Public Health 102

Allostatis

(Change) processes through which biological regulatory systems alter their functioning to adapt to new conditions and demands. Stability is achieved through change rather than through resisting change System trade-offs are made accommodate immediate needs. Activation of autonomic nervous system and neuroendocrine system to mobilize energy; this may be advantageous in the short run, but lead to biological damage in the long term. Allostatic load: "wear and tear" that accumulates in body systems when individuals are exposed to chronic stress.

Social integration theory (Durkheim's theory)

(Durkeim wanted to understand why rates of suicide were higher in some social classes than others. Durkheim believed that society exerted a powerful force on individuals. He concluded that a people's beliefs, values, and norms make up a collective consciousness, a shared way of understanding each other and the world.) Testable assumption: -Structure of the network is largely responsible for determining individual behavior and attitudes -Does so by shaping the flow of resources or information that determine access to opportunities and constraints on behavior. Structure of networks may not always conform to preconceived notions of what constitutes "community" defined on the basis of geographic or kinship criteria. The essence of community is its social structure, not its spatial structure. WIKI: Social integration is focused on the need to move toward a safe, stable and just society by mending conditions of social disintegration and social exclusion - social fragmentation, exclusion and polarization; and by expanding and strengthening conditions of social integration - towards peaceful social relations of coexistence, collaboration and cohesion.

Robustness

(Resistance) How well your body reacts to stress. allows an organism to maintain effective functioning in the face of internal and external perturbations to the system. maintaining the functions of a system rather than maintaining a particular equilibrium point. capacity of the system to change in flexible ways in order to meet varying demands on the system. However will too much stress this can deteriorate.

Socioeconomic position vs Status

*Socioeconomic position*: relational, focused on groups relate to each other. *Socioeconomic status*: focused on the differences between groups, usually in regards to resources. SE focuses on SES, which is easier to operationalize, but may obscure some things.

Dirty dangerous and Demeaning

- 3Ds join psychosocial stressors of low control, job insecurity, and work/ life imbalance. -Low/middle-wage earners have limited family resources, longer commutes, burden of physically demanding and possibly toxic jobs

Weathering

-Higher psychosocial stress levels and lack of resources to cope can manifest in physical deterioration at an earlier age -Higher rates of chronic illness and lowered life expectancy in certain groups Stress weathers you, makes you in worse health.

Contextual effect of income inequality

-When the incomes of the top 1% pull away from the rest, they cause a variety of "pollution effects" ~Stiglitz: As rich get richer, they "secede" from the mainstream --Rich begin to see less reason for why they should be subsidizing everyone else for public services they do not themselves use. --The rich begin to agitate for tax relief, decreasing services for the rest of the society --The countries with largest increases in income inequality have passed the largest tax cuts to those at the top. ~Ergo: Income inequality degrades the quality of life for all but the very richest in society.

Structural discrimination

-totality of ways societies foster discrimination, via mutually reinforcing systems of discrimination that in turn reinforce discriminatory beliefs, values, and distribution of resources. --Ex: housing, education, employment, earnings, benefits, credit, media, health care, criminal justice, etc.

Five guiding concepts of SE

1. A POPULATION PERSPECTIVE 2. THE SOCIAL AND ECONOMIC CONTEXT OF BEHAVIOR 3. CONTEXTUAL MULTILEVEL ANALYSIS 4. DEVELOPMENTAL AND LIFECOURSE PERSPECTIVE 5. RESISTANCE AND SUSCEPTIBILITY TO DISEASE

MThe health models of employment

1. Economic deprivation models: - changes in family income by unemployment hamper the ability to accumulate wealth and reduce access to material resources that are relevant to health ( but offers a narrwo view of how labor marker transitions influence health 2. The nonfinancial benefits of work -theory of latent functions: in modern welfare states, no longer threats of starvation and physical deprivation accompanies unemployment -this implicates that work provides not only manifest but also latent funtions -unemployment can harm health bc work has a number of nonfinancial benefits: a time structure, social conact, self-esteem, status and prestige, and collective purpose. 3. Stress model -unemployment psychosocially stimulates/triggers stress mechanism -unemployment stress can lead to distress withdrawal and lower motivation leading to disease over shot and long periods of time

Theoretical model of influence of social networks on health

A "cascading causal process" (SE, 243) of dynamically linked processes, from the macro- social to the psycho-biological

Bowlby

ATTACHMENT THEORY Bowlby proposed that there is a universal human need to form close affectional bonds separation of infants from their mothers was unhealthy. loss and separation as key issues for psychotherapy. Attachment theory contends that the attached figure— most often, but not necessarily, the mother— creates a secure base from which an infant or toddler can venture forth and explore. Bowlby argued with many psychoanalysts that attachment is a "primary motivational system" - not secondary to feeding or warmth Form a secure base for solid attachment in adulthood and provide prototypes for later social relations. Secure attachment - as opposed to avoidant, ambivalent, or disorganized attachment - allows the maintenance of affectional bonds and security in a larger system. We now have increasing evidence of the importance of such early attachment for emotional regulation and adult health IN THE BOOK 1first formulated attachment theory. 2.John Bowlby has been described as one of the most important psychiatrists in the twentieth century (51). He qualified as a psychoanalyst in 1937 and soon thereafter was proposing theories to the British Psychoanalytic Society suggesting that the environment, especially in early childhood, plays a critical role in the genesis of neurosis. Early in his career, he believed that the separation of infants from their mothers was unhealthy. He saw loss and separation as key issues for psychotherapy. Bowlby proposed that there is a universal human need to form close affectional bonds (52). . Social Epidemiology (p. 238). Oxford University Press. Kindle Edition.

