SOC162 (M2)- Lecture Slides

What are health disparities?

Differences in health outcomes and healthcare access between population groups (class, race, gender, etc.).

Why are health disparities a social justice issue?

They create preventable suffering and unequal life chances

Why do health disparities matter economically?

They increase healthcare costs, reduce productivity, and increase premature deaths.

What is the central pattern of U.S. health inequality?

Large and persistent gaps by class and race

What is the “fundamental cause” idea?

Social conditions (like class or racism) produce health inequality through access to flexible resources

What are flexible resources?

Money, knowledge, power, prestige, and beneficial social connections.

Why do flexible resources matter for health?

They allow people to avoid risks and adapt to new health threats

What is the class-health relationship in the U.S.?

The poorer you are, the worse your health outcomes

Why do class health gaps persist over time?

New risks replace old ones, but inequality in resources remains

What is the key mechanism linking class to health?

Unequal access to flexible resources.

What is stress’s role in class health inequality?

Chronic stress from inequality damages physical and mental health (“gets under the skin”).

What does “risk of risk factors” mean?

Social conditions (like poverty) create exposure to unhealthy behaviors (like poor diet).

What is a food desert?

An area with limited access to affordable healthy food

Why don’t supermarkets alone fix food inequality?

Habits, prices, and long-term social conditions still shape behavior

What are policy solutions to food inequality?

Subsidies, taxes on sugary drinks, and school nutrition programs

What racial disparities exist in health?

Higher rates of infant mortality, maternal mortality, chronic illness, and lower life expectancy among minorities

Do income gains eliminate racial health gaps?

No — even high-income Black Americans often face worse outcomes

What did the maternal mortality study show?

High-income Black women had similar outcomes to low-income white women

What is racism as a fundamental cause?

Racism structures access to resources that protect health.

What are race-related flexible resources?

Prestige, power, social connections, and freedom.

How does racism reduce prestige?

Bias leads to lower respect and worse treatment in healthcare.

How does racism reduce power?

Limits influence in social, political, and institutional settings.

How does racism affect social connections?

Residential segregation limits access to jobs, networks, and opportunities.

How does racism reduce freedom?

Through discrimination, surveillance, incarceration, and self-censorship.

Why doesn’t controlling for SES eliminate racial disparities?

Because racism affects health independently of income.

What is the Latino paradox?

Latino immigrants often have better health than expected given low SES.

Why does the Latino paradox happen?

Healthy migrant selection and strong family/social ties

Why does the paradox weaken over time?

Assimilation increases stress, chronic disease, and exposure to inequality

What is familism?

Strong family loyalty, obligation, and interdependence

How can familism help health?

Provides emotional support and protection from stress

How can familism hurt health?

Creates stress from family obligations and role overload

Why does “place” matter for health?

It shapes exposure to pollution, climate risk, and resources.

What health problems are linked to pollution?

Cancer, asthma, cardiovascular disease, and hormonal disorders.

What did the Stanford pollution study find?

Air pollution can alter gene expression and cause long-term disease.

Who is most exposed to pollution globally?

Low- and middle-income countries.

What is environmental injustice?

Unequal exposure of poor/minority communities to environmental hazards

What is the “siting problem”?

Pollution sites are disproportionately located in disadvantaged communities

Why did environmental injustice occur in “Versailles”?

Political power imbalances led to hazardous landfill placement near minority communities.

Who causes most climate change emissions?

Wealthy countries

Who suffers most from climate change?

Poor countries and vulnerable regions

Why is Bangladesh more vulnerable than California?

Geography + low resources for adaptation.

What is the climate inequality “vicious cycle”?

Climate damage worsens poverty, making adaptation harder

What is the global emissions inequality fact?

Rich countries are ~12% of population but responsible for ~50% of emissions

What is climate justice?

The idea that those least responsible suffer the most harm.

What is e-waste?

