SOC364
why was the neighbourhood observation data collection form created?
to study cities with problematic built env, built spaces decaying etc....
what is referred to as a city of neighbourhoods?
toronto! why? due to high variane and distinctiveness
Ross: We consider ___________ a profound form of social alienation that has gone beyond a perceived separation from others to a suspicion of them."
trust
Fitzpatrick 2 views
urban health penalty vs. urba sprawl
how are neighbourhoods defined?
ward, census, block cenus tracts typically used for boundaries
who argues that the belief that medical care equals health "great equation" was not true
wildavsky
who discusses the epidemiological transition, from material scarcity to social disadvantage?
wilkinson
from 1971-1996, did the causes of death amenable to medical care diminish more for men or women?
women, in IHD, more for men
were there positive health benefits in wakefields study?
yes especially for elderly
do condiitons matter beyond penalty or sprawl?
yes! concentrate public health intiatives, avoid confounding urban with poor/ethnic community
structural amplification
"when conditions undermine the personal attributes that would otherwise moderate their undesirable consequences."
According to McKinlay, "to boldly go.." what are some limitations of epidemiology?
- Biophysiologic reductionism Absorption by biomedicine Lack of theory development Limitations of dichotomous thinking Risk factorology Association versus causality Dogmatism by design
other than biological factors, what is another downstream determinant?
- behavioral pathways
2 focuses in the study of urban health
- description of health patterns - urban determinants of health patterns
urban infrastructure
- how a city provides water, energy and disposes of garbage -
diagram of "change in the census tract avg individual income 2000 compared to 1970"
- increase of 20% or more in middle, decrease of 20% or more on outskirts,
what was uncovered regarding risk factors associated with prostate cancer?
- only 18% of the risk factors are known!! family history highest
4 Fundamental features of how city living can affect health?
- population - physical environment - social environment - availability and access to services
what is CBPR
- research structure is flat rather than hierarical - particiaptory and collaborative -expertise is diffuse and local
gene-environment interactions
- the context interacts with the individuals attributes - combination of individual and contextual antecedents - example job demands
population composition
- the social and demographic characteristics of individuals (gender, age, family form)
allostatic load
- wear and tear on the body grows when exposed to repeated or chronic stress - lower status individuals greater exposure and vulnerability to allostatic load exposure: poor work conditions, family problems, economic hardship (Stressors) vulnerability: inability to cope, less resources (financial, social psychological)
can behavioral factors (Eating, smoking, drinking, coping) explain the socioeconomic health association?
...clear association between class and behavior no clear relationship between behavior and the SES association but its behavioral and psychosocial
from 1971-1996, differences in life expectancy between the richest and poorest income quintiles diminished by well over.. ___ year for each sex
1
george kaplan 2 types determinants of health...
1) downstream determinants of health - features of the individual (individual level antecedents) 2) upstream determinants of health (features of the environment, broader social situation, contextual-level antecedents)
Why is there not a stronger relationship between the wealth and health of a nation among the more developed countries?
1) spurious pattern - approaching the limit of human life expectancy 2) association real - the epidemiological transition
2 problems with urban sociology
1. focus on schools of thought rather than the problem at hand 2. ignore health outcomes - the health and well being of residents is focal to development and sustainability of urban soc
how to study differences in upstream vs. downstream explanations?
1. observe patterns across time and context - assume only changing factor is context - cross national studies suppress patterns of inequality 2. multi level modeling - statistical approach to examining different explanations while controlling for individual factors
what was the whitehall study?
1967, study exained determinants of health among british male civil cervants aged 20-64 results: found a strong inverse association between class of work and mortality! men in lowest grade of work (messenger, doorkeepers) had a mortality rate 3x higher than that of men in highest grade (admin)
how does structural amplification occur?
2 stages 1) Neighbourhood disorder breeds a sense of powerlessness (low sense of control) 2) This has two simultaneous consequences: Lower sense of control increases anxiety, anger, and depression. Lower sense of control undermines its role as a moderator (buffer) of the effect of disorder on mistrust
what percentage of variation in mental health is due to between neighborhood variation?
30-40%! neighbourhood structural factors account for these differences, the remaining variation due to individual-level factors Effects of neighbourhood disadvantage persist controlling for individual socioeconomic status. Wheaton and Clarke show that the effect of neighbourhood disadvantage is worse when individual disadvantage is worse.
profile of st. jamestown
44,000 average income
how many census tracts (neighborhoods) are there in toronto?
