final review

Question 1

• Define emerging infectious disease and resurgent infectious disease. What did they think would bring a close to the “era” of infectious disease?

Answer 1

• Emerging – clinically distinct conditions whos incidence in humans has increased – can be new or old
• Resurgent- old diseases that show an increase in incidence
• Thought that era would end w antimicrobial drugs/antibiotics and widespread vaccination
• 20th century transition where infections diseased no longer appeared to be a major threat to health in wealthy countries

Question 2

What did this view of infectious diseases as a thing of the past reveal a lack of concern for? By the 1980s, what shifted this view?

Answer 2

• Thought that era would end w antimicrobial drugs/antibiotics and widespread vaccination
o View point lacked a concern of the suffering and death due to infectious diseases for many of the worlds citizens
• 1980s increase in death by infectious disease in the united states

Question 3

o What is driving the emergence or resurgence of infectious diseases? What is the primary driver? Briefly sum up the sociodemographic, environmental, and biological factors seen as important in the emergence and/or resurgence of infectious diseases.

Answer 3

o Primary driver is human social behavior, affecting both environmental conditions and biological evolution in pathogens
o Sociodemographic factors such as increase in pop density, urbanization, poverty, infrastructure decline
o Environmental factors such as deforestation, agriculture, natural disasters
o Biological factors such as bioweapons or change in pathogen genomes due to exposure to antimicrobial agents
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Question 4

What does Paul Farmer mean with the ideas that infectious diseases are “hidden” among the poor?

Answer 4

many of the diseases
classified as emergent or resurgent have long been “hidden” among
the poor, and only when they capture media attention do they come
into the larger public consciousness

Question 5

briefly sum up how the transition to agriculture created a series of social transformations that “profoundly shaped global infectious disease patterns”.

Answer 5

• Cultivation places greater demand on labor = strain on individual energy resources
• Settled agriculture lead to social stratification – ownership of critical resources as a means of amassing wealth – health differentials
• expansionist
activities into new areas and control over new populations also began
on a large scale in the post-agricultural period. Infection and war go
together, with injuries, poor diets, and crowded conditions all
providing new opportunities for pathogens.

Question 6

o How did the rise of urban centres increase infectious disease spread? What influenced the low levels of immunological resistance among poor urban dwellers within this new urban ecology?

Answer 6

o The rise of urban centers, supported by agricultural surpluses from
the rural areas, provided new loci in which infectious diseases could
take hold and expand.
o crowded housing with scant means of waste
disposal became a new kind of breeding ground for more
“domesticated” pathogens, those that thrive indoors or in the water
supply, such as TB or cholera
o low levels of
immunological resistance among many poor urban dwellers worn
down by poor nutrition, stress, violence, pollutants, and other
pathogens.

Question 7

o What influenced the creation of a common “disease pool” in the Old World? How did this disease pool expand into new areas of the globe? What is a virgin soil epidemic?

Answer 7

 Civilized pattern of disease - long-distance trading routes and large urban centers
 this disease
pool began expanding into new areas when Europeans began more
extensive global exploration and colonization.
 virgin
soil epidemics, which occur when a new pathogen enters a new
population, are akin to epidemics of emerging infectious diseases;
they hit in successive waves and are associated with massive
mortality.

Question 8

was smallpox the only infectious disease that decimated Indigenous populations? What is seen to have destroyed the populations and cultures of Indigenous peoples? What was the “net effect” of the waves of disease?

Answer 8

• no, it was one of many
• the successive wave of new diseases collectively destroyed
• net effect was the widespread cultural and demographic collapse

Question 9

o How was smallpox eradicated? Briefly describe how the British and French colonialists viewed the demise of Indigenous populations.

Answer 9

o By a global vaccination effort by WHO

o They viewed as a positive/success

Question 10

”, why were the Europeans not as successful in colonizing other parts of Asia or in Africa? What is sleeping sickness and why was it particularly problematic for European colonists? Briefly sum up the result of people hearing descriptions of “the white man’s grave”?

Answer 10

• Due to a shared disease pool with Asians and a disease barrier in some parts of Africa (diseases Europeans had not encountered before/ no immunity)
• Sleeping sickness – disease spread by flies that feed on cattle. Disease leads to coma and death, partucularily problematic for Europeans as they tried to establish cattle herds
• Ppl did not want to move there after hearing of white mans grave

Question 11

o How were native populations viewed? What widespread colonial sentiment did these views support?

