Deck 9: Political Economy of Health Disparities

Question 1

Which of the following keeps poor people poor or anyhow makes it hard for poor people to move up into the middle class?

A) All these things contribute to continued, trans-generational poverty
B) occupational exposures to chemicals that people in better paying jobs are not exposed to (e.g., pesticides, mine dust)
C) lower availability of fresh produce and less-processed foods, contributing to malnutrition so that people aren't at their best cognitively and are more likely to gt sick
D) cognitive impairment brought on by stress, lead exposure, etc.
E) higher likelihood of stress, toxic exposures, and poverty-linked diseases that cause setbacks in achieving goals

Answer 1

A

Question 2

Schell describes the multigenerational persistence of poverty by pointing to how a number of interlinked factors leave us with the false impression that marginalized populations are inherently less clever. What on this list is NOT among those factors?

A) exposure to stressors, including toxic insults to development
B) none of the answers here is right
C) poor qualifications for employment
D) low occupational status and few employee benefits
E) all the substantive answers contribute to the cycle

Answer 2

E

Question 3

High rates of obesity and diabetes among the Tohono O'odham Nation of Arizona

A) stem from genetic changes that occurred in this population after their river water was diverted to service non-native farmers.
B) are not linked to any change in their diet
C) are seen in even the very first historical records ever kept on their health
D) are directly linked to the diversion of their river water to service non-native farmers upstream
E) can be sustainably solved with gene therapy

Answer 3

D

Question 4

For the Tohono O'odham Nation of Arizona, the loss of water

A) hardly mattered because the Tohono O'odham people herded sheep for a living
B) was devastating because they had been farmers
C) meant a gain in terms of electricity provided by the hydroelectric power plant that the diverted water now fueled
D) led to an overall loss of weight among members of the population
E) was not a problem because they were genetically fitted to a dry environment

Question 5

The 'structural violence' model teaches that achieving health equity and full human rights for all depends upon

A) Providing scholarships to the poor
B) Changing the social structure
C) Providing famine relief to impoverished nations
D) Sending books to poor people
E) Physiological adaptation

Question 6

Which framework allows us to best evaluate or understand 'structural violence'?

A) biological determinism
B) reductionism
C) political economy
D) disease ecology
E) primary health care

Question 7

What is NOT a focus of (or the least important to) the 'political economy' framework?

A) Power dynamics
B) Authority
C) Interconnected regional, national, and global economies
D) Profit
E) Proximal ecological factors

Question 8

Which epidemiological profile was prominent BEFORE the so-called epidemiological transition?

A) The mortality rate from infectious and chronic diseases was low.
B) The mortality rate from infectious diseases was low while the mortality rate for chronic diseases was high.
C) The infant mortality rate was low while the mortality rate from infectious diseases was high.
D) The infant mortality rate was high and infectious diseases were much more common.
E) The infectious disease mortality rate was high but the infant mortality rate was low.

Question 9

The high COVID-19 rates among people of color in the USA result directly from or provide a clear example of:

A) structural violence.
B) genetic diversity.
C) epidemiological polarization.
D) biological determinism
E) exposure to toxicants

Question 10

When we refer to 'biocultural diversity' today, as measured in terms of differential health outcomes or different epidemiological profiles, what we are really talking about is:

A) the inherent biological differences that determine 'natural' social organization.
B) the inherited inequalities resulting from the diverse geographies in which ones ancestors lived.
C) genetic variation within a population.
D) the consequences of different groups holding different positions within local and global social structures.
E) none of the answers provided is correct.

Question 11

Which dimensions of identity listed below would an 'intersectionality' framework NOT focus on or prioritize?

A) Gender
B) Age
C) Sexuality
D) Race/ethnicity
E) Genotype

Question 12

Why did the drug-related mortality rate for White people in the US with a high school degree or less increase so dramatically in the mid-late 2000s and the 2010s?

A) They are genetically inclined toward drug abuse
B) They are more prone, biologically, to heart attacks from opioids than other populations
C) The law was much stricter with White drug users and this resulted in reliance on illegal drugs instead of doctor-prescribed pharmaceuticals
D) Actually, this increase was seen in Whites with more education, not those with less
E) This population's high expectations for a middle-class lifestyle were dashed by deindustrialization and the resulting despair that many felt fueled an epidemic of addiction

Question 13

In what way have poor Whites from the Southeastern US been subject to structural violence?

