Topic 1
Sunday, October 01, 2006
11:31 PM
Topic 1: Concepts and Measures of Health
From Lecture Slides
· What do sociologists do? How is this relevant to the study of health?
o Sociologists study their topics within the context of an entire society: for example, if they study gender roles they will think about how these roles affect many different things throughout society such as social status, earning power, likelihood of being a murder victim, etc.
o This is relevant to health because health behaviors are no different - they are subject to many different sociological factors as well
· For example, the likelihood of someone smoking is directly related to their socioeconomical status - there is a GRADIENT such that the highest social class smokes to some degree, then as we go lower in SES the likelihood of smoking steadily rises higher
· In fact, this pattern holds true for almost all health behaviors/conditions, except for breast cancer
· How has health been defined over the years? Why is its definition important?
o Historically, health was the "absence of disease and infirmity" (note that this is a negative definition, meaning that it is focused on the ABSENCE of something)
o These days, health is "a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity" (note that this is now a partially positive definition because we are talking about the presence of something)
· Also interesting to note is the way that health has been constructed SOCIALLY, in the sense that society has its things which it considers to be "unhealthy" - but the thing to realize is that this definition is more based on social norms than anything scientific
o Its definition is important because our health care system will be based on it!
· What is the Canada Health Act, and what principles did it espouse?
o It was an act that essentially created what we now know as Medicare (our health care system) because:
· It set a national standard for how the financing of health care would work (by federal transfers to the provinces)
· It defined what the health care system would look like by making a list of essential characteristics which the provinces must follow if they wished to receive their funding from the federal government
o The 5 characteristics of the health care system defined by the Canada Health Act are:
· Universality
· Portability
· Accessibility
· Publicly administrated
· Comprehensive
· Why might we have to re-think the Canada Health Act?
o Because since it was created, many things have changed:
· Health care system has changed, i.e. the burden of care is shifting to the home
· Health care expenditure patterns have changed
· Population changes, i.e. now there are more older people and their health care is different
· Morbidity and mortality patterns have changed, i.e. now we are suffering more from chronic diseases than acute ones
· What factors drive the creation of health policy in Canada?
o Ideology: we all have our own ideas/philosophies of what good health care should look like
o Vested interests: we all have our own things that we look out for, and we are going to want to see these things benefit from the creation of any policy
o Evidence: hard data which we can actually point at
From Lecture Slides
· Discuss how health can be defined objectively and subjectively.
o We measure health objectively when we compare against uniform standards and have real data such as blood pressure, heart rate, etc.
o Subjective health is individual-based, in the sense that it depends on how he/she is "feeling", i.e. "Do you feel healthy?"
· Note that this definition is then affected by things such as the patient's worldview, personal pain threshold, etc.
· Often it uses the Likert scale, which is based on the extent to which the individual agrees/disagrees with some statement
· What are the 3 main lay methods of thinking about health?
o Simple absence of disease (this is the traditional model)
o A reserve of health (we have some level of it, and it allows us to do stuff)
o A state of well-being or equilibrium (a positive concept)
· Distinguish between positive and negative concepts of health.
o Negative: this is when we think about deleterious things such as disease, disability, distress, etc.
· So there is some imaginary limit of deleterious conditions we are allowed to have before becoming unhealthy…as long as we are not over the limit, we are healthy
o Positive: it is…much more difficult to define! It is the presence of good things rather than the absence of bad things
From "The Concept of Health", by Rootman and Raeburn
· Talk about the roles of the different components of the health care system with respect to the traditional definition of health.
o Firstly, recall that we originally defined it as the presence of disease and sickness - and so the health care system was based on combating this
o We attribute its successes to vaccinations, medical care, and so on -- but there is compelling evidence to suggest that public health measures such as sanitization and isolation of viruses played a larger part
· Discuss how we gradually shifted from the traditional definition of health to the current WHO definition.
o Beginning in the 1960's, a number of reservations about the original definition began to arise:
· It is a narrow, uni-dimensional definition: it tends to over-emphasize physical dimensions of health and neglect the emotional, interpersonal and social dimensions.
· It doesn’t consider that health can exist in the presence of disease: the idea that we can have a disorder but still live a produce and satisfying life
§ The prevalence of chronic diseases makes this an important point
· Also, the reverse: the traditional definition doesn’t say that even though individuals may not have a diagnosable disorder or disease, they may experience health problems
§ For example: back pain, fatigue, loneliness -- how am I supposed to diagnose/treat that?
· What are the implications of the NEW definition?
o Medicalization of life: many problems, simply because they are the lack of well-being, will start to be considered as medical issues and this will tax the system
o Leads to over-treatment: a consequence of medicalization; doctors will also consider everything to be a medical condition and thus will prescribe medications when perhaps they are not necessary
o Leads to over-investigation: another consequence of the above two is that people are going to start getting freaked out about every little thing, and will want to be tested for everything (i.e. full body scans)
· i.e. Think about Viagra and Cialis for erectile dysfunction
From "Towards an epidemiology of positive health", by Kemm
· What are the different kinds of variables we can use in discussing health? Expound on each.
o Dichotomous variables: these are either one or the other
· For example:
§ Blood pressure: it is high or low
§ Cancer: we have it or not
· But these are hard to define because (for example) we don't know when cancer actually starts
o Continuous variables: such as ordinal, interval, ratio, etc.
