Summary Second Opinion: an Introduction to Health Sociology - selected chapters PDF

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An in-depth summary of major concepts outlined in the textbook chapter. - An in-depth summary of major concepts outlined in the textbook chapter. - An in-depth summary of major concepts outlined in the textbook chapter. merged files: Imagining Health Problems as Social Issues.docx - Gendered Heal...

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Imagining Health Problems as Social Issues -

What is sociology and how can it be used to understand health and illness? What social patterns of health and illness exist? What is the social model of health and how does it differ from the medical model?

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Health sociology focuses on the social patterns of health and illness – such as the different health statuses between women and men, the poor and the wealthy or the Indigenous and non-indigenous and seeks social rather than biological or psychological explanations. The social origins of health and illness can clearly be seen when we compare the life expectancy figures of various countries. For example, the average life expectancy at birth of people living in the least developed countries of the world is around 20 years less than that of developed countries. Australian life expectancy is one of the highest in the world, second only to Japan. This is not due to any biological advantage but a reflection of our distinctive living and working conditions. However, life expectancy is not an indicator of nation-wide good health.

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Sociological Imagination: A Template for Doing Sociological Analysis Sociological Imagination: A term coined by Charles Wright Mills to describe the sociological approach to analysing issues. We see the world through a sociological imagination, or think sociologically, when we make a link between personal troubles and public issues. 

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Sociological imagination is used to describe the distinctive feature of the sociological perspective. The sociological imagination is ‘a quality of mind that seems most dramatically to promise an understanding of the intimate realities of ourselves in connection with larger social realities.’ According to Mills, the essential aspect of thinking sociologically, or seeing the world through a sociological imagination, is making a link between ‘private troubles’ and ‘public issues.’ Australian sociologist Evan Willis suggests that the sociological imagination consists of four interrelated parts; 1) historical factors; how the past influences the present 2) cultural factors; how culture impacts on our lives 3) structural factors; how particular forms of social organisation affect our lives 4) critical factors; how we can improve our social environment. Sociological analysis involves applying these four aspects to the issues or problems under investigation. For example, a sociological analysis of why manual labourers have a shorter life expectancy would examine how and why the work done by manual labourers affect their health by examining… 1. Historical factors: to understand why manual workplaces are so dangerous. 2. Cultural factors: such as the cultural value of individual responsibility. 3. Structural factors: such as the way work is organised, the role of managerial authority, the rights of workers, and the role of the state. 4. Critical factors: such as alternatives to the status quo.

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Is Society to Blame? Introducing the Structure – Agency Debate Sociology makes us aware that we are social animals and that we are a product of our environment. We are influenced by the social structure such as our cultural customs and our social-institutions. Agency is the ability of people, individuality and collectively, to influence their own lives and the society in which they live. The structure-agency debate is a key debate in sociology over the extent to which human behaviour is determined by social structure. The issue of structure and agency is central for sociology. Sociologists recognise two main determinants of social phenomena, social structure and individual actions (human agency); what is contested is their relative importance. Social structure refers to those larger and relatively enduring features of society which provide the background against which social life is carried out: for example, the class structure. It highlights the fact that human societies have certain regularities in the social relationships which people engage in. Agency, on the other hand, refers to the volitional and purposeful nature of human activity. Social structure is believed to exert a constraining effect on human activity; agency refers to the ability of individuals to act independently of this. Structure and agency are interdependent, one cannot exist without the other.

Social Medicine and Public Health 

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Public Health/ Infrastructure: public policies and infrastructure to prevent onset and transmission of disease among the population, with a particular focus on sanitation and hygiene such as clean air, water, food and immunisation. Public health infrastructure refers specifically to the buildings, installations, and equipment necessary to ensure healthy living conditions for a population. There is a strong link between disease and poor living and working conditions as an outcome of capitalist exploitation, In Australia, public health approaches were resisted by many doctors who viewed them as unscientific. Despite the influence of social medicine and the success of public health measures, health care would develop in an entirely different direction. The insights of social medicine would be cast aside for almost a century as the new science of biomedicine gained ascendancy.

The Rise of the Biomedical Model 

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Biomedical model: the conventional approach to medicine in Western societies, based on the diagnosis and explanation of illness as malfunction of the body’s biological mechanisms. Pasteur developed the germ theory of disease where illness was caused by germs infecting organs of the human body; a model of disease that became the foundation of modern medicine. Koch refined this idea via the doctrine of ‘specific aetiology’ (specific cause of disease) through ‘Koch’s postulates.’ The central idea was that specific micro-organisms caused disease by entering the human body through air, water, food, and insect bites.

