Week 10: Inequalities in Health Flashcards
What are the two takeaways from the Robert Sapolsky video about stress and hierarchy in baboons?
1) Hierarchy is bad for health - Those at the bottom of the hierarchy have higher stress responses
2) Hierarchy gone -> Lower status started to thrive. Low levels of aggression and high levels of social affiliation can help to buffer stress
What are the two ways of defining social class?
- Objective social class
- Subjective social class
What are the components of objective social class?
1) Income
2) Education
3) Occupation
One’s own or parents’
What is subjective social class?
Own judgment of where you stand along the social ladder in society
What are the characteristics of the social class health gradient?
- Continuous
- Relative rank is important
What are the findings of the Whitehall Studies?
- Tight categorisation of rank within London Service sector, very hierarchical
- All service workers have access to same health benefits (i.e. access to healthcare controlled for)
- YET: a strong association b/w employment rank and mortality rates
What are the aspects of the environment that are related to SES?
- Physical
- Social
How does SES relate to one’s physical environment?
- Higher levels of toxins and pathogens
- Noise, pollution and crowding
- Poor infrastructure
- Jobs that are more physically dangerous
- Limited access to recreational facilities, quality healthcare, healthy foods
How does SES relate to one’s social environment?
- Crime and violence
- Less social support
- Social (family) conflict
What are the aspects of psychological response that are related to SES?
- Affect
- Cognition
How does SES relate to affect?
Anxiety/distress from awareness of negative stereotypes about low SES, that can evolve into depression
How does SES relate to cognition?
Low sense of personal control and mastery
Perceived control at work explained a sig. portion (more than half) of the health gradient among the Whitehall civil servants
How does cognition relate to affect?
Low optimism increases feelings of hopelessness, hostility and anger, and subsequently the risk of chronic health disorders
Slows recovery from major surgeries e.g. coronary bypass surgery
How does environment and psychological response relate to health-compromising behaviours?
- (Short-run) Stress-relieving behaviours e.g. smoking, sedentary lifestyle, high-fat diet
- Lower adherence to medical treatments, particularly among those with lower education
How does environment and psychological response relate to biological response?
- Allostatic load
What is allostatic load?
Cumulative “wear and tear” from chronic exposure to stress
How is the allostatic load score calculated? What are its implications?
Sum of indicators in the highest risk quartile (top 25%)
BP, waist-to-hip ratio, cholesterol, blood glucose, cortisol, etc
Higher AL score, higher disease risk and earlier mortality
How does SES relate to allostatic load?
Karlamanga et al (2002)
- Low SES indivs. had higher AL scores at baselines
- Higher scores predicted poor physical and cognitive functioning, cardiac health and mortality up to 7 years later
What are psychosocial buffers?
Factors that protect low SES indivs from stressors that lead to poor health
What are some types of psychosocial buffers?
- Social support: strong family r/s
- Psychological beliefs: sense of control, non-essentialist beliefs
- Resilience strategies: shift-and-persist
How does sense of control act as a psychosocial buffer for low SES indivs?
High control -> lower stress and better health
How do non-essentialist beliefs act as a psychosocial buffer for low SES indivs?
Non-genetic beliefs -> lower stress and better health
What is shift-and-persist?
A resilience strategy for dealing with adversity
Protective against stressors, particularly for low SES children, adolescents and young adults
What is shift? What is persist?
Shift: Accept and reappraise
Persist: Meaning and optimism
How does shift-and-persist come about?
Stable and positive role models –> Attachment, socialisation of behaviours, future orientation –> Shift-and-persist
What is shifting?
Shifting involves
1) ACCEPTING stressors, followed by
2) RE-APPRAISING the stressors to adjust oneself to the external envmt
What is re-appraisal?
Re-evaluating a stressful situation to reduce its emotional impact
Stressors of lower emotional impact become more manageable
Children who are able to reappraise stressors have…
Less behavioural problems and higher emotional well-being
What is persisting?
Persisting involves enduring adversity through
1) FINDING MEANING in life, and
2) MAINTAINING OPTIMISM about the future
- - developing a long-term orientation
What are the outcomes of finding meaning?
Increases sense of security, place, and coherence in the world
Helps reconcile stressful encounters about one’s beliefs about world and self
How does finding meaning and optimism relate?
Finding meaning can increase optimism
And being optimistic can increase sense of meaning
What are the reciprocal effects of shifting and persisting?
Secondary control from shifting motivates meaning-finding and optimism
Finding meaning and having optimism facilitate accepting and reappraisal of stressors
What is the indirect evidence for the shifting aspect of the shift-and-persist model?
Successful reappraisals are linked to
- Reduced BP and cardiovascular reactivity during acute stressors
- Lower ambulatory BP in adolescents during daily social interactions
- Lower CVD risk profiles
- Lower inflammation levels (specifically, C-reactive protein)
What is the indirect evidence for the persisting aspect of the shift-and-persist model?
Optimism and meaning in life are linked to
- Lower BP and cardiovascular reactivity
- Reduced systemic inflammation
- Less cortisol secretion throughout the day
- Faster recovery from CHD and lower likelihood to future heart attack
What is primary and secondary control?
- Primary: Changing envmt to fit the self
- Secondary: Changing self to fit the envmt
Why is shift-and-persist helpful for low SES indivs?
Lack of resources afford low SES indivs secondary rather than primary control
- Shifting facilitates secondary control
- Persisting helps to sustain secondary control
What is the direct evidence for the shift-and-persist model?
Inflammation
- Low SES indivs who have high S&P have lower glucocorticoid resistance/CRP+IL6
Obesity
- Low SES indivs who have high S&P have lower BMI
How to “shift-and-persist”?
- Role models (e.g. nurturing parents, mentor)
- Socialisation of behaviours
- Positive attachment figures and r/s
How does socialisation of behaviours teach shift-and persist?
- Teach appropriate emotion regulation behaviour (“shifting”)
- Children or young adults learn appropriate responses to difficult situations by observing role models (“shift”)
- Keep children/young adults focused on their future (“persist”)
- Successful role models serve as an inspiration (“shift”)
How do positive attachment figures and r/s teach shift-and-persist?
- Help children or young adults learn that they can turn to someone for help and to trust their word (“persist”)
- Increase optimism (“persist”)
What other groups can shift-and-persist be applied to?
Minority groups who face discrimination (e.g. African-Americans, immigrants)
Indivs. facing life-threatening events or dealing with chronic illnesses
What is the importance of studying psychosocial buffers?
- We know a lot about WHY low SES is linked to poor health
- But we still don’t know enough about HOW to reduce this health gap
- Uncovering psychosocial buffers or protective factors can inform psychological interventions and government policies to help improve low SES indiv’s health
What are some unanswered questions about inequalities in health?
- Psychologists - indiv. factors vs. sociologists, economists, epidemiologists - direct effects of material and structural factors that affect health
- SES and race confound
- Changes in SES? Do effects of childhood SES “stick” with you?
- Bidirectional effects of SES and health
- Role of economic inequality
What is the relationship between national income and life expectancy when comparing between societies vs. within society?
- No r/s when comparing b/w societies
- Socioeconomic health gradient within society
What are the two takeaways from the Richard Wilkinson’s talk on how inequality harms societies?
1) Health and social problems are worse in more unequal societies
2) It doesn’t matter how lower inequality is achieved as long as it is achieved
