Health and Society Exam 3
Culture of medicine
-"Medical imperative to treat" makes treatment the default option. --The system is set up to keep people alive. --Perception among many physicians that a dying patient is a professional failure.
Why does Raunch argue against the idea of the "midlife crisis"?
-Believes midlife is a time for recalibration and people invest in what is most important, which is typically meaningful relationships -View lives in terms of social connectedness -Not actually a crisis but a manageable downturn -it's a difficult but natural transition
What are some obstacles to tackling the opioid abuse epidemic?
-High costs -Physicians and Pharmacist complain mandatory drug monitoring programs are burdensome and constrain them -Stigma of Naloxone use Ex: condoning drug use from needle exchange -Politicalization
Challenges of aging in term of cost?
-It's expensive for individuals --Increasingly high medical costs as individuals age -Expensive for society --Expensive every year until 96 -End-of-life care expensive, dying even more
What social factors are correlated with food deserts according to Walker et al.?
-Lack of financial resources (income/ SES) -Race and ethnicity -Chain vs Non-chain -Cost of food -Availability of food items -Crime rates in area
When and how does the perception of aging get better?
-One adjusts to their situations -They invest in what is most important (meaningful relationships) -After they've past the trough in the U-curve typically around the middle of their life "life satisfaction swings upward. And the crossover, in Schwandt's sample, happened about where you would expect: in the 50s."
What personal relationships and experiences shape experiences of aging?
-Positive, personal, meaningful, long lasting relationships -Intimate experiences
Puhl and Heuer say we need to look at the "obesogenic environment" when understanding obesity in society. What do they mean by this?
-There are multiple forces that contribute to the development and maintenance of obesity. Our environment shapes how we respond instead of us lacking will power. -An obesogenic environment is one that tends to promote obesity in residents thus these environments are set-up for people to become obese
what explains high technology use patterns
-We're addicted to access info and the interactions it provides -Results in a strong compulsion to gain information -We want to fulfill our psyche needs of relatedness, competence, and autonomy -We need to feel socially connected (relatedness) -We need to feel effectiveness and mastery (competence) -We also have a need to self-regulate experiences and actions (autonomy) Three variables explain our heavy screen use --Variable reinforcement schedule Like phone buzzing Like pulling a lever in Vegas --Supernormal stimuli An exaggerated stimuli gives off an exaggerated response Tech motivates behavior and disrupts natural tendency --Novelty and Information Naturally curious
How do cultural factors in the U.S. shape downstream patterns of food consumption?
-We're always on the go and need fast and convenient food which promotes the consumption of unhealthy processed foods. -Feeding cows lower quality food makes the meat costs less.
How does health care provider bias perpetuate the stigma of obesity?
-Weighing in -Made to feel ashamed -Health problems reduced to excess weight -Weight reduction is the focus of the clinical encounter
How does this idea of the "obesogenic environment" relate to Bittman et al. and Pollan?
-Weight bias and the stigma of being obese must be addressed in obesity interventions -Stigma distracts from positive health outcomes, encourages eating disorders. -Must focus on the larger scale coordinated policies that initiate social changes to help reverse societal and environmental conditions that create obesity in the first place. -Legislation to prohibit weight based discrimination will improve health of the obese
How many people experience mental illness each year?
1 / 5 for common 1 / 25 for serious
How common are different mental health diagnoses?
1% schizophrenia, 2% bipolar, 6.9% major depression, 18% anxiety
Vaccine Hysteria
Are vaccines an individual choice? Parental choice? State's rights?
How do prescription opioids relate to heroin use and synthetic opioids like fentanyl?
As prescription opioids become harder to get, people turn to other sources like heroin and synthetic opioids to satisfy their needs; therefore, the demand for those two alternatives go up.
What is weight bias? Why is it pervasive in our society?
Bias is prejudice for or against someone. We have an idea of health and wellness. Health is considered by personal responsibility and its characterized to be important to society. People are blamed for their own health or unhealthy lifestyle. Negative attitudes against obese people. common stereotypes and assumptions about obese persons.
How prevalent is opioid abuse? Does this constitute an epidemic? How do we know?
By 2012, 259 million prescriptions were written for opioids, which is more than enough to give every american adult their own bottle of pills.
palliative care
Care designed not to treat an illness but to provide physical and emotional comfort to the patient and support and guidance to his or her family.
Are these changes for the better or the worse, according to Bittman et al.?
For worse, they argue that we need to change our food policy to emphasize what is best for the health of U.S. citizens.
Is there a downside to hospice? If so, what is it?
If there's a new treatment for a disease, then the previous treatments in hospice must be discontinued in order for them to be reimbursed.(unless a child)
When and why did we start "supersizing" according to Pollan?
In 1968 at Mcdonalds and because we knew it was taboo to look like gluttons
How is obesity defined in a public health context? What measurement is used to determine obesity?
It's defined and measured through body mass index (BMI)
What populations are the most vulnerable or likely to be living within a food desert?
Low SES/ ethnic and racial minorities (especially women) in rural areas.
Ch. 6 - "Letting Go":
Making disabled/senile people's health better involves curbing medical imperatives to treat (get involved, fix it, meddle, esp. control). This overtreatment and overmedicalization worsens quality of life in the end, as there is always something doctors can do but they really should stop at some point. Doctors are not prepared to have this discussion about when to stop treatment with their patients. People live longer with focused and curbed medical care at the end.
What are the advantages of hospice?
Never turn anyone away Provide same level of care to everyone
How do both of these frames shape the moralizing of certain public health problems?
