Chapter 6 social determinations of health

What is social stratification?

Society organized into layers/groups (upper, middle, working, lower class) with different wealth, status, and opportunities.

Marx vs. Weber on class — what's the difference?

Marx = class is fixed, based on whether you own production (bourgeoisie) or sell your labour (proletariat).

Weber = class is fluid, based on "life chances" from status, skills, and connections.

What is class-consciousness?

A shared sense of identity that comes from a group recognizing their common position/exploitation — leads to collective action (e.g., unions).

Functionalism's view of inequality?

Inequality is necessary — it motivates people to fill important, hard-to-train-for jobs (e.g., doctors) by rewarding them more.

Conflict theory's view of inequality?

Inequality benefits only the powerful (capitalists) and exploits workers — created through the profit-driven system, not necessity.

Feminist view on inequality?

Class inequality intersects with gender/race — e.g., the gender wage gap hits racialized and Indigenous women hardest.

Symbolic interactionism's view?

Focuses on symbols of status — e.g., "conspicuous consumption" (Veblen), buying visible luxury to show class.

What is cultural capital (Bourdieu)?

Non-money advantages — manners, taste, education, credentials — that help you get ahead socially and economically.

What's the difference between exchange and structural mobility?

Exchange = you can only move up if someone else's spot opens. Structural = new jobs/positions are created, so mobility doesn't require displacing anyone.

Intergenerational vs. intragenerational mobility?

Intergenerational = compared to your parents. Intragenerational = movement within your own lifetime/career.

What is meritocracy, and why is it criticized?

The belief success comes purely from talent/hard work. Criticized because it ignores real barriers (bias, systemic exclusion) and blames people for structural failures.

LICO vs. MBM vs. LIM — quick difference?

LICO = spends way more than average on necessities. MBM = can't afford a basic "basket" of goods (Canada's official poverty measure). LIM = earns less than half the median income (relative poverty).

Absolute vs. relative poverty?

Absolute = can't meet basic survival needs. Relative = can survive, but far below the average standard of living around you.

What is the "digital divide" (3 levels)?

1) Who has internet access, 2) who has digital skills, 3) who can actually turn internet use into real-life benefits (jobs, services, etc.).

What are Social Determinants of Health (SDOH)?

The social and economic conditions people live in (income, education, housing, employment, etc.) that shape their health — often more than diet/exercise or doctors do

How much of health outcomes do SDOH explain, vs. other factors?

SDOH ≈ 40% • Health behaviours (diet/exercise/smoking) ≈ 30% • Clinical care (doctors/hospitals) ≈ 20% • Environment ≈ 10%.
(Memory trick: Where/how you live matters more than the doctor you see.)

Name 5 examples of SDOH (Mikkonen & Raphael list).

Income, education, employment/job security, housing, and social exclusion. (Others: early childhood development, food security, health services, Indigenous status, gender, racialization, immigration, ability.)

Why is income called the single most important SDOH?

Because it directly shapes access to housing, food, education, and even indirectly shapes diet, stress levels, and health-related choices.

How does employment affect health beyond just income?

It gives structure, social interaction, and a sense of purpose. Unemployment increases stress, anxiety, depression, and suicide risk.

What's the difference between the biomedical, behavioural, and biopsychosocial models of health?

• Biomedical = health = biology/genetics.

• Behavioural = health = your personal choices (diet, smoking, exercise).

• Biopsychosocial = health = combination of physical + mental + emotional + social factors (the most complete model).

Why is it a problem to only use the behavioural model of health?

It blames individuals for poor health ("victim-blaming") and ignores that social conditions (poverty, exclusion, discrimination) are often out of their control.

What are microaggressions and how do they relate to health?

Small, everyday acts of discrimination (e.g., being ignored, mocked for an accent). Repeated exposure raises stress and worsens both mental and physical health over time.

Which groups experience worse health outcomes due to SDOH?

Indigenous people, women, racialized Canadians, immigrants/refugees, LGBTQ+ people, and disabled people — due to compounding social/economic disadvantages, not biology.

: Does Canada's universal health care eliminate health inequality?

No — people with lower income still have worse health outcomes even with free health care, because SDOH (housing, stress, food security, etc.) matter more than access to a doctor.