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  6. I want to say that ” I wanted to touch upon the film from last week “Escape Fire”. I thought it was interesting and brought up some good points about the systemic problems in our medical system and who really is benefiting (pharma, insurance, medical devices, etc.). I also liked how it highlighted the “quick-fix” approach our medical system uses vs prevention and education. I was curious about Dr. Weil’s Integrative Fellowship that they highlighted- I wonder actually how accessible this is to doctors? It certainly is depressing to see that even the doctor who really wanted to spend time with her patients met push back from the system.

    Onto the readings- Similar to Rohina, it was depressing to read how Neo-Liberalism benefits the dominant class and causes harm to the dominated class and it’s subsequent impact on health inequalities. Navarro comments on the deaths resulting from lack of health care “these deaths are so much a part of our everyday reality that they are not news” (pg. 27). This comment brought to mind the idea of hegemony- “the success of the dominant classes in presenting their definition of reality, their view of the world, in such a way that it is accepted by other classes as ‘common sense’” (https://s9-gameapp.com/. How horrible that these atrocities are becoming commonplace. By highlighting the “causal chain” of causes of inequality, Marmot emphasizes the importance of looking at our social/economic policies in place.

    The two articles highlighting specific examples of structural causes of inequality (school dropout and displacement) were very telling. I may have brought this up in class in Health Communication but the school dropout article brought to mind some work the youth at Nuestras Raices did “push-out”, what they described as the consequences of the school cafeteria experience. Here is the transcript of the youth describing it in a video we did:

    Youth 1: Once in a while I ate chicken patties but those ended up being gross too so I just went to the vending machine and grabbed a drink and that was my lunch

    Youth 2: Push out is when a student doesn’t eat lunch because it tastes nasty or gross or there’s something wrong with it and they put their head down in class.

    Youth 3: By putting their head down they’ll get sent out of class. Getting sent out of class enough will get you suspended. So you can’t come back to school.

    Youth 1: This turns into detention, detentions turn into suspension, and a suspension gets turns into expelled. as in getting pushed out of school. The school system is pushing them out since they’re not getting good food.

    Youth 2: If we have food that we want and that is healthy for us, then we’ll focus better, and we’ll have more to, like, learn.

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  20. Public health and social justice are closely intertwined concepts that address health disparities and promote equity in health outcomes. Here are some key points on their relationship:

    Health Disparities: Social determinants such as income, education, race, and geographic location significantly impact health outcomes. Public health initiatives aim to identify and reduce these disparities.

    Equitable Access: Social justice advocates for equitable access to healthcare services, ensuring that marginalized communities receive the resources they need for better health.

    Policy Advocacy: Public health professionals often engage in policy advocacy to promote laws and regulations that address systemic inequalities, such as those affecting access to clean water, nutritious food, and healthcare.

    Community Empowerment: Empowering communities to take control of their health through education and resources is a key aspect of both public health and social justice.

    Intersectionality: Understanding how various forms of discrimination (e.g., racism, sexism, classism) intersect is crucial in addressing health inequities effectively.

    Global Perspective: Social justice in public health also encompasses global health issues, advocating for fair treatment and resources for populations in low-income countries.

    Sustainable Solutions: Both fields emphasize the importance of sustainable practices that promote long-term health and well-being for all communities.

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  211. I appreciate Navarro’s outspoken passion about the importance of naming classism as a significant contributor to the health inequities that are evident on a global scale. The Marmot study so clearly points to gradients in wealth as an indicator of health, yet at least in the U.S, health outcomes are rarely reported based on income levels. Health data that I utilize breaks down morbidity and mortality rates across varying racial and ethnic categories yet does not do so across income categories. I imagine that if this data were readily available, more people (I hope) would truly be outraged. Navarro’s speech (which is movingly written, I would be curious to know if it is as moving when he was speaking) identifies the existing and established power differentials as the root cause of poverty. At the same time, he does not explore the relationship between race and class, which I found disappointing as I see them as inherently linked. His call for improved approaches to health promotion specifics the need to identify and work to address inequities on a social versus an individual level, which is an essential distinction often lacking in the dominant discourse about health promotion.