PURITAN -Abortion - the AMA launched the anti-abortion campaign because "abortion was undermining the white, middle-class birth rate while foreign immigrants multiplied and threatened to swamp American blood" -STDs- Diseases bred in the urban ghettos and spread into middle-class families -AIDS hysteria -Personal behaviors like drinking, drugs, sexual practices, teen pregnancy, birth control, abortion, etc. threaten the community Social gospel: -Jane Addams - poverty caused drunkenness as much as the other way around -Low salaries and harsh factory conditions pushed women into prostitution -Roosevelt and social security
Ch. 2 - "Things Fall Apart":
Process of dying is long and slow. Things randomly break down over time, not all at once.
What are the signs of mental illness?
Prolonged sadness or irritability Highs and lows Extreme fears, worries, and anxieties Social withdrawal Dramatic changes in sleeping or eating Growing inability to cope
What are the signs of someone who is at risk for committing suicide?
Prolonged sadness or irritability Highs and lows Extreme fears, worries, and anxieties Social withdrawal Dramatic changes in sleeping or eating Growing inability to cope
What are the two frames of morality politics that Morone discusses?
Puritan: Focus on vices and sinners (individualistic approach). --Shapes arguments to evoke stances against the "immoral." (The fears tilt political debates; they sink the communal urge by eroding our sense of common values and shared fate. The policy problem turns instead to protecting us from them.) Social Gospel: Focuses on society and SE pressures. -Looks at fixing an unjust system and taking care of others victimized by the system. (the economic system, race prejudice, underprivileged,and social stress put pressure on people.)
What different types of hospice care are available?
Routine Home Care. The most common level of hospice care, this includes nursing and home health aide services. Continuous Home Care. This is when a patient needs continuous nursing care during a time of crisis. General Inpatient Care. Short-term care during times when pain and symptoms can't be managed without a hospital setting. Respite Care. Short-term care in a facility during times when the patient's caregiver needs a break in caregiving.
CH 1 "The Independent Self":
Society doesn't talk about death/dying, medicine is focused on staving off death as long as possible through any means possible.
What other measures are being taken by our politicians to tackle the opioid epidemic? How does this issue get politicized?
State, county, and city-wide OD prevention programs -Increasing naloxone availability -Medication-based treatment (methadone, suboxone/bupronephrine)
How do moral beliefs shape our perceptions of the epidemic and of those affected?
The argument of condoning drug use Needle exchange program Use of Nalaxone Are we promoting drug use?
What are different types of treatment for mental health conditions?
Therapy (group or individual. The most prevalent indiv type is cognitive behavioral) Medication (ex: antidepressants)
what are the consequences for using too much technology
those who chase it are lonely and isolated
What would a truly effective campaign to tackle prescription drug abuse entail?
Ø Increased federal funding Ø Treating addicts as sick, not criminals Ø Grants to train first responders Ø Alternatives to incarceration Ø Prescription drug monitoring programs Ø Politicization of treating addicts. Ø Emergency needle exchange programs
How might other American practices and behaviors work against longevity? How so? What evidence can you point to in our readings throughout the term? How does this relate to individualism?
-Obesity and poor eating habits shorten lives -Unhealthy eating practices fail to help -We are the ones who are in control of increasing our longevity
How does an understanding of racial profiling and racial disparities in drug-related arrests, convictions and sentencing matter in this cultural conversation?
-Punitive policies for Black users. -Rehabilitation for White users. -Different policies for those who sell vs. those who use. -Hart, "why are we paying attention now?" - most opioid abusers are white and has ravaged white rural communities
What does it mean when we say that health care in the U.S. is politicized?
-Politics includes the structure, distribution, and effects of power in society. -People and groups who have resources or power to make choices advocate for their interests, and influence the distribution of resources. Health is correlated to our fundamental access to resources
What role does the media play in shaping how we perceive and understand obesity?
-shows like the Biggest Loser to see who loses the most weight and who looks the best. The way to win is to not be obese essentially. You are rewarded for losing weight and keeping the weight off. Being slim is a sign of discipline and money. -Media depict obese people negatively like the ashley madison ad. -The nutty professor (fat people are funny) -Marker of low status
How does looking at the individual as both the culprit and solution of obesity "depoliticize" the issue of obesity?
-shows that obesity is strictly an individual problem that can't be solved by outside authority. And only the individual can fix them based on a narrow focus on the issue -masks the true responsibility of government lack of public policy that is the more upstream issue, and if fixed could be a more effective solution to help reduce obesity
Who is most at risk of opioid abuse? Why? Where do these people live?
-Living in rural areas (more social connection and ways to spread opioids) and having low income -Having a history of mental illness, alcoholism, and other substance abuse -taking high daily dosages of prescription opioid pain relievers -obtaining overlapping prescriptions from multiple providers and pharmacies
Can you explain medicine's "Medical imperative to treat"?
-Makes treatment the default option -System is set up to keep people alive -A dying patient is a professional failure
HPV vaccine
-Many people believe that the vaccine causes autism -some claim/worry that promoting the HPV vaccine is an endorsement of sexual promiscuity
Communal Tradition (Social gospel)
Collective goals and common good are focus. Some collective goals may be dangerous. More about the health of the community
Also know what "concurrent care" means with regards to hospice (in Gawande).
Concurrent care: pursue curative treatments while still receiving hospice care
What are the public health challenges of an aging population in terms of increased rates of chronic illness?
Everyone's living longer with chronic diseases, but they're quality of life has decreased. Takes up time and money to treat. Not expanding the medicaid or medicare, so there's money for older people. Also less money for people who cannot afford treatment.
