bhs302notesUnit1.pdf BHS 302
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One Day of Notes
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verified elite notetaker
This 18 page Bundle was uploaded by Sin yee Au on Tuesday November 4, 2014. The Bundle belongs to BHS 302 at University of Washington taught by Nora J. Kenworthy in Fall. Since its upload, it has received 165 views. For similar materials see Community Health in Public Health at University of Washington.
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Eugh...this class is soo hard! I'm so glad that you'll be posting notes this semester.
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Date Created: 11/04/14
162014 Class Introduction 1 Health is sociallysituated socially determined and impacted by culture 2 Inequalities inequities and injustices in health across pops exist in part because of our society 3 Health patterns and health interventions are also distributed unevenly across the world gt Global health What makes keeps us healthy 0 Exercise Diet Awareness Hygiene Altitude Beliefs Behaviors Information Education 0 Genetics Life stage Age 0 Health cares Health care laws Health access Med Care Insurance Alternative med 0 Environment Occupation job Social connections Money Education Social status class Culture Cultural norms 0 Happiness Stress Religion 182014 Poverty Class and Health Life at the top in America Class and health Effect of heart attack This is the story of two New Yorkers with little in common who had heart attacks in 2004 Class played a powerful role in the emergency care each received and in their efforts to recover The article mostly focuses on individual resources and constraints for three individuals What about neighborhood context 0 Mr Miele Park Slope Brooklyn Good place 0 Mr Wilson Bedford Stuyvesant Bkln 0 Ms Gora Greenpoint Brooklyn Some re ections 0 Position in the social gradient has clear and durable effects on health 0 Subtle differences in opportunity translate into longterm extensive inequalities remember the description of Mr Miele as the kind of person who makes things happen but access to neighborhoods real estate capital translates into Wealth power and prestige 0 over the long term and thus health benefits 0 What look on the surface like health behaviors and choices can be deeply in uenced by lifetimes of privilege or deprivation 0 Keep paying attention to stress Whitehall study of English civil servants found that men in the lowest pay grades have a mortality rate three times higher than men in the upper pay grades Marmot The Status Syndrome 0 Multiple overlapping factors 0 Not just poverty just education 0 Gradients 0 Not rich poor educated uneducated 0 Not just absolute material deprivation 0 The experience of being unequal itself contributes to our illhealth broken down in the brain 0 Less control more social exclusion more stress 0 Prestige matters OscarWinners live longer 0 Need to focus at a population level to find meaningful explanations rather than look at individual cases of causation History lesson social reformers and public health Rudolf Virchow 1821 1902 Physician scientist social activist anthropologist Founded modern science of pathology biological study of disease Sent to study outbreak of typhus in Upper Silesia now Poland Damning report of social conditions of disease History lesson social reformers and public health Friedrich Engels 18201895 Condition of the Working class in England Industrialization urbanization working conditions making people much sicker than those in the countryside Focus on manufactured conditions of suffering Recognition of Working class Class matters The Working class Engels was one of the first scholars to think about class as a social phenomenon Working class the laboring poor who expend mental and physical labor to produce Wealth primary Wealth for others but don t own the means of production What does this mean for the health of the working poor McKeoWn s Thesis Increased standards of living dramatically improved life expectancy from 1850s1950s Broad social change is the major driver of health improvements after the industrial revolution Curative medical interventions play a small but important role Not surprisingly this caused quite a bit of controversy especially among doctors 0 Some of his findings have been overturned especially those that attributed population growth to these declines in mortality 0 More nuanced story Social factors but different ones 0 What is important here is understanding that though McKeown s argument and methods had ows the underlying idea is essential important broad social changes including those brought about by public health interventions account for a great deal of the dramatic declines in mortality in the past 2 centuries Here s what we do know there have been general declines in mortality due to all kinds of diseases across population life expectancy has risen diseases have been essentially eradicated Disparities over time 0 Over the past 2 centuries we have developed a powerful capacity to control disease and death germ theory medicines vaccines improvements in lifestyle and environment etc 0 But that capacity to control and limit death essentially is not equally distributed The benefits of that capacity are distributed according to who has knowledge money power prestige social connections and enabling environments 0 In addition we are mostly burdened now with diseases that require more nuanced small and complicated responses chronic disease or the premature births we saw in the video last time Our ability to keep these diseases at bay is ever more impacted by social