PSYC 312- Exam 1

what are health disparities?

differences in health outcomes among specific population groups (i.e. socially disadvantaged groups)

• the problem

what are health differences?

neutral variations between groups

• simply differences based on age (elderly vs young adults)

• injuries in athletes vs. general population

• hypothetical higher disease rates in millionaires vs non-millionaires

how do health disparities differ from general health differences?

health disparities cause different health outcomes among specific groups, while health differences can be based on age or income comparisons

what is the latina paradox?

hispanic populations show better health outcomes than expected, given their socioeconomic status

protective factors: strong family/social support, cultural practices promoting healthy pregnancy behaviors, lower rates of smoking and alcohol use

what does the latina paradox imply about health outcomes in disadvantaged groups?

implies the role of culture factors that are more prevalent in hispanic populations vs other disadvantaged groups (such as family, healthy eating, coping strategies, and natural remedies)

what is health equity?

principle of reducing and ultimately eliminating health disparities by addressing social determinants of health

• eliminating health disparities and their social determinants

• the main goal

how does health equity inform public health policy?

shifts focus from individual framework of treatment to the barriers that are non medical drivers for disparities, the social determinants of health

• culturally competent care: trained to recognize social determinants of health and avoid assumptions based on race

• scalability, integration of services, shift in healthcare focus

what are human rights?

principles that obligate countries to distribute health resources equitably across populations

how are human rights applied to address health disparities?

U.S. treats healthcare as a privilege, shifts focus on a legally enforceable entitlement

• support access to basic resources for health: food, housing, and medical care

how is health defined?

complete physical, mental, and social well-being, not merely the absence of disease or infirmity

what are the models of health? (Barr)

• medical (absence of disease or disorder)

• sociocultural (social and cultural context shapes health and illness)

• psychological (thoughts, emotions, and behaviors shapes health)

• does not include the holistic model

what is the medical model of health?

• two fundamental dimensions: an absence of signs & symptoms

• problems:

  • over-reliance on disease detection

  • ignores mental/social aspects

  • disagreements between doctor and patient

• what an individual has in terms of illness

what is the sociocultural model of health?

• ability to function within one’s social context

• performing roles and tasks despite physical conditions

• activities of daily living (ADL’s)

• health is measured by what an individual can do

• problems:

  • depends on people’s social roles (ex: arthritis in violinist vs house cleaner)

what is the psychological model of health?

• relies on self-assessment of health

• individuals rate their own health based on their perceptions of well-being

  • recognizes mental health and well-being, harder to measure consistently, variance of mood

• problem:

  • fluctuates based on immediate circumstances and is time-sensitive

  • subjective, can be influenced based on immediate emotions, stress, or external factors

  • variability, rating health differently based on temporary conditions

  • less reliable for long-term health assessment

what are ADLs?

activities of daily living to measure health, used to determine a person’s eligibility for extra benefits (ex: home health care)

what is race?

• typically distinguished by continent of origin or common descent

• great division of human kind, created by humans

• socially constructed around politics

what is ethnicity?

• pertaining to or having common racial, cultural, religious, or linguistic characteristics

• distinguishing groups based on the way they look

• based on cultural traditions

how are race and ethnicity conceptualized in health research?

socially constructed around politics, oversimplifies what we know about others

• latent factor influenced by physiognomy and societal/cultural factors

how does race get recorded?

• birth certificates: recorded administratively, category may not match how a person identifies

• self-report: choosing from fixed categories

  • 52% of asian american adults use their ethnic origin most often to describe themselves

• interviewer observation: assigning race from perception, may differ from self-identity

how are people categorized?

historically, individuals have been categorized based on skin color and physical features

• categories shaped U.S. social and health research

what is the historical and social significance of categorizing individuals by skin color in the U.S.?

the foundational mechanism for establishing social hierarchies, economic systems, and legal rights

• genetic variation is often tied to geographic roots

• Tuskegee Syphillis study, treatment african american men

what is chronic stress?

a key factor linking low SES to poor health that can turn into mental, emotional, and physical illness

• damages the brain’s memory centers and declines cognitive abilities

• leads to hypertension, heart disease, and immune suppression

how is chronic stress impacted by racial discrimination?

increases allostatic load, leading to diseases like hypertension and heart disease

• living with discrimination contributes to adverse birth outcomes, health, and mortality rates

what is allostatic load?

cumulative wear and tear from repeated stress

• chronic stress links to biomarkers and disease

• discrimination and daily hassles add to allostatic load

what is the physiological impact of racial discrimination?