How does our addiction to technology relate to the way our brain is wired and evolutionary impulses?
Evolutionary impulses are being exaggerated and disrupts our natural tendency to react appropriately
What are the rates of treatment in the U.S.?
Fewer than 40% are accessing treatment
What are the consequences of untreated mental health conditions or mental illness?
It becomes harder to treat Individual harms themself or others
Why are reproductive technologies (contraception use and abortion among them) so politicized?
It displays power between groups (Ex: HB 2 legislation)
What are rates of suicide for men vs. women and why are men more successful? Connect the dots from all you've learned across the term. What accounts for high rates of suicide for white, middle-aged men?
7/10 white males will succeed
How many people died in 2017 from drug overdoses? From opioid overdoses?
72,306 lethal drug overdoses in 2017. Opioid drug addiction that led to these deaths were 49,068 people.
What is the role of the government in determining how food is grown, processed, eaten, and advertised?
They give into agribusiness because some used to work as corporate executives and now they are working in congress for their own interests. Congress is controlled by agribusiness who controls everything.
How ideas about morality shape our understanding of medical conditions and treatments?
They help determine how we classify and distinguish medical conditions. They also shape what kind of treatments we want to pursue
What are the upstream and downstream factors that contribute to a healthy or unhealthy diet? What factors shape food consumption according to Food, Inc.?
Upstream factors: -Lack of Regulatory policies POWER -Conflict of interest POWER -cost -little resources -Multinational corporations with huge influence POWER -lack of transparency (labeling) -Education -Advancing technologies -occupational hazards (chicken farm/ slaughter houses/ undocumented workers) Downstream factors: -Eat healthier foods -Avoid fast food -Exercise
What is the fundamental philosophy of hospice that Nancy McCranie discussed in class?
-"Philosophy of care: we serve the person first and foremost. Their comfort is our priority." -Person is central, disease is peripheral -It is possible to die with dignity and peace
texas abortion bill
-20-week abortion ban, admitting privileges requirements, ambulatory surgical center requirement, reporting requirements, restrictions on medication abortion -Would have closed as many as 37 of Texas's 42 abortion clinics --Argument for the bill - would improve patient safety and hold abortion clinics to safer standards --Opponents of the bill - unconstitutional attack on legal abortion and that many of the restrictions were found to be medically unnecessary by physicians groups. Closing clinics affects poor, rural women's access to other reproductive and preventative health care -Planned Parenthood and abortion: abortion is only 3% of Planned Parenthood services
Be able to know how often and why Millennials (and other youth) use technology.
-8-13 have 9 hours of entertainment per day -24% report constant use -23% of youth 10-23 witness cruelty -13% experience cruelty
How and why is "aging a challenge to the self"?
-Aging and illness shape perceptions of the self and identity processes. --Shift in social relationships and living arrangements; spouses and significant others die. -Aging body is a "failing" body. --Must revise one's self-concept in the context of a culture that interprets bodily differences as a sign of physical or moral inferiority. -Loss of independence --Financial worries compound fears of dependence. --Increased medical costs make savings inadequate. -Experience is moderated by social variables (SES, race/ethnicity, gender).
What changes do Bittman et al. argue are necessary to improve the current system of food production and food policy in the U.S.?
-All Americans have access to healthy food -Farm policies are designed to support our public health and environmental objectives -Our food supply is free of toxic bacteria, chemicals and drugs -Production and marketing of our food are done transparently -The food industry pays a fair wage to those it employs -Food marketing sets children up for healthful lives by instilling in them a habit of eating real food -Animals are treated with compassion and attention to their well-being -The food system's carbon footprint is reduced, and the amount of carbon sequestered on farmland is increased -The food system is sufficiently resilient to withstand the effects of climate change.
What would a truly effective campaign to tackle opioid abuse more generally entail?
-Arrest and convict executives in the pharmaceutical, manufacturing and distribution industries. They have made billions of dollars in profits yet, according to a 60 Minutes investigation, not a single industry official has seen a day in jail. -Stop arresting and incarcerating people for minor drug-related offenses. According to the Drug Policy Alliance, 1,632,921 people were arrested in 2017 for drug law violations; 85% of arrests were for possession only; 46.9% of those arrested were Black or Latino (even though they comprise just 31.% of the U.S. population) -Fine/penalize rehabilitation programs that refuse to admit people on life saving medications like methadone and buprenorphine (medications for addiction treatment, or MAT). Most outpatient residential programs continue to follow abstinence-only models, and believe (falsely) that MAT simply substitutes one addiction for another. These programs "do not facilitate patients' long-term recovery," according to Nora Volkow, director of the National Institute of Drug Abuse. -Mandate ALL correctional facilities to offer methadone and buprenorphine. These medications decrease cravings and increase outcomes for long-term recovery. If a jail or prison is offering insulin and coumadin - both FAR more dangerous to dose - then they should offer MAT. -Embrace and implement ALL forms of harm reduction. Decades of data from around the world (Portugal, Canada and the S.) have shown that syringe exchange programs, care coordination and safe consumption sites (latter currently unavailable in the U.S.) decrease drug use, overdose deaths and HIV and hepatitis C transmission. This is how you reduce harm, save lives and improve the quality of lives. -Alternatives to incarceration for drug offenses --Expanded drug treatment programs Increased awareness of lack of racial equity in sentencing --Wider Implementation of harm-reduction strategies --Needle exchange programs --Good Samaritan Laws -Collab w police and public health workers -More support for ppl when treatment ends -Recovery support groups, peer groups, narcotics anonymous -Accountability of Pharmaceutical companies -Class action suit (civil litigation of opioid manufactures and even pharmacies at the state and county level (Big Tobacco comp ex)
What is mental health? What are common mental health conditions?
