HSS 2321 Sociopolitical perspective related to health and illness

HSS 2321 Sociopolitical perspective related to health and illness Health: • World Health Organization defined health as “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” • Health depends on the individual's experience; it is an individual issue. • Socio-political: • Politics have to do with power. Power is that ability to act on someone or on some situation • Many examples of politics: it can be exercised at the level of the state, level of municipalities, and level of the family, and interventions in health (covid 19 vaccine) • power at a broader sense at different levels Socio-economic status: • Socio-economic status is income, education, It incorporates a lot of a network of resources, you have money involved, knowledge, prestigious part of status, our social ties, but all these are interests they protect. • Health and illness are socially patterned: Ex: Are you aware of the relationship between ethnicity and sickle - cell anemia? • Sickle - cell anemia is found more in people with African or Mediterranean background. • Did you know that unemployment is often followed by ill health? • Most types of morbidity and mortality are inversely related to income. • The sociology of health and illness: Seeks to describe and explain some of the social causes and consequences of illness, disease, disability, and death; to show the ways lay people and medical professionals construct their own distinct categories of disease and illness; and to describe the identities and experiences associated with illness and wellness. • Sociology of medicine: How does it recognize illness and define illness and respond to illness. We look at the profession and other competing healthcare professions and medical care. • Medicalization: Is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Structural functionalism theory: • Auguste Comte (1798–1857); Émile Durkheim (1858–1917); Talcott Parsons • The dominant theory in public health and epidemiology • Social facts Focuses on the social causes of social facts o Social fact has effects on behavior on attitudes and feelings. They are real and external. Ex. Norms: standards of conduct that are found in various parts of the society in family and economy. o The social system is composed of parts, institutions that function to maintain order o Keeping order so everything goes well and avoiding conflict. It’s important that all the parts work together, if one part does not work a lot of effort is put in to making sure again it functions • Positivist methodology: • Emphasizes objectivity that can be generalized • Example: the sick role • Criticisms of the sick role • Human health behaviors as both independent and dependent variables • They assume that you can measure human behavior through experiments and research Assumptions: 1. The goal of sociology is to discover and explain the impact of social facts on human behavior, attitudes, and feelings. 2. Social facts are to be treated as real and external 3. Social facts= norm 4. Objectivity 5. quantitatively measurable The sick role: • inability of the sick to fulfill their necessary social roles • only temporary Rights and duties of the sick roles: 1. The sick person is exempt from “normal” social roles. 2. The sick person is not responsible for his or her condition. 3. The sick person should try to get well. 4. The sick person should seek technically competent help and co-operate with the physician. Conflict theory: • Karl Marx (1818–83): a radical critique of structural-functional sociology • History as a class struggle • Level of analysis is society system • Historical and socio-political origins and causes of injustice rather than objectivity • Early capitalist production and negative health effects • Advanced monopoly capitalism, globalization, and neoliberalism • The role of the state in promoting capitalism and the threats to health and wellbeing. • Home health-care work Assumptions: 1. the sociologist’s work is to discover and document injustice (and sometimes to attempt to change it) 2. All knowledge is rooted in social, material, and historical contexts 3. Sociological research methods must acknowledge social, economic, and historical circumstances. When the conflict theorist is particularly influenced by Marx’s analysis, the primary subject of study is social classes, because they are thought of as the most important means to effect change Example: Early capitalist production: • Had negative effects • Capitalism introduced mechanization on farms, causing an increase in unemployment. Many moved to cities to found work. • Capitalists in the city want to make profit. So, they paid the workers low wages, resulting in an unfavorable living situation (the great clumps) that led to the increase in diseases. People with higher income live longer. Interpretive/social constructionist theory or Symbolic interactionist theory: • Max Weber • Subjective meaning • Study how the subjective definitions of social reality are constructed and how this reality is experienced and described by the social actors. • Inter subjectivity or reflexivity: • The level of analysis is microanalysis • Require different methods • Rich, carefully detailed description and analysis of unique social situations from the perspective of the subjects under investigation are typical of interpretive research. • Disease is the pathology; illness is the meaning • “How do you think men deal with their masculinity when they are diagnosed with breast cancer as compared to prostate cancer? Or how do people change or adapt as they construct their identities after receiving a diagnosis of a sexually transmitted infection. Example: • Epilepsy and the different perspectives of people who have it Feminist and Critical Anti-Racist Theories: • Feminist Theory: • Betty Friedan • Radical critique of social sciences and medical care system/practice • Feminist analysis of health has been a criticism of the medicalization of women’s lives • Critical anti-racist theory: • Sefa Dei • All knowledge is racialized, associated with power and wealth • Lack of objectivity- • Intersectionality theory: • Activist’s standpoint Post-Structuralism: • Michel Foucault • Bio power • “Medical or clinical gaze” • “The rapid, widespread uptake of the human papillomavirus (HPV) vaccine for young girls, ostensibly to prevent cervical cancer and genital warts” Notes of Arezoo-- Chapter. 1 sociological perspective related to health and illness 1. Structural functionalism Theory: This theory view sociology as science and work of Emile Durkheim. Society is social system of interlocking and interrelated parts such as institution. Sociology in the Durkheim Ian tradition is often called structural functionalism/ level of study for sociologist is the system. The social system composed of parts called institutions that function to maintain order. Example, just like organs in human body are connected to one another and function interrelated components. So too does the parts of institution of society – the Family, economy, politics , education, welfare, justice military and medical care system. All these institutions operate interdependently to keep the society functioning. The sick role has 4 components -first two are right -second 2 are duties. 1. The sick person is exempt from normal social roles: Sick person has legitimate excuse for missing exam, major presentation at work and staying in bed. Sick persons need to obtain official diagnosis /medical certificate to proof as illness. 2. The sick person is not responsible for his /her condition: the circumstances are beyond the control of individual. Not to be blamed punished /have sympathy rather than blame. 3. Sick person should try to get well. Duty of sick to get well e.g., if person diagnosed with pneumonia must do what doctor orders if not the legitimacy of the sick role deteriorates to a foolish, careless individual. 