Alameda County Study

Alameda County Study Men and women who lacked ties to others were 1.9 to 3.1 times more likely to die in a 9-year follow-up period from 1965 to 1974 than those who had many more contacts. The relative risks associated with social isolation were not centered on one cause of death Relationship between social isolation and mortality risk was independent of health behaviors such as smoking, alcohol consumption, and physical activity.

Crossover and spillover

Almost always linked! Crossover is interpersonal: 1 person impacts another person. EX: mom at work stress affects the children. Spillover: intrapersonal. Since mom is stressed at home it is causing her to be stressed at home. It spills over within your self and when it crosses over to someone else is crossover.

Meth, HIV, MSM

An example of a Syndemic. HIV/AIDS and methamphetamine use are intertwined among MSM ~Meth use lowers inhibitions and immune response which can lead to HIV infection ~Depression and fatalism after an HIV infection can lead meth use ~Poverty, depression, and other infections can be involved in the feedback loop

Population Perspective

An individual's risk of illness cannot be considered in isolation from the disease risk of the population to which s/he belongs. We must incorporate the social context into explanations about why some people stay healthy while others get sick. Some prevention activities should target whole populations regardless of the variation in individuals' risk status (Using a bird eye view of the whole population)

Stiglitz

As rich get richer, they "secede" from the mainstream ~begin to see less reason for why they should be subsidizing everyone else for public services they do not themselves use. ~The rich begin to agitate for tax relief, decreasing services for the rest of the society ~The countries with largest increases in income inequality have passed the largest tax cuts to those at the top.

Work-family conflict

Beginning in the 1950s and 1960s, women in many countries around the world joined the paid labor force in unprecedented numbers -In some countries women struggled to balance work and family demands - in other countries public policies and workplace practices enable working families to maintain labor force participation and family life simultaneously. Work-family conflict based on role theories -Conflicting roles, expectations, and demands shape strains. Conflict can move from work to family, or family to work. -The model links job demands, job control, and social support to a broad range of outcomes for working families Women are especially affected, but men increasingly suffer from many of the same work-family demands. -Health effects among mothers may spill over directly to their children during in utero experiences and may play out over childhood via related behavioral and environmental interactions -Work-family conflict was thought to take its greatest toll on organizational outcomes such as turnover, absenteeism, and job dissatisfaction. -Mental disorders are often significantly associated with work-family conflict among both men and women.

social and economic context of behavior

Behaviors are not randomly distributed in the population. They are socially and economically patterned and often cluster with one another..The social environment influences behavior 1. shapes norms 2. enforces patterns of social control 3. provides (or not) opportunities to engage in certain behaviors 4. reduces or produces stress for which certain behaviors may be an effective coping strategy, at least in the short term.

Biological embedding "Epigenetics"

Biological embedding: When social environments alter biological and developmental processes in enduring ways, influencing long-term health -a lifecourse orientation, with early experiences setting up a chain of events that influence later development and health, or due to cumulative effects of repeated exposures. -Various biological mediators epigenetic processes, tissue remodeling, alterations in neural structure and function, HPA axis effects, and shifting immune patterns toward inflammatory processes Hope to explain several phenomena -while social inequalities in health are often evident early in life, they persist into adulthood and manifest in different biological systems as individuals age -social inequalities in health are not fully explained by measured behavioral risk factors -social inequalities differentially influence long-term health outcomes depending on when during the lifecourse adversity is experienced -social inequality often appears to be intergenerational, with effects "TRANSMITTED" from parents to children.

Bonding and bridging

Bonding social capital resources accessed within networks in which the members share similar background characteristics. In *disadvantaged communities, strong bonding capital develops as an important survival mechanism for residents* But: If the poor only have each other to turn to for support, they can remain "trapped." Ex: One study of poor African-Americans found that while high bonding capital was associated with more mental distress the opposite was true for network ties to others who came from different race/ class backgrounds - bridging capital Bridging social capital resources accessed across networks that cross (or "bridge") class, race/ ethnicity, or other social characteristics. Links social capital to structural inequalities in power, resources, and authority. Ex: In Kobe earthquake Strong bonding capital helped to deal with the immediate aftermath of the disaster During reconstruction phase, new social capital forged bridging ties between city authorities, nonprofit organizations, and community residents— speeding the process of recovery.

Bourdieu

Bourdieu (6) referred to the acquisition of certain habits (e.g., going to museums and concerts), preferences, or styles of speech and dress as "cultural capital," which individuals use to express their symbolic status in society. "Social capital" expresses the idea that there are tangible resources embedded in social relationships, available for members to access. That is, when we hang out with our friends, we may be simply having a good time, but at the same time, our network connections are also available for us to draw on material and psychological resources. . Social Epidemiology (p. 291). Oxford University Press. Kindle Edition.

