Social Determinants Of Health Quotes

Human rights violations are not accidents; they are not random in distribution or effect. Rights violations are, rather, symptoms of deeper pathologies of power and are linked intimately to the social conditions that so often determine who will suffer abuse and who will be shielded from harm

My friend Kira always said that life is like an extremely difficult, horribly unbalanced videogame. When you’re born, you’re given a randomly generated character, with a randomly determined name, race, face, and social class. Your body is your avatar, and you spawn in a random geographic location, at a random moment in human history, surrounded by a random group of people, and then you have to try to survive for as long as you can. Sometimes the game might seem easy. Even fun. Other times it might be so difficult you want to give up and quit. But unfortunately, in this game you only get one life. When your body grows too hungry or thirsty or ill or injured or old, your health meter runs out and then it’s Game Over. Some people play the game for a hundred years without ever figuring out that it’s a game, or that there is a way to win it. To win the videogame of life you just have to try to make the experience of being forced to play it as pleasant as possible, for yourself, and for all of the other players you encounter in your travels. Kira says that if everyone played the game to win, it’d be a lot more fun for everyone. —Anorak’s Almanac, chapter 77, verses 11–20

So many disabled people live short lives, largely because of social determinants of health like lack of healthcare, inadequate housing, or unmet basic needs such as clean air and water.

Farmer points to what he calls "structural violence," which influences "the nature and distribution of extreme suffering." The book is, as he explains, "a physician-anthropologist's effort to reveal the ways in which the most basic right-the right to survive-is trampled in an age of great affluence." He argues: "Human rights violations are not accidents; they are not random in distribution or effect. Rights violations are, rather, symptoms of deeper pathologies of power and are linked intimately to the social conditions that so often determine who will suffer abuse and who will be shielded from harm.

Human rights violations are nit accidents; they are not random in distribution or effect. Rights violations are, rather, symptoms of deeper pathologies of power and are linked intimately to the social conditions that so often determine who will suffer abuse and who will be shielded from harm.

Despite growing evidence to the contrary, we all share a cultural belief that fat bodies are an individual failing that each of us can and must control. Despite a mountain of evidence linking physical and mental health to social discrimination, the conversation about fat and health stubbornly refuses to acknowledge the possible influence of stigma in determining fat people’s health.

In a section of The Vaccine Book titled “Is it your social responsibility to vaccinate your kids?” Dr. Bob asks, “Can we fault parents for putting their own child’s health ahead of that of the kids around him?” This is meant to be a rhetorical question, but Dr. Bob’s implied answer is not mine. In another section of the book, Dr. Bob writes of his advice to parents who fear the MMR vaccine, “I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the disease increase significantly.” I do not need to consult an ethicist to determine that there is something wrong there, but my sister clarifies my discomfort. “The problem is in making a special exemption just for yourself,” she says. This reminds her of a way of thinking proposed by the philosopher John Rawls: Imagine that you do not know what position you are going to hold in society—rich, poor, educated, insured, no access to health care, infant, adult, HIV positive, healthy immune system, etc.—but that you are aware of the full range of possibilities. What you would want in that situation is a policy that is going to be equally just no matter what position you end up in. “Consider relationships of dependence,” my sister suggests. “You don’t own your body—that’s not what we are, our bodies aren’t independent. The health of our bodies always depends on choices other people are making.” She falters for a moment here, and is at a loss for words, which is rare for her. “I don’t even know how to talk about this,” she says. “The point is there’s an illusion of independence.

A genetic fundamentalism permeates public awareness these days. It may be summed up as the belief that almost every illness and every human trait is dictated by heredity. Simplified media accounts, culled from semidigested research findings, have declared that inflexible laws of DNA rule the biological world. It was reported in 1996 that according to some psychologists, genes determine about 50 percent of a person’s inclination to experience happiness. Social ability and obesity are two more among the many human qualities now claimed to be genetic. True or not, narrow genetic explanations for ADD and every other condition of the mind do have their attractions. They are easy to grasp, socially conservative and psychologically soothing. They raise no uncomfortable questions about how a society and culture might erode the health of its members, or about how life in a family may have affected a person’s physiology or emotional makeup. As I have personally experienced, feelings of guilt are almost inevitable for the parents of a troubled child. They are all too frequently reinforced by the uninformed judgments of friends, neighbors, teachers or even total strangers on the bus or in the supermarket. Parental guilt, even if misplaced, is a wound for which the genetic hypothesis offers a balm

Rights violations are, rather, symptoms of deeper pathologies of power and are linked intimately to the social conditions that so often determine who will suffer abuse and who will be shielded from harm. If assaults on dignity are anything but random in distribution or course, whose interests are served by the suggestion that they are haphazard?

My friend Kira always said that life is like an extremely difficult, horribly unbalanced videogame. When you’re born, you’re given a randomly generated character, with a randomly determined name, race, face, and social class. Your body is your avatar, and you spawn in a random geographic location, at a random moment in human history, surrounded by a random group of people, and then you have to try to survive for as long as you can. Sometimes the game might seem easy. Even fun. Other times it might be so difficult you want to give up and quit. But unfortunately, in this game you only get one life. When your body grows too hungry or thirsty or ill or injured or old, your health meter runs out and then it’s Game Over. Some people play the game for a hundred years without ever figuring out that it’s a game, or that there is a way to win it.

