Sociological Perspectives

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 on Health
The Sociological View of Health
   How does society handle illness?
   Who decides when someone is ill and when they
    are well?
   How does health vary over different social
   Sociologists do not believe that a purely
    objective (biological) view of illness can be
    achieved because illness is social as well as
   every social group has a range of “acceptable activities”.
    Behavior outside of these limits is considered unacceptable
        every person has a number of socially defined roles, based on
         our ascribed and achieved statuses, that serve as a guide for
         our behavior and responsibilities (e.g. woman, physician, father,
   illness is viewed as a disturbance that interrupts normal social
   illness is when a person cannot function in their normal social roles
    (unacceptable behavior). According to Parsons, in order to maintain
    social order they are temporarily placed in the ‘sick role’
        the sick role provides the person with a set of social
         responsibilities and privileges that guide their behavior and
         restore normal order
        illness is negative; people in the sick role are expected to try to get
         better and return to their normal roles
Talcott Parsons (1951); Emile Durkheim
              Conflict Theory
 A perspective that emphasizes the struggle for power
  and privilege in society; one group benefits at the
  expense of another
 the health care system is an elite system intent on
  maintaining its power: professional privilege
 the health care system legitimizes its power by claiming a
  specialized body of knowledge and uses its power to gain
  wealth and maintain the status quo
    e.g. the medicalization and commodification of child
      birth (ob-gyns vs. midwives)
 hence, the sick role and illness are used to perpetuate a
  pillar of the exsisting social system
Karl Marx; C. Wright Mills; feminist & critical theories
Political Economy perspective
   Focus on socio-economic determinants of health
   ways in which illness is produced by the capitalist
    economy and how the distribution and management
    of illness is related to Western industrial economies
   shows how illness and disability are differentially
    distributed along social class lines
   health care decisions based on profit: ‘health care
   exportation of ill health to the developing world (e.g.
    dumping of cigarettes)
   direct effects of economic system
     e.g.   occupational caused diseases
   indirect economic effects
 focus on the social meaning of illness and the
  construction, negotiation and transmission of that meaning
 focuses on the individual as opposed to society
  (microsociological orientation)
 crisis approach: the crisis created by illness or disability
  and how it affects individuals (e.g. parents of ill children)
 self approach: effect on the individual of the identity
  changes which accompany the fall in status associated
  with illness
    impact of labels and stigma resulting from illness (the
      meaning of illness changes due to the labels we attach:
      ‘patient’, ‘disabled’)
Chicago school
      Useful Sociological Concepts
   Social capital:
      developed by Pierre Bourdieu (1973) who
       distinguished three types of capital: economic
       (money), cultural (education/knowledge), and social
       (social networks)
      the extent to which members of a community view
       themselves as forming a coherent group, and the
       extent to which they work toward the common good,
       not just the individual good
          trust, mutual aid, and reciprocity
      in communities with high social capital members feel
       they can, and should, cooperate and take collective
       action to support the good of the community
      the tendency of the group to cooperate becomes a
       resource for individuals within it; people with high
       social capital are at an advantage
 working  together, the group is able to achieve
  more then its individual members
 lack of social capital is empirically associated
  with higher levels of inequality and crime
 increased social capital has been shown to
  have positive health effects in the Canadian
      the relationship is especially strong in vulnerable
       populations: women, the elderly, immigrants, men
       in low income households
Source : Putnam, 2000.
   Social solidarity (cohesion):
      high social capital creates communities with high
       social solidarity
      “social cohesion instills in individuals the sense of
       belonging to the same community and the feeling
       that they are recognized as members of that
       community” Commissariat général du Plan
      Jane Jenson’s five dimensions of social cohesion:
          Belonging; Inclusion; Participation; Recognition;
      the absence of latent social conflict (e.g. income
       inequality) and the prescence of strong social bonds
      social solidarity consists of the integration of
       individuals into social groups and their regulation by
       shared norms (Emile Durkheim)
             mechanical (police) vs. organic (voluntary)
             ‘anomie’: individual actions are not properly
              regulated by shared norms (normlessness)
     Durkheim’s Theory of Suicide
   Émile Durkheim aimed to show that suicide, although the most
    individual and personal of acts, was socially patterned
   social forces shaped the likelihood that a person would commit
    suicide, which Durkheim demonstrated by showing how suicide
    rates varied according to
           religion: Jewish people had lowest rate of suicide,
             Catholics less likely than Protestants
           family type: married people less likely than single,
             parents less likely than those without children
           war: suicide rates drop in times of war (both in defeat and
             victory) when society shares a common goal
           economic instability: suicide rates increase not only in
             times of economic downturn but upturns as well; not the
             state of the economy but sudden changes that caused
             rates to rise
   the degree of social solidarity affects a person’s likelihood of
    committing suicide
   if a person is loosely connected with society he or she is more
    likely to commit suicide. However, if the level of solidarity is too
    strong than this can also lead to increased rates of suicide
   Durkheim described two types of social connection
      integration: the strength of the individual’s attachment to social
      regulation: the control of individual desires and aspirations by group
        norms or rules of behavior
   four types of suicide
      egotistic: weak integration leads to isolation of the individual
                e.g. war integrates people into society; Protestantism
                 emphasizes the individual
      anomic: lack of regulation (anomie). People are only happy when
        their needs and passions are being regulated and controlled
        because this keeps their desires and circumstances in balance;
        change in their situation upsets this balance and results in anomie
                e.g. economic change
      altruistic: too much integration, social bonds are too strong, people
        sacrifice themselves for the group (e.g. Japanese military)
      fatalistic: excessively high regulation that oppresses the individual
   suicide cannot be explained solely by psychology alone, even suicide is
    socially organized behavior
   Durkheim demonstrated not only that the behavior of the individual was
    social but also that the individual’s internal world of feelings and mental
    states was socially produced.
