Health and Society Exam 2

Causality

Looking for causal links. You cannot have a causal relationship between variables without having a correlation.
- Which social factors explain (cause) health outcomes?
- Which are merely correlated with explanatory variables?
- You must know the direction and strength of the relationship between variables.

Correlation v. Cause

Correlation is a statistical technique that shows the strength and direction of a relationship between 2 variables. Cause is a variable that gives rise to something or produces an effect or outcome.

Measuring strength and direction of correlation graphs

R is the correlation between 2 variables. A perfect correlation is (+/-) 1. 0 means no relationship between variables. Most relationships are in between 0 and 1. Exam questions will ask you to determine the strength AND direction of the r value.

Control variables

Control variables MUST be controlled lest they affect data results. They are associated with both the independent and dependent variables in a research model.

Mediator variables

You will have a variable that has a relationship with another variable, but only by intervening through a mediating variable. NOTE: You can simultaneously have an independent relationship between the independent/dependent variable alongside a mediator.

The Status Syndrome by Michael Marmot

To what extent do social factors explain health outcomes in a population or social group?
- Which factors matter, in what contexts, and why?
- Determine HOW social factors shape health outcomes and mortality. Through what mechanisms?
Marmot notes that 2 social factors contribute to poor outcomes: material deprivation (like Link and Phelan), and psychological disadvantage/relative status assessment.

Fine details of Marmot’s Studies

- Studied those working for the British Civil Service to control healthcare coverage, as everyone working had the same access.

- Cardiovascular health and mortality rates were unequal and stratified among occupational groups.
- His data reflected a social gradient; lower the occupational grade, the higher the mortality.

- More autonomy lowers risk of disease. Low status means less control, therefore poorer health.

- Biological stress can affect hormone fluctuations and metabolic levels.
- Bad habits aren’t directly caused by the individual, but by high stress and lack of control.
- Connection to community lowers risk of disease as mental health is less likely to decline.

Social Gradient

Outcomes are best for those at the top of the gradient, worst for those at the bottom. NOT just the difference between the haves and have-not’s, rather health in populations are distributed on a scale including everyone. Found cross-culturally, in societies, and in communities.

Absolute v. Relative Poverty

Absolute - severe deprivation of basic needs including food, safe drinking water, sanitation facilities, shelter, education, and access to health information.
Relative - Defined in a specific context; a comparative experience. A measure of relative income inequality.

Epidemiological Transition Theory

Refers to major shifts in the disease-scape that have happened in human history.
- Abdel Omran published the first model in 1971 focusing on the 2nd transition.

- Considers health at the population level, NOT individual level.

Omran’s Three Stages:
- Age of Pestilence and Famine (Stage 1)
- Age of Receding Pandemics (Stage 2)
- Age of Chronic and Human-Created Diseases (Stage 3)

Newly considered stage 4: Delayed Degenerative Diseases and Emerging Infections.

First Transition

- Hunting/gathering to agriculture.

- Proximity to human waste increased.

- Domestic animals created new pathogens.

- Diet reliant on crops; led to nutritional deficiencies. Food spoilage.

- Rise of social stratification leading to different outcomes.

- Causes for morbidity and mortality were infectious diseases like malaria, smallpox, measles, and tuberculosis.

Revision to Omran’s original model.

The first era was not characterized by pestilence and famine. The shift to agriculture was the cause for worse nutrition and disease. Increased diseases spread as people lived in close quarters.

Second Transition

- Began in the most developed countries.

- Agricultural practices improved and diets became more varied.

- Improved sanitation, nutrition, vaccination, and antibiotics resulted in major declines of infectious diseases.

- Increased life expectancy.

- Causes of morbidity shifted to degenerative diseases like heart failure, stroke, diabetes, and cancer.

- Low-income countries continued to have poor health, living conditions, and higher morbidity despite the transition.

Third Transition

- Began around the end of the 20th century.

- Globalization facilitates rapid travel for humans, but also for pathogens.

- Continued prominence of chronic, degenerative diseases.

- Rise of autoimmune disease and allergies.

- Rise and recognition of mental health disorders.

- Resurgence of familiar infections due to vaccine hesitancy and rejection and antibiotic resistance.

What is antibiotic resistance, and how does it spread?

Antibiotics kill unresistant bacteria, then resistant bacteria multiply and transfer drug immunity to other bacteria. Antibiotics given to animals can spread resistant bacteria through meat, fertilizer spread resistant bacteria through plants, and humans can transfer resistant bacteria to each other.

