Assignment 12 Health Care Gender Race 6pages

Social Inequity, Disease, and Death: The Social Determinants of Health – Age, Gender,

Racialization, and Ethnicity

Name:

Institution:

We have followed in this course how concepts of health and illness in socially

constructed narratives and ideologies reflect cultural values and stereotypes, and how socio-

structural factors such as class, gender, age, race influence health care decisions ( Clarke 2012,

pp.151-155) . “Politics influences who gets what, when, and how,” Robert J,Byrmn ( 2011)

quite rightly concludes in a study he carried out cooperatively with the aid of his students. “It

involves a struggle to divide resources among competing constituents, many of whom have

compelling claims but not all of whom can be completely satisfied because resources are

limited” (p.101).

We had in fact tracked age, race, gender and social class in a struggle within

organizational cultures and in its administrations in hospitals and similar health-care institutions .

These carry out policies and practices imposed from above concerned with cost-reduction in a

context by which we cannot escape responsibility as professionals. For all individual and groups

within organizations and society confer meaning and significance equally to health care delivery

(Varcoe & Rodney, 2009, p. 122) . It may even be our duty on the front-lines of health-care

facilities and agencies to resist what Varcoe and Rodney call a corporate- inspired program of

scarcity through the assent of nurses and allied health care providers at the front lines. We are in

sum are urged by various means to look after cost first, often working against their own best

interests and that of their patients in administering unequal care to their clients (pp. 122- 151).

This essay therefore takes as its basis “conflict theory” which best approximates the

conditions by which tensions created by injustice are either exposed or concealed by a super-

structure at the theoretical or ideological narratives. It is noteworthy that the “materialist”

interpretation is said to best account in our textbook for the social structures and constraints by

which we as professionals work among those subject to discrimination (Clarke 2012, pp. 156-

157). This method of scholarship assumes that a basic level of “material adequacy” is in fact

available in society, but that there is an unequal distribution of resources, as shown in many

evidence-based studies from many societies that have instituted progressive measures to redress

the balance in favour of the poor in conflict with the claims of the wealthy and powerful (Clarke

2012, pp. 97-98). While all four categories of the disadvantaged in our textbook (social class,

gender, age and race) are considered, it is the first or social class that needs emphasis by the way

social class cuts across different races, genders and Aboriginal communities as a significant

factor for unequal policies and conditions we need to contest as health-care professionals with

conscience.

As Clarke (2012) explains in Health, illness, and medicine in Canada the definition of

poverty is “political” (p.115) and not easily defined, but insists that there is a long history of

evidence-based literature in which comparable data is compared with each study of the poor.

Social class, after all, is socially visible in dense areas of the city where such diseases as

tuberculosis and influenza are more commonly spread (p.115). In our society in which profit is

celebrated and its loss mourned, there is, it is said, a price placed on everything and every person

and there is considerable room for self-improvement and pulling oneself up by the bootstrap

allowing for the idea that we all have free-choice and the poor pay for bad decisions financially

and poor work habits.

Put briefly, some people are worth more others less, they say. This is called

“commodification” (Clarke 2012 p.116) and based on principles business people are happy to

celebrate in good times when unemployment was low, profits high and the wealthy and powerful

running corporations and hospitals could afford to be generous. However, in hard times of

scarcity such as ours there is a social process at work which divides by class the old and the

young, males and females, indeed people on Native Canadian reservations who are also rich or

poor. By its own admission, business requires a profit and that calls for support only for the most

successful organizations creating “excellence” everywhere, at least in theory. But that same drive

is put in place in bad times to drive down costs and replace marginal workers including health

care workers, creating tensions and conflicts that we witness in our times affecting hospitals,

health centers and front-line workers in health care at all levels (Clarke 2012,p.117).

Let’s take cancer as an example of how the corporate control of health care following this mode

of organizing societies fails us all. Robert J. Brym (2011) outlines in the fifth chapter of his The

Social Bases of Cancer how a fortune was spent searching in vain for the genetic markers of

cancer to the benefit of drug companies, with little accomplished. By contrast, Brym called upon

his own students who volunteered readily to search through literature on cancer systematically.

His cost-effective study required regression analysis so that the age distribution of the

population at the later time point had to equal an earlier time point to ensure that any change

observed in incidence rates is not due to population aging.

It was an extraordinary inequality which came to the team’s attention. After numbers

were crunched, between 1973 and 2010 the age-standardized lung cancer incidence rate fell

by just 2.1 percent for men while it rose 271.3 percent for women who started smoking in the

Sixties and Seventies. Lung cancer is the second most common cancer in Canada, accounted

for 13.8 percent of cases (pp.81-83). Brym then led his class research-team through a cost-

benefit analysis such as those favoured in business practice to conclude that the war on

cancer was lost by the way investment dollars have been spent on searching for genetic

markers for cancer that would transcend ticklish questions involving gender, class, age and

the rights of native Canadians over their land and the environmental causes which account

for over 90% of cancer rates (Brym 2011,pp. 86-88).

