Embodying Inequality

Epidemiologic Perspectives

Nancy Krieger

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781351844598
• Edition: 1
• Topic: Psicología
• Subtopic: Salud mental en psicología

To advance the epidemiological analysis of social inequalities in health, and of the ways in which population distributions of disease, disability, and death reflect embodied expressions of social inequality, this volume draws on articles published in the "International Journal of Health Services" between 1990 and 2000. Framed by ecosocial theory, it employs ecosocial constructs of "embodiment"; "pathways of embodiment"; "cumulative interplay of exposure, susceptibility, and resistance across the lifecourse"; and "accountability and agency" to address the question; and who and what drives current and changing patterns of social inequalities in health.

SECTION II
Empirical Investigation: Social Epidemiology at Work

Preface to Section II

It is one thing to have social epidemiologic theories of disease distribution. It is another to apply them to concrete analysis of population distributions of disease and social inequalities in health. Examples of how this can be done are provided by the chapters in the three parts of Section II, which empirically investigate inequities in health in relation to work, income, physical hazards, violence, discrimination, and access to health services.

Yet, while the investigations in Section II consider various societal determinants of diverse health outcomes, appropriately none attempt the impossible task of addressing all the possible pathways leading to embodiment of inequality for any given outcome. The point of social epidemiologic theories is not to imply that all pathways should be investigated in any one study. Instead, what these theories can do is enable researchers to think through, systematically, choices about what to measure (and how) and to identify what are likely to be important unmeasured covariates. With this knowledge, investigators can better understand the meaning and limitations of the analytic findings our studies generate as well as identify the partners with whom we need to work to achieve sustainable advances in meeting the goal of social equity in health.

Part 1, concerned with "Dying for a Living: Income, Work, and Health," includes four empirical analyses focused on outcomes involving social inequalities in both health and health care. The first, in Chapter 12, by Carles Muntaner and P. Ellen Parsons, concerns "Income, Social Stratification, Class, and Private Health Insurance: A Study of the Baltimore Metropolitan Area" and was first published in International Journal of Health Services in 1996 (2). Emphasizing that societal conditions affecting generation and distribution of income, and not just income itself, are relevant to explaining social inequities in the distribution of health insurance, the authors empirically demonstrate the salience of incorporating "theory-driven indicators of social stratification such as human capital, labor market segmentation, and control over productive assets" into analyses of access to health care. Next, highlighting the importance of poverty as a determinant of population health, is a national study conducted by Robert Hahn and colleagues, on "Poverty and Death in the United States," presented in Chapter 13 and first published in International Journal of Health Services in 1996 (3). Illustrating the need to consider effect modification by race/ethnicity and gender, this investigation found that while poverty was associated with increased risk of mortality in all groups, the greatest excess risk of mortality associated with poverty occurred among black men and the least among white women. Moreover, standard "risk factors" (e.g., smoking, cholesterol levels, and physical inactivity) contributed to explaining the excess risk associated with poverty only among women, not men, which raised important questions about conventional explanations for the patterning of mortality by poverty.

Providing another, cross-national vantage on links between class, gender inequality, and health is the investigation reported in Chapter 14, by Ossi Rahkonen and colleagues, on "Understanding Income Inequalities in Health among Men and Women in Britain and Finland," first published International Journal of Health Services in 2000 (4). Relevant findings included the greater salience of household, compared to individual, income for understanding the population distribution of self-rated health among women compared to men; and, related, the stronger income gradients evident in Britain compared to Finland, likely reflective of the latter's higher social wage. Further illustrating the relevance of a lifecourse perspective on work, Chapter 15, by Sarah Arber, takes on the topic of "Integrating Nonemployment into Research on Health Inequalities" (5). In this analysis, first published in International Journal of Health Services in 1996, Arber demonstrated the importance of including the non-employed in analysis of class inequalities in health, especially older women and men, if accounts of the working class burden of ill-health are to be adequately estimated.

Part 2 in turn addresses social inequalities in health as they pertain to "Physical Hazards: Work, Violence, and Safety," with its three chapters considering workers' injuries and health in a globalizing economy, gender and occupational health, and associations between state-mandated safety regulations and injury mortality. Chapter 16, by Hector Balcazar and colleagues, on "Factors Associated with Work-Related Accidents and Sickness among Maquiladora Workers: The Case of Nogales, Sonora, Mexico," was first published in International Journal of Health Services in 1995 (6). Revealing the high prevalence of occupational injuries and illness among these workers, this study also importantly obtained data on work-policies implicated in these hazards, including whether the employer offered information about occupational hazards or ensured the presence of a doctor or nurse on-site in the plant. Next, highlighting discrepancies between gender ideology and gendered realities of work, an innovative study by Karen Messing and colleagues, reported in Chapter 17, analyzes "Sugar and Spice and Everything Nice: Health Effects of the Sexual Division of Labor among Train Cleaners" (7). First published in International Journal of Health Services in 1993, its principal finding was that while "women's work" typically is portrayed as cleaner and less hazardous than "men's work," in the case of French train cleaners, the reverse was true. Specifically, women's assignment to the "womanly" tasks of cleaning toilets and human waste resulted in their having more physically hazardous, demanding, and dirtier jobs than their male counterparts. Chapter 18, in turn, by Phil Brown and colleagues, presents a study that analyzed "State-Level Clustering of Safety Measures and Its Relationship to Injury Mortality" (8). First published in International Journal of Health Services in 1997, this investigation interestingly found that while associations often existed between...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Introduction: Embodiment, Inequality, and Epidemiology: What are the Connections?
• SECTION I Social Epidemiology: History, Hypotheses, Methods, and Measurement
• SECTION II Empirical Investigation: Social Epidemiology at Work
• Conclusion: Epidemiology, Social Justice, Human Rights, and Population Health—A Beginning
• Index
• About the Editor