-Being mentally healthy means we can enjoy life and feel good -Dealing with stress and emotions in a positive way -Can be maintained with good habits -Mental health conditions are medical conditions -They are conditions that can change the way we think, feel, and act. -Common and treatable, not anyone's fault -Normal life is still possible -Major depression, bipolar, schizophrenia, anxiety
How might these beliefs adversely affect the health and well-being of those who are growing older?
-Believe they are a burden -Interpret bodily differences as a sign of physical or moral inferiority -Fear of dependence -Struggle with the lost of independence -Women transition better
What does Aamodt say in her TED talk that challenges an individualistic argument about weight loss?
-Body naturally tells you when you need to eat -Not good to fight body natural responses -Body stays w/in a range of 10-15 lbs. Evolutionary standpoint -Conserve energy when food was scarce -Why the body is resistant to weight loss -Set point usually goes up and never down -Brain wants to replace that weight -Changing the food environment is the most effective solution for obesity
In what ways is health politicized?
-Can direct the cultural conversation around a certain health problem or public issue -Pay lobbyist to advocate for your special interest, even if they negatively affect public health -influence the FDA to approve drugs -write specific health care policies
How do these changes in agriculture shape public health policies?
-Congress beholden to "agribusiness." -Conflict of interests and corruption persist. --Industry executives later work for FDA, USDA, etc. -Food-related issues are treated as discrete rather than systemic problems, so special interests prevail. --Looking at eating as individual choice, masks the role of power.
What do I mean when I say that politics is not merely about partisan issues, but also about power?
-Debate or conflict among individuals and groups hoping to maintain or achieve power. -Actions undertaken by individuals and groups to maintain or achieve power. -Individuals and groups who have resources or power to make choices advocate for their interests, and influence the distribution of resources (i.e. interest group politics). --Health is correlated to our fundamental access to resources. -Power=resources to make choice and influence the distribution elsewhere
What factors explains our cultural aversion to discussing and managing end-of-life issues? Be sure to consider Gawande here, but also Rev. McCranie's guest lecture and the video "Except for Six."
-Denial -Individualistic culture -Youth oriented culture not age oriented culture -Social systems focused on young people
Gun Violence
-Dickey Amendment 1996: forbids the CDC from using budget to conduct research that might "advocate or promote gun control" -Annually, Congress rejects bills that would cover the cost of researching gun violence -Guns For Groceries - gift certificates given for guns returned
Why is healthy food more expensive than unhealthy food?
-Due to agricultural subsidies and the US has no systematic policy of food regulation. There's more profit in meat than in fruits and vegetables -Conflict of interests and corruption within the FDA
What forces (biological, social, cultural, economic, political) have helped cause the current opioid abuse epidemic?
-Economic- can't afford medicinal opioids instead buy cheap synthetic opioids -Political- Drug enforcement laws get harsher and have no effect at lowering drug abuse prevent minorities from getting help -Social- strong social networks in rural areas can create great distribution networks
How has agriculture changed in the last several decades in the U.S.?
-Fewer family owned farms -Now a small number of multinational corporations own and control agricultural production. -Increased access to food; increased efficiency of production, distribution, and consumption of food. -Overnutrition- consuming more calories than we need has a detrimental effect on the body -Industry has power to dictate the terms of animal husbandry, labor practices, environmental contamination, crop development (e.g. GMOs) and regulation, etc.
How is hospice different than medical care?
-Hospice care focuses on other aspects besides the health/medical issues. -They will pay attention to social and emotional needs
What factors affect doctors' prognoses at the end of life? Be sure to consider Gawande here.
-How long can they extend their lives -How realistic are the outcomes -Is the disease curable -The patients attitude (optimistic/pessimistic)
What harm reduction strategies might help curb the opioid epidemic? Have they been universally adopted? Why or why not?
-Increase federal funding -Prescription drug monitoring program -Other state run prevention programs -Increased availability of naloxone -Politicization of treating addicts
How do both stigma and bias shape the care provided to obese individuals?
-Independent of health effects, obesity is a stigmatized health condition and social label. -obese individuals are more likely to be looked down upon by healthcare providers -more likely to receive lower quality care and have negative experiences so less likely to seek out care
abortion
-Is abortion important/crucial for women's health? -Does abortion have anything to do with public health? -Increased polarization around abortion at the national level, but polls revealed more nuanced views Pro-choice: Decisions to terminate a pregnancy are personal ones between a woman, her family, and her doctor Focuses on the woman/mother Pro-life: Life begins at conception Abortion is against God's will Focuses on fetal rights -Subjects of bills concerning abortion: provider/facility requirements Waiting periods Ultrasound requirements Parental/"father" notification and consent Medication abortion limitations Fetal pain/late-term abortions Insurance coverage prohibitions
What is the role of high fructose corn syrup in the American diet? Why does it matter? How is related to agricultural subsidies? How is related to feed-lots?
-It's added and fed to almost everything because we have an excess of it available -it shows how efficient we have become in farming, but it also shows that we sacrifice our health for cheap access to food. -It's related to agricultural subsidies since it's so widespread and used for almost everything so its given more subsidies and the price is cheap. -It relates to feed lots because we feed our livestock it since it's cheap and can make a profit.
How do Millennials compare to other demographic groups in terms of mental health diagnoses, beliefs, and treatment?
