Wed Week 3

Fundamental Causes of Disease
Overview of the Course

  • Course title: SOC 2280 Medical Sociology

  • Week: 3

  • Date: Wednesday, 1/28

Educational Attainment and Mortality

  • Main Idea: Research demonstrates a significant correlation between educational attainment levels and mortality rates among adults in the United States.

  • Data Source: Montez, J. K., et al. (2012). "Educational Attainment and Adult Mortality in the United States: A Systematic Analysis of Functional Form," published in Demography, 49(1), pages 315-36.

    • Observations:

      • A high school degree significantly lowers the odds of mortality, indicating the importance of minimum educational standards for public health.

      • A trend exists showing that individuals who achieve more years of education experience lower mortality rates, reflecting healthcare access, lifestyle choices, and knowledge about health.

Life Expectancy Data

  • Title: Catching Up, Falling Behind - Average Life Expectancy at Age 25 by Education and Race

    • Observations:

      • Life expectancy varies markedly by educational attainment:

      • Individuals with less than a high school degree have an average life expectancy of 75 years.

      • Those possessing a high school diploma can expect to live up to 80 years.

      • Individuals with a bachelor’s degree may live an average of 85 years.

      • Data reveals pronounced disparities in life expectancy correlating with both education levels and racial demographics, emphasizing the intersection of education, race, and health outcomes.

    • Sources:

      • Case, A., & Deaton, A. (2021). Data referenced in Proceedings of the National Academy of Sciences (PNAS), and visual representation found in The Economist, published March 17, 2021

Persistence of SES Health Disadvantages

  • Key Question: Investigate why health disadvantages linked to lower socioeconomic status (SES) persist even with medical advancements and improved knowledge that could potentially reduce prevalence of leading diseases.

Contextualizing Risk Factors

  • Fundamental Areas of Inquiry:

    • Understanding why certain populations face specific health risks or possess protective factors.

    • Evaluating the conditions under which these factors affect health and influence disease progression.

Fundamental Causes Concept (Link & Phelan, 1995)

  1. contextualizing risk factors:

    1. Why are some ppl exposed to certain health risks or protective factors

    2. Under what conditions do those factors shape health/disease

  2. Fundamental causes can be understood as the underlying social conditions that drive health disparities, emphasizing the need to address these root causes to effectively improve public health outcomes. For instance, socioeconomic status, education, and access to healthcare are critical components that determine individual and community health, thus highlighting the importance of policy interventions aimed at reducing inequality. By recognizing these fundamental causes, public health initiatives can focus on creating equitable resources and opportunities that promote health and well-being across all populations.

  • Definition of Fundamental Cause:

    • A social condition that embodies access to a set of flexible resources that can be leveraged, enabling individuals to mitigate risks and adopt strategies to protect or improve health. The SES health connection persists because people with superior resources can continually leverage them to avoid risks and benefit from new treatments, knowledge, etc.

  • Key Features of a Fundamental Cause:

    • Affects resource accessibility, with higher-quality resources associated with improved health outcomes.

    • multiple mechanisms to evade health risks or enhance access to health protections. (there are many ways (mechanisms) that the social condition, like SES can affect health)

    • Associated with multiple health outcomes, reflecting a broad impact on population health.

    • reproduced over time via replacement of intervening mechanisms

      • enduring inequality amid change - newly pathways re-emerge as environment/knowledge changes, reproducing health disparities over time

      • Outcomes, risks, knowledge of risks, and treatments must all change over time. if not dynamic, then not fundamental (then we could just address all the risks and no new pathways would emerge).

        E.g., Poor housing, sanitation, & work conditions often linked lower ses to leading causes of death (infectious diseases) prior to 1960. when these factors were address through public health initiatives and vaccines, one might expect the ses-health gradient to go away. However, persisted. As new leading causes and new risk factors emerged, the disparate flexible resources that across ses continued to shape exposure to risks & health outcomes. E.g., risks replace by individual risk factors like exercise & diet (both shaped by social conditions & environment), as well as exposure to stressors, access to care, etc.

        Flexible resources are the key feature that explains the persistence of the gradient over time.

        As risks/diseases change & knew knowledge or technologies emerge, higher ses or those with more social advantages in general are better positioned to learn about the risks and be able to act on protective measures

Flexible Resources

  • Categories of Flexible Resources Include:

    • Financial capital (Money)

    • Knowledge and information (Knowledge)

    • Authority and influence (Power)

    • Social status (Prestige)

    • Supportive relationships (Beneficial social connections)

    • Autonomy in health-related decision-making (Freedom)

Mechanisms for Health Outcomes

  • Multiple Mechanisms:

    • Access to nutritious food and dietary options.

