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SOC102H1 (261)

Soc102 Lec 7

10 Pages

Course Code
Lorne Tepperman

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Sociology Lecture 7: Consequences of Inequality 1: Sickness and Health An Interesting Finding -Adolescent victimization and income deficit in adulthood -MacMillon reports people (mainly women) who are sexually assaulted under 18 will experience earning deficit of $241600/yr compared to those who weren't -criminal violence experienced in adolescence appears to influence later earnings by disrupting processes of education attainment -consider how this connects income, gender, age inequality, health and crime -creates depression, anxiety -interferes with "processes" Canadians Care About Good Health -most important to Canadians in general -largest gross national product devoted to health care -Good health=sound mind and body -Note: mental and physical health are linked -people often separate these two What is Good Health? -World Health Organization Def: health is a state of well-being, not merely an absence of illness -both mental and physical well-being -Canadians favour preventing premature death and suffering -stress good diet -exercise -cessation of smoking Social Inequality and Health -good health affected by inequality -how much of our health cost is a result of social inequality? -how much can we reduce cost by reducing inequality? -Presumably, Canadians would support such actions -Note: we are not talking about health as a consequence of poverty -social inequality and poverty are studied separately Overall Health Quality Indicates How Well Society is Functioning and Organized -particular interests to social scientists -a measure of societal functioning: whether society is working well or not -Mind and body show signs of stress, decline and diminished functioning as a result of continuous adversity -Makes health a superior measure -better then reported satisfaction of well-being Despite Good Measures of Health and Inequality, Sowing the Connection is Difficult -particularly attractive -doctors are very precise in measurement -problem: many social and non-social factors influence health -difficult to isolate individual contributions of inequality The Problem: Making All the Connections -proof is a problem -need to make many connections at every analysis level -need to make connections between: i) macroscopic: social changes ii) microscopic: individual levels such as death in a population Ex: between 1980-2008 -widespread inequality began during Reagan regime in US -same with Thatcher’s policies in UK -Harris’ policies in Ontario -hard to trace effects -takes a long time to measure @ small scale -consequences also may not appear immediately How do Changing Policies Translate into Changing Health Experiences -Mike Harris’ government was severely anti-welfare and anti union -what as the effect of this increased inequality on people’s health? -answer hard to calculate precisely Here’s One Attempt: The Results of 2013 Study -“Cause-specific mortality by income adequacy in Canada: A 16-yr follow-up study” -by Michael Tjepkema, Russell Wilkins and Andrea Long -Statistics Canada, July 2013 -study on Canadian adults -poele who were at the top 5th quintile in income are less likely to die then bottom 5th How Much “Excess” (i.e. potentially preventable) death is due to inequality? -base on data from 1991-2006 -Canadian census mortality and cancer follow up study -tracked 2.7 million people -25 or older -426979 died in that period -used age-standardized mortality rates (ASMRs) -excess mortality calculated by income quintile for various causes of death Results -For most causes of death: -ASMRs were highest among people in lowest income quintile -lowest in people in highest quintile -Inter-quintile rate ratios (between lowest to highest) - >2 for AIDS/HIV, diabetes mellitus, suicide, cancer of the cervix -causes of death closely associated with smoking and alcohol -if we standardized the lifestyles, still twice as likely to die What this means… -The deaths due to … - AIDS/HIV -diabetes mellitus -suicide -cancer of the cervix -smoking and alcohol -were more than twice as likely to kill those of the lowest quintile than those at the top (controlling for age) over period of study Inequality Had a Similar Effect at Every Income Level, Especially Near the Bottom -association not just for those at the bottom of income distribution -for each successive level, the mortality rate increased -gap between adjacent quintile was largest between the lowest two quintiles -results very consistent with other Canadian research The Significance of This Effect -If all cohort members had experienced same mortality (age-specific) rates of those in highest quintile: -all cause ASMRs would lower 19% for men and 17% for women -Extrapolated to the total non-institutional adult pop.: Estimated 40000 fewer deaths per year -25000 fewer for men, 15000 for women -equivalent of eliminating all ischemic heart disease deaths -eliminate a slew o f inequality related deaths Income Inequality and Death -Income is a well-established health determinant -lower incomes = less favourable health outcomes -include poorer self-rated health -higher disease prevalence -decreased life expectancy (relative to people with higher income) -income affects health directly -through access to material resources -includes quality food and shelter Similar to Problem with Linking Death and Cigarettes -people still continue the debate the link between health and inequality -hard to actually show the direct link -inequality is on a social level -death is on a personal -the data is probabilistic, not a certainty -difficult to demonstrate link between macroscopic and microscopic -people misconceive this issue to be related to poverty, not inequality A Demonstration of Link Between Status Inequality (Not Poverty) and Death -most famous proof from Whitehall Studies -two studies -from 1967-1988 -examined detailed health info on British Civil Servants -subjects were not impoverished -had access to very good health records -lower status subjects were not impoverished; had a steady pay Not Due to Poverty, Due to Status -found death rates from chronic heart disease was 3x higher among lower ranked workers -gradient in health witnessed in entire job spectrum -decrease in job grade = increase in health risk -even if lifestyles very similar, get same ratio -means it is not due to poverty or faulty lifestyles The Psycho-Social Model vs. Material Model of Health Inequality -One popular model is the material model -identifies material living conditions as main source of health problems as a result of inequality -Psychological Model: social environment can impact health and disease under conditions of affluence Stress and Cortisol -psychological model -inequality = excess and unrelenting stress -excess stress leads to high cortisol levels -hormone produced by body as response to stress -cortisol levels normally fluctuate -adapt to dangers in environment -bad if at high levels constantly -due to unrelenting stress However, Sometimes There is Unrelenting Stress, and This Does Harm -In 2 Whitehall study -examined workplace stress on 3 dimensions 1) effort-reward imbalance 2) Job strain 3) Organizational injustice -certain occupations were found to be unrelentingly stressful -low status jobs in particular -Study directed our attention to job strain -Top Echelon: give orders, less strain -bottom: take orders -no control or autonomy over work -can't control pace of response -especially over prolonged periods Consider the Problems Associated with Serving Food and Drink -ex: waitressing and other low level jobs -Waitresses are under a lot of pressure -perform rapidly and accurately -little control over job conditions -tend to have higher average cardio-vascular death risks - (Karasek and Theorell) -a result of inequality, victimization and domination Drawing the Conclusion -at individual level, BOTH poverty and inequality cause risks to personal health Ex: low status, poor salary, poor access to health care, poor nutrition -at societal level, we see a higher mortality rate -rate considered excess/preventable -it may be better to be poor in egalitarian society then rich in unequal -inequality has big consequences At the Community Level (cf. Sampson article posted on BB) -High-SES people more likely to live in high SES neighbourhoods -these neighbourhoods tend to be cleaner, safer/comfortable and healthier -crime, violence, noise, pollution and traffic have been minimized -social participation and cohesion at high levels -this helps reduce stress -Increasing Geographic Inequality in Toronto -hard 30yrs ago to say where income statuses were located -much easier to differentiate now 1) increase average inequality between neighborhoods (pockets of poverty and disadvantaged) -once a neighbourhood goes bad, hard to turn around 2) People living there find it hard to escape -suffer consequences of living there -transportation to these areas are poor -hard to get goods jobs -social cohesion decreases = increase in crime Inequality Also Affects Mental Health -According to Health Canada, Mental Disorder is: -any condition characterized by alterations in thinking, mood or behavior (or combo) associated with significant distress and impaired functioning over an extended period of time -can come and go all the time -Mental Illness: should only be used for clinical diagnoses -r
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