Health Science Class Notes Final Semester 1.docx

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Department
Health Sciences
Course
Health Sciences 1002A/B
Professor
Shauna Burke
Semester
Fall

Description
Health Science Final Class Notes October 16  Social inequalities that influence health status: o SES- inequalities/ Gender- patriarchal/power distribution o Traditionally and generally, males have greater access to power and resources than females o Example: work required to do subsistence farming and to raise children is defined as “unproductive labor” o “gender paradox” – men die quicker but women are sicker o Marylin Warring- domestic labor not counted as ‘visible, productive’ labor  Race: differences in health between racial groups; health outcomes also vary by ethnicity or “race”; i.e. there are racial inequities in health; mostly focused in the US between African Americans and Caucasians  African(AA) men tend to die 5 years earlier than white men; AA women tend to die 4 years earlier these differences are not static!; the health immigrant effect is if you control education and income, immigrants will have better health than non-immigrants; however, by the second generation health decreases to the norm of non-immigrants  Race and class intersect to produce particular health outcomes; there’s a racial gradient of health- AA do more poorly on most health indicators than their white counterparts  Health differences b/w ethnic groups often persist even after socioeconomic factors are taken into account  Intersectional analyses examine how gender, race and socioeconomic inequality (class) intersect to produce particular kinds of health inequities; social gradient as we increase income/education is not equal for AA and whites o AA have higher mortality rates with a college degree than whites with no high school education  Race: a social and political construct that is used to distinguish between and rank different groups of people on the basis of physical characteristics (such as skin colour); biological/genetic factors account for very little of health problems (US vs Africa) o It is an enduring social category that captures differential access to power and resources in society; real material effect  “Race” is just a way of categorizing differences; how we assign meaning to those differences; it is the basis of discrimination; determines whose lives are valued more or less- who should be excluded/included; basis of inequality/suppression; inequalities and death are not distributed in a random way o “Difference is also used as a basis for including some and excluding others, for rewarding some more and others less, for treating some with respect and dignity and some as if they were less than fully human or not even there *…+ The resulting patterns of inequality and oppression not only ruin people’s lives, but also create division and resentment fed by injustice and suffering that eat away at the core of life in communities, workplaces, schools, and other social situations ” (Johnson, p. 8)  Biology and Race: There is no biological basis to race; there is no one gene location that code from one race; differ very little genetically o For example, genetic explanations cannot explain the repeated observation that there are systematic differences in health between racialized groups; Genetic variation does not correspond to differences in what we have come to understand as “race” > “The Difference b/w Us”  Dangers of explaining social differences in terms of biological/genetic differences: there is little we can do to change it; legitimizes racial discrimination- something about them makes social inequalities (*natural*); differences actually produced by social/political structure, NOT biology  Race as an ideology: system of culturally located ideas; a story constructed in order to further political/economic gains; this story has provided a particular ‘lens’ or ‘view’; aware of this assigned meaning- who is the narrator the power of narrative lives beyond the his/her life because it is put into policies/education/rights/freedom, etc th  Examples: 18 century > classifications of human group by naturalists > indigenous peoples described as “primitive”, “savages” o Attempts to quantify differences in races (e.g. Head measurements, intelligence tests) o Scientific research used to confirm and authorize folk beliefs about human difference and discriminatory policies  Race is an important concern for policy > provide insight into health-care and housing inequalities  VIDEO: there was not always such a divide- race differences appeared more when the US was becoming a nation: o Thomas Jefferson admitted that AA were inferior, even though he said ‘all humans are equal’; explanation was AA were ‘sub-human’ o Native Indians were seen as having hope, as savages; they needed to be educated and civilized into Christian religion, education (mission of residential schools), and removed from hunting/gathering toward farming and agriculture o Thomas Jefferson commissioned science to study the nature of A.A people, such as the various features, physical and mental factors science can only answer questions that are asked; racialized responses occurred (racialized science- innate or natural differences); this science is then used to support policies o Tendency to make ‘essential’ differences October 18  Racism: Set of beliefs and practices that assert the superiority of one racial group over another; distinct personal prejudice; an organized system, based on an ideology of inferiority, that categorizes, ranks, and differentially allocates societal resources to socially defined “races” o Structural racism operates at an institutional level and involves processes and policies that favour dominant groups; allocates societal resources to socially defined ‘races’  If race is not biological in origin, then how does it affect health?  