Attachment theory

Bowlby proposed that there is a universal human need to form close affectional bonds separation of infants from their mothers was unhealthy. loss and separation as key issues for psychotherapy. Attachment theory contends that the attached figure— most often, but not necessarily, the mother— creates a secure base from which an infant or toddler can venture forth and explore. Bowlby argued with many psychoanalysts that attachment is a "primary motivational system" - not secondary to feeding or warmth Form a secure base for solid attachment in adulthood and provide prototypes for later social relations. Secure attachment - as opposed to avoidant, ambivalent, or disorganized attachment - allows the maintenance of affectional bonds and security in a larger system. We now have increasing evidence of the importance of such early attachment for emotional regulation and adult health

The various physiological effects of social adversity

Chronic psychosocial stress a key pathway linking social adversity with health -Often seen as direct effects on physiology or indirect effects mediated by behaviors. -These pathways may not always be so clearly defined Psychological responses to social adversity are hypothesized to trigger a cascade of pathophysiological processes -When people are overwhelmed or unable to cope with external events, the stress triggers a biological stress response. --When this occurs repeatedly or doesn't allow for restorative processes, these stresses can initiate disease-related processes These psychological responses to stress can also trigger unhealthy behaviors -Smoking, drinking, overeating, risk-taking can lead to numerous kinds of poor health outcomes Most models and conceptualizations of these pathways assume people (and bodies) facing psychological or biological adversity make tradeoffs and adaptations in behavior and biology -may be beneficial in the short term but have negative consequences over the long run - Some models see the effects of social adversity as cumulative, sometimes affecting developmental process

Collective efficacy

Collective efficacy: to the ability of the collective to mobilize to undertake collective action the group-level analog of the concept of self- efficacy Appropriable social organizations: an association established for one purpose could be later appropriated to serve a different purpose. Once civic organizations are established for one purpose (protesting against pollution), they can be flexibly adapted for a different purpose (responding to a disaster). What about free-loaders? Many of us would prefer to sit back and let others do the work to fix a collective problem. Why then do people volunteer to clean up the debris after an earthquake? They may be already connected to each other via existing community-based organizations. Free-riding risks damage to one's reputation as well as social sanctions, like ostracism. The extent of civic participation in a community is a crude indicator of the social capital of a community.

Conditional Cash Transfers

Conditional cash transfers (CCTs) are programs that transfer cash to poor households -- on the condition that they comply with a set of behavioral requirements -- to invest in the human capital of their children. - Parents may hold misguided beliefs about the process and returns of investments in their children -Redistribution to the poor through cash transfers may enjoy little societal support unless it is perceived to be conditioned on "good behavior." Good evidence that CCTs have strong beneficial effects on child health and may also improve mother's health, too. - increased share food expenditures may also improve the quality of diet among adults and children. -CCTs led to a decrease in obesity among adolescent women. But: also higher rates of smoking among adolescent females

Organizational Justice

Consists of two domains: distributive justice and procedural justice. Distributive justice -"the degree to which a worker believes that she is fairly rewarded in the basis of effort and performance" - overlaps to a considerable degree with Siegrist's concept of effort-reward imbalance Procedural justice encompasses two dimensions: -the existence of formal procedures in the workplace (the extent to which decision-making processes are fair and consistent, etc.) -interactional justice (the extent to which supervisors treat subordinates with respect, transparency, and fairness) Lack of organizational justice has been shown in a cohort of Finnish workers to be associated with poor self-rated health, minor psychiatric disorders, and sickness

Homeostatis

Coordinated physiological process designed to regulate stress-induced changes in order to maintaining constancy in major biological systems (like blood glucose levels, blood pressure, etc.) Problem: too much stress will threaten homeostasis. If you get a lot of stress, what happens when homeostasis is a perminant response?

Cultural capital

Cultural capital: The acquisition of certain habits (e.g., going to museums and concerts), preferences, or styles of speech and dress as "which individuals use to express their symbolic status in society."

DOHAD

Developmental origins of adult health and disease (DOHAD) model events that affect fetal growth can permanently alter the structure and physiology of the offspring in ways that increase the risk of chronic disease in later life Ex: "fetal programming," whereby specific developmental paths are triggered that improve survival under calorie-poor conditions but have enduring consequences for cardiovascular risk. ~Because social conditions shape nutritionally and material deprivations, DOHAD has been invoked to help explain enduring social inequalities in health.

Differential susceptibility to context

Differential susceptibility to context (DSC) hypothesis Stress response phenotypes serve to calibrate a child's behavior to his or her likely environment, and the same phenotype is not most advantageous in all circumstances. Some children are "dandelions," having a lowreactive phenotype and a capacity to flourish within a large range of environmental circumstances, much like the weed By contrast, the "orchid" child, can be highly successful in positive social environments but fare very poorly in more adverse environments - like actual orchids.

