Health and Society Essay Exam 1

7 good health practices in Western society

- 7-8 hours of sleep a night - eating breakfast every day - seldom if ever eating snacks - controlling one's weight - exercising - limiting alcohol consumption - never having smoked cigarettes

Koo's study of Regionville (SES)

- Class I (most successful) --most likely to recognize symptoms as needing medical attention - Class II (middle class) - Class III (least skilled workers and poor) -- indifferent to most symptoms -- cost, fear, and relative need, as well as group expectations about symptoms important factors inhibiting help-seeking

Stigma

- Goffman - defined as some deeply discrediting attribute

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

Culture of poverty

- a phenomenon in which poverty, over time, influences the development of certain social and psychological traits among those immersed within it -- dependence, fatalism, inability to delay gratification, and lower value placed on health - tends to reinforce the poor person's disadvantaged social position

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 biotech, consumers, and managed care

Main forms of stigma

- abominations of the body - blemishes of individual character (STDs, etc.) - tribal stigmas of race, religion, and nationality

General adaptation syndrome

- after an initial alarm reaction, a second stage of resistance to prolonged stress was initiated if stress continued and pituitary and adrenal defenses were consumed, a person would enter a third stage of exhaustion (premature aging due to wear and tear on the body)

Cooley symbolic interaction

- an individual's perception of himself/herself as a social object is related to the reaction of others - stress can result from the failure of the other person to reflect a self-image consistent with that intended by the individual

Life changes: extreme situations

- appear to be a likely source of stress because of the great anxiety people usually attach to being caught in such circumstances - the disaster experience, though severe, is usually short in duration and the effects on mental health likewise tend to be short-term and self-limiting - coherence is a personal orientation that allows an individual to view the world with feelings of confidence, faith in the predictability of events, and a notion that things will most likely work out reasonably well --attained by overcoming challenges and coping with varying degrees of stimuli -- overly routine and predictable lives can weaken coherence and make it more difficult to handle surprises and sudden changes

Casual agents of epidemiology

- biological (bacteria) - nutritional (fats) - chemical (pollution) - physical (climate) - social (occupation)

Richard Wilkinson's income inequality hypothesis

- blames degree of inequality among classes within a society for health inequalities - society's overall level of wealth less important

Passive orientation toward health services

- characteristic of the lower class - influenced by an external locus of control and the culture of poverty - individuals more readily turn over control of health issues to the medical system

Consumer orientation toward health services

- characteristic of the upper and middle classes - individuals take responsibility for their own health and deciding when to seek medical care

Women's liberation movement directed attention to previously ignored areas such as:

- childbirth - abortion - family planning - illegitimacy - sexual stratification within the medical profession - doctor-patient relationship

Key to distinguishing among sick roles in labeling theory is notion of legitimacy

- conditional legitimacy -- temporary exemption from normal obligations, obligation to get well (colds) - unconditional legitimacy -- permanent exemption from obligations, plus gain extra privileges because of hopelessness of deviance (cancer) - illegitimacy -- exempt from some obligations but no additional privileges and may be stigmatized (stammers)

Criticisms of the sick role

- does not account for behavioral variation - does not account for the type of disease - does not account for variations in the patient-physician relationship - does not apply well to lower-class patients - can still be viewed as an 'ideal type' model

Criticisms of Labeling theory

- does not explain what causes deviance other than social reactions to an act - does not examine commonalities among deviant actors (other than their sharing a label) - does not explain why certain people commit deviant acts and others in the same circumstances do not

Goffman symbolic interaction

- 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 - 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 embarrassing and stressful situation

Development of medical sociology

- early works written by physicians focused on connections between social conditions and health - early sociologists did not give much attention to matters of health and medicine - federal funding after WWII gave sociomedical research a boost

Brenner functionalism

- economic recessions represent periods where obtaining the basic necessities of life and self-satisfaction are more difficult and stressful - reasons for increased mental illness during recessions -- provocation hypothesis: disruption of usual lifestyle causes mental illness in vulnerable people -- uncovering hypothesis: exposes people with mental illness by reducing the resources they used to cope

Moral controversies related to debates about:

- euthanasia - abortion - genetic engineering-cloning - stem cell research - reproductive technology

How stigma affects health

- experience of psychological stress - delays in seeking health care due to fears of being stigmatized and the subsequent discrimination - experience of adverse reactions from others in health care settings by stigmatized individuals - slow provision or withholding of resources by communities when stigmatized groups may be the primary recipients

What is science?

