HLSC120
WHO Definition of 'health'
"Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity"
Popular Culture
'Popular' culture is related to ordinary people and their everyday cultural patterns which may be considered less worthy - e.g., rap music, hip-hop dancing, McDonalds, pizza, etc. Implies popular cultural patterns are readily accessible to some but not all members of a society
Structure-Agency Debate: agency
An individual 'contributes, however minutely, to the shaping of this society and to the course of its history, even as (s)he is made by society and by its historical push and shove'
4. Norms / Folkways
Folkways designate a society's customs for routine, casual interaction. Less moral significance than mores - proper dress, appropriate greetings and common courtesy. Mores - right and wrong Folkways - right and rude People can have some lenience and discretion in relation to folkways
Globalization
Globalization theory examines the emergence of a global cultural system. Globalization theory suggests that global culture is brought about by a variety of social and cultural developments: existence of a world-satellite information system; emergence of global patterns of consumption and consumerism; cultivation of cosmopolitan life-styles;
Top 10 Most Spoken Approximate number of Languages of speakers
Mandarin - 1,075,000,000 English - 514,000,000 Hindustani - 496,000,000 Spanish - 425.000.000 Russian - 275,000,000 Arabic - 256,000,000 Bengali - 215,000,000 Portuguese - 194,000,000 Malay-Indonesian - 176,000,000 French - 129,000,000
5. Material culture: High culture and popular culture
Much cultural diversity has roots in social class. 'High' culture is related to society's elite: sophisticated art forms such as classical ballet, literature, music, painting. People may be considered 'cultured' if they enjoy and can afford the 'finer things in life' e.g. French cuisine.
What is globalization?
Robertson (sociologist):Globalization is a process by which we come to experience, or become aware of, the world as a single place. Friedman (columnist):G. is the inexorable integration of markets, nation-states, and technologies to a degree never witnessed before. It is an international system. Giddens (sociologist):G. is the intensification of worldwide social relations that link distant localities in such a way that local happenings are shaped by events occurring many miles away and vice-versa. Steger (political theorist): G. refers to a multidimensional set of social processes that create, multiply, stretch, and intensify worldwide social interdependencies and exchanges while at the same time fostering in people a growing awareness of deepening connections between the local and the distant. Stiglitz (economist): G. is the removal of barriers to free trade and the closer integration of national economies. McNamee (venture capitalist): G. is the environment in which we live. We've got one world. Get used to it. Make the most of it. Debating globalization? It's like asking fish to debate the merits of living in the sea.
5. Material culture, Subcultures and countercultures
Subculture - cultural patterns that set apart some segment of a society's population - e.g. Homosexual versus heterosexual lifestyle choice; frequent-flyer executives, jazz musicians, old people in residential care and homeless people. Counterculture describes cultural patterns that strongly oppose those widely accepted within a society. Contra culture is youth-oriented counterculture of the 1960s - rejected cultural mainstream as too competitive, self-centred and materialistic - 'drop out' of society - involves distinctive values and unconventional behaviour, music and dress
5. Material culture
Tangible human creations - artefacts - e.g., Chinese eating with chopsticks vs British eating with knives and forks vs people in Middle East eating with fingers. Asian toilets in floor vs European toilets above floor. People in India and Middle East wearing flowing robes vs fitted clothes of Europe
What is Socialization?
"Socialization is the process by which people acquire cultural competency and through which society perpetuates the fundamental nature of existing social structures" Interaction leads to the internalization (absorption) of one's culture .
Acknowledging the limitations of biomedicine by defining health...
' a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity' (WHO 1946) ? Utopian and vague... Underlined importance of a social model of health to propose interventions at population and community levels (Germov, 2014, p. 15-16).
Module 4
- Health care systems Australian health care system issues that shape distribution of health resources eg. Race, power, social status multinational patterns of ownership of health organisations private/public health care primary health care
Globalization cont...
- recognition of a world-wide ecological crisis; - development of world-wide health problems such as AIDS; the emergence of world political systems such as the League of Nations and the UN; - creation of global political movements such as Marxism, ecological change; extension of the concept of human rights; the complex interchange between world religions; - new consciousness of the world as a single place - "the concrete structuration of the world as a whole" - "A social process in which the constraints of geography on social and cultural arrangements receded and in which people are becoming increasingly aware that they are receding" The term, Globalisation, in the 1970s and 1980s, was "internationalization" which means "relating to two or more nations"; whereas "global" relates to "the whole world" [Gopinath, 2008, p. 9] Although internationalization was used to represent a transnational phenomenon, Globalizations' effects are felt at different levels- the individual, the nation, or any other group, such as organizations or ethnic communities. The term first appeared in the Oxford English Dictionary in 1992 [Gopinath, 2008, p. 9].
Social Determinants of Health: The Solid Facts
- social gradient - stress - early life - social exclusion - work - unemployment - social support - addictions - food - transport World Health Organization, 1998 http://ezproxy.acu.edu.au/login?url=http://search.informit.com.au/documentSummary;dn =459011281778654;res=IELHEA
Top five Languages spoken in Australia
1. English 2. Italian 3. Greek 4. Cantonese 5. Arabic
what are the 5 Major Components of Culture?
1. Symbols 2. Language 3. Values and beliefs 4. Norms 5. Material culture
Postmodernity - Major Features [effects of Globalization]
6. A move from a labour economy to a market economy 7. All-pervading anxiety and fear of the void 8. Modernity did not solve all of our problems; it created problems - "end of time", "end of history", etc. [Bauman, 1992, 2004; Mestrovic, 1993, p. ix, Rosenau, 1992, p. 65].
