Health, Illness and Society Flashcards
1
Q
What are the characteristics of social anthropology?
A
Interdisciplinarity, holism, non-judgemental, disaggregative, cultural perspective, local and global interest, individuals/populations/groups/societies, methodological pluralism with innovation and sensitivity, comparative, historical, language/symbols/rituals/narrative
2
Q
How is medical anthropology interdisciplinary?
A
Looks and bioscientific epidemiology, the construction of knowledge, the politics of science, norms and institutions, and globalisation
3
Q
What were some of the earliest examples of medical anthropology?
A
Pre WW2, W.H.R Rivers looked at Medicine, Magic and Religion. Also Ackerknecht looked at ‘primitive medicine’/ethnomedicine
4
Q
What is ethnomedicine?
A
Relating to disease that are products of indigenous cultural development
5
Q
What are culture bound syndromes?
A
Locality specific problems such as Hikikomori (Japan), voodoo death, cannibal compulsion, agoraphobia (Western)
6
Q
How did medical anthropology develop post WW2?
A
International public health and community health development. Kleinman used term ‘clinical anthropology’
7
Q
What is the diversification of medical anthropology?
A
Organisationally/nationally-internationally/multi-disciplinarity/theoretically
8
Q
What are the three health definitions?
A
Disease (medical experts view), illness (patients view) and sickness (society’s view)
9
Q
What are diseases?
A
Abnormalities in structure/function of body organs or systems. Pathology, biomedically diagnosed and treated. Eg cystic fibrosis has both genetic and environmental factors, and is a biochemical dysfunction
10
Q
What is Dingwall’s view of disease?
A
‘there are no…diseases in nature’ it is a social construction
11
Q
What is Eisenberg’s view of illness?
A
Illness is experiences of disvalued changed in states of being/social function
12
Q
What are illnesses?
A
People have illnesses where organs have diseases. Illnesses are the movement from independence to dependence. They are influenced by social and economic factors. Cystic fibrosis sufferers have the same disease but different illnesses due to different perspectives
13
Q
What is Cassell’s view of illness?
A
Illness is why you go to a doctor and disease is what you have after visiting the doctor. You cure a disease but heal an illness
14
Q
What is sickness?
A
The sum total of disease and illness in an individual. Also process for socialising disease and illness (worrying behavioural/biological signs are given socially recognisable meanings (Young)
15
Q
In sickness, what are the social relations of, and responses to, ill health?
A
Patients associations, fundraising for research, shared metaphorical associations/stigma, discrimination against minorities/the vulnerable/dispossessed
16
Q
What are possible examples of restricted categories (conditions that are not diseases and illnesses and sicknesses all together)?
A
Hypertension, mental health problems, hypochondria
17
Q
When did homosexuality stop being viewed as a mental illness?
A
It was removed from the DSM III in 1980 and the ICD 10 in 1992
18
Q
What are some different approaches in medical anthropology?
A
Medical ecology, cultural interpretive theory, and critical medical anthropology
19
Q
What is medical ecology?
A
It discusses the determinants of disease and suffering: natural environment, social environment, systems approach and adaptation
20
Q
what is cultural interpretive theory?
A
Semantic determinants of disease and suffering: culture, interpretation, social construction
21
Q
What is critical medical anthropology?
A
Political-economic determinants of disease and suffering: power, resistance, global systems, ethics and rights, hegemony
22
Q
What are some methods in medical anthropology?
A
Surveys, participant observation (ethnography) (important reflexive dimension), interviews (informal, semi-structured), focus group discussions, life histories, participatory/action research (essays/mapping/seasonal calendar)
23
Q
What is applied medical anthropology?
A
Critical understanding of perspectives, for better management of ill health
24
Q
What is health?
A
A human construct, not an empirical fact
25
What are the three models of health?
Medical (absence of disease etc (negative definition)), functional/sociological (can perform daily tasks), idealist (complete well-being in all areas (biopsychosocial))
26
What are other conceptions of health:
Balanced relationship to/between god, world of spirits, unconscious and constitutive elements. Being 'normal' (a commodity). May not bear any relation to one's medical history
27
What is wellbeing?
The overlap of health, prosperity and happiness
28
What do health systems include?
Institutions (formal/informal), activities (clinical/non-clinical practices), skills, knowledge/beliefs/attitudes. These are interconnected but not necessarily integrated
29
How can health systems be understood?
In relation to society. They cannot be understood in isolation from other aspects of society. Medicine is important but not the sum total of all health care activities that take place in a health system
30
What are the three sectors of health care?
Popular (lay/common-sense/informal), folk (alternative/complementary/traditional/non-orthodox/non-conventional), professional (scientific/biomedical/formal/ orthodox/conventional/ western/allopathic)
31
What is the popular sector?
Self-help. Consult with other lay people. 70-90% of all healthcare. Mainly provided by women/older people. Cults of affiliation/self-help groups/therapeutic communities (Hearing Voices Network)
32
What is the folk sector?
Healers/therapists. Not part of 'official' medical system. Sector/technical to sacred experts. Specialised skill. 'Traditional medicine'. Some becoming increasingly professional, eg acupuncture, aromatherapy, herbalism, reflexology
33
What is the professional sector?
