Lecture 9 and 10

Question 1

What can we do to reduce SES inequalities in obesity?

Answer 1

1. target material and/or structural resources
2. target culture/behaviour
3. target historical context
4. target discrimination

Question 2

What effect does improving resources have on reducing SES inequalities in obestiy?

Answer 2

We can try to reduce health inequalities relating to obesity by improving:

1. material resources
2. physical structural resources
3. non-physical structural resources

Question 3

What is the first example of improving material resources?

Answer 3

Sales Tax Exemptions
Issue: Limited $=limited choices
Solution: some countries have sales tax exemptions to reduce inequalities and improve health
a. UK most ‘food’ if VAT exempt - plant and seeds, various sport, leisure cultural activities, various health, welfare and educational items + others
b. Australia GST exemptions for some medical aids and services, as well as ‘basic foods’ and cars for disabled people

Question 4

What is the first example of improving Non-physical structural resources?

Answer 4

Mandatory Calorie Information
Issue: people have a very poor understanding of the number of calories in different foods
Solution: NYC implemented a law in 2007 forcing chain restaurants (15+ outlets) to post the calorie count of each food in the same size and font as the price
other cities have followed and federal legalisation is in the pipeline
has won some huge legal battles with the food industry

Question 5

What is the second examples of improving Material resources?

Answer 5

Tax Unhealthy Foods
Issue: Limited $ = limited choices = +cheap unhelathy food
Solution: some countries have taxes on unhealthy foods
Fast food taxes: ‘fat tax’
Sugar and soft drink taxes

Question 6

What is some information about Fast food taxes ‘fat tax’?

Answer 6

At least 13 states in the US impose a sales tac on ‘prepared food’
A lot of different rates, definitions and methods
Some other countries do this (e.g. Denmark) and many other countries are seriously considering it (e.g. UK)
Unlike most taxes, most people actually think this tax is a good idea

Question 7

What is some information about Sugar and soft drink taxes?

Answer 7

More the 20 states in the US have a tax on soft drinks
France has recently introduced tax on soft drinks
Denmark introduced a tax on sugar and fat and then removed them
Other countries are heading down the same path and many others are considering it

Question 8

What is an example of improving physical structural resources?

Answer 8

Better Community Parks
Issue: People in poorer areas have fewer safe places to engage in physical activity
Solution: the Lets Beat Diabetes programme in Counties Manukau worked with a number of stakeholders to turn some unsafe and unused open space into a safe park for families
“changing urban design to support health active lifestyles”

Question 9

What are 6 examples of stake holders?

Answer 9

Housing New Zeland Coroporation
CMDHB Lets Beat Diabetes
Maukau City Council Parks Department
Manurewa Community Board
Habitat for Humanity
Clendon Community Action Group

Question 10

What are two elements of community perspective in building better community parks?

Answer 10

Methodology: a.Consultation Day. b. Survey
Findings: a. residents wanted to have children’s play equipment and sports facilities in the park. b. residents were concerned about park and walkway maintenance and safety.

Question 11

What was involved in Community Perspective: Methodology in building better community parks?

Answer 11

Methodology:

a. Consultation Day.
b. Survey

Question 12

What was involved in the Community Perspective: Findings in building better community parks?

Answer 12

Findings:

a. residents wanted to have children’s play equipment and sports facilities in the park
b. residents were concerned about path and walkway maintenance and safety

Question 13

What were the two baseline observations in building better community parks?

Answer 13

Day observations

Evening-night bservations

Question 14

What was involved in the Baseline Observations: Day in building better community parks?

Answer 14

Used as a shortcut
very little recreational use of the park by adults
little children play either on the road or on the container
park is poorly maintained: rubbish, broken glass, graffiti and unsupervised dogs

Question 15

What was involved in the Baseline Observations: Evening-Night in building better community parks?

Answer 15

Used by more people, especially those playing touch rugby in the evenings
Used at night by people drinking alcohol
Used to do ‘motorbike wheels’

Question 16

What was some process issues involved in building better community parks?

