PSYC 592 exam 1 class slides

internalized ableism

-"a practice where disabled people internalize the ideas and prejudices of society that see disability as 'other', as something undesirable, as tragic as something to be shunned if not pitied. this in turn results in the disabled person loathing themselves" -this can occur in any aspect of life and is often more damaging -this is a form of ableism that can creep up in unpredictable ways even around people you are comfortable with

criticisms of psychology from disability perspectives: assumption #5: disability as perpetually in need of help

-"handicapped role" -a PWD is compelled to suspend all other activities until recovered and to concentrate on getting expert therapy, to follow instructions, and to get well in order to resume a "normal life" -ex: nondisabled P's gave least amount of help to a seemingly competent PWD than to either a perceived incompetent PWD or a nondisabled control

the tangible impact of ableism

-"living in a world not built for me" -assumptions about intellectual capacity and physical limitations -ignorance and lack of care by others: --bathroom --parking spots --inaccessible areas --comments ---"watch out for that wheelchair!" --depersonalization

stereotyping misconceptions: stereotypes as "pre-stored"

-'stored pictures in our heads' -how could they be fixed and stored when they are contextual representations based on particular categories? --fit with particular group realities --amend to ensure a meaningful inference --flexible and constructive --stability of stereotype is due to stability of group relations

global disability data and statistics: key figures

-15% world population -80% live in developing countries -150 million children living with a disability, less likely to attend school and have lower rates of staying and being promoted in schools -approximately 20 million women become disabled each year as a result of complications during pregnancy or childbirth

medical advances vs. disparities (1991-2000)

-176, 633 deaths averted due to declines in mortality -assume all the decline is due to medical advances -if the death rates of blacks and whites were identical, 886, 202 deaths would have been averted -5 deaths could be averted by reducing disparities for every life saved by medical advances -eliminating disparities in health would save more lives than current advances in medical technology

place, race and opportunity structures: neighborhoods and access to opportunity

-5 decades of research indicate that your environment has a profound impact on your access to opportunity and likelihood of success -high poverty areas with poor employment, underperforming schools, distressed housing and public health/safety risks depress life outcomes ---a system of disadvantage ---many manifestations (urban, rural, suburban) -people of color are far more likely to live in opportunity deprived neighborhoods and communities

education (key domain of social determinants of health)

-HS graduation -enrollment in higher education -language and literacy -early childhood education and development -quality of education

persons with disabilities conclusion: key messages

-PWD account for approximately 15% of the world population, i.e. more than 1 billion people -80% of people with disabilities live in developing countries -there is a strong link between disability and poverty -any effort to reduce and eliminate poverty can only be effective if takes people with disabilities into account, who are among the most vulnerable groups -it is important to consult with PWD directly to understand their situation and better meet their priorities

forms of discrimination: transportation

-PWDs have disproportionately high need for public transportation -in 1990 only one-third of public buses were accessible -handi-vans still segregate

what is the evidence that physician biases and stereotypes may influence the clinical encounter? pt. 2

-Rathore et al. (2000): found that medical students were more likely to evaluate a white male "patient" with symptoms of cardiac disease as having "definite" or "probable" angina, relative to a black female "patient" with objectively similar symptoms -Abreu (1999): found that mental health professions and trainees were more likely to evaluate a hypothetical patient more negatively after being "primed" with words associated with African American stereotypes

conclusion of SES disparities

-SES can't be removed, but we have to act to reduce their effects on health -equality can't be achieved, but equity within health *must* be achieved

what is the evidence that physician biases and stereotypes may influence the clinical encounter?

-Van Ryan and Burke (2000): study conducted in actual clinical settings found that doctors are more likely to ascribe negative racial stereotypes to their minority patients. these stereotypes were ascribed to patients even when differences in minority and non-minority patients' education, income, and personality characteristics were considered -Finucane and Carrese (1990): physicians more likely to make negative comments when discussing minority patients' cases

life course theory (LCT)

-a conceptual framework that helps explain health and disease patterns--particularly health disparities--across populations over time -is also community (or "place") focused, since social, economic and environmental patterns are closely linked to community and neighborhood settings

diversity science: how is it done? colorblindness

-a conscientious effort to ignore difference, emphasize sameness, and attempt to assimilate into a unifying category -has become a political resource for privileged groups to evade conversations of inequality and attempt to assimilate minority groups into the "superordinate" (dominant) identity -reflects perspectives of the majority/dominant group rather than the minority/oppressed group--justifies the status quo

defining policy

-a decision made by an authority about an action--either one to be taken or one to be prohibited--to promote or limit the occurrence of a particular circumstance in a population -in the public sector, the authority charged with making policy is a legislative, executive, or judicial body operating under the purview of a federal, state, or local public administration

way to build inclusive, healthy places for all #1: know the neighborhood

-a first step for planners is to invite everyone within a community to help map conditions, strengths, and resources -public data sets, resident surveys, and observation can help identify what to build on and what needs changing

internalized racialism and health (Jerome Taylor and colleagues)

-a high score on internalized racialism was related to: 1) higher consumption of alcohol 2) higher levels of psychological distress 3) higher levels of depressive symptoms

key domains of the life course theory (LCT): examples of protective factors

-a nurturing family, a safe neighborhood, strong and positive relationship, economic security -access to quality primary care and other health services, and access to high quality schools and early care and education

social identity approach: social identity theory pt. 2

-a person's self-concept is derived in part from that person's group memberships and the emotional end evaluative importance granted to such group memberships -people will be motivated to maintain positive social identities as a source of psychological well-being -achieving this goal requires making favorable comparisons with relevant outgroups --minimal group studies: all about the distinctiveness

ableism: also known as disability oppression

-a pervasive system of discrimination and exclusion of people who are differently abled -examples of these are visible and invisible: physical, mental, emotional differences

accommodation (dimensions of health care access)

-ability to accept patients when they need to be seen -communication (email, phone) -technology (central data/access)

engaging in social competition: self-worth

-ability to accomplish and participate in self-and other important tasks -depends on the belief that persons experiencing disability are the same worth as persons not experiencing disability -belief that PWDs can be productive members of society and PWDs are artificially undervalued in society

impact of poverty on disability: causes

-about 80% of disabilities have causes associated to poverty -it is estimated that 100 million people in the world acquired a disability due to malnutrition

culture also affects health in other ways, such as:

-acceptance of a diagnosis, including who should be told, when and how -acceptance of preventive or health promotion measures (vaccines, prenatal care, birth control, screening tests, etc.) -perception of the amount of control individuals have in preventing and controlling disease -perceptions of death, dying and who should be involved -use of direct vs. indirect communication. making or avoiding eye contact can be viewed as rude or polite, depending on culture

caveats of health care

-access (ex: insurance status, ability to pay for healthcare) is one of *the* most important predictors of the quality of healthcare across racial and ethnic groups -it is difficult--even artificial--to separate access-related factors from social categories such as race and ethnicity -the bulk of research on health care disparities has focused on black-white differences--more research is needed to understand disparities among other racial and ethnic minority groups/intra-group differences

health and health care (key domain of social determinants of health)

-access to health care -access to primary care -health literacy

neighborhood and built environment (key domain of social determinants of health)

-access to healthy foods -quality of housing -crime and violence -environmental conditions (grass, trees) -exposure to toxic substances -physical barriers (disability)

impact of prejudice on PWD: prejudice and discrimination against persons with disabilities result in a lack of:

-accessibility to economic and educational opportunities -inadequate medical care -and exclusion from social interaction -this lack of accessibility leads to poverty, social isolation, and political powerlessness

raising public awareness about discrimination against people with disabilities: individuals: encourage people with disabilities to:

-acknowledge the act of discrimination -challenge it openly -ask for equal treatment -form networks -ask for support from the organization which represents them -inform media -start a blog -if need be, go to the courts

engaging in social competition: pride

-acknowledgement of one's status as a person who is physically or mentally different than others and who experiences disability because of this difference -antithesis of passing -passing risks furthering beliefs that disability is somehow negatively different from able-bodiedness -revalue disability and overturn the tragedy model of disability

why social determinants of health? (part 2)

-acknowledges that we need to take a multidisciplinary approach to achieve health equity -draws our attention to the specific characteristics and the routes by means of which the social conditions affect the health, which they can be altered through documented actions -these social processes and conditions are essential factors that determine limits or exert pressures, although without being necessarily determinist in the sense of a fatalistic determinism -it is a departure from efforts to address a single disease and causes. this helps us to look beyond the individual -however, they are not fixed nor do they suggest that a person is doomed by their fate or that the causes of the social conditions leading to ill health is inevitable

major principles of adjustment

-acquisition and reaction to disability are not uniformly disturbing or distressing and do not necessarily result in maladjustment -reactions to disability are not related in a simple way to the physical properties of disabilities--no different than what would occur under equally weighted psychological stress

unequal treatment

-across virtually every therapeutic intervention, ranging from high technology procedures to the most elementary forms of diagnostic and treatment interventions, minorities receive fewer procedures and poorer quality medical care than whites -these differences persist even after differences in health insurance, SES, stage and severity of disease, co-morbidity, and the type of medical facility are taken into account -moreover, they persist in contexts such as medicare and the VA health system, where differences in economic status and insurance coverage are minimized

major principles of adjustment: coping

-active and independent -emphasize participation and engagement; promote meaning and life satisfaction -focus on assets and intrinsic qualities -no devaluation of self, skills, or limits -work to alter or eliminate physical and social barriers -negative aspects of daily life are deemed manageable -understanding and accepting of limitations -seek helpful medical procedures, assistive devices or helpers

what does it mean to be an ally: advantaged group ally (AGAs)

-advantaged group activist who are committed participants in action to improve the treatment and/or status of a disadvantaged group --can be a variety of disadvantaged groups or a particular disadvantaged group -generally conceived as dominant group members who work to end prejudice in their personal and professional lives, and relinquish social privileges conferred by their group status through their support of non-dominant groups

misguided activism: dependency oriented help

-advantaged group is helping to provide the full solution for the disadvantaged group's problem --taking over work that could be done by members; become spokesperson; give unwanted or unneeded advice

the "identity" problem continued

-advantaged group may seek to change the content of the group to one of common group identity (anti-racism) --this "common in-group" is often dominated by advantaged sub-group -recommendation to be conscious of one's advantaged group identity as a way of maintaining awareness of privilege and encouragement to confront their ingroup members

how could education affect health (educational attainment): work

-affects: working conditions; work-related resources; income

take home message regarding health

-all experiences, including health, are patterned -the way that society/societies are organized and structured influences people's daily experiences and life changes -social structures and organization are not inevitable or natural

unequal access example: ethnicity and analgesia: a chart review of 139 patients with isolated long-bone fracture at UCLA emergency department (ED)

-all patients aged 15 to 55 yrs, had the injury within 6 hours of ER visit, had no alcohol intoxication -55% of Hispanics received no analgesic compared to 26% of non-Hispanic whites -with simultaneous adjustment for sex, primary language, insurance status, occupational injury, time of presentation, total time in ED, fracture reduction and hospital admission, Hispanic ethnicity was the strongest predictor of no analgesia -after adjustment for all factors, Hispanics were 7.5 times more likely than non-Hispanic whites to receive no analgesia

possible interventions: infrastructure

-all projects involving infrastructure and transportation, construction, reconstruction and/or reform of the building environment, as well as services rendered to the public should be planned and implemented under the principle of inclusive design -all projects with private sector should take into consideration persons with disabilities and their families among their regular beneficiaries -projects related to tourism should take persons with disabilities into consideration to address new growing markets such as tourism for older persons and social tourism

possible interventions in human development

-all projects related to education, health promotion and social protection should consider persons with disabilities and their families among their regular beneficiaries -all projects involving construction, reconstruction and/or reform of school, health facilities and social protection services rendered to the public should be planned and implemented under the principle of inclusive design

possible interventions in human development continued

-all teacher training programs and activities to promote/enhance quality in education should have an inclusive education component -all health reform projects should have inclusive components (ex: appropriate services, equipment in primary health care level, and training of health personnel on community based rehabilitation approaches -all health and youth projects should include persons with disabilities and their families among their focus groups and as their direct beneficiaries

possible interventions in environment and social development

-all the environmental and social assessments should include disability indicators -all projects involving gender, indigenous peoples, involuntary resettlement, social participation and inclusive governance (among others) should take into consideration disabled people and their families among their regular beneficiaries -studies, resources and materials directed to civil society and the public in general should include disability issues and should be available in accessible formats (braille, audio, sign language, etc.) -training and meetings involving civil society should include persons with disabilities and be held in accessible sites

physical (built) environment pt. 2

-all things created or modified, serving human needs, wants, and values, helping humans manage the natural environment to increase comfort and well-being, and shaping the physical and social environment within which humans function -impacts virtually all aspects of human existence and quality of life, is ubiquitous, subtle, and often "invisible" with the result that it impacts mental health in ways that are often overlooked, and therefore, unaddressed

summary: impact of culture on health

-along with other determinants of health and disease, culture helps to define: 1) how patients and health care providers view health and illness 2) what patients and health care providers believe about the causes of disease 3) which diseases or conditions are stigmatized and why 4) what types of health promotion activities are practiced, recommended, or insured

broad determinants of health policy: political system

-although a democratically governed country is more likely to develop health policies that reflect public interest (officials are publicly elected and presumably represent the electorate's interests) -the process of policy development is typically more difficult in democratic systems than in single-rule governments not only because the development of legislation in a democracy is arduous but also because the public's interests are rarely coherent

creating healthier neighborhoods

-although the links between neighborhoods and health are complex, overwhelming evidence indicates that neighborhoods influence health in important ways -children may be particularly vulnerable to unhealthy conditions in neighborhoods, with consequences for health in childhood and later in life

supportive contact: communicating support

-ambiguity of support can raise doubts as to the legitimacy of collective action against the advantaged group -what are some barriers to communicating support? what might help such barriers?

work stress (the #1 factor among employment, working conditions and occupational health)

