fr the final Flashcards
What are the different paradigms we use to view health?
→ Structural-Functionalist
→ Conflict
→ Symbolic Interactionist
→ Feminist
→ Sociology of the body
→ Indigenous
Structural Functionalist Paradigm
It sees society as a harmonious social system made up of interconnected parts that work to maintain order and stability.
It investigates how large-scale social structures and institutions work together to have an influence on human behaviour.
Ex: Educational institution
They study human behaviour by using an empirical approach (using experience or observation rather than logic) to discover the impact social structure has on behaviour.
It understands health + illness as social roles and they view these social roles as being attached to the institution of health care.
It emphasizes that good health and effective health care are essential for a society’s ability to function.
What is the Sick Role?
Right?
Duties
The expectations of others /society regarding how one should behave when sick.
People learn from culture on how to behave in response to health and illness.
RIGHTS
- You’re allowed to not take responsibility for your illness
- You are temporarily exempt from regular role responsibilities
DUTIES
- You have a duty to try and get well and resume responsibilities
- You need to seek competent help and cooperate in the process of doing well
Conflict Paradigm
Capitalist society is composed of a bunch of competing interest groups in a constant power struggle with one another and composed of inequality.
It understands health + illness as professional constructs
Their attention is on the political economy of health and social inequalities in the distribution of an illness and access to health care services
Symbolic Interactionist Paradigm
Focuses a lot on the interaction of individuals who produce the construct of society.
It views society as a socially constructed product of everyday interactions b/w individuals
It understands health and illness as interpersonal meanings.
Feminist Paradigm
It understands health and illness as gendered experiences.
Emphasizes the presence of oppression in health care.O’Brien + other sociologists believe that Western social scientific thinking has been dominated by androcentric thinking
(The dominance + privileging of the masculine perspective when studying the social sciences + focused on men)
This paradigm focuses on the oppression of women over time
In HSCI, this paradigm recognizes the gender roles in society and how it contributes to gender inequality and how it shapes the lives and health of both genders
Life Course Perspective Paradigm
Looks at early childhood, adulthood and elderly
Understands health + illness from the life course perspective
It sees society as a intersection of individual biographies and historical events
Sociology of the Body Paradigm
This paradigm believes that embodiment is a vital part in our experience w/ society
Their focus is on how society and social relations shape and are shaped by human bodies
Applications of epidemiology
Identifying the cause of a new syndrome
Assessing risks of exposure
Determining whether treatment “x” is effective
Identifying Health Service Use Needs + Trends
Identifying Practical Prevention Strategies
What is the biomedical model?
focuses on purely biological factors and excludes psychological, environmental, and social influences. It is considered to be the leading modern way for health care professionals to diagnose and treat a condition in most Western countries.
What are the Different Ways to View Health?
It is a social construct and we all have ideas on what this construct is based on our experiences, our culture, our social, our political and historical context.
What happened from 1867 to early 1900’s ?
no income or social services programs established at federal/provincial levels
there was no federal involvement
British North America Act fed marine hospitals + quarantine
the province is responsible for health/ there’s a provincial responsibility
What happened from the 1920’s to 1930’s?
first federal Department of Health created in 1919
increasing recognition of problem of vulnerability
beginning of growth of hospitals
What happened from 1947 to 1961?
Sask initiated first hospital insurance plan in 1947, other provinces followed
Hospital Insurance and Diagnostic Services Act in 1957 insures hospital care
all provinces w/ hospital had insurance systems by 1961
What happened in 1962?
Sask established medical insurance plan for physicians’ services
What happened in 1966 to 1972?
Medical Care Act 1966
this was implemented in 1968
federal government to share the costs 50-50 w/ the provinces for all medical services provided by a doctor outside of hospitals
What happened in 1977?
Established Programs Financing Act
cost sharing was replaced by block funding
funding was cash payments and taxing policies based on population size and GNP
there was federal funding for extended health care: nursing + long-term care
there was now extra billing for physicians
there was also user fees
What happened in 1984?
Canada Health Act- principles + criteria for provinces to receive federal support
there are prohibitions of extra billing and user fees added to existing components
What are the 5 principles of Canada Health Act?