Racism affects SDH through processes of social exclusion and by perpetuating inequitable distribution of opportunities and resources (e.g. jobs, education, income, safe neighbourhoods, etc.)  Segregation: key structural factor in perpetuating in policies; affects population health both directly and indirectly racism exerts its effects, in part, through segregation (in US) o Effects of segregation:  Social exclusion  Economic opportunity  Healthy “choices”  Environmental hazard o The above exhibit social exclusion: poverty is concentrated in AA communities; as of 2000, AA were 7.3x more likely to live in a high poverty neighbourhood than a poor white person; Latin Americans were 5x as likely as white people o Poor neighbourhoods have less gob opportunities, less of a housing market, less food choices (AA are 5x less likely to live in an area with supermarkets); contributes directly, for food/vegetable intake increases 30% for each supermarket that is located in an area o Less greenery and less safety as well o Poor communities are also exposed to environmental hazards- exposed to industrial pollution  White privilege: we tend to think of racism in terms of effects on its victims; racism also operates through acknowledged privilege; not encouraged and not acknowledged o As a white person, I realized that I had been taught about racism as something that puts others at a disadvantage, but had been taught not to see one of its corollary aspects, white privilege, which puts me at an advantage o “… people are so reluctant to talk about privilege, especially those who belong to privileged groups. When the subject of race and racism comes up, for example, white people often withdraw into silence as if paralyzed by guilt or other feelings they don’t dare express” (p. 8)  McIntosh learnt ‘not to see’; NOT to be guilty, we should know that we get things in life a little bit easier o The ‘invisible knapsack’ is a metaphor for thinking about racism in terms of privilege (eg. Colour of skin- unearned) and confirmed by system as seen in some groups as naturally dominant of others; given to us because of the system. o The knapsack contains unearned assets that you can count on everyday as a free pass; enable us to live through life a little easier (eg. To navigate the world/get out of trouble/guarantee safety/get jobs and instill confidence)  Racialization: The social and political processes through which hierarchies based on “race” are constructed and reinforced; this concept shifts the focus away from race as a product of individuals towards the idea of race as a social product o Provides attention to social/political policies  Self-reflection is a good starting point to examine the effects and operation of racism; we become aware and can act in society in a much more efficient way o "We are always participating in something larger than ourselves and if we want to understand social life and what happens to people in it, we have to understand what it is that we're participating in and how we participate in it" October 23  Aboriginal: includes all persons of Aboriginal origins, including First Nations (North American Indian), Metis and Inuit peoples; in a 2006 census: o 1,172,790 (3.8% of total population) o 698,025 = First Nations (North American Indian) o 389,785 = Metis o 50,485= Inuit  Population reductions after extended contact with Europeans; infectious disease outbreaks > measles, influenza, smallpox, tuberculosis; exact figures and statistics are debated but population declines due to: “virgin soil epidemics” + deteriorated social conditions due to forces of colonization  Colonization identified as fundamental health determinant in 2007 WHO Commission on SDH o “The colonization of Indigenous Peoples was seen as a fundamental underlying health determinant. This process continues to impact health and well-being and must be remedied is the health disadvantages of Indigenous Peoples are to be overcome. One requirement for reversing colonization is understand the complexity of the issue, to help restore to Indigenous People’s control over their lives and destinies”  The Indian Act (1876) – the legislative authority of internal colonization; brought First Nations peoples under control of Canada’s federal government; created the reserve system ; forced relocation of Aboriginal communities; outlawed traditional ceremonies; forced removal and placement of children in residential schools (worst effect); fostered racist attitudes towards Aboriginal