De facto discrimination

Discrimination sanctioned by custom and practice. Not always intentional. For Example: judging a Muslim on an airplane or generalizing an entire race. Discrimination is a socially structured and sanctioned phenomenon, justified by ideology and expressed in interactions among and between individuals and institutions, that maintains privileges for members

Institutional discrimination

Discriminatory policies or practices CARRIED OUT BY STATE OR NON-STATE INSTITUTIONS -- Ex: racial profiling by police, same-sex marriage bans

***Durkheim

Durkheim's primary aim was to explain individual pathology as a function of social dynamics. He argued that individuals are bonded to society by two forms of integration: attachment and regulation. Attachment is the extent to which an individual maintains ties with members of society. Regulation involves the extent to which an individual is held in the fabric of society by its values, beliefs, and norms He viewed suicide not as an "isolated tragedy" in the life of an individual but as a reflection of conditions of society as a whole Durkheim's primary aim was to explain individual pathology as a function of social dynamics. He argued that individuals are bonded to society by two forms of integration: ATTACHMENT AND REGULATION -Attachment is the extent to which an individual maintains ties with members of society. -Regulation involves the extent to which an individual is held in the fabric of society by its values, beliefs, and norms He viewed suicide not as an "isolated tragedy" in the life of an individual but as a reflection of conditions of society as a whole IN THE BOOK 1 Durkheim wrote eloquently about another profound social experience, that of social integration and how it was related to patterns of mortality, especially suicide Durkheim's discovery about suicide: that the rate of suicide in a society is linked to collective social forces. .

Differences between standard Epifemiology and Social Epidemiology

EPI: the study of what is upon the people; study of distribution and determinants of health across populations Social EPI: The branch of epidemiology that studies the social distribution and social determinants of health **Epidemiology is the study of contracted disease whereas social epidemiology looks at the social determinants that could possibly have put the patient in that position to get the disease.

contextual multilevel analysis

Ecologic-level exposures in environmental and infectious disease epidemiology are well established. Also valid ecologic-level exposures related to the social environment. Lead to an understanding of social determinants of health that is more than the sum of individual-level measures.

Effort reward imbalance model

Effort-reward imbalance model When a high degree of effort does not meet a high degree of reward, emotional tensions arise and illness risk increases. The demand-control-support model focuses on the organization's structure, while the effort-reward model examines the individual's fit within the environment Effort is defined as the individual's response to the demands made on him or her. extrinsic effort, which refers to the individual's effort to cope with external demands intrinsic effort, which corresponds to his or her own drive to fulfill his or her goals. Ex: young employees without extensive work experience with a high degree of "vigor" get involved in more and more commitments. Due to the increasing number of commitments, there may be a rise in the number of conflicts, increasing frustration and irritation. A corporate culture that includes a high level of psychological demands may force employees to internalize extrinsic demands. Reward is a composite measure of financial rewards, self-esteem, and social control. A "healthy state" occurs when reward is increased as effort increases. achieved by means of external work-related changes such as increased salary and improved social status or increased possibilities for promotion.

Egocentric and sociocentric approaches in social network analysis

Egocentric approach -The structure and function of the network based on the perspective of an individual. Sociocentric approach -The study of entire networks: relationships of entire schools, towns, or workplaces

Precarious Employment

Employment insecurity or "precarious employment" has been shown to lead to poor physical and mental health negative health effects of job insecurity might be comparable with those of unemployment Those exposed to chronic job insecurity had the worst health profile. Effects shown in blood pressure and body mass index. Transitions to unemployment but also transitions to underemployment are associated with worse psychological health. Both "precarious employment" and "underemployment" encompasses many elements Which specific aspects of underemployment may be detrimental to health? Which ones may be amenable to policy?

Swedish Volvo Plant

Ex: Swedish Volvo plant where the traditional assembly line work (high demand, low control) replaced by flexible team-based production process IN THE BOOK: One of the few workplace intervention studies that attempted to boost worker autonomy was carried out in a Swedish Volvo plant where the traditional assembly line work (machine-paced, high demand, low control) was replaced by a production process based on a more flexible team-work approach (42). The results of this small intervention found that workers' assessment of autonomy and skill utilization improved, as did their physiological stress profiles, as measured by epinephrine excretion. Unfortunately, the experiment was not continued for long enough to examine long-term health outcomes; on the other hand, productivity was not adversely affected by the flexible work arrangement, suggesting that job redesign may present a win/ win solution for employers and workers. . Social Epidemiology (pp. 159-160). Oxford University Press. Kindle Edition.

Welfare to Work

Experimental study - randomly assigned low-income and welfare-recipient single parents to a variety of welfare and employment policy treatments -a control group that continued to receive welfare as usual. -strong positive effects on children's cognitive outcomes and educational achievement.

Fundamental cause theory

Explains inequalities persisting across time and geography. *As new diseases emerge, new inequalities emerge.* Theory of fundamental causes to explain why the association between (SES) and mortality has persisted despite radical changes in the diseases and risk factors that are presumed to explain it.

Five primary downstream pathways

Five primary downstream pathways - provision of social support - social influence - social engagement and attachment - access to resources and material goods - negative social interactions including conflict and abuse.

Development of SE as a field

Focus on specific social phenomena such as socioeconomic stratification, social networks, discrimination, workplace organization, and public policies rather than on specific disease outcomes. Some diseases are more heavily influenced by social experiences than others. The vast majority of diseases and other health outcomes such as functional status, disability, and well-being are affected by the social world surrounding us all.