    • Availability of quality healthcare services and preventive measures.

    • Safety and security in living environments to reduce stress and health risks.

    • Awareness and recognition of early disease signs, vital for timely intervention (e.g., identifying stroke symptoms).

    • Comprehensive health literacy and early signs of stroke

    • advocate to oneself in healthcare scenarios, community.

    • Trust and assurance of respectful treatment within healthcare institutions.

    • Community efforts in knowledge and resource sharing, enhancing collective health outcomes.

Policy and Intervention Considerations

  • Key Considerations for Effective Health Policies:

    • Policies must not solely address health risks but also tackle underlying factors creating those risks to promote comprehensive health improvements.

    • Strategies should affect multiple diseases as well as their determinants, integrating holistic approaches to health.

    • Must impact the distribution of flexible resources across populations, reducing inequalities and enhancing community health.

COVID-19 as a Case Study

  • Context: The COVID-19 pandemic emerged against a backdrop of existing societal inequalities, exacerbating health disparities.

  • Evolution of COVID Response:

    • Initial Mortality: Lacking key knowledge and prevention strategies led to an early high mortality rate.

      • Increasing Inequalities: Uneven diffusion of knowledge and access to effective treatments contributed to health disparities.

        • Think about how once we knew about masking, social distancing, higher ses folks were better able to buy masks, advocate for working from home, buy covid tests, or take other prevention or mitigation strategies that weren’t as available to those of lower ses.This disparity highlighted systemic issues in our healthcare system, where those from lower socioeconomic statuses often faced significant barriers to accessing these vital resources, ultimately exacerbating the challenges they had in preventing infection.

      • Reducing Inequalities: Ensuring broader access to knowledge and prevention methods may lower mortality and enhance overall health within vulnerable populations.

        • As knowledge about the disease and resources were better distributed, those with less superior flexible resources (i.e., lower ses) newly could take advantage, reducing the inequalities that emerged

      • Aim for the widespread implementation of strategies and treatment options to eradicate diseases, with a focus on equitable healthcare access.

        • Impt – even if a disparity is lessened or is eliminated (e.g., disease eradicated) for one health outcome, new risks & health outcomes will emerge and disparities will continue (this is the enduring part of the FCT). Therefore, it is crucial to continuously monitor health trends and adapt our strategies to address the evolving landscape of health disparities across different populations.

Life Expectancy by Education Level (1992-2021)

  • Data Visuals:

    • Trends indicate stark differences in life expectancy based on educational accomplishments:

      • Adults with a bachelor’s degree displayed a steady increase in life expectancy, reaching about 84 years by 2021.

      • Conversely, individuals without a degree averaged around 74 years in life expectancy as of 2021.

      • Prior to covid hitting in 2020, you see large and diverging trends related to life expectancy (how long people can expect to live) across educational attainment statuses. Those with a BA likely live longer lives, in alignment w/FCT.

        When covid hits, life expectancy drops for both groups, reflecting the really (relatively) high mortality rates across all age groups during the pandemic; however, this drop is steeper for those w/o a BA (78→ 74.8) – in other words, life expectancy drops farther, indicating that COVID had a larger impact on the lower resourced group

Childhood Poverty as a Health Issue

  • Article by Perri Klass, M.D. (May 13, 2013)

  • Main Theme: Analyzes the connections between childhood poverty and associated health outcomes.

    • Mechanisms Include:

      • Poor living conditions such as overcrowded housing, impacting mental and physical health.

      • Economic pressures leading to compromises in nutrition and poor dietary choices influencing long-term health.

      • Insufficient childcare options due to financial limitations, resulting in negative health impacts on children.

Addressing Childhood Poverty Using Fundamental Cause Theory

  • Income as a Vital Factor:

    • Increased financial resources support better parenting practices and improve health outcomes for children and families.

    • Important to implement family support systems that extend beyond mere financial assistance to include:

      • Parenting skill development programs.

      • Interventions within primary healthcare settings to address broader issues.

      • Universal access to preschool education and development resources.

  • Urgency for Pediatricians:

    • Urges the medical community to recognize childhood poverty as a vital public health concern and to move towards addressing the root causes rather than solely the symptomatic manifestations of health issues stemming from poverty.