C: COMPREHENSIVENESS- all medically necessary services provided by hospitals, doctors and dentists working in the hospital should be covered
U: UNIVERSALITY- certain groups should not have an advantage to priority access to providers - just because you have more money/power should not make you get better treatment and prioritized - uniform delivery and conditions
the plans that are existing in each province must entitle all insured persons to health insurance coverage on uniform terms and conditions
P: PORTABILITY- you are covered while traveling within Canada or if you go to the US - if there is an emergency in Alberta and you’re from BC, you’re charged the same rate as in BC
the system must cover persons when they move to another province or territory or when they travel
P: PUBLIC ADMINISTRATION- the provincial government is accountable to us, the people
operated on a non-profitable basis by a public authority that is accountable to the provincial/territorial government
A:** ACCESSIBILITY**- must have reasonable access without financial barriers
the system must have reasonable access to medically necessary hospitals + physician services w/o financial or other barriers
What are the key features of the Canadian Health Care System?
- Health care delivery is the responsibility of the PROVINCES
- Privately delivered and publicly financed
- Private providers and public not-for-profit hospitals (hospitals have budgets)
- Fee-for-service funding and global budgets
- Choice of practitioner
- Universal coverage applies to less than ½ of total health care expenditures ( we spend a lot of our own money on our healthcare needs)
What was the spending trend from 1975-2016?
over time, there was a steady growth up
about 11% of GDP (gross domestic product)
What is Canada’s health spending like in 2023? (from 1975-2023)
about $334 billion was spent on healthcare in 2023
there has been a steady increase
What did the total health expenditure as a percentage of GDP in Canada from 1975-2016 say?
it went up around 11%
we’re at 12.9%
How is the spending distributed in health care?
25.6% on hospitals
13.8% on physicians
13.9% on drugs
What is the health spending like on seniors ?
for age 65+ in years 2011 to 2021…
> the share of spending went from 14.4% to 18.5% - it’s steady
> the share of the population went from 44.9% to 43.2%
aging has an impact but not the only driving factor
How much of BC’s budget gets spent on healthcare?
43%
- it is increasing
- percentage that gets spent on education decreases
What provinces spend less than average ($5167) on healthcare?
BC ($4872)
ONTARIO ($4883)
PEI ($4988)
NB ($4350)
NS ($5064)
How much is BC spending on per person for healthcare in 2023?
$9182
4.6% per person growth
Which country spends relatively more on their healthcare than any other country?
America
almost 20% of the GDP is spent on healthcare in the US
America is the highest spender
Canada spends b/w 10% to 15% of the GDP
Canada is one of the top senders (#4)
What was the method,findings, and conclusion of Rudolf Virchow’s Study in 1848?
- Typhus -
Method: sent to investigate an epidemic of typhus
Findings: feudalism, unfair tax policies + lack of democracy leads to poor living conditions, inadequate diet and poor hygiene which results in the epidemic of typhus
Conclusion: preserving health + preventing disease requires “full + unlimited democracy” and radial measures rather “mere palliative”
What is the traditional/conventional health promotion?
- biomedical model
- pathogenesis-origins of disease
- emphasis on personal factors/consciousness raising
What is the alternative health promotion?
- Upstream approach, emphasizes social determinants of health (SDoH)
- Salutogenesis-origins of positive health
- Emphasis on structural factors
What are the personal determinants (individual level)?
- lay health beliefs
- self-health management
- self care capacity
- coping skills
- biology + genetic endowment
- health protective behaviour
- personal health practices
- healthy lifestyle
What are structural determinants?
-
social environment
> socioeconomic status/ Socio-Economic Position
> social status
> income + income distribution
education
employment + working conditions
> gender, ethnicity/race, age, culture
social support networks
- physical environment
- healthcare + social services
> disease prevention
health promotion
healthy child development
What are the 12 key determinants of health?
- income + social status
- social support networks
- education + literacy
- employment/working conditions
- social environments
- physical environments
- personal health practices + coping skills
- healthy child development
- biology + genetic endowment
- health services
- gender
- culture
The social gradient + health
a graded association b/w the indicator of socioeconomic status + population health
What did marmot say about social hierarchy?
depending on where you stand on the social hierarchy is related to your chances of getting ill and your length of life
Socio-economic position
the social + economic factors that influence what position individuals and groups hold in the social structure of a society
How does socio-economic position impact health?
