Population and Society Exam 2

When were the first cases of AIDS discovered in the US?

- June 1981

What is life expectancy?

- statistical measure of how long a person or organism may live, based on the year of their birth, their current age and other demographic factors including sex. -standard measure for comparing across countries and over time

How did the type of diseases prevalent in the population (and the primary causes of mortality) shift during the mortality transition?

-Advances in medicine (like antibiotics & mass immunization against disease) came relatively late in MDR mortality transition, but more recent improvements in mortality, esp. at older ages, helped by modern medical advances -Immediate cause was control of infectious, parasitic and respiratory disease People first died because of infectious diseases like small pox and then later onto noninfectious disease like lung cancer from smoking.

What are some of the causal mechanisms through which socioeconomic status might affect health?

-Behavioral factors-access to healthy food, access physical activities -Psychosocial factors-Feelings of being alone, engaging in high-risk relationship -Access to medical care (may exacerbate disparities)- -Housing and the environment -Early life conditions-people are finding that its not just what happens when youre an adult, things that happen in infancy and euturo and past conditons can effect how well you develop.

Who was Ryan White, and why was he important?

-he was diagnosed with AIDS at age 13, his mother and him fought for his right to attend school and against AIDS discrimination -passed legislation just months after he passed away-->Ryan White CARE act now known as Ryan White HIV/AIDS Program

What's happened with Russian men's life expectancy recently? Why?

-Collapse of economy, social disruption, erosion of public health systems, increase in drinking -Russian men saw declines in life expectancy of 4.2 years between 1980 and 2000.

How has population aging in MDCs and LDCs differed in terms of the timing, pace, and level of socioeconomic development? What are some of the potential implications of these differences?

-Currently, the countries with the oldest populations (in terms of the % ages 65+) are mostly in Europe (as well as Japan); population aging started earlier in MDCs -But the current pace of population aging is faster in less developed countries, which will have less time to adjust to the consequences of population aging than MDCs (which have aged over a longer time period) -Population aging is also taking place at lower levels of socio-economic development in LDCs than has been the case for MDCs, making policies to lessen the potential negative impact more difficult

Why do decreases in infant mortality lead to the largest improvements in life expectancy?

-If infant mortality is lowered, children surviving the early years will likely survive until much older ages, thereby contributing substantial years tolife expectancy in the population. -the life expectancy age is weighted downward due to the number of deaths occurring at young ages.

What is meant by a social gradient in health? Does it apply throughout the socioeconomic distribution, or just at particular levels?

-In general, the lower an individual's socioeconomic position, the worse their health -Positive association present at every level of the social hierarchy

What were Vaupel and Olshansky's central arguments regarding the future of life expectancy improvements? Where did they differ? Where did they agree?

-Olshansky believes we are fast approaching a limit to how high average life expectancy can rise, all of the previous progress was due to decreases in infant mortality -Vaupel believes there is no limit -Their bet: $150 that the first 150-year-old human was born before 2000. -Agreement: accurately predicting life expectancy is important for entitlement spending, savings, social services, pensions, healthcare resource allocations, general economic stability -->Gains will have to be made by prolonging age of the elderly (agrees with Olshansky).

What are some of the potential limits to future increases in life expectancy?

-Senescence: physical condition of the body declines, person becomes more susceptible to disease. -"Wear and Tear" theory: Body's parts break down from use, like a machine. -Planned Obsolescence theory-->human body like a machine...meant to give out at a certain time so new ones can survive ***

What are some pieces of evidence suggesting a social gradient in health in the US and in other countries?

-Social causation - SES (socioeconomic status) causes health -Social drift/selection - Health causes SES "drift" - loss of job and wealth due to poor health (downward mobility) poor health may limit capital accumulation in the first place (preventing upward mobility). (if you're poor, you have limits to how healthy you can be, and if you're not healthy, it will limit your ability to gain more wealth) -Spurious relationship - SES-health association is due to some third factor

What do we mean by social determinants of health?

-The social determinants of health (SDH) are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems the social factors beyond biology that affect your health( availability of resources to meet daily needs, access to educational, economic, and job opportunities, access to health care services) for example: poor people don't have a lot of access to health care and may work in unsafe working/living conditions, thus their social determinants of health are not great and they are more prone to getting diseases or dying.

What are age- and sex-specific mortality rates, and why are they useful measures?

-age-->A mortality rate limited to a particular age group -sex-->A mortality rate for either ♂ or ♀ - they are useful measures because they can help determine age pyramids

What was the role of medical technology in the improvement in mortality during the mortality transition in more developed countries? And how has this differed in less developed countries?

-immunization of diseases was a huge factor -antiseptic surgery started -antibiotics and insecticides Didn't have much of a role in MDR. Improving living standards and public health efforts were key. LDR countries needed them, influenced mortality rate dramatically.

