SYO4402 - Exam 1
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
Second epidemiological transition:
- About 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
Bubonic plague
- Affected Europe between 1340 and 1750 - Killed approximately one-third of the European population - Transmission of the disease was not understood initially but social patterning in the distribution of the disease was observed
General adaptation syndrome (Selye 1956)
- 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 • This stage represents a premature aging due to wear and tear on the body
Primary mode of transmission (HIV/AIDS):
- Among adult and adolescent males: • 64 percent of all cases reported were homosexual and bisexual men • 16 percent were IV drug users • 7 percent were homosexuals and IV drug users • 12 percent resulted from heterosexual contacts • 1 percent from other causes like blood transfusions - Among adult and adolescent females: • 72 percent are from heterosexual contact with infected males • 26 percent are infected from IV drug use • 2 percent from other sources
Education
- Appears to be the most important component of SES in predicting health outcomes • Influences: - Knowledge about healthy lifestyles - Seeking preventive care or medical treatment for health problems when needed - Likelihood of having better income and satisfying jobs - Education influences the onset of chronic diseases
Physiological Responses to Stress
- As an organism, the human body is prepared to meet both internal and external threats to survival - Physiological changes in the body, as a result of stressful situations, primarily involve the autonomic and neuroendocrine systems - Whether the stressful situation actually induces physiological change depends upon an individual's perception of the stress stimulus and the personal meaning that the stimulus holds
Black Report in 1980 sponsored by British government:
- Assessed trends in population health - Demonstrated health inequalities were not decreasing among different social classes despite increased welfare services
Third epidemiological transition:
- 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
Race: Black Americans
- Blacks are disadvantaged compared to whites in longevity • Significantly more blacks than whites have hypertension, a major contributor to black mortality • Multiple reasons are suggested for this pattern: - Genetic predisposition - Physical exertion (more likely than whites to be engaged in manual labor) - Associated disorders (more likely to have other diseases that cause hypertension) - Psychological stress (from racial discrimination) - Dietary patterns - Poorer medical care
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 - Compelling argument but thus far findings in other research have not supported his position
Pandemics
- Distinguished from epidemics by their widespread nature - Affect not only the countries of one region but multiple regions and continents in the world
West Nile Virus
- First appeared in New York City in the summer of 1999 - Initially puzzled medical personnel and public health officials, since the disease had not been seen before in the Western hemisphere - Eventually spread throughout the U.S. - Peak cases/mortality in 2006
Bioethics is concerned with controversial areas of medical practice and research:
- Funding of research by pharmaceutical companies - Practices such as "ghost-writing" academic articles on the use of medical interventions - Stem cell research - Use of human genetic material, including cloning - Abortion - Euthanasia - Reproductive technology
Current cohort of elderly:
- Healthier, better educated, and more affluent than past cohorts - Increased political power to influence relevant legislation (especially regarding Social Security and Medicare) - Although healthier, will place greater demand on health care delivery systems as there are more of them
Gender: The Narrowing Gap in Longevity:
- In preindustrial societies, life expectancy for men and women was similar - Since 1850, women made greater gains in life expectancy and today outlive men in all but a few countries - Changes in work and family circumstances in the 1970s and a convergence between men and women in lifestyles mean the gap between men and women is narrowing
SES is measured by three variables:
- Income - Occupational prestige - Education
Poor more likely to suffer from:
- Infectious diseases - Chronic diseases - Mental illness
American sociologists usually rely on socioeconomic status (SES):
- Influenced by theories of Karl Marx and Max Weber - Wealth an important component but Weber also included social status and power
John Snow
- Investigations into cholera outbreaks in London - He systematically mapped out cases of infection, interviewed victims, and traced their daily activities to a common source: contaminated well- pumps - Provided the foundation of modern epidemiological methods
Leonard Pearlin (1989) identified two major types of social stressors:
- Life events (divorce, marriage, or losing one's job) - Chronic strains (the relatively enduring conflicts, problems, and threats that many people face on a daily basis)
Robert Straus
- Notes division between sociology in medicine and sociology of medicine (1957), division found mostly in the US
First epidemiological transition:
- Occurred around 10,000 years ago - Human societies shifted from foraging (hunting and gathering) to agriculture - Marked by the emergence of novel infectious and nutritional diseases
Influenza
- Pandemic - Past outbreaks, such as 1918 "Spanish flu," have killed millions worldwide - Recent outbreaks of H1N1 ("Swine flu") and H5N1 ("Avian flu") have the potential to become especially serious pandemics - Predicting outbreaks of influenza and controlling the spread of infection remains challenging for epidemiologists
HIV/AIDS
- Pandemic - Transmission is firmly rooted in social behaviors - Has influenced changing norms, values, sex habits, and lifestyles throughout the world - Appeared in the U.S. in 1979 - Represented a significant epidemiological puzzle: first in determining what the new disease was, then in how it was transmitted and where it originated
The poor have the greatest exposure to risk factors that cause ill health:
- Physical (poor sanitation, poor housing) - Chemical (pollution) - Biological (bacteria, viruses) - Psychological (stress) - Economic (low income, unhealthy jobs) - Lifestyle (poor diets, smoking, lack of leisure-time exercise)
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
Important field of study because:
- Recognizes the critical role social factors play in determining or influencing the health of individuals, groups, and the larger society.
