Women & Minority HealthWomen & Minority Health

Dr. Dawn M. UpchurchDr. Dawn M. Upchurch

PH 150PH 150

Fall ‘04Fall ‘04

Overview of LectureOverview of Lecture

Short review of HP 2010Short review of HP 2010

Concept of Social StratificationConcept of Social Stratification– Social stratification and healthSocial stratification and health

Women’s healthWomen’s health– Gender paradoxGender paradox– Key issues in women’s healthKey issues in women’s health

““Minority” healthMinority” health– Key issuesKey issues

Ways of ameliorating health disparitiesWays of ameliorating health disparities

Healthy People 2010Healthy People 2010

Two overarching goals:Two overarching goals:1.1. Eliminate health disparitiesEliminate health disparities2.2. Increase quality & years of healthy lifeIncrease quality & years of healthy life

Objectives organized into 28 “Focus Objectives organized into 28 “Focus Areas”Areas”Each objective has “Leading Health Each objective has “Leading Health Indicators”Indicators”

– Importance of health promotion & disease Importance of health promotion & disease preventionprevention

What are “health disparities”?What are “health disparities”?

Mortality Mortality – Varies by genderVaries by gender– Varies by race/ethnicityVaries by race/ethnicity– Varies by other sociodemographic factorsVaries by other sociodemographic factors

MorbidityMorbidity– Varies by genderVaries by gender– Varies by race/ethnicityVaries by race/ethnicity– Varies by other sociodemographc factorsVaries by other sociodemographc factors

Explanations for Health Disparities Explanations for Health Disparities

Theory of “Social Stratification”Theory of “Social Stratification”– Society “stratified” by several Society “stratified” by several

sociodemographic characteristicssociodemographic characteristicsGenderGender

AgeAge

Race/ethnicityRace/ethnicity

SESSES

Others?Others?

– Stratification: Differential access to resourcesStratification: Differential access to resources

Theory of Social Stratification Theory of Social Stratification

All known societies have inequalitiesAll known societies have inequalitiesWhat are social “resources”?What are social “resources”?– WealthWealth– PowerPower– Prestige Prestige

Rules of allocation:Rules of allocation:– Variable distribution of goods/resources across Variable distribution of goods/resources across

various positions in social structurevarious positions in social structure– Most privileged enjoy disproportionatelyMost privileged enjoy disproportionately

What is “social structure”? What is “social structure”?

Types of Social StratificationTypes of Social Stratification

Degree of inequality of resourcesDegree of inequality of resources– DispersionDispersion– ConcentrationConcentration

Degree of rigidityDegree of rigidity– High: “social closure”High: “social closure”– Low: “social mobility”Low: “social mobility”

Ascriptive vs. Achieved Ascriptive vs. Achieved – Ascriptive: Traits present at birth influence Ascriptive: Traits present at birth influence

subsequent social standingsubsequent social standing– Achieved: Traits acquired over lifetime influences Achieved: Traits acquired over lifetime influences

subsequent social standingsubsequent social standing

How is U.S. Society Stratified?How is U.S. Society Stratified?

Both ascriptive & achieved stratification Both ascriptive & achieved stratification processesprocesses– AscriptiveAscriptive

GenderGender

Race/ethnicityRace/ethnicity

Nativity, cultureNativity, culture

SES of familySES of family

– AchievementAchievementEducation, etc.Education, etc.

Concept of Status AttainmentConcept of Status Attainment

Social status individuals achieve over their Social status individuals achieve over their liveslives– Key Indicator: Educational attainmentKey Indicator: Educational attainment– Concept of “human capital”Concept of “human capital”

Examples of status attainment processExamples of status attainment process– ““Intergenerational transfer” of statusIntergenerational transfer” of status– Individual status attainment over life courseIndividual status attainment over life course

Key Sociodemographic Key Sociodemographic Characteristics Associated with Characteristics Associated with

Stratification & Health Stratification & Health AgeAge– Biological & social componentsBiological & social components

Gender (Sex)Gender (Sex)– Biological & social componentsBiological & social components

Race & ethnicityRace & ethnicity– Biological & social componentsBiological & social components– Social meaning of race & ethnicity changesSocial meaning of race & ethnicity changes

Socioeconomic status (SES)Socioeconomic status (SES)Contingent effects of age, gender, race/ethnicity Contingent effects of age, gender, race/ethnicity & SES on health& SES on health

Women’s Health – Gender ParadoxWomen’s Health – Gender Paradox

““Women get sicker, men die quicker.”Women get sicker, men die quicker.”– What does this mean?What does this mean?– WomenWomen

Higher morbidity rates than menHigher morbidity rates than men

Lower mortality rates than menLower mortality rates than men

– MenMenLower morbidity rates than womenLower morbidity rates than women

Higher mortality rates than womenHigher mortality rates than women

– But, higher morbidity should predict higher mortality – But, higher morbidity should predict higher mortality – What’s happening?What’s happening?

Gender ParadoxGender Paradox

Gender differences in health care seeking Gender differences in health care seeking behaviorsbehaviors– Women more likely to go to HCP early & often Women more likely to go to HCP early & often

vs. menvs. menVisits are “counted” in morbidity ratesVisits are “counted” in morbidity rates

– Men more likely to wait and/or not go to HCPMen more likely to wait and/or not go to HCPSo, lower morbidity ratesSo, lower morbidity ratesBut, wait until conditions more severe But, wait until conditions more severe increased increased risk of mortalityrisk of mortality

So, both “true” & “artifact” differencesSo, both “true” & “artifact” differences

Race/ethnicity, SES, & HealthRace/ethnicity, SES, & Health

Gender, race/ethnicity, & SES associated Gender, race/ethnicity, & SES associated with one anotherwith one another

Distribution of risk factors & resources are Distribution of risk factors & resources are shaped by the conditions under which shaped by the conditions under which people live & work.people live & work.

What are some of the explanations for the What are some of the explanations for the observed race/ethnic & SES differences in observed race/ethnic & SES differences in health? health?

Factors Associated with Race/ethnic & Factors Associated with Race/ethnic & SES Differences in HealthSES Differences in Health

Medical careMedical care– Differential use of preventive careDifferential use of preventive care

Health behaviorsHealth behaviors– Unhealthy behaviors account for 50% of deaths in USUnhealthy behaviors account for 50% of deaths in US

Environmental conditionsEnvironmental conditions– Working conditions, environmental exposuresWorking conditions, environmental exposures

PersonalityPersonality– Self esteem; mastery; fatalismSelf esteem; mastery; fatalism

Early life conditionsEarly life conditions

Reducing Health DisparitiesReducing Health Disparities

Intersection of Research, Policy, & ProgramIntersection of Research, Policy, & Program

PolicyPolicy

ResearchResearch

ProgramProgram

Reducing Health DisparitiesReducing Health Disparities

National Public Health AgendaNational Public Health Agenda– National Health Policies & ProgramsNational Health Policies & Programs– Healthy People 2010Healthy People 2010

State & Local State & Local – Policies & ProgramsPolicies & Programs

Targeted PopulationsTargeted Populations– Policies & ProgramsPolicies & Programs

Program Development & EvaluationProgram Development & Evaluation