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The “Haves” and “Have Nots”: Why Are There Disparities?

The “Haves” and “Have Nots”: Why Are There Disparities

Application: The “Haves” and “Have Nots”: Why Are There Disparities

Earlier in the course, the different population health outcomes of two culturally and economically similar neighbors (the U.S. and Canada) were considered. This week, the focus shifts to the eastern hemisphere and an examination of health inequalities between and within nations with large, diverse populations.

Both India and China had similar health outcomes at the end of WWII. Unlike India, China’s health improved tremendously over the next 30 years. When it did not have a focus on economic growth, China’s health achievements surpassed India. Since the economic reforms 30 years ago, health progress in China has not been growing as much. Today, India is booming and is home to some of the richest people in the world, but it is also home to more food insecurities than anywhere else in the world.

To prepare for this Assignment, review your Learning Resources this week. Consider how certain large populations within a single political entity can still display disparate health outcomes. Think about how areas such as Kerala can have remarkably different health outcomes than the countries they are in. What makes those areas different from the rest of the country


I. Paper demonstrates an excellent understanding of all of the concepts and key points presented in the text(s).

II. Paper must provide significant detail including multiple relevant examples, evidence from the readings and other sources, and discerning ideas.

III. Paper is well organized, uses scholarly tone, follows APA style, uses original writing and proper paraphrasing, contains very few or no writing and/or spelling errors, and is fully consistent with graduate-level writing style.

IV. Paper must contain multiple, appropriate, and exemplary sources expected/required for the assignment.


The Assignment (3 pages):

1.Describe two health outcomes for which India and China have had different experiences in the last half-century.

2.Explain the reasons for the disparities noted.

3.Describe the experience for those outcomes in Kerala and suggest reasons for why they are similar or different from the rest of India.

4.Expand on your insights utilizing the Learning Resources.
Use APA formatting for your Assignment and to cite your resources.

Dummer, T. J. B., & Cook, I. G. (2008). Health in China and India: A cross-country comparison in a context of rapid globalisation. Social Science & Medicine, 67(4), 590–605.
Retrieved from the Walden Library databases.

Kanjilal, B., Mazumdar, P. G., Mukherjee, M., & Rahman, M. H. (2010). Nutritional status of children in India: Household socio-economic condition as the contextual determinant. International Journal for Equity in Health, 9(1), 19–31.
Retrieved from the Walden Library databases.

Mukherjee, S., Haddad, S., & Narayana, D. (2011). Social class related inequalities in household health expenditure and economic burden: Evidence from Kerala, south India. International Journal for Equity in Health, 10(1), 1–13.
Retrieved from the Walden Library databases.

National Informatics Centre, Government of India. (2014). Know India—Kerala health. Retrieved from http://knowindia.gov.in/knowindia/state_uts.php id=60

Tang, S., Meng, Q., Chen, L., Bekedam, H., Evans, T., & Whitehead, M. (2008). Tackling the challenges to health equity in China. Lancet, 372(9648), 1493–1501.
Retrieved from the Walden Library databases.

Living in Disadvantaged Neighborhoods is Bad for Your Health
Program Transcript

ANGELA GLOVER BLACKWELL: We had vast public investments in building the suburbs of America. Federally supported loans, FHA loans, went to people who were moving to the suburbs, and for many years, up until the ’60s, those loans were available on a racially restricted basis. African Americans and other people of color didn’t have access to them.

NARRATOR: Until 1962, out of $120 billion in government backed home loans, less than 2% went to non-white households. In northern California, between the war in 1960, of 350,000 federally guaranteed new home loans, less than 100 went to black families. In cities like Richmond, African Americans were left behind, in increasingly neglected neighborhoods. In the 1980s, poor Latino and Southeast Asian immigrants began joining them in these same neighbors.

LAURA KUBZANSKY: Once a community starts to go downhill, nobody wants to actually invest in the community. So the banks don’t want to come in, and the shops don’t want to come, and then you don’t have a commercial base. You don’t have the community taxes that can then feed back into the schools. Now you don’t have good schools. So families don’t want to move into the community if they don’t have to because you don’t have good schools. And you get a sort of vicious cycle of everybody who can, will leave the community.

