Soc of Health and Illness Looking Upstream

8/3/2019 Soc of Health and Illness Looking Upstream

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How do we know it when we see it?

“Health status” measured by looking at:

morbidity/mortality rates

prevalence of health practicesrates of specific disease

prevalence of symptoms of well-being

‘objective’ indictors used internationally:

death rates

life expectancy

availability of health services (how measured?) (hospital beds

eg)Friday, November 18, 11



Sociology of Health and Illness...

...studies how social and cultural factors influence health and people’s

perceptions of health and healing, how healing is done in different

societies. Social structures and cultural practices have concrete

consequences for people’s lives.

Even before birth, our lifetime health outcomes have begun to take shape

according to our mother’s family status, income, education, lifestyle, and

other factors

At birth, an infant’s life chances, including probability that she will live, be

well, acquire the skills for success in her culture, are powerfully

influenced by all the social circumstances she will encounter throughout

her life.

In short, a baby’s life chances, including possibilities for health and long

life or sickness and death, are shaped or constructed by society itself.

Friday, November 18, 11



Historical Examples of Social Influences on Health

John Snow and the 1854 cholera outbreak in London

mapped occurrence of disease

interviewed people in places of high prevalence

identified common use of water pump among them




Historical Examples of Social Influences on Health

Manchurian Plague of 1910–a fashion trend causes an epidemic

Russo Japanese War of 1905; Harbin becomes Russian city in China

Russian hunters catching Manchurian marmots as women’s fashiontrends in Europe begin demanding fur

Inexperienced Chinese hunters begin trapping marmots, unaware of

traditional practice of avoiding sick animalsChinese hunters become infected, spread disease in crowded markets

and inns where they sell their furs

Plague spreads along rail lines into other cities in Northern China Friday, November 18, 11



Social and Cultural Impacts on Health

One’s position in a social structure influences one’s health:

Gender

Chronic illnesses are more prevalent

women report more illness and visits to physicians

higher mortality/morbidity in states where levels of

political participation and economic autonomy are lower

Why?

power; body ideals; reproductive health; male-dominated

institutions of medicine/science; norms of care





One’s position in a social structure influences one’s health:

Race a nd ethnicity

genetics (Tay Sachs disease)

differential medical treatment

access to health care/promotion

built environment

culture of poverty?


http://thesocietypages.org/citings/2010/10/20/dont-call-it-a-comeback-the-culture-of-poverty/





American Human Development Report

Grouping

LifeExpectancy

(years),20051

InfantMortality

Rate,02-04

Age-specificDeath

Rate, 1-4 Year

Olds per 100,000

pop.,02-04

Food-Inse-cure

House–

holds,2005

ChildImmun-ization

rate

(%),2006

Diabetes(% age18 and

older),04-06

Obesity(% age20 and

older),04-06

TeenPreg.(per

1,000girls

age15-19)

TobaccoUse (%18 and

older),04-06

PeoplewithoutHealth

Insurance

(%),04-06

U.S.

GENDER

Female

Male

RACE/

ETHNICITY

Native Am

Asian/PI

Black

Latino

White

78.0 6.9 30.9 11.4 83.2 10.2 ... 41.1 20.8 16.6

80.5 ... 27.4 ... ... 8.9 29.6 ... 18.4 15.1

75.4 ... 34.2 ... ... 11.7 30.1 ... 23.3 18.2

78.0 8.6 49.8 ... 80.0 ... 27.6 52.5 26.9 35.1

86.3 4.8 22.6 ... 84.9 ... ... 17.3 11.7 16.2

73.0 13.7 47.4 23.6 79.1 14.2 41.4 63.1 20.9 17.7

82.1 5.6 29.1 19.6 82.3 ... 28.3 82.6 14.6 34.2

78.2 5.7 27.2 8.6 84.7 8.8 26.6 26.7 22.6 12.2

A Long and Healthy Life





Socioeconomic status (lack of access to health information,

health practices, health care)