-Less stigmatization than previous generations -12% More anxiety -More emphasis on perfection -Parents more involved -Compare ourselves to others -We are digital natives -More likely to get counseling (more options to receive counseling)
Inadequacies of medical education
-Medical training often encourages emotional detachment. -Focus on disease processes and body parts, not whole person. -Doctors are not trained to help patients negotiate end-of-life decision-making.
In what ways does Morone say morality and politics shape public health policy?
-Morality make us determine what's a privilege and what's a punishment; what's a public matter and what's private (as in, is it the individual's fault?). Politics only serves as a vessel for us to convey our morals on say, public health. Therefore, people will use politics to shape policies to their moral beliefs.
What is Naloxone/ Narcan? Explain political issues that relate to Narcan access. What laws help to increase use of this drug?
-Naloxone is a synthetic drug, similar to morphine, that blocks opiate receptors in the nervous system (reverses an opioid overdose) -However, FDA has recently approved a new hand-held auto-injector of naloxone to reverse opioid overdose; however, only care-givers/family can carry these.
What does Rauch say are the real "roots of Midlife crisis"?
-Not feeling content with life (dissatisfaction) -Not looking at today and contemplating about what could've been. -Being satisfied is possible but it's harder for most
What does Laura Carstensen say about aging, positive experiences, and happiness?
-Older people are happier (paradox of aging) -More positive = more mentally sharp -Carstensen says. "As people perceive the future as increasingly constrained, they set goals that are more realistic and easy to pursue." -"people invest in what is most important, typically meaningful relationships, and derive increasingly greater satisfaction from these investments."
Why is discussing the issue of death and dying difficult?
-People don't know how and when the battle is lost -Death is certain, but the timing is not
A medicalized death is normalized in American culture
-People who support "always taking extraordinary measures to save a life" has increased in recent years. -15% in 1990, 22% in 2005, 31% in 2013. -Fear and control
Is stigma an effective tool to fight obesity according to Puhl and Heuer? Why or why not?
-STIGMA does not help motivate people who are overweight or obese to lose weight. Stigma itself detracts from positive health outcomes; encourages eating disorders. -Must focus on larger-scale coordinated policies that initiate social changes to help reverse societal and environmental conditions that create obesity in the first place.
Why has hospice been historically underutilized? What about now? What are the trends in hospice use?
-Social Stigma about who and why people don't utilize hospice -Believed hospice shortens life -Didn't know about hospice care -It's growing
sex education
-Texas, Alabama, and South Carolina are the only states where discussion of sexual orientation was not allowed -Many states allow sex and HIV education, if provided, to not be medically accurate -States with some of the highest rates of teenage pregnancy promote abstinence teaching
Be sure to know how the "puritanism" frame maps onto the politics of individualism and how the "social gospel" frame relates to a more social justice/collective responsibility orientation.
-When a school nurse is introduced and some parents feel they lose parental authority and individualism is not protected. -SG: allows kids to get the education and healthcare they need
What does Gawande say about nursing homes as places to spend one's final months/years?
-They care for you, but don't let you live -Their priorities are medical goals which are means without an end -Like a prison -All aspects of life are conducted in the same place and under the same central authority -Each phase of the members daily activity is carried on in the immediate company of others, which are treated similarly -Everything is scheduled -The various activities are brought together into a single plan designed to fulfill the aims of the institution -Built for safety -Don't make life worthwhile when weak and frail
Be able to articulate how cultural factors and structural factors shape this final stage of life.
-Typically hard to talk about since we live in a youth oriented culture -Never imagine or think about death since we believe were too young -Put grief off because we're too busy GREIF ILLITERATE SOCIETY -Structurally doctors try to solve your problems instead of making you comfortable
How does the opioid epidemic, and our current sympathetic responses to addicts relate to the history of drug criminalization in the U.S.?
-Typically it was only white citizens that were given sympathy -Black citizens were treated more like criminals and given little opportunity for treatment -There were different drug policies for each race -Now it seems we're moving toward a policy that treats both equally
If obesity is known to have a "complex etiology," why do we so often adopt an individual responsibility model?
-Using individualism is much easier and faster in reaching a conclusion about obese individuals plus, social stigmas around such people are so incredibly prevalent that it's hard to not look at the "advertised" direction. -we're insecure about our own weight/body so we will try to pin the blame on the obese individuals behaviors to make us feel better about our own behavior or appearance. -Genetics and other biological factors, environmental factors, social and economic influences as well as health behaviors are linked to obesity.
How does U.S. food policy affect availability of healthy food?
-We are subsidizing poor nutrition with one hand, financing the "war" on Type 2 diabetes on the other. -More money is provided for meat farms than fruits and vegetables -US has no systematic process for food regulation, different agencies control a bunch of different issues and act on special interest.
FRAC Brief
-Women are more likely to be obese if they are food insecure -Maternal stress in combination with adolescent food insecurity increased an adolescent's probability of being overweight or obese -According to USDA, vehicle access is the most important determinant of whether or not a family can access affordable and nutritious food -Healthy food is more expensive and is often of lower quality in lower income neighborhoods. -Low-income neighborhoods have greater availability of fast-food restaurants, especially near schools - energy-dense, nutrient-poor foods at relatively low prices -Those who are eating less or skipping meals to stretch food budgets may overeat when food does become available, which can contribute to weight gain -Research has linked stress and poor mental health to obesity in children and adults, stress and poor mental health may lead to weight gain through stress-induced hormonal and metabolic changes as well as unhealthful eating behaviors and physical inactivity
What do Puhl and Heuer say explains the stigma of obesity?