peoples  Colonialism: process that involve oppression of one group by another: includes processes of ‘othering’ that sort of population into hierarchical categories  “It is simply not possible to understand the circumstances of Aboriginal people in Canada – their marginalized socio-economic circumstances, their social exclusion – without acknowledging the historical and ongoing impact of colonization” o Europeans ‘colonized’ and made standards- Indigenous People (‘others’) needed to be assimilated because they were racially inferior and needed to be legitimize  Internal colonization: the process of encroachment and subsequent subjugation of Aboriginal peoples since the arrival of the Europeans. From the Aboriginal perspective, [internal colonization] refers to loss of lands, resources, and self-direction and to the severe disturbance of cultural ways and values; personal troubles reflect public issues o Colonization is also internalized as the experience of inferiority, hopelessness; this internalization can lead to self-abusive & destructive behaviours  Mortality rates: in 1935, about 1/3 of Aboriginal deaths occurred before the age of 5 years o Maternal and infant/child mortality related to lack of proper medical care: “No doctor, no help. If your child was sick, it had to die. That’s how it was in those days” o infectious disease killed Aboriginals more frequently than non-Aboriginals; e.g. ID= 12% of deaths in general population in 1935 and this decreased to 10% in 1940; in comparison, ID= 39% of deaths in Aboriginal population in 1935 and this increased to 44% by 1940; TB was the main contributor  Implementation of the reserve system: interfered with seasonal cycles of hunting, gathering, fishing and preserving which led to changes in nutritional status and starvation; low immunity to infectious disease which were difficult to resist  Termed ‘aggressive assimilation’: a policy strategy adopted by the Canadian government > residential schools were government-funded and run by the Church o The first residential schools opened around 1880; the last government-run residential school closed in 1996 in SK; at peak there were 130 schools operating in Canada; run federally under the Department of Indian Affairs o About 150,000 Aboriginal children were removed from their communities o By 1930 – 75% of Aboriginal children were in RSs; located in every province/territory (except NFLD, PEI, NB) o In early 1900s many children died from TB due to unsanitary conditions and neglect (mortality rates ranged from 24%-69%) o Many Aboriginal students were subject to physical and sexual abuse o The legacy of Indian residential schools has contributed to social problems that continue to exist in many communities today; government recognizes and made an official statement or ‘apology’  Cultural genocide: the (deliberate) destruction of a cultural heritage of a people/nation:  Loss of land- environmental dispossession  Loss of language  Disruption in passing one of traditions/customs  Intergenerational alienation- not belonging to either culture  Familial disruption (residential schools, foster homes)  Legacy of physical, sexual and substance abuse o In combination with economic marginalization, this has had drastic consequences for many Aboriginals o Health research, particularly epidemiological research, has played a role in constructing colonizing images of Aboriginal women and communities as sick, disorganized, and dependent, reinforcing unequal power relationships and justifying ongoing paternalism and dependency in health care  Household incomes for on-reserve FN families are half that for non-Aboriginal families  More on-reserve Aboriginal Canadians are extremely low income compared to Euro-Canadians (19% vs. 8%, respectively, earn ‘ $2,000 annually)  Income gap is widening and living conditions for many are worsening; translates into health disparities  Aboriginal peoples living in Canada are: o 4X more likely to live in crowded dwellings o 4X more likely to live in home that requires major repairs o This living in the North have particular challenges o 38% live in crowded homes compared to 11% of total Aboriginal population and 3% of non-Aboriginal population o Children living in North have some of highest rates of severe lower respiratory tract infections in the world!! o Lack of safe drinking water also a concern on many reserves  Life expectancy: 5-14 years less among FN peoples with Status and Inuit people compared to Can population  Infant Mortality Rates – 1.5 – 4 X higher than national rates o The prevalence of diabetes among First Nations is at least 3X the national average, with high rates across all age groups; tuberculosis rates for First Nations populations on- reserve are 8 to 10X higher than those for the Canadian population  Suicide rates are more than twice the rate of the “general “ population; leading cause of death among FN youth and young adults between the ages of 10 and 24 years; “epidemic” of suicide on reserve (reservations) across North America; this is a ‘universal’ challenge; it is not evenly distributed- self-determination for community is needed o Communities with traditional knowledge and practices and