Occupation (stress/strain; repetition; free time; physical

risks)

Age (young/old most susceptible to infectious, respiratory

and other diseases)





All of these factors influence

Differential exposure to pathogenic or salutary circumstances

Vulnerability to disease

Access to healthcare resources




Examples of Patterns of Illness

Autism–more common in boys and those with higher SES

Anorexia–white, higher SES adolescents

ADD/HD–more common in boys

Asthma–more prevalent in people of color and low SES




0

4

8

12

16

< $15,000 $15-$24,999 $25-$49,999 $50-$74,999 >=$75,000

Prevalence(percent)

Prevalence of Asthma by Income




Prevalence of Asthma by Age/Income

0

3.5

7.0

10.5

14.0

0 - 4 5 - 14 15 - 34 15 - 19 20 - 24 25 - 34 35 - 64 65+

P r e v a l e n c e

Age

0-.99 1.00-2.49 2.50-4.49 4.50 and above

Income relative to poverty line: 1=at poverty level; 2=2X poverty level; 3=3X poverty level




Dominant Perceptions of Illness

Biomedical Model

mind-body dualism–understand and treat body in isolation from other

aspects of person inhabiting it

physical reductionism–disease is localized in the body; excludes social,

psych., and behavioral dimensions of illness

doctrine of specific etiology –disease is caused by a specific, identifiable

agent

machine metaphor–body is seen as biomechanical machine, disease is

malfunction of mechanism

body as object of regimen and control–individual is responsible for

exercising control to maintain or restore healthFriday, November 18, 11



Disease and the Illness Experience

Disease vs. Illness

Disease=physiological process in the body

Illness=subjective, personal experience of the body

disease can be present but not experiencedearly stages of cancer, PD, Alzheimer’s

ill health can be experienced without disease

psychosomatic conditions

undiagnosed/undiscovered disease (e.g., GW illness)




Disease and the Illness Experience

Medicalization is a particularly critical concept because it emphasizes the fact that medicine is a social enterprise, not merely

a scientific one. A biological basis is neither necessary nor

sufficient for an experience to be defined in terms of illness.

Rather, illness is constructed through human action–that is,

illness is not inherent in any behavior or condition, but conferred

by others. Thus, medical diagnosis becomes an interpretive

process through which illnesses are constructed.”




Where do diseases come from?

They may exist in nature and enter human societies in various

ways

Manchurian plagueLyme Disease (suburban sprawl)

They may be produced by changing societies/social structures

anorexia (emerged in the 1960s)

alcoholism (goes up during recessions)

Or there may be an interaction between the two

asthma




How are diseases discovered?

Disease discovery usually results from epidemiology; but

Sometimes diseases are invented

onanism

rosacea PMS

micromastia

Erectile Dysfunction

If societal needs include maintaining healthy individuals, why wouldsocieties “invent” diseases?

social control (e.g., protect the moral order)

for profit




Onanism

1716, Dutch theologian Dr. Balthazar Bekker: "Onania, or the Heinous

Sin of self-Pollution, And All Its Frightful Consequences, In Both Sexes,

Considered: With Spiritual and Physical Advice To Those Who Have

Already Injured Themselves By This Abominable Practice."

Onanism causes "Disturbances of the stomach and digestion, loss of

appetite or ravenous hunger, vomiting, nausea, weakening of the organs

of breathing, coughing, hoarseness, paralysis, weakening of the organ of

generation to the point of impotence, lack of libido, back pain, disorders

of the eye and ear, total diminution of bodily powers, paleness, thinness,

pimples on the face, decline of intellectual powers, loss of memory,

attacks of rage, madness, idiocy, epilepsy, fever and finally suicide."


http://en.wikipedia.org/wiki/Balthazar_Bekker

http://en.wikipedia.org/wiki/Balthazar_Bekker



Oanism (cont.)

1760, Tissot’s L'Onanisme cites case studies of