Answer 11

o Native pops viewed with suspicion, as possible vectors of disease that must be avoided
o Supported sentiment that they were biologically inferior + needed to be civilzed

Question 12

o Who became the “the acceptable face of colonialism”? What was problematic about the care they provided?

Answer 12

o Missionaries, problematic bc the care they provided came at the cost of religious conversion and repudiation of traditional healing practices

Question 13

o As discussed in the text, why and where did centers for “tropical medicine” emerge? What influenced the priorities of these centers? What was a key criticism of “tropical medicine” (i.e., what was seen as another way to address poor health)?

Answer 13

o Established in european capitals to study tropical diseases and medicine

o Priorities aligned with European colonists and scientists

o Key crit. = tool of colonial powers – cleaning up the mess they created by colonization

Question 14

in broad terms, what the legacy of the colonial era? What was the phenomenon, that saw European health improve but colonized peoples’ health deteriorate, attributed to? What did McKeown, in contrast, propose? What most likely provided the resources to improve European nutrition?

Answer 14

• The legacy was twofold – global homogenization of infectious disease and divergence in the burden of infection shifting onto colonized peoples
• Phenomena attributed to rise of biomedicine and scientific advancements surrounding it
• Mckeown proposed that disease in Europe began to decline before biomedicine because of improvement in nutrition and public sanitation
• Resources from colonization- funds from the colonies

Question 15

• As discussed in the section “Cholera”, what was one of the first diseases considered in relation to climate change? How does cholera spread? Where does cholera thrive?

Answer 15

• Cholera was. Spreads from fecal matter in water that others come into contact with. Thrives in large, dense pops making use of a single water source with insufficient hygienic measures to assure separation of waste water and drinking water

Question 16

o Cholera is now considered a resurgent disease. Identify the three sources considered to underlie the continued spread of cholera.

Answer 16

o Three main sources fuel the continued spread
o Inadequate water sanitation (poverty, conflict)
o Global shipping traffic (port cities)
o Global warming (warmer saline waters; algal blooms)

Question 17

. Other than its “refusal to disappear”, what are the current concerns about TB? How is TB spread?

Answer 17

• Also from rise of multidrug resistant and extremely multidrug resistant forms
• Tb is spread through fluid droplets – the air

Question 18

o There is a vaccine for TB and the treatment for TB usually lasts at least six months. What is usually blamed for “failure” to finish the full course of treatment?

Answer 18

o Patient noncompliance

Question 19

o Briefly describe the concern with the use of racial and ethnic categories as “risk groups”. What do most TB patients have in common, regardless of their nationality?

Answer 19

poverty

Question 20

o MDRTB and XDRTB are true emergent diseases. Briefly sum up the factors that these emergent diseases derive from.

Answer 20

o Derive from prolonged treatment – when sporadic it allows antibiotic resistant bacteria to flourish

o Failure to assess the correct antibiotic for treatment of specific strains

Question 21

o Review Paul Farmer’s story of a Peruvian peasant woman living in the slums of north of Lima who developed TB. Why is this saga much more than a case of medical mismanagement? What is the “ultimate” solution to TB?

Answer 21

o MDRTB is essentially untreatable bc of the expenses of drugs – economic development issue, ultimate solution to tb is to focus efforts on economic development bc it is a disease of poverty

Question 22

in 1980, reports came out of young men in New York City suffering from unusual diseases. What one thing did the victims have in common? What other groups were eventually found to be suffering from the same illness?

Answer 22

• They were gaymen

* Urban immigrants (Haitians), transfusion patients, intravenous drug users,

Question 23

o In 1987, US President Reagan finally publicly acknowledged the existence of the AIDS epidemic. Who were the disease’s “innocent victims” he mentioned in his speech?

Answer 23

o T5hose who contracted via blood transfusions or the children of intravenous drug users

Question 24

o HIV was formally recognized as the cause of AIDS in 1984. Outline the three routes HIV is most transmitted by.

Answer 24

o Exchange of bodily fluids: sexual contact, blood to blood contract ,or mother to fetus

Question 25

o In terms of the history of how the discovery of HIV came about, what did the appearance of the disease among hemophiliacs and those receiving blood transfusions indicate? Who are in the group that became known as the 4-Hs? What was this group then subject to?