4. The sick person should seek technically competent help and cooperate with the physician. Seek appropriate medical attention comply with the treatment provided. Positivism: Is the research methodology associated structural functional perspective? Contemporary positivist study human health behaviors as both independent and dependent variable. Example: Cystic fibrosis on the family of the ill person treats health behavior related to the diagnosis as the independent variable and impact of income level on the incidence of disease is studied human health behavior becomes the dependent variable. Conflict theory: Karl Marx work, society is a system of classes. Theory concerned about the documentation and elimination of injustices, particularly those based on economic inequalities. History as a class struggle: Society composed of constantly varying balance of opposite forces that generate change through ongoing struggle. Motivating force behind continuous struggle is the way in which people interact with one another as they attempt to obtain their livelihood. Struggle between classes related to the means of production. Example: land /factory member of one class own the means of production and members of the other class sell their labor for goods and services and cash end to conflict was both possible and desirable and would happen in a communist state in which all citizens owned the means of production. Levels of analysis is society system: Home health -care work: Composed 4 elements: 1. Provision of healthy conditions in the home (maintenance of war and clean home with sufficient space for rest /relaxation all family members. Nutritious foods, clean water. Managing social relationship meeting emotional needs for mental health of family members. 2. Nursing the sick caring for sick child adult the elderly or disable people falls on the shoulder of women in home, nursing sick time-consuming exhausting job, sleepless night heavy lifting prep complicated menus, administering medicine copping with budges. 3rd teaching health modelling good health habits giving instruction on diet, hygiene exercise. 4. Mediate with doctors’ hospital making visits to clinics talking with social public health worker getting advice from professional health care are such as nutrition. Prenatal resources income and education associated with better safety practices in respect of their children not leaving a child alone in bathtub using approved car seat, wear safety helmet wile cycling. Advanced monopoly capitalism, globalization and neo liberalism: Have generated considerably different but equally inhumane working conditions for workers and their families under neo-liberalism inequality has widened in the developed world. Interpretive or social constructivist theory: Writing of Max Weber see sociology as the study of social action/selves who make their social lives meaningful through interaction. Subjective meaning: Interpretive sociologist study how the subjective definitions of social reality are constructed and how this reality is experienced and described by social actors. Human beings create their social worlds. As the subjects who are being studied are busy defining reality for themselves so too are the researchers. The interpretive theorist is faced with the problem when collecting data of inter subjectivity or reflexivity. The data given a subjective slant by the people /researcher being studied. The lever of analysis is microanalysis: Desirable methodological stance of the researcher, collect data by observing social action in close participation with the subjects or by long unstructured interview the level of analysis is not of the system but rather of individual interactions with others. The mind /self / meaning is microanalysis. Focus on systems are macro analyses. Assumptions characteristic of perspective: 1st sociology is a science purpose to understand human social action and interactions. 2nd reflexivity or inter subjectivity rather than objectivity or critical analysis, characterized the relationship between the subject and the researcher. Required different methods: Analysis of society demands different methods to describe nature world. Methods grasp the motives and meanings of social acts. E.g., the study of the meaning of the diagnosis of epilepsy within the lives of a sample of people with disease. Researchers distinguish disease and illness. Disease is a pathology of human body illness is the meaning of the experience associated with a given pathology. The study of meaning of illness is extensive. Study on how masculinities may be affecting the use of health care and management of illness and disability. How a man manages their identities when are diagnosed with a disease that is not only more common among women. How man decided to deny taking the treatment because they believe they can handle it. Feminist theory: Are more recent, the work of Canadian sociologist Dorothy smith is used to exemplify feminism. Critical race theory and feminist studies focus both on structural problems within society and its institutions. (To understand society, we must be aware of inequity, social organization’s structure power and knowledge from women’s perspective. A major theme in a feminist analysis of health has been a criticism of the medicalization of women’s lives. Research focused on dominance of the medical care system, medical practitioners’ medical construction of knowledge and power over women. –regarding reproductive issues, birth control childbirth and menopause. Feminist researcher examined gender differences in disease and death reaction to disease interaction with health care system. Women poor health is a result of social structural inequalities e.g., class racialization participation labor force family domestic roles. Health polices show how women body’s minds are increasingly likely to be subject to medicalization in area related to reproduction such as the period immediately after childbirth women thought to become depressed after childbirth. Other common disease postpartum depression. Premenstrual syndrome was considered variable experience personal challenges including acne tiredness tender breast. Through expanding medicalization, it become a specific diagnosis creating with specific treatment Critical anti-Racist theory: Work of George sefa dei Canadian: how racism effects inequity social organization and power is necessary to understand society. Intersectionality theory: From activist standpoint it is often best to focus on one oppressed status at a time e.g., health of first nation status. Racism major source of inequality. Shot of being shot by police 20 times higher from black Canadians living in Toronto that for other citizens. Post structuralism: by Michael Foucault: focus on how power produces effects through reflexive and circulating discourse Biopower: Biopower Is the answer to how social control and power occur in bodies in modern democratic and capitalist states the population is controlled in his view by the government categorizing counting and developing polices related to managing bodies through public health, science, and medicine. Medical or clinical gaze “is part of new technology of power. our very notion of what constitutes a human body anatomy physiology relation to the mind and so on is determined by circulating disciplinary knowledge such as medical science what we consider to be disease illness good functioning are continually recreated as we are subjected to produce and resist prevailing discourses via everyday conversation and the mass media and interaction with the medical care system. E.g., of powerful governmentality is rapid widespread uptake of human papillomavirus (HPV) vaccine for young girls prevent cervical cancer and genital warts. Summary Chapter 1. 