Social Determinants of Health - Midterm Flashcards
Takes into account the individual factors, interpersonal factors, and social/structural factors
ecological systems theories
What is the critique of the conventional view of assessing an individual’s risk factor?
it ignores some of the broader parts in the ecological systems theories that affect the health of said individual
Which scientist came up with the population perspective?
Rose
“to find the determinants incidence and prevalence rates, we need to study characteristics of populations, not the characteristics of individuals”
population perspective
“factors that explain difference between individuals within a population may not explain differences between population”
population perspecctive
Why is a ubiquitous exposure a problem in identifying determinants?
the more widespread a cause, the less it explains the distribution of individual cases
What are the implications of rose’s population perspective?
use the population strategy rather than the high risk strategy
A large number of people at a small risk may give risk to more cases of disease than the small number who are at a high risk
the rose and prevention paradox
CC: Tailored interventions appropriate to the individual who is most motivated to receive it
advantage of the high-risk strategey
CC: Cost-effective use of limited resources
advantages of the high-risk strategy
CC: Favorable benefit to risk ratio
Advantage of the high-risk stratgey
CC: radical - attempts to remove underlying causes that make a disease more common
advantage of the population strategy
CC: significant potential for population health
advantage of the population strategy
CC: can change norms, so maintenance of health behavior no longer requires effort
advantage of population strategy
CC: challenge and cost of repeated screening
disadvantage of the high-risk strategy
CC: palliative and temporary -does not address root causes
disadvantages of the high-risk strategy
CC: limited potential for individuals and population
disadvantages of the high risk strategy
CC: behaviorally inappropriate - cannot divorce the tail from the mean
disadvantages of the high risk strategy
CC: small benefit to each individual - weak motivation
disadvantage of thepopulation strategy
CC: problematic benefit to risk ratio
disadvantage of the population strategy
Who created the Fundamental causes strategy?
Link and Phelan
A durable Inequity creates health inequality and gap , due to resources, that translates SES into health status
Fundamental Causes
What are some types of resources someone with SES may have?
material goods, knowledge, social ties
What are some types of material goods?
medicine, housing, food, health care access, cash
What are some types of knowledge?
health literacy, knowing about diseases, risks, “good” health behaviors
What are some types of social ties?
networks, connection to things that can help your health, prestige
relationships between a fundamental cause and health can be preserved even if the mechanism change
fundamental cause
when effect of one mechanism declines, the effect of another can emerge and become more prominent
fundamental cause
social conditions affect access too and ability to deploy flexible resources of all kinds
fundamental cause
what is one implication of the fundamental causes?
many interventions have an SES bias, or more generally are oblivious to larger social conditions
Emphasis beyond the individual, towards the social world where the person is located
overlap between population perspective and fundamental causes
not just interested in surface level risks - but looking for the cause of the causes
overlap between population perspective and fundamental causes
Going to population level gets us into all sorts of interesting areas
overlap between population perspective and fundamental causes
broadest possible targets
overlap between population perspective and fundamental causes
a socially derived economic factors the influence what positions individuals or groups hold within the multiple stratified structure of a society
SES
what are the dimensions of SES?
location in social structure, function of economic and social factors, material and social resources, and prestige resources
What is a key feature of the empirical relationship between SES and health?
often a confounding variable
What are 5 facts of the relationship between SES and health?
incremental, evident above material deprivation, not explained by risk-factors, modifiable, and bi-directional
What was the key finding in the Whitehall data?
large differences in health outcomes across occupational categories, despite accounting for key proximate risk factors
What is the “residual” effect of SES?
the difference in health outcomes that can’t be explained by some other factor such as confiders or proximate risk factors
SES causes health
social causation
Health causes SES
selection, social drift, reverse causation
What are three proxies with which we can measure SES?
income, education, occupation
What are some pro’s to using occupation as a proxy for SES?
captures major structural link between education and income, capurses resources and prestige
What are some con’s to using occupation as a proxy for SES?
difficult to standardize and rank, excludes those not in the labor force, highly subject to drift
What is a pro of using education as a proxy for SES?
universal applicability, approximates material, prestige, and cognitive resources, categories corresponding to thresholds are meaningful theoretical thresholds, relatively immune to drift in adulthood
What are some con’s of using education as a proxy for SES?
doesn’t capture quality, meaning across timed place are highly variable, subgroup differences in economic returns
What are some pro’s for using income as a proxy for SES?
granularity in ascertainment, compare across time, most closely related to means fro material consumption
What are some con’s for using income as a proxy for SES?
subject to drift, differential applicability, variability over the life course, doesn’t capture wealth
What is one was that SES and race often intersect?
whites have had the opportunity to accumulate more wealth than blacks
Lewontin - genetic variation within populations?