What, then, would it mean to imagine a system in which punishment is not allowed to become the source of corporate profit? How can we imagine a society in which race and class are not primary determinants of punishment? Or one in which punishment itself is no longer the central concern in the making of justice? An abolitionist approach that seeks to answer questions such as these would require us to imagine a constellation of alternative strategies and institutions, with the ultimate aim of removing the prison from the social and ideological landscapes of our society. In other words, we would not be looking for prisonlike substitutes for the prison, such as house arrest safeguarded by electronic surveillance bracelets. Rather, positing decarceration as our overarching strategy, we would try to envision a continuum of alternatives to imprisonment—demilitarization of schools, revitalization of education at all levels, a health system that provides free physical and mental care to all, and a justice system based on reparation and reconciliation rather than retribution and vengeance. The creation of new institutions that lay claim to the space now occupied by the prison can eventually start to crowd out the prison so that it would inhabit increasingly smaller areas of our social and psychic landscape. Schools can therefore be seen as the most powerful alternative to jails and prisons. Unless the current structures of violence are eliminated from schools in impoverished communities of color—including the presence of armed security guards and police—and unless schools become places that encourage the joy of learning, these schools will remain the major conduits to prisons. The alternative would be to transform schools into vehicles for decarceration.

Perfect Joy (excerpts) Is there to be found on earth a fullness of joy, or is there no such thing? . . . What the world values is money, reputation, long life, achievement. What it counts as joy is health and comfort of body, good food, fine clothes, beautiful things to look at, pleasant music to listen to. What it condemns is lack of money, a low social rank, a reputation for being no good, and an early death. What it considers misfortune is bodily discomfort and labour, no chance to get your fill of good food, not having good clothes to wear, having no way to amuse or delight the eye, no pleasant music to listen to. If people find that they are deprived of these things, they go into a panic or fall into despair. They are so concerned for their life that their anxiety makes life unbearable, even when they have the things they think they want. Their very concern for enjoyment makes them unhappy. . . . I cannot tell if what the world considers "happiness" is happiness or not. All I know is that when I consider the way they go about attaining it, I see them carried away headlong, grim and obsessed, in the general onrush of the human herd, unable to stop themselves or to change their direction. All the while they claim to be just on the point of attaining happiness. . . . My opinion is that you never find happiness until you stop looking for it. My greatest happiness consists precisely in doing nothing whatever that is calculated to obtain happiness: and this, in the minds of most people, is the worst possible course. I will hold to the saying that:"Perfect Joy is to be without joy. Perfect praise is to be without praise." If you ask "what ought to be done" and "what ought not to be done" on earth in order to produce happiness, I answer that these questions do not have an answer. There is no way of determining such things. Yet at the same time, if I cease striving for happiness, the "right" and the "wrong" at once become apparent all by themselves. Contentment and well-being at once become possible the moment you cease to act with them in view, and if you practice non-doing (wu wei), you will have both happiness and well-being. Here is how I sum it up: Heaven does nothing: its non-doing is its serenity. Earth does nothing: its non-doing is its rest. From the union of these two non-doings All actions proceed, All things are made. How vast, how invisible This coming-to-be! All things come from nowhere! How vast, how invisible - No way to explain it! All beings in their perfection Are born of non-doing. Hence it is said: "Heaven and earth do nothing Yet there is nothing they do not do." Where is the man who can attain To this non-doing?

...public health literature often focuses on African American mistrust of the health care system in terms of historical mistrust of health services, emanating particularly from the Tuskegee experiments, which were conducted on African-American men between 1932 and 1972. The Tuskegee experiments are certainly a good reason for ongoing mistrust, but it is important not to overlook mistrust that is generated from contemporary health care experiences. If today, in twenty-first century America, African- American men have reason to believe they will be discriminated against by health service providers at a time when they are unwell and vulnerable, is it surprising that they delay or avoid seeking care?

friend Kira always said that life is like an extremely difficult, horribly unbalanced videogame. When you’re born, you’re given a randomly generated character, with a randomly determined name, race, face, and social class. Your body is your avatar, and you spawn in a random geographic location, at a random moment in human history, surrounded by a random group of people, and then you have to try to survive for as long as you can. Sometimes the game might seem easy. Even fun. Other times it might be so difficult you want to give up and quit. But unfortunately, in this game you only get one life. When your body grows too hungry or thirsty or ill or injured or old, your health meter runs out and then it’s Game Over.

Nature vs. nurture is part of this—and then there is what I think of as anti-nurturing—the ways we in a western/US context are socialized to work against respecting the emergent processes of the world and each other: We learn to disrespect Indigenous and direct ties to land. We learn to be quiet, polite, indirect, and submissive, not to disturb the status quo. We learn facts out of context of application in school. How will this history, science, math show up in our lives, in the work of growing community and home? We learn that tests and deadlines are the reasons to take action. This puts those with good short-term memories and a positive response to pressure in leadership positions, leading to urgency-based thinking, regardless of the circumstance. We learn to compete with each other in a scarcity-based economy that denies and destroys the abundant world we actually live in. We learn to deny our longings and our skills, and to do work that occupies our hours without inspiring our greatness. We learn to manipulate each other and sell things to each other, rather than learning to collaborate and evolve together. We learn that the natural world is to be manicured, controlled, or pillaged to support our consumerist lives. Even the natural lives of our bodies get medicated, pathologized, shaved or improved upon with cosmetic adjustments. We learn that factors beyond our control determine the quality of our lives—something as random as which skin, gender, sexuality, ability, nation, or belief system we are born into sets a path for survival and quality of life. In the United States specifically, though I see this most places I travel, we learn that we only have value if we can produce—only then do we earn food, home, health care, education. Similarly, we learn our organizations are only as successful as our fundraising results, whether the community impact is powerful or not. We learn as children to swallow our tears and any other inconvenient emotions, and as adults that translates into working through red flags, value differences, pain, and exhaustion. We learn to bond through gossip, venting, and destroying, rather than cultivating solutions together. Perhaps the most egregious thing we are taught is that we should just be really good at what’s already possible, to leave the impossible alone.