Answer 25

o Indicated blood supply might be a source of contamination

o Homosexuals, hemophiliacs, Haitians, heroin addicts – subjected to stigmatization and ostracization
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Question 26

o Briefly describe how the view of AIDS as “God’s wrath” posed a dilemma for the male gay community. How was the stigmatization that Haitians faced different?

Answer 26

o Was seen as a punishment for being gay – thought that there is something unhealthy about the gay lifestyle- worries abt erosion of rights

o Stigma of Haitians as evil, practices of black magic and voodoo

Question 27

one mechanism researchers have focused on is bushmeat hunting in Africa. Briefly sum up Stephanie Rupp and colleagues’ argument that the emphasis on a bushmeat hunter as the “index case” of HIV is misplaced.

Answer 27

o Larger context of colonial activities at the time were implicated in the emergence

o The expansion of agriculture, forced labor + labor migration, access to guns for hunting, domestication of primates by colonists, and invasive colonial medical practices

Question 28

o HIV remains pandemic. Which countries are currently hardest hit by HIV/AIDS? How is HIV transmitted in this region? Briefly describe the social processes that contribute to the spread of HIV in this region.

Answer 28

o Sub Saharan African countries hardest hit – through heterosexual contact and from mothers to fetus

o Colonial period led to men searching for work – few opportunities for female labor resulting in prostitution without use of protection due to gender inequality

Question 29

• As discussed in the lecture and the text, briefly explain how women’s health is seen as synonymous with reproductive health. In this perspective, whose body is ideal? Whose is defective?

Answer 29

• Reproductivity - men are seen as productive, women are seen as reproductive
o Historically - hysteria - sometimes referring to menopause or just females in general
• Female reproductive physiology is viewed as complicated
o Male physiology as ideal; female as defective
• Women’s reproductive lives have become medicalized

Question 30

outline various cultural perspectives on conception using the traditional biomedical ‘’story” of the sperm and the egg, the view from the patrilineal society of the Kaulong, and the practices of the Bari of Venezuela as examples.

Answer 30

• Gendered gametes- sperm as male, eggs as female
• Biomedical views of conception reflect the “princess ovum” being “rescued” by a “sperm in shining armor” - conception story around the sperm being active vs passive egg
• Patrilineal societies downplay the contribution to conception
o e.g. kaulong of New Guinea see the female body as housing the fetus placed in the womb by ancestral spirit
• The bari indians of venezuela
o A fetus is nourished and developed over time with repeated washes of semen
o “see how a woman grows fat while the man grows thin”
o A woman’s body is a vessel where men do all the work

Question 31

, compare the differences between human menstruation and non-human estrus (e.g., human ovulation is not visual).

Answer 31

• Menstruation unique among humans
o No estrus (heat) or visible signs during ovulation
o Sexually active throughout ovulatory cycle
o Menstruation is the last phase of an ovulatory
cycle and only occurs if conception has not taken place during that
cycle.

Question 32

Briefly outline the three evolutionary hypotheses for why humans menstruate.

Answer 32

o 1. Adaptation as a defense against pathogens carried by sperm bc menstrual blood vis rich in immune cells + no estrus
o 2. Menstruation a byproduct of thinning of endometrium in humans. Only humans have the last part of endometrial development occur whether there is an egg to implant – results in period
o 3. Ovulatory cycling in nature, not the mensturation – cycling of endometrium more energy efficient then maintaining it for an extended period of time – metabolic rate increase in luteal phase = more efficient to shed endometrium if no implantation than to maintain

Question 33

o What is meant by the “modern period”? Outline key influential factors in the emergence of the modern period. How does the modern period relate to conceptualizations of the body?

Answer 33

• Changing views of menstrual periods over the 20th century:
0. Creating of new technologies (e.g. tampons- easily concealable)
1. Sex and hygiene education (e.g. toxic shock syndrome)
2. Changing beliefs about menstruation (e.g. sex during menses)
• Made periods more manageable
0. In line with new conceptualizations of the body
• Efficient, predictable and presentable

Question 34

first menstruation (menarche) marks not only biological reproductive maturation but also a social transformation to a new status (i.e., woman). What does menarche also symbolize in India? Briefly describe the symbolism of menarche among the Apache of Arizona.

Answer 34

o menarche often symbolizes new restrictions on a girl’s movements and activities, as she is now considered marriageable and vulnerable to sexual
overtures
the Apache of Arizona,
rituals following the achievement of menarche are celebratory and
symbolically rich and complex. The girl is thought to take on some of
o the powers of the deity known as the Changing Woman, who has
powers to enhance fertility, health, and material abundance. Thus,
menarche is an opportunity to celebrate a girl’s transition to
womanhood, her health, and her productive value to the group

Question 35

• Is PMS universal? Has a biological marker been found that correlates with reported PMS symptoms?

