Chapter 19 Population, Aging, and Health True or False 1. The Population Bomb, written by Paul Ehrlich and published in 1968, postulated that the world's population was then in an early stage of the first demographic transition. Answer: False 2. The number of human beings alive doubled in the 100 years between 1910 and 2010. Answer: False 3. The first demographic transition is characterized as a transition by a region or country from a pretransition period of high fertility and high mortality to a post transition period of low fertility and low mortality. Answer: True 4. In the transitional period in the middle of the first demographic transition, mortality begins to decline first, followed by a decline in fertility. Answer: True 5. Once fertility decline has begun (or, in some cases, once it passes a certain threshold), it does not reverse. Answer: True 6. The 7 billion humans alive in 2012 will almost certainly reproduce so that the world's population will become 14 billion in the foreseeable future. Answer: False 7. In 2010, the population of the United States exceeded 300 million. Answer: True 8. Age pyramids are plots of age distributions. Answer: True 9. The age pyramid for the United States does not look like a pyramid until after age 60 because mortality influences the U.S. age distribution in notable ways only after age 60. Answer: True 10. Demographers usually put replacement fertility at 1.9 children per woman to deal with the relatively small numbers of those who die before reaching the typical ages of childbearing. Answer: False 11. Current estimates, rounded to the nearest million, put the number of legal immigrants in the United States at 21 million and the number of illegal immigrants at 11 million. Answer: True 12. Population momentum means that a country's population begins to decline sharply when fertility dips below replacement level. Answer: False 13. There has been a steady decline in mortality even in very poor countries like Sudan, even though infectious diseases are an extremely common cause of death, especially for infants and young children. Answer: True 14. Most of the baby boomers in the United States are still alive and can be expected to live for at least another 15 to 25 years. Answer: True 15. If fertility in a population were to remain just a bit below replacement, population decline would be very rapid. Answer: False 16. Life expectancy is one of the most common measures used to describe the health of a population. Answer: True 17. Since 1935, the United States has provided healthcare for citizens 65 and older through Medicare. Answer: False 18. Hospice care is a type of palliative care. Answer: True 19. The population model for prevention, with its focus on shifting the distribution of risk, has never been tried in the United States. Answer: False 20. The idea that things that happen to you during critical periods of development can change the way that the tissues and structures of your body function has been largely discredited. Answer: False 21. Americans live shorter, less healthy lives than we would expect based on the wealth of the country. Answer: True 22. An extraordinarily poor predictor of one's health is one's SES. Answer: False 23. The body's stress-response system, when mobilized in response to threats, causes your heart beat to slow and your blood pressure to decline. Answer: False 24. The suicide rate for non-Hispanic black men is higher than that for non-Hispanic white men. Answer: False 25. Since the 1970s, the gap between men's and women's mortality in America has been increasing. Answer: False Multiple Choice 1. What observation did Paul Ehrlich make, in The Population Bomb (1968), about the world's population? A. that the world's population was growing much too quickly B. that the world's population was growing much too slowly C. that the world's population was unlikely to double again D. that the world's population was fluctuating dramatically Answer: A 2. When did the world's population first begin to grow very rapidly? A. 1810 B. 1910 C. 1950 D. 1970 Answer: A 3. How many people are alive today? A. 5 billion B. 6 billion C. 7 billion D. 8 billion Answer: C 4. What are demography's "big three"? A. fertility, mortality, and median age B. fertility, mortality, and migration C. fertility, mortality, and mobility D. fertility, mortality, and morbidity Answer: B 5. How do fertility and mortality change during the first demographic transition? A. They transition from low fertility and high mortality to high fertility and low mortality. B. They transition from high fertility and low mortality to low fertility and high mortality. C. They transition from low fertility and low mortality to high fertility and high mortality. D. They transition from high fertility and high mortality to low fertility and low mortality. Answer: D 6. What happens mid transition during the first demographic transition? A. both mortality and fertility decline B. both mortality and fertility grow C. mortality first declines followed by a decline in fertility D. fertility first declines followed by a decline in mortality Answer: C 7. At which point in the first demographic transition does population grow rapidly? A. pretransition B. mid transition C. post transition D. a priori transition Answer: B 8. Which of the following statements about the first demographic transition is false? A. Once fertility decline has begun or passes a certain threshold, it never reverses. B. In the middle of the first demographic transition, population growth can be very rapid. C. To date, nations and regions that have gone through the first demographic transition always return to pretransition levels of high fertility. D. Fertility levels, post transition, have been observed to fluctuate. Answer: C 9. What is the key to why the 7 billion humans alive in 2012 will almost certainly not grow to 14 