o Bipolar and unipolar variables: this is when there is some sort of scale
· For unipolar variables, there aren't two ends of the scale but rather it goes from neutral to positive or neutral to negative
§ i.e. Smoking is neutral ---> a lot
· Bipolar variables have both extremes represented
§ i.e. Physical fitness can be described as better <---> worse
· How does the concept of dimensionality relate to health?
o This is just the discussion which concerns whether the positive measures of health (such as no exercise to a lot of exercise - you can't have negative exercise!) and the negative measures of health (such as no smoking to a lot of smoking) are on the same dimension - meaning that you are either on the positive side or the negative side
o The alternate thinking is that they are separate dimensions so you can be extremely positive but also extremely negative - and furthermore, that positivity does not affect negativity
More from "The Concept of Health", by Rootman and Raeburn
· Explain how disease, illness, and sickness are related.
o The point is that they are all slightly different and are (potentially) exclusive from each other, thus there are implications for the way we think about health…
o Firstly, let's define them:
· Disease: it is when something outside our body comes in and attacks, causing specific signs and symptoms
· Illness: it is a personal experience - a state we are in that is abnormal (thus we assume that a normal state exists)
§ It can be caused by disease!
· Sickness: it is a social role that someone who has an illness brought on by a disease can take - resting in bed, being tired, not working, etc.
o If we were to draw a Venn diagram of disease, illness, sickness, and health, the circles would overlap each other - but only partially
· The point is that they can be independent of each other
Topic 2
Tuesday, October 03, 2006
3:54 PM
Topic 2: Canadian Health Trends/Health Indicators
From SECTION 1: GENERAL in "Disease and Death: Canada in International and Historical Context", by Clarke
· What is the epidemiological transition?
o The epidemiological transition itself is just the idea that morbidity and mortality conditions have changed both in terms of how high the numbers are, and also what the causes are for these things
· More specifically:
§ Transition from high to low mortality
§ Transition from high to low fertility
o It is due to the "demographical transition", which is a change in the social demographics of a certain population of people - the most relevant one being overall SES
· What are the causal factors resulting from the demographic transition which effected the epidemiological transition?
o There are 3 main areas of effect which caused the health landscape to change:
· Decline in fertility: there are fewer children, better birth control mechanisms, etc.
· Change in risk factors: a lot of the risk factors (such as hygiene) which caused the earlier conditions were improved, and so now the dominant causes of morbidity and mortality have changed
§ The major trend of note here is that we are moving from infectious diseases to chronic diseases
· Improvement in case-fatality rates: because of improved medical interventions, on a case-by-case basis we are nursing more patients back to health
o Note that it is (very) significant that medical interventions were NOT the main causal agent - it was more the public health interventions such as hygienic improvement
· What other morbidity trends are relevant here?
o "Cultural inflation of morbidity": this is how aspects of culture are causing morbidity (think smoking, junk food, etc.)
o "Compression of morbidity": this is how the length of time we are "morbid" has been decreased due to medicine
· What are the 3 stages through which an epidemiological transition progresses?
o Age of pestilence and famine: lots of acute, infectious diseases
o Age of receding pandemics: mortality declines and the population explodes
o Age of degenerative and manmade diseases: chronic diseases come to the forefront
· According to McKeown, which factors are responsible for the overall decline in mortality rate and increased life expectancy in the developed world? Comment on something that seems to be missing.
o The factors are:
· Improved nutrition
· Improved hygiene
· Control of disease-causing microorganisms (i.e. mosquitoes, Walkerton's water supply, etc.)
· Improvements in child birth and birth control
o Interestingly, the role of the medicine is relatively minor
· This is proven by McKinlay & McKinlay's study which showed how the eventual decline in death rates from many major diseases such as measles, scarlet fever, tuberculosis, etc. came BEFORE the introduction of immunizations
· The point being is (again) that public health measures had the most benefit - NOT immunization
From SECTION 2: GLOBAL in "Disease and Death: Canada in International and Historical Context", by Clarke
· On a global scale, what are the socio-economic and cultural factors that have the greatest effect on health?
o Poverty & inequality, food security, physical & social environment, position of women/birth control, and comprehensive health care
· Discuss poverty and inequality further. What factors does it include? How do we know these things are so significant?
o This includes factors such as unemployment, income, and social benefits
o The fact that it is closely tied to infant mortality is enormously significant, because infant mortality is a very sensitive indicator of health
· Discuss the difference between absolute and relative poverty.
o An interesting issue here concerns the difference between absolute and relative poverty:
· Absolute poverty is measured by how much we need to survive
· Relative poverty is measured against everyone else
o Interestingly, in the DEVELOPED world we see that relative poverty is a better indicator of health status than absolute poverty is
· Discuss a study that demonstrates how equality has a huge effect on health.
o There was a study that showed child mortality rates in many different countries before tax money was used for health care, and after it was
o Obviously before the taxes, child mortality was higher…and after taxes it was lower
o But the CHANGE in mortality gives us an idea of how much the respective countries use taxes to care for their poor children…and we see that there are huge differences
· Sweden had a large drop
· US had a small drop
· What about comprehensive health care as a factor?
o It definitely has an impact, but (this is a theme) it is not as huge of an impact as one might think!
o In fact, the "Black" study showed that when comprehensive health care was introduced in England, health DID improve BUT there was still a gradient such that the richer people were far healthier than the poor ones