Miderm 1 Study Notes

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Health Sciences
Health Sciences 1002A/B
Jessica Polzer

Social Model of Health 10/29/2012 1:48:00 PM Key Concepts Ideology of Individualism  Lifestyle explanations rooted in ideology of individualism  Ideology – a set of beliefs  A period of cultural transition in Europe, their work shifted a lot from religion to someone who could direct their own futures. Religion took on less value on a way of everyday life, people could guide their own lives  People live longer in richer counties  Countries with the best health care live longer (example – Cuba is a poor country, however they have good health care, therefore they live longer)  Depending on your location, women tend to live longer than men due to war and conscription circumstances Individual perspective on health  Health is not as self evident as it might seem. Perspectives depend on our background education or training. Someone with a specific health problem or affected by a problem may look differently at it than someone without one o if something has never been an issue for you it may be difficult for you to understand where someone is coming from. Every persons perspective is biased as a result of what that person has gone through  Perspectives have limits and boundaries Social perspective on health  Sociological ways of thinking recognizes o Limitations of individualist explanations (of health) o Dynamic relationship between individuals (and their behaviours) and social systems  In our culture, health is a primary factor. If you do things that are unhealthy, that is considered bad  Social perspective focuses on o Social systems and social conditions o Health of groups and populations o Relationships between macro-level social structures and micro-level experiences of health  Challenges us to be critical; that is, to: o Consider what we know about health o Create new ways of understand health o Create new strategies to enhance opportunities for health and wellbeing for everyone  There are various ways to act that are acceptable, and ways that are not. In order to be critical we have to think about what we know about health and create new ways of understanding it  Root causes of illness and suffering are in social arrangements and inequalities  In order to understand current trends in health, we need to know about more than biology or genetics, and more than individual behaviours  Social Model of Health – 3 components according to Germov + Hor. o Social productions/distribution of health and illness o Social construction of health and illness o Social organization of health care  Social determinants of health o Rooted in social perspective on health o Broadly speaking, factors that affect the chances people will have to live healthy lives o A multi-disciplinary field of study that involved examining the social, political, economic and cultural forces and factors that influence the health and potential wellbeing of groups and populations Negative vs. positive definitions of health  There is not a distinct definition of health. Explanations of health vary across cultures and over time  Roots in the Greek word “holos” which means “whole”  Hippocrates described health as “a condition in which the functions of the body and soul are in harmony with the outside world” Public Health and Social Medicine  Public health focuses on policies, programs and services designed to keep citizens health and improve quality of life  Epidemiology – the statistical study of patterns of disease in the population Biomedical model of health  By the late 1800’s germ theory of disease took hold  Cause of disease is located within the body  This model of health became dominate by the early 1900s  This is when medicine as a profession began to take off because germs were not in the environment but in the body  Biomedical model of health defining features o Specific etiology – specific cause for specific disease, tied with the idea of the ability to see in the body, pathogens observed through microscopes. However, when perspective is so microscopic the view gets obscured o Machine metaphor – the individual body is seen as a machine both in medical textbooks and pop culture (example – food is digested like a conveyer belt) o Mind-body dualism/Cartesian – completely separated from mental and spiritual. Mind/body are distinct substances, must be treated very different. The human body is just a physical object  Limitations of the biomedical model o Fallacy of specific etiology – specific cause or origin for each specific disease o Objectification to machine metaphor o Reductionism and Biological Determinism – the belief that all illnesses can be explained and treated by reducing them to biological factors o Victim Blaming – lifestyle choices and factors o Iatrogenesis – means that there are new problems that are generated/produced by biomedical intervention (example – chemo kills off pathogens but makes you lose your hair/causes physical pain) o More attention to disease than health – health and disease are two different types of things o Really good practitioners will see the patient as a whole person (example – if you have a broken leg, you don’t want to get to know the doctor, you just want your leg fixed). Good doctors are just technicians o Definitions of Health  Negative/positive definitions does not mean bad/good  Negative recognized health when there is an absence of disease o not defining what health is, it just assumes if you cannot find cause of distress, you must be healthy. They assume health is present when disease is not  Positive definitions actually try to define what health is o Health is produced under circumstances about trying to optimize, improve and treat health. Not just about lacking disease o Consider the whole person (holistic) o See individuals and biological processes in social context (family, friends) o Focus on the factors and conditions that facilitate or promote health (not just treating a problem or disease) o Health as an ideal state of being (WHO definition) o Health as capacity to fulfill roles o Health as personal energy reserve o Health as personal potential o WHO: “State of complete physical, mental and social well- being, and not merely the absence of disease or infirmity” o Health Canada: “health as a capacity or resource, not a state; being able to pursue one’s goals, to acquire skills and education, and to grow.” “The capacity of people to adapt to, respond to, or control life’s challenged and changes”  Antonovsky o Salutogenesis  Health and disease on a continuum  Not enough to understand disease processes; must also understand the health-promoting factors that contribute to the onset of disease and experience of illness o He was very interested in stress and health  We tend to think of health care as a solution to everything, but lack of health care does not promote good