A full and concise summary of all the literature and all lectures of the course Health and Society (7332E005AY) within the bachelor Sociology at the University of Amsterdam.
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,Readings.............................................................................................................................. 3
Chapter 1: Introduction in A History of Population Health .................................................. 3
Health inequalities among British civil servants: the Whitehall II study ............................... 6
Definitions of Health and Illness and medical sociology ..................................................... 7
The Meaning of Health in Rural South Africa: Gender, the Life Course, and the
Socioepidemiological Context .......................................................................................... 12
Standards for validating health measures: definition and content .................................... 15
Does the predictive power of self-rated health for subsequent mortality risk vary by
socioeconomic status in the US? ..................................................................................... 18
What do global self-rated health items measure? ............................................................ 20
Evaluating the continued integration of genetics into medical sociology .......................... 21
Chapter 2: Long-term trends in population health ............................................................ 25
Chapter 3: Understanding trends in population health ..................................................... 30
Social determinants of health inequalities ........................................................................ 37
Genetic variants linked to education predict longevity ...................................................... 39
The links between education and health .......................................................................... 40
Health inequality in the life course ................................................................................... 44
Life course epidemiology ................................................................................................. 44
Does the body forget? Adult health, life course dynamics and social change .................. 45
Life-course perspectives on mental health....................................................................... 45
Stress, mental health and aging ...................................................................................... 47
A disease like any other .................................................................................................. 49
Obesity stigma as a globalizing health challenge ............................................................. 50
Health effect of overweight and obesity in 195 countries over 25 years ........................... 50
The genetics of obesity: from discovery to biology ........................................................... 51
Overweight, obesity and depression: a systematic review and meta-analysis of longitudinal
studies ............................................................................................................................. 51
Weights stigmatization and bias reduction: perspectives of overweight and obese adults 52
Lectures ............................................................................................................................. 53
Lecture 1 – Introduction ................................................................................................... 53
Lecture 2 – What is Health and How to measure it? ........................................................ 53
Lecture 3 – Determinants of population health (SDH) ...................................................... 55
Lecture 4 – Life course perspective on population health ................................................ 56
Lecture 5 – Life course development and social change in mental health........................ 58
Lecture 6 – Body weight and health................................................................................. 59
2
,Readings
Chapter 1: Introduction in A History of Population Health
Mackenbach
Utopia come true?
‘Utopia’ as described in a book of Thomas More, describes an imaginary and perfectly
organized kingdom, located just off the coast of America. A few decades before, the ‘New
World’ had been discovered, and this had sparked the idea that an ideal society did not have
to await the hereafter, but could be created here and now. As More notes, “[not] anywhere are
there healthier men and freer from diseases.”
Although the term ‘utopia’ has become synonymous for unattainable ideals of perfect
societies, it is remarkable how much of More’s utopian health vision has been realized in the
20th century.
Rising life expectancy
Over the past three centuries, health of Europeans has improved enormously. This can most
clearly be seen in the spectacular increase in the length of life. Around the middle of the 19th
century, life expectancy at birth fluctuated around an average of less than 40 years, but in the
last decades of that century life expectancy began to rise rapidly, to reach the current values
of between 65 and 80 years among men, and between 75 and 85 years among women.
This increase in the length of life has been accompanied by enormous changes in
people’s health. Many diseases have disappeared, and while other diseases have taken their
place, these occur at higher ages than the diseases of the past, so that most health problems
now occur among older people. This goes hand in hand with the increased number of years
that Europeans can expect to live in both good and ill health.
Health improvements have occurred at different times and with different speeds,
resulting in the very broad band of upward moving life expectancies. More generally, for most
of the time Northern and Western Europe have taken the lead, later joined by Southern
Europe, and with most parts of South-eastern and Eastern Europe consistently staying behind.
The rise and fall of disease
Some of the dips in the life expectancy curves were very deep indeed – the deepest dip
occurred during the 1933 famine in Ukraine when average life expectancy at birth briefly
declined to below 10 years. Specific causes of death have risen and fallen over time, and it is
only because ‘falls’ ultimately had the upper hand that life expectancy could rise. This is one
of the main findings of this book, which reviews the history of around 40 health conditions.
