Sociology Health and Illness

Demography
Study of human populations, a sub-discipline of sociology

Epidemiology
The study of the distribution of disease in populations, a sub-discipline of public health

Fertility
The number of births to an individual or a population

Mortality
The number of deaths in a population

Life expectancy
the average (mean) numbers of years a person can expect to live, based on death rates at the time

Demographic transition
The decline in mortality, and then in fertility rates in industrializing societies beginning in the 19th century

Epidemiologic transition
The shift from infectious to chronic diseases as causes of death

The Demographic Transition Stages
1-5; high stationary, early expanding, late expanding, low stationary, declining?

High Stationary
Birth rate high, death rate high

Population pyramid
back-to-back horizontal bar graphs that show the composition of a population by age and sex

Birth cohort
individuals born in the same calendar year, or group of years

Median age
the midpoint of the age structure; 50% of the population is older, 50% is younger

Sex ratio
the number of males for every 100 females

Aged dependency ratio
the number of persons aged 65 and older for every 100 persons aged 20-64

Total dependency ratio
the number of persons aged 65 and older, plus the number aged 0-19, for every 100 persons aged 20-64

Social gradient
the observation that health is correlated with social class/status all the way up and down the scale, that poor health is not simply a problem of poverty, but of overall income inequality

Age dependency ratio
# persons aged 65+/ # persons aged 20-64 X 100

Life Expectancy in the US
Males-75.64 Females-80.78

Wilkinson, Chapter 1
“material success but social failure,” most diseases have some environmental cause, “epidemiological transition” is the change from infections to chronic diseases as the most frequent cause of death.

The Stress Response graph by Dr. Hans Selye
Phase 1- Alarm reaction (mobilize resources)
Phase 2- Resistance (cope with stressor)
Phase 3- Exhaustion (reserves depleted)

General Adaptation Syndrome by Hans Selye
Alarm reaction:
adrenal enlargement
thymus shrinkage
lymph node shrinkage
“Fight or flight”

Resistance:
state of arousal until threat is over, hormones depleted if threat does not resolve

Exhaustion:
acquired adaptation is lost if threat is continuous

Income inequality
The distribution of income in a population; all societies are unequal but some are more unequal that others

Social gradient in health
Life expectancy and health levels decline at each lower level of the socioeconomic ladder; this means that health inequities affect everyone, not only the poorest

Hypothesis
The statement of an expectation of the association between two variables

Survival curve
line graph depicting the loss of members of the sample over time

White hall study
Whitehall I began in 1967, as a study of heart disease mortality among 18,000 male British Civil Servants. Whitehall II began in 1985, with 10, 308 males and female members of the Civil Service. Michael Marmot began work on the Whitehall Studies in 1976; he led the UN Commission on the Social Determinants of Health.

Cross-sectional study
Survey or other analysis of data where all variables are measured at the same time. Associations between variables represent correlations only, and no casual direction can be inferred

Longitudinal (or follow-up) study
Survey or other data are collected at one time, and an outcome (health) is measured at a later time

Representative (or population-based) sample
Individuals chosen for a study are selected with equal, known probability; this allows findings from the sample to be generalized to the population from which the individuals were selected

Dependent (or outcome) variable
What the study is trying to explain (measured at the later time point)

Independent (or predictor, or exposure) variable
What the study is testing as a possible influence on the dependent variable (measured at the start or baseline of the study).

What is the equation of social ties?
Social ties = social support + social control + social capital

Wilkinson Chapter 2
quality of social relations in society is driven by inequality
Social capital measured by levels of trust, membership in community organizations, political involvement
States with higher income equality have high social capital
US states with greater income inequality have higher rates of violence and homicide

Race
each of the major divisions of humankind, having distinct physical characteristics

Ethnicity
the fact or state of belonging to a social group that has a common national or cultural tradition

Social capital
Robert Putnam’s concept in Bowling Alone. The resources that flow to people through their social connections. A characteristic of both individuals and societies.

Bicycling reaction
Bowing to those who are superior, but increasing one’s status by asserting one’s own superiority over those lower in the hierarchy

Gini coefficient
measure of income inequality- lower numbers are more equal

American “exceptionalism”
term that can refer to many aspects of American culture and society but is often used to refer to our one-of- a kind health care model

Bismarck model
(Germany, Japan, Switzerland) Health insurance is private, financed by employers and employees, but it is not-for-profit and tightly regulated; providers are private

Beveridge Model
(Great Britain, Italy, Spain) Health care is provided and paid for by the government as a public service, financed through taxes. Physicians may be public employees on salary, or stay in the private sector and collect fees

National Health Insurance Model
(Canada, Australia, South Korea) Health insurance is provided by the government and financed by premiums; providers are private

Out- of- pocket Model
(the developing world) People pay for all the needed services themselves

Health insurance
Insurance that pays for physician care, hospital services, prescription medications, and/or other health care needs. Insured persons and/or their employers pay a premium, and the coverage may be subject to deductibles and co-payment

Fee-for-service
Payment model in which the patient or his/her insurance pays for each visit or treatment provided

Managed care
Techniques used by organizations to reduce health care costs through economic incentives to: select less costly care; review the medical necessity of specific services; increase cost sharing; control hospital admissions; encourage outpatient surgery; selectively contract with health care providers; and intensively manage high-cost cases

Gross domestic product
the total value of all goods and services produced within a country in a given year

Guaranteed issue
the requirement in the PPACA that no one can be denied insurance because they have a pre-existing condition

Individual mandate
the requirement in the PPACA that everyone purchase insurance

Recission
the practice of canceling insurance policies when an injured person becomes sick, now prohibited by the PPACA

Annual or lifetime limits
thresholds for rescission of coverage, now prohibited by the PPACA

Public option
the proposal to include a single-payer, Medicare-at-any-age option in the health care exchanges. This provision was not included in the final bill

Medicare
single-payer health insurance for citizens eligible for Social Security aged 65 and older. Administered by the federal government and paid for by payroll taxes and premiums.

Medicaid
program to provide health care for the poor. Jointly funded by the states and federal government and paid for by income taxes.

Why do we need the Affordable Care Act?
Too many people lack health care coverage, U.S. healthcare spending is unsustainable, health outcomes are poor, our system emphasizes treatment instead of prevention, health disparities exist among numerous populations

What’s covered in Health Insurance Marketplace
Outpatient care, trips to the emergency room, treatment in the hospital for inpatient care, care before and after your baby is born, mental health and substance use disorder services, your prescription drugs, services and devices to help you recover if you are injured or have a disability or a chronic condition, lab tests, preventative services, pediatric services

adverse selection
only sick people will buy coverage if it is not needed

Medical loss
the money that for-profit health insurance companies spend on providing medical care

Capitation
Payment model in which the health care provider agrees to provide all care for a patient for a specified period of time and a specialized, prepaid cost, regardless of how much care is utilized

Ambulatory care
health services provided in facilities that do not keep patients overnight. May include diagnostic

Key informant
an “insider” member of a demographic group or social institution who is knowledgeable about the subjects a researcher is interested in

Medicare
Canada’s National Health Insurance system, enacted at the federal level in 1964; it covers Canadians of all ages. The US Medicare program was enacted in 1965; it covers only US citizens eligible for Social Security (over age 65 or disabled).

Cadillac tax
Starting in 2018, the Affordable Care Act will put a 40% tax on expensive (annual premiums over $10,000) employer- based health insurance plans