mental health Lay Understandings of Health  Lay is a short word that represents people who are not experts  Lay understandings of health tend to vary with social position  How to individuals make sense out of health information Health indicators  How do we measure health? o Subjective measures – are usually just about asking someone how health they think they are (self rated health) o Morbidity – is sickness, particular kind of disease measured often through hospital measures and time taken off work is often used as an indicator o Morality – used a lot in health research, constructed usually from morality rates (poor people don’t get accounted for, missing bodies never get counted in statistics, this is BAD) o Life expectancy – the number of years a newborn can expect to live based on morality data o Incidence – the number of new cases of a particular disease or illness at a particular time (example – in 2011-2013 there were 35 new cases of diabetes) o Prevalence – is a snap shot, how wide spread of a prevalent or particular disease is at a particular moment (example – in 2011 there were 35 000 people with diabetes) o Infant mortality – is the death of an infant in the first year of life. Expressed usually per 1000 births. Says a lot about a nations ability to take care of people. The rates have gone down a great deal, this means improvement of taking care of people Composite measure  Human development index is used to compare health across countries  A composite measure, and includes o life expectancy o educational attainment o income levels Key Themes  Ideas about health are not static – they are time and context dependent  There are important distinctions between negative and positive definitions of health, and between disease and illness  Health is a complex and multifaceted concept th  In 20 century, Canada had improvements in life expectancy and showed changed in disease patterns  Lifestyle explanations of health are rooted in ideology of individualism  We must look beyond the individual in order to understand why particular groups and populations suffer ill health consistently more than other groups and populations Constructions of health in Canadian Policy Frameworks 10/29/2012 1:48:00 PM Demographic Transition  Health as a social product o Health varies in relation to how resources are distributed (financial and social) and how power and distributed  Transition from high fertility and high mortality to low fertility and low mortality  Epidemely – the study of population McKeown Thesis  Landmark Study thesis – What causes rise of modern population? What were the determinants of health in the 19 thcentury? o Retrospective analysis o Conclusion: decline in mortality from infectious disease driven by improved economic conditions  The population growth that started in Europe in the 18 thcentury o Death rates decreased, birth rates increased o Mortality rates decreased, immigration rates increased  Rise in population was due to the improvement in standard of living, better economic conditions and nutrition status  BUT economic growth cannot explain the fall in mortality rates on its own. Improved sanitation voted as medical breakthrough that provided the greatest benefit to human health o Organized public health efforts (example – improvements to sanitations, more specifically clean water and waste disposal) Canadian Contributions to the Conceptualization of Health  Lalonde Report, Ottawa Charter, Health Promotion Movement, Population Health Approach  Official definitions and statements from politicians help guide our decision making. These are important to look at when looking at how a society divides up its resources  Helps determine what is priority for the government and society The Lalonde Report  Presented a “new perspective” on the health of Canadians  New title on health should be distributed  The first Canadian document to go beyond health care and create a policy that would include a health care system but to go beyond it Health Field Concept  There are four components o Human Biology – genetics, viruses o Enviornment – pollutions o Lifestyle – behaviours, smoking, drinking  Influences health promotion practice the most, ours will change everyday, easiest to influence, everyone has control over their own lifestyle so it can be changed. As a society we tend to do individual things o Health care services and organization – are there enough? (example – health care workers, are they organized in a way to treat disease?) WHO definition of health  Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease and infirmary  Emerged in context of post WWII. WHO tried to define what health is, there was an effort to rebuild health  This is an example of a positive definition of health  Policies, programs and service designed to keep citizens healthy and to improve the quality of life. The focus is on enhancing the health status and well being of the general population Health promotion  Health Promotion – a field of knowledge and practice that draws on a social perspective of health, and that seeks to build healthiness rather than just prevent disease  Core Values and Commitments o Empower o Community definition of health problems o Community action/development o Participatory research methods Ottawa Charter  Health is a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.  “Health promotion is the process of enabling people to increase control over and to improve their health. To each a state of complete physical, mental and social wellbeing, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond health life-styles to well-being”  Emphasized fundamental conditions and resources required for health, including o People o Stable exosystem (social setting in which the individual does not have an active role) o Shelter and housing o Social justice and equality o Education o Food  Strategies to improve health include o Strengthening community action (involve the process of adjusting to their needs) o Creating healthy public policy o Create supportive environments o Reorienting health services (to focus on health services, not only when they are sick) o Develop personal skills (teaching people how to adopt healthy behaviours) Population Health Approach  Health is a capacity or resource rather than a state, a definition which corresponds more to the notion of being able to puesue one’s goals, to acquire skills and education, and to grow  Recognized the important of population-level social, economic and environmental factors that contribute to health  Operationalized as very specific factors o Range of individual and collective factor interactions o 12 determinants of health including social, environmental, income, gender, culture, employment and working conditions, health services o be familiar with these determinants of health o produce certain outcomes  Distinction
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