-amount of a person's perceived control over demands at work, their work satisfaction, perceived levels of physical risk, and job insecurity -work stress affects more women, which coincides with other determinants such as income -low income paying jobs report high rates of stress due to: job insecurity; dissatisfaction; insubordinate position -there's a mismatch between work effort and reward: jobs that demand high effort for low gain produce feelings of strain that predict poor health

diversity science: how is it done? multiculturalism

-an attempt to value and even celebrate identity differences -more outward focus, more positive, other directed comments ---closer sitting distance and higher salary assigned in category conscious as opposed to category-blind model ---less racial bias and greater acceptance and openness to others -greater perspective taking and preparation for the expectation of difference -more psychological engagement from minority group members in the workplace

generalizability of unconscious bias

-an important characteristic of social interaction across a broad range of cultures and societies where individuals are characterized into social groups -in the US, race, sex and age are the 3 primary characteristics of individuals that are attended to across a broad range of social contexts

transportation as social determinants of health

-another aspect of our built environment that impacts health is transportation choice -a network of multi-modal options, rather than automobile dependency -infrastructure and services that provide independence

definition of disability

-any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being -ex: walking, seeing, hearing, speaking, breathing, learning, performing manual tasks, caring for oneself, working, sitting, standing, lifting, reading

stereotypes

-are oversimplifications of a group's characteristics -can be based on some factual elements but are not generally applicable to an entire cultural group -it would be accurate to say that there are many African Americans who are rappers or who play professional basketball -saying that all African Americans play basketball and listen to rap would be stereotyping

stereotyping misconceptions: stereotypes as invalid

-are we actually misrepresenting what is really 'out there' in the world when we stereotype? -is there a "kernel of truth" in those stereotypes? -categorizations are a reflection of the moment to moment reality of the person --reflect the relative reality of the intergroup moment --just moving to the level of the individual doesn't make it more real

global situation

-around 150 million adults experience significant difficulties functioning -disability prevalence is increasing -disproportionately affects vulnerable populations: women, older people and poor households

critiques of the life course theory (LCT) continued

-as LCT continues to evolve, one way of addressing these critiques is to place greater emphasis on the concept that the development of health over a lifetime is an ongoing, interactive process and that *pathways are changeable* -an individual's health status results from the interaction *throughout life* of genes, experiences and exposures, and individual choices ---it is possible, therefore, to intervene to improve protective factors and reduce risk factors throughout life

race and health recommendations pt. 2

-as research on the human genome moves forward, we also need major new efforts to provide comprehensive, detailed, and rigorous characterization of the risk factors and resources in the social/physical environment that may interact with biological predispositions to affect health risks

stereotyping misconceptions: stereotype irrationality

-assumes that group behavior is irrational -as a social species we do depend on group coalitions in order to survive -stereotypes are a cognitive process that help to make sense of that reality --we can put people into groups/characteristics to easily understand what is happening. shortcut--cognitive process to simplify how we understand

legal, regulatory, and policy recommendations

-avoid fragmentation of health plans along socioeconomic lines, and take measures to strengthen the stability of patient-provider relationships in publicly funded health plans -increase the proportion of underrepresented US racial and ethnic minorities among health professionals -provide greater resources to the US DHHS office of civil rights to enforce civil rights laws

consequences of stereotypes: can affect the "stereotyped" target's level of performance, persistence, and feelings of belonging in context

-awareness of negative stereotypes may motivate targets to distance themselves from the group in order to escape stereotypes -has significant drawbacks for receiving social support

medical model of disability: disability must be cured

-based on science/medicine -views disability as a genetic defect that must be fixed -people with disabilities are viewed as tragic, helpless, pitiful

psychological immune system: meaning making

-basic human motivation, especially in relation to misfortune and its consequences -positive adaptation is predicted by people finding some meaning in the event after it occurs --"silver linings"--positive aspects of otherwise negative events --"things happen for a reason" --"attaching significance to or seeing implications of an event"

social validity of disability stereotypes

-be mindful of your own position --what is our relationship with the target? -should try to occupy different levels of abstraction to see if there is agreement -what does this mean for our adjusting our stereotypes of people with disabilities?

major principles of adjustment continued

-because linkage between body structure and psychology is often less direct, it is appropriate to refer to the influence of disability as facilitative or mediated by other factors (ex: social expectations, conventions, personal values) -environmental factors are at least as important in determining psychological reactions to disabilities as are internal states of PWDs -of all the factors that affect the total life situation of a person with a disability, the disability itself is only one, and often its influence is relatively minor

engaging in social competition: political identification

-belief of shared experiences -the belief that these experiences should be changed -what needs to be changed is shared -belief that working collectively to achieve these outcomes is necessary

public policies for all

-besides what is specific, persons with disabilities have many aspects and needs in their daily life that are not necessarily related to their disability: --they need to go to an agency and pay their bills --they need to take their kids to school or to receive vaccination on a health center --they need to vote, to work, to eat, to go to the movies, to take vacations, to socialize --to be full citizens in their own community, as everybody else

psychological immune system self-enhancement biases: positive illusion

-better off than real or imagined (average) others on some dimension --idealistically positive views of self --sense of control over events --unrealistic optimism regarding the future

psychological immune system self-enhancement biases

-better-than-average effect -positive illusion -fortune phenomenon -downward/upward social comparison

summary of findings regarding racial and ethnic disparities pt. 2

-bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers may contribute to racial and ethnic disparities in healthcare -racial and ethnic minority patients are more likely than white patients to refuse treatment, but differences in refusal rates are generally small, and minority patient refusal does not fully explain healthcare disparities

social and community context as social determinants of health

-both social and community factors decisively influence peoples' health -the social and community context as perceived by its members has repercussions on individual health -there is a wealth of studies demonstrating that many of the common health problems have their causes in the societal structures and community context

strategies to create healthier neighborhoods

-bringing retail food markets into disadvantaged communities, to increase the availability of affordable, healthy food choices in neighborhoods that have the most limited choices -smart growth, such as the clustering of homes near shopping areas, public transportation and employment possibilities -community revitalization initiative designed to promote neighborhood economic development and improve physical, social and service environments in neighborhoods -community organizing to motivate action, bringing people together to work collectively to improve neighborhoods

determinants of health policy

-broad determinants include the nature of the health problem, the sociocultural norms that influence the perception of the problem, and the political system within which policy is formulated. the more narrower determinants are: ---potential solutions to the identified health problem ---views and efforts of the stakeholders ---demonstrated leadership of the policymakers ---available resources needed to implement the policy

where is disability in diversity science?

-bulk of studies regarding multiculturalism or colorblindness focus on race/ethnic vs. white -can less frequently include religion, gender, and sexual orientation

inclusive and sustainable public policies continued

-but independently of who they are, where they live and how they function, they are all equal citizens with equal rights and responsibilities under the law -the cost of special services to address the specific needs of each group in society is always much higher and less cost effective than of those of public policies and programs designed and implement for all

disparities in the clinical encounter: stereotyping (a definition)

-can be defined as the process by which people use social categories (ex: race, sex) in acquiring, processing, and recalling information about others -these beliefs may serve important functions--organizing and simplifying complex situations and giving people greater confidence in their ability to understand, predict, and potentially control situations and people

disparities in the clinical encounter: stereotyping: risks

-can exert powerful effects on thinking and actions at an implicit, unconscious level, even among well-meaning, well-educated persons who are not overtly biased -can influence how information is processed and recalled -can exert "self-fulfilling" effects, as patients' behavior may be affected by providers' overt or subtle attitudes and behaviors

examples of the link between poor housing and health pt. 2

-can have confounders, but studies consistently show this link -at times when pollution is so bad, docs may advise people not to go outside, and stay inside, but if their indoor environment is just as bad, or contributing to the problem, it does not help

consequences of stereotypes: can shape basic expectations and assumptions about what uncertain about interaction

-can point to the social circumstances groups face -disabled people are more likely to be poor and unemployed

consequences of the social creativity strategy: cons

-can potentially be threatening to people who do not strongly identify as a member of the group -can potentially threaten the dominant group's higher status, especially if lauded values are diminishing in importance -social creativity does not change the fundamental reality of disadvantage

criticisms of psychology from disability perspectives: assumption #4: disability central to self-concept, social comparisons: examples of findings

-cancer patients need to make downward social comparisons in order to cope with their conditions -recently disabled paraplegics are assumed to make comparisons to others who are also paralyzed -people with disabilities may prefer to avoid social interactions and social comparisons with nondisabled people; may only make comparisons to other disabled people more worse off

poverty and health (the evidence): poverty increases the prevalence and mortality of many diseases

-cardiovascular disease -diabetes -cancer -depression -chronic obstructive pulmonary disease

defining disability identity

-characteristics that make people distinct, denote individuality, allow people to make sense of themselves -ways of conceiving the self and connections to particular others and groups -disability provides a context that ties people with disabilities to a minority group that encounters stigmatization, prejudice and discrimination

sources of discrimination: patronization and pity

-charity; benevolent paternalism -"your life must be horrible and worse than death"

local health policy

-cities or counties offer a variety of health care services to meet the needs of their residents -examples include free or reduced-rate immunizations, tobacco-free buildings, safe drinking water, enforcement of seat belt and child restraint laws, and provision of an emergency medical system

mainstreaming disabilities

-clear political will and allocation of adequate resources for mainstreaming--including additional financial and human resources, if necessary -mainstreaming does not replace the need for targeted, disability-specific policies and programs, and positive legislation; nor does it do away with the need for disability units or focal points

levels of influence

-close influences tend to be the strongest -filtered through broader context -family influences -friend influences -centrally located within a social group

data collection and monitoring

-collect and report data on healthcare access and utilization by patients' race, ethnicity, socioeconomic status, and where possible, primary language -include measures of racial and ethnic disparities in performance measurement -monitor progress toward the elimination of healthcare disparities -report racial and ethnic data by OMB categories, but use subpopulation groups where possible

food security: utilization

-commonly understood as the way the body makes the most of various nutrients in the food -this food security dimension is determined primarily by people's health status

healthier built environments are a shared responsibility

-community planners and design professionals, public health practitioners and local governments all have a role in promoting well-being and preventing illness and injury through the built environment -it is our shared responsibility to ensure that population health impacts are considered in decisions which impact the planning and design of local neighborhoods -the population and public health team must collaborate with diverse stakeholders in order to support the inclusion of health considerations within community planning and design processes

defining the built environment

-constructed places, features, and elements that together make our cities, villages, and towns -varies from large-scale urban areas to rural development and personal space -includes indoor and outdoor places

how could education affect health (educational attainment): control beliefs

-coping and problem solving -response to stressors -health-related behaviors

social creativity strategy #3: importance/meaning of dimensions continued

-cornerstone of early disability scholarship worked along these lines to denaturalize what is considered "normal" and consider the historical roots of the term itself as a source of disability-based oppression --questioned correspondence between what is "normal" and what is "valuable", which in turn bolstered disability identity development in what has been termed a 'coming out' process for PWD -"coming out disabled" represents a rejection of the culturally presumed inferiority of disability status and an indication by the PWD that the state of being disabled has inherent value

narrative approaches to disability identity

-critical analysis and evaluation of people's stories: largely qualitative -stories allow: --meaning in ongoing experiences --actors to predict their own and others behavior in the future --for negotiating various social worlds --people to establish personal identities for themselves and for others

level of identification with group

-crucial determinant of people's preferences for employing either individualistic or group-level strategies -how do differential levels of group identification arise? -low ingroup identification and pursuit of personal self-esteem are more likely to occur in majority groups --don't need each other for positive outcomes --haven't suffered unjust treatment or common failure -high group identification more likely to occur in numerically smaller groups, and groups in which members experience shared outcomes or fates

potential sources of racial and ethnic healthcare disparities: healthcare systems-level factors

-cultural and linguistic barriers: many non-English speaking patients report having difficulty accessing appropriate translation services -lack of stable relationships with primary care providers: minority patients, even when insured at the same level as whites, are more likely to receive care in emergency rooms and have less access to private physicians -financial incentives to limit services--may disproportionately and negatively affect minorities -"fragmentation" of healthcare financing and delivering

acceptability (dimensions of health care access)

-cultural barriers and preferences -user's attitudes and expectations/household expectations -community and cultural preferences, attitudes and norms -characteristics of the health services (ex: management/staff efficiency)

culture: the hidden and the obvious

-culture has been described as an iceberg, with its most powerful features hidden under the ocean -visible aspects of culture: dress; food; language; music; games; literature; rituals; visual art; festivals -non-visible aspects of culture: beliefs; values; communication style; handling emotions; notions of time; notions of modesty; handling physical space; competition vs. cooperation; ethics

the cultural continuum

-culture is commonly divided into 2 broad categories at opposite ends of a continuum: collectivistic or individualistic -most cultures fall somewhere between the 2 poles, with characteristics of both -collectivistic and individualistic cultures can give rise to different views on human health, as well as on treatment, diagnoses and causes of illness

impact of poverty on disability: statistics

-data will differ depending on the definition of disability -different definitions are applied for different objectives

social creativity strategy : intra-group comparisons to other categories of disability

-deaf community has historically labelled itself as a linguistic minority group thereby positively differentiating itself from low-status, non-deaf disabled others -injured veterans with disability diagnoses such as traumatic brain injury (TBI), PTSD, or limb amputations, may identify as a collective ("injured veterans"), but often make favorable comparisons against other non-veteran, disabled groups as a way of escaping the negative cultural stereotypes attached to disability -relatively common for physically disabled persons to try to distance themselves from intellectually disabled people as a way of maintaining positive distinctiveness--essentially saying "at least we're not them" --intellectual and mental disabilities and mental health issues have been difficult to incorporate into existing 'social constructionist' frameworks in disability studies

public policy

-decision making that affects the general population or significant segments of the general population -is meant to improve the conditions and general welfare of the population or sub-populations under its jurisdiction

relative poverty

-defines poverty in relation to the economic status of other members of the society -three perspectives are relevant to further develop the definition of the concept of relative poverty: 1) the income perspective 2) the basic needs perspective 3) the capability (or empowerment) perspective

engaging in social competition: policy alternatives and political engagement

-definition of disability is not characteristic of the individual -who is culpable for social role is shifted to policy makers -belief that PWDs are a constituency group and by acting on behalf of the group, PWDs can effect change

civil rights/minority model of disability

-deinstitutionalization -independent living movement -disability identity groups formed by people with disabilities

stereotyping is 'sense-making'

-dependent on focus and readiness -informed by socialization -interest driven categorization -not a cognitive distortion, just a positioned reality

where does stigma come from: evolutionary reasons for exclusion: parasite avoidance

-desire to avoid physical contact with potentially parasitic targets (marks, legions, discolorations, asymmetries, coughing, etc.) -signal-detection issues: based on false positives

providing health care to different cultural groups

-developing a guide to help health professionals understand cultural preferences and characteristics around the world would be a mammoth undertaking -however, health care providers should learn skills around a cultural competence and patient-centered care. such skills can be a compass for exploring, respecting and using cultural similarities and differences to improve quality of care and patient outcomes

sources of discrimination: stigmatization

-difference from the norm, physically and mentally -value judgment: this difference is undesired, negative

diversity science

-differences are not simply natural, neutral, or abstract -constructed by and interpreted through social practices and institutions -reflect historically derived ideas and beliefs about what differences mean

criticisms of psychology from disability perspectives: assumption #1: located in biology

-disability and the person are assumed synonymous and the cause of others' behaviors and attitudes -ex: laboratory simulations of disability using a confederate in order to manipulate anxiety and discomfort

a practical legal case involving disability

-disability goes unmentioned or is listed as an attribute without context -an impairment is used to evoke pity or sympathy for the victim -a medical condition or "mental illness" is used to blame victims for their deaths -in rare instances, we have identified thoughtful examinations of disability from within its social context that reveal the intersecting forces that lead to dangerous use-of-force incidents. such stories point the way to better models for policing in the future

where does ableism come from?