Answer 35

• Not universally recognized
• Not typically associated with societies that perceive menstruation as health, youth, fertility, and/or femininity
• No specific biological marker associated with symptoms

Question 36

briefly sum up the factors supporting PMS as a culture bound syndrome. As discussed in the text and in class, what may PMS reflect (e.g., how does PMS relate to 19th century hysteria)? When does the recognition of PMS become more likely in non-Western societies?

Answer 36

It appears
that although menstrual symptoms are widely recognized, PMS
historically was not universally recognized as a medical syndrome
and was much less frequently noted in subsistence societies, where
menstruation is more often perceived as a sign of health, youth,
fertility, and femininity than in the United States or in European
countries (Johnson 1987)

• 19th century hangover:
  ○ Women as naturally abnormal with troublesome biologies
  ○ Women’s complaints (e.g. female rage) as mental health
  ○ PMS as a modern version of hysteria
  ○ Reinforcement of the idea that the female body is a defective male body - when not in a state of maternity – dysfunctional
• recognition of PMS becomes more likely
  with exposure to and adoption of Western societal norms and practices

Question 37

what may be responsible for the global falling sperm counts? Briefly explain the medicalization of male sexual dysfunction. As discussed in class, how may this relate to ideals surrounding male gender (i.e., what it means to be a man)?

Answer 37

• Global falling sperm counts may be due to exposure to environmental estrogens (e.g. EDCs, PBCs, DDT)
o Through epigenetics, BPA is associated with a variety of disorders and diseases
• Medicalization of male sexual dysfunction: erectile dysfunction
• Viagra: “gentlemen, start your engines”
o Focus on performance creates new standards of normal across male life span
 ED as a problem needing a pharmalogical solution
• Men emasculated without typical sexual function – idea that men are functional bodies

Question 38

briefly sum up the different forms of female genital cutting (FGC) and where FGC occurs. Identify key local explanations for the practice of FGC.

Answer 38

1. Clitoridectomy – simplest form, only clitoris or clitoral hood is removed
2. Excision, clit. And part or all of labia minora removed
3. Infibulation, most radial, removal of clitoris, labia minora and most or all of majora. Remaining skin is stitched together, leaving a small opening only for urine and menstrual blood. Stitches must be removed for intercourse and birth, usually restitched after birth
   - Local explanations for the practice of FGC include preparing a girl
   for marriage and increasing her marriageability, emphasizing a
   woman’s femininity by reducing the likeness of her genitals to those
   of males, enhancing fertility, maintaining female purity and virginity, solidifying a girl’s identity and membership within the group, or
   establishing the appropriate bounds of female sexuality.

Question 39

o What is meant by the statement, “Social customs, however, are not ‘pathologies’; and such a view is a poor starting point for change since it is not one necessarily shared by the people whose customs are under attack.”

Answer 39

 You cannot solve the issue by treating it pathologically; need to have some cultural relativism

Question 40

o Briefly outline the short-term and long-term health consequences of FGC.

Answer 40

 Short: pain, infection, or hemorrhage
 Long: difficulties with urination, UTIs, menstrual difficulties, scarring, cysts, painful sex or sexual dysfunction, problems with pregnancy or birth, and emotional/sexual suffering

Question 41

o Is male genital cutting considered in the same way? What reasons for different treatment were identified in class?

Answer 41

 No, circumcision is treated differently - medicalized, seen as hygenic

Question 42

• In terms of contrasting views of Other, compare “female genital mutilation” with “corrective surgery”.

Answer 42

o FCG- seen as barbaric cultural practice, mutilation, disfiguring the innocent, “third world” – theirs, imagery of a girl undergoing the procedure (eyes not blacked out), personal
o Corrective surgery- seen as scientific normalizing surgery, medicalized clitorectomy, corrects the deviant, 1st world = ours, imagery of extreme genital close ups – full shots have eyes blacked out, scientific/privacy

Question 43

• As discussed in the section on pregnancy in the text, what is NVP? What was it commonly called previously? What have some researchers argued NVP evolved to protect the embryo from?