1. Illness is experienced in a social context: we learn to think and talk about it with a vocabulary that others share, and we learn what to do about it through interactions with family and friends, the formal medical system, and the media. 2. Sociologists use several perspectives to study the social world: structural-functional theory, conflict theory interpretive/social constructionist theory, feminist and critical anti-racist approaches, and post-structuralism theory. Each of these perspectives makes different assumptions about the social world and therefore, has different ways of understanding it. 3. Structural-functional: theory was first discussed by Emile Durkheim. Its goal is to understand the social causes of social facts: it does this by studying the causal relationships among institutions. The parts of society are inextricably bound together to form a harmonious system. Human beings are constrained by the external world, and they are, therefore predictable and controllable through the knowledge of social facts. Conflict theory: study competing groups within societies through history the basic competing forces are the different classes. Conflict theorists are committed to the description and documentation of injustice through the understanding of economic arrangements, and they’re impact on other conditions of social life. In the conflict perspective health and illness are related to the unequal social arrangements found in capitalist patriarchal societies. 4. Interpretive/social constructionist theory is based on the definition of sociology given by max Weber. These theorists are called symbolic interactionists attempt to understand the subjective meaning and causes that social actors attribute to events. The meaning social actors give to their diseases affects their self-concepts and their relationship with others. 5. The feminist and critical anti=racist perspective: provided a critique of sociology and corrective to its narrow neglectful or biased representations. 6. Post – structuralism highlights the ways the power produces its effects through the bodies and minds of individuals and populations. It describes how changes in public health and medicine provide new ways of governing populations. Notes: Chapter. 2 Disease and Death: Canada in international and Historical context The dramatic changes in life expectancy that have occurred in the past 100-150 years in Canada: • Life expectancy of Canadians improved over time. primary causes are: • A decrease in infant mortality • Result of public health advancement (such as immunization among children and development of penicillin and insulin for children and adults. Epidemiological transition: The idea that economy changes from low to high per capita income corresponding transition happens from high mortality/fertility to low mortality/fertility. • 3 distinct stages: 1. The age of pestilence and famine Socio-economic conditions in which communities are traditional, economically underdeveloped, low per capita income and agrarian. women have low status, extended family, illiteracy is high, high mortality rate attributable to famine and infectious disease. 2. The age of receding pandemics: a decrease in epidemics and famine, decline in mortality rate however high fertility rate resulting in a “population explosion” . 3. The age of degenerative and man-Made disease: fertility rate decline as people begin to live longer and die of emerging industrial and degenerative disease such as Cancer, Stroke, heart disease. 4. Decline in mortality rate: Causes -------- Decline in mortality rate due to decline in infectious disease because of 3 basic changes: 1. Improvement in nutrition 2. Improvement in hygiene 3. Increasing control of disease-causing microorganisms 4. Improvement in birth control another factor The Political economy perspective: Compares life expectancy infant mortality rate around the world and roles of economic and political development position of workers in the global economy in term of occupational conditions (employment, income, security, and safety primary determinant of equality living conditions and ultimately health and well being both directly and indirectly. Dependency Theory: explains how global economic order and globalization fundamental factors in global inequality are explains how multinational expansion by the wealthy and powerful nations maintains and over- utilization of resources and relative under-financing of labor in the rest of the world trade relations and political interventions also buttress the continuation of dependency. • World system theory names three types of national economic actors: 1. The core: • Canada, the United Kingdom, and Japan are among the nations represented. These countries have diverse economies, stable governance institutions, and significant middle classes. These are the industrial and post-industrial democracies. • There is minimal overt class conflict, and civil freedoms are generally well respected. Core countries exploit peripheral and semi-periphery countries by extracting raw materials (e.g., oil, lumber, and metals), exploiting their citizens as cheap labor, and using these poorer countries as consumers at the end of the manufacturing and distribution process. 2. Periphery countries: • Such as Cambodia, Haiti, and Ethiopia have much less developed or diverse economies, as well as limited infrastructure and technology (such as transportation and communication networks). • Their economies are based on subsistence agriculture and a few basic commodities such as tea, fruits, coffee, metals, and lumber. • They are characterized by weak state organization and are exploited by core countries for their raw materials, cheap labor, and markets. • Simultaneously, these countries have a higher proportion of people who cannot meet their basic needs. • Countries on the outskirts of the global economy may require foreign capital and may enter into agreements with international corporations to provide these firms with preferential access to raw materials, a willing labor force, and product marketing. 3. The semi-periphery countries • fall between core and periphery countries and include, for instance, Mexico, Chile, and Saudi Arabia. • Over time, the periphery and semi-periphery countries may become less likely to develop because the corporations have substantial levers of power and control in the context of global capitalism and neoliberalism.  Death, Disease, and Disability in Global Context: • Childhood poverty, malnutrition, and lack of clean water and adequate sanitation are significant factors in most deaths in developing countries • In a worldwide context, the prime determinant of health is the (absolute) ability of individuals and families to meet their basic human needs. • Inequality has both direct and indirect effects on health. Absolute Poverty • relatively poor: Inequality also has indirect effects on health through the psychosocial issues and feelings such as shame and anger • Development Targets: The Millennium Development Goals and the 2030 Agenda for Sustainable Development (2015) Major social determinants of health and well-being: Poverty and Inequality: • Income level is the context for all the other elements of daily life such as work, education, food, shelter, transportation, green space, water, hygiene, and sanitation • Economic growth better health, however, economic decline affects the standard of living = to standard of health Food Insecurity: • either chronic or acute, in which people do not have access to enough safe, nutritious, and culturally acceptable food. • The availability, an adequate amount of nutritious food is fundamental to the health of a population and, especially the protein component, has a larger impact on morbidity and mortality than any other public health or medical measure. • More than half of death caused by malnutrition • Africa has the highest prevalence of chronic hunger with 23 per cent of