SOC 211 Unit One

Social Inequality

"The condition in which members of society enjoy different amounts of wealth, prestige, or power"

Stratification

"The structured ranking of entire groups of people that perpetuates unequal economic rewards and power in a society"

Race/ Ethnicity and Health

"Ultimately, what makes race important in a causal sense for health is its close association with class circumstances. It is the convergence of social, economic, cultural, and political variables impacting on health along racial lines that makes race important. When these nonbiological variables are applied in a discriminatory fashion to less powerful racial minorities, the disadvantages include reduced opportunities for good health and this is seen repeatedly in research outcomes."

Age as a structural determinant of health

"What lifts age above the level of the individual and places it in position to serve as a structural variable is that people belong to age cohorts (a group of people banded together or treated as a single unit) that pass in an orderly and predictable fashion through the life course." Each age cohort has particular experiences and shared circumstances that influence them and their families.

Stucture

"sets of mutually sustaining schemas (rules or procedures applied to the enactment of social life) and resources that empower or constrain social action and tend to be reproduced by that social action." (Sewell, 1992: 19) -Involves socialization (how we internalize social norms and ideologies) -Agency is limited due to cultural barriers and inequalities within a society's social structure.

organic solidarity

- social cohesion is based upon the dependence individuals have on each other in more "advanced" social groupings (urban society) -Large population -Broader division of labor -Rules are enforced by formal institutions (cooperative law - civil, commercial, procedural, administrative and constitutional law) -Concerned with human (individual) interests -Low volume of intense social relationships and interactions Increasingly secular

Profile of the U.S Poor: A closer look

-12.3% of population below poverty line (39.7 million); 41.5% are non-Hispanic white -Age: at greatest risk are children (21.9% in 2011); 19-64 years of age (13.7%); 65 and older (8.7%) -Race: non-Hispanic whites (9.7%); African Americans (27.2%); Hispanics (25.6%); Asians (11.7%) -Gender: adult women (14.5%) vs 11.2% for adult men; 51% of poor families are headed by a woman with no husband present (11% headed by a single man) -Region: Rural areas have higher rates of poverty; the South has the highest overall rates and the Northeast the lowest (nearly 20% of rural counties have poverty rates of 20% or more)

Contemporary Definition

-A community is "a usually positive form of sustained social cohesion, interaction, and organization that exists between the larger society and individuals who have similar characteristics and attributes (e.g., norms, values, beliefs, religion, ethnicity, geography)." (Treviňo, 2019). -Communities often share a sense of place that is situated in a given geographical area (e.g. a country, village, town, or neighborhood) or in virtual space through communication platforms.

SES and Stress

-According to Cockerham (2013), life events (e.g., death of a spouse, divorce, job loss), chronic strains (persistent demands related to problems such as poverty), and daily hassles (traffic jams, long wait times for service) serve as the three major types of social stressors. -Low SES puts both the young and old at heightened risk for stress exposure. Studies have found differential exposure by SES position to negative life events and other types of stressors (see Cockerham, 2013 page 122).

Cohen and Community

-According to Cohen, people construct community symbolically, making it a resource and a repository of meaning, and a point of reference for social identity. -As such, communities can provide members with varying degrees of resources, both material (access to critical health services) and nonmaterial (social capital and social support).

Communities and Social Cohesion

-As Bradshaw (2008) points out, places are not necessarily communities, especially if they lack a sense of cohesion and shared identity or generate alienation. Meaning, some measure of shared experience and identity and a sense of solidarity are needed for community to exist. -People tend to define social ties formed within communities as important to their identity, practice, and roles in social institutions (e.g., family, home, work, government, society, or broader society as a whole).

Individual (Intrapersonal) Factors

-At this level, SES, age, gender, race and ethnicity, religious identity, sexual orientation, values, beliefs, knowledge, attitudes, personal goals, expectations, literacy, social stigma, and self-efficacy all serve as important variables that influence health behaviors and exposure to factors that impact our health. -As the model illustrates, there are also other external factors that impact us beyond the level of the individual.