Postmodernity: effects of Globalization
A blurring of boundaries A breaking down of structures A levelling of hierarchies A generalised lack of trust in designated order and expertise Difficulties in preserving identity and focus on surface and image. What is Postmodernism? http://www.youtube.com/watch?v=oL8MhYq9owo&feature=related Blurring of boundaries - Boundaries between nation states blurred as more focus on global than on individual nation states - e.g.., people can now order and receive goods via the internet, and thus avoid paying customs duty to the nation/state. e.g.., - dangers of people buying medications over the internet from Mexico, etc. Boundaries between technology have blurred - e.g.., phones are now cameras, diaries, text messagers, etc., photocopiers are now also faxes, scanners, etc. Boundaries between genders have blurred - e.g.., gender re-assignment surgery, uni-sex toilet facilities, uni-sex clothing, etc., sexuality - bisexuality. Boundaries between real and virtual have blurred - e.g.., visiting a prospective home in virtual reality - attending an overseas nursing conference in virtual reality. Boundaries between race and culture blurred - multiculturalism because of people moving around world; inter-racial marriage, etc. Time and space boundaries have blurred because of super-fast methods of transportation and travel. Confusion between the real and the copy -copies of money/diamonds - look as good as the real; people who copy stars/singers - Elvis Presley impersonators, Marilyn Monroe look-alikes, Queen Elizabeth II impersonators, etc. Confusion between the real and the spectacle usually provided by TV and mass media - e.g.., 911 confused by some as a movie - unable to believe it was real and it was happening; "Turf wars" between doctors, nurses, physios, etc. - sharing of certain aspects of roles. Breaking down of generational boundaries - parents wanting to be "friends" to their children. Breaking down of gender-specific roles - e.g., house husbands, corporate wives, make nurses, female engineers, etc. Above can lead to anxiety and confusion in people, also lack of empathy - hardened to killing people in computer games, seeing death daily on the TV news, graphic horrific scenes in violent movies, confusion between reality and non-reality, lack of certainty as to roles and responsibilities, confused children who lack boundaries - behaviour problems, bullying, etc., etc. Breaking down of structures - Marriage, family breakdowns - effects on those involved. Breaking down of society structures - e.g.., government entities and judiciary exposed of corruption/dereliction of duty, Church exposed of covering up child abuse - loss of trust/confidence in previously stable societal structures. Role of media in exposés to public - leads to loss of confidence, scepticism of citizenry. Above can lead to confusion and behaviour problems of children, serial relationships between adults, angry/confused adolescents who lack clear role modelling and rules. A levelling of hierarchies - Hierarchy in families levelled. Hierarchy between teacher and student levelled Instead of strong hierarchical organisations (ACU excluded!!!), tendency to matrix organisations, with multiple lines of communication. A generalised lack of trust in designated order and expertise Lack of confidence in recognised "experts" (e.g.., doctors, politicians, nurses, teachers, academics, etc.) as people realise they can be an "expert" in anything - just need to find the information on the internet. E.g., people looking for information to help with diagnosing health problems, health treatments, on internet. "Experts" no longer are the only ones with access to "expert" information - everyone has it, even if they don't know how to critique the quality of the information. Because of a lack of trust in designated expertise People will check Can lead to people who lack confidence in society's institutions, such as church, legal system, systems of government - resulting in fear, anxiety and depression. Increased crime levels - lack of feelings of safety and security in own home/community. Difficulties in preserving identity and focus on surface and image Constant changing of images we observe - the human body is seen as the "sole constant factor" so people focus on "body-cultivation" (Bauman, 1992, p. 194). People can express their individuality, autonomy and freedom of choice through the image they portray to the world, but in so doing, they reinforce a reliance on external agents produced by the consumer culture (Bauman, 1992). Thus, people concentrate on their images - whether through intense exercise and aerobics, health foods, junk foods, high fashion, or through sub-cultures such as swampies, Gothics, vampires, skin-heads, and punks. Focus on surfaces and images - "biggest loser", body tattoos, body piercing, body shaving and body painting. Sometimes difficulty in determining if someone walking down the street is male or female or if they are 30 or 60 years of age. Explosion of advertising industry promoting images which feed into our consumer culture. Whichever ad is the most bizarre, unusual or eye-catching is the one that will sell the most products. We can do our shopping through the simulated images on the internet - we can overcome space and time by our ability to shop at a distance in numerous places throughout the world, without even moving from our favourite chair in front of our computers. These technological developments in which the social is simulated and manipulated (Connor, 1997) not only change our shopping habits, but also contribute to health problems caused by reduced human interactions and reduced physical activity. People change their image regularly in order to keep themselves "current," "up to date," "saleable," "employable," "dateable," "glamorous", etc. See Madonna, Kylie Minogue, etc. Life becomes an awareness of a pervasive ever-presentness and search for the novel, the aesthetic, the beautiful, and the appreciation of beautiful things, people and experiences. See Paris Hilton, Casey Johnson, etc. (Students to add others). A move from a labour economy to a market economy - Instead of countries in the global society focusing on industry and jobs, there is more of a focus on selling and buying in the marketplace. The world has become a global marketplace in which people can buy/sell anything they want (e.g.., beauty, beautiful body, health, beautiful lifestyle). Anything can be bought or sold providing people can pay the price. People will go into debt in order to be able to play/live in the global marketplace. Hugs number of people (esp. generation X young people) who "max" out their credit cards/live above their income, in order to be a player in the global marketplace. Anything in the way of health, well-being, beauty and lifestyle can be selected and taken off the global supermarket shelf - hedonistic society. People in undeveloped/developing countries being used as cheap labour to increase profits of global corporations who are focused only on selling profitably in the marketplace. People in developed countries losing jobs to poorer people "off-shore" who can work for much less hourly rate but often in very poor conditions - health dangers of poor regulation of work conditions - increased accidents, lack of sick leave, holidays for poor, exploited workers, etc. Effects of the above - people who live beyond their means - denial, anxiety, depression, hypertension, gastric ulcers from worry about paying for credit cards, etc. People who can never get involved in buying and selling in the global marketplace because of lack of money, opportunities, physical/mental disabilities, etc., experience a sense of exclusion, which affects their sense of identity. Can result in depression, anxiety, obesity, exclusion and lack of self-esteem, loneliness, and lack of sense of community. All-pervading anxiety and fear of the void - People become increasingly aware that modernity and its promise of science and scientific achievement solving all of our problems, may have in fact created more problems than it solved - e.g.., environmental issues, including tsunamis, hurricanes, global warming, threat of nuclear war, weapons of mass destruction, chronic illness, death, high crime levels, lack of safety and security, Talk of "end times", etc., related to Mayan calendar, various prophetic predictions (e.g.., Nostradamus) - people anxious, fearful, etc., - effects on health, particularly depression, anxiety, anger/rage management, loss of connection to family, community, etc. Using various technologies (e.g.., computer games, overeating, ) to numb the mind/fill in time so that one doesn't have to think of global problems and their resolution. Loss of a sense of identity and community - joining chat rooms, social networking, radio talkback as forms of imagined communities to replace the communities of premodern and modern times that focused more on place.
