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5002 Week 3 - Week 5

Terms in this set (89)

Social class is a central concept in population health and a key structural determinant of health.
Social class is taken as a marker of a person's socioeconomic position, which refers to a person's educational, income and occupational resources, and the status they hold based on these. Social class is often measured by 'Socio-Economic Status' (SES), which is a statistical measure of income, education and occupation level (Germov, 2014). Most studies that report on class inequalities use statistical data about SES. However, class is more than just SES measures. As Connell (1977, p.33) notes, class is also about culture, or 'lived reality'. It is about the day to day experiences of living and working, of shared values and life-styles, of accessing institutions for work, education or health, as well as style of speaking, social connections, and (for 'lower'- classes) the experience of marginalisation, discrimination and stigma (Germov, 2014, p.207).

Social class has a direct impact on health. EG Working-class Australians are "worse off than people from more advantaged backgrounds... [with] substantially higher mortality and morbidity rates, but with poorer access to health services... [they are] more likely to experience high rates of recent illnesses, serious chronic illness and disability" (Gray, 2006, p.263). As Gray (2006) notes, "the poor health outcomes for working-class people are linked to factors such as 'poor living and working conditions', exposure to hazards at work, poor housing, lack of safety in poor areas, poor access to health services, financial constraints in regard to leisure and lifestyle choices, stress, lack of hope, and experiences of stigma and marginalisation (Germov, 2014; Gray, 2006).

Power and resources are distributed unevenly in societies. --> Some groups have access to more resources than others •--> there is a hierarchy in how these resources are distributed •--> These different layers (or "strata") in this hierarchy are
referred to social classes.
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Explanations are not mutually exclusive

1. Cultural-Behavioural • Theorises the link between class and health is a result of differences in terms of behaviours such as smoking, alcohol and
drug consumption, dietary intake, physical activity, and health service usage. • Simplistic versions propose that all difference in health inequality attributable to individual behaviour, reinforcing
stereotypes of irresponsible poor people. • More recent versions emphasise the role of cultural influences on behaviour, taking structural factors such as the experience of deprivation and powerlessness.

2. Materialist • Focuses on how income enables access to the goods and services that enable good health. • Decent income enables access to health care, adequate diet, quality housing, social participation. • Allows for avoidance of hazards, such as poor working conditions.

3. Psychosocial • Focuses on how social inequality makes people feel. • Feelings of inferiority or subordination stimulate stress responses which can have long term consequences for physical
and mental health. • Perceptions of social status, especially in comparison to other people, is an important factor.

4. Life course idea that all the above theories are embodied in the individual -- Differences in health states between social classes result from the accumulation of social, psychological, and biological advantages and disadvantages over time. -- "The social is literally embodied,; and the body records the past"

5. Political Economy • Is a combination of materialist and psychosocial explanations • Social determinants of health shaped by higher-level structural
determinants: politics, the economy, the organisation of government, the labour market. • Politics is understood as "the process through which the
production, distribution and use of scare resources is
determined in all areas of social existence" (Bambra et al, 2005). • Politics and the balance of power between key groups (labour and capital) determine how the government acts to reduce inequality (e.g. neoliberal or social democracies)
Critical Race Theory (CRT) 1977 onwards
- key figures in the US: Martin Luther King Jr, Malcolm X, Sojourner Truth, Fredrick Douglass, W.E.B. Du Bois. - Inspired by the civil rights movement

- Came out of critical legal studies

- CRT advanced understanding of law, politics and history

- Like ethnicity, idea that race, instead of being biologically between groups grounded and natural is a socially constructed concept - a product of social thought, practice and relations • Geneticists agree that racial taxonomies at DNA level are invalid
• Genetic differences within a so called 'racial' group are greater than between groups

- Rather than focusing on socially constructed notions of race, it attends to power and oppression in the lives of people of colour
- the power of social categorising based on race continues to shape the lives of people - and has led to the privileging of white people and the oppression of Indigenous people and people of colour - Examines how race as a concept functions to maintain oppression of people of colour and the interests of the white population in institutions, labour markets and politics. - It traces histories of oppression and resistance such slavery, civil rights and racial profiling, deaths in custody - Explores how racism leads to poverty, exclusion and criminalisation of people of colour