First, our emotional state determines where we direct our attention, what we remember, and what we learn. Second is decision making: when we’re in the grip of any strong emotion—such as anger or sadness, but also elation or joy—we perceive the world differently, and the choices we make at that moment are influenced, for better or for worse. Third is our social relations. What we feel—and how we interpret other people’s feelings—sends signals to approach or avoid, to affiliate with someone or distance ourselves, to reward or punish. Fourth is the influence of emotions on our health. Positive and negative emotions cause different physiological reactions within our bodies and brains, releasing powerful chemicals that, in turn, affect our physical and mental well-being. And the fifth has to do with creativity, effectiveness, and performance.

But overprotection is just one part of a larger trend that we call problems of progress. This term refers to bad consequences produced by otherwise good social changes. It’s great that our economic system produces an abundance of food at low prices, but the flip side is an epidemic of obesity. It’s great that we can connect and communicate with people instantly and for free, but this hyperconnection may be damaging the mental health of young people. It’s great that we have refrigerators, antidepressants, air conditioning, hot and cold running water, and the ability to escape from most of the physical hardships that were woven into the daily lives of our ancestors back to the dawn of our species. Comfort and physical safety are boons to humanity, but they bring some costs, too. We adapt to our new and improved circumstances and then lower the bar for what we count as intolerable levels of discomfort and risk. By the standards of our great-grandparents, nearly all of us are coddled. Each generation tends to see the one after it as weak, whiny, and lacking in resilience. Those older generations may have a point, even though these generational changes reflect real and positive progress. To repeat, we are not saying that the problems facing students, and young people more generally, are minor or “all in their heads.” We are saying that what people choose to do in their heads will determine how those real problems affect them. Our argument is ultimately pragmatic, not moralistic: Whatever your identity, background, or political ideology, you will be happier, healthier, stronger, and more likely to succeed in pursuing your own goals if you do the opposite of what Misoponos advised.

My friend Kira said that life is like an extremely difficult, horribly unbalanced videogame. When you're born, you're given a randomly generated character, with a randomly determined name, race, face, and social class. Your body is your avatar, and you spawn in a random geographic location, at a random moment in history, surrounded by a random group of people, and then you have to try to survive for as long as you can. Sometimes the game might seem easy. Even fun. Other times it might be so difficult you want to give up and quit. But unfortunately, in this game you only get one life. When your body grows too hungry or thirst or ill or injured or old, your health meter runs out and then it's Game Over. Some people play the game for a hundred years without ever figuring out it's a game, or that there is a way to win it. To win the videogame of life you just have to try to make the experience of being forced to play it as pleasant as possible, for yourself, and for all of the other players you encounter in your travels. Kira says that if everyone played the game to win, it'd be a lot more fun for everyone.

My friend Kira always said that life is like an extremely difficult, horribly unbalanced videogame. When you’re born, you’re given a randomly generated character, with a randomly determined name, race, face, and social class. Your body is your avatar, and you spawn in a random geographic location, at a random moment in human history, surrounded by a random group of people, and then you have to try to survive for as long as you can. Sometimes the game might seem easy. Even fun. Other times it might be so difficult you want to give up and quit. But unfortunately, in this game you only get one life. When your body grows too hungry or thirsty or ill or injured or old, your health meter runs out and then it’s Game Over. Some people play the game for a hundred years without ever figuring out that it’s a game, or that there is a way to win it. To win the videogame of life you just have to try to make the experience of being forced to play it as pleasant as possible, for yourself, and for all of the other players you encounter in your travels. Kira says that if everyone played the game to win, it’d be a lot more fun for everyone.

The interpenetration of chance and determination bears on the problem of how there can be a scientific approach to society when individual human behavior and consciousness seem unpredictable. Those who despair to point out that people are not machines, that there are subjective processes in the making of decisions, that it is not 'classes' but individuals who make choices. Terms such as "the human factor" or "subjective factors" with their implication of chance and unpredictability are invoked as the negation of regularity and lawfulness. And indeed it is true that individual behavior and consciousness are the consequences of intersection of a large number of weakly determining factors. But it does not follow that where there is choice, subjectivity, and individuality there cannon also be predictability. The error to take the individual as causally prior to the whole and not to appreciate that the social has causal properties within which individual consciousness and action are formed. While the consciousness of an individual is not determined by his/her class position but is influenced by idiosyncratic factors that appear as random, those random factors operate within a domain and with probabilities that are constrained and directed by social forces.

It is unsurprising that social isolation or loneliness have been strongly associated with depression,18 suicide,19 anxiety,20 insomnia,21 fear and the perception of threat.22 It’s more surprising to discover the range of physical illnesses that they can cause or exacerbate. Dementia,23 altered brain function,24 high blood pressure, heart disease and strokes,25 lowered resistance to viruses,26 even accidents,27 are all more common among chronically lonely people. One study suggests that loneliness has a comparable impact on physical health to smoking fifteen cigarettes a day.28 The doctrine has also helped to create what some people describe as a spiritual void: when human life is conceived as a series of transactions, when relationships are recast in purely functional terms, when personal gain counts for everything and pro-social values for nothing, the sense of meaning and purpose is sucked from our lives. We find ourselves in a state of alienation, of anomie, an experience of dislocation that extends beyond the more immediate determinants of mental health. Our psychological and economic welfare depends on our connection with others. Of all the fantasies human beings entertain, the idea that we can go it alone is the most absurd, and perhaps the most dangerous. We stand together or we fall apart.