billion humans in the foreseeable future? A. pretransition reversal B. mid transition stagnation C. mortality decline D. fertility decline Answer: D 10. Which of the following statements about fertility in low-income countries is true? A. Fertility decline has begun in virtually all low-income countries because fertility is low. B. Although fertility remains high in many poor nations and regions of the world, fertility decline has yet to begin in any of these nations. C. Although fertility is now low in many low-income countries, fertility decline is fluctuating in many of these nations. D. Although fertility remains high in many poor nations and regions of the world, fertility decline has begun in virtually all of these nations. Answer: D 11. Where is Sudan positioned in terms of its first demographic transition? A. Sudan has yet to enter its first demographic transition. B. at the beginning C. in the middle D. at the end Answer: C 12. In the period from 1950 to 2010, when did Sudan's fertility start to decline? A. about 1950 B. about 1970 C. about 1980 D. not until 2000 Answer: C 13. At the peak of the baby boom, how many children, on average, did U.S. woman have? A. 6.7 children B. 5.7 children C. 4.7 children D. 3.7 children Answer: D 14. What does the structure of Sudan's age pyramid tell us? A. that the numbers of those who are very young and those who are much older are roughly the same B. that the numbers of those who are in their 30s and 40s and those who are in their 60s and 70s are roughly the same C. that nearly all children survive to adolescence D. that infant mortality is quite high Answer: D 15. Women, on average, have to produce _________ offspring to achieve replacement fertility, according to demographers. A. 0 B. 1.5 C. 2 D. 2.1 Answer: D 16. Countries whose fertility is at or below replacement can continue to gain population because of __________. A. immigration and rising life expectancy B. immigration and population momentum C. population momentum and dependency ratio D. population momentum Answer: B 17. Since the 1970s, Japan has experienced __________ levels of fertility. A. below-replacement B. at-replacement C. fluctuating D. super replacement Answer: A 18. __________ refers to the tendency of a population that has been changing in size to continue to change in size even if factors such as fertility and mortality have shifted to levels that would, in the long run, imply no change in population size. A. Population expectancy B. Population momentum C. Population parity D. The push-pull theory of population dynamics Answer: B 19. Of the following countries, or groups of countries, which is exhibiting population momentum? A. Japan B. Japan and the United States C. Japan, the United States, and Sudan D. the United States and Sudan Answer: B 20. Epidemiology is the study of __________ events in populations, their characteristics, their causes, and their consequences. A. age-related B. death-related C. health-related D. marriage-related Answer: C 21. The latter phase of the epidemiological transition is associated with __________. A. childhood diseases B. chronic diseases C. infectious diseases D. sexually transmitted diseases Answer: B 22. The effects of infectious disease are more likely to shape the epidemiological condition of __________. A. Japan B. the United States C. Sudan D. both Japan and the United States Answer: C 23. The effects of chronic disease are more likely to shape the epidemiological condition of __________. A. Japan B. the United States C. Sudan D. both Japan and the United States Answer: D 24. Which of the following diseases, because it is infectious, is more likely than the others to be associated with the initial phase of the epidemiological transition? A. arthritis B. cancer C. diabetes D. flu Answer: D 25. Immunization is a method of __________. A. combating infectious disease B. treating chronic disease C. curbing the spread of chronic disease D. isolating chronic conditions from infectious conditions Answer: A 26. A key adjective associated with chronic diseases or chronic health conditions is __________. A. acute B. mild C. persistent D. recurring Answer: C 27. Which of the following health-related risk factors is less likely than the others to lead to a chronic health condition? A. poor eating habits B. too much sun C. drinking too much unfiltered water D. lack of exercise Answer: C 28. How old were the oldest baby boomers in 2010? A. 50 to 54 B. 60 to 64 C. 70 to 74 D. 80 to 84 Answer: B 29. Given that Japan's fertility has been between 1.2 and 1.4 for several decades, there is a distinct possibility that in the future Japan will experience __________. A. a sharp drop in infant mortality B. a slow and steady increase in population C. a slow and steady decline in population D. a very rapid decline in population Answer: D 30. Many countries besides Japan have equally low levels of sub replacement fertility, including all of the following EXCEPT __________, A. Cuba B. Italy C. the United States D. Germany Answer: C 31. Should fertility remain at very low sub replacement levels, countries like Japan face which of the following prospects at some point in the future? A. the prospect of rapid population aging B. the prospect of rapid population decline C. the prospect of rapid population aging and the prospect of rapid population decline D. the prospect of rapid population aging and the prospect of steady population decline Answer: C 32. Were a country to have, over the long run, a constant sub replacement level of fertility of 1, how many years would it take for the population of that country to halve? A. slightly less than 20 years B. slightly less than 30 years C. slightly less than 50 years D. slightly less than 70 years Answer: B 33. How does the World Health Organization define what it means to be healthy? A. as the absence of disease B. as