Sociological Perspectives on Health The Sociological View of

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Sociological Perspectives on Health

Sociological Perspectives on Health

The Sociological View of Health n n How does society handle illness? Who decides

The Sociological View of Health n n 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 every social group has a range of “acceptable activities”. Behavior outside of these

Structural-Functionalism every social group has a range of “acceptable activities”. Behavior outside of these limits is considered unacceptable n 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’ n the sick role provides the person with a set of social responsibilities and privileges that guide their behavior and restore normal order ¨ n 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;

Conflict Theory A perspective that emphasizes the struggle for power and privilege in society; one group benefits at the expense of another n the health care system is an elite system intent on maintaining its power: professional privilege n 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) n 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 n

Political Economy perspective n Focus on socio-economic determinants of health n ways in which

Political Economy perspective n Focus on socio-economic determinants of health n ways in which illness is produced by the capitalist economy and how the distribution and management of illness is related to Western industrial economies n shows how illness and disability are differentially distributed along social class lines n health care decisions based on profit: ‘health care industry’ n exportation of ill health to the developing world (e. g. dumping of cigarettes) n direct effects of economic system ¨ e. g. n occupational caused diseases indirect economic effects

Symbolic-Interactionism focus on the social meaning of illness and the construction, negotiation and transmission

Symbolic-Interactionism focus on the social meaning of illness and the construction, negotiation and transmission of that meaning n focuses on the individual as opposed to society (microsociological orientation) n crisis approach: the crisis created by illness or disability and how it affects individuals (e. g. parents of ill children) n 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 n

Useful Sociological Concepts n Social capital: ¨ developed by Pierre Bourdieu (1973) who distinguished

Useful Sociological Concepts n 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 n 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

¨ 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 n the relationship is especially strong in vulnerable populations: women, the elderly, immigrants, men in low income households

Source : Putnam, 2000.

Source : Putnam, 2000.

n Social solidarity (cohesion): ¨ high social capital creates communities with high social solidarity

n 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: n 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 n n Émile Durkheim aimed to show that suicide, although

Durkheim’s Theory of Suicide n n 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 n religion: Jewish people had lowest rate of suicide, Catholics less likely than Protestants n family type: married people less likely than single, parents less likely than those without children n war: suicide rates drop in times of war (both in defeat and victory) when society shares a common goal n 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

n n Durkheim described two types of social connection ¨ integration: the strength of

n n 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 n Social networks ¨ people’s ties to each other and the structure

Social Support n Social networks ¨ people’s ties to each other and the structure of those ties n 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 n received support: transactions that actually occur n

How does social support operate? n n reduces the effects of stress in times

How does social support operate? n n reduces the effects of stress in times of adversity (stress buffering) support accelerates recovery n n practical (instrumental) and emotional support indirectly ¨ the people in our social networks influence our behaviors, including health behaviors (e. g. obesity) n effect cause relationship ¨ does social support increase health or does bad health decrease social contacts?

Gender and Health n Gender vs. Sex ¨ sex refers to anatomy; gender refers

Gender and Health n 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 n why do women live longer than men? why is the gap between male and female life expectancy shrinking? n ¨ 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”

n analyses of gender and health often need to incorporate the biological and the

n analyses of gender and health often need to incorporate the biological and the social n females have a younger average of HIV infection than males ¨ gender 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 n Although women live longer than men, a higher

Gender Based Trends in Health n Although women live longer than men, a higher percentage of women have chronic illnesses and women use health services more often n men tend to drink and smoke more and are more likely than women to be overweight n women report higher levels of stress at home and in the workplace n 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 n Common debating topics in feminist theories on

The Medicalization of Pregnancy and Childbirth n 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 n n n n contrary to common public opinion population growth is

Demographic Trends n n n n contrary to common public opinion population growth is not increasing population growth rate has fallen by more than 40% since the late 1960 s (See the Baby Bust) experts predict that human population will peak at 9 billion by 2070 and then start to contract the average 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)

n falling birthrates are the result of changing economics ¨ more of the world’s

n 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

n n the demographic transition [←hyperlink!] ¨ stage 1: high birth and death rates

n n 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

n n some countries have not had the opportunity to grow rich before they

n n 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

n n n as fertility falls below replacement levels the workforce shrinks and the

n n n 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

n n n modernity and demographic trends: spread of urbanization and industrialization is a

n n n modernity and demographic trends: spread of urbanization and industrialization is a cause not only of decreasing fertility but also the “diseases of affluence” n overeating, lack of exercise, substance abuse, social isolation, pollution n resulting in increased rates of chronic illness n 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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