factors 0 Finally we see an increasing trend towards personal responsibility in controlling limiting disease 0 Thus while overall mortality declines disparities are actually increasing Bruce Link quoted in Scott s article progress in addressing disease is creating disparities It s almost as if it s transforming health which used to be like fate into a community So some lessons for today 0 Health inequalities happen along multiple social gradients Those gradients are durable and some inequalities are becoming more not less severe Social factors are also responsible for some significant improvements in health over the past two centuries How We think about health mortality the causes of illness and personal responsibility has a lot to do with how We understand those social factors What is inevitable can t avoid it What is unjust What can be changed And you may be noting that We need more information about What these social gradients are how they are related and how individual choices and chances are tied up in them 1132014 social determinants of health Defining terms Socioeconomic Status SES combined measure that re ects both economic and social position Typically some combination of income education and occupation Life expectancy expected number of years remaining in life at a given age It calculated using average ages at death of a population group Mortality rates a measure of the number of deaths in a population over a specific period of time Typically represented as per 1000 people Population health from Hertzman broad social ecological contexts of health focusing on patterns among population groups Does not simply represent the aggregate of individuals health statuses but recognizes that health is partly a collective phenomenon Hertzman and Siddiqi the crucial important points 0 Health inequalities fall on a gradient sound familiar 0 The gradient can be more or less steep thus health inequalities are more or less acute serious depending on macro social factors 0 Big slowmoving social changes can affect the gradient over time 0 Public policies regarding how resources are shared and distributed in a society have the most important effects on the gradient Hertzman and Siddiqi the crucial important points 0 Three levels for thinking about social factors 0 Marco national socioeconomic context ex taxation 0 Meso social organization and cohesion ex trust among neighbors Working conditions 0 Micro the private realm area ex family support child development trend to yourself 0 What are some of these factors for the lowincome hotel Workers in Seattle and Vancouver 0 Unionization better Wages insurance better neighborhoods better state services for children Working parents 39 7 Rlsks behavlors So how does it Work anyway biology Symptoms A basic model adapted from Link and Phelan Controllable at the individual level Key must try to contextualize these risk Why this is important factors by understanding their causes Because this idea affects everything we do in trying to make population healthy How do social factors get under the skin 0 Hertzman Siddiqi s answer a few processes that probably occur at the same time 0 Increased inequality in a society actually results in decreased willingness to help out those who are less well off which results in fewer important social services and redistribution of money 0 Stress powerlessness becomes biological Marmot agrees 0 Social connectedness social support also impacts health in many ways 0 Lik and Phelan s answer this is the wrong question By focusing on this process we tend to forget about the original social conditions fundamental causes 1152014 Racism injustice and health 3 Levels of Racism 0 Institutionalized formal 0 Pink in shade 0 Cultural deficit priv 0 Access determined by others 0 Better Privileged quality of care 0 Personally mediated Prejudice informal 0 Gardener likes red 0 Assumptions 0 Based treatment 0 Internalized opinion by myself 0 Red happy to be red 0 Pink assumed pink deficient 0 Poor selfconcept 0 Would rather be red 0 Why bother trying 0 Knew would die Pink 1222014 Community Health Assessment How do We define community A community is a social system in which members share a common geography space identity heritage set of experiences interests goals or Values What is the different between a geopolitical and a phenomenological community Geopolitical community Spatial designation 0 Natural boundary 0 A river mountain range 0 Humanmade boundary 0 Structural Street bridges 0 Political school area congressional districts 0 Legal City county Phenomenological community relational designation 0 member s feeling of belong or sense of group Carpiano s list of What We can find out from filed observations 1 Availability and location of local resources or lack of resources 2 Extent and maintenance of public spaces and their uses or lack of use 3 Natural or built landmarks 4 Degree of local community 5 Extent to which people from different groups are present or absent in the community and to what extent they are interacting 1272014 Group discussion 1 How can we help prevent people from feeling the need to isolate themselves Social activities 2 If racial stereotypes were not prevalent in neighborhoods and communities would less people feel obligated to remain in their homes People didn t feel safe if they are not live in there 3 How deleterious is social isolation Does social isolation predict mortality Give an example of a new world situation of how deleterious social isolation is or can be Can be harmful Yes mortality More alone more likely suicide Ex Language barriers 4 How are communities personally affected by the death of an