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Health Studies
HLTH 101
Elaine Power

Health Exam Notes 11/28/2013 12:10:00 PM WEEK 1: SDOH: the factors that affect the chances that groups of people have to led long and healthy lives Factors beyond individual control are more important in explaining differences in health outcomes among groups of people than lifestyle factors Normative disciplines: are profoundly moral – in the deep & broad sense of seeking the essence of who we are as human beings & as a society Seek to understand human suffering & social injustice, in order to alleviate it – need systematic ways to understand problems There are alternative ways of organizing ourselves – ―a better world is possible‖ Individualism: ―a way of thinking that encourages us to explain the world in terms of what goes on inside individuals and nothing else‖ Society is just a collection of individuals Consequences: affects how we think about social life and how we make sense of the world: blame individuals for problems and expect individuals to fix problems Problems with individualism: ignores the difference between individuals who participate in social life and the relationships that connect them to one another and to groups & societies: personal solutions can‘t solve social problems. Forest and the trees: ―people aren‘t systems and systems aren‘t people, and if we forget that, we‘re likely to focus on the wrong things in trying to solve our problems‖ (forest and the trees p 14) Social Problems like Racism: Are both about/not about individuals Individuals are not responsible for a world they did not create Individuals are responsible for choosing how to participate in that world and understanding how & why those choices matter – how can I be part of the solution not part of the problem As we participate in systems, our lives are shaped by socialization & paths of least resistance Social systems  are not ―things‖ but rather ongoing processes Constantly being created and re-created as people do things to make them happen. They can and do change 1 Fears, Anxieties, Worries: Failure: failing oneself and one‘s parents/family Failing academically or in career/sports & other activities Take responsibility: use the resources available to you to learn the lessons of the small failures; sometimes you can prevent the big failures Failure can change the direction of our lives – it is up to us whether that is positive or negative in the end What is Health? ―official (expert) definitions of health: *negative definitions (disease oriented) – biomedical model *positive definitions (holistic) – social models (e.g., WHO, Health Canada, Antonovsky) ―Lay‖ (ordinary people) understandings of health Problems with dominant biomedical model of health: mechanistic, reductionist, technical approach – body separate from mind, emotions, spirit/soul More attention to disease (and curing it) than health (and promoting it) Health as absence of illness: the subjective feeling of pain or discomfort; may or may not accompany disease – self-rated assessments of health correlate well with objective measures of health **Doctors & their patients define & understand health differently Disease: professional/medial diagnosis – medically defined, objective pathology Illness: person‘s sense of being unwell – subjective experience of ill health Aaron Antonovsky: American-Israeli sociologist Searched to understand the factors contributing to good health, the origins of good health. Core concepts: salutogenesis, sense of coherence How do we survive (and thrive) in the midst of constant stress and disease? Salutogenesis – Antonvosky‘s term for the origins of positive health Salutogenic model of health: Antonovsky‘s conceptual model to guide out identification and understanding of the factors that protect and enhance good health 2 Sense of Coherence (SOC): ―The extent to which one has a pervasive, enduring though dynamic, feeling of confidence that one‘s environment is predictable and that things will work out as well as can reasonably be expected.‖ Three Components: Comprehensibility: extent to which events are perceived as making logical sense, that they are ordered, consistent, and structured Manageability: extent to which a person feels they can cope Meaningfulness: how much one feels that life makes sense, and challenged are worthy of commitment Antonovsky showed that those with a high SOC are more likely to feel less stress and tension – may protect against depression; improves life satisfaction; reduces fatigue, loneliness & anxiety Development of strong or weak SOC is related to a person‘s natural coping style, upbringing, education, financial assets, social support SOC highest in highest social classes ―Lay‖ understandings of Health consequences of ordinary people‘s attempts to make sense of the numerous sources of information to which they have access pragmatic, enabling us to cope with the complexity of health vary systematically according to social position (class, gender); also vary by age and culture do not necessarily line up with medical diagnoses of disease a state of being (absence of illness), something to be had (reserve of physical health; potential to resist illness), a