-disability history -lack of knowledge and understanding of the varied experience of disability -outdated stereotypes about what disabled people can achieve -pity and inspiration -official and unofficial practices and policies

is disability a poor fit for diversity? why might disability not fit with colorblind or "difference blind" framework?

-disability is a serviceable other which affords other groups to define themselves as the "same" -diversity, within the neoliberal system, is used as a tool of self-interest for the dominant group to uphold the same system which benefits them -disability is antithetical to the neoliberal outlook of autonomy, development, and self-determination

criticisms of psychology from disability perspectives: assumptions

-disability is located solely in biology -impairment causes most if not all problems -disabled person is a "victim" of their condition -disability is central to the disabled person's self-concept, self-definition, social comparisons, and reference groups -disability is synonymous with in capacity and needing help

taking a disability studies perspective: central tenet

-disability is produced as much by environmental and social factors as by bodily conditions -it has meaning and that meaning changes across time and context, both between conditions and within the same conditions -there is a wide array of types -there is a remarkable fluidity to the category

coping framework

-disability is treated as one quality among many others comprising life and experiences -ways to expand on coping: --activities of daily living ---dealing with concrete here-and-now demands --success stories --seeing others manage

full participation of persons with disabilities

-disability mainstreaming requires that efforts be made to broaden the equitable participation of persons with disabilities at all levels of decision-making -the integral involvement of civil society, including of organizations of persons with disabilities, in national and international mechanisms is an essential ingredient in effectively guiding the development agenda towards integrating and including persons with disabilities

defining adjustment to disability: it's multidimensional

-disability or chronic illness can potentially affect a number of life domains (psychological, social, physical, environmental) -adjustment needs to capture the multidimensional effects of a condition

coping framework continued

-disability symbols: reduce shame by increasing connotations of positive functioning and positive representations in communication media and television -widening opportunities: the possible-impossible: cut through limitations based on prejudices; frame as challenge rather than threat -brainstorming

types of ableism: eternal child stereotype

-disabled people are often seen as eternal children -this can lead to: --the person not being able to make decisions for themselves --segregation --others not taking people's statements seriously

privilege and ability: in order to have a phenomenon of ability privilege, there must be a reality of disability oppression

-disabled people as a group whose member are in an inferior position to other members of society because they are disabled people -disadvantages are related to an ideology or group of ideologies which justify and perpetuate this situation -disadvantages and their supporting ideologies are neither natural nor inevitable -there is a beneficiary of this state of affairs

criticisms of psychology from disability perspectives: assumption #3: disability as victimization

-disabled person is a victim who copes with suffering by self-blame, reinterpreting the suffering to find positive meaning or by denying that he or she is really suffering -ex: study of 29 recently paralyzed individuals described as "young people who had been recently condemned to spend the rest of their lives crippled" -strategies used by "victims" to make sense of their situations; manage or camouflage what must be truly tragic

where does stigma come from: dimensional perspective

-discrediting mark links to essential dispositions that are permanent and central to a person -dimensions of stigma --concealability --course --disruptiveness --aesthetic qualities --origins --peril

systemic discrimination: examples of systemic practices include:

-discriminatory barriers in recruitment and hiring of PWD -exclusion of qualified PWD from traditionally able-bodied dominated fields of work

evidence of racial and ethnic disparities in healthcare

-disparities consistently found across a wide range of disease areas and clinical services -disparities are found even when clinical factors, such as stage of disease presentation, co-morbidities, age, and severity of disease are taken into account -disparities are found across a range of clinical settings, including public and private hospitals, teaching and non-teaching hospitals, etc. -disparities in care are associated with higher mortality among minorities

strategies for eliminating disparities in healthcare pt. 2

-disparities in quality of care by a provider may be addressed by promoting maximal adherence to certain guidelines, seeking to ensure that all patients receive evidence-based care for their condition; such an approach may rely on established quality improvement (QI) techniques -disparities that are embedded in regional or institutional variation in quality may be prime candidates for an approach that seeks to raise quality for all patients in a community or even a state (ex: community capacity building)

poverty in the US

-disproportionate overrepresentation of some groups: ---indigenous and other racialized people ---people with disabilities ---women; children; elders

where does stigma come from: research: disability assumptions in research

-doesn't include voices of people who are stigmatized -located in biology; problems are impairment produced; victimized by disability; central to self-concept; synonymous with needing help -individual's problem, absence of disabled researchers/voice, essentializing portrayals; person-fixing vs. context changing; insufficient attention to disability as minority group, etc. -decidedly individualistic focus; focus is on interpersonal interactions and person perception

education and health

-due to its influence on both the social and economic development of individuals, education also corresponds with the overall well-being of communities. according to the agency for healthcare research and quality, the health benefits of instruction are seen in the following areas: ---individual ---community ---social/cultural context

key domains of the life course theory (LCT): early programming

-early experiences can "program" an individual's future health and development -adverse programming can either result directly in a disease or condition, or make an individual more vulnerable or susceptible to developing a disease or condition in the future

social determinant of health (SDOH)

-economic and social conditions in the environment in which people are born, live, earn, work, play, worship, and age that affect a wide range of health, functioning, and QoL outcomes and risks -these are the complex, integrated, and overlapping social structures and economic systems that are responsible for most health inequities -these systems and structures include the social environment, physical environment, health services, and structural and societal factors -these are shaped by the distribution of money, power, and resources throughout local communities, nations, and the world

way to build inclusive, healthy places for all #3: design public spaces for equity and dignity

-efforts to build trust can also help foster an inclusive, equitable process that involved listening to diverse groups, ranging from homeless migrants to activists, to young parents, to the elderly -accounting for diverse perspectives help inform design decisions that respect the dignity of all people -design has the ability to reflect values of social dignity, respect, and empathy -even small details can make a huge difference, like the positioning of a small shelf on municipal trash cans that allow people to deposit and collect bottles for refund without rummaging through the bin -creating inclusive, healthy places demonstrates just how important compassion is as a community value

coping strategies: cognitive responses

-emphasize heterogeneity of ingroup, as well as outgroup -overlap of group is perceived as greater than those high identifiers

where does stigma come from: evolutionary reasons for exclusion: coalition exploitation

-emphasize within-group cooperation for the purpose of between group competition -pertains mostly to inter-group stigmatization

occupation/employment

-employment status is an indicator of economic instability, which is an important context of social determinants of health -unemployed adults are more likely to delay or not receive needed medical care and prescriptions -several studies have shown that mental health conditions, chronic disease and premature mortality are higher among the unemployed -unemployment has also been shown to be associated with unhealthy behaviors such as increased alcohol and tobacco use, and decreased physical activity

narrow determinants of health policy: stakeholders

-entities or individuals who have a direct or indirect role in the development of policy are considered stakeholders -the influence of stakeholders is particularly strong in a democracy, as elected officials often cater to the interests of their constituency--either to fulfill a campaign promise or to gain reelection

strategies to create healthier neighborhoods pt. 2

-environmental justice interventions to reduce toxic exposures in the physical environment in communities with large concentrations of low-income residents -strategies to reduce residential segregation, such as through zoning, affordable housing in neighborhoods with quality schools and employment opportunities, and enforcement of fair housing laws

everyday discrimination and subclinical disease: in the study of women's health across the nation

-everyday discrimination was positively related to subclinical carotid artery disease (IMT; intima-media thickness) for black but not white women -chronic exposure to discrimination over 5 years was positively related to coronary artery calcification (CAC)

advancing health equity: achieving optimal health for all

-expand the understanding about what creates health -strengthen community capacity to create their own health future -promote a health in all policies approach with health equity as the goal

how could education affect health (educational attainment): working conditions

-exposure to hazards -control/demand -imbalance -stress

disability studies, diversity science, and disability inclusion: particular outcomes from the institutional perspective

-extra-curricular programming by and for persons with disabilities (ex: student organizations, performances, speakers, etc.) -representative curricular emphases (more representation within the cultural and critical studies perspective) -enrollment and graduation rates of persons with disabilities -overall accessibility of the campus

sources of discrimination: discomfort

-fear of disease and death, embarrassment -"I got served in a separate room of a restaurant"

for what would we be looking for as social psychologists? particular outcomes from the disabled perspective

-feeling of belongingness to the community -positive identification with disabled identity -academic achievement outcomes (academic motivation, graduation rate, perseverance, GPA) -psychological outcomes (well-being, self-efficacy)

1990 ADA (Americans with Disabilities Act)

-first comprehensive civil rights law that outlawed disability discrimination in public and private areas -emphasis on defining discrimination broadly --in employment (title 1) --in public services (title 2) --in public accommodations (title 3)

impact of food on health

-first, by generating uncertainty over the ability to maintain food supplies or to acquire sufficient food in the future, food insecurity can provoke a stress response that may contribute to anxiety and depression -acquiring foods in socially unacceptable ways can induce feelings of alienation, powerlessness, shame, and guilt that are associated with depression -may also magnify socioeconomic disparities within households and communities that could increase cultural sensitivities and influence overall mental well-being

what to do about the food impact on health

-first, far more analytical and financial resources need to be aimed at preventing food crises by understanding the causes of sharp spikes in food prices and designing the policy approaches that can dampen them. stabilizing food prices in America will be easier if there are fewer shocks to world prices, but they will also require much better infrastructure to alleviate the impact of local shocks to production -beyond reducing food price instability, building the institutions and human capital to sustain inclusive economic growth will be essential. only input from behavioral political economy, broadly for development policy and more narrowly for food policy, can help governments to meet these challenges

characteristics of individualistic cultures

-focus on "I" -value autonomy -view ability to make personal individual choices as a right -emphasize individual initiative and achievement -lesser influence of group views and values, and in fewer aspects of life

characteristics of collectivistic cultures

-focus on "we" -promote relatedness and interdependence -connection to the family -value respect and obedience -emphasize group goals, cooperation and harmony -greater, broader influence of group views and values

food security and health

-food insecurity is an important indicator of economic instability and is therefore a social determinant of health. adults who experience food insecurity report being hungry because they did not have enough money for food and not eating at all for an entire day -a healthy diet is key to having positive health outcomes. not being able to access nutritious meals can create health problems and food insecurity has been shown to increase consumption of high energy-dense foods that can lead to weight gain, poor physical health, chronic disease and health risk behaviors -in addition those who experience food insecurity also experience low dietary variety. this analysis examines the impact of food insecurity on the prevalence of health risk behaviors and chronic health conditions

key domains of the life course theory (LCT): examples of risk factors

-food insecurity, homelessness, living in poverty, unsafe neighborhoods, domestic violence, environmental pollution -inadequate education opportunities, racial discrimination, being born low birth weight, and lack of access to quality health services

inclusive public spaces for all are a central part of healthy, resilient communities

-for a project in Toronto, for ex: planners set up tents in local parks, recreation centers, and farmers' markets to answer residents' questions and help understand how the spaces were used over time -and in the south Bronx, community members brainstormed ideas for renovating Lyons square playground during a series of sessions held at a nearby community center -participating in the urban planning process empowered Bronxites to share their own visions of how best to fix what they viewed as a historic site -during the session, community members discussed nuts and bolts of how to engineer a park so that dog walkers, aspiring basketball stars, senior citizens, and toddlers would want to spend time there

additional terms: passing

-for nonvisible, important questions about disclosure, secrecy, and information management -"passing" might shield a person from certain forms of denigration and abuse, but may also cause additional stress from potentially being "stigmatiz-able"

challenge of positive cross-group contact

-friendly cross-group contact can improve intergroup attitudes, but it has been shown to reduce collective active intentions of disadvantaged groups --positive contact is motivated to ignore collective identities ---collective ID-->collective action --positive contact is motivated to break down negative stereotypes ---negative stereotypes (advantaged group)--> perceived injustices

federal health policy

-funds health-related research -funds education for health professionals, including nurses and physicians -pays for health care through medicare, medicaid, SCHIP, and the veterans administration health care system -plays a monumental role in shaping health practices -ex: passage of the patient protection and affordable care act (PPACA) (2010)

accessibility (dimensions of health care access)

-geography (ex: service location, household location) -infrastructure -transportation

giving everyone a fair chance

-giving everyone a fair chance to be healthy does not necessarily mean offering everyone the same resources to be healthy, but rather offering people specific resources necessary for their good health -for ex: consider 3 children of different heights. offering them all the same size bench to stand on would mean that shorter children do not have a fair chance to see over the wall. offering each child a bench to stand on that is the right size for their height gives all children a fair chance to see over the wall

more to think about regarding good health

-good health is more than just having access to care -it is important to consider what happens *before* an individual needs to go to a doctor and to consider what is happening in the community where that individual lives -where people live, work, worship, and play has a greater impact on health outcomes than having access to a physician -ex: we need to redefine health policy to include housing, employment, community development, income support, transportation, and environmental policies; healthy eating programs for students, food at home, location of their houses, pollution/crowding, etc.

state health policy

-governs practitioners through health practice act -provides "invisible services" through regulatory activities ---maintaining a safe meat supply through livestock inspections ---ensuring safe food storage and preparation in restaurants ---ensuring that health care facilities provide safe, quality care

engaging in social creativity

-group boundaries appear to be impermeable -status relations are unlikely to change

health equities

-health equity is attainment of the highest level of health for all people -achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities -when all people have the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstance

housing as social determinants of health

-health hazards in homes concentrated in lower-income communities and communities of color -disproportionately harm poor and minority families -exposures to hazards directly linked to substandard housing conditions -more likely to live near pollution sources

how could education affect health (educational attainment): work-related resources

