Health, Illness, & Medicine TCU Exam 2

Role of social location in utilization of health services: *Race*

Difference between white and black individuals' physician utilization has diminished (especially for middle-class and above); Mexican Americans have lowest utilization of professional health services

Stress

Heightened mind-body reaction to stimuli inducing fear or anxiety in the individual

Face

It is defined by Goffman as an image of the self which depends on both the rules and values of a particular society and the situation the social interaction is embedded in. It hence mirrors the way a person wants to be perceived by others in his surrounding space. Goffman describes three levels which influence an individual's actions in order to correspond to one's face needs:

Functionalist approach to deviance as illness

Like those more traditionally thought of as "deviants" (e.g. criminals), ill people interfere with stability of the social system

Contributions of Weber and Bourdieu to the study of lifestyles

Max Weber's concept of formal rationality and ideas about lifestyles in general are applied to current trends in health lifestyles. The central contribution of Weber's thinking is recognition of the dialectical interplay between formal versus substantive rationality, consumption versus production, choice versus life chances, class similarities versus distinctions, and self-control versus conformity in shaping health life-styles and the reality of their operationalization in the postmodern world. In a largely applied subdiscipline like medical sociology, Weber's work offers a theoretical background on which to enrich our understanding of health lifestyles and grapple with the initial theoretical challenges posed by lifestyle research.

Dramaturgical Theory

Sociologist Erving Goffman developed the ______________ _________, the idea that life is like a never-ending play in which people are actors. Goffman believed that when we are born, we are thrust onto a stage called everyday life, and that our socialization consists of learning how to play our assigned roles from other people. We enact our roles in the company of others, who are in turn enacting their roles in interaction with us. He believed that whatever we do, we are playing out some role on the stage of life.

Effects of stress on physical health

Stress affects several bodily systems: --> Autonomic nervous system --> Parasympathetic system --> Sympathetic system --> Neuroendocrine system

Example of *Face*

The dependence of face on social values is, for instance, reflected in the way a person behaves when representing a particular religious community or profession. Sense of face in social interaction is mutual with regard to individuals sending and receiving a message. The person committing a social act is equally aware of the addresses' face. Aiming at avoiding threats to one's own and the other person's face, verbal and non-verbal acts are modified accordingly. These interaction patterns serve as face-saving acts. On the contrary, acts which work against the face needs of sender and recipient are known as face-threatening acts.

Class-based Healthcare Consumerism

U.S. has two tired system: public & private

Social Capital

Unlike physical capital (cars, houses, or money) or cultural capital (education or career), _________ ________ depends on the groups that you are a part of, the people that you know, and the extent to which you engage with that group. A CEO of a large corporation, for example, has a significant amount of social capital because they have a large and influential social network, which is the connections that they have made through their career.

Role of social location in utilization of health services: *SES*

Used to be that those of lower SES were less likely to see symptoms as worthy of a doctor's visit (Koos 1954); by 1960s middle income people less likely to go to doctor; by 1970s poor utilized physicians more than any other income group -->Place of care and type of care varies greatly

Why are illness stories/narratives important?

When you practice narrative medicine, you integrate the stories your patients tell about themselves and their illnesses into their care. ... Narratives can reveal how your patient feels about their condition, enabling you to address the emotional and psychological issues that can occur as a result of physical illness

Role of social location in utilization of health services: *Gender*

Women use health services more than men

Health Lifestyle Theory (cockerham)

_______ _________ theory maintains that health lifestyles choices are not the unconnected random choices of individuals, but cluster in distinct patterns based on class, gender, and other structural variables. The theory, formulated by Cockerham in 2005 and based on the earlier work of Weber (1978) and Bourdieu (1984), emphasizes the manner in which structural variables, such as class circumstances, age, gender, and race/ethnicity, collectivities (social networks), and living conditions provide the social context for socialization and experience that ultimately determine lifestyle dispositions and practices.

Face

________ is a sociological concept for an individual's public self-image. One's _______ is always in progress and develops within social interaction. Each individual in a social group has his/ her own ______ that he/she wants to protect against threats.