the absence of disease or infirmity C. as a state of complete physical, mental, and social well-being D. as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity Answer: D 34. Of the following measures, which does the United States NOT use to track healthy life expectancy? A. expected years of life in good health B. expected years of life in retirement C. expected years of life free from limitation of activity D. expected years of life free from selected chronic diseases Answer: B 35. According to current statistics, how many Americans over 18 report having a chronic disease? A. almost one in six B. almost one in four C. almost one in three D. almost one in two Answer: D 36. Which of the following statements about Medicare is false? A. Medicare does not cover the entire cost of an eligible recipient's medical bills. B. Citizens 65 and older are Medicare eligible. C. Medicare beneficiaries have no out-of-pocket healthcare expenses. D. Until recently, Medicare included no prescription drug benefits. Answer: C 37. A(n) __________ is a legal document that defines the conditions under which a person prefers to die. A. advance directive B. living will C. power of attorney D. order for life-sustaining treatment Answer: A 38. Which of the following statements best explains the manner in which a physician's approach to illness differs from that of a sociologist? A. Sociologists are interested in the immediate causes of illness. B. Doctors consider how social contexts shape individual health behavior. C. Doctors are interested in the causes of illness that can be remedied with medical treatments. D. Sociologists generally focus on how our current day-to-day lives affect illness because those are the contexts that they can influence. Answer: C 39. English epidemiologist Geoffrey Rose had an important insight about the way most health systems work. What was it? A. Rose realized that the rate of disease in any society is a product of composite DNA profiles. B. Rose realized that the cause of poor health could lie deep in a person's past. C. Rose realized that individuals are part of societies with particular rates of disease. D. Rose realized that individuals in poor health have more than a few worrisome symptoms. Answer: C 40. Which of the following statements about health risks is true? A. Health risks operate on a continuum. B. Health risks are an either/or phenomenon. C. Health risks resist study and classification. D. Health risks have immediate consequences on life expectancy. Answer: A 41. What is the focus of the population model for prevention? A. avoiding high-risk behavior B. raising the risks for poor healthcare choices C. shifting the distribution of risk D. treating at-risk populations Answer: C 42. Which of the following actions is an example of putting the population model of prevention into action? A. Giving people medicine for hypertension if their blood pressure rises above a certain level. B. Disallowing elective surgery for varicose veins. C. Restricting the caloric intake of obese hospital patients. D. Eliminating vending machines that dispense sugary sodas from schools. Answer: D 43. Obesity in the United States has increased substantially in recent decades, a pattern that many have attributed to changes in __________. A. the American diet B. life expectancy C. Medicare eligibility D. population momentum Answer: A 44. Emile Durkheim, in his book Suicide, showed that __________. A. fewer people are likely to commit suicide in communities where social integration is extremely low B. fewer people are likely to commit suicide in communities where social regulation is extremely high C. suicide rates are not affected by group needs D. suicide rates are affected by the amount of social integration and social regulation in people's lives Answer: D 45. Which of the following statements best supports the supposition that social contexts shape what counts as "normal" behavior and what behavior are socially sanctioned or accepted? A. Binge drinking appears constant across all age groups, from age 18 to age 65 and older. B. If all of the students in Lee's dorm binge drink on the weekends, it's more likely that Lee will, too. C. If all of the students in Lee's dorm binge drink on the weekends, it's less likely that Lee will, too. D. It's more likely for Lee to engage in binge drinking if he has to actively seek out opportunities to do so. Answer: B 46. Our social relationships affect our health in three major ways. What are they? A. through person-to-person contact, role-playing behavior, and family authorization B. through access to resources, social conditioning, and mentoring C. through social isolation, person-to-person contact, and access to empirical data D. through social influence, person-to-person contact, and access to resources Answer: D 47. Sociologists have produced empirical evidence that suggests that people who are obese __________. A. are more likely to make choices privately to eat more than people who are not obese B. are more likely to have friends who are obese C. are more likely to eat alone D. are more likely to be in the 18- to 24-year-old age group Answer: B 48. The Dutch famine, when Germany placed a ban on food transports in the Netherlands in the winter of 1944, illustrates which sociological approach(es) to health? A. the fetal programming hypothesis B. the fetal programming hypothesis and the life-course perspective C. the life-course perspective D. the life-course perspective and the cumulative-trajectory model Answer: B 49. Another name for the sensitive-period model of the life-course perspective is the __________. A. cumulative-exposure model B. cumulative-trajectory model C. latency model D. social-trajectory model Answer: C 50. According to the sensitive-period model, __________. A. your position in the social pecking order can have long-term implications for your