No one acts in a void. We all take cues from cultural norms, shaped by the law. For the law affects our ideas of what is reasonable and appropriate. It does so by what it prohibits--you might think less of drinking if it were banned, or more of marijuana use if it were allowed--but also by what it approves. . . . Revisionists agree that it matters what California or the United States calls a marriage, because this affects how Californians or Americans come to think of marriage. Prominent Oxford philosopher Joseph Raz, no friend of the conjugal view, agrees: "[O]ne thing can be said with certainty [about recent changes in marriage law]. They will not be confined to adding new options to the familiar heterosexual monogamous family. They will change the character of that family. If these changes take root in our culture then the familiar marriage relations will disappear. They will not disappear suddenly. Rather they will be transformed into a somewhat different social form, which responds to the fact that it is one of several forms of bonding, and that bonding itself is much more easily and commonly dissoluble. All these factors are already working their way into the constitutive conventions which determine what is appropriate and expected within a conventional marriage and transforming its significance." Redefining civil marriage would change its meaning for everyone. Legally wedded opposite-sex unions would increasingly be defined by what they had in common with same-sex relationships. This wouldn't just shift opinion polls and tax burdens. Marriage, the human good, would be harder to achieve. For you can realize marriage only by choosing it, for which you need at least a rough, intuitive idea of what it really is. By warping people's view of marriage, revisionist policy would make them less able to realize this basic way of thriving--much as a man confused about what friendship requires will have trouble being a friend. . . . Redefining marriage will also harm the material interests of couples and children. As more people absorb the new law's lesson that marriage is fundamentally about emotions, marriages will increasingly take on emotion's tyrannical inconstancy. Because there is no reason that emotional unions--any more than the emotions that define them, or friendships generally--should be permanent or limited to two, these norms of marriage would make less sense. People would thus feel less bound to live by them whenever they simply preferred to live otherwise. . . . As we document below, even leading revisionists now argue that if sexual complementarity is optional, so are permanence and exclusivity. This is not because the slope from same-sex unions to expressly temporary and polyamorous ones is slippery, but because most revisionist arguments level the ground between them: If marriage is primarily about emotional union, why privilege two-person unions, or permanently committed ones? What is it about emotional union, valuable as it can be, that requires these limits? As these norms weaken, so will the emotional and material security that marriage gives spouses. Because children fare best on most indicators of health and well-being when reared by their wedded biological parents, the same erosion of marital norms would adversely affect children's health, education, and general formation. The poorest and most vulnerable among us would likely be hit the hardest. And the state would balloon: to adjudicate breakup and custody issues, to meet the needs of spouses and children affected by divorce, and to contain and feebly correct the challenges these children face.

Mueller kicked off the meeting by pulling out a piece of paper with some notes. The attorney general and his aides believed they noticed something worrisome. Mueller’s hands shook as he held the paper. His voice was shaky, too. This was not the Bob Mueller everyone knew. As he made some perfunctory introductory remarks, Barr, Rosenstein, O’Callaghan, and Rabbitt couldn’t help but worry about Mueller’s health. They were taken aback. As Barr would later ask his colleagues, “Did he seem off to you?” Later, close friends would say they noticed Mueller had changed dramatically, but a member of Mueller’s team would insist he had no medical problems. Mueller quickly turned the meeting over to his deputies, a notable handoff. Zebley went first, summing up the Russian interference portion of the investigation. He explained that the team had already shared most of its findings in two major indictments in February and July 2018. Though they had virtually no chance of bringing the accused to trial in the United States, Mueller’s team had indicted thirteen Russian nationals who led a troll farm to flood U.S. social media with phony stories to sow division and help Trump. They also indicted twelve Russian military intelligence officers who hacked internal Democratic Party emails and leaked them to hurt Hillary Clinton’s campaign. The Trump campaign had no known role in either operation. Zebley explained they had found insufficient evidence to suggest a conspiracy, “no campaign finance [violations], no issues found. . . . We have questions about [Paul] Manafort, but we’re very comfortable saying there was no collusion, no conspiracy.” Then Quarles talked about the obstruction of justice portion. “We’re going to follow the OLC opinion and conclude it wasn’t appropriate for us to make a final determination as to whether or not there was a crime,” he said. “We’re going to report the facts, the analysis, and leave it there. We are not going to say we would indict but for the OLC opinion.

with the recognition that the health status of a population depends on much more than health care. In particular, they stress the powerful direct and indirect effects that social factors exert. These determinants range widely: across income, education, housing, stress, social relationships, and more.

The field of public health refers to the conditions that are not medical but that can produce or undermine health as the “social determinants of health.” These are the socioeconomic, environmental, and behavioral factors that research over many decades has shown to be strong influences on health.

They determined that the death count based solely on the medical autopsies had underestimated the damage. Between 14 and 20 July, 739 more Chicago residents died than in a typical week for that month. In fact, public health scholars have established that the proportional death toll from the heat wave in Chicago has no equal in the record of U.S. heat disasters.