Medical/paramedical professionals in a legally sanctioned healing system
34
How can biomedicine be seen as a cultural system?
Varies cross-culturally and intra-culturally. Randomised controlled trials. Hierarchical, specialist oriented, individual case-centred. Increasingly dominant. Medicalisation (non-medical problems become defined/treated as medical problems eg social anxiety etc)
35
What are similarities across medical systems?
Therapy managing groups. Explanatory models. Medical pluralism with separate use, hierarchy of resort or simultaneous use. Syncretism. Ritual
36
What are types of ritual?
Calendrical/cosmic cycle (rites of reversal: convival/saturnalia), transformative (rites of passage), misfortune
37
What are the characteristics of rituals?
Punctuate life. Performative acts (physical/emotional/cognitive elements). May indicate/create social transition. Elements often synthesised-shared/collective/powerful symbols
38
What is the transformational power of ritual?
Two functions: expressive and creative. There are three stages: separation, transition-liminality, incorporation. Example of going into hospital used to explain these three stages
39
What are the 6 stages of going to the doctor described by Byrne?
Establish rapport, discover why patient has come, verbal/physical examination, both parties consideration of patients condition, doctor details treatment and further tests, termination of consultation, usually by doctor
40
What does Katz discuss?
Ritual in the operating theatre: separation (scrubbing up), transition (cutting open-silence and concentration), incorporation (jokes/release of tension). Ritual certainty inspires confidence
41
What are the three bodies in the mindful body?
The individual body (phenomenologically experienced). The social body (relationships among nature, society and culture). The body politic (artefact of social and political control, including regulation/surveillance)
42
What is a problems that the concept of the mindful body causes?
It problematises Cartesian dualism
43
What is phenomenology?
The study of consciousness and object of direct experience. Discussed by Husserl/Heidegger/Merleau-Ponty. Ontology: study of being or 'what is'. Epistemology: study of knowledge
44
What is the phenomenology of health?
Study of direct experience of health. Linked to experience of body and senses. Heidegger talks about the 'transparency of the body'
45
What is embodiment?
Condition of bodily experience. Body understood to be: material, means of expression/representation, locus of practice and experience. Moving away from 'biological essentialism'. The 'lived body'-bodily experience is not fixe but lived
46
What is sensorial anthropology?
How sensations are experienced phenomenologically, interpreted culturally, and responded to socially
47
What is empathetic experience and pain in Yap?
Techniques such as massage are used to sense pain. Empathy is a complex phenomenon (tactile, intersubjective and multi-sensory
48
What are the advantages of sensorial anthropology?
Can help us understand more about: popular health cultures, pharmaceutical practice, use of particular foods, drugs and substances, the ways cultures experience distress, healthcare systems
49
What are illness narratives?
They shape the interpretation and analysis of experiences. They are based on cultural beliefs and explanations. The 'wounded storyteller'
50
What does Fran, say about illness narratives?
Restitution (culturally preferred/clinically encouraged). Chaos (anti narrative. Depp illness). Quest (learning. can be passed on)
51
What are lay explanations for ill health?
Diverse/fluid. May have different concerns to folk/professional sector. May be patterned by socio-economic position, age, gender, religion, ethnicity, geography
52
What are sites of illness aetiology?
Individual (sin/breach taboos/soul theft/weak immune system). Natural world (germs/behaviour/humoural imbalance/fate). Social world (sorcery/witchcraft/evil eye). Supernatural causes (punishment from God/spirit/ancestor)
53
Who talks about witchcraft, oracles and magic among the Azande?
Evans-Pritchard who talks about questions of rationality
54
Why do people believe things like witchcraft, oracles and magic are deficient?
Not based on sufficient evidence, not held critically or are held 'unreflectiviely', and called 'beliefs', not 'knowledge'
55
What is Koro?
It was a small scale epidemic in west Africa, which led to somatisation
56
Where do ideas about illness aetiologies come from?
Rationality, personal experience, 'media', magazines, advertising, identity, culture, social structure (moral prescription to 'be well'), position
57
What do Davidson et al talk about?
The 'prevention paradox'
58
How does industrial capitalism affect health?
Production: self denial/control/discipline/rationality. Consumption: irrationality/indulgence/pleasure seeking/release
59
What is the significance of lay explanations?
Help determine 'health seeking behaviour', stigma and explanatory models, form core part of much medical anthropology
60
What is health seeking behaviour?
Determined by health knowledge/beliefs, triggers to consult (Zola-cultural differences in reporting triggers), access issues.
61
What are barriers to consultation?
Fear, previous experience, symptom severity, access costs, stigma etc
62
What is the illness iceberg?
75% of UK experience symptoms in two week period, but much less consult a doctor (Scambler et al-health diaries study)
63
Why have explanatory models been criticised?
For individual focus/hiding power relationships, and ignoring social processes
64
What sort of health statistics are generally higher in poorer countries?
Under 5 mortality estimates, maternal mortality estimates, estimated TB incidence rates, malaria rates, life expectancy at birth (lower) , absolute poverty
65
What is critical medical anthropology?