adult health outcomes B. accumulative exposure to carcinogens over a long period of time can have long-term implications for your adult health outcomes C. things that happen to you in your mother's womb can have long-term implications for your adult health outcomes D. norms about smoking and other harmful behavior can have long-term implications for your adult health outcomes Answer: C 51. __________ may provide the best example of the cumulative-exposure model. A. Infectious disease B. Pneumonia C. Smoking D. Underage drinking Answer: C 52. In America, the leading causes of death are __________. A. diabetes and cancer B. heart disease and cancer C. heart disease and hypertension D. cancer and alcohol poisoning Answer: B 53. Of the following countries, which has the highest physician-to-population ratio? A. Cuba B. Germany C. Spain D. the United States Answer: A 54. Where in the United States is the "Stroke Belt" located? A. the Midwest B. the Northeast C. the South D. the West Answer: C 55. The socioeconomic gradient in health coincides with which of these phenomena? A. People with lower social statuses are as healthy as those with middle statuses. B. People with higher social statuses are healthier than those with middle statuses. C. Life expectancy and disease prevalence are lowest among people with higher social statuses. D. Life expectancy and disease prevalence are highest among people with lower social statuses. Answer: B 56. Which of the following statements about links between health and education is false? A. The better health behavior of the more educated can explain 100 percent of their health advantage. B. People with more education use preventative healthcare more. C. Those with more education use illegal drugs, alcohol, and tobacco less. D. Studies find that students who attended school for more years had higher survival rates as adults. Answer: A 57. The effects of family income on child health appear to __________. A. diminish over time B. increase over time C. remain constant over time D. vary more for boys than for girls Answer: B 58. In the Whitehall studies, what did the researchers hypothesize? A. that not having enough food or enough nutritious food leads to worse health B. that exposure to discrimination in everyday life increases stress C. that the effects of income on health are larger for those with less money D. that the mechanism linking rank and health was control of one's environment Answer: D 59. African Americans live almost __________ fewer years than white Americans. A. five B. eight C. ten D. twelve Answer: A 60. When the body mobilizes its responses to stress too often, __________. A. there is no residual effect on health B. the body is at increased risk for disease C. the adoption of coping mechanisms ceases D. basic therapies for pain, such as taking aspirin, are less effective Answer: B 61. It is well documented that black patients who come to hospitals with a heart attack are less likely to get certain treatments, such as bypass surgery. What explanation has been proposed to explain the disparity? A. that geography is a strong determinant of racial disparities in healthcare B. that black patients are treated in a larger number of hospitals than whites C. that there is a universal nonwhite health disadvantage D. that blacks are healthier than whites to begin with Answer: A 62. Of the following, which group has the highest suicide rate? A. non-Hispanic white men B. Hispanic women C. non-Hispanic black women D. Hispanic men Answer: A 63. Hispanics are substantially __________ to smoke. A. less likely than African Americans B. more likely than non-Hispanic whites C. more likely than African Americans D. less likely than African Americans or non-Hispanic whites Answer: D 64. Of the following health-related conditions or diseases, which are women more likely to suffer from? A. accidental death B. depression C. homicide D. delayed care for urgent medical situations Answer: B 65. Which of the following explanations of the differences in health between men and women is true? A. Women's health advantages derive from their more flexible circulatory systems. B. Men's health advantages derive from their more robust immune systems. C. Men tend to engage in more risky behaviors when they are older. D. Women tend to engage in more risky behaviors when they are younger. Answer: A Scenario Multiple Choice 1. What factors led to confusion and concern over the exploding population growth in the mid1900s? A. Fertility rates declined, but mortality rates did not. It was not known then that mortality rates would decline shortly thereafter. B. A massive influx of immigrants occurred. It was not known then that immigration rates would quickly decline. C. Mortality rates declined, but fertility rates did not. It was not known then that fertility rates would fluctuate for a few more decades. D. Mortality rates declined, but fertility rates did not. It was not known then that fertility rates would decline shortly thereafter. Answer: D 2. Using your sociological knowledge of how people adapt to a changing environment and your knowledge of demographics, why would fertility rates eventually decline in response to lower mortality rates? A. Developed countries are the first to experience lower mortality rates, and these are the countries most concerned about population growth. B. An explosion in population growth scares the average person and so they have fewer children. C. As fewer people die young, couples have smaller families since more of their children will live to be adults. D. Population growth leads many governments to enact extreme measures to limit fertility rates. Answer: C 3. What factors are most relevant in comparing Sudan's age pyramid to that of the United States? A. Despite high fertility rates, Sudan's poverty leads to a higher mortality rate for infants and