state of doing (well-being; happiness, relaxation) Being able to carry out everyday responsibilities Health from Aboriginal Perspectives – wholistic, incorporates spiritual, intellectual, physical, emotional dimensions of life Inter-generational – exists on multiple levels – individual, family, community, nation Encompasses cultural, social, economic & political spheres WEEK 2 : 3 What is public health? Rob Baggott: Public health refers to the health of a population, the longevity of its members and the extent to which they are free of disease – ―the public‘s health; the health of the public‖ Main goal: improve the health status of the population by reducing disease and early (preventable) deaths in populations Recognizes the importance of individual contributions to injury & disease but more interested in understanding how to reduce or alleviate hazards by addressing underlying causes (i.e, ―upstream‖ not ―downstream‖) In public health: the ―patient‖ is the population; saves ―statistical‖ lives through prevention Health benefits to the population does not equal health benefits to the individual The interpretation of public health is an essentially political process. Public health is a political arena in which various ideological (and moral) perspectives compete for supremacy (Baggott) Collective enterprise – requires strong state (government) willing to act. Restrictions on individual liberty: Paternalism: Restricting the individual‘s liberty (freedom) to promote his or her own idea of well-being Public health paternalism: a different form of paternalism – minor infringements on the liberty of individuals are justified by the greater good of society Ideology: a relatively coherent system of values, beliefs, or ideas shared by some social group and often taken for granted as natural or inherently true; the consciously shared ideas and beliefs that members of a society have about themselves and the world around them; how we understand the world in which we live. Collectivist (communication) & Socialist (social democratic) Ideology: Emphasis on: the role of the state as a principal means of social improvement – limiting the effects of capitalism – ―positive‖ liberty (freedom ―to do‖ things- state ensures basic needs (income, education) enabling citizens to fully participate in society) 4 Define: humanitarianism, interdependence Liberal Individualist or Neo-liberal Ideology Emphasis on: the role of the market in promoting individual freedom; social goods secondarily Limiting the role of the state (except in maintaining order & protecting private property) ―Negative‖ liberty (freedom ―from‖ interference in my life) define: self-determination/discipline, the market, consumer choice Environmental and Green Ideology Emphasis on: interconnectedness of humans, human health and the environment Destructiveness of economic growth at all costs; indifference of the state to the environment Local, community-based actions Define: ecological model of health, interdependence, holistic, precautionary principle The bias of public health Duty and moral obligation to promote the health of all and to reduce inequities among groups This work is always political in the sense that it involves taking a position and often that position challenges authority and prevailing power arrangements Geoffrey Rose: Prevention Paradox Key Messages: a lg. number of people exposed to a small risk may generate many more cases than a small number exposed to a high risk Causes of individual cases may not be the same as causes of population rate of disease Prevention paradox – a preventive measure which brings much benefit to the population offers little to each participating individual 5 Implication: must find a way to lower risk of large numbers of people who, more often than not, will not benefit from the change Conflict between collective interest, requiring community- wide change, and individual interest-> people may not want to bother, but public health will improve only if they do Conclusion: it is common to find that the burden of ill health come more from the many who are exposed to low inconspicuous risk than from the few who face an obvious problem. This sets limit to the effectiveness of an individual (high risk) approach to prevention Capitalism: An economic and political system in which the means of production is owned privately by individuals or corporations and operated for profit Vs. state-owned or cooperatively owned means of production Communism: A way of organizing society in which government owns the means of production; no privately owned property; goods are owned in common and available to all as needed; wealth is equally distributed Canadian Contribution to thinking about Social Determinants of Health: LaLonde Report, 1974  first official Cdn recognition that health depends on more than the health care system Goal of the Cdn gov – to give as much attention to human biology, the environment and lifestyle as the financing of health care  Social justice: a condition in which everyone has fair treatment and an impartial share of society‘s benefits; a fair distribution of advantages/disadvantages: collectivists -> equality of outcomes & economic egalitarianism achieved through income or property redistribution -- neo-liberals  equality of opportunity achieved through the market Epp Report, 1986  Official recognition that –disadvantaged groups are sicker, die sooner & have more disability –community support impt for coping & health Three challenges in improving Canadians‟ health: 6 1. Reducing health inequities 2. Increasing prevention efforts 3. Enhancing people‟s capacity to cope  Proposed that health promotion became a cornerstone of the Canadian health system, and the primary way to meet the three challenges: Health promotion: ―the process of enabling people to increase control over, and to improve, their health.