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The biomedical model is based on the assumption that each disease or ailment has a specific cause that physically affects the body in a predictable way meaning that universal cures for people are theoretically possible. The Limits of Biomedicine

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The major criticism is that the biomedical model underestimates the complexity of health and illness, particularly by neglecting social and psychological factors. The idea of specific aetiology only applies to a limited range of infectious diseases. Not all people exposed to infectious disease contract it. Therefore disease causation is more complex than the biomedical model which implies that it is more likely to involve multiple factors such as physical condition, nutrition, and stress, which affect an individual’s susceptibility to illness. A further criticism of biomedicine is its reductionism. The development of medical science has led to an increasing focus on smaller and smaller features of human biology for the cause and cure of disease. Reductionism is the belief that all illnesses can be explained and treated by reducing them to biological and pathological factors. Reductionism can also lead to biological determinism, a form of social Darwinism that assumes people’s biology causes or determines their inferior social, economic and health status. A final criticism of the biomedical model is its tendency toward victim blaming by locating the cause and cure of disease as solely within the individual. This is the process whereby social inequality is explained in terms of individuals being solely responsible for what happens to them in relation to the choices they make and their assumed psychological, cultural, and/or biological inferiority. The WHO effectively acknowledged this limitation of biomedicine in 1946 when it included in its constitution of health as ‘a state of complete physical, mental and social well-being.’ While it is now widely accepted that the causes of illness are multifactorial, it is still fair to claim that the biomedical model remains the dominant influence over medical training and practice to this day.

Rediscovering the Social Origins of Health and Illness  

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McKeown (doctor) was the first author to expose the exaggerated role of medical treatment in improving a population’s health. McKeown argued that the medical profession and governments had overestimated the influence of medical discoveries on improvements in life expectancy during the twentieth century. McKeown had discovered that death from most infectious diseases had declined before the development of effective medical treatments, meaning that improvements in life expectancy were not substantially due to medical intervention. McKeown suggests that the major reason for the increase in life expectancy throughout the twentieth century was not due to medical treatments, but rather to rising living standards, particularly improved nutrition, which increased people’s resistance to infectious disease. He states; “improvement in health is likely to come from modification of the conditions which lead to disease, rather than from intervention in the mechanism disease after it has occurred.”

The Social Model of Health (new public health) 

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Social model of health: focuses on social detriments of health such as the social production, distribution, and construction of health and illness, and the social organisation of health care. It directs attention to the prevention of illness through community participation and social reforms that address living/working conditions. Focuses on the societal level of health detriments and health intervention. The social model of health locates people in social contexts, conceptualises the physical environment as socially organised, and understands ill health as a process of interaction between people and their environment. Therefore the social model is not intended as a replacement for the biomedical model, but rather coexists alongside it. The social model assumes that health is a social responsibility by examining the social determinants of individuals’ health status and health-related behaviour. While the biomedical model concentrates on treating disease and risk-taking among individuals, the social model focuses on societal factors that are risk-imposing or illness-inducing.

The Three Main Dimensions of the Social Model of Health The social model arose as a critique of the limitations and misapplications of the biomedical model. Sociological research and theorising, which underpins the social model of health, have comprised three main dimensions that are reflected in the structure of this book. 1. The social production and distribution of health and illness highlights the many illnesses are socially produced. For example, illness arising from exposure to hazardous work practices are often beyond an individual’s control and therefore need to be addressed at a societal level. 2. The societal construction of health and illness refers to how definition of health and illness can vary between cultures and change over time- what is considered a disease in one culture or time period may be considered normal and healthy elsewhere and at other times. For examples, homosexuality was once considered a psychiatric disorder despite the lack of scientific evidence of pathology. It is no longer medically defined as a disorder. This is an example of how cultural beliefs, social practices, and social institutions shape, or construct the ways in which health and illness are understood. 3. The social organisation of health care concerns the way a particular society organises, funds, and utilises its health services. A central focus of study has been the dominant role of the medical profession which has significantly shaped health policy and health funding to benefit its own interests. 

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Much of health sociology has arisen as a critique of the dominance of the medical profession and its biomedical model. Health sociology examines social patterns of health and illness, particularly various forms of health inequality, and seeks to explain them by examining the influence of society. When groups of people experience similar health problems, there are likely to be social origins that require social action to address them. The sociological imagination, or sociological analysis, involves four interrelated features- historical, cultural, structural, and critical- which can be applied to understand health problems as social issues. Health sociology challenges individualistic and biological explanations of health and illness through a social model of health that involves three key dimensions: the social production and distribution of health, the social construction of health, and the social organisation of health care.

HSBH 1008 Gendered Health (Germov pg 122) Gendered and health is a complex interaction between material circumstances, physical entities, cultural processes and social organisation. The discussion here focuses on the interplay between health and gender in Australia and in similar contemporary developed societies.