Answer 43

o nausea and vomiting in early
pregnancy (NVP).
o Previously called morning sickness
o Possibly protects embryo from toxins the mother might ingest during early pregnancy

Question 44

o Food aversions of early pregnancy may stem from the mother’s immune system being suppressed during pregnancy. Why is the immune system suppressed? Cross-culturally, what is the focus of most food aversions of early pregnancy?

Answer 44

 because the developing embryo produces antigens that
are not the same as those the mother herself produces. These
“foreign” proteins derive from the father’s genes. For gestation to
proceed, the mother’s immune system must be suppressed to some
extent to prevent her from generating a response to the foreign
proteins expressed by the embryo
 focus tends to be animal products, which are more likely sources of infectious pathogens than plants

Question 45

o The craving of specific foods during pregnancy is a widely recognized dietary phenomenon across societies, including non-food items such as clay. Briefly sum up the known benefits of clay consumption during pregnancy.

Answer 45

 Clay particles have large SA – ability to bind foodborne toxins, preventing them from being absorbed into maternal circulation
 Quells unpleasant gastrointestinal symptoms of NVP
 Dietary supplement – high calcium

Question 46

• Among the Bari of Venezuela, how can a child how more than one biological father? What is having two fathers associated with?

Answer 46

o A fetus is nourished and developed over time with repeated washes of semen
o “see how a woman grows fat while the man grows thin”
o A woman’s body is a vessel where men do all the work
o Man gets tired = bring in other men A child can have multiple biological fathers
o Two fathers is associated with greater maternal health and childhood survival

Question 47

• As discussed in the text, what is SIDS? Briefly sum up the relationship between infant sleep and SIDS in terms of infant breathing, co-sleeping, and the adult sleeping environment.

Answer 47

o Sudden infant death syndrome- a mysterious disease in which infants, mostly between the ages of two months and six months, simply stop breathing and die in their sleep
- Reduced risk with bed-sharing - infants who sleep alone during this period have no
rhythmic stimulus against which they can pattern their breathing. As
his research has demonstrated, in a solitary sleeping environment,
infants are more likely to go into deeper layers of sleep, from which it
is more difficult to be aroused (McKenna and Mosko 1993). It is
during deep sleep that the risk of SIDS increases. Sleep apnea, the
cessation of breathing during sleep, is more likely to occur at this
o time and, in infants with disordered breathing patterns, can lead to
SIDS. In contrast, when bed-sharing, infants are exposed to the
parent’s rhythmic breathing and their presence in bed produces a
lighter sleep, during which the infant is more easily aroused.
Therefore, infants are less likely to go into the deeper layers of sleep,
o occurs during a relatively narrow window of time in infancy
constitutes an important clue to its underlying cause(s). During this
period, infants’ breathing undergoes a transition from a pattern of
reflexive breathing to one under greater control by higher brain
centers. Some infants
experience disordered breathing during this transition, leading to an
increased risk of SIDS.

Question 48

• Human menopause (like menstruation) is unusual as compared to other primate groups. Briefly outline the three evolutionary hypotheses (e.g., the “grandmother hypothesis”) attempting to explain the evolution of menopause. How has biomedicine tended to view menopause?

Answer 48

• 1. “grandmother hypothesis,” which posits that natural selection
favored truncating a woman’s reproductive span to reduce
competition between her offspring and her grandchildren and allow
for increased grandmaternal care of grandchildren
• 2. menopause may be a byproduct of
atretic follicles, which produce the progesterone required to support
pregnancy
4. menopause is of recent
origin, occurring only when it was “uncovered” by the lengthening
human lifespan - Because human ancestors did not live as long as
contemporary humans, they never would have experienced
menopause. As discussed earlier, this hypothesis fails to consider
that low life expectancies in the past, as in the present,
disproportionately reflect high levels of infant and child mortality rather than old age mortality, and many women would have lived
into their postreproductive years.

Question 49

How did the standard use of HRT solidify this view of menopause?

Answer 49

• biomedical views of
  menopause tend to pathologize the cessation of ovulation.
  Menopause has become an “estrogen deficiency disease” caused by
  “ovarian failure” and “treated” with hormone replacement
  therapy (HRT)

Question 50

o Margaret Lock studied menopause in a variety of non-Western cultural settings and in particular the variability of menopausal symptoms between different societies. Briefly sum up the differences in views of menopause and menopausal symptoms among Japanese women.