-it is highly prevalent in society, and it is not being addressed as it should be -stigma results from our individualistic mindset, our view that weight is always under a person's control, and our ignoring of other factors that influence weight like environmental and social factors
What are the public health implications of weight bias and obesity stigma?
-obesity stigma creates significant barriers in efforts to address obesity and deserves recognition in the public health agenda. -weight-based stigma and discrimination increase vulnerability to psychological distress that may contribute to poor physical health. Given the increased risk of adverse outcomes already present with obesity, the additional negative impact of weight stigmatization on health is concerning. -Weight stigma threatens the psychological and physical health of obese individuals, impedes the implementation of effective efforts to prevent obesity, and exacerbates health disparities.
What are considered the three waves of opioid epidemic?
1st wave is rise in prescription opioid related deaths - 1999 2nd wave is rise in heroin overdose deaths -2010 3rd wave is rise in synthetic opioid overdose deaths - 2013
Where are the Blue Zones? What kinds of things does Dan Buettner say we should do if we want to live to 100? How do health behaviors shape outcomes according to Buettner?
1. Sardinia (island off coast of Italy) 2. Okinawa 3. Loma Linda, California -Move naturally (walks, gardening, stay busy) -Right outlook (pray, downshift) -Eat wisely (80% rule, wine @5, Plant Slant) -Connect (family first, faith, the right tribe)
How common is suicide in the U.S.?
10th death cause 1/25 are successful Most common in white middle aged men
Medicaid Expansion
37 states have expanded Work requirements Rural health
What social factors are related to obesity according to Himes?
AGE -Obesity in childhood is associated to obesity in adulthood -The prevalence of obesity generally increases with age SES -Strong effects of SES for women -People with higher income were better at controlling weight gain -Obesity in young adulthood may influence the attainment of socioeconomic status, creating a bidirectional relationship -Social disadvantage is a fundamental cause of obesity -Obesity prevalence varies little by SES status for men GEOGRAPHY -Obesity is more common in Central and southern states -Tribal islands in western US have higher rates of obesity GENDER -Women are more likely to be obese than men RACE AND ETHNICITY -Black and hispanic women are more likely to be obese than white women
How does one's moral status relate to health and health care? (Think about abortion and obesity here, among others.)
Abortion: pro-life or pro-choice, they decide how to approach their own health or others Obesity: It's the individual's fault compared to its the fast food industries that screw us over.
Who is responsible for the rise in obesity in children and adults in the U.S. in the last 40 years?
Agribusiness and congress
What are the health consequences of obesity?
All-causes of death (mortality) • High blood pressure • High cholesterol • Type 2 diabetes • Coronary heart disease • Stroke • Gallbladder disease • Osteoarthritis • Cancer (endometrial, breast, colon, kidney, gallbladder, and liver) • Low quality of life • Mental illness • Body pain and difficulty with physical functioning
Ch. 4 - "Assistance":
Assisted living homes are a better alternative to nursing homes because the residents have more autonomy. In most nursing homes the residents have no control over their lives, like prison.
Can you give some examples of how politics might shape health at the state and federal levels? At the individual level?
Direct the cultural conversation around a certain health problem or public health issue. Pay lobbyists to advocate for your special interests, even if they negatively affect public health. Influence the FDA to approve drugs/technologies. Choose among healthy options and healthcare. (Get vaccinated or not) Choose judges to defend or challenge specific legal protections. Write specific health care policies. (ACA)
How does medical culture and medical education shape end of life decision-making with one's doctors according to Gawande?
Doctors would rather prolong life and attempt to save it instead of making the patient comfortable when passing.
Bittman et. al article
Having public policies/regulations that control food will help us maintain better wages/working conditions to farmers, transparent production/description of food, and guarantee consumers to have healthier foods. Need to focus on the people not just the production of food. The conflict of interest prevent the advancement of health in society. The government is advancing two opposing goals - funding for corn and grains and not for vegetables and fruits contradicts the healthcare agenda
Be conversant with Andrew Solomon's chapter on depression. How does he characterize this condition? What makes depression particularly challenging according to Solomon?
He characterizes depression as a demon that leaves you appalled. It's living on the brink of dying that is challenging and living with constant pain.
What factors are most important at the end of life according to patients, family, physicians, and other care providers? Be sure to consider and watch Except for Six.
How you die Who you die with (surrounded by family members) Where you die Getting goals taken care of (traveling) Planning how you want to die
Ch. 8 - "Courage":
It is courageous to have the difficult end-of-life discussions. Needs to be done. Better to go out with dignity & least amount of suffering possible, but need to know patient's desires and values to do this. "Death with dignity."
What are the obstacles to adopting mandatory prescription drug monitoring programs?
Mandatory programs are burdensome and would constrain doctors and pharmacies
How are food insecurity and obesity connected? How does this connection reveal the importance of looking beyond the individual level in eradicating obesity as a public health problem? FRAC brief
It's a strong positive relationship for women and children. Women have a lower income and fewer resources. There are also obvious biological differences where women have more body fat. Some challenges include: • Limited resources of both time and money • Lack of access to affordable, healthy food (food deserts) • Food deprivation and skipping meals can cause weight gain • Stress-induced hormonal and metabolic changes • Environmental obstacles; unsafe environment for exercise • Greater exposure to marketing of unhealthy products • Limited access to health care The connection shows that it's a systematic way people are left with fewer resources, and w/o access to the grocery store.
How has obesity prevalence changed over time? What social factors are related to obesity according to Himes?