Critical theory and ethnographic methods to look into political economy of health in specific contexts
66
How are AIDS and other illnesses similar to problems in history?
"Distributions of AIDS and tuberculosis-like that of slavery in early times-is historically given and economically driven"
67
How did ideas of HIV first start to come about?
First thought to be a zoonotic disease. Believed to have started in central Africa, then move to the West until a global pandemic occurred. There has now been a shift in focus from individual behaviours to wider social and cultural settings (individual risk behaviour to situated risk)
68
What are the problems with individual risk?
| or does it mean problems of situated risk? Read up and correct this
Victim blaming, overly simplistic, deterministic, focus on the exotic, underpinned by racist or classist assumptions. There are immodest claims of causality
69
How did Acéphie explain AIDS?
'multitaxial modes of suffering' including structural violence
70
What does the embodiment of inequality lead to?
Social misery
71
What is biomedicine?
Common model of medical anthropologists employed by health professionals or medical researchers to uncover 'local beliefs and practices' , eg reasons for vaccine refusal
72
What is the aim of biomedical research in anthropology?
To overcome barriers to effective health interventions
73
Hoe does Scheper-Hughes critique clinically applied medical anthropology?
Compared 'today's' and 'earlier' anthropologists. Anthropology is hand-maiden of clinical medicine. There is overemphasis on 'local culture' as a 'problem'. Ignoring/downplaying wider field of social power relations in which 'culture' is embedded/how politics structure meaning/possibility biomedicine may be a cultural product
74
What are implicit assumptions of anthropology and biomedicine?
Biomedicine is qualitatively different and superior as it is objective, based on measurable 'facts' and is socially/culturally neutral
75
What is the anthropology of biomedicine?
Removes brackets. Biomedicine is a cultural phenomenon. It is one form of ethnomedicine rooted in particular cultural and historical settings
76
What themes in the study of biomedicine can be seen as a form of ethnomedicine?
Historical contextualisation, biomedical discourse, practices and clinical settings, biomedical artefacts and material culture, questioning biomedical homogeneity and universality, globalisation and its consequences, doctor-patient interactions
77
What are key characteristics of biomedicine?
Empiricism, proximalism, physicalism, generalisability, modernism, reductionism
78
What is the biomedical model of sickness?
Confined to individual bodies, attributed to malfunctioning of basic material building blocks of bodies, assumes 'truth' uncovered by microscope/test tubes. Focuses on 'cure' rather than 'healing'
79
What does Martin say about studying biomedical discourse?
Unmask cultural assumptions hidden behind accounts of reproductive biology. Ideas shape ideas about how reproduction works and can have important 'knock-on' effect
80
What is an example of studying practices and clinical settings
Quality and outcomes framework in UK general practice-phased out as costing NHS too much money to implement
81
How is biomedical homogeneity and universality questioned?
Different roles in medical practice. International variations in biomedical practice. 'Doctors' different clinical specialists
82
What is an example of cultural differences in biomedicine in Japan?
3x more beds than UK. Appointments are seen as disrespectful. Surrogate patients-family/friends take over interactions with doctor. Attitudes to cancer is not to tell the patient
83
What are some consequences of globalisation?
India=major supplier of health professionals to the developed world. International migration of health personnel (10.3% doctors registered in uk qualified in India). Migration of doctors is a heavily debated topic
84
What are the two types of doctor-patient interactions?
Mutualistic and paternalistic
85
What are mutualistic interactions?
Patient-centred. Involve listening, reflecting and clarifying. More often if the patient is younger, higher class, higher educated, or with high experience with their condition
86
What are paternalistic interactions?
Doctor-centred. Involve closed questions and the disease model. More often used if patient is older, lower class, lower education, or have less experience with their condition
87
What are limitations of seeing biomedicine as 'just another ethnomedicine'?
Acts more powerfully on many conditions. Has a reflexivity enabling paradigm shift. Product of socio-historical milieu. However, there are medically unexplained symptoms (Moatz et al), and mental illness with the cultural assumptions of 'normal'
88
What is the social context of 'pathological'?
There is controlled abnormality-rites of reversal
89
What does Hugh-Jones say about medicines, drugs and foods?
They are commonalities linked with communication and expression of social values
90
Why are medicines so popular?
Efficacy, detachable from context (allow power to help self), and metaphoric and metonymic qualities (affections, gifts, parental responsibility)
91
What are meanings behind medicines?
Metaphors-make sense of the world. Concreteness-make sense of and convey illness. Metonyms-draw on other kinds of connections. Retain partial connection to culture, ideas, and knowledge that produced them
92
What is the placebo effect?
Important way in which meaning influences work of medicine. More to medicine than pharmacological properties-symbolic dimensions
93
What are 3-arm clinical trials?
Involve three groups-medication with active ingredient, placebo, and no intervention
94
What makes a placebo work?
(Moerman) physicians enthusiasm and confidence, appearance of the medicine including branding, patients adherence, culture and national identity
95
What are case studies of placebos?
The physical properties of medicines in India and antiretroviral medicines in Zambia
96
What is pharmakon?