POWER PRINCIPLES PRINCIPLE #1 Power is about altering the states of others. PRINCIPLE #2 Power is part of every relationship and interaction. PRINCIPLE #3 Power is found in everyday actions. PRINCIPLE #4 Power comes from empowering others in social networks. PRINCIPLE #5 Groups give power to those who advance the greater good. PRINCIPLE #6 Groups construct reputations that determine the capacity to influence. PRINCIPLE #7 Groups reward those who advance the greater good with status and esteem. PRINCIPLE #8 Groups punish those who undermine the greater good with gossip. PRINCIPLE #9 Enduring power comes from empathy. PRINCIPLE #10 Enduring power comes from giving. PRINCIPLE #11 Enduring power comes from expressing gratitude. PRINCIPLE #12 Enduring power comes from telling stories that unite. PRINCIPLE #13 Power leads to empathy deficits and diminished moral sentiments. PRINCIPLE #14 Power leads to self-serving impulsivity. PRINCIPLE #15 Power leads to incivility and disrespect. PRINCIPLE #16 Power leads to narratives of exceptionalism. PRINCIPLE #17 Powerlessness involves facing environments of continual threat. PRINCIPLE #18 Stress defines the experience of powerlessness. PRINCIPLE #19 Powerlessness undermines the ability to contribute to society. PRINCIPLE #20 Powerlessness causes poor health.

The separation of mind and body that informs medical practice is also the dominant ideology in our culture. We do not often think of socio-economic structures and practices as determinants of illness or well-being. They are not usually “part of the equation.” Yet the scientific data is beyond dispute: socio-economic relationships have a profound influence on health. For example, although the media and the medical profession — inspired by pharmaceutical research — tirelessly promote the idea that next to hypertension and smoking, high cholesterol poses the greatest risk for heart disease, the evidence is that job strain is more important than all the other risk factors combined. Further, stress in general and job strain in particular are significant contributors both to high blood pressure and to elevated cholesterol levels. Economic relationships influence health because, most obviously, people with higher incomes are better able to afford healthier diets, living and working conditions and stress-reducing pursuits. Dennis Raphael, associate professor at the School of Health Policy and Management at York University in Toronto has recently published a study of the societal influences on heart disease in Canada and elsewhere. His conclusion: “One of the most important life conditions that determine whether individuals stay healthy or become ill is their income. In addition, the overall health of North American society may be more determined by the distribution of income among its members rather than the overall wealth of the society…. Many studies find that socioeconomic circumstances, rather than medical and lifestyle risk factors, are the main causes of cardiovascular disease, and that conditions during early life are especially important.” The element of control is the less obvious but equally important aspect of social and job status as a health factor. Since stress escalates as the sense of control diminishes, people who exercise greater control over their work and lives enjoy better health. This principle was demonstrated in the British Whitehall study showing that second-tier civil servants were at greater risk for heart disease than their superiors, despite nearly comparable incomes. Recognizing the multigenerational template for behaviour and for illness, and recognizing, too, the social influences that shape families and human lives, we dispense with the unhelpful and unscientific attitude of blame. Discarding blame leaves us free to move toward the necessary adoption of responsibility, a matter to be taken up when we come in the final chapters to consider healing.

Biomedicine locates sickness in a specific place in an individual body: a headache, a stomachache a torn knee, lung cancer. Medical anthropologists instead locate sickness and health in three interconnected bodies: the political, the social, and the physical. The prevailing political economy impacts the distribution of sickness and health in a society and the means available to heal those who are sick. For example, poor individuals worldwide are more exposed to toxins that make them sick, while the rich stay healthier. The social body constructs the meanings and experiences surrounding particular physical states. It determines the ideal physical body, legitimizing biomedical practices like plastic surgery to attain it. The social body also determines the boundaries of the physical body. Some cultures locate sickness not in individuals but instead in families or communities. As any caregiver knows, we live the sickness too. And while biomedicine can cure diseases it flounders with permanent hurts, troubles of the mind, states present from birth or that are incurable or progressive. In biomedicine, these states are stigmatized and feared. We medical anthropologists have a term for this: social death.

To reform the most important aspects of the social contract such as education, health care, environment and pensions, requires boldness and steadfastness. It takes a generation to determine whether reforms have been successful so government policy must hold its course despite changes in prime ministers and control of parliament.

The Tuskegee experiments are certainly a good reason for ongoing mistrust, but it is important not to overlook mistrust that is generated from contemporary health care experiences. If today, in twenty-first century America, African-American men have reason to believe they will be discriminated against by health service providers at a time when they are unwell and vulnerable, is it surprising that they delay or avoid seeking care?

These “social determinants of health” play a major role, in fact, the major role, in determining a person’s health and well-being. Studies have shown that as much as 90 percent of a person’s life expectancy depends on these factors, and only 10 percent on medical care.

Research shows that the number of years of education a person has is a more important factor in determining risk of heart disease than all the other risk factors combined.23 While educated people are more likely to read and understand written health warnings, they also tend to be more aware of what is going on around them and how social forces act to affect their life.

The Maori of New Zealand, for example, used to sleep communally in longhouses and still sleep this way at funerals to accompany a corpse on its journey from this world to the next.38 The Asabano of New Guinea never let a stranger sleep alone because of the dangers of nighttime witchcraft, and the Warlpiri of Central Australia sleep under the stars in rows whose order is determined by strict social rules.39 In

The literature on African-American men’s health has often been informed by a “health behavior framework” as opposed to a “social determinants of health framework.

