Transcript Sociological Perspectives on Health

Sociological
Perspectives
on Health
Simon Corneau
Jean-François Roy
Sociological Perspectives on Health


« From a sociological point of view, factors contribute
to the evaluation of a person as ‘healthy’ or ‘sick’. »
(Schaefer & Smith, 2004).
Because health is relative, we can view it in a social
context and consider how it varies in different
situations or cultures.
Functionalist Approach
Conflict Approach
Interactionist Approach
Feminist Approaches
Functionalist Approach

Illness entails at least a temporary disruption in a person’s social
interactions.

« Sickness » requires that one take on a particular social role,
even if temporary ; the « sick role ».

The « sick » are expected to try to get well (e.g., seek medical
care) and return to their normal activities.

Being sick must be controlled so that not too many people are
released from their societal responsibilities at any one time.

An overly broad definition of illness would disrupt the workings of
a society.
Conflict Approach

Conflict theorists seek to determine who benefits, who suffers,
and who Inequities
dominates
atin
theHealth
expense
of
others
in a given
Medicalization
ofCare
Society
Delivery
situation.
There arehas
Medicine
inequities
expanded
in health
its
domain
care
delivery
of expertise
within Canada:
in recent
decades.and
northern
Once
rural
a problem
areas. is
appropriated,
There
are global
it becomes
inequities:
difficult
25
doctors
to view
per 1000
theseinissues
USA,
as shaped
less
then 1 by
persociocultural
1000 in
African
factors. nations.
A « brainmaintains
drain » isan absolute
Medicine
contributing
the poor
health
monopoly
overtomany
health
of developing
countries.
care
procedures.
It places
« Dumping
» of unapproved
health
care professionals
suchor
drugsand
in developing
asfraudulent
chiropractors
nursecountries.
midwifes
outside the realm of
acceptable medicine.
Interactionist Approach




Focus on micro-level study of the roles played by
health care professionals and patients.
The patient is an active actor whose action can
have a negative or positive impact on his health.
Interactionists also attempt to shed light on the
« social meaning » of illness and how they affect
one’s self-concept and social interaction;
« labelling theory » focus on the effects of the
social stigma of the illness (e.g., AIDS, women’s
health, homosexuality).
Cultural differences in « social meanings » of
illness and health care delivery.
Feminist Approaches

Health is an area of central concern for women. Women
form the majority of health workers, of health care users
and of caregivers.

Research on women’s health has focused on reproductive
health issues, overshadowing a range of other health and
illness issues; everything was related to the uterus and
hormones.

There is still sexist bias in the health literature today
(Janzen, 1998).

Feminists theorists also draw the attention on how multiple
minority status intersects to produce varying levels of
health and disease (ex : being black and being a lesbian).
Morbidity Rates and Populations

Sociologists find morbidity rates useful because they
reveal that a specific disease occurs more frequently
among one segment of a population then another.
Social
Class
Race and
Gender
Sexual
Age
Orientation
Ethnicity
Clearly is
associated
with
differences
morbidity
andof
Females
Health
profiles
care
have
oneservices
ofaofthe
life
many
overriding
expectancy
often
racial
assume
and
concerns
ofethnic
81,7
ainpatient
and
of
minorities
the
males
is elderly.
mortality
Why
is class
linked
towhere
? patient
reflect
76,3.
heterosexual
Gender
Asocial
difference
isrates.
most
inequalities.
and
important
create
attributed
aThe
insituation
to
the
health
behavioural
study
ofhealth
ofCanada’s
health
the
factors
and
Firstis
Crowded
living
conditions,
housing,
Nations
(drinking
less
aging
likely
since
reflects
and
towomen
openly
dangerous
patterns
live
talk longer;
about
driving),
ofsubstandard
years
health
yetoccupational
ofelderly
exclusion
matters
women
related
limiting
hazards
to
poor
diet,
stress,
limited
education,
workplace,
etc.
theirsexual
(construction),
his
receive
access
little
orientation,
research
to and
many
women’s
ofattention.
like
the
sexual
social
tendency
Social
health
determinants
to
support
orseek
mental
health
is
ofahealth
key
like income,
care
(high
factor
services
rate
related
of education
suicide
to
earlier
the health
among
and
and
more
ofemployment.
young
older
often.
gay
menmen).
and women.
Social Capital
One of sociology’s main contributions has been to
identify social capital as a determinant of health.
 Many recent studies have explored the links
between social capital and health. Social capital
may contribute directly to health or may result in
policies that are more supportive of healthy
outcomes.

Social Capital

Social capital refers to the institutions,
relationships and norms that shape the quality
and quantity of a society’s social interactions.
(World Bank, 2001)
How is it Measured?

Social capital as a social determinant of health is measured
with non-medical indicators. For example,
Key indicators
Trust (in
others, in institutions)
Civic engagement (participation)
Social network (social support)
Social cohesion (sense of belonging)
Income distribution
Social Capital and Crime
3 dominant theoretical perspectives

1) Social disorganization: lack of social control
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2) Anomie: weakening of behavioural norms
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3) Strain theory: lack of opportunities
Geographic areas with ↑ levels of social capital have lower
homicide rates. High homicide rates may undermine social
trust and civic engagement and ↓ the stock of social capital
(Rosenfeld et al., 2001).
Criminology and Health
Health status is affected by socioeconomic status → people
from low socioeconomic classes are over-represented in
prison → health condition is also affected by the prison
context (they live and work with people carrying infectious
diseases)
Areas of inquiry:
Utilization
of prison health services
Consequences of confinement
Aging offenders
Policy level
Causes of Crime
Conditions that make crime more likely:

Poverty (women)

Wealth (white-collar crime)

Drug abuse
Who are in Prisons ?
Over-representation of native people
 People of lower socioeconomic status (except for
Martha Stewart)
 Drug related crimes
 People with mental health problems
 Prevalence of unhealthy lifestyles: cigarette &
alcohol abuse, drug abuse, poor diet, sexual
promiscuity (Smith, 2002).

Healthy Prisons?
High prevalence of HIV/AIDS and Hep C, tuberculosis is coming
back
Risk factors :
 Consensual sexual activities
 Prison rape
 Drug injection
 Tattooing
All these behaviours are prohibited by the prison code of conduct
(affects likelihood of conditional release)
 ↑ Suicide rate
 Self mutilation (women)
 ↑ level of stress (violence and power relations)

How to Explain this...

Deprivation model (Krebs, 2002) : what do you
learn behind bars
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Importation model (Krebs, 2002) : what do you
bring with you in prison
How the System Reacts?
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Condoms: can only be obtained through nurses,
one at a time

No clean needles; bleach available only in some
provinces

War on drugs (random testing)
That Means…

Inmates can become infected while in prison,
becoming a threat to the general population
when released.

CCS Mission: Protection of society
Questions (1) ?
Do people from lower socioeconomic classes
really commit more crime, or are they just more
often targeted by official formal control?
 Can we really « rehabilitate » someone while in
prison when we know that the person will return
into the same socioeconomic conditions after
incarceration (low stock of social capital)?
 Is a punitive approach appropriate for drug
related offences? (Rehab vs. Punishment)

Questions (2) ?
How would a functionalist analyze the
medicalization of society?
 How would a interactionist analyze AIDS ?
 How would a conflict theorist analyze links
between health and occupation?

Some Figures on
Social Capital
Bowling alone : the collapse
and revival of American
community.
Robert D. Putnam (2000)
Source : Putnam, 2000.
Source : Putnam, 2000.
Source : Putnam, 2000.
Source : Putnam, 2000.
Source : Putnam, 2000.