Introduction

Question 1

Define susceptibility

Answer 1

The degree to which a biological entity is vulnerable to the threat posed by a risk factor

Question 2

Define resilience

Answer 2

A biological entity’s capacity to resist injury or disease

Question 3

What is the conventional model of health and disease?

Answer 3

Assumes health relevant outcomes are a consequence of the interaction between variables associated with resilience /vulnerability and biological and behavioural variables.

Two examples: biomedical and behavioural variants

Question 4

What is the medical model?

Answer 4

A focus on the biological or physical aspects of disease or disability

Question 5

Define sex

Answer 5

Biological characteristics typical of males and females

Question 6

What is epidemiology?

Answer 6

Study of the patterns, causes and effects of various health related features in a population

Question 7

Define risk factor analysis

Answer 7

A reductionist approach to determining the probability of disease or death by calculating the potential impact of agent variables, biologic marker variables and behaviour variables on an individual

Question 8

What is a population attribute?

Answer 8

A characteristic of a group of people that does not apply to each and every individual making up that group

Eg. average blood pressure

Question 9

Define political economy

Answer 9

The social science that studies the relationships between individuals and the community and markets and the government.

Question 10

Describe the Lalonde report

Answer 10

Named because Marc Lalonde was federal minister of health in 1974

Key findings:

• Health care services are not primary means of improving health
• Biological factors alone don’t account for disease
• Economic progress introduced new threats to wellness
• Key risks to health are reckless use of resources and irresponsible personal behaviour

Question 11

Describe the Epp report

Answer 11

1986
Named after Epp, then federal minister of health

Challenges:
1. To reduce inequities between rich and poor Canadians
2. To prevent injury and disease

• Prevention focuses on lifestyle
• Need to provide better support to individuals and communities in chronic disease, mental health and disability
• Introduces health promotion framework
• The health promotion framework leads to a multifactoral approach that aims at engaging communities and governments at all levels to support individuals in making healthy choices

Question 12

What are the 12 determinants of health defined by the Public Health Agency of Canada?

Answer 12

1. Income and social status
2. Social support networks
3. Education and literacy
4. Employment and working conditions
5. Social environments
6. Physical environments
7. Personal health practices and coping skills
8. Healthy child development
9. Biologic and genetic endowment
10. Health services
11. Gender
12. Culture

Question 13

What are the 7 social determinants of health covered in the textbook?

Answer 13

1. Income
2. Social status
3. Social support
4. Gender
5. Employment
6. Housing
7. Neighborhood

Question 14

Define health inequalities

Answer 14

Patterned differences in disease incidence, disability and life expectancy between sub-populations

Question 15

Define health inequities

Answer 15

Patterned differences in disease incidence, disability and life expectancy between sub-populations that are avoidable

Question 16

How do health inequalities differ from health inequities?

Answer 16

Health inequities are differences in disease incidence, disability and life expectancy between sub-populations that arise from conditions that can be changed through collective action such as changes in public policies.

Health inequalities can’t.

Question 17

What are liberal regimes?

Answer 17

Countries that place high value on personal liberty and rights. The leave most social and economic activity to non-governmental organizations such as voluntary organizations and corporations and avoid as much as possible, the regulation of social and economic affairs.

Term stemmed from Esping-Andersen

Examples: USA, Canada, UK and Australia

Question 18

Define neo liberal

Answer 18

An ideology that emerged in the 70s and 80s that holds that governments should minimize tax and regulatory burden on individuals, reduce public services in favour of for profit corporate services, and promote economic growth through encouraging trade and consumerism

Question 19

Define population

Answer 19

The people sharing some characteristic (e.g. living in the same country or belonging to a particular racial or ethnic group)

• Exception: people born in the same time period —> cohort

Question 20

What are the components of the biomedical variant?

Answer 20

Version of risk factor model that emphasizes agent and biological variables as key determinants of health

Question 21

What are the components of the behavioural variant?

Answer 21

Version of risk factor model that emphasizes behaviour and lifestyle factors as key determinants of health.