The literature on African-American men’s health has often been informed by a health behavior framework as opposed to a social determinants of health framework.

derived from the assessment tool, the Emotional Quotient Inventory 2.0 or EQ-i 2.0®, distributed by Multi-Health Systems, one of the world’s leading assessment companies. This instrument measures a cross-section of interrelated emotional and social competencies, skills, and facilitators that determine how effectively we understand and express ourselves, understand others and relate with them, and cope with daily demands. We use this assessment with many of our clients to establish a baseline of competencies and identify areas of improvement. We know that what gets inspected and measured does improve. In

Hitler promises that the nervous years have ended, that with him, the German way of life will be determined for the next thousand years. He promises national health care, government schooling, partnerships between the government and businesses. He says he will inject government funds into social welfare and the industrial sector, as well as the military. And he says that he will not bring war to Europe, that the only way it would happen would be if the Communists began a conflict. He says he will protect us and our need for peace—he will bring us out of our deep national crisis. We need strength.

It is high time for American citizens and policymakers to recognize the American male’s postwar flight from work for what it is: a grave social ill. It is imperative for the future health of our nation that we make a determined and sustained commitment to bringing these detached men back—back into the workplace, back into their families, back into our civil society. I do not propose here to offer a comprehensive program to accomplish this great goal. This is not a “how to” book. America’s “men without work” problem is immense and complex and has been gathering fully for two generations. Reversing it will surely require action on many different fronts—and certainly not just governmental action. It will also require suggestions and strategies from voices across the political spectrum; only a broad and inclusive approach will develop and sustain the consensus needed to turn this tide. In

In the ensuing chapters, we will look in some detail at particular manifestations of the modern scientific ideology and the false paths down which it has led us. We will consider how biological determinism has been used to explain and justify inequalities within and between societies and to claim that those inequalities can never be changed. We will see how a theory of human nature has been developed using Darwin's theory of evolution by natural selection to claim that social organization is also unchangeable because it is natural. We will see how problems of health and disease have been located within the individual so that the individual becomes a problem for society to cope with rather than society becoming a problem for the individual. And we will see how simple economic relationships masquerading as facts of nature can drive the entire direction of biological research and technology.

The long-term effects of stress are determined by the pattern of stress activation. When the stress-response systems are activated in unpredictable or extreme or prolonged ways, the systems becomes overactive and overly reactive—in other words, sensitized. Over time, this can lead to functional vulnerability, and since the stress-response systems collectively reach all parts of the brain and body, a cascade of risk in emotional, social, mental, and physical health occurs.

Your mindset will determine your sunset.

Perhaps it does come back to valuing community, after all. Recent studies in science communication have suggested what I've sketched out in this chapter: that scientific literacy is not the variable that determines whether or not a group will accept the reality of a public health issue like vaccination or global warning: social groups are. While those individuals tested demonstrated a surprising ability to factually interpret scientific findings, they tended to eventually revert to in-group thinking about the issue, siding with whatever their main social group already believed. We humans are social, after all. Our social nature is why solitary confinement is potentially a human rights violation, why just about all of us wish we weren't having to stay home during the COVID crisis, why we all cling to Zoom meetings-why children yell at one another across balconies, starved for the sound of another child's voice. We all do the same dance of retreating to our social safety spaces. And if our 'safe' social group told us that our experience during the pandemic was a lie? Well, it seems we'd be more likely to believe our friends than science, because, as I've argued elsewhere...in times of desperate calamity, all we humans really have is one another. I have no answer to this twisted dilemma that the healthy carrier narrative, via the vehicle of COVID-19, has presented to us in the United States, but understanding the dilemma rightly is surely important.

Human rights violations are not accidents; they are not random in distribution or effect. Rights violations are, rather, symptoms of deeper pathologies of power and are linked intimately to the social conditions that so often determine who will suffer abuse and who will be shielded from harm. If assaults on dignity are anything but random in distribution or course, whose interests are served by the suggestion that they are haphazard?

Hitler promises that the nervous years have ended, that with him, the German way of life will be determined for the next thousand years. He promises national health care, government schooling, partnerships between the government and businesses. He says he will inject government funds into social welfare and the industrial sector, as well as the military.

By the end of 1913 progressive Europeans were calling for social reform and better conditions for the poor. They seemed to have won the emotional argument, as historian Roy Hattersley rightly concludes. But the material and political fulfilment of such reforms were much slower in coming. The question was when, and how, to introduce them. Many conservatives were determined to delay or throttle altogether the role of government intervention in education, health and the workplace, declaring reforms of basic humanity that we take for granted today ‘socialist’. The Lords rejected the Education Bill of 1906, for example. Between

With the ‘modern labour market services’ legislation (‘Hartz I and II’), part-time employment and agency work were liberalized. The latter particularly abolished the ban on ‘synchronization’ and dismissal (it had previously been illegal for employment agencies to take on workers only for the duration of a particular job in a client company).90 The boom in agency and low-paid work in the following years was a direct result of these measures. On top of this, precarious workers, particularly agency and subcontracted staff, are considered second-class citizens in terms of employment.91 This is particularly clear in the case of agency workers. In formal legal terms, although the modernization of employment law in 2001 gave these workers additional rights of co-determination, in practice these were curtailed: within the agency they have the same rights as other employees, but in the firm where they actually work, possibly for several years, they have only very limited participation rights. Appearing on the balance sheet as ‘material resources’, they have no protection from dismissal, they often earn only half as much as permanent staff for the same work, and their position is inferior in terms of labour and health protection. As a result, they fall into a new dependency—for example, earning so little that their income does not cover their needs and they are forced to seek greater support from the state.

