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Week2Macro-SocialInfluences.pptxMacro-social influences
Objectives
Define the term ‘macro-social’ and its relevance to health psychology
Show an awareness of corporate influences on health
Critically describe the constraints on individual health choices
Pinpoint factors affecting health across the world
Understand the significance of population growth, globalized promotion of unhealthy commodities, poverty and shrinking natural resources
Explain what is meant by a ‘health gradient’ and its implications
Definition of the term ‘macro-social’
The term macro-social refers to large-scale social, economic, political and cultural forces that influence the life course of masses of people simultaneously
Macro-social influences include:
Actions and policies of governmental and non-governmental organizations
Cultures
Historical legacies
Organized religions
Multinational corporations and banks
Unpredictable, large-scale environmental events
Facts of life and death
Where a baby is born, and the mother’s access to water, food and education, determine whether the baby lives or dies
A baby in Sierra Leone has a 72% chance while a Japanese baby has a 96% chance of reaching age five. Health inequalities have always existed; in this presentation, we examine why
Each individual human is a creation of genetics, environmental experience and the interaction between the two
Facts of life and death
The environment can be broken down into macro and micro levels. The macro-social environment affects health and well-being in a huge variety of ways
What individuals can do to change their lives is not simply a matter of personal choice – such changes are constrained politically, economically and culturally. In the globalized economy, everything is inter-connected. Macro-social economic, political and cultural factors create the context for everything else, including health, illness and health care
Policy, ideology and discourse
The dominant discourse within neo-liberal health policy has been that of the autonomous individual in which each individual is an agent, responsible for his/her own health
Accordingly, responsibility for illness relating to personal lifestyle is seen as the fault of the individual, not an inevitable facet of a social, corporate, economic environment designed to maximize shareholder profits
Policy, ideology and discourse
Common observation and decades of research show that people are really pushed and pulled in different directions while exercising their ‘freedom of choice’. Emotions and feelings are as important in making choices as cognition. The beneficial satisfaction of needs and wants must be balanced against perceived risks and costs. Health policy is beginning to acknowledge both the complexity of health and the power of the market
Epidemiological transition and globalization
Epidemiology is concerned with the distribution of disease and death and their determinants and consequences
Diseases can be divided into two broad categories: communicable and non-communicable
Communicable diseases spread from one person to another or from an animal to a person, e.g. influenza, HIV infection and polio
Non-communicable, or chronic, diseases are generally diseases of long duration and have a slow progression, e.g. cardiovascular diseases, cancer, chronic respiratory diseases and diabetes
Epidemiological transition and globalization
Non-communicable diseases (NCDs) are currently the leading cause of death in the world, representing 63% of all annual deaths (World Health Organization, 2014). NCDs kill at least 36 million people each year, some 80% of which occur in low- and middle-income countries
Epidemiological transition and globalization
Omran (1971) described what he termed the ‘epidemiological transition’
This refers to a reduction in prevalence of communicable diseases and an increase in the prevalence of NCDs that occurs as a country becomes economically stronger
NCDs are lifestyle-related chronic diseases that accompany increased usage of unhealthy commodities such as alcohol, tobacco and processed foods
Epidemiological transition and globalization
In industrial countries such as the USA, Germany, the UK and Japan, the prevalence of communicable diseases is much lower compared to chronic NCDs
In India, and other low- and middle-income countries, while communicable diseases are still present, the rise of NCDs has been rapid (Anjana et al., 2011). Low- and middle-income countries like India are currently facing an epidemiological transition with a ‘double burden’ of disease
Population growth
The most populous region on the globe is China which contains 19% of all people on Earth, the second is India. It is expected that India’s population will surpass China’s, with around 1.5 billion by 2040
One intervention for population growth, birth control, is practised in many countries. However, religious edicts influence sexual and reproductive practices. Consider the position of the Roman Catholic Church as one example. Pope Paul VI reinforced the traditional values of the church by forbidding abortion and artificial contraception
Population growth
The human failure to practise abstinence as the only acceptable method for birth control in South America and Africa is adding to population growth, poverty, and the spread of HIV infection
Birth control is also cheaper than other methods of reducing carbon emissions (Wire, 2009; Tickell, 2008). Failing to prevent unwanted births increases the population and causes poverty and malnutrition, and the physical climate becomes more unstable
Increasing life expectancy
Life expectancy has been increasing almost everywhere due to dramatic decreases in infant and adult mortality from infectious diseases
Recent research suggests that life expectancy will continue to increase in the twenty-first century and that, by 2060, it could reach 100 years (Oeppen and Vaupel, 2002)