    In fact in the movie “Escaping Fire” there was a distinct focus on individual choice as the key to health promotion. I am thinking about the CEO of Safeway when he was reflecting on the success of their employee wellness program. In many ways I think the concept is great: build in and allow time during the workday for exercise. What makes me nervous however, is that this idea of using weight or BMI as an “encouragement” to be more proactive could have hugely negative ramifications if broadened to a population level. Although all Safeway employees have access to a work environment that values and prioritizes health, this is not the reality for the rest of the world. This individualistic spin to health promotion made me think of libertarian policies that have historically advocated for school vouchers as a way to address education inequities; in reality, this type of approach ultimately benefits the wealthy.

    Marmot’s identification of social support as an essential component to community health is a theme that is repeated in the Fullilove and Freudenberg articles. In particular, the Fullilove article identifies displacement as a negative predictor of health. I found this article particularly enlightening in regards to the policies that were enacted that perpetuated neighborhood segregation and the undermining of low-income neighborhoods. I had heard about red lining before, but was unfamiliar with the “shrinkage policies” in NY. I see this concept being repeated currently in Detroit. Of course the city as a whole is undergoing significant economic challenges, but as I understand it essential city services are limited to a small sector of the city, leaving may of the low-income areas to be at risk for fires, theft, and other health and safety issues, mirroring the example that Fullilove gives about the South Bronx in the 1980s. For me, this issue of housing is a perfect and sad illustration of structural violence, which ties this weeks readings back to the Farmer article from last week.

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  212. Like Mim, what Navarro’s said in page 26: “One should never confuse a country’s people with its government”, caught my attention. This statement also made me realize that it’s not how rich is your country, but the quality of life of the people that might determine its richness. Therefore, as some of the authors of the other readings explained, if the government still focusing on benefit high-income groups and/or companies rather than the low or middle classes, health disparities and inequalities will still happening. The best example, I guess, was given also by Navarro about the privatization of health services and how health insurance companies have been converting the people’s health in the most expensive business that could exist nowadays. Moreover, as was also presented on the film Escape Fire, the saddest story is about the underinsured people that suffer from the “health business” in major magnitude, having to struggle with paying a health insurance that barely covers primary care services and that is not enough to cover their medical bills.

    Likewise, one important thing I have learned through all the years I have been studied public health is that education is essential to assure a better quality of life for any person. Indeed, education is recognized as part of the social determinants of health, sometimes correlating with occupation, income among other factors. Moreover, lack of “adequate health education” in the participants of the research projects that I worked with in Puerto Rico was part of my motivation to study community health education. However, this week’s readings made me to think, once again, about what should be consider “adequate” or who has the right to determine what “adequate education” stands for. As we discussed in class last week, article 26 of the Universal Declaration of Human Rights says that “everyone has the right to education”, but certainly, disparities in education, especially among racial groups (e. g., Black and Latino groups) are socially determining the quality of health in these populations.

    Therefore, it’s sad to read news like the one presented by The Nation about how, in other words, education is not seriously taken as an important social determinant of health, by cutting resources in marginalized communities that are in so much need of an “adequate” education. Once again, the famous human rights are being violated and not so much is been done against that. Yet, as Navarro concluded in his speech: “… as public health workers we can and must do so” (page 37).

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  213. After doing the readings for this week I keep thinking about the different policies and who they affect. Why are these policies put into place? Who benefits from them and who suffers as a result? Not only which policies are put into place but the lack of policies? As Navarro writes “Public interventions have benefited some classes at the expenses of other classes, some races at the expense of others, on gender at the expense of the other, and some nations at the expense of other nations” (p.25) … Does on to talking about class and how the scientific literatures ignores the work class and sometimes replaces it with status. Fullilove give examples of how policies that were put into place that resulted in people losing their housing and the connection between destruction of housing and the spread of HIV in the US. One of the videos we watched in class stated that these policies or lack of policies don’t just happen. The system is broken and is set up in a way for some people to benefit while others suffer.

