Medical Soci

Max Weber's 5 class model

(1) upper class (2) upper-middle class (3) lower-middle class (4) working class (5) lower class

Michael Marmot, Whitehall

- _______ ______ investigated the mortality of over 17,000 British male civil government employees - known as the ________ studies, this research provided especially strong evidence of social class differences in mortality - those with the highest occupational rank has the lowest percentage of deaths - found a clear social gradient in high to low in mortality - the highest social strata lives longer than the next highest - found medical care alone cannot counter the adverse effects of class position on health

medical sociology

- a focus in sociology upon the social causes and consequences of health and illness - plays critical role in determining or influencing the health of individuals, groups, and society

Health Insurance Portability and Accountability Act (HIPAA)

- act that regulates the handling of patient data and privacy within the health care realm - established in 1996

the sick role

- describes a pattern set of expectations defining the norms and values appropriate to being sick, for both the sick person and others who interact with that person - illness is the deviance, and it motivated medical professionals to reinforce being healthy because of the undesirable nature of sickness for everyone

middle-class norms of medical practice:

- emphasizes scientific explanation from doctors - believes that technology in medicine is good - cooperative patients (Eric Cassell)

effects of poverty

- exposed to more unhealthy situations in their daily lives and find themselves in circumstances where there is less opportunity for quality health care - the poor are more likely to engage in practices that induce ill health and less likely to engage in practices that forestall illness-inducing situations

Talcott Parsons

- functional theorist - developed concept of the "sick role" - first major theory in medical sociology -credited as the first sociologist to deal with health

medicine of social species

- not concerned with curing diseases, but preventing disease - prevention requires greater government involvement in regulating the conduct of daily life - especially public hygiene

John Shaw Billings

- organizer of the National Library of Medicine and complier of the Index Medicus - wrote about hygiene and sociology as early as 1879

neighborhood disadvantage

- physical environment - surroundings @ home, work, and play - services provided to support people - sociocultural aspects (safe to walk?) - reputation of an area

guidance-cooperation model

- physician-patient interaction model that applies when the patient has an acute, often infectious illness, such as the flu or measles - patient knows what is going on and can cooperate with the physician by following his or her guidance in the matter, but the physician makes the decisions

activity-passivity model

- physician-patient interaction model that applies when the patient is seriously ill or being treated on an emergency basis in a state of relative helplessness , due to a severe injury or lack of consciousness - physician has full decision making power in the relationship

Link and Phelan

- proposed that the degree of socioeconomic resources a person has or has or does not have, such as money, knowledge, status, power, and social connections, either protect health or causes premature mortality - resources shape access to broad contexts such as neighborhoods, occupations, and social networks that vary dramatically in associated profiles of risk and protective behaviors - suggested social power and personal control as a health factor - found a strong relationship between SES and deaths from preventable causes

social gerontology

- sociologists concerned with aging usually work in ______ _______ that deals primarily with the nonphysical aspects of aging - these specialists study the ways in which the elderly adjust to their society and how society adapts to the elderly

Hispanic paradox

- states that 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 - there is evidence that Hispanics are less likely than non-Hispanic whites to smoke cigarettes, as well as being more likely to have diets high in fiber and protein and occupations high in physical activity

#7 a case for refocusing upstream

-a majority of health resources focus on downstream efforts, treatments, and reactive medicine without investigating the manufacturers of illness -manufacturer of illness: those individuals, interest groups, and organizations which , in addition to producing material goods and services also produce widespread morbidity and mortality as a by-product -there is too much emphasis on the individuals and groups that get sick - it causes culpability of the individual -the author emphasizes refocusing on upstream political and economic forces -legislative action: restrictions on advertising -lobbying: regulating the lobby of corporations -public education: teaching about the actions of the manufacturers of illness

#4 racism and health

-institutional racism shapes SES and opportunities -cultural racism is damaging to health -interpersonal discrimination negatively impacts health -defines aversive racism, discrimination, institutional racism, and cultural racism -social inequalities in knowledge and communication play an important role in health inequalities -residential segregation (institutional), incarceration -cultural racism leads to internalized racism leads to adverse health outcomes -- needs more research -bias can lead to unequal access to healthcare -we need better ways to measure discrimination