individual especially if they weren t aware that person was in isolation How do you think communities react to learning an individual has passed in their area that they weren t aware of Klinenberg and the Banes Family 0 Klinenberg s big point is that the isolation of older adults is not the result of their individual choices or their irrational fears but the result of social conditions of hardship particularly 0 Increases in the number of urban elderly living alone and without family support estranged from social networks 0 Justified fears of crime that push elderly to withdraw from public space life 0 Destruction of poor urban neighborhoods loss of commercial communal public areas 0 Social service programs that fail to reach out to elderly and expect the elderly to act like consumers in seeking out the services they need One important term to remember Social capital the network of relationships among people who live and work in a particular society which enable that society to function more effectively Social networks have value social capital is not just a nice community benefit but a valuable resource that communities can deploy in order to achieve aims and meet goals 0 Variously measured as social cohesion mutual trust believe each other interconnectedness mutual understanding civic virtue civic participation social efficacy etc 0 bridgingdifferent community bonding together vs bonding same community people bonding together ex Go to see Seahawks game together The roots of urban segregation and degradation With the industrialization of northern cities in the mid to late 1600s city administrations implemented more and less overt measures for keeping black and white populations separate 0 Property deeds restricted to whites 0 Resulted in welldefined areas in cities where minorities could live 0 Overcrowded areas but spatially isolated too 1930s 60s 0 New Deal programs aimed to increase home ownership helping families purchase homes in mostly suburban areas Almost all of these benefits went to whites 0 Beginning of white fight to suburbs 0 1950s 60s 3 million African Americans migrated move from the South to northern cities 0 As whites moved out of cities public services were diverted as well 1960s 90s 0 In now understand overcrowded cities US government decided to clear out blighted 79 area 0 Though the goal was to improve the urban landscape 20 of housing occupied by African Americans was destroyed in the 60s and 90 of low income housing units destroyed by urban renewal were never replaced 60 of those displaced by urban renewal were minorities 0 The solution for those who were displaced was public housing 0 Isolated largescale projects became a second ghetto reliant on public assistance These histories can make health long term effect Vulnerability in cites age gender matter 0 How is this true in Klinenberg 0 In South Africa s cities and rural areas adolescents mapped safe unsafe spaces 0 Space for girls shrinks as they age from 633 square miles among grade 5 girls to 262 square miles for grade 89 girls 0 Space for boys doubles as they age 0 Even though girls public Smallest grade 89 girls gt grade 5 boys gt grade 5 girls gt grade 89 boys largest Urban population status and trends 2000 47 of human population lived in urban areas 2030 estimate 65 of humans will live in urban areas Some estimate that in the foreseeable future 90 of all people will live in megacities 1 billion living in slums globally defined as insecure not safe housing with the absence of one or more essential important urban services sewer water electricity etc 782 of the urban population in lessdeveloped countries lives in slums 1292014 Culture and Health Bridging the Cultural Gap Group Discussion 1 Do you believe that Lia Lee s death could have been prevented Why or why not A physical simple awareness of cultural framework can dramatically affect patients perceptions of the quality of care they receive Do you think hospitals and clinics in the US have the moral responsibility to educate themselves in this way 2 What type of policies can we develop to help medical professionals integrate the idea behind other cultures in order to create a strategic treatment for the patients that takes into account the patient s culture and the ideas behind the medical professional 3 What could be done to bridge the cultural gaps and barriers between doctors and patients whilst maximizing patient care 4 How can their be a balance between different cultures and hospitals What programs can we provide to the immigrant community to offer them better health care One of Lia s doctors Lia s parents seemed to accept things that to me were major catastrophes as part of the normal flow of life For them the crisis was the treatment not the epilepsy I felt a tremendous big responsibility to stop the seizures and to make sure another one never happened again and they felt more like these things happen you know not everything is in our control and not everything is in your control After Lia s brain damage Lia s brain damage had cured her epilepsy and over time as she grew taller her obligatory soft food cured her obesity Suddenly Lia was as Bill Selvidge once told me dryly just the kind of patient nurses like She had metamorphosed change from a hyper active child with a frightening seizure disorder and inaccessible veins into an inert uncomplaining body Who would probably never need another IV Simultaneously in the eyes of the family practice staff her parents were miraculously transformed from child abusers into model caregivers Some basic ideas 0 Culture no single definition but We recognize it to be 0 O O O 0 Shared not just