Transcript Sociological perspectives on health

Sociological
Perspectives
on Health
The Sociological View of Health
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How does society handle illness?
Who decides when someone is ill and when they
are well?
How does health vary over different social
groups?
Sociologists do not believe that a purely
objective (biological) view of illness can be
achieved because illness is social as well as
biological
Structural-Functionalism
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every social group has a range of “acceptable activities”.
Behavior outside of these limits is considered unacceptable
 every person has a number of socially defined roles, based on
our ascribed and achieved statuses, that serve as a guide for
our behavior and responsibilities (e.g. woman, physician, father,
etc)
illness is viewed as a disturbance that interrupts normal social
functioning
illness is when a person cannot function in their normal social roles
(unacceptable behavior). According to Parsons, in order to maintain
social order they are temporarily placed in the ‘sick role’
 the sick role provides the person with a set of social
responsibilities and privileges that guide their behavior and
restore normal order
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illness is negative; people in the sick role are expected to try to get
better and return to their normal roles
Talcott Parsons (1951); Emile Durkheim
Conflict Theory
A perspective that emphasizes the struggle for power and
privilege in society; one group benefits at the expense of
another
 the health care system is an elite system intent on
maintaining its power: professional privilege
 the health care system legitimizes its power by claiming a
specialized body of knowledge and uses its power to gain
wealth and maintain the status quo
 e.g. the medicalization and commodification of child
birth (ob-gyns vs. midwives)
 hence, the sick role and illness are used to perpetuate a
pillar of the exsisting social system
Karl Marx; C. Wright Mills; feminist & critical theories
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Political Economy perspective
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Focus on socio-economic determinants of health
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ways in which illness is produced by the capitalist
economy and how the distribution and management
of illness is related to Western industrial economies
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shows how illness and disability are differentially
distributed along social class lines
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health care decisions based on profit: ‘health care
industry’
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exportation of ill health to the developing world (e.g.
dumping of cigarettes)
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direct effects of economic system
 e.g.
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occupational caused diseases
indirect economic effects
Symbolic-Interactionism
focus on the social meaning of illness and the
construction, negotiation and transmission of that meaning
 focuses on the individual as opposed to society
(microsociological orientation)
 crisis approach: the crisis created by illness or disability
and how it affects individuals (e.g. parents of ill children)
 self approach: effect on the individual of the identity
changes which accompany the fall in status associated
with illness
 impact of labels and stigma resulting from illness (the
meaning of illness changes due to the labels we attach:
‘patient’, ‘disabled’)
Chicago school
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Useful Sociological Concepts
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Social capital:
 developed by Pierre Bourdieu (1973) who
distinguished three types of capital: economic
(money), cultural (education/knowledge), and social
(social networks)
 the extent to which members of a community view
themselves as forming a coherent group, and the
extent to which they work toward the common good,
not just the individual good
 trust, mutual aid, and reciprocity
 in communities with high social capital members feel
they can, and should, cooperate and take collective
action to support the good of the community
 the tendency of the group to cooperate becomes a
resource for individuals within it; people with high
social capital are at an advantage
 working
together, the group is able to achieve
more then its individual members
 lack of social capital is empirically associated
with higher levels of inequality and crime
 increased social capital has been shown to
have positive health effects in the Canadian
population
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the relationship is especially strong in vulnerable
populations: women, the elderly, immigrants, men
in low income households
Source : Putnam, 2000.
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Social solidarity (cohesion):
 high social capital creates communities with high
social solidarity
 “social cohesion instills in individuals the sense of
belonging to the same community and the feeling
that they are recognized as members of that
community” Commissariat général du Plan
 Jane Jenson’s five dimensions of social cohesion:
 Belonging; Inclusion; Participation; Recognition;
Legitimacy
 the absence of latent social conflict (e.g. income
inequality) and the prescence of strong social bonds
 social solidarity consists of the integration of
individuals into social groups and their regulation by
shared norms (Emile Durkheim)
 mechanical (police) vs. organic (voluntary)
 ‘anomie’: individual actions are not properly
regulated by shared norms (normlessness)
Durkheim’s Theory of Suicide
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Émile Durkheim aimed to show that suicide, although the most
individual and personal of acts, was socially patterned
social forces shaped the likelihood that a person would commit
suicide, which Durkheim demonstrated by showing how suicide
rates varied according to
 religion: Jewish people had lowest rate of suicide,
Catholics less likely than Protestants
 family type: married people less likely than single,
parents less likely than those without children
 war: suicide rates drop in times of war (both in defeat and
victory) when society shares a common goal
 economic instability: suicide rates increase not only in
times of economic downturn but upturns as well; not the
state of the economy but sudden changes that caused
rates to rise
the degree of social solidarity affects a person’s likelihood of
committing suicide
if a person is loosely connected with society he or she is more
likely to commit suicide. However, if the level of solidarity is too
strong than this can also lead to increased rates of suicide
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Durkheim described two types of social connection
 integration: the strength of the individual’s attachment to social
groups
 regulation: the control of individual desires and aspirations by group
norms or rules of behavior
four types of suicide
 egotistic: weak integration leads to isolation of the individual
 e.g. war integrates people into society; Protestantism
emphasizes the individual
 anomic: lack of regulation (anomie). People are only happy when
their needs and passions are being regulated and controlled
because this keeps their desires and circumstances in balance;
change in their situation upsets this balance and results in anomie
 e.g. economic change
 altruistic: too much integration, social bonds are too strong, people
sacrifice themselves for the group (e.g. Japanese military)
 fatalistic: excessively high regulation that oppresses the individual
suicide cannot be explained solely by psychology alone, even suicide is
socially organized behavior
Durkheim demonstrated not only that the behavior of the individual was
social but also that the individual’s internal world of feelings and mental
states was socially produced.