531
mortality from all cause declined ___% between 1900 and 2010
54%
community gardening in NY film (eco tipping)
A once vital and beautiful area deteriorated into urban decay until 1973 when Liz Christy started the garden/greenspace projects
epidemiological transition
Defined as "...the shift in the main causes of death—from infectious diseases to degenerative cardiovascular diseases and cancers" (p. 65) Diseases of affluence became diseases of the poor Social class distribution of smoking, obesity, etc. gout "Thus, it seems that in the later stages of industrial development countries go through a health climacteric after which the health of the vast majority of the population is no longer substantially affected by the absolute material standard of living"
Is perceived neighborhood disorder associated with decreased social and psychological resources?
Disorder leads to social decay and social withdrawal Individuals become more isolated, more mistrusting Tend to feel less in control of their circumstances
what does distress embody?
Distress embodies anxiety and depression symptoms reflecting affective impairment of functioning ranging from mild to severe, and indicative of the probability of disorder.
example of benefits of social capital on morality in low income neighbourhoods
Hutchinson et al. (2009) 68 neighbourhoods in Philadelphia Benefits of social capital on life expectancy were stronger in neighbourhoods with higher proportion of same ethnic background (minority)
which causes of death showed progress toward "health for all"?
IHD for males/females, cirrohisis of liver men/women
differences between cause of death in 1990 USA and cause of death in 2010 USA
IN 1990, 53% people died of infection diseases!, today 33 and 32% die of heart disease, and cancer
where did wakefield study the health impacts of community gardening in Toronto
In areas characterized by high rates of poverty (up to 70%) With pronounced ethnic diversity (79% visible minorities vs. 43% for the city as a whole)
what is the social model of the neighborhood?
Individuals' perspectives of the neighbourhood, and the interactions between residents 1. Social organization Collective efficacy, cohesion, trust, social ties, and capital 2. primary stressor secondary stresserReal and perceived disorder - "objective social and physical conditions that indicate a breakdown of social control in the community"
urban health penalty
Inner-city core Exposure to risks (Beck 1995) Reduction in resources Social disorganization (Wilson 1996) Communalism (weak ties, Granovetter 1973) Largely a product of segregation Massey and Denton 1993 The process of inner-city, disadvantaged populations experiences negative health impacts f
what are compounding effects?
Interaction between past and current neighbourhood AND individual-level attributes
who discusses avoidable mortality by neighborhood
James
fitzpatrick: health is a result of 4 forces
Life chances associated to position in social structure Level of exposure to risk Cultural factors (health beliefs and lifestyles) Individual access to formal/informal support networks
Evidence of upstream determinants
MTO study 1994..... - 4,600 low-income families with children living in public housing within some of the nation's most disadvantaged urban neighborhoods the chance to move to private-market housing in much less distressed communities. Randomly assigned Results for adults Improved physical health: lower prevalence of severe obesity and diabetes Improved mental health: depression and distress. Results for youth No effect on physical health. Improved mental health for females but not for males: lower prevalence of distress, mood disorders, panic attacks, and oppositional defiant disorder and fewer serious emotional or behavioral difficulties.
are people randomized into neighborhoods?
NO! based on preferences, constraints - we usually cannot measure these things MTO goo example of how to address selection biases
so is there evidence that psychosocial state solely explains the socioeconomic health association?
NO!... it can be attributed to more obejctive conditions, ie stress process model
what was the first megacity? how many exist today?
NYC in 1940 more than 15 exist today
so discuss structural aplification on neighborhood disadvantage
Neighbourhood disadvantage leads to greater threat and disorder Threat and disorder undermines sense of control, which in turn: Increases mistrust, and Lowers the benefits of sense of control on the impact of threat.
Does segregation always lead to urban health penalty
No, Can sometimes have beneficial qualities
do sociologists focus more on the right or left side determinants of health?
RIGHT.. different typologies of these determinants
Does perceived neighbourhood disorder mediate the association between neighbourhood disadvantage and resources?
