Health and Society Midterm

The WHO divides the 20th century into the:

- "Medical era" • The first half of the 20th century • The dominant approach to health was mass vaccination and the extensive use of antibiotics to combat infection - "Postmedical era" • Present period in history • Physical well-being is threatened by social and environmental factors that cannot be directly improved by medicine

Bourdieu : Habitus

- Class-related set of durable dispositions to act in particular ways - Serves as a set of perceptions that routinely guides and evaluates a person's choices and options • People of a particular social class tend to share similar lifestyles because they typically have a similar upbringing and experiences in life - That is, they are socialized to prefer their lifestyle preferences over those of other classes

• Comparisons between the U.S. and Germany:

- Lack of difference between social classes in health behavior - The presence of a comprehensive, national health insurance system (Germany) does not appear to undermine personal incentives to stay physically fit compared to the American system

Health lifestyles appear to be spreading throughout Western society

- Most extensive participation in the U.S., Germany, and the Netherlands - Signs of spread in Britain and France - More research needed in other countries - Participation greatest among upper and middle socioeconomic groups

19th Century

- Systematic implementation of public health measures and improvements in public sanitation - Period sees declining mortality rates from infectious diseases • Improvements in population's health mainly due to improvements in diet, housing, public sanitation, and personal hygiene instead of medical innovations

*Whole person health care (late 20th -21st century)

-Transition from infectious to chronic diseases as leading causes of death (epidemiological transition) around mid-20th century - Recognition that social environment and lifestyle practices influence chronic diseases encourages emphasis in medicine on treating the "whole person"

Poor People Face

-worse health than the affluent -treated within the framework of welfare medicine -live in disadvantaged urban and rural locales

How does stigma affect health

1) Experience of psychological stress 2) Delays in seeking health care due to fears of being stigmatized and the subsequent discrimination 3) Experience of adverse reactions from others in health care settings by stigmatized individuals 4) Slow provision or withholding of resources by communities when stigmatized groups may be the primary recipients

*Talcott Parson did....

1) Published The Social System in 1951 2) First major social theorist to deal with health, illness, and role of medicine issues 3)Structural-functionalist Perspective 4)Introduced concept of the sick role

What are seven good health practices identified in research?

1) Seven to eight hours a night of sleep 2) Eating breakfast every day 3) Seldom if ever eating snacks 4) Controlling one's weight 5) Exercising 6) Limiting alcohol consumption 7) Never having smoked cigarettes

*What do medical sociologists study?

1) Social causes and patterns of health and disease 2)Social behavior of health care personnel and their patients 3)Social functions of health organizations and institutions 4)Relationship of health care delivery systems to other social systems

What is stress?

A heightened mind-body reaction to stimuli inducing fear or anxiety in the individual Typically starts with a situation that people find threatening or burdensome

What is Epidemiology?

A multi-disciplinary field that studies the origin and distribution of health problems, whether infectious diseases, chronic ailments, or problems resulting from unhealthy behaviors the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population.

*What is the Sick Role?

A patterned set of expectations defining the norms and values appropriate to being sick

Medicalization

A process by which previously non-medical problems are defined and treated as medical problems, usually in terms of illnesses or disorders • Doctors initially responsible for medicalization of new areas of life as they sought to expand the boundaries of treatable conditions • Primary forces driving medicalization now are biotechnology, consumers, and managed care (menopause is an example)

What is social class?

A social class is a category or group of people who have approximately the same amount of wealth, status, and power in a society

Sickness

A social state signifying an impaired social role for those who are ill

Illness

A subjective state pertaining to an individual's psychological awareness of having a disease and usually causing that person to modify his or her behavior

*Illness Behavior

Activity undertaken by a person who feels ill for the purpose of defining that illness and seeking relief from it

Illness Behavior

Activity undertaken by a person who feels ill for the purpose of defining that illness and seeking relief from it

*Health Behavior

Activity undertaken by individuals for the purpose of maintaining or enhancing their health, preventing health problems, or achieving a positive body image

Disease

An adverse physical state, consisting of a physiological dysfunction within an individual

What is Symbolic Interaction

Assumes that all behavior is self-directed on the basis of common understandings symbolized by language that are shared, communicated, and manipulated by interacting human beings in social situations

Being Sick and Disabled

Being sick is an undesirable state, despite the exemption from one's usual activities • Illness disrupts daily routines, causes various degrees of suffering, and threatens ability to plan for the future • Particularly damaging to a person's concept of self when illness is experienced as overwhelming, unpredictable, and uncontrollable because it paralyzes the ability to act and manage one's life normally

*Germ Theory of Disease (late 19th-20th century)

Biomedical approach: every disease has a specific pathogenic cause best treated by removing or controlling that cause. Little attention to social causes. Search for drugs as "magic bullets" that could be "shot" into the body to kill or control health disorders.