How education is linked to health:

-Education is the portal to occupational options (safer jobs) and higher earnings (more education = more income = access to greater resources = better health). -Education can convey relevant information for preventing disease of delaying disability and death after disease onset (more formal education can increase access to knowledge about health and foster health-promoting decisions throughout the lifecourse). -Time spent in school means less time engaged in health-damaging activities (less chance of working in hazardous working conditions or engaging in unhealthy behaviors such as drug use). -Increase odds of participating in a more well-educated social network that provides health advantages (e.g., health information and resources).

Gender Differences in Health Practices

-Females tend to have healthier lifestyles as males report higher rates of smoking, excessive alcohol consumption, and illicit drug abuse. -While men exercise more, they have less healthy dietary habits. -Women consult with physicians far more often for preventive care and routine physical checkups.

Health status is significantly impacted by:

-Having the financial resources to avoid disease risk factors -Levels of education attainment -Position in the occupation hierarchy in the workplace

Why adopt the Social Ecological Model?

-Health problems are very complex and are generally influenced by multiple factors. -Factors associated with health problems interact with one another. This means that efforts to intervene and promote positive health require a more nuanced understanding of the social, cultural, economic, environmental, and political variables that impact individual and population health. -By expanding our focus beyond the individual-level, we are better able to identify the "upstream conditions" that affect health.

Gender as a Structural Determinant of Health

-In the United States, men are less healthy than women and are also less likely to use health services across all social classes. -This holds true for most countries, but the reverse is found in a number of developing countries where the marginalized status of women limit their access to critical resources necessary for proper health maintenance.

Public Policy

-Local, state, national, and global governing bodies that determine the policies, laws, and regulations by which we live that affect our ability to lead healthy lives. -School, workplace, and residential policies are critical for promoting individual and population health. -Government (at all levels) policy and funding can help provide for physical and natural environments, create jobs, support public recreation and safe after school programs, insurance coverage, etc. -Federal policies can impact access to health insurance and determine the allocation of other resources for maternal, newborn, and child health and access to healthcare services.

SES and Stress

-Lower SES tends to generate greater stress related to living environment. -Financial adversity over the life course is a potent stressor. -Low social class position also generates stress when opportunities are denied and through the exposure to negative treatment by others of higher social class standing.

Social Ties and Communities

-MacQueen et al. (2001: 31) explain that respondents in their study commonly identified interpersonal relationships as fundamental for forming the foundation of communities. -The Section 1.4 lecture (slides 12-15) included a discussion of how interpersonal (social) factors influence physical and mental health. -Community as a key influence on health is also demonstrated in the Gattino and colleagues (2013) study that found that a quality of life is affected by possessing a sense of community.

SES and Preventive Care

-More affluent (higher SES) members of a population are more knowledgeable about health problems, practice healthier lifestyles, and are more likely to seek preventive care (medical checkups and treatment for potential health problems like high blood pressure). -Lower SES members of society are less likely to prioritize preventive health care and "typically wait to visit physicians until they feel bad, are less likely to have a regular physician familiar with their medical history and lifestyle, and are more likely to go to a hospital emergency room to see whatever doctor is on duty when sick (Cockerham, 2012).

"Upstream" Conditions and Health

-On page 40, Berkman discusses the difference between "upstream" and "downstream" conditions that contribute to poor health. Upstream conditions are the social and economic sources of health. In short, they are the fundamental causes of poor health. -While upstream conditions (such as neighborhood environment, work settings, and poverty) serve as the primary sources of poor health, most health campaigns in the United States focus on addressing downstream conditions (e.g., blood pressure and other physical symptoms). -Berkman argues that addressing upstream conditions that lead to poor health would increase our chances of reducing social inequalities in health.