The social model of health (the new public health)
A general umbrella term to refer to approaches that focus on the social determinants of health and illness. The social model locates people in social contexts, conceptualises the physical environment as socially organised, and understands ill health as a process of interaction between people and their environments. (Broom 1991, p. 51 cited Germov 2014, p. 16). The widespread recognition of the limitations of the biomedical model has led to the development of a number of different multifactorial models, e.g., the ecological model but to a greater or lesser degree they remain focused on health interventions aimed at the individual, particularly through lifestyle/behaviour modification and health education. Argued that what is required is an explicitly social model of health in order to propose effective health interventions at the population and community levels.
Family
A group of kin - or a household/domestic group sharing a roof and meals. (Weber 1978). Families offer guidance, support a sense of belonging - extended family usually 3 generations.
Definition of family:
A group of kin - related through blood, marriage and or adoption, who share a household and pool together economic and other resources for the purpose of survival - The family is the basic unit of society - The family is one of society's main socialising institutions - Families offer guidance, support, a sense of belonging and instil norms and values The family is an institution, a social system and a social group
Principal feature of the Australian health care system
A private, for profit component (GPs, pharmacists, dentists, private hospitals, private specialists and alternative practitioners) A public component (community health centres, maternal and child health, mental health, hospital, HACC) A NGO (non-government organisation), not-for-profit A domestic component - carers at home (Adapted from Owen and Lennie, 1992)
how is a society characterised?
A society is characterised by the study of relations and relationships between people, rather than the study of individuals.
3 Types of Stigma - Goffman
Abominations of the body - physical defects Blemishes of individual character perceived as weak will, domineering/unnatural passions, treacherous & rigid beliefs and dishonesty (e.g., record of mental disorder, addiction, unemployment, sexual orientation, imprisonment, radical political behavior, etc.) Tribal - race, nation and religion transmitted through lineages and contaminate all members of the family Erving Goffman, Stigma. 1963, p. 4
Module 6
Aboriginal and Torres Strait Islander Peoples Socio-historical-political contexts colonisation assimilation traditions spirituality
Comparison between Values: european values
Age of the enlightenment - values of rationality, science and progress from 18th C philosophers; - People believed they could make own future and could exert rational control over world - make it a better place. Centred on Judaeo-Christian values, culture and identity. Development of nation states - belief in 'citizenship' - core values about being a good Englishman, a good Scot, a German. Hierarchical - recognise superiors and inferiors - deep roots in values of a feudal and aristocratic system - class system. Strong individualism.
Question : What is the truest definition of Globalization? Question: How come?
Answer: Princess Diana's death. Answer: An English princess with An Egyptian boyfriend - Crashes in a French Tunnel, driving a German car - With a Dutch engine, Driven by a Belgian - Who was drunk on Scotch whisky, Followed closely by Italian paparazzi, on Japanese motorcycles; treated by an American doctor using Brazilian medicines !
Discrimination
Any form of distinction, exclusion or restriction affecting a person, usually, but not only, by virtue of an inherent personal characteristic (UNAIDS, 2000, p. 7) Discrimination involves stereotyping and stigma
Comparison between Values: asian values
Asian Values Belief in strong families Reverence for education Hard work is a virtue A social contract between people and state. East Asians practice national teamwork. Citizens can become stakeholders in the country. Governments should maintain a morally wholesome environment. Do not believe in extreme forms of individualism.
Important definitions
Assimilation Integration Multiculturalism
Examples of Diverse Values & Beliefs about Health & Illness
Australian society - dominant cultural model of health and illness - biomedicine - experts are health professionals e.g.., doctors. Structure of health care system (e.g.., hospitals, general practice) reflects above medical dominance; Other cultures have different perspectives - e.g.., Chinese medicine - balance between yin and yang - experts are TCM practitioners;
Theoretical pluralism advocated!
Caution: Why are theoretical perspectives confused with specific theories?
Module 1
Changes in contemporary Australian society, culture and health from world globalising processes: global capitalism voluntary and forced migration multiculturalism electronic communication and technology health issues related to social changes
Structure-Agency Debate: structure
Compare previous slide with concept of people as "puppets jumping about on the ends of their invisible strings" and the "all the world's a stage and we are mere actors'' analogy
Module 2
Cultural diversity in Australia and the impact on provision of health care cultural identity values and beliefs cultural sensitivity/safety changing family forms alternative healing systems health issues related to social change
Terms to be familiar with: cultural diversity, multiculturalism
Cultural diversity: A term used to refer to the existence of a range of different cultures in a single society. In popular usage, it typically refers to ethnic diversity. Multiculturalism: A policy term referring to the expectation that all members of society have the right to equal access to services, regardless of 'race' ethnicity, culture, or religion. It is based on the recognition that all people have the right to maintain their culture beliefs and identity while adhering to the laws of the nation state. Germov 2014
3. Values: Inconsistency and Conflict
Cultural values can be inconsistent and even outright contradictory - e.g., - torn between a "me first" attitude and a need to belong and contribute to the larger community. - A belief in equality versus criticism of others because of ethnicity, gender or sexual preference
What do the following concepts mean: Culture
Culture is... a design for living; the values, beliefs, behaviour, practices and material objects that constitute a people's way of life; otherwise known as a toolbox of solutions to everyday problems and a bridge to the past as well as a guide to the future
Symbols: define culture shock
Culture shock is the inability to 'read' meaning in one's surroundings. People feel lost, isolated & afraid outside the symbolic web of culture that joins individuals and gives meaning to their social life
The structure - agency debate
Debate over the extent to which human behaviour is determined by social structure; BUZZ GROUPS How much agency do we have over our lives? What is the 'structure-agency' continuum? Is society to blame for our personal behaviour and interactions with others?
Culture Shock
Definitions: A state of bewilderment and distress experienced by an individual who is exposed to a new, strange or foreign environment (Random House Kernerman Webster's College Dictionary, © 2010 K Dictionaries Ltd. Copyright 2005, 1997, 1991 by Random House, Inc. All rights reserved.). Noun (sociology) the feelings of isolation, rejection, etc., experienced when one culture is brought into sudden contact with another, as when a primitive tribe is confronted by modern civilization (www.collinsdictionary.com › English Dictionary).
