Discussion questions 2

Definitions

What is social epidemiology and its main concepts?

• Social epidemiology: branch of epidemiology that looks at the distribution and determinants of health and disease in populations and focuses on socio-structural factors

• 4 main features of social epidemiology

  1. It takes a population-level perspective → considers society as a whole

  2. It analyzes the social context of behaviour → relationships between individual- and collective-level variables and how it determine opportunities/constraints

  3. It relies on multi-level analysis

  4. It takes a developmental-life course perspective → time, life stages, life experiences…

• It claims that the distribution of health and disease in a society reflects the distribution of advantages and disadvantages in that society

What is the bio-psychosocial paradigm?

• Bio-psychosocial paradigm: the multi-level interactions with environments determine human biology

  • Human biology is more than just the sum of individuals

What were the Whitehall studies?

• These prospective cohort studies investigated the determinants of health among British public employees

  • Main findings:

    • There are large differences in health between employment grades → health gradient

    • Risk factors like smoking and inactivity were more common among lower-paid and lower-status employees

    • Individual risk factors don’t account for the size of the differences in health between employment grades

    • Part of the health gradient can be attributed to job factors, and the most important factor is the degree of control employees have over their work (less autonomy = worse health)

• Implications for understanding causes of poor health

  • Having a lower status or employment grade is related to poorer health

  • Job factors (included in social context) are important in determining poor health outcomes

What is the health gradient?

• People who are less advantaged in terms of socioeconomic position have worse health and shorter lives than those more advantaged

What is social selection theory?

• Social selection theory: argues that a person’s health status determines their social class

  • Having poor health → low social status

What is the materialist theory?

• Materialist theory: argues that the absolute resources available to individuals determine their health

  • More income, education → better health

• Concept of diminishing marginal returns:

  • At a certain point, additional resources will not make a difference in improving one’s health

    → So you can donate these resources to less well-off people so that it improves their health

What is the neo-materialist theory?

• Neo-materialist theory: argues that the absolute resources available to individuals determine their health, but also considers communal and public resources and tax policy

What is the psychosocial theory?

• Psychosocial theory: argues that more societal inequality leads to worse health for those lower in the hierarchy

  • Relative deprivation of resources + inequality → no cooperation and solidarity → low-social status individuals feel less secure → elevated stress and effects on biology → worse health outcomes

What is the concept of biological embedding?

• Biological embedding: process by which early life experience alter biological processes and affect adult health outcomes

  • It occurs when:

    • Experience alters human biological and developmental processes

    • Systematic differences in experience in different social environments in society lead to systematically different biological and developmental states

    • These differences are stable and long term → persistence over time

    • These differences influence health, well-being, learning, or behaviour over the life course

What is the inequality hypothesis?

• According to Preston: a country’s GDP correlates strongly with life expectancies in poorer countries but very weakly with life expectancies in richer ones

  • Absolute income is the main consideration for life expectancy in poorer countries

  • The distribution of available income (inequality, relative) is the main consideration for life expectancy in richer countries

  • The Preston Curve: there is a curvilinear relationship between income and life expectancy

    

• According to Rodgers: there is a correlation between infant mortality and country-level income inequality

  • For life expectancy:

    • The relationship between income and life expectancy at the country level is roughly linear

    • The relationship between income and life expectancy at the individual level is asymptotic

• According to Kaplan: the income share of the lower half of the income distribution is strongly associated with the state-level mortality rate

• According to Wilkinson:

  • Income distribution is a marker of how unequal a society is

  • The size of income inequalities reflects how hierarchical the society is

  • Big differences between individuals across society will diminish social capital and cause social breakdown

  • Chronic stress will be generated among the less well-off because they perceive their situation to be that of inferiors due to competition → affects health through biological pathways

What is the difference between proportional and progressive taxation?

What is residualism and neoliberalism?

• Residualism: A government must not be involved in matters associated with individuals or households unless there is no other party (e.g. NGOs) willing or capable of addressing the need

  • Government intervention should only occur as a last resort

  • Government intervention should be as limited as possible

• Neoliberalism: drive to make the government’s footprint smaller

• Policy implications for health:

  • Responsibility falls on NGOs and other organizations to support individuals and their health

Readings

What are the main arguments of Nancy Ross et al.?

• Variations in the equality of the income distribution are associated with mortality

• Canada vs. USA:

  • There is no significant association between income inequality and mortality in Canada, both at the provincial and metropolitan area levels

  • There is a significant association between income inequality and mortality in the USA, both at the provincial and metropolitan area levels

• 2 possible reasons for the differences between Canada and USA:

  • The relation between income inequality and mortality is non-linear

  • The relation between income inequality and mortality is not universal but instead depends on social and political characteristics specific to place → context matters

What are the main arguments of Wilkinson & Pickett?

• Large income differences between rich and poor cause increasing frequency of most of the problems associated with low social status

What are the main arguments of Angel and Lein?

• The formal social service safety net (governmental) for low-income families is precarious and unstable

• Many low-income families therefore depend on secondary service providers such as NGOs and other organizations for their health

  • However, these organizations have many disadvantages:

    • They function in ways that are ineffective or uncoordinated

    • They don’t have full responsibility

    • They don’t have enough resources to help those with more difficult/long-term problems

    • They may be biases towards certain types of clientele

Critical thinking questions

1. How might the materialist theoretical orientation influence thinking about taxation and social programs?

2. Alternatively, how might the psychosocial orientation influence policy considerations?

3. Where would the 2 theories lead to similar conclusions? Where would they yield different assessments of the outcomes of policies?

4. Based on your current understanding, and the ideas presented in this chapter, do the reduced-health prospects of the indigenous peoples in Canada arise mostly from racism and social exclusion or from poverty and its correlates?