2.3: Health inequalities

Question 1

What are the 3 major conclusions of adaption theory?

Answer 1

1. Biological adaptation primarily arises through phenotypic acclimatisation rather than genetic
2. Genetic adaptation has selected for individuals who have been able to adjust to environmental constraints without recourse to genetic change
3. As a species we are a specialist in adjusting to rapidly changing conditions

Question 2

List 3 types of environmental stressors

Answer 2

Physical
Biotic
Socioeconomic

Question 3

List the 3 impacts of environmental stress

Answer 3

Dysfunction
Disease
Death

Question 4

Which environmental stressor exerts the greatest pressure on human biology and why?

Answer 4

Socioeconomic stressors

Because those who are powerless and in poverty have limited adaptive capability

Question 5

List the effects of low socio-economic status

Answer 5

Greater exposure to environmental stressors (cold/heat, toxins/pollutants, disease, energy, social)
Less access to resources to buffer these stressors

Question 6

Stress

Answer 6

The physiological response of the body to challenging stimuli

Question 7

Stressor

Answer 7

External challenging stimuli (psychological and/or physiological)

Question 8

Compare adaption to stress in response to environmental stressors

Answer 8

Adaptation concentrates on beneficial responses to environmental stressors

Stress emphasizes the adaptive costs and limitations of adaptive processes in response to the stressors

Adaptive response to stressors can become a health problem in and of itself when the line between adaptive response and stress becomes blurred

Question 9

3 stages of Selye’s General Adaption Syndrome model

Answer 9

1. Alarm – mobilise resources to meet threat (adrenaline, immune system)
2. Endurance – body resists but can’t keep up forever
3. Exhaustion – stress response itself causes damage/sickness

Question 10

(Psycho)social stressors

Answer 10

Social events and circumstances that increases risk of disease

Question 11

Acute social stressors. Give 9 examples.

Answer 11

Past or present events that increases risk of disease:
Marital problems
Death of a loved one
Abuse
Health problems
Financial crises
Child abuse
Bullying
Violence
Trauma

Question 12

Chronic social stressors. Give 9 examples.

Answer 12

On-going challenges that increases risk of disease:
War
Discrimination
Violence
Illness
Provert
Caring for an ailing parent/disabled child
Every day pressure of fulfilling your social role as a worker, parent, spouse, etc.
Getting to work on time
Managing unpredictable finances

Question 13

Do acute or chronic social stressors have more of an impact on health?

Answer 13

Chronic social stressors have more of an impact on health
The hidden effect is the continuous activation of the flight or fight response in the body (physiological response to stress in automatic nervous system)

Question 14

What is the rapid physiological response to stress?

Answer 14

Adrenal gland secretes hormones
Stimulates release of glycogen from the liver
Inhibits the release of insulin from the pancreas
Raises blood pressure and blood sugar
Epinephrine mobilises fat reserves and releases them into the bloodstream

Question 15

What is the long-term physiological response to stress?

Answer 15

If stress is on-going, the pituitary gland continues to secrete ACTH
Stimulates the output of glucocorticoids through the secretion of the steroid hormone cortisol
Elevates glucose and lipids in the blood

Question 16

Resistance resources

Answer 16

Buffers to mitigate and/or eliminate stressors; buffers can be internal or external

Question 17

Examples of generalised resistance resources (GRR)

Answer 17

Knowledge and intelligence
Ego identity
Coping strategies
Social support
Commitment and cohesion with one’s cultural roots
Cultural stability
Ritualistic activities
Religion and philosophy
Preventive health orientation

Question 18

What are the two types of resistance resources for social stressors? Give examples of each

Answer 18

Personal;
Strong sense of self-efficacy
Cognitive strategies to alter meaning of stressor

Social support (emotional or instrumental):
Reassurance/expressions of care
Direct tangible help (practical advice/loans)

Question 19

Aim of adaptive response

Answer 19

To restore homeostasis

Question 20

Homeostasis

Answer 20

Constant maintenance of internal body environment within a fairly narrow range though regulatory mechanisms that compensate for a changing external environment, which ensures continued survival

Question 21

Allostasis

Answer 21

Co-ordination by the brain of all the functions that bring the body back to homeostasis under stress; includes a wider range of parameters (blood pressure, blood glucose); can achieve different ‘set’ points (raised blood pressure in response to chronic stress); brings all homeostatic mechanisms under equilibrium as well

Question 22

Allostatic load

Answer 22

The cumulative impact of adjusting to perceived or actual challenge

Question 23

How is allostatic load measured?

Answer 23

Can be measured via the use of biomarkers (hormones, blood-tests, saliva-tests, physical exercises, etc.)

Question 24

Describe the 3 elements of the Nepalese study of allostatic load in children

Answer 24

1. Biological developmental adversity (growth status, pathogen load, cardio-vascular fitness)
2. Psychosocial stress (average cortisol, EBV antibody values)
3. Indicators thought to mediate vulnerability to stress (cardiovascular reactivity, day to day cortisol variance)

Question 25

What did research in the 60s and 70s on the health effects of modernisation (move from rural to urban) reveal?

Answer 25

Blood tests researching the chronic elevation of blood pressure
Revealed there was an ecological effect of living in a modern community; raised blood pressure

Question 26

What did John Casel’s migrant studies reveal about adaption to new cultural environments?