-health insurance -sick leave -wellness programs -stress

important points about health

-health is a socially constructed reality: a product of the physical and social environment in which we live and act -differences in people's health status, including gender differences, arise not only from biological differences, but also differentials in social and economic status

housing instability

-health is shaped by where a person lives, learns, works, and plays. as a social determinant of health, housing insecurity has been associated with worsening health outcomes -in 2010, approximately 20.2 million US households (more than 1/4 of the US households) paid more than half of their income for housing. this large financial burden can have serious health consequences and impact a person's chances of becoming sick and dying at an early age -housing insecurity has been linked with poor mental health status, insufficient sleep and increased risk for high blood pressure, respiratory conditions and exposure to infectious disease. this analysis examines the impact of housing insecurity on the prevalence of health risk behaviors and chronic health conditions in Kansas

regulatory health policies

-health policies may be used as regulatory tools that call on government to prescribe and control the behavior of a particular target group by monitoring the group and imposing sanctions if it fails to comply -ex: include prohibition of smoking in public places, licensure requirements for medical professions, and processes related to the approval of new drugs

potential sources of disparities in healthcare

-health systems-level factors--financing, structure of care; cultural and linguistic barriers -patient-level factors: including patient preferences, refusal of treatment, poor adherence, biological differences -disparities arising from the clinical encounter

availability (dimensions of health care access)

-health workers, drugs, equipment -supply and demand mismatch (ex: waiting time (s); wages and quality of staff (s); price and quality of drugs and other consumables (s); information on health care choice/providers (d); education (d)) -rural and urban

stakeholders of health policy: healthcare organizations

-healthcare organizations are the institutional settings in which healthcare providers work or provide care to patients -traditional settings include hospitals (inpatient and outpatient) and community-based offices

access to health care

-healthcare refers to the services that promote and preserve health through the diagnosis, treatment and management of disease and illness -access to health care may vary across countries, communities, and individuals, largely influenced by social and economic conditions as well as the health policies in place

misguided activism: "intergroup helping"

-helping can often reflect and reaffirm existing status differences between groups --offer of help implies helper has resources the recipient lacks and needs; acceptance of help can signal lower status and power --takes away from self-reliance and independence --helpers often get the bulk of the praise

how could education affect health (educational attainment): income

-housing -neighborhood environment -diet and exercise options -stress

what is the value of incorporating disability? interrogate the hidden assumptions of diversity

-how does the discourse of diversity assume values antithetical to disability (ex: self-determination, development, and autonomy) -are there possible alternative values to consider, and would they have different outcomes than traditional frameworks

social influence

-how individual behavior is influenced by other people and groups -a complex set of processes: 1) conformity 2) obedience 3) compliance

additional examples of social determinants of health

-how much education a person obtains -access to educational, economic, and job opportunities -transportation options, public safety -having food or being able to get food (local markets) -access to mass media and technology (internet, cell phones) -language/literacy -culture -exposure to crime, violence, social disorder (lack of cooperation in a community) -having access to health services and the quality of those services -housing status, residential segregation -how much money a person earns -social norms and attitudes (discrimination, racism) -social support

why does the built environment matter? pt. 2

-how we design and create our built environments has significant implications for health and other aspects of human development -the features of the built environment influence our health by interacting with the other determinants of health, including social networks and access to important resources that we all need to access everyday -these population health impacts can be described through indicators such as level of social cohesion, mental and physical fitness, chronic disease, healthy weights, and injury rates -ex: making active transportation convenient and safe has been shown to increase physical activity, which is in turn linked to decreased unintentional injuries, improved mental health, social connectivity and healthy weights

social identity approach: social identity theory pt. 3

-how will people respond to their position in the social structure? -which of the identity management strategies will people use when they are aware that their identity is devalued in a particular context? -improve one's own personal situation: --individual mobility (escape the group) -improve the position of the group as a whole --social creativity (reinterpret the meaning of the group) --social competition (work to change the status of the group)

disability intersectionality: theoretical challenge

-how would we begin to consider the psychological processes associated with someone who is poor, black, elderly, disabled, and lesbian? -is there a hierarchy of difference? -what if some differences coalesce to create a more severe form of oppression while others give privilege/invisibility within the same oppressed community? --ex: can we use "race" as the primary category of oppression and then measure other oppressed categories against the primary "race" category?

disability is out there, everywhere

-if society is composed by people with diverse ways of functioning -if disability is part of everyone's life cycle and it can appear in different moments of life -if we tend to acquire functional limitations as we age and the world population is aging more and more -if many causes of disability are a result of poverty and exclusion -if people who are considered "different" or who live with a disability tend to be invisible to/excluded from the system

why address social determinants of community health and development?

-if you want to solve or prevent a problem for the long term, you have to deal with its root causes -if you address the root causes, you're more likely to successfully address the issue for the short term as well -the social factors involved may have more resonance for those affected than the issue itself

major principles of adjustment: different levels of predictability between the body structure affected by disability and the psychological outcomes

-impairment can affect instrumental skills that have learned components -impairment can affect emotional states but this is mainly concerned with reactions or adjustment to the impairment rather than the impairment effects -impairment can affect overall self-concept or meaning in life, but so many factors other than body state are operating here that minimal level of correlation occurs -neurological damage usually has predictable effects on reflexive responses

green space in our communities is good for health

-improves health outcomes (reduced blood pressure, blood cortisol, surgery recovery time) -improves psychological/cognitive well-being/child development -increases social well-being -improves air quality and reduces related illness -reduces heat island effect -can provide opportunities for a local nutritious food production -increases physical activity

summary of social factors and health

-in addition to genetic factors, health results from the choices that people are able to make in response to the options that are available to them in their social environments -these social factors can affect access to timely and quality health care and its utilization, which lead to inequities in the health promotion, disease prevention, treatment and recovery from illness and survival

health care as a determinant

-inadequate health care may account for 10% of premature death -health care receives by far the greatest share of our resources and attention

disabling barriers: widespread evidence

-inadequate policies and standards -negative attitudes/discrimination -lack of provision of services -inadequate funding -problems with service delivery -lack of accessibility -lack of consultation and involvement

social norms

-independent effects -perceived social norms play a role in socialization and selection processes -normative perceptions that binge drinking is cool may lead to a reassessment of acceptability of adolescents who excessively drink or party

what are neighborhoods effects?

-independent effects of neighborhood conditions on health outcomes (above and beyond the effect of individual level variables) ---what would a person's health be under alternative neighborhood conditions (bad) and (good) -ex: obesity (diet): if you are biologically predisposed to be obese, will you have different health outcomes in different neighborhoods? neighborhood effects tend to suggest that ---family income ---availability of healthy food options

raising public awareness about discrimination against people with disabilities: organizations: encourage organizations of people with disabilities to:

-inform their members of their rights and existing legislation -collect cases of discrimination -act on behalf of their members after receiving their agreement -create projects on awareness raising -organize media and information campaigns -create policy documents -start legal cases -same obligations apply to public bodies

racism: potential mechanisms

-institutional discrimination can restrict economic attainment and thus differences in SES and health -segregation creates pathogenic residential conditions -discrimination can lead to reduced access to desirable goods and services -internalized racism (acceptance of society's negative beliefs) can adversely affect health -racism can lead to increased exposure to traditional stressors (ex: unemployment) -experiences of discrimination may be a neglected psychosocial stressor

diversity science: how is it done?

-investigations into how majority and minority groups understand and accommodate difference -models of managing diversity have really taken 2 broad forms: 1) colorblindness: a conscientious effort to ignore difference, emphasize sameness, and attempt to assimilate into a unifying category --ex: attempting to ignore race and not appear racist 2) multiculturalism: an attempt to value and even celebrate identity differences --ex: common ingroup identity model, subgroup respect, mutual intergroup differentiation model

allocative health policies

-involve the direct provision of income, services, or goods to certain groups of individuals or institutions -they can be distributive or redistributive

intersectionality backlash

-is a fixation on intersectionality resurrecting "identity politics," reinforcing harmful structures of gender, race and class that the progressive movement was meant to break down? -is it leading to infighting within various movements, encouraging "privilege-checking" as a form of bullying and silencing? -is it likely to lead to all talk and no action--lots of think-pieces, but no action consideration in law, policy or day-to-day action? -are these concerns valid? what does intersectionality look like outside of the academy, and why--if at all--does it remain necessary?

example: inequality or inequity? the disproportionate number of poor and minority citizens in the US that do not have adequate access to healthcare

-is it a health inequality: yes, since there is a difference in rates of access to healthcare amongst segments of the population -is it a health inequity: depends on whether your idea of justice involves "the right to healthcare"; if so, then yes, it is unfair and unjust that there are differences in this fundamental right: the right to healthcare

how culture influences health

-it affects perceptions of health, illness and death, beliefs about causes of disease, approaches to health promotion, how illness and pain are experienced and expressed, where patients seek help, and the types of treatment patients prefer -both health professionals and patients are influenced by their respective cultures

example of distinction between colorblindness and multiculturalism: one of the comparison/contrasts lies between the idea of accommodations vs. universal design

-it is important to consider the ways in which accommodations are important for including people with disabilities into higher education spaces, yet they tend to match more with a colorblind approach to diversity -conversely universal design may prove to have similar inclusivity effects, yet it tends to match more with a multiculturalist approach to diversity -other ways to approach disability-as-disability through a multiculturalist orientation might be increasing programming that focuses on disability cultural contributions or have curriculum, minors, majors, certificates that takes disability studies perspectives -it is important to remember that little empirical research in the area of diversity science considers disability and the potential effects of such interventions

long-term group effects: individual risks

-it is uncertain whether attempts to separate the self from the group will be successful or not -it is not clear that attributing negative outcomes to prejudice will consistently result in self-esteem protection

why address social determinants of community health and development? continued

-it may be easier to approach an issue through its underlying social factors than to deal with it directly -addressing the social determinants of community issues is crucial to understanding them fully, so that your strategy and tactics for dealing with them correspond to reality -addressing social determinants presents a tremendous opportunity for learning and community leadership development

way to build inclusive, healthy places for all #2: gauge trust, build trust, develop social networks

-it's crucial to understand how people's trust in civic institutions and in one another affects their engagement in the planning and design processes--and in their own community -planners must create opportunities to work with communities and build trust among its members

structural inequity: education

-it's suggested that less educated people are less likely to survive into older age, and those who do survive are relatively healthy. it's also mentioned that there's an association between education and health -health-related factors such as hunger, physical, and emotional abuse, and chronic illness may lead to poor school performance. all of these factors combine to shape a person's health experience across the life course

disability activism and allyship: self-advocacy: promoted by:

-knowledge of self and rights -ability to communicate and be a leader -ability to embrace disability as part of one's sense of self -possibly viewing disability as a social construction (social mode)

housing as social determinants of health: compounded by:

-lack of access to health care; high proportion of recent immigrants; language barriers; housing discrimination that limits choice; weak tax base -poor credit; inadequate public services; un/underemployment; relative lack of political power; stress -poor housing can cause worsened health -poor health can also select worse housing -hard to get a mortgage without a regular income

affordability (dimensions of health care access)

-lack of insurance -underinsured -costs and prices of services/direct price of service, including informal fees -household resources and willingness to pay/opportunity costs

there's lots of variability with social determinants of health. no two trees are alike

-leaves and branches are like the health behaviors/outcomes -the tree stem represents the individual leading to the leafs -the roots represent the social determinants: age, gender, SES, race and ethnicity, insurance, neighborhood, access, social networks, etc. -both are dependent on the functionality of the roots

poverty and health (the evidence): children in low-income families are at higher risk of

-low birth weight -mental health problems -micro-nutrient deficiencies -asthma -injuries -hospitalization

coping strategies: behavioral responses

-low identification results in pursuit of individual mobility -willing to leave fellow ingroup members behind when afforded the opportunity --depends on perceived costs, level of support, and opportunities for change

coping strategies: emotional responses

-low identifiers are more likely to emphasize personal outcomes and feel gratified by them -frustration occurs when self is included in devalued group

barriers have negative consequences

-lower educational achievements -lower levels of employment -higher rates of poverty -poorer health outcomes -exclusion from social and political life -lack of community participation

where does stigma come from: dramaturgical perspective

-maintenance of social norms through the rituals of everyday life -3 categories: 1) abominations of the body: physical "deformities" 2) blemishes of individual character: moral transgressions 3) tribal stigmas: race, ethnicity, nationality, religion

types of ableism: nonsexual being

-many disabled people are not seen as sexual beings or capable of being in a romantic relationship -"you would be really pretty if you didn't have those crutches!" -another stereotype is that disabled people can only (or want to) date other disabled people -media portrayals of sexuality and disability are non-existent or reinforce dangerous stereotypes -me before you movie -impacts: people killing themselves after acquiring a disability, lack of inclusion and experience, target for abuse

are features of places really that important for health--or should we focus primarily on the individuals who live in them?

-many researchers have questioned whether links between neighborhood conditions and health might be largely a function of the characteristics of individuals living in neighborhoods, rather than of the features of neighborhoods themselves. it is reasonable to question whether neighborhood conditions really matter once individual characteristics are taken into account -many (but not all) studies have found relationships between neighborhood disadvantage and health even after considering individual characteristics--that is, the links do not appear to be due only to characteristics of the individuals themselves

long-term group effects: individual benefits

-may experience considerable personal prestige and wealth as a result of successful adaptation -may serve as models for other, upwardly mobile ingroup members

is disability a poor fit for diversity? why might disability not fit with a multiculturalist "value-positive" ideology

-medicalized model of disability represents it as an individual concern -difficult to identify if you're told you are a one-of-a-kind amid countless other types of disability -differences are not seen as valuable or positive ---no one would "choose" to have a disability -group is widely stereotyped as dependent, incompetent, and asexual. in other words, powerless with no real hope to gain power

evidence of racial and ethnic disparities in healthcare pt. 2

-minority Americans are more likely to have problems accessing high-quality healthcare than whites -numerous studies have shown that even when accounting for insurance and income, disparities in access to care still exist -factors such as geographic isolation that makes finding and getting to care difficult, language and cultural barriers that deter non-English speaking patients from seeking out care, and the availability of support services such as child care and transportation

diversity: why does it matter?