the population chronically lacking adequate nourishment • The place of women in a society is also pivotal for children’s food security. Nutrient deficiency in women is an even more prevalent and significant problem than it is for men. Because women bear and breast-feed their children, they have a greater need for calories at times. The Physical and Social Environment: • The availability of a sufficient amount of clean drinking water is another fundamental factor in health. • Shortages of clean, potable water are often due to political and economic conditions that disable infrastructural development because of the lack of a necessary tax base and other investments. Numerous fatal and debilitating chronic illnesses are spread by unsanitary water. • The lack of available and affordable drinking water was one of the factors in the historical crisis that occurred in the developing world Safety, Security, and Stability: • Personal safety is of great concern, particularly in times of heightened national tensions. • Civil war, international warfare, and violence in communities, workplaces, and the home all are threats to fundamental safety. As local and international inequities grow, so, too, do violence and war. The consequences of violence have expanded dramatically globally along with population growth. • In general men are at greater risk of death through violence than women. But women are at greater risk of domestic violence Health and Women’s Place in Society: • the position of women in a society has a significant impact on the health of men and children. In a worldwide context women’s health is considerably poorer than that of men. In no region of the world are men and women equal in legal, economic, or social rights. • The World Bank Gender and Development Group believes that the relationships between gender inequality and poverty are mutually reinforcing, with causal links moving in both directions. Power matters in both the private and public spheres. • Women's power in the home is important because they are more likely than men to use available household resources for food, education, and health-related expenses for their children. • Gender equity in the home and in politics boosts productivity, economic growth, health, health care, and effective governance. Birth control, pregnancy, and childbirth: • Effective birth control is another important cause of the decline in the mortality rate around the globe. Too many pregnancies, or pregnancies spaced too closely together, are a threat to the health of the mother and the child for several reasons. • First, when the pregnancy is unwanted, women may seek illegal abortions, which is extremely dangerous. • Second, because of malnutrition, women’s bodies may be undernourished and small their pelvises misshapen. They may experience fatigue during pregnancy and a difficult delivery. • Third, pregnancy itself takes a toll on a woman's body because nutrients are needed for the baby as well as the mother • Fourth, because energy is used up during pregnancy, rest, especially in the last trimester, is important. Most women in developing nations, however, do not have the leisure to take the necessary rest. • Fifth, childbirth itself, because of the lack of sanitation, prenatal care, or emergency medical services, is responsible for a much higher rate of maternal mortality and morbidity in developing nations than in developed nations. Some of the most prevalent causes of childbirth-related deaths are postpartum hemorrhage, which occurs when a woman has anemia, and sepsis (infection), which occurs because of inadequate sanitation or because of hypertensive disorders of pregnancy Violence against women: Comprehensive medical care: • Comprehensive medical care, although largely ineffective without such fundamentals as adequate food and clean water, is also an important factor in good health. • Primary--- health care emphasizes, equitably distributed prevention through community development and education. • Secondary health care is directed towards disease treatment in hospital and community via various medical practitioners • Tertiary care especially occurs in a teaching hospital attached to university and has a side emphasis on health promotion immunization: The impact of specific issues on global health: • World economic forum published its forecast of the top threats to global health in next 10 years • All of them have known consequences for nations, families, and individuals. They include fiscal crises in key economies, structurally determined high underemployment and unemployment, clean water availability and accessibility, income disparity, climate change, extreme weather events, failures in global governance, food crises, and political instability. • Mental illness is another of the most significant contributions to the disease burden of people around the globe and causes years of disability in the lives of millions. • Poverty, economic insecurity, and a lack of education are all associated with mental illness. • Mental illness rates are linked to hopelessness, poor physical health, rapid change in social status, and limited opportunities because of educational deprivation. • Most people suffering from mental illnesses do not have access to care or treatment. • People suffering from mental illnesses are frequently stigmatized and isolated. Suicide may be an option for those who feel they have no other options. Refugee Health around the World • Many people do not have a permanent home. Many others do not even have a curry in which to establish a home. • Many of these refugees do not have access to the basics of everyday living, such as reliable shelter, food, water, recreation, health care, or, especially for those who are stateless, a legitimate identity. • Many of the refugees are children who are not accompanied by family. • Most of these many millions of people will experience challenges to their mental health. Some will experience such horrible conditions as to be diagnosable with post-traumatic stress disorder, grief disorders, anxiety, and depression. • Living in a war-torn country or a country overwhelmed by a natural disaster such as a tsunami, major volcanic eruption, or earthquake, attempting to survive in a land impacted by floods, droughts, or massive fire events caused by climate change, or belonging to a stigmatized group such as the Rohingya in Myanmar is clearly not conducive to mental or physical health. • Such events clearly cause death, disability, and ongoing diseases. They also contribute to food insecurity, a lack of access to clean water, poverty, and a plethora of other social, economic, and human health issues. Death, disease, and disability in Canadian society • One of the most sensitive indicators of a country's health has dropped significantly because of improved nutrition and living standards for mothers and babies, as well as improved prenatal and postnatal medical care. • Canada had the most significant drop in infant mortality rates however higher rates of infant mortality Canada has is the infant mortality rate of Indigenous peoples in Canada • The chief causes of all death in Canada today: are cancer, heart disease, and cerebrovascular diseases, followed by lower respiratory infections and accidents. This ranking reverses the historical situation when heart disease was the first and growing cause of death, but now it only makes about 24% of deaths • Heart disease was the leading cause of death from 1921 to 1955, followed by influenza, bronchitis, and pneumonia, childhood diseases, tuberculosis, and cancer. • Tuberculosis is no longer a leading cause of death, rates of pneumonia, bronchitis, influenza are lower. • The fact that these infectious diseases were more common among young people contributed significantly to lower life expectancy. • Cancer has grown in importance as a cause of death, primarily because