    Reframing school drop out as a public health issue: My first week as a freshmen in Holyoke High school the freshmen class was asked to go to the auditorium for an assembling. I found a seat near my middle school friends towards the front of the auditorium. The assembling started, as teachers struggled to get the student to quite down. The funny thing about freshmen year is that I don’t remember much but I will never forget the words I heard coming out from those cheap speakers in the auditorium. “ I want you all to take a minute and look to your left and your right. A lot of you will not make it to your senior year. More then half of you will not graduate. It is up to you to make that decision.” Those few sentences were like tiny bells ringing in my ears all throughout high school. Those few sentences turned out to be a fact. Class of 2009 Holyoke High School was very small compared to my freshmen class. Holyoke public school systems has a horrible reputation for it’s high drop out rate, teen pregnancy rate, and crime rate. I pushed myself to finish high school like my life depended on it. In high school I never thought about how having an education would affect my health. I never made that connection. But what I did understand and what my family made very clear was I was a poor Puerto Rican woman in a white man’s world and the only was for me to achieve upward mobility was through an education. I had control over these social determinates of health that I was born into but the only way for me to change that was to get an education. In high school I was able to make the connection that money= power and control. Education was the key to success. There were no excuses I had to hit the floor running.

    The only time I heard about drop out rates in Holyoke being a public health issues is in regards to teen pregnancy. The article points to teen pregnancy and parenting as one of the causes for school dropout. Interesting in Holyoke the opposite is happening a lot of the youth drop out before they are pregnant or parenting. This is an example of how one intervention may not fit all the communities targeting for drop out prevention. You have to understand what is going on in the community and in the school system in order to make a successful intervention

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  214. In reference to the video that we watched in class last week, I am still impressed by the doctor ( I forget her name) that chose to no longer serve in a hospital where the concentration was not on the patient. We need more people and health professionals that place more emphasis on the quality of care and not on quantity. Because there can be a high amount of people seen, but with a high number seen, does not mean a good quality of service; which is what we all realize.

    This country is known as the leaders in health care in all aspects (research, technology, and services), yet our life expectancy is near the bottom compared to other nations and our infant mortality and obesity rates are at the top. So obviously there is something wrong with the U.S. & health. Will this country ever change? And that is the question that we will never know the answer to. maybe it will, but none of us will be around to see it. To change people’s behavior and shift the culture to where there is more accessibility and less disparities is the goal that will forever be desired.

    I feel that the chapter that explained the practice of “Neo-liberalism” did a good job in putting the issues into context (pg 25).
    “Neoliberalism is the ideology of the dominant classes in the North and in the South. And the privatization of health care is a class policy, because it benefits high-income groups at the expense of the popular classes. Each of the neoliberal public policies defined above benefits the dominant classes to the detriment of the dominated classes. The development of these class policies has hugely increased inequalities, including health inequalities, not only between countries but within countries. ”
    Which leads me to question, if the US has all of these resources that are more accessible to the “high class”, is this really the best country in the world. Most of the country do not fall into the “high class, so much of the population dies early and/or suffers from a disease or condition until they do.

    Lastly, in reference to the article about high school drop out rates. I feel that all U.S. citizens should be required to complete at least that level of education. Whether it is a HS diploma or G.E.D, why not? If research tells us that improved education = improved health, especially to the Black & Latino population. The chapter brings up an important point on the high rates of teenage pregnancy being a major contributor to the outcome. Then why not offer programs such as some do to provide child care in the schools for those teenage parents. i know of one particularly in Philly (Simon Gratz HS) who was one of the first to implement child care for students in the schools and it has increased their graduation rates as a result. Of course some other things come into mind and i do not know all the details, but just an idea.

