Patricia Rieker et al. in “Understanding Gender and Health – Old Patterns, New Trends and Future Directions” discuss the gender gap in longevity and overall health in the United States and at the global level. Women have shown higher life expectancy than men, and this pattern is consistent across different countries. Although clinical research had previously focused on solely biological mechanisms to explain the health disparities between the sexes, Rieker emphasizes that the size of this gender gap is a result of complex interactions between social and biological factors. Rieker and Bird propose a multilevel constrained choice model to explain how individual choice in addition to actions performed at the family, work, community, and government levels shape the differing health outcomes of males and females. I found it very interesting that men, who are normally thought to have more privilege in today’s society, actually have a short life expectancy than women. They discussed how this intriguing paradox could be a result of social and biological determinants. For example, men may feel social pressures to fulfill masculine identities and engage in more risky behaviors than do women, which leads to negative health outcomes. However, biological mechanisms come into play as men may be more genetically apt to abuse alcohol and other deleterious substances. The discussion provides for a new area of health consciousness; a better understanding of the differing constraints experienced by the genders can help propel prevention and interventions necessary for improving overall population health.
This discussion post doesn’t come directly from the readings for the week, but the general ideas from the readings apply well. Last night I watched a Vice documentary about President Obama’s visit to jail in his quest to reform the criminal justice system. One part of the documentary really stood out to me. A police officer being interviewed said that he was instructed to go to neighborhoods where young african americans lived, in search for people age 18-24 in possession of drugs. He was instructed to make arrests for any amount of drug, whether recreational or intent to sell. The cop then said if he went to a white neighborhood instead, with the same strategy, he would make just as many arrests as he did in the african american neighborhoods.
It seems as if cops are preying on easy targets. These cops travel to lower social economic status regions in search of arresting targets who may not have enough money to hire a lawyer or pay fines to get out of going to prison. The documentary continues to talk about how people end up getting trapped in a system where after they get out of jail, it’s impossible to get a job to pay fines to prevent getting sent back to jail.
How does someones SES effect their discrimination in the face of the law? Can our generalizations about the disadvantage of race also be extended to the justice system? Do flaws in our justice system promote these endless cycles of low SES? If so, these cycles can lead to less healthy lives for people involved and their families.
In Williams’ and Sternthal’s article, “Understanding Racial-Ethnic Disparities in Health: Sociological Contributions”, they explain that factors such as race, racial discrimination, gender, socioeconomic status, and social structure all have a role in health outcomes in the United States. Although we as a country have come a long way in the fight against racial discrimination, it seems that it is still a pressing issue in today’s society regarding the media, health care, violence, etc. In regards to health care, where doctors take an oath to do no harm and what ever they can to provide care to someone, it is hard for me to agree that health outcomes are because of race alone. Sure, there will be outliers that do discriminate their patients because of race, but generally, I do not think race plays a huge role in health outcomes. I think most health disparities are due to socioeconomic status. Socioeconomic status and race are intertwined and the go hand-in-hand. Thus, I do not think racial discrimination alone accounts for a lot of health disparities but instead I believe that health disparities are due to socioeconomic status and that those people just happen to be apart of a minority racial group. This is the reason why people are seeing health disparities when they look at solely at racial groups.
I would love to hear the opinions of others who think similarly or that that racial discrimination in the health care settings play a major factor in health disparities. Does racism alone actually correlate to health outcomes? Another question I want to ask is that how do these studies access racism and quality of care for someone who can afford to see a doctor among different racial groups. If the argument against my claim holds true and that racial discrimination alone influences health outcomes, then what are the health outcomes of minorities who can afford doctors and are well off? If racial discrimination is a big influence, shouldn’t their outcomes reflect among the general population among their race or is it different?
This year, thanks to the combined efforts of Nicolle Gonzales, Brittany Simplicio, and the nonprofit “Changing Woman Initiative,” a plan has been put into place to create the first ever Native American birth center. Gonzales and Simplicio are two of only fourteen certified nurse midwives who are Native American. The pair have a firsthand understanding of how frequently Native American women suffer the consequences of being minorities with a low socioeconomic status when it comes to health, and, more specifically, pregnancy, birth, and neonatal care.
