9/8/24
Sociology of
Medicine &
Healthcare
Joanna Kempner, PhD
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A view of the
world that
focuses on
social patterns
rather than on
individual
behaviors.
What’s the
sociological imagination?
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Troubles vs Issues
“Perhaps the most fruitful distinction with which the sociological
imagination works is between the ‘personal troubles of milieu’ and the
‘public issues of social structure...’
Troubles occur within the character of the individual and with the
range of his immediate relations with others...
Issues have to do with matters that transcend these local environments
of the individual and the range of his inner life....”
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Unemployment
“When, in a city of 100,000, only one man is unemployed, that is his
personal trouble...
But when in a nation of 50 million employees, 15 million men are
unemployed, that is an issue, and we many not hope to find its solution
with the range of opportunities open to any one individual.”
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Structure vs
Agency
•Structure – Recurrent
patterned arrangements
which seem to influence or
limit the choices and
opportunities that
individuals possess
•Agency – The capacity of an
individual to act
independently and make
their own free choices.
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Structure
Agency
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C. Wright Mills
1916-1962
“What ordinary men are
directly aware of and what
they try to do are bounded
by the private orbits in
which they live…The facts
of contemporary history
are also facts about the
successes and failures of
individual men and
women.”
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C. Wright Mills
1916-1962
The sociological
imagination occurs when
we reframe our individual
experiences within a
broader cultural and
historical context.
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Fostering an awareness of the relationship
between personal experience and the wider society.
History/
Structure
Biography/
Agency
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Social Structure
Rules: the formal and
informal expectations
for behaving in any
given situation
Resources: the things
we have or acquire such
as money, education,
and status.
Structure often limits the
choices people can make,
but it also enables some to
Girl in Schoolroom
have choices that others may not have.
In either case, structure does not determine our actions,
but it does have a significant influence on the behaviors we choose.
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Statuses and Roles
Social status: a person’s or group’s
socially determined positions within a
large group or society
Social Role: the set of expectations
concerning the behavior and attitudes of
people who occupy a particular social
status
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Statuses and Roles
Ascribed status: assigned to a person by
society without regard for the person's
unique talents, efforts, or characteristics; this
often happens at birth.
Achieved status: a status that results from
your efforts.
These can get complicated in interesting
ways.
• e.g., race, class, and gender
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Life Chances
The opportunities to provide yourself with material goods and favorable
life experiences. Occupying a high status in society improves your life
chances, provides more structural resources, and brings greater access to
social rewards.
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L es s th a n h igh s c hoo l Hi gh s c hoo l gr ad uat e
gr a duat e
Som e c ol le ge or
as s oc i at e' s de gr ee
Ba c helo r' s d egr e e
G r adu at e or
pr of es s i onal deg re e
E d u ca tio n
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Agency
Our capability to act given the
structural rules and resources
that impact our behaviors.
Agency refers to the choices
that individuals make and the
actions they ultimately take.
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Individual Agency and Social Structure
INDIVIDUAL
actions
identities
SOCIAL STRUCTURE
rules
resources
statuses
roles
groups
networks
institutions
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Socialization
Agents of socialization; the
individuals, groups,
organizations, and
institutions that influence
your sense of self and help
you learn the ways of being
a member of society
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The Looking-Glass Self and the Generalized Other
Looking-Glass Self: the
way our perception of
how others see us affects
our sense of self
Generalized Other: the
values and norms of the
larger culture, that are
used to guide your
actions
Preparing to face the world
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C. Wright Mills
The Sociological Imagination
History
Biography
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To see “what is happening in [ourselves] as minute points of
the intersections of biography and history within society.”
History
Biography
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Developing a sociological imagination
• How does the structure of this particular society contribute to
the issue at hand?
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“We believe it is
implausible that each age,
sex and ethnic group, with
massive differences in life
experience and attitudes,
had a simultaneous decline
in willpower related to
healthy nutrition or
exercise.”
–Rogers et al 2018
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Developing a sociological imagination
• How does the structure of this particular society contribute to
the issue at hand?
• How has this problem changed over time? How is this
problem different in other cultures?
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US Spending on Health Care, 2008
Total health care
costs comprise
14% of GDP!
$1.7 trillion
Source: O E CD H ealth D ata
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Best Health Care in the world?