it is a disease of aging. That is not to dismiss the significance of childhood cancer as a cause of disease. • Diseases of civilization or diseases of affluence or “man - made diseases” include heart disease, cancer, and accidents. • socio-economic inequity within developed societies and lifestyle, environmental, and work- related factors are particularly important in explaining Canada’s present mortality rates. Precursors to the Major Causes of Disease and Death in Canada: • excessive alcohol consumption has been linked to morbidity /mortality via alcoholism, cirrhosis of the liver, malnutrition, accidents, obesity, suicide, homicide, and other violent behavior, as well as fetal alcohol syndrome when ingested by a pregnant woman. • Drinking excess alcohol problem for Canadians. • Street drugs can cause a multitude of health effects, ranging from immediate death because of overdose or poisoned drug intake, to diseases and disabilities resulting from long-term addiction. • As a result of their drug use and subsequent unconstrained sexual behavior, a significant minority of Canadians being homeless are at danger of developing and spreading sexually transmitted illnesses (STIs), such as HIV/AIDS and blood-borne infections. • cannabis is no longer a prohibited substance in Canada. • It has the potential to raise tax revenues and stock prices. • Another significant development in drug use is the increased use of opioids as street narcotics, • In Canada, opioid abuse is increasingly considered a crisis. • based in Vancouver, was the country's first government-approved and supervised clinic for those addicted to injectable narcotics to learn how to use them "safely." Impact of Cigarette smoking: • Cigarette smoking a major public health concern and a cause of premature mortality • cigarette smoking is spreading rapidly, and tobacco is quickly becoming a major cause of death. • Approximately 50 percent of people who smoke die because of their addiction to cigarettes According to the World Health Organization, about 7 million people die annually because of smoking. • Cigarette smoking is the leading cause of preventable death in Canada (CDC, 2019b). • Some people have used e-cigarettes to quit smoking, but this may not be the best way to quit. • People who use such products tend to be heavier smokers, are more likely to perceive themselves as heavy smokers, and experience more barriers to quitting Physical activity: • The level of physical activity declines as men and women age. • Physical activity is negatively related to socio-economic status, and the types of physical activity are related to family income. • Fitness clubs may be costly and unaffordable yet necessary in some seasons of the year in Canada. The Impact of Weight, Body Image, and eating disorders: • The number of overweight Canadians has increased. Obesity has nearly tripled around the world since 1975 according to the World Health Organization. • Sixty-four per cent of Canadians are overweight or obese according to the government of Canada. • Men are more likely to be overweight and obese than women, but women are more likely to be underweight. • Now considered an epidemic, obesity is a significant risk factor for a variety of diseases, including cardiovascular disease, non-insulin-dependent diabetes mellitus (NIDDM), cancer of the breast, colon, and prostate, musculoskeletal problems, and gallbladder disease. • Obesity in children is a particular problem. Sexual Assault and Rape: • Sexual assault is one of the most under-reported of crimes • The "#MeToo" movement, which started to bring sexual assaults in Hollywood and in the entertainment industry more generally to light and to make the perpetrators take responsibility for their actions, spread rapidly across the US in 2016. • This movement may result in widespread changes both in reporting and in prosecuting sexual assaults in the US and in Canada. • Rape on college campuses has become a particular problem in recent years. • Some even argue that there is a "culture of rape" on college campuses in Canada. Sexuality and AIDS: • Sexual activity is another aspect of the public health of Canadians. • It is monitored regularly as an indication of the effectiveness of public health policy, especially regarding STIs. • About 30 per cent of teenagers between 15 and 17 have had sex at least once. • In the absence of consistent condom use it is no wonder that sexually transmitted infections (STIs) in Canada have increased. • These figures reflect a need for continuing concern about unwanted pregnancies and the spread of AIDS and other sexually transmitted diseases among Canadian young people. • We will focus on HIV/AIDS in the subsequent discussion. • AIDS is a highly infectious and contagious disease. • The incidence of HIV/AIDS among women is increasing in Canada. the human papillomavirus vaccine is widely accepted and legitimated by the state via the provinces • It is administered in schools to girls, and to (fewer) boys, beginning at age nine. • It is designed to prevent several strains of the human papillomavirus, which cause some cervical, anal, and penile cancers. • The vaccine is not mandatory in Canada, but because it is frequently administered in schools it is offered with an image of substantial legitimacy, without cost, and likely with some felt pressure; consequently, it is widely taken up. • controversy has been associated with the administration of the vaccine. • There may also be some resistance due to the link between HIV and sexual activity, particularly as it is administered to girls as young as nine years old. • insufficient evidence that the Gardasil vaccine, in particular, reduced the incidence of cervical cancer. Chapter 3: The Major Environmental Issues: • Environmental hazards in the air and water and on land have increased tremendously over the last century. • Onlyby accumulating different types of studies—epidemiological, animal, genetic, and others—all of which address the same environmental issue, will it be possible to adequately demonstrate the effects of specific aspects of the environment on health. • It is urgent that we understand the negative effects of the environment on human health. • Many diseases of major organ systems—lungs, heart, liver, and kidneys—as well as • reproductive problems, birth defects, and behavioural disorders, have been associated with environmental factors. • However, more than two million people face possible devastation if these estimates are faulty. • These people live within its fallout zone. • But it has a few more years before it will have to be decommissioned. • In the meantime, other experts warn that it may be unsafe and that it has been patched together so many times that its longevity is not really guaranteed. • Despite the fact that the Pickering facility is meeting all of its government required • safety checks there is always the possibility of error. • Thus, there may be some potential for a nuclear disaster posed by this facility just 30 kilometers east of Toronto. • No one expected the Fukushima nuclear disaster. • It occurred after a confluence of events, which led to the meltdown at the Fukushima nuclear generating station on 11March 2011 (see Box 3.1). • Thousands of people died as a result of the disaster, and 100,000 people were evacuated in the aftermath of this catastrophe. • Most of the possible health effects are not yet known. • Environmental risks are now ubiquitous—and growing in potential destructiveness. • Like other health threats, environmental hazards are unequally distributed. • Poorer people are more threatened by various environmental hazards and are more likely to live on and near contaminated land,and water, and near industrial sites with poor air quality. • The poorer, less-developed countries are unequally subject to the destructive effects of environmental degradation when they, for