• significant source of chronic stress

• linked to both mental and physical health issues

• leads to higher rates of: hypertension, depression, and anxiety in marginalized groups

how do racial health disparities persist even when SES is adjusted?

due to discrimination, chronic stress, and limited access to resources, disparities exist even after adjusting for educational attainment and income

how is race a variable in health research?

race is often oversimplified as a clearly defined category in health research, leads to misleading interpretations of racial differences

• misuse of race as a variable and it is quite complex

• race is viewed as a social, rather than a biological category

what are the limitations of using race as a dummy variable?

one race indicator can hide the social exposures and mechanisms behind a difference

• when included in a model, a race coefficient often acts as a crude “black box” proxy for unmeasured or omitted social variables

how is race used in medical contexts?

race has been used to predict biological responses to treatments in some contexts

what are the arguments for and against using race in medical research?

for: race has been used to predict biological responses to some treatments, Barr discuses ACE-inhibitor study by Exner and colleagues an example of this debate

against: race is a crude proxy for the biology that matters, in organ transplantation HLA match between donor and recipient predicts success more accurately than patient race

• associated with measure errors

how should race and skin color be measured?

race and skin color should be measured as nuanced, continuous variables to capture the complexity of these categories

• choosing measures that fit the research question

• careful considerations

• consider ethnic and cultural identifies

• avoid automatic ‘control’ for race unless justified

what are the best practices for measuring race in health research?

• careful consideration when including race in analysis

• look past controls

• go beyond dummy variables (single race indicator oversimplifies categories)

• need for clearer interpretation of race-related findings

• race is a complex, multidimensional construct

• implications for health services and policy development

how is race categorized in demographic data collection?

U.S. Census Bureau categories people based on race, cross-societal differences in racial classification

• treated as a simple proxy

what is physiognomy?

the process by which individuals assign racial status to others based on physical features

• public perceptions based on skin color or physical traits

how does physiognomy affect minority responses in research?

• minority responses on how they are perceived based on identity descriptions and public perceptions

• ex: latinos selected lighter skin colors than darker skin colors

• ex: identifying as white on demographic data, but not being perceived that way

how does racial discrimination impact hypertension?

racial discrimination leads to chronic stress, which contributes to the development of hypertension (high blood pressure)

what is the link between discrimination, stress, and physical health? (discrimination as a source…)

discrimination is a significant source of chronic stressors, which is also linked to both physical and mental health issues

• discrimination serves as a cycle of stress

  • it creates chronic stress

  • linked to higher rates of heart disease and mental health disorders

what is the relationship between SES and health?

it is a continuous relationship, health improves as SES increases

• lower SES—> more illness, disability, shorter life span

• slight improvements lead to better outcomes

• not a gradient, threshold phenomenon

how does higher SES lead to better health outcomes across all levels?

• based on biological, behavioral, and environmental factors

• higher SES correlated with better health outcomes

• higher education —> better jobs and higher income —> better health outcomes

why do black and hispanic individuals experience fewer health improvements compared to white individuals as SES increases, and how does this impact racial health disparities?

• disparity widens despite education and socioeconomic improvements

• barriers to treatment and access (structural)

• living environments

• racial discrimination (stigma, self blame)

• health care cannot close gaps, social determinants must be addressed (education, income, and neighborhood)

what is status syndrome?

higher social status correlates with better health across the entire social spectrum, not only at the bottom

social gradient of health: health improves each step up the social hierarchy

• even among non-poor individuals, higher status leads to better health outcomes

how does social hierarchy contribute to health outcomes?

the higher you are in the social hierarchy the better health outcomes you have

• higher levels of education—> lower mortality rates

• accumulation of wealth predicts health as income and education are intertwined

what is social disadvantage in health?

refers to a person’s relative position in a social hierarchy including race, gender, ethnicity, and disability

how does psychological stress get impacted by social status?

psychological stress due to perceived low social status contributes to poorer health outcomes

how does stress from social hierarchy impact health disparities?

