2.3: Health inequalities Flashcards
What are the 3 major conclusions of adaption theory?
- Biological adaptation primarily arises through phenotypic acclimatisation rather than genetic
- Genetic adaptation has selected for individuals who have been able to adjust to environmental constraints without recourse to genetic change
- As a species we are a specialist in adjusting to rapidly changing conditions
List 3 types of environmental stressors
Physical
Biotic
Socioeconomic
List the 3 impacts of environmental stress
Dysfunction
Disease
Death
Which environmental stressor exerts the greatest pressure on human biology and why?
Socioeconomic stressors
Because those who are powerless and in poverty have limited adaptive capability
List the effects of low socio-economic status
Greater exposure to environmental stressors (cold/heat, toxins/pollutants, disease, energy, social)
Less access to resources to buffer these stressors
Stress
The physiological response of the body to challenging stimuli
Stressor
External challenging stimuli (psychological and/or physiological)
Compare adaption to stress in response to environmental stressors
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
3 stages of Selye’s General Adaption Syndrome model
- Alarm – mobilise resources to meet threat (adrenaline, immune system)
- Endurance – body resists but can’t keep up forever
- Exhaustion – stress response itself causes damage/sickness
(Psycho)social stressors
Social events and circumstances that increases risk of disease
Acute social stressors. Give 9 examples.
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
Chronic social stressors. Give 9 examples.
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
Do acute or chronic social stressors have more of an impact on health?
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)
What is the rapid physiological response to stress?
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
What is the long-term physiological response to stress?
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
Resistance resources
Buffers to mitigate and/or eliminate stressors; buffers can be internal or external
Examples of generalised resistance resources (GRR)
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
What are the two types of resistance resources for social stressors? Give examples of each
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)
Aim of adaptive response
To restore homeostasis
Homeostasis
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
Allostasis
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
Allostatic load
The cumulative impact of adjusting to perceived or actual challenge
How is allostatic load measured?
Can be measured via the use of biomarkers (hormones, blood-tests, saliva-tests, physical exercises, etc.)
Describe the 3 elements of the Nepalese study of allostatic load in children
- Biological developmental adversity (growth status, pathogen load, cardio-vascular fitness)
- Psychosocial stress (average cortisol, EBV antibody values)
- Indicators thought to mediate vulnerability to stress (cardiovascular reactivity, day to day cortisol variance)
What did research in the 60s and 70s on the health effects of modernisation (move from rural to urban) reveal?
Blood tests researching the chronic elevation of blood pressure
Revealed there was an ecological effect of living in a modern community; raised blood pressure
What did John Casel’s migrant studies reveal about adaption to new cultural environments?
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
Status inconsistency
Simultaneously occupying unequal ranks, which leads to uncertainty/frustration, causing negative health impacts
What is important to studying the stress process in ethnographic research? Give an example.
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
Methodology to measure cultural consonance (4)
- Build a cultural model
- Define social boundaries
- Investigate how well people within these social boundaries conform to the model (status consistency/status inconsistency)
- If they don’t conform to the model (because they can’t or won’t) have low cultural consonance
What is the consequence of low cultural consonance?
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
Give one ethnographic example of the effect of high cultural consonance
In urban Brazil, as cultural consonance increases, BMI and abdominal circumference decline (more strongly for men than women)
Health disparity
Differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups
Health inequity
Differences in population health that can be traced to unequal economic and social conditions are systemic and unavoidable; thus are inherently unjust and unfair
Name 5 factors that depend on ethnicity, sex and socioeconomic status
- Infant mortality
- Life expectancy at birth
- Death rate
- Prevalence of obesity and hypertension
- Mental health
What is Dressler’s first model to explain racial & ethnic health disparities? Provide evidence for/against.
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
What is Dressler’s second model to explain racial & ethnic health disparities? Provide evidence for/against.
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
What is Dressler’s third model to explain racial & ethnic health disparities? Provide evidence for/against.
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
What is Dressler’s fourth model to explain racial & ethnic health disparities? Provide evidence for/against.
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
What are the 3 approaches of the psychosocial–stress model?
- Make distinction between institutional racism (structural inequality) and perceived racism (self-reports of experiences of discrimination)
- More general understanding of term psychosocial stress as negative effect (anxiety/ depression) is used to incorporate psychosocial data into large national studies
- 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
What is Dressler’s fifth model to explain racial & ethnic health disparities? Provide evidence for/against.
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
