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Cockerham_C1-1.ppt

Chapter x

MEDICAL SOCIOLOGY, 13TH EDITION
William C. Cockerham

Chapter 1

Medical Sociology

Introduction

The Social Determinants of Health

The term social determinants of health refers to:
social practices and conditions (such as lifestyles, living and work situations)
class position (income, education, and occupation)
stressful circumstances, poverty, and economic (e.g., unemployment, business recessions)

The Social Determinants of Health

political (e.g., policies, government benefits)
religious factors that affect the health of individuals, groups, and communities, either positively or negatively

The Development of Medical Sociology

Most early works were written by physicians focused on the connections between social conditions and health
Early sociologists did not give much attention to matters of health and medicine

The Development of Medical Sociology

Federal funding after WWII gaves sociomedical research a boost
Early collaborations with psychiatry (e.g., the Hollingshead & Redlich 1958 New Haven study, and the Srole et al. 1962 Midtown Manhattan study)
Funding forces an early emphasis on applied research

The Development of Medical Sociology

Talcott Parsons
Publishes The Social System in 1951
First major social theorist to deal with issues of health, illness, and the role of medicine
Structural-functionalist perspective
Introduced concept of the sick role
A patterned set of expectations defining the norms and values appropriate to being sick

The Development of Medical Sociology

Practical application versus theory
Robert Straus (1957) notes division between sociology in medicine and sociology of medicine
Division found mostly in the U.S.
Initial tension between areas resolved by:
Orientation of most research (whether in medicine or in sociology) toward practical application due to funding pressures
Convergence with main discipline of sociology: regardless of area, all sociologists receive same training; increased use of sociological theory in medical sociology

Defining Health

World Health Organization (WHO) definition:
A state of complete physical, mental, and social well-being, and not merely the absence of disease or injury
Laypersons tend to view health as the capacity to carry out their daily activities
Health as the ability to function

Contrasting Ideas about Health and Social Behavior

Primitive humans tended to rely on magic as the fundamental explanation of disease and illness
Hippocrates of ancient Greece represents first attempt to base understanding of the body on rational thought; recognizes contribution of the environment to human well-being

Contrasting Ideas about Health and Social Behavior

Middle Ages introduces a split in responsibility for human well-being: Church attends to social needs while physicians focus on physical ailments
Modern medicine and regulation of the body (late 18th century)
Michel Foucault (1973) describes development of modern medicine and notes split between two trends:

Contrasting Ideas about Health and Social Behavior

Medicine of the species gave strong emphasis on classifying diseases, diagnosing and treating patients, and finding cures
Medicine of social spaces was concerned with preventing disease, especially through government involvement in matters of public hygiene
Modern medicine rejects supernatural explanations for disease and treats it as an object to be studied, confronted scientifically, and controlled

Contrasting Ideas about Health and Social Behavior

The public’s health (19th century)
Systematic implementation of public health measures and improvements in public sanitation
Period sees declining mortality rates from infectious diseases
Improvements in population’s health mainly due to improvements in diet, housing, public sanitation, and personal hygiene instead of medical innovations (McKeown 1979; Porter 1997).

Contrasting Ideas about Health and Social Behavior

Germ theory of disease (late 19th-20th century)
Biomedical approach: every disease has a specific pathogenic cause best treated by removing or controlling that cause
Medical practice gives little attention to social causes of health and instead focuses on treating disease and illness with drugs

Contrasting Ideas about Health and Social Behavior

“Whole person” health care (late 20th-21st century)
Transition from infectious to chronic diseases as leading causes of death (epidemiological transition) around mid-20th century
Recognition that social environment and lifestyle practices influence chronic diseases encourages emphasis in medicine on treating the “whole person”