Exam 1 - Health Disparities

Disease

A biological condition; biological irregularity; can often be tested for

Illness

The social meanings of a condition; refers to the state of being physically or mentally unwell

Population Health

The health outcomes of individuals, including the distribution of these outcomes within group OR Integrates social factors that impact health with biological factors; concerned with the removal of systemic barriers

Public Health

Seeks to provide maximum benefit for the largest number of people; involves the efforts of health departments

Morbidity

Presence of illness or disease

Mortality

Frequency or number of death

Incidence

number of new cases

Incident Rate

number of new cases/Number in population at risk

Prevalence

Total number of cases (i.e., new and old cases)

Prevalence Rate

Total number of cases/Number in population; helps us understand the total burden of disease in a population

Health Disparities

"preventable differences that populations experience in the burden of disease, injury, violence, or opportunities" (CDC)

Social Determinants of Health

factors apart from medical care that impact health; the conditions people are born, grow, work, and live in

Public Policy

"a course of action taken by a government or legislature with regard to a certain issue" (Knill & Tosun 2020); “who gets what, when, and how”

Upstream Factors (Distal Causes)

Community-level conditions

Downstream Factors (Proximal Causes)

Individual-level health behaviors

Psychosocial Pathway

psychosocial behaviors and stress-related processes

1) SES (2) Reduces Stress Exposures (3) Increases Coping Resources (4) Differential Health Outcomes

Materialist Pathway

social and economic structural factors

(1) SES (2) Increases Material Resources (3) Differential Health Outcomes

Socioeconomic Status

an individual's position within the status structure, which determines available resources

Socioeconomic

the actual resources

Status

Privilege or rank-based characteristics

Educational Attainment

the highest level of formal education an individual has completed

Human Capital Theory

Education develops skills, habits, and dispositions

Commodity Theory

Education provides access to material assets

A spurious pathway?

Family SES (Socioeconomic Status)

SES

Socioeconomic Status

Learned Effectiveness

“education shapes a sense of personal control and encourages a healthy lifestyle and conveys much of education’s effect”

Health Lifestyle

merging of “otherwise unrelated habits and ways into a health lifestyle that consequently behaves as a coherent trait”

Personal Control

“a learned expectation that outcomes depend on one’s choices and actions”

Commodity

A material resource that can be bought or sold

Demand-Control Model

Job strain (i.e., work-related stress) results from the interaction between job demands and decision latitude or control

Gig Worker

Independent workers who complete short-term jobs or tasks for temporarily clients

The Worker (in relation to gig work)

the person who performs a short-term contracted task

The Client/Consumer (in relation to gig work)

the person who needs the task

The Company (in relation to gig work)

connects the work to the client

Labor Providers (in relation to gig work)

commonly lower-income and less-educated workers who rely on gig work for their entire livelihood, often because they have trouble finding other job options

Good Providers (in relation to gig work)

higher-income and more-educated workers who don't depend on their gig work income, often because they have another full-time job

Hostile Architecture

aspects of the built environment that dissuade people form using public spaces

The Poverty Tax

the higher costs of necessities, services, and time incurred by low-income residents due to their poverty

Compositional Factors

health differences are due to the type of people who live in those areas

Contextual Factors

health differences are due to characteristics about the place that people are living in

Cognitive Health

our ability to think, learn, and remember clearly (NIA 2024)

Cognabilitiy

a measure of local places that encourage physical activity, social connection, and cognitive stimulation

Residential Segregation

the extent to which members of a different groups live in separate neighborhoods within a geographic area

Suburbanization

population shift (primarily White folks) from city cores to formerly rural areas, now suburbs

The New Deal

a series of public policies enacted form 1933-1939

HOLC

Home Owner's Loan Corporation (HOLC), an agency aimed at attempting to prevent foreclosures by refinancing home mortgages in default

Redlining

Discriminatory practices where financial services are withheld from neighborhoods that have high rates of racial and ethnic minority residents

Racial Formation

"The process by which social, economic, and political forces determine the content and importance of racial categories" (Omi & Winant 1994)

Primary Stressor (in relation to Stress)

the initial event, situation, or problem that is perceived as a source of stress

Secondary Stressor (in relation to Stress)

subsequent strains or difficulties that arise due to the primary stressor

Allostatic Load

“wear and tear on the body” associated with chronic stress (McEwen & Stellar 1993)

Paradox

something that contradicts our doxa (i.e., taken-for-granted assumptions about the world)

Health Paradox

a pattern that contradicts our theories about health

Fundamental Social Cause Theory

“Social factors with "persistent association with disease despite changes in intervening mechanism"

Stress process model

Low status produces stressful life conditions that erodes health (also, worse coping due to poor psychosocial resources)

Somatic Symptoms

physical manifestations of distress

1.5 Generation (in relation to Immigration)

a person born in a different country who migrated as a child

Emigration Selection (in relation to the Healthy Immigrant Paradox)

the people who leave their home country are healthier on average

Selective Remigration (in relation to Healthy Immigrant Paradox)

immigrants who get sick might return home, leaving only the healthiest immigrants

Barrio Effect

Immigrants are more likely to live in "ethnic enclaves" where they are (1) less exposed to discrimination and (2) can share information and resources with each other

The Medical Model views health as…

an absence of symptoms (sensations noticed by the patient and interpreted as abnormal); an absence of signs; focuses on physical health

The Sociocultural Model views health as…

the ability to function/complete social roles within a specific social context

The Psychological Model views health as…

a general feeling of well-being

Challenges with The Medical Model

differences in signs and symptoms: Who’s account matters more?