- facts and observation of facts giving rise to observed regularities - forming a hypothesis - testing the hypothesis by using various methods - construction of a theory - forming a scientific law - objectivity - understanding ("Verstehen")

Dutton's 3 possible explanations for why the poor show lower rates for use of health services

- financial barriers - culture of poverty --negative attitudes toward medical practices and a willingness to ignore illness - systems barrier -- long waiting times, travel, etc.

Three epidemiological transitions in human history

- first: occurred around 10,000 years ago -- human societies shifted from foraging to agriculture -- marked by the emergence of novel infectious and nutritional diseases - second: around 200 years ago -- improved nutrition and living standards, public health measures, and medical advances in developed societies led to a decline in infectious diseases and a rise in chronic and degenerative diseases - third: beginning now -- resurgence of infectious diseases previously thought to be under control -- the potential for the spread of infectious diseases has been significantly enhanced in today's world by the globalization of trade and travel

Bourdieu health lifestyle

- 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 -- they are socialized to prefer their lifestyle preferences over those of other classes

SES measures

- income - occupational prestige - education (most important in predicting health outcomes)

Changes in society and in medical care which encouraged the development of sociology of health and illness are:

- increase in population - decline of epidemic diseases - advanced medical knowledge and technology - changing patterns of diseases - new organization of medical care

SES direct cause of poor health because it:

- influences multiple diseases - affects these diseases through multiple pathways of risks - is reproduced over time - involves access to resources that can be used to avoid risks or minimize the consequences of disease if it occurs

Four basic aspects of the sick role

- is exempt from "normal" social roles -- depends on severity of condition and approval by the physician - 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 - 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 - should seek technically competent help and cooperate with the physician

"Whole person" health care

- late 20th-21st century - transition from infectious chronic diseases as leading causes of death - recognition that social environment and lifestyle practices influence chronic diseases encourages emphasis in medicine on treating the "whole person"

Leonard Pearlin two major types of social stressors

- life events (divorce, marriage, losing one's job) - chronic strains (the relatively enduring conflicts, problems, and threats that many people face on a daily basis

Sociology in medicine (Strauss, 1957)

- medical institutions - collaborates directly with physicians and other health personnel in studying the social factors that are relevant to a particular health problem - intended to be directly applicable to patient care or to the solving of a public health problem - applied research and analysis primarily motivated by a medical problem - had an advantage in funding

Weber health lifestyle

- members of the same social class generally share similar lifestyles - lifestyles reflect the types and amounts of goods and services one uses or consumes - lifestyle choices are influenced by one's life chances, or socioeconomic circumstances - lifestyle patterns distinguish social classes from one another (some patterns eventually spread across class boundaries)

People belonging to close and exclusive groups are either

- more likely to seek medical care if it is consistent with cultural beliefs and practices - less likely to seek medical care if cultural beliefs support skepticism and distrust of professional medicine

Mechanic's 10 determinants operate at two levels

- other defined: other people attempt to define an individual's symptoms as illness and call those symptoms to the attention of that person - self defined: the individual defines his or her own symptoms

Factors that cause ill health, specifically in the poor

- physical (poor sanitation) - chemical (pollution) - biological (bacteria) - psychological (stress) - economic (low income) - lifestyle (poor diets)

