Health Disparities Test 1
What is the main outcome of the dominance of Symbolic Interactionism in medical sociology?
"despite its currently less status, symbolic interaction nevertheless played a prominent role in advancing agency orientation into American med soc. in doing so, it undermined the pursuit of social causation thesis bc of its success in rendering structural-functionalism impotent"
Cockerham & Agency-Oriented Theories
"social reality is created by people choosing their own behavior and acting accordingly, not by large social processes/structures channeling activities down more or less option-less paths" -being agency-oriented does NOT imply that structure is unimportant -ex. Mead's concept of generalized order = "the organizational attitudes of a community and the social process through which the community exercises control over the conduct of individuals"
Why bother with theory?
"sociological theory provides explanatory models of social process producing specific health outcomes. it remains the most important pillar of medical sociology's uniqueness in studies of health/disease. it's the sociological perspective through theoretical gaze that gives med soc its distinction"
One solution = use epidemiological triad (3)
(1) AGENT = immediate/proximal causes; can be biological, chemical, physical, nutritional, social (2) HOST = people susceptible to agent (3) ENVIRONMENT = factors external to host
Social factors directly effect (3):
(1) EXPERIENCE of illness - help/hinder adaptation, less accessibility, providing good/bad environments (2) social PATTERN of population and disease - social hierarchies w/social gradient of health (3) CAUSATION of health and disease
Alternatives to fundamental cause theory (4):
(1) Risk Factor Approach = eliminate risk factor breaks connection between social factors and health outcomes (2) Marmot & Wilkinson = stress of low placement in social hierarchy is the source of the SES-health association (3) Gottfredson = intelligence is key flexible resource that drive both SES attainment and wise health behaviors (4) Heckman = noncognitive traits (time horizon, perseverance) are key flexible resources that drive both SES attainment and wise health behaviors
In response to alternative theories, fundamental cause theory predicts that (4): 1
(1) SES association will be stronger for diseases that we have substantial capacity to prevent/cure than for diseases we know little about -Empirical evidence suggests that SES-mortality association is stronger for preventable as opposed to less-preventable causes of death
Fundamental Cause Theory 4 Components:
(1) a fundamental cause is related to multiple disease outcomes -ex. SES was related to cholera, TB, diptheria in the 19th c but now related to heart disease, stroke, cancer (2) fundamental causes operate through multiple risk-factor mechanisms (3) Link/Phelan: new intervening mechanisms reproduce association between fundamental causes and health over time (4) Link/Phelan: the essential feature is that they involve access to resources that can be used to avoid risks or to minimize consequences of disease
RECAP: 3 main obstacles to structural thinking in medical sociology:
(1) assault on structural functionalism by micro-soc revolution in 1960s (symbolic interactionists) (2) assault on Marxism fueled by intellectual/political dissatisfaction with it (3) shift in understanding of culture away from social structural influences toward psychological emphasis on how culture influences personal identity
Fundamental Cause Theory does NOT predict that (2):
(1) associations between fundamental causes and health outcomes will always be of the same magnitude (2) it is impossible to influence the relationship between fundamental causes and health outcomes
Symbolic interactionism declined in 1980s because it could not explain (2):
(1) cause of deviance (other than reactions) -ex. labeling theory ignored how people shared characteristics relevant to deviance (poverty, stress) (2) relationships between institutions and societal-level process that influence each other (not just individuals) -ex. Mead's "generalized other"
Types of health-related ties (3):
(1) direct personal interaction (sex, smoke, drink, exercise) (2) transfer of material goods/info (3) role-based ties (kin, friends)
To qualify as a fundamental cause, a social conditon must (4):
(1) influence multiple diseases (2) affect diseases through multiple pathways of risk (3) be reproduced over time (4) involve access to resources that can be used to avoid risks or minimize consequences of disease
Fundamental Cause Theory DOES predict the relationship between social factors & health disparities will weaken when (3):
(1) social factors are improved -ex. ending segregation in U.S. reduced resource disparities, reducing health disparities (2) universal interventions (do NOT rely on flexible resources) are provided -ex. installing airbags instead of relying on seat belts (3) interventions are aimed at helping people adopt new knowledge/technology -it's one thing to make medical breakthrough. it's another to provide info about the breakthrough. it's even another thing to aim interventions at helping people receive/apply the info about the breakthrough
Examples of networks influencing health (3):
(1) social support (2) sex (3) food consumption individual choice about these are constrained and contingent on behavior of others, local norms, and sometimes commercial distribution of networks
Networks can influence health through (4):
(1) strength of connection/isolation from others (2) position within one's overall network (3) quality of network (cohesion, distance) (4) flow of helpful/harmful substances through network