Health Behavior

__________ ________ is an action to maintain, attain, or regain good health and to prevent illness. Some common _______ _______s are exercising regularly, eating a balanced diet, and obtaining necessary inoculations. _______ ________ are influenced by the social, cultural and physical environments in which we live and work.

Social capital

_____________ is a term used to describe a person's participation or position within a particular social group, which contributes to their lives in certain ways. For example, in small towns people tend to know each other more than those living in cities, and they bond more over commonalities. In this case, the people within the town possess significant social capital which strengthens the community.

Illness behavior

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

Face-work Avoidance Strategies: *Preventive Acts*

are so-called announcements about potential awkward incidents that might take place in the flow of events.

Types of Insurance: *Medicare*

coverage for older adults (65+)

Allostatic Load

cumulative wear and tear on the body's organic systems as it copes with chronic stressors

Brenner: *Provocation hypothesis*

disruption of lifestyle causes stress

34. Types of health insurance (All)

i. *Medicare* = coverage for older adults (65+) ii. *Medicaid*= low-income individuals iii. *Other public insurance* (e.g. TRICARE for military personnel and veterans) iv. *Private insurance* = insurance typically paid by employer; could also be insurance bought on an individual basis

Affordable Care Act (ACA a.k.a. "Obamacare")

i. Can no longer be denied insurance because of pre-existing conditions ii. Basic level of care had to be provided by all insurance plans iii. Health insurance required by law iv. Can stay under parents' insurance until age 26

Why do we need to intersectional approach to studying health?

i. Medical sociologists need to consider how systems of oppression intersect ii. The intersectionality framework addresses the "interlocking effects of gender and race" iii. Kimberlé Crenshaw: "Race and gender converge so that the concerns of minority women fall into the void between concerns about women's issues and concerns about racism"

Illness as deviance (what does it mean to frame illness as deviant?) *Criteria for disease:*

i. The patient's experience of subjective feelings of sickness; ii. The finding by the physician through examination and/or laboratory tests or other indicators that the patient has a disordered function of the body; iii. The patient's symptoms conforming to a recognizable clinical pattern

Main findings of potter et al's study: *Purpose of this study & article:*

i.Previous work does not adequately emphasize social, structural constraints, lack of resources, and the ways in which social interactions produce and reinforce social meanings that constrain health-related choices, especially for those in poor communities. ii.This is first known article (as of 2016) that focuses solely on dietary information seeking behavior by African Americans who do not share a common health condition. iii.Supports research that critiques the wide-spread cultural belief that socially perceived "problem populations" do not understand the concept of healthy eating; African Americans are aware of food-related health issues *Method:* Conducted interviews with African-Americans in two Kentucky communities *Research Question:* How do African American adults in the selected communities adopt, understand, and live by their food practices?

Onge & Krueger article: *Why does this Matter?*

i.Some physical fitness activities may be more difficult to sustain throughout the life course, leading to exercise (and health) disparities in later life ii.The findings can have implications for the most effective interventions and means for getting people from different racial groups to be physically active throughout their entire lives

WHY DOES THIS MATTER? (Once & Krueger)

i.Some physical fitness activities may be more difficult to sustain throughout the life course, leading to exercise (and health) disparities in later life ii.The findings can have implications for the most effective interventions and means for getting people from different racial groups to be physically active throughout their entire lives *Physical activity reflects social identities and social circumstances, therefore, we need to go beyond looking at who does and doesn't exercise and look at what exercises they are doing. ----->"the narrow focus between energy expenditure and health overlooks the socially meaningful aspects of exercise" (p. 1)*

Goffman describes three levels which influence an individual's actions in order to correspond to one's face needs:

i.The need to fulfill one's own desires is described as pride. ii.One's emotional and physical attitude in social interaction is described as dignity. iii.An individual's duties towards the society are defined as honor.

Face-work Avoidance Strategies: *Protecting Strategies*

include polite behaviour towards the addressee, and thus to modify utterances in a conversation.

Face-work Avoidance Strategies: *Defensive Strategies*

include the avoidance of particular topics and to suppress one's emotions, as soon as they do not seem to be appropriate in certain situations.