-minority groups in the US are growing at a considerable rate--there will be a "majority-minority" (numerical) crossover within 30 yrs -increasing globalization, international trade, and technological advancements bring individuals into contact an unprecedented array of national and cultural diversity than ever before -social and economic inequality persists across minority groups in areas such as wage and employment, criminal justice representation, housing, education, and wealth

potential sources of racial and ethnic healthcare disparities: patient-level factors

-minority patients may be more likely to refuse recommended services, adhere poorly to treatment, and delay seeking care -these may develop as a result of poor cultural match between patients and providers, misunderstanding of provider instructions, poor prior interactions with healthcare systems, lack of knowledge of how to best use services -patient level factors unlikely to be major sources of healthcare disparities

health care as a determinant pt. 2

-missing routine or preventive medical care can lead to the need for emergency care or even to preventable hospitalizations -lack of access to transportation due to not owning a vehicle, not having a vehicle available via a friend or family member, or not having access to public transportation can lead to difficulty in seeking medical care

examples of the link between poor housing and health

-mold: respiratory problems, asthma, allergies, eczema -indoor pollutants and infestation: asthma -overcrowding: increased risk of infectious disease -affects mental well-being, depression -stress -unsafe outside, unhealthy inside

what is the value of incorporating disability? reconceptualize disability

-more than just how bodies may differ, we need to include the ways social structures and cultural meanings are embedded in particular bodies -investigate the impact of types of representation of disability on feelings of belongingness for disabled persons

privilege vs. disadvantage

-most advantaged group members perceive intergroup inequality as a focus on the plight of the disadvantaged rather than the privilege of the advantaged --seeking to "raise up" the disadvantages; not considering "tearing down" certain unearned advantages -results in: --assuming position of responsibility --uncommitted activism --insensitive to consequences of activism

engaging in social competition

-most likely to be pursued when members of disadvantaged groups see the intergroup status relations as illegitimate and unstable --perceive the high-status group's position to be insecure in the dual sense of being unwarranted and potentially changeable --stimulates counterfactual thinking (an awareness of "cognitive alternatives to the status quo") that provide the hope and scope for social change -under these conditions under disadvantaged will mobilize to secure social change

race and health recommendations

-move from descriptive studies of race and health to studies that identify the specific factors linked to race that affect health -whenever feasible, additional information that captures these characteristics should be collected -this will include the assessment of SES, acculturation, and economic and non-economic aspects of discrimination

poverty in the US pt. 2

-nationally, 15% of the population lives at or below the poverty threshold -women are more likely to be living in poverty than men, regardless of relationship status -indigenous children are 2.5X as likely to live in poverty -in 2013, approximately 3 in 20 Kansas adults 18 years and older were below the federal poverty level

the built environment: types of environments that affect human health

-natural -built -social

health

-not merely the absence of disease but a state of complete physical, mental, and social well-being -this begins and is dependent upon where we live, learn, work, and play

what does it mean to be an ally?

-not simply persons motivated to express minimal or no prejudice --willing to take action; promote social justice actively and willingness to support disadvantaged group members --intentional choice to promote social justice; ensuring that privileges of advantaged group are extended to disadvantaged group

social competition

-occurs when an ingroup seeks positive distinctiveness via direct comparison with the outgroup --favoritism for the ingroup occurs on a value dimension that is shared by all relevant social groups

global disability continued

-on this account disability is always the product of an individual and a system; it is about; --power and relations, --scientific knowledge and social perception --capitalism and ideology -disability is produced, both locally and globally

additional terms: stigma spread

-once a person is stigmatized other qualities tend to get associated with that stigma -people with visible disabilities are talked to as if they have all the disabilities (ex: addressed in simpler language or given overly positive feedback)

how do we identify systemic discrimination: underrepresentation

-only 30% of PWDs who are working age are in the labor force --this is compared to the 81% of nondisabled people who have jobs -less than half of PWDs, age 21-64, have at least attended some college, with only 13% finishing a B.A. degree --this is compared to over 30% completion rate of a B.A. degree for non-disabled persons

long-term group effects: social risks

-only a few token members are selectively admitted by the higher status group, thus continued subtle discrimination is likely -mainly serves to suggest that existing status differences are just, while the system is not in fact providing equal chances for all -use "tokens" as examples of success; unsuccessful group members are blameworthy

forms of discrimination: employment

-only one-third of PWDs qualified to work can find jobs -low-level jobs, no advancement

discrimination persists

-pairs of young, well-groomed, well-spoken college men with identical resumes apply for 350 advertised entry-level jobs in Milwaukee, Wisconsin. two teams were black and two were white. in each team, one said that he had served an 18-month prison sentence for cocaine possession -the study found that it was easier for a white male with a felony conviction to get a job than a black male whose record was clean

the "identity" problem

-participating on behalf of a disadvantaged group can lead to an advantaged group member showing strong identification with that disadvantaged group --dominating role may be the result of seeing oneself as earning symbolic membership in the disadvantaged ingroup --can be offensive and often rejected by disadvantaged group

coping vs. succumbing frameworks: succumbing

-passive and independent -focus on shortcomings; things that cannot be accomplished -assess development or progress against nondisabled ("normal") standards -deemphasize areas in which participation is possible by dwelling on loss -view self as victim or passive in the face of disability and linked changes -resign self to condition or act as if no disability exists -pity self or others with a disability devalue life and future potential -see prevention or cure, not adaptation or adjustment, as the only reasonable solutions to disability

key domains of the life course theory (LCT)

-pathways or trajectories -early programming -critical or sensitive periods -cumulative impact -risk and protective factors

health systems interventions pt. 2

-patient education programs should be implemented to increase patients' knowledge of how to best access care and participate in treatment decisions -integrate cross-cultural education into the training of all current and future health professionals

state health policy continued

-pays for health care services through various programs: ---medicaid and state children's health insurance program (SCHIP), which are partly funded by federal funds ---other indigent care programs, which vary from state to state

where does stigma come from: evolutionary perspective

-people are stigmatized because they possess a characteristic viewed by society or a subgroup as constituting a basis for avoiding or excluding other people -evolutionary reasons for exclusion: --mutual engagement --coalition exploitation --parasite avoidance

affective forecasting

-people frequently overestimate how good or bad they will feel in the future in response to the vagaries of life --bad events (ex: loss, failure) projected to have worse and lasting consequences than is the case in the fullness of time --impact bias -"happiness gap" between expectation and reality where predicting feelings about health and disability are concerned -how might this issue affect adjustment to disability acquisition? interpersonal communication with PWDs?

1990 ADA (Americans with Disabilities Act): title 2: public services

-people with disabilities have the right to access and participate in public programs and services that people without disabilities participate in -affects all activities of state and local governments --public universities, voting, public meetings, public libraries, state parks -public transportation -public buildings --most libraries are covered under title 2 if they are public entities and part of state or local government

negative consequences

-people with disabilities have the same general health care needs as others -but they are: --2x more likely to find health care providers' skills and facilities inadequate --3x more likely to be denied health care --4x more likely to be treated badly in the health care system

discrimination and disparities in health

-perceptions of discrimination account for some of the racial differences in: --self-reported physical and/or mental health in the US --birth outcomes --health care trust --sleep quality and physical fatigue

inclusive and sustainable public policies

-persons have different needs in various levels and at the same time --for instance, a woman, who is black, Muslim, mother, leader of her union, tax payer and lives in a rural area. due to so many personal factors, each individual has a diverse way of functioning in society

food security: 4 main dimensions

-physical availability of food -economic and physical access to food -adequate food utilization -stability of the other three dimensions over time

way to build inclusive, healthy places for all #4: foster social resilience

-places constantly change -sustained inclusiveness relies on the capacity of communities and stakeholders to adapt to and leverage social, economic or physical changes around them -fostering stewards of a space through participatory decision-making and other engagement means that when change occurs, everyone will continue to benefit from it

intervening in poverty: we routinely screen for and intervene in health risk factors such as:

-poor diet -lack of exercise -substance use -high-risk sexual behavior -high risk alcohol use

housing as social determinants of health pt. 2

-poor housing quality and housing instability are major public health concerns, affecting both physical and mental health outcomes among adults and children -elderly populations, as well as young mothers and children who spend more time in the home, may be particularly vulnerable to the adverse effects of poor housing quality

poverty and disability: there is a vicious circle between poverty and disability

-poor people are more at risk of acquiring a disability because of lack of: --access to good nutrition --health care, sanitation --and living conditions --social exclusion --education --employment --and public services that could help an exit from poverty

supportive contact

-positive cross-group contact in which the disadvantaged group member explicitly communicates opposition to inequality and/or support for the disadvantaged group and their goals --seems to work by heightening perceptions of injustice

narrow determinants of health policy: solutions

-potential solutions to a health problem facilitate policy development -if solutions do not emerge, policymakers may direct their efforts away from full-fledged policy consideration and toward finding a solution, likely by initiating a research study

key domains that define economic stability: typically measured as the same factors in virtually every society

-poverty -employment -food insecurity -housing instability

economic stability (key domain of social determinants of health)

-poverty -employment -food security -housing stability

development and sustainability

-poverty and social exclusion affect millions of people worldwide, prevent human development and a decent life with quality--and that in countries of the south this situation affects over half of the population -to sustain and promote economic growth and well-being, it is essential to incorporate the concept of human functioning, and inclusiveness into development programs --people's functioning levels vary significantly, whether in relation to physical, intellectual or sensory (hearing and vision) abilities, or the impact of mental health

possible interventions in poverty reduction studies and measurements

-poverty assessments, data collection and other sector studies should include indicators of disability (violence, gender, indigenous, etc.) -studies/flagships involving life-cycle and topics like job generation, aging and social security reform, cash transfers, etc, should include disability indicators -when specific disability-related studies are conducted, they should be broadly disseminated -the world bank, in partnership with the UN statistics office and the Washington disability statistics group, the IDB and the MECOVI project have all been working hard to increase the quality and quantity of data available in the field of disability

poverty pt. 2

-poverty rate/household income is a key component of economic instability. low income and poverty level is a social determinant of health that is strongly correlated with poor health -poor people are less likely than those who have more money; when there are greater differences between the richest and the poorest then there is a greater difference in health -it's common knowledge that wealthier locations tend to have healthier populations. in these places, there's often a lower rate of unemployment and steadier incomes. these are important factors to keep in mind regarding the well-being of a community, in addition to expenses, amount of debt and level of support

physical (built) environment

-presence and quality of features of space and geography that determine access to health benefits or exposure to health risks (parks, housing, power, plants, access to other communities) -farmers' markets, supermarkets, fast food, liquor stores, littered, empty lots; trees and green open spaces; pedestrian friendliness (able to walk to school); housing conditions (maintenance and quality), etc.

health inequities

-presence of systematic disparities that are avoidable and unjust -disparities in health that are a result of systemic, avoidable, and unjust social and economic policies and practices that create barriers to opportunity -these can be thought of as differences in opportunities and exposures that cause different health outcomes -when we talk about health inequities, we are talking about the systemic patterns -we are also talking about power -we often use health inequity interchangeably with health disparities but they aren't quite the same thing

impacts of colorblindness

-priming with colorblindness leads to more racial bias as opposed to multicultural condition -more likely to engage in less friendly nonverbal behaviors and be rated as more prejudiced as a function of reduced inhibitory control -more prevention orientation and more negative affect toward interaction partner -low representation and colorblind philosophy leads to less trust and comfort -when representation is high, it conveys identity will be irrelevant

1990 ADA (Americans with Disabilities Act): title 2: public services: title 3: public accommodations

-privately own public accommodations and services -restaurants, stores, hotels, theaters, privately owned transportation, private schools, gym, taxis, doctor's offices, zoos, sport stadiums, funeral homes -not residential facilities -exempt: religious entities, private clubs

health systems interventions

-promote the consistency and equity of care through the use of evidence-based guidelines -structure payment systems to ensure an adequate supply of services to minority patients, and limit provider incentives that may promote disparities -enhance patient-provider communication and trust by providing financial incentives for practices that reduce barriers and encourage evidence-based practice -promote the use of interpretation services where community need exists. the use of community health workers and multidisciplinary treatment and preventive care teams should also be supported

defining disability identity: the social identity approach

-provides an analysis of people with disabilities as social beings, belonging to myriad social categories, and as such, being psychologically impacted by the reality of the groups of which they are a part -affords a portrayal of disability as a minority group that continues to change its social reality through continued socio-political activity -forces us to address the structural features of the world in order to make predictions about psychological correlations of disability

consequences of the social creativity strategy: pros

-provides source of collective self-worth in the face of stigma -enhance psychological well-being -catalyzes social competition or engaging in social changes

succumbing framework

-pulled under by the negative force of the disabling event and its consequences -concentrates upon the difficulties of being disabled and not the challenges for meaningful adaptation and change

social determinants of health

-quality of education -biology -smoking -poverty -genetics -housing -stress -access to healthcare -racism/discrimination -neighborhoods -social and family support -substance abuse -poor working conditions

health outcomes associated with our built environments

-quality of life; mental health; respiratory health; reproductive health; birth outcomes; social cohesion; body mass index; obesity; stress -diet related illness; autoimmune disease; attention deficit disorder; depression; injuries; unintentional injuries; premature mortality; food insecurity

making sense of racial differences

-race reflects simultaneous unmeasured confounding for genetic factors (ancestral history and geographic origins) and environmental exposures -race reflects unmeasured confounding due to the current social environment -race reflects unmeasured confounding due to exposures over the life course (and generations) and biological adaptation to these environmental exposures. this includes changes in gene expression

summary of findings regarding racial and ethnic disparities

-racial and ethnic disparities in healthcare exist and, because they are associated with worse outcomes in many cases, are unacceptable -racial and ethnic disparities in healthcare occur in the context of broader historic and contemporary social and economic inequality, and evidence of *persistent* racial and ethnic discrimination in many sectors of American life -many sources--including health systems, healthcare providers, patients, and utilization managers--contribute to racial and ethnic disparities in healthcare

discrimination and health care behaviors

-recent studies indicate that experiences of discrimination are associated with: --delays in seeking treatment --lower adherence to treatment regimens --lower rates of follow-up

for what would we be looking for as social psychologists? particular outcomes from the nondisabled perspective

-recognition of discrimination/privilege associated with difference of ability -dominant group identity associated with disability -attitudes about incorporating of different levels of ability into a shared institutional identity

the emerging concept of inclusive development

-recognizes diversity as a fundamental aspect in the process of socioeconomic and human development -claims a contribution by each human being to the development process -and rather than implementing isolated policies and actions, promotes an integrated strategy benefiting persons and society as a whole -this is an effective tool for overcoming social exclusion, combating poverty and ensuring social and economic sustainability

broad determinants of health policy: sociocultural norms

-reflect the accepted values, beliefs, attitudes, and behaviors of a society or group -these norms play a significant role in the public's perception of the nature of a health problem, the role of government versus individuals in addressing that problem, and the type of solution or policy implemented to manage it

ableism continued

-reflects the sentiment of certain social groups and social structures that value and promote certain abilities, productivity, competitiveness vs. empathy, compassion, and kindness -lacking these values or abilities equals a diminished state of being and a justification for marginalization

is disability a poor fit for diversity? disability is generally an invisible or suppressed difference, lacking positive representation