‖ Ottawa Charter for Health Promotion, 1986  birth of the ―new‖ public health –emphasis on health inequities; broad social factors affecting health & politics; community involvement not just ―experts‖ Prerequisites for health: peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice and equity Health Promotion Actions: Advocating for health & for the conditions that promote health Enabling all people to meet their fullest health potential Mediating between competing interests & coordinating action among various sectors Health Promotion Strategies: build health public policy, create supportive environments (natural & built environment) strengthen community action, reorient health services towards health promotion The concept of ―Population‖, 1990s- is an approach to health that aims to a.) improve the health of the entire population and to b.) reduce health inequities among population groups. In order to reach these objectives, it looks at and acts upon the broad range of factors and conditions that have a strong influence on our health. Public Health Agency of Canada Mission: to promote and protect the health of Canadians through leadership, partnership, innovation and action in public health Vision: Health Canadians and communities in a healthier world WEEK 3: Tobacco Industry: Deceit & Denial 7 Through the 20 thcentury, the tobacco industry argued: Nicotine was not addictive Link between cancer & smoking was not proven In Canada: provinces are suing tobacco companies for health-care costs related to smoking Average age when smokers begin their habit: 9/10 smokers start smoking before age considered as addictive as heroin Content Quiz for this week: 8 WEEK 4: Smoking and Social Justice article: written by Voigt Smoking is disproportionately common among the disadvantaged, a problem of social justice: even though smokers do in a sense, ‗choose‘ to smoke, the extent to which these choices can legitimize the resulting inequalities is 9 limited by the unequal circumstances in which they are made. The disadvantaged are more likely to become smokers and less likely to quit successfully. The social justice perspective developed here poses a challenge for policy-makers: on the one hand, social justice concerns strengthen the case for tobacco control policies because such policies disproportionately benefit the health of the disadvantaged. At the same time, however, we must be particularly sensitive to any harms associated with such policies because such burdens, too, will fall largely on the disadvantaged. (This is because there are less info about health risks in lower income countries, advertising that is targeted to low income groups and higher density of advertising, different smoking norms; different social meaning of smoking. There is also the means of coping with stress when other coping methods are unavailable, and there is a lack of availability of NRT in lower income countries.) Main argument: disadvantaged groups are exposed to a range of factors that make smoking cessation more difficult for them than it is for others. The unequal outcomes arising from the choices made against such background conditions should concern us as a problem of justice, irrespective of whether or not the inequalities in background conditions should concern us as a problem of justice, whether or not the inequalities in background conditions undermine the autonomy or voluntariness of the choices individuals make. Opposing Positions: opponents of tobacco control legislation emphasize that smoking is an activity that smokers ‗freely‘ engage in and that the risks associated with it are assumed ‗willingly‘ by them. Proponents of tobacco control respond that the addictive nature of nicotine undermines the voluntariness and autonomy of smoking decisions, especially when, many smokers become addicted as adolescents. Dennis Raphael: Discourses of SDOH (System of thinking  similar to ideology) composed of ideas, attitudes, beliefs that direct actions and practices #1 SDH as identifying those in need of health & social services 10 1. Individuals & communities identified as ‗marginal,‘ ‗vulnerable,‘ ‗high risk‘ – requiring services 2. Downstream approach; does nothing to address source of problem 3. Reinforces dominant health care & social service provision #2 Health lifestyles SDH discourse 1. Attention directed to modifying risk behaviors among the poor 2. Disadvantages: Risk factors account for little of poor health outcomes – assumes individuals can make free ‗choices‘ & are therefore responsible for poor health – low effectiveness – obscures importance of SDOH #3 SDH indicates material conditions that shape health 1. Living conditions and their material, psychological and behavioural effects are the primary determinants of health 2. Recommendations can be downstream if public policy is not explicitly seen as the cause and target of action (e.g., stress management, food banks, school mean programs) #4 SDH indicate material conditions as a function of group membership 1. similar to #3, except health outcomes seen as function of class, gender, race 2. similar pitfalls as #3 #5 SDH result from government public policy decisions 1. exposures to adverse SDoH, & their inequitable distribution come about because of public policy decisions. 