Biomedical Model
Disease focus leads to lack of preventive Efforts Victim blaming; Reductionist; Biological determinism reinforced.
The Australian Health Care System
Has elements of Free Enterprise and Welfare Socialised systems Funding is through the Tax system - general taxes and Medicare levy, collected by the Fed Govt and allocated to the States Under the current Liberal Govt the move is to a more Free Enterprise System with more user pays Subsidies for Private Health insurance - you need private insurance because queues for public services are too long Increased GP payments - but increased gap (user pays) Reduced no. of bulk billing GPs The Australian Health Care System Has elements of Free Enterprise and Welfare Socialised systems The goal in the mis 20th cent was to provide medical services based on need rather ability to pay Under the current Liberal Govt the move is to a more Free Enterprise System with more user pays Increased GP payments Excess - the first amount of health cost must be paid by the consumer currently being debated by political parties with the Govt suggesting $1,000 plus lower allowances for needy and the Democrats suggesting $500 Funding is through the Tax system - general taxes and Medicare levy
Global Capitalism
Has the world become a giant market place? Globalisation has "helped capitalism to be more widespread and entrenched than ever" (Scholte, 2005 p. 160) Globalisation allows financial accumulation through offshore centres, transworld companies increasing concentrations of wealth What is the relationship between wealth & health? Cultural imperialism? In 1980, the richest countries of the world, representing only 10% of the global population, had a combined national income that was 60 times greater than the poorest countries; by 2005 the income gap had increased so that it was 122 times greater. Westernisation / Americanisation of the world Domination by American consumer brands McDonalds, Nike, Coca-Cola McWorld - (Benjamin Barber) Dominance by American mass media Disney, Time-Warner, Many many TV series Cultural homogenisation Same consumer goods everywhere Same ways of thinking everywhere
World Health Organisation (1946)
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. As far back as 1946 the World Health Organisation (WHO) effectively acknowledged this limitation of biomedicine when it included in its constitution the now-famous holistic definition ..
Conclusions
Health officials and organizations cannot improve health by themselves. Improving health and reducing inequalities in health is not just about more health programs, it is about a new path to health. All policy that affects health is health policy. Health officials need to work collaboratively with other sectors of society to initiate and support social policies that promote health and reduce inequalities and health. Inequalities in health are created by larger inequalities in society SES and racial/ethnic disparities in health reflect the successful implementation of social policies Eliminating them requires political will and a commitment to new strategies to improve living and working conditions. There is a great need to use all of the current knowledge that we have in a systematic and comprehensive manner
What are we spending?
Health spending for Australia, like other OECD countries, has increased over the past decade at a faster rate than spending on all goods and services. As a proportion of GDP, Australia's spending in 2009 was much less than that of the United States (17.4%), slightly less than the United Kingdom (9.8%), New Zealand (10.3%) and Canada (11.4%), and close to the OECD median (9.6%). Of the $121.4 billion: the Australian Government contributed 44% state, territory and local governments 26% individuals out-of-pocket payments 30%.
can Human beings turn culture into human nature?
Human beings make culture and it in turn makes us - what we often describe as "human nature;" No cultural trait is inherently "natural" to humanity - we have the capacity to create culture in our collective lives; Animals behave in more instinctive, uniform, species-specific ways than do humans Only humans generate and then rely on culture rather than instinct to ensure the survival of their kind
5 Major Components of Culture 1. Symbols
Humans create symbols which are anything that carries a particular meaning recognised by people who share culture (e.g., thumbs up, a wink, graffiti, flashing red light, raised fist); The meaning of the symbol can change according to the setting/context or the beliefs of the person; We take symbols for granted; Entering an unfamiliar society reminds us of the power of symbols e.g. head movements
Health Practitioners - Central Values
If we further explore the first link above as an example, the Code of Professional Conduct (2008) referred to above also emphasises other central values of this unit - the need to respect the "dignity, culture, ethnicity, values and beliefs of people receiving care and treatment and of their colleagues" In addition to the above regulatory authority admonition, the Graduate Attributes of the University relevant to this unit state that you, as a student who will one day move into a professional health care role, need to "recognise (your) responsibility to the common good, the environment and society" & "demonstrate respect for the dignity of each individual and for human diversity." In addition, you are required to -"work both autonomously and collaboratively." Therefore, in addition to developing your skills of thinking critically and reflectively this semester, you are also expected to develop values that involve respecting your own dignity and that of everyone you meet, including your friends and family members, and your University community, including lecturers and peers who are from a range of different, cultural, religious, and ethnic backgrounds. These values will underpin your ability to work well and collaboratively with your student peers as you prepare and implement your student seminars during semester and throughout your degree. In turn these skills will become attributes that you possess when you complete your degree and move into a professional role in the health care system.
Who gets Stigmatised?
Inequality - People disadvantaged relative to others in a social context Social Stratification - Sociological study of the distribution of power wealth and income in society Stratification - People are ranked in groups on the basis of Power Class Gender Ethnicity Income and wealth - fees, salaries, and social benefits Employment status Housing tenure - rent or ownership
GLOBALISATION: review
Inexorable - unstoppable World as a single place Intensification of worldwide social relations World trade - available from home Health & globalization: health benefits and risks (Cockerham & Cockerham, 2010). Brings health and economic inequity into focus
Health-related Stigma
Influences health seeking behaviour e.g., health beliefs and access to health services Can result in stress reactions Shift to 'personal responsibility' for health and blame 'victims' - obesity, D&A problems
Racism and Health: Mechanisms
Institutional discrimination (segregation) can restrict SES attainment and group differences in SES and health. Segregation can create pathogenic residential conditions. Discrimination can lead to reduced access to desirable goods and services. Internalized racism (acceptance of society's negative characterization) can adversely affect health. Racism can create conditions that increase exposure to traditional stressors (e.g. unemployment). Experiences of discrimination may be a neglected psychosocial stressor David R. Williams. Race, Racism and Health: Patterns, Paradoxes and Needed Research Harvard University
The social impact of globalisation
Key feature in contemporary society is globalisation! "the process through which an ever expanding free flow of goods, services, capital, peoples and social customs lead to further integration of economies and societies worldwide" (Sharma, 2008, p. 1) Contemporary Australia is changing politically, culturally, economically and socially in the light of globalisation, e.g., immigration, the changes to communication patterns, access to information online, changing patterns of health issues.