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(2) Introducing new medical knowledge and technology will widen the gap in health disparities between people at the top and bottom -Health inequalities emerged for diseases where medical progress was made (heart disease, lung cancer) but not for diseases where much less progress was made (brain, ovarian, pancreatic cancer)
Bryan Turner (1945-)
-"Body of Society" 1984 -focus on social control over body by wider society (state, religion, family) -seminal work on soc of body, subspecialty in med soc w/agentic slant -strong reaction to Foucault
Michel Foucault (1926-1984)
-"History of Sexuality" 1979 -influenced social constructionism, medicalization, sociology of body -structural approach to social constructionism (nightmare)
Peter Berger (1929-2017) & Thomas Luckman (1927-2016)
-"Social Construction of Reality" 1967 -grounded in symbolic interactionism -agentic approach to social constructionism
Ex. Peggy Thoits
-"despite attributions of the origins of stress to large-scale social structure, few have attempted to examine links between macro factors and micro experiences, preferring to assess status in role strains, powerlessness, lack of control at individual level only" -public health studies followed a similar approach, producing prevention aimed at motivating people to minimize risk behavior -until Link and Phelan in 1995, the idea that social structural factors were causal was ignored
Role of Resources
-"people w/higher SES had higher probabilities of survival from preventable causes of death bc they used greater resources. their access to/effective use of resources (money, knowledge) served as social mechanism allowing them to live longer" -when fundamental cause theory is reduced to its basics, it's the idea that resources (money, power, prestige, knowledge, social connection) are vital for health advantage...conversely, absence/shortage of resources causes poor health outcomes/early death
Cockerham and Chronic Illness
-"there has been little success in eradicating chronic illness bc strategies that tackled infectious disease before have proved inappropriate for chronic/degenerative conditions and it has been hard to discard the successful "microbe hunters " formula. therefore, modern med is increasingly required to develop insight into the social behaviors of people" -rise of chronic illness --> recognition of causal role of social factors
Cockerham & Smoking
-"there is a social pattern to smoking that indicates tobacco use is not a random, individual decision independent of social structural influences" -smoking has a social gradient, meaning the behavior is rare among upper classes and concentrated among low classes
Rise of U.S. Sociology
-1893 = first sociology department at University of Chicago -1901 = 169 institutions of higher ed offered sociology courses -1901 = divide between "pure soc" (analysis) vs "applied soc" (social probs) -American soc focused on empirical research and analysis of contemporary social life (unlike Germany which focused on historical/philosophical)
American Medical Sociology 20th Century
-1920s = first work from sociological perspective = Bernard Stern's "Social Factors in Medical Progress" in 1927 -1930s = Lawrence Henderson's paper on physicians/patients in social system in 1935 --> important bc influenced student Talcott Parsons -1940s = federal agencies/private foundations fund joint research by physicians/sociologists --> research in med soc took off -1950s = Talcott Parson's "The Social System" in 1951 discussing the sick role -1960s-70s = symbolic interactionism is biggest theoretical influence
History of British Medical Sociology
-1940s = establish National Health System in 1948 (w/o input from soc) -1950s = med soc first appears, confined in London School of Economics -1960s = med soc gains strength, increases in universities -more applied than theoretical (like U.S.) -ex. focus on improving patient care, solving health inequities, contributing to health policy
Critics of Structuralism
-1960s= point out flaws in structural theory -methodological individualists = inexact about how social change occurs (why do individuals choose to facilitate social change?) -conflict theorists = justifies maintaining status quo (civil rights) -symbolic interactionists = diminishes individual agency and micro-level social process
Émile Durkheim & Suicide
-4 types = anomic (low regulation), egoistic (low integration), altruistic (high integration), fatalistic (high regulation) -suicide rates in 19th c. West Europe result from social facts (religious) -ex. Protestant areas have higher suicide rates than Catholic bc of lower social integration among Protestants -"sociologists are attracted to Durkheim's work bc it maintains that society exists external to individuals to constitute a reality of its own having strong influence on individual social behavior"
Causation
-BUT physical factors (virus/cancer) cannot cause illness when they are quarantined (lab) -physical factors are not factors themselves -to be CAUSAL, material factors must be introduced to the body -"assigning causation to biological factors does not account for the relevant factors in a disease's pathogenesis, especially related to social behaviors/conditions that bond people to disease. Social factors can initiate the pathology and serves as a direct cause for a # of diseases"
Diabetes Triad
-Host = genetically predisposed people -Agent = negative health lifestyle -Environment = social/economic disadvantaged neighborhoods -NOTE: the agent is not a pathogen or gene
AIDS Triad
-Host = periphery (not carrying HIV) -Agent = core (carrying HIV) -Environment = intra-racial network
Does this mean we can abandon micro-level research?