2. Target of action must be public policy to improve SDOH & material conditions of living – income, education, food, housing, employment conditions, childcare #6 Ideology 1. Add justifying ideology to #5 2. Understanding ideology explains why Canadians are lagging behind in improving SDOH despite the vast body of evidence 11 #7 Power & Influence 1. Some groups benefit from social & health inequities –e.g. tax structures; reduction in government expenditures & services; relaxation of labour standards; stagnant household incomes -> growing income inequality 2. EP (not DR): internal logic of neoliberalism & capitalism Food Security as a Social Determinant of Health Food security exists when all people, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life. Two main emphases: physical & economic access to healthy food for individuals & households; skills & knowledge to prepare healthy food. Sustainable food system- ensuring that food producers are able to produce food that is healthy for humans, the environment and other creatures Refers to a particular condition in which households‘ access to food is inadequate or precarious because of insufficient income Three Levels of Severity: Worry or anxiety about running out of food b/c of lack of $ Changing types of food or cutting back b/c of lack of $ Outright hunger- skipping meals altogether b/c of lack of $ Food strategies to avoid hunger: doing more invisible foodwork -budgeting; planning; checking flyers; clipping coupons; altering recipes to stretch the meal; serving only food that the family likes; making food from scratch etc. cut portion seizes, using food bank Charity as practice: voluntary giving of help to those in need, not related to the giver As virtue: concept of unlimited loving- kindness to all 12 Poppendieck – Pros of Charity Model of Food Banks: avoids food waste, gives people food that they can use, provides opportunities for interaction, outreach, education, can nourish compassion and advocate for political change Advocacy Ottawa Charter: political process activities that aim to influence public policy, activities include media campaigns, letter-writing campaigns, lobbying politicians etc Cons of Charitable model: Absence of legally enforceable rights (entitlements); lack of dignity Does not reach the majority of food insecure; stigma & procedures prevent many from using Dependent upon volunteers, donations and good will: almost always inadequate to meet demand Reliant on leftover food & donations: does not meet nutritional requirements or alleviate food insecurity Food response to a poverty problem: a ―Band-Aid‖ approach that does not address the fundamental problem, poverty Undermines public support for the welfare state: normalization of charity as the response to hunger Consider the differences between charity* and social justice Charity* ‗helping the needy‘ (downstream) – direct, practical, tangible gift that the donor thinks the recipient needs; -can be awkward or difficult for recipient, despite donor intentions  social justice – creates fair, just structures (upstream) – works on ‗root causes‘, ‗big picture‘ issues (poverty) Time to close food bank article  Dr. Power‟s argument: Canadians believe that food banks are taking care of the problem of hunger, thereby alleviating pressure to look „upstream‟ to the underlying problem of poverty Inadvertently*, food banks have become a smoke screen for poverty, clouding out ability to really see the situation Research Evidence: only 20-35% of Canadians who can be objectively classified as ‗food insecure‘ use food banks Problem is too big for community based charities (poppendieck) 13 Content quiz for this week: 14 WEEK 5: Eisenstein on the economic system- Reading Money has brought insecurity, poverty, and the liquidation of our cultural and natural commons. Money originates when the Federal Reserve purchases interest-bearing securities on the open market. This is the first step in $ creation. The money created accompanies a corresponding debt, and the debt is always for more than the amount of money created. 15 The second step occurs when a bank makes a loan to a business or individual. Here again, new $ is created as an accounting entry in the account of the borrower. When a bank issues a business a $1 mill. Loan, it doesn‘t debit that amount from some other account; it simply writes that amount into existence. 