gph definitions

sex -krieger

a biological construct premised upon biological characteristics enabling sexual reproduction.

gender -krieger

a social construct regarding culture-bound conventions, roles, and behaviors, as well as relationships between women and men, boys and girls

biologic expressions of gender

differences in health in relation to social divisions premised on power and authority (class, race/ethnicity, religion)- vary within and across societies

gendered expressions of biology -krieger

• Gendered expressions of biology- Sex linked bio characteristics ( presence or absence of ovaries, testes, vagina, penis; various hormone levels; pregnancy) can, in some cases, contribute to gender diff in health but can also be interpreted as gendered expressions of biology and wrongly used to explain biologic expressions of gender

sexism -krieger

members of dominant gender groups (typically men) accrue privileges by subordinating other gender groups (typically women)

sexuality -krieger

how someone expresses sexual desire, power, and diverse emotions, mediated by gender and other aspects of social position (e.g., class, race/ethnicity, etc.

heterosexism

the type of discrimination related to sexuality, whereby heterosexuals discriminate against people who have or desire same-sex sexual partners

krieger

Understanding health requires examining both the social effects of gender and the biological effects of sex, without assuming in advance that one or the other explains a health difference

moore on “doing gender”

• Doing health” becomes “doing gender” bc new paradigm promotes monitoring body, recognizing symptoms, seeking med advice, & taking personal responsibility for staying healthy, which are traditionally feminine traits, male “unhealthy traits” conflict with idea of what “healthy person” does

moore main point

The idea of a “healthy body” has become gendered, particularly through traits traditionally associated with femininity:

balch

Womens health understudied because med research has historically treated the male body as the norm, excluded or underrepresented in medical research so still don’t fully understand how some diseases, meds, and treatments affect women

krieger

-gender and sex are different and need to be separated, not used interchangably; they have their own different effects on health outcomes

Health as a “signifying” practice

health is shaped by social structures and peoples experiences, and it is connected to other social meanings and practices -crawford

New Health Consciousness -crawford

an emerging idea that defines problems of health and their solutions as matters within the boundaries of personal control

Social cynosure -crawford

a meaningfully and emotionally charged fixation – both a goal & source of anxiety, a value for self and others, a state of that is continually assessed and an organizing concept for a vast organization of social action.

healthism -welsh

the focus on health as being an judge of moral goodness (both in promoting it in others and in oneself)

Good Health Imperative (aka the “Empowered People” plan -welsh

National Prevention and Health Promotion strategy emphasizes that individual choice is the centerpiece of health promotion.

Alimentary ableism -welsh

dominate food movements or wellness cultures frame healthy eating as a way to prevent illness or cure disability, assuming disability is undesirable and needs to be cured

Affirmative culture of self-care -welsh

Individuals should see their health as a matter of personal responsibility making disability, class, and gender merely private matters to attend to with proper healthy self-care

Docile subjectivity -welsh

focus on fostering subjects that not only are good consumers and workers but also subjects that make good choices—that is, choices that do not disrupt capitalist postcolonial distributions of wealth, power, and control

two writers that speak on health being a way to judge ones self and others

welsh & crawford

welsh critiquing

Critiques the “good health imperative”: the idea that individuals have a responsibility to constantly work on making themselves healthier, leads to HEALTHISM, ABLEISM, workplace conditions workers faul

personal responsibility gives…. welsh

easy way to hide structural reasons for health condition

crawford said practicing health in this way is an anxiety causer

“spiral of control”- More health information → awareness of more dangers → more anxiety → more attempts at control → awareness of even more dangers → more anxiety.

hart

need to measure gender in more nuanced ways because treating gender as simply “women vs. men” can hide important differences in how gender relates to health. (self rated study)

Zero-sum gender conflict vs. universal harm. -homan

higher levels of sexism have increased benefits for men but increased harm for women in zero-sum, universal is when increased sexism harms M&W

Structural sexism -in homans research

systematic gender inequality in power and resources (in her research at the macro (institutional), meso (interactional), and micro (individual) levels of the gender system in the U.S.)

Gene-environment system -fausto sterling

system in which genes only assume importance when they respond to a particular environment (interaction between genes & environment, not genes alone

Genetic purity vs admixture levels. -fausto

GP the assumption that a group has uniform, unmixed genetic markup, GA- mixing genetic material from diff ancestral populations

Science/Politics dichotomy -faust

influence and shape eachother

Structural vulnerability/Material deprivation

historically embedded social, economic, cultural & institutional structures can come together to put certain groups at greater risk for poor health vs how poverty, malnutrition, homeless, no health insurance lead to poor health- MD= resources they lack SV= systems that cause it that are likely causing them to lack those mat

Precarity

ongoing insecurity and uncertainty in people's lives, especially because of insecure work and a weakened social safety net.

homans structural sexism findings

macro- harmful M&W meso- benefit M harm W micro- only unmarried women harmed

fausto-sterling gene problem

Your genes can make you more vulnerable to a certain health problem, but whether that vulnerability actually leads to the health problem can depend on your environment and experiences.