Life expectancy is increasing by 3 months every year in developed countries. If life expectancy increases to 85, 90 or even 100, social, health and pensions systems will be difficult to maintain in their present form
Increasing life expectancy
China has the fastest changing demographic profile in the world with the largest population of senior citizens. Currently China has more than 130 million senior citizens who are above 60, more than 10% of the total population. By the middle of this century senior citizens in China will exceed 400 million, one quarter of the total population
Poverty
Of 7.2 billion people alive in 2014, approximately 5 billion (70%) live in low- and middle-income countries
One-and-half billion people live on less than 1.25 dollars per day
Initiatives that have attempted to improve the health of people in extreme poverty mostly have failed
Half of the world’s population lacks regular access to medical care and most essential drugs. International organizations such as the UN state with some justification that poverty is the greatest cause of ill health and early mortality
Poverty
The major impacts of poverty on health are caused by the absence of safe water, environmental sanitation, adequate diet, secure housing, basic education, income generating opportunities and access to medication and health care
The most common health outcomes of poverty are infectious diseases, malnutrition and reproductive hazards (Anand and Sen, 2000)
Poverty implies lack of access to necessary medicines. In 2004, 6 million people living with HIV infection and AIDS in developing countries urgently needed access to antiretroviral therapy (HAART)
Poverty
The major barrier to increasing access to HAART is cost. The pharmaceutical industry holds the patents and loses profits if patent rights are relinquished to enable generic production of HAART medication
Poverty reduction has been a priority for many international organizations. At the United Nations in 2000, 189 countries adopted the ‘Millennium Development Goals’. It is expected that the world poverty rate of 28% as it was in 1990 will be reduced by half by 2015
However, poverty in sub-Saharan Africa is still getting worse. UN Secretary-General Ban Ki-moon asserted that ‘the current trends . . . indicate that no African country will achieve all the Goals by 2015’ (United Nations, 2008)
Inequalities within a country
The existence of health gradients within health care is a universal constant
Many determinants of ill health were identified by Edwin Chadwick in his studies of public health in Victorian England: poverty, housing, water, sewerage, the environment, safety and food. In addition, we recognize today that illiteracy, tobacco, AIDS/HIV, immunization, medication and health services are also important (Ferriman, 2007)
Inequalities within a country
Recent studies of the social determinants of health have pinpointed various kinds of inequity. The first of these is based on socio-economic status (SES): people who are higher up the ‘pecking order’ of wealth, education and status have better health and live longer than those at the lower end of the scale
Health gradients are found in all societies. Wealthier groups always have the best health; poorer groups have the worst health. These differentials occur in both illness and death rates, and health gradients are equally dramatic in both rich and poor countries
The most important predictors of infant survival are educational and environmental
Inequalities within a country
The most effective long-term structural interventions to combat inequality are to improve the educational opportunities for women and to improve the supply of drinking water
High literacy among mothers and access to water supplies and toilets are highly associated with low infant mortality
High numbers of doctors and nurses, immunization rates and health service expenditure are associated with lower mortality rates, but these health service variables are less influential statistically speaking than literacy, domestic water and sanitation. The latter provide the foundations of good health, while health services are the bricks and mortar
Gender
Significant differences exist in health outcomes between men and women
Lifespan
In industrialized societies men die earlier than women, but women generally have poorer health (Macintyre and Hunt, 1997)
Evidence suggests that from the Palaeolithic period to the industrial revolution men lived longer than women, 40 years as compared to 35. Also, in less developed countries (e.g. India, Bangladesh, Nepal and Afghanistan) men still live longer than women (World Health Organization, 1989)
Gender
Illness type
Women suffer more non-fatal chronic illnesses and more acute illnesses. They also make more visits to their family physicians and spend more time in hospital. Women suffer more from hypertension, kidney disease and autoimmune diseases (Litt, 1993). They also suffer twice the rate of depression
Men, on the other hand, have a shorter life expectancy, and suffer more injuries, suicides, homicides and heart disease
Gender
Psychosocial and lifestyle differences play a role in gender-linked health differences
In industrialized societies women suffer more from poverty, stress from relationships, childbirth, rape, domestic violence, sexual discrimination, lower status work, concern about weight and the strain of dividing attention between competing roles of parent and worker
Financial barriers may prevent women from engaging in healthier lifestyles and desirable behaviour change (O’Leary and Helgeson, 1997)
Gender
Although physical and mental well-being generally benefit from social support, women often provide more emotional support to their families than they receive. Thus, the loss of a spouse has a longer and more devastating effect on the health of men than on that of women (Stroebe and Stroebe, 1983)
The burden of caring for an elderly, infirm or dementing family member also tends to be greater for females in the family than for males, especially daughters (Grafstrom, 1994)
