HS 301

What evidence do scholars such as Christopher Barnes and Christopher Drake cite to back up the claim that the US is facing a public health crisis due to lack of sleep?

Barnes & Drake claim that lack of sleep has become a public health crisis because it can adversely affect cognitive abilities, mental and physical health, quality of work, and safety.

Explain the concept of GDP. How much does the US spend on health care as a fraction of GDP? What do our peer nations spend as a fraction of their GDP?

Gross domestic product is the best way to measure a country's economy. GDP is the total value of everything produced by all the people and companies in the country. The US spent roughly 16% of its GDP on healthcare in 2014. Whereas our peer nations spent between 8-10%.

How does US life expectancy compare with that of other industrialized nations today?

Life expectancy in the United States is ranked 32nd in the world below most other industrialized nations. Americans experience higher rates of disease, injury, and health-damaging behaviors that do men and women in other high-income countries.

What are some of the causes of mortality that are particularly high in the US compared with the other OECD countries?

Mortality rates from infectious diseases; complications of pregnancy, childbirth and the puerperium; and conditions originating in the perinatal period are higher in the United States than in nearly all other OECD countries.

Describe the overall relationship between mental health and socioeconomic status.

No one is immune to mental health problems, but low-income individuals are still disproportionately likely to suffer from serious mental health problems

What often happens to well-being as individuals begin to enter middle age? As they begin to exit middle age?

The U-bend

How does the US health care system rank internationally? On what measures are we faring reasonably well? On what measures do we rank poorly?

The US ranks last in health care system performance among the 11 countries included in this study. The US ranks last in Access, Equity, and Health Care Outcomes, and next to last in Administrative Efficiency, as reported by patients and providers. Only in Care Process does the U.S. perform better, ranking fifth among the 11 countries.

Explain the idea of the "eight Americas." How do mortality rates in the eight Americas compare to the other OECD nations?

The eight Americas are subdivisions of the United States into eight race-county combinations. Large differences were found in life expectancy among these groups. For young and middle-aged males and females, mortality in the disadvantaged Americas is up to two times worse than that in the worst OECD country. Disparities across US regions have grown since the 1980s, a factor that has contributed to the overall US lag in life expectancy.

Name at least three factors that may contribute to the US/OECD gap in health outcomes.

The four mechanisms for the explanations for the US/OECD gap are: Medical care and public health, individual behaviors, social/demographic factors and physical environment. Medical and public health specific factors are access to health care insurance, quality of medical care, and quality of public health system. Individual behavior specific factors are: tobacco use, obesity, diet, physical inactivity, alcohol and other substance use, sexual practices, violence (especially firearm suicide and homicide), and automobile reliance. Social/demographic factors specific factors are socioeconomic inequality and poverty, racial disparities and residential segregation, and social integration and social interactions. Physical environmental factors specific factors are built environment (urban design, transport infrastructure, land-use mix, urban planning and design), and food environment.

How did US life expectancy compare with that of other industrialized nations fifty years ago?

The past 50 years have witnessed remarkable gains in life expectancy and 16 other country members of the Organization for Economic Cooperation and Development (OECD). However, improvements have occurred at various paces across nations. Life expectancy gains in the US have not kept pace with gains in other countries.

What are some of the social implications of this new phenomenon of aging?

a. Americans haven't come to grips with the new reality of aging b. Retirement at 65 was instituted when life expectancy was lower and 65+ year olds were only a small sliver of the population c. ◦Not as reasonable as they approach 20% of the population d. We are not planning for old age e. ◦People are not putting aside savings for old age f. ◦More than half of the very old live without a spouse g. ◦People have fewer children than ever before

What are the top actual causes of death in the US?

a. Causes of death in the U.S. in 2000 i. Tobacco ii. Poor diet and physical inactivity iii. Alcohol consumption iv. Microbial agents v. Toxic agents vi. Motor vehicle crashes vii. Firearms incidents viii. Sexual behaviors ix. Illicit drug use