Five features of neighborhoods that can affect health

- physical environment - surroundings at home, work, and play - services provided to support people - sociocultural aspects of the neighborhood - reputation of an area

Talcott Parsons

- publishes The Social System in 1951 - first major social theorist to deal with issues of health, illness, and the role of medicine - structural-functionalist perspective - introduced concept of the sick role

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

Life changes: life events

- research emphasizes the harmful impact of the accumulation of several events in a person's life - Social Readjustment Rating Scale, developed by Holmes and Rahe -- as the total value of life change units mounts, especially in a short period of time, the probability of having a serious illness also increases -- doesn't distinguish between stressful events and stressful situations leading to events -- fails to account for intervening variables such as social support or mastery of an event

Stages of epidemiology

- sanitary era (early 19th century) - infectious disease era (late 19th to mid-20th century) - chronic disease era (mid to late 20th century) - eco-epidemiology (21st century)

Possible reasons for gradient include differences between classes in:

- self-esteem and stress levels - effects of income inequality - deprivation through life course - health lifestyles and social support - socioeconomic environment - use of preventive health services

Patterns promoting self-care by laypersons

- shift in disease patterns from acute to chronic illnesses and the accompanying need to care for symptoms that cannot be cured - dissatisfaction with professional medical care that is depersonalized - recognition of the limits of modern medicine - increasing awareness of alternative healing practices - heightened consciousness of the effects of lifestyles on health - a desire to be in control of one's own health when feasible

What do medical sociologists study?

- social causes and patterns of health and disease - social behavior of health care personnel and their patients - social functions of health organizations and institutions - relationship of health care delivery systems to other social systems

What has sociological of health and illness contributed and related to the medical sciences?

- studies in the analysis of organizations - studies in interpersonal sociology - studies of value systems (ethical and ideological values)

SES plays an important role in the stress process how:

- the higher one's position in a social hierarchy, the better one deals with stressful situations and the effects of stress on the body - this advantage decreases proportionally the lower one goes down the social ladder - the lower class is subject to the most stress and has the fewest resources to cope with it

Patient-physician relationship defined by the sick role

- 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

Thomas symbolic interaction

- 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

Social capital

- the social investment of individuals in society in terms of their membership in groups - resources contained in networks have the potential to reduce stress

Contributions of medical sociology are in:

- the study of the way in which individuals seek help from doctors - the doctor-patient relationship and the doctor's role - social factors involved in the etiology of disease

Suchman's stages of illness experience

- the symptom experience - the assumption of the sick role - medical care contact - the dependent-patient role - recovery and rehabilitation

Sociology of medicine (Strauss, 1957)

- university departments - deals with such factors as the organization, role relationships, norms, values, and beliefs about health as a form of human behavior - research and analysis of the medical or health environment from a sociological perspective - most sociologists of medicine are employed as professors in the sociology departments of universities and colleges - thought to produce "good sociology"

Functionalist approach to deviance

- views society as a system of interrelated parts, with an emphasis on the tendency of those parts to work together to maintain order and equilibrium - deviance represents behaviors which disrupt normal social functioning and are reduced and/or controlled through the application of various sanctions -- sickness can be seen as deviance because it threatens the stability of social systems - medical profession offsets the dysfunctional aspects of sickness by controlling or preventing disease

Mechanic's 10 determinants for seeking medical care

- visibility and recognition of symptoms - extent to which the symptoms are perceived as dangerous - extent to which symptoms disrupt family, work, and other social activities - frequency and persistence of symptoms - amount of tolerance for the symptoms - available information, knowledge, and cultural assumptions - basic needs that lead to denial - other needs competing with illness responses - competing interpretations that can be given to the symptoms once they are recognized - availability of treatment resources, physical proximity, and psychological and financial costs of taking action

Cooley's "looking-glass self"

- we see ourselves in our imagination as we think we appear to the other person - we see in our imagination the other person's judgment of ourselves - 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

Labeling theory

- what is regarded as deviant behavior by one person or social group may not be so regarded by other persons or social groups - deviance is not a quality of the act a person commits but instead is a consequence of the definition applied to that act by other people

Practitioners role

Accept the importance of social factors in the etiology of disease and treatment thus sociology has been introduced as a subject in medical schools

Who suggested sociology might be a science?