On this topic, I have mixed feelings.
On one hand, Native American women will have better access to pregnancy and birth care, but I also wonder, how in the world is this first ever birth center for this already largely underserved group of people? How much has this group had suffer as the result their inability to access a birth center?
There is no greater illustration of how institutional racism and mishandled bureaucracy directly harm health outcomes for Native American people than what we see with Indian Health Services (IHS), particularly at the Santa Fe location where Gonzales used to work. Due to underfunding, native women only have access to prenatal care because the labor and delivery ward was shut down in 2008. When I see that, I immediately wonder and worry: when a native woman does go into labor, how far does she have to travel to safely give birth? Does she have access to a safe, clean place if she gives labor at home? How far is the nearest hospital if something goes wrong? The answer all of these to these questions are provided nowhere other than the disproportionately high rates of infant mortality among Native American people.
To add insult to injury, at the Santa Fe location, women are provided neonatal care through IHS, which is funded by the federal government, but for delivery at a hospital, they must apply for Medicaid. The interaction between IHS and Medicaid—for all medical procedures, not just birth—has created a confusing mess for native American people who don’t realize they’re eligible for both.
Gonzales and Simplicio explain that “poverty, discrimination, geography, and racism” have created cultural disparities that leave Native American people less healthy than they should be. These disparities manifest as “higher rates of gestational diabetes, increased rates of postpartum depression, and higher rates of preterm birth and low birth weights.”
It’s just amazing to me that it could take this long to finally give Native American people access to a service that might have saved an unknown number of lives had it been provided earlier.
While women around the world generally have higher morbidity rates than men, the former have lower mortality rates compared to the latter. Weitz posits that the gender gap in the United States and other industrialized countries have been closing, a great improvement for modern times. As a result, gender convergence continues to evolve, which is defined as men and women having similar social expectations for every day behaviors. This will lead to greater convergence in men and women’s patterns of health, morbidity, and mortality. In what ways would this shift affect how our healthcare systems are run? What would the morbidity and mortality patterns look like for men and women?
However, it is interesting to me that traditional gender roles still continue to affect health outcomes for both men and women. The notion that gender roles indirectly impact health outcomes is often dismissed by many disciplines. Yet, it is apparent that the different choices that men and women make according to their gender roles ultimately affect their cumulative health. For instance, Patricia Rieker proposes in “Understanding Gender and Health: Old Patterns, New Trends, and Future Directions” an integrative framework called the “constrained-choice model,” which addresses how structural inequalities limit choices for specific groups, such as by gender, racial/ethnic, and socioeconomic status. Differences between racial/ethnic groups are often exacerbated by discrimination, which creates differential opportunities for various clusters of people. Reiker continues, “This multilevel model explains how decisions made and actions taken at the family, work, community, and government levels contribute to differences in individuals’ opportunities to incorporate health into a broad array of everyday choices.” (62). The “constrained-choice model” addresses three levels of organizational context–social policy, community actions, and work and family–that may affect the differential health outcomes between men and women. Specifically, certain social government policies such as universal healthcare that are not tied to the market or employment (as in Japan and Austria), often result in better longevity and health statuses for both men and women. If gender disparities due to traditional roles continue to exist, how can gender convergence even begin to occur? How could we attempt to intervene on a small-scale?
The “constrained-choice model” reminds me of the “social-ecological model” that is often used in for public health interventions. This model is also rooted in the notion that no individual is an island; our health outcomes are affected by the greater, external forces that surround us, from the interpersonal level and communities, to the larger context of institutions, structures, policies, and systems.
The article “Understanding racial-ethnic Disparities in Health: Sociological Contributions,” by Williams and Sternthal stresses four points. It challenges the biological understanding of race, it emphasizes how social structure determines racial differences in disease, it discusses how racism affects health, and finally it discusses how immigrant status can play a role in healthcare quality.