#3 social class, susceptibility, and sickness

-lit review showing how gradients of mortality among social classes have been observed over the world by many investigators -access to medical care alone does not explain this -environmental factors alone do not explain this -declining mortality rates can be attributed to improved technology and knowledge -we know little about how stress interacts with social gradients -those in lower social classes consistently have higher rates of disease in part sue to compromised disease defenses and increased general susceptibility -we need to better define low class, disentangle the physical and social consequences of living in poverty, clarify the cause and effect, and explore further the possible importance of stress, life events, etc

#18 notes on the decline of midwives and the rise of medical obstetricians

-new model of midwifery for America built on English notion of less intervention -doctors developed training programs in new york and philidelphia but few women came Ewell supported the idea of midwifery school but without gov help, women could not afford it and they didnt need men to tell them what to do -midiwfery was unregulated an open market in 1810 -gradual disappearance of women from midwifery with the redefintion of women's place and their lack of group organization -doctors went unregulated and unpreparred for birth -choice in birth atendant often based on social class ***social class determinant of health - the exclusion of women from birth was necessary to the professionalization of medicine during the 19th cen and slandered male midwives -medical convenience and intervention; increased medicalization of birth -manmidwifery becomes obstetrics; nasty descriptions of interventions -exclusion of women gave obstetrics a sexist bias -the advertising of men as having more to offer contributed to women's choices against midwives

#24 prescriptions and proscriptions: moralizing sleep medicines

-redefining sleep as a medical problem requiring pharma intervention -bad side effects, moralized prescription -think of hypnotic medicines as consumer goods that are personalized and reconfigured in the home -turned into socio-pharmacological objects -6 moral repertoires of moral drug use: 1- the deserving patient: depicted themselves as deserving patients who had had their sleep problems medically recognized and rx prescribed as a necessary medical treatment 2- the responsible user: responsible for their drug use, carefully monitoring their levels of consumption and acting to minimize their use of the sleeping pills, of their own volition 3- the compliant patient: compliant with medical advice with some self-adjustment of dosage; puts themselves in a sick role identifying their medical need - emphasis on stigma 4- the addict: often divided emotions over the abuse of hypnotics versus the moral advice of the doctor to discontinue use 5- the sinful user: discussing a variety of unsanctioned practices the were guilty of; but they are able to forgive themselves through recognizing the extenuating circumstances of the "sin" 6- the noble or virtuous non-user: showed moral strength in not relying on artificial sleep; some refusal even in times of legitimate need - moral themes: addiction (fear of misrepresentation), control (to counter the addict), ambivalence (in modern challenge to authority), reflexivity (as an active participant rather than passive consumer)

#19 the end of the golden age of doctoring

-since the 80s, us healthcare has transformed from mostly fee-for-service to corporatized systems dominated by increasingly consolidated corporate interests -extrinsic factors of the decline of professionalization (outside the control of profession): 1- the changing nature of the state and loss of partisan support for doctoring 2- the corporatization of doctoring 3- the emerging threat from other healthcare workers (non-physician clinicians) 4- the consequences of globalization (internet diagnoses) 5- the epidemiologic transition in how we see the human body (agricultural transition, industrial transition, reemergence transition, age of chronic disease and globalized health threats) 6- changes in the doctor-patient relationship and the erosion of trust (physicians as double agents to patient and corporation) -intrinsic factors (which the profession could potentially change themselves): 1- the weakening of physicians through oversupply (too many graduates) 2- the fragmentation of the physicians union (declining influence and specialization) -different views of the state (Marxist, Pluralist, New Right)

information can be therapeutic in medical situations if it meets 3 criteria:

1- it reduces uncertainty 2- it provides a basis for action 3- it strengthens the doctor-patient relationship

Lawrence Henderson

1935 paper on the physician and the patient as a social system; influenced Talcott parsons

the gender gap reached its highest point of ____________ in 1979

7.98 years

Florence Nightingale

Established sanitary nursing care units. Founder of modern nursing. began professional education of nursing. served in the Crimean war. theory of the social causes of mortality

Elizabeth Blackwell

First woman to receive a medical degree in the U.S.

