364F Sociology Urban Health (fall)
Fall 2005, Half Year Course Thursday 6:00 8:00pm Room LM 158(room description) (click for map) Teaching Assistant TBA Course Webpage (important): http://www.chass.utoronto.ca/~bberry/Soc364F.htm Instructor: Brent Berry Assistant Professor Department of Sociology University of Toronto Office: 725 Spadina Ave, Rm366 (click for map) Email: [e-mail] Office Hours: Thurs 3-4, & generously by appointment
Course Description
Sociologists are interested in human differences, the sources of human differences, and how we should respond to those differences. Health and health behaviors arise from a complex web of influences, from individual and household characteristics to institutional, organizational, and environmental contexts. An ecological approach may be fruitful for understanding patterns of health by focusing on the settings that individuals enter into, influence, and are influenced by. To set the context for the course, we will first examine patterns of health within and between nations and cities, focusing on Canada and the United States. Second, we will review historical changes in health (the epidemiological transition) and urban form (urbanization and suburbanization, the nature of community, social life in urban areas) in the last 100 years or so. Third, we examine why place is relevant to health and for whom. What are the obstacles to drawing inferences about "context"? We will cover the literature about the relevance of everyday settings (e.g. neighbourhoods, schools, households, work environments); as well as contrast the insight that different methodological strategies can give (survey research, ethnography, in-depth interviews, and historical comparative methods). Fourth, we focus on the risks and protections for special populations in urban areas, including the poor, the homeless, racial and ethnic minorities, and the young and old. How can public policy better maintain health among these groups? Fifth, we critically discuss the current capacity of medicine and public health for improving the health of urban populations. The topics covered in the course are not intended to be comprehensive. For instance, the lectures and readings focus on urban health problems in more industrialized nations, such as Canada, the U.S., and Western Europe. However, I consider the topics we cover to be both interesting and relevant in and of themselves as well as a good entry point into further study. I always welcome any suggestions for improving the course.
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Course Requirements and Grading:
Course grades will be based on 4 components. Component Value 1. Exercise 10 % 2. Research Paper 30 % 3. Test 1 30 % 4. Test 2 30 % NOTE: If you cannot give them to me in person, hand in exercises and papers in Room 225 of the Sociology department, where there is an automatic date and time stamper, and 4 deposit boxes. Make sure you time-stamp your assignment. Once you have placed your assignment into the box, please notify me so I will know to go and retrieve it. Grade deductions for late assignments will be made as follows: Extent of Lateness Late one day Late two days Late three days Late four or more days * No assignments will be accepted after assignments have been handed back to the class Deduction minus 10% minus 20% minus 30% minus 50%
Attendance is not mandatory but I suggest that you come to class since you will be responsible for knowing what is covered in the lectures.
Letter Grade 4-Point Scale Percentage (%) A+ A AB+ B BC+ C CD+ D DF 4.0 4.0 3.7 3.3 3.0 2.7 2.3 2.0 1.7 1.3 1.0 0.7 0.0 90 to 100% 85-89 80-84 77-79 73-76 70-72 67-69 63-66 60-62 57-59 53-56 50-52 0-49
*taken from ROSI Readings 1. REQUIRED TEXT: The course reader (CR) may be purchased at the Quality Control Copy Centre, 333 Bloor Street West (West of St. George Street). 2. REQUIRED TEXT: Most of the readings must be downloaded from the class web page: www.chass.utoronto.ca/~bberry/Soc364F.htm. Due to copyright restrictions, you must login 2
using the username and password that I gave you in class. From the download page, simply click the link to view the Adobe Acrobat PDF file. You can either read the document in the viewer or print it out. I assume that everyone knows how to do this (if not, please let me know). The university has numerous computers from which you can do this. 3. SUPPLEMENTAL TEXT: For further reading, I recommend that you purchase a copy of Kevin Fitzpatrick and Mark LaGorys book Unhealthy Places (UP). I have put a copy on reserve (short-term loan) at the Gerstein Library (7 Kings Circle) as well as at the UTM library. You can also buy this book online at http://www.chapters.ca it costs about $25. E-Mail: Finally, I expect every one of you to provide me with an e-mail address. Most of you already have one --and probably use it frequently-- so all you have to do is e-mail or give it to me in class during the first week of school. If