4 kinds of sexual networks

Four kinds of sexual networks: a core in which a group of high-activity actors pass infection to one another and diffuse infection out to a less connected population an inverse core, which is a central group such as truckers infected with HIV who spread disease out to others but not directly to themselves; bridging networks where two groups engaged in different behaviors have network members who bridge and link entire groups to each other a spanning tree, which is a long chain of connections that stretch across a population with very sparse density.

Head Start

Head Start US federal program intended to improve the learning skills, social skills, and health status of poor children - Nonrandomized evaluations following quasi- experimental designs. - significant educational benefits and reduced criminal involvement among African American children who participated in Head Start. - Has important cognitive and social benefits. - These changes are likely to lead to better health in the long term, even though to date there are few informative analyses of adult health

Brenner

Health and Economy Brenner in the 1970s, using data on economic outcome and mortality for England and Wales

Human capital theory (Grossman Model)

Human capital: "the stock of knowledge, competencies, or other personal attributes that an individual has and that contribute to his or her 'productivity'" (SE, 183) Health is a form of human capital, and it complements other forms of human capital. -Job loss may lead to a loss of human capital by eroding skills and earnings, which may in turn lead to poor health in the long run. - Staying in labor market reduces the human capital loss, providing health gains for mothers and children. The Grossman model: -rational actor theory of the demand for health -Health is capital, a stock determined by investments and speding. -A consumption good providing utility and an investment good Predicts various effects on the labor market: - Health status determines the total time an individual spends in sickness, and therefore determines the total time available for market and nonmarket activities. However: ~Increased labor supply decreases the time available for producing better health through exercise, better cooking, etc. and increases likelihood of experiencing poor working conditions

Ecosocial theory: direct and indirect methods

INDIRECT Compare health outcomes of subordinated and dominant groups without direct data on exposure to discrimination. - If outcomes differ, researchers determine whether disparities can be explained by "known risk factors." -Interpret findings in light of how discrimination may shape distribution of the relevant "risk factors." -If a residual difference persists, even after controlling for these other risk factors, additional aspects of discrimination may be inferred as a possible explanation for the remaining disparities. Weakness in making causal inferences based on omitted variables, but better than leaving the question unasked and the inequities unanalyzed. -utility for analyzing outcomes where individual knowing about not only her or his own experience but also that of others Nevertheless: Extensive evidence indicates that racial/ethnic inequities in income contribute significantly to explaining racial/ethnic inequities in disease occurrence, survival, and mortality. DIRECT: effects of those people that have face discrimination 1st hand! Devising valid and reliable instruments to measure individuals' exposure to discrimination across the lifecourse direct target or as a witness behaviorally, psychologically, and physiologically responses Many of these instruments measured mental health depression, anxiety, other psychological stressors Other focuses have been hypertension or blood pressure Two of the early studies reported that blood pressure and heart rate among African Americans increased more quickly upon viewing movie scenes involving racist, as compared to nonracist but angry, or neutral, encounters.

developmental and lifecourse perspective

Identification of periods of causation is central to improving population health. Three main lifecourse trajectories: 1. Early development and childhood: the importance of early life exposures in shaping cognition and brain 2. Most adult disease is not likely the result of early childhood or prenatal exposure but rather the result of a lifetime of accumulated exposures 3. Social trajectory model of health and disease: early life exposures do not directly affect adult health. They influence adult social conditions, which, in turn, affect adult health.

1995 heat wave in Chicago

In Klinenberg's "social autopsy" of the 1995 heat wave in Chicago - One of the biggest risk factors for death among low-income seniors was failing to seek relief at an emergency cooling station. -Too afraid to come outdoors because of their fear of crime. -Contrasts the radically divergent mortality of two adjoining neighborhoods in the west side of Chicago - South Lawndale, residents described informal control and collective efficacy: mortality rate of 4 per 100,000 - In North Lawndale, residents felt unsafe and refused to come out to seek help: heat-wave mortality rate reached 40 deaths per 100,000.

****Framingham Study

In the Framingham Study -smoking cessation was found to be contagious across social networks, but so was obesity -happiness is contagious but so isdepression Downsides include: exclusion of outsiders, excess claims made on group members restrictions on -individual freedoms downward-leveling norms. Framingham Study Many effects have come under attack because the analytical methods used by the researchers failed to take account of homophily, that people with shared characteristics tend to befriend each other this might not be because of social contagion; it might be because "birds of a feather like to flock together" perhaps the stigma of obesity leads overweight people to seek each other's company where they can feel more comfortable in the Framingham Study -smoking cessation was found to be contagious across social networks, but so was obesity ***happiness is contagious but so is depression**** - Many effects have come under attack because the analytical methods used by the researchers failed to take account of homophily, that people with shared characteristics tend to befriend each other -this might not be because of social contagion; it might be because "birds of a feather like to flock together" -perhaps the stigma of obesity leads overweight people to seek each other's company where they can feel more comfortable

Relative income hypothesis

Income inequality creates a bigger gap between your income and the incomes of others you compare yourself to. The size of this gap leads to stress and frustration. As inequality rises, gap between one's income and the incomes of others (to whom they compare themselves) increases. -Might have enough money for basic needs but cannot afford the things others in the same community can.