stop treating genes as the main explanation or solution for racial health disparities and instead address the social conditions that produce those health differences.

fausto- sterling main point

health disparities should be understood through a system of interacting biological, social, environmental, and political factors, rather than assuming that genes alone explain differences in health between racial groups.

whittle research on food insecure women

ot having enough money could force someone to choose between buying food, medication, paying rent, or paying for transportation to a doctor's appointment.

bowleg main point FAIR

researchers shouldn't just document that certain groups have worse health. They should examine interlocking systems of power - used to understand why they happen and help change the conditions causing them

bowleg fair

researchers should think about their own position in relation to power, examine interlocked systems of power -not treating them as isolated categories, lead actual change

evidence based medicine (EMB) merone

the explicit use of the current best evidence in deciding the clinical care of the individual patient

Evidential hierarchies morone

favoring practices that science has the most evidence for, (RTS)  limiting medical research by neglecting theoretical frameworks that may better integrate knowledge

Ecological fallacy in clinical trials

difficulty translating from large RCTs to an individual : population differences (genetic, cultural, and health systems) are different from individual patient differences (comorbidity, age, and previous treatments) Systemic issues with “average” or “typical” patients

EBM’s time-lag challenge

17 year lag between publication of evidence and translation of findings into practice, resulting in clinicians reliance on potentially out of date data

Androcentric medicine

assuming male bodies as the norm, regarding male-dominated knowledge as most valid, all people valued according to male standard

morone main point

Critical thinking should be done to see if the best available evidence applies to the individual circumstances of the patient and how it should be integrated into individual patient care. EMB movement tries to make Drs. Rely less on intuition and more on scientific research and evidence, center of EMB is the hierarchy of evidence

separates critics of western biomedicine into 5 categories: med as a Stratified and discriminatory system, med as concerned with profits, as a system of normalization, as individualizing and privatizing, and as alienating and displacing

gupta

Fem critic of history of western biomed

women judged against standard male body,  W that failed to conform to fem stereotyoes diagnosed with mental illness, ppl of color that resisted racism diagnosed w mental ill, enslaved ppl often test subjects, trying to convert gays

Med as a stratified & discriminatory system

men hold higher job positions, W & pp of color segregated into lower, access to medicine is stratified, minority patients experience discriminatory treatment at the hands of medical personnel, racial minorities, low income less included in clinical trial, many studies found evidence of racial, gender, other biases among med. Prof,

medicine as profit, not ppl motivated

pharmaceutical industry, develop drugs that will be profitable but not needed drugs that will not be

Weathering Hypothesis:

Black women may experience accelerated biological aging because repeated exposure to racial, economic, environmental, and gender-related stressors produces cumulative biological wear and tear. The authors argue that structural inequalities can become biologically embedded through chronic stress, helping explain racial health inequalities.

Geronimus study

found shorter telomeres among Black women than white women, corresponding to an estimated 7.5-year difference in biological aging,

geronimus main point

unequal social conditions can create chronic stress that becomes biological embedded in the body, proven blacks are more likely to experience stressful hardship

bailey hiring study

used identical résumés, which difered only in the name of the applicant, hiring managers called back those with traditionally white names 50% more, white applicants with criminal records were called back more often than were black applicants without criminal records.

hoffman pain study

white laypeople and medical students and residents believe that the black body is biologically different—and in many cases, stronger

-black patients are less likely to be given pain meds even when self reports of pain are the same

Constrained choice moore

The idea that people’s health choices are limited by their circumstances, including their gender and the opportunities available to them.

healthy citizen moore

A person who sees health as a “way of life” and regularly monitors themselves, checks their body, and makes lifestyle changes.

Health promotion

Efforts to prevent illness and promote health, encouraging people to take responsibility for and actively manage their own health

healthy body moore

In the new paradigm, a body that is constantly monitored and maintained through body awareness, attention to symptoms, reducing risks, and seeking medical advice.

Old paradigm: moore

Health care focused mainly on treating/curing illness after it occurred.

new paradigm moore

Health care focused on preventing illness and promoting health, with individuals expected to take responsibility for managing their health.

structural vulnerability

social and structural conditions put certain people at greater risk by limiting their access to basic resources and opportunities.

ambient stressors

stressful conditions in someone’s everyday environment that put stress on the body:noise, crowding, decaying housing, danger, extreme temperatures, hunger, and infection.

Structural racism -bailey

the totality of ways in which societies foster discrimination, (reinforcing systems in housing, education, employment, earnings,, media, health care, criminal justice) that in turn reinforce discriminatory beliefs, and distribution of resources”

institutional racism —bailey

discriminatory policies and practices carried out in institutions

ICE -bailey

measures how much a neighborhood is concentrated toward one socioeconomic extreme or the other

interpersonal racism

racial discrimination that occurs between individuals.