Sociological Perspectives on Health

							Sociological
Perspectives
on Health

        Simon Corneau
     Jean-François Roy
Sociological Perspectives on Health

   « From a sociological point of view, factors contribute
    to the evaluation of a person as ‘healthy’ or ‘sick’. »
    (Schaefer & Smith, 2004).
   Because health is relative, we can view it in a social
    context and consider how it varies in different
    situations or cultures.

      Functionalist Approach   Interactionist Approach
        Conflict Approach       Feminist Approaches
Functionalist Approach
   Illness entails at least a temporary disruption in a person’s social
    interactions.
   « Sickness » requires that one take on a particular social role,
    even if temporary ; the « sick role ».
   The « sick » are expected to try to get well (e.g., seek medical
    care) and return to their normal activities.
   Being sick must be controlled so that not too many people are
    released from their societal responsibilities at any one time.
   An overly broad definition of illness would disrupt the workings of
    a society.
Conflict Approach
   Conflict theorists seek to determine who benefits, who suffers,
               dominates at the expense Society
    and who Inequities in Healthof of others in a given
                   Medicalization Care Delivery
    situation.

There are inequities in health
Medicine has expanded its           A « brain drain » is
                                   Medicine maintains an absolute
care delivery within in recent
domain of expertise Canada:         contributing to the poor health
                                   monopoly over many health
northern Once a areas.
decades.and ruralproblem is         of developing countries.
                                   care procedures. It places
appropriated, it becomes
There are global inequities:        « Dumping » of unapproved or
                                   health care professionals such
difficult to view 1000 in USA,
25 doctors per these issues         fraudulent drugs in nurse-
                                   as chiropractors and developing
less then 1 per 1000 in
as shaped by sociocultural          countries.
                                   midwifes outside the realm of
African nations.
factors.                           acceptable medicine.
Interactionist Approach
   Focus on micro-level study of the roles played by
    health care professionals and patients.
   The patient is an active actor whose action can
    have a negative or positive impact on his health.
   Interactionists also attempt to shed light on the
    « social meaning » of illness and how they affect
    one’s self-concept and social interaction;
    « labelling theory » focus on the effects of the
    social stigma of the illness (e.g., AIDS, women’s
    health, homosexuality).
   Cultural differences in « social meanings » of
    illness and health care delivery.
Feminist Approaches
   Health is an area of central concern for women. Women
    form the majority of health workers, of health care users
    and of caregivers.
   Research on women’s health has focused on reproductive
    health issues, overshadowing a range of other health and
    illness issues; everything was related to the uterus and
    hormones.
   There is still sexist bias in the health literature today
    (Janzen, 1998).
   Feminists theorists also draw the attention on how multiple
    minority status intersects to produce varying levels of
    health and disease (ex : being black and being a lesbian).
Morbidity Rates and Populations
   Sociologists find morbidity rates useful because they
    reveal that a specific disease occurs more frequently
    among one segment of a population then another.

SexualClass
Social
Race and Ethnicity
Age
Gender Orientation
Clearly care servicesexpectancy of 81,7 minorities
        is one of many differences a patient is and
         associated often assume in morbidity
Health profiles a thewith racial and ethnicand males of
Females haveof life overriding concerns of the elderly.
Gender rates. important situation where factors
heterosexual and attributed linked to of health
76,3. A difference create in the study health ? and
mortalityis most Why is class to health of Canada’s Firstis
reflect social inequalities.aThe behavioural the patient
Nations reflectsconditions, substandard housing,
(drinking living patternsabout yet elderly women
Crowded andopenly live longer;healthexclusionrelated to
less likely towomen talk driving), occupationallimiting
aging since dangerous of years of matters hazards
his sexual orientation, attention. Social support etc.
poor access researchof thesexual health or mental health
their diet, stress, limited education, workplace, health
receive little to many like social determinants of
(construction), and women’s tendency to seek is a key
care services to the health employment.and
like income, education and of older gay men).women.
factor related earlier and more often.
(high rate of suicide among young men
Social Capital
 One of sociology’s main contributions has been to
  identify social capital as a determinant of health.
 Many recent studies have explored the links
  between social capital and health. Social capital
  may contribute directly to health or may result in
  policies that are more supportive of healthy
  outcomes.
Social Capital

   Social capital refers to the institutions,
    relationships and norms that shape the quality
    and quantity of a society’s social interactions.

                                   (World Bank, 2001)
How is it Measured?
   Social capital as a social determinant of health is measured
    with non-medical indicators. For example,
Key indicators

     Trust (inothers, in institutions)
     Civic engagement (participation)
     Social network (social support)
     Social cohesion (sense of belonging)
     Income distribution
Social Capital and Crime
3 dominant theoretical perspectives
   1) Social disorganization: lack of social control
   2) Anomie: weakening of behavioural norms
   3) Strain theory: lack of opportunities
Geographic areas with ↑ levels of social capital have lower
  homicide rates. High homicide rates may undermine social
  trust and civic engagement and ↓ the stock of social capital
  (Rosenfeld et al., 2001).
Criminology and Health
Health status is affected by socioeconomic status → people
  from low socioeconomic classes are over-represented in
  prison → health condition is also affected by the prison
  context (they live and work with people carrying infectious
  diseases)
Areas of inquiry:
  Utilizationof prison health services
  Consequences of confinement
  Aging offenders
  Policy level
Causes of Crime
Conditions that make crime more likely:

   Poverty (women)

   Wealth (white-collar crime)

   Drug abuse
Who are in Prisons ?
 Over-representation of native people
 People of lower socioeconomic status (except for
  Martha Stewart)
 Drug related crimes
 People with mental health problems
 Prevalence of unhealthy lifestyles: cigarette &
  alcohol abuse, drug abuse, poor diet, sexual
  promiscuity (Smith, 2002).
Healthy Prisons?
   High prevalence of HIV/AIDS and Hep C, tuberculosis is coming
    back
Risk factors :
 Consensual sexual activities
 Prison rape
 Drug injection
 Tattooing
All these behaviours are prohibited by the prison code of conduct
    (affects likelihood of conditional release)
 ↑ Suicide rate
 Self mutilation (women)
 ↑ level of stress (violence and power relations)
How to Explain this...

   Deprivation model (Krebs, 2002) : what do you
    learn behind bars

   Importation model (Krebs, 2002) : what do you
    bring with you in prison
How the System Reacts?
   Condoms: can only be obtained through nurses,
    one at a time

   No clean needles; bleach available only in some
    provinces

   War on drugs (random testing)
That Means…

    Inmates can become infected while in prison,
     becoming a threat to the general population
     when released.

    CCS Mission: Protection of society
Questions (1) ?
 Do people from lower socioeconomic classes
  really commit more crime, or are they just more
  often targeted by official formal control?
 Can we really « rehabilitate » someone while in
  prison when we know that the person will return
  into the same socioeconomic conditions after
  incarceration (low stock of social capital)?
 Is a punitive approach appropriate for drug
  related offences? (Rehab vs. Punishment)
Questions (2) ?
 How would a functionalist analyze the
  medicalization of society?
 How would a interactionist analyze AIDS ?
 How would a conflict theorist analyze links
  between health and occupation?
Some Figures on
  Social Capital

  Bowling alone : the collapse
  and revival of American
  community.
  Robert D. Putnam (2000)
Source : Putnam, 2000.
Source : Putnam, 2000.
Source : Putnam, 2000.
Source : Putnam, 2000.
Source : Putnam, 2000.