Remedy and poison, reflected in users' accounts permeated with feelings of both attraction and repulsion. Ambiguity
97
What is 'the pharmaceutical person' (Emily Martin)?
Poison aspects often displaced. Side effects and adverse effects
98
What are cyborgs?
Half organism, half machine/artefact/technology/tool
99
What problems occur when medicines travel?
Appropriation and indigenisation
100
What is the social life of medicine?
Acquire meaning through social relationships
101
What are the three overlapping ways anthropologists 'handle' medicines?
Populist (sympathetic and celebrates capabilities), enlightened (doubts capabilities, critical, false consciousness), pragmatic (participation and engagement to create knowledge)
102
What is the oxygen case study?
Pharmakon-like properties. External 'lung' as cyborg. Following oxygen through industry from local market
103
What is the case study of access to ARVs in Uganda an example of?
Power, control and pharmaceiticalisation
104
What is personhood?
What a constitutes a person can be constructed differently cross-culturally
105
What is the western notion of the body?
Individual, autonomous whole. Separation between mind and body (Cartesian dualism). Mind rules the body in a healthy person
106
What are composite persons/bodies?
In Luo in Kenya. Healing is restoring balance and openness to outside influences. Different models of worms (Luo model and biomedical model) and different boundaries and processes of life
107
What are cross-cultural notions of parenthood?
Partible personhood in Melonesia (Stathern) and the fractal person (Taylor)
108
What is possession?
Discussed by Boddy (Zar cult-'cult of affliction') and by Ong (spirit possession in a multinational factory)
109
What is the Máori river system?
It was granted legal personhood
110
What is biomedicine and bounded body?
Disease=boundary infringement. Prioritise physical over mental illness . Ethical and legal personhood complications with stem cells due to status of embryos and immortalised stem cell lines
111
How can personhood can be partial/potential?
Prisoners, and when in persistent vegetive state
112
What are health interventions?
Activity promoting behaviour improving mental/physical health or discourages/reformed risky behaviour. In or out of formal research or formal 'health' context
113
What are forms of research?
Quantitative research, qualitative research, ethnography
114
What is qualitative research?
Empirical, reductionist, 'facts', objectivity, validity, generalisability, reliability. Eg descriptive/analytic studies, experiments, surveys, case control and cohort studies, experiments, and RCTs. Eg afterlife of a malaria vaccine trial
115
What is quantitative research?
Holistic, understanding, empathy, subjectivity, rapport, role of researcher, reflexivity, naturalism, generalisability, replicability, reliability, triangulation. Eg observation, interviews, focus groups, existing materials, participant-observation, semi-structured interviews, existing materials
116
What are ethnographies?
Methodology-written product
117
What is the case studies of tobacco control?
Fresh Smoke Free North East. WHO's Framework Convention on Tobaccon Control
118
What is the evolutionary/biomedical perspective in context?
We all live and die within sociocultural systems
119
What are Elwell's three types of phenomena?
Material (observable facts), structural (broad level), ideational (values, norms, ideologies)
120
What does Rickard and Bentley discuss in terms of health inequalities?
Rickard: socioeconomic health inequalities. Bentley: other inequalities include age, gender, ethnicity etc
121
What are non-communicable diseases?
Many causes, difficult to determine in clinical practice. Sometimes irreversible. The aim is management of conditions
122
What are the 4 main categories of non-communicable diseases?
Cardiovascular, diabetes, chronic respiratory diseases and cancer
123
What is epidemiology?
The study of how often diseases occur in different groups of people and why
124
What is social epidemiology?
A branch focusing on the effects of social-structural factors on state of health
125
What is the standardised mortality ratio?
Ratio of observed deaths in study group to expected deaths in general population
126
What is evolutionary biology?
Study of patterns of variation among living things
127
What is modern synthesis?
Genetics and Darwinian/Wallacean theories
128
What four biological evolutionary processes give rise to genetic change in a population?
Drift, migration, mutation, natural selection
129
What are plastic adaptive traits?
Development, physiological, behavioural etc
130
What are fixed adaptive traits?
Eg anatomical
131
What is the stress response?
HPA (hypothalamic-pituitary-adrenocortical axis), cortisol released: mobilises sugars and fats for energy/reduces bone growth. Priorities short term survival. Balance of positives/benefits and negatives/costs
132
What are living things?
Aggregations of organic matter that extract material resources from the environment and convert those resources into offspring
133
What is one of the negative responses to that definition of living things?
It is true, but an oversimplification (reductionist)
134
What is a defining feature of mammals?
Practicing parental care, which is provided by mothers in over 90% of species
135
Why are humans different to other mammals?
Cannot produce/reproduce/live independently of other humans. Live in communities of different scales. Absolutely dependent despite size of community
136
What is cumulative culture?
Food/consumption is a very social activity. Technology is crucial in industrialised societies. Technology requires culture which requires technology. Food is a cultural universal
137
What is somatic vs extra-somatic digestion?
Humans have weakest bite force of all apes (mechanically digest food). Small intestines=nutrient absorption and large intestine=water reabsorption. Humans have smaller gut but longer small intestine (gene-culture coevolution)
138
How are mammals unlike other animals in regard to reproduction?
