GGRB28H3 Study Guide - Comprehensive Midterm Guide: Health Equity, Global Health, Structural Inequality

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Published on 6 Feb 2017
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GGRB28H3
MIDTERM EXAM
STUDY GUIDE
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GGRB28 Lecture 2: Social and Spatial Determinants of Health January 11th, 2017
What are SDOH?
o Approach to health policy increasingly popular from beginning of the
1990s
o Social Determinants of Health (SDOH) describes incluences of class,
income, education, housing status, home environment, gender, race,
workplace environment, gender, race, workplace environment on the
health outcomes of a population or an individual
o Limits: correlation does not equal causation describing a relationship
between two things, even one of influence (i.e. neighbour hood and
diabetes risk) doesn’t explain the correlation (why do you live where you
live?)
Some scholars use SDOH to describe (correlation), and some use
it to explain (and theorize hierarchies like race and class)
Describing a relationship without providing an explanations can
leave readers to draw on their own biases, moral judgements about
the world (Slater notes that showing correlation alone is an
instrument of accusation)
i.e. Wallace and Wallace illustrate the danger od describing
correlation without asking “why insist that suburaban audiences
can’t ignore urban problem
economic, social, sexual linkages between cities and
suburbs means health vulnerabilities are connected
“disease rates in the core city and the local pockets of
poverty in the country determine disease rates in suburban
counties via the economic linkages within the region”
they successfully illustrate that suburban policy-makers can’t
afford to ignore urban problems, but they can’t explain why
those problems exist (racism, class structure, patriarchy,
homophobia) lack of explanatory power leads into
judgemental language about “lack” of weak social ties,
“negative acts,” multiple sexual conquests,” “drug taking” in
poor places, poverty as “leakage”
1990s NYC Video: 40+ years of white flight, suburbanization
driven by racialized fear of the city, upward class mobility
three was a phobic response to HIV/AIDS as “urban” (Black,
gay, poor, drug/sex-fueled) problem in the 80s and 90s
A related way of thinking asks about people’s “life chances” (health, success,
expectancy (life chances: the ability for one to do whatever they want to do)
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Farmer and Slater state that uneven outcomes are expressions of structural
power relationships and that there is a focus on structural relationships between
populations rather than blaming or stigmatizing individuals or groups (which is a
problem) and that distinguishing between “deserving” and “undeserving” patients
tens to result in more disenfranchisement for all (i.e. drug trials)
o Only those who fully complied with the drug trial were able to gain access
to vaccines, other times outrageous prices were added
o Rhetoric of “deserving/undeserving,” “realistic,” covers up the bigger
picture (greed) and makes for bad medicine (i.e. MDR-TB treatments in
Haiti and Peru)
Short-course treatment is cheaper and easier to implement; but
more expensive second-line drugs required to help beat MDR-TB
Whose “modern” medicine?
o Farmer: Medicine can’t stop at describing correlations – it needs to critique
and grapple with unjust power structures
Readings Week 2: Community marginalisation and the diffusion of disease and disorder
in the United States by Wallace and Wallace
Describes diffusion of inner city problems of disease and disorder in the United
States
o Public policies and economic practices which increase marginalisation
damage the weak ties of community social networks that bind central city
neighbourhoods into functioning units
o Large metropolitan regions with high prevalence of urban decay constitute
great epicentres from which disease and disorder spread nationally
o Public health problems of the central city is regionalised (incidence in the
central city determines the incidence in the surrounding counties)
i.e. violent crime in Washington DC and St Louis areas and low
weight births in the Detroit area
Neighbourhoods embody “weak ties” through which the larger society channels
information, support, and social control to families and individuals these are
relations of occupation, common interest, and neighbourliness beyond strong ties
of kinship, ethnicity, or peer group which bind small groups tightly and exclusively
together into isolated equivalence classes
o As neighbourhoods disintegrates under assaults of public policies of
planned shrinkage and benign neglect the weak ties begin to fray which
decrease possibilities for individuals and families
Readings Week 2: Infections and Inequalities by Paul Farmer
Developed countries are able to access modern medicine more readily
o Black men and women died from HIV a lot more than white men and
women
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Document Summary

Ggrb28 lecture 2: social and spatial determinants of health. What are sdoh: approach to health policy increasingly popular from beginning of the. Some scholars use sdoh to describe (correlation), and some use it to explain (and theorize hierarchies like race and class) Economic, social, sexual linkages between cities and suburbs means health vulnerabilities are connected . Negative acts, multiple sexual conquests, drug taking in poor places, poverty as leakage . A related way of thinking asks about people"s life chances (health, success, expectancy (life chances: the ability for one to do whatever they want to do) Short-course treatment is cheaper and easier to implement; but more expensive second-line drugs required to help beat mdr-tb. Whose modern medicine: farmer: medicine can"t stop at describing correlations it needs to critique and grapple with unjust power structures. Readings week 2: community marginalisation and the diffusion of disease and disorder in the united states by wallace and wallace.

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