U.S Census 2016 - Income Divide

-One half, 49.98%, of all income in the US was earned by households with an income over $100,000 (the top 27.7%). -Over one quarter, 28.5%, of all income was earned by the top 13.6% (those households earning more than $150,000 a year). -The top 7%, with incomes over $200,000, earned 17.5%.

Association between SES and Health

-Phelan, Link, and Tehranifar (2010: 31) demonstrate that socioeconomic resources (money, knowledge, power, prestige, and beneficial social connections) are vital to maintaining a health advantage. -Individuals have some measure of control over their own choices about their health, but there are many factors beyond our control that influence the our health behaviors (e.g., income and ability to afford health dietary options). High social class standing provides more options that aid our ability to avoid health problems through better health behaviors.

Poverty and Poor Health

-Poor individuals are more likely to engage in unhealthy behaviors (drinking, smoking, lack of exercise, etc.) -Poor mothers are less likely to get prenatal care, have health insurance, or vaccinate their children -Poor individuals have limited housing, nutrition, and transportation -Low paying jobs are generally more labor intensive and hazardous (for example: exposure to poisons and waste materials or requiring repetitive motions)

Material deprivation and exposure to toxins among the poor

-Poor people are also less able to avoid harmful environments (e.g. hazardous waste dumping in neighborhoods of minorities and those with concentrated poverty) -This exposure creates a cumulative disadvantage over time -Juggling job insecurity and inflexible jobs, as well as job stress can also contribute to poor health -Receiving inadequate information also a problem

"Fundamental Causes" of Disease

-Previous studies focused on proximal causes as Western (more-developed countries) cultures emphasized the belief that individuals could control their personal fate and, thus, their health behaviors (Becker, 1993). -Link and Phelan (1995: 80) argued this belief was fundamentally flawed in stated that social factors such as socioeconomic status (SES) and social support "are likely 'fundamental causes' of disease that, because they embody access to important resources, affect multiple disease outcomes through multiple mechanisms, and consequently maintain an association with disease even when intervening mechanisms change."

Gender and Mental Health

-Research suggests that females in the U.S. are more vulnerable to mental disorders than males (see page 147) -Women experience higher rates of depressive and anxiety disorders and dementia, while men have consistently higher rates of personality disorders and substance-related disorders. *These findings are consistent across cultures and age groups, over time, and in both rural and urban areas.

More recent view of community

-Social Anthropologist Anthony Cohen (1946-present) argues that "community" consists of a symbolic boundary that we establish around a class of people. -We use language to establish differences between those inside our community and those outside of it. -He defines community as "a group or category of people, who have something in common with each other, which distinguishes them in a significant way from other groups.

Categories of Communities

A number of ways to categorize types of community have been proposed. One such breakdown is as follows (also see Slide 12): -Location-based Communities (communities of place or place-based communities) - range from the local neighborhoods, suburbs, villages, towns, cities, regions, nations, or even the planet as a whole. -Identity-based Communities: range from the local cliques, sub-cultures, ethnic groups, religions, or the global community cultures of today. They may be include communities of need, such as disabled persons, or the elderly. -Organizationally based Communities: range from communities organized informally around family or network-based guilds and associations to more formal incorporated associations, political decision making structures, economic enterprises, or professional associations at a small, national or international scale.

Early Social Ecological Models

A variety of social ecological models have been used to identify influences on human behavior. The most commonly used models are those designed by Urie Bronfenbrenner and McLeroy and colleagues (1988) and Stokols (1992). -Bronfenbrenner's (1977) model (see slide 5) identifies four interconnecting dimensions of influence: 1) Microsystems; 2) Mesosystems; 3) Exosystems; 4) Macrosystems. A 5th dimension, Chronosystems, was added to reflect environmental constancy and change over time.

Ethnicity

Affiliation or identity with a group of people bound by common ancestry and cultural tradition (implies ancient relations among a people over time), often living as a minority group in a larger society or host culture.

