SOCL 4451

socioeconomic status

differences between individuals and groups in the possession of highly valued societal resources, most importantly educational attainment, occupational status, income, and wealth

Marxist based ideas

SES differs from these; based upon an individual's relationship to the means of production

key components of social stratification

Weber highlighted class (economic status), status (social standing), and party (political power) as important dimensions

life chances

Weber also developed that individuals actively utilize their class, status, and power to improve these

health and longevity

two critical components of life chances

education attainment

most often utilized measure of socioeconomic status in US studies of population health; does not typically change when individuals experience decline in their physical or mental health which is not necessarily the case with occupational status, income, or wealth

low income

individuals who have a or live in a household with _ simply have far fewer monetary resources to protect their health

relative deprivation

beyond the poorer material conditions that individuals may experience when living with low income, individuals who have low income while living in a wealthy society may also experience the psychological costs of ___ when comparing themselves with their much more affluent peers

wealth, income

___is far more unequally distributed in american society than is ____

15%

the bottom _ of US families have no wealth

40%

___ of american families have less than $40,000 in wealth

1970s

changes in American social stratification since the ___, have resulted in the highest ever levels of income and wealth inequality in american history

deunionization

What specific institutional changes and circumstances have led to such a widening in the US distribution of income and wealth in recent decades?

governed

The rise of top executive compensation in US corporations has increased greatly due to changes in the way corporations are __

tax policies

US congress has enacted enormous changes in _ favoring high earners and the wealthy

income transfers

aggregate federal government spending on____has been increasingly redistributed away from the poorest people to those with higher incomes

SES disparities, largest

____in key measures of population health have grown wider over the past several decades for both men and women and the disparities are now the ___ that have ever been documented in the United States

education, health

the association between ___ and ___ has become increasingly strong since the 1980s

young adulthood, middle adulthood

SES differences in health tend to be relatively small in ___ but are much larger in ____ and early old age, as the accumulation (or lack of accumulation) of socioeconomic resources unfolded across the life course.

childhood SES and adult SES

very important predictors of old age functional health in the United States

single mechanisms

The issue of multiple mechanisms is one of the key reasons why a policy or programmatic focus on __ is not nearly enough to reduce or eliminate SES disparities in health.

technological, availability, medicine

social factors like socioeconomic status have become especially important in modern societies because _ advances, the rapid __ of health-enhancing information, and advanced now facilitate human control over health more so than at any point in history

genetic, background, characteristics

it may be that makeup, family ___, or infant and child health ___ are the underlying factors responsible for the strong SES-health associations that are observed across the life course

experimental designs

scientific work on the causal effect of SES on health is extremely difficult because researchers generally cannot use in this area of study

unit analysis

the entity being studied, most common people with researchers focusing on individual thoughts, feelings and behaviors.

people

most common unit of analysis

other units of anaylsis

families, high schools, corporations, religious congregations, cults, governments, counties, nations

mismatches

Researchers must be mindful of __ between units of analysis, or using data from one type of unit to draw conclusions about another type of unit

ecological fallacy

researchers will incorrectly conclude that "ecological" or contextual factors directly influence individual-level experiences, where group-level data are used to make claims about individual-level processes

data, observations

___or ___from one level of analysis should be used to draw conclusions about that level of analysis on

sociology and social change

understand the world before you change it

confirmation bias

the tendency to search for, interpret, favor, and recall information in a way that confirms or supports one's prior beliefs or values

the englightenment

17th and 18th century intellectual movement; emphasis on reason, skepticism, tolerance of free speech, individual freedom

John lock, Issac newton

key figures of the englightenment

32-42%

Percent of population in Louisiana on Medicaid

Healthy Louisiana

Primary Medicaid program in Louisiana

Aetna, Amerigroup Louisiana, Amerihealth Carrtas Louisiana, United Healthcare community plan

Healthy Louisiana has different private plans that help manage care and benefits

health care systems

funding, institutions built, delivery, access

economic resources, social/political values, historical experience

Health care systems reflects national:

critical juncture

situations of uncertainty in which decisions of important actors are causally decisive for the selection of one path of institutional development over other possible paths

path dependency

a situation where a system or organization follows one possible path such that others become progressively more difficult to adopt

Europe

-health services late 19th century
-expanded gradually

-many europeans receive comprehensive health insurance today

economic/military powers, political stability

motivations for Europes health services

>80%

percent of all health costs in EU financed from public sources

United states model

mostly private health care system with public insurance and for profit insurance but no universal coverage

-profit

-some public insurance 

-low regulation of prices 

Bismark model

mostly private health care system with both private and public insurance with universal coverage

-nonprofit (mostly) and for profit

--providers are generally private

--doctors offices: private businesses

funding of bismark model

payers are generally private; multipayer system; employer/employee tax, premiums, general t

