswick, Manitoba

• Comparison between countries 2011

  • US is the outlier

Canada health spending 2023 (MCQ)

12.1% GDP

Largest categories of spending and where they are being spent in 2023

• Categories of spending

  • hospitals

  • Drugs

  • Physicians

• Where they are being spent

  • Hospitals — 25.6%

  • Drugs — 13.9%

  • Physicians — 13.8%

Aging is only a relatively modest contributor to overall growth in health spending

• accounts for about 1% increase per year

• varies across the country

• More significant in the Atlantic provinces and Quebec

• Smaller impact in Ontario and the West

• Future challenges of providing care for

  • Frail elderly persons, as the percentage of the population age is 80 and older

  • Seniors with multiple chronic conditions

Prompt 1 - possible short answer

• This is only to be used as an idea of what you can use to write

• Q : How has your approach to health changed? How? What would you add to your assignment today?

  • Social factors that can determine it

    • Social background

    • Cultural identity

    • Physical environment

  • Stress in health

  • Environment

    • Systemic racism, racism

  • Social economic status

Prompt 2 — possible short answer

• use as a reference/ideas of what you can write

• Q : if Premier Eby asked you for your recommendations as to how to improve the health of British Columbians, what would you say based on your understanding of the determinants of health and health sciences that developed in HSCI130

  • Make a better change fro those who are in poverty / lower income

  • Make things more accessible

    • Grocery stores, prices, restaurants (not fast food)

  • Lower the cost of hospitals

  • Support groups for those who are struggling

  • Provide appropriate services