Types of Insurance: *Private insurance*

insurance typically paid by employer; could also be insurance bought on an individual basis

Social Support

is one of the important functions of social relationships. ______ ________ is always intended by the sender to be helpful, thus distinguishing it from intentional negative interactions (such as angry criticism, hassling, undermining). _______ __________ is commonly categorized into four types of behaviors.

Durkheim's Four types of Suicide: *Fatalistic Suicide*

is when people are kept under tight regulation such as in Korea. Where there is extreme rule in order or high expectations set upon a person or peoples in which lead them to a sense of no self or individuality.

Durkheim's Four types of Suicide: *Altruistic Suicide*

is when social group involvement is too high, expectation from a group is being met at a very high level such as a sacrifice for a cult or religion. Another example would be a Marta or a suicide bomber.

Types of Insurance: *Medicaid*

low-income individuals

Face-work Avoidance Strategies: *Ignorance of uncomfortable and unforeseen incidents*

might help to continue in the desired flow of events. One example is the ignorance of stomach noises. However, ignorance strategies do only work in cooperation with the addressee.

Types of Health Knowledge: * Emancipatory knowledge*

offers freedom from social forces which limit our options and control our lives; these are insights gained through critical self-awareness ---->Example: when people are inspired by others' lives to act in new ways, such as increasing the range of quality of their diet

Role of social location in utilization of health services: *Age*

older adults use health services the most of any age group

Brenner: *Uncovering hypothesis*

recessions do not actually cause mental illness, rather they highlight those who have an underlying disorder

Types of Health Knowledge: * Technical knowledge*

related to instrumental action whereby people access "how-to information" to learn how to control and manipulate their environment --->Examples: information on how to prepare particular meals; how to purchase food at lower prices

Durkheim's Four types of Suicide: * Anomic*

relates to a low degree of regulation and this kind of suicide is carried out during periods of considerable stress and frustration. A good example would be great financial loss or when the financial market that person controls collapses with severe consequences for many involved.

Types of Health Knowledge: *Practical Knowledge*

relies on reciprocal understanding, shared knowledge, mutual trust, and accord with one another ---->Example: interpersonal advice

chronic stressors

sources of stress that occur continuously or repeatedly

Cultural capital perspective (Onge & Krueger)

suggests that highly educated individuals use lifestyles—including health behaviors and patterns of consumption — to reinforce their differences from lower status individuals ---->Education is associated with high status, and highly educated individuals gravitate towards particular types of exercise

Human capital perspective (Onge & Krueger)

suggests that individuals with more education are more likely to exercise and participate in additional kinds of exercise because they are more knowledgeable about the benefits of exercise and better able to maintain exercise regimens --->Education is positively associated with all types of exercise

Durkheim's Four types of Suicide: *Egoistic Suicide*

suicide relates to the person being alone or an outsider and subsequently they see themselves alone within the world. This type of person has a low social interaction with others.

Intersectionality & why it is important for study of health *Ray's Argument*

"I argue that being physically active is a privilege rooted in how race, place, gender, and body image converge differently on Black women's propensity to be physically active than other raced and gendered groups. In other words, middle class Black women are excluded from these class-based privileges and experience a form of space invasion where their temporal space, geographic space, and bodily space are invaded. This invasion occurs because time allocation, neighborhoods, and social construction of bodies are privileged to support other raced and gendered groups. Consequently, Black women's concerns are placed on the margins. This marginalization transcends social class to affect all Black women regardless of socioeconomic status. As a result, their level of physical activity and overall health suffers" (p. 281)

Healthicization

"an ethos that holds individuals responsible for health-related choices they make in their everyday lives" (p. 1961) ----> "a proscriptive process in which individuals are exhorted to change their behaviors and to actively seek out healthiest activities and knowledge" (p. 1963)

Healthism

"the preoccupation with personal health as a primary...focus for the definition and achievement of well-being; a goal which is to be attained primarily through the modification of lifestyles...healthism treats individual behavior, attitudes, and emotions as the relevant symptoms needing attention" (p. 1963)