The Changing Disease-Scape in the Third Epidemiological Transition by Kristin Harper and George Armelagos

Epidemiological transition models must be complex to capture observations made in different nations; transitions occur at dramatically different paces in different places.

- Not necessarily sequential; many regions have not gone through the 2nd transition, while already suffering the effects of the 3rd.

- Delayed onset of degenerative diseases. Varies by social position.

- Model based on westernized countries.

- Globalization has multiple impacts on disease burden.

What is “Politics?”

Reflection of different value commitments. Also includes structure, distribution, and effects of power in society; the actions taken among individuals and groups seeking to maintain/achieve power to shape society.

How can power shape health?

Power can be leveraged anywhere from upstream and downstream. individual/group decision making, public policies, and larger social and economic policies are not defined as health, but still influence health outcomes.

Politicization

Made political or into a power struggle. Health problems are interpreted in a social context, therefore different groups vie to assert lenses to view a problem; different side fight for how we control or regulate a problem too.

Why I’m Not a Liberal - David Brook

Conservative:
- Individual decision-making and agency.

- Manners, morals, norms, traditions, and religious values more important over laws. Character matters.

- Culture is necessary to develop human capital, more important than economics in decision-making.

Progressive:
- Material conditions matter, not cultural or moral ones.
- Poverty explains social problems so giving money to create opportunities should solve them.

- Believe in the science of society.

- Money can be counted more easily than culture.

Hellfire Nation: The Politics of Sin in American History - James Morone

Morality politics are unique in the US and shape health policy. Political differences have often become moral disputes between individualism and the “social gospel.”

Individualism (Puritanism)

- Focuses on sinful behaviors. Illness reveals one’s relationship with God.

- Emphasis on individual rights and individual responsibility.

- Distrust of government.

- Individual rights trump the collective.

- Politics of self-interest or religion often at odds with medical science.

Communal Tradition (Social Gospel)

- Movement in latter half of the 19th century applying Christian ethics to social problems.

- Argues that an unjust system must be fixed.

- Prioritizes taking care of others who are vulnerable in society.

- Focuses on collective goals and the “common good.”

- Some collective goals may be dangerous.

Moral History of School-Based Heath Clinics

- Proponents of these clinics offered “down-to-earth descriptions of kids getting care” and argued improved health measures. (Social Gospel)

- Opponents leveraged “moral complaints” about removing parental authority, and the concern that sexual health education received in school would encourage promiscuity. (Individualism)

Shifting Politics of Abortion as an Example

The “pro-choice” framing takes an individualism approach, while the “pro-life” framing focuses on the collective, the social gospel; typically opposite approaches to what each party focuses on. Abortion was legal until physicians sought to consolidate power seeking roles as social leaders and healers. The argument in the Dobbs decision was that abortion should be turned over to the states. Lack of protection at the federal level prolongs the debate.

Behaviors Linked to Better Health

- Exercise: functional movement, cardiovascular health, strength training.

- Healthy Diet: Plant-based diet, or any diet that procures a positive image of oneself.

- Getting enough sleep.

- Stress Reduction: Meditation/prayer, being in nature, cultivating inner calm.

- Sunscreen use.

- Committing yourself to a purposeful life filled with meaning.

Behaviors Linked to Poor Health

- Alcohol Consumption: Once thought only excessive use was harmful, research shows no safe level. Especially negative effects for women.

- Drug Use/Abuse: Illicit and prescription abuse.

- Risky Behaviors: sexual and physical behaviors like self-harm.

- Sedentary Lifestyle (lack of exercise).

- Excessive Screen Time: linked to low social interaction, self-esteem, and sedentary behavior.

- Poor Diet: Ultra-processed foods, sugar, and overeating/disordered eating.

How to Make Stress Your Friend - Kelly McGonigal

What if we saw physiological symptoms associated with stress as helpful? People who saw stress response as helpful were less stressed, less anxious, and more confident. This perspective also changed the stress response; the stress didn’t affect arteries.

- Stress makes you social - Oxytocin

- Enhances empathy

- Stress response has a mechanism that drives human connection

- How you think and act can transform your experience of stress.

- Stress creates the biology of courage!

Fixed Mindset

- Abilities and intelligence are set.

- Every interaction or assignment is a test to prove your ability.

- Effort is for those who don’t have the ability.

- Challenge is scary and should be avoided when possible.

- Setbacks equal failure.

