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Health Psych > Week 10: Inequalities in Health > Flashcards

Week 10: Inequalities in Health Flashcards

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1
Q

What are the two takeaways from the Robert Sapolsky video about stress and hierarchy in baboons?

A

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

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2
Q

What are the two ways of defining social class?

A
  • Objective social class

- Subjective social class

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3
Q

What are the components of objective social class?

A

1) Income
2) Education
3) Occupation

One’s own or parents’

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4
Q

What is subjective social class?

A

Own judgment of where you stand along the social ladder in society

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5
Q

What are the characteristics of the social class health gradient?

A
  • Continuous

- Relative rank is important

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6
Q

What are the findings of the Whitehall Studies?

A
  • 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
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7
Q

What are the aspects of the environment that are related to SES?

A
  • Physical

- Social

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8
Q

How does SES relate to one’s physical environment?

A
  • 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
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9
Q

How does SES relate to one’s social environment?

A
  • Crime and violence
  • Less social support
  • Social (family) conflict
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10
Q

What are the aspects of psychological response that are related to SES?

A
  • Affect

- Cognition

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11
Q

How does SES relate to affect?

A

Anxiety/distress from awareness of negative stereotypes about low SES, that can evolve into depression

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12
Q

How does SES relate to cognition?

A

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

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13
Q

How does cognition relate to affect?

A

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

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14
Q

How does environment and psychological response relate to health-compromising behaviours?

A
  • (Short-run) Stress-relieving behaviours e.g. smoking, sedentary lifestyle, high-fat diet
  • Lower adherence to medical treatments, particularly among those with lower education
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15
Q

How does environment and psychological response relate to biological response?

A
  • Allostatic load
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16
Q

What is allostatic load?

A

Cumulative “wear and tear” from chronic exposure to stress

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17
Q

How is the allostatic load score calculated? What are its implications?

A

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

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18
Q

How does SES relate to allostatic load?

A

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
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19
Q

What are psychosocial buffers?

A

Factors that protect low SES indivs from stressors that lead to poor health

20
Q

What are some types of psychosocial buffers?

A
  • Social support: strong family r/s
  • Psychological beliefs: sense of control, non-essentialist beliefs
  • Resilience strategies: shift-and-persist
21
Q

How does sense of control act as a psychosocial buffer for low SES indivs?

A

High control -> lower stress and better health

22
Q

How do non-essentialist beliefs act as a psychosocial buffer for low SES indivs?

A

Non-genetic beliefs -> lower stress and better health

23
Q

What is shift-and-persist?

A

A resilience strategy for dealing with adversity

Protective against stressors, particularly for low SES children, adolescents and young adults

24
Q

What is shift? What is persist?

A

Shift: Accept and reappraise
Persist: Meaning and optimism

25
Q

How does shift-and-persist come about?

A

Stable and positive role models –> Attachment, socialisation of behaviours, future orientation –> Shift-and-persist

26
Q

What is shifting?

A

Shifting involves

1) ACCEPTING stressors, followed by
2) RE-APPRAISING the stressors to adjust oneself to the external envmt

27
Q

What is re-appraisal?

A

Re-evaluating a stressful situation to reduce its emotional impact

Stressors of lower emotional impact become more manageable

28
Q

Children who are able to reappraise stressors have…

A

Less behavioural problems and higher emotional well-being

29
Q

What is persisting?

A

Persisting involves enduring adversity through

1) FINDING MEANING in life, and
2) MAINTAINING OPTIMISM about the future
- - developing a long-term orientation

30
Q

What are the outcomes of finding meaning?

A

Increases sense of security, place, and coherence in the world

Helps reconcile stressful encounters about one’s beliefs about world and self

31
Q

How does finding meaning and optimism relate?

A

Finding meaning can increase optimism

And being optimistic can increase sense of meaning

32
Q

What are the reciprocal effects of shifting and persisting?

A

Secondary control from shifting motivates meaning-finding and optimism

Finding meaning and having optimism facilitate accepting and reappraisal of stressors

33
Q

What is the indirect evidence for the shifting aspect of the shift-and-persist model?

A

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)
34
Q

What is the indirect evidence for the persisting aspect of the shift-and-persist model?

A

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
35
Q

What is primary and secondary control?

A
  • Primary: Changing envmt to fit the self

- Secondary: Changing self to fit the envmt

36
Q

Why is shift-and-persist helpful for low SES indivs?

A

Lack of resources afford low SES indivs secondary rather than primary control

  • Shifting facilitates secondary control
  • Persisting helps to sustain secondary control
37
Q

What is the direct evidence for the shift-and-persist model?

A

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

38
Q

How to “shift-and-persist”?

A
  • Role models (e.g. nurturing parents, mentor)
  • Socialisation of behaviours
  • Positive attachment figures and r/s
39
Q

How does socialisation of behaviours teach shift-and persist?

A
  • 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”)
40
Q

How do positive attachment figures and r/s teach shift-and-persist?

A
  • Help children or young adults learn that they can turn to someone for help and to trust their word (“persist”)
  • Increase optimism (“persist”)
41
Q

What other groups can shift-and-persist be applied to?

A

Minority groups who face discrimination (e.g. African-Americans, immigrants)

Indivs. facing life-threatening events or dealing with chronic illnesses

42
Q

What is the importance of studying psychosocial buffers?

A
  • 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
43
Q

What are some unanswered questions about inequalities in health?

A
  • 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
44
Q

What is the relationship between national income and life expectancy when comparing between societies vs. within society?

A
  • No r/s when comparing b/w societies

- Socioeconomic health gradient within society

45
Q

What are the two takeaways from the Richard Wilkinson’s talk on how inequality harms societies?

A

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

Health Psych (10 decks)

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