Symptom, no sign: Chronic headaches

Sign, no symptom: High blood pressure

Challenges with The Sociocultural Model

Two individuals with identical signs/symptoms may be deemed to have different levels of health

Arthritis for a concert violinist vs for a retiree

Challenges with The Psychological Model

May be too specific (answers change depending on situation

Subjective wellbeing when experiencing a stressor vs after it has gone away

Demographic Transition Theory

As a society develops from pre-industrial to industrial economy: (1) death rates decline, then (2) birth rates decline

Approximately what percent of health outcomes are due to social factors (including environment and behaviors)

60%

Ecological Model of Social Determinants of Health (SHD)

*Order matters

1) Individual: motivating change in individual behavior by increasing knowledge, or influencing attitudes or challenging beliefs

2) Interpersonal: recognizing that groups provide social identity support. Interpersonal interventions, such as family members of peers

3) Community: coordinating the efforts of all members of a community

4) Organizational: changing the policies, practices, and physical environment of an organization

5) Public Policy: developing and enforcing state and local policies that can increase beneficial health behaviors developing

Fundamental social causes..

" maintain an association with disease even when intervening mechanism change"

The Epidemiological Transition

The historic shift from morbidity and mortality mostly dominated by infectious disease to mostly dominated by chronic illness

The SES Gradient of Health

strong findings for a health “gradient” associated with socioeconomic status. More education, higher income, and better jobs are linked to better health and longer life. Inequalities grow with age

What are the three (3) components of learned effectiveness

Health lifestyles, sense of personal control, and creative work

T/F: Commodity is the economic link between education and health

False: Stress

What are The White Hall Studies

Sir Michael Marmot examined the health of British civil servants, focusing on heart disease and other chronic conditions, and found that there is an inverse relationship between job status and chronic disease (Whitehall II: 13 waves of data collected. 1985-present)

Today, an what estimated percent of adults are exposed to “hazards” on the job?

50%

T/F: Today, workers are more commonly taking short-term, flexible roles instead of permanent, full-time employment

True

Out of 10, how many people today work in jobs that weren’t created in 1960?

6/10

What are first, second, and third spaces?

First spaces: Home

Second spaces: Work

Third spaces: places outside the home and work where people gather to socialize

Mediator

an intermediate factor that explains how or why a social exposure causes an outcome

Confounder

Third, pre-existing variable that distorts the relationship by affecting both the exposure and the outcome (e.g., marriage)

What are physical, social, and psychological aspects of a neighborhood

Physical: built and natural environment (ex: housing quality, public transport)

Social: community relationships (ex: retail, resources, job opportunities)

Psychological: emotional response to the neighborhood (ex: violence, crime, belongingness)

How did HOLC Work?

Roosevelt made it in hopes to save homes from foreclosure and help homeowners. He created a Residential Security Map to identity which neighborhoods were the safest/riskiest to give to (had racist undertones)

What was the color/alphabet coding system of Residential Security Maps

A (Green): Best - primarily White middle-class Christians

B (Blue): Still Desirable - primarily White middle-class

C (Yellow) Declining - racially/ethnically diverse w/ limited Black residents; working class

D (Red): Hazardous - older, deteriorating, primarily non-white

Who coined the term stress?

Hans Selye who defined it as a response to change in the organism

What are the 3 stages of stress

alarm in response to threat, resistance, and exhaustion

Social Scientists created what to capture a lifetime of stressors?

Life Event Checklists - famously Holmes and Rahe’s Social Readjustment Rating Scale (43 events, 1967)

Types of stressors

Major life events (ex: death of a loved one)

Chronic psychosocial (ex: discrimination)

Daily hassles (ex: crowded buses)

Anticipatory stressors (ex: exam worry)

Non-event stressor (ex: miscarriage)

Who created The Stress Process Model?

Pearlin & Colleagues (1981) to help understand how stress shapes mental health (still sociology’s #1 framework)

T/F: Black people tend to have poorer mental health and White people tend to have poorer physical health

False: Black people tend to have poorer physical health and White people tend to have poorer mental health (called: The Race Paradox)

The Healthy Immigrant Paradox

Immigrants on average have better health and mortality outcomes relative to their native-born peers

T/F: Since the 1980s, research has shown that Hispanic people (esp. immigrants) have heath profiles similar to white Americans despite being closer to Black Americans in terms of marginalization and SES characteristics

True

Between what ages is Immigrant Advantage highest?

13-14. It weakens as the generations go by and is often gone by the third