Embodied Inequalities and Epidemiology

In Class, we discussed the ways in which morbidity and mortality are affected by inequalities (Social Class, Gender/Sex, Race/Ethnicity, Nationality/Global Inequality). You guys nicely displayed 1. the relationship between mortality/morbidity and theses forms of inequality. 2. the main arguments that are used to explain these relationships; and 3. you indicated the methodological shortcomings associated with the data-collection.

You guys are not required to write responses to this entry. It is a resource for the exam.

Social Class

1. The higher the social class, the lower the infant mortality rate. Lower social class is correlated with higher morbidity/ mortality rates. Life expectancy is increasing, but it is increasing faster for the higher class in comparison to lower classes. Those in the lower class are 2x more likely to suffer neurotic disorders. The poor have a higher chance of smoking, drinking, obesity, and death from accidents. The lower class has a higher rate of low birth weight babies, infant mortality and mortality rate under 5yo.
2. Lower social classes participate in unhealthy behaviors (smoking, diet, ect). Lower classes have less control over their lives (polluted work environments, crowded environment, accident risks, bad housing/transportation, and less access to resources that will help with improve their health (gym memberships, vegetables, medical care, ect). Drift Hypothesis: the sick drift down social ladder. Psychosocial explanations: less variation between class/ the healthier society I as a whole.
3. Social class is constantly changing, so it becomes difficult to establish morbidity and mortality rates in relation to class. The numeration denominator problem (inaccurate death reporting/ inaccurate occupation reporting). Different definitions of class.

Gender/ Sex

1. Gender is associated with longer life. On average, women live longer than men (Men: 74 Women: 80). Men die earlier of more life threatening illnesses; Women are more likely to visit the doctor. (In an interview, 19% of women had gone to their general practitioner in the last 14 days vs. 13% for men.) Women are more likely to have neurotic disorders; men: mental health disorders. Healthy life expectancy is 69 for women and 67 for men. The global infant mortality rate is greater for boys that girls.
2. Biological: genetic and physiological differences. Psychosocial: personality differences (masculinity/feminity). Behavioral: risky behaviors. Occupational and work related factors. Social roles and relationships. Power and resources with in the home. Social Structural differences with in society.
3. Accuracy of death certificates. Differences in illness reporting and the interpretation between the sexes. Accuracy/ Methods of the surveys. Historical Contexts. Cultural and social differences.

Race/Ethnicity

1. People born in Indian subcontinents have higher than average rates of heart dx, diabetes and Tb, but lower rates of certain cancers and bronchitis. Men born in Bangladesh, Ireland, Scotland, West/South Africa have higher levels of mortality for all causes of death. Prenatal mortality rates: UK: 7.8, Bangladesh 10.5, Indian 10.8, Pakistan 14.5, Caribbean 15.4 per 1000 live births. Blacks have higher rates of hypertension and heart dx.
2. Biological factors and genetic variation. Migration: only the healthy migrate, migration is stressful and damaging. Socioeconomic factors: some ethnic minorities are over represented in disadvantaged economic groups. Culture, Beliefs, Behaviors: some groups may have unhealthy lifestyles shaped by culture of beliefs. Racism: people in fear of racial harassment are more likely to report poor health. Health services access and use: unequal access to care with different ethnic groups.
3. There is not universally agreed definitions or categories of ethnic or racial groups. It is often defined as place of birth, which isn’t an accurate indicator. Is race social or biological? Not everyone is accounted for. Amounts and sources of immigration have changed. Inter-racial marriages effect might affect

Nationality & Global Inequality

1. Nations with higher GDP’s have higher life expectancies. The greater the gap in the distribution of wealth, the greater the rates of morbidity and mortality. Thus the more egalitarian a nation, the better the nations health. Populations of displaced people result in a higher rate of disease. War related injury and death are devastating to the health and well being of a country (Afghanistan has the 4^th highest rate of mortality under 5 yo).
2. A lack of social cohesion lowers self-esteem, while increasing anxiety and stress.
3. Life expectancy doesn’t account for a variation of subgroups within a particular society. Life expectancy reflects past experiences of people rather than its present distribution of income.