Answer 50

• In Japan, there is no term that corresponds
  precisely to menopause (Lock 1998). Instead the term koˉnenki is
  used to describe a female climacteric—a long, gradual process of
  change in middle-age women, of which the end of menstrual cycles is
  just one part. In her interviews with Japanese women, Lock found
  that the end of menstruation is not seen as a distressing event to
  them
• • Japanese women less likely to report trouble sleeping, hot flashes, and cold or night sweats
• Japanese women’s language, including their self-assessment
  of koˉnenki stage and the linguistic demarcation of symptoms, seems
  to be more fine-grained than the Western biomedical terms of
  menopause status and hot flash, and may offer insight into subtle
  differences in the experience and underlying physiology of
  menopause”

Question 51

• As discussed in the lecture and in the text, there is a relationship between reproductive events and breast cancer. Compare differences in reproductive events and breast cancer rates among women in industrialized societies (i.e., North America) and in hunter-gatherer societies.

Answer 51

• Women in industrialized societies have higher rates
o As compared to common reproductive pattern of women in foraging societies
• Link between the number of ovulations and breast cancer through the hormone estrogen
o If ovulatory cycles (periods) are continuous for a long period of time, a woman is exposed to continual spikes of estrogen
• Pregnancy and breastfeeding both interrupt this cycle and allow breast tissue to differentiate (milk producing glands)
o Differentiation is protective against the effects of estrogen on breast cancer
• Less kids in industrialized societies = less differentiation = higher likelihood of breast cancer

Question 52

• Define health disparities. What points to the underlying causes of health disparities? What are health disparities directly or indirectly associated with? To address health disparities, what do we need to navigate?

Answer 52

o Health disparities: indicators of a relative disproportionate burden of disease on a particular population
o Directly or indirectly associated with social, economic, political, and cultural inequalities
o Need to navigate the interstices between the person and the wider social + historical contexts

Question 53

• Who are the most vulnerable to disease in urban settings? Briefly describe what is known about the world’s urban poor. In terms of health and wellbeing, what are the four key concerns for the urban poor?

Answer 53

o The urban poor are most vulnerable
o Higher mortality and morbidity, lacking infrastructure leading to health issues (inadequate public health care + sanitation, transport systems)
o Four key concerns: homelessness, violence, malnutrition, and infectious diseases
•

Question 54

• Define synergism. What synergistic relationship is most commonly cited? What is meant by syndemic? Does it refer solely to biological afflictions?

Answer 54

o Synergism: the interaction of conditions/diseases produce an effect that is greater than the sum of the individual conditions/diseases
o Most commonly cited: malnutrition weakens immunity increasing susceptibility to infectious disease further impacting nutritional status
o Syndemic: a set of interactive and mutually enhancing epidemics involving disease interactions.
 Refers also to the forces that cluster afflictions in persons, places, and/or times

Question 55

• Briefly describe inner-city syndemics

Answer 55

o Living in poverty increases likelihood of exposure to TB (overcrowding, homeless shelters)
o More likely to develop active TB due to compromised immune system due to other infections (HIV. Hep c) and malnutrition
o Poverty and discrimination place the poor at unequal access to diagnosis and healthcare
o Residential instability and economic and social crises in poor families (ie stress)

Question 56

• Briefly describe the Slavery Hypertension Hypothesis. Is this hypothesis supported by pathophysiological, historical, and anthropological data?

Answer 56

o Similar to thrifty gene hypothesis
o High rates of hypertension among Black people in the New World are due to selection bias preferring individuals who retain more sodium among Black slaves during the Middle Passage.
o The hypothesis is strongly disputed

Question 57

• As discussed in the section “Biology of the Stress Response”, what is the stress response? What is unique about humans and the stress response (as compared to other animals)? Define allostasis and sum up how it differs from homeostasis.

Answer 57

o The stress response: the way your physiology is altered when you are exposed to a stressor
o Unique in humans – large brain + consciousness allows the activation of a stress response just by imagining a stressful situation – the perception of a stressor is an important determinate of whether a stress response will be activated
o Allostasis: the range of normal for different physiological systems varies by circumstances
 Different from homeostasis in that the normal range shifts In response to environmental stressors

Question 58

stress for humans is often more chronic. Sum up the two key reasons for this.

Answer 58

o One is that humans have a very large brain that allows them consciousness, language, and extensive memory. here are numerous means by which our large brains allow for increased perception of stress, even in the absence of actual stressful events. Chronic anxiety about the future requires persistent vigilance and ongoing activation of the stress response
o The second reason is that the social situations in which contemporary humans live are themselves often the source of stressors.