Ross and others (2001; Ross 2011) find evidence that disadvantage leads to disorder, which reduces sense of control, and increases mistrust
what are neighborhood facts to date
Social inequality prevalent across neighbourhoods and growing poverty Concentrated disadvantage does matter (segregation, low income, lone parents, disorder)
Social processes in neigh's (Sampson)
Social ties - concept of social capital Frequency of social interaction, density of social ties between neighbours, patterns of neighbouring Norms/Collective Efficacy Intervening in a neighbourhood context where the rules are unclear and people mistrust or fear one another Institutional Resources Quality, quantity and diversity of institutions in the community Routine activities Land use patterns and ecological distributions of daily routine activities bear on children's well-being (location of schools, public transit nodes etc...)
what country has effectively managed to improve life expectancy and the gradient of social class mortality together
Sweden
example of compound disadvantage results regarding educational attainment
The effect of neighborhood disadvantage is worst for children of parents with low educational attainment. Thus, there is a specific disadvantage to personal disadvantage in the presence of disadvantaged neighbors. In addition, having college-educated parents completely negates the mental health effect of neighborhood disadvantage; in other words, for these children's mental health, context does not matter
what does hans rosling say needs to happen in 2050 in order for population growth to stop?
The lowest ranks of the developing world need to move out of the lowest levels of industrialization and development Move into a better phase of the development continuum The rest of the world joining the developed west in terms of child survival Need to improve to 90% in order for them to keep up
Why do we see differences in patterns of segregation between Philidelphia and Toronto?
Toronto concentrated segregation
T/F Neighbourhood disadvantage only matters for those with personal disadvantage
True
T/F Socioeconomic status nullifies the effect of neighbourhood disadvantage on children.
True
what was the black report?
UK : although health care contributed to improved health and well being there were socioeconomic factors of greater importance in determing health Created a debate about the allocation of resources in tackling health problems
collective efficacy (sampson)
Willingness to intervene in situations that may impact the well-being of the group Combination of cohesion, trust, and informal social control
Does perceived neighbourhood disorder mediate the association between neighbourhood disadvantage and depression?
Yes. The remaining net effect of neighbourhood disadvantage (after we consider individual-level attributes) is associated with higher levels of perceived neighbourhood disorder, which, in turn, elevates levels of depression .
Is perceived neighborhood disorder associated with levels of depression?
Yes. There is a positive association that is steepest at the lowest and highest levels of neighborhood disorder—especially at the upper end.
polarizer
a person or thing which accentuates divisions or differences
ghetto
a quarter in a city, an area occupied by an isolated or segregated group as a result of SES pressures
what are the 2 hypotheses
a) neighborhoods that lack resources and present threats to individuals produce distress b) disadvantaged neighborhoods only seem distressing because individuals distressed by their own eprsonal disadvantages tend to live in them
what are some of the differential effects within neighbourhoods for residents?
access to resources exposure to stressors access to safe social spaces
consequences of social comparison
additional stress problematic behaviors psychosocial resources
what are advantages of hierarchical approach?
advantages: (1) it encourages multidisciplinary approaches; (2) it permits the integration of different levels of analysis (from social determinants, geographic and environmental variations, and health care access and utilization to the behavior and lifestyles of individuals and the influence of biophysiologic and family history); and (3) it suggests that profoundly different actions are required, depending on which level of explanation one focuses on
physical environment
air quality, infrastructure, accessibility, safe drinking water, garbage removal
what are explanations for biological symptoms for low SES? why lower class exhibit worst bio-related symptoms?
allostatic load gene-environment interactions
what was kaplan's conclusion of downstream determinants?
any explanations of socioeconomic inequalities in health that takes refuge in the differential distribution of behavioral or psychosocial states [or biological states] by socioeconomic position must take up the causal issue of why these states are more prevalent among those with lower status
absolute deprvation
average incomes for each society as a whole (national or individual level)
social factors that are most important in determining how well we live
behavior!! diet tobacco etc, then genetics, then environment public health, then health care delivery
issues with sprawl and penalty
both focus on a single phenomenon: the concentration and diffusion of populations between central city and its surrounding suburbs, and thus ignore many other important dynamics... important to Study physical, social, population, and service-related conditions within each context
how could this growing disparity be slowed?
by public policies
where was life expectancy highest/lowest?
canada/australia african countries, particularly congo
largest proportion of global NCD deaths under age of 70
cardiovascular disease
multi-level/mixed data sources
census data - administrative data - systematic social observation - face to face interview
the worldwide growth in the next 30 years will be in..