#2 social conditions as fundamental causes of health inequalities

Link and Phelan explain the 4 essential features of a fundamental social cause of health (fundamental cause theory): 1- it influences multiple disease outcomes 2- it affects these disease outcomes through multiple risk factors 3- it involves access to resources that can be used to avoid risks or minimize the consequences of disease 4- the association between the fundamental cause and health is reproduced over time via the replacement of intervening mechanisms -flexible resources are how SES fulfills these requirements 1&2- low SES is associated with mortality from many diseases and specifically the 14 major causes of death, and it is clearly associated with risk factors 3- there is more SES inequality of mortality for cause of death that are highly preventable (and able to put resources towards their prevention depending on SES ability) 4- SES-mortality association continued even after mechanisms (ex: sanitation) were addressed and new mechanisms are taking their place (ex: smoking) - reproduction -but, people may do things counter to their health for many reasons, including status attainment (countervailing mechanisms) -health policy suggestions: reduce resource inequalities, or the extent to which these resources buy a health advantage ***helps me more specifically understand how SES impacts health

the model of class structure often followed in the united states:

Max Weber's 5 class model

structural explanation

Riska's explanation that holds that barriers, such as a lack of mentors, keeps women from advancing to top positions in medicine

Voluntaristic view

Riska's explanation that holds that women are socialized to follow stereotypical gender expectations and consequently tend to make occupational choices that fit those expectations

power

Weber defined this as the ability to realize one's will even against the resistance of others; the amount of political influence a person has

patient compliance

a patient's willingness to follow a treatment plan and take an active role in his or her health care; requires patient comprehension can be swayed by their -motivation to be healthy -perceived vulnerability to an illness -the potential for negative consequences -the effectiveness of the treatment -the sense of personal control -the effectiveness of the communication

consumerism

a phenomena common in modern American society where people make educated decisions about the purchasing of health care plans and coverages based off of the mini-max principle

world health definition of health

a state of complete mental, physical, and social wellbeing, not merely an absence of illness, disease or injury

sociology in medicine

applied research and analysis primarily motivated by a medical problem - applied research

- the most prevalent health problem of persons above the age of 65 is _______

arthritis

Louis Pasteur & Robert Koch

bacteriologists that decisively confirmed the germ theory of disease and uncovered the cause of a host of disease, including typhoid, tetanus, and diphtheria, along with the vaccines providing immunity through their research

second epidemiological transition

began about 200 years ago as 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

male inferiority in terms of life expectancy may result from combined biological and social factors:

bio: prenatal and neonatal weakness social: more risky behavior, suicide, dangerous jobs

ultimately, what makes race important in a causal sense for health is its close association with _____ __________

class circumstances

third epidemiological transition

currently entering this epidemiological transition where there has been a resurgence of infectious disease previously thought to be under control - factors such as globalization, urbanization, and global warming are contributing to this change

Alexander Fleming

discovered penicillin in 1928 - the first antibiotic

Szasz & Hollender's Models of Care

doctor/patient interaction depends on the severity of symptoms - activity/passivity model - guidance/cooperation model - mutual participation model

Hayes-Bautista model

doctor/patient interaction is a process of negotiation -model limited to situations in which the patient is not satisfied with the treatment and wants to persuade the doctor to change it -patients counter the treatment with their own actions or try to convince the physician that the treatment is not working

defined normative dynamic of the sick role

doctors will do things to make us feel better and patients listen and cooperate

_____________ is the single strongest predictor of good health

education

the beginning of Medical Sociology

federal funding for socio-medical research became available after World War II in the 1940s

Harriet Martineau

first sociologist 1844 wrote about life as an invalid - life in the sick room

Jane Addams

founder of chicago's hull house focused on industrial poverty - emphasized hazardous working conditions fought for labor reform, public sanitation, and progressive policy classical sociology

the single most important determinant of the quality of an elderly person's life is ______

health

first epidemiological transition

human societies shifted from hunting and gathering to agriculture which was marked by the emergence of novel infectious and nutritional diseases - occurred some 10,000 years ago

Richard Wilkinson

income inequality hypothesis - it is the degree of inequality within a country, not between countries, that determines a population's health

the most important social factors determining health:

income, accumulated wealth, education, occupational characteristics, and social inequality based on race an ethnic group

SES consists of 3 variables

income, occupational prestige, and level of education

Zola found that ______ patients tended to understate their symptoms, whereas ________ patients tended to overstate them

irish, italian

social class

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

education

is indicative of a person's skills for acquiring positive social, psychological, and economic resources such as good jobs, nice homes, health insurance, access to quality health care, and knowledge about healthy lifestyles

medical decision rule

is the notion that since the work of the physicians is for the good of the patient, physicians tend to impute illness to their patients rather than deny it and risk overlooking or missing it - Thomas Scheff the guiding principle behind everyday medical practice; doctors are supposed to believe patients complaints and patients are supposed to cooperate

medical sociology did not emerge as an area of study until the ______ and did not reach a significant level of development until the _________

late 1940s, 1960s

________-_____ persons tend to be more passive in dealing with doctors as authority figures and show a decreased sense of personal control over health matters

low-class

mid-1900s, medicine's thinking was dominated by the search for drugs as _______ ________ that could be shot into the body to kill or control all health disorders

magic bullets

Sue Fisher found that...