Answer 16

Design process and the expectations of community - toilets and lighting
Changing the walkway
Funding process between LBD and Manukau City Council
Redevelopment to occur in stage
Inter-agency collaboration is a complex and long lasting process

Question 17

What is the second example of a Non-physical structural resource improvement?

Answer 17

Health Food Policies for Schools
Issue: schools have historically offered a lot of unhealthy food options and a few health options
Solution: National policies controlling the foods that schools can offer
e.g. Mission On

Question 18

What does the Mission On example of Non-physical structural resource improvement include?

Answer 18

Non-physical structural resource

1. Food and beverage classification system - Everyday, sometime, occasional
2. Resources for schools and students
3. Regulation around foods offered - only healthy foods

Question 19

Movie notes:

Answer 19

identical twins, if one changes environment which influence health causes difference
Excess death= be able to predict in a time frame death that should occur, anything above that number is excess
age, suffering, what degree of preventable illness
More east= more affluent communities
lower grade of employment= higher grade of heart disease/major cause of disease
Death rates and illness= correlates and links
America wealth health gradient 71% good health = reverse slope of disease - CVD, Diabetes, Heart diseases= excess death for middle and low income americans
Large mass in middle of society are also affected
Louisville= health of popn and social conditions seen
college graduates live 2.5 x longer than high school graduates
optimism of future, type of job= ability to pay for education
35x college fees increase
home ownership= able to build financial security
life expectancy gradient
cultural demarkation in city
Not a natural thing, rise as a result of policies of absences of policies which cause inequalities in access to resources
health social policies: better transportation, more mixed income housing, tax on unhealthy eating
able to predict = high school gradients, income, how long live, die = life expectancy determined by resources available to you
all inextricably intertwined
influences events that impinge on your life
middle class= 2 jobs, not me with kids, job insecurity = decrease control of peoples live = increase risk of illness
Stress response, adrenal potent stress hormones, cortisol, raise BP= neg effects of cellular functions and tissues= atherlosclerosis= completely comprised artery=myocardial infarction
cortisol = improve memory, enhances immune response
overtime= chronically can impair immune function, brain shrinkage, ability to handle insulin and glucose
university hospital = more stress
chronic stress not equally distributed on a hierachy
Dominant animal able to control environment
mor eucation= less cortisol
more income = more cortisol
higher status less streess better immune function
power, resources and control to manage stress= so much determined by class= time to exercise, don’t have to catch bus to work, not use demands when not working, ability to get to places to exercise, time to make health meals which you can buy, ability to take vacation
1/5 american med work in high demand low control job = more likely to experience high BP at work, less range to fall even when not at work
Live, grow up, work
most poor in america= white 21% american children live in poverty= lifelong health influences=toxic to brain
interfere with development of brain circuitry and connections=long term impacts=accumulative burden of risk rather than accumulate protection
Homeownership (as a kid)= more year parents own home, less likely to get a cold when we expose them to a virus
pile up risk factors= more threatened immune system
Not white = more susceptible
African amierican, no matter health status, more susceptible, across social gradient, elevated risk of disease
= not bad genetics, vigilance and burden to be constantly on guard, changes biological markers and
racial discirmination, hbp, ifant mortality, cornary artery disease
excess death of afircna ameriacen
not a fixed property of society
magnitude changes over time
living conditions and medical care improved= through social reforms as universal education, sanitation, Gi bill(african american excluded
non medical public health infrastructure, better housing
1960/70 health and income gap decrease
Economic policiy= health policy
improve economic, narrow,
interevene or seal world, constrain health inequalities
1980’s oppoaire direction
dergulation, reduace wealthy tax
tax law changes benefited the rich
1976 record low
poor=poorer
middle class=squeezzed= more health problems in society inf future
dependant on idividual assessts and
Us has steepest wealth health gradient but richest country= poor use of resources
France 2x minimum wage= break tight linakge between income, wealth and health
ecudation, access to recreation= subsidise through ta policy mechanisms= more equitably distributed
social conditions drive overall health conditions of a population - not just food and exercise
empower communities
Power is a population health issue
Individual sself interst
hospital net dependance drawing resources
loss of productivity to business due to chronic stress
invest early to set good trajectory