Health Disparities
conflict theory
suggests that stratification benefits some and not all, often the rich and not the poor. Thus, it perpetuates inequality in society
Distributive Justice
the equitable allocation of resources in a society. Suggests that priority should be given to improving the situation of the most disadvantaged in a society.
Human rights relating to health
the idea of nondiscrimination. This refers to the right not to experience discriminatory treatment based on one's social group - race/ethnicity, religion, tribe, national origin, or refugee status.
policy implications
the type of care received, as well as other factors, influences outcome. Since health care influences health, it should be socially guaranteed to reduce inequalities.
does mass media play a role in the social environment?
yes. Mass media and emerging communication and information technologies, such as the Web and cellular telephone technology, are ubiquitous components of the social environment that can affect health and wellbeing. The availability of resources to meet basic daily needs (e.g., educational and job opportunities, adequate incomes, health insurance, personal assistance services, and healthful foods) is an important facet of the social environment.
Neighborhood and Built Environment
Access to Foods that Support Healthy Eating Patterns Crime and Violence Environmental Conditions Quality of Housing
Health and Health Care
Access to Health Care Access to Primary Care Health Literacy
examples of social determinants of health
Access to safe housing, Good jobs with living wages, Quality education, Affordable health care, Nutritious foods, Safe places to be physically active, Racism, Discrimination, and Bias.
Eliminating health disparities and promoting health equity
Address all important determinants of health disparities that can be influenced by institutional policies and practices. These include disparities in health care as well as other health determinants -- the conditions of daily life and the circumstances in which people are born, grow, work, and age.
examples of social determinants of health
Availability of resources to meet daily needs (e.g., safe housing and local food markets) Access to educational, economic, and job opportunities Access to health care services Quality of education and job training Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities Transportation options Public safety Social support Social norms and attitudes (e.g., discrimination, racism, and distrust of government) Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community) Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it) Residential segregation Language/Literacy Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social media) Culture
addressing the social and physical environment
Changes in social environments, physical environments, and policies can affect entire populations over extended periods of time and help people to respond to individual-level interventions. Policies that can increase the income of low income persons and communities (e.g., through education, job opportunities, and improvement in public infrastructure) may improve population health.
social community context
Civic Participation Discrimination Incarceration Social Cohesion
The notions of "avoidability," "injustice," and "unfairness" are defined implicitly by these examples:
Differences in children's life expectancy according to their parents' social class; Adults' life expectancy according to their own social class; Differences in a range of health indicators by residence in urban versus rural settings.
education
Early Childhood Education and Development Enrollment in Higher Education High School Graduation Language and Literacy
five key areas (social determinants)
Economic Stability Education Social and Community Context Health and Health Care Neighborhood and Built Environment
Healthy People 2020 Goals
Eliminate preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote healthy development and healthy behaviors across every stage of life.
economic stability
Employment Food Insecurity Housing Instability Poverty
Whitehead on equity in health
Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential, if it can be avoided.
Reasons for widening disparities in mortality
Growing inequality in other dimensions of welfare, such as income and wealth. Rising income inequality post 1980, with a concentration of family wealth at the top.
health equity vs health equality
Health equity isn't the same as health equality because it's not enough to make sure everyone has the exact same opportunities; they should have the opportunities that are appropriate for their situation. (ex: everyone gets size 10 shoes instead of everyone getting shoes that fit them)
Healthy People 2020 health disparities data
If a health outcome is seen to a greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual's ability to achieve good health.
examples of physical determinants of health
Natural environment, such as green space (e.g., trees and grass) or weather (e.g., climate change) Built environment, such as buildings, sidewalks, bike lanes, and roads Worksites, schools, and recreational settings Housing and community design Exposure to toxic substances and other physical hazards Physical barriers, especially for people with disabilities Aesthetic elements (e.g., good lighting, trees, and benches)
influences of health also include
Nonmedical determinants of health, as both ethical and human rights principles both call for equal opportunities for all people to be as healthy as possible, not merely using medical care to buffer the health. It recognizes the damaging effects of underlying unjust living conditions.
examples of health disparities despite Medicare
Older black Americans still have higher rates of premature death from diabetes and often receive a lower quality of care. They face a higher risk of disability than older white Americans, Older American Indians and Alaska Natives often face the highest rates of disability among all population groups. Only one-half of older Hispanic Americans have received the pneumococcal vaccine.
Disparities can include:
The allocation of resources for health care, The actual receipt (utilization) of services, The quality of care, and How they are financed (including the burden of payment on individuals or households).
impact of health disparities
The negative consequences of health disparities impact the individual, their children, communities, and society. Health disparities are often self-perpetuating. A parents who is too sick to work, can become poor. Unemployed, low-income individuals are less likely to have access to health insurance. These individuals are less likely to afford health care, They could get sicker (less able), making it more difficult for them to find a new job. Getting healthy and out of poverty becomes increasingly difficult.