How do levels of anxiety, depression, and substance use differ between teenagers from low-income vs. high-income families? What explains these results?

a. Cohort I (affluent suburban high schoolers) i. ◦Significantly higher rates of use of cigarettes, alcohol, marijuana, and hard drugs compared to national norms & inner-city samples ii. ◦Higher rates of anxiety and depression iii. ◦For boys, popularity with classmates was linked to high substance abuse iv. ◦Among affluent youth, but not inner-city youth, substance use was linked to depression and anxiety (which makes it more likely to persist vs. "experimental" use) b. Children of the Affluent Cohort II (affluent suburban middle schoolers) i. The 6th grades were doing great ii. Problems emerged in 7th grade iii. Among girls, the rates of clinically depressive symptoms were twice as high as those in national samples iv. No boys in 6th grade had used alcohol or marijuana, but by 7th grade, 7% reported becoming intoxicated about once a month c. Children of the Affluent Cohort III (affluent suburban middle schoolers & high schoolers) i. The 6th grades had lower levels of depression & anxiety compared to national samples and inner-city youth ii. Trouble emerged around 7th grade iii. ◦Depression and anxiety iv. ◦Substance use, especially among those who were popular with peers

How do non-fatal health outcomes in the US population compare to those in the other OECD countries?

a. Compared with most other countries, Americans have higher prevalence of low birth weight, traffic injuries and HIV incidence. Americans are more likely to rate their own health as good than are men and women in other high-income countries. Americans also have higher prevalence of preterm births and poor maternal health; adolescent pregnancy and sexually transmitted infections; and overweight, obesity, and diabetes during childhood and middle age. Older Americans report a higher prevalence of heart disease, stroke, hypertension, diabetes, obesity, lung disease, and limitation with basic instrumental activities of daily living than do their European counterparts at ages 50 and above.

What are the benefits of providing geriatric specialty care to the elderly population? Why are there too few geriatricians?

a. Compensation sucks b. Taking care of "The Old Crock" is not glamorous c. This is a patient who is often hard of hearing, has poor vision, may have impaired memory d. You have to slow down and repeat yourself e. There isn't a clear fix for a chief complaint - there are fifteen chief complaints i. ◦High blood pressure ii. ◦Diabetes iii. ◦Arthritis iv. ◦Back pain f. Doctors are trained to treat disease and leave the rest to take care of itself g. Aging isn't a medical problem, or is it?

What can be gained from downstream approaches to solving sleep problems? What remains unsolved?

a. However, her approach is criticized for being less useful for those with less autonomy in their everyday life, especially those in poverty. Conversely, the solutions posed in the Barnes & Drake article would be able to help this demographic better because they offer an upstream approach through their promotion of policy implementation and change.

What are some downstream approaches to solving the problems associated with lack of sleep?

a. Huffington's approach is downstream while the Barnes & Drake article is upstream. Upstream approaches focus on how change can be implemented at the societal level while downstream approaches focus on implementing change at an individual level. Huffington focuses on the individual as the solution to the problem stating steps they can take to help resolve the issue of their own sleep deprivation. Arianna Huffington recommends that in order to get more sleep people should: sleep seven to eight hours a night by just saying no to things getting in the way of sleep, start by sleeping thirty additional minutes than one is currently sleeping, have a friend to help with the goal of increased sleep, drop projects at the end of the day, turn off all devices and get away from them once a day, and to not immediately go to one's phone in the morning.

