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HLTH 101 Notes.doc

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Health Studies
Course Code
HLTH 101
Elaine Power

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Health 101 Notes Week 4-Lecture 1 (Sep.30) Smoking and Social Justice - Smoking is disproportionately common among the disadvantaged - She is arguing this is a problem of social justice - Smoking is not just an individual problem - The disadvantaged are more likely to smoke and less likely to quit successfully - Kristin Voigt’s main argument is that disadvantaged individuals are more susceptible to becoming smokers because they are exposed to a range of factors that make them more prone to turn to smoking as well as factors that will make it harder to stop Unequal Contexts of Choice -Less availability of nicotine replacements in places like Indonesia How might public health tobacco control strategies be harmful? -Higher prices for tobacco takes money away for other things -Increased stigmatization and marginalization Dennis Raphael -Professor, School of Health policy & Management @ York University -Widely recognized public health expert on social determinants of health, with over 150 publications Discourse- Dennis Rapahel -Dennis created 7 different discourses -a system of thinking (similar to ideology) -composed of ideas, attitudes, beliefs that direct actions and practices -reflect and reproduce relations of power -dominant discourses are powerful, often excluding from view and understanding other discourses; generally only the dominant discourse is seen to be legitimate **note: finish notes on 7 discourses Week 4 - Lecture 2: Movie Week 4- Lecture 3 Food Insecurity and Food Banks Food Security: Exists when all people, at all time, 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 Emphasis -Physical and economic access to healthy food for individuals and households; skills and knowledge to prepare healthy food -sustainable food system: ensuring that food producers are able to produce food that is healthy for humans, the environment etc. Food Insecurity: refers to a particular condition in which households’ access to food is inadequate or precarious because of insufficient income Three Levels of Severity 1) worry or anxiety about running out of food because of lack of money 2) changing types of food or cutting back because of lack of money 3) outright hunger- skipping meals altogether because of lack of money Food Strategies to avoid - doing more invisible food work; budgeting; planning; checking flyers; clipping coupons; altering recipes to stretch the meal, serving only food that the family likes, making food from scratch; making low cost meals of minimal ingredients - cutting portion sizes - mother goes hungry so children not hungry; send kids to relatives - numerous strategies to juggle money (ex. paying only part of a phone bill or credit card statement in order to save money) - using foods banks In 2011 almost 4 million Canadians, including 1.1 million kids, lived in food insecure households Almost 900,000 Canadians used food banks in 2012; half of those households are on social assistance; 35% of food banks ran out of food Food Banks -began in Canada in 1982 during a time of recession, high unemployment and high poverty/Canadians going hungry -thought as an emergency response during a desperate time of need; wasn’t planned to be a long term organization/plan and thought to close up once the recession ended -a charity Charity -voluntary giving of help to those in need, not related to the giver Jewish Tradition: 8 Levels of Giving 1) a gift, loan or partnership that enables the recipient to live without further charity 2) to give anonymously to unknown recipient via trustworthy mechanism 3) giving anonymously to a known recipient 4) giving publicly to an unknown recipient 5) giving before being asked 6) giving adequately after being asked 7) giving willingly but inadequately 8) giving out of pity Pros of Charity Model of Food Banks - avoids food waste - gives people food that they can use - can be “kinder, gentler”, personal - provides opportunities for interaction - provides opportunities for outreach, education - can nourish compassion - advocacy for political change Advocacy -political process; activities that aim to influence public policy Activities include media campaigns, letter-writing campaigns, petitions, public speaking, research, letters to the editor, lobbying politicians Cons of Charitable Model -absence of legally enforceable rights (entitlements); lack of dignity -does not reach the majority of food insecure; stigma and procedures prevent many from using -dependent upon volunteers, donations and good will: almost always inadequate to meet the demand -reliant on leftover food and donations: does not meet nutritional requirements or alleviate food insecurity Differences between charity and social justice *Charity*; helping the needy (downstream approach): -direct, practical, tangible gift that the donor thinks the recipient needs -can be awkward or difficult for recipient, despite donor intentions -creates an us/them *Social Justice*; creates fair, just structures (upstream approach) - works on “root causes”, “big picture” issues Week 5- Lecture 2 Points from movie last week (Unnatural causes) • Status correlates with health outcomes • health shaped by economic and social circumstances • those in lower class positions are exposed to more health threats and have less access to opportunities and resources to have a healthy lifestyle • Economic policy is health policy, social policy is health policy • Racism effects health; racially divided groups, where there is one dominant group of a specific race Professor Sir Michael Marmot • Professor of Epidemiology and Public health Whitehall l & Whitehall ll • Two longitudinal, epidemiological studies of civil servants in the UK • Prospective survey design -a group of healthy people enrolled in a study & followed over time to watch for disease development Whitehall l • over 18,000 men aged 40-64 screened between 1967-1969 • classified into 4 grades of employment; administrative, professional/executive, clerical and other 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 >20 cigarettes a day known risk factors explain only 1/4 to 1/3 of the differences • • general pattern holds for all causes of death, not just cardiovascular disease Whitehall ll • over 10,000 people, one third were women, aged 35-55, screened between 1985-1987 • more measurements; included social, support, personality measures • Cortisol -stress hormone that dampens immune system function -levels rise as rank decreases -lack of control over work, heart rate, stress hormones • Self-esteem FINISH