Interestingly, Brym tells us, the vastly increased funding for breast cancer that

women’s liberation has created is the positive side of women coming in great numbers into

the workforce, even though early in the process women had taken over the smoking habits of

men (Brym 2011, p.100). This success points to the way forward to better health services

through social activism, for women have gained through self-organization and independent

struggle, which may, it is suggested, apply to other communities such as the poor and

Aboriginals

Brym concedes that “the lower a person’s education and income, the more likely that

person is to get cancer” (2011, p.89). Receiving inferior care are working men and women

with lower education and income who get up in the morning in poor, more environmentally

threatened neighbourhoods with high air and water pollution, and are found

disproportionately in occupations where they handle hazardous material such as asbestos,

paint or solutions used in footwear production, furniture manufacture, the rubber industry or

petroleum refining. Moreover, these are the people who may find healthy food too expensive

to eat on their low income (Brym 2011, p. 89).

Of course, it is widely and falsely assumed that we are all free actors competing for

scarce resources on equal footing with the poor blamed for their own plight. “They” are poor

because they drink too much or else have poor hygienic habits. That has been shown in complete

error by evidence based research (Clarke 2012, p.155). but still the stigma remains for which we

need be careful in our own practice so that we don’t ourselves reproduce, however

unconsciously, the social inequality we seek to overcome in our health-care practice.

The solution proposed by Professor Brym and his students, building in poor

neighbourhoods clinics dedicated to the environmental causes of cancer, requires political

activism and the power of the ballot box. But Byrm’s sophisticated analysis of how the

health industry is rigged against the poor is a means of liberation only if you have relatively

sophisticated understanding of the process he describes of evasion of responsibility and

misdirecting of research funds into ineffective genetic areas of cancer research in which

governments, industry and the ruling class collude ignoring real but costly solutions ( Brym

2011, pp.80-88).

Here rises a problem. Byrm is speaking of the dominant groups against which

women’s liberation fought successfully, but seems to neglect that women’s liberation does

not exclude the educated, moneyed and powerful, even celebrates its successful women.

Even so his extended case study of an isolated Native Canadian reservation threatened with

high rates of cancer because of resource extraction surely demonstrates the environmental

impact on cancer rates due to industrial pollution, but it is less clear that it is entirely an

Aboriginal issue distinct from other previously mentioned factors such as age, gender, race

and social class.

From the perspective of such factors as income, education, employment and housing

there is more sexually transmitted disease, addiction and death at an early age in Aboriginal

communities entirely accounted for by social class which has the same rate of disease and

mortality rates as other Canadians from the same class with the same advantages. In sum,” the

same factors that explain health care differences among other Canadians affect the health of

Aboriginal people” (Clarke 2012, p.146).

In the current corporate climate of speed-up and scarcity, it is perhaps closer to home

where we should look to overcome inequalities, in our own minds and in our own practices.

The varied inequalities in health care delivery whether in areas of race, gender, class, or the

elderly, to name the disadvantaged (Clarke 2012, p.155) inevitably raise socio-economic and

political issues shaping the daily circumstances of our lives, as Varcoe and Rodney (2009)

demonstrate in their “Constrained agency: The social structure of nurses’ work”.

In effect, daily processes and procedures require from us as professionals not just strictly

ethical but also social and political decision. These are, they explain, made under specific

constraints from many stakeholders, some with great, others less power of influence reinforcing

inequality that we are told to combat officially in nursing practice by , for example,

understanding the culture of our clients and make ethical decisions on their care. But we

ourselves absorb the dominant ideology of the powerful in daily practice from which we need

free ourselves if we are to make progress combating powerful forces in and over hospital

administration and other care facilities. This is a corporate ideology of scarcity by which, though

there are great profits made elsewhere, never sufficient money to address health care issues with

the losing war with cancer mentioned above as only one instance of shortcomings in our health

care delivery under these dispensations.

There are negative attitudes displayed in various ways from the professionals on the same

team who put pressure on fellow nurses, which tends to negate precisely that understanding and

empathy we are told is the ethical foundations of our professional practice. Varcoe and Rodney

show in their study how nurses accept speed up and search for corporate efficiencies as a

necessary condition of daily nursing practice. Not only do they carry out physical care faster than

advised and frown upon those who are “slow or “spend too much time talking” (pp.130-131), but

we have in effect in effect as health-care professionals internalized the dominant ideology, and

should look to free themselves and each other before any program favourable to greater equality

has any chance of success.

Bibliography

Brym, Robert J. (2011) “Sociology as a Life or Death Issue”, Chapter 5, The Social Bases of.

Cancer. 2nd ed. Toronto: Nelson. pp 80-102. Retrieved from

projects.chass.utoronto.ca/brym/ch5.pdf

Clarke, J. N. (2012). Health, illness, and medicine in Canada . (6th ed.). Oxford University

Press.

Varcoe, C., & Rodney, P. (2009). Constrained agency: The social structure of nurses’ work. In

B. S. Bolaria & H. Dickinson (Eds.), Health, illness and health care in Canada(4th ed.,

pp.122-151). Scarborough, ON: Nelson Thomas Learning.

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Assignment 12 health care gender race 6pages

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