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 Social  Behaviors/Risks  Outcomes

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