- CRT not just about theory, but seeks tangible real world impact to create a
fairer world

CRT - not all racism overt -- Racial Microaggressions:
- Concept theorised in Critical Race studies
- Brief and commonplace daily verbal, behavioural or environmental •-> i.e. words gestures, tones, dismissive looks, snubs, moving
away, not being included, being overly nice, or lack of inclusive literature in health settings etc.
- Can be intentional or unintentional
- Communicate hostile, derogatory or negative racial slights and insults towards people of colour
First, federal, state and local support for health dis-
parities research and workforce diversity in health care and science must increase. Immediate needs include the collection and reporting of accurate and detailed national data on race, ethnicity and SDOH. Furthermore, researchers should be challenged to stretch beyond investigating implications of SDOH and health disparities to the discovery and implementation of interventions to reduce inequities. In the long- term, we must bolster financial resources allocated to pipeline programmes and minority- serving institutions, substantially increasing funding for the National Institute on Minority Health and Health Disparities (one of the lowest- funded NIH institutes in the USA), and mandating implicit bias training and mitigation for grant review committee members.

Second, racism must be declared a public health crisis and resources need to be deployed to mitigate it. remains a need for a national legslative priority with long- term investment aiming to strengthen the public health infrastructure and its ability to respond efficiently and effectively to local and national public health crises, dismantle discriminatory policies and practices, and foster healthier communities, starting with the most vulnerable.

Third, those most proximal to the inequity must be given voice to propose and implement solutions. Meaningful partnerships between public and private sector stakeholders, civic organizations and local grass-roots efforts will build social capital, foster resilience, cultivate political will and effectively challenge discriminatory policies, practices and norms that disproportionately affect vulnerable populations. National medical societies and organizations must also be invested in this response.
When invoking the Black community explanation, respondents rarely acknowledged that shelter location, ethnic composition of shelter staff and clients, or admissions policies might have discouraged Black women from seeking services. The othering implicit in assumptions that women of color are different and take care of their own is an important component of White privilege.

The Black community explanation is not the only stereotype that is invoked. In service provision to battered women, as in many other areas of our society, there is the danger of seeing Black as synonymous with poor (Cole, 2001). Blacks are often also stereotyped as being more aggressive and more likely to use drugs and alcohol than Whites. This type of racial stereotyping was evident in the following response to a question on racial and ethnic tensions among shelter residents

These (often contradictory) stereotypes create a double bind situation for Black women. When they use battered women's ser- vices, they risk being stereotyped as poor, aggressive, drug-using women and savvy manipulators trying to milk the system. Their needs may be seen as less real or urgent than those of White women. On the other hand, when they avoid the system, their ability to withstand violence is offered as an explanation, and they are assumed to have their own cultural resources for dealing with abuse. Either way, the end result is a lack of comprehensive outreach in their communities and a dearth of culturally compe- tent violence programming suited to their specific needs.

Although they were trying to avoid racism, the respondents made implicit assumptions about women of color that often dis- advantaged these women. They talked at length about how women of color were different from White women, handled things in their own communities, and were not always in need of services from mainstream (i.e., White) agencies.
Biological & sex role categories - Multiple patterns of masculinity and femininity - masculinities and femininities. - Different patterns of masculinities and femininities are related to each
other - Masculinities and femininities are 'embedded' in social institutions. - Hegemonic masculinity - top of the hiearchy • Ideal man is depicted as physically and strong, emotionally contained, rational, in control, able to dominate others, heterosexual, wealthy and powerful • Pressure to expel qualities associated with femininity • Ideal masculinity is based on a fantasy of reality, not based on real lives
of men. Exemplars from media • Men may police each other around this notion of the ideal e.g. wimps
and jocks. • Use homophobic, transphobic or misogynistic slurs (also used to verbally
assault gay men, women and trans people)

Associated problems with Conventional understandings of gender situates gender as binary and fixed
- Scientifically problematic and obstacle to scientific progress
- Leads us to overlook social and political causes of gender inequity
- Can dictate how people are treated - stereotypes about gender • E.g. idea of what men and women are good at, what kinds of jobs they
should do, what kind of roles they should hold in society