- The strategies you use don’t matter too much because success depends on your ability.

Growth Mindset

- Ability can be changed and developed through learning.

- No matter your current ability level, your effort can ignite ability and turn it into accomplishment.

- Challenge may be difficult but is a necessary part of growth.

- You can convert setbacks into future successes.

- Changes in strategies may be necessary based on learning needed.

Peter Conrad’s Shifting Engines of Medicalization

Sociologist that studies medicalization. Described the 3 engines—biotechnology, consumers, and managed care—as taking the power away from doctors, when physicians were once the only ones with power in the medical field.
- Biotechnology: drugs, genetics, and medical technology shape what counts as illness.

- Consumers: patients request diagnoses and treatments.

- Managed Care: insurance companies influence what treatments are approved.

Socioeconomic Status

Multidimensional variable measuring social class. Income is the most common measure, as it comes from a variety of sources, and fluctuates over time. Researchers have found persistent correlations linking dimensions of SES with health outcomes: cancer, diabetes, depression, etc.

Income

Often measured as a percentage of the Federal Poverty Level (FPL). Defined as an amount that provides the bare minimum of shelter, food, clothing, and other necessities. Number varies by family size. Program eligibility is based on income: medicaid, SNAP, Head Start, WIC, etc.

Food Insecurity

Disruption of food intake or eating patterns due to material deprivation at the household level. In 2021, 12.5% of families with children experienced food insecurity. In 2025, the government paused data collection on food insecurity, saying it’s “relatively unchanged.”

Social Determinants of Health

Non-medical factors that influence health outcomes.
- Economic Stability.

- Neighborhood and Physical Environment

- Access and Quality of Healthcare

- Education Access and Quality.

- Food

- Community Safety and Social Context.

Food Deserts

Geographic locations with a lack of healthy, affordable food. Persistent with low-income communities, and can occur in both rural and urban areas. Fewer grocery stores, gas stations, even restaurants are only sources of food.

Wealth

Measured by taking the cash value of all assets and subtracting debts. More complete information about a person’s lifetime economics resources compared to income alone. Higher wealth means lower mortality.

Access to Healthcare

More resources = more access to quality healthcare. It is NOT the primary explanation of health disparities between SES groups; 20% of outcomes. Access is not the same as healthcare utilization: using the care you have access to. Not everyone utilizes healthcare they have.

Health Behaviors and Lifestyle Choices

SES linked to behaviors that have positive/negative effects on health. Health behaviors account for roughly 30% of health outcomes. (See poor and healthy behavior flashcards) Need to consider structural advantages of affluence; high SES means better nutrition, better housing, schooling, and more money.

Environmental Stressors

Toxic environments persistent in low-income housing. Noise pollution, violence, industrial pollution all account for negative health outcomes, roughly 10%. Low SES individuals are exposed more to physically debilitating, repetitive labor jobs that are dangerous with few workplace protections. Also less likely to have employer insurance.

Psychosocial Stressors

Low SES is correlated to economic strain, less education, less autonomy, less security, and more stress. Has a cumulative effect of powerlessness over time. Stress helps in the short-term, not the long-term. Cortisol weakens digestion, reproduction, and the immune system, and Low SES individuals have higher exposure to the damaging long-term stress.

Why Americans are Dying from Despair by Atul Gawande

- 75% of college graduates are married by 45, but only 60% of non-college graduates are.

- A decline in religious institutions resulted in loss of social hubs.

Physicians view the seeds of illness and mortality caused by life events. However, Gawande notes that social climate, and the instability of it, matters too. When people’s material and social conditions don’t meet expectations, it causes despair and a heavy sense of powerlessness; just as powerful of a connection to other forms of self-harm too.

Education as an Indicator of SES

You can learn about healthy behaviors in school, increased employment opportunities that increase resources, a greater sense of control and social standing, and are more likely to engage in healthy behaviors of those you associate with. Quality of education is important.

Deaths of Despair

Non-college educated white people had significantly higher rates of drug overdose, suicide, and alcohol-related liver diseases. Reflects the bleak economic prospects of these communities and the working-class experiencing stagnation. Also connected to a lack of social connections and cultural factors; social power and privilege in exchange for culture is VERY important to consider here.

Economic, Human, Social, and Cultural Captial

Economic: Financial resources, income, assets and accumulated wealth.

Human: Skills, talents, and knowledge that serve as resources to be productive in society.

Social: Resources from relationships and people create opportunities, support, as serve as a buffer.