Health Lifestyle

*Collective patterns of health-* related behavior based on choices available to people according to their life chances ---->Health lifestyle theory (Cockerham): encompasses four social structural variables (goes beyond SES)- socialization, habitus, behaviors/practices, and lifestyles

Role of social location in utilization of health services: * Social networks*

--> "lay-referral system" (Suchman 1965) ---> Family is primary agent of socialization regarding utilization of healthcare ---> People oftentimes belong to social networks with similar health lifestyles or help-seeking behaviors ---> Those in networks suggest, advise, and influence help-seeking, while also serving as caregivers and advisors

Being stressed makes you more prone to have health complications such as:

-Cardiovascular issues -Hypertension -Peptic ulcers -Muscular pain

Self-care

-a layperson's preventing, detecting, and treating his or her health problems --->It is universal --->Not completely independent of medical profession

Trends in Suicidal Occupations

.....

Two theories about the relationship between education, race, and exercise ( described by Onge & Krueger

.....

Types of Health Knowledge (ALL)

1. .Technical knowledge: related to instrumental action whereby people access "how-to information" to learn how to control and manipulate their environment 2. Practical knowledge: relies on reciprocal understanding, shared knowledge, mutual trust, and accord with one another 3. Emancipatory knowledge: offers freedom from social forces which limit our options and control our lives; these are insights gained through critical self-awareness

Looking glass Self (Cooley): Core Assumptions

1. An individual in a social situation imagines how they appear to others. 2. That individual imagines others' judgment of that appearance. 3. The individual develops feelings about and responds to those perceived judgments.

*Role of physical activity choices on identity:* Factors influencing differences in types of exercise among racial groups

1. Differences in school quality 2. Availability of recreational facilities in more segregated communities 3. Perceived constraints and historically limited leisure opportunities

Social Support: *Four Types of Supportive Behaviors*

1. Emotional 2. Instrumental 3. Informational 4. Appraisal

Sources of Knowledge (ALL)

1. Formal authoritative and regulatory bodies 2. Media Sources 3. Physicians and health professionals 4. Emic Community leaders 5. Family members

Life Events

1. Life events are time-limited and episodic in nature, such as getting into an accident, being laid off, being broken up with, or receiving a life-threatening diagnosis. Life events can be events that seem positive on the surface but are in fact quite demanding such as getting promoted at work or getting married. These circumstances occur in a specific moment in time, with an identifiable onset. Although the actual event can be relatively brief, events can have varying long-term consequences, depending on the nature of the event and its sequelae, especially in relation to initiating chronic stressors.

Looking glass Self (Cooley)

1. The _____________ describes the process wherein individuals base their sense of self on how they believe others view them. Using social interaction as a type of "mirror," people use the judgments they receive from others to measure their own worth, values, and behavior. 2. Cooley's theory is notable because it suggests that self-concept is built not in solitude, but rather within social settings. In this way, society and individuals are not separate, but rather two complementary aspects of the same phenomenon.

38. The Sick Role Theory (Parsons)

1. The sick person is exempt from "normal" social roles 2. The sick person is not responsible for his or her condition 3. The sick person should try to get well 4. The sick person should seek technically competent help and cooperate with the physician

Three intersectional barriers to physical activity for Black women (Ray)

1. Time allocation 2. Racial composition of neighborhoods 3. Body size perceptions

Determinist of seeking medical care (mechanic)

1. Visibility and recognition of symptoms 2. Extent to which symptoms are perceived as dangerous 3. Extent to which symptoms disrupt family, work, and social activities 4. Frequency and persistence of symptoms 5. Amount of tolerance for the symptoms 6. Available information, knowledge, and cultural assumptions 7. Basic needs that lead to denial 8. Other needs competing with illness responses 9. Competing interpretations that can be given to the symptoms once they are recognized 10. Availability of treatment resources, physical proximity, and psychological and financial costs of taking action

Role of social location in utilization of health services (ALL)