Specifically, in the section on Racism and Health, Williams and Sternthal discuss how segregation has played a role in minorities’ health, especially African Americans. Additionally, this section also discusses discrimination, but only generally, and not in the context of a healthcare setting.
Thus, this article leaves out some of the medical sociology factors, like racism and discrimination by health care professionals. Therefore, I question and wonder about how quality of care after one has access to and can afford the healthcare varies for different minority groups. How does discrimination by doctors and other healthcare professionals affect the health of these groups? What research has been done to challenge this and bring it to light?
While the culture of the United States is rooted in core values such as individual responsibility, equality, and progress and change, Phelan, Link, and Tehranifar posit in “Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications” that, in reality, inequality pervades the current state of our society. Rather than focusing on individual responsibility (which is so often aggressively advocated in the United States), the authors argue that there are many “fundamental causes” that shape the built environment surrounding individuals. Why do we think that it is important to link individual habits and social contextual factors? What is missing if we focus solely on the individual? How does looking beyond the individual affect possibilities for change?
In addition to the theory of fundamental causes, what I found intriguing was the notion of reducing health inequality by implementing interventions that benefit the whole population instead of only the most affluent. Phelan et al. states, “The idea that medical progress often leads to increased health inequality leads to an obvious conundrum: Must we choose between improving overall levels of health and reducing inequalities in health?… We, on the other hand, are committed to reducing health inequalities, but it seems wrong-headed to oppose advances in health knowledge and technology because those may increase inequalities” (S36-S37). I think this is a really interesting point–on the one hand, we promote advances in medical technology to better treat patients; on the other hand, these advancements in knowledge and technology may also promote disparities in health, as those who are affluent can afford new, expensive technology while those who are poor will not be able to. Ultimately, to what extent do new advances in technology endorse the gap between the wealthy and poor? As the authors inquire, is it possible to achieve both goals: reducing health inequalities and improving overall health with advanced technology? I feel that a class-less society will be difficult to attain in a capitalist nation such as the United States, so it is possible that many people would prioritize advancements in technology to improve population health over reducing the health disparity.
In their article, “Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence and Policy Implications,” Phelan et al. elaborate on the historically prevalent theory that socioeconomic status (SES) is intimately linked with health outcomes. They provide compelling evidence as to why this association has persisted despite the ever-changing diseases and risk factors encountered by our developing population. It was of no surprise that “flexible resources” such as knowledge, power, and social connections that exist at the individual and contextual level were at the center of their proposed fundamental cause theory. However, it was interesting that they found that SES-related health disparities were more prominent for diseases that had recent progress in treatments than the level of disparities found for diseases that did not have new found knowledge or interventions. These findings supported their fundamental cause theory on the basis that those of high SES are better equipped to seize these newly developed medical treatments. They claimed that strategies that aim to reduce these SES-related health disparities must reduce disparities in socioeconomic resources and the strategies must include interventions that are equally distributed across SES groups.
In their article “Social conditions as Fundamental Causes of Health Inequalities: Theory, Evidence and Policy Implications,” Phelan and Link discuss the reality that socioeconimc status plays a large role in the health and healthcare of an individual and even a community. They provide evidence indicating that the roles played by money, power, prestige, knowledge, and beneficial social connections allow people with higher socioeconomic statuses to receive better care and have better health overall. Continue reading “Status, Equality, and Healthcare”
The article titled “Social conditions as Fundamental Causes of Health Inequalities: Theory, Evidence and Policy Implications” backs up the claim that socioeconomic status influences both health and mortality rates in communities and individuals and explains in detail why socioeconomic inequalities persist. The authors discuss that the social causes in health inequalities must include four parts: it influences multiple disease outcomes, affects these disease outcomes through multiple risk factors, involves access to resources that can be used to avoid risks or to minimize the consequences of disease once it occur, and replacing intervening mechanisms allow the association between a cause and health to be reproduced over time. Continue reading “Combating Socioeconomic Inequalities”