What are some of the current concerns regarding population aging in Japan, and why is this issue particularly important in that country?

-in 2060 there is predicted to be 78 out of 100 people in retirement -1/4 of population is over 65 -causes problems with replacement and dependency ratios -in 2050 their older populations will grow to around 75% of their population making it even more problematic -they cannot be cared for and they don't have money to support themselves because they aren't working

What does the AIDS pandemic look like worldwide today? What geographic areas (in general terms) have been hardest-hit by the disease?

-it has appeared to stabilize -the annual number of HIV infections has steadily decreases since 1990 -significant decrease in AIDS related deaths because of increases antiretroviral treatments -but with the rate of people getting infected has decreased, the number of people with it has increased because of less deaths and better treatment -Sub-Saharan Africa

How have antiretroviral drugs for AIDS contributed to higher prevalence rates for the disease?

-it is keeping HIV/AIDS patients alive longer instead of dying off, it isn't a bad thing

What has happened to life expectancy in the United States and other Western, industrialized countries over time? When were the largest improvements made? What about in less developed countries?

-life expectancy has increased in industrialized countries over time -the largest improvements were made in the industrial revolution where there were decreases in infant and child mortality -LDRs getting better at a slower rate

Does life expectancy have to be calculated from birth?

-no it is often though -accurate when older ***

Why is population aging of potential concern for the sustainability of elderly support policies?

-not enough people to support the elderly population if they can no longer work to support themselves

What are some of the barriers to providing treatment/prevention for HIV/AIDS worldwide?

-not having political support for programs (ex. condom use) -historical denial of disease -financial barriers

Who was Jeanne Calment, and how long did she live?

-oldest woman alive -122 years old

What did WWII have to do with penicillin?

-penicillin was found before WWII but was still being tested, the war forced doctors to use the drug and it greatly decreased mortality rates, stopped gangrene and blood diseases. -it saved many during the wait time to see a doctor after being wounded

Has the worldwide HIV/AIDS pandemic peaked in terms of incidence? In terms of prevalence? What's the difference? (HINT: Look at the quote from the UNAIDS 2010 report in the lecture about the AIDS epidemic for this question).

-prevalence rates are still high due to the better technology and medicine helping people to stay live longer with the disease It appears to have stabilized. New infections has been declining since the 1990's, however prevalence is high due to antiretroviral therapy because mortality has declined so more people are living with aids.

Where does the United States rank in terms of infant mortality among industrialized countries? What are some possible explanations for this?

-the US lags behind other MDRs -there are many preterm births, but it is unclear as to why there are so many

What was the "epidemiological transition"?

-the changes in MDR mortality and life expectancy during a certain era. -it can be split into three segments: --pre transitional segment of high mortality --transitional segment characterized by a decline in epidemic and infectious diseases --a late-transition segment characterized by degenerativeand human-made diseases Reduction in risk of dying in infancy and childhood from infectious diseases and higher risk of dying from "degenerative" or "Chronic" diseases later in life. Transition related to improved, social, economic, and health conditions associated with modernization/development

What is the "double burden of disease," and where does it tend to be found (in general terms)?

-the double burden of disease means that there is both infectious and noninfectious(starvation) diseases -it tends to be found in LDCs

What is morbidity, and why is it important to study? How does morbidity differ from mortality?

-the prevailing condition of disease in a population(includes disability and illness) -disease is universally a problem which makes it a good thing to classify with -Disease and disability also affect the likelihood of successfulchildbearing, as well as cohabitation, marriage, divorce and widowhood, migration, -mortality is death while morbidity is disease

What were the Whitehall studies? Where were they conducted, who was their study sample, and what did they find? Why was this important?

-they were a study of the social determinants of health specifically cardiovascular disease and mortality rates among 18,000 British male civil servants between the ages of 20-64 -over a period of ten years started in 1967 -found a strong association between position and mortality-->men in the lowest grade had a mortality rate 3 times greater than that of men in the highest grade -the lower grade showed signs of higher risk factors-->obesity, smoking, high blood pressure. they had more prevalent incidences of heart disease

What are Disability Adjusted Life Years (DALYs), and how and why are they used? What assumptions do they make regarding the value of additional years of life at younger versus older ages?

-years of life lost+years of living with a disability -gives a total picture of morbidity and mortality impacts due to specific causes. -one DALY shows one year of healthy living lost, helps to distinguish diseases that cause early death opposed to those that do not kill but cause disability they put more weight on additional years of health life lived at younger ages because they value younger lives more than older

Related to the previous questions, be able to think about how different types of diseases (in terms of how quickly they spread, how curable/fatal they are, etc) would lead to different scenarios in the sink.