Informal social control

Informal social control: the ability of adults in a community to maintain social order From criminology: A cohesive community is one in which residents can rely on its adults to step in when they witness unlawful behavior not just parents or formal law enforcement The likelihood rises when there is network closure When adults in a community are socially connected to each other. Applicable and relevant to the prevention of many health behaviors including underage smoking, drinking, or drug abuse. Whenever a parent relies on her neighbors to police the behaviors of their children when they are not looking, she is benefiting from the network to which she belongs. Informal control is a collective characteristic of the group.

De jure discrimination

Mandated by law. Things that are considered discrimination and are enforced by law. For example: back in the day school's were seperated by race and this was put into place by the state and discriminated against those of color

Invisible and historic discrimination

Many forms of discrimination are institutional and often invisible or unnoticed. research can be used to make visible the structures and behaviors involved in discriminatory practices. While racial prejudice has declined overtime, cultural ideologies supporting discrimination are embedded in the culture. Historic: *People underreport negative social attitudes *Dominant groups typically deny discrimination exists, especially if it is no longer legal*EX: no more racism because no more slaves. ~For example: Pew research conducted a study to see white versus black. More whites thought that racism is gone than black people. -Friendly feelings toward individual members of subordinate groups are often combined with the denial of any responsibility for institutional discrimination.

Health effects of uneployment and recessions

Mental and physical health respond differently to economic shocks. Several measures of mental health seem worsen during economic recessions and improve during economic expansions. People behave in more healthy ways during harsh economic times, while they tend toward less healthy behavior when the economy is doing well. Recessions may lead to short-term changes in health behavior, over the long-term, exposure to recessions in key periods of the lifecourse may lead to permanent changes in health and aging Effects of economic downturns on the health of low-skilled, low-wage workers may also differ from the effect on higher-skilled workers with more stable careers. One study based on US data: Working-age adults with low educational level and the employed overall suffer increased mortality during economic contractions More highly educated, unemployed, disabled, and retired experience reduced mortality during economic downturns

Endogeneity

Most social behaviors are rooted in the individual's choices and preferences, endogenous in any equation linking social capital to health outcomes. In statistics, an endogeneity problem occurs when an explanatory variable is correlated with the error term. Endogeneity can arise as a result of measurement error, autoregression with autocorrelated errors, simultaneous causality (see Instrumental variable) and omitted variables. Two common causes of endogeneity are: 1) an uncontrolled confounder causing both independent and dependent variables of a model; and 2) a loop of causality between the independent and dependent variables of a model. For example, in a simple supply and demand model, when predicting the quantity demanded in equilibrium, the price is endogenous because producers change their price in response to demand and consumers change their demand in response to price. In this case, the price variable is said to have total endogeneity once the demand and supply curves are known. In contrast, a change in consumer tastes or preferences would be an exogenous change on the demand curve. Know the Framington study

Perry Pre-School Project

Perry Preschool Project Randomly assigned disadvantaged African American children in Ypsilanti, Michigan an experimental group (n = 58) receiving center- based preschool, home visits, and parent group meetings or to a control group (n = 65). With follow-up through age 40 a cost-benefit analysis suggested a $ 12.90 return for every $ 1 in program cost better health and lower cumulative mortality lower use of tertiary health care services and lower drug use

Three types of social capital intervention

Proof of the utility of social capital: interventions to improve health outcomes. 1. build new forms of social capital (such as building brand-new community centers, described in the previous section). The Experience Corps was a community-based intervention based in Baltimore sought to mobilize retirees to volunteer as teachers' assistants in public elementary schools An attempt to build new network connections that bridged generations (between seniors and schoolchildren) as well as teachers, parents, and volunteers a "win/win" result: program succeeded in elevating the senior volunteers' level of physical activity and functional mobility as well as the children's academic scores. 2. social capital is the channel (mediating variable) through which another, unrelated intervention is predicted to affect health. Many kinds of microcredit and microfinance interventions have been introduced in resource- poor settings to stimulate economic development. Depending on the way in which the microfinance is set up, a by-product of the intervention can be a strengthening of social capital 3. social capital is treated as the segmenting device (moderating variable) to predict the success or failure of other community-based interventions. in disaster research, wide variability in the recovery and resilience of affected communities Explained by variations in the stocks of community social capital predating exposure to disaster

IV drug user networks

Research on the social networks of injection drug users illustrates the myth that social networks and support are inevitably health promoting Participation in risk networks socializes an individual to a health-compromising lifestyle and then reinforces that pattern through various channels of social influence. In a study of 293 inner-city injecting drug users (IDUs) -Network density and size of drug-using subnetworks were positively associated with frequency of drug use. -Injectors whose personal networks contained a non injecting partner injected less frequently -Some kinds of ties may be protective against high-risk exposure. "Interventions should work with, not around, those networks"

Ruhm

Ruhm found that economic downturns were associated with reductions in mortality and expansions were associated with rising mortality ( different from Brenner)

Ways increased education may improve health

Set of cognitive or emotional skills foster health promoting decisions throughout life. More *abstract skills, such as the ability to think abstractly, self-regulate, delay gratification, or adhere to organizational rules*. Education may promote lifelong participation in cognitively challenging activities, which may in turn increase the chances of better health and survival. (More education better job) Time spent in school is also time not spent engaged in other activities, some of which may be health-damaging. May improve long-term health by increasing the chances that you will have a well-educated spouse, well-educated friends, and well educated acquaintances.

