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Lecture 1 - Social Inequality & Material Foundations of Health & Illness.docx

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Dalhousie University
Soc & Social Anthropology
SOSA 2503
Emma Whelan

Social Inequalities and Material Foundations of Health and Illness Sept. 10 10/5/2013 8:05:00 AM Social Determinants of Health  Aboriginal status; gender; disability; housing; early life; income and income distribution; education; race; employment and working conditions; social exclusion; food insecurity; social safety net; health services; unemployment and job security  Effects “much stronger than the ones associated with behaviours such as diet, physical activity, and even tobacco and excessive alcohol use.”  Income “the single most important social determinant of health”  Income and income inequality, lower income = more health problems  Suicide rates in poorest neighbourhoods are 2x those in wealthiest neighbourhoods  Life expectancy differs between Rich=86.3 years, Poor=65.5 years (in Hamilton study) –Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts. Toronto: York University School of Health Policy and Management. Two Basic Positions on Health & Inequality - Materialist  Inequality is unfair  Goal: equality of conditions  Health as community responsibility - Neo-liberal/Conservative  Inequality is inevitable, may be justifiable in some situations,  Goal: equality of opportunity, rather than condition  Awards hard work and merit  Opportunity encourages effort  Health as individual responsibility  De-emphasize negative effects of health inequalities, rich wouldn’t use medicare = privatization History of Research - Mid 1800s – mid 1900s  Links between illness and poverty made  Urban and poor health - 1950s – 1960s  Postwar consensus  Demographic transition to aging population (longer lives, fewer children)  Societies well off, should improve help of population  Expansion of state services & support  Increase health of population - 1960s – 1970s  Relative deprivation vs. absolute poverty  Social movements  Marxist revival, relative position of poor health improves  Overall/everyone’s health improved, but gap still present The Black Report (1980)  UK by working group, commissioned by labour government of the time  UK Prime Minister in 1980 = Margaret Thatcher (neo-liberal)  Leftwing commissioned the report, right wing got results of report MEASURES  Mortality before 65 years of age  Premature death = indicator of social conditions and health of child bearing women (infant mortality)  Social class & Mortality = related, increased social class = decreases morality - Class affects health - Four possible explanations: 1. Measurement artefact (Artefactual) a. Premature mortality not relevant indicator b. Social mobility – occupation not as relevant now - Result
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