instance, allow the destruction of precious rainforests for agribusiness, such as cattle ranching, and to provide timber for furniture,housing, or other purposes for the developed world. • Thus, the environment of the underdeveloped South, in spite of a relative lack of industrialization, is more vulnerable in some ways than that of the developed North. Climate Change: • The most critical is climate change, sometimes referred to as global warming. • The problem is that carbon dioxide and other air pollutants, including methane and nitrous oxide, reflect the sun's radiant energy back to earth, causing a warming trend that affects, among many things, crop growth and the probability of flooding from the melting of • glaciers. • According to recent estimates the average global temperature on earth has grown about 0.8 degrees Celsius since the end of the nineteenth century, or about 1880. • This could result in a continuation of severe weather patterns and drought, greater flooding, more devastating hurricanes and tornadoes, and increasing wildfires, along with a rise in sea levels that could displace coastal and island people. • Global warming has both direct and indirect effects on human health. • Canada's global role in climate change is significant. • Canadians emitted an estimated 704 million tonnes of greenhouse gases (GHGs) into the atmosphere in 2016, a decrease from 2007 emissions of 761 megatonnes. • When Canada ratified the Kyoto Accord in December 2002, it made a commitment to reduce emissions to 6 percent below the 1990 levels by 2008–12. • By 2008, Canada's GHG emissions, driven primarily by energy-intensive projects in Alberta's oil sands, were 24 per cent above 1990 emissions and 31 per cent higher than the Kyoto target Chemicals and Health: • The World Health Organization has summarized research on the major threats to health caused by a few select and well-researched chemicals that are part of the everyday life of people around the globe. • These substances include arsenic, asbestos, benzene,cadmium, dioxin or dioxin-like substances, fluoride, lead, methyl mercury, and highly hazardous pesticides. • They are especially problematic for the most biologically vulnerable,including children, infants, fetuses, and the elderly. • Pesticides have also been linked to attention deficit hyperactivity disorder (ADHD) through an epidemiological study of 1,139 children. • Children living on and near farms are especially susceptible to pesticide ingestion but all children (and adults) who eat non-organic food regularly absorb pesticides . • An estimated 21,000 premature deaths are attributable to air pollution in Canada every year. • Several studies have found a link between living near a busy road and a 50 per cent increase in leukemia in children, possibly because of the higher concentrations of benzene, a product of gas combustion. • The study found a strong relationship between distance from high-traffic roads • and levels of particulate matter in the air. • Our continued dependence on the car for transportation ensures that this is an • ongoing source of major pollutants. • It is essential to the healthy future of the country and of Canadians that we support the use of alternative means of transportation such as electric cars, bicycle lanes, scooters, and forms of public mass transportation that do not rely on gas and oil and are less polluting or not at all polluting. Air Pollution and Human Health • Both indoor and outdoor air contribute at least low levels of pollutants, including ozone, sulphur oxides, nitrogen oxides, carbon monoxide, and other particulates that may irritate eyes and inflame the respiratory tract. • Ground-level ozone has been linked to health impacts ranging from minor respiratory problems to cardiovascular disease, hospitalizations, and premature death. • Air pollution is already known to kill men and women across the globe. • The World Health Organization estimates that nine out of ten people in the world breathe polluted air. • Air pollution also gets inside buildings. • An extreme case of indoor air pollution is the "sick-building syndrome" in which the presence of air pollution inside tightly sealed buildings can lead to • a variety of illnesses. • Total environmental sensitivity, in which a person is allergic to myriad components in the modern environment, including indoor and outdoor air pollution, has forced some people to live in totally sterile environments. • The chief source of air pollutants is industrial manufacturing and the second is transportation. • Recently published research has linked high radon levels in the home to lung cancer. • Another indoor pollutant with serious health costs is asbestos. • Thirteen per cent of Canadians smoke cigarettes. • There were 33.8 million registered vehicles in Canada in 2016. • Three of the top-selling automobiles in 2017 were "gas-guzzling" pickup trucks (D, 2018). • Four common air contaminants from automobiles are carbon monoxide, nitrogen oxides, hydrocarbon, and ground-level ozone. • Any of these may contain chemicals that are bad for your health. • This is especially problematic because of the substantial ingestion of highly toxic chemicals as pharmaceuticals, a routine part of end-of-life health care. • In the long term PPCPs are building up in the air, water, and earth and have the potential to increase pollution. Water Pollution and Human Health: • The overuse of water is another environmental threat, and Canada is among the top water consumers in the world. • Overfishing and bottom dredging by foreign and Canadian trawlers exhausted the cod stocks off Newfoundland. • In response,the Canadian government declared a moratorium on the cod fishery in 1992. • The World Wildlife Foundation has posted a notice that the cod fishery is in the process of being partly restored with new guidelines to govern fishing policies. • In fact, cod fishing was restored to the south coast of the island in March 2014. • On both sides of Canada and around the world the health of the oceans is threatened. • Literature on hazardous waste disposal in Canada and the United States points to a problem with fewer and fewer solutions as land masses on both sides of the border and,indeed, around the world become populated. • Canada is both an importer and exporter of hazardous wastes for disposal. • As the deleterious effects of hazardous waste disposal become more widely known, dumping wastes becomes a complicated legal and political issue.. • Hazardous waste dumping in countries of the Global South is a similar problem. • When some industries in the richer developed world needed to get rid of hazardous wastes, they shipped them to countries in the developing world. E-Waste: • E-waste refers to all waste that comes from or is caused by electronics. • E-waste is a major concern because of our heavy and growing reliance on electronics. • E-waste is the fastest-growing hazardous waste in Canada and around the world • Clearly,we have far to go in ensuring that all e-waste makes it to recycling centres. Biodiversity: • All of these threats to the air, water, and land have another profound implication for the future of life on the planet—the decline in biodiversity. • The impact of the decline in biodiversity on the health of human populations are not entirely known. • You may be aware of the serious concerns raised by the collapse of some honeybee colonies (colony collapse disorder). • The incidence of colony collapse disorder seems to have been decreasing. Food Safety: • Frequent outbreaks of food-borne diseases have caught the attention of the media and, thus, the public, including but not limited to bovine spongiform encephalitis (BSE). • Each year, about one in eight Canadians or 4 million people are affected by a food-related illness, including salmonella, norovirus, and listeria. • Another source for contaminated food is