The definition of privilege is in reality much simpler than a lot of social justice discussions would have you believe. Privilege, in the social justice context, is an advantage or a set of advantages that you have that others do not. These privileges are not due 100 percent to your efforts (although your hard work may indeed have helped), and the benefits of these privileges are disproportionately large or at least partially undeserved when compared to what the privilege is for. These advantages can often be ascribed to certain social groups: privilege based on race, physical ability, gender, class, etc. But these privileges can also lie in areas that you may have not considered, like sexuality, body type, and neurological differences. It is in these advantages and their coupled disadvantages that the health and well-being of large amounts of people are often determined. If we are truly dedicated to addressing systemic oppression and inequality, we must understand the full impact of these advantages and disadvantages in order to move toward real change in our society and ourselves. Let’s use a bit of my privilege as an example: I have

There were hundreds of pages whose proper home I was at a loss to determine. Should they go in the Medicine folder? The Mental Health folder? The Animism folder? The Shamanism folder? The Social Structure folder? The Body/Mind/Soul Continuum folder? I hovered uncertainly, pages in hand, and realized that I was suspended in a large bowl of Fish Soup. Medicine was religion. Religion was society. Society was medicine. Even economics were mixed up in there somewhere (you had to have or borrow enough money to buy a pig, or even a cow, in case someone got sick and a sacrifice was required), and so was music (if you didn’t have a qeej player at your funeral, your soul wouldn’t be guided on its posthumous travels, and it couldn’t be reborn, and it might make your relatives sick).

Social determinants of health are the environmental, social, and cultural conditions that affect our physical and mental health and quality of life, both positively and negatively.

In this groundbreaking study, her team found that the single most important factor (above gender, income, social background, loneliness, and functional health) in determining longevity was how people felt about and approached aging.

First, their sheer prevalence; according to the World Health Organization, ageism is the most widespread and socially accepted prejudice today.

important than gender, income, social background, loneliness, or functional health—was how people thought about and approached the idea of old age.6 Age beliefs, it turns out, can steal or add nearly eight years to your life. In other words, these beliefs don’t just live in our heads. For better or worse, those mental images that are the product of our cultural diets, whether it’s the shows we watch, the things we read, or the jokes we laugh at, become scripts we end up acting out.

There’s a lot more to health than what you eat—your relationship with food, mental health, social determinants of health, to name a few. Besides, body weight is not a behavior.

The Tuskegee experiments are certainly a good reason for ongoing mistrust, but it is important not to overlook mistrust that is generated from contemporary health care experiences.

There are three essentials for good public health programs. The first is the conviction that the basis for public health is to achieve health equity; therefore, the bottom line is social justice in health. Second is the understanding that the science base is epidemiology. It is epidemiology that determines the gaps in social justice, identifies the groups with poor health outcomes, discovers the details of disease causation, and provides clues to how corrective action might improve health. The third essential is the need for good management for efficient implementation of corrective actions.

I want to call on people with mental disorders to challenge the status quo and speak up about all the things that contaminate your lives. Accept that mental illness is a part of you (not a defining part), a part of you that you don’t have to hide. Embrace it. Don’t be ashamed that your reality looks different from those of others. Remember, regardless of your gender, age, race, religion, work title, or any other sociodemographic determinant, it’s okay to have a meltdown, crumble, crack, and shatter into a million pieces. You are only human. You are well within your rights to express the true extent of the things you are experiencing. Don’t cover up parts of yourself you think are socially undesirable or culturally inappropriate. Own each and every inch of your being; the good, the bad, and the ugly. Be unapologetically you. Let the judgers judge you, let the haters hate you, let the critics critique you, but let no one silence you. Let us help normalize mental health discussions.

First, lucky people notice and act on chance opportunities in their life, creating strong social networks and holding themselves open to new experiences: I was lucky; I went to a grad school that was very open to risk taking and very open to freedom. That was at McGill back in the 1960s. I think they almost had a culture of risk taking, and my supervisor used to tell me, “Just have a go. It doesn’t matter if they reject it.” (Michael Corballis, Psychology, University of Auckland) Second, they trust their intuition: I’m a big fan of following serendipitous encounters: you leave no stone unturned and follow all kinds of paths even if you don’t really expect much there. Some of them of course don’t pan out well, but occasionally, you really get rewarded. (Ann Blair, History, Harvard University) Third, they persevere in the face of criticism and rejection: When I first started getting published in medicine, I was accused of being fluffy, Mickey Mouse. All kinds of awful criticisms were made of my work and my writing—“This isn’t medical,” “You can’t publish this kind of thing as medical research.” The more I received that criticism, the more absolutely determined I became to overcome it. (Gillie Bolton, freelance writer in literature and medicine, United Kingdom) And fourth, they transform bad luck into good by seeing the positive side of unlucky events: I absolutely subscribe to the notion that any feedback is a blessing. I don’t actually care how negative the feedback is; I just keep thinking, “Gosh, this could only strengthen my paper for the next place I’m going to send it to.” (Shanthi Ameratunga, Population Health, University of Auckland)

Flipping it another way; do gods give a damn about universal health care, access to stable, affordable housing, and the right to earn a living wage with benefits for everyone? What use are gods who don’t protect bodily autonomy and the right to self-determination for queer, nonbinary and gender nonconforming folks? What use are they if they don’t protect these rights for women or folks with disabilities? What do supernatural deities say about these specific socioeconomic, cultural, and social issues? Why do they remain abjectly silent if they are in fact omnipotent and omnipresent?

Sanity is socially and politically determined and when politics change, the definition of who is well and unwell, who is sane and who is sick, tends to change with it. The traits of good mental health, of the supposedly well-balanced individual, are often suspiciously similar to those of the compliant citizen, the obedient worker, the dutiful woman - whatever those traits might be, depending on the mood of the world and the whims of the powerful. Those who oppose the existing order can count on being labelled as deranged, as irrational, especially if they make the mistake of showing emotion in a power regime that considers all emotions weakness, all feelings laughable - except the rage of the ‘white working class’, as long as this is properly harnessed in the service of vested interests.