Answer 26

Migrants experience every day stressors that include:
Uncertainty
Failure to produce socially acceptable behaviour
Repeated social sanction in mundane social interaction
Lack of social support

These stressors increased allostatic load (blood pressure)
Migrants that keep original traditions in new culture have far lower blood pressure than those who don’t

Question 27

Status inconsistency

Answer 27

Simultaneously occupying unequal ranks, which leads to uncertainty/frustration, causing negative health impacts

Question 28

What is important to studying the stress process in ethnographic research? Give an example.

Answer 28

Need for cultural specificity in understanding stress and the stress process
Specifying variable measurements in terms of local cultural contexts is key
E.g. Samoan leaders (matai) in Samoa have high status; higher social status is associated with the accumulation of western goods. With modernization & migration, the matai status persisted but with a different function: Californian Samoan’s have matai status but lower socioeconomic status, which results in higher blood pressure/lower immune function

Question 29

Methodology to measure cultural consonance (4)

Answer 29

1. Build a cultural model
2. Define social boundaries
3. Investigate how well people within these social boundaries conform to the model (status consistency/status inconsistency)
4. If they don’t conform to the model (because they can’t or won’t) have low cultural consonance

Question 30

What is the consequence of low cultural consonance?

Answer 30

Confusion, misunderstanding and negative social sanction in ‘mundane’ social interaction
Less positive social feedback that re-assures them that accepted & valued
Repeated unsatisfying social interaction – could result in increased allostatic load
Disease/illness

Question 31

Give one ethnographic example of the effect of high cultural consonance

Answer 31

In urban Brazil, as cultural consonance increases, BMI and abdominal circumference decline (more strongly for men than women)

Question 32

Health disparity

Answer 32

Differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups

Question 33

Health inequity

Answer 33

Differences in population health that can be traced to unequal economic and social conditions are systemic and unavoidable; thus are inherently unjust and unfair

Question 34

Name 5 factors that depend on ethnicity, sex and socioeconomic status

Answer 34

1. Infant mortality
2. Life expectancy at birth
3. Death rate
4. Prevalence of obesity and hypertension
5. Mental health

Question 35

What is Dressler’s first model to explain racial & ethnic health disparities? Provide evidence for/against.

Answer 35

Racial-genetic model:
Attributes disease risk to a racial-genetic component

Evidence against:
➢ Race is not a biological construct
➢ There are extremely variable rates of disease in genetically similar populations
➢ Gene technology has been unable to link variant gene structures that contribute to blood pressure, and those that could are not differentially distributed across conventional racial groups
➢ Virtually no empirical evidence for Grim’s ‘slavery hypothesis’, which suggests that New World African-descendants retain more sodium in their diet because their ancestors had sodium deprivation, therefore they have higher blood pressure

Question 36

What is Dressler’s second model to explain racial & ethnic health disparities? Provide evidence for/against.

Answer 36

Health-behaviour model:
Discrete health behaviours voluntarily adopted by individuals of different ‘races’ (black, white, Hispanic) create health disparities (e.g. high caloric intake, low physical activity)

Evidence against:
➢ High calorie intake does not account for health disparities between the ‘races’
➢ Data shows that physical activity level makes no difference to risk of hypertension between black and white women
➢ Smoking does not account for health disparities because there are no differences in rates of smoking between black and white men and women
➢ There is little evidence that differences in alcohol intake account for large health disparities

Question 37

What is Dressler’s third model to explain racial & ethnic health disparities? Provide evidence for/against.

Answer 37

Socio-economic status model:
Racial and ethnic disparities confound with socio-economic disparities in health (differences in SES causes health disparities)

Evidence for:
➢ Race and SES are correlated
➢ SES may moderate racial or ethnic differences

Evidence against:
➢ Controlling for SE status reduces magnitude of health disparities and therefore doesn’t account for them completely
➢ Research often confused SES disparities with racial and ethnic health disparities, and little or no consideration is given to why this occurs

Question 38

What is Dressler’s fourth model to explain racial & ethnic health disparities? Provide evidence for/against.

Answer 38

Psychosocial–stress model:
Psychosocial stressors associated with institutional and interpersonal (perceived) racism and discrimination account for health disparities

Evidence for:
➢ Studies shows direct association between perceived discrimination and blood pressure/low birth weight/greater risk of developing hypertension
➢ High socioecologic stress (low SES and high social instability), with added insult of racist interactions creates highest blood pressures
➢ John Henryism hypothesis

Evidence against:
➢ Strength of anger expression and suppression effect is modest
➢ John Henryism model needs further specification and elaboration because it is dependent on variables

Question 39

What are the 3 approaches of the psychosocial–stress model?

Answer 39

1. Make distinction between institutional racism (structural inequality) and perceived racism (self-reports of experiences of discrimination)
2. More general understanding of term psychosocial stress as negative effect (anxiety/ depression) is used to incorporate psychosocial data into large national studies
3. Adapt general models of the stress process to specific ethnographic realities of the African-American community.
   For example, a high SES area consists of low SES, crime, racist interactions, suppressed hostility, limited ‘resistance’ resources, and status inconsistency

Question 40

What is Dressler’s fifth model to explain racial & ethnic health disparities? Provide evidence for/against.

Answer 40

Structural-constructivist model:
Asks how goals/aspirations are constructed within racial/ethnic groups and how these collide with social structures in which they are played out; if status consistency arises, individuals have low cultural consonance, which results in health disparities

Evidence for:
➢ Individuals with higher cultural consonance (better able to approximate the valued lifestyles) have lower blood pressure
➢ Persons with darker skin colour but high cultural consonance had lower blood pressure than white Brazilians at any level of cultural consonance