assimilated communities have lower suicide rates than communities that are neither traditional nor assimilated  Examples of community factors that are important and protective: o Self government- control over political decision making o Aboriginal control of schools o Aboriginal control of health services o Control of land base/over land use o Control over police o Having cultural facilities available where they can carry out their customs/traditions  In communities in BC with no community protective factors, suicide rate 10 X national average; if all factors present, 0 reported suicides  Health inequalities: are not simply the result of individual traits of Aboriginal peoples but are related to economic, political and social disparities that have resulted from colonial processes; cannot be sufficiently changed without addressing the colonial history of Aboriginal peoples  Intergenerational Impact of Residential Schools (IGIRS): IGIRS = the enduring effects of residential schools across generations; study of views and experiences of city-based stakeholders; o How to improve care for pregnant and parenting Aboriginal people in Canada?- pregnant and parenting Aboriginal women experience the residential schools as well; carried over for parental care o Interviewed community leaders, community members, community care providers • Health inequalities: are not simply the result of individual traits of Aboriginal peoples but are related to economic, political and social disparities that have resulted from colonial processes; are related to loss of cultural identity; cannot be sufficiently changed without addressing the colonial history of Aboriginal peoples • Main theme: Pregnancy and childbearing viewed as opportunity to “turn around” the IGIRS on Aboriginal individuals, families and communities • Understanding IGIRS o Res schools have enduring effects > crosses generations; spirals of addiction, violence, and poverty in individuals, families and communities rooted in IGIRS; survivors pass on to their children the school teachings they grew up with • Healing o involves: (i) facing up to the harm one has imposed on others; (ii) forgiving others for imposing harm; (iii) changing beliefs about oneself and others; (iv) accepting responsibility for self and others • Building strength and capacity o Community capacity building > community identifies issues and sets goals, e.g. economic, social, educational development; requires collective efforts; role models, mentors, and support people all important • Colonization intersects with sexism and racism to add an additional burden or threat to Aboriginal women: • Indian Act (1867) is inherently racist and sexist; is a case study of how multiple forms of oppression are built into institutional structures of society (e.g. legislation); Aboriginal women are “doubly othered” o Women had greater disconnection from their communities: women had their Indian status removed and their relationship to Indians denied if they were married outside of Aboriginal men; removed status from children too; they could no longer live on Reserve which broke ties geographically as well men who married a non-Aboriginal did NOT get their status removed o Women could not own property- if their husband died their land was confiscated o 25,000 women lost their status before 1985- rights were restored through Bill C-31 November 6 • Official list of Canadian health determinants supported by PHA; focuses on health indicators that go beyond negative health approach; how these determinants combine to produce patterns between groups downfall: treats determinants s the same thing; not an explicit theory of power; what produces these inequalities is often left unstated o Income and social class o Social support networks o Education o Employment and working conditions o Social environment o Physical environment o Personal health practices & coping skills o Healthy child development o Culture o Gender o Health services o Biology and genetic endowment • Critical Population Health Approach: Population health approach is dominant paradigm in health research; has replaced health promotion and public health; • Critical population health approach addresses these critiques through 3 types of engagement: o Engage theoretically: theoretical work- explanations for why there are health inequalities o Community engagement- work with communities to better understand and help their health issues o Policy engagement- policies to lessen health inequalities • critical population health approach has 2 goals: o To understand how historically specific social structures, economic relationships and ideological assumptions create and reproduce conditions that undermine the health of specific populations o To effect social change by reconstructing social, political and economic relations along emancipatory lines – towards justice, fairness and freedom (social, political, and economic relations); built on social values and is NOT neutral o Critical population health research is built on explicit social values • Richmond and Ross: Use critical population health approach to “examine how processes of environmental dispossession work to fundamentally undermine