Cultural: Signals that communicate power, education, expertise, and social standing. Credentials, cultural knowledge, language and abilities are all examples.

What is the maximum income for a nuclear family (family of 4) that falls on the Federal Poverty Level (100% FPL)? What is the income difference between family sizes on the poverty line?

$33,000. There is an approximate $6,000 difference between family sizes above and below the nuclear family size.

Race

Defines a group of people based on shared physical characteristics, such as skin tone, hair color and type, facial features, etc. Linked to superficial biological characteristics, but is NOT BASED ON GENETICS; it is a social construct.

Ethnicity

Defines a group of people based on shared nationality, religion, language, or cultural traditions. Ex: Native American or Navajo; Indian or Bengali; European or Irish etc.

Structural Racism as a Root Cause

Operates through laws, institutional practices, and social norms (e.g. historical lining, segregation, weath gaps)

Healthcare Bias and Access

Minorities often receive lower-quality medical care and face systemic barriers.

Race as a Social Construct

Treating race as an innate biological difference reinforces false medical assumptions; disparities are driven by unequal distribution of risks and resources, not genetics.

Racism as a Chronic Stressor

Interpersonal Racism → daily micro-aggressions → stress, anxiety, higher blood pressure.

Institutional Racism → unequal education, housing, healthcare → chronic disadvantage.

Structural Racism → Historical layering of exclusion across systems.

Physiological Pathway: chronic discrimination → elevated cortisol → allostatic load (“wear and tear” on bodily systems)

Similar effects as job strain or relationship conflict.

Racism as a Chronic Stressor (Continued)

Stress on the body, not just emotions. High blood pressure, heart disease, obesity, low birth weight, etc. Health differences and experiences can start before birth and build up. Social factors affect health as much as medical care.

Epigenetics

Our experiences can influence how our genes work. Social experiences like discrimination can actually affect the body at a biological level long term.

Hispanic Paradox

Hispanics have better than expected health and mortality outcomes compared to non-Hispanic Whites despite their lower socioeconomic status.

- Do immigrants have better overall health to begin with?

- Cultural protection: the level of acculturation matters. Protective effect of maintaining ethnic identity. The longer latinos stay in the US, the protection goes away.

What We Should Learn from Nordic Happiness

Nordic countries have better health conditions because they invest in social welfare and improving human capital.

- Higher minimum wage.

- Higher GDP per capita.

- More productivity.

- Investment in human capital (education and childcare).

- Emphasis in cooperation, trust and helping others.

How Structural Racism Works by Bailey et al

Defines structural racism and the machinations that keep it running throughout our medical/legal systems in the US.

- Redlining and Segregation: housing policies restricted black wealth and concentrated disinvestment, pollution, and stress.

- Police Violence and Incarceration: Violence, surveillance, and incarceration harm health directly.

- Unequal Medical Care: Biased treatment and under-resourced facilities both contribute to poorer care in Black communities.

- Race as a Social Construct

Addressing racial health inequalities requires changing the systems that distribute risk and resources.

Why Progressives Should Embrace the Genetics of Education

Genes can affect success in school, but they do not decide someone’s future; success comes partly by luck, not just hard work. Studying genes can help researchers understand which school programs help students. These findings DO NOT explain racial differences in education. Everyone deserves opportunities and support, regardless of their genes or education.

Stress Portrait of a Killer - Sapolsky

How chronic stress affects the body and mind. Stress is strongly influenced by a person’s social environment and conditions.

- Stress responses are useful for short-term threats, but can cause harm when activated repeatedly.

- Stress is especially harmful when people feel they have no control over their circumstances.

Natural Experiments

We cannot ethically run a randomized, controlled trial that exposes one group to discrimination and another group to no discrimination, and then measure the health effects between groups. In effect, “nature” assigns people to an experimental group and a control group.

How Racism Makes Us Sick by David R Williams

Racism produces a rigged system associated with higher levels of discrimination toward Black people, slowly chipping away at the health of Black individuals.

- Discrimination in healthcare and daily microaggressions.

- Residential segregation: eliminating residential segregation could reducing the differences between Black and White people by 2/3rds.

- Implicit Bias: holding a negative stereotype against a group of people will lead to discrimination.

- Black people still earn 59 cents for every dollar White people receive.

School centers have been targeting these unjust systems by providing the tools—health evaluations, mentorship, and academic enrichment—for Black individuals who’ve been discriminated against by the system.