It's become more prevalent overtime with more caloric and processed food consumption. Portion size has increased. BMI increased. Age, Race and Ethnicity, Gender, geography, and SES are social factor related to obesity.
How does public policy (or the lack thereof) shape obesity rates in the U.S.?
Lack of public policy and food production regulation promotes and increase obesity rates.
What "frames" are used by different sides or vested parties to promote their understanding of the issue?
Liberals typically use SG while conservatives use individualistic (puritan beliefs)
What does the shift in our aging population mean for our society's demographic composition? Revisit the epidemiological transition.
Life expectancy is increasing but fertility rates are decreasing. The youth are focusing more on their careers, lives, etc than family.
What are prescription drug monitoring programs? What type of this program is most effective?
Limiting physicians from prescribing opioid drugs to patients
How might different players (individual consumers, workers, industry-contracted farmers, small-family farmers, lobbyists, politicians, and multinational agricultural conglomerates) have different interests that might not all work to improve health in the U.S.?
Lots of gov agencies that oversee different parts of the system -Work on their own projects for their own interests instead of together -Work individually instead of systematically -Congress doesn't work for your best interest , lobbyist pay for representation. Congress beholden to big players and how we regulate what we cant (FDA, USDA)
How do SES, race/ethnicity, and LGBTQ relate to the use of mental health services and outcomes?
Low SES are more likely to experience MI and not receive care Highest in Native Ethnicities and AA have high rates of schizophrenia LGBTQ also don't get as much help
What social factors are likely to precipitate a fatal overdose?
Mental health issues Old age means more chronic pain High-risk jobs Lower job security and lack of paid sick leave Low SES Low education
What is the economic impact of mental illness?
Mental illness can affect someone to the extent of not working or losing their job.
Know about addiction treatment. How expensive is it? What is the difference between what treatment specialists and politicians say about it?
More expensive than treating diabetes, a year of methadone treatment costs $6,552 Hospitals and clinics overwhelmed by costs of treating overdoses
How do these changes shape our food choices?
More fast-food and unhealthy processed food is available to the public Less fruits and vegetables are more affordable and bought
How does this compare with other causes of death we've discussed? Car accidents? Suicide?
More than car accidents
Ch 5 - "A Better Life".
Need to give residents a reason to live. "The battle of being mortal is the battle to maintain the integrity of one's own life-- to avoid becoming so diminished or dissipated or subjugated that who you are becomes disconnected from who you were or who you want to be."
What does it mean that medicine rewards "doing" or as Gawande says, "saving lives"?
No doctor wants to lose a life so there comes a reward when a treatment does work and save life even if it is lesser of a life the patient is use too
Is "palliative care" the same as hospice?
No, but all hospice care is palliative care.
How does weight stigma shape the health care for obese individuals? How does weight stigma shape the behavior of obese patients?
Obese patients won't be as truthful with the doctor because they feel insecure in the office or like they're being judged. They avoid routine care.
How does obesity shape health behaviors, preventive care, and experiences in the health care system?
Obesity promotes unhealthy behaviors, which then lead to the necessity of preventative care. Increases medical costs due to doctor visits and added prescriptions. Most likely to avoid medical care due to judgement fears. Puhl and Heur argue that: weight bias and the stigma of being obese must be addresses in obesity interventions. Stigma does not help motivate people who are overweight or obese to lose weight. Stigma itself detracts from positive health outcomes; encourages eating disorders.
What are the problems with this model when it comes to end-of-life decision-making and care?
Often, the doctor's input or wishes will override that of the person whose life is close to an end. End-of-life discussions can not be had and patients desires can not be met
Individualism:
Our nation is built on self-interests and freedom so political endeavors have the focus of "what's best for me/my people?" in mind. Which means that, "in politics, economic self-interest is every bit as legitimate as medical science," or concerns. And therefore, we will extract any sort of moral argument that will bolster our political decisions, not science as that can be used against or for our arguments. Individualism is at odds with medical science
Ch 3 - "Dependance":
People are not prepared for the downward slope of aging. Nursing homes are made to fulfil societal obligations but the priority is never on the residents.
Ch. 7 - "Hard Conversations":
People prefer to die at home than at the hospital. Result of the 3rd epidemiologic transition. 3 different types of doctors: paternalistic (makes all the decisions, no patient input), informative (lays out all the information and lets the patient decide), interpretive (ask about the patient's priorities and use their knowledge to achieve them). Need to have hard conversations about what people value and how to prioritize those values (interpretive).
Also think about how existing power relations between individuals and groups shape various public health debate.
Politics shape debates and secure scientists Lack of public funding prevents research
How has the opioid epidemic hurt children? Communities?
Pregnant women are using and causing newborn children to have opioid withdrawal Neglection of children Increased car crashes involving opioid use Increased HIV/AIDs and Hepatitis B and C transmission
How do the social factors we've been discussing throughout the term relate to aging? SES, race/ethnicity, gender?
SES -Low SES have higher rates of chronic disease and disability -High SES have greater resources and have options for treatment -Working-class and poor accept physical pain as unavoidable and put off medical care until it interferes with the ability to function GENDER -Women more likely to seek treatment than men -Women's costs are greater than mens -They are more likely to live alone -Live longer, but sicker than men. -They accept aging better than men. RACE/ETHNICITY -Reluctant to pursue care among racial and ethnic minorities
What helps predict a "healthy" aging experience?