- political, cultural and institutional factors influence how socio-economic conditions influence health incomes
- location in society impacts exposures and resources used for health
What are the 3 explanations of social gradient?
- materialist explanation
- cultural behavioural explanation
- psychosocial explanation
Materialist explanation
-DIFFERENTIAL EXPOSURE HYPOTHESIS: greater exposure to psychosocial stressors from financial problems, neighbourhood issues and social isolation
- people that are exposed to both positive and negative exposures over their life and outcomes in adulthood are indicators of advantages + disadvantages
- differences in exposure to stress influence biological factors that influence health outcomes
Materialist vs. neo-materialist explanations
materialist explanation :
- emphasizes the material conditions under which people live
- aspects of the social structure (for example: differences in socio-economic status) are powerful determinants of health
- influenced by the political economy perspective of the conflict paradigm
neo-materialist explanation:
- health is not only affected by differential access to social + economic resources
- it’s also affected by the level of funding invested in social infrastructure
Cultural behavioural explanations
- DIFFERENTIAL VULNERABILITY HYPOTHESIS: all have stressors; position in social gradient can make some worse than others
- helps us with learning how to behave in society
- lower socio-economic status individuals are less healthy due to a result of engaging in health-related behaviours such as smoking or poor eating habits
! culture plays a broad part in shaping people’s ideas about health and illness and their subsequent treatment activities
- culture influences differences in health outcomes associated w/ membership in various cultural groupings
! Leduc + Proulx found that ethnocultural identification is an important determinant of health-care behaviour
Psychosocial explanation
- people’s interpretation of their standing in the social hierarchy matters
- sense of relative deprivation can generate feelings of low self-esteem, shame and envy
- it’s not only absolute deprivations but also about where you are in the hierarchy
What is the traditional focus vs the modern focus for quality of work and health?
Traditional: workplace
Modern: work organization and employment conditions
How do stressful job characteristics result in adverse health effects?
2 conceptual models
- the demand-control model
- the effort-reward imbalance model
The demand control model
2 dimensions:
- the psychological demands on the working person
- the degree of control the person has over work schedules + job conditions
- low level of control + high job strain = negative health outcomes
Effort-reward imbalance model
- emphasizes the importance of social reciprocity in our work lives
- there are adverse effects on health if…
> time + effort devoted to work are not matched by adequate rewards: - income
- career advancement opportunities
- job security
Precarious employment
seen as a social determinant of health
a multidimensional construct encompassing dimensions such as…
- employment insecurity
- individualized bargaining relations b/w workers and employers
- low wages + economic deprivation
- limited workplace rights + social protection
= powerlessness to exercise workplace rights
What does precarious employment and health include?
- workplace closure studies
- effects of downsizing on surviving employees
- perceived job insecurity
- flexible work environment studies
What are the precarious employment and health pathways?
- higher exposure to working conditions w/ harmful health consequences
- limited control over professional and personal lives (stress)
- social + material consequences of precariousness
- decision making
- family material wealth
- absolute deprivation - housing
- under and unemployment
Income adequacy
- sufficient income to meet needs
- this and relative position are important determinants of health on the social gradient
What is the general adaptation syndrome ?
- alarm
> body recognizes a stressor and is in the state of alarm
> activation of flight or fight response + HPA axis
- resistance
> follows alarm reaction - removal of symptoms - exhaustion
> as result of chronic stress, the body’s resources are depleted and unable to function normally
What is the SAM system (sympatho-adrenal- medullary pathway) and the consequence ?
- a FAST biological stress response
- the autonomic nervous system activation of the sympathetic nervous system increases the secretion of EPINEPHRINE + NOREPINEPHRINE
- increased blood pressure/heart rate
- sweating
- constriction of blood vessels
CONSEQUENCES
- suppression of cellular immune function
- increased blood pressure and heart rate
- variations in normal heart rhythms (cause of sudden death)
- neurochemical imbalances
What is HPA + the consequences ?
