Intersectionality and Health Disparities (10A) - Psych & Soc

1. What is the difference between access to care and quality of care?

   Access is ability to obtain services; quality is effectiveness and safety. Access means getting care; quality means receiving appropriate care.

2. What is implicit bias in clinical decision-making?

   Unconscious attitudes that influence judgments and actions toward patients. Implicit bias affects clinical decisions subconsciously, leading to disparities in diagnosis, treatment recommendations, and patient interactions without overt intent.

3. What is stereotype threat, and how can it affect patient behavior in clinics?

   Fear of confirming stereotypes that impairs communication and engagement. Anxiety about stereotypes can reduce help-seeking and disclosure.

4. What are social determinants of health (SDOH)?

   Conditions of life (housing, education, work, food) shaping health risk. Non-medical factors profoundly influence health outcomes.

5. What is cultural competence in health care?

   Ability to deliver care that respects patients' cultural beliefs and needs. Cultural competence involves providers acquiring knowledge and skills to effectively navigate cultural differences, enhancing patient satisfaction and health equity.

6. What is medical mistrust, and what typically produces it in marginalized groups?

   Distrust of healthcare due to historical and ongoing mistreatment. Past abuses (e.g., Tuskegee) create lasting healthcare avoidance.

7. What is a health inequity (distinct from a simple difference in health outcomes)?

   Unfair, unjust disparities caused by social and structural conditions. Disparities rooted in injustice, not just biological variation.

8. What is a health disparity as used in public health and on the MCAT?

   A preventable health outcome difference linked to social disadvantage. Emphasizes preventability and social roots of health inequities.

9. What is language concordance in clinical care?

   Patient and clinician share a language, improving communication and outcomes. Language concordance reduces miscommunication barriers, leading to better patient understanding, adherence, and overall health outcomes in multicultural settings.

10. What is allostatic load in the context of chronic stress and health disparities?

    Cumulative physiologic wear from repeated stress responses. Body's wear-and-tear from chronic stress activation.

11. Identify the concept: a clinician spends less time with a patient due to unconscious assumptions.

    Implicit bias affecting care delivery. Unconscious stereotypes shape provider behavior and patient interactions.

12. What is a health disparity (as used in public health and MCAT contexts)?

    Systematic, avoidable health outcome differences across social groups. Differences that could be eliminated through social change.

13. What is institutional discrimination in health care?

    Policies/practices that produce unequal care across groups, independent of intent. Systemic patterns create disparities regardless of individual bias.

14. Identify the most appropriate interpretation: a disparity persists after SES adjustment.

    Other mechanisms (discrimination, environment, care quality) likely contribute. SES doesn't capture all pathways creating disparities.

15. What is intersectionality in the context of health disparities?

    Overlapping identities create unique, compounded health advantages or harms. Multiple social identities interact to shape health experiences.

16. What is the key distinction between a health disparity and a health difference?

    Disparity is unjust and preventable; difference may be nonpreventable. Disparities stem from social injustice, not just biology.

17. What is implicit bias, and why is it relevant to clinical disparities?

    Unconscious attitudes that can alter decisions and patient care. Automatic biases influence clinical judgment without awareness.

18. What is the weathering hypothesis regarding chronic stress and health?

    Chronic social stress accelerates physiologic aging and disease risk. Cumulative stress from discrimination causes premature aging.

19. What is the "quality" component of health care disparities most directly about?

    Differences in appropriateness, safety, and effectiveness of delivered care. Quality disparities reflect systemic biases in care delivery, resulting in suboptimal treatment efficacy and safety for marginalized groups despite access.

20. What is cultural humility (and how does it differ from cultural competence)?

    Ongoing self-reflection and power-awareness rather than mastery of cultures. Emphasizes learning from patients, not claiming expertise.

21. What is implicit bias, and why is it relevant to health disparities?

    Unconscious attitudes affecting decisions; can alter diagnosis and treatment. Unconscious biases shape clinical decisions and outcomes.