ANGELA GLOVER BLACKWELL: This isn’t something that happens overnight. And it isn’t the fault of the people who live there. The people who live in a low income, dis-invested communities did not do this to themselves.

NARRATOR: Twenty years before his heart attack, Gwai tried to move family out of Richmond. But 11 months later, they had to move back.

GWAI BOONKEUT: I can’t find a job up there, and she can’t find a job up there and move back. My oldest son hanging around with the wrong group, and then using some kind of drug. I just don’t know what to do. I tried to help you him. Tried to straighten him out; spend a lot of money, own people a lot of money. That’s what’s in my mind all the time, such worry, just worry, worry. When I’m going to pay up all of these, and how I’m going to do it.


LAURA KUBZANSKY: If you think about when you’re worried, your a little bit more activated, there’s a little bit more vigilance. You’re sort of checking things out a little bit more carefully. And if you can imagine that happening, day after day, all day, every day, it’s exhausting. And it wears on the body’s system.

NARRATOR: When stress is chronic, when we’re endlessly worried about bills, our job, our children’s safety, the body pumps out cortisol and adrenaline. But too much of these stress hormones over time, can increase arterial plaque. Raise blood pressure, and weaken our immune system, increasing our risk for almost every chronic disease, including heart disease, the leading killer in America.

FEMALE SPEAKER: We’ve done that studies that have shown that living in disadvantaged neighborhoods is related to an increased risk, about 50% to 80% increase in the risk of developing heart disease. And this has been replicated in other studies.

Wealth Equals Health
Program Transcript

MALE SPEAKER: In America wealth pretty much equals health. And that’s true for me as it is true for the poorest person in the quote unquote “inner city.” There’s a gradient and all the way along the way, you could find yourself somewhere along that gradient. It’s not like, you’re poor and you have bad health and then you’re not poor and you have good health. For each step along that wealth gradient, you have a corresponding step of health.

When you’re a new immigrant, the relationship between wealth and health is relatively loose. As you become more American, that relationship becomes tighter and tighter and tighter.

NARRATOR: After only five years in the US, Latino immigrants are 1.5 times more likely to have high blood pressure than when they first arrived, and to be obese. Rates of heart disease and diabetes also increase.

More than 20% of Latino households are poor. The longer they’re here, the more immigrant families struggle with discrimination, low paying jobs, bad schools, and bad housing.

MALE SPEAKER: And if that environment is giving you cues, that you’re not valuable, that you have very little prospect for a good future. That starts to build up and you internalize that devaluation.

Laureate Education (Producer). (2011). Global health and issues in disease prevention [Multimedia file]. Retrieved from https://class.waldenu.edu

“Population Medicine for Rich Nations,” featuring Stephen Bezruchka, MD
Population Medicine for Rich Nations Program Transcript
DR. STEPHEN BEZRUCHKA: And you can already tell from what you’ve learned before that changing circumstances in early life is really important; that providing policies that take care of everyone instead of the wealthy and powerful are really important. But you might say, if we think about the United States, yes, we have a big gap between the rich and the poor. Yes, we have almost half of the world’s billionaires. We can’t change that. That’s some of the frustration that a lot of people working in public health realize. We can’t change the economic structures of the United States.
But we’ll find out that back in the 1940’s, a democratic president in the United States actually proposed a maximum wage to limit the gap between the rich and the poor. We’ll find that a republican president in 1969 actually proposed a guaranteed income for all American families with children. That legislation actually made its way through the House of Representatives and it languished in the Senate, and Watergate gave it the death knoll.
But think about it, both democratic and republican presidents have espoused the kinds of policies that would have limited inequality in this country. And so these ideas are not radical or revolutionary. All we need to do is take today’s record inequality in this country and try to close the gap a bit.
How are we going to do this Well, the key thing is that most Americans are not aware of these critical factors that impact the health of whole societies, nor are they aware that we die younger than people in all the other rich countries. So part of the challenge for you as a public health student is to try to present these ideas to the American people and to others and get discussion going.
It’s much the same as the way things started a couple of hundred years ago in the United States when we had slavery, and we all thought that this was what made America great. We had slaves to do all the cotton picking and other work in this country. And so we were able to export cheap cotton.
But a group of concerned women in New England said, “You know, we don’t have the vote. That’s not so good, but slavery’s even worse,” and so they formed sister societies and got together, and talked in communities about what really was important for the United States. And they worked slowly and determinedly for decades, and eventually we got an emancipation proclamation.
So we want you to think in the same way. What can I do collectively to try and change the economic inequality in this country, and get us living longer, because that’s really what it’s all about. But very few of us recognize the links between economic inequality and our health as a society. So that’s the challenge that we face in this section, and hopefully it’ll be a challenge that you’ll maintain for the rest of your working life.

