Health Status Canada
Denotations and Connotations
symbols are multivocal
• complexity of associations
• many ideas, relations between things, actors,
interactions & transactions represented
simultaneously by the symbol vehicle
• enables a wide range of groups & individuals to
relate to the same symbol in a variety of ways
• semantically open & manipulable
• Ambiguous
• instrumentalities of various forces
• triggers of social action
• operating in changing fields of social
relationships
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Symbol (Sign, Image, Text)
Analytic distinction
 Denotation
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◦ the ‘literal’ meaning of a sign
◦ Transcription of ‘reality’ into language
◦ Produced without the intervention of a ‘code’
(concepts, discourses, ideologies)
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Connotation
◦ Associative meanings
◦ Articulation with concepts, discourses, ideology
Denotation and connotation
The articulation of language on real relations and
conditions
• Ways of talking about the world
• a system of representation
• Codes and conventions
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"Discourse, Foucault argues, “constructs the topic. It
defines and produces the objects of our
knowledge. It governs the way that a topic can be
meaningfully talked about and reasoned about.”
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Discourse -- the bearer of various subject positions
– Subject positions -- specific positions of agency and identity
in relation to particular forms of knowledge and practice
– Subjectivity --produced within discourse, subjected to
discourse.
discourse
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symbolic strategy for encompassing
situations that they respectively represent
the justificatory, apologetic dimension of
culture
style is ornate, vivid, deliberately suggestive
objectifies moral sentiment
seeks to motivate action
definition of a problematic situation
response to a felt lack of needed information
attitude contained toward them IS one of
commitment
Ideology: a style
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symbolic strategy for encompassing
situations that they respectively represent
names the structure of situations in such
a way that the attitude contained toward
them is one of disinterestedness
restrained, spare, resolutely analytic
seeks to maximize intellectual clarity
definition of a problematic situation
science is the diagnostic, the critical,
dimension of culture
Science: a style
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Science – denotation
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Ideology – connotation
Denotation and connotation
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Social determinants of health
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Health and illness behavior
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Health care system
Sociology of health
Denotations of the health status of
Canadians
Mortality rates
Mortality and gender
Life expectancy
Life expectancy: nation
cancer
Lung cancer
smoking
Chronic health conditions
Disability by age
Disability days
Depressive episode by age
Physical activity: gender and age
Prevalence of ‘risk factors’
medication
Stress and wellness
Self-rated health status
Health hazards
Health care use
immunization
The Social and Society
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In policy area trend is to view health care
system as producer of health – most
important determinant of health status
◦ Implications for public health
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Social factors as most important determinant
of health status
◦ Implications for public health
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From individual determinants (e.g., lifestyle
choices) to ‘environmental’ conditions (e.g.,
poverty)
Social etiology of health and
illness
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Social structure
Norms
Statuses & roles
Interactions & exchanges
Institutions
power
What is the social?
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Networks of social relations
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forms of associations found amongst
human beings
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social integration & functional
differentiation
Social structure
Norms
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the unequal distribution of goods and
services, rights and obligations, power
and prestige
Social stratification:
interaction & exchanges
Roles -- tasks & activities that a culture
assigns to people
 Stereotypes -- oversimplified strongly
held ideas about the characteristics of
people
 Stratification -- unequal distribution of
rewards (socially valued resources, power,
prestige, personal freedom) between
people reflecting their position in the
social hierarchy
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Roles, Stereotypes,
Stratification
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status - ascribed & achieved
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ascribed status - social positions that
people hold by virtue of birth
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achieved status - social positions attained
as a result of individual action
STRATIFICATION & STATUS
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stratification means
◦ there are significant breaks in the distribution of
goods services, rights, obligations, power prestige
◦ as a result of which are formed collectivities or
groups we call strata
Stratified Society
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Rights:
◦ The sick person is exempt from “normal” social
roles.
 relative to the nature and severity of the illness
◦ The sick person is not responsible for his or her
condition.
 An individual’s illness is usually thought to be beyond
his or her own control
 A morbid condition of the body needs to be changed
and some curative process apart from person will
power or motivation is needed to get well.