Question 59

o Was chronic stress typical for our Paleolithic ancestors? Why? Were the lives of our Paleolithic ancestors “nasty, brutish, and short”? How do we know this? Briefly describe how the socioeconomic structure differs for hunter-gatherers as compared to state-level societies.

Answer 59

 No, contemporary stress is novel – we are noy well adapted to it
 although our Paleolithic ancestors had a fully modern brain size and well-developed linguistic capabilities, the social environments they lived in were different from those in which most twenty-first-century peoples live
 No, studies of contemporary hunter-gathers and the osteological record of paleolithic peoples show this characterization is false
 hunter-gatherers spend relatively little time actively engaged in subsistence work and have plenty of time for leisure and social gatherings + egalitarian socioeconomic structure
 one of the major contemporary sources of stress, social and economic inequality, was not likely to have been typical of the lives of our ancestors

Question 60

briefly describe how 19th and early 20th century cadaver dissections biased views of biological normalcy. How is this also seen in contemporary views of blood pressure and age?

Answer 60

• cadavers most often came from the unidentified poor. The sizes of various organs were duly noted, including the adrenal gland. The adrenal gland enlarges when it chronically secretes high levels of epinephrine and cortisol, and hence the perception of the normal adrenal was that of a large organ. It was often remarked on when a cadaver of a higher-class person was dissected that the adrenal gland was unusually small. They were thought to suffer from the syndrome “idiopathic adrenal atrophy
• it is often assumed that blood pressure rises with age. Yet studies of other more traditional cultures or nuns living in secluded cloisters show that aging is not necessarily associated with increased blood pressure.
• Thus, what is seen as a part of normal aging may be a byproduct of aging under stressful psychosocial conditions.

Question 61

• As discussed in the section “Inequality, Stress, and Health”, what has research shown the variation in life expectancy among wealthy countries as related to? Is relative income or absolute income more important in this research? What is the health like for people living in countries where resources are distributed more evenly?

Answer 61

• Research has shown that variation in life expectancy among wealthy
countries is closely related to how wealth is distributed within those
countries. That is, relative income may matter more than absolute
income.
• People living in countries where resources are distributed more evenly have better health regardless of their income than people living in countries in
which there are substantial differences between rich and poor.

Question 62

riefly describe the Whitehall studies and the key findings of these studies.

Answer 62

• The Whitehall studies are a set of well-known studies carried out among British civil servants since 1967, and these studies enabled researchers to tease out the relationships between social inequality and health. The British civil service is highly stratified, with distinct ranks assigned to different classes of employees. The hierarchy is unambiguous, with each grade subdivided further into higher and lower ranks. With ample data on health characteristics of individuals of all ranks, it provides a “natural experiment” for examining the relationship between hierarchy and health.
• The Whitehall studies show that there is a clear gradient in health, with the highest classes having the best health.
• As you move down the occupational hierarchy, health
  gradually worsens, such that overall death rates among the lowest classes are almost one and a half times those of the highest classes

Question 63

o Define social cohesion. What does it allow? Do hierarchical societies facilitate this?

Answer 63

Social cohesion refers to shared values, goals, and
distribution of resources within a society. It also allows for individual
participation in social life, through involvement in meaningful social
activities and organizations. Hierarchical societies tend to be less
integrated and offer fewer opportunities for social participation and
network formation, especially among the lower classes

Question 64

 Briefly describe how Japan provides an illustrative example of the health benefits of social cohesion.

Answer 64

• Japan has the highest life expectancy of any country in the
world, at 83 years. It has also been characterized as a society with a
strong group ethos, where individuals are secondary to the group,
and the group’s well-being is privileged such that selfish individual
behavior is not tolerated. The income distribution in Japan is also
much narrower

Question 65

 Briefly describe the paradox that Kerala (India) seems to present.

Answer 65

• Kerala’s per capita income is among the lowest in India, yet its health
statistics are astonishingly positive. Much has been written about the
apparent paradox that Kerala seems to present, but social cohesion,
participation in the public and political spheres, high rates of female
literacy, strong labor unions, accessible health care, and various
forms of social security have been highlighted as contributors to
good health there

Question 66

 Briefly sum up how the collapse of the Soviet Union provides an example of the health impact of when a society becomes less socially cohesive.