NOTES LATER. Week 6- Lecture 1 How power works • -all choices can be absorbed into the system and support the system -fighting the system to improve the lot of all women requires individual sacrifice • For change to happen -acknowledge the power of the system -recognize that we all have choices -have empathy for the difficult choices we all face Wilkinson: Impact of Wealth Inequality • Wealth Inequality: the gap between the rich and the poor -Wilkinson states that wealth correlates with health and life expectancy -a way of measuring income inequality is measuring how much richer the richest 20% is compared to the poorest 20% • Index of health and social problems: a scale that measures more than just income and life expectancy but also aspects like literacy, infant mortality, mental illness, social mobility (how easy it is to move up or down the social class ladder), drug & alcohol addiction, obesity etc. Week 7- Lecture 1 Income Inequality in Canada The financial crisis, austerity and health • The richest 10% of individuals makes approx. 10x the avg. individual income • avg. family income is $76,000 • growing income gap • last data regarding Canadian income stats from 2006 - data is dated Portrait of the wealthiest in Canada • mostly male • aged 45-54 • married or common-law • 2/3rd have a university education vs. 21% of the total population • Rate of change of income inequality is growing at a staggering rate • market income for the poorest 10% of Canadians fell by 45% between 1980 and 2000; market income for the richest 10% rose by 18% • n 1980’s gov’t used takes and transfers to temper the growth in inequality • 1990’s gov’t started cutting social programs • tax policy and social programs can moderate market income inequality Why does it matter? • shrinking equality of opportunity • undermines the efficiency of the economy • society starts falling apart: wealthy become more reluctant to spend money on common resources Inequality • shifts the balance of power so that richest are better able to influence politics Two ways some look at society: • YOYO: You’re On Your Own • WITT: We’re In This Together Social Policy is health policy: • guaranteed paid vacation • living wage • paid parental leave • affordable housing • free or low cost post-secondary education • affordable child care • early childhood education • income security programs (social assistance, guaranteed annual income or basic income) • universal health care *income inequality cuts taxes and essentially leads to cut in funds for government run social programs Austerity • the policy of cutting a state’s budget, in order to promote growth in response to an economic downturn Results: -unravelling safety net -precarious unemployment -increased demand for unpaid labour -increased income inequality Global economic crisis: • began in US, 2008 • US banks gave high risk mortgages (subprime mortgages) • with mortgage defaults, banks all over the world failed; banking failures caused a credit crunch, with no lending, economies began to shrink; governments bailed out European economies needing bail-out - these countries essentially ran out of money; could not keep the country efficiently running • Ireland • Greece • Spain • Portugal • Cyprus “The Troika”: • the European Union; European Central Bank; International Monetary Fund • in exchange for loans, to keep countries from bankruptcy, governments must agree to strict austerity measures -privatize state enterprises, lay off public employees, cut social programs; raise taxes on fueal and other commodities Greece: -national budget cut by 40% since 2008 -35,000 doctors and nurses lost jobs -infants mortality has risen by 40%; suicides up by 45% -IV drug use increased, budget for needle exchange programs cut, new HIV infections doubled Eurozone Unemployment: alarmingly high • • 12.1%; 19 million people unemployed • much higher for young people 23.5% overall; Greece: 62.5%; Spain: 55% Compare to Iceland: • Icelandic government spent more money towards improving their public health system • does austerity or stimulus improve public health and the economy Week 7- Lecture 3 Introduction to racism Race a social constructed categorization. It is used to divide individuals according to physical differences • such as skin colour, facial features and hair. • no biological basis; genetic diversity within “races” is greater than genetic diversity across “races” • captures differential access to power and resources in society Racialized groups • groups who have been assigned a “race” category, as measured against “whiteness” • racialization is a process of assigning groups to a hierarchical order • racialized groups are arbitrarily assigned various personal and social traits, which limits their life Racism • prejudice or discrimination based on the belief that race is the primary factor determining human traits and abilities • includes the belief that genetic or inherited differences produce the inherent superiority or inferiority of one race over another • can be intentional or unintentional Corollary of racism: white privilege • unearned, mostly unacknowledged and invisible and advantages that come with having white skin in a white dominated society confers dominance because of skin colour • • white people benefit from living in a racist society A few daily effects of white privilege: 1. I can if I wish arrange to be in the company of people of my race most of the time. 2. I can go shopping alone most of the time, pretty well assured that I will not be followed or harassed. 3. I can turn on the television or open to the front page of the paper and see people of my race widely represented. 4. When I am told about our national heritage or about "civilization," I am shown that people of my color made it what it is. 5. I can go into a music shop and count on finding the music of my race represented, into a supermarket and find the staple foods which fit with my cultural traditions, into a hairdresser's shop and find someone who can cut my hair. 6. I do not have to educate my children these choices to the bad morals, the poverty or the illiteracy of my race.thout having people attribute 8. I can do well in a challenging situation without being called a credit to my race. 9. I am never asked to speak for all the people of my racial group. 10. I can easily buy posters, post-cards, picture books, greeting 11. I can worry about racism without being seen as self-interested or self-seeking. 12. If my day, week or year is going badly, I need not ask of each negative episode or situation whether it had racial overtones. 13. I can be sure that if I need legal or medical help, my race will not work against me. Other types of racism: •
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