2. Language
Language is the Key to the world of culture. It is a system of symbols that allows members of a society to communicate with one another Symbols take the form of the spoken and written word which is culturally variable. Writing conventions differ: o Generally, Western societies write from Left to right. o Northern Africa & Western Asia write Right to left, o Eastern Asia write from top to bottom; o The Egyptians used Hieroglyphics
2. Language and cultural reproduction
Language is the major means of cultural reproduction. A process by which one generation passes culture to the next. Just as our bodies contain the genes of our ancestors, so our symbols carry our cultural heritage. Language gives us the power to gain access to centuries of accumulated wisdom. Throughout history, people have transmitted culture through speech - oral cultural tradition. Language skills set free the human imagination to use symbolic power to dream of a better world and to bring it into being
Cultural Diversity in Australia
Major effect of post-war immigration program - cultural diversity + structural inequality between different ethnic groups; Many groups est. large number of ethnic organisations, but only some groups develop institutional structure that enables establishment of ethnic communities; Problems for ethnic groups without institutional structure; Different values and beliefs to most mainstream Australians; Different health and healing practices to biomedical model [Germov, 2009; McMurray, 2007]
SOCIOLOGICAL THEORIES AND HEALTH
Marxist Approach - emphasizes the determining role of economic interests in both producing disease and in shaping the way it is dealt with. Marxists argue that medicine serves a key function in capitalist societies - it blames the victims of disease, which are caused by the capitalists' pursuit of profit, for their own condition. The very way in which disease is treated is itself an aspect of capitalist society. The medical profession acts as an agent of social control of the working class, individualizing and depoliticising disease, and controlling access to the sick certificate. High-cost, technical 'fixes' are pursued, which do not heal people but do produce enormous profits. Medicine in a capitalist society reflects the characteristics of capitalism: it is profit-oriented, blames the victim, and reproduces the class structure in terms of the people who become doctors (generally male, privately educated, upper-middle-class students), or nurses (generally lower-middle-class women). Access to health services also reflects class inequality. Parsonian - an alternative analysis of medicine is provided by T. Parsons who argued that modern societyies, while having a capitalist economy, have noncapitalist social structures. He argues that the medical profession is one such structure. Medical professionals are motivated by factors other than making money, such as caring for their patients. They perform a key noneconomic function by acting in the interests of the whole community, treating individuals specifically for their disease, without passing judgement on them, and utilizing the best of scientific knowledge. They are a balance to the fly-wheel of competitive capitalism in which the market would otherwise run over individuals. At the same time, Parsons goes on to make the important point that medicine is a major institution for controlling deviance in modern societies. It is not just a benign institution based on scientific care, but acts to check the deviant tendencies of individuals, who otherwise might try to escape their social roles. Parsons argues that the strains of modern life may be so great as to drive people into the sick role to escape their normal responsibilities, and this tendency needs to be checked. So while he has a more favourable perspective on medicine than the Marxist, he still sees it as performing a social function that is beyond its claim to be the purely scientific treatment of disease. P's analysis shows how the medical profession acts to control motivated deviance, and provides an account of illness as a response to social strain. Foucauldian - Foucault is concerned with the development of the category of disease, the product of the professionalization of medicine. F. Calls attention to another important aspect of modern society: it is an administered society, in which professional groups define categories of people - the sick, the insane, the criminal, the deviant - on behalf of an administrative state. For F, medicine is a product of the administrative state, policing normal behaviour, and using credentialed professionals to enforce compliance with the 'normal.' Modern society is a version of Weber's Iron Cage, in which the profession (and its disease categories) provide a totalizing surveillance of citizens. F also makes the important point that most of us, most of the time, have internalized these norms of behaviour and rarely require the services of the helping professionals - we surveil ourselves. F's theory of power emphasizes its diffuseness and the willingness of most of us - men and women - most of the time to comply with societal norms. Equally, F's argument challenges Marxist accounts that focus on power as centralized in the hands of the capitalist class. For F, power is not the property of any one group, whether based in class relationships or patriarchy. The usefulness of F's position is the way in which he historically locates medical knowledge, especially allowing for the development of the sociology of the body. By showing how the body is historically constructed, F has been appropriated and extended by feminists who show that it is the construction of gender-specific bodies that needs analysis. Feminism - Marxists overlook the ways in which contemporary life is not always shaped by economic factors, that Parsons does not go very far in documenting the 'strains' of social life, and that for all his interest in bodies, F does not discuss gender. Feminist sociology seeks to extend and develop especially Marxist and Fouldian sociology. Feminists' key argument is that the way in which we are socialized into masculine and feminine social roles will have a determining effect on our health and illness. They argue that medicine plays a vital role in enforcing conformity to these social roles, and is especially targeted at women. This is because controlling women's ability to reproduce is central to a patriarchal society. It is no accident, the feminists argue, that almost all the medical attention paid to women is around their reproductive organs and their life cycle, as it relates to the ability to have children. In many cases, the diagnoses and treatment of women as diseased are no more than thinly disguised social norms of women's appropriate social roles, especially their role as mother. Marxist-feminists have argued that the origins of capitalism, patriarchy and medicine are intertwined. The need to guarantee the legitimacy of offspring, to allow for the inheritance of capital, meant that the medical profession played a crucial role in the control of women. In contemporary capitalism, the profession performs the function of legitimizing the domestic role of women in the 'private' sphere, converting into a 'fact' of nature, women's mothering and nurturing roles. It thus guarantees the rearing and nurturing of the next generation of workers at minimum cost to capitalists. It also makes women responsible for a larger part of the health care of the unprofitable sectors of the population - the children and the aged (White, 2009, pp.. 7-10). .
Australian HealthCare System
Medibank - Whitlam Government 1970s Community Health Program - 1973 Medicare levy - 1.25% levy 1984 More recently -Increased focus on private health insurance after a drop off in the number of people taking out primary health insurance Introduction of the private health insurance rebate by the Howard Liberal Government.