1 mill of new money is created and more than 1 mill of debt. An Economic Parable: (Bernard Lietaer) story of how everyone would barter in the markets, exchange something as equal to them and everyone would help each other out. One day a banker introduced a more efficient way to trade in place of chickens (cowhide pieces) this created competition and greed woven into their economy because of interest. The banker produced more rounds, as long as the villagers kept on increasing the production of chickens. Some families ended up going bankrupt, others stock increased 10% and started to own their neighbour‘s land. Problems that arose: it became apparent that no one really all those chickens, in order to keep consumption of chicken products growing, the villagers invented all kinds of devices. All the vegetation had been stripped away to plant grain to feed the chickens. Despite efforts to maintain growth, its pace began to slow. Debt began to rise in proportion to income, until many people spent all their available rounds just paying off the banker. Many had to work at subsistence wages for employers who themselves could barely meet their obligations to the man in the hat. This is where things stand today. The Growth Imperative: Because of interest, at any given time the amount of money owed is greater than the amount of money already existing. To make new money to keep the whole system going, we have to breed more chickens –in other words, we have to create more ―goods and services.‖ Lecture notes: Unnatural causes movie—our health is shaped by economic, social & built environments 16 --those in lower class positions are exposed to more health threats and have less access to opportunities & resources to control their destinies --people in higher class positions have access to more power and resources and live longer, healthier lives --chronic activation of the body‘s stress responses wears down out organs over time and increases disease risk --racism threatens health, indpt. Of class. At every income level, racialized groups tend to have worse health than their white counterparts --‗economic policy is health policy‘; ‗social policy is health policy‘ Prof. Sir Michael Marmot Principal investigator of the Whitehall Studies of British civil servants Whitehall 1 and Whitehall 2: two longitudinal, epidemiological studies of civil servants in the UK Prospective survey design: a group of health people enrolled in a study & followed over time to watch disease development; very powerful research design; requires large #‘s & long follow-up time; very expensive Whitehall I over 18,000 men aged 40-64 screened between ‘67-‗69 Classified into 4 grades of employment: administrative professional & executive; clerical; other Showed that low-ranked British civil servants are almost twice as likely to die from heart disease as administrators of the same age. Differences in risk factors – for e.x higher smoking rates among the support staff- account for less than half the gap in mortality rates. Results: 3-fold difference in mortality between lowest and highest employment grades Higher cardiovascular disease mortality among those in ‗other‘ group who did not smoke vs. administrators who smoked more than/equal to 20 cigs/day Highest inversely related to mortality -> suggests early life influences Whitehall II Over 10,000 people, one third women, aged 35-55, screened between ‗85-‗87 More measurements; included social support, personality measures 17 Results: gradients between grades persistent for mortality; similar for morbidity Gradients similar for women as for men Similar social gradients found for: heart disease, some cancers, chronic lung disease, gastrointestinal disease, depression, suicide, general feelings of ill- health Four main findings: People at the bottom had a higher risk of heart attack than people at the top There is a gradient in health Gradient applies to all major causes of death Possible explanations: early influences; differences in health behaviours; social circumstances (housing, social support); work environment Conclusion: we need to pay more attention to job design, social environments, and the consequences of income inequality – to improve overall health, we need to decrease social hierarchies and improve people‘s control over their lives “The Status Syndrome” (Marmot):  The higher the status in the pecking order, the healthier people are  Health follows a gradient that reflects income, education, occupation, early childhood influences  Above a material threshold, health is more influenced by autonomy & opportunities for social participation  The way we organize out societies leads to inequalities in health people can achieve Poverty As a Determinate of Health – Article: Sapolsky Rudolph Virchow‘s insight- first the spread of disease has much to do with appalling living conditions, and second, that those in power have enormous means to subjugate the powerless. Socioeconomic status (SES), a composite measure that includes income, occupation, education and housing conditions, it becomes clear that, starting with the wealthiest stratum of society, every step downward in SES correlates with poorer health. 