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  215. “ One should never confuse a country’s people with it’s government” (Navarro, 2012:26) in sum is what all the articles touched upon this week going from the more broad definition-based writing of Marmot to the case specific examples of Fullilove. Navarro’s speech impressed me in the way he connected media, class and political/corporate power, starting by saying there had been minimal American coverage of the WHO Commission on Social Determinants of Health. By naming the absence of acknowledging socioeconomic class in American discourse surrounding health disparities he began to unpack the ways in which our political realm overlaps with other powerful agencies, particularly in the private sector. This was similarly outlined by our in-class film last week, which touched upon how lobbyist groups and health insurance companies had as much (if not more) heft in the creation of the Affordable Care Act than the American people ultimately did. This aspect of the film and of Navarro’s speech connect to the importance of discussing the role of class in both politics and health. The BB’s of wealth (http://www.youtube.com/watch?v=EVwftZ8SK64) is a 5 minutes video that uses audio to depict the vast difference in income between groups of American people in a way that is profound.

    In the Fullilove piece I appreciated the use of the word “incessant” because her article and research emphasizes greatly the ways in which policy has been relentless in moving specific populations out. There was a recent This American Life episode (http://www.thisamericanlife.org/radio-archives/episode/512/house-rules) that chronicled the history of housing laws and made comparisons between educational access and current housing discrimination, which touches on many of the points made by both Fullilove as well as Freudenburg and Ruglis. In the framing of education as a health issue, I kept reflecting on a particular story in the above “This American Life” episode which chronicles one girl and her experience in two different public schools. When she uses a relative’s address in a more affluent neighborhood she gets a greater quality of education whereas when she is caught and is sent back to school in her underserved area the quality of her education and the available resources are diminished again. If nothing else, this seems incessant.

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  216. Escape Fire: I thought this documentary was very powerful in helping people understand the complexities of health care in the United States. This message is not a new one, especially for those of us that took the Health Care in the USA class, however I appreciated how this documentary put faces to the problems. The take away message was that we are a disease management system rather than a health care system where physicians are rewarded for doing the procedure rather than for talking (which is crucial in finding a sustainable solution) with their patients. A lot of focus is on the system, which very right so it should be, but i think we the consumers also have a responsibility here.

    Let me explain what I mean here. Being the unofficial health navigator for my family and my community (now that I am seen as a health expert because I am studying public health) I often hear very interesting experiences. One of the most recent one is, many people’s desire to switch their medical providers. When I ask why, i am often told “they do not seem to care about me…I went in sick so many times (taking days off from work) and the doctors does not give me any medicine to help me get better”. When I heard this I wondered where my people hear the message that drugs treats, because we do not come from a culture where drugs are the first go-to solution for our health problems? Back home I was brought up on boiling a root of x plant for y problem and spice a for problem c. So how did we go from making home remedies to drugs? Another questions is shouldn’t we the consumers also be responsible since the physicians are meeting demands, many of which are created by us?

    Readings:Health Disparities is a topic that I am very much interested and invested in. I focused my undergraduate study on health and education disparities in America. Therefore, found the article by Freudenberg and Ruglis to be the most refreshing. I had always wondered why school dropout is not seen as a public health issues. Very rarely do we hear of a public intervention aimed a decreasing high school drop out as the main outcomes of a PH issue. It is as if issues related to health and education are two different problems when there is enough literature showing their relation.

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  217. I would like to talk about the film first, which we watched in last class. I could see an overall problem in U.S. health care system. The impressive thing was U.S. has disease MANAGEMENT system, one women said it is not disease CARE system. I could easily know why U.S. has lots of health problems. I think the word ‘management’ was an apt expression for the U.S. health care system. The money should be used in terms of management. I mean that using health care system to everyone is dependent on the individual’s financial circumstances. It is also related with lack of primary care. I can simply say that primary care is not good for making money currently. So, what we can do in this environment is that we can focus on people’s healthy behavior. This is easily said than done, however, if we have a goal to make healthy behaviors for everyone, more poor people can get basic health services than before.