children. B. Sudan is at replacement fertility. On average, a child is born for every person who dies. C. Sudan is poor, but its population is educated. More Sudanese are practicing birth control to maintain healthy population numbers. D. Sudan is fast approaching lower mortality and fertility rates. It will soon mirror the United States in its age pyramid. Answer: A 4. Which of the following scenarios most accurately reflects how the epidemiological transition impacts the health conditions of people in poor and rich countries? A. Bob, an 89-year-old man in the United States, suffers from high blood pressure; Ammani, a 10year-old boy in Ethiopia has malaria. B. Misako, a 14-year-old girl in Japan, frequently suffers from bacterial infections; Jean-Pierre, a 79year-old man in Haiti, suffers from heart disease. C. Paula, a 5-year-old girl in Great Britain, has contracted measles; Juanita, a 67-year-old woman in Bolivia, has diabetes. D. Mae Li, a 15-year-old girl in China, died from the flu; Sahim, a 70-year-old man in Afghanistan suffered a stroke. Answer: A 5. What factor plays a key role in determining why the population of Japan will most likely age more quickly than the U.S. population? A. Japan's fertility rate has maintained its below-replacement rate for many decades. B. Japan's medical advances surpass those of the United States. C. The U.S. mortality rate is considerably higher than Japan's. D. The lack of respect for the elderly in the United States hinders the quality of care they receive. Answer: A 6. Which of the following scenarios best depicts the implementation of the population model for prevention? A. A doctor's office offers detailed health maintenance information packets to its high-risk patients. B. In an effort to have some control over their own lives, a group of elderly people have each filled out an advance directive. C. A hospital will not discharge a patient until it is satisfied that the patient and her family fully understand her postoperative plan for care. D. Over the course of two years, a soft drink manufacturer is required to gradually and incrementally reduce the amount of sugar in its drinks. Answer: D 7. Which of the following scenarios most accurately demonstrates how our social contexts help shape our health? A. Antonio has never smoked, but his best friends at work take smoking breaks outside, and he usually joins them. Antonio eventually starts smoking, too. B. Celia works from home, but her boss hosts an annual party for telecommuters. Most everyone in attendance drinks heavily at the event, so Celia has one or two drinks to be sociable. C. Evan's parents have greatly reduced their sodium intake and strongly encourage their son to do the same while away at college. D. Marta's Facebook friends often post about different diets they're trying, with varying rates of success. Marta sometimes thinks about losing a couple of pounds. Answer: A 8. Darla's childhood health issues interrupted her schooling, which led to poor academic achievement. Eventually, she dropped out of school and began working. Her part-time job offers no health insurance coverage, so she's not keeping up with her regular medical check-ups. This scenario is an example of __________. A. the cumulative-exposure life-course model B. the life-course perspective C. the sensitive-period life-course model D. the social-trajectory life-course model Answer: D 9. Which of the following best demonstrates the relationship between SES factors and health? A. Education and income levels have little to no impact on a person's health. B. Higher education levels cause a person to have better health. C. Higher education and income levels are associated with better health. D. Higher education and income levels cause a person to have better health. Answer: C 10. Which of the following most accurately explains why African Americans have worse overall health than non-Hispanic white Americans? A. African Americans are genetically predisposed to have worse health issues. B. African Americans' worse health is directly attributable to their lower SES levels. C. African Americans' worse health is directly caused by their low representation in the healthcare field. D. Psychosocial stress and inferior healthcare treatments for African Americans most likely lead to their poorer health. Answer: D Short Answer 1. What is Paul Ehrlich's basic premise in his 1968 book The Population Bomb? Whose views anticipated his by almost two centuries? Answer: Ehrlich holds the view that the world's population is growing faster than the earth's ability to sustain it, an argument made by the English demographer Thomas Malthus in 1798. 2. Why would the rapid decline in population in, say, the United Kingdom, have a negative impact on living standards? Answer: It could mean that not enough people are available to sustain the living population. 3. The dire reading that Ehrlich took of human population doubling and redoubling at an alarming pace turned out to be wrong, at least, in its timing. What demographic factors did he not consider? Answer: Population dynamics, such as fertility, mortality, and migration, make predictions such as Ehrlich's far more complicated. 4. How might have Ehrlich's—and Malthus's—arguments changed had they understood the "more complete story" of the first demographic transition? Answer: They would not have made the blanket assumptions that they made based on the middle point of the transition, when mortality rates are very low but the fertility rate is still very high, which caused them to see a population time bomb that would later disappear once the fertility rate begins to decline. 5. Describe, in brief, the process of replacement fertility for a nation or region. Answer: Replacement fertility for any region or nation means that, on average, each person in a generation has two children, which results in an essentially unchanging size in the population, where each father and mother would, on average, produce two offspring, thus replacing themselves by this number of offspring. 