• low SES= greater exposure to chronic stressors

• stressors like financial insecurity, unsafe neighborhoods, and job instability

• chronic stress harms cognition & performance—> reduces educational/job opportunities

what were the findings from the Whitehall Study?

among british civil servants, mortality generally increased with each step down the hierarchy

• black report and whitehall findings: health differences persisted despite broad availability of healthcare

• pathway: autonomy and perceived control over one’s circumstances, psychological stress tied to race links

how does social hierarchy impact time preference?

social hierarchy shapes one’s ability to delay gratification for future rewards

• depends on longevity of job

how does social status affect decision-making and long-term health benefits?

• Higher status provides more resources, time, and autonomy to prioritize long-term preventive health

• Follows a strict "health gradient" where life expectancy and physical health improve at every step up the social ladder due to lower allostatic load

how does employment impact mortality risk?

employment reduces mortality risk

• Being temporarily unemployed, never employed, or laid off significantly increases all-cause mortality risk

how does educational attainment and income affect race?

at all levels of educational attainment, Black men and women earn less than White men and women

• black americans: are less likely to complete high school

• latin americans: college completion rate is about 20%, overrepresented in low-wage and high-risk jobs

• native americans: highest poverty rates

• asian americans: overall high education rates

how does education and race interact to influence income disparities?

• higher levels of education are associated with lower mortality rates

• lack of education is associated with higher mortality rates, even with education in some minorities the disparities persist

how does occupation status contribute to health disparities?

lower occupational status correlation with higher mortality rates

higher-status occupations are associated with better health outcomes

• Higher education —> better jobs and higher incomes —> better outcomes

• unemployment predicts depression and financial strain

  • treatment gap widens when unemployed

• health improves as income rises, continuous across all levels of income

how does escaping poverty impact health outcomes?

escaping poverty leads to substantial health improvements

• farther a family gets from poverty, the higher its income and associated standard of living —> better health becomes

what are the benefits associated with improving socioeconomic status?

• reduced disease risk

• better access to healthcare

• healthier living environments (food, recreation, etc.)

how does racial segregation impact health outcomes?

segregated neighborhoods tend to have fewer healthcare resources and greater environmental risks, which worsen health outcomes

• residential racial segregation shapes access to healthcare, education, and employment

• infant mortality is highest in segregated neighborhoods

what was the impact of the chicago heatwave on risk factors?

social isolation and low income were key risk factors identified in the 1995 Chicago heatwave deaths

• social determinants of health during crises

what are the social determinants of health during crises?

• Social isolation

• Low income

what is the effect of social support during natural disasters ?

strong social support reduces the risk of death by mitigating isolation and stress during events like heatwaves

what is the role of social networks in protecting health?

• strong social networks buffer stress

  • social isolation —> worse health outcomes

• strengthening social ties over time may improve overall health

how does social isolation impact health during natural disasters?

people living alone with limited social contacts are more vulnerable during heatwaves

how does healthcare access impact health status?

health status differences cannot be fully explained by access to healthcare

what are the broader factors beyond healthcare that impact health disparities?

• individual factors

• socioeconomic factors

• politics factors

• historical influences

• multiple causes (racial/ethnic groups)

how does social capital impact health?

high levels of social capital reduce stress and improve health by enhancing social support networks

• collective characteristics such as trust and community connections

what is the role of community connections in improving health outcomes?

• communities with higher social cohesion can reduce health disparities (empowerment of communities)

• interventions that strengthen social ties may improve health outcomes

what is the role of intersectionality in public health?

social identity are multiple, interdependent, and intersecting

• analyzes how multiple identities reflect systems of privilege and oppression

• argues that public health studies often overlook intersections of race, gender, and class

• acknowledges overlap “women and minorities”, term that separates race and gender

how does intersectionality integrate multiple social identities to explain health disparities?

values experience of women of color and acknowledges overlapping identities

ex: black + women identity

• shows need for policies accounting for all identities, addressing everything together

how is intersectionality applied in health disparities?

helps explain complex health disparities by considering how identities like race, gender, and class intersect with structural inequalities

what is problematic about using “women and minorities” in public health discourse?

the term “women and minorities” implies that overlapping identities cannot exist

• seperates gender and race