many female patients were not satisfied with the explanations given them by their doctors - also stated that male physicians have a tendency to misdiagnose heart attacks as stomach or anxiety problems

occupation

measures status, responsibility at work, physical activity, and health risks associated with one's job

#23 from Lydia pinkham to queen levitra

medicalization occurs when previously noon-medical problems are defined and treated as medical problems -patent medicines and their medicalization due to false claims and advertising -vegetable compound - creates its own market -ethical regulations come down -reemergence of direct to consumer advertising during 80s -changing dynamics between physician, patient, and pharma; patients as consumers demanding products and having direct relationships with pharma -wishes to maintain the role of physicians as gatekeepers to medicalization -1997 DTCA comes to TV -erectile dysfunction meds medicalizing life problems as Lydia pinkham did

mortality-morbidity paradox

men have higher mortality while women have higher morbidity

________ and _______ class persons tend to be more consumer-oriented and active participants in the physician-patient encounter

middle, upper

the greatest declines in life expectancy are among ____________

non-Hispanic white women with less than a high school education

Boyer and Lutfey found that:

patients today have become more active in the relationship, seek multiple forms of care, often have needs that are long -term because of chronic illnesses, and have risk-based strategies

Eliot Freidson

person that suggested that physicians tend to have bias in favor of finding illness in their patients

medicine of the species

pertains to the strong emphasis in Western medicine upon classifying diseases, diagnosing and treating patients, and finding cures

mutual participation model

physician-patient interaction model that applies when the patient fully works together with the doctor to manage a chronic illness such as diabetes or heart problems

the earliest works in medical sociology were undertaken by _________

physicians

medical care and health services are acts of ________________

political philosophy; social factors are also important in influencing the manner in which societies organize their resources to cope with health hazards and deliver health care to the population at large

Michael Davis and Bernard Stern

published books on health with a soci perspective

income

reflects spending power, housing diet, and medical care

bioethics

relatively new area of medical sociology because ethical (or unethical) decisions in medicine can have profound social implications and may reflect discrimination and prejudice against particular social groups

sociology of medicine

research and analysis of the medical or health environemnt from a soci perspective - academic, theological

those patients who are similar to physicians in _______ ______ are more likely to share their communication style and communicate effectively with them

social class

social determinants of health

social practices and conditions, class position, stressful circumstances, poverty, and discrimination, along with economic, political, and religious factors that affect the health of individuals, groups, and communities, either positively or negatively

status indicates a persons level of _____ ______, which is derived particularly from social judgements about a person's lifestyle

social prestige

Michel Foucault

social theorist that noted the emergence of two distinct trends in medical practice called "medicine of the species" and "medicine of social spaces"

the differences in life expectancy of blacks and whites can largely be explained by...

socioeconomic status

_____________ or ______________ is the strongest and most consistent predictor of a person's health and life expectancy throughout the world

socioeconomic status or social class

Robert Strauss

suggested that medical sociology was divided into two separate but closely interrelated areas - sociology in medicine and sociology of medicine

besides ICU physicians, _________ are also known for trying to retain decision-making authority for themselves and to present information to their patients and their families that justifies action

surgeons

Susan Hinge found that the top specialties such as _______ and ________ _________ were characterized as masculine, with traits like "toughness," "macho," and "demanding," while those as the bottom like family practice, pediatrics, and _________ were considered "soft" and feminine

surgery, internal medicine, psychiatry

effectiveness of the doctor-patient interaction depends upon:

the ability of the participants to understand each other through effective communication from the physician to the patient, and vis-versa

lay person definition of health

the ability to carry out your daily activities

the most important factor endangering trust in the doctor-patient relationship

the physicians behavior

the government in the case of Medicare and Medicaid, private health insurance companies, and managed care programs are all examples of ______-______ ______ intruding on the traditional doctor-patient relationship

third party payers

James Warbasse

wrote a book in 1909 called medical sociology about physicians as a unique social class

Charles McIntire

wrote a medical article on the importance of social factors in health in 1894 that first coined the term "medical sociology"