Chapter 4 - Social Inequity, Disease & Death: SDOH

Question 1

Different Explanations of Inequality, Health & consequences

most obvious?

Answer 1

**materialistic approach to SODH **

• health linked to provision of basic material goods/services
• income is central

health depends on available, accessible & good quality food/water/transport/housing etc.

Question 2

(2) aspects of income relevant to materialistic approach

Answer 2

1) income sufficiency - *buy food, shelter etc. *
2) income stability - consistent/predictable availability of money

Question 3

Neomaterialistic Approach

Answer 3

focuses on relative distribution of material/social goods in society

• argument that once certain degree of absolute material adequacy reached..

equity & perceived equity = essential to overall health

Question 4

3rd explanation for link b/w SDOH & health

explains how neo-m theory may work empirically at level of individual social-psych functioning

Answer 4

focuses on **relative distribution **of material/social goods in society

social capital (*access to & presence of certain social benefits) *enhances inclusion

**social inclusion **- relates to social capital

• presence of well-functioning infrastructure contributes to high levels of SI

Question 5

Life Course Approach

Answer 5

overlaps with previous 3 but focuses on fact that impoverishment, inequity, lack of distr. policies, social exc., are exacerbated when occur among children & thru life

pathway effects - experiences set children on course (ECD)

latency effects **- **in early developmental stages & influences later life

cumulative effects - advantage/disadvantage (includes combo of previous 2)

Question 6

Example of Life Course Approach

Answer 6

examine class-associated pre-marital/teen pregnancy

working/lower class more likely to get prego

• tend not to have adequate eco/emo/social support
• passed to child
• also less access to good food, prenatal care

Question 7

Political Explanations for Inequality and Poor Health

Answer 7

Health inequities result from forces & decisions at global/national political & economic level

Question 8

Navarro & Shi study

Answer 8

compared 4 types of OECD countries

**social democratic **countries characterized by extensive taxation & redistrib. policies & high rates of female engagement in labor market

• lower infant mortality rates (sensitive indicator of popn health)
• supports theory of importance of SODH to popn health

Question 9

Inequality & inequity growing since ___ & justification rooted in ideology of ___

Answer 9

1980

neo-liberalism

Question 10

main assumptions of neo-liberalism

Answer 10

1) markets = best & most efficient allocators of resources in production & distribution
2) societies are composed of autonomous individuals (producers & consumers) motivated mostly by material/economic means
3) competition = major vehicle for competition

Question 11

Neo-liberalism

Answer 11

against redistribution policies bc it interferes with eco growth

• idea that everyone in society will do better if market is allowed to generate jobs as it creates wealth thru **trickle-down effect **
• assumes wealth from market will auto provide work/income for all
• based on **philosophy **that emphasizes individual rights/freedom over collective integration & wellbeing

Question 12

Operating Model for SDOH

levels that impact health

Answer 12

Health, illness & death linked to social organization of society

broadest level - globalization & neoliberal ideology (political-economic system)

culture - degree of medicalization

social policies

social structure
individual behaviors

Question 13

SDOH - Canada

history of defining health

Answer 13

changed with **1974 Lalonde Report **- influenced world to broaden understanding of social/env/eco causes of health/illness

(4) causes - human bio, env, lifestyle & HC organization

**1986 **- **Jake Epp **responsible for document proposing framework of health promo

also Ottawa Charter for Health Promo in 1986

Question 14

SDOH explain sig differences among communities in health outcomes

(what %?)

Answer 14

25-55%

Question 15

Inequality

Answer 15

significant predictor of popn health

Question 16

Inequality in Japan & USA

Answer 16

• *Japan** - highest life expectancy despite 2x smoking rates of Canada
• • cohesive society in which income equity is chief value *

**US - **high mortality rates & income inequality

• top 1% of popn control 40% of wealth

poorest 40% have 1% of wealth (1997)

Question 17

Food Security

Answer 17

1st food bank - Edmonton (*over 25 years ago) *

2.3 million CDNs affected in **2004 **

Question 18

Poverty

Answer 18

defn is political matter

• refers to eco position/stability of ppl with difficulty meeting basic needs

In Canada - defined as those who spend over **20% **of income on food/shelter/clothing

Question 19

Employment

Answer 19

• also must consider stability/safety of work, salary, holidays, hours, autonomy etc.
• occupation = important predictor of health through mechanisms of income

Question 20

Unemployment

Answer 20

rate in **2011 = 7.1% **

Question 21

Education/Literacy

Answer 21

• increases job opportunities, health literacy, financial stability/security
• related to types of employment, income level & health behaviors, self-esteem

Question 22

Housing

Answer 22

homeless popn growing - estimated b/w 200-300k

**absolute homelessness - **street/shelter

**hidden homeless - **in car, couch surfer

**relative homelessness - **on verge of losing shelter

• *2000 - **less than **56% **of Ab homes considered adequate
• **over 5% **unfit for human occupancy

Ab ppl **4x **more likely to live in overcrowded house

Question 23

Neighborhood

Answer 23

characteristics have powerful/independent effect on health status

• explains large part of health gap by race in US
• poor neighborhoods linked to **higher levels of mental/physical illness & stress **

Question 24

Relationship between economy & health status

Answer 24

many documents on this beginning with Friedrich Engels’ **The Condition of the Working Class in England - ****1845 **

when need for profit = determining principle

popn health needs = secondary importance

Question 25

Commodification

Answer 25

Commodities = objects/activities with exchange value
– can be bought/sold (value determined by market factors such as supply & demand)

Health can be seen as a commodity
In capitalist economy, health is subject to supply & demand
- best example = buying/selling organs for transplantation
- also used to **indicate productive value of individual to society **

when corps/gov allow continuation of destructive practice to health in interest of financial benefits, **health is being commodified **