Auzzie health care system
Most people's first presentation to health care is via their GP Currently, primary health care intervention is limited Some GPs provide PHC, others provide none Socially disadvantaged: access to GP is variable depending on locality
Culture can be divided between thoughts, things and practices...
Non-material culture - the wide-ranging, intangible world of ideas created by members of a society (e.g., from altruism to Zen); Material culture - the wide-ranging, tangible things created by members of a society (e.g., from mobile phones to pottery) Both of the above involve cultural practices - the practical logics by which we both act and think in a myriad of little encounters of daily life
4. Norms
Norms are rules and expectations by which a society guides the behaviour of its members. Proscriptive norms - mandate what we should not do (Chinese parent scold young couple for holding hands in public). Prescriptive norms - mandate what we should do - (European schools teach 'safe sex' to students). Norms can be situation specific i.e. not allowed to clap after a sermon in church, but allowed to clap after a musical performance at a concert Mores are norms that are more crucial to our lives than others. Mores are a society's standards of proper moral conduct. People develop an emotional attachment to mores and defend them publicly. Mores apply to everyone, everywhere, all the time Violation of mores - e.g., society's prohibition against sexual relations between adults and children - brings swift/strong reaction
Critical reflections on the biomedical model. Explain the following terms:
Objectification of the patient - Reductionism - Biological determinism - Victim blaming - Lifestyle choices/factors - Objectification can lead to patients' thoughts, feelings and subjective experiences of illness being dismissed. Reductionism - by focusing on disease at biological, cellular, molecular, and genetic levels medicine downplays or ignores the social and psychological aspects of illness. Marginalises the importance of social networks, and ignores the role of social factors such as poverty, poor working conditions, and discrimination in affecting an individual's physical and mental health Biological determinism - the poor are poor because they born lazy and stupid. BD underpins most elitist, racist and sexist beliefs.
Critical reflections on the biomedical model
Objectification of the patient - treating 'it', i.e., the disease rather than seeing the patient (the case) as an individual. Reductionism - increased focus on smaller and smaller features of biology for the cause and cure of disease. Biological determinism - an unproven belief that individual and group behaviour and social status are an inevitable result of biology. (underpins most elitist, racist and sexist beliefs eg. false belief that poor are poor because of lower IQ). Victim blaming - social inequality is explained in terms of individuals being solely responsible for what happens to them in relation to the choices they make and their assumed psychological, cultural, and/or biological inferiority. Lifestyle choices/factors - the decisions people make that are likely to impact on their health such as those relating to diet, exercise, smoking, alcohol and other drugs. The term implies that people are solely responsible for choosing and changing their lifestyle. Objectification can lead to patients' thoughts, feelings and subjective experiences of illness being dismissed. Reductionism - by focusing on disease at biological, cellular, molecular, and genetic levels medicine downplays or ignores the social and psychological aspects of illness. Marginalises the importance of social networks, and ignores the role of social factors such as poverty, poor working conditions, and discrimination in affecting an individual's physical and mental health Biological determinism - the poor are poor because they born lazy and stupid. BD underpins most elitist, racist and sexist beliefs.
Australian PHC Model
Original ideals about PHC according to Alma-Ata declaration have changed, in an attempt to make it more achievable. Ideals have changed from "Comprehensive PHC" to "Selective PHC" https://www.youtube.com/watch?v=jnqMM2kiDyc Ottawa Charter and the 'new public health'. Despite differences, the term PHC model is used to describe both, creating confusion
PRIMARY HEALTH CARE
PRIMARY HEALTH CARE Based on practical, scientifically sound and socially acceptable methods Technology made universally accessible to individual and families Incorporates the spirit of self reliance and self-determination Integral part of the health system Focus on social and economic development First level of contact is the individual and family Bring health care as close as possible to where people live and work First element of a continuing health care process (WHO, Declaration of the Alma Ata, 1978)
The rise of the biomedical model
Prior to development of medical science views on health illness were often shaped by spiritual/religious views. Illness was connected with sin, penance and evil spirits. Louis Pasteur (1822-96) - the germ theory of disease. The foundation of modern medicine. Robert Koch (1843-1910) - the doctrine of 'specific aetiology'. The body as a machine. In 1878, Louis Pasteur developed the germ theory of disease, whereby illness was caused by germs infecting organs of the human body: a model that become the foundation of modern medicine. Robert Koch further refined this via the doctrine of 'specific aetiology' - meaning specific cause of disease. Central idea was that specific micro-organisms caused disease by entering the human body through air, water, food and insect bites. This mono-causal model of disease which came to be known as the medical or biomedical model, become the dominant medical paradigm by the early twentieth century. While early discoveries led to the identification of many infectious diseases, there were few effective cures. The biomedical model is based on the assumption that each disease or ailment has a specific cause that physical affects the human body in a uniform and predictable way, meaning that 'universal' cures are theoretically possible. Involves a mechanical view of the body as a machine made up of interrelated parts, such as the skeleton and circulatory system. Role of the doctor is like that of a mechanic identifying and repairing the broken parts.
Challenges facing Health Services
Private and publicmix Prevention, early intervention and treatment Pressure Medicare /PBS -costs Bulk billing declining Tensions between State and Federal Governments Ageing of the population Infrastructure/Technology Shorter admissions, high costs, emphasis on throughput Power of hospitals - can they become self serving organizations Dental health services
Australia as a 'multicultural' society
Result of a series of socio-historical processes - post-war immigration (the most significant) - White Australia policy Patterns of cultural diversity & social inequality - not all immigrants establish visible ethnic communities - labour force issues: ethnicity & gender, refugee unemployment - demographics: ageing of the post war immigrants. Post WW2 the Australian Government commenced a mass immigration program, but committed to 'racial purity' - first Minister for Immigration (Arthur Caldwell) was committed to goal of racial purity and promised to accept 10 British immigrants for every 'foreigner'. This was difficult to achieve so migrants were accepted from many sources. White Australia policy was dismantled in 1970s - proportion of people from European descent declined. Now an increase in immigrants from Asia, the Middle East and Africa. Not all immigrants establish visible ethnic communities - none is totally segregated from mainstream Australian society. Furthermore erroneous assumption that an ethnic community exists on basis of a shared aspect of culture. Assumes homogeneity and overlooks differences based on class, gender & political orientation. Immigrants are spread throughout the class structure in Australia, but labour force is segregated along lines of ethnicity & gender. Australian-born and postwar Anglophone males overrepresented in the 'primary' industries, with postwar non-Anglophone women concentrated at the bottom of the heap in shrinking jobs in manufacturing. Changes over last 20 years owing to economic restructuring and increased number of 'skilled' migrants. Bimodal model has developed with clustering at upper and lower levels of the labour market and developing 'multicultural middleclass'. Refugees have very high rates of unemployment and welfare dependency compared with Australian-born and other immigrants. Demographics - early postwar immigrants are ageing and growing number of second and third generation Australians.
