Society and Health

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Society and Health Wiess 398 Lecture 5
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Today

• Short essay 4 due Return Short Essay 3
• Lecture discuss models by Adler, Ross, Ellison
• Discussion House, Pictures
• Update -- Office Hours Rice Campus
• Where BH 246
• When Tuesday, 11am 1pm

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Short Essay 3

• Scores ranged from 8 to 10.
• Students social determinants smoking,
  redistribution of population assets, social
  networks, race, gender, obesity, SES, income
  inequality, education, national state government

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Vocabulary

• Epidemiology study of the distribution and
  determinants of diseases and injuries in human
  populations
• Incidence measure of new cases of disease that
  develop in a population during a specified period
  of time
• Prevalence proportion of individuals in a
  population with a disease at a specific point in
  time
• Morbidity relative incidence of disease
• Mortality the proportion of deaths in population
• Misc.
• Etiology study of the causes and origins of
  disease
• SES socioeconomic status

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Vocabulary

• Crossectional study aka prevalence study.
  nondirectional study design where measurement is
  taken at a single point in time.
• Case-Control study aka case-referent,
  retrospective. A backward or nondirectional
  design that compares a group of cases and one or
  more groups of noncases (i.e. controls) with
  respect to a given study factor.
• Cohort study aka incidence study, prospective
  study. Information about study factor is known
  at study onset. The population at risk is
  followed for a given period.

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What is a Social Determinant?

• A social determinant of health is something that
  affects many people in a population rather than
  residing within one person. For example social
  networks are a social determinant. Social
  support is a psychosocial process that people
  engage in as a result of being in a network.
  Which can influence health.

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What is a Social Determinant?

• We need to think about what society does to
  affect the distribution of say blood pressures as
  shown in the next slide. Surely we can engage in
  activities to support physical activity, but this
  keeps us focused on the individual, not social
  factors.

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Some Examples of Social Determinants?

• Religion
• Race
• Gender
• Ethnicity
• Social Class
• Socioeconomic Status
• Socioeconomic Position
• Income
• Education
• Occupation
• Social Networks
• Social Integration
• Social Isolation

• Social Cohesion
• Neighborhood
• Housing
• Crowding
• Marital Status
• Retirement
• Job Strain
• Effort-Reward Imbalance
• Family

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Review Term Paper Components
100
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Discuss Models

• Adler Socioeconomic Status and Health
• Ross Education and Health
• Ellison Religion and Health

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Adler article

• In effect, Adler outlines two models describing
  the causal pathway between SES and health

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Adlers 1st Model
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Adlers 1st Model
Education

• Individual occupational opportunities, earning
  potential
• Population increase human capital, productivity,
  improving socialization of next generation,
  decrease health care costs

Income
Individual purchase healthcare, better
nutrition, better housing, better
schooling Population (i.e. income tax, social
security, welfare policies, earned income tax
credit, tax and transfer benefits) reduce income
inequality

Occupation
Individual health benefits, identity
construction, prestige, job control Population
(i.e. work reorganization) increased profits,
increased productivity, reduced absenteeism,
reduced medical costs

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Adlers 2nd Model
Socioeconomic Status
Health
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Adlers 2nd Model SES shapes . . .
Environmental Exposures

• Characteristics toxic exposures, residential
  crowding/noise
• Policy environmental racism, environmental
  justice

Social Environment
Characteristics social isolation, social
networks, social cohesion, social capital Policy
community infrastructure/architecture, community
institutions

Health Care
Characteristics uninsured, access, quality,
Medicare, Medicaid Policy increased enrollment
in Medicare,/Medicaid, universal healthcare
(mixed bag)

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Adlers 2nd Model SES shapes . . .
Behavior/ Lifestyle

• Characteristics tobacco use, sedentary
  lifestyle, poorer diet
• Policy bike lanes, well-lit neighborhood,
  nutritional information campaigns, improve local
  schools

Chronic Stress
Characteristics job insecurity, economic strain,
stressful life events Policy stress management
programs (implement in healthcare system and
offer insurance coverage)

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Question to Ponder

• What role does relative deprivation play in
  Adlers two models?

