Sociological Perspectives

on Health

The Sociological View of Health

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 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

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 systemKarl Marx; C. Wright Mills; feminist & critical theories

Political Economy perspective Focus on socio-economic determinants of health ways in which illness is produced by the capitalist

economy and how the distribution and management of illness is related to Western industrial economies

shows how illness and disability are differentially distributed along social class lines

health care decisions based on profit: ‘health care industry’

exportation of ill health to the developing world (e.g. dumping of cigarettes)

direct effects of economic system e.g. 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

Useful Sociological Concepts 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

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

Source : Putnam, 2000.

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 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

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 Social networks

people’s ties to each other and the structure of those ties

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

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

adversity (stress buffering) support accelerates recovery

practical (instrumental) and emotional support

indirectly the people in our social networks influence our

behaviors, including health behaviors (e.g. obesity)

effect cause relationship does social support increase health or does bad

health decrease social contacts?

Gender and Health 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 why do women live longer than men? why is the gap between male and female life

expectancy shrinking? 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”

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

females have a younger average age 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

Although women live longer than men, a higher percentage of women have chronic illnesses and women use health services more often

men tend to drink and smoke more and are more likely than women to be overweight

women report higher levels of stress at home and in the workplace

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 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 re-

labels 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 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)

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

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

slow population growthstage 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 pacee.g. fertility rates are falling faster in the

Middle East than anywhere in the world resulting in the population aging rapidly

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

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

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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