What are some of the health consequences of obesity?

a. Increased risk of... i. All-causes of death (mortality) ii. High blood pressure iii. High cholesterol iv. Type 2 diabetes v. Coronary heart disease vi. Stroke vii. Gallbladder disease viii. Osteoarthritis ix. Cancer (endometrial, breast, colon, kidney, gallbladder, and liver) x. Low quality of life xi. Mental illness xii. Body pain and difficulty with physical functioning

What is "nutritionism"?

a. Nutrition is a science. But, nutritionism is an ideology where: the nutrient is the key to understanding food. If you accept the idea that the importance of food is the nutrients it contains then you believe that experts must tell us what to eat. We need a priest hood to mediate this relationship. Divides nutrients into good and evil. Vitamin c, fiber, antioxidants and omega 3s are blessed. Saturated fats, high fructose corn syrup are all evil. But the ideas are constantly changing.

What explains the link between poverty, depression, and anxiety?

a. People who live in poverty are at increased risk of mental illness b. Incidence of depression i. ◦31% of Americans living under the poverty line ii. ◦15.8% of those not in poverty c. Those living in poverty are also more likely to experience asthma, diabetes, heart attacks, and other physical health problems d. What explains these disparities? i. ◦Poverty is tied to stressful lives, difficult childhoods, and more ACEs ii. ◦Possible over-diagnosis of mental illness

What do social scientists mean when they say that aging is new?

a. Relatively few humans have experienced aging b. Until the 2000 years, the average lifespan of human beings was not much more than 30 years c. Today, the average life span in developed countries is nearly 80 years d. Historically speaking, aging is not a "natural" process

Explain socioemotional selectivity theory. How does it explain the greater sense of well-being often reported in old age?

a. Socioemotional selectivity theory (SST) is grounded in the uniquely human ability to monitor time (Carstensen, 1993, 2006; Carstensen, Isaacowitz, & Charles, 1999). According to SST, a core constellation of goals operates throughout adulthood, including basic goals associated with attachment and control as well as goals associated with instrumental needs and emotional gratification. The key postulate of SST is that the relative importance of goals within this constellation changes as a function of future time horizons. Because chronological age is inversely associated with actual and perceived time left in life, systematic age differences emerge in preferred goals. Importantly, according to SST, age differences in goal hierarchies reflect perceived future time more than time since birth (viz., chronological age). When the future is perceived as long and nebulous, as it typically is in youth, future-oriented goals related to gathering information and expanding horizons are prioritized over emotional gratification. When time horizons are constrained, present-oriented goals related to emotional satisfaction and meaning are prioritized over goals associated with long-term rewards.

What policies do they recommend to address this problem?

a. They draw from the scientific literature to recommend the following: establishing national standards for middle and high school start times that are later in the day, stronger regulation of work hours and schedules, eliminating daylight saving time, educating the public regarding the impact of electronic media on sleep, and improving access to ambulatory in-home diagnostic testing for sleep disorders.

How is obesity defined in a public health context? Explain the benefits and drawbacks of this approach.

a. Why Use BMI? i. Better measurements ii. Ease b. Not a complete picture... Lebron is overweight by these standards i. BMI is a surrogate measure of body fatness because it is a measure of excess weight rather than excess body fat. Factors such as age, sex, ethnicity, and muscle mass can influence the relationship between BMI and body fat.

Why do students from high SES families appear to be at more risk for mental health problems today than their counterparts in the past?

a. Why might privileged youth be troubled? i. ◦Achievement pressures 1. ◦Depression, anxiety, and substance use associated with perfectionist strivings and having parents who emphasized accomplishments over personal character ii. ◦Isolation from adults 1. ◦Both physical and emotional 2. ◦Among upper-middle-class families, the students were left home alone for many hours each week

How have obesity rates across the country changed over the past several decades?

adult obesity rates by state 1950s: 0-14%; 2010: 20->30%;

Explain what is meant by the "rectangularization" of survival.

b. The result of fewer deaths at younger ages has been the "rectangularization" of survival c. For most of human history, the population formed a pyramid d. In 1950, i. ◦Children under age 5 were 11% of the population ii. ◦Adults over 80 years old were 1% of the population e. In 30 years, we will have the same number of people under 5 as over 80