HS 325 - exam 2 notes (made this set myself)

What are the social determinants of health?

The conditions in which people are born, grow, live, work, and age that affect a wide range of health, functioning, and quality of life outcomes and risks

Absolute poverty

a lack of resources that is life-threatening (deprivation)

Relative poverty

the lack of resources of some people in relation to those who have more (inequality)

How many people live (in 2022) in absolute poverty?

682 million, 8.5% of the population

Gini Index (Gini Coefficient)

measures inequality on a scale from 0 to 1.

higher gini coefficient

more unequal distribution of income

The lower the Gini index

the more equal the country

Examples of SDOH

Income, housing, job opportunities, education, food access, housing

T/F: indigenous people in Canada experience more food insecurity than nonindigenous people

True, indigenous people in Canada experience more food insecurity than nonindigenous people

T/F: bisexual people in Canada experience more food insecurity than straight people

True, bisexual people in Canada experience more food insecurity than straight people

Indigenous inequities are rooted in...

....colonialism (forced displacement into reserves, banning of languages and practices, creation of residential schools, unaddressed inter generational trauma).

T/F: The U.S. has the same maternal health as Armenia

True. It's bad, 62 other countries have it better!

The social gradient

the observation that health is correlated with social class/status all the way up and down the scale, that poor health is not simply a problem of poverty, but of overall income inequality

NHS (National Health Service)

the British healthcare system. universal healthcare, offers a full range of services, free at use, publicly funded

T/F: the U.S. and Britain and relatively open about the existence of social class

False. BRITAIN is relatively open abt the existence of social class, not so much the U.S.

Whitehall studies studied...

...the impact of the social gradient on health

Whitehall I findings

The lower the job grade of men (in governmental jobs), the poorer their health.

Relationship between class and health was especially strong for coronary heart disease.

Whitehall II findings

Replicated findings of Whitehall I

included more male professions AND women

detailed the relationship between psychosocial factors (work stress and family conflicts) with heart disease and diabetes

T/F: Whitehall II is still going

True! The initial intake started in 1985 with follow ups every 5 years and it's still going.

Whitehall I methodology

Initially a questionnaire and physical exam, followed by a follow-up after 33 years

The social gradient states that life expectancy is shorter and most diseases are more common where?

Further down the social ladder in each society

How does stress impact health outcomes?

Stressful circumstances make people feel worried, anxious, and unable to cope may lead people to premature death.

Affects both cardiovascular and immune systems.

Effects accumulate over time.

According to Wilkinson and marmot, the solid facts of the SDOH are:

the social gradient

stress

early life

social exclusion

work

unemployment

social support

Slow growth and poor emotional support raise the lifetime risk of...

...poor physical health and reduce physical, cognitive, and emotional functioning in adulthood.

In infancy, insecure attachment and poor stimulation can lead to...

...reduced readiness for school, low educational attainment, and problem behavior later in life

Poor physical growth in infancy is associated with...

...reduced cardiovascular, respiratory, pancreatic, and kidney development and function, which increase risk of illness in adulthood.

Stresses of living in poverty are particularly harmful...

...during pregnancy and for babies, children, and elderly persons

The greater the length of time that ppl live in disadvantaged conditions, the more likely they are likely to suffer from...

...a range of health problems, especially cardiac disease

Having little control over work leads to...

...increased low back pain, sickness absences, and cardiovascular disease

Job insecurity

Chronic stressor that grows with length of exposure, increases sickness absences and health service use

Social cohesion

Quality of social relationships and existence of trust, mutual obligations and respect in communities or in wider society (when this declines, heart disease rates increase).

Conclusion of closing the gap in a generation report states that "this unequal distribution of health-damaging experiences is not in any sense a 'natural' phenomenon but is the result of a...

...toxic combination of poor social polices and programmed, unfair economic arrangements, and bad politics

WHO overarching recommendations for achieving health equity within a generation

Improve daily living conditions

tackle the inequitable distribution of power, money, and resources

measure/understand the problem and assess the impact of action

access to medical care is a part of what causes socioeconomic inequalities in health, but only a...

...small part

Because inequalities have such profound impacts on health, we can think of them as...

...disease causing agents

Inequalities are a product of _______ ________ _______, and we as humans can change our ______ _______.

Human social structures, social structures

Social structures include...

...economy, law, social class, religion, family

What is social capital

network of relationships and connections that give opportunites and advantages

T/F: race is a biological reality

FALSE. Race is NOT a biological reality. It's socially constructed but it still has significant impacts on people.

Skin color is a trait of...

...continuous variance

T/F: there is more genetic variation within races than between races.

True! Theres more genetic variation WITHIN races than between them. How diff races are categorized differs from place to place.

Racial _____ is an indication of the social constriction of race (one drop rule)

Hypodescent

T/F: ethnicity is also a social construct

True. Ethnicity refers to social category of identity based on cultural distinctions of history, religion, language, shared traditions, etc.