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Ellison Levin Article

• Health-Religion Model
• Illustrates the way in which religious
  involvement may yield positive outcomes and
  reduce the risk of negative outcomes (703)

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Ellison Levins Model
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Ellison Levins Model Religion shapes . . .
Characteristics discourage extreme behaviors,
dietary restriction (i.e. Mormans), internalize
socio-religious norms, promote emulation of others
Individual Lifestyle/Health Behaviors

Characteristics denser social networks, social
integration, pastoral advise, social support,
instrumental aid
Social Resources

Characteristics prayer, scriptural studies,
relationship with the divine, fellowship with
like-minded folks/church
Positive Self Perceptions

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Ellison Levins Model Religion shapes . . .
Characteristics prayer, meditation, devotional
pursuits provide mechanism with which to cope
with stress
Coping Resources

Characteristics prayer and worship, alone or
collective enhance particular positive emotions
and thereby PNI pathways
Positive Emotions

Characteristics expecting god to reward ones
worship/piety promotes beliefs of optimism and
hope
Healthy Beliefs

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Questions to Ponder

• In terms of intervention, what are the ethical
  implications of religion-health research?
• Does religion equal religious involvement?

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Death Rates in 1960 and 1986 Why?
(Pappas et al NEJM 1993)
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Ross Wu Article

• Education-Health Model
• Moderated by determinants such as work/economic
  conditions social-psychological resources and
  health lifestyle

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Ross Wus Model
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Ross Wus Model Education shapes . . .
Characteristics more likely to be employed,
receive employment benefits, determines income,
degree of economic hardship (ie paying bills,
obtaining food/clothes/shelter), sense of work
fulfillment and meaning, level of job satisfaction
Work-Economic Conditions

Social-Psychological Resources
Characteristics sense of personal control
(belief that outcomes are contingent upon ones
own choices and actions) social support (sense
of being cared for and loved) and part of network

Health Lifestyle
Characteristics determine health behaviors such
as exercise, smoking, drinking

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Harsh or dangerous occupational conditions, by
education and sex (Mirowsky Ross 2003)
Male
Female
Harsh or Dangerous Occupation Index
elementary
high school
college
PhD/professional
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Question to Ponder

• What does education mean
• Years?
• Competencies?
• Credentials?

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Jim Houses Picture
Health Outcomes Mortality Institutionalization Mor
bidity Functional Limitations Self-rated
Health Cognitive Function Depression
Race-Ethnicity
Socioeconomic Status
Gender
Explanatory Variables
Explanatory Variables
Medical Care and Insurance
Psychosocial Risk Factors Health Behaviors Social
Relationships and Supports Chronic and Acute
Stress Psychological Dispositions Social Roles
and Productive Activities
Social, Political, and Economic Conditions and
Policy
Physical/Chemical and Social Environment Hazards
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Discussion Groups

• Discuss your illustration. Each student should
  distribute his or her illustration and be
  prepared to discuss it.  After each student
  presents the group should consider whether there
  are a general set of pathways that are useful to
  consider.  Compare with your drawings from the
  first class assignment and discuss how your
  pictures differ from those of Lynch and
  colleagues and Marmot and Wilkinson.

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Next Class The Role of Meaning and Culture in
Health

• READINGS
• Chapter 9 (The Cultural Frame Context and
  Meaning in Health) in Society and Health Book.
• Cassel J, Patrick R, Jenkins D. Epidemiological
  analysis of the health implications of culture
  change a conceptual model.   Annals of the New
  York Academy of Sciences.  196084938-949.
• Short essay 5
• describe the importance of culture and meaning in
  the context of the societal feature you have
  chosen to do your term paper about. 
• What role does meaning have with respect to
  social determinants of disease?
• Why is meaning important with respect to health? 
  
• If culture and meaning are important how does
  this affect how you critically read the
  literature?