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Lecture 4

Health Sciences 1002A/B Lecture Notes - Lecture 4: Bourgeoisie, Industrial Revolution, Infant Mortality

Health Sciences
Course Code
HS 1002A/B
Jessica Polzer

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Tuesday, September 20, 2016
Health Sci 1002 - Lecture 4
Income Inequalities and health
Social gradient and health
Key Concepts and People
-Social determinants of health (p. 70)
-Social class (p. 61), social structure (p. 66)
-ruling class (p. 66)
-social capital (p. 76)
-Rudolph Virchow, Karl Marx, Friedrich Engels
-Income inequalities
-Social gradient
-Whitehall studies
-Median share of income
-Gini coefficient
-Social Exclusion (p. 342)
-Social Inequality
-Absolute poverty
-Relative poverty
-Depth of Poverty
Medicare Paradox
-did medicare result in a more equitable use of care?
-publicly funded hospital and medical insurance eliminated income as a determinants of access to
health services but
-improving equity of access to medical care and hospital services does not assure equity in health
status across socio-economic groups
-created equitable access, did not produce equity in health status
-health is worse for those in the lowest income quintile compared to those in highest income
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Tuesday, September 20, 2016
Health Indicators
a number of ways to measure health:
-subjective measures (self rated health) - self reported, subjective, single item (based on one question)
or global response (combine responses to different questions)
-morbidity (disease) - hospital/doc records, self-reported sickness, time off work, can be for specific
diseases or general levels of sickness, combined
-incidence - indicates the rate of new cases of disease within a specified period of time
-prevalence - indicates how prevalent/widespread the disease is
-incidence is number of new cases, prevalence is a snapshot in time
-incidence will show trends in a way that just one figure or number wont provide
-mortality (death) - the proportion of deaths in a given population within a specified period (usually one
year, /100 000)
-measured in rates to show proportion, can compare between populations as they are based on
the same number of people and the proportion of these people
-causes of death have moved away from infectious disease, more towards cardiovascular illness
and cancer
-life expectancy - average number of years an individual can expect to live based on current mortality
-your gender and your living place will influence this (females tend to live longer)
-infant mortality - death during the first year of life, rate/1000 or 100 000
-sometimes smaller reference group because infant mortality is lower in some regions
-reflects the quality of health care and living conditions
-particularly sensitive measure to health care access and prenatal care, access to child birth and
care after birth
-can give a really quick understanding of the quality of the health care
-illness comparison can indicate trends
-tuberculosis in Canada, aboriginals have increased risk
-there is also a geographical component
-immigrants also tend to have higher trends than those born in Canada (non aboriginal), but still
less than aboriginal population
Social Determinants of Health
the social and economic environments in which people live and that determine their health
-housing, job security, working conditions, education, income, social class, gender, aboriginal status,
and the social safety net
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Tuesday, September 20, 2016
-SDH reflect the quantity and quality of resources that society makes available to its members
-the quality of these determinants is a reflection of how society is organized and how it distributed its
economic and social resources
-focus on resource distribution, government has a role to play in maintaining and improving the health of
the population
Recent Context for the SDH
studies of social patterning in health - mortality and morbidity increase as occupational status
could also be income status or just social status
health follows a social gradient (slope)
2 landmark studies: Whitehall studies, Black Report
The Social Gradient in Health
relationship between income and health follows a gradient (social position and health)
very obvious difference between rich and poor
incremental increase in life expectancy as time and income increases (moving from quintile to
social position describes that people are positioned differently in society and can be placed here by
birth or by opportunity
there are a number of social hierarchies that exist with some social groups higher than others
health is determined largely by economic status
every social hierarchy is different, this gradient could be measured by income levels, occupational
status, neighbourhood, etc.
trends are consistent
higher income = higher expectancy than those of lower income
does not just explore the extremes, it shows every point in between
one of the most robust findings
White Hall Study (1967)
study of 18 000 civil servants aged 35-55
civil servants = government worker; different occupational grades/levels
used these civil servants because in London there were obvious classes (class 1 - 5, class 1 being
the highest paying and decision making power, class 5 - also government worker and similar
environment, but people who are less educated and have no power)
could measure health and relate it to these different grades, observe powers
focused on cardiovascular
only included males
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