It also involves maternal care. Infancy is the period of dependency, which ends when the infant is weaned
139
What are allomothers?
Other mothers. These are present in new world monkeys, barbory macaques and humans
140
How do humans use allomothers?
Human children are not raised by mothers independently. Allomaternal care is extremely important for child's survival and wellbeing after child has been weaned
141
How do human birth intervals compare to other apes?c
Chimpanzee: 4-5 years. Orangoutangs: 8 years. Humans: 2.5 years-3.5 years in all societies
142
What is cumulative change?
Evolution has unhelpful connotations. 'March of progress'. Complexity increases over time and comes with diversification of function
143
What is the neolithic revolution?
Domestication of plants/animals for production of food on a big scale. Followed by a centralised state. Inevitable consequence of the creation of surplus food
144
When was the industrial revolution?
18th century but with roots in the 17th century
145
What is modernisation theory?
Progressive transition from traditional to modern society. Capitalism and efficient markets are central to this
146
What does the Rostow model show?
Five stages of economic growth, though it is criticised due to ethnocentric perspective and over reliance on efficient markets
147
What is dependency theory?
(Frank) Development of rich world achieved by exploiting poor world. Resources move from periphery to core
148
What is the guns. germs and steel theory?
(Diamond) Eurasia: East to West. Africa and Americas: North to South
149
What are neoevolutionist theories?
(White and Lenski) Emphasis on technology and builds from Marx, Weber, Durkheim etc
150
What is cultural group selection?
(Boyd and Richardson) Cultural norms and natural selection
151
What is the Gini coefficient?
Measure of statistical dispersion intended to represent income/wealth distribution of a nation's residents. It is a commonly used quantitative measurement of inequality
152
What study looks at inequality through the ages with human life expectancy?
Cumulative survivorship probability for three non-agricultural populations (!Kung-Southern Africa/Ache-Paraguay/Yanamani-Brazil)
153
What was Mudler et al's research?
Egalitarian hunter-gatherers? Data from 22 small scale societies (5 hunter gatherers) and measured 3 kinds of wealth (embodied/relational/material), The Gini coefficient for hunter gatherer communities was estimated to be .25
154
What is the Gini coefficient like after agriculture?
Mulder's analysis from 8 small scale farming communities estimated at .48. Scheidel et al analysis of data from Roman Empire estimate .43. Questionable whether slaves where considered properly, skewing results
155
What is the McKeown thesis?
Mortality by tuberculosis. Population growth since late 18th century mostly due to improvements in economic conditions
156
What are three explanations for the relationship between wealth and income inequality, and health inequality?
Reverse causation (health affects wealth and income), confounding factor (eg genetic factors affect both), wealth/income affects health
157
What are the different theories on whether wealth and income affect health?
Materialist (ability to afford healthy food etc). Behavioural/cultural (eg alcohol consumption). Psycho-social (eg work stress). Macro-social/political economy (eg poor provision of social housing (Kings Fund)). Life course explanations (eg effects of all explanations in the family on a child's development)
158
What are the macronutrients?
Carbohydrates, protein, fat, fibre and water
159
What are carbohydrates for?
Fuel and other functions eg enabling fat metabolism
160
What is protein for?
Structure and functions (high turnover)
161
What is fat for?
Broken down into glucose
162
What is fibre for?
Some are digested and some are not
163
What is water for?
Medium for chemical reactions. It is essential
164
What are the micronutrients?
Minerals and vitamins
165
What are minerals?
Chemical elements required in small quantities eg Na/Cl in salt necessary for maintaining blood pressure and nerve function
166
What are vitamins?
Organic compounds with a variety of functions, eg B vitamins catalyse energy metabolism
167
What are reference intakes?
Based on average sized woman doing average amount of physical activity, but people vaqry
168
What are dietary reference values (DRV)?
Takes account of variation-more relevant to a population perspective
169
What is the national diet and nutrition survey?
Shows % people below LRNI for many micronutrients. Should all be less than 2.5% if population has healthy consumption. Magnesium and Selenium are particularly low for adolescent girls
170
What happens if vitamin A is deficient?
Vision and immune function issues. Deficiency in 1/3 under 5, and kills over 600 thousand every year
171
What are low levels of magnesium associated with?
Chronic conditions such as hypertension, cardiovascular diseases and diabetes
172
What is hidden hunger?
Asymptomatic or difficult to detect micronutrient deficiency
173
What is malnutrition?
Can be over or undernutrition. Leads to a 'dual burden'
174
What are the leading causes of death in modern times?
Coronary/Ischaemic heart diseases and type 2 diabetes which are linked and sociall patterned. CHD overtaken by dementia due to decline
175
How can type 2 diabetes be understood?
Need to understand insulin resistance. Inulin produced by pancreas beta cells and acts on cells to enable uptake of glucose from blood
176
What is the difference between type 1 and type 2 diabetes?
Type 1 is not enough insulin, and type 2 is that cells stop being able to use insulin
177
What causes insulin resistance?