22. What is implicit bias in clinical decision-making?

    Unconscious attitudes that influence judgments and actions toward groups. Operates without awareness, affecting clinical interactions.

23. What is health inequity (as distinct from disparity)?

    An unfair, avoidable health difference rooted in injustice. Emphasizes moral dimension and systemic causes vs. mere differences.

24. What is structural violence in the context of health disparities?

    Institutional arrangements that systematically harm marginalized groups. Social structures inflict harm through unequal resource distribution.

25. Which concept best explains why new medical innovations can widen SES health gaps?

    Fundamental cause theory. Flexible resources allow advantaged groups to benefit first.

26. Identify the term for unequal environmental exposures by neighborhood and race/SES.

    Environmental injustice. Marginalized groups face disproportionate toxic exposures.

27. Identify the level of racism: a clinician assumes a patient is drug-seeking due to race.

    Interpersonal (often driven by implicit bias in patient-clinician interaction). Interpersonal racism involves direct biased interactions, where subconscious stereotypes influence clinical judgments and contribute to disparate health experiences.

28. What is discrimination in health research (operational definition)?

    Unequal treatment due to group membership (race, gender, class, etc.). Differential treatment based on social category membership.

29. What is the "weathering" hypothesis in explaining health disparities?

    Chronic stress accelerates physiological wear in marginalized groups. Discrimination causes premature biological aging through stress pathways.

30. What is patient-centered communication, as a strategy to reduce disparities?

    Eliciting values/preferences and shared decision-making with the patient. Collaborative approach respects patient autonomy and cultural context.

31. What is discrimination in health care (as a determinant of disparities)?

    Differential treatment based on group status that worsens access or quality. Discrimination in healthcare manifests as biased treatment that exacerbates disparities by reducing trust, adherence, and equitable provision of services to affected groups.

32. What is medical mistrust, and what commonly contributes to it?

    Low trust in health systems, often due to historical and ongoing mistreatment. Past abuses and current discrimination erode patient confidence.

33. What is discrimination in healthcare, and how does it differ from prejudice?

    Discrimination is behavior; prejudice is an attitude or belief. Actions vs. thoughts - both contribute to health inequities.

34. Which term describes patient mistrust due to historical and ongoing medical harm?

    Medical mistrust. Medical mistrust arises from legacies of exploitation like the Tuskegee study, reducing engagement with healthcare systems and perpetuating disparities in vulnerable communities.

35. What is cultural competence in health care delivery?

    Ability to deliver effective care that respects patients' cultural contexts. Skills to provide care aligned with patients' cultures.

36. Identify the concept: a patient avoids clinics due to fear of stigma about their identity.

    Anticipated stigma. Expecting discrimination prevents seeking needed health services.

37. Identify the term for unequal care for equal need across social groups.

    Healthcare inequity. Describes systematic differences in healthcare quality by social group.

38. What is the key difference between intersectionality and additive risk models?

    Intersectionality emphasizes nonadditive, interacting effects of identities. Identities interact synergistically, not just sum together.

39. Identify the concept: risks for a Black transgender woman cannot be predicted by adding race and gender effects.

    Non-additive (interaction) effects consistent with intersectionality. Intersecting identities create unique vulnerabilities beyond simple addition.

40. What is the "fundamental cause" theory explanation for persistent disparities?

    SES-linked resources repeatedly shape disease risk despite changing mechanisms. Resources enable health protection across changing risks.

41. What is stereotype threat in health care settings?

    Anxiety about confirming stereotypes that impairs performance or communication. Fear of confirming negative stereotypes creates stress and barriers.

42. What is health literacy?

    Capacity to obtain, process, and use health information to make decisions. Health literacy empowers individuals to navigate healthcare systems effectively, reducing disparities by enabling informed choices and preventive behaviors.

43. What is cultural humility in health care?

    Lifelong self-reflection and power-awareness when engaging diverse patients. Cultural humility emphasizes continuous learning and self-awareness of biases, fostering respectful partnerships that improve care for diverse populations.

44. What is a health disparity (public health definition) on the MCAT?

    A preventable difference in health linked to social disadvantage. Focuses on differences that could be eliminated through social change.