A) They fought (and were injured and died in) the civil war on Southern slave owners' behalf
B) They served as a cheap and easily expendable and replaceable source of labor for coal mine owners
C) They worked as sharecroppers for rich landowners and then, after tractors displaced them, they headed west to become migrant farm laborers
D) They have serviced and been 'cannibalized' by the economy in all three ways mentioned
E) This is a trick question: White people have never been subject to structural violence.

Question 14

The Better Babies and Fitter Families competitions and sterilization programs of the early 1900s reflected belief in _________ and diverted attention from the effects of _________.

A) biological determinism; structural violence
B) intersectionality; racism
C) hard work; luck
D) epidemiology; exploitation
E) biological determinism; disease ecology

Question 15

Better Babies and Fitter Families competitions and sterilization efforts of the early 1900s sought to naturalize inequity in a way that reflected

A) structural violence's dependence on its immediate invisibility
B) the popularity, at the time, of cultural determinism
C) the equality of all White people, as a counterbalance
D) social soundness
E) our nation's democratic roots

Question 16

One's location within the social structure largely determines the degree or amount of _________ one has or can express and therefore affects one's ability to take control of one's destiny.

A) intersectionality
B) immunity
C) agency
D) mental fortitude
E) integrity

Question 17

What does the Tohono O'Odham group TOCA's approach to diabetes management have in common with the Akwesasne Mohawk Nation's approach to PCB poisoning?

A) they both apply a gene-based understanding for individualized treatment.
B) both realize the need to let outside experts lead the way.
C) rather than to get caught up in prevention, treatment is prioritized
D) both focus on Native rather than Western concerns and priorities
E) They are not the same because the Tohono O'Odham have always been prone to diabetes

Question 18

Taken together, the Akwesasne Mohawk Nation's and the people of Barrio Logan's experiences with toxicants show that

A) Rural Native Peoples are biologically more resistant to PCBs and heavy metals than other populations
B) Between-group differences in cognitive, growth, behavioral, reproductive, and other measures can often be traced to environmental toxicant exposure rates
C) Structural violence is not real or measurable
D) A 'social soundness' approach to community organizing rarely works.
E) Certain populations are biologically less well-equipped than others for expelling heavy metals and PCBs from the bloodstream.

Question 19

Which of these causes cognitive impairment and therefore helps explain the cycle of low socioeconomic mobility in exposed groups?

A) environmental contaminants (e.g., PCBs)
B) 'Parasite stress'
C) a high disease burden from bacteria, viruses, etc.
D) Lack of iodine (cheap salt)
E) Everything listed can impair cognitive skills

Question 20

Under normal circumstances, when a parent with three children who holds two jobs has an accident at one workplace due to tiredness, the ultimate culprit is most likely

A) Personal: Greed on the worker's part leads to taking two jobs
B) Structural: the social system makes holding two jobs necessary to survive, for certain groups
C) Staying up too late on social media / the internet
D) Structural: people often do not pay attention during training
E) Social: Laziness, which is common among people who need two jobs

Question 21

People attributed or endowed with less 'agency' by the social structure generally

A) hold high social positions.
B) have fewer choices and less ability to impose their will
C) have better health outcomes.
D) have made the epidemiological transition.
E) are less at risk for exposure to environmental or occupational toxicants.

Question 22

Effective community interventions for the Akwesasne Mohawk Nation, whose lands have been polluted by corporations upstream, will include first and foremost:

A) Putting an end to fishing
B) Stopping the people from using wild herbs
C) Encouraging young people to focus on schoolwork
D) Stopping people from fishing and from using wild herbs
E) Ensuring against a loss of culture, which would further destabilize Native groups

Question 23

Ignaz Simmelweis was an obstetrician who realized hand-washing could save lives:

A) when he saw that doctor-assisted births had better outcomes than midwife-assisted births.
B) but it took a long time before anyone would believe that invisible germs might be carried on human hands.
C) and his ideas were instantly accepted.
D) when a doctor complained to him about the dirty midwives.
E) and because hot running water was easily available the doctors and midwives were willing to try it.

Question 24

From the perspective of 'political economy,' how did the Russian prisons become a source of multidrug resistant tuberculosis?

A) After being exposed to TB in the cities, civilians were quarantined in prisons; this backfired by making the prisons epidemiological pumps.
B) Prisoners shared close quarters and were malnourished; this sped TB's spread.
C) Unequal access to resources led many people to end up in jails that therefore became overcrowded and were not well-funded enough to supply proper medical treatment.
D) The Russian government prescribed the wrong drugs.
E) Prisoners were infected with TB for medical studies.