Answer 66

• in the aftermath of the breakup of the Soviet Union, adult health took an unexpected turn for the worse. Mortality of Russian men soared, their life expectancy declined
• After privatization of many enterprises previously run by
the state, the income distribution widened and unemployment rose,
generating an increasing gap between rich and poor.
• There were rising perceptions of greater inequality, fewer
sources of social support, and a general lack of cohesion.

Question 67

o In terms of social support, what is lifestyle incongruity?

Answer 67

o Lifestyle incongruity refers to inconsistency between
one’s real or desired lifestyle and one’s education and occupation,
such that the expectations associated with a particular lifestyle (i.e.,
accumulation of material possessions) are higher than what one’s
education or occupation can reasonably maintain.

Question 68

 Briefly sum up Dressler’s work in Brazil with blood pressure

Answer 68

• Dressler found that higher levels of lifestyle
incongruity were associated with higher blood pressure. Having—or desiring—more material manifestations of high status while economic resources are insufficient generates higher blood pressure, an indicator of the stress response. also found that the stress associated with lifestyle incongruity can be attenuated by social support.

Question 69

describe McDade’s work with lifestyle incongruity and antibodies against EBV among Samoan adolescents.

Answer 69

• Samoa has been undergoing rapid social and economic lifestyle changes, with increasing availability of material goods associated with Western lifestyles and greater access to Western-style education.
o McDade reported that adolescents living in households
with greater lifestyle incongruity had higher levels of antibodies
against Epstein–Barr virus (EBV). EBV antibodies are a marker of
stress levels—increased cortisol levels reduce the immune system’s
ability to maintain pathogens in a latent state
o High levels of EBV antibodies suggest a reduction in immunoprotection that keeps this virus in the latent state. Thus, living in households where accumulation of material goods exceeded economic resources was associated with higher stress levels among adolescents.

Question 70

 How did McDade explain the findings that seemed to contrast Dressler’s work?

Answer 70

in contrast to Dressler’s work, McDade found that
adolescents living in households with high levels of social support
had higher levels of stress than those with fewer sources of social
support or those who were less socially integrated. He suggests that
in Samoan culture, social support is associated with the subsuming
of the individual’s interests to those of the family or community, a
theme consistently noted by ethnographers working in Samoa. Thus,
networks of kin impose substantial financial and social burdens on
individuals. Individuals firmly embedded in such networks may
experience heightened anxiety about not having sufficient economic
resources to maintain their desired lifestyle because of the
obligations these networks put on them

Question 71

• As discussed in the section Race/Ethnicity, Racism/Discrimination, and Health in the United States”, what did Richard Lewontin’s (1972) famous study find?

Answer 71

o The study found that little of human biological variation could be accounted for by racial affinity

Question 72

o The use of race as a biological category is remains very common in health research. Is there evidence that races differ in their overall health in ways that can be directly traced to biological differences between groups?

Answer 72

There is little evidence suggesting that races differ in their overall
health in ways that can be directly traced to biological differences
between groups

Question 73

o Briefly sum up Clarence Gravlee’s argument that “race becomes biology”.

Answer 73

Social inequalities shape the biology of racialized groups, and embodied inequalities perpetuate a racialized view of human biology.

Question 74

o What is embodiment? Within this view, how are biologies shaped? What can leave “vastly different bodily signatures”? How does this change the view of group differences in particular health outcomes (such as blood pressure)?

Answer 74

 Embodiment refers to how individuals incorporate, biologically, the world in which we live, including our societal and ecological circumstances
 Privilege and discrimination can leave vastly different bodily signatures. Those with multiple identities subject to discrimination are likely to suffer the most, as noted in the earlier discussion of intersectionality, and in ways that might be unexpected.
• Ex. Discrimination toward African americans leads to higher cortisol – embodiment

Question 75

o Briefly describe Krieger’s three types of discrimination.

Answer 75

o Institutional discrimination: discriminatory policies or practices carried out by the state or nonstate institutions
o Structural: the totality of ways in which societies foster discrimination, In which mutually reinforcing systems of discrimination reinforce discriminatory beliefs
o Interpersonal: directly perceived discriminatory interactions between individuals

Question 76

o Regarding racial discrimination in medical care, sum up Schulman and colleagues’ findings with different treatment for Black and White patients with similar cardiac symptoms.

Answer 76

Schulman and his colleagues
reported that Black patients were much less likely to be referred for
treatment than were White patients, and Black women were the least
likely of all to be referred, although all patients were describing the
same set of symptoms.