Specific Social Factors Affecting Health

Age Sex Race SES Marital Status

Age

Machine analogy Spencer and organismic theory “wall” of longevity Chronic vs. acute disease

Gender

Women uniformly live longer than men Male fetuses are aborted more often than

female Males have a higher risk of death under age 5

than females Women use care more than men and believe

they are sicker

Gender

Women exhibit less stress than men Women have more cancers except lung and

prostate Men have more coronary disease, injuries,

ulcers because of risk behaviors, social expectations

Type of morbidity therefore differs as well as type of cause of death

Race

Effect of race modulated through SES usually Article on reserve (Hayward et.al.) shows that

absent effects of SES there is still a difference in morbidity and mortality that can be shown to vary by race and ethnicity

Marital Status

There is a salutary effect of being married to health of participants

Social Isolation—Durkheim Social networks defined Social integration What is a social network and can we

standardize it?

Social Networks

Research design is affected by how social networks are defined

Experimental vs. quasi-experimental designs Is this ethical? Self-reports of health status vs. objective

measures Outcome measures

Social Class

Classic Whitehall studies in UK Now divide effects into SES= education+

income+ occupation

SES

SES defined In general, improved SES=improved health

and less morbidity and mortality This was not always the case Factors interact Examples

Key Idea—Link and Phelan

Again, social determinants are more important to health, by any measure of outcome used, than genetic or etiologic causes

Fundamental causes—who we are in society Proximate causes—behaviors Behaviors are controlled by social conditions Social causes are fundamental SocialBehaviors/RisksOutcomes

Religiosity

Religious people have better health than non-religious

May be modulated by improved social networks and decreased stress

Diet

Modulated by SES Cultural and social differences Vegan and “Meat Eaters”

Genes

See lecture from last week May have modulation from maternal diet and

stress, fetal alcohol and smoking affect birth weight and maturity, neural development

DM, HTN, CAD

Proximate Causes

Stressed in our culture Better controlled behaviors are socially

modulated Examples—drugs, alcohol, smoking, sex,

violence and guns Machines Technology

Global example--Bangladesh

Poor SES Poor access Women, religion and bias Acute vs. chronic Mortality and morbidity

Summary

Social causes are fundamental to health, proximate (behavioral) causes are less important but easier to change

Many social factors affect levels of health and illness, including social views on justice and rights

Health status measurement complex