How does physical environment harm individual health?
The physical environment can harm individual and community health, especially when it exposes individuals and communities to toxic substances, irritants, infectious agents, stress-producing factors (e.g., noise) and physical hazards. Such exposures can occur in homes, schools, worksites, and other settings, and through transportation systems. Physical barriers within these environments can present tangible safety hazards or impediments to persons with disabling conditions. The physical environment also can promote good health and wellbeing. For example, aesthetic elements can be included in a neighborhood, or community settings and environments can be provided to facilitate healthful behavioral choices in such areas as diet, physical activity, alcohol use, and tobacco use
Tumin's counter to the Davis-Moore thesis
What determines a job's degree of importance? Believed social stratification prevented qualified people from attempting to fill roles. (i.e. an underprivileged youth has less chance of becoming a scientist, no matter how smart they are, because of the relative lack of opportunity available to them)
social stratification
a system by which a society ranks categories of people in a hierarchy
health disparity
a type of health difference that is closely linked with social, economic, and/or environmental disadvantage. This means disadvantaged social groups systematically experience worse health or greater health risks than more advantaged groups
structural functionalists
argue that social inequality plays a vital role in the smooth operation of a society
Margaret Whitehead health disparities opinion
defined health disparities as differences in health that "are not only unnecessary and avoidable but, in addition, are considered unfair and unjust."
human rights encompasses
economic, social, and cultural rights, such as the right to a decent standard of living, which in turn encompasses rights to adequate food, water, shelter, and clothing requisite for health, as well as the right to health itself.
Socioeconomic position often is measured based on
educational attainment; occupational characteristics; income/expenditures, wealth, or living conditions; health insurance; or residence in geographic areas with particular social or economic conditions
WHO regarding health and human rights
everyone has the right to enjoy the highest attainable standard of health in their society. health is a unique resource for achieving other objectives in life, and a way of promoting the freedom of individuals and societies.
social determinants
family, community, income, education, sex, race/ethnicity, place of residence, and access to health care, among others. People who lack social and economic resources are likely to be less healthy, which may both result in and result from discrimination. Frequently, issues of equity and social justice are involved in the social determinants of health
Social advantage/disadvantage
grounded in the attributes that define society by hierarchical groupings -- wealth, power, and/or prestige. A health disparity must be systematically associated, not random, but significant and frequent or persistent.
physical determinants
include our natural and built environments. Exposure to natural toxins (e.g., coal tar), manmade pollutants, or substandard housing are examples of physical determinants that can adversely affect our health
symbolic interactionism
offers a micro-level perspective of stratification. It argues that "social stratification has a built-in system that groups people together." So peoples social standing drives their daily interactions, and these everyday interactions of individuals is used to explain society as a whole. (ex. people interact primarily with others who share their same social standing; people live, work, and associate with others like ourselves, people who share their same income level, educational background, or racial background, and even tastes in food, music, and clothing.
Human rights
often focuses on civil and political rights such as freedoms of assembly and speech and freedom from torture and cruel or arbitrary punishment. Human rights also encompass economic, social, and cultural rights -- the right to a decent standard of living, which in turn encompasses rights to adequate food, water, shelter, and clothing requisite for health, as well as the right to health itself.
Health equity
oriented toward achieving the highest level of health possible for all groups. Achieving health equity requires both short- and long-term actions: Particular attention to groups that have experienced major obstacles to health associated with being socially or economically disadvantaged. Promotion of equal opportunities for all people to be healthy and to seek the highest level of health possible. Distribution of the social and economic resources needed to be healthy in a manner that progressively reduces health disparities and improves health for all.
greatest threats to the health and longevity of Americans are...
preventable diseases. this is closely related to the social determinants of health and the circumstances that influences individual's opportunity to achieve good health and adopt healthy behaviors.
social environment at the community level
reflects culture, language, political and religious beliefs, social norms and attitudes (e.g., discriminatory or stigmatizing attitudes). It also includes socioeconomic conditions (e.g., poverty), exposure to crime and violence, social cohesion, and social disorder (e.g., the presence of trash and graffiti)."
The Role and Function of Healthy People 2020
should provide overarching, national-level goals. On a practical level, it is a road map showing where we want to go as nation and how we are going to get there—both collectively and individually
examples of social stratification
slavery, caste system, estate system, social classes
why is society morally compelled to attach value to maintaining physical functioning?
so that "people can live a life they value"
Davis-Moor Thesis
social stratification is necessary to promote excellence, productivity, and efficiency, thus giving people something to strive for. (i.e., assign reward based on role functions - unequal value)