(W HO
Rankings 2000)
1. France
2. Italy
3. San Marino
4. Andorra
5. Malta
6. Singapore
7. Spain
8. Oman
9. Austria
10. Japan
11. Norway
12. Portugal
13. Monaco
14. Greece
15. Iceland
16. Luxembourg
17. Netherlands
18. United Kingdom
19. Ireland
20. Switzerland
21. Belgium
22. Colombia
23. Sweden
24. Cyprus
25. Germany
26. Saudi Arabia
27. United Arab Emirates
28. Israel
29. Morocco
30. Canada
31. Finland
32. Australia
33. Chile
34. Denmark
35. Dominica
36. Costa Rica
37. United States of America
38. Slovenia
39. Cuba
40. Brunei Darussalam
Source: World H ealth O rganization, H ealth System s: Im proving Perform ance, 2000
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Developing a sociological imagination
• How does the structure of this particular society contribute to
the issue at hand?
• How has this problem changed over time? How is this
problem different in other cultures?
• Who benefits?
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How might sociological imagination
change the experience of someone
struggling to assist a family
member who has opioid use
disorder?
• How is addiction typically
understood?
• What do we know about
opioid use now?
• Agency or structure?
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Developing a sociological imagination
• How does the structure of this particular society contribute to
the issue at hand?
• How has this problem changed over time? How is this problem
different in other cultures?
• Who benefits?
What compels people to make choices?
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What compels people to make choices/
behavioral changes?
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Developing a sociological imagination
• How does the structure of this particular society contribute to the issue
at hand?
• How has this problem changed over time? How is this problem different
in other cultures?
• Who benefits?
• What compels people to make choices?
• What norms/values are embedded in medicine, clinical practice, and
health policy?
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Structure
vs
Agency
•Structure – Recurrent
patterned arrangements
which seem to influence or
limit the choices and
opportunities that
individuals possess
•Agency – The capacity of an
individual to act
independently and make
their own free choices.
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The Sociological Imagination/
C. Wright Mills
Structure/
History
Agency/
Biography
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Mills redefine our life narratives as data
points that exit within the intersections
of biography and history within society.
Structure/
History
Agency/
Biography
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Emile Durkheim
Published in 1897.
Foundational book in sociology.
Durkheim, a “father of sociology,”
was committed to using
empirical methods to understand
society.
Suicide draws on statistical
analyses.
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Collective Phenomena
Social behaviors, norms, and beliefs that exist outside the individual,
exerting influence on their actions. These phenomena reflect the
shared values, practices, and structures of a society, shaping
individual behavior and contributing to social cohesion or
dysfunction.
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Collective Phenomena
Social behaviors, norms, and beliefs that exist outside the individual,
exerting influence on their actions. These phenomena reflect the
shared values, practices, and structures of a society, shaping
individual behavior and contributing to social cohesion or
dysfunction.
Social Facts
A social fact is a specific way of acting, thinking, or feeling that exists
outside of the individual and has a coercive influence. It can be an
element of collective phenomena but is usually more specific, such
as a law, norm, or value that influences individual behavior (e.g.,
laws against theft, norms around marriage, etc.).
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Social Facts
• Social facts are broad. Includes everything from political
systems and moral beliefs to suicide rates, holiday
celebrations, and architectural styles.
• Social facts are external to individuals. Social facts have a
life of their own, independent of any one person.
• Social facts are coercive. They compel people to act in ways
they might not otherwise choose
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Collective Consciousness
All the beliefs, values, and ideas that make up the social facts in a
society.
We don’t all have to hold the same ideas, but social cohesion is formed
when a critical mass share the same ideas.
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Durkheim noticed suicide is socially-patterned
Suicide rates increased in the modern world.
Modern life had less social integration than feudal societies.
Likewise, suicide rates were higher in Protestant societies than in
Catholic societies.
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Durkheim noticed suicide is socially-patterned
Suicide rates increased in the modern world.
Modern life had less social integration than feudal societies.
Likewise, suicide rates were higher in Protestant societies than in
Catholic societies.
Catholics had a more “integrated” community structure,
whereas Protestants had fostered an individual relationship
with god
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Suicide remains a collective phenomena
• 1300 people have died
from jumping off the
Golden Gate Bridge.
• It’s easy to do so – the rail
is only 4’ tall.
• Why? Joseph Strauss, he
chief engineer was only 5’
tall, and he wished to see
the view.
• Efforts to build a suicide
barrier have been
thwarted 7 times.
Research shows that people who are
stopped from jumping from the bridge
rarely die by suicide at a later juncture by
using another suicide method.
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New suicide net added
in 2023
Usually, about 30 jumps/year.
Trained staff are on site to
perform rescues.
If you are having thoughts of suicide, call the National Suicide
Prevention Lifeline at 1-800-273-8255 (TALK). The website
is National Suicide Prevention Lifeline.
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Obesity?
What has caused the
“obesity epidemic”?
Question:
What might a doctor
advise a patient whose
weight measures
“obese?”
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What norms are embedded in medicine, clinical
practice and health policy?
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