These range from famine and plague to motor vehicle injuries and suicide, and from maternal
mortality and cholera to diabetes and cerebrovascular disease.
Although each disease has its own specific causes, we will see that the general
explanation for rises of disease is that human efforts to improve their living conditions often
required or allowed them to undertake new activities, which later turned out to be health-
damaging.
Similarly, declines of disease had many specific explanations, but when one takes a
bird’s eye view it becomes crystal-clear that it is highly unlikely that most declines occurred
spontaneously. The general explanation is that the drive for better living conditions not only
brought new health risks, but also created the necessary conditions for reducing these risks.
3
, The epidemiologic transition theory
The ‘epidemiologic transition theory’ was originally proposed in a paper by Egyptian-American
epidemiologist Abdel Omran (1971). The epidemiologic transition describes the mortality
component of the ‘demographic transition’: the long-term decline of (first) mortality and (then)
fertility that accompanied socioeconomic modernization around the world.
Omran characterized the epidemiologic transition as a “long-term shift […] in mortality
and disease patterns whereby pandemics of infection are gradually displaced by degenerative
and man-made diseases as the chief form of morbidity and primary cause of death.” This shift
occurs in three stages:
1. The “age of pestilence and famine” in which life expectancy “vacillat[es] between 20
and 40 years” and “mortality [is] high and fluctuating”
2. The “age of receding pandemics” in which life expectancy “increases steadily from
about 30 to about 50 years” and “epidemic peaks become less frequent or disappear”
3. The “age of degenerative and man-made diseases” in which life expectancy “rises
gradually until it exceeds 50 years” and mortality “eventually approaches stability at a
relatively low level.”
In his 1971 paper Omran did not define ‘degenerative and man-made diseases’, but in a later
update he mentioned cardiovascular disease, cancer, stroke, diabetes, and metabolic
disorders as examples of ‘degenerative diseases’. “Radiation injury, accidents, occupational
hazards, carcinogens in the environment and in industry, and food additives” are examples of
“diseases introduced by man.”
Omran recognized that in Western Europe and North America the shift started early
and took approximately 100 years. This is the ‘western’ or ‘classical’ model of the
epidemiologic transition. In a number of other countries, notably Eastern Europe and Japan,
the transition started later but proceeded much more quickly (the ‘accelerated’ model).
His notion of epidemiologic transition has stuck, but it has since been proven that this
is less than accurate. The characterization of the shift as one from ‘pandemics’ of infectious
diseases to ‘degenerative and man-made diseases’ is imprecise, as is the distinction between
the three ‘stages’.
Can more recent changes simply be accommodated by adding a fourth stage, as some
authors have proposed, or should these be seen as the start of an entirely new transition?
The McKeown debate and the Preston-curve
It cannot be a coincidence that both life expectancy and national income showed steep rises
over the 19th and 20th centuries – but how exactly are the two related? Two scientific studies,
both published in the 1970s, still form the anchor-points of present-day discussions of this
question.
The first is a series of publications by British professor of social medicine Thomas
McKeown whose analyses showed that the decline in mortality was the result mainly of a
decline of infectious diseases, and that infectious disease mortality decline for the most part
antedated the introduction of specific medical interventions, such as vaccinations and
antibiotics. In other words: the role of medicine can only have been marginal. He also
concluded that public health interventions were not necessarily targeted towards the most
deadly diseases and their decline was therefore not due to public health interventions.
A second paper, published in 1975 by American demographer Samuel Preston, also
dealt with the explanation of the rise of life expectancy, but came to rather different conclusions
on the role of rising living standards. This paper is mainly famous for the introduction of the
so-called ‘Prestoncurve’, which relates national income to average life expectancy at birth. It
shows that people living in richer countries on average live longer than people in poorer
countries, and that although the relation is steeper at lower levels of income, it holds at higher
levels as well.
However, an equally important finding in this paper was that when Preston compared
these curves for different points in time (i.e. the 1900s, 1930s and 1960s), he found that the
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