you do not have an account, get one. The easiest (and most economical) way is to get it through the university. As a student, you are entitled to one --and to the use of computers in the various computer labs. In my courses, e-mail (and the ability to access the class webpage) is an essential supplement to lectures and office hours. This means that you can expect to hear from me regularly throughout the semester. I will use e-mail for reminders, clarifications, last-minute notifications, etc. Needless to say, I expect you to check it regularly. Conversely, you should feel free to contact me via e-mail with questions, requests or problems that were not --or could not be-- addressed in class. The class email listserv is [e-mail] The email address that you give me will be used on the listserv. I encourage you to share interesting and informative information on urban health from sources such as newspaper articles, political decisions, etc. with the class. However, please use the class email responsibly. Comments on Reading: The mathematician and philosopher Bertrand Russell once suggested that all works of theory should be read, in a sense, twice --although sometimes the two readings can be done simultaneously. First, you should do a sympathetic reading. A reading in which you try to understand the authors point of view (i.e., where he is coming from). You put yourself in the authors shoes (or, changing the metaphor, get inside his head), suspend any criticism, pretend that you wrote the text or agree completely with it, and prepare yourself to defend it. Secondly -and only after this first reading-- you should do a critical reading. Here is where you get a chance to detach yourself from the writer, see him as a historical figure subject to the influences and limitations of his time and place, and criticize his argument. This technique will not only guarantee a better understanding of the material, but will also guard you from two common mistakes: unquestioned acceptance and ungrounded criticism. Comments on writing: My hope is that the topics we discuss throughout the semester will inspire you to write good papers, and that by the end of the semester all of you will have become better writers. With writings and writers, as is the case with many other things, it is much easier to spot a bad one than it is to recognize a good one. This is partly due to the fact that good writing often appears as nothing more than just writing: Its direct and it conveys the message unambiguously. In other 3
words, the craft becomes invisible while the message comes across clearly. Furthermore, nowadays there is a broad spectrum of styles which constitute good writing; and their appeal, like the appeal of any work of art, is often a matter of taste. Fortunately, most of us eventually discover a style (or styles) that we like. In time, we stumble upon authors or written pieces that we enjoy reading and that impress us stylistically. Hopefully, we remember them and model our writing after them. A bad writer, on the other hand, is someone who lacks some basic skills. Turgid prose, endless sentences, bad grammar and spelling, and unclear ideas are some examples of the dangers that plague writing. Care and practice go a long way towards preventing these errors. Two basic guidelines are: First, keep it simple, and second, say what you mean the way you mean it. Finally, imitate. If you like somebodys style, try to emulate it. In fact, when I find myself in a writing rut --either at a loss for words or unable to put some great idea into comprehensible sentences-- I usually stop trying to write and go back to reading something that I consider to be well written. Try this. In this course there is plenty of reading material --most of it well written-so you will not be short of examples. I urge you to use the university's writing resources, which are described at the following link: www.utoronto.ca/writing I also am happy to read over drafts of your work. All too often, bright students are one or two drafts from where they need to be come paper due date. Just one rewrite can make the difference between a "C" and an "A" paper. A note on Plagiarism: Plagiarism is using somebody else's words without quotation and citation, or somebody else's ideas without explicit citation. Students who are found to have done this will be referred to the appropriate university body for disciplinary action. There is no acceptable excuse. If you have any questions about what constitutes plagiarism, ask the TA or the professor. It is easy for us to use search engines to find the source of suspicious paragraphs in papers. Please do not violate these rules. For further information, please see: http://www.utoronto.ca/writing/pdf/plagsep.pdf Note: "Students agree that by taking this course all required papers may be subject to submission for textual similarity review to Turnitin.com for the detection of plagiarism. All submitted papers will be included as source documents in the Turnitin.com reference database solely for the purpose of detecting plagiarism of such papers. The terms that apply to the University's use of the www.Turnitin.com service are described on the Turnitin.com web site." Stop by to meet the Prof (wont you?) In the past, I have required students to come and meet me in office hours, because students are often too shy to do it on their own and they often really need to discuss material and also because I like to know who's out there.. This year, I won't force you to visit; I'll beg. I urge you to drop in during office hours or make an appointment. 4