SOCIAL FACTORS: -SES/access to resources -Social support and emotional connections -Social engagement -Cultural perception of aging -Some cultural subgroups value the elderly PHYSICAL ENVIRONMENT: -Sense of home -Safe environment INDIVIDUAL FACTORS: -Adopting healthy behaviors such as physical activity and healthy eating. -Avoiding high-risk health behaviors e.g. smoking, excessive drinking and opioid use. -Sense of purpose
Be sure to be able to apply his conceptual model to theorize about different public health issues today, especially with regards to school-based clinics and obesity that he addresses in detail.
School clinics Puritan: May have feared that providing treatment (possibly without parental notification) in school health care centers would implicitly condone illegal drug use,underage drinking, and premarital sex. SG: As children started receiving treatment, parents, teachers, and health providers rallied around the centers, countering moral complaints with down-to-earth descriptions of kids getting care. Some liberals confronted the moral issues head on, responding that young people needed counseling on sexuality and chemical dependency. If teens were going to have sex, argued these advocates, they ought to be prepared. Obesity Puritan: Some conservatives blame overweight individuals. Heavy people lack will power, they make foolish food choices, they live in unhealthy ways. Like smokers, drug abusers, and heavy drinkers, obese people have made personal choices; they should just say no and push away from the table. The distinct echo from other substance abuse controversies has another unhappy parallel: obesity tends to concentrate in poor and minority communities. SG: focus on the industry suggests requiring better food labels, rethinking school nutrition, restricting advertising, regulating fat content, punishing misleading claims, taxing unhealthy ingredients, and so on. Successfully demonizing big food—directing popular anger at the industry—may cut through the checks and balances of the political system and provoke action. As the most ardent critics put it, a cynical industry targets children and reshapes their eating habits.
Why do health issues that relate to gender issues and especially sexuality often carry a moral status?
Some believe gender health rights are human rights and deal with health care policy
How does stigma relate to diagnosis and treatment of mental health conditions?
Stigma lowers treatment and diagnosis of mental health conditions.
What is the STOP Act? What does it claim it will help do? What do critics say?
The STOP Act requires the Postal Service to scan incoming packages from overseas for opioids. This act claims to decrease the amount of opioids coming into the U.S. Critics claim that requiring screenings will not decrease opioid abuse. Upstream solutions: alternatives to incarceration for drug offenses, wider implementation for harm-reduction strategies, decrease of stigma of drug use/naloxone, accountability of pharmaceutical companies, and collaboration between police and public health workers
What impact does the "built" environment have on individual dietary choices?
The built environment has decreased opportunities for healthy lifestyle behaviors through factors such as urban design, land use, public transportation availability,density and location of food stores and restaurants, and neighborhood barriers such as safety and walkability
What is a food desert?
The lack of access to affordable, healthy food.
What is the demographic reality of aging in the U.S.?
The population differences between the young, middle-aged, and old are growing smaller.
What does research show health care providers think about obese individuals?
They think the patient is not taking their health seriously, or that they are being lazy toward the treatment option. "An accumulation of research has found that health care settings are a significant source of weight stigma, which undermines obese patients' opportunity to receive effective medical care. Both self-report and experimental research demonstrate negative stereotypes and attitudes toward obese patients by a range of healthcare providers and fitness professionals, including views that obese patients are lazy, lacking in self-discipline, dishonest, unintelligent, annoying, and noncompliant with treatment, There is also research indicating that providers spend less time in appointments and provide less health education with obese patients compared with thinner patients."
How do most people wish to die? How do they actually die? What different factors explain this disparity?
Want to die at home, actually die in hospitals and high intensity care -Economic factors --Healthcare system interested in efficiency, innovation, and often profits, not about meaning of life or maximizing quality of time left. --Conversations about death take time. --No billing code for talking about end-of-life decision-making or care. -Cultural aversion to discussing and accepting death --Dying has only recently become a prolonged process due to increased life expectancy and technological innovations. --Cultural denial of "accepting" death --We don't see death, and we don't accept it. --American Prosperity Gospel -Fear and the illusion of control --Family members frequently intervene to prolong life, often despite patients' wishes. --Role of doctors. ----Control patients life in order to "save" them or prolong life -Misconception that hospice hastens death so hospice is underutilized.
What does science tell us about "novelty" and how does this help explain our addiction to technology?
We Seek novelty and sensations in our environment as its critical for our survival
What did Dr. McVey mean when he said that technology is an "exaggerated stimulus"?
We are innately equipped to be attracted to things that brings rewards and with the accessibility of technology, we are able to increase our needs for rewarding stimuli such as positive affirmation, attention, escapism, etc. TV, Video games, and SNS are more specific examples of exaggerated stimuli.
Basic Ideas of Pollan's article
We are more likely to eat more calories in "less quantities." For example, we'll probably pick a 3lb bucket of popcorn over two 1.5lbs of popcorn. Also, more food for less money is appealing to us so we buy such options, even if they're not necessarily healthy.
What are our cultural beliefs about aging in the U.S.?
We have a negative aging culture -Anti-aging culture --Valorization of youth; loss of status with aging --Rugged individualism at odds with aging -Medicalization of aging --It's a disease --Fight aging --Overlap of beauty and health -Elderly are a financial burden --Take more than given in terms of benefits --They drain the healthcare system --Economic self-sufficiency with personhood
Be able to explain the issues at play in end-of-life decision-making.
We have failed to prepare for the outcome that's more probable
Who is most likely to be obese in the U.S.? What factors explain these demographic realities?
Women, children, and black or Hispanic women, and low SES citizens who live in rural areas (food deserts). Age, Race and Ethnicity, Gender, geography, and SES