Largely due to obesity (BMI>30). The role of sugar is controversial. IR-high insulin/glucose in blood-breakdown of sugar regulation
178
What is the link between diabetes and heart disease?
Glucose damages nerve cells/blood vessels in circulatory system directly. CHD mainly caused by atherosclerosis. Glucose causes inflammation, increasing risk of atherosclerotic plaque
179
What is cortisol?
The main endocrine hormone and is produced by adrenal glands
180
What is the mortality in civil service graph?
Adjusted for age and other risk factors to reduce influence of confounding factors. There is a gradient in mortality even in middle class. Nutrition cannot explain this. Largely thought to be due to cardiovascular disease
181
How are social animals affected by social environment?
In social animals, the way individuals experience their environment is largely influenced by social environment. Access to food/mates. Social life is stressful, and stress is experienced by different animals in different ways
182
What does cortisol do?
Reduce hormone growth, alter immune response, increase blood pressure, increase fibrinogen, increase low density lipoproteins, increase central fat deposition, and mobilises sugars and fats for energy
183
What can social support do?
It can influence physical health outcomes
184
What are two main families of mechanism of social support?
Behavioural pathways and stress appraisal
185
What influences self regulation?
Emotional support from belonging to a group
186
What is the job strain model?
Job strain (risk of physical illness) = high job demands and low job latitude
187
What is the reward imbalance model?
Job imbalance risk of physical illness) = high effort and low job rewards
188
What is psychological demand vs decision control?
Low control+high demand=adverse outcome
189
What is neighbourhood deprivation and binge drinking?
Deprivation predicts binge drinking. Due to cultural norms, pressures, pr lack of social cohesion (none are mutually exclusive)
190
How is strength of social relationships a predictor of mortality?
In comparison with other risk factors, it is a good predictor. Mortality risk and giving or receiving social support
191
What is the life course effect?
Highlights link between the psychological and physical. Difficult to determine if other social confounds play a role. Relationship between childhood abuse and household dysfunction to many of the leading causes of death in adults. Also long-lasting health benefits of intensive daycare
192
What determines healthy development?
Good nutrition, physical activity, immunological exposures, good social status
193
What are world stats on undernourishment?
11% of world is undernourished. 19% in sub-saharan Africa, and 7% in latin America
194
What are world stats on over-nourishment?
In USA 68% adults and 29% children. UK 52% adults and 27% children. India 22% adults and 8% children
195
What is the dual burden of malnourishment?
Increased wealth leading to problems of over-nutrition alongside under-nutrition in BRIC countries (health costs are enormous, especially for developing countries
196
How is nutritional insecurity dealt with in the UK?
Eg Trussell Trust, a charity with a goal to reduce UK hunger/poverty
197
How much does obesity cost in the UK?
£4.2 billion/year treating obesity related diseases. Primarily type 2 diabetes and cardiovascular diseases
198
What is energy needed for?
Growth, maintenance eg BMR/physical activity/immune challenges, reproduction
199
How much energy is in one calorie?
1kcal is 4.2kj
200
How many calories are in 1g of protein/fat/carbs
1g protein=4kcal, 1g fat=9kcal, 1g carb=4kcal
201
What is basal metabolic rate?
Number of calories you'd burn "if you stayed in bed all day"-15xweight+692(kcal/day)-secondary adjustments for age, sex, height
202
What are the daily calorie requirements of each macro/micro nutrient?
330g carbs, 100g protein, 75g fat, 2000g water, <300mg vitamins, 5-10g minerals. Calorie requirements vary with age
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How do you measure nutritional status?
Anthropometry
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What are anthropometry measures?
Height, weight, BMI, skin fold thickness, mid-upper arm circumference, waist and hip circumferences, waist to hip ratio
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What BMI in adults is considered to be chronically malnourished?
<18.5
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What is the formula for BMI?
weight (kg) divided by height squared (m squared)
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What are anthropometry measures in infants?
Birth weight, ponderal index (body weight divided by length), head circumference, abdominal circumference
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What is anthropometry in children?
Measure children to assess standards of growth and health
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What are growth standards for children?
Has been revised over the years (Tanner). Percentiles: z scores
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What is stunting and wasting?
Stunting is low height for age, and wasting is low weight for height
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What is good social status?
Most sources equate stunting to poor nutrition and infectious diseases, but not social status however there is supporting data for social status. Height is a marker of social status in humans but could be confounded with better wealth/nutrition
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What is nutritional supplementation?
Advocated to reduced stunting, however Hermanussen et al said it increased weight, not height. There are nutritional or sanitation interventions to improve stunting in children but have limited effects
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What is nutritional stress in Europe?
Hermanussen et al-historical data in old german medical journals
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What is the correlation between nutrition and height?
Nutrition is essential for growth but final height may be determined by social inequalities
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How necessary is physical activity?
Need to be physically active to develop properly. Humans have evolved to be much more active than ape relatives
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What is evidence that humans have evolved to be more active?
Leg muscles 50% larger in humans. More slow twitch muscle fibres (reduce fatigue). More haemoglobin to carry oxygen to muscles. Higher metabolic rate. Require significantly less sleep. Brain responds well to exercise (reward). Palaeorunners?