1 Disease that spreads rapidly and is highly deadly- a lot of water flowing in but sink not filling up because it would go straight through due to lots of people dying 2 Disease that is non-deadly but essentially incurable- a lot of water filling up but non draining because nobody is being cured (STDs, the flu, mental illness)

What are the three stages described by Omran in the Western model of the epidemiological transition?

1) Age of pestilence and famine Leading causes of death: respiratory diseases, diarrhea, smallpox, TB, and other diseases that took heaviest toll on the young; life expectancy at birth between 20 and 40 2) Age of receding pandemics Time of most rapid changes due to changes in sanitation and standards of living, life expectancy increased to about 50 3) Age of degenerative or human-made diseases Mortality stabilizes at a lower level.Major causes of death are heart disease, cancer, stroke.

What are some of the arguments for limitless life? Who is Aubrey De Gray, and what does he argue?

Aubrey De gray is a theoretician in the field of gerontology. He believes that future medical technology can far exceed the life expectancy that we have seen. He focuses on whether regenerative medicine can thwart the aging process arguments for limitless life: -There has been a steady linear increase of life expectancy overtime. History of life expectancy limitation predictions have been proven false. Declines in mortality are slowing and the next medical innovation could change everything.

What role did public health advances play in the mortality decline in more developed countries over time? What are some examples of public health advances that helped reduce mortality?

Better decline due to better sanitation and nutrition -removal of garbage, building of covered sewers, purification of drinking water-->removed cholera and waterborne diseases

What is the "Hispanic health paradox" in the United States?

Despite having lower average levels of SES, Latinos in the US often (but not always) have better health outcomes. -Cultural or social buffering effects -Migration effects -"Healthy migrant effect" -"Salmon bias effect"

What is infant mortality and why is it so important to demographers? What has happened to infant mortality over time?

Death rate during the first year of life. Important measure of a population's health. Major improvements over time but still a lot of regional variation. Improving infant mortality leads to large improvements in Life Expectancy.

Who was John Snow and why was he important? What did he find, and how did this help control the spread of infectious diseases like cholera?

Father of epidemiology. Adaptation of anesthesia and hygiene. Did important study to figure out how cholera spread. -john snow mapped cases of cholera in london only to find that the contaminated water was coming from one specific well. -removing the pump handle ended the epidemic and proved a turning point in understanding infectious diseases

What are the (general) patterns in life expectancy worldwide today?

Generally increasing except in some LDRs (low developed regions)

What is the difference between incidence and prevalence? Why might you be interested in one over the other? In the sink diagram we discussed in class, what does the water coming in from the faucet represent? How about the level of water in the sink at a particular moment? And what about the water going out through the drain?

Incidence --> rate of number of new cases of disease. Prevalence --> total number of disease. Incidence rate=(# of new cases)/(population at risk), Prevalence rate=(# of cases)/(total population). Incidence --> water coming in from faucet Prevalence --> the water level in the sink (if it is high then you know there are more cases of the disease/illness if it is low then you know there are less cases) The amount coming out of the sink --> if there is a cure for the disease or if people are dying (so if people are quickly being cured or there is a high death rate for the disease the sink won't be full and there would be a lot of water flowing down the drain)

Where do Vaupel and Olshansky agree future improvements in mortality will need to come from to extend life significantly? How is this different from the improvements in mortality seen in the 20th century?

Vaupel and Olshansky both agree that we need to improve mortality among the elderly instead among the young. Much of the previous progress was due to decreases in infant mortality.

What is a life table, and how is it used? What are some uses beyond human life expectancy calculations?

a life table (also called a mortality table or actuarial table) is a table which shows what the probability is that a person of that age will die examples: marriage, migration, school dropouts, anything that has duration

What are some examples of social determinants of health?

public policies, culture and societal value, governance, macroeconomic policies, behavior and biological factor, psychological factors, material circumstances. economic and social conditions that effect individual and groups in their health status. Where you live. Level of income, racism, sexism.

What are some of the implications of longer life expectancies for things like retirement and social security? Are the potential effects equal across all groups in society?

retirement--> the age is going to have to increase to keep enough people working to support the non eligible workers... peeps can no longer retire at age 65... retirement age needs to rise as our life expectancy rises... this means there will be a large decline of the population of prime working age... creates substantial pressures on public finances and reduces the living standards social security--> becoming increasingly more difficult to support our elders... as age rises we will have to support them for longer years (and we can't even sufficiently support our older nation now) ***more so a problem with elders receiving no other form of money or income because it is barely enough to survive

What is oral rehydration therapy, and how has it been useful in declining mortality, particularly in developing countries?

type of fluid replacement used to prevent and treat dehydration, especially that due to diarrhea. It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium. - used to prevent millions of deaths from diarrheal disease. -fluid replacement strategy to prevent or treat dehydration