-NO -"the fact that structure may be able to influence agency/individual action in some social situations doesn't negate the need to account for micro-level phenomena"
Why does it matter who is correct?
-Our view of causes will direct our intervention efforts ⁃If you think risk factors are key, then you will try to eliminate proximal causes ⁃If you think stratification stress is key, then you will try to shrink inequality ⁃If you think intelligence is key, then not much can be done. ⁃If you think noncognitive resources are key, then you will try to address deficits in them ⁃BUT if you think social factors are key, then you will try to increase flexible resources
Exceptions to the Rule
-The model suggests that high SES people utilize flexible resources to gain health advantages -But, sometimes, these flexible resources may be useless or harmful
How do social factors influence the epidemiological triad?
-agents can be social (health influenced by class position, occupation, neighborhood, etc.) -hosts can be both biological (age, sex) and social (habits, customs, norms) -environments are both physical and social (poverty, segregation, networks) NOTE: most attention given to LIFESTYLE as social mechanism producing positive/negative health
Conflict Theory
-all societies have inequality, which causes conflict producing social change -norms and values are NOT the glue that produces consensus in society (structural) but are imposed on low class by dominant groups -social processes = struggles over limited resources (drives change in society) -ex. Friedrich Engels = health disparities among English working class
How do people decide to start smoking?
-almost all smoking begins SOCIALLY (groups) -rarely does anyone start smoking alone -smoking usually originates in adolescent peer groups, in which teens emulate adults or older teens -smoking is used to promote social relationships, reinforce personal bonds, and express group affiliation
Process of Quitting Smoking
-also social in origin -most people who quit are connected in strong/weak social networks of people who have decided to quit smoking at the same time -those who quit often run out of people to smoke with -those who don't quit are marginalized from networks where quitting is occurring
Why are social factors thought to be distant/secondary influences on health/illness?
-because social factors (lifestyles, norms, values) are neither pathogens (germs, virus) nor physical conditions (cancer cells) -poverty --> exposure to pollution --> illness -poverty is portrayed as secondary cause and pollutants as the primary cause
Talcott Parsons
-built his structural functionalist approach on Durkheim -sick role = Parson's main contribution to med soc (1951) -specified normative behavior of ill people and their family, peers, caregivers -ex. people in sick role have social imperative to get well
Ex. of protective strategies:
-cancer screen, smoke knowledge, gaining access to best docs, have family that supports healthy behavior -some ex. depend on individual initiative (flu shot) and some do not (supportive family)
SES as Social Condition
-class influences multiple diseases in multiple ways over multiple centuries -multiple studies link low SES w/worse health outcomes -ex. poor were more affected by bubonic plague in 14th c. Europe
British Cores
-core theoretical approach in British med soc = social constructionism -"social constructionism maintains that scientific knowledge/biological discourse of body/health/illness are produced by subjective, historically determined human interests and subject to change" -ex. Bryan Turner = things are not discovered but are socially produced -"an illness is socially constructed in that the expression of symptoms is shaped by cultural norms and values, experienced through interaction w/others, and influenced by beliefs of health/illness. A diagnosis represents transformation of physiological symptoms into socially constructed behavior"
ex. 20th c medical care
-developed nations provide free national health programs to make access to health care universal -such programs may have kept SES inequalities in mortality from rising, but they have NOT diminished them
Structural Functionalism
-dominant theory in 1950s-60s when med soc established as academic specialty -structural theories (Durkheim, Parsons, Barthes, Strauss, Braudel, Saussure) minimize/deny individual role in social processes
Symbolic Interactionism
-flourished 1963-70 -leading agency-oriented approach (w/some influence on med soc) -major figures = George Herbert Mead, Herbert Blumer -based in social psychology of behavior -focus on development of individual's self concept w/reference to social experience -individuals interacting construct social reality based on shared meaning -both objects in material world and people's self-concepts must be given meaning through social interaction
Why is this so popular in the Western world?
