The Sources Of Social Power, Volume 2: The Rise...
Distinguishing four sources of power in human societies ideological, economic, military, and political The Sources of Social Power traces their interrelations throughout human history. This second volume of Michael Mann's analytical history of social power deals with power relations between the Industrial Revolution and the First World War, focusing on France, Great Britain, Hapsburg Austria, Prussia/Germany and the United States. Based on considerable empirical research, it provides original theories of the rise of nations and nationalism, of class conflict, of the modern state and of modern militarism. While not afraid to generalize, it also stresses social and historical complexity. Michael Mann sees human society as a patterned mess and attempts to provide a sociological theory appropriate to this. This theory culminates in the final chapter, an original explanation of the causes of the First World War. First published in 1993, this new edition of volume 2 includes a new preface by the author examining the impact and legacy of the work."
The Sources of Social Power, Volume 2: The Rise...
Racial and ethnic minority providers play an important role in addressing disparities because they help bridge cultural gulfs (Butler et al., 2014; Cooper et al., 2003; Lehman et al., 2012), and greater proportions of them serve minority and socially disadvantaged communities (Cooper and Powe, 2004); however, these providers are underrepresented in the health professions, and they face challenges that may constrain their professional development and the quality of care they are able to provide (Landrine and Corral, 2009). Specifically, they are more likely to serve patients in resource-poorer areas and lack professional privileges associated with academic and other resource-rich institutions. The structural inequities have implications not only for individual clinicians but also for the patients and communities they serve. Pipeline programs that grow the numbers of minority providers may help to address underrepresentation in the health professions. The available data suggest that pipeline participants are more likely to care for poor or underserved patients when they join the workforce (McDougle et al., 2015). Supporting the professional development of and expanding the resources and tools available to providers working in resource-poor communities seems to be one option for improving access to and quality of care; however, the literature does not clearly elucidate the relationship between health care workforce pipeline programs (e.g., to grow the numbers of minority providers) and their impact on the social determinants of health for poor and underserved communities (Brown et al., 2005; Smith et al., 2009). A commitment to equity is not enough to remedy the discriminatory treatment that results from implicit biases because the inadvertent discriminatory behavior co-occurs alongside deeply held personal commitments to equity. Identifying implicit biases and acknowledging them is one of the most effective steps that can be taken to address their effects (Zestcott et al., 2016). Trainings can help health care providers identify their implicit biases. Well-planned allocations of resources, including time, may afford them sufficient opportunity to account for it while serving diverse persons/patients.
Wealth affects health through mechanisms that are not necessarily monetary, such as power and prestige, attitudes and behavior, and social capital (Pollack et al., 2013). Even in the absence of income, wealth can provide resources and a safety net that is not available to those without it. (See Box 3-5 for an example of an initiative seeking to build income and wealth in communities around the country.)
The existing literature on the social determinants of health makes it clear that there is a positive correlation between SES and health (Adler and Stewart, 2010a; Braveman et al., 2005; Conti et al., 2010; Dow and Rehkopf, 2010; Pampel et al., 2010; Williams et al., 2010). Occupational status, a composite of the power, income, and educational requirements associated with various positions in the occupational structure, is a core component of a person's SES (Burgard and Stewart, 2003; Clougherty et al., 2010). Occupational status can be indicative of the types of tangible benefits, hazards, income, fringe benefits, degree of control over work, and level of exposure to harmful physical environments associated with a job (Clougherty et al., 2010). While the mechanisms by which occupational status influences health have not clearly been delineated, there is evidence that the type of job does affect such health outcomes as hypertension risk and obesity (An et al., 2011; Clougherty et al., 2010).