- a SLOWER biological stress response
- the hypothalamus sends messages messages to the pituitary gland
- anterior pituitary gland secretes ACTH
- this activates the adrenal cortex to produce cortisol + other glucocorticoids
CONSEQUENCES
- pathogenic processes
> cognitive decline
> immuno-suppression
> insulin resistance
why is there a doctor shortage?
there’s a distribution problem
> more doctors choose to work in urban areas
> doctors are NOT located in the places they’re need
> even if they go to the rural areas, they tend to want to come back
> a solution to this was to get med students from rural areas that would want to actually stay there
another part of this is how doctors are practicing and who is practicing
> who is practicing medicine has shifted
> there’s more women, and they practice differently
> even if there are enough doctors that are proportional to the population, the way they practice makes a difference
-> not all doctors are going to want to work for 70 hours a week, they want a work-life balance - working less
What are the 4 hypotheses explaining gender differences in health + illness?
- role-accumulation hypothesis
suggests that taking on multiple roles leads to positive health effects - role-strain hypothesis
states the opposite of role-accumulation hypothesis - social acceptability hypothesis
suggests that women have been socialized into accepting the sick role - risk-taking hypothesis
suggest that men engage in risky behaviour, b they are socialized to do so
What is the relationship b/w health and race?
- processes of racialization are capable of affecting biochemical, neurophysical + cellular aspects of human bodies and thus health
What is the cognitive appraisal theory?
- individuals constantly evaluate their relationship with the environment
- behavioural + environmental responses determined by meaning attached to situation/experience
- there are 3 types of stress appraisals
> harm or loss
> threat
> challenge
What is social relations?
- a structural level component
- how we interact or are treated in the world based on ‘gender’
- interacts with other constructs of identity: ‘race’, ethnicity, class
- many societies show inequitable distributions of power
- idea that gender dictates relationships + interactions in the social world: in families, workplaces, etc.
What is the prevalence of ill health in the different genders?
- WOMEN across all ages are more likely to experience…
> chronic conditions
severe + moderate disability
twice the prevalence of depression
men appear to embody the mental health effects of stress through alcohol + substance use
- there is a difference in the way women and men embody + express stress
Explain ethnic differences in health-care behaviour
- ethnicity influences people’s willingness to adopt the sick role, consult a physicians and make use of formal health-care services
What are the explanations of ethnic differences in health and illness?
- the biomedical model examines differences in biophysical traits
- the cultural behavioral perspective argues that culture shapes behaviour which shapes health
- the socio-economy perspective believes the differences are due to social class
Biological determinist explanations
! several studies have attempted to treat race as a purely biological variable
! the term race is a scientifically discredited concept, there are no race-based biological differences among humans
Socioeconomic explanations
- Socioeconomic status…
> mediates the relationship b/w ethnicity and health
> influences other determinants of mental health such as…
- access of healthcare
- physical environment
- chronic stress
- a member of a socially excluded minority group will have a lower socioeconomic status leading to…
> less access to health care
> poorer living and working conditions
> fewer material prerequisites for good health
What are doctors and nurses expected to do?
- demonstrate cultural sensitivity
- exercise cultural competency
- practice cultural safety
Cultural Competence
a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations
Cultural Sensitivity
being aware of, and understanding, a deeper level of emotions that attach to your own culture and the way your culture may be perceived by others.
Cultural Safety
Cultural safety analyzes power imbalances, institutional discrimination, colonization, and colonial relationships as they apply to health care and health education.
What are User Fees?
fees charged to patients for certain services in the healthcare system
What are the myths about user fees?
some people believe that user fees will deter unnecessary use of the public system
- generates revenue for the system
- doctor’s compensating for monetary
- another myth is doctor shortage
What is the evidence for user fees?
- these fees have been repeatedly proven to negatively affect citizens
- RAND experiment: the more patients have to pay, the less they use it
- causes people to forego necessary treatment, especially elderly
- low income families reduce their use of services by about 20%
- inappropriate hospital stays do not change
- user fees are a tax on poverty and age
What is the healthy immigrant effect?
Immigrants that arrive to Canada report better health than those who are Canadian born
those who are healthy enough to deal with the stress of migrating are more likely to migrate to another country
several studies have shown that immigrants have self-reported better health status, less chronic diseases, less disability, and avoidable mortality compared to those born in Canada
their health does start deteriorate once they become accustomed to the Canadian culture
