Health & Social Justice Ch.24: "Addressing Structural Influences on the Health of Urban Populations" By Arline Geronimus
LHAL Pittsburgh - Latino Health Advocacy & Leadership
Health & Social Justice - Ch.24: "Addressing Structural Influences on the Health of Urban Populations" By Arline Geronimus.
The author discusses the importance of research in understanding not just socioeconomic and demographic risk factors on the quality of health in urban populations, but also historical and structural factors contributing to today's urban ghettos.
Failure to do so when mounting a public health campaign will risk distorting the expected returns or overlooking important targets, approaches or resources.
POVERTY
There is an association between health and poverty. The poor may engage in unhealthy behaviors, depression and "persistent high effort coping" (stress).
There is a cumulative health impact of persistent disadvantage in access to health information, services, technologies by the poor.
The shift from manufacturing to service economy has been a factor in lowering wages, eliminating health benefits, increasing stress.
Lack of adequate housing is another factor.
Author claims that inadequate levels of support urban public park areas is another factor to urban decay, affecting the poor.
Needed programs:
(1) jobs
(2) quantity/quality/affordable housing
(3) municipal services
(4) clean environment
(5) health insurance and more physicians
RACE ETHNICITY (wrt poverty & health)
Concept #1: set of institutionalized social relationships between majority & minority populations
Concept #2: set of autonomous institutions within minority groups to respond/resist/mitigate/undo effects of concept #1
Rise of cultural frameworks to counter the dominant cultural framework in which they are marginalized. "As a minority group's economic strength diminishes, its ability to supply the protection conferred by social support and identity-affirming symbols may be especially critical to preserving the health of its members" (p.546). These frameworks tend to become overburdened and hard to sustain.
IMPLICATIONS FOR PUBLIC HEALTH
-- First do no (more) harm: paramount importance of protecting the formal organizations, the informal networks, the ideologies/ethos, the cultural frameworks, and the immense value of building coalitions with organizations that pursue goals shared by the majority (e.g., environmentalists, entrepreneurship).
-- Work to alter public perspective on race: recognize existing negative stereotypical judgments in the community. "In a structural framework, understanding what shapes public sentiment on race and how it might de influenced, becomes a critical public health objective" (p.548). In LHAL terms, if the majority can be made to understand the historical factors of illegal immigration and present Latino life and health, it may alter the way they think about Latinos. Discussion: the John Henry dilemma.
-- Distinguish between "ameliorative" and "fundamental" approaches: "ameliorative approaches target the risks factors that link socioeconomic position to health in a particular context,but do not fundamentally alter the context (or underlying inequalities)" (p.549). Note that a given risk factor may be virtually inevitable in a given social context... or it may be one of many factors present... or it may be followed by new a larger risks after being eradicated (!!!). "The only way to eliminate differentials in health is to address the underlying social inequalities that so reliably produce them". (p.550). Author urges for "working in partnerships with communities, engaging in bottom-up approaches, and recognizing that historical important and effective social movements derive their moral, political, and practical force from the autonomous networks and institutions developed and kindles within minority communities" (p.550).
CAVEATS/CAUTIONS: too much reliance on community-centered approaches... unrealistic expectations...
-- Increase attention to the needs of adults: adults as economic and moral foundations of families and communities... maternal health leads to infant health... etc. Downward spiral otherwise...
CONTINUED RESEARCH
Quality of health has important interactions with factors of race, poverty, locality which are not fully understood yet. Need more research on personal experiences with racism ("racialized stress")... the broader role of culture on health... understanding the functioning (not form) of autonomous social institutions within communities (e.g., ask who performs the mother role not whether the mother married or not)... the role of the dominant cultural system...
Health & Social Justice - Ch.24: "Addressing Structural Influences on the Health of Urban Populations" By Arline Geronimus.
The author discusses the importance of research in understanding not just socioeconomic and demographic risk factors on the quality of health in urban populations, but also historical and structural factors contributing to today's urban ghettos.
Failure to do so when mounting a public health campaign will risk distorting the expected returns or overlooking important targets, approaches or resources.
POVERTY
There is an association between health and poverty. The poor may engage in unhealthy behaviors, depression and "persistent high effort coping" (stress).
There is a cumulative health impact of persistent disadvantage in access to health information, services, technologies by the poor.
The shift from manufacturing to service economy has been a factor in lowering wages, eliminating health benefits, increasing stress.
Lack of adequate housing is another factor.
Author claims that inadequate levels of support urban public park areas is another factor to urban decay, affecting the poor.
Needed programs:
(1) jobs
(2) quantity/quality/affordable housing
(3) municipal services
(4) clean environment
(5) health insurance and more physicians
RACE ETHNICITY (wrt poverty & health)
Concept #1: set of institutionalized social relationships between majority & minority populations
Concept #2: set of autonomous institutions within minority groups to respond/resist/mitigate/undo effects of concept #1
Rise of cultural frameworks to counter the dominant cultural framework in which they are marginalized. "As a minority group's economic strength diminishes, its ability to supply the protection conferred by social support and identity-affirming symbols may be especially critical to preserving the health of its members" (p.546). These frameworks tend to become overburdened and hard to sustain.
IMPLICATIONS FOR PUBLIC HEALTH
-- First do no (more) harm: paramount importance of protecting the formal organizations, the informal networks, the ideologies/ethos, the cultural frameworks, and the immense value of building coalitions with organizations that pursue goals shared by the majority (e.g., environmentalists, entrepreneurship).
-- Work to alter public perspective on race: recognize existing negative stereotypical judgments in the community. "In a structural framework, understanding what shapes public sentiment on race and how it might de influenced, becomes a critical public health objective" (p.548). In LHAL terms, if the majority can be made to understand the historical factors of illegal immigration and present Latino life and health, it may alter the way they think about Latinos. Discussion: the John Henry dilemma.
-- Distinguish between "ameliorative" and "fundamental" approaches: "ameliorative approaches target the risks factors that link socioeconomic position to health in a particular context,but do not fundamentally alter the context (or underlying inequalities)" (p.549). Note that a given risk factor may be virtually inevitable in a given social context... or it may be one of many factors present... or it may be followed by new a larger risks after being eradicated (!!!). "The only way to eliminate differentials in health is to address the underlying social inequalities that so reliably produce them". (p.550). Author urges for "working in partnerships with communities, engaging in bottom-up approaches, and recognizing that historical important and effective social movements derive their moral, political, and practical force from the autonomous networks and institutions developed and kindles within minority communities" (p.550).
CAVEATS/CAUTIONS: too much reliance on community-centered approaches... unrealistic expectations...
-- Increase attention to the needs of adults: adults as economic and moral foundations of families and communities... maternal health leads to infant health... etc. Downward spiral otherwise...
CONTINUED RESEARCH
Quality of health has important interactions with factors of race, poverty, locality which are not fully understood yet. Need more research on personal experiences with racism ("racialized stress")... the broader role of culture on health... understanding the functioning (not form) of autonomous social institutions within communities (e.g., ask who performs the mother role not whether the mother married or not)... the role of the dominant cultural system...
posted by Fernando @ 4:42 PM
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