Adverse work schedule

Shift work increasing working outside the hours of 8 am to 5 pm and ROTATING SHIFT workers do not work the same shifts over time experiencing an especially elevated risk for POOR HEALTH Sleep deprivation and dysregulation of circadian rhythms leading to adverse health outcomes. While few night shift workers ever make the full shift in circadian rhythms, rotating shift workers can never hope to achieve a full transition, and as a result experience additional health risks, Ex: Workers in transportation, health care, mining, and construction often have such schedules. Researchers focus more on the direct physical consequences of such schedules than on the socially mediated mechanisms related to job strain. Ex: shift workers selecting schedules to maintain family cohesiveness and care (positive and negative effects) Most obviously, shift work disrupts workers' daily routines, so that they end up snacking at odd hours, or becoming socially isolated from their peers. Shift work also suppresses melatonin secretion, leading to increased production of estrogen that may increase the risk for breast cancer. The global integration of economies worldwide has resulted in increased pressure for "labor flexibility." A notable aspect of this trend has been the rise in nonstandard work arrangements, which include (involuntary) part-time work, temporary agency-based work, fixed-term contingent work, and independent contracting. Schedule control refers specifically to the timing of work, how much people work, when they are able to start and stop work, and whether they can take time off during the workday. Control over work schedules is associated with reduced work-family conflict.

Social capital

Social capital: Tangible resources embedded in social relationships, available for members to access.

Social contagion

Social contagion: behaviors spread more quickly through a tightly knit social network. The greater the transitivity of a network the more paths there are for members to influence the behavior of others. Transitivity: how saturated the social connections are between individuals in a network Behaviors spread through a network through the diffusion of information through the transmission of behavioral norms. Sometimes the behavior that spreads via the network can be deleterious to health Spread of obesity or drug use, through a social network The behavior can be health-promoting Spread of smoking cessation or healthy eating Christakis and Fowler's smoking data from Framingham Influenced by the behavior of people we do not even know by virtue of our membership in a network, we may still "benefit" from the rippling contagion triggered by the behavior of others in a distant part of the network. Corollary: We expect to observe faster diffusion of behaviors in networks with higher social capital that are more cohesive.

Health effects of employment protection policies

Social protection- helping rational economic actors overcome market failures in human capital formation: 1 Maternity leave policies: - Reduce gender differences in labor market trajectories, labor supply and accumulation of human capital due -Increase labor market attachment by making it easier and more likely women will return to work 2Retirement policies: -in theory, workers invest more in skills and human capital if they expect to retire later- thus increasing retiement ae may be a good idea. -Retirement policies influence human capital investment decisions concerning work and employment, in turn influencing trajectory of careers and earnings

Cognitive and structural social capital

Social support is transactional. Give and take within a normative framework Behavior is guided by norms of interdependence, solidarity, and reciprocity Within context of long-standing social network ties. Differentiate between cognitive and behavioral support. A person may perceive support is available but it may not be provided when a request is made. Support that is received: enacted or experienced support

Ecosocial Theory:

Started by *Krieger* in 2001: *Who and what is responsible for population patterns of health, disease, and wellbeing, as manifested in present, past, and changing social inequalities in health?* The ecosocial theory of disease distribution concerns *who and what drives social inequalities in health.* *How we literally biologically embody exposures arising from our societal and ecological context, thereby producing population rates and distributions of health.* Explicit consideration of pathways of embodiment -types and levels of exposure -the period and spatial expanse involved -historical context -phenomena that affect susceptibility and resistance to exposure, ranging from micro (gut microbiome) to macro (organizing to challenge health inequities). *Key issues*: accountability (causal responsibility for) and agency (the power and ability to act) -not only to the magnitude of health inequities but also to how they are monitored, analyzed, and addressed. Discrimination is conceptualized as a dynamic phenomenon: simultaneously structures individual risk and population rates of disease, thereby giving rise to health inequities.

Krieger

Started by Krieger in 2001: Ecosocial theory,

SAVA

Substance abuse, violence, and AIDS. Violence when an adolescent lead to diseases and conditions later in life ~HIV/AIDS, Hepatitis C, STDs, drug overdoses, and mental illness.

Temporary income shocks

Temporary income shocks may thus be used for the consumption of goods with little or no effect on health, as opposed to other income shocks such as CCTs, which influence monthly consumption and potentially increase human capital investments.Meaning, a sudden short time increase in income only helps on a surface level for example buying groceries but if its only temporary income increase it's not going to have a lasting effect on your/your families health.