    In Vicente navarro’s article, inequalities and class were main points that the author wanted to give us to think about. In United States, class mortality differentials are larger than race mortality differetial. More interesting thing is many people think that race is equal to class. It looks like there have been still difference between races from a historical view. In my point of view, U.S. is developed but this country needs to solve problems, which are still dispersed in developing countries. Longer life-expectancy is not standard for good health system any more.

    There were two case studies for this week. One is related to housing and the other one is related to education. Interestingly, the housing and education (school dropout) problems are appeared in the city. Through this point, maybe city has big gap between the rich and poor. From the interviews and data in the articles, the housing and education problems are widespread on specific races.
    I think we need to focus on individuals. We may not see a great outcomes at first, but healthy individuals can influence to families, schools, and towns, cities, and countries.

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  218. I wanted to touch upon the film from last week “Escape Fire”. I thought it was interesting and brought up some good points about the systemic problems in our medical system and who really is benefiting (pharma, insurance, medical devices, etc.). I also liked how it highlighted the “quick-fix” approach our medical system uses vs prevention and education. I was curious about Dr. Weil’s Integrative Fellowship that they highlighted- I wonder actually how accessible this is to doctors? It certainly is depressing to see that even the doctor who really wanted to spend time with her patients met push back from the system.

    Onto the readings- Similar to Rohina, it was depressing to read how Neo-Liberalism benefits the dominant class and causes harm to the dominated class and it’s subsequent impact on health inequalities. Navarro comments on the deaths resulting from lack of health care “these deaths are so much a part of our everyday reality that they are not news” (pg. 27). This comment brought to mind the idea of hegemony- “the success of the dominant classes in presenting their definition of reality, their view of the world, in such a way that it is accepted by other classes as ‘common sense'” (http://faculty.washington.edu/mlg/courses/definitions/hegemony.html). How horrible that these atrocities are becoming commonplace. By highlighting the “causal chain” of causes of inequality, Marmot emphasizes the importance of looking at our social/economic policies in place.

    The two articles highlighting specific examples of structural causes of inequality (school dropout and displacement) were very telling. I may have brought this up in class in Health Communication but the school dropout article brought to mind some work the youth at Nuestras Raices did “push-out”, what they described as the consequences of the school cafeteria experience. Here is the transcript of the youth describing it in a video we did:

    Youth 1: Once in a while I ate chicken patties but those ended up being gross too so I just went to the vending machine and grabbed a drink and that was my lunch

    Youth 2: Push out is when a student doesn’t eat lunch because it tastes nasty or gross or there’s something wrong with it and they put their head down in class.

    Youth 3: By putting their head down they’ll get sent out of class. Getting sent out of class enough will get you suspended. So you can’t come back to school.

    Youth 1: This turns into detention, detentions turn into suspension, and a suspension gets turns into expelled. as in getting pushed out of school. The school system is pushing them out since they’re not getting good food.

    Youth 2: If we have food that we want and that is healthy for us, then we’ll focus better, and we’ll have more to, like, learn.

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  219. Being a public health/health professional I was very curious to read how social determinants of health are articulated in the first chapter of this week. Getting back to what we routinely experience in our daily life we use to be aware of social determinants of health in some extents but the readings this week helped me to look at the issue more critically from different aspects. The examples drawn from WHO’s Commission Report were frustrating indeed. 43 years of disparity in life expectancy between people who both live on this planet but one in extreme welfare and the other opposite of which. It gets more intense when you came up with such disparities in class differentials. How it happens?

    I, to be honest, was surprised when I read the extensive social, political and economic changes resulted from the theory of neo-liberalism. It has affected not a nation but the world. Generally speaking, theories usually have their pros and cons but based on the elaborative discussion in the chapter failure of neo-liberal theory is peaked. Economic growth is always admired and required for the sake of development of countries and societies since financial resource is a key point for any progress. However, in such economic-driven circumstance and world-wide market-centered economy life of individuals and communities are hugely and reversely affected. Regardless of its all admiring features, I notice the health insurance pertaining burdens on people in the US. It becomes cruel and depressing when you learn about importance of class within a developed country too.