cities.. less developed countries
which cities are expected to grow/diminish?
city 1 = 30% (from 19%) growth, city 3: 59% growth (from 40%), city 2: decrease from 40% to 9%
describe the 3 cities as discussed by hulchanski?
city 1: a pre-dominantly high-income area of the City of Toronto in which neighbourhood incomes have risen a great deal relative to the Toronto Census Metropolitan Area (CMA) average since 1970; these neighbourhoods are generally found in the central city and close to the city's subway lines. city 3: By contrast, City #3 is a generally low-income area of Toronto, in which neighbourhood incomes have fallen substantially over the past few decades compared to the CMA average; these neighbourhoods are found mostly in the northeastern and northwestern parts of Toronto. city 2: in between.. a mainly middle-income area, where neighbourhood incomes have remained fairly close to the CMA average since 1970.
population wise what has happened to the cities?
city 2 has increased significantly over time city 1 has slightly grown city 3 has shrank dramatically
What are these benefits
cohesion Eg. Chinese immigrants in Toronto you do not find that eventual deterioration of benefits Economic, more opportunities
trust is vital in...
collective efficacy
Key facets of upstream determinants
communities and neighbourhoods (multiple complex influences) social and economic policy (often factors influencing communities exist outside the community, allocation of resources)
james: health policies should focus not only on individuals but also on...
communities in which people live
gemeschaft
community
the association b/w __________________ with ________________ mediated by collective efficacy
concentrated disadvantage and instability with violence
what happened to differences in infant mortality?
declined!
how are ghettos characterized today?
densly populatioed area extreme poverty, racial monorities
2 major forms of psychological distress
depression anxiety
the social life of small urban spaces
details efforts by social scientists in NY to identify key design features of public spaces that people like! key feature is built environment and physical structure! can offer safe and welcoming spaces for interaction and exploration have residents who are less socially isolated and more physically active
are patterns of distress related to neighborhood structure or individual disadvantage?
diffcicult to discern
relative deprivation
differences between groups of people in the same society (national level only)
what does wilkinson argue?
economic growth does not necessarily lead to prosperity, which leads to good health... health of the population depends on the RELATIVE inequality of individuals in that context
some main aggregate stats about the residents and households
education, employment, income, minority
industrial revolution (17th century)
education, improved hygiene and sanitation hygiene movement (19/20th cntury) control diseases, sexual education despite advancements, a health gradient emerges (inequality in nutrition, height diff across classes)
graph on diminishing returns to economic growth (GDP)
essentially, there is a threshold at which the health beenfits of economic growth level off upward trend, but beyond a certain point, it becomes more random mortality rates in debeloped world no longer related to per capita economic growth, but are related instead to the scale of income inequality in each society
ethnic/income profile of the annex
ethnic: compared to all of toronto, lots more canadian citizens, less aboriginals, less visible minorities, less recent immigrants income: majority make 100,000$ and more
what are mixed methods approaches?
ethnograhic work, quaitative interview, historical comparative research
the goal in the class is to critically review research to date on these topics and discuss potential solutions to remedying _______________ and ________________
exposure and vulnerability
agricultural revolution (15th century)
farming communities/towns increased population, health of population is a focus (food/nutrition determine good health)... cultural and social changes also contributed to good health
who discusses "placing" health in an urban sociology, cities as mosaics of risk?
fitzpatrick and lagory
who discusses discrepancies in health from a historical perspective?
frank and mustard!
example of downstream determinants
genetic factors individual risk factors
who provided a useful metaphor in explaining the socioeconomic-health association?
george kaplan
examples of perceived neighborhood disorder
graffiti, noise, vandalism, substance use
Why still such a large disparity in health outcomes post industrial rev?
growing inequality b/w socioeconomic classes... as a whole mortality rates are falling! but gradient in mortality is GROWING between classes .. most apparent in countries with high inequality (US) compared to more equitable countries (Sweden)
urban health sprawl....
growth of suburban population (low density patterns, separation bhy custom and zoning laws, extensive roads and distance to amenities) health risks (automobile dependent - air pollution, car crashes, pedestrian fatalities, land use - physical activity, water use, mental health- commuting, road range, work fam conflict, social interactions-limited social capital, support)
Wakefield study results:
health benefits: improved access to food, improved nutrition, increased physical activity, improved mental health, social health thru community cohesion
what have long been used as a standard of understand the relationship between nutritional status and mortality
height/weight
Levels of explanation suggest a ______________ (as opposed to _________) approach to disease causation.