Question 25

In comparing a social structure to a factory, the folks in the lower levels of the social structure (e.g., slaves) can be considered the factory's:

A) fuel.
B) owners.
C) foremen/women or unit supervisors.
D) customers.
E) inspectors.

Question 26

What is "Healthy People 2030"?

A) an eye health marketing slogan
B) an initiative to achieve health for all via simple solutions.
C) a new trend
D) a magazine offering focused health advice
E) a documentary advocating for improvements in global health

Question 27

A scholar taking a 'political economy' point of view focuses on all of the following EXCEPT:

A) who is exposed.
B) what happens when the germ enters the body.
C) why some persons are exposed and not others.
D) who profits.
E) who has the power and authority.

Question 28

Which of the following does NOT support sustainable health?

A) social justice approach
B) primary health care approach
C) prioritizing preventive care and simple solutions
D) social soundness approach
E) All approaches listed support sustainable health.

Question 29

Which of the following is NOT a key route to 'prevention' in 'primary health care'?

A) making sure that nutritious food is available
B) providing immunizations
C) treating disease
D) providing safe drinking water
E) None of the answers provided is correct.

Question 30

'Epidemiological profile' refers to:

A) the relation a disease has to particular kinds of environments.
B) the health problem pattern of a specific group.
C) a categorized listing of diseases and their severity globally.
D) the relation between diseases and their causes, both ultimate and proximate.
E) No answer provided is correct.

Question 31

A description of diseases and other health challenges that trouble a specific group is:

A) an epidemiological index.
B) a disease profile.
C) an epidemiological profile.
D) a disease pattern profile.
E) a health index.

Question 32

In terms of stability, 'epidemiological profiles':

A) cannot evolve at all (are totally stable).
B) change shape so quickly that measurement is a major challenge.
C) can shift over time, for instance as subsistence modes evolve.
D) change very little over time, even in the face of grave environmental pressure.
E) are unstable proximate features of the environment.

Question 33

The radical shift seen in prototypical disease profiles toward the end of the industrial revolution (and previously thought of as universal) is referred to as the:

A) epidemiological transition.
B) epidemiological polarization.
C) proximate transition.
D) transitional polarization.
E) foraging transition.

Question 34

The most important reason for the 'epidemiological transition' was:

A) a drastic change in diet following the agricultural revolution.
B) decreasing reliance on soap and hot water.
C) the vaccination revolution.
D) increased attention to sanitation.
E) All of the answers provided are correct.

Question 35

The 'epidemiological transition' entails a transition or shift:

A) away from many infant and child deaths from acute, communicable diseases to more deaths among mature and older adults from chronic, noninfectious diseases.
B) away from low levels of child and infant mortality to high levels of child and infant mortality.
C) away from large numbers of non-infectious disease deaths toward large numbers of deaths from epidemics.
D) toward longer life spans and away from deaths from non-infectious diseases.
E) away from more death at older ages toward more death at younger ages.

Question 36

How/why did 'epidemiological polarization' occur?

A) The epidemiological transition diffused (spread) only to some parts of the globe.
B) The epidemiological transition diffused (spread) only to groups with similar epidemiological profiles.
C) Social inequalities affected the distribution of the epidemiological transition.
D) The epidemiological transition affected only infectious disease, and therefore did not spread to groups where other diseases were more prominent.
E) The epidemiological transition caused a decrease in social inequality.

Question 37

The 'political economy' perspective focuses on:

A) proximate causes.
B) evolution.
C) ultimate causes.
D) co-evolution.
E) disease ecology.

Question 38

Which of the following is the best example of a 'political economy' analysis?

A) A group of people get TB when they are exposed to it in jail, due to sharing close quarters.
B) A group of people get cancer from workplace exposures that haven't been taken care of because doing so would cut into the factory's profits.
C) A group of people get sickle cell anemia because each member carries two sickle cell alleles.
D) A group of people develop allergies because they were not exposed to irritants as children.
E) All of the answers provided are correct.

Question 39

Scholars seeking the 'ultimate' cause of documented group-to-group variations in health status generally examine:

A) factors relating to immune response.
B) culturally specific actions that may differ from group to group.
C) environmental enablers in the immediate vicinity of the problem.
D) barriers to cure and prevention that are embedded in the social structure, such as in unequal power relations.
E) proximate variables that require close examination.

