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94 Cards in this Set
- Front
- Back
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Social Determinants of Health
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The factors that affect the chances that groups of people will have to lead health lives.
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Sociology According to Allan G. Johnson
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The study of individuals and society and how they are related to each other.
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Normative
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Concerns how things should be, how they ought to be, rather than how are actually.
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Public Health
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A normative field of study and profession. Concerned about how things should be not how they actually are.
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Individualism
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Society is a collection of individuals.
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Consequences of Individualism
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Blame individuals for problems and expect individuals to fix the problems.
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Problems with individualism
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Ignore the relationships that are made in-between people. Personal solutions can't solve social problems.
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Rob Baggott
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Public Health refers to the health of a population, how long they live and how free of disease they are.
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Institute of Medicine
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What we can do to make public health better as a society. For example legislation, public policies, city design and vaccinations.
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Main Goals of Public Health
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Improve the average health by preventing disease and preventable death. Interested in the upstream causes not the immediate fixes.
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Looking at Public Health
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The Patient is the population; save "statistical" lives. Health benefits to the population does not equal health benefits to the individual. Requires strong government willing to act.
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Paternalism and Paternalism in Public Health
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Not giving the person full freedom to protect them more. Paternalism in Public Health: minor limits on freedom for the greater good of society.
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Public Health Ideology (Collectivist and Socialist)
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Think that the state has a very important role in maintaining the health of the population. Limiting the effects of capitalism. "positive" liberty freedom to do things -state ensures basic needs - income, education - enabling citizens to fully participate in society.
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Neo-Liberal Ideology
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The role of the market in promoting individual freedom; social goods secondarily. Limiting the role of the state.
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Key Words for Neo-Liberalism
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Freedom, self-determination, self-discipline, personal responsibility, limited government; tax cuts, consumer choice, and the market (the Center for consumer freedom)
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Geoffrey Rose (Paradox)
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A bunch of people exposed to a small amount of danger could be worse than a small amount of people exposed to a large danger. The causes of individual illness may not be the causes for the majority of the illness
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What is Health
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Negative definitions - disease oriented, medical approach. Positive definitions - holistic, social models (underlying causes).
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Negative Understandings of Health
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They are healthy is there is an absence of disease or illness. Biomedical understanding of health.
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Problems with Dominant Biomedical model of Health
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There is more attention to disease than health (promoting health).
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Social, Holistic or Positive Model of Health
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Health as a positive state, health is more than just the absence of disease, focus on what facilitates health, consider the whole person, and the biological processes located within the broader context
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World Health Organization's (WHO) definition of health
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State of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.
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Social Determinants of Health
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Poverty, racism, working conditions, trade agreements, social security, job security.
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Public Health Agency of Canada definitions
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Health is not necessarily how biological sound you are it is more how you are in total. The capacity of people to adapt to, respond to, or control life's challenges and changes.
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"Lay" Understanding of Health
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How normal people understand health
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Examples of "Lay" Understanding of Health
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Absence of illness. Being able to carry out everyday responsibilities.
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Health from Aboriginal Perspectives
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Wholistic. Incorporates spiritual, intellectual, physical, emotional dimensions of life. Inter-generational. Exists on multiple levels - individual, family, community, and nation. Encompasses cultural, social, economic and political spheres. Aboriginal Medicine Wheel.
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How to Measure Health
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Life expectancy/longevity. Infant mortality rates. Diseases.
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Historical Roots of Public Health
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Louis Villerme (1782-1863). Friedrich Engels (1820-1895). Rudolf Virchow (1812-1902). Edwin Chadwick (1800-1890). John P. Snow (1813-1858
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Louis Villerme
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French economist and statistician.
Demonstrated a near perfect fit between neighbourhood mortality and relative poverty; protested against child labour in manufacturing. Recommended improving school and working conditions to improve health. |
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Friedrich Engles
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German political philosopher.
All conceivable evils are heaped upon the poor. He examined nutrition and alcoholism. He concluded that capitalism forced working-class people to live and work under circumstances that inevitably caused sickness and early death. |
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Rudolf Virchow
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Concluded that material conditions of life can either make people either healthier or worse health.
Disease, disability and early death generated through poverty and political disenfranchisement. He recommended; increased employment, better wages, local autonomy in government, agricultural cooperatives, a more progressive taxation structure. Welfare. |
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Edwin Chadwick
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English social reformer.
Author of The Sanitary Conditions of the Labouring Population of Great Britain. Said that clean water, sewers and adequate housing required to prevent the spread of infectious disease (first Public Health Act 1848 |
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John Snow
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English physician.
