Women & Minority Health Dr. Dawn M. Upchurch PH 150 Fall ‘04

Overview of Lecture Short review of HP 2010 Concept of Social Stratification –Social stratification and health Women’s health –Gender paradox –Key issues in women’s health “Minority” health –Key issues Ways of ameliorating health disparities

Healthy People 2010 Two overarching goals: 1.Eliminate health disparities 2.Increase quality & years of healthy life Objectives organized into 28 “Focus Areas” Each objective has “Leading Health Indicators” –Importance of health promotion & disease prevention

What are “health disparities”? Mortality –Varies by gender –Varies by race/ethnicity –Varies by other sociodemographic factors Morbidity –Varies by gender –Varies by race/ethnicity –Varies by other sociodemographc factors

Explanations for Health Disparities Theory of “Social Stratification” –Society “stratified” by several sociodemographic characteristics GenderAgeRace/ethnicitySESOthers? –Stratification: Differential access to resources

Theory of Social Stratification All known societies have inequalities What are social “resources”? –Wealth –Power –Prestige Rules of allocation: –Variable distribution of goods/resources across various positions in social structure –Most privileged enjoy disproportionately What is “social structure”?

Types of Social Stratification Degree of inequality of resources –Dispersion –Concentration Degree of rigidity –High: “social closure” –Low: “social mobility” Ascriptive vs. Achieved –Ascriptive: Traits present at birth influence subsequent social standing –Achieved: Traits acquired over lifetime influences subsequent social standing

How is U.S. Society Stratified? Both ascriptive & achieved stratification processes –Ascriptive GenderRace/ethnicity Nativity, culture SES of family –Achievement Education, etc.

Concept of Status Attainment Social status individuals achieve over their lives –Key Indicator: Educational attainment –Concept of “human capital” Examples of status attainment process –“Intergenerational transfer” of status –Individual status attainment over life course

Key Sociodemographic Characteristics Associated with Stratification & Health Age –Biological & social components Gender (Sex) –Biological & social components Race & ethnicity –Biological & social components –Social meaning of race & ethnicity changes Socioeconomic status (SES) Contingent effects of age, gender, race/ethnicity & SES on health

Women’s Health – Gender Paradox “Women get sicker, men die quicker.” –What does this mean? –Women Higher morbidity rates than men Lower mortality rates than men –Men Lower morbidity rates than women Higher mortality rates than women –But, higher morbidity should predict higher mortality – What’s happening?

Gender Paradox Gender differences in health care seeking behaviors –Women more likely to go to HCP early & often vs. men Visits are “counted” in morbidity rates –Men more likely to wait and/or not go to HCP So, lower morbidity rates But, wait until conditions more severe  increased risk of mortality So, both “true” & “artifact” differences

Race/ethnicity, SES, & Health Gender, race/ethnicity, & SES associated with one another Distribution of risk factors & resources are shaped by the conditions under which people live & work. What are some of the explanations for the observed race/ethnic & SES differences in health?

Factors Associated with Race/ethnic & SES Differences in Health Medical care –Differential use of preventive care Health behaviors –Unhealthy behaviors account for 50% of deaths in US Environmental conditions –Working conditions, environmental exposures Personality –Self esteem; mastery; fatalism Early life conditions

Reducing Health Disparities Intersection of Research, Policy, & Program PolicyResearchProgram

Reducing Health Disparities National Public Health Agenda –National Health Policies & Programs –Healthy People 2010 State & Local –Policies & Programs Targeted Populations –Policies & Programs Program Development & Evaluation