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Week9_HealthIllnessandHealthcare.pptx
Health, Illness, and Healthcare
Week 9
The Sociology of Health
According to the World Health Organization (WHO), health “is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO 2014).
Types of questions examined in the sociology of health:
What does “health” mean to you?
How does the WHO definition relate to contemporary issues of health?
Do you believe that there are too many people taking medications in American society?
Can you think of anything that was historically considered a disease, but is now considered within a range of normality?
Do you believe all children should receive vaccinations?
Medical Sociology
Systematic study of how humans manage issues of health and illness, disease and disorders, and health care for both the sick and the healthy
Social construction of health: sociocultural lens, cultural meaning of illness, social construction of the experience of being ill, social construction of medical knowledge
Cultural Meaning of Illness
The stigmatization of illness: Erving Goffman
Stigma is the relationship between an “attribute and a stereotype”
Social stigmas keep individuals from fully integrating into society
Stigmatizing an illness affects the kind of care a patient receives and how the patient thinks of themself
The sick role: Talcott Parsons
Sick people should not be perceived as having caused their own sickness
Sick people must want to get well
Sick people are expected to confirm their illness with a physician
Contested Illnesses: illnesses that are questioned by or questionable to some medical professionals (e.g., fibromyalgia, chronic fatigue, etc.)
The Social Construction of Medical Knowledge
Example: pregnant women in the early 20th century were discouraged from driving and dancing for fear of hurting the fetus, as much as they are now discouraged from drinking or smoking today
Some illnesses have been commodified – example: breast cancer
COVID-19
What changes (cultural, social, and scientific) have we witnessed, within healthcare, that have been a direct result of the pandemic?
How are people with disabilities differently affected by the pandemic (especially in terms of receiving care, and avoiding COVID-19)?
Theoretical Perspectives and Assumptions about Health
Intersectionality: For health systems, intersectionality analysis can be woven into examining distributive justice (fairness in inputs and outcomes), procedural justice (who is involved in decision-making processes and in what way), and interactional justice (the quality of relationships among people, including aspects of status and dignity).
Draws attention to drivers of inequality
Global differences in health and illness
Social Epidemiology: the study of the causes and distributions of diseases
Poorer nations suffer the most; high rates of infant and maternal mortality; high death rates; shorter life spans
Poorer nations also have relatively little access to adequate sanitation facilities
Health Care in Industrial Nations
All industrial nations, except for the US, provide some variation of national health care and national health insurance.
Pros: Reduction in infant mortality, extends life expectancy, enables residents to have good health, less expensive overall
Cons: There can be long wait times for elective surgeries, specialists do not make as much income as in the US
Discussion
What do you think should be done to help improve the health of poor nations? What role should the United States play in any efforts in this regard?
Health Problems in the US
Overall health has improved steadily over the past 100 years – innovations in sanitation and the discovery of antibiotics
Life expectancy has nearly doubled since the 1900s
Infant mortality, cigarette smoking, and lead levels in children’s blood have all declined since the 1950s, 60s, and 70s
But…
The US lags far behind many other wealthy democracies even though it is one of the wealthiest nations in the world
Big problems: Food insecurity, infant birth weight, asthma, chronic conditions
Health Disparities: Physical Health
Social Class: Poor people have much worse health; greater risk for heart disease, diabetes, arthritis, types of cancer, high blood pressure
Causes: stress – higher for people with low incomes
Race & Ethnicity: Black and African American residents have a life expectancy about 5 years fewer than white Americans; Infants from BIPOC families have higher mortality rates than white infants
Health Disparities: Physical Health
Gender: Women live longer than men (by more than six years), across racial categories – however – women tend to have more health problems throughout their lives
Men are more likely to have a life-threatening disease, some of that is due to their likelihood to work in places that are filled with environmental and safety hazards
Men are less likely than women to tell anyone that they have a health problem or to seek help
Health Disparities: Mental Health
Social Class: Low-income populations exhibit more mental health problems than wealthier people – poverty contributes to mental illness
Race & Ethnicity: African Americans and Latinos are more likely than whites to exhibit mental distress
Gender: Women are more likely than men to be seriously depressed; men have higher rates of diagnosed antisocial personality disorders
Health Care Problems in the US
Private health insurance: patients under 65 are expected to pay for their own medical costs aided by insurance.
Although more than half of Americans have private insurance and 29% have a form of public insurance, 16% (50 million) are still uninsured because they don’t qualify for cost-free public care, and they cannot afford private insurance. (as of 2015)
According to research, Black patients do not receive the same care, as white patients, for the same health problems
Less research on other minoritized/underserved groups
Women are less likely than men to be given care/procedure choices for their health issues
Other issues:
Sleep deprivation among health-care professionals
Shortage of physicians and nurses
Mistakes by hospitals
Racial and Gender Bias in Health Care
Discussion
What types of policies and reforms could we put in place to create a better and more equitable healthcare system?
Transgender Health Disparities to Understand Stigma
Group Activity
Conceptualizing Stigma (Link & Phelan 2001)
5 Interrelated Components of Stigma
Distinguishing and labeling differences
Associating human differences with negative attributes (stereotyping)
Separating “us” from “them”
Status loss
Discrimination
“For stigmatization to occur, power must be exercised.”
Social-ecological model of stigma
Societal norms/expectations and institutional policies that constrain access to resources
Direct or enacted forms of stigma – verbal harassment, physical violence, sexual assault – because of a person’s “differentness”
Feelings people hold about themselves or the beliefs they perceive others hold about them – can shape future behavior like avoidance or anticipation of discrimination
Transgender Stigma and Health ( Hughto et al. 2015)
Examples of stigma experienced by trans individuals
Individual
Concealment, avoidance, and internalization of stigma
Interpersonal
Healthcare and workplace discrimination, family rejection, hate crimes, sexual and/or physical assault
Structural
Gender conformity to natal sex norms, stigmatizing policies and enforcement practices, lack of provider training & education, healthcare access barriers, economic inequality, gender inequality
Transgender Stigma and Health ( Hughto et al. 2015)
Importance of interventions
Recent US non-discrimination policies might reflect greater acceptance of trans people, but widespread interpersonal stigma still exists and severely impacts the health of trans individuals
Interventions are needed at all levels – structural, interpersonal, and individual – i.e., multi-level interventions
Interventions can reduce shame around one’s own identity, cope with effects of stigma, reduce negative impacts on physical and mental health, and create more general acceptance