Health issues related to social changes: electronic connectedness, colonisation and migration (forced and voluntary).
Sedentary lifestyle Alcohol, smoking and other recreational drugs Increased travel to and from developing nations Drug resistance Ageing population Indigenous health issues.
Module 3
Social constructions of health and illness in diverse cultures - Diverse frameworks for health and illness bio-medical constructions of health and illness social determinants of health compliance with therapeutic recommendations non-systemic health care -home and family care, women's roles in caring, mutual aid and self-help groups health and wellness
Sociology is ....
Sociology is the systematic study of human society and social interaction using both theoretical perspectives and research methods in the examination of social life (Kendall, 2005 p. 4). the study of the relationship between the individual and society; it examines how human behaviour both shapes and is shaped by society, or how "we create society at the same time as we are created by it" (Germov, 2009 p. 8). Its premise is that society guides our thoughts and actions i.e. behavior is not simply individual choice Sociology is divided into Social Statics- society as it is - Structure Social Dynamics - How society changes
Definition of Stigma
Stigma is possessing undesirable, "deeply discrediting" attributes that "disqualify one from full social acceptance" and motivate efforts by the stigmatized individual to hide the mark when possible. Erving Goffman, Stigma, 1963, p.1 For stigma to persist, a language of relationships is required -- beyond individual attributes... Erving Goffman, Stigma, 1963, p.1 Any personal characteristic associated with social disgrace, rejection, or discrediting. Stigma effects individuals with mental illnesses, drug addictions, physical deformities and impairments, and HIV and AIDS Ethnic minority status
what do Symbols mean? (Symbolic meanings)
Symbolic meanings vary even within a single society - e.g., a fur coat is considered luxury for one but inhumane treatment of animals to another Symbolic meanings can change over time: e.g., jeans as a symbol of working class and hard work changed to designer jeans as a symbol of status and affluence, depending on the designer label! Manipulating symbols correctly allows us to engage others readily within our own cultural system
Define agency:
The ability of people, individually and collectively, to influence their own lives and the society in which they live.
Biomedical model
The conventional approach to medicine in Western societies, based on the diagnosis and explanation of illness as a malfunction of the body's biological mechanisms. This approach underpins most health professions and health services, which focus on treating individuals, and generally ignores the social origins of illness and its prevention. (Germov 2014, p. 11) Throughout the twentieth century, medical research, training and practice increasingly focused on attempts to identify and eliminate specific diseases in individuals, and thus moved away from the perspective of social medicine and its focus on the social origins of disease.
Dimensions of the social model of health
The social production and distribution of health and illness. For example, illnesses arising from exposure to hazardous work practices are often beyond the individual's control and need to be addressed at a society level, e.g., OHS legislation. The social construction of health and illness. Definitions of health and illness can vary between cultures and over time. The social organisation of health care. How society organises, funds and utilises its health services.
Health Sociology is.....
The study of social patterns of health and illness. A counterpoint to the hegemony of the medical model of illness (biological and psychological explanations). Understanding the social context - social, economic, cultural and political features of society - can explain why some groups of people experience certain illnesses and why some die earlier than others. To find answers to why health inequalities exist, we need to go beyond the individual and investigate the social origins of illness. To find answers to why health inequalities exist, we need to go beyond the individual and investigate the social origins of illness.
Theoretical perspective
Theoretical perspective provides a way to convey a basic understanding of the main assumptions, concepts and approaches between perspectives; This lays a foundation to understand various sociological theories (Germov, 2014, p. 35).
Theoretical pluralism: many theories have answers at different levels.
Theoretical pluralism accepts that many theories have something to offer; Imperative is to assess the insights of a theory and evaluate how well it fits the research evidence (Germov, 2014, p. 35).
Stereotypical Thinking
These ideas draw on psychology Prejudice operates through Stereotypical Thinking Stereotypical Thinking thought processes involving rigid inflexible categories is not a problem where it is not associated with high emotion Where Stereotypical Thinking is associated with high emotion - with anxiety or fear - attitudes are often infused with hostility or hatred
How does understanding sociology help us as health professionals?
This slide illustrates the relationship between sociology and health sociology as well as research methods. Leads into the following slide which expands concepts: social context/experience of health and illness.The relationship between the individual and society.
The Extended family usually consists of
Three generations, with extensive prescriptions of relationships duties and responsibilities between members of the family extend into include cousins and aunts and uncles, nephews and nieces etc
Prevention Paradox
Treating diseased or high risk individuals does not have much impact on the population as a whole. ... changing a risk factor across a whole population by just a small (and often clinically insignificant) amount can have a large impact on the incidence of a disease or problem in the community Rose, Geoffrey (1992) The Strategy of Preventive Medicine, Oxford Is this true for addiction? - in policy terms this is a question we need to consider very carefully in relation to those addiction we want to do something about
Social Model Work is allocated on the basis of gender (Broom, 2014) Terms: Gender (psychosocial) or sex (biological) Sociology used to differentiate sharply Gender role socialisation (pink and blue) Power and work roles: Paid and non paid work: which is more valued? Gender role noted in health care Women's roles : Women as healers Education of girls single most powerful way to promote equitable personal opportunities Feminist sociology highlights patriarchy & subordination of women as carers/healers Historical: healers burnt at stake
Utopian goal of equality leads to unfeasible attempts to change society Over emphasis on harmful side effects of biomedicine Proposed solutions can be complex and difficult to implement in short-term Sociological opinions can underestimate individual responsibility and psychological factors
3. Values and beliefs
Values are standards people have about what is good and bad. They vary from culture to culture There are abstract standards of goodness. Beliefs are specific statements people hold to be true Particular matters individuals consider to be true or false. They colour how we perceive our surroundings They form the core of our moral world view. We learn from families, schools and religion to think and act according to approved principles and to believe a host of cultural truths whilst rejecting alternatives as false
Ethnocentrism - a definition
Viewing others from one's own cultural perspective, with an implied sense of cultural superiority based on an inability to understand or accept the practices and beliefs of other cultures [Germov, 2009, p. 160]
Module 5 :
Vulnerable people in marginalised groups and health related issues socio-historical-political contexts marginalised groups stigma health-related issues of vulnerable people role of health care professional
So far...