The health care system has an important role to play in addressing the social determinants of health. At the community level, it can partner with community-based organizations and explore locally based interventions (Heiman and Artiga, 2015), creating payment models that take into account social determinants and implementing service delivery models that lend themselves to more community engagement and intervention. Health care systems can center equity by involving the community in decision making, allocating resources to act on the determinants of health in mind, and increasing community-based spending (Baum et al., 2009). Communities can be viewed as places of change for health systems, allowing for work both at micro and macro levels. (See Box 3-7 for an example of a community-based health system.) Cost-effective interventions to reduce health disparities and promote health equity should be recognized and explored, including attention to the structural barriers that affect access to health services.
Housing, as a social determinant of health, refers to the availability or lack of availability of high-quality, safe, and affordable housing for residents at varying income levels. Housing also encompasses the density within a housing unit and within a geographic area, as well as the overall level of segregation and diversity in an area based on racial and ethnic classifications or SES. Housing affects health because of the physical conditions within homes (e.g., lead, particulates, allergens), the conditions in a multi-residence structure (an apartment building or town home), the neighborhoods surrounding homes, and housing affordability, which affects financial stability and the overall ability of families to make healthy choices (Krieger and Higgins, 2002). The Center for Housing Policy has outlined 10 hypotheses on how affordable housing can support health improvement (Maqbool et al., 2015). These range from affordable housing freeing up resources for better nutrition and health care spending to stable housing reducing stress and the likelihood of poor health outcomes (e.g., for mental health or the management of chronic disease).
How the social environment is conceptualized varies depending on the source (Barnett and Casper, 2001; Healthy People 2020, 2016). However, there are common elements identified by the literature that collectively shape a community's social environment as a determinant of health. For the purposes of this report, the social environment can be thought of as reflecting the individuals, families, businesses, and organizations within a community; the interactions among them; and norms and culture. It can include social networks, capital, cohesion, trust, participation, and willingness to act for the common good in relation to health. Social cohesion refers to the extent of connectedness and solidarity among groups in a community, while social capital is defined as the features of social structures (e.g., interpersonal trust, norms of reciprocity, and mutual aid) that serve as resources for individuals and facilitate collective action (Kawachi and Berkman, 2000).
It is important to note that high levels of social capital and a strong presence of social networks are not necessarily guarantors of a healthy community. In fact, they can be sources of strain as well as support (Pearce and Smith, 2003). Some studies explore the potential drawbacks of social capital, such as the contagion of high-risk behaviors (e.g., suicidal ideation, injection drug use, alcohol and drug use among adolescents, smoking, and obesity) (Bearman and Moody, 2004; Christakis and Fowler, 2007; Friedman and Aral, 2001; Valente et al., 2004).
At the community level, an important element of the social environment that can mediate health outcomes is the presence of neighborhood stressors. While the occurrence of stress is a daily facet of life that all people experience, chronic or toxic stress, in which the burden of stress accumulates, is a factor in the expression of disease (McEwen, 2012). Stressful experiences are particularly critical during early stages of life, as evidenced by the adverse childhood experiences study (Felitti et al., 1998), and are associated with abnormal brain development (IOM, 2000; Shonkoff and Garner, 2012). For low-income communities, stressors are salient because of the lack of resources, the presence of environmental hazards, unemployment, and exposure to violence, among other factors (McEwen, 2012; Steptoe and Feldman, 2001). (See Box 3-11 for an example of a community working to combat these stressors.) This applies as well to children in low-income households, who are more likely to experience multiple stressors that can harm health and development (Evans and Kim, 2010), mediated by chronic stress (Evans et al., 2011).
The rise of low-carbon power generation to meet climate goals also means a tripling of mineral demand from this sector by 2040. Wind takes the lead, bolstered by material-intensive offshore wind. Solar PV follows closely, due to the sheer volume of capacity that is added. Hydropower, biomass and nuclear make only minor contributions given their comparatively low mineral requirements. In other sectors, the rapid growth of hydrogen as an energy carrier underpins major growth in demand for nickel and zirconium for electrolysers, and for platinum-group metals for fuel cells. 041b061a72