hierarchal, lateral
who discusses the 3 cities within toronto?
hulchanski
what characterizes the pre industrial revolution?
hunter gathered society, nomadic, environmental risks, slow population growth, communal
what are main take aways from hans roslings's global population growth, box by box?
in 1960, global pop is 3 billion. 1 billion people in industrialized world, 2 billion in developing world (different aspirations .. health, education, money VS. food, shoes etc)ty as of 2010, developing pop has doubled... some are emerging populations, who are gaining aspirations of past industrialized populations!...car into plane, shoes into bike The gap is now more of a continuum
What appears to contribute to the lack of association between development and population health by country
income inequality!
what happened for causes amenable to public health?
increased 20% for women! and 0.7% for men
avoidable mortality
indicator of healthcare performance at the population level and to signal possible deficiencies in healthcare systems
traditionally, health research has focused on......
individual level antecedents! emphasis on genes biology, behaviours (medical modoel, neoliberal approach)
2 major types of social philosophy as mentioned by mckinlay
individualism collectivism
what is the main cause of the decreasing gap between rich and poor countries in terms of life expectancy?
infant mortality rates! improving standards of living, basics of life, public health
who is doing the best in this regard?
japan and sweden! canada in middle, usa all the way towards the top, portugal near top as well
who discussed the cholera outbreak in london?
john snow!
"A house may be large or small; as long as the neighboring houses are likewise small, it satisfies all social requirement for a residence. But let there arise next to the little house a palace, and the little house shrinks to a hut. The little house now makes it clear that its inmate has no social position at all to maintain, or but a very insignificant one; and however high it may shoot up in the course of civilization, if the neighboring palace rises in equal or even in greater measure, the occupant of the relatively little house will always find himself more uncomfortable, more dissatisfied, more cramped within his four walls."
karl marx
challenges with figuring out urban health
lack of precise definitions and research questions, difficult to consider multiple overlapping influences, complexity of cities
what did james find in regards to expected years of life lost?
large declines neighbourhood differences for medical care, but little change due to public health r other causes
what group of men/women had highest number of deaths?
lower middle income, mostly non communicable diseases
which causes of death sowed increase mortality rates and higher disparity by income!
lung cancer females, mental disorders, diabetes men/women
which causes of death have showed little change?
lung cancer males, breast cancer females, suicivide males and females
according to james, what made the largest contribution to narrowing socioeconomic mortality disparities?
medical care
are appendicitis and asthma amenable to medical care or public health?
medical care!
can biological factors explain the socioeconomic health association?
medical model assumes yes..... although no clear ONE biological factor associated with low status
2 views advocated by mckinlay?
medical science (medical model) focuses on disease states and factors that predispose people tp, are associated with or increase the changes of entering into a diasease state.. dichotomous! healthy vs. diseased vs. holistic view (social model), not statis but fluid, arrow back/forth from healthy and unhealthy
health and social services
mental health facilities, hospitals, family docs, nutritious foods, homeless shelters
what is a megacity?
more than 10 million inhabitants large area where people live in close proximity
what do studies find regarding the structural model?
most studies only find MODEST support for the structural model after considering individual level variation
what is on neighborhood and individual level
neigh level: disadvantage, resources individual level: attributes, behaviors, health
is ghettoization along us lines, a factor in canadian cities?
no, but.. a new polarization/ghettoization
is there a direct relationship between how long you live and how much money you make?
no. urbanization and improvements of quality of life
The study of _______________ demonstrated the association between income and mortality... cost determined by height
obelisk
what are the 2 new exclusive neighbourhood environments?
outcast ghettos: for people with no choice, location is not chosen voluntarily, exclusive neighbourhood for the economically most disadvantaged elite (or privileged ghettos): for people with every choice, location chosen voluntarily, exclusive neighbourhood for economically most advantagedttr
community gardening data and methods:
participant observation, focus groups, in depth interview
According to Galea and Vlahow, what are some characteristics of the physical environment, social environment, and health/social resources?