Auguste Comte

Who says sociology is not a science?

Many pure scientists, church leaders, moralists, and even some sociologists

Women are more likely to have chronic conditions that are not a leading cause of death; have a higher morbidity rate

Men have more of the chronic health problems that end one's life; have a higher rate of mortality

Epidemics

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

Administrators role

Recognize a sociological component in administrative and organizational problems

Why is sociology an important field of study?

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

Social gradient in mortality

Whitehall studies - showed social class differences in mortality among British male civil government employees - observed even among relatively high-ranked groups where poverty was not an issue - differences in mortality were linked to hierarchy rather than deprivation - observed in numerous countries regardless of the specific variable used to indicate social position

Social class

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

Self-care

a layperson's preventing, detecting, and treating his or her own health problems

Epidemiological measure: age-adjusted rate

a more specific measure than crude rate and shows differences by age in the distribution of health problems

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

Sick role

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

WHO definition of health

a state of complete physical, mental, and social well-being, not merely the absence of disease or injury

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

Epidemiological measure: case

an episode of a disorder, illness, or injury involving a person

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

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

medicine of social spaces (Foucault, 1973)

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

Lay-referral system (ethnicity and social networks)

consists of nonprofessionals who assist individuals in interpreting their symptoms and in recommending a course of action

Biomedical approach (germ theory of disease)

every disease has a specific pathogenic cause best treated by removing or controlling that cause

Sanitary era

focus was largely on sewage and drainage systems and the major preventive measure was the introduction of sanitation programs

Chronic disease era

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

medicine of the species (Foucault, 1973)

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

Durkheim functionalism

illustrates how society creates stressful situations where people are forced to respond to conditions not of their own choosing - egoistic suicide is a result of stress brought about by the separation of a strongly integrated individual from his or her group - anomic suicide results when sudden changes induce a chronic lack of regulation and lead to a state of restlessness in which norms no longer bind one to society - altruistic suicide is where people feel themselves so strongly integrated into a demanding society that their only escape seems to be suicide

Since 1970

lowest classes visit doctors the most, middle class next, upper class visiting doctors the least

Eco-epidemiology

preventive measures are multidisciplinary as scientists from many fields use their techniques to deal with a variety of health problems at the molecular, social-behavioral, population, and global levels

Physiological responses to stress

primarily involve the autonomic and neuroendocrine systems

Infectious disease era

principal preventive approach was to break the chain of transmission between the agent and the host

illness

refers to a subjective feeling of discontent experienced by an individual (individual) - 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

Social environment

refers to the 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

Epidemiological measure: incidence

refers to the number of new cases of a specific health disorder occurring within a given population during a stated period of time

sickness

refers to the role negotiated with society (social) - a social state signifying an impaired social role for those who are ill

disease

refers to the signs, symptoms, and behaviors regarded by doctors as pathologically abnormal (medical; an objective medical fact) - an adverse physical state, consisting of a physiological dysfunction within an individual

Preventive 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

Social support from families and groups

subjective feelings of belonging, being accepted, and being needed produce feelings of well-being and relieves symptoms of tension

Point prevalence

the number of cases at a certain point in time, usually a particular day or week

Lifetime prevalence

the number of people who have had the health problem at least once during their lifetime

Epidemiological measure: crude rate

the number of persons (cases) who have the characteristics being measured during a specific unit of time

SES or social class is:

the strongest and most consistent predictor of a person's health and life expectancy across the life course regardless of access to health care or health care delivery system

Period prevalence

the total number of cases during a specified period of time, usually a month or year

Epidemiological measure: prevalence

the total number of cases of a health disorder that exist at any given time