Women & Minority Health
Dr. Dawn M. Upchurch
PH 150
Fall ‘04
Overview of Lecture
Short review of HP 2010
Concept of Social Stratification
– Social stratification and health
Women’s health
– Gender paradox
– Key issues in women’s health
“Minority” health
– Key issues
Ways of ameliorating health disparities
Healthy People 2010
Two overarching goals:
1. Eliminate health disparities
2. Increase quality & years of healthy life
Objectives organized into 28 “Focus
Areas”
Each objective has “Leading Health
Indicators”
– Importance of health promotion & disease
prevention
What are “health disparities”?
Mortality
– Varies by gender
– Varies by race/ethnicity
– Varies by other sociodemographic factors
Morbidity
– Varies by gender
– Varies by race/ethnicity
– Varies by other sociodemographc factors
Explanations for Health Disparities
Theory of “Social Stratification”
– Society “stratified” by several
sociodemographic characteristics
Gender
Age
Race/ethnicity
SES
Others?
– Stratification: Differential access to resources
Theory of Social Stratification
All known societies have inequalities
What are social “resources”?
– Wealth
– Power
– Prestige
Rules of allocation:
– Variable distribution of goods/resources across
various positions in social structure
– Most privileged enjoy disproportionately
What is “social structure”?
Types of Social Stratification
Degree of inequality of resources
– Dispersion
– Concentration
Degree of rigidity
– High: “social closure”
– Low: “social mobility”
Ascriptive vs. Achieved
– Ascriptive: Traits present at birth influence
subsequent social standing
– Achieved: Traits acquired over lifetime influences
subsequent social standing
How is U.S. Society Stratified?
Both ascriptive & achieved stratification
processes
– Ascriptive
Gender
Race/ethnicity
Nativity, culture
SES of family
– Achievement
Education, etc.
Concept of Status Attainment
Social status individuals achieve over their
lives
– Key Indicator: Educational attainment
– Concept of “human capital”
Examples of status attainment process
– “Intergenerational transfer” of status
– Individual status attainment over life course
Key Sociodemographic
Characteristics Associated with
Stratification & Health
Age
– Biological & social components
Gender (Sex)
– Biological & social components
Race & ethnicity
– Biological & social components
– Social meaning of race & ethnicity changes
Socioeconomic status (SES)
Contingent effects of age, gender, race/ethnicity
& SES on health
Women’s Health – Gender Paradox
“Women get sicker, men die quicker.”
– What does this mean?
– Women
Higher morbidity rates than men
Lower mortality rates than men
– Men
Lower morbidity rates than women
Higher mortality rates than women
– But, higher morbidity should predict higher mortality –
What’s happening?
Gender Paradox
Gender differences in health care seeking
behaviors
– Women more likely to go to HCP early & often
vs. men
Visits are “counted” in morbidity rates
– Men more likely to wait and/or not go to HCP
So, lower morbidity rates
But, wait until conditions more severe  increased
risk of mortality
So, both “true” & “artifact” differences
Race/ethnicity, SES, & Health
Gender, race/ethnicity, & SES associated
with one another
Distribution of risk factors & resources are
shaped by the conditions under which
people live & work.
What are some of the explanations for the
observed race/ethnic & SES differences in
health?
Factors Associated with Race/ethnic &
SES Differences in Health
Medical care
– Differential use of preventive care
Health behaviors
– Unhealthy behaviors account for 50% of deaths in US
Environmental conditions
– Working conditions, environmental exposures
Personality
– Self esteem; mastery; fatalism
Early life conditions
Reducing Health Disparities
Intersection of Research, Policy, & Program
Policy
Research
Program
Reducing Health Disparities
National Public Health Agenda
– National Health Policies & Programs
– Healthy People 2010
State & Local
– Policies & Programs
Targeted Populations
– Policies & Programs
Program Development & Evaluation