Reflection Questions

1. Think about the community you live in. What are physical and social factors in the community that create health inequities?
2. In thinking about your community, what has been a process for the community changing something (a rule or regulation) in an attempt to improve community health and well-being. In what ways has the process been equitable or inequitable?
3. What would you consider are the key features that define a “healthy” community?

Discussion Questions

1. Lacey et al conducted a qualitative study, finding that “for women in our groups, smoking was associated with relief from the heavy burden of stress in their lives”. What lessons can we draw from their work that could inform health promotion programs today?
2. Wilson and Daly did something very interesting with life expectancy in their analysis, something different from most studies in this field. What did they do differently, what line of analysis did they open up as a result?
3. The work of Sampson et al highlights the importance of “concentrated disadvantage” as a critical variable for social epidemiology. What do they mean by this term?
4. Collins and David observed that “the effect of violence on small-for-gestational age rates outweighs the benefits of early initiation of prenatal care”. How does their conceptualization of this relationship compare to other chapters in this book, for example, Warren-Findlow’s analysis of “weathering”?
5. “Reverse causality” is discussed by Lochner et al as an important limitation of their work: “we cannot exclude reverse causality, that is the possibility that higher death rates led to erosion of trust and other indicators of social capital”. This is an important issue in many cross-sectional studies. Compare the concern over “reverse causality” with Faris and Dunham’s “drift hypothesis”.
6. Gupta et al used the “community vitality index” as a predictor of area-level asthma burden, exploring the importance of positive community factors. Why might this be a particularly valuable way of modeling health inequities?

Solution Finding

1. Imagine that you are a community leader reading this section of the book. What concepts resonate with you? How would you use these findings to make real change?

Further Readings

Block, D., & Kouba, J. (2006). A comparison of the availability and affordability of a market basket in two communities in the Chicago area. Public Health Nutr, 9(7), 837-845.

Browning, C. R., & Cagney, K. A. (2002). Neighborhood structural disadvantage, collective efficacy, and self-rated physical health in an urban setting. J Health Soc Behav, 43(4), 383-399.

Masi, C. M., Hawkley, L. C., Piotrowski, Z. H., & Pickett, K. E. (2007). Neighborhood economic disadvantage, violent crime, group density, and pregnancy outcomes in a diverse, urban population. Soc Sci Med, 65(12), 2440-2457.

Subramanian, S. V., Lochner, K. A., & Kawachi, I. (2003). Neighborhood differences in social capital: a compositional artifact or a contextual construct? Health Place, 9(1), 33-44.

Palazzo, L., Guest, A., & Almgren, G. (2003). Economic distress and cause-of-death patterns for black and non-black men in Chicago: reconsidering the relevance of classic epidemiological transition theory. Soc Biol, 50(1-2), 102-126.

Papachristos, A. V., Wildeman, C., & Roberto, E. (2015). Tragic, but not random: the social contagion of nonfatal gunshot injuries. Soc Sci Med, 125, 139-150.