-relegated to the accommodations or disability services office -intellectually position in the specialized applied fields--problem identity to be remediated and exited

who should address social determinants of community health and development? continued

-respected community leaders and citizens -those who will be asked to change, sacrifice, or take action in order to address the issue -anyone else who has a stake in the issue

limits of multiculturalism

-risks of reifying or essentializing group differences; increasing stereotyping and subtyping, reducing intersectional or dual identities; and potentially failing to challenge inequality -high identifiers with sub-group may not be responded to so favorably by the dominant group members -can serve as a symbolic threat to majority group members that moves them toward various legitimating ideologies

social construction model of disability

-role of society in addressing barriers to integration -active and equal participants in the communities in which you live and work -they argue that actions can only be interpreted through the meanings people give them -the reality of a thing--and what it means--is dependent on the attitudes, values and norms of the society in which the thing is and the context of the situation

building active communities

-safe; accessible; connected; inviting -safety issues and concerns can often hinder people's desire and ability to be physically active -lack of walkways present a huge barrier in overcoming challenges to increase activity in open spaces and maintaining safety in walkable areas -sidewalks reduce pedestrian crashes -complete streets policies help to improve public safety by installing and maintaining sidewalks, crosswalks, ADA-compliant ramps and bike lanes, as well as reducing crossing distances, lowering motor vehicle travel speeds and improving sight distances

sources of discrimination: stereotyping

-see the disability before you see the person -"the disabled", "the retarded", "the autistic" -most common stereotypes: --the subhuman, the menace, the poster child, the object of pity, the "supercrip"

how could education affect health (educational attainment): social standing

-social and economic resources -perceived status

how could education affect health (educational attainment): social networks

-social and economic resources -social support -norms for healthy behavior -stress

social and community context (key domain of social determinants of health)

-social cohesion -civic participation -perceptions of discrimination and equity -incarceration/institutionalization

psychological immune system: meaning making: well-being following amputation predicted by positive meaning making processes

-social comparisons: I have one leg, what about the person who has no legs? -imagining worse outcomes: I survived. I have a second chance at life -forgetting negative outcomes: I found that I can still do about everything I did before--it only takes longer -finding side benefits: I changed to a different occupation where I became very successful -reframed event positively: all good has come out of it. I found god through it. it has given me purpose. it makes me special

social context: why might social context matter?

-social context can be dynamic -culture -nested hierarchies ---reinforce conventional norms and values -can contribute to proximal social influences

poverty

-social determinants of health generally study the reasons for poverty, such as the roles of culture, power, social structure and other factors largely out of the control of the individual -accordingly, the multidimensional nature of poverty, in particular social aspects such as housing poor, health poor or time poor, needs to be understood in order to create more effective programs for poverty alleviation -poverty is also social, political and cultural. moreover, it is considered to undermine human rights--economic, social, political, and cultural

social identity approach: social identity theory

-social identities are aspects of the self that are informed by membership in social groups --gives us a feeling of belongingness --gives us a sense of meaning and purpose --informs and motivates our action in particular contexts --consider when and how people categorize themselves as members of a social group, sharing with others significant aspects of their identity

social network and social support

-social networks refer to the structure of relationships that provide information on how an individual is integrated with others -not only channel information but determine value and importance -within social networks, people can provide social support -others that provide or supply resources -life-span approach: perceived and received

strategies for eliminating disparities in healthcare

-some disparities may be driven, for example, by gaps in access and insurance coverage. the appropriate strategy will entail directly addressing these shortcomings (ex: access to high quality healthcare) -an observed disparity in care for a specific population group at a given site may instead be addressed with a highly targeted intervention (ex: culturally competent educational materials or enhanced interpreter services)

are features of places really that important for health--or should we focus primarily on the individuals who live in them? pt. 2

-some groups of people may be more affected by neighborhood conditions than others. children may be particularly vulnerable to unhealthy conditions in neighborhoods, with consequences for health both in childhood and later in life -the physical features, social relationships, services and opportunities available in neighborhoods can either enhance or constrain an individual's choice of benefiting health and well-being

defining disability identity: can people with disabilities *not* have a disability identity?

-some people are either unaware or rarely recognize their disability; do not view themselves as disabled -some people can "pass" as being nondisabled -people can see disability as a big part of their self concept and feel quite connected to the larger disabled community -people might be activists who champion the welfare and civil rights of PWDs

levels of influences

-starts at the individual: 1) spouse; family 2) church; school/education; peer; work setting 3) community/economics; laws; media; history; neighborhood setting; norms; adult role models; politics

generalizations

-statements or beliefs about a cultural group based upon factual evidence -while these apply to the majority of people within a cultural group, they may not be true of every single person within that group -ex: generally speaking, the majority of Latin Americans are catholic, but not every Latin American is catholic

intersectionality: concept arouse out of the work of feminists and race theorists as a way of conceptualizing the consequences of membership in multiple protected classes

-static or singular notion of being or of identity is that the fore-grounded identity is expected to account for all life experiences of individual/group -single-identity politics have historically conflated or ignored intra-group differences --can result in tensions between social movements themselves -acknowledges that one can both benefit from and be oppressed by systems and institutions -oppression can be fought on the one hand and perpetuated on other fronts -acknowledges that oppressions are interlinked

consequences of stereotypes: can perpetuate group differences and legitimize the status quo

-stereotype becomes an essential feature of the group, thereby making treatment seem "natural" -neglects sociopolitical nature of differences -can be a tool of ingroup "distinctiveness" --ascribe characteristics to the "outgroup" that the ingroup doesn't want or doesn't value

some stereotyping misconceptions

-stereotypes are irrational -stereotypes are rigid -stereotypes are pre-stored -stereotypes are oversimplifications -stereotypes are often invalid

where does stigma come from: attribution theory of stigma

-stigma characteristics drive response through attributions --(un)controllability provides information as to whether one is responsible or not and worthy of blame, anger, and help --instability/severity also provide grounds for social rejection ---often the case for mental/behavioral disabilities ---especially for those seen as reversible

social creativity strategy: intra-sub-group disabled comparisons

-strategic comparisons can be made with other lower performing in group members and with other non-disabled low status groups in order to protect people with learning disabilities' self-esteem -students with learning disabilities often talked about their peers in terms of their deficits and resisted making comparisons with them unless certain those would result in favorable outcomes -cancer support group set-up to provide strategic downward comparisons for everyone in the group

some mechanisms through which neighborhoods may affect health

-stress (crime, safety) -health behaviors (ex: diet, smoking, physical activity) ---targeting (fast food, tobacco) ---neighborhood physical and social environment (playground quality, walk-ability, safety) -environmental pollutants -long term effects of limited access to high quality education

structural inequities

-structures or systems of society--such as finance, housing, transportation, education, social opportunities, etc.--that are structured in such a way that they benefit one population unfairly (whether intended or not) -conditions where one category of people are attributed an unequal status in relation to other categories of people

disability activism and allyship: self-advocacy: related to:

-successful college adjustment -persistence -academic performance -development of a sense of belonging

social creativity strategy #2: dimensions of comparison continued

-swain and french (2000) find related to this social creativity strategy that: --disability can even be reinterpreted by disabled group members as an opportunity for growth unavailable to nondisabled people, thereby positively distinguishing the ingroup from the outgroup

what is structural inequity?

-systematic or structural elements of society that benefit one population unfairly -ex: finance; housing; transportation; education; social opportunities, etc.

opportunities for the promotion of inclusive development

-take advantage of the existing opportunities -propose inclusive strategies in the programs and projects that are being implemented -develop capacities among the different actors, to negotiate the presentation of wider and inclusive projects and programs -establish mechanisms for participation and collaboration of the beneficiaries (PWD and families) for the implementation, the monitoring and evaluation of the programs and inclusive actions

universal attention

-the UN agencies estimate that in countries of the South, health, education, social protection and other existing services, only reach 3-4% of persons with disabilities who need them -these are basically focused on specialized attention, and centralized in the great urban centers -as general public services are commonly not accessible for them, these invisible 96-97% of persons with disabilities and their families are usually kept excluded of/by the system and condemned to poverty

why does the built environment matter?

-the built environment directly and indirectly affects human health and the natural environment -the diseases of the 21st century will be chronic diseases, those that steal vitality and productivity, and consume time and money. these diseases--heart disease, diabetes, obesity, asthma, and depression--are diseases that can be moderated by how we design and build our human environment -promoting healthy lifestyles is not enough. effects of the built environment must also be addressed

the web of causation

-the causes of the cause (a chain of causal influences) -ex: "why is Mabel in the hospital?" because she had a bad infection in her leg?; "but why does she have an infection?" because she has a cut on her leg and it got infected; "but why does she have a cut on her leg?" because she was rummaging...; "but why was she rummaging...?" because... etc.

what is health policy

-the collection of specific laws, programs, entitlements, regulations, administrative directions, and conditions of participation in various aspects of the health care system -policy that pertains to or influences the attainment of health -in terms of the DOH framework, health policy refers to legislation that may influence, directly or indirectly, social and physical environments, behaviors, socioeconomic status, and availability of and accessibility to medical care services -health policies affect groups or classes of individuals, such as physicians, the poor, the elderly, and children -they can also affect types of organizations, such as medical schools, HMOs, nursing homes, medical technology producers, and employers

what is stigma?

-the disqualifying or devaluation of individuals from the full social acceptance based on such a mark -difference based on a distinguishing characteristic or mark -in some particular social context or physical environment

what health professionals can do?

-the following suggestions may help with care for and communication with patients 1) consider how your own cultural beliefs, values and behaviors may affect interactions with patients 2) respect, understand and work with differing cultural perceptions of effective or appropriate treatment 3) make sure you understand how the patient understands his or her own health or illness 4) recognize that families may use complementary and alternative therapies 5) negotiate a treatment plan based on shared understanding and agreement

economic stability: a key determinant of health

-the gap in all-cause mortality between high and low SES persons is larger than the gap between smokers and non-smokers -Americans who have not graduated from high school have a death rate 2-3 times higher than those who have graduated from college -low SES adults have levels of illness in their 30's and 40's that are not seen in the highest SES group until after the ages of 65-75

life course impact of social determinants of health

-the impact of social determinants can accumulate over a lifetime and can cause significant changes in an individual's health trajectory -this adds to the complexity of SDOH -ex: from birth to the duration of their lifespan, low-income African Americans are more likely to live in poverty-stricken neighborhoods where their vulnerability to chronic illnesses are very high and they have limited or no access to care and treatment options for these diseases

access to services

-the incidence of disabilities of all kinds--according to levels of severity--is higher among the low and moderate disabilities, being the severe conditions, the less frequent -in most cases, these can receive primary care attention, at the community level, with simple interventions and at a lowest cost -on the other hand, if the person does not receive the necessary attention, a low functional limitation, can become a severe disability, generating high possibility of social and economic exclusion

cultural stereotypes of disabilities: media/movies

-the media has a long track record of using stereotypes to portray people with disabilities. these stereotypes can be negative or positive--but either way, they're rarely true to life 1) villains 2) the superhero 3) the victim 4) the butt of the joke 5) internally innocent

global trends and evolutions

-the number of people with disabilities is increasing -significant inequalities: --ex: those most excluded from the labor market are often those with mental health difficulties or intellectual impairments

types of ableism: outright discrimination

-the other forms of ableism are mostly invisible and often well intentioned -children with disabilities are almost two times more likely to be physically or sexually abused -abuse is also typically more severe and more likely to occur over a longer period of time -sexual abuse is 5 times more likely for people with intellectual or mental health disabilities -descriptions like crazy, nuts, wacko -questions during job interviews like, "time for the white elephant in the room: why do you walk like you do?"

what is culture?

-the pattern of ideas, customs and behaviors shared by a particular people or society -may include all or a subset of the following characteristics: ---ethnicity; language; religion and spiritual beliefs; gender; socio-economic status; age; sexual orientation; geographic origin ---group history; education; upbringing; life experience

socialization

-the process of learning values, ideas, practices and roles; it is about becoming a socially aware and socially skilled member of a society -tends to encourage an adjustment of beliefs to fit within a social group -social reinforcement -direct and indirect -peer pressure

global disability

-the rights and justice claims for people with disabilities and impairments living in other countries -treats disability as the result and expression of patterns of interaction between a person and their: --social --political --and physical environments

summary of social factors and health pt. 2

-the social factors involved may have more resonance for those affected than the issue itself. it may be easier to approach an issue through its underlying social factors than to deal with it directly -addressing the social and community factors alongside other determinants is crucial to understanding them fully, so that your strategy and tactics for dealing with them correspond to reality

types of ableism: helpless victim stereotype

-their disability controls every aspect of their lives and dominates their thoughts -they cannot participate in activities or make decisions for themselves -any difficulties they experience are due to personal characteristics rather than an inaccessible community -they long for a cure for their disability -"let me push you up this hill" -ex: artie on glee, tiny tim, forrest gump -impacts include pity, loss of autonomy, lack of inclusion

key domains of the life course theory (LCT): pathways or trajectories

-these are built--or diminished--over the lifespan -while individual trajectories vary, patterns can be predicted for populations and communities based on social, economic and environmental exposures and experiences

defining the built environment pt. 2

-these are the urban and rural human-made surroundings that provide the setting for human activity. -they encompass buildings and spaces (ex: homes, schools, workplaces. parks, etc.), the products they contain, and the infrastructure (ex: transportation, energy, and agricultural systems) that links and supports them -it extends overhead in the form of electric transmission lines, underground in the form of waste disposal sites and subway trains, and across the country in the form of highways

the nature of stereotypes continued

-they are cued and therefore they are emergent, based on context, social knowledge, motivations, values, and lay theories of group relations -certainly we draw from cultural products to inform the stereotypes we hold

the nature of stereotypes: their content will fluctuate depending on nature of intergroup status relations

-they are flexible, not rigid, and can change over time and in different contexts -the seeming stability of stereotypes reflects longstanding status relations--not a set in stone cognitive schema

the nature of stereotypes

-they are valid psychologically; they are not irrational, oversimplifications...psychologically -they may represent problematic intergroup status differences and troubled relations, but that is more of a political matter

economic instability general information

-this alone is one of the strongest predictors of poor health and development, not just because material deprivation constrains behavior and lifestyle choices among those living in poverty, but because neuroendocrine responses to the stress that SES imposes influences psycho-social well-being

how could education affect health (educational attainment): health knowledge, literacy, coping, and problem solving

-this can affect: ---diet ---exercise ---smoking ---health/disease

narrative identity

-this is a person's internalized and evolving life story, integrating the reconstructed past and imagined future to provide life with some degree of unity and purpose -the private, unfolding story of the self each person both knowingly and unconsciously crafts to merge the various aspects of the self --doesn't matter if they're fully true, just that they are sense-making

disability as a social construction continued

-this offers a new lens for understanding ability and disability as a social construction that frames how society understands and interacts with individuals who behave in ways that are different from the norm -it is a tool to assist in recognizing how ability is framed so that people can recognize and work toward more equitable, inclusive practices and perceptions of individuals who are different ---this entry discusses the perspective of disability as socially constructed

life course perspective

-this perspective is that human development and aging are *lifelong processes* -biological, intellectual, and social development continues to occur throughout life, which means that one's health at any point in the life course has been shaped, not only by recent, proximal circumstances and resources, but also by a lifetime of opportunities and constraints, or more distal influences

defining health policy continued

-this private policy is made by health care organizations such as hospitals and managed care organizations -also, these policies can also be made through the private sector (ex: insurance companies) -refers to local, state, and federal legislation; regulation; and court rulings that govern the behavior of individuals and organizations in the provision of health care services -in the US, each branch and level of government can influence health policy ---for ex: both the executive and legislative branches at the federal, state, and local levels can establish health policies, and the judicial branch at each level can uphold, strike down, or modify existing laws affecting health and healthcare

who should address social determinants of community health and development?