and reduce the quality of health determinants in rural and remote First Nation and Inuit communities” (Richmond and Ross, 2009, p. 405, original emphasis) • Environmental dispossession: undermines/ reduces quality of life/health determinants; processes through which access to traditional environment has been reduced; land is fundamental to health/wellness • Effects of colonization - multiple displacements: o Forced relocation to reserves; physical/geographical displacement o Assimilation strategies (eg. Residential schools); individuals/ families lost their children o Loss of or disruption to self-government • Interviews with 26 Community Health Representatives (front-line health workers that work with issues that impact the natives’ lives, as well as direct health concerns- representatives and have community engagement) revealed 6 themes: o Balance: physical, emotional, mental, spiritual health o Life control: take care of yourself, make decisions, manage your own disease, economic issues, capacity to socialize and make personal decisions o Education: access to high quality facilities (early care as well), health education, education means environmental and cultural passing on of knowledge intergenerational o Material resources: people can earn money/hold a job to support themselves- housing, clothing, quality food o Social resources: quality of social ties, access to social support networks o **Environmental/social connections: broader themes that affect all the above determinants • Environment dispossession: Affects quality of health determinants for Aboriginal peoples: o Life imbalance: less self-reliant due to the loss of patterns- no self-sufficiency; growing dependency of some on Canadian government and band councils for health and social services is an effect of policies by government o reduced consumption of traditional food o shift toward more sedentary lifestyle (e.g. Decrease in fishing, hunting) o Education: affects quality of health determinants: changing forms of education; cultural exchange and traditions associated with the land diminished; loss of skill; quality of education on-reserve poor o Lacking material resources: environmental dispossession leads to limited opportunities for economic deviation o Strain on social life: people were less trustworthy, competition very high with less resources, decreased sense of community o Health effects of environmental dispossession most evident within the social environment; less trust among community members; inc. competition for scarce resources; decreased interdependency; increased unemployment, and drug and alcohol addiction problems • Environmental Racism: the disproportionate impact of environmental hazards and “natural disasters” on: o unequal protection from environmental hazards o disadvantaged communities shoulder a disproportionate burden of effects of industrialization • Chemical Valley Film: “Because a substantial proportion of the Aboriginal diet in rural and remote areas consists of traditional foods, contamination from local and global sources of industrial development can reduce the purity of traditional foods and medicines, all of which impact upon the physical and spiritual health of Indigenous peoples” o On three sides of Sarnia there is a big chemical industry; benzene, chlorine organics, mercury, arsenic, hydrogen peroxide, propane, exposure o Endocrine Disruptors – chemicals that interfere with hormonal messages involved in the control of growth and development, especially in the fetus- lead to miscarriages, fertility problems, breathing/lungs/sinus problems o Long term health effects that will show up later in life- 51 over the age of 18 (25%) have had at least 1 miscarriage/stillbirth November 8 • Grassy Narrows First Nation: North western Ontario; located 180 km downstream from plant that pumped > 10 tons of industrial waste into the Wabigoon River in the late 1960s and 70s. o Grassy Narrows residents were exposed to mercury through the consumption of fish o could no longer rely on fishing as a means of tradition and business o Contamination poses risks to physical health and to health of local economies and business • Love Canal: (US example of Environmental Racism (ER)) o “a public health time bomb”; 21,000 tons of toxic waste buried beneath the neighbourhood “love canal” o Efforts of local journalist and activists led to then President Jimmy Carter designated LC as a “federal health emergency” and demanded that federal emergency funds be used to remedy the situation • Dumping in Dixie o Industrialization of the Southern US led to rapid increase in jobs and environmental pollution • Environmental Justice: Background- originated as social movement in the US; the EJ movement took root in the 1980s o This "new" movement redefined environmentalism to address issues of equity, disparate impact, and unequal protection from environmental harms and hazards o “The environmental justice movement has basically redefined what environmentalism is all about. It basically says that the environment is everything: where we live, work, play, go to school, as well as the physical and natural world. And so we can't separate the physical environment from