45. What is structural racism as a determinant of health?

    Policies and institutions that produce racialized inequities in health. Discriminatory systems embedded in laws, policies, and practices.

46. What is allostatic load in stress physiology and health disparities?

    Cumulative wear-and-tear from chronic stress on multiple body systems. Chronic stress causes measurable physiological damage.

47. What is structural racism in health, as a population-level cause of disparities?

    Institutions and policies systematically produce unequal health outcomes. Systems and policies create health inequities, not just individuals.

48. What is the difference between equality and equity in health care access?

    Equality gives same resources; equity allocates by need to equalize outcomes. Equity recognizes different starting points require different support.

49. What is cultural humility in healthcare practice?

    Ongoing self-reflection and power-awareness to improve cross-cultural care. Recognizes culture as dynamic and patients as experts on themselves.

50. What is allostatic load in health disparities research?

    Cumulative physiological burden from repeated or chronic stress. Stress hormones and inflammation accumulate, damaging body systems.

51. What is meant by a social determinant of health (SDOH)?

    Social and environmental conditions shaping health, risk, and access to care. SDOH encompass upstream factors like education, income, and community safety that influence health risks and outcomes independently of individual behaviors.

52. Which concept best explains how neighborhood segregation affects health outcomes?

    Place-based exposure to resources and hazards (neighborhood effects). Geographic concentration shapes access to health-promoting resources.

53. What is a social determinant of health (SDOH)?

    Nonmedical conditions (housing, education, income) shaping health outcomes. Social factors beyond healthcare determine health status.

54. What is the social gradient in health?

    Health improves stepwise with higher socioeconomic status. Each increase in income/education correlates with better health outcomes.

55. Which approach best applies intersectionality when comparing outcomes across groups?

    Stratify by combined identities (e.g., race × gender) rather than single categories. Examines how identity combinations create distinct outcomes.

56. What is the fundamental cause theory explanation for persistent health disparities?

    Access to flexible resources sustains disparities despite new risks/treatments. Resources (money, knowledge) enable health advantages across contexts.

57. What is intersectionality in health disparities research?

    Overlapping identities create unique, non-additive health risks. Multiple marginalized identities interact to produce compounded disadvantages.

58. What is the biopsychosocial model of health used to frame disparities?

    Health reflects interacting biological, psychological, and social factors. Integrates multiple levels of analysis to understand health outcomes.

59. Identify the most likely mediator: discrimination increases hypertension through chronic stress.

    Allostatic load. Physiologic dysregulation from repeated stress responses.

60. What is internalized stigma and how does it relate to health disparities?

    Adopting negative beliefs about one's group; worsens stress and health behaviors. Self-stigma creates stress and unhealthy coping behaviors.

61. Which study design best tests whether discrimination mediates the link between race and hypertension?

    Mediation model: race → discrimination → hypertension. Tests if discrimination explains how race affects health outcomes.

62. What is structural violence as a cause of health disparities?

    Social structures that systematically harm health by limiting resources. Social systems inflict harm through resource deprivation.

63. What is interpersonal discrimination in the context of health outcomes?

    Direct biased treatment by individuals that can impair health and care access. Face-to-face bias affects treatment quality and access.

64. What is allostatic load?

    Cumulative physiologic wear from repeated or chronic stress responses. Allostatic load measures the biological cost of adapting to stressors, accumulating damage that heightens vulnerability to chronic diseases in marginalized groups.

65. Which concept explains why race is treated as a social, not biological, category in health?

    Race is a social construct; disparities reflect social conditions, not genes. Health differences stem from racism, not biological race.

66. What is weathering as an explanation for racial/ethnic health disparities?

    Accelerated health decline from chronic exposure to social adversity. Continuous stress exposure ages bodies prematurely.

67. Identify the concept: unequal health outcomes persist after controlling for income and education.

    Structural factors (for example, racism) beyond individual SES. Shows health gaps stem from systemic inequities, not just poverty.

Study these flashcards