-those affected by the issues (the targets of change) -those who can have an effect on the issues (the agents of change) -staff members form organizations that work directly with the target population and/or the issue

key domains of the life course theory (LCT): risk and protective factors

-throughout the lifespan, protective factors improve health and contribute to healthy development, while risk factors diminish health and make it more difficult to reach full developmental potential. thus, pathways are changeable -these are not limited to individual behavioral patterns or receipt of medical care and social services, but also include factors related to family, neighborhood, community, and social policy

ways of challenging ableism: denaturalizing

-to problematize or call into question ways-of-being or world views considered superior -how do we take this denaturalizing step? --prioritize marginalized and intersectional subjectivities (especially disability subjectivities) --'turn the lens' back on taken-for-granted understandings --call into question world views, technologies, and infrastructures that form the basis for the particular way-of-being --call into question 'just-so' arrangements that produce impairment and are themselves disabling to the majority world communities

ways of challenging ableism: normalizing

-to valorize ways of being that mainstream systems of knowledge portray as abnormal or pathological -how can we perform normalizing steps --by considering the value and viability of diverse disability experiences including the productive and expressive forms of disability culture --by relocating pathology from inside the individual to the cultural and ecological context --by reconceptualizing disability as a historically oppressed minority group identity rather than an individual aberration

why social determinants?

-traditionally, when we have seen associations between behavior or lifestyle and health we have sought to fix the person's decision making -these efforts have had limited impacts -social determinants perspective pushes us to go deeper or further back -ex: poor eating habits: why is she deciding not to eat healthy or buy healthy foods? if we can get her to eat healthy the problem will be solved ---but it transcends the decision to eat or not to eat healthy ---what if she has no access to healthy food? what if they don't have a store in their neighborhood? ---what if she can only afford unhealthy food? what if they have no transportation?

social creativity strategy #1: changing comparison group

-trying to compare the ingroup with other groups that are even more disadvantaged (ex: as if to say "we may be impaired, but at least we're not ____") -offer a more favorable comparison, specifically one with lower status or one which can serve as a downward social comparison on relevant negative dimensions -this strategy depends on comparative dimensions which, when compared to nondisabled group members, provide unfavorable outcomes, but can be better than other ingroup members --such dimensions may include but are not limited to physical or mental capacities, social role, and aesthetic characteristics

social creativity strategy #2: changing the dimension of comparison

-trying to evaluate the ingroup on more flattering dimensions of comparisons ("we may be disabled but we're courageous") -emphasizing qualities which are specific to PWDs as a way of setting them apart from the non-disabled in a positive way -point of comparison could be shifted from physical and mental capabilities or aesthetic characteristics to other attributes which are *also* socially valuable --qualities like empathy, patience, work-ethic and innovativeness and generalize these qualities to the disability group more generally

social creativity strategy #3: changing the importance/meaning of dimensions

-trying to redefine the meaning of the ingroup membership -reevaluating certain comparative dimensions traditionally viewed as negative related to the (nondisabled) outgroup --similar to the "black is beautiful" campaign started around the civil rights movement -reinterpret physical and mental differences as creative and paradigm shifting rather than limiting or dysfunctional --disability offers a radical vantage point with which to re-imagine what it means to be human

why is it important to study health policy?

-understanding how health policy is developed is the first step toward influencing policy -the study of health policy allows one the ability to engage in efforts to improve it -the importance of health policy itself is another reason to study it -in addition, policy influences other determinants of health and therefore must be thoroughly understood to enhance the country's health system

privilege and ability

-unearned benefits afforded to powerful social groups within systems of oppression --requires social structures that confer advantages to some groups and not others --the focus is on macro-level systems that create and maintain unearned benefits --not just about material resources ---entails general normativity of those social identities which then require others to "keep up" ---implies an absence of social "friction" where one can exert maximum control over his/her environment and is unconstrained by physical, material, or sociocultural factors

social disadvantage

-unfavorable social, economic, or political conditions that some groups of people systematically experience based on their position in society -restricted ability to participate fully in society and enjoy the benefits of progress -the extent (single or multiple domains), depth (severity), durations (ex: across multiple generations)

where does stigma come from: evolutionary reasons for exclusion: mutual engagement

-unpredictable goals and behaviors -poor prospect for reciprocity -known history of cheating

sources of discrimination: prejudice

-urge to create in and out groups -assumptions about superiority/inferiority

types of ableism: supercrip

-used to describe someone who is disabled but has some sort of genius or other skill -coming into popular use around the time of the passage of the 1990 Americans with disabilities act (ADA), the term denotes a type of disabled person more likely to appear in the mainstream mass media -represents the antithesis to the other despised image in mainstream culture -impact: low expectations and pity, view of disability as a "bad" thing

defining adjustment to disability: it's subjective

-variation exists within and across individuals in the adjustment process -the individual's subjective analysis of her or her total situation appears to be the most important factor in guiding response

disadvantaged group responses to "dependency-oriented" help

-viewed with suspicion, frustration, and rejection --clashes with cognitive alternatives to the status quo and precise version of the future the social change is directed toward -warmer reception among those who have reduced feelings of collective control --do not see instability in intergroup activities --have relatively little perceived agency or collective efficacy to take advantage -may be accepted in order to be re-directed toward autonomy-oriented help

stereotyping misconceptions: stereotype rigidity

-we assume they are "hard-wired in the brain" --stereotypes change according to changing status relations between groups --stereotypes depend on both intergroup relations and who you're comparing the group to

what is the healthy built environment?

-we can think of this as a holistic concept including the 5 core planning realms 1) housing 2) transportation systems 3) natural environments 4) neighborhood design 5) the food system

why do we need to think beyond the individual?

-we do not exist outside of our social context. what surrounds us shapes us -our environments shape our opportunities and choices -yes, within reason perhaps we can shape our environments, but ask what kind of agency would that take? what kind of power or privilege?

building a health-promoting workplace pt. 2

-we have to look at the type of jobs people are working and the risks associated with particular kinds of employment in regards to overall health -monitor the implementation of work-related enactments such as: ---ADA: Americans with disability act ---age discrimination act in employment ---family and medical leave act ---title VII of the civil rights act of 1964

research: Arab American birth outcomes

-well-documented increase in discrimination and harassment of Arab Americans after 9/11 -Arab American women in California had an increased risk of low birth weight and preterm birth in the 6 months after sept. 11 compared to pre-sept. 11 -other women in California had no change in birth outcome risk pre-and post-September 11

asking the right questions about assumptions help change the narrative about what creates health: the central questions to identify assumptions are:

-what values underlie the decision-making process? -what is assumed to be true about the world and the role of the institution in the world? -what standards of success are being applied at different decision points, and by whom?

who should address social determinants of community health and development? continued pt. 3

-when it's clear that simply focusing on the issue isn't enough -when you're advocating for changes in laws, policies, or funding -when you're seeking fundamental change -when you're seeking a long-term solution to a long-term problem -when your focus is on community wellness and prevention

unconscious discrimination

-when one holds a negative stereotype about a group and meets someone who fits the stereotype s/he will discriminate against that individual -stereotype-linked bias is an: --automatic process --unconscious process -it occurs even among persons who are not prejudiced

summary of education and health

-when things like literacy, language, vocational training and higher education are lacking, disparities begin to form -as a result, death rates have been steady or increasing among the least educated populations, according to a study published by the public library of science -to aid in the development of individual skills and increase access to economic and social resources, we need to closely monitor and examine the effects of education on the well-being of individuals and communities

neighborhood, built environment, and health

-wherever we are, and whatever we are doing, our behavior is influenced by aspects of the environment ---buildings ---scenery ---people ---sound, etc. -these influences can be so powerful that they can completely change the way we behave and our health outcomes

barriers also prevent access to rehabilitation and assistive devices

-which can enable people with disabilities to participate and be independent -70 million people need a wheelchair. only 5-15% have access to one -360 million people globally have moderate to profound hearing loss -production of hearing aids only meets: --10% of global need --3% of developing countries' needs

key domains of the life course theory (LCT); critical or sensitive periods

-while adverse events and exposures can have an impact at any point in a person's life course, the impact is greatest at specific critical or sensitive periods of development -ex: during fetal development, in early childhood, during adolescence, etc.

social conflicts and stereotypes

-why do we have so many problems with stereotypes? --it's always other people's stereotypes that are the problem right? -there will be inevitable disagreements; what is valid for the in-group will not be valid for the outgroup --rejection of stereotype is a political act, not a psychological act

cultural stereotypes

-widely communicated messages and representations reinforced through socialization -may not be endorsed on a personal level, but no less impactful --simple awareness can be learned early and incorporated into one's knowledge base --can lead to judgments and behaviors in accordance with social categorization

culture also affects health in other ways, such as (pt. 2):

-willingness to discuss symptoms with a health care provider, or with an interpreter being present -influence of family dynamics, including traditional gender roles, filial responsibilities, and patterns of support among family members -perceptions of youth and aging -how accessible the health system is, as well as how well it functions

need to embrace complexity--study multiple layers

-with the knowledge that SDOH can have impact throughout the life course, then it is important that we embrace and study the complexity of social contexts which makes for better of ill health -"we need to embrace and study the complexity of the world, rather than attempting to ignore or reduce it by studying only isolated and often unrepresentative situations"

percent of job applicants receiving a callback: black

-without a criminal record: 14% -with a criminal record: 5%

percent of job applicants receiving a callback: white

-without a criminal record: 34% -with a criminal record: 17%

conclusions of stereotyping

-without direct contact, some persons without disabilities may begin to form their own opinions about a person with a disability -these opinions may be based on a global view of disability -rather than looking at each person's own unique characteristics, abilities, and disabilities, many people simply focus on one prominent attribute--a person's disability -this stereotyping or generalization is often an unfair characterization of the person with a disability

what are the factors that lead to health disparities in the workplace?

-workplace discrimination -ineffective training -inadequate communication (due to literacy or language barriers) -pressures to accept risky work assignments due to economic insecurity -employment of some demographic groups in high-risk jobs can lead to disparities in work-related exposures and rates of illnesses and injuries, including fatalities

every day discrimination: how often the following things happen to you can impact your health

-you are treated with less courtesy than other people -you are treated with less respect than other people -you receive poorer service than other people at restaurants or stores -people act as if they think you are not smart -people act as if they are afraid of you -people act as if they think you are dishonest -people act as if they're better than you are -you are called names or insulted -you are threatened or harassed

how do you identify social determinants of community health and development?

-you assess the community -you ask people who know -you apply critical thinking principles to the issue -you ask the right questions

defining individual health in context of community health

1) access to recreation and open space 2) access to healthy foods 3) access to medical services 4) access to public transit and active transportation 5) access to quality affordable housing 6) access to economic opportunity 7) completeness of neighborhoods 8) safe neighborhoods and public spaces 9) environmental quality 10) green and sustainable development and practices

why race still matters

1) all indicators of SES are non-equivalent across race 2) health is affected not only by current SES but by exposure to social and economic adversity over the life course 3) personal experiences of discrimination and institutional racism are added pathogenic factors that can affect the health of minority group members in multiple ways

critiques of the life course theory (LCT)

1) being fatalistic or excessively deterministic: that is, holding out little or no hope that individuals who have experienced adverse events or exposures early on might attain optimal health and well-being 2) that the concepts of early programming and critical or sensitive periods lead to "front loading" of interventions around pregnancy and early childhood, and that LCT tells us little about the value of interventions with other age groups, at different life stages

social creativity strategies

1) changing comparison group 2) changing the dimension of comparison 3) changing the importance/meaning of dimensions

providing health care to different cultural groups: above all, remember that:

1) cultures are dynamic 2) there is huge diversity within any culture 3) even when you think you understand one culture, it will have evolved or you will have identified exceptions

how disability is defined determines what is measured

1) disability is restricted activity (caused by social barriers) 2) disability is a form of social oppression 3) disability is created by categorizing bodies/minds as normal or abnormal

where does stigma come from: a more sociological perspective

1) distinguishing and labeling difference --construction of what is significantly different 2) difference = negative --additional (de)valuation of certain kinds of differences 3)separating "us" vs. "them" --accentuation of differences between the stigmatized and stigmatizer 4) status loss and discrimination --stigmatized therefore occupy lower status positions; delegitimized, dehumanized, have less control and power, their exclusion is more justifiable for a variety of reasons

are people who live in poor neighborhoods less healthy only because they themselves are poor as individuals, or do features of the neighborhoods they live in add something extra to the mix?