18 ―SES gradient‖ has been documented throughout Westernized societies for problems that include respiratory and cardiovascular diseases, ulcers, etc. Lower SES may give rise to poorer health, but conversely, poorer health could also give rise to lower SES. Chronic illness can compromise one‘s education and work productivity. How does SES influence health? Posits that for the poor, health care may be less easily accessible and of lower quality. (e.g States, many do not have family physicians, and many medical care consist of trips to the ER) But, SES gradients also occur in other countries with socialized medicine (the UK has universal health care) Another telling finding is that SES gradients exist for disease for which health care access is irrelevant. No amount of medical checkups, blood tests, will change the likelihood of someone getting type 1 diabetes. It is reasonable to assume that the wealthier a country, the more financial resources its citizens have to buy protection and avoid risk. Health should improve incrementally as one moves up the wealth gradient among nations, but it does not. Instead, among the wealthiest quarter of countries on earth, there is no relation between a country‟s wealth an the health of its people. (One must consider whether most of the gradient arises from a different set of considerations: the psychosocial consequences of SES) Psychosocial Stress For us, most stressors concern interactions with our own species, and few physically disrupt homeostasis. These stressors involve the anticipation of an impending challenge. Psychosocial stressors are not evenly distributed across society. Just as the poor have disproportionate share of physical stressors (hunger, manual labor, chronic sleep deprivation with a second job, etc), they have a disproportionate share of psychosocial ones. Numbering assembly0line work and an occupational lifetime spent taking orders erode workers‘ sense of control. Marmot has shown that regardless of SES, the less autonomy one has at work, the worse one‘s cardiovascular health. Furthermore, low control in the workplace accounts for about half the SES gradient in cardiovascular disease in his Whitehall population. 19 Feeling Poor Nancy Adler – proposed a diagram of a ladder with 10 rungs asking subjects in society where on the ladder they would rank themselves. A person‘s subjective assessment of his or her SES takes into account the usual objective measures (ed., income, residence) as well as measure of life satisfaction and of anxiety about the future. Alder‘s provocative finding is that subjective SES is at least as good as objective SES at predicting patterns of cardiovascular function, measure of metabolism, incidences of obesity and levels of stress hormones- suggesting that the subjective feelings may help the objective results. This same point emerges from comparisons of the SES/health gradient among nations. A relatively poor person in the U.S. may objectively have more financial resources to purchase health care and protective factors than a relatively wealthy person in a less developed country yet, on avg, will still have a shorter life expectancy. Being Made to Feel Poor Richard William- reported that the extent of income inequality in a community is even more predictive that SES for an array of health measures. Some critics have Q‘d whether the linkages between income inequality and worse health is merely a mathematical quirk. The relation between SES and health follows an asymptotic curve: dropping from the uppermost rung of society‘s ladder to the next-to-top step reduces life expectancy & other measures much less drastically than plunging from the next to bottom rung to the lowest level. Wilkinson has shown, that decreased income inequality predicts better health for both the poor and the wealthy. (indicates that the association between illness & inequality is more than just a mathematical articact) Higher income inequality intensifies a community‟s hierarchy & makes social support less available: truly symmetrical, affiliative support exists only among equals. The surest way to feel poor is to be made to feel poor- to be endlessly made aware of the haves when you are a have-not. Social Capital Ichiro Kawachi- refers to the broad lvls of trust and efficacy in a community. Has shown that @ the lvls of states, provinces, cities and neighbourhoods, low social capital predicts bad health, bad self-reported health and high 20 mortality rates. High degrees of income inequality come with low lvls of trust and support, which increases stress and harms health. In conclusion; when it comes to health, there is far more poverty than simply not having enough money. The psychosocial school has occasionally been accused of promulgating an anti-progressive message: don‘t bother with universal health care, affordable medicines because there will still be a robust SES/health gradient after all the reforms. Content #3 for this week: 21 WEEK 6: Income inequality and its effects of health Paradox of Modern Industrial Societies – pinnacle of human material and technical achievement, wealth & physical comfort YET tremendous emotional & mental suffering: anxiety, stress, unhappiness 22 Inequality: A byproduct of progress? Globe and Mail article: By late 1990s, real median after-tax income fell to its