Examples of bismark model

netherlands, switzerland, belgium, france, japan, US full time works can roughly fit

Beveridge model

mostly public health care system with public insurance (and some private insurance) with universal coverage
-supplemental private insurance
-free or minimal cost at point of service
-providers public/private
-regional administration
-tight regulation
-strong individual mandate
-strong (or complete) government control of medical procedures and prices

funding of beveridge model

payer is typically government; single payer (almost); taxes

Nonpure beveridge model

Great Britain, Italy, Spain, Nordics

pure beveridge model

cuba, US VA and IHS

National Health Insurance model

mix of Bismark and beveridge

-national or regional
-providers: (typically) private

funding of national health insurance model

payer: public insurance; everyone pays into

National health insurance model examples

Canada, South korea, taiwan, australia (has population has private insurance too), US Medicaid/Medicare/CHIP/TriCare

Tommy Douglas

father of medicare in Canada
-1962 law in Saskatchewan
-1971 Medicare in all of Canada

Out of Pocket Model

no mass medical system, some public and private insurance and care, no universal coverage
-urban with economic means/well connected: private insurance/pay directly for reliable care
-public/charitable care options may exist; significant access/quality issues
-much of population: little access, insufficient menas

funding of out of pocket model

pay directly for care

Out of pocket model examples

Cambodia, India, Central African Republic, uninsured in US

rising costs, aging populations, acute shocks (eg pandemic)

Challenges to health care systems worldwide

US serious problems internal to system

-prices 
-forgone care (eg insulin rationing)
-national spending: 17% GDP vs 7-13% of other countries
-precludes other investments
-medical debt/bankruptcy
-uninsured
-forgone care

sources of health care spending in US (biggest contributors top three)

-provider services 
-provider administrator activities
-provider salaries
-insurance administrative activities
-prescription drugs
-medical technology/equipment
-for profit element
-utilization

contributors to US life gap

-cardiometabolic disease
-healthcare access
-gun violence
-road deaths
-drug overdoses
-inequality (socioeconomic)

30%

Proportional contribution to premature death of genetic predisposition

15%

Proportional contribution to premature death of social circumstances

5%

Proportional contribution to premature death of environmental exposure

10%

Proportional contribution to premature death of health care

40%

Proportional contribution to premature death of behavioral patterns

medical sociology

societal factors shape health; american public generally recognizes the idea that social factors influence health

behavioral medicine, public health, epidemiology

social factors minimized (distant or secondary causes, not direct causes); exception: stress

exposure, susceptibility, disease course/outcome

social factors shape:

causal

Social factors have direct effects on health; Social conditions are needed to bind a person to the disease; therefore are _

effects of smoking

associated with more diseases than any health related lifestyle behavior

45%, 20%

US smoking rates declined _ in 1950s, ____ in recent decades; low SES people more likely to smoke

Hughe's 5 stages of smokign

1. becoming a smoker
2. continued smoking
3. regular smoker
4. addicted smoker
5. smoking cessation

biomedical model

every disease has a specific pathogenic origin whose treatment can best be accomplished by removing or controlling its cause using medical procedures (eg. drugs)

epidemiological transition

replacement of infectious diseases with chronic diseases as the major threat to health

3 ages of epidemiological transition theory

1. age of pestilence and famine (early time to 1800s)
-infectious/parasitic diseases
2. Age of receding epidemics (1800s-1960)
-infectious/parasitic diseases controlled
3. age of degenerative and human mode diseases (1960-present)
-chronic diseases
-social factors become more prominent; whole person
4. Age of mixed causes (present)
-chronic and emerging infectious diseases

limited success, social conditions and behavior

Limits of biomedical model for addressing chronic disease

social determinants

the condition in which people are born, grow, work, live, and age, and the set of forces and systems shaping the conditions of daily life

fundamental cause theory

social conditions can be fundamental causes of disease and mortality

fundamental cause must

1.) affect multiple diseases
2.) have multiple pathways
3.) over time
4.) access to health protective flexile resources

social conditions

factors that involve a person's relationship with other people

flexible resources

broadly useful across times and places
-when a new risk emerges, or a new protective factor is discovered, shape who benefits and who is harmed
-can limit choices 
-can expand choices

resources and contexts

individual people use resources (eg. knowledge, money) to get healthy outcomes
-resources can provide access to salutary contexts (eg. neighborhoods, occupations, marriages)

collective health agency

resource pooling where people in such contexts push for good circumstances in the context (eg. good schools, safe parks, reduced crime, good medical facilities)

bachelor degree effects life expectancy in. U.S

1.) education gap
2.) widening gap
3.) widening from BA improvement and non-BA stagnation