6. Given the epidemiological transition, when is the human population most vulnerable to infectious diseases? Answer: Infectious diseases do not usually kill people in developed countries such as the United States and Japan, but they are an extremely common cause of death, especially for infants and young children, in poor and developing countries. 7. Why might healthy life expectancy be important to know for social planners building retirement communities? Answer: This metric tells them how long the elderly population can live free from limitations in activity and chronic disease and not need expensive assisted living options. 8. Why do chronic diseases in the elderly place a special burden on society? Answer: The rise of chronic disease as the cause of death, unlike acute events such as heart attacks, entails higher costs and the involvement of others, either as caregivers or as those who must pay for the care in the form of taxation. 9. How does the sociological approach to improving health differ from the medical approach? Answer: Doctors focus on treating high-risk groups—for example, those most likely to have hypertension. Getting fewer people to become sick in the first place is the sociological approach, what is referred to as the population model for prevention, which focuses resources on shifting the distribution of risk. 10. Given how social contexts influence our well-being, how do our social relationships affect our health? Answer: Our social relationships affect our health in three major ways: (1) social influence, (2) person-to-person contact, and (3) access to resources. 11. What is the life-course perspective that sociologists use to study health, the individual, and society? Answer: When sociologists consider the effects social contexts you have inhabited throughout your life have on your health, they call this a life-course perspective. Of particular interest are the long-term impacts of adverse childhood conditions, which can have negative effects on health long after they are no longer experienced. 12. Does the United States have the most doctors per 1,000 people? How many health workers does the World Health Organization recommend for that many people? Answer: No, the United States falls below such developed nations as Germany and Spain. According to the World Health Organization, there must be a minimum of 2.3 health workers—meaning medical doctors, nurses, and midwives—per 1,000 people in order to sufficiently meet the healthcare needs of a population. 13. Given fundamental cause theory, why do higher SES people in the United States enjoy better health even as the healthcare options for lower SES people have improved? Answer: Fundamental cause theory holds that higher SES individuals have access to knowledge, money, power, and social connections that are deployed throughout the life course to avoid disease and death. These resources can be deployed in a range of situations. As a result, this theory predicts that no matter what the causes of bad health, socioeconomic gradients will emerge. 14. The association between one's social status and health is one of the most consistent findings in social science. So, when researchers discuss health disparities, which factors do they mean, especially in regard to inequality? Answer: When researchers discuss health disparities, they mean differences in health status linked to social, economic, or environmental conditions. These conditions include SES, race and ethnicity, gender, and geographic location. 15. One approach to understanding gender differences in health is the biological approach. What does it consider? What is one of its limitations? Answer: The biological approach holds that women's health advantages derive from differences that protect women in pregnancy such as more flexible circulatory systems and more robust immune systems. These factors may explain women's increased life expectancy. They do not, however, explain why they have higher rates of chronic disease. Essay 1. Why didn't Paul Ehrlich's predictions about the so-called "population bomb" not come to pass in the way he foresaw in 1968? Will the population double in the foreseeable future? Answer: Many demographers who study over- and underpopulation would say that the world's population is unlikely to double again—from the current 7 to 14 billion—in the foreseeable future. Indeed, most demographers would view Ehrlich's claim as either simply wrong or, at the very least, as a much too simplistic portrait of what is a more complicated situation. To demographers, the assertion that the world's population will continue to explode in size is a claim about population dynamics; that is, how the size of the world's population has changed, and will be changing, over time. And for demographers, population dynamics involve a detailed understanding of fertility, mortality, and migration; that is, the births, deaths, and the movement into and out of a given population. Part of this is obvious in that how a region's or nation's population changes over time is determined by these three factors. How a population changes—rises or falls—requires not only statistical evidence but the reasons for any change in fertility, mortality, and migration as well. These factors, being dynamic, make predictions much more difficult. However, the current trends, on a global scale, suggest that the population is unlikely to double in the foreseeable future. 