1) ex: 1 study that compared heart disease among people living in different neighborhoods found that individuals who lived in the most socioeconomically disadvantaged neighborhoods were more likely to develop heart disease than socioeconomically similar individuals who lived in the most advantaged neighborhoods 2) findings from another study suggests that low-income women are more likely than higher-income women to benefit 3) although the links between neighborhoods and health are not simple, the overwhelming weight of evidence indicates that both features of neighborhoods and characteristics of individual residents influence health. both places and people matter

cultural stereotypes of disabilities: health messaging

1) health communication negatively portray PWDs, even if unintentionally, to reduce suffering 2) eventual outcome always going to be a reinforcement of stigma, because you're trying to discourage certain conditions and phenomena

5 ways to talk about social determinants of health

1) health starts--long before illness--in our homes, schools, and jobs 2) all Americans should have the opportunity to make the choices that allow them to live a long, healthy life, regardless of their income, education or ethnic background 3) your neighborhood or job shouldn't be hazardous to your health 4) your opportunity for health starts long before you need medical care 5) the opportunity for health begins in our families, neighborhoods, schools, and jobs

access to health care: impact on health

1) increase/decrease mortality, life expectancy through detection and treatment of conditions 2) decreased morbidity through education of healthy life choices

social creativity strategy #1: changing the comparison group: downward comparisons in this case are likely to occur on 2 levels

1) intra-group comparisons to other categories of disability besides one's own 2) intra-sub-group comparisons or interpersonal comparisons made within one's category of disability

the nature of the social constructionist model reaction against the medicalization of disability

1) it implies that "within-individual" (physical and psychological) factors are the primary or exclusive causes of disability 2) it de-emphasizes the role of social factors in creating disabilities 3) it creates a taxonomic system for categorizing disabilities, and an identification process that results in labeling people with disabilities 4) it implies the medical treatment of disability, which, in turn, is equated with stigma, unnecessary hospitalization, and asylums

4 ways to build inclusive, healthy places for all

1) know the neighborhood 2) gauge trust, build trust, develop social networks 3) design public spaces for equity and dignity 4) foster social resilience

disability as a social construction: the concept of the social construction of disability has become popularized as a result of 2 major factors

1) on one hand, individuals with medical and physical disabilities have been working for their civil rights to fully participate and have access to society commensurate with their able-bodied, able-minded peers 2) on the other hand, the disproportionate representation of minorities in special education has created the question of how disability is socially constructed, and the system may, in fact, misinterpret cultural behavior or tendencies as disability rather than difference

racial disparities conclusions

1) racial disparities in health are large, pervasive and persistent over time 2) racial inequalities in health reflect larger social inequalities in society, of which SES is one component 3) accordingly, race still matters for health when SES is considered 4) research is needed that elucidates how risks and resources linked to living and working conditions combine, over time, to affect the health of socially disadvantaged populations 5) we need to act now on current knowledge

conclusions of racial and ethnic disparities

1) racial disparities in health are large, pervasive, and persistent over time 2) inequalities in health are created by larger inequalities in society 3) racial differences in health reflect the *unsuccessful implementation* of social policies ---eliminating them requires *political well and commitment* to implement new strategies to improve living and working conditions 4) eliminating disparities in health requires (1) acknowledging and documenting the health disparities, and (2) efforts to ameliorate their negative effects, dismantle the structures of health inequities and/or establish countervailing influences to the pervasive processes that produce health disparities

the danger is to assume that:

1) racism is *not* relevant in the scientific pursuit of solutions for the elimination of health disparities 2) that some populations will always suffer premature illness and death by virtue of their culture bound lifestyle choices; and thus, 3) that the elimination of disparities is impossible and health equity *unachievable* in a free market society

becoming prejudiced: how do prejudices develop

1) scapegoating 2) social learning theory --association --reinforcement --modeling 3) social sources (norms, conformity) 4) historical and cultural sources 5) others (social status, ethnocentrism, threat (real or imagined) and fear, economic competition)

examples of ableist privilege

1) television, movies, and advertisements often show people who look like me 2) I can dress in a hurry or talk to myself without people attributing it to the pitifulness of my disability 2) I can do well in a challenging situation without being called courageous

disparity recommendations

1) we need to identify markers better than race to identify the potential contribution of genetic factors 2) whenever racial/ethnic data are reported, we must give more attention to interpretation: always indicate why race/ethnicity is being used, the limitations of racial/ethnic data, and how findings should be interpreted. the presentation of data on racial differences should routinely stratify them by SES within racial groups. failure to do so may mid-specify complex health risks and even lead to harmful social stereotypes

building a health-promoting workplace

1) workplace design and organization 2) occupational safety and health 3) healthy lifestyles 4) understanding cultural diversity 5) non-occupational factors 6) improved health services 7) leadership, communication, and team building 8) personal development and learning

the nature of the social constructionist model reaction against the medicalization of disability continued

5) it connotes a cruel professional attitude toward people with disabilities, a paternalistic relationship between the professional and the clients with disabilities, and it invades people's privacy 6) it connotes the treatment of people with disabilities by medical and paramedical professions and creates powerful, vested interests in the medical industry for finding a "cure" for disability or preventing it

social environment (type of environment that affects human health)

SES, schools, jobs, churches, etc.

defining prejudice

a negative evaluation of a social group or a negative evaluation of an individual that is significantly based on the individual's group membership

disparities in the clinical encounter: the core paradox: uncertainty

a plausible hypothesis, particularly when providers treat patients that are dissimilar in cultural or linguistic background

able-ism

a set of beliefs, processes, and practices that produce a particular understanding of oneself, one's body, and one's relationship with others of humanity, other species, and the environment based on what abilities one exhibits and values

individual mobility

a strategy that is aimed at maintaining a positive *personal* identity, and it is likely to be preferred by people who self-categorize at the individual level in a given social context

disability activism and allyship: self-advocacy

ability to communicate needs and wants, locate services, and obtain necessary supports

transportation choices lead to active living

active transportation contributes to the societal goals of public health, economic vitality, equitable mobility, transportation options, livability, reduced congestion, reduced energy use and improved air quality

food security: food availability

addresses the "supply side" of food security and is determined by the level of food production, stock levels and net trade

stakeholders of health policy: businesses and corporations

american businesses and corporations have a keen interest in health policy that, among other issues, mandates healthcare coverage levels

defining adjustment to disability

an individual's highly personalized response to disability or illness-related disruptions across a wide range of life domains

impairment

any loss or abnormality of psychological, physiological, or anatomical structure or function

how do we identify systemic discrimination: overrepresentation

around 31% of PWDs in the US (vs. 11.7% nondisabled) are considered impoverished

criticisms of psychology from disability perspectives: assumption #2: impairment is source of difficulties

assumes obstacles to be solely the person's biological limitations rather than human made barriers of architecture or discriminatory practices

key themes in disability identity (from narratives): discrimination

awareness of self and other PWDs as targets of prejudiced behavior in daily life

social mobility

basically the movement of individuals or groups in social position over time

key themes in disability identity (from narratives): pride

being proud of one's identity while recognizing and possessing a devalued quality, disability

disparities in the clinical encounter: the core paradox: possibilities examined

bias (prejudice), uncertainty, stereotyping

poverty is a risk factor for many health conditions: toxic stress

children from low income families are more likely to develop a condition that requires treatment by a physician later in life

food security: food access

concerns about insufficient food access have resulted in a greater policy focus on incomes and expenditure in achieving food security objectives

stakeholders of health policy: consumers and patients

consumers and patients are typically the intended beneficiaries of health policy because they suffer the consequences of a health problem that could be the target of health policy

key themes in disability identity (from narratives): communal attachment

desire to affiliate with other PWDs

health inequality

differences, variations and disparities in the health achievements of individuals and groups of people

unequal access

discrimination can lead to reduced access to desirable goods and services

dimensions of stigma: disruptiveness

does it block or hamper interaction and communication?

disparities in the clinical encounter: the core paradox: stereotyping

evidence suggests that providers, like everyone else, use these 'cognitive shortcuts'

perceived discrimination

experiences of discrimination are a neglected psychosocial stressor

discrimination: group-based differential treatment and group-based exclusion

extends definition so it can include instances when discrimination is appraised as legitimate by both the advantaged and disadvantaged group

key themes in disability identity (from narratives): personal meaning

finding significance, making sense, and identifying benefits associated with disabity

stakeholders of health policy: educational and research institutions

health policy affects the type and quantity of healthcare providers to be trained, making educational institutions another significant stakeholder

education and health: community

health-related characteristics of the environment in which people live

internalized racism

how can the acceptance of society's negative characterization adversely affect health?

potential sources of racial and ethnic healthcare disparities: disparities arising from the clinical encounter: the core paradox

how could well-meaning and highly educated health professionals, working in their usual circumstances with diverse populations of patients, create a pattern of care that appears to be discriminatory?

the fundamental causes of illness

if risk factors are the precursors of illnesses, then the environmental and contextual factors that precede or shape these risk factors are the causes of the causes

long-term group effects: social benefits

if success is actually achieved this is constitutive of meritocracy in its ideal form

impact of poverty on disability: family impact

if the disability prevalence was 5% (lower than reality) and families of 6 members average, more than 25% of the whole population would be directly affected by disability

stakeholders of health policy: regulators

in addition to providing public insurance for the elderly and indigent, the government functions as a regulator, seeking to make sure that basic services are provided and their quality maintained by the providers and that the overall cost of providing care in the community or sector is contained

how can we eliminate physician biases and stereotypes? (general recommendation)

increase awareness of racial and ethnic disparities in healthcare among the general public and key stakeholders, and increase health care providers' awareness of disparities

poverty is a risk factor for many health conditions: chronic disease

individuals living in poverty experience an elevated risk of hypertension, arthritis, COPD, asthma, and having multiple chronic conditions

psychological immune system self-enhancement biases: fortune phenomenon

individuals tend to rate themselves at least average, and very often above average, in terms of how fortunate they are in general or on some specific dimension

built environment (type of environment that affects human health)

indoor (buildings) and outdoor (roads, parks, walking and biking paths, shopping centers/malls, etc.

defining adjustment to disability: affective

internalization of oneself as a person with a disability; new or restored sense of self-concept, values, and meanings

the intersection of education and health

interrelationship between demographic and family background indicators, effects of poor health in childhood, greater resources with higher level of education, and learned appreciation for the importance of good health behaviors, and one's social networks

dimensions of stigma: concealability

is the condition hidden or obvious? to what extent is its visibility controllable?

inclusive/universal design

it is estimated that the additional costs to bring universal access to the infrastructure is lower than 1% in the stage of design and planning

impact of poverty on disability: demographics

it is expected that the number of persons with disabilities will increase by 120% in the next 30 years in developing countries

poverty is a risk factor for many health conditions: diabetes

lower-income individuals are more likely to report having diabetes than higher-earning individuals (10% vs. 5% in men, 8% vs. 3% in women)

stakeholders of health policy: medical device and pharmaceutical manufacturers

manufacturers of medical equipment and drugs have a vested interest in health policy, especially with regard to payments for the use of their products

absolute poverty

measures poverty in relation to the amount of money necessary to meet basic needs such as food, clothing, and shelter

disparities in the clinical encounter: the core paradox: bias

no evidence suggests that providers are more likely than the general public to express their biases, but some evidence suggests that unconscious biases may exist

narrow determinants of health policy: leadership

no matter how significant the problem or how determined the stakeholders, health policy addressing a particular problem will not appear on the policy agenda without the approval of the governing body's leader

narrow determinants of health policy: resources

not even the most effective policy can be implemented without the availability of financial and administrative resources

impact bias

overfocusing on the immediate consequences of the event and neglecting the role of other competing factors

stakeholders of health policy: payers and insurers

payers and insurers can be private (commercial or other private enterprise) or public (government-operated entity)

moral view of disability

people who were not "perfect" in the body were thought to be "flawed" in the eyes of god

distributive allocative health policies

policies spread benefits throughout society

redistributive allocative health policies

policies take money or power from one group and give it to another

key themes in disability identity (from narratives): affirmation of disability

private thoughts and feelings of inclusion in the larger society, including the same rights and responsibilities as other citizens

defining adjustment to disability: behavioral

pursuit of personal, social, and vocational goals

time for action

racial disparities in health are really costly to our society

psychological immune system self-enhancement biases: better-than-average effect

rating one or more of personal qualities above a hypothetical mean

defining adjustment to disability: cognitive

reconciliation of the condition, its impact, and its chronic or permanent nature

systemic discrimination

refers to patterns of behavior, policies or practices that are part of the structures of an organization, and which create or perpetuate disadvantages for PWD

disparities in the clinical encounter: stereotyping: when is it in action?

situations characterized by time pressure, resource constraints, and high cognitive demand promote stereotyping due to the need for cognitive 'shortcuts' and lack of full information

education and health: the individual

skill development and access to resources

education and health: social/cultural context

social policies, residential segregation and unequal access to educational resources

psychological immune system self-enhancement biases: downward/upward social comparison

strategic comparisons with others in similar positions

forms of discrimination: education

students with disabilities drop out 3 times the rate of nondisabled peers

forms of discrimination: public accommodations

testimony to congress: PWDs ejected from movie theatres because "disgusting to look at"

how is examining social determinants of health like a ball of multi-colored yarn?

the domains are intricately linked to one another and cannot be easily parsed out

defining intersectionality

the interconnected nature of social categorizations such as race, class, gender, sexuality, and ability as they are applied to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage

broad determinants of health policy: health problem

the nature of the health problem is typically the first consideration of policy, the significance of which is determined by its magnitude and severity

poverty is a risk factor for many health conditions: cancer

those in low income groups experience higher rates of lung, oral and cervical cancers

poverty is a risk factor for many health conditions: cardiovascular disease

those in the lowest income group experience circulatory conditions at a rate 17% higher than the Canadian average

stakeholders of health policy: healthcare providers

those individuals who provide direct patient care--include physicians, nurses, dentists, pharmacists, and other health professions

poverty is a risk factor for many health conditions: mental illness

those living below the poverty line experience depression at a rate 58% higher than the Canadian average

additional terms: courtesy stigma

to be seen in the company of or associated with someone who is stigmatized is to invite stigmatization on oneself

dimensions of stigma: aesthetic qualities

to what extent does the mark make the possessor repellent, ugly, or upsetting?

dimensions of stigma: origins

under what circumstances did the condition originate? was anyone responsible for it and what was he or she trying to do?

key themes in disability identity (from narratives): self-worth

valuing oneself with disability; equal to nondisabled individuals

natural environment (type of environment that affects human health)

water, air, soil---food

dimensions of stigma: peril

what kind of danger is posed by the mark and how imminent and serious is it?

dimensions of stigma: course

what pattern of change over time is usually shown by the condition? what is its ultimate outcome?

food security

when people, at all times, have physical, social and economic access to sufficient, safe and nutritious food preferences for an active and healthy life