the cultural environment. We have to talk about making sure that justice is integrated throughout all of the stuff that we do.” o Environmental Justice (EJ): response to environmental racism; goes beyond pollution; focus is on justice and environmental equity calls on the government and the law to protect inhabitants from environmental harms and exposure to toxins without discrimination; involves building meaningful community participation with government and industry decision- markers o Principles of EJ:  Public policy should be based on mutual respect and justice for all peoples  right to ethical, balanced and responsible uses of land and resources  considers governmental acts of environmental injustice a violation of human rights  opposes the destructive operations of multi-national corporations  affected communities demand the right to participate as equal partners at every level of decision-making  protects the rights of victims of environmental injustice  requires that individuals make personal and consumer choices that consume as little of earth’s resources and to produce as little waste as possible • Policy Responses to Environmental Racism and Injustice: o Precautionary Principle (PP): when the health of humans and the environment is at stake, scientific evidence not necessary to take protective action; precaution places the burden of proof on the proponents of an activity rather than on victims o When science cannot provide clear answers, environmental and health regulations and policies should emphasize safety and protection over risk and harm November 13 • Global Health Inequalities: enduring health disparities between countries; infant (death under age of 1) and child (death under the age of 5) mortality are good measures because children do not tend to die of chronic disease from lifestyle choices (diabetes, etc) strong mortality gradients (child) within developing countries • Child mortality (mortality < )- Sierra Leone – 316/1,000 live births; Iceland – 3/1,000; Finland – 4/1,000; Japan – 5/1,000; o Child mortality rose in 1990s by 43% in Zimbabwe, 52% in Botswana, 75% in Iraq; these are different than in Africa because these are also related to war and political violence o Sanitation/poor nutrition/poverty lead to chronic diarrheal which cause 18% of child mortality deaths • Probability of death for men b/w ages of 15 and 60: Sweden-8.3%, Zimbabwe-82.1% • “Developing Countries”: 132 “developing” countries out of 194; 72 are high mortality countries; 46 in Africa; characterized by: o Profoundly low levels of income; less industrialization o High population density o High fertility o Wide gaps between the rich and poor lots of absolute poverty o High morbidity and mortality (compared to industrialized nations) • Increased morbidity and mortality: o Internal Factors:  Inadequate public health infrastructure and services (building, material resources)  Extreme poverty; high death rate  Gender inequity, racism (of indigenous peoples)  Failure to observe human rights (within and by foreign investors)  In some, corrupt governments (which often go unchecked) o External Factors:  Foreign debt- loans from international banks  SAP’s- structural adjustment programs  Inadequate assistance from high0income countries; many program reflect the goals of donors and not the needs of the gainers  ‘Brain Drain’- idea of low job opportunities; professionals move out of countries; emigration of highly educated people  High cost of drugs/vaccines • Global Health Inequalities: Globalization- economic globalization; world bank; IMF o Structural Adjustment Programs o Role of World Bank and International Monetary Fund (IMF) • Neoliberalism: form of globalization strongly shaped through government programs guided by political ideology; forwarded and endorsed by US/Canada/UK, o The World Bank comes with the most world power: most likely to develop policies to develop that orientation; neoliberalism becomes globalized though these systems o Neoliberalism supports the idea that:  Free trade on its own produces economic growth  All social problems can be solved through market  Individuals/families should provide for themselves  Individual ownership better than collective o Neoliberalism fails to consider:  Relations of inequality that it requires and sustains  Economic development is not directly correlated with human wellbeing > e.g. GNP o Supporters of economic globalization say growing wealth will improve society o Critics say that it will increase health/social inequalities; in extreme inequality, health may actually decrease • Globalization: economic, political, cultural- 2 important components o Opening up borders: to increase flow of capital (no charge) o Changes in policies: to promote flows of capital across boarders • Current forms of economic globalization: o Shifts in major trade centers from European to include Asia and North America (70% through those regions specifically) o Scale and speed of trade between countries- facilitated by computing technology (in 1973 the daily trade in money was 20 billion US, in 1987, it was 590 billion, and in 2004, it was up to 1.5 tril
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