• Leads to gender discrimination
- e.g. women not promoted as idea that men are natural leaders. Men not understood as also having emotions and may struggle to find support
- Shapes social policy and law - Denies existence of those people who do not identify as (mis)assigned sex at birth
Anorexia Nervosa -- 90% of anorexia nervosa cases are girls or women
- Usually begins in adolescence
- age when there is a particular emphasis on heterosexual attractiveness
- Link to emphasised femininity and stress (femininity is always in relation to masculinity in the hierarchy of society)
- Raewyn Connell 2012: -- "Shifts in social definitions of attractiveness that place a premium on women being thin have created conditions for widespread difficulty in young women's relationships with their bodies"

90% affected are women, and overwhelmingly it begins in adolescence. This is an age when a particular form of social embodiment, heterosexual attractiveness, is a vital issue for most young women in metropolitan society - within a gender order that, as Jónasdottír (1994) points out, makes women more dependent on their desirability to men than men are dependent on their desir- ability to women. Shifts in social de!nitions of attractiveness that place a premium on women being thin have created conditions for widespread dif!culty in young women's relationships with their bodies. Anorexia is in fact a gendered form of social embodiment - though not one that is normatively approved.

HIV: When the HIV/AIDS epidemic was !rst recognized in the early 1980s, it was gender-structured in a contrasting way, involving networks of men. The sexual practices of gay men in rich countries were distinctively shaped by gender dynamics. Gay Liberation, a powerful collective challenge to the stigmatization of homosexual men, had been followed by the expansion of urban gay communities and a certain turn towards hegemonic masculinity as found in the heterosexual world. This included a revival of butch fashion and personal style, and sexual techniques that included rough, unprotected anal sex, which unintentionally created pathways for the virus (Levine, 1992). By the 1990s HIV/AIDS was recognized as a global issue and its gender pattern was much more complex. In southern and central Africa, where the heaviest burden has lain, transmission is mainly through heterosexual practice, and women now have a higher rate of infection than men. The social circumstances include poverty and rapid urbanization, but also involve gender orders that privilege men and subordinate women, especially young women
1. use of heterosexist terminology, 2. endorsement of heteronormative culture/ behaviors, 3. assumption of universal LGBT experience, 4. exoticization, 5. discomfort/ disapproval of LGBT experience, 6. denial of the reality of heterosexism, and 7. assumption of sexual pathology/abnormality. 8. An eighth theme, threatening behaviors, emerged from the data and was independent from the original taxonomy.

1. Use of heterosexist and transphobic terminology occurs when someone uses derogatory heterosexist language toward LGBT persons (e.g., saying
words like "******" or "dyke," an employer refusing to use individuals' preferred gender pronouns, or people using phrases like "That's so gay!").

2. Endorsement of heteronormative or gender normative culture/behaviors transpires when an LGBT person is expected to act or be heterosexual or gender conforming. For instance, a heterosexual person telling a gay individual not to "act gay in public" and a parent forcing her or his child to dress according to birth sex would be both examples of endorsing heteronormative or genderist values.

3. Assumption of universal LGBT experience occurs when heterosexual people assume that all LGBT persons are the same (e.g., stereotyping all gay men to be interested in fashion or interior design or assuming all lesbian women to act or look "butch").

4. Exoticization microaggressions take place when LGBT people are dehumanized or treated as objects. This can be exemplified by heterosexual people stereotyping LGBT people as being the "comedic relief" or asking transgender people intrusive questions about their genitalia.

5. Discomfort/disapproval of LGBT experience occurs when LGBT people are treated with disrespect and criticism, such as when a stranger stares at an affectionate lesbian couple with disgust or a heterosexual or nontransgender person tells an LGBT individual that she or he is "going to hell," they are expressing their disapproval or discomfort.

6. Denial of societal heterosexism or transphobia transpires when people deny that heterosexism and homophobia exist (e.g., a coworker telling a gay friend that he's being paranoid thinking someone is discriminating against him).

7. Assumption of sexual pathology/abnormality microaggressions come about when heterosexual or nontransgender people oversexualize LGBT persons and consider them as sexual deviants. For example, many people may assume that all gay men have HIV/AIDS or are child molesters or that transgender women are sex workers.

8. Finally, denial of individual heterosexism / transphobia occurs when non-
LGBT people deny their own heterosexist and transgender biases and prejudice (e.g., someone saying, "I am not homophobic. I have a gay friend!").