Absolute income effect

The concave shape of the relationship between income and health predicts that, ceteris paribus, more unequal societies have worse average health. If you know you are going to "absolutly" be recieving money every month, you are more comfortable spending that money. Higher absolute income increases your spending but we still won't spend all of our increase.

resistance and susceptibility to disease

The general susceptibility hypothesis: 1. whether individuals developed one disease or another depended on their behavioral or environmental exposures as well as their biological or genetic makeup. 2. whether they became ill or died at earlier ages or whether specific socially defined groups had greater rates of disease depended on socially stressful conditions. Social epidemiology has became more integrated neuroscience: clear biological mechanisms have been defined.

Ways income are associated with health

The more income and wealth are associated with better health. *Higher income may enable better access to the means to produce good health*, including better access to health care, as well as other forms of "healthy consumption" such as better housing, means of transportation,or clothing.

Iso-strain model

The most "toxic" jobs are those that combine high strain with social isolation Combines psychological demands and decision latitude with social support from coworkers and supervisors. -Jobs that are characterized by high strain often have low levels of social interactions with other employees and hierarchical relations between supervisors and employees. -Call centers, assembly lines, etc. People experiencing low social support + high psychosocial demands + low control highest relative risk for cardiovascular disease compared to the people experiencing other combinations of demand-control and social support

Positional competition

The rich express their power and status by displaying of the luxuries only they can afford EX: keeping up with the joneses

***Christakis

The social network landscape changed with the analysis of the Framingham Heart Study by Christakis and Fowler. . Social Epidemiology (p. 248). Oxford University Press. Kindle Edition.

Demand control model

This is the picture in WEEK 3 day 1 slide 4 this of this as a Punnett square Psychological demands: LOW High Decision latitude High (LS 3) (active2) (control) Low (passive 4) ( HS 1) - LS - Low strain -HS- High strain 3 and 1 have Risk of psychological strain and physical illness 4 and 1- learning motivation to develop new behavioral patterns

Socioeconomic status as a fundamental determinant of health

Three key markers of SES are (EDUCATION, EMPLOYMENT, INCOME) What can we do when we identify these statuses? Simple: Determine where to focus services Complicated: Figure out how to intervene **The causal relationship between SES and health is not as obvious as the correlation**

Upstream vs downstream

Up: Much social epidemiologic research is concerned with upstream determinants of population health Down: Identifying the biological mechanisms linking social exposures to health is needed to understanding causality and creating interventions

Yitzhaki

Violation of norms of fairness Yitzhaki Index is most widely used metric Based on calculating relative deprivation based on one person's income compared with others with similar characteristics The main problem is what constitutes the reference group

Workplace social capital

Workplace seems like a natural setting to examine the influence of social capital setting in which people are spending an increasing part of their daily lives context in which many people form durable network ties. More Finland studies: Increase in the mean of repeated measurements of self-reported social capital was associated with a 19% decrease in the risk of all-cause mortality Male employees in work units characterized by low workplace social capital were 40- 60% more likely to develop hypertension compared to men in work Not every health behavior or outcome in the Finnish studies were correlated with workplace social capital. new-onset depression and smoking cessation are not. does not predict medication adherence among individuals being treated for hypertension Difficult to predict whether its effects on workers' health will be beneficial or detrimental. A future challenge: understand the effects of the multiple social contexts in which the individual is embedded.

TB Syndemic

a set of intertwined and mutually enhancing epidemics involving disease interactions at the biological level that develop and are sustained in a community/population because of "harmful social conditions and injurious social connections".

Whitehall Study

compared with men in the highest grade (administrators) and men in the lowest grade (clerical and office support staff) An age-adjusted odds ratio of 1.50 of developing incident coronary heart disease. For women, the odds ratio in the lowest grade was 1.47 for any CHD. The Whitehall cohort studies found a strong association between grade levels of civil servant employment and mortality rates from a range of causes. Men in the lowest grade (messengers, doorkeepers, etc.) had a mortality rate three times higher than that of men in the highest grade (administrators).

Cultural consensus and consonance

cultural consensus: locally ACCEPTED NORMS of material consumption cultural consonance: degree to which the individual is able to conform to the normative standard of consumption.

Interpersonal discrimination

directly perceived discriminatory interactions BETWEEN INDIVIDUALS- whether in their institutional roles or as public or private individuals. -- Ex: Shopkeeper, teacher, co-worker

Industrial Revolution vs contemporary work-related health research

during the INDUSTRIAL REVOLUTION focused on physical demands of jobs -Important exposures at work were related to physical or toxic exposures -Physical concerns at work are diminishing for many, though not for coal mining, forestry, and agriculture In the MID 20TH CENTURY: the ways work was organized could be fundamentally stressful, meaningful, challenging, or demeaning. -Psychosocial working conditions have gained recognition in recent years -As women have joined the labor force, work-family conflict has been reported to be on the rise among working parents. -The Belgian bank study, comparing public and private banks: Work demands, higher in the private banks, were associated with the risk of MI. Industrial Revolution( physically dangerous)---- Contemporary (Mentally damaging/ work family conflict leads to stress at home)

Syndemics theory

interaction between two or more co-existing diseases and resultant excess burden of disease

Intersectionality and Discrimination

multiple forms of discrimination, sometimes simultaneously, oftentimes in different ways in different contexts. Ex: White women may be subject, as women, to gender discrimination, women of color— whether black, Latina, Asian or Pacific Islander, or American Indian— may be subject to both gender and racial discrimination.