              Social Support
   Social networks
     people’s ties to each other and the
      structure of those ties
   Social support
     thetransactions that occur within a
      person’s social networks, specifically the
      perception of assistance that is or could be
      available from that network
        perceived support: the sense of acceptance in
         a group
        received support: transactions that actually
How does social support operate?
   reduces the effects of stress in times of
    adversity (stress buffering)
   support accelerates recovery
           practical (instrumental) and emotional support
   indirectly
     thepeople in our social networks influence our
      behaviors, including health behaviors (e.g.
   effect cause relationship
     does  social support increase health or does bad
      health decrease social contacts?
              Gender and Health
   Gender vs. Sex
     sex refers to anatomy; gender refers to the norms and
      roles associated with, and behaviors expected of, men
      and women
     biology determines sex; society determines gender
   why do women live longer than men?
   why is the gap between male and female life
    expectancy shrinking?
     seems   to be mainly the result of changing mortality
      due to smoking-related respiratory cancers, men’s
      rates are falling while women’s are increasing
     women are increasingly taking on “male behaviors”
   analyses of gender and health often need to
    incorporate the biological and the social
   females have a younger average age of HIV
    infection than males
     gender  power imbalance results in sexual
      relationships between older men and younger
      women, which reinforces the imbalance with the
      woman having less power (condom use)
     the HIV virus is more easily transmitted from male
      to female than from female to male
    Gender Based Trends in Health
   Although women live longer than men, a higher
    percentage of women have chronic illnesses and
    women use health services more often
   men tend to drink and smoke more and are more
    likely than women to be overweight
   women report higher levels of stress at home and in
    the workplace
   women's apparent resiliency may result from their
    greater tendency to build social support networks
    which, in turn, help them cope with stress and deal
    with painful chronic conditions.
The Medicalization of Pregnancy and Childbirth
   Common debating topics in feminist theories on health:
      majority of ob-gyn doctors are men
      until well into the nineteenth century childbirth was an event
       that took place in the private sphere
      reclassification of childbirth as a “medical” procedure re-
       labels it as an “illness”
      pregnant and would-be pregnant women are required to take
       on a variant of the “sick role”
      increase in the use of caesarean sections which take much
       less time than a traditional birth
      increases in induced labor, which allows hospitals to
       schedule births
      use of painkillers and fetal monitoring technologies reduce
       women’s options and control during the delivery
      a primarily male profession usurps what was once a primary
       concern of women
          Demographic Trends
   contrary to common public opinion population growth is not
   population growth rate has fallen by more than 40% since
    the late 1960s (See the Baby Bust)
   experts predict that human population will peak at 9 billion
    by 2070 and then start to contract
   the average age of the world’s citizens will increase
      the populations that will age the fastest are in the
       developing world
   these trends are caused by falling birthrates
   the average woman today bears half as many children as
    her counterpart did in 1972
   industrialized countries are not producing enough children
    to maintain their populations (see dependency ratios)
   falling birthrates are the result of changing
      more of the world’s population is moving to
        urban areas where children have little economic
      women are acquiring economic opportunities and
        reproductive control
      increased educational and skill requirements
        necessary for today's marketplace mean more
        people are remaining dependent on their parents
        into their own childbearing years and putting off
        having children
      meanwhile the social and financial costs of
        having children continue to rise
   the demographic transition [←hyperlink!]
      stage 1: high birth and death rates with
       slow population growth
      stage 2: death rates fall, birth rates remain
       high (predicated by industrialization
       causing improved food supply, reduced
       infant mortality); rapid population growth
      stage 3: low birthrates and low death rates,
       slow (or no) population growth
   today developing countries are experiencing
    the same transition industrialized countries
    did but at a much faster pace
      e.g. fertility rates are falling faster in the
       Middle East than anywhere in the world
       resulting in the population aging rapidly
   some countries have not had the opportunity to grow
    rich before they grow old
      e.g. China’s shrinking labor force will not be able
        to support its rapidly aging population
      the problem will only increase as the strong
        gender imbalance in their population will result in
        many men not reproducing
   by 2045 the world’s fertility rate will have fallen below
    replacement levels (2.1 births per woman)
   at first these trends have a positive effect: the
    demographic dividend
      the fewer the dependant children, the more
        resources are freed up for infrastructure and
        industrial development and adult consumption
   however this dividend has to be repaid
   as fertility falls below replacement levels the
    workforce shrinks and the number of dependent
    elderly increases
      the elderly consume more resources than
       children mainly in health-related expenses
   economic growth needs population growth
      to keep economic growth above zero each
       member of a shrinking workforce needs to
       dramatically increase their output while being
       taxed at higher and higher rates to pay for the
       expenses of the elderly
   changes in lifestyle are resulting in declines in
    population fitness (e.g. increased obesity) and
    increases in disability rates in the working age
   modernity and demographic trends:
   spread of urbanization and industrialization is a
    cause not only of decreasing fertility but also the
    “diseases of affluence”
         overeating, lack of exercise, substance
          abuse, social isolation, pollution
         resulting in increased rates of chronic
         this “western” lifestyle is spreading to the
          developing world
   modern, high tech medicine does little to promote
    productive aging because by the time most
    people need it their bodies have already been
    damaged by their lifestyle

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