lowest level in more than 3 decades, and income inequality reached its peak. The increase in median income masks the shifts occurring in and among different income ranges. Dividing the population into 5 income groups (or quintiles), real avg. after-tax income grew most strongly in the top quintiles – those with the highest income levels. Furthermore, the gap between the top and bottom income quintiles increased the most in the 80s and 90s. The top 20 % got relatively richer, and the bottom 20 per cent got relatively poorer. *middle class in being squeezed in Canada. There is no easy solution to income inequality. Investment in education – from early childhood through postsecondary- offers the greatest potential payback. Increasing access to the labour market also needs consideration. Content #4 for this week: 23 WEEK 7: Income inequality in Canada, the financial crisis and austerity & health Market income for the poorest 10% of Canadians fell by 45% between 1980 and 2000; market income for the richest 10% rose by 18% Why does it matter? 24 Shrinking equality of opportunity-wasting human assets Undermines the efficiency of the economy Society falls apart: wealthy become more reluctant to spend money on common resources Inequality: shifts the balance of power so that the richest are better able to influence politics and support their children‘s achievement independent of their talent -> the great Gatsby curve- correlation between generational mobility and income inequality Austerity: the policy of cutting a state‘s budget, in order to promote growth in response to an economic downturn Results: unraveling safety net, precarious employment, increased demand for unpaid labour, everyday insecurity, powerlessness, loss of control over life Austerity vs. Stimulus Many governments committed to austerity measures used economic calculations by 2 Harvard economists: Reinhart and Rogoff suggested that economic growth fell steeply once the ratio of government debt to GDP rose past 90% Article: How Austerity Kills – Stuckler and Basu The correlation between unemployment and suicide has been observed since th the 19 century. People looking for work are about twice as likely to end their lives as those who have jobs. People do not inevitably get sick/die because the economy has faltered. Fiscal policy, it turns out, can be a matter of life/death. IMF bailed Iceland out, but instead of bailing out the banks and slashing budgets, IMF demanded Iceland‘s politicians took a radical step by putting austerity to vote. Icelandsers voted in two referendums, to pay off foreign creditors gradually, rather than all at once through austerity. Iceland‘s economy has largely recovered, while Greece‘s teeters on collapse. No one lost health care coverage or access to medication, even as the price of imported drugs rose. There was no significant increase in suicide. There are 3 principles that guide responses to economic crises: 25 1 do not harm: if austerity were tested like a medication in a clinical trial, it would have been stopped long ago, given its deadly side effects. Each nation should est. a nonpartisan, independent Office of Health Responsibility, staffed by epidemiologists and economists, to evaluate the health effects of fiscal and monetary policies. nd 2 treat joblessness like the pandemic it is. Unemployment is a leading cause of depression. Politicians in Finland and Sweden helped prevent that by investing in ―active labour-market programs‖ that targeted the newly unemployed and helped them find jobs quickly, with net economic benefits. Finally, expand investments in public health when times are bad. It is far more expensive to control an epidemic than to prevent one. Lecture  According to Hugh Segal: Poverty is, in the beginning and in the end, about not having enough $ to live on with self-respect, dignity or hope. Marginalization: occurs when ppl are systematically excluded from meaningful participation in economic, social, and other forms for human activity in their communities and thus are denied the opportunity to fulfill themselves as human beings. The implications of Early Childhood Development for Adult Health Outcomes: UN Convention on the Rights of the Child: human rights treaty setting out the civil political, economic, social, health and cultural rights of children Ratified by all members of the UN, expect the US and Somalia How does poverty affect child health? More likely to have low birth weight, asthma, type 2 diabetes, malnutrition Less likely to have benefit plans for prescription drugs, vision, dental How does childhood poverty affect social determinants of health? Poorer access to nutritious food Fewer opportunities for recreation, poorer educational outcomes-less likely to graduate HS/UNI therefore, less likely to get a well-paid secure job with benefits What are the effects of childhood poverty on adult health? More likely to exp addictions, poor mental health, chronic illness, premature death 26 How does childhood poverty shape adult health outcomes? Childhood socioeconomic conditions: directly related to childhood health Sets a life-course trajectory that rends to accumulate soc
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