Free Essay Example: The Rise of Americans' Body Mass Indexes

Obesity is a complex, multifactorial, and mostly preventable disease affecting overweight, over a third of the world. If secular trends continue, by 2030, an estimated 38% of the world's adult population will be overweight, and another 20% will be obese. In the USA, the direst projections of earlier secular trends point to over 85% of adults being overweight or obese by 2030 (Starr, 2017). While growth trends in overall obesity in most developed countries seem to have leveled off, morbid obesity in many of these countries continues to climb, including among children. Besides, obesity prevalence in developing countries continues to trend upwards toward U.S. levels.

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In parallel, new disciplines have emerged e most prominently, social epidemiology and population health e whose core definition is not being risked factor epidemiology and rejecting the emphasis on individual-centered public health practices. These reconfigured fields aim to find new means of improving societal health outside the provision of healthcare services, for example, by influencing social and economic policies, mass communication, and the built environment.

One contentious issue in establishing this emerging paradigm is the mechanism by which social factors lead to health and disease in individuals' bodies. Frequently, the shorthand for this issue is ''how does culture get under the skin?'' Most everyone recognizes social, economic environmental exposures socioeconomically, and differential access to health care makes a difference what these new fields want to understand and socio-economic contextual factors ''above'' the individual's level.

Two broad causal conceptions have emerged, especially salient in debates over the health socio-economic of income inequality. One emphasizes material mechanisms over the life course, such as the availability and quality of schools, housing, and socioeconomics (2017). The competing conception emphasizes the critical role of psychosocial mechanisms, such as the perception of one's position on the socio-economic ladder, in shaping societal health (Starr, 2017).

Psychosocial proponents point to research on stress and heart disease and the role of relative not only comprehensive income on health outcomes. These are ways that individuals and populations' health results from how societies generally recognize, define, name, and categorize disease states and attribute them to a cause or set of objectives. These framing ideas and practices can have profound effects by influencing individual and group behavior, clinical and public health practices, and societal responses to health problems.

Many of these causal pathways are frequently uncovered in standard epidemiological studies but are categorized as biases or confounders rather than causes or mediating influences. This dismissal makes sense if we assume. As most health researchers do, that social and historical variation in health beliefs, diagnostic practices. What problems are medicalized are mere epiphenomena concerning ''real'' health status. But I will argue below that these framing phenomena are sometimes the very mechanisms by which the social patterning of health and illness emerges.

I use framing somewhat euphemistically for what is often referred to as the social construction of disease (Starr, 2017). This usage may avoid a few unwanted connotations. Sometimes, the style of the constructionist argument of dated cultural relativism lacks common sense. And reflexive opposition to biomedicine. In recent socio-historical scholarship, have not only there been terminological shifts. A substantive one from case studies of prominent borderline diagnostic categories (e.g., homosexuality as a disease in psychiatric nosology) to more complex and systematic research. Into normative medical categories and classifications (cancer, heart disease, etc.).

Although there is no inconsistency between attributing a causal role to framing phenomena and materialist and psychosocial ones, they are rarely combined and often sort by discipline (e.g., historians focus on framing aspects while social epidemiologists focus on materialist and psychosocial ones). Yet, knowledge and insights stored in these different silos might profitably borrow from one another, resulting in more complete accounts of the social patterning of health.

Below I survey a range of framing mechanisms. And consider the plausibility of understanding them as etiological in the social patterning of health. Some of the examples are drawn from the epidemiological literature. Investigators typically explored associations hitherto recognized in material or psychosocial terms. But upon further and more subtle analysis. It proved to explain reporting and selection biases, misclassifications better. And misapprehension of changed diagnostic criteria. And patterns for actual disease change, or misleading representations of efficacy.

Other examples come from the social sciences. Consideration of framing phenomena in disease has a long history within medical history, sociology, and anthropology, albeit, under different labels, each with their own (often contested) scope and connotations social construction, medicalization, labeling, U.S. It is much less widely recognized, especially in the emerging field of population health and the policy attention given to healthy individuals. In U.S. phenomena in aggregate represent a mechanism that is causing mediating .some social and temporal patterns of health and disease in the contemporary U.S. That the evidence for ''framing as mechanism'' is right before our eyes in the medical and epidemiological literature. And yet is not recognized as such, in no small measure because from the perspective of everyday medical and public health rationality, these phenomena are obstacles and diversions from understanding ''true'' causal mechanisms.