Richard Wilkinsons Income Inequality Hypothesis

Blames degree of inequality among classes within a society for health inequalities Society's overall level of wealth less important Compelling argument but thus far findings in other research have not supported his position

Health Lifestyles

Collective patterns of health-related behavior based on choices from options available to people according to their life chances - Involves decisions about food, exercise, relaxation, personal hygiene, risk of accidents, coping with stress, smoking, alcohol and drug use, as well as having physical checkups

THE SICK ROLE

Composed of four basic aspects. The sick person: 1) Is exempt from "normal" social roles • Depends on severity of condition and approval by the physician 2) Is not responsible for his or her condition • Illness is beyond a person's own control and help is needed in order to get better 3) Should try to get well • Sickness should be viewed as undesirable by the individual, and exemption from roles and responsibility for illness is conditional on the obligation to get well 4) Should seek technically competent help and cooperate with the physician

Medicine of social spaces

Concerned with preventing disease, especially through government involvement in matters of public hygiene

Symbolic Interaction: Cooley

Cooley's "looking-glass self" concept has three basic components: 1) We see ourselves in our imagination as we think we appear to the other person 2) We see in our imagination the other person's judgment of ourselves 3) As a result of what we see in our imagination about how we are viewed by the other person, we experience some sort of self-feeling, such as satisfaction, pride, or humiliation An individual's perception of himself or herself as a social object is related to the reaction of other people • Stress can result from the failure of the other person (the observer) to reflect a self-image consistent with that intended by the individual (the subject)

Health Lifestyles in Russia and Eastern Europe

Declines in life expectancy over the second half of the 20th century - Rise in mortality largely among middle-aged working-class males • Health lifestyles characterized by extremely heavy drinking and smoking, disregard of diet, and an absence of leisure-time exercise

Talcott Parsons (1902-1978)

Developed a complex functionalist model of society - Included an analysis of the function of medicine and the role of the sick person in relation to the social system within which that person lived

Criticism of the Sick Role

Does not account for behavioral variation Does not account for type of disease Does not account for variations in the patientphysician relationship Does not apply well to lower-class patients Despite limitations, Parson's concept of the sick role can be viewed as an ideal type model

When did epidemics begin to affect people

Epidemics only began to affect human populations as trade between regions increased and as humans began moving in greater proportions into cities

Sanitary era (early 1800s)

Focus was largely on sewage and drainage systems, and the major preventative measure was the introduction of sanitation programs.

Chronic disease era (1950s-2000)

Focus was on controlling risk factors by modifying lifestyles, agents, or the environment.

*Medicine of the species

Gave strong emphasis on classifying diseases, diagnosing and treating patients, and finding cures

Stigma

Goffman - Defined as some deeply discrediting attribute - Main forms of stigma: 1) Abominations of the body (e.g., physical deformities) 2) Blemishes of individual character (e.g., mental disorder, alcoholism, STDs) 3) Tribal stigmas of race, religion, and nationality

*First epidemiological transition

Human societies shifted from foraging (hunting and gathering) to agriculture. Marked by the emergence of novel infectious and nutritional diseases. 10,000 YEARS AGO

Great Britain

Important differences still exist between social classes on health behaviors

Second epidemiological transition

Improved nutrition and living standards, public health measures, and medical advances in developes societies led to a decline in infectious diseases and a rise in chronic and degenerative diseases. 200 YEARS AGO

Modern Diseases and the Poor

Infectious diseases Chronic diseases Mental illness

John Snow

Investigated cholera in London. Mapped out cases of infection, interviewed victims, and traced their daily activities to a common source: a contaminated water source (the Broad Street pump). Provided the foundation of modern epidemiological methods.