Non-place communities

Bradshaw (2008: 7) refers to these as social relations that are uncoupled from place. These include: n -Global cities where transactions (economic and social) occur as people come together, but they do not feel bound to that location. -Virtual online communities - social control, values, rewards, shared identity, and social ties are not reliant upon exchanges bound to a physical place. Strong bonds can still be formed and serve as a valuable resource and source of support for individuals and groups.

"Fundamental Causes" of Disease

Bruce Link and Jo Phelan (1995) developed the "theory of fundamental causes" to help health researchers identify the social influences that serve as risk factors for disease. -They pointed out that previous research on risk factors had over-emphasized proximal causes (factors that act directly or nearly directly) of disease such as diet, cholesterol level, exercise, etc. -They argued that more focus should be placed on distal causes (social factors that are further back in the causal chain) in order to develop truly effective health interventions that could promote better overall population health.

Public Policy Intervention Strategies

Change existing policies or introduce new ones that restrict negative health behaviors (e.g., tobacco use in public spaces and alcohol sales and consumption). Introduce policies that provide behavioral incentives, both positive and negative (e.g., increased taxes on cigarettes and alcohol). Introduce laws and policies to reduce disparities in the distribution of health services and access to care (e.g., reducing the number of those lacking health insurance).

Gender differences in health

Cockerham (page 148) argues that SES and other structural variables such as gender "provide the social context for the emergence of healthy lifestyles through socialization and experience." -Beginning at a very young age, women typically have the shared experience of visiting physicians more often than males and are socialized to take better care of their bodies. -Women also tend to adopt and maintain healthy practices (e.g., stop smoking and drinking, eating healthier) during pregnancy and continue these behaviors after giving birth. -Women are more likely to participate in emotional, informational, and instrumental support groups. -Males engage in more risky behavior than females. -Women moving into professional fields in greater numbers and are having fewer children.

Race as a social determinant of health

Cockerham points out that many researchers argue that, unlike age and gender, race is not a social determinant of health because of its lack of independent explanatory power. While there are very noticeable differences in many health behaviors and health outcomes across categories of race, SES and living conditions often serve as confounding variables. -Racial differences in health are closely correlated with these other factors. -However, discrimination can still have long-term consequences for health.

Why income inequality is a concern?

Economic inequality is the central aspect of inequality U.S. has the 4th widest income distribution among 35 developed nations (CIA, 2015) -Has the 2nd highest rate of child poverty (UNICEF & CIA, 2015) Poverty rate in 2006 (prior to the recession) was 12.3%; 14.8% in 2015 (47.7 million people - 6 years after the end of the recession); dropped to 12.7 in 2016 (43.1 million) -Top 5% of households reported increases in income during the recession (U.S. Census, 2016)

Gender and Physical Health in the U.S.

Females have higher rates of acute (a disease with an abrupt onset and, usually, a short course) illnesses -The only category of acute health problems in which males have a higher incidence than women is injuries. Among chronic conditions (a condition that lasts for a very long time and usually cannot be cured completely), females have higher rates of some chronic health problems, men others (see page 146) The overall pattern is that females have a higher prevalence of ailments that are not a leading cause of death, while men have more health problems that result in death.

Early views of community

Ferdinand Tönnies (1887) - rural-urban continuum Gemeinschaft (community) - "Society based on personal relationships and face-to-face interactions in which social relations are valued as an end or goal." Gesellschaft (society) - "Society based on impersonal, formal, and contractual relationships for which social relations are simply a means to an end."

Features of Fundamental Causes

Four essential features include of a social variable that classifies it as a fundamental cause are (Link and Phelan, 1995: 29): -It influences multiple disease outcomes - it is not limited to only one or a few diseases or health problems. -It affects these disease outcomes through multiple risk factors. -It involves access to resources that can be used to avoid risks or to minimize the consequences of disease once it occurs. -The association between a fundamental cause and health is reproduced over time via the replacement of intervening variables.