Obligations:
◦ The sick person should try to get well. The first two
aspects of the sick role are conditional upon the third
aspect
◦ The sick person should seek technically competent
help and cooperate with the physician.
the Sick role (T. Parsons)
Open Class System
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facilitates mobility
individual achievement & personal merit
determining social rank
hierarchical social status is achieved on
the basis of people's efforts
ascribed status (family background,
ethnicity, gender, religion, skin color) less
important
blurred class lines & wide range of status
positions
class societies
Unequal access to all 3 advantages,
economic resources, power, prestige
 Open & closed class systems
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◦ the extent to which mobility occurs allowing
people to pass through inequalities
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Closed system
◦ No mobility
◦ tend to persist across generations
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Open system
◦ ease of social mobility permitted
a society's recurrent patterns of
activity, such as religion, art, a
kinship system, law, and family life.
• Institutions fulfill human needs: a
function
• EXAMPLE:
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– The division of labor serves two functions:
social integration & functional differentiation
institutions
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power: ability to bring about results
◦ power may be informal and based on force
◦ coercive power versus persuasive power
◦ Symbolic power based on positive expectations
of those who accede to it
authority is the socially recognized right
to exert power
 legitimacy - the socially recognized right
to hold, use, and allocate power
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distinction between power and
authority
Potency, capability, charisma (individual)
 Ability of person to impose its will in social
action upon another
 Tactical or organizational power -- The
instrumentalities through which
individuals or groups direct or
circumscribe the actions of others
 Structural power – power that organizes
and orchestrates the settings themselves
& that specifies the direction &
distribution of energy flows
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Power: 4 modalities
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Equality and equity
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Health is a domain in which equality of
opportunity & condition is a mark of a
“civilized society” (democratically
distributed resources, not stratified)
Theme is public health
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Networks of social relationships
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Bundle of institutions (recurrent patterns
of behavior
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Norms
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stratification
society
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Gender
Region
Age
class
Ethnicity
Income (SES)
Other forms of association
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Social determinants & health disparities
◦ Equality & equity
Inequalities and health status
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Access
Availability of medical practice,
practitioners, perception, technology
Availability of insurance
“iatrogenic” health care (e.g., MSRA)
Medicalization & labelling
Proliferating use of pharmaceuticals &
market system
Health care system as determinant
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how social phenomena develop in
particular social contexts
a concept or practice which may appear to
be natural and obvious to those who
accept it, but in reality is an invention or
artifact of a particular culture or society -SOCIAL CONSTRUCT
 Structure-seeking vs. meaning-seeking
research
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Social Constructionism
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DISEASE — as a bio-scientific concept
◦ Abnormalities in the structure & function of
body organs & systems
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ILLNESS -- lay concepts
◦ Illnesses are “experiences” of disvalued
changes in states of being & in social function
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Biomedicine presses the practitioner to
construct disease as the subject of study
& treatment
Disease-Illness distinction
Social labelling
Order & disorder – normal & abnormal
 Social labeling & illness, disease, disability
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◦ Who is to be called ill, diseased, disabled is
determined by the individual’s social position and
society’s norms rather than by universal and
objectively defined signs and symptoms
A person is labeled in the course of social
negotiations
 de-labeling difficult
 At each decision point it may be possible to
return to the normal label
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the process by which health or behavior
conditions come to be defined and treated as
medical issues
the process by which certain events or
characteristics of everyday life become
medical issues, and thus come within the
purview of doctors and other health
professionals to engage with, study, and treat
typically involves changes in social attitudes
and terminology, and usually accompanies
(or is driven by) the availability of treatments
medicalization
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Medicine is a set of categories that filters
and constructs experience
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Medicine produces its own objects and
subjects (subjectivity & subject positions)
◦ i.e. body mind dualism – nature is separate
from society
Medicine as Social Construct
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agency - "patients... are reflective actors who
review information about health and illness
and make decisions based on what makes
sense given their experience of bodily
changes, the framework of their prior
knowledge, and the everyday life situation in
which illness is lived and treatment is used."
Hunt et al., Compliance and the Patient’s Perspective
(1989)
Hierarchies of Resort &
Medical Pluralism
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Social determinants of health
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Health and illness behavior
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Health care system
Sociology of health