Health Status of the Former Soviet Union, India, and China Program Transcript
DR. STEPHEN BERUCHKA: So a lot of this course is looking at the patient or the unit of study as a country. If we look at a country as a unit of analysis or a group of countries, and then we see where inequalities–if they’re as important as you’ve been studying–if inequalities change, what happens to health of those societies So there are natural experiments that take place. Things that historically have happened that can help us understand the key principles in this course. So let’s look at a few examples. The former Soviet Union, Russia and the various Soviet Socialist Republics are a prime example of what happens when inequality increases. You remember that in 1990-91, the former Soviet Union broke apart. What happened after that Inequality increased incredibly. Russia came to have the second or third largest number of billionaires in the world. And you had none in 1990. So suddenly, there was a big gap between the rich and the poor.
What happened was that health in Russia declined absolutely. That is, death rates went up and it was only one of two times in the entire last century where there was a sustained decline, not only a lack of health improvements, but an absolute decline in health status. That is, mortality rates went up. This is well documented. It was amazing how it became an intense subject of study among experts in the 1990’s, and the studies have been maintained through the 21st Century. So Russia demonstrates what can happen when a society becomes highly unequal and this actually leads to a large number of excess deaths.
Similarly in the former Soviet Socialist Republics, there’s been the same findings but attributed at different parts of the life span, because what happened in Russia is that the caring and sharing cohesive nature of society really fell apart and the most vulnerable were single, middle-aged men, and each society kind of falls apart in different ways. And these single, middle-aged men in Russia consumed even more alcohol than they were doing before, and they died from alcohol-related diseases.
Now mostly in this course we don’t talk about diseases because we’re really interested in health. But sometimes where a disease understanding helps us gain some new insight, this will be presented. And Russia and its increased mortality from cardiovascular disease represents one such example; so an important case study, countries of the former Soviet Union.
We’ll also see that in 1900, Russia was much less healthy than the United States, but by 1960, it had caught up. But after 1960 it didn’t improve to the same extent that the United States did. So population health is an incredibly dynamic subject. Things keep changing, and whatever’s true today–we can make some predictions about the future, but there will always be surprises because it’s hard to predict what the political changes will be five or ten years from now. Maybe we’ll go back to our policies in the 1940’s or 1960’s in the United States, and health will begin to improve compared to other countries.
Another example of case study is comparing two other patients or entities: India and China. Both were brand new countries around the same time: 1947 and 1949. They were a comparably sized: 400 million, 600 million, pretty similar. They then underwent a very different trajectory. One was a highly structured society, built upon Maoist principles. And both countries had comparable health indicators in 1949. But by 1980, China had exceeded India in almost all the mortality indicators of health, and was far ahead. During this period it hadn’t had any economic growth, what we think of as progress. But since 1980, China embraced a Western model and has experienced some of the highest growth rates in the world and its health improvements have languished. Isn’t that interesting Its health improved tremendously before it underwent economic growth, and then it kind of tapered off after that. And that tends to be the case.
Now, life expectancy or these measures of health of a society are averages. They hide huge discrepancies within the borders. So we see that actually health is not doing so well. It’s even declining among young children in rural China, and quite different in other parts of China. India, on the other hand, has sort of caught up a little bit in health status to China for a variety of puzzling reasons. When we break India up, we will find that Kerala state in India is almost as healthy as the United States, despite being one of India’s poorest states that hasn’t embraced the corporate globalization that other states in India have. So this will enable us to compare and contrast two societies, India and China, and how they attain various health outcomes as another example of looking at the country as our unit of analysis.

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