Gemeinschaft (community)

Gemeinschaft - According to Tönnies' ideal typology, community was characterized as: •Small rural villages where people work together for the common good and are united by ties of family (kinship) and neighborhood. •Land is worked communally by the residents, and social life is characterized by intimate, private and exclusive social networks. •Members of communities are bound by common language and traditions, recognized perceptions of right and wrong, share common friends and enemies, and have a sense of shared experience and identity.

Education and Health

Generally operationalized as years of schooling or degree credentials. However, this ignores the quality of education between individuals (some argue literacy is a better measure).

Gesellschaft (society)

Gesellschaft - Such social groupings are characterized by: •Large city life, disunity (lack of routine social interaction and personal unity), and rampant individualism and selfishness. •Social life shifts from a focus on the good of the group to the individual. •Social interaction is very rational, calculating, and each person is viewed largely for the particular role and service they provide. •Social life superficially resembles the Gemeinschaft in so far as the individuals peacefully live together.

SES Access to Medical Care

Historically, the lower class has not received the same quality of medical care in contrast to their middle and upper class counterparts. lThe 2010 Affordable Care Act extended health insurance to nearly 20.5 million Americans (48.6 million lacked insurance before the Act was passed). However, the number had grown back to over 30 million by 2017. -In 2016, non-Hispanic Whites had the lowest uninsured rate among race and Hispanic origin groups, at 6.3 percent. The uninsured rates for Blacks and Asians were higher than for non-Hispanic Whites, at 10.5 percent and 7.6 percent, respectively. Hispanics had the highest uninsured rate, at 16.0 percent. (U.S. Census, 2016) -Those lacking health insurance are generally the near-poor who work low-income jobs earning just enough so that they do not qualify for Medicaid and do not earn enough to pay for insurance.

Measuring Social Class

How do we determine someone's class position? -Class as a statistical category (wealth, income, educational attainment, occupation, social networks) Use of multiple measures: Socioeconomic status (SES) - based on income, education, and occupation

Race and the uninsured in America

In 2017, non-Hispanic Whites had the lowest uninsured rate among race and Hispanic-origin groups (6.3 percent). The uninsured rates for Blacks and Asians were 10.6 percent and 7.3 percent, respectively. Hispanics had the highest uninsured rate (16.1 percent).

Each age cohort has both a life course and historical dimension:

Life course dimension - particular cohorts share similar social roles (e.g., children, student, parents) and experiences. -Sharing similar roles at particular ages help foster shared attitudes, interests, and views. Historical dimension - cohorts experience distinct periods of history together (e.g., living through the depression, wars, civil rights movement) and share specific events on the basis of age.

SES and Health Behavior

Lower SES is associated a more marked decline in physical activity in adulthood (Grzywacz and Marks, 2001), higher levels of stress, poor diet and unsafe housing, and higher rates of alcohol and illicit drug use and smoking (Mirowsky, Ross, and Reynolds, 2000).

SES and Mental Health

Lower class are also disadvantaged with respect to mental health. -Have higher overall rates of mental disorder, including schizophrenia, than upper and middle classes. -Have slightly lower rates of anxiety and mood disorders than upper and middle classes. -Report higher levels of stress.

How Does SES Determine Your Health? Or, the Reverse?

Many, but not all relationships between SES and health outcomes are causal (Glymour, Avendano & Kawachi, 2014). -The onset of poor health can trigger the loss of employment and earnings as well as generate considerable out-of-pocket medical expenses (referred to as reverse causality) -The relationship between SES and health behaviors is very complex and additional (confounding) variables could potential serve as pre-existing influences (e.g., early factors that contribute to smoking initiation that occur before educational differences - page 30).