2. What is population momentum? What analogy can be used to explain the concept? Answer: Population momentum refers to the tendency of a population that has been changing in size to continue to change in size even if factors such as fertility and mortality have shifted to levels that would, in the long run, imply no change in population size. Population momentum is thus very similar to the momentum of a physical object. Take, for example, a jet airplane that has been climbing rapidly. If the pilot were to ease off on the jet thrusters, the plane would continue climbing, at least for a while. There is a level of fuel supplied to the jet thrusters that makes the plane eventually fly at a constant altitude—neither climbing nor descending. Anything less than this level means that the jet will eventually begin to descend, and anything above this level means that the jet will continue climbing. 3. Why are aging societies, and the individuals who live in them, victims of their own success? Answer: The multiple social challenges that they face—chronic disease, financial burdens, and issues around an extended period of end-of-life care—exist precisely because of increases in life expectancy over the last century. The rise of chronic disease as the cause of death, rather than an acute event like a heart attack, creates new challenges for caring for people at the end of their lives. Chronic diseases generally unfold slowly, so those suffering from them can expect to experience a series of health emergencies that ultimately culminate in their death. That said, most societies are still committed to caring for a person until they die on their own. The United States has a culture and religious traditions that condition its people to operate around a heroic model of medicine, where we expect doctors as well as other caregivers right down to the family itself to "do everything they can" to prolong lives—even when the quality of such a life is suffering for the most part. 4. A doctor, a patient, and his or her family think of illness as an individual event. It is even seen as a contest between the patient and the disease (e.g., "she is winning her battle against breast cancer"). How do sociologists see health issues? Answer: Sociologists take a decidedly different approach to the study of health. First, they focus on the social causes of disease within a population rather than on the immediate causes of an individual's illness. Sociologists want to know why people in some countries are much more likely to die early than those in others, or why poor populations consistently die earlier than more affluent ones. Most approaches to health research focus on individual genetic risk factors or individual behavioral risks. Instead, sociologists are interested in how interactions between individuals and the societies in which they live affect health. Sociologists also consider how social contexts shape individual health behaviors. When confronted with an overweight person, sociologists look beyond the individual's self-control to explain that outcome. Sociologists focus on how social contexts may lead individuals to eat more, and exercise less, than is healthy. They also consider how social interactions and norms affect people's willingness to stop engaging in behaviors that are bad for their health. Finally, doctors generally focus on how our current day-to-day lives affect illness because those are the contexts they can influence. In contrast, sociologists think about how the contexts we inhabit throughout our lives affect our health. For example, babies who weigh too little when they are born are more likely to have a range of health problems as they age. Because poor early health conditions may be as important as your later health behaviors, sociologists consider how events occurring now and, in the past, affect your health. 5. Describe Emile Durkheim's findings when he studied how suicide rates differed across social groups and how social change affected rates of suicide. What does this have to do with how one conducts his or her life in a group? Answer: Durkheim showed that suicide rates are affected by the amount of social integration and social regulation in people's lives. One of Durkheim's most paradoxical results was that social integration and regulation could be either helpful or harmful. In communities where either social integration or regulation is extremely low or high, more people are likely to commit suicide. Strongly integrated groups benefited from the sense of inclusion that strong social ties foster. But Durkheim also showed that too much integration is also associated with higher rates of suicide, as group needs take precedence over individuals' need to survive. On the other hand, social ties not only integrate individuals but regulate their behavior. Without these ties, Durkheim argued that individuals' desires could exceed their ability to fulfil them and thus lead to higher suicide rates. Sociologists, given such evidence, look at the contexts that people inhabit and the relationships that they have with others and at how these play an important role in shaping the choices that people make, especially in regard to behaviors that affect their health and how they either contribute or burden society. 6. Describe the three stages of the life-course (perspective) model that sociologists consider when they examine health issues and demographics. Answer: The first life-course model is a sensitive-period model (or latency model). In this model, very early life exposures can affect adult outcomes but may remain latent for years. Trying to improve health in adulthood does not work if the damage is done once. The idea is that things that happen to you even before you were born—that is, while you were in your mother's womb—can have long-term implications for your adult health outcomes, but their effects do not show up for a long time. The second life-course model is the cumulative-exposure model. Smoking may provide the best example of this model. If you are a smoker, you accumulate exposure to carcinogens over a long period of time. Each cigarette adds up, and by the time you are older, you are more likely to have emphysema and lung cancer if you have exposed yourself to these carcinogens over a long period of time. The final model is the social-trajectory model. According to this approach, your early life experiences determine where you end up in the social pecking order, which in turn influence your health. For example, if you are sick as a child, you may do more poorly in school. As a result, you are less likely to go to college and thus less likely to get a higher paying job. Because you work in an industry that does not provide health insurance, your health is further negatively affected. 