We have looked at culture and socialisation globalisation cultural diversity the social construction of health and illness social determinants of health primary health care vulnerable and marginalised groups This section will look at the mechanisms that result in poor health for these groups
THE SEXUAL DIVISION OF LABOUR
Work is allocated on the basis of gender (Broom, 2014) Terms: Gender (psychosocial) or sex (biological) Sociology used to differentiate sharply Gender role socialisation (pink and blue) Power and work roles: Paid and non paid work: which is more valued? Gender role noted in health care Women's roles : Women as healers Education of girls single most powerful way to promote equitable personal opportunities Feminist sociology highlights patriarchy & subordination of women as carers/healers Historical: healers burnt at stake
when was writing invented?
Writing was invented only 5,000 years ago - only in 20th C did literacy become nearly universal in high-income countries.
When health inequalities are explained solely in terms of individual responsibility, without regard to social factors, this can lead to:
a. Medicalisation b. Healthism c. Social closure. d. Victim-blaming.
Select the correct answer. What does the term 'agency' refer to?
a. Society's influence on people's lives through social institutions, cultures and traditions. b. People's ability to influence their own lives and the society in which they live. c. People's socio-economic status (SES). d. Patient's behaviour in old age.
Atkins and Murphy (1983) believe that there are specific cognitive and affective skills needed to participate in reflection. Please use the online dictionary to ascertain the meaning of the words, "cognitive" and "affective". What are the main differences in the meanings?
cognitive - relating to cognition. affective - relating to moods, feelings, and attitudes.
Atkins and Murphy (1983) outline the cognitive and affective skills required for reflection and describe them as follows -
cognitive and affective skills necessary to engage in reflection including self-awareness, description, critical analysis, synthesis, and evaluation. Self-awareness allows a person to honestly examine how the situation affects the individual and how the individual affects the situation.
Institutions can stigmatise
economic, political, legal, and social forces embed discrimination into the processes of the institutions eg the way resources are allocated, or policies about bed allocation
How does understanding a distinctive sociological perspective help us as health professionals?
how Uncovers the social structures that are often taken for granted. Enables individual health professionals to implement sociological analysis. Offers an effective way of thinking and analysing in a sociological way to gain insights into the structure-agency debate. eg? Dominance of the medical profession; Lower life expectancy for lower SES. Using four parts of sociological imagination template simplifies sociological analysis. Reduces the harm of health professionals stigmatising, socially excluding and victim blaming in clinical practice.
How does understanding health sociology help us as health professionals? 2
how: Provides understanding of the social context of health and illness. Illustrates that health and illness is not just an individual experience it is also a social experience. Explains inequalities in global and Indigenous Australian health. Raises awareness of harm and dispels myths resulting in stigmatisation and victim blaming. eg Lowest SES & Indigenous Australians have a lower life expectancy (LE) than the national average. social patterning of suicide, HIV/AIDS, & Tb among others. due to fundamental structural inequalities and continued economic and political marginalisation, Gray, Saggers, Stearne (2014), p. 158 in Germov. The social construction of obesity and stigmatisation such as in the 'Biggest Loser' and stigmatised illness such as Hep C, lung cancer.
How does understanding health sociology help us as health professionals?
how? Provides understanding of the social context of health and illness. Illustrates that health and illness are not just an individual experience they are also a social experience. Explains inequalities in global and Indigenous Australian health. Raises awareness of harm and dispels myths resulting in stigmatisation and victim blaming. eg?
•Concepts from definitions:
inexorable globalizing process, global cultural system, global consumption and consumerism, integration, markets, electronic technologies, world as a single place, cosmopolitan lifestyles, ecological crisis, world-wide health problems, multidimensional, social processes, connecting local and distant, free trade, intense capitalism.
What does the following concept mean: Society
is the name given to a "system of interrelationships which ; refers to a "common habitat" (Harris, as cited in Hawkins, 2006, p. 5); stresses the links between individuals, groups, and institutions; is characterised by the study of relations and relationships between people, rather than the study of individuals; Is the study of friendship, which is the "ultimate social cement" (Turner, as cited in Hawkins, 2006, p. 5); is something separate from human beings, that influences and controls people's thoughts and behaviours (Hawkins, 2006). The recurring patterns of social interaction through which people are related to each other, such as social institutions and social groups [Germov, 2009, p. 7].
define Sociology and what does it examine?
is the study of the relationship between the individual and society; it examines how human behaviour both shapes and is shaped by society, or how "we create society at the same time as we are created by it"
The Study of symbols and signs is called semiotics; Semiotics suggests that:
meanings are never inherent in objects but are constructed around them through various practices; Theorists in semiotics include: - Peirce (USA) - De Saussure (France) - Roland Barthes (France)
Stereotypes
simplified internal representations act - templates help to interpret the social world Common stereotypes are used to interpret whole persons but based only on their sex race age nationality religion socio-economic status physical/mental health Stereotypes are often used when we know or care little about the target group
Aboriginal and Torres Strait Islander Peoples socio-historical-political contexts
socio-historical-political contexts colonisation assimilation traditions spirituality Government policies racism institutional racism
Social Institutions are:
the formal structures within society that are organised to address identified social needs such as: - health care, - government - education - religion - the media
Social Structure is:
the recurring patterns of social interaction through which people are related to each other, such as social institutions and social groups
what is the structure-Agency Debate about
the structure-Agency Debate is a key debate in sociology over the extent to which human behaviour is determined by social structure. Structure-agency are interdependent.
how many languages in the world
• Approx. 6,912 languages in world; • nearly 420 are already 'nearly extinct' •Thousands of languages will die out in 21st C;
The Nuclear family consists of:
◦ Adult partners and their children (by birth or adoption) where the family is living on its own and largely depends on its own resources