1.*Gender:* Women use health services more than men 2. *Age:* older adults use health services the most of any age group 3.*Social networks* --->"lay-referral system" (Suchman 1965) ---->Family is primary agent of socialization regarding utilization of healthcare ----->People oftentimes belong to social networks with similar health lifestyles or help-seeking behaviors ----->Those in networks suggest, advise, and influence help-seeking, while also serving as caregivers and advisors 4.*Race:* Difference between white and black individuals' physician utilization has diminished (especially for middle-class and above); Mexican Americans have lowest utilization of professional health services 5.*SES:* Used to be that those of lower SES were less likely to see symptoms as worthy of a doctor's visit (Koos 1954); by 1960s middle income people less likely to go to doctor; by 1970s poor utilized physicians more than any other income group -->Place of care and type of care varies greatly

(Goffman, dramaturgical theory) In order for social interaction to be possible, people need information about the other participants. This includes: _________

1..A person's appearance 2.Past experience with similar individuals 3.The social setting 4.Information a person communicates about themselves through words and actions• ---->Stress can arise as people try to save face while engaging in impression management - particularly when they fail to do so successful

"Definition of the Situation" (Thomas)

1.As long as definitions of a social situation remain relatively constant, behavior is generally orderly 2.When rival definitions appear and habitual behavior becomes disruption, disorganization and uncertainty may be anticipated -> Crises will not produce the same effect uniformly in all people -> The adjustment to and control of a crisis situation result from an individual's ability to compare a present situation with other similar situations from the past and in the present •Judgment is revised based on past experien

*Main findings of the Onge & Krueger article;* where are the implications of their study?

1.Education was positively associated with fitness activities, and negatively associated with team sports. 2.Black Americans and Mexican Americans reported higher rates of participation in team sports, and lower rates in participating in activities such as tennis, golf, or swimming. 3.With increasing education, Black Americans and Mexican Americans diverged from whites in the exercise activities they engaged in.

Durkheim believed that various sociologically factors and influences were at work such as work pressure, financial, religious, marital to name just a few. *According to Durkheim, What are the four types of suicide?*

1.Egoistic suicide relates to the person being alone or an outsider and subsequently they see themselves alone within the world. This type of person has a low social interaction with others. 2. Altruistic suicide is when social group involvement is too high, expectation from a group is being met at a very high level such as a sacrifice for a cult or religion. Another example would be a Marta or a suicide bomber. 3. Anomic suicide relates to a low degree of regulation and this kind of suicide is carried out during periods of considerable stress and frustration. A good example would be great financial loss or when the financial market that person controls collapses with severe consequences for many involved. 4. Fatalistic suicide is when people are kept under tight regulation such as in Korea. Where there is extreme rule in order or high expectations set upon a person or peoples in which lead them to a sense of no self or individuality.

Sociology of Lifestyles

1.People in similar status groups share similar lifestyles (Weber) -->One's lifestyle is a reflection of the types and amounts of goods and services one uses or consumes ---->Lifestyles are based on choices; choices are based on an individual's potential for realizing them 2.Habitus (Bourdieu): class-related set of durable dispositions to act in particular lifestyle practices for individuals that are similar to others in their social class. -->"distance from necessity" is a key for class distinctions in lifestyle

Stress adaption Theory (Mechanic)

1.a person's ability to cope with problems is influenced by a society's preparatory institutions (family an school) 2.A person's emotional control and ability to cope are also related to society's incentive systems - that is, society's rewards and punishments for those who control their behavior 3.Society's evaluative institutions provide norms of approval or disapproval for following particular courses of action

Provocation Hypothesis v. Uncovering hypothesis (Brenner) *Key Points*

1.linked a number of illnesses to undulations in the economy 2.Economic recession increases the amount of stress due to uncertainty about future 3.Higher incidence of heart attacks 4.Higher infant mortality 5.Rates of mental hospitalization are also higher during recessions

Face-work

According to Goffman, ________ needs to be done in order to avoid and correct misleadings of face

*Role of physical activity choices on identity:* Trends in racialized differences in exercise activities

African Americans are more likely to participate in team sports and some fitness activities, but less likely to participate in outdoor activities such as camping and hiking