Two causal pathways for explaining health inequalities by race

raciogenetic and lived experience

Raciogenetics

Based on genetic differences in disease susceptibility among races (outdated, flawed and incomplete due to complexity of human biological variation).

Lived experience

Health inequities are explained by the accumulation of stresses and insults, along with environmental factors and poor health care

A few specific examples aside, it is overwhelmingly _______ that accounts for differences in health, not race itself

Racism

T/F: racism interacts with the social and ecological determinants of health

True! Examples: Black people are made less healthy by things like increased levels of homelessness or unsafe housing. Environmental racism means that black people are more likely to develop health conditions like asthma due to the high prevalence of high-polluting industries in and near black neighborhoods.

These social realities (of racism affecting health outcomes) are NOT based in biological differences but BECOME biological realities through...

...the impact that they have on a person's health across the life course

Medical racism

systematic and wide-spread racism against people of color within the medical system

Serena Williams and bedside racism

Serena Williams nearly died after doctors initially ignored her request for a CT scan, which later discovered blood clots in her lungs after giving birth

Racism is deadly when people take their last breath because of...

...policy violence, including global and national policies that result in people being unable to get the medicines or care that could save their lives

To tackle racial inequality, it is essential to tackle...

…Economic disparities

(and a multifaceted approach in general that acknowledges the intersectionality of race, class, gender and other inequalities).

In what countries do black people make up the majority yet still experience widespread discrimination?

Brazil and South Africa

T/F: mortality from Covid19 in Brazil was higher among black people than non black people

True! Mortality, infection severity, and ICU admission rates were all higher

In South Africa, the apartheid officially ended in 1994, yet apartheid era patterns in housing, socioeconomics, and heath care infrastructure are...

...fundamentally unchanged 20+ years later

HIV+ population in sub-sahara Africa

7.9 total, 7.6 black (and black individuals living in highly segregated areas were 2x as likely to be HIV+ as those living in non-segregated areas

What was AIDS referred to in the early years (1982)?

GRID (gay related immune deficiency)

Zoonotic origin of HIV

HIV-1, including the pandemic strain HIV 1-M, comes from chimpanzees

Bush meat crisis

unsustainable hunting and commercial trade of wild animals for meat, which leads to the decline/extinction of wildlife species, loss of culture (taboos, norms) and risk of contracting diseases like Ebola, anthrax, Marburg fever, east coast fever, SIV, and tuberculosis

In 1981, MMWR articles published on...

...atypical pneumonia among homosexual men in LA (later followed by reports on opportunistic infections and Kaposi's sarcoma among Haitians in the US and Hemophiliacs)

Ronald Reagan and HIV

Commissioned major report on AIDS, spearheaded by Surgeon General C Everett Koop and Anthony Fauci (Koop released directly to public). He didn't act on the report (or read it), and criticized its recs for comprehensive sex ed

Margaret Thatcher and HIV

Embraced harm reduction polices for injection drug use. Hesitated in releasing public health advertisements that addressed risky sex, finding it 'distasteful'.

Thabo Mbeki and HIV

Widely criticized for delays in responding to the threat of HIV in South Africa. Appointed AIDS denialist Manta as Health Minister, who promoted non-evidence based holistic and alternative treatments in place of ARVs

Thabo Mbeki (President of South Africa) argued that what caused AIDS

that malnutrition and poverty were the DIRECT causes of AIDS, rather than contributory causes ("we could not blame everything on a single virus").

4 H's of the early days of HIV

Homosexuals, heroin users, hemophiliacs, Haitians

Two very different arguments for why HIV prevalence is so high in sub-Saharan Africa

Concurrency and ecological conditions

Concurrency

• Overlapping sexual partners. Viral load is much higher in the acute infection window (~3 weeks) following HIV infection.

• Argument rests upon the time span within which there are multiple sexual partnerships, not overall # of partners.

Male circumcision rates and network of sexual relationships are diff for much of West & North Africa compared to...

...Southern and East Africa

A person who is HIV+ and NOT receiving treatment will have a viral load that is...

...VERY HIGH right after initial infection and then drops to a much lower level

T/F: When viral load is low, it is less likely that a sexual partner of an HIV+ person will become infected.

True. It's not impossible, but it is less likely that when viral load is low, it is unlikely that the person will become infected.

What is required is address problem of complex causation and multiplicity of environmental risks?

Multifactorial solutions

How does sex pose benefits and risk for health?

It can contribute positively to social support, mental health, and general wellbeing, but it also presents risks of STIs, unintended pregnancy, and sexual assault

Who is more vulnerable to the negative health effects of sex for biological AND cultural reasons?

People with uteruses

T/F: the UN considers access to contraception as a human right

True, the UN considers access to contraception as a human right

Population control programs (family planning) led to a...

...mismatch between local interests and global or governmental agencies in low-resource settings and have led to disruption of health agencies