1. Modern Mortality and Morbidity Differentials in the U.S. SOC 331, Population and Society, 07.08.2009

5. Sex and Mortality Risky behaviors (Waldron) –Alcohol consumption –Violence –Illegal activities –Driving accidents –Gun use suicide

6. More Sex and Mortality Sex roles (Waldron) –Employment accidents –Type-A personalities –Historically, women as caretakers exposed them to infectious disease –Discrimination

7. Sex and Mortality, again Infant & child mortality (Waldron) –Historically, female infants had higher mortality, probably from discrimination –Presently, male infant mortality higher –Female child mortality still higher in many cultures - related to economic productivity?

8. Sex and Mortality… Biology & environment (Waldron) –Women have higher rates of sex-specific cancer because of breast cancer –Some speculate that women might be protected from heart disease by estrogen –Incidence of cancer & heart disease accounts for much of sex differential - prognosis accounts for much less

9. Sex and Mortality Smoking (Pampel; Waldron) –Much more common among men –Smoking accounts for much of lung cancer, which causes 3/4 of men’s excess mortality –Contributes to heart disease excess among men

10. Smoking, Sex and Mortality Smoking diffusion(Pampel) –Men take up smoking first Risky behavior is more socially acceptable –Male mortality increases 20th C increasing divergence –Females begin to take up smoking –Female mortality increases –Male & female smoking rate converges –Female advantage decreases

11. Smoking, Sex and Mortality Cigarette diffusion varies (Pampel) –History –Place/culture –Public policy –Commercial differences

12. Sex and Mortality Questions Cigarette diffusion hypothesis: –What impact would public policy measures have, such as smoking bans in public places? –What type of sex differences might exist in public policy design, implementation, and impact? –Even with our knowledge about the detrimental effects of smoking, Pampel’s hypothesis states that women will smoke at rates comparable to those of men. Is this inevitable?

13. Race and Mortality Overall trends: –Asian-Americans have lower mortality than whites for almost all causes of death –African-Americans have higher mortality than whites for almost all causes of death Suicide is the one notable exception –Primary causes of death are similar across races - just the rates are different

15. Race and Mortality Smoking –Blacks males and females have higher cancer rates than whites (Rogers) Blacks more likely to smoke Whites and African-Americans more likely to smoke than other groups but whites are heavier smokers

16. Race and Mortality Family (Rogers) –Married individuals have lower mortality, but blacks are less likely to be married –Individuals living in smaller families have lower mortality rates, but blacks are less likely to live in small families –Diabetes: those who are married manage their illness better than single people & those diagnosed early have better health outcomes

17. Race and Mortality Homicide (Rogers; Guest et al.) –Blacks are 3, 6 or 9 times more likely to be victims of homicide than whites (it depends on who you ask) –Alcohol –Poverty –Cultural and social differences in how blacks and whites deal with personal and interpersonal difficulties (Rogers)

18. Race and Mortality Accidents (Rogers) –Alcohol consumption plays a role –House fires –Drowning –Pedestrian accidents But fewer car accidents

20. Race and Mortality Questions What component of being married confers health benefits on an individual? By what mechanisms might this operate? –What might be the effects of cohabitation on mortality? –How might the effect of marriage (or cohabitation) on mortality vary by race?

21. Class and Morality (Guest, Feinstein, Rogers et al.) Inverse relationship between class and mortality, stable over time (Feinstein) Education (Feinstein, Guest, Rogers et al) –Usually strong inverse relationship –Less education can contribute to social disadvantage among NA, Mexican Am., and AA (Rogers et al) Unemployment –Positive relationship –Contextual versus individual effects –Causal order

22. Class and Mortality (cont) Income –Inverse relationship –Problems with causal ordering Measures of wealth may solve this problem Inverse relationship between wealth and mortality (Feinstein) –Strength of SES varies by race (Guest) –Some evidence that mortality may be higher in “poverty areas” Basic public services and health access may be substandard

23. Materialist and Behavioral Explanations Materialist explanations involve both personal financial resources (housing, automobiles) used to “purchase” good health and public resources (sanitary living conditions, public housing, public transportation, reducing environmental pollution and occupational safety hazards) Behavioral explanations are connected to individual characteristics…for which a healthy state cannot be purchased directly with money (smoking, diet, exercise habits, driving habits, alcohol and drug consumption)

24. The Health Care System There is also some evidence that lower socioeconomic groups have poorer experiences… –In preventative care –Diagnosis and entry into the health care system –Treatment efficacy –Follow-up and readmission

25. Many of the features of class can work at the individual or contextual level. Which of these processes seems more important? Is this dependent on setting (developing versus developed)? Do materialist or behavioral explanations seem to explain more of the disparities in health? What might be the role of mental health? Stress? How might mental health be subject to the same causal order problems as unemployment, education or income?

26. Bongaarts, “How Long Will We Live?” Pessimists believe that future life expectancy has an upper limit of about 85 years –Biological argument: determined age pattern of senescent mortality Rises steeply after age 30 –Demographic argument: improvements in life expectancy at birth can only result from improvements in “premature” mortality

27. Bongaarts (cont) The large increase in life expectancy pre-1950 was primarily attributable to reductions in juvenile and background mortality Post 1950 the rise in female senescent life expectancy became the dominant cause of the rise in life expectancy (p. 614) Smoking provides a plausible partial explanation for the stall in male life expectancy and the divergence of trends in male and female life expectancy in the 1950s and 1960s (p. 615) Future increases in life expectancy must come from improvements in senescent mortality.

28. Final question How long will we live?

29. Not very long if you smoke. It also doesn’t look so good if you’re black, poor or male.