Urban Health Historical Perspectives

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Urban HealthHistorical Perspectives

• Thursday 12 Oct 2006

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Todays Class

• Opening Remarks
• Review of Last Week
• Lecture
• Discuss upcoming Test (Oct 26)

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Opening Remarks

• How are your exercises going?
• Turn it in Oct 26 (2 weeks)
• Selected lecture slides on webpage

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Review of Last Week

• Urban form and life, yesterday and today
• The ingredients of urban life (Wirth)
• Changes in urban form the megalopolis
• Anywhere is everywhere variations on a theme park

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Today

• Health Determinants and Health Inequalities in a
  Historical Perspective
• Not only has urban form and urban lifestyle
  changed (last week), but the determinants of
  health have changed as well (today).
• Why? Urbanization? Prosperity? Public Health
  measures? Medicine?
• Implications the challenges to alleviating
  health disadvantage are a moving target and
  require a multi-level perspective on the
  determinants of health

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Determinants of Health Historical Perspective

• Different views depending on how far back we go.
• Pre/Post Hunter Gatherer Societies
• Food, physical hazards social supports,
  infectious diseases, sanitation, stress
• Pre/Post Industrial Revolution
• Food distribution, organizational control over
  environment, public health measures and new norms
  about hygiene and health behaviors,
  sanitation/water systems, general will to improve
  urban society.
• Reasons for emerging health gradient?
• Pre/Post WWII
• Start with 1953 UN report

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Determinants of Health Historical Perspective

• How much has medicine contributed to minimizing
  health disparities?
• Barriers to health care were once thought to be
  panaceaused as justification for National Health
  Care
• However, health inequalities have not declined
  with National Health care
• Not that Health Care hasnt made a difference,
  but social inequalities persist because
  underlying stratification has not changed

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Determinants of Health Historical Perspective

• Black Report changed the debate to emphasize
  socioeconomic conditions as root causes of health

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Determinants of Health Historical Perspective

• Relative position in the social hierarchy
• We are nested in many hierarchies at once
• Important implications for our identity,
  competencies, coping skills
• Relative position has always mattered, but only
  recently appreciated
• Study Military personnel stationed at home vs.
  abroad
• How do we think of absolute and relative
  deprivation working together?
• Relative deprivation is based on social
  comparisons mechanisms?
• How can it be minimized?

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The Epidemiological TransitionMaterial Scarcity
to Social Disadvantage

• Have probably heard about he demographic
  transition
• What is the Epidemiological Transition?
• Why is ET important for our understanding of
  health inequalities?

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Relative deprivation

• How is it manifested after ET?
• Material ? Spatial (segregation of social
  environments)
• Cognitive processes of social comparison are
  involved (70)social meanings attached to
  conditions and how people feel about them.
  Social distinctions, culture, lifestyles, modes
  of living, consumer identities
• Relative income is a social concept. It cannot
  be dealt with at an individual level societies,
  not individuals have income distributions

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Moving Target

• My research addresses historical changes in the
  prices of particular goods, some relevant to
  material well-being, others indicators of social
  deprivation.
• Pricing of space vs. a breadbasket of goods
• Increases in economic residential segregation
• Prices reflect a lot of things, but ultimately
  the value of a good, service, lifestyle, or way
  of living to consumers able to pay
• The sociopolitical economy of pricing of space.

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Example Test Question

• The epidemiological transition is
• A fundamental shift marked by declining mortality
  and birth rates, leading to greater life
  expectancy
• A shift in the main causes of deathfrom
  infectious diseases to degenerative
  cardiovascular diseases and cancers.
• A movement to improve sanitation and hygiene in
  developing nations
• The shift of population settlement from rural
  areas to the cities
• Third year of medical school

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Example Test Question

• QUESTION What is the difference between absolute
  and relative deprivation?