7. Why is SES such a useful tool for discussing inequalities in staying healthy, having access to healthcare, and living quality lives? Answer: The idea of SES as a fundamental social cause of health attempts to explain the persistence of the association of health and SES across time and place. Indeed, SES is a multifaceted concept that encompasses access to material resources, access to information, relative status, and control over one's work. These measures of SES have different relationships to health, and the mechanisms that link education to health may not be the same as those that link occupation and health. Another concern is that the causal relationship between SES and health may differ across these measures. It could be the case that poorer health is a cause of lower occupational status. Finally, different dimensions of SES may matter differently throughout the life course. Financial resources may be particularly important at some times, but education may be more important in others. 8. Explain the connection between wealth and health. Why does this connection matter so much in the early periods of the life-course model? Answer: Those with higher incomes have better health. Indeed, health can affect one's income because it affects participation in the labor force. People who are sick may work fewer hours or retire earlier, both of which reduce their income. Poor health also reduces one's wealth. When people become sick, they may have to rely on their savings when they can't work, or spend some these savings on healthcare. Where income and wealth clearly matter, however, is in affecting children's health. Parents with more income can purchase more nutritious food, safer environments, and better medical care for their children. The effects of family income on child health, moreover, appear to increase over time. That is, the difference of the health of poorer and more affluent children is greater later in childhood. Chronic conditions, such as asthma, become more common as children age. Families with more resources can use them to control these health conditions and minimize their effects. 9. What have researchers discovered about education as a cause for better health? What is an additional factor that makes this connection apparent? Answer: Researchers have used a number of creative natural experiments to establish causality. Some of the best-known studies rely on changes in compulsory education laws. As attending school became increasingly compulsory, a metric could be established and studied. Researchers found that students who attended school for more years had higher survival rates as adults, which suggests that education does in fact have a direct effect on health. Income, however, may also explain the association between education and health. Health behaviors clearly play an important role. Those with more education use illegal drugs, alcohol, and tobacco less. Even for people with the same income, people with more education use preventative healthcare more, and they do a better job of managing existing conditions—for example, remembering to take their medications. By some estimates, the better health behaviors of the more educated can explain 40 percent of their health advantage. 10. Discuss the reasons why African Americans have worse health outcomes than non-Hispanic white Americans. Answer: Four main arguments have been made. The first is a genetic explanation, an argument that can be traced to the pre–Civil War debate about slavery. Science played an important role in those debates, as medical evidence was called on to determine whether blacks were biologically inferior to whites and capable only of being slaves. The "scientific" basis for these claims has been disproven, and current research in genetics continues to show that the study of human diversity is not well captured by socially constructed racial groups. The second argument is that racial differences really represent class differences. If this were true, however, there would be no residual racial differences in health once we control for SES. The current literature suggests that black disadvantages in health remain even after these controls are introduced, suggesting that we need to identify causes beyond SES. The third argument is a psychosocial stress explanation. Exposure to discrimination in everyday life may increase stress. When the body mobilizes its responses to stress too often, it loses its ability to regulate itself, which leaves the body at increased risk for disease. Stress may also lead to the adoption of coping behaviors, such as eating or drinking, that have negative effects on health. The fourth argument relates to the quality of treatment that African Americans receive in healthcare settings. Because cardiovascular disease is a leading cause of death, a substantial fraction of this literature has focused on its treatment. It is well documented that black patients who come to the hospital with a heart attack are less likely to get certain treatments, such as bypass surgery. Test Bank for The Sociology Project : Introducing the Sociological Imagination Jeff Manza, Richard Arum, Lynne Haney 9780205949601, 9780205093823, 9780133792249
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