As a final introductory note, I want to point out that while I evoke ''how culture gets under the skin'' to situate my argument about framing as the mechanism. I do so only because it is the most common shorthand that epidemiologists and clinicians use to map social conditions to biological phenomena. They intuitively want to capture what exactly is inside and outside the body or culture, or what culture is and is not. In other words, I am using an existing and problematic term of reference.

Yet, by arguing for the inclusion of framing phenomena, I want to challenge medicine and epidemiology's every day if poorly articulated assumptions about the location and meaning of this culture/body interface. Starr's book of Social Science & Medicine (2017) means a unique challenge. Still, I hope to contribute to the burgeoning population health field by using findings from within the medical and epidemiological literature and the interpretive social sciences, which are non-trivial in their scope and implications, and that are not confined to borderland health conditions.

Some beliefs, linguistic and classificatory norms, and social dynamics not usually understood in etiological terms. They are not down payments on a new conceptual model. The expanding literature on the social determinants of health does not need another ''arrow salad'' in which everything causes everything else. Focusing on a few identifiable pathways because of the very complexity of multi-causal and multi-level models can and has been used as a pretext to give up population-based health interventions. Critics argue that it is too challenging to imagine sensible and practical points of leverage (Starr, 2017). Social and structural framing of diagnoses.

It has been widely observed in the United States that asthma's incidence, mortality, and hospitalization rates have been rising and that these trends are dramatically worse for the urban poor and ethnic minorities. Biomedical and social scientists have generally looked to micro-environmental (e.g., dust mites and cockroaches) and psycho-biological (stress formulations with immune mechanisms) explanations.

Yet, there are clues in the existing clinical and epidemiological literature that the distribution of asthma diagnoses also reflects historically conditioned values, interests, and social structures, many of which might be profitably studied and understood with the methods of a cultural anthropologist or medical historian. For example, star (2017) has demonstrated some socio-economic conditions when the prevalence of wheezing and rates of asthma diagnoses in an emergency room setting.

These authors cautiously suggested that race and socio-economic status may be more critical to the acquisition of a diagnosis of asthma than to the prevalence of symptoms themselves. In an accompanying editorial, Starr (2017) interpreted these results to possibly mean that inadequate primary care (and emergency physic social-economic about poor follow-up) led to more asthma diagnoses among poor children who had wheezing episodes.

If this framing effect was the widespread social-economic, the observed temporal, income, ethnic, and geographic variation in asthma, there might be differences in the diagnostic and label put at the socio-economic role played by more material aspects of poverty). In this case, ''culture may have gotten under the skin'' by how people interact with socio-economic realities (lack of insurance, inadequate primary care) and beliefs about the disease. (e.g., that people with poor follow-up do better with the asthma diagnosis and immediate treatment than watchful waiting) create social patterns of health and illness that can, at some point, also become self-sustaining.

The self-sustaining aspect occurs when the perceived social patterning of the disease itself becomes a part of the diagnostic act; in this case, the fact that asthma is seen to be more prevalent among the poor itself favors the diagnosis of asthma among the poor. Medical diagnosis is a necessarily Bayesian exercise. The ''prior probability'' of disease shapes the diagnosis. Such beliefs also influence individuals' health-seeking behavior.

An extreme form of this kind of self-sustaining pattern exists when the social shaping of disease classification has resulted in a small set of stable, highly culturally framed diagnostic options. This nosology constrains individual symptomatic acts. While at the same time. Their cumulative effect can reinforce the stability of the nosological system. Consider the highly gendered framing of headache diagnoses in the United States today.

As a result of a complicated if personal social history for gendered diagnoses (Starr, 2017), many American neurologists came to believe that most headache syndromes could be classified as either a primarily female ''migraine'' or a mostly male ''cluster headache.'' Aside from the contribution played by any putative biologically based sex differences in the etiology of different headache patterns, once these gendered diagnoses were made available and legitimated these clinical and epidemiological ''facts would constrain individual diagnostic acts.''

Technological change affects frame in a widely cited Starr (2017) article, epidemiologist coined the term the Will Rogers phenomenon to explain an apparent paradox in cancer statistics. (Starr, 2017). Starr, (2017) recalled that humorist Will Rogers had once quipped that when the Okies migrated from Oklahoma to California during the Depression, the average I.Q.s of both 1 I thank Bruce Link for this term.