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What dies Liberman say about physical activity?
Our species evolved to be endurance runners based on a number of skeletal features
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What are human activity level trends?
Sedentary behaviour is increasing. There are also inequalities in physical exercise. Traditionally the poor worked very hard but now it is reversed in developed countries
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What are immunological exposures?
Global epidemiological transition with decline in infectious diseases
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Why do we need exposure?
For development, to educate our immune system to stop over-reaction
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What are immunological trade-offs?
Hygiene hypothesis and old friends' hypothesis
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What is the hygiene hypothesis?
Modern world is too sanitised to our immune systems are underdeveloped. Leads to dysfunction and increase in auto-immune disorders
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What is the old friends' hypothesis?
No longer exposed to parasites
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What is the evolution of ageing?
Neoteny is appealing (Gould-Mickey Mouse). Old age us not adaptive/no adaptive pressure to find the elderly attractive or to provide care, which is the opposite with babies and children, and so elderly must devise strategies to ensure respect/care
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What is a theory on why we age?
Kikwood's disposable soma theory
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What is disposable soma theory?
Natural selection favours reproduction over bodily maintenance. Ageing occurs through accumlation of random somatic damage. Life span variance may be due to varying levels of somatic maintenance and repair. Systems decline with age/immune system weakens/loss of muscle mass/slower metabolism/increasing wear and tear. Bathtub curve of hypothetical failure rate vs time
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What is maximum lifespan?
Supposed oldest person was Jeane Calment 122. Max life span has increased across time as health improves but there may be a max. 103 in 1798 then 117 in 2018
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What are examples of primate longevity?
Gregoire (Africa) 66 and Auntie Rose (Uganda) 60
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What is the demography of ageing?
Mean age at death determined by infant/child. Population pyramids show demography
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What is demographic transmission theory?
Late 18th century=1st transition. Preindustrial to industrial (Europe)
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What are demographic and epidemiological transitions?
Fertility/mortality both decline (family planning). Decline in infectious diseases but replacement with chronic diseases
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What is an example of epidemiological transition?
Proportion of elderly increasing
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What does Marmot show?
Life expectancy varies within countries, illustrate by tube map
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What is the correlation between ageing and health?
Does longer life just mean more years with illness?
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What are DALYs?
Disability adjusted life years
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What is the cost of ageing?
NHS costs=53% more in >65s in 2030 than in 2000
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What is elder abuse?
Abused by offspring/spouse. Children abused by parents (relatives=main abusers). Can be abused physically, sexually, emotionally, financially, health care fraud, neglect, abandonment
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What are risk factors for abuse by home carers?
Inability to cope/depression/lack of support/substance abuse/negative perceptions
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What are risk factors for abuse by institutional carers?
Stress/port training/over burdened/unsuited to job/poor work conditions
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What are risk factors for the patient?
Frailty/severity of condition/social isolation/relationship to carer/financial status/history of domestic volence
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What is elder self abuse/neglect?
2 million cases each year in the USA
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What is sex?
Biological/physical characteristics
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What is gender?
Socially constructed-what given society considers appropriate
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What is life history theory?
Energy has to be divided between growth, maintenance and reproduction
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What is sexual selection theory?
Female reproductive energy into producing babies. Male reproductive energy into finding a mate/acquiring resources/protecting mate and offspring
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What is the cost of reproduction?
80,000 calories to maintain pregnancy to term. Lactation requires roughly 500 extra calories a day. Total weight gain of 27.5lbs. Sex act is 25% more costly for men
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What are pregnancy costs?
Can use mechanisms to avert pregnancy and can compensate cost of pregnancy to some degree (slow basal metabolic rate, shorten gestation length, adjust blood flow to uterus/placenta). Iron deficiencies associated with menstruation and pregnancy. Women lose 1mg iron per cycle
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What are male costs?
Testosterone associated with higher rate of growth, higher aggression, lower immune system (Wingfield-challenge hypothesis)
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What is the Wingfield challenge hypothesis?
Trade-off's faced by males in allocating resources to mating and parenting. Underpinned by mediating testosterone levels. Developed theory in studying birds
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What is male mortality?
Males die faster and younger. More males are born to compensate
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Why are males costly?
Trivers Willard hypothesis-mothers only invest in sons if have good access to resources. If not, they will invest in daughters-tested in red deer in Scotland
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How do males take risks?
Males (15-25) are likely to take more risks
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What are gender differences in labour?
Hunter (male) vs gatherer (female), which probably reflects constraints of pregnancy and lactation
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What is the division of labour?
More pronounced differences emerge with development of hoe agriculture. Development of patriarchal societies. Females seen as inferior: biologically, intellectually, economically and emotionally
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What are the consequences of patriarchy?
Loss of opportunities/control/health-women's education/early marriage/women's issues
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What is child neglect by gender?
Selective neglect usually targeted at females
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What is mate guarding and health?
All have serious health consequences. Who to blame-traditions have become entrenched. Women become willing participants in many cultural traditions
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What are reproductive burdens?
Women bear main burden for contraception. Women's cycles are much more complex than male reproductive function
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How has gender affected clinical trials?