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
Bioterrorism
- Relatively new threat of infectious diseases - Takes place when people knowingly prepare biological agents or gases and use them to deliberately induce illness and death among other people • Overt - the perpetrator announces responsibility for the event or is revealed by the attack • Covert - characterized by the unannounced or unrecognized release of agents; the presence of sick people may be the first sign of an attack - Examples: • 1995 release of sarin gas in Japan by the Aum Shinrikyo cult in the Tokyo subway • 1996 outbreak of gastroenteritis when a disgruntled coworker put dysentery bacteria in pastries consumed by staff members in a large medical center laboratory • 2001 anthrax sent through the U.S. mail
Heart Disease
- Represents an example of the complexity of modern health problems - Multiple factors contribute to the risk of developing heart disease by pathways not yet fully understood
STDs
- Represents greatest threat to worldwide health - Four factors responsible for dramatic increase in rates: • (1) Birth control pill reduced fears of unwanted pregnancy • (2) Ideology of sexual liberation and permissiveness among young urban adults throughout the world • (3) New pattern of migrant employment in developing nations spreads STDs acquired in urban areas to the countryside • (4) Availability of multiple sexual partners - Most important risk factor in exposure to infection
Possible reasons for social 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
Risk factors of Heart Disease:
- Sex (specifically male) - High blood pressure - Diabetes - Advancing age - Cigarette smoking - Obesity
Whitehall studies conducted by Marmot:
- Showed social class differences in mortality among British male civil government employees - Regardless of the cause, those with the highest occupational rank had the lowest percentage of deaths - Mortality increased across each job category - Lowest-ranked occupations had the highest percentage of deaths
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
Age
- The 20th century has seen the rapid growth of the aged population worldwide - Most elderly rate their health as good despite the deterioration of health that accompanies old age • Suggests two important points about self-rated health: - It is a relative assessment • People compare themselves to others who are similar in age and sex - Shows how health is perceived in terms of ability to function • Older adults generally have reduced daily activities compared to young adults, thus poor health is less likely to be viewed as disruptive
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 - Few studies consistently linking social capital to health • Difficult concept to define and measure
In the United States, the poor face substantial barriers in life:
- Typically have worse health than the affluent - Are treated within the framework of welfare medicine - Live in disadvantaged urban and rural locales
Five-class model used in the U.S:
- Upper class - Upper-middle class - Lower-middle class - Working class - Lower class
SES can be described as a direct cause of poor health because it:
1) Influences multiple diseases 2) Affects these diseases through multiple pathways of risks 3) Is reproduced over time 4) Involves access to resources that can be used to avoid risks or minimize the consequences of disease if it occurs
Five features of neighborhoods that can affect health:
1) Physical environment 2) Surroundings at home, work, and play 3) Services provided to support people 4) Sociocultural aspects of the neighborhood 5) Reputation of an area
How many epidemiological transitions in human history are there?
3
Age-adjusted rate
A more specific measure than crude rate and shows differences by age in the distribution of health problems. Ex: Infant mortality rate
Sick Role
A patterned set of expectations defining the norms and values appropriate to being sick, introduced by Talcott Parsons
Health
A state of complete physical, mental, and social well-being, and not merely the absence of disease or injury (WHO definition)
Case
An episode of a disorder, illness, or injury involving a person
Causal agents
Any entity that produces an effect or is responsible for events or results, 5 recognized today
Bioethics
Area of study focused on ethical decisions and practices with respect to medical care, research, and human's rights over their bodies
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
Biological agents
Bacteria, viruses, or insects
Social class
Category or group of people who have approximately the same amount of wealth, status, and power in a society
Orderly neighborhoods
Clean and safe, houses and buildings are well maintained, and residents are respectful of each other and each other's property
Physical agents
Climate or vegetation
What makes incidence different than prevalence?
