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HLST 3010 Social detriments of health Jan 15th 2016

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Unequal – social inequalities in health Montreal=> video o Bottom 20% and top 20% o Factors affecting the middle the same as bottom 20% o Bottom 20% in the extreme; is the homeless; literally living pay check to pay check; social assistance; lost jobs; not done well in school; die early? o Top 20%; happy and well; healthy looking; lawyers; doctors; doing well; house security; job; benefits; o Middle; teachers; drivers; doing fairly well; have security; o Health outcomes in terms of dying early or spending a lot of time in the hospital o Same process affects the middle o Incident of disease; 6-8% diabetes for the top 20% and the bottom twice as that o Living and working conditions to illness and disease o Improves living conditions and psychological process o Family income or level of education o Underprivileged 6% income=> 6 times bigger o more women than man; o single parent situations and teen growns o living conditions and parental level of education o developmental delays => less likely to graduate from school o factors have negative impact on health o poor physical and mental health o more deaths; more hospitalizations; o socio-economic conditions => cumulate over time and affect health o depression; suicide; => how do these conditions kill people? o Living under deprivation; under uncertainty affect health? o What’s driving all of this? o Why are they such conditions among Canadians? Social Determinants of health: Mechanisms and Pathways o Poverty in the city; Toronto  28% of children and women in Toronto are in the bottom 20% o visible minorities  15-year-old whose parents are immigrants do better than kids who are born in Canada o where diabetes hits hardest what are the societal factors (e.g., income key themes o Theme1; empirical evidence o Theme2:

o Died off diseases such as influenza. etc  Anti-biotic, vaccines, …etc  Medical  Life expectances; 15 years later => better medical care but only responsible for 6 extra years  Life style; coronary heart disease => die off heart attack  Manual labour=> others  More likely to smoke; obese; more cholesterol  Bio-medical factors; less exercise; living and working conditions; childhood affect health  Psychological model;  Observation of social inequality o Housing o Education o Social acceptance o Job o Income  Experience of inequality o Employment instability o Limited opportunity o Social segregation o Inequality  experience a gap between expectation and reality  Creates dissonance  Stress; anxiety; depression  Messes up your body;  Morbidity; get an illness  Mortality; death  Well-being  Pathophysiological changes pathway  Respiratory disease  Actual material living in the house  Lack of nutrients; crappy food  Insecure housing  Insecure job o Social structure pathway; society o Gap between people  Psycho-social pathway  Stress; insecurity; anxiety  Sense of control  Sense of identify  Sense of self-esteem  Health behaviours pathway

 Drinking  Smoking  Eating junk food  All of it is affected by Control; work; money; social environment o Income and health; a life-course perspective  Childhood circumstances affect health  Transition to adulthood affect health  Adult circumstances affect health  Predict how your kids will do  Goes through generations  Continued circumstances through life  Living standards  Cumulative health factors o How childhood circumstances affect health  Affect your socio-economic position  Direct affect on health  Lower income kids not going to do so well  Develop certain personalities; depressed  Drink; smoke => because stressed out  Develop certain habits; ways of coping  Living conditions; pathways shape your health and whether you get sick or not? o Blood pressure; cholesterol; stress hormone; vesicular

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o Psychological demands (stressors)  Feeding your kids  Medication o Resistance and vulnerability factors  The psychobiological stress response  Immune o cytokines  Autonomic metabolic o Renal function o Respiration o Fat metabolism  Neuroendocrine o Insulin o Cortisol Pathways (clyde hertzman) o Latent: certain things that happens to you as your child will affect you later in life- life long effect o Pathway: experiences that set you on a certain pathway o Cumulative: all of this stuff accumulate through time

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Psycho-social comparison o Deprivation affects health o Compare ourselves to each other o Creates psychological effects; angry; depressed; raises blood pressure o Basis for bad health o in contradiction to materialist approach neo-materialist interpretation of income inequality and health o income inequality o neo-liberalism=> business control things; raised tuition  run finance;  result of economy run the shots  income inequality o a lot more poverty o a lot more insecurity o deprivation o infections o more stressed out middle and low people  government; community infrastructure of neo-material living condition o stop funding o province investment on living conditions o no affordable housing working-aged male (25-64) mortality rate o o gap of income => bottom 50% gets => 23% of income o the greater the inequality is, the higher the morality rate o a lot of poor people and no support and services; lots of investment jails and police => security systems unnatural causes video; o is inequality making us sick? o Socio-economic factors o Social influence on health => social status o Arise due to Policies or the absence of polices o Social polices o Stress response; cortisol  On alert  Chronical cortisol => negative effects on function and tissues  Diabetes and heart disease o More income-more education; less cortisol level  Immune system=> less stress better =>immune function o Hormone levels interfere with brain circuity/function o Economic security; home ownership => o health outcomes;

racial discrimination vigilance; guard on time increases coronary heart disease increase blood pressure excess death regardless of social status health equality; social reforms; better medical and sanitation  better education; housing  better infrastructure; social movement o health inequality;  less social movements  wealth inequality;  health depends on individual assets and resources income … equality; mortality o managing economy; neo-liberalism  neo-liberalism; idea  liberalism; political ideology =>  model of understanding key tenets of Neo-liberalism o markets are the most efficient allocators of o privatize everything; hospitals; pharmacies; educations; universities o justice values o competition is the major market economic; Globalization o globalization, welfare states, and population health o economic globalization; business moves wherever o resolved in the fact the global sector have more power=> power of capital o privatize => corporate sector o welfare regimes=> liberal welfare regime o not interfere with management  less access to social resources  not affordable housing  poverty  living conditions shape health o       

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Deadly action => TITTLE FOR SUMMARY...