Leader in the adoption of anaesthia and medical hygiene. Founder of epidemiology. Sanitation Immunizations |
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Canadian Contributions to SDOH
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LaLonde Report
Epp Report Ottawa Charter for Health Promotion The concept of Population Health |
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LaLonde Report
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First official Canadian recognition that health depends on more than the health care system
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Social Justice
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Everybody is treated fairly and share in society's benefits; a fair distribution of advantages/disadvantages
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Epp Report
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Three Challenges in improving Canadians' health
1. Reducing health inequities 2. Increasing prevention efforts 3. Enhancing people's capacity to cope It proposed that health promotion become a conerstone of the Canadian health system |
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Ottawa Charter for Health Promotion (1986)
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Birth of the new public health - emphasis on health inequities, broad social factors
Prerequisite for health - peace, shelter, education, food, income, a stable economy, and social justice and equity. Health Promotion Actions - Advocating - for health and for the conditions that promote health. Enabling - all people to meet their fullest health potential. Mediating - between competing interest and coordinating action among various sectors. |
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Tobacco Public Health
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Single largest cause of preventable premature death in industrialized countries.
Associated with higher rates of cancer; heart disease; stroke; lung disease; hypertension; peripheral vascular disease. Estimated 100 million premature deaths worldwide in the 20th century Lung Cancer |
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Why have rates gone down?
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Comprehensive, multi-faceted PH efforts have enabled people to quit
Requires individual action, but the personal, social, political, and economic context matters |
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Smoking in Canada
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Provinces are suing tobacco companies for health-care costs related to smoking
9/10 smokers start smoking before becoming of age Considered as addictive as heroin |
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Stuff that the Tobacco Industry Has Done
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Said that nicotine was not addictive
Said theres no link between cancer and smoking Basically just lied a lot and tried to say that smoking wasn't bad for you |
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Smoking and Social Justice
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In lower income countries there is less info about how bad smoking really is for you.
Advertisements are targeted to lower income groups. For lower income it is harder to get the resources needed to be able to quit smoking. |
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Seven Ethical Principles
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Free and informed consent
Respect for vulnerable persons Respect for privacy and confidentiality Respect for justice and inclusiveness Balancing harms and benefits Minimizing harm Maximizing benefit |
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Whitehall Studies
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Done by Sir Michael Marmot
2 longitudinal, epidemiological studies of civil servants in the UK prospective survary design |
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Whitehall I
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18,000 men age 40-64 screened
Classified into 4 grades of employment, administrative. professional and executive and clerical Found: 3-fold difference in mortality between lowest and highest employment grades Higher cardiovascular disease mortality among those in lower groups who didn't smoke compared to those in higher groups who did smoke Known risk factors only explain a 1/4 of why these health disparities exist Suggests that early life influences the rest of your life |
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Whitehall II
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Included social support, personality measures.
4 Main Findings 1. People at the bottom had a higher risk of heart attack than people at the top 2. There is a gradient in health 3. Gradient applies to all major causes of death 4. The classic risk factors don't account for everything |
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Explanations for the Whitehall Studies
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Early life influences
Differences in health behaviours Social circumstances (housing, social support) Work environment (control; skill level; variety) |
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Conclusion from the Whitehall Studies
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We need to pay more attention to job design, social environments, and the consequences of income inequality - to improve overall health, we need to decrease social hierarchies and improve people's control over their lives.
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Themes in Unnatural Causes
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Our health is shaped by economic, social and built environments
Those in lower class positions are exposed to more health threats and have less access to opportunities and resources to control their destinies. People in higher class positions have access to more power and resources and live longer healthier lives. Chronic stress wears down our organs over time and increases disease risk Racism threatens health (independent of class) |
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Income inequality in Canada
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Income for the lowest is falling whereas income for the highest is rising.
Tax policy and social programs can moderate market income inequality |
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Costs of Poverty
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Direct costs (social assistance)
Indirect costs (homelessness) Societal costs (wasted potential, lost tax dollars) Human costs (indignity, humiliation, shame guilt...) |
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Poverty as a SDOH
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Messes up early development, because they are more likely to have low birth weight, asthma, diabetes, malnutrition.
Less likely to have drug plans to get the correct medication. Poorer access to nutritious food. More likely to experience addictions, poor mental health, chronic illness, and premature death. |
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Basic Income
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Financial benefit that is universal unconditional and adequate to ensure a decent life.
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Benefits of a Basic Income
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Recognition of unpaid labour (domestic, volunteer)
More flexible labour force Enhances consumer purchasing power Potential to end poverty and limit the disparity in wealth |
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Downsides of a Basic Income
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Loss of labour force attachment and non-monetary benefits
Downward pressure on wages Less incentive to get a job |
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Mincome Experiment
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War on Poverty, expansion of the welfare state.
People appear to live healthier lives when they don't have to worry about making ends meet keeping a roof overhead, feeding their families, having a sense of dignity. |
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Effects of Income Inequality
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Greater social status differences, more authoritarian relations.
Worsening relative poverty. Deteriorating quality of family relations and early childhood Leads to stress, depression, and general bad things. |
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Food insecurity
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When people to not have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life.
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Impact of food insecurity on health
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General poor health.
Mental health problems. Physical limitations. Multiple Chronic conditions. Academic and socio-behavioural problems |
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Examples of Food Insecurity in Canada
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Profound lack of food choice.