-great success in treating/curtailing infectious disease around the world -by 1960s = eradication of polio, smallpox -how? drugs (microbio, chem) and improving living conditions (diet, housing, sanitation)
Statistical Methods: Structural Effects
-hierarchical linear models (HLM) test strength between variables describing individuals at one level, structural entities (household) at the next level, and higher levels (neighborhood, community) -"rather than treat structural variables as an aggregation/sum of individual variables, problems of ecological inference can be overcome w/structural variables that are direct measures the structure, such as neighborhood characteristics that reflect the neigborhood not the residents"
ex. 19th c public health initiatives
-higher mortality rates among poor people were thought to result from overcrowding, poor sanitation, and infection (measles, syphilis, etc.) -virtual elimination of risk factors in developed nations did NOT diminish SES inequalities in mortality
social factors
-influence health/illness of individuals, groups, and communities = stress, poverty, low SES, unhealthy lifestyle, unpleasant living/working conditions, etc. -lay people understand that social factors can make people ill -even illnesses thought to be biological (rheumatoid arthritis) are grounded in SES -social gradient = low-status persons have greater risk of becoming arthritic
Why did postmodern theory never gain a foothold in medical sociology?
-it's tools fo deconstruction provided little assistance in accounting for the structure/character of society after the transition from modernity to postmodernity
Criticisms of social constructionism:
-lacks uniformity -can be more agentic (Berger and Luckmann) or structural (Foucault) -fails to acknowledge biological reality of illness -rejects possibility that knowledge can be discovered -claims no form of knowledge is more valid than another (self-contradictory)
American Medical Sociology 19th Century
-med soc influenced more by medicine than sociology -first use of "med soc" by Charles McIntire in 1894 = "science of social phenomena of the physicians as a class apart/separate; and the science that investigates the laws regulating the relations between the med profession and human society and any related subject"
How about other diseases?
-most individuals (all races) die from heart disease, cancer, cerebrovascular diseases -but blacks have higher death rates from these diseases than whites -these differences cannot be explained by biology alone -in many cases, the factors are social
Defining Social Networks
-networks = composed of actors and social ties between them -actors = individuals or organizations (hospital) -ego = individual of interest in network -alters = others in network around ego -component = subgroup of directly/indirectly connected actors -clique = subgroup where every actor directly connected -centrality = measure of network prominence/influence (# direct ties)
Critics of Conflict Theory
-not as influential on med soc as structuralism -downward conflation (individual behavior determined from above) -conflict may be important in some but not all health situations -contradictory = accuses med profession of being BOTH expansionist (take control over more social probs) AND exclusivist (discriminate poor) -Marxism (underpinning of conflict) lost influence from 1970s -existing Marxists failed to provide health social conditions/adequate health care delivery -ex. lacked administrative flexibility needed to shift from infectious to chronic disease
Pierre Bourdieu (1930-2002)
-only recently attracting med soc -"Distinction" 1984 -concepts of lifestyles, habitus, and field have been applied to health behavior/delivery
Upward Conflation
-opposite of downward conflation -"upward conflation describes behavioral models where individuals monopolize causal power that operates one-way, upward and seems incapable of acting back to influence individuals"
Émile Durkheim
-origin of theoretical support for causal role of social factors in health outcomes -social facts = structures that are external to and constraining of individuals -ex. norms and values are external to individuals and can constrain their behavior -"Durkheim: societal reality emanates from macro-level social structures constituting a system of interrelated parts functioning together to produce stability, order, integration"
Risk Factors Approach
-portrays chain of causality: social conditions --> risk factor --> disease -ex. risk factor = diet, smoke, exercise, pollution -fix disease by eliminating risk factors (proximal, behavioral, biomed)
Diabetes & Race
-rates of diabetes rising in US and race is key factor -how? blacks and hispanics are twice as likely to become diabetic -race is salient bc black and hispanics are overrepresented among low-income groups -low-income is associated w/diabetes risk factors: high sugar/fat diet, little/no exercise, inadequate med care
Structural Effects
-recognizing effects of social conditions has been difficult bc hard to isolate methodologically -qualitative studies (observation) face shortcomings in determining effects of structures on people -quantitative studies require construction of independent variables having collective properties
Ex. Cholera
-seems biomedical -what causes it? biomed model says vibrio cholera bacteria -what causes people to get the bacteria? poor sanitation -what causes poor sanitation? poverty/lack of infrastructure -model = poverty (macro environment) --> lack of sanitation (micro environment) --> bacteria (agent) --> cholera (in host)
British Structural Influence: Materialistic Explanation
-seen as alternative to social causes approach -evolved from 1980 Black Report on class disparities in health -finding = health differences emerge from specific cause of income differences -why? income difference determines diet, housing, pollution and eventually health outcomes -similar to social causes but focused on income
Social Determinants (Link and Phelan)
-seminal work on role of social conditions in disease causation
Ex. Smoking
-smoking is associated with more diseases than any other health lifestyle practice -biomed model = tar in smoke --> cancer/impair circulation -problem = tar is not causal; must enter human body to have effect -usual response = individuals are the ones that choose to smoke!