Question 22

Describe Ottawa Charter of Health Promotion

Answer 22

1986

Calls for coordinated action among all levels of government, NGOs, communities and families in pursuit of a physical and social environment conducive to health, access to health information and development of life skills and opportunities for making healthy choices.

Question 23

Who is credited for these new shifts in public health?

Answer 23

Evans, Stoddart and Mustard

Question 24

What are conservative regimes?

Answer 24

Political agendas are shaped by by family and traditional community values
- Family takes care of their own

Example: Portugal

Question 25

Give an example of classic epidemiology

Answer 25

Gay men being blamed for HIV

Question 26

What are versions of classic epidemiology?

Answer 26

Risk factor analysis - Behavioural variant - Biomedical variant

Question 27

What are problems with the risk factor analysis?

Answer 27

- Probabilities are dressed as certainties - Individualistic - Moralizing personal responsibility - Ignores social responsibility - Ignores other, social and political factors that may be more important

Question 28

How can we come to understand causal arguments around health?

Answer 28

Cause is construed as physical, biological Statistical association —> probabilistic Socially deterministic Davidson claims that social causes are more important, impactful

Question 29

What are Davidson’s key claims?

Answer 29

1. Traditional risk factor threats matter little on the macro scale 2. They account for little of the disparities between social groups 3. Risk factor analysis is of questionable consequence for whole societies 4. Population health is primarily determined by social, economic and political factors 5. Economically liberal policy philosophies have harmed population health

Question 30

What is one important note about population health researchers?

Answer 30

Population health researchers are political actors

Question 31

Why is the Lalonde report significant?

Answer 31

Gradually more holistic view of health Gradually more appreciative of population level phenomena Movement beyond individual choice Individual determinism continues to tempt

Question 32

What are social democratic regimes?

Answer 32

Health and economic opportunity are human rights

Question 33

How do economic worldviews and health interact?

Answer 33

Ideological stances vary Smaller government, lower taxes Consistent with notions of free choice Fewer obligations for governments, corporations and wealthy people A threat to health and wellbeing

Question 34

Summarize the introductory chapter of Davidson’s text

Answer 34

Risk factor approach is useful in some aspects but has flaws Health is not just a question of personal responsibility Social, economic and political circumstances too

Question 35

What caveats should be kept in mind when defining health and illness?

Answer 35

Language is flexible Language is metaphorical Definitions are preferably useful, not obligatory Anything more is arguably rhetorical

Question 36

What makes defining health and illness hard?

Answer 36

Caveats Overlapping concepts Mental health is especially tricky

Question 37

Define health

Answer 37

A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity Contains realist and construed elements

Question 38

Describe illness

Answer 38

Diminutive of evil Emphasis on the first person perspective, experience The supreme authority is the one who is ill Still very social in micro and macro senses

Question 39

Describe disease

Answer 39

Dis-ease Realist interpretation The most objective but is it? The supreme authority is the medical practitioner

Question 40

Describe sickness

Answer 40

Social role Legalistic role How sick people should be treated

Question 41

Describe Talcott Parson’s criteria

Answer 41

1. Legit reason for assuming the role 2. Beyond individual’s control 3. Commitment to get well eventually 4. Commitment to follow medical advice

Question 42

How are political economy and health tied together?

Answer 42

Environmental policy Housing policy Economic policy, growth Globalization Democracy, decision making infrastructure

Question 43

Describe medicalization

Answer 43

- Shifting boundaries between healthy and unhealthy - Some social actors have a stake in where those boundaries occur - Also resistance to medicalization - pharmaceutical determinism - Medicine as social control E.g. ADHD

Question 44

Describe medical professions

Answer 44

Power dynamic among them too Leads to contested definitions of health Who is right? Medical ‘hegemony’

Question 45

What are other important issues?

Answer 45

Social capital? Vis a vis social support, cohesion Child health Nutrition and health

Question 46

What conclusions can be drawn from intro lecture?

Answer 46

Health is a murky concept People and social groups have a stake in shifting definitions Both realist and constructivist frames are available Other important components that course can’t cover