Lack of control over what foods you eat. |
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Food Banks
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Began in 1982 because of unemployment, high poverty and Canadians going hungry
Was ment to be a temporary solution. |
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Charity
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Different ways of giving.
Jewish Tradition: 8 levels of giving |
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Pros of Charity Model
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Avoids food waste.
Give people food that they can use. Provides opportunities for outreach, education. |
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Cons of Charity Model
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Lack of dignity.
Very dependent on volunteers and donations. Not always the most nutritious food is given out. More of a bandaid solution. Undermines the governments role in poverty. Creates a divide of "US" and "them" |
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The Barker Hypothesis
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Poor nutrition, health and development among girls and young women is the origin of high death rates from cardiovascular disease int the next generation.
Heart disease is linked to low birth weight Low brith weight results from the mother's lifetime nutrition, not what mother has eaten each day in pregnancy |
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Impact of Racism
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Shown to have direct health effects - stress, hypertension
Indirect health effects through poverty, underemployment, poor housing, poor neighbourhoods. |
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White Privilege
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Unearned. mostly unacknowledged and invisible benefits and advantages that come with having white skin in a white-dominat society.
Confers dominance because of skin colour. White people benefit from living in a racist society. |
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Colonialism
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A practice of domination, which involves the subjugation of one people to another.
Exploitation by a stronger country of weaker one; the use of the weaker country's resources to strengthen and enrich the stronger country. |
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Residential schools
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Key instrument of colonization - a deliberate attempt to destroy Aboriginal people's economic and political system, cultures and religions
Assimilation Attendance was mandated by law Racism |
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Colonial Trauma
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Cumulative emotional and psychological wounding spanning generations, which is the result of massive group trauma.
Intergenerational Also ongoing and current |
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Results of Colonial Trauma
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Changes in social structures and relationships
Impairment of community development and economic development PTSD Identity problems Depression, lack of hope, anger gone underground Substance abuse |
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Cultural Stress
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Product of historical colonial relations
Loss of land, language, traditions, culture, spirituality, and autonomy |
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Cultural Continuity
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Perserving your culture.
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The Tipping Point
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When an idea, trend, or social behaviour crosses a threshold and spreads like wildfire.
Social epidemics |
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Global Health
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Global distributions of power, wealth and resources intertwined with international distribution of disease,social determinants of health and access to health promotion and health care
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Globalization
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A pattern of transnational economic integration animated by the ideal of creating self-regulating global markets for goods, services, capital, technology, and skills.
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The Eight MDG
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Eradicate extreme poverty and hunger
Achieve Universal Primary Education Promote Gender Equality and Empower women Reduce child mortality Improve maternal health Combat HIV/AIDS, malaria and other diseases Ensure environmental sustainability Develop a global partnership for development |
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Internal Factors for Global Health Inequities
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Inadequate public health services and medical care
Extreme poverty Discrimination against women, indigenous peoples, racial and ethnic minorities Unrepresentative, unaccountable and corrupt governments Failure to protect human rights |
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External Factors for Global Health Inequities
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Debt
Structural adjustment programs Trade barriers Export of hazardous gods from developed to developing countries Inadequate financial and technical assistance from developed countries Arms trade High cost of drugs and vaccines needed to treat and prevent serious and widespread diseases |
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Short Term Dangers of Climate Change
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Death - flooding, fires....
Lack of access to medical care Power outages - food spoilage |
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Long Term Dangers of Climate Change
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Mental health - trauma
Water pollution Damage to hospitals |
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Adverse health outcomes of climate change
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Changing patterns of disease and mortality
Food Water and Sanitation Shelter and human settlements Extreme events Population and migration |
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Paul Farmer
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Pioneered the treatment of multi-drug resistant tuberculosis
Community based approach to health-care |
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Partners in Health
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Bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair
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We have a strong moral obligation to help those in need
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1. Suffering and death from lack of food, shelter and medical care are bad
2. If it is in your power to prevent something bad from happening, without sacrificing anything nearly as important, it is wrong not to do so 3. By donating to aid agencies, you can prevent suffering and death without sacrificing anything nearly as important 4. Therefore, if you do not donate to aid agencies you are doing something wrong |
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Inequity in Health
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Unfair, avoidable differences arising from poor governance, corruption or cultural exclusion
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Inequality in Health
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Uneven distribution of health or health resources as a result of genetic or other factors or the lack of resources
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The One Thing Sociology has to offer
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Can help us understand that we are participating in something larger than ourselves.
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Focus of Public Health through most of the 20th century
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Sanitation. Food regulation. Immunizations. Health education (especially mothers and children).
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Collectivist views on social justice
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Equality of outcomes and economic egalitarianism achieved through income or property redistribution
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Neo-liberists views on social justice
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Equality of opportunity achieved through the market
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Poverty According to Hugh Segal
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Not having enough money to live with dignity, self-respect, and hope
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Peter Singer
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Strong moral obligation to donate to the poor.
At least 1 percent of salary. |