British Sociology
-soc in general was resisted by Oxford and Cambridge bc political philosophy deeply engrained in classical education of 19th c -so new style of thinking sociologically was not immediately embraced
Core topics in current British medical sociology:
-soc of body -subjective experience of illness -gender, race, class health inequalities -emotion -formal/informal health care -healthy policy/politics -pharmaceuticals -health risks -internet med
Why are social conditions fundamental causes of health inequalities?
-social conditions are connected to multiple health outcomes through multiple mechanisms over multiple times -imagine model = SES --> risk factor --> mortality -if we eliminate risk factors, we would expect SES-mortality connection to disappear -but SES disparities in mortality have persisted in several important instances even after eliminating major proximal risk factors
Why study social support in medical sociology?
-social isolation (absence of social support) = linked to psychological disturbance and increased mortality -even moderately cohesive networks promote # positive health outcomes
Britain & Agency
-strong agency-oriented (more than US) top 2 theorists emphasize agency: -Anthony Gidden's structural theory was designed to solve agency-structure conundrum (ends up prioritizing agency) -Margaret Archer's critical realism, which focusses on ability of individual to withstand or minimize effects of structure -neither theory has been influential in med soc but both examples of strong agency orientation among Brits
Evaluation of Risk Factor Approach
-success = positive effect on pop health -shortfall 1 = downplays social conditions, which shape capacity to modify/eliminate risk factors -shortfall 2 = identifying risk factors can increase health disparities (bc med interventions not distributed equally in pop.) -interventions are available/utilized by groups less likely to experience discrimination and have greater access to knowledge, money, power, prestige, and social connections
Teens & Smoking
-teen taught to overcome unpleasant choking by pulling smoke into lungs -later, teens identify individual effect of nicotine (reduce anxiety) and begin smoking as personal habit -"in almost all cases, smoking is initially acquired in the company of others...the origin of this causal chain is social. removing the social element breaks the chain and prevents the disease process from occurring"
Basic Argument of U.S. Sociology
-the history of theorizing has diminished the ability to think structurally in med soc -Europeans often ignored med bc not thought to influence social structures/behavior like religion, politics, law, economics
Risk Factor & Fundamental Cause
-theory of fundamental cause arose in 1990s as response to risk factor approach -Link/Phelan: "from this point, major health disparities by race, ethnicity, and SES are social products that we create"
Proving Causation
-to prove that social factors are causal, must show how social mechanisms at aggregate level influence health/disease at the individual level
Diabetes & Genetics
-variant of gene TCF7L2 increases risk of type 2 diabetes and is carried by 1/3 US pop -but this gene has been around for generations and rapid rise of new cases cannot be explained genetically (bc human gene pool doesn't change that fast)
Functional systems produce social order
-when dysfunctional processes (crime/ill) produce instability restorative/punitive institutions (health care/jail) emerge to restore balance
AIDS & Race
-why should blacks have higher rates? -SES alone is NOT the answer; hispanics and poor whites have lower rates than blacks -intra-racial network effect = blacks more segregated than other races -high # sexual contact between infected black CORE and a PERIPHERY of uninfected black sexual partners contains infection within black communities -even if a single african american from periphery has only one partner, the probability that the partner is from the core is 5 times higher than it is for peripheral whites and 4 timers higher than hispanics
When are they useless or harmful?
1) having med knowledge does little good bc it's sparse (brain/pancreatic cancer) 2) adopting current practice is directly harmful (hormone-replacement to treat heart disease increase cancer) 3) acting on correct knowledge is harmful in other ways (having children = good maternal health but = impede career) -these exceptions are not fatal to the main argument bc each scenario still involves basic driver of flexible resources which block capacity to deliver benefits
Fundamental cause theory has a difficult time explaining why (2):
1) women live longer than men 2) some immigrant groups have better health than native-born Americans
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3) Intelligence is a flexible resource rather than a cause of both SES attainment/health outcomes ⁃ Gottfredsson = intelligence —> BOTH socioeconomic status AND health outcome ⁃ Link/Phelan = social factors —> flexible resources (including intelligence!) —> health outcomes ⁃ Link/Phelan: "The analysis found little evidence of a direct effect of intelligence on health once adult education and income are held constant. In contrast, the significant effects of education and income on health change very little when intelligence is controlled."