Question 40

When we look at the world using the theoretical framework or lens of 'political economy,' we look mainly at:

A) how monetary value has been placed on specific diseases.
B) power relationships and authority.
C) the specific governmental rules that regulate medication, such as FDA regulations.
D) the ways in which governmental hierarchies are matched at local levels.
E) community based solutions to disease.

Question 41

The Russian prison system has been characterized as an "epidemiological pump" specifically for:

A) cholera.
B) syphilis.
C) MDR TB.
D) prostitution.
E) cystic fibrosis.

Question 42

'MDR TB' stands for:

A) major demographic reservoir for tuberculosis.
B) malignant dangerous resistant tuberculosis.
C) multi-drug replicating tuberculosis.
D) multi-drug resistant tuberculosis.
E) minor drug resistant tuberculosis.

Question 43

When the shape of a given society's social structure harms a group of people within that society, which of the following has occurred?

A) intersectionality
B) structural violence
C) epidemiological transition
D) disease economy
E) None of the answers provided is correct.

Question 44

From the _________ _________ perspective, a hierarchical social structure harms people who occupy certain positions while people in other positions benefit.

A) disease epidemiology
B) epidemiological profile
C) structural violence
D) disease ecology
E) political epidemiology

Question 45

The person who has 'agency':

A) is at the bottom of the social hierarchy.
B) can impose his/her will or make changes to his/her world.
C) has little ability to make choices.
D) must be a participant in a foraging society.
E) has hired another person to do his/her work.

Question 46

Evidence of 'structural violence' can be seen in the archaeological record as far back as:

A) when the first state societies emerged.
B) the industrial revolution.
C) the beginning of the agricultural revolution.
D) when the cultural revolution got started.
E) ancient scavenging days.

Question 47

The most 'pathogenic' area of a hierarchical 'social structure' is:

A) the bottom.
B) the top.
C) the middle.
D) the left side.
E) the right side.

Question 48

The archaeological record shows that as people settled down and social complexity increased:

A) social inequalities decreased.
B) health disparities (inequalities) increased.
C) access to care was better for everyone.
D) health problems decreased overall.
E) the rich got sicker than the poor.

Question 49

One sign of structural violence in the archaeological record is when/that:

A) skeletons in elite burial grounds have fewer indicators of stress than those in the burial grounds for slaves or working classes.
B) engineering techniques could support up to three stories or floors in dwelling houses.
C) evidence indicates that invaders pulled the keystones out of arches to collapse storage vaults, causing starvation.
D) occupational injuries are seen in equal numbers in skeletons from people of all social positions.
E) we find separate burial grounds.

Question 50

'Syndemic' refers to health problems that:

A) have the same epidemiological cause.
B) have the same proximate cause.
C) cluster together and reinforce each other.
D) are mutually exclusive
E) are isolated within a given population.

Question 51

The term for two or more health problems that work together, reinforcing and exacerbating each other, is:

A) pandemic.
B) endemic.
C) syndemic.
D) epidemic.
E) None of the answers provided is correct.

Question 52

A health improvement program that uses a 'social soundness' approach must feature:

A) community involvement.
B) socialization.
C) economic development.
D) market economy involvement.
E) global involvement.

Question 53

Why did so many programs attempting to end epidemiological polarization fail during the late 60s and 70s?

A) They worked from the top down, ignoring community needs and cultural factors.
B) Front-line workers were not actually interested in seeing change.
C) Appropriate technologies were not yet available.
D) They worked from the bottom up, ignoring the governmental sanctions put on people.
E) They focused too much on prevention and not enough on treatment.

Question 54

'Social soundness' uses which of the following methods to fight health problems?

A) targeting specific endemic diseases
B) manipulating cultural values to ensure the acceptance of medical cures by local peoples
C) connecting with and involving the target community
D) distributing treatment options evenly among members of specific groups
E) implementing expensive, technologically complex health solutions at the local level, so that real people would benefit

Question 55

'Primary Health Care' provides or focuses on:

A) sanitation, social soundness, and immunizations.
B) social soundness, prevention, and curative drugs.
C) safe drinking water, good nutrition, and immunizations.
D) a preferential option for the poor.
E) proper nutrition, prevention, and social soundness.

Question 56

The 'primary health care' approach focuses most of all on:

A) making sure that drug cures are available to all.
B) pediatric health.
C) follow-up care.
D) prevention.
E) family-based treatment.