an individual perspective Learned not just inherited genetically Varied not a single perspective either across or Within cultures Flexible able to adapt to new conditions constraints and challenge Changing not static always evolving When We think about cultural perspectives it helps to think in terms of four concepts 0 Emic system of thought Ways of thinking about the world that are particular to a specific culture 0 Lia s parents think that the medicine would hurt their daughter s body 0 Etic system of thought or Ways of thinking about the World that are universal applicable to all cultures 0 Ex Bio medicine vaccine 0 Subjective based on related to in uenced by one s personal experience opinions values or beliefs 0 Objective ostensibly not in uenced by personal feeling opinions experiences values and beliefs Illness gt experience subjective gt Symptoms Disease gt Expertise objective gt Signs ex Temp We each have an explanatory model for illness Qs for eliciting an explanatory model 1 What do you call the problem 2 What do you think has caused the problem 3 What do you think it started when it did 4 What do you think the sickness does How does it Work 5 How severe is the sickness does Will it have a short or long course 6 What kind of treatment do you think the patient should receive What are the most important results you hope he she receive from this treatment 7 What are the chief problems the sickness has caused 8 What do you fear most about the sickness Ex Flu 1 Cold In ection 2 Bacteria Viruses stress the Weather 3 Run in the rain too much stress not enough sleep 4 Makes me Weak and tired 5 Not very important of heshe has a good care Can be either short term or long term 6 cover more blanket make body hot 7 Loss money miss school or exam 8 No one care loss money miss class own feeling Feeling of I am gonna die Group Re ection 1 What does it meant to you to be healthy What do you do to be healthy What do you do to reestablish your health when you have problems or have been sick Physical mental health environment Health is that you feel comfortable to be What you are Exercise eat health such as drink Water vegetables Become normal life 2 What are some values you associate with good or poor health If you encounter a very sick person what personal values or successes failures might you attribute to them What about a very healthy person Money 3 Name a disease that has a moral quality to it that is a disease in which We can recognize not just physical symptoms but indications about a person s character morals behavior or deservingness for care gt HIV cancer 232014 Cultural to Health vbreckuWedu Medical thought Cartesian dualism Mind body are separate 0 Mind is immaterial and thinking 0 Body is material biological but unthinking 0 Medicine deals with the abnormalities dysfunction of the biological body 0 Now heavily contested Within medicine But also body seen as a composition of different parts and systems 0 Med Specialties anatomy Medical values 0 Intervention as primary form of treatment 0 Treatment involves socially accepted trespassing beneath skin into private lives etc 0 Toughness through emotional detachment 0 Forma of expert knowledge through clinical experience based on scientific expertise 0 A profession of doing good Power and the gaze A number of accepted norms and values in medicine give doctors significant power when it comes to dealing with patients In the social sciences we talk about a medical gaze from the doctor towards the patients The gaze is 0 Unilateral only goes one direction 0 Seemingly allknowing 0 From a more powerful position In addition doctors tend to View patients in the following ways 0 With distrust skeptical of subjective patient narratives 0 As a collection of parts and processes not a whole individual 0 As disconnected from psycho social contexts 0 As an impediment to the practice of scientific medicine Individual re ections 0 How does this resonate with your own experiences in the health care system Accurate Inaccurate Why 0 How do you feel when you have to go to a doctor or have to go to the hospital 0 How do you think the health care system might feel for someone who is illiterate cannot speak English or does not have health insurance History of medical dominance 0 What do we note is changing about the profession of medicine in this article What has changed in medicine since this article was published 2001 Medicine also a changing culture 0 Financial amp legal pressures 0 Democratization of knowledge WebMD of course but also new ACA regulations 0 More diverse profession to an extent 0 Privatization amp corporatization 0 Shifts away from primary care towards specialty professions Doctors advice 1 Don t smoke If you can stop If you can t cut down 2 Eat a balanced diet with plenty of fruits and vegetables 3 Make sure you stay physically active and exercise at least 3 times a week 4 Manage your stress Try taking time off and planning relaxing getaways 5 Make sure you practice safer sex What isn t said 1 Don t be poor If you can stop If you can t don t be poor too long 2 Live near good supermarkets and affordable produce stores 3 Live in a safe neighborhood with parks and green space and make sure you can buy a gym pass 4 Work in a rewarding job with good compensation benefits and vacation time 5 Make sure you live in a society where women have equal rights SINYEE AU BHS 302 Notes Unit 1 Video If you Want to help me prescribe me money Gary Bloch Q What you believe Not moral issue Income is a disease Ask and listen Prescribed income Build a poverty team Demand Change Q What you doubt
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