Sociology of health lecture 4 and 5
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WHO definition of health:
state of complet physicial mental and social well being, and not merely the absence of disease
Ottawa charter for health promotion definition of health
Health is a resource for everyday life, not the objective of living. Health is a positive concept emphasizing personal resources, as well as physical capacities.
improvement in healthcare has made only a minor contribution to the massive improvementsin population health between mid 19th and mid 20th centuries in the developed world.
What are the principal drivers of reduced mortality in developed countried between mid19th century and mid20th century? How was this figured out?
increased sanitation and nutrition and social welfare
mckeown noticed that mortality was decreasing before scientific advances were made
a person's social and economic position in society exerts a powerful influence over their health throughout their life.
How is the variation in your health broken down
- 50% your life i(income, disability, race etc. )
- 25% your healthcarae
- 15% your biology
- 10% your environment (infrastructure, air quality etc. )
Define downstream determinants
- flow in part from social stratification
- determine differences in exposure and vulnerability to risk
- ex. genetics, physiology,gender
Define midstream factors
- Flow from social stratification
- ex. family environments, peers, health knowledge, beliefs, school, community
Define upstream factors
related to economic and social resources and opportunities that influence an individuals access to health promoting living, working conditions, and healthy choices
economic/political/social welfare on a national scale
WHO definitionof SDOH
conditions in which people oare born, grow, work and age. These circumstances are shaped by the distribution of money,power and resources at a global, national, and local level.
Define excess death. What does it assess?
actual deaths- predicted death
is a measure of preventable illness
When controlling for unhealthy behaviours, are lower socioeconomic status people as healthy as upper socioeconmic status people?
What are two really strong predictors of life expectancy?
education and income
Years that your parents owned their home while you were growing up is correlated with
susceptibility to cold virus
What is "control of destiny"
- unable to control events in your life leads to increased stress
- chronic streess elevation
- macaque monkeys: non-dominant monkeys had lower life expectancy even though they shared the same environment.
What is Health inequality
avoidable differencesin health status closely linked to social, economic and /or environmental disadvantage
What is the social gradient of health?
Inequalities in population health status are related to inequalities insocial status
the idea is to reduce the disparity between each quintile of classes
What is Wilkinson's hypothesis?
- mortality in developed countries is affected more by relative than absolute living standards
- indirect effects: risky behaviours
- direct effects: physiological effects of chronic stress
What is epidemiological transition?
- Increases in economic development has less influence on health outcomes after a certain point in economic development
- -country changes from disease burden to chronic disease burden because of expansion of health services"
- -thus diminishing returns on life expectancy after certain amount of economic growth
What kind of actions/tasks increase stress the most?
Tasks that threaten self-esteem or social status increase stress the most.
Is there an association between a countriy's gdp and life expectancy?
Not after a certain threshold. A Developed country's population life expectancy can be more accurately predicted by socioeconomic status
What is meant by a larger wealth gap? What other trait is this associated with?
more unequal distribution of wealth
Is associated with trust between citizens.
What is some evidence for Wilkinson's hypothesis?
- mortality more related to relative income within countries than differences in absolute incomebetween them
- national mortality rates tend to be lowest in countries that have smaller income differences, thus lower levels of relative deprivation
- long-term rise in life expectancy seems
- unrelated to long-term economic growth rates
since Wilkinson's hypothesis highlights the importance ofrelativedeprivation, psychosocial pathways may be particularly important
How has income inequality changed in Canada over the past 20 years?
- Income inequality has increased,richest increase their share while middle and lower class lost share.
- Not a single province became more equal over the past 30 years
- richest 1% make 15% more than average Canadian
- not a significant problem in Canada overall
- but very high in Nunavut and other territories
What is the relationship between immigration and education?
The higher the education of immigrants, the greater the disparity between employment rates of immigrants and non-immigrants
How has wealth gap in toronto changed? What are areas of low socioeconomic status correlated with?
- Increase in low income share, decrease in middle income share
- wealthier areas=lower diabetes=greater distance to grocery stores=greater concentration of fast food
What is "accumulation of factors"
SDOH accumulate over the course of a lifetime to affect an individual
What can pharmacists do to help with SDOH?
- Medication therapy
- disease state manager
- public health advocate
- increase awareness of disparities
- more diverse health care force
- promote culturally competent care
- effective communication between HCP and patients
- multi-disciplinary teams + EBM
- collect and monitor data on health disparities
- research health disparities
Describe the RX Help: house calls for better health video
- patient's dont know how best to take meds or concerned about side-effects
- community health worker addresses their concerns (ppl intimidated by pharmacists); helps to reduce preventable drug related morbidity
Bigger income gaps lead to deteriorations in three main areas:
- human capital
- social relations
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