Week by Week Class Schedule
I. Patterns, Definitions, and Contexts of Urban Health (Class 1) Sept 15. Introduction Meet and greet; introduction and Overview of the course and the emerging field of urban health Basic Definitions: What is urban health? What is health? What is urban? Is urban health a forced marriage of the sociology of health and urban sociology? What is an ecological perspective of health? (Class 2) Sept 22. Patterns of Health in Urban Areas (with a focus on Toronto) Today's Discussion: How does health differ across and within nations and cities? How do the worst and best off compare in Canada to the U.S.? Health in urban areas is patterned ecologically. Besides patterns of health along dimensions of stratification (education, income, wealth, occupation), health and health behaviours are patterned by social environments or settings, including neighbourhood, workplace, and schools. We are interested not only in why urban people are healthier than rural people. The urban/rural dichotomy is too simplisticlife chances and quality of environments vary substantially within urban areas, requiring a closer look at the texture of social environments and milieu of daily life in various settings. Neighbourhoods must be understood as embedded within metropolitan areas. Each is tied to not only adjacent areas, but to the social and political economy of the metro area. Readings (each of these is short): Trends in mortality by neighbourhood income in urban Canada from 1971 to 1996. Statistics Canada Report, Catalogue 82-003. Supplement to Health Reports, Vol 13, 2002 (WEB) The Health of St. James Town by Margaret Kittel Canale. Centre for Health Promotion, University of Toronto. January 1997. (CR) The State of the Citys Health: Implications for Public Health. City of Toronto, Public Health Dept. February 19, 1998. www.city.toronto.on.ca/health/state_health.htm Threats (web) to Health in the Changing City: Choices for the Future. City of Toronto, Public Health Department. September 9, 1997. www.city.toronto.on.ca/health/state_health.htm (web) A Decade of Decline. (web) www.unitedwaytoronto.com/media_tools/pdfs/Decade_in_Decline_Info_Pack.pdf 5
Strong Neighbourhoods, Healthy City: Meeting the needs of Torontos Inner Suburbs. (web) www.unitedwaytoronto.com/media_tools/pdfs/strong_neighbour_press_release.pdf www.unitedwaytoronto.com/media_tools/pdfs/strong_neighbour_fact.pdf www.unitedwaytoronto.com/media_tools/pdfs/strong_neighbour_background.pdf In-class film (time permitting)
The Social Life of Small Urban Spaces 1988
(60 min) Presents an engaging and informative tour of the urban landscape, while exploring how it can be made more hospitable for those who must live in it. (Class 3) Sept 29: Health, Urban Settings, and the Concept of Upstream and Downstream Determinants Assign Exercise Readings: Fitzpatrick, Kevin M. and Mark LaGory. Forthcoming. "Placing" Health in an Urban Sociology: Cities as Mosaics of Risk and Protection." City and Community:126. (WEB) Kaplan, George A. 1999. "Upstream and Downstream Approaches to Inequalities in Health." Pp. 1-11 plus tables, Karolinska Research Lecture at the Nobel Forum. (WEB) Kaplan's Tables #1-15, Kaplan's Tables #16-30, Kaplan's Tables #31-39 (Class 4) October 6. Health in the city in historical context: The changing relevance of urban life to health Cities have unique forms, densities, and patterns of interaction; the social and physical environments of cities have always been relevant to health, but how life in cities is relevant to health has changed over time. Changes in institutional arrangements, the flow of capital, and corporatization of public space have important influences on segregation, the currency and symbols in social environments, and patterns of interaction and influence. What consequence do these changes in urban life have for the health of urban residents? Readings:
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Wirth, L. (1938). Urbanism as a Way of Life. American Journal of Sociology, 44(9) (WEB) Fishman, Robert. "Megalopolis Unbound." reprinted from The Wilson Quarterly (Winter 1990) in Metropolis: Center and Symbol of our Times. Philip Kasinitz, ed. p395-417. New York: New York University Press, 1995. (CR) "Introduction" in Sorkin, Michael, ed. Variations on a Theme Park: The New American City and the End of Public Space. New York: Hill and Wang, 1992. (CR) Further Reading (optional) Wacquant, Loic J. D. "The Ghetto, the State and the New Capitalist Economy" reprinted in Metropolis: Center and Symbol of our Times. Philip Kasinitz, ed. New York: New York University Press, 1995. Mann, P.H., The neighborhood, in Neighborhood, City and Metropolis, R. Gutman and D. Popenoe, Editors. 1970, Random House: New York. p. 568-583. Smith, Neil. 1996. The New Urban Frontier: Gentrification and the Revanchist City. Routledge, New York, NY, Bauman, Zygmunt, Community - seeking safety in an insecure world, Cambridge: Polity, 2001. Discuss in the last 15 Minutes of class (time permitting): Assign Paper, where you must Pick one of the topics outlined here (Class 5) October 13. The Health Climacteric: From Material Scarcity to Social Disadvantage? Readings: "The Determinants of Health from a Historical Perspective"--by John W. Frank, Institute for Work and Health, Toronto and J. Fraser Mustard, Canadian Institute for Advanced Research, Toronto, Canada. "Health and Wealth" issue of Daedalus Volume 123, Number 4, Fall 1994. (WEB) "The Epidemiological Transition: From Material Scarcity to Social Disadvantage?"--by Richard G. Wilkinson, University of Sussex, England. "Health and Wealth" issue of Daedalus Volume 123, Number 4, Fall 1994 (WEB) Further Reading:
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Cubbin, C., W.C. Hadden, and M.A. Winkleby, Neighborhood context and cardiovascular disease risk factors: The contribution of material deprivation. Ethnicity and Disease, 2001. 11(Late Autumn): p. 687-700. II. Explaining Patterns of Urban Health: Concepts and Controversies (Class 6) October 20. Two Basic Explanations: Health Investment and Patterned Responses to Social Structure. Exercise 1 is due at the beginning of class. Why do some residents in the urban landscape have better health and behave in healthier ways than other people? Readings: David Williams. 1990 Socioeconomic Differentials in Health: A Review and Redirection. Social Psychological Quarterly. 53:81-99. (WEB) James P. Smith and Raynard Kington. 1997. "Demographic and Economic Correlates of Health in Old Age," Demography, Vol. 34, No. 1, February 1997, pp. 159-170. (WEB) Other Readings (optional): James F. Crow. Unequal by nature: a geneticists perspective on human differences. Daedalus, Winter 1994. pp 81-88. (WEB) (Class 7) October 27th. Test today in class on Material and Lectures up to today Pick up Paper Assignment Pick one of the topics outlined here (Class 8) November 3 How do we know that place matters? How do social environments influence health? areas of concentrated health disadvantage exist simply as consequence of selective migration of people with problems in (and those without problems out), intergenerational transmission of disadvantage (family background), lack of social services, problems of community (lack of social capital), social supports, stress, pollution, systemic (a discriminatory society). In this class I will discuss the ways that selectivity contributes to observed patterns of health in urban areas. Clearly some urban areas are destination of at-risk populations, but 8
social structure constrains residential choice as well. Some places are receiving grounds of the disadvantaged and at-risk populations. Other places have buffers. After addressing selectivity, I will begin to discuss the importance of context. Readings: Robert, Stephanie A. 1999. Socioeconomic Position and Health: The independent contribution of community socioeconomic context. Annual Review of Sociology. 25:489-516. (WEB) Sampson, R.J. and J.D. Morenoff, and Thomas Gannon-Rowley. 2002. "Assessing "Neighborhood Effects": Social Processes and New Directions in Research." Annual Review of Sociology 28:443-78. (WEB) Yen, I.H. and S.L. Syme. 1999. The social environment and health: A discussion of the epidemiologic literature. Annual Review of Public Health. 20: 287-308. (WEB) Further reading (optional): Macintyre, Sally, Anne Ellaway, Steven Cummins. 2002. Place Effects on Health: How can we conceptualise, operationalise, and measure them? Social Science and Medicine. 55 (2002): 125-139. (WEB) Lewis, O. (1966). The culture of poverty. Scientific American (215), 19-25. Lieberson, S. (1989). When Right Results Are Wrong. Society, 26(5), 60-66. Ross, Catherine E. and John Mirowsky. 2001. "Neighborhood Disadvantage, Disorder, and Health." Journal of Health and Social Behavior 42:258-276. (WEB) III. Special Populations in urban areas (A social problems perspective) Putting aside the debate about the sources of patterns of health disadvantage, the reality is that some urban areas contain a disproportionate share of disadvantaged people. The next few lectures focuses on the most at-risk groups of the urban landscapethe homeless, the young and old, the socially disadvantaged (the poor, residents of public housing, stigmatized minorities), and recent immigrants. We will also examine the community and service environments intended to alleviate and sometimes aggravate health problems for these populations. (Class 9) November 10: Special needs of the homeless and socially disadvantaged Discussion Topic: Needs and Risks of the Socially Disadvantaged (Homelessness, Poverty, Family Structure, Race, and Gender dimensions). Readings: Stephen W. Hwang. 2001. Homelessness and Health. Canadian Medical Association Journal 164(1): 229-33. (WEB) 9