Members of the same social class generally share similar

Lifestyles Lifestyles reflect the types and amounts of goods and services one uses or consumes

Chronic disease is most associated with....

Modernization and Upper class (Lifestyle changes among the affluent have reduced their risks of chronic diseases)

Disease and Modernization

Modernizing countries experience: - Reduced mortality from infectious diseases and parasitic disorders - Declines in other diseases of the digestive and respiratory systems with a communicable component - Increases in life expectancy - Declines in infant mortality - Increases in mortality from heart disease, cancer, and other physical ailments associated with modern living

Eco-epidemiology era (2000-present)

Preventative measures are multidisciplinary as scientists from many fields deal with a variety of health problems at the molecular, social behavioral, population, and global levels.

Infectious disease era (1870s-1950s)

Principal preventative approach was to break the chain of transmission between the agent and the host.

*Why medical sociology important?

Recognizes the critical role social factors play in determining or influencing the health of individuals, groups, and the larger society

Social environment

Refers to actual living conditions, such as poverty or crowding, and also the norms, values, and attitudes that reflect a particular social and cultural context of living.

Third epidemiological transition

Resurgence of infectious diseases previously thought to be under control (west nile virus, sexually transmitted) diseases. The potential for the spread of infectious diseases has been significantly enhanced in today's world by the globalization of trade and travel. BEGINNING NOW

*Practical application vs theory

Robert Straus (1957) notes division between sociology in medicine and sociology of medicine

Preventative Care

Routine physical examinations, immunizations, prenatal care, dental checkups, screening for heart disease and cancer, and other services intended to ensure good health and prevent disease—or minimize the effects of illness if it occurs Underutilization of preventive care among the poor is common in both the U.S. and Europe - May not have regular source of care - Health care facilities may not be nearby - Personal expenses if insurance does not cover services or if uninsured

DEVELOPMENT OF EPIDEMIOLOGY

Sanitary era Infectious disease era Chronic disease era Eco-epidemiology era

Why can sickness be seen as deviance

Sickness can be seen as deviance because it threatens the stability of social systems

What is an epidemic?

Significant increase in people affected by a disease (or the first appearance of a new disease).

What is the strongest and most consistent predictor of a person's health and life expectancy?

Socioeconomic status or social class

Illness as Deviance

Sociologists have typically viewed sickness as a form of deviant behavior - Deviance: Any act or behavior that violates the social norms within a given social system Being ill can disrupt normal social functioning and is generally viewed as undesirable by both individuals and society Such a perspective goes beyond a purely biological definition of disease as an abnormality of the body

Who developed medical sociology?

Talcott Parsons

Symbolic Interaction: Thomas

The same crisis will not produce the same effect uniformly in all people The outcome of a situation depends on an individual's definition of that situation and how they come to terms with it

Alternate Defenition fo the sick role

The sick role also defines patterned expectations of behavior for the patient-physician relationship - The physician should work to return the sick person to a normal state of functioning - Physicians hold greater power in the relationship. This allows them to exert leverage over the patient to encourage compliance with medical procedures

In The Birth of the Clinic (1975)

Thinking of Michel Foucault he analyzes how medicine shifted from focusing on using lists to diagnose diseases to focusing on human beings ,their bodies and how diseases afflicted them.

In Discipline and Punish (1979)

Thinking of Michel Foucault he is concerned with the punishment of criminals' bodies. Imprisonment he argued involved constant mental torture of the "soul" of the prisoner

*Define Health

World Health Organization (WHO) definition: - A state of complete physical, mental, and social well-being, and not merely the absence of disease or injury

Lifestyle choices are influenced by one's

life chances, or socioeconomic circumstances • Lifestyle patterns distinguish social classes from one another - But some patterns eventually spread across class boundaries

Symbolic Interaction: Goffman

• Dramaturgical ("life as theatre") approach • Information is communicated in social interactions through: - A person's appearance - A person's experience with other similar individuals - The social setting - A person's own words and actions • Goffman calls this "impression management" • A person's "face" is an image of the self projected by the individual to others - Engaging in "face-work" means to take actions to make one's activities consistent with the face they are projecting - The self is sacred and more important to us than anything else because it represents who we are - For someone to challenge the integrity of that self as a social object can be an embarrassing and stressful situation