SOCIOLOGY OF HEALTH
STRUCTURAL-FUNCTIONALISM
• FUNCTION - the satisfaction of a need by an activity in
which human beings cooperate, use artifacts, & consume
goods
• Social structure or structure – forms of associations
(structure) found amongst human beings
• SOCIETY as a bundle of interrelated institutions
• institutions: 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:
– The division of labor serves two functions: social integration &
functional differentiation
• EQUILIBRIUM-FUNCTION-STRUCTURE
Structure-function imagined
Sociology of health: medicine
• Focus on “medicine”
• Social aspects of medicine, health, disease
• Social factors shaping medicine
– Social labelling & social control
– Sick role
– Patient-doctor relationship
– Disease-illness distinction
– Medicalization
Social labelling
• Order & disorder – normal & abnormal
• Social labeling & illness, disease, disability
– 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
STRUCTURE-FUNCTION & MEDICINE
• Doctor-patient relationship
– Institutional integration
• Institutions defined as a society's recurrent patterns of
activity
– The “sick role” (T. Parsons)
• Illness as a form of “deviance”
– Physicians & return to equilibrium
– Alcoholism? Poverty related health issues?
– Compliance as solution?
– Local healthcare system
Abnormality/Deviance
& the Sick role (T. Parsons)
• 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.
Disease-Illness distinction
• DISEASE — as a bio-scientific concept
– Abnormalities in the structure & function of body
organs & systems
• ILLNESS -- lay concepts
– Illnesses are “experiences” of disvalued changes in
states of being & in social function
• Biomedicine presses the practitioner to
construct disease as the subject of study &
treatment
medicalization
• 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
• The process of medicalization typically involves
changes in social attitudes and terminology, and
usually accompanies (or is driven by) the availability
of treatments
Challenging medicine: theoretically
• Medico-centricism
– Disease and mortality are problematic and require
medical intervention
• Focus on disease (not illness) – obscures social
conditions and experience
– Focus on disease and the right that professionals
have vis a vi individuals
– Patient’s fault if there are problems
• Critical theory
Critical Theory, Social Structure,
Medicine
• Questions about the neutrality/objectivity of
medicine, use of technology, science
• Ideology -- a system of shared beliefs that
legitimize particular behavioral norms &
values at the same time they claim & appear
to be based on empirical truths
• ideologies transform power (potential
influence) into authority (legitimate control)
Medicine & Social Structure:
critical theoretical perspective
• E.g. compliance as ideology transforms
physician’s theories about the proper behavior
of patients into a series of research strategies,
research results, & potentially coercive
interventions
• that appear appropriate
• & that reinforce physicians authority over
health care
Science, Medicine, Social Structure:
critical theoretical perspective
• Science names the structure of situations in such a
way that the attitude contained toward them is one
of disinterestedness
• its style is restrained, spare, resolutely analytic
– objectifies moral sentiment
• Science is diagnostic, critical, dimension of culture
• Social control
• Objectivity? - actively concerned with the
establishment & defense of patterns of belief & value
The social production of health
• Shift from disease focus of medicine
• Shift from focus on medicine
• Same emphasis on power, inequality, social
relationships/organization/structure
• Social characteristics play a predominant role
in determining sickness and health status
• Occupation related to health
• Social position: class, ethnicity, gender, age
• disease & feelings of sickness not determined
solely by underlying biology
Society and health
• Correlations: number of operations performed
and proximity of number of surgeons in the
area
– Available technology
• Class, environment, residence, distributions of
cancer
• Drapetomania, Gambling, alcoholism, learning
disabilities, childbirth & medicialization
• The social need argument -- ?
Society and health
• Social relations of sickness which produce
forms and distributions of sickness in society
• Sickness is the process through which
worrisome behavioral and biological signs,
particularly ones originating with disease, are
given socially recognizable meanings resulting
in socially significant outcomes
• Sickness is a process for socializing disease
and illness
• The social order is embedded in medical
beliefs
Society and health
• choices & forms of medical interventions &
transactions are determined by sickness (not
illness or disease)
• Medicine continues to divorce disease from its
social relations of production
– Ignoring power differentials that originate and
reside in arrangements between social groups and
classes
• Symbols of healing are equated with power
• Medicine is an ideological practice
EPIDEMIOLOGICAL -- HEALTH
TRANSITIONS
• complex change in patterns of health and
disease
• the interactions between these patterns and
the demographic, economic, and sociological
determinants and consequences.
Transitions & Disease Profiles
• pestilence and famine
• receding pandemics
• degenerative and man-made diseases
Life Expectancies as Measure of Health
Transitions
From Infectious to Chronic Diseases
10 leading causes of death in US
1900
1998
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Influenza and pneumonia
Tuberculosis
Gastritis
Diseases of the Heart
Cerebrovascular Disease
Chronic Nephritis
Accidents
Cancer
Certain diseases of infancy
Diptheria
Heart Diseases (31.4% )
Cancer (23.3%)
Cerebrovascular diseases (6.9%)
COPD (4.7%)
Accidents (4.1%)
Pneumonia and Influenza (3.7%)
Diabetes (2.7%)
Suicide (1.3%)
Diseases of Arteries (1.2%)
Nephritis (1.1%)
Ten leading causes of death (2000)
Developed countries
Developing countries
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1. IHD 9.1%
2. CVD 8.0%
3. Respiratory infections 7.7%
4. HIV/AIDS 6.9%
5. Perinatal conditions 5.6%
6. COPD 5%
7. Diarrhoeal diseases 4.9%
8. Tuberculosis 3.7%
9. Malaria 2.6%
10. Road accidents 2.5%
IHD 22.6%
CVD 13.7%
Lung Ca. 4.5%
Respiratory infections 3.7%
COPD 3.1%
Colon Ca 2.6%
Stomach Ca 1.9%
Self-inflicted injuries 1.9%
Diabetes 1.7%
Breast Ca 1.6%
Beaglehole and Yach. Lancet 2003
Demographic Transitions and Health
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Decreased fertility rates
Decreased infant mortality rates
Increased life expectancies at birth
Reflect shifts in social and economic patterns
Changes in health conditions
Changes in health care
Population and demographic changes
Human Determinants of Transitions
• technological change
• alterations in the environment
• alterations in food type, availability,
production, preparation, and consumption
• alterations in patterns of energy expenditure
• interplay of environmental factors and the
genetic pool of a community
Epistemological Framework of
Epidemiological Transitions
MULTIPLE EPIDEMIOLOGIC
TRANSITIONS
• recent resurgence of infectious disease
mortality marks a third epidemiologic
transition
• characterized by newly emerging, reemerging, and antibiotic resistant pathogens
in the context of an accelerated globalization
of human disease ecologies
Human Determinants of Transitions
REDUX
• technological change
• alterations in the environment
• alterations in food type, availability,
production, preparation, and consumption
• alterations in patterns of energy expenditure
• interplay of environmental factors and the
genetic pool of a community
• Social inequality? Where is it?
“SOCIAL FORCES AND PROCESSES
EMBODIED AS BIOLOGICAL EVENTS”
THE CRITICAL PERSPECTIVE
• Paul Farmer:
• “Inequality itself constitutes our modern
plague – inequality is a pathogenic force”
• “Social inequalities often determine both the
distribution of modern plagues and clinical
outcomes among the afflicted”