Overview: What gender differences in the experience of health and illness? What have been the origins and main activities of the women’s health movement and the men’s health movement? What are intersectionality and gender mainstreaming, and how can they be used to improve our understanding of gendered health?

Gender and Sex This pair of terms refers to socially constructed categories of feminine and masculine (the cultural identities and values that prescribe how men and women should behave), and the social power relations based on those categories as distinct from the categories as distinct from the categories of biological sex (female and male). The words sex and gender are commonly used interchangeably, but many linguists would argue that their usage is quite distinct. Sex refers to the biological and physiological characteristics, while gender refers to behaviours, roles, expectations, and activities in society. Sex refers to male or female, while gender refers to masculine or feminine. The differences in the sexes do not vary throughout the world, but differences in gender do. Here are some examples of characteristics related to sex: Females have a vagina, males do not Males have a penis, females do not Males have deeper voices than females Females can get pregnant, males cannot Males have testicles and females have ovaries Here are some examples of characteristics related to gender: Women tend to do more of the housework than their spouses do A higher percentage of US doctors are women, compared to Egypt Nursing is often seen as a woman's job, although many men enter the profession In some countries women have to cover their heads when they go outside the house

Therefore; Sex refers to the biological and physiological characteristics, while gender refers to behaviours, roles, expectations, and activities in society. Or, Gender is a biological construct and sex is a social construct. Gender and Health   

Health is gendered, for example; women can contract ovarian and cervical cancer while men can get testicular and prostate cancer. OR, stomach cancer is more common among males than in females. Why? The sexes differ in the types of lives that they typically live, and these differences can influence health, thus gender is a significant and complex element in the social production of health and illness.

Disease and Death: Sex Comparisons 

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The Australian population is evenly balanced, there is an equal amount of females and males but because the female life expectancy is about 5 years longer than males, there tends to be more women in the older population. The main causes of death are largely similar for both sexes, and sexually specific diseases contribute to only a small portion of the overall death rate. Dementia is a larger cause of death among women only because a larger number of women live into an older age.

Gendered Health    

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Gendered experiences of health can be summarised by ‘women get sick; men die.’ (this is an oversimplification) Men tend to experience higher rates of several life-threatening conditions (heart disease) and risk factors (dangerous driving). Women have a higher rate of non-lethal conditions (arthritis, migraines) An example of gendered health is psychological distress which appears to be more common in women than men. Or the rate of suicide which is higher in men than in women. An emphasis on sex differences tends to focus our attention on those health conditions for which simple contrasts can be drawn. However, gender plays a relatively small role in health when compared to other factors such as race and age.

Gendered Exposure    

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Men are more likely than women to pick up smoking and therefore men are more likely to contract lung cancer. Smoking also results in higher rates of premature morbidity and mortality from cardiovascular and respiratory diseases. These comparisons illustrate the dynamic interaction between gender and illness. Certain occupations are significant sources of injury and disease and the sexual division of labour has tended to concentrate men in occupations in which the risk is greater (construction, mining, farming, etc.) Few female dominated occupations are as dangerous (office jobs, nursing, etc.) However, health hazards common in work commonly done by women are often more difficult to detect.

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The nature of the risk may also differ. For example, low levels of autonomy and pay in female dominated areas may lead to the disintegration of one’s mental health. Such work conditions are also known to lead to a poor physical health. There is considerable debate about gender differences in exposure to violence and its health consequences. Males are the main perpetrators of violent acts but are not the main victims to all kinds of violence. Sexual assault and domestic violence are overwhelmingly crimes against women.

Gendered Experiences 

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The examples of violence discussed above points directly to a consideration of how gender shapes the experiences of health conditions. A particular injury such as a concussion or laceration may be physically the same, regardless of how it was sustained, but the personal meaning and social consequences will be very different depending on whether the injury was sustained in a car accident, a bar fight or by an attack by ones partner. Women, if experiencing domestic violence, are often poorly equipped, physically and psychologically to deal with the attacker. These attacks are particularly devastating and debilitating and therefore shrouded in shame and secrecy. If men experience domestic violence, other elements of shame and denial play a role in maintaining secrecy as a result of the social stigma around masculinity. Thus the experience of violent assault is highly variable and contains important gender dimensions. Another area shaped by gender is the diagnosis and treatment of heart disease. Australian research suggests that cardiovascular symptoms may be investigated less thoroughly and treated less intensively in women than in men. There is evidence of systematic under-diagnosis of and under-treatment of women. The failure to pursue symptoms vigorously could be a result of the erroneous belief that women are less likely to suspect heart disease in a women and hence less likely to manage such illnesses appropriately. It may also promote the belief among women that heart disease in not a women’s health problem. Doctors tend to diagnose and manage patient...