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University of Toronto Scarborough
Health Studies
Rhan- Ju Song

HLTC05 –Social Determinants of Health Lecture 4: Social Inequality and Health Tuesday, October 2, 2012 Explaining the Inequality –Ill Health Connection  Three Hypotheses (see Nguyen and Peschard 2003) : 1. Social cohesion: clinical epidemiological studies indicate that density of social networks correlates with better disease outcomes and decreased mortality o Better health, less health disparity o Less social cohesion unequal 2. Psychosocial mechanisms: e.g., Stress as an entry point for harmful biological pathways – psychosocial mechanism through which hierarchy exerts negative effects on human health o Any type of stress acts as entry point for harmful health o Eg., Lose your job you end up with a lot of stress about income and supporting family o Prolonged type of stress 3. Material factors: material deprivation leads to poor health, o i.e., via fewer investments in infrastructure, social services; more “stuff” shields you from environmental, behavioural and social risks; material deprivation in childhood perpetuates “unhealthy” behaviour later in life o Material deprivation of poverty (WHO: 40% of world’s population; live on US$2/day or less) is what is “unhealthy o Inadequate housing and/or transportation o Not have the basic things to protect us Quiz # 1: Material factors in human health do not include: a) Housing and support groups b) Employment and income and sanitation c) Private transportation and food d) Clothing and medicines Important Themes  Structural violence o How we view ill health  Historical dynamics that produce inequality  Anthropology of the body (commodification) o We have to view ill health as just a biological product o People sell parts of the body such as vital organs o Made a body another thing to trade  Notion of risk (and blame) o Linking micro to macro, local to abroad o How globalization affects an individual  Linking local context to broader analysis, i.e., materialist factors placed within a broader geopolitical context; globalization, macroeconomics  Role of therapeutic systems (biomedicine) in fortifying inequalities/social hierarchies o Biomedical vs. social health on disease o Development of drugs o Acts a structural violence  Spiralling “illness poverty trap” (adverse health impact of inequalities exacerbates those very inequalities; poverty produces ill health which worsens poverty) o Being poor makes you sick which makes you more poor  important role of ethnography (linking policy with everyday life) o practice of ethnography  very effective way we can think about micro macro linkage to globalization and a person’s ill health  having a case study to help people relate to it Nguyen and Peschard (2003)  The body is fashioned by cultural, political, and historical processes o Not just a biological entity with basic epidemiological  To better understand how social relations condition relative disease patterns, we must view the human body as deeply historicized and socialized o Not just biological statistics o Not just cause or effect, but the complexity of historical and other factors Socioeconomic Status  Refers to a hierarchical structure that represents wealth, power (social, economic, political) and social prestige o Can indicate inequality  Measured by factors such as occupation, income (very common), education (esp. women)...  Individuals with higher SES tend to have better outcomes: higher academic achievement, better physical and mental health, increased literacy and decreased mortality rates  This “gradient effect” of SES with outcome is evident in all developed, industrial societies  It persists throughout the lifespan, thus kids born into low SES households tend to have poorer outcomes, even if they have higher SES later in life o Because of negative influences that happened in early life, especially during infancy and childhood o Likely due to the sensitivity of the developing brain to its environment during infancy and childhood  The Gradient Effect – Individuals with high SES have better outcomes than those with low SES. Figure adapted from McCain, Mustard and Shanker (2007)  Furthermore, the Gradient Effect entails that even with same absolute level of income, an individual in a more egalitarian society (equality) will be healthier than one in a less egalitarian society (inequality disparity)  Gradient effect impacts health across all income levels o Disparity and inequality within the society o Less disparity, less social disparity and vice versa  Now recognize that social inequality contributes to ill health independently of income level Biological Clear consequences due to gradient effect (there’s many more)  Infant and Maternal Mortality  Adult life Expectancy  Cardiovascular Disease  Blood Pressure Diabetes  Reflects maternal education  No maternal education = higher infant mortality rate  Maternal education reflects SES Proximate Causes  Immediate cause for something  Maternal education: infant mortality is higher in one group of women who are uneducated Ultimate Causes  beyond the reason, factor behind nutrition  Example: structural violence Structural Violence  A term broadly describing unjust, aberrant and corrupt social structures characterized by poverty and extensive social inequality, including racism and gender inequality  Structural violence is violence exerted systematically - that is, indirectly (and directly) - by everyone who belongs to a certain social order (Farmer 2004) o we’re all part of it, we accept it, which makes its more daunting  Reflected in differences in morbidity and mortality (TB, malaria, HIV) (Farmer 1997) o Seen globally o Diseases of poverty (e.g., HIV has a high prevalence in parts of Africa) reflects structural violence  Structural violence is visible in the steep gradients of social inequality that, by producing severe poverty in an era of increasing wealth (and
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