restaurants. • Many people have turned to organic foods in the past few decades as a way to avoid the pesticides and fertilizer and other contaminants that may be found in food grown in the standard way. • The reasons people buy organic food include a belief that it is healthier, that it lacks pesticides, that it is not genetically modified,and to prevent allergic reactions. • However, and perhaps ironically, organic foods are not necessarily safer than non-organic foods because of potential contamination by E. coli, for instance. • Another important issue affecting the quality of food both in the short term and in the long run is genetic modification. • However, others are seriously opposed to genetically modified foods because of the potential unknown dangers. Occupational health and safety: · Canadians face a relatively high degree of danger when they go to work. Statistics on workplace accident and work-related injuries underestimate the number of injuries that occur because many injured people don’t receive /request compensation. Some unaware of labor rights unwilling to pursue claims for variety of reasons. e.g., necessity of making living while working through pain and disability. some workers fear job loss if report injury or disability or lack believe in the fairness of the workplace safety and insurance board (WSIB). The three largest sectors from which claims emanate are service industry, manufacturing, a chemical processing .in 2012 there were 977 reported workplace=related fatalities in Canada. Highest death in manufacturing, construction, transportation, and mining. In addition to workplace accidents, workers face a number of hazards in the job like physical (noise, heat cold, postural, radiation,) Chemical (solvents, heavy metals, pesticides, pharmaceuticals), biological (HIV, hepatitis B and C) psychological (occupational stress and violence. Workplace hazards like accidents and death on the job increase under globalization and free trade. To attract multinational companies, poor countries will compete with one another by lowering labor costs, banning workers’ unionization, reducing environmental standards, and creating free-trade industrial zones such as the maquiladoras along the US border in Mexico. Lower labor costs and the lack of unionization result in, among other things, fewer health, and safety precautions for workers as well as an absence of workers’ compensation for job-related injuries. In 2013, fire in a clothing factory in Bangladesh, where a portion of the clothes being constructed at very low cost were for the popular Canadian label “Joe Fresh,” several hundred people were killed and many others were burned and maimed as a result (Toronto Star, 2013). Women work and stress · Occupational health and safety are major concerns for all working women. clerical and administrative jobs in places such as banks, retail stores, child-care institutions, schools, and health clinics and hospitals. Each of these occupations have its own peculiar health risks. Clerical workers may be subject to poor lighting and ventilation, excessive noise, and toxic substances such as emissions from computer terminals. They may spend long hours sitting on uncomfortable and poorly designed furniture, which may lead to back and neck pain, and working at keyboards can cause repetitive strain injuries, such as carpal tunnel syndrome. Working at relatively tedious jobs in which they may lack personal control may lead to stress, boredom, anxiety, and other related psychological harms. Retail and service workers may be vulnerable to health hazards from bending, lifting, and carrying. They may experience varicose veins and foot, neck, and back problems. Hairdressers, who usually stand all day, suffer neck, back, foot, and leg problems along with the dangers of exposure to toxic chemicals such as hair permanents, dyes, and aerosol sprays. Respiratory difficulties and skin reactions may occur. Teachers and child-care workers are continually exposed to a variety of contagious and infectious diseases. Health-care workers, exposed to radiation, toxic chemicals, and contagious diseases, and may have to cope as well with excessive lifting, bending, and standing as well as the aggression of patients. In this regard the health-care work of nurses is among the most vulnerable to violence at the hands of their patients. women who work at home may be subject to dangers from all sorts of household cleaning substances, including abrasives, astringents, soaps, and detergents, as well as to the possibility of injury due to falls, burns, and the like. HomeBased work can lead to loneliness and isolation and mental health issues, including depression and anxiety. Occupational stress associated with several poor health outcomes. Workplace stress arise from the content of work, workload, and pace, working hours, and lack of control over the working environment. Persistent stress can cause all manner of physical and mental health symptoms such as depression, increased blood pressure, increased blood serum cholesterol, increased risk of coronary disease, migraine headaches, and increased drug and alcohol consumption as well as sleep deprivation, depression, anxiety, and so on. Gender parity has almost been reached in the public service. men are much more likely to be in positions of higher income and power in the private sector and business world. Many of the jobs in which women dominate are characterized by lower pay, less power, and, often, little independence, autonomy, or control. Despite an acceptance of the principle of equality of opportunity as a basic tenet of human development and well-being. The Conference Board of Canada (2020) has found that the wage disparity between men and women varies by age, by occupational group, and by level of education. women’s jobs are considered less important than men’s jobs, women have less power to demand safe, clean, and healthy working standards. relative poverty and lack of control in the female-dominated parts of the labor force are exacerbated among women of minority status who may be likely to work in even more marginalized settings such as domestic work, office cleaning, agriculture, cottage industries, and prostitution. Women with disabilities are also more likely to be underemployed, unemployed Shift work: About one-quarter of employed Canadians work shifts (Institute for Work & Health, 2010). Canada has long needed 24-hour service from the medical, elder care, police and fire protection, and transportation sectors, but “24/7” has also for commercial, financial, and industrial services in the neo-liberal economy. Some research has found that people who work shifts also tend to have an increased propensity for heavy drinking, poor eating habits, and weight problems. Following is a list of some of the effects of shift work on health. 1. Persistent fatigue is common. Sleep problems are frequent. 2. Possibly because long-term shift work disrupts the circadian rhythms, it is associated with breast and colorectal cancers, mental health problems, gastrointestinal disorders, and preterm childbirth. 3. Shift workers are more vulnerable to heart disease and heart attacks. In general, shift workers have lifestyles associated with ill health, including smoking, obesity, little recreation or regular exercise, and poor diets. 4. Medication may affect the person on shift work in an unpredictable way. 5. Shift work has negative effects on family activities and relationships, which can lead to depression, isolation, broken relationships, and loneliness. The lack of daycare associated with most shift work may mean that children sometimes are left unattended. Participation in “normal” parent–child, husband–wife, and family socializing is severely restricted because of the unpredictability of scheduling. 6. Some evidence indicates that more work-related accidents occur among shift workers. 