Emile Durkheim and Community

Mechanical Solidarity - associated with traditional and small-scale (rural) societies. -Small population -Solidarity typically based on kinship ties (family networks) -Feel connected through similar work, educational background, religion, and a shared way of life -Focus on the good of the community -Very religious -High volume of intense social relationships and regular interactions

Interpersonal (Social) Factors

Our relationships with family, friends, work colleagues and neighbors are all important influences on physical activity.

Problems Linked to Poverty

Poor health ("wealth means health") -Food insecurity -Poor health behaviors -Fewer resources to fight back (1/3 of poor lack health insurance) -2x higher rate of infant mortality -More likely to die from infectious diseases, violence, and natural disasters

Organizational Factors

Refers to the organizational characteristics of social institutions and includes rules (formal & informal), regulations, guidelines and governance of operation. Includes healthcare organizations (e.g., primary care physicians, hospitals, rehabilitative care), which provide care and health information. Physician recommendations are important for health maintenance.

Interpersonal level intervention strategies

Strategies should focus on changing the nature of the existing social relationships to encourage and provide support for physical activity and mental health support. While the ultimate target of the strategies may be to increase physical activity in individuals, the interim targets are the social norms and social influences. For example, to increase the physical activity of individuals in a community elderly care facility, the interim target is to create and promote a healthy lifestyle culture within the facility (e.g., promoting healthier heating, physical exercise, and positive mental health).

Organizational Level Intervention Strategies

Target institutional policies at all levels to promote health behavior and the equitable distribution of services. Focus on government regulations and other regulatory processes, procedures, or laws to protect health for all. Increase accessibility to primary care physicians. Improve access to health information.

Health Care in the United States

The United States ranks 1st in health spending per capita; this amounted to $9,237 in 2017 (The World Bank) -However... We rank in the bottom half of industrialized nations in life expectancy (80.1 years); 45rd overall out of 223 countries or territories (2018, CIA World Factbook) -We rank 25th in infant mortality among 38 developed countries; 55th overall (2018, CIA World Factbook)

Why the health gap in the united states?

The United States ranks 1st in health spending per capita; this amounted to $9,237 in 2017 (The World Bank) However... -We rank in the bottom half of industrialized nations in life expectancy (80.1 years); 45rd overall out of 223 countries or territories l(2018, CIA World Factbook) -We rank 25th in infant mortality among 38 developed countries; 55th overall l(2018, CIA World Factbook)

Community Level Intervention Strategies

The focus here is on altering the social environment. -Efforts could include changing community norms, values, and attitudes. -Improving the natural and constructed (human made) environment to provide spaces that offer safe and affordable opportunities to exercise and promote positive mental health through human interaction. -Improving access to public recreational facilities (e.g., ramps or smooth surfaces for wheelchair access and low-cost services such as public parks) -Promoting participation in civic organizations to increase social interaction (good for both physical and mental health promotion) -Build new recreational facilities that are in close proximity to at risk populations. -Improve transportation to increase access to health care facilities. -Traffic calming zones near schools could promote more physical activity if parents and children feel safe walking or biking to school.

Individual Level Interventions Strategies

The focus here is on characteristics of the individual and can include (to name a few): Educational programs (e.g., exercise programs and healthy eating) Participation in support groups (e.g., mental health) Counselling Mass media, by targeting individuals to adopt more active healthier lifestyles even when the message is aimed at the population level.

Internet and Community

The internet has clearly transformed and challenged our perception of what a community is and what it means to be a part of a community. The internet has allowed us to create new communities more rapidly than in the past. -The internet can be an outlet for more introverted people -Online communication can be less stressful than face-to-face interactions -It also allows people to become connected where, previously, it was locations that were connected and made us feel connected. -As we will see later in the semester, online communities also serve as valuable sources of social support and information for promoting health and assisting those already experiencing health problems.