Bill O'Grady & Stephen Gaetz. 2004. Homelessness, Gender and Subsistence: The Case of Toronto Street Youth. Journal of Youth Studies. Vol. 7, No. 4, December 2004, pp. 397416 (WEB) "The Subculture of Street Life", Chapter 3 in Snow, David and Leon Anderson. 1993. Down on Their Luck: A Study of Homeless Street People. Berkeley, California: University of California Press. (CR) Further Reading (optional): O'Flaherty, Brendan. 1996. Making Room: The Economics of Homelessness. Cambridge, MA: Harvard University Press. 1997. "Uneasy Sanctuary: Homeless People Camping on Public Lands." International Journal of Visual Sociology. 12(2):49-64. House, James S., James M. Lepkowski, David R. Williams, Richard P. Mero, Paula M. Lantz, Stephanie A. Robert, and Jieming Chen. 2000. "Excess Mortality among Urban Residents: How Much, for Whom, and Why?" American Journal of Public Health 90:1898-1904. In-class film (time permitting) HOMELESS NOT HELPLESS: OPENING DOORS 1991 44 min. VC #2977 Jerry Jones A critical assessment of programs that deal with the problems of homelessness. Emphasizes solutions including takeovers of abandoned housing by the homeless. (Class 10) November 17: Special Populations: the young and old Discussion Topic: Special Populations in the City: Needs and Risks of the Young and Old. Readings: Chapter 7 of Unhealthy Places Special Populations in the City: Needs and Risks of the Young and Old pp 167-200. (CR) Aneshensel, CS, Sucoff CA. 1996. "The neighborhood context of adolescent mental health." Journal of Health and Social Behavior 37:293-310. (WEB) The "Squash It" Campaign to Prevent Youth Violence. Harvard School of Public Health, Center For Health Communication. http://www.hsph.harvard.edu/chc/squashit.html Further Reading (optional): 10
Ward, Russell, Mark LaGory, and Susan Sherman. 1988. The Environment for Aging: Social, Interpersonal and Spatial Contexts. Tuscaloosa, Alabama: University of Alabama Press. Ostbye, Truls; Runa Steenhuis; Christina Wolfson; Ruth Walton; Gerry Hill. 1999. "Predictors of Five-Year Mortality in Older Canadians: The Canadian Study of Health and Aging." Journal of the American Geriatrics Society 47:1249-54. Russell, C., Hill, B. & Basser, M. Identifying needs among at risk older people: Does anyone here speak health promotion? In V. Minichiello, N. Chappell, H. Kendig and A. Walker (eds) Sociology of Aging: International Perspectives. Melbourne: International Sociological Association Research Committee on Aging, 1996, pp. 378-393. (Class 11) November 24: Special populations: immigrants Discussion Topic: Special Populations in the City: Needs and Risks of Immigrants Noh, Samuel and William R. Avison. 1996. "Asian Immigrants and the Stress Process: A Study of Koreans in Canada." Journal of Health and Social Behavior 37:192-206. (WEB) In-class film (time permitting) JANE FINCH AGAIN 1997 47 min. VC #4526 Roger McTair speaks to residents who were in the 1983 film, HOME FEELING, about the impact of changes undertaken by community organizations and the police to improve life in the area. (Videocassette 004297 at the Audio Visual Library) (Class 12) December 1st. Critical Perspectives on Urban Health and the Study of Urban Health. A Critical Look at Interdisciplinary Perspectives on Urban Health: What does sociology have to contribute? Kelly, M.P., J.K. Davies and B.C. Charton (1993). Healthy Cities. A modern problem or a post-modern solution?. In J.K. Davies and M.P. Kelly (Ed.), Healthy Cities. Research and practice (pp. 159-167). London / New York: Routledge. (CR) McKinlay JB, Marceau LD. 2000. To boldly go ... American Journal of Public Health. 90 (1): 25-33 (WEB) Further readings (optional): Hancock, Trevor. 1992. "The Development of the Healthy Cities Project in Canada" in John Ashton's (eds) Healthy Cities. Open University Press. pp43-48. (CR) 11
Hancock, Trevor. 1992. "Toronto" in John Ashton's (eds) Healthy Cities. Open University Press. 175-185. (CR) Klawiter, Maren. 1999. Racing for the cure, walking women, and toxic touring: mapping cultures of action within the Bay Area terrain of breast cancer. Social Problems 46(1):104-26. (WEB) Leeuw, E. de (1993). Health policy, epidemiology and power: the interest web. Health Promotion International, 8(1), 49-52. (Class 13) December 8 Test 2 in class on material covered since Test 1. Paper Due No later than Friday Dec 9, at 5pm Enjoy your well-deserved break!
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