Women mostly absent in USA before 2004. 8/10 prescription drugs withdrawn from US markets by 2000 due to different gender responses
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What are gender differences in employment?
Women have less values jobs or inequality in pay, plus higher risk of sexual harassment at work
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How are women sexualised?
Objectification, and unrealistic ideals of beauty, but is this changing?
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How does domestic violence affect women?
Affects 1 in 3 women worldwide. Physical/psychological/sexual. Health costs to women+legal fees+housing etc
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What are gender gaps in health?
Eg higher male suicide and higher female mental health issues
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How do African-American men demonstrate ethnicity and health?
Higher incidence of prostate cancer, more advanced stage at diagnosis and higher mortality. 25% less likely to receive treatment than white men. Odds ratio decreased with severity of cancer rating
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What is ethnicity?
English ethnic categories (ONS 2011) white, mixed ethnicity, asian, black and other
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How does migration affect ethnicity?
Immigrants. Ancestors come from Germany, Belgium, France and Scandinavia
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What does Leslie et al say?
Fine scale genetic structure of British population
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What were earliest modern humans in Britain like?
Possibly had dark skin and originally oriented from Middle East
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What is race?
Highly criticised as a concept. US use race rather than ethnic categories (are such classifications meaningful?). There are problems defining race as many traits are continuous. Races or racism-more genetic variation in populations than between
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What are examples of human genetic diversity?
Skin colours (cancers), lactose intolerance, haemoglobinopathies (sickle cell, thalassemias, morality, anaemias), homozygotes and heterozygotes. CVD risks differ across ethnic groups in UK (South Asians generally higher risk
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What was the SABRE cohort study?
Study in London compared white and Indian. CVD mortality higher in Indians. Controlled for number of risks in models, but were still unexplained factors
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What are health characteristics of South Asians?
Have persistent low birth weight, preservation of fat overlying central organs, more likely to have central adoposity in later life, linked to higher risk for metabolic disorders
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What is 'thrifty phenotype'?
Association between low birth weight and later life health. Fetal programming. Low birth weight of African Americans: an intergenerational effect of slavery-Jasienska
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What is the health migrant effect?
Some data suggest USA hispanics have lower infant mortality, lower mortality from cancer/stroke/hip fractures despite being low SES
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What are reasons for the hispanic paradox?
Healthier people migrate, stronger kinship/social support, less stress
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What is racial medicine?
Medicine can be tailored, due to different predispositions and responses
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What are pros of racial medicine?
If there are differences, there can be improvement. Targeted rather than 'one size fits all'
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What are cons of racial medicine?
May lead to distribution inequalities. Risk of confusing genetic variability with other confounds. Commercial interests may override science
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What is an example of racial medicine?
BiDil, however it was criticised
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What did the invention of fire cause?
New hazard for humans and start of atmospheric pollution
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How is outdoor pollution measured?
Using PM 2.5 particles (_
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What is outdoor pollution?
Reduces ambient visibility/causes smog. Mostly caused by human activities. US EPA chart outlines levels of acceptable and dangerous pollution. Can cause ischaemic heart disease, stroke, CPODs, ALRIs and lung cancer
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What are stats on outdoor pollution?
4.2 mill died in 2016 due to it. Recommended limit is 25.4ng/m3. >90% of world population live in areas with air pollution over the limit (Africa affected by Saharan dust). In the UK 16335 deaths in 2012 from outdoor pollution, cities most affected eg London reached legal 2018 limit in February
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What are environmental inequalities?
Does not discriminate. In large cities smog is everywhere, but may concentrate in places. USA case study. African-Americans and Hispanics exposed to far more than they produce while whites are exposed to 17% less than they produce. Housing locations are mostly responsible for this
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What causes indoor pollution?
>33% world population still use biomass to cook/for heating. Over 50% use 'solid fuel' if coal is included
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What are stats on indoor pollution?
1.6 mill deaths each year due to smoke-related morbidity from cooking. It is the 4th biggest global killer. Women and children most affected. Main problems caused is acute lower respiratory infections (ALRIs)
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What is RESPIRE?
Randomised exposure study of pollution indoors and respiratory effects. In San Marcos, Guatemala
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What were the results of RESPIRE?
Higher exposure to CO in open hearth homes. 30% reduction in severe pneumonia among children with household stoves. Less exposure to carbon monoxides. 4/11 reached statistical significance
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What is the problem with plastics?
8.3 bill tons produced by 2017. UN conference in 2017 agreed to stop plastic waste entering oceans
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Where do a lot of plastics end up?
North Pacific Subtropical Gyre. Great Pacific Garbage Patch (East and West). East patch=2x larger than size of Texas
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How is ocean life affected by plastics?
All sea life and deep ocean trenches are polluted with plastic. They are ingested and deadly for many animals, and degrade slowly. They sequester in fat tissue and are endocrine disruptors (structure mimics natural hormones)
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What is a chemical in plastics that has been said to cause problems?
Bisphenol A
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How is the Arctic affected?
It is now one of the most contaminated places on Earth. Inuit have higher levels of PCBs etc in breast milk