Question 57

The 'social justice' approach to combating epidemiological polarization promotes, first and foremost:

A) the equitable distribution of basic human rights.
B) sanitation.
C) prevention.
D) social soundness.
E) a community based approach to health care.

Question 58

The __________ __________ approach sees healthful living conditions as a basic human right.

A) disease ecology
B) social justice
C) political economy
D) primary health care
E) social soundness

Question 59

Which of the following is a 'political economy' approach to explaining developmental delay in poor children?

A) Lead, once ingested, interferes with nervous system development.
B) Poor children are more likely to live in older homes with lead pipes and leaded paint, and therefore more likely to ingest or be exposed to lead poisoning.
C) The poor are more likely to buy and cook with iodized salt than pure sea salt.
D) Poor children ingest an overload of sodium (salt) found in fast food.
E) None of the answers provided is correct.

Question 60

New York City child lead poisoning statistics demonstrate that:

A) lead poisoning affects all ethnic/racial groups identically.
B) lead poisoning affects all socioeconomic groups the same way.
C) poverty and lead poisoning are positively correlated.
D) poverty and lead poisoning are nonconcordant.
E) lead poisoning is determined by iodine intake.

Question 61

Nation by nation, average IQ scores:

A) go down as the disease burden index (or parasite stress) goes up.
B) go up as the disease burden index (or parasite stress) goes up.
C) can be compared without weighting to show who is born smarter.
D) are the same.
E) are not related to the disease burden index (or parasite stress).

Question 62

IQ differences between diverse population groups are:

A) created through human actions that lead to different disease-related and nutritional challenges in different populations.
B) indicative of the natural variation or biodiversity of humankind.
C) excellent indicators of a population's genetic disposition toward intellectuality.
D) not actually found in reality.
E) a result of geographic factors.

Question 63

In the Barrio Logan (San Diego) example, zoning laws allowing metal stripping and plating are explained as a product of:

A) social justice.
B) political economy.
C) bad luck.
D) disease ecology.
E) primary health care.

Question 64

In response to the imposed elimination of their traditional farming lifestyle and the onset of high diabetes rates, the Tohono O'odham people of Arizona:

A) saw genetics as the primary cause.
B) moved to a new location and started up new businesses.
C) volunteered as human test subjects for a metabolism research project.
D) founded a community-based organization to re-create a sustainable, healthy culture.
E) focused on clinical models of diabetes care.

Question 65

Diabetes rates among the Tohono O'odham people of Arizona:

A) have remained constant over the past 100 years.
B) went from no known cases prior to the early 1960s to 50 percent today due to radical lifestyle changes brought on by the diversion of their river, which squashed their farm-based livelihood
C) have been linked to the very active nature of the native lifestyle.
D) went down once the river dam was completed.
E) have fluctuated (up and down, up and down) over the past 100 years.

Question 66

Tohono O'odham Community Action, or TOCA, is:

A) a community-based organization dedicated to re-creating a sustainable, healthy culture that builds on traditional lifeways for the Tohono O'odham people of Arizona.
B) committed to determining which Tohono O'odham genes cause diabetes.
C) committed to the disease ecology perspective.
D) one example of a community-based organization that failed due to a lack of social soundness.
E) a community based organization that promotes participation in genetic testing programs.

Question 67

The classic 'epidemiological transition' refers to a modern-day (post-industrial) shift to:

A) more infectious disease.
B) more chronic, degenerative (non-infectious) disease.
C) less chronic, degenerative (non-infectious) disease.
D) high sickness rates among the young.
E) high mortality.

Question 68

Which model of epidemiological change fits best with the 'structural violence' framework?

A) demographic shift
B) intersectionality
C) epidemiological transition
D) epidemiological stabilization
E) epidemiological polarization

Question 69

Biological morbidity and mortality in human populations are:

A) affected by social arrangements.
B) known now to be random.
C) inherent or a given (not affected by culture or social structure).
D) promoted by modern polyculture.
E) the same across all cultures or societies.

Question 70

Exposure to toxic levels of lead and various other heavy metals, which can cause severe health problems:

A) no longer occurs within any social sector (group) in the United States thanks to laws created to protect the nation's health.
B) occurs more frequently in poor neighborhoods due to aging infrastructures and business zoning laws.
C) occurs more frequently in richer neighborhoods, because more consumer goods containing these metals are purchased by the rich.
D) does not affect children due to their developmental potential and plasticity.
E) has been fueled by social epidemiological pumping.