We’re not even breathing. Many of us suffer from “screen apnea” or “email apnea”—we stop breathing or breathe shallowly when we look at screens. The apps that we download might be “free,” but when we spend hours scrolling on social media, what we’re paying with is our attention and health—the most valuable things we have. What we pay attention to determines the quality of our lives. As twentieth-century Spanish philosopher José Ortega y Gassett said, “Tell me to what you pay attention and I will tell you who you are.” We owe it to ourselves to look and listen closely to understand the systems and biological technologies that have created the conditions for life for the past four and a half billion years. We must first learn to listen and look to nature to see how we can design technology that is aligned to how the systems of the earth work.

Recall that GDP, gross domestic product, the dominant metric in economics for the last century, consists of a combination of consumption, plus private investments, plus government spending, plus exports-minus-imports. Criticisms of GDP are many, as it includes destructive activities as positive economic numbers, and excludes many kinds of negative externalities, as well as issues of health, social reproduction, citizen satisfaction, and so on. Alternative measures that compensate for these deficiencies include: the Genuine Progress Indicator, which uses twenty-six different variables to determine its single index number; the UN’s Human Development Index, developed by Pakistani economist Mahbub ul Haq in 1990, which combines life expectancy, education levels, and gross national income per capita (later the UN introduced the inequality-adjusted HDI); the UN’s Inclusive Wealth Report, which combines manufactured capital, human capital, natural capital, adjusted by factors including carbon emissions; the Happy Planet Index, created by the New Economic Forum, which combines well-being as reported by citizens, life expectancy, and inequality of outcomes, divided by ecological footprint (by this rubric the US scores 20.1 out of 100, and comes in 108th out of 140 countries rated); the Food Sustainability Index, formulated by Barilla Center for Food and Nutrition, which uses fifty-eight metrics to measure food security, welfare, and ecological sustainability; the Ecological Footprint, as developed by the Global Footprint Network, which estimates how much land it would take to sustainably support the lifestyle of a town or country, an amount always larger by considerable margins than the political entities being evaluated, except for Cuba and a few other countries; and Bhutan’s famous Gross National Happiness, which uses thirty-three metrics to measure the titular quality in quantitative terms.

A familiar criticism, which we echo in part, is that justice is concerned with more than distributive principles. In addition, much of what justice comprehends lies beyond an assessment of each person’s distributive shares and includes equally concerns about the nature of the relations among persons. For example, worries about social subordination and stigma, lack of respect, lack of institutions, and social practices that adequately support capacities for attachment and self-determination also are matters of justice—for both individuals and groups.

CHAPTER 4 SUMMARY: BEST WAYS 71–80 71. When it comes to ensuring your family’s financial well-being, and securing a meaningful and rewarding job, you need to create a written action plan or a MAP (Meticulous Action Plan). 72. When you create a MAP, you are actually programming your own “employment GPS” so you can go from where you are to where you want to be. 73. When you’re done developing your action plan, you’ll have a highly structured schedule of activities for each day of the week. This includes your job transition campaign as well as your personal, social, and fitness activities. 74. If you are unemployed, you should invest 50, 60, or 70 hours a week on your job campaign. If you have a full-time job, you need to set aside a defined number of hours every week as your investment in your future. 75. Whether you are employed and looking for a better job or out of work seeking a new one, you must hold yourself fully accountable for putting in as many hours as possible and getting the most out of every hour you put in. 76. The first question you will need to address is, how many hours a week will you commit to your job transition campaign? Then, based on the number of weekly hours you’ll invest in getting a new job, your next step is to break weekly hours down into daily hours. 77. There are 13 primary job transition strategies for landing a job in troubled economic times. Your job is to determine which 4 to 6 strategies will be most effective for you. a. Networking and contact development b. Target marketing (identifying companies you want to work for) c. Internet searches and postings d. Federal jobs e. Search firms and employment agencies f. Blogs with job listings g. Classified advertisements in newspapers and trade journals h. Job fairs i. College placement departments and alumni associations j. Workforce System and One-Stops k. Volunteer work l. Job transition strategists m. Creative self-marketing 78. Once you have identified which job transition strategies will work best for your campaign, determine when, during the week, you will work on each. You want to create a structured weekly schedule. When you create a structured weekly schedule, you will have a detailed plan with specific daily tasks both for your job campaign and for personal and social activities. 79. Once you have a structured weekly schedule, you must set goals that you want to achieve from your weekly activities. A MAP without specific goals is not an effective plan. You will want to set specific goals for each strategy so you can track your success or modify the MAP if you are not achieving your weekly goals. 80. Prepare for the worst-case scenario. It is vitally important to remain in a positive, optimistic, and enthusiastic state of mind. But sometimes your plan won’t come to fruition as quickly as you’d like. So expect the best, but plan for the worst. This would include looking at your long- and short-term finances and health and other issues that need to be addressed to free you up to concentrate on getting your next job.

Most people don’t want to acknowledge the uncomfortable truth that distraction is always an unhealthy escape from reality. How we deal with uncomfortable internal triggers determines whether we pursue healthful acts of traction or self-defeating distractions. For Chance, racking up Striiv points provided the escape she was looking for. For other people, the escape comes from checking social media, spending more time in the office, watching television, or, in some cases, drinking or taking hard drugs.

The World Health Organization, for example, currently lists ten determinants of health: income and social status, education, physical environment, employment and working conditions, social support networks, culture, genetics, personal behavior and coping skills, health services, and gender.