7. Working conditions can be substandard (lighting, ventilation, cafeteria services) and opportunities for socializing may be restricted. 8. The rates of psychological stress are high. 9. There are increased odds of being diagnosed with a chronic condition. Lecture 3 (in class notes) Environmental and Occupational health and Illness Introduction • Positive and negative effects of environmental factors on health o People who live near trees or water have better health effects. They have better health on a psychological level. Peace of mind. • Disasters: “the nuclear accident at Chernobyl in 1986; the Bhopal, India, gas accident of 1984; PCBs in the Great Lakes; the 2011 tsunami in Japan; the depletion of the Newfoundland cod fishery; the 2000 Walkerton, Ontario, water crisis; and the 1992 Westray mine disaster in Nova Scotia” (Clarke 2018) o Ex: The Fukushima meltdown;Earthquake lead to tsunami which will lead to power outage and so loss of power leading to the calling of the nuclear reactors and therefore leading to a meltdown o Ex: industrial disaster in India which was reported as one of the worst according to historians. Emission of gas that was toxic and very dangerous to humans which killed 6000 people and thousands who were blinded and disabled.  When developing countries are trying to attract investors from rich countries, in most cases, they ignore the minimal health and safety standards. • Risk society but global ecosystem: risks and accidents are being normalized and not body to question. The problem is that we live in a global system where we are all related and we are all Interlinked. A problem may happen in one part of the world but the whole world is affected by it. o Ex: Fukushima, the debris from the meltdown was observed as far as the West Coast of Canada o COVID-19, on the very end happening in one part of the world but it spread like a wildfire so the whole world is infected by it now • We are all affected by environmental hazards yet unequally o Defect is not equally distributed. o Ex: in poor countries, most countries don’t have clean water and so they cannot drink bottled water because they can’t afford it. Even the bottle watered is a hazard because it has plastic. Poor people live near contaminated land and poor air quality • Environmental degradation in poor countries: example: dumping of wastes within their borders Environmental issues Climate change and global warming: The average global temperature has been increasing by 0.80° since the end of the 19th century. Since 1975, 2/3 of global warming has happened. Reasons for it is because of the pollutant, examples would include, methane, nitrous oxide. These pollutants reflect the sun's radiant energy back to us and therefore cause global warming. Indirect effects: • Ex: Drought on the prairies • declines of water supply in southern Canada • Soil degradation, erosion, flooding of coastal regions • Extreme weather patterns, world fires which take very long to end • Ice declining in the north (hunting and fishing is affected) enter availability of food and water is effective Direct effects: heat waves , death (Los Angeles, temperature and beyond for 40°C in there for this little more deaths than usual due to heat waves) • Cardiovascular, respiratory tract system • Malaria is increasing because of the heat and mosquitoes breed more when you have it extreme weather conditions that are hot Increases in deaths due to carbon dioxide concentration, heat waves/excessive heat exposure causes: Greenhouse gas emissions and political economy • Political economy/-Systems of government that may be brought to doing something to improve the health and safety concerns related to the environment however because of pressure from industries and lobbying organizations call Linda and you find out there is no clear environmental regulation that enacted in the reasons that industries provide is that this “ if you’re going to put in place environmental regulation it means that we are going to lose revenue because they’re going to affect theIndustries and secondary jobs would be lost” Because of this pressure mini government failed to set in place safety measures regulations that are prohealth that would be enacted to regulate these industries. • Some political parties say that no climate change don’t exist Environmental issues • Chemicals -:Arsenic; Asbestos; Benzene’s; Cadmium; Lead; Methyl mercury (from fish); Hazardous Pesticides (exposed to us through food, water, air) o People living on farm is most affected o All these chemicals affect children who are vulnerable, including the infants and the unborn o Chemicals Give heart diseases, cancerAir Pollution and Human Health • Air Pollution and Human Health • Industrial manufacturing and transportation, methane from countryside; household cleaners, pharmaceutical and personal care products (PPCPs)- perfumes and fragrant after-shave products • Environmental Illness-Multiple chemical sensitivity (MCs) o Symptoms that people suffer from but cannot be explained (examples include headaches, rashes now and then)  These people are sometimes considered as mentally sick or are refused because they have problems I cannot be explained as for this leads to a lot of effects on health • Indoor and outdoor air—-Air pollution • Water Pollution/ Human Health o Unclean water lead to cholera, polio o Great Lakes basin polluted o Overfishing • Solid waste, Land Pollution/ Human Health o How waste is managed (dumped into the developing countries) • Biodiversity: because of the changes in the environment we are losing many species so we have extinctions o Honeybee colonies are almost extinct • Impacts on the mental health: depression do to environmental impacts/disasters • Food safety/ poor food handling (poor hygiene, lack of regular monitoring) o Both at home and restaurants • Research: lots of research being done but since companies just want people to purchase their products it's not very easy to establish the objectivity of the research. • Genetically modified foods Occupational health and safety Service industry, manufacturing and chemical processing highest incidence of death:Manufacturing, construction, transportation and mining Workplace accidents, other physical, chemical, biological and psychological Women, work and stress women work as: clerical workers; retail and service; hairdressers;Teachers and childcare workers and healthcare workers • Problem is woman’s work is not considered as important as men work so there is still in equality Women who work at home Persistent stress gender parity shift work • Not paid well • Affect mentally and physically • Agriculture • Temporary, immigrant, illegal, or undocumented workers o face various problems because they don't know the language, coming from poor countries where they are looking for a better job, and therefore willing to take anything they are offered with. problems for temporary immigrant legal or augmented workers, because they are vulnerable and that affects their health. • Traffic accidents • Falls • Sports-related accidents; sports enhancing drugs (very dangerous) • domestic violence or sexual violence- “culture of “macho” violence on television and in the movies along with the availability of guns” (Clark, 2018) o Men too: lose self esteem; once that happens, they may also suffer from depression, they may be unable to work because of suppressed anger. These are some of the issues from domestic violence, not surprising to women but also men. • Medical error Lecture 4: Social determinants of health(1) Key concepts • Inequality refers to the differences that can happen (differences that happen between the young, the youth, and the older) o Some differences that are observed are between gender and between countries and within countries o these differences also relate to differences in access to resources o The differences in our health a