    Following the chapters about Social Determinants of Health and Social Causes of Inequalities in Health it was very appropriate to read the articles at which evidences of inequalities and their impact on health have been discussed. Incessant Displacement and Health Disparities reminded me of very similar case in my country. Around a hundred years ago or so the regime in power initiated a displacement strategy through which thousands of people from a tribal community were displaced from the south (where they originally belong to) to the north (where is the habitation of other/completely different ethnic groups) in order to establish a life-long control over all ethnic groups but to gradually expand tribal group’s presence in the north – which is still incessant. The new settlers were freely provided the land and sometimes the native habitants were forced to sell their lands. The more time spent the more powerful became the newly settled tribal communities in the north since they were given all types of governmental support, advocacy and benefits. Gained top authority positions in provincial departments of education, health and so on. Similar situation is ongoing in the central part of the country where the native settlers that are one of the minorities in the country are forced to leave the neighborhood; and when they resist they become deprived from having access to water source in order to irrigate their farms and lands.

    The two articles included on the reading list this week were absolute and real evidences that how non-bio-logical causations play role of determinants on individuals and communities’ health. The question is how public health would as a multidimensional profession can take a more active role in this respect.

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  220. Throughout this week’s readings one word came to mind: CONTROL. Although there is a vast list of the social determinants of health, I feel that control is an important concept that links many of the various ideas. Just typing into Google, control is defined as: “the power to influence or direct people’s behavior or the course of events” and some synonyms that may look familiar (cough from the readings cough cough) include: “sway, power, authority, command, dominance, government, mastery, leadership, rule, sovereignty, supremacy, ascendancy; charge, management, direction, supervision, etc.” Think about this.

    In the article by Donohoe there was a statement of particular significance: “One should never confuse a country’s people with its government. And this is particularly important in the Untied States: 82 percent of the population believes the government does not represent their interests, but rather the interests of the economic groups…that dominate the behavior of the government” (p.26). This is a perfect example of the idea of control and how it has become pervasive in our society. A LARGE majority of people feel un/under-represented by government officials, yet this is not enough to evoke change, so only the dominant or the “corporate class” are pleased with outcomes. On the individual level there is a sense that power is lacking when it comes to income, housing, access, work environment, education, etc. However, these are the very things that foster a sense of control.

    According to Marmot, individuals who report a low control, in turn, have worse health. Control is a huge component; if groups or individuals do not feel in control of their lives then how can they feel empowered to make changes? How can we expect marginalized populations to feel like their vote counts, when they don’t even feel represented by their officials? How can we as health educators and advocates convince someone from the subordinate community that their voice matters?

    One thing that truly stuck out to me in Wallace’s article is how displacement impacts health. The accounts from individuals from the communities were upsetting–it seemed as if everything unique was lost and along with it, the identities of cultures, groups, and individuals were shattered. In my mind, having a home, a safe space, should be a right–but in society it is not, it’s a privilege. People should feel safe and as if they have a sense of CONTROL at home, but because of segregation, redlining, urban renewal, disinvestment, gentrification, and mass criminalization these (what I believe are..) rights have been stripped away and have left people to suffer with the health implications.

    One more impressive observation made by Donohoe was the disappearance of “class” as a widely used term. This to me, is another example of dominant power and the attempt to maintain things the way they are and to keep the subordinate populations in order. The author made an important (…and mildly funny, yet sadly valid…) comparison: “To define class analysis as antiquated is to confuse antique with antiquated. The law of gravity is antique, but it is not antiquated. If you don’t believe this, test the idea by jumping from a fourth floor window…Forgetting or ignoring scientific categories carries a huge cost. One of them is an inability to understand our world” (p.25). So many concepts in these readings and in society in general demonstrate this vast gap between the social classes, the lack of ability to call it out as it is, and to do something to address it. Even if we can’t change social classes right away—identifying and talking about them is a good starting point…from there perhaps we can adhere to the 7 steps proposed by Rodrick Wallace in the fight against health disparities (Wallace, p.151).

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