Health 20 MC

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Lecture6A.pptx

Introduction to Health Sciences

Lecture 6: Health Disparities II

Instructor: Jen-Hao Chen, Ph.D

Social Factors and Health

Many social factors can cause diseases and health problems

Income

Education

Race/ethnicity

Neighborhood you live

Furthermore, these social factors can cause many diseases and health problems

Hypertension

Diabetes

Mental illness

Shorter life span

Social Factors and Health

We hear the term ”social causes of disease” throughout the documentary

The evidence seems convincing

Social factors matter for diseases and health conditions

But why people not think about social factors when they talk about the cause of a disease?

Any idea?

Thinking about Causes of A Disease

Let’s take type 2 diabetes as an example

If you go to ask a doctor or healthcare professional, ask him/her about causes of diabetes……what kinds of answer you will get?

Thinking about Causes of A Disease

Thinking about Causes of A Disease

Let’s now take a closer look at one key social cause of type 2 diabetes: income

Thinking about Causes of A Disease

So what are the differences between the “first types” of causes versus “second types” (like income) of causes of disease?

Thinking about Causes of A Disease

Why people talk about first types of causes instead of social causes?

Thinking about Causes of A Disease

Let’s now take a closer look at income and health again:

Thinking about Causes of A Disease

Why Income Matters?

The two health conditions are different

Diagnosed with diabetes: based on clinical diagnosis

Self-report health: based on the question “in general, would you say that your health is excellent, very good, good, fair, or poor?”

Question: take 2-3 minutes, think about WHY income is related to diabetes and self-report health. Write down your answer.

Fundamental Cause Theory

It’s seems that the two types of causes we discussed are very different

But they are so important causes of disease

How can we better understand the different types of causes of disease?

Medical sociologists Bruce Link & Jo Phelan (1995) propose a theory called “fundamental cause theory”

Fundamental Cause Theory

A theory of causes of disease

In principle, we can distinguish two types of causes of disease

First, we have Proximate Cause: cause that directly affect our body, human physiology, cells and organs…etc.

Fundamental Cause Theory

Second, we get another very different type of cause Fundamental Cause

Like a super cause

Cause of “causes”: fundamental cause ”causes” many proximate causes

Fundamental Cause Theory

Take the example of diabetes

All these are proximate causes, right?

Fundamental Cause Theory

Take the example of diabetes

All these are proximate causes, right?

Then, we get fundamental cause

Cause of all proximate causes

Obesity

Smoking

High blood pressure

High fat foods

Income

Fundamental Cause Theory

Because all proximate causes are fundamentally affected by “fundamental cause”, so our understanding of causes of disease is incomplete/partial without knowing the fundamental cause

Fundamental cause is the source, the place where we get sick in the first place!!!

Fundamental Cause Theory

So, from the fundamental cause theory, why people often ignore income, education, gender, race……these social causes?

Because

Not directly causes damage on body, cells, organs……

Not get mentioned in medical reports, news……

Implications of Fundamental Cause Theory

Despite the concept of social factors as fundamental causes of diseases often ignore by medical scientists and general public, the theory has great implications on our understanding of health disparities

The theory predicts that

Advantaged social positions are always related to good health (so health disparities persist) throughout the history and regardless the nature of disease

Medical advancements or public health interventions cannot eliminate health disparities

Why? Think about why by yourself for 2-3 minutes

Implications of Fundamental Cause Theory

For example, even causes of death change dramatically between 1990 and 2010, we will see the same health disparities by income

Implications of Fundamental Cause Theory

The proximate causes of the top 3 deadly diseases are different in 1990 and 2000

Proximate cause of infectious diseases: contact with patients, poor living environment, drink contaminated water (eat contaminated food)……

Proximate cause of chronic disease: stress, obesity, smoking/heavy drinking……

Proximate causes differ but socially advantaged positions enable people get away from the proximate causes throughout human history

Implications of Fundamental Cause Theory

Second Implication: It’s also predict that medical advancements public health interventions cannot eliminate health disparities

Implications of Fundamental Cause Theory

Diabetes

Obesity

Smoking

High blood pressure

High fat foods

Income

Implications of Fundamental Cause Theory

On the contrary, sometimes medical advancements can widen the gap of health disparities ! ! !

Why?

Implications of Fundamental Cause Theory

On the contrary, sometimes medical advancements can widen the gap of health disparities ! ! !

Why?

Because medical advancements may reveal new, previously unknown proximate causes of diseases.

Socially advanced people can mobilize their resources to block the newly discovered path, leaving that proximate cause disproportionally affect the disadvantaged populations!!!