Discarded electronics like phones, TVs, and computers

Why is e-waste harmful?

Toxic chemicals like lead and burned plastics pollute air and water

Why is e-waste exported to poor countries?

Cheaper labor and weaker environmental regulations.

What happened in Guiyu, China?

Large-scale toxic informal recycling of electronics

What is Ghana’s role in e-waste?

Receives global e-waste for recycling but exposes workers to toxins.

What is the Basel Convention?

A treaty regulating international toxic waste trade

Why hasn’t the U.S. ratified Basel?

Political opposition and industry lobbying

What is NIMBY activism?

Not In My Backyard” local resistance.

Why must environmental activism go beyond NIMBY?

Environmental problems are global and systemic

What are direct effects of climate activism?

Individual behavior changes (driving less, eating less meat)

What are indirect effects of climate activism?

Policy and institutional change.

Which activism is more effective?

Political and institutional activism

Why is lobbying important in climate policy?

It influences laws that shape emissions at scale.

What was the professional dominance era?

Doctors controlled healthcare (1945–1965), fee-for-service system

What was federal involvement (1965–1982)?

Medicare and Medicaid introduced.

What was the HMO era?

Cost control through managed care and restricted provider networks.

What is fee-for-service?

Providers are paid per service delivered

What is an HMO?

Insurance system limiting care to provider networks.

What is medical rationing?

Allocation of limited healthcare resources

What are the three ACA “legs”?

No pre-existing condition discrimination, individual mandate, subsidies

Why are the three ACA legs connected?

Each depends on risk pooling and affordability.

What did the ACA improve?

Expanded insurance coverage.

What problems remain after ACA?

High costs, administrative waste, and underinsurance.

What happened to ACA under Trump?

Mandate weakened and subsidies reduced

What did Biden do to ACA?

Expanded subsidies but did not restore mandate.

Why does the U.S. spend more but achieve worse outcomes?

High prices, administrative waste, fragmented insurance.

What is single-payer healthcare?

Government-run insurance (e.g., Canada).

What is state-run healthcare?

Government employs doctors and runs system (UK).

What is regulated private insurance?

Private insurers with strict government control (Switzerland, Germany, Japan)

Why is Switzerland efficient?

Strong price controls + mandatory insurance + nonprofit basic plans.

Why is Canada efficient?

Single payer reduces administrative costs

What is Australia’s model?

Public Medicare + optional private insurance.

What is Taiwan’s system outcome?

Near-universal coverage with low cost but overcrowding.

Why are U.S. healthcare prices so high?

Weak regulation and fragmented insurance bargaining

Why are drug prices higher in the U.S.?

Lack of centralized price negotiation

How much higher are U.S. drug prices?

2.78x overall; ~3.22x for brand drugs

What are administrative costs?

Billing, insurance, coding, and management expenses.

How wasteful are U.S. administrative costs?

About 50% is estimated waste.

How do U.S. admin costs compare to Canada?

Much higher (~$2,500 vs $550 per person).

Why does risk pooling matter?

Insurance requires healthy and sick people in the same system

What is medical loss ratio?

Percent of premiums spent on care vs profit/administration

What is the ACA public option idea?

Government insurance competing with private plans

Why do insurers oppose public options?

It reduces their market share and profits

What is the key tradeoff in healthcare systems?

Cost vs choice vs speed of access

What is Fundamental Cause Theory?

Health inequality persists because social inequality controls access to flexible resources.

How does racism function as a fundamental cause?

It shapes SES AND limits resources like prestige, power, and freedom.

Why does place matter in health inequality?

Environmental hazards and resources are unevenly distributed

Why is healthcare reform difficult in the U.S.?

Competing interests: government, insurers, employers, and providers.

What is the core explanation of U.S. healthcare failure?

Fragmentation + weak regulation + for-profit incentives.

What is the overall course argument?

Health outcomes are shaped more by social structure than medical care alone.