Gender
Social construction of gender
Gender is a social construction and social constructions of masculinity and femininity have relevance in particular to young men’s and young women’s health-seeking behaviour
Gender-specific beliefs and behaviours are likely contributors to these differences (Courtenay, 2000). Men are more likely than women to adopt risky beliefs and behaviours, and less likely to engage in health-protective behaviours that are linked with longevity
Gender
Alternative constructions that subvert normative ideas of masculinity include non-drinking. A study of non-drinkers’ discourse examined the manner in which not drinking alcohol is construed in relation to the masculine identity. Three prominent discourses about non-drinking were revealed:
(1) as something strange requiring explanation; (2) as simultaneously, unsociable, yet reflective of greater sociability; (3) as something with greater negative social consequences for men than for women (Conroy and de Visser, 2013)
Ethnicity
The health of minority ethnic groups is generally poorer than that of the majority of the population
This pattern has been consistently observed in the USA between African-Americans (‘blacks’) and Caucasian-Americans (‘whites’) for at least 150 years (Krieger, 1987)
Under the age of 70, cardiovascular disease, cancer and problems resulting in infant mortality account for 50% of the excess deaths for black males and 63% of the excess deaths for black females (Williams and Collins, 1995)
Ethnicity
Similar findings exist in other countries. Analyses of three censuses from 1971 to 1991 have shown that people born in South Asia are more likely to die from ischaemic heart disease than the majority of the UK population (Balarajan and Soni Raleigh, 1993)
There are many possible explanations for these persistent health differences
Racism: Minority ethnic groups are the subject of discrimination at a number of different levels. Discrimination in the health care system exacerbates the impacts of social discrimination through reduced access to the system and poorer levels of communication resulting from language differences
Ethnicity
Ethnocentrism in health services and health promotion unofficially favours the needs of majority over minority groups. These problems are compounded by cultural, lifestyle and language differences. For example, if interpreters are unavailable, the treatment process is likely to be improperly understood or even impaired
SES: Race is strongly correlated with SES and is even sometimes used as an indicator of SES (Williams and Collins, 1995; Modood et al., 1997). Studies of race and health generally control for SES, and race-related differences frequently disappear after adjustment for SES
Ethnicity
Cultural and social norms: Differences in health-protective behaviour and differences in readiness to recognize symptoms may occur as a result of different cultural norms and expectations
Access to services: There is evidence that differential access to optimal treatment may cause poorer survival outcomes in African-Americans who have cancer, in comparison to other ethnic groups (Meyerowitz et al., 1998)
Ethnicity
Environment: Members of minority ethnic groups are more likely to inhabit and work in unhealthy environments because of their lower SES
Genetics: There are genetic differences between groups that lead to differing incidence of disease, and some diseases are inherited (e.g. sickle cell disorder affecting people of African-Caribbean descent)
Future research
The causes of poverty and interventions to ameliorate poverty should be the priority for economic and social research
Studies in psychology and sociology must be designed to understand humanitarian values, altruism, oppression, fear, aggression and cross-cultural issues
Possible mechanisms underlying ethnicity differences in health, such as differences in early life conditions, power and control, and stress must be explored
Research is needed with large community samples so that the influence of the above variables and their possible interactions can be determined
Summary
The world population is increasing dramatically. From one billion in 1800, it will climb to nine billion by 2050, while the amount of drinkable water available per person will fall by 33%. The increased shortage will affect mainly the poor where water shortage is already chronic
Consumption of tobacco, alcohol, ultra-processed food, drink and other unhealthy commodities is increasing throughout the low- and middle-income countries and is driving a huge increase in prevalence of non-communicable diseases
Summary
The greatest influence on health for the majority of people is poverty. Half of the world’s population lacks regular access to treatment of common diseases and most essential drugs. Globally, the burden of death and disease is much heavier for the poor than for the wealthy
In developed countries life expectancy is increasing by three months every year. If this trend continues, life expectancy will approach 100 years by 2060 placing social, health and pensions systems in a perilous position
Economic growth does not reduce disparities in wealth across a society. ‘Trickle-down’ is a myth. Health gradients remain a universal feature of the health of populations in both rich and poor countries
Summary
Gender differences in health, illness and mortality are significant and show striking interactions with culture, history and socio-economic status
The health of minority ethnic groups is generally poorer than that of the majority of the population. Possible explanations include racial discrimination, ethnocentrism, SES differences, behavioural and personality differences, cultural differences and other factors
‘Doom and gloom’ is not inevitable. Prospects can significantly improve if policy-makers intervene. The future health of populations depends upon actions taken by governments and corporations