physical environment: Built env, air/water quality, noise, parks etc... Can affect physical (asthma, respiratory problems, injuries) and mental health (distress, child development) Built environment lay out, accessibility and design can impact amount of physical activity for inhabitants, urban infrastructure social environment:Social strain resulting from unpleasant stimuli associated with poor health and deviant behaviour Stress/distress and social strain relationship Individual social resources Poor more vulnerable to distress due to lack of coping mechanisms Spatial segregation of ethnic/racial/socioeconomic groups Environmental racism Inequality important to human health resources: Disparities in wealth between neighbourhoods can be seen through disparities in health due to access and availability to health/social services Difficulties accessing health care Sharp disparities between relatively proximate neighbourhoods
what is the key focus of the film "the social life of small urban spaces" - william whyte
physical structure and built environment
what are 4 broad areas in urban health?
population composition, physical environment, social environment, health and social services
name some of the defining characteristics of the 3 cities?
population, households, immigrants, visible minorities, education, employment, income, travel
what 3 stages do frank and mustard discuss in terms of the determinants of health from a historical perspective?
pre-industrial revolution agricultural revolution the industrial revolution (post ww2)
what is influenced by objective conditions?
psychological pathways (powerlessness, isolation, meaninglessness, normlessness
are lung cancer and cirrhosis, motor vehicle accidents, amenable to medical care or public health?
public health
THE 1953 un ATTRIBUTED the great decline in mortality rates over the past 150 years to....
public health measures, advances in medical knowledge, improved personal hygiene, improved standards of living
What did sampson's meta analysis involve?
recent studies that consider neighborhood as an independent variable affecting adolescent outcomes
the health gradient is defined by.....
relative deprivation versus absolute deprivation
when looking at income and mortality (life expectancy), when do we see a correlation?
relative deprivation within society when looking at absolute deprivation, there is no correlation
what were challenges to community gardening and CBPR?
resistance and challenges... (insecure land tenure and access, bureaucratice resistance, concerns about soil contamination, lack of understanding by communities and deicison makers - fewer rewards to CBPr from granting agencies and elite institutions
the relationship between urban stressors and health is buffered by
salutary resources (health care and social services)
who discusses social capital?
sampson
example of collective efficacy
sampson: aggregated collective efficacy, neighborhoods in chcago...
who discusses community gardening in south east toronto?
sarah wakefield
what do ross and mirowsky say is key to reducing mistrust
sense of control! opposite of powerlessness
key features of the social life of small urban places
shading, fountains,
how was the ghetto referred to in the 14th century?
small neighborhoods
Why does relative deprivation have such a strong impact on the health of individuals in developed nations?
social comparisons! "less a matter of the immediate physical effects of inferior material conditions than of the social meanings attached to those conditions and how people feel about their circumstances and about themselves..." (p. 70)
what can potentially buffer the negative effects of disadvantage?
social ties and interactions
example of upstream determinants
social/economic policies institutions neighbourhoods
what was a major trend when looking at the 3 torontos?
socio economic status! , individual incoem and employment income
what has been the main contributor to paradigm shift from medical model to social collectivist model?
socioeconomic-health association
what are 3 focal dimensions of neighborhoods
spatial (physical boundaries), structural (social and demopgrahic characteristics of individuals in neighborhood), social (cohesin, trust, organization, interactions)
what is an explanation for the neighborhood stressors as outlined by len pearlin?
stress process model
when looking at neighborhood effects, what has traditionally been the focus?
structural disadvantage (female headed households, drop outs, male unemployment,
social environment
structure of social relationships within the community
WHat does Kaplan suggest we do regarding unequal risk?
suggests a need to identify and focus on groups with unequal risk Low socioeconomic position Disadvantaged places in terms of opportunities and resources Sensitivity to stages of the lifecourse and cumulative nature of disadvantage How can welfare states help address these problems? Or, do welfare states sometimes undermine more "organic" solutions?
what are other factors to consider?
temporal and contextual influences on mental health
polarization
the accentuation of a difference between 2 or several things or groups; division into sharply contrasting groups
according to hulchansky, while all cities can be divided into various groupings, the important finding is the consistent trend over time:
the three groups of neighbourhoods are changing at different rates and moving further apart.
what is an example of class inequalities as discussed in class?
the whitehall study (marmot)
what were the take aways from hans roslings, 200 countries 200 years, 4 minutes?
the world is rapidly catching up with the wealthy countries in life expectancy gap between west vs rest closing potential of everyone making it to wealthy sector of world in terms of health?