Social Support
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Social networks
 people’s
ties to each other and the
structure of those ties
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Social support
 the
transactions that occur within a
person’s social networks, specifically the
perception of assistance that is or could be
available from that network
perceived support: the sense of acceptance in
a group
 received support: transactions that actually
occur
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How does social support operate?
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reduces the effects of stress in times of
adversity (stress buffering)
support accelerates recovery
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practical (instrumental) and emotional support
indirectly
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people in our social networks influence our
behaviors, including health behaviors (e.g.
obesity)
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effect cause relationship
 does
social support increase health or does bad
health decrease social contacts?
Gender and Health
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Gender vs. Sex
 sex refers to anatomy; gender refers to the norms and
roles associated with, and behaviors expected of, men
and women
 biology determines sex; society determines gender
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why do women live longer than men?
why is the gap between male and female life
expectancy shrinking?
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 seems
to be mainly the result of changing mortality
due to smoking-related respiratory cancers, men’s
rates are falling while women’s are increasing
 women are increasingly taking on “male behaviors”
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analyses of gender and health often need to
incorporate the biological and the social
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females have a younger average age of HIV
infection than males
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power imbalance results in sexual
relationships between older men and younger
women, which reinforces the imbalance with the
woman having less power (condom use)
 the
HIV virus is more easily transmitted from male
to female than from female to male
Gender Based Trends in Health
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Although women live longer than men, a higher
percentage of women have chronic illnesses and
women use health services more often
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men tend to drink and smoke more and are more
likely than women to be overweight
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women report higher levels of stress at home and in
the workplace
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women's apparent resiliency may result from their
greater tendency to build social support networks
which, in turn, help them cope with stress and deal
with painful chronic conditions.
The Medicalization of Pregnancy and Childbirth
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Common debating topics in feminist theories on health:
 majority of ob-gyn doctors are men
 until well into the nineteenth century childbirth was an event
that took place in the private sphere
 reclassification of childbirth as a “medical” procedure relabels it as an “illness”
 pregnant and would-be pregnant women are required to take
on a variant of the “sick role”
 increase in the use of caesarean sections which take much
less time than a traditional birth
 increases in induced labor, which allows hospitals to
schedule births
 use of painkillers and fetal monitoring technologies reduce
women’s options and control during the delivery
 a primarily male profession usurps what was once a primary
concern of women
Demographic Trends
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contrary to common public opinion population growth is not
increasing
population growth rate has fallen by more than 40% since
the late 1960s (See the Baby Bust)
experts predict that human population will peak at 9 billion
by 2070 and then start to contract
the average age of the world’s citizens will increase
dramatically
 the populations that will age the fastest are in the
developing world
these trends are caused by falling birthrates
the average woman today bears half as many children as
her counterpart did in 1972
industrialized countries are not producing enough children
to maintain their populations (see dependency ratios)
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falling birthrates are the result of changing
economics
 more of the world’s population is moving to
urban areas where children have little economic
value
 women are acquiring economic opportunities and
reproductive control
 increased educational and skill requirements
necessary for today's marketplace mean more
people are remaining dependent on their parents
into their own childbearing years and putting off
having children
 meanwhile the social and financial costs of
having children continue to rise
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the demographic transition [←hyperlink!]
 stage 1: high birth and death rates with
slow population growth
 stage 2: death rates fall, birth rates remain
high (predicated by industrialization
causing improved food supply, reduced
infant mortality); rapid population growth
 stage 3: low birthrates and low death rates,
slow (or no) population growth
today developing countries are experiencing
the same transition industrialized countries
did but at a much faster pace
 e.g. fertility rates are falling faster in the
Middle East than anywhere in the world
resulting in the population aging rapidly
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some countries have not had the opportunity to grow
rich before they grow old
 e.g. China’s shrinking labor force will not be able
to support its rapidly aging population
 the problem will only increase as the strong
gender imbalance in their population will result in
many men not reproducing
by 2045 the world’s fertility rate will have fallen below
replacement levels (2.1 births per woman)
at first these trends have a positive effect: the
demographic dividend
 the fewer the dependant children, the more
resources are freed up for infrastructure and
industrial development and adult consumption
however this dividend has to be repaid
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as fertility falls below replacement levels the
workforce shrinks and the number of dependent
elderly increases
 the elderly consume more resources than
children mainly in health-related expenses
economic growth needs population growth
 to keep economic growth above zero each
member of a shrinking workforce needs to
dramatically increase their output while being
taxed at higher and higher rates to pay for the
expenses of the elderly
changes in lifestyle are resulting in declines in
population fitness (e.g. increased obesity) and
increases in disability rates in the working age
population
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modernity and demographic trends:
spread of urbanization and industrialization is a
cause not only of decreasing fertility but also the
“diseases of affluence”
 overeating, lack of exercise, substance
abuse, social isolation, pollution
 resulting in increased rates of chronic
illness
 this “western” lifestyle is spreading to the
developing world
modern, high tech medicine does little to promote
productive aging because by the time most
people need it their bodies have already been
damaged by their lifestyle
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