"The Health Divide"

This Berkman (2004) article examines health disparities in the United States and how they account for our poor global ranking in many measures of population health. Illustrates how improving access to health care alone does not necessarily reduce health disparities between the rich and the poor. Berkman's discussion of the health divide in America and comparisons to Great Britain is also covered in Cockerham Chapter 5 (see pages 114 and 120-121).

Community factors

This level entails the social and physical (natural and human constructed) environment. It includes our cultural values and norms, relationships among organizations and institutions, civic organizations (community groups), community leaders, public parks and other safe community spaces that provide opportunities for physical exercise and to interact with others, etc.

Social Ecological Models

Up to this point in the course, we have examined a number of different social and economic factors that influence health behaviors and outcomes. Social ecological models examine the interactive effects of a broad range of individual and environmental influences all in one model.

Weak Ties

Weak ties are our many diverse acquaintances that we make in many different social contexts (settings). These are social ties that exist outside of our intimate circle of family and friends. -They are usually one-dimensional relationships (you only share one thing in common with these people) They typically do not last as long as strong ties. These social contacts are often with dissimilar others that expose us to new information and modes of thought, help us develop a range of cultural interests, link us to jobs, and provide health benefits.

Wealth - Not the same as Income

Wealth not usually used for daily expenditures or factored into household budgets, but: -Combined with income it comprises a family's total opportunity to secure a desired standard of living and to pass their class status along to their children. -It determines our options and opportunities -Wealth generates income -Nearly 50% of the factors that contribute to individual poverty are the result of the economic status of one's parents

Strong and Weak Social Ties

When discussing our relationships, it is useful to distinguish between two types of social ties. Strong ties are connections to people that are multi-dimensional (you share and do multiple things with those people), long lasting (multiple years), and usually contain an emotional component. Our strong ties tend to be our close family members and intimate friends. Strong ties confer such benefits as: -Numerous health benefits -Lower levels of depression -Access to material support

Race

a socially and politically constructed category of people who share biologically transmitted traits that members of a society define as important -The process by which people come to define a group as a race is based in part on physical characteristics, but also on historical, cultural, and economic factors.

Social classes

categories of people who have similar access to resources and opportunities (one's social position relative to the economic sector)

Link and Phelan (Fundamental Cause Theory)

explain that high-SES individuals and groups poses social and economic resources such as "money, knowledge, prestige, power, and beneficial social connections." These resources help to protect their health over the lifecourse. - While major causes of morbidity (the condition of being ill, diseased, or unhealthy) and mortality (death) have changed over time, social inequalities in health have persisted. Socioeconomic differences create disparities in access to preventive measures and medical innovations. -Link and Phelan argue that low-SES individuals are often limited their ability to behave in healthy ways (e.g., eating a nutritious diet, exercising regularly, having healthy living conditions) due to their social circumstances. Meaning, healthy behaviors are often beyond their grasp as they are too costly or not accessible. This makes the introduction of health intervention complicated (page 20)

Socio-ecological model

individual, interpersonal, organizational, community, public policy

Models Used promoting health

nMcLeroy and colleagues (1988), Stokols (1992), and others that use SEM for health education/behavior change developed a model consisting of five levels of influences on behavior: 1) Intrapersonal; 2) Interpersonal; 3) Organizational/Institutional; 4) Community; and 5) Public Policy (see slides 7 & 8). The purpose of this model, along with numerous variations of this multilevel framework, is to identify interacting influences on health behavior and to offer guidelines for possible intervention strategies at each level (McLeroy et al., 1988).

Agency

the capacity of individuals to act independently and to make their own free choices. -Also referred to as individual autonomy.

Income

•refers to salary or wages from jobs plus earnings from investments or any other source -The median family income in 2016 was $59,039 (U.S. Census Bureau).

Wealth

•refers to the value of all the economic assets owned by a person or family minus any debts. -The wealthiest 5% of families in the U.S. own approximately 60% of all the nation's wealth. -About half of all families in the U.S. have no wealth at all.