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4) Noncognitive traits alone do not explain health outcomes ⁃ Link/Phelan: "While the evidence concerning the role of noncognitive traits in socioeconomic attainment is arguably strong, the evidence linking them to health, particularly with adequate consideration of socioeconomic status, is both thin and weak."
Counterarguments: Pharmaceuticals
= biomed model accounts for advancements in disease containment in modern world -ex. polio vaccine in 1950s leveled disparities between upper and lower class bc administered universally -BUT introduction of statins has not leveled disparities in heart disease between classes -why? bc high income are more likely to use them. only recently low-cost, generic statins come to the market
Counterargument: Mechanisms
= class or SES cannot be causal factor bc it is too difficult to identify specific causal mechanisms -this assumes that a single causal mechanism can produce only a single outcome -BUT Link and Phelan argue that social conditions are FUNDAMENTAL causes bc they cause morbidity/mortality in multiple ways -"fundamental cause concept doesn't imply a theory of specific proximate mechanisms responsible for persistent association; rather, the theory is meta-mechanisms responsible for how several specific mechanisms that affect health are generated over time"
Ex. of Structural Effects
= difficult to measure influence of class bc usual socioeconomic variables of income, education, occupation prestige can be depicted as individual characteristics -solution = measure class as family or household (highest level labor = social status) -solution = measure education w/prestige of institution -solution = living condition by average value of homes
Biomedical Model
= every disease has a pathogenic origin whose treatment can be accomplished by removing/controlling its cause using medical procedures -main pathogen origins = germ, virus, cancer, genes -main med procedures = pharmaceuticals, surgery
Social Conditions
= factors that involve relationships w/other people -can range from personal (intimacy) to structural (economy) -ex. = class, race, gender, stress, social support, etc. -thesis = social conditions are FUNDAMENTAL causes of disease -application = broad social interventions may produce more health benefits than individual interventions
Epidemiological Shift
= major threat to health changed from infectious disease to chronic illness -chronic illness = long-term/incurable (cancer, heart disease) -shifted medical attention from battling pathogens to treating the "whole person"
Richard Wilkinson
= post-Marxist approach -tradition to high living standards improves health of pop -but high levels of within-nation inequality reduce health outcomes that have social gradient for all citizens -critics claim that Wilkinson's research has not been replicated and is flawed
Social Networks & Health
= relationship between networks and health is reciprocal -social networks shape health behavior/outcomes -health contributes to formation, maintenance, dissolution of networks
What causes new risk factors to emerge?
Link/Phelan: "fundamental cause theory claims that new mechanisms arise bc high SES people are able to deploy resources - knowledge, money, power, prestige, social connections - that can be used individually/collectively in different places/times to alive disease/death. bc they can be applied in different circumstances, called flexible resources. so when new knowledge about risk/protective strategies emerge, people use the resources available. people w/more resources benefit more, creating a new mechanism linking social conditions to morbidity/mortality"
Downward Conflation
Margaret Archer - theories that portray society "unilaterally molds individuals to act in particular ways and has a complete monopoly over causation"
Agency-Oriented Theories
agency = individuals capacity to freely select behavior -agency-oriented theory emphasizes ability of individual to choose actions regardless of structural constraints
Why does the connection between SES and mortality persist?
as old risk factors are eliminated/contained, new risk factors emerge
Other micro approaches
ex. Erving Goffman's "Asylums" in 1961 coined "total institutions" in studying confined mental patients
Social Determinants
ex. of how race/class serve as social determinants of health in U.S. -diabetes -HIV/AIDS
HIV/AIDS
mid 1980s = beginning of epidemic -disease in gay white men -but these men were more affluent/educated so adopted safer sex practices 1990s = dramatic shift -after 1995, epidemic declined -disease shifted to non-hispanic blacks and hispanics
Theories in U.S. Medical Sociology
structural functionalism = early but short-lived influence of macro theory -ex. Parsons sick role in 1951 symbolic interactionism = individual, agentic, micro approach -ex. Becker and Strauss "Boys in White" about physician training in 1961 -ex. Becker's labeling theory (deviance defined by others) applied to mental patients