85%
Lewontin - genetic variations between racial groups
6-8%
Is there a genetic base to race?
no
What did Rich argue?
people who identify as a certain race match that race’s genetic profile
genetic drift in humans - differences in the genetic code in non-coding regions
Ancestry Informative Markers
a part of the code where 1 of the nucleotides is different
single nucleotide polmorphism
How do we explain genetic diseases predominantly in certain racial groups?
created based off of founder effect and genetic drift in one ancestry group - happens in small groups - these diseases tend to be due to geographical history, not race
What do diseases specific in certain ethnic groups tell us about genetics and race?
tells us migration patterns
What is the founder or drift effect?
when one subset of the population is isolated, the small group must interbreed, meaning that the gene pools is smaller and gets to be more similar, so certain diseases become more prevalent
Where do we see health disparities in terms of genetic diseases?
only in genetic diseases that are complex genetic diseases for which there is no single gene or mutation that causes the disease (rather than mendelian ones in founder effect), meaning there is some social/enviornmental determinant
What can we conclude about genetic diseases and races?
the genes that cause disease are the same across all races, and specific mutations are shared. For most complex diseases, a SNP is not sufficient to cause disease
How does environment affect gene expression?
environment can affect gene expression through epigenetic interactions - but then you are no longer looking at a straightforward genetic causes
What is the implication for precision medicine if genes = disease?
no racial implication - look for specific mutations, not race as a proxy
Are there differences in how subgroups metabolize drugs?
yes - but if you look at computer generated clusters versus socially constructed clusters, those subgroup differences become less apparent - you can’t generalize that much
What are the risks of using racial stereotypes to address health?
tailoring therapy and treatment to patient race/ethnicity may ignore other at risk-populations, which leads to imprecise racial profiling and then bad medicine
What is one problem with BiDil and other race-based drugs?
maximize racial ethnic variations and look for subgroup differences and capitalize on these - then cost problems with generic drug
What is the inequality paradox?
Most intervention strategies are SES bias.
Race, as an arbitrarily, socially defined category of people
social contrust
What is the problem with not collecting data on race?
while race is a social construct, racism is real, and has real implications on health and many other factors
What is the fallacy with saying that sickle cell anemia is a racial disease?
It’s an ancestral disease based off of geography - those with ancestry in India also have higher races of the nickel cell trait
includes prejudice and discrimination, intentional and unintentional actions, lack of respect, suspicion, dehumanization, and devaluation
interpersonal racism
stereotypes/predjudice
interpersonal racism
implicit bias
interpersonal racism
discrimination
interpersonal racism
What did the Pager study find?
Black applicants without a criminal record were less likely to be hired than white applicants with a criminal record for an entry level job
differential access to resources and power due to policies and practices
structrual/institutional racism
residential segregation and redlining
structural/institutional racism
racial wealth gap
structural/institutional racism
acceptance and internalization of negative stereotypes about one’s group, and awareness of these stereotypes
internalized racism
What’s a problem with internalized racism?
ignores other factors such as resilience in the face of adversity
the cumulative wear and tear on the body’s system due to adaptation to stressors
weathering (geronimus)
measured with biomarkers across multiple physiological system 0 how hard the body has to work to maintain homeostatsis
allostatic load
What happens to telomeres as stress, allostatic load, et al increases?
telomere shortens
What does the telomere affect
aging process - short telomere tell a person’s real age
What are a fews ways that institutional racism translated to health outcomes?
food availability, green space, distance to toxic waste centers and industrial hazards, access to health care
knowing the negative stereotype associated with your groups puts the individual at risk of confirming stereotypes
Stereotype threat
How can stereotype threat be shown experimentally?
administer tests and alter the stereotype threat
What is an intervention that can come fro the theory of stereotype threat?
Telling people the truth, there is no difference in ability, gets rid of the stereotype threat so marginalized groups will perform just as well
What are two legislation and policy changes around Racism?
Equal Employment Opportunity commission and Civil Rights Act of 1964 and Fair Housing Act of 1968
What is an example of grassroots activism that can fight racism?
Student Nonviolent Coordinating Committee
