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University of Missouri Individual Unnatural Causes Discussion Questions

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watch the video and answer the 8 questions

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Unnatural Causes Discussion

Q1. Dr. Adewale Troutman says that he promotes individual responsibility, but always within the context of social determinants. Why does he link the two? What is missing if we focus exclusively on individual responsibility? How does this affect possibilities for change?

Q2. Dr. Ichiro Kawachi observes that the ability to avoid smoking and eat a healthy diet depends on access to “income, education, and the social determinants of health.” Do conditions in your community promote or hinder healthy choices? What policies shape those conditions?

Q3. Angelique Anderson says: “I always wanted to have a house with a big back yard…” Corey adds: “I want to own a house so that if anything happened to me, she wouldn’t be put out on the street.”

1. What health benefits might derive from affordable, quality and secure housing?

2. How does home ownership (or its lack) affect conditions in your community?

3. How easy or difficult is it to find quality, affordable housing in your community?

Q4. Some chronic stressors mentioned in the film are: being on guard all the time, having little control at work, living in an unsafe neighborhood, being uncertain about where food will come from, and worrying about one’s children.

1. What additional stressors can you think of?

2. How does exposure to stressors – and resources available to manage them – vary with class position?

3. Describe the societal forces that create and reinforce these stressors.

4. What additional set of stressors might racism impose?

Q5 . Dr. Troutman says: “There’s almost a cultural demarcation in the city where on one side of this particular street, Ninth Street, there’s a tremendous amount of new development going on, condos rising up…And right across the street is where the public housing projects begin…Every city has a Ninth Street.”

1. Where is the Ninth Street, the dividing line, in your city or area?

2. How would you characterize either side of the line? List and compare the health promoters and health threats.

3. Who lives there and who doesn’t? Why?

4. Were these areas different in the past? What government, land use, development and other investment decisions changed them?

Q6. Dr. Jack Shonkoff, when talking about early childhood, says, “The concept here is the pile-up of risk, the cumulative burden of having things that are increasing your chances of having problems, as opposed to the cumulative protection of having things in your life that increase the likelihood that you can have better outcomes.” What are examples of the “pile up” of cumulative advantage – and disadvantage?

1. Sociologist David Williams says, “Economic policy is health policy.” How has the U.S. influenced health inequities and health outcomes? What kinds of economic policies might reduce health inequities and improve the overall health of most Americans?

Q7. The film notes that sweeping social reforms made during the Progressive Era, the New Deal, and the Civil Rights Movement improved population health.

1. Why would changes that promote greater equity translate into population health improvements?

2. What do you notice about whether those policies or programs emphasized medical advances, greater individual responsibility, new programs and services, or structural and social change?

3. Should knowing about the health effects of social policies change the value that Americans place on these kinds of policies? Why or why not?

Q8. Whitehall study director Sir Michael Marmot says, “If inequalities in health were a fixed property of society, then you’d say ‘We can’t do anything about it.’ But that’s not the case. The magnitude of inequalities in health changes over time. It can get rapidly worse, and if it can get rapidly worse, it ought to be possible to make it rapidly better.” Describe how the policies below might promote better health for everyone. What other policies or social changes might you add to this list?



8-hour work day

Guaranteed paid vacation

Minimum wage

Living wage

Unemployment insurance

Job training and placement

Free K-12 public education

Paid parental leave

Affirmative action (limited)

Housing assistance

Social security

Universal health care

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