Distinguished from prevalence as the rate at which cases first appear, while prevalence is the rate at which all cases exist
The Development of Epidemiology:
Epidemics only began to affect human populations as trade between regions increased and as humans began moving in greater proportions into cities
Nutritional agents
Fats and carbohydrates
Sanitary era
Focus was largely on sewage and drainage systems, and the major preventive measure was the introduction of sanitation programs (Early 19th century)
Chronic-disease era
Focus was on controlling risk factors by modifying lifestyles, agents, or the environment (Mid-to late 20th century)
Chemical agents
Gases and toxic chemicals that pollute the air, water, and land
Symbolic Interaction: Durkheim
His study Suicide illustrates how society creates stressful situations where people are forced to respond to conditions not of their own choosing
Chronic diseases:
Most associated with modernization and were associated with upper classes
Epidemiology
Multi-disciplinary field that studies the origin and distribution of health problems, whether infectious diseases, chronic ailments, or problems resulting from unhealthy behaviors
Social agents
Occupation, social class, location of residence, or lifestyle
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 (21st century)
Infectious disease era
Principal preventive approach was to break the chain of transmission between the agent and the host (Late 19th to mid-20th century)
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
Social Gradient
Refers to the fact that inequalities in population health status are related to inequalities in social status
Incidence
Refers to the number of new cases of a specific health disorder occurring within a given population during a stated period of time
Disorderly neighborhoods
Reflect a breakdown in social order, as there is noise, litter, poorly maintained houses and buildings, vandalism, graffiti, fear, and crime
Egoistic suicide
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
The Social Demography of Health:
Socioeconomic status 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
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
Layman definition of Health
The capacity to carry out their daily activities, or ability to function
Race
The convergence of biological factors with geographic origins, and multiple cultural, economic, political, and legal variables
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
Crude rate
The number of persons (cases) who have the characteristics being measured during a specific unit of time. Ex: Birth rates and mortality rates
Period Prevalence
The total number of cases during a specified period of time, usually a month or year
Prevalence
The total number of cases of a health disorder that exist at any given time
Layman definition of social environment
What a person does, who a person is, and where a person lives influences what health hazards are most likely to exist in that individual's life
Altruistic suicide
Where people feel themselves so strongly integrated into a demanding society that their only escape seems to be suicide
Race: Hispanics
• "Hispanic paradox" - younger population - Hispanics have lower mortality rates than non- Hispanic whites at most ages despite their lower socioeconomic status and levels of health insurance in the United States - Population is younger than other racial groups and may explain the paradox • Hispanics more likely to be without a regular source of health care
Coherence
• 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
HIV/AIDS - Worldwide
• Africa (33.4 million cases) - South of the Sahara the hardest hit - Primary mode of transmission: heterosexual contact - Migrant labor system plays a vital role in transmission, spreading disease from urban to rural areas - Women account for 60 percent of cases • Western Europe (850,000 cases) and Eastern Europe (1.5 million cases) - Primary mode of transmission: Homosexual activity and IV drug use • Asia (South/Southeast Asia, 3.8 million cases; East Asia and China, 850,000 cases) - Primary mode of transmission: Heterosexual activity (especially through migrant labor systems and prostitution) • Latin America (2.0 million cases) and Caribbean (230,000 cases) - Originally spread through homosexual activity and IV drug use - Now spreading to women through bisexual activity by men
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
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)
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
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
Race: Native Americans
• Have experienced a significant improvement in their overall level of health, but important problems remain. In particular, there are high rates of: - Diabetes and mortality from diabetes - Accidents - Alcoholism and alcohol-related diseases - Suicide
Race: Black Americans cont'd
• Health disparities between blacks and whites point to the importance of socioeconomic factors - Poverty, marginal employment, low incomes, segregated living conditions, and inadequate education are more common among blacks than whites and are features of socioeconomic stratification known to cause poor health • The "intra-racial network effect" is offered as one explanation for why blacks have the highest rates of STDs - Blacks are more segregated than other racial/ethnic groups in American society - A high number of sexual contacts between an infected black core and its periphery of yet uninfected black sexual partners tends to contain the infection within the black population
Functionalism: Brenner
• Linked increased incidence of disease in the United States and several Western European countries to downturns in the economy • 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 illnesses by reducing the resources they used to cope
Gender: Male-Female Life Expectancy:
• Male death rates still exceed those of females at all ages and for the leading causes of death such as heart disease, cancer, cerebrovascular diseases (stroke), accidents, and pneumonia • Male inferiority in life expectancy has both biological and social components - Higher mortality rates even at the prenatal and neonatal stages - Higher rates of accidents, aggressive and risky behavior, and occupational stress • Men generally have a higher rate of mortality, but women appear to have a higher morbidity rate - Women are more likely to have chronic conditions that are not a leading cause of death (except for diabetes) - Men have more of the chronic health problems that end one's life
Gender: Mental Health:
• No consistent differences between men and women in clinically diagnosed cases of mental illness, except: - Women have higher rates of mood and anxiety disorders - Men have more personality disorders • Marriage and employment carry mental health benefits for both men and women
Race: Asian Americans
• Overall, Asians and Pacific Islanders are the healthiest racial group in American society when mortality rates are considered • Again, demonstrates importance of socioeconomic status - Asian Americans have the highest levels of income, education, and employment of any racial/ethnic minority in the U.S.
Life Changes: Life Events
• Research emphasizes the harmful impact of the accumulation of several events in a person's life • Further research needed to determine: 1) Whether any event, pleasant or unpleasant, induces stress, or if only unpleasant events are responsible 2) Whether the rate of change or desirability of change has a greater impact 3) The significance of the degree of impact on individual lives and the area of life impacted by change • Problems of accurately measuring the relationship between stress and particular life experiences
Stress and socioeconomic status
• Socioeconomic status also plays an important role in the stress process - 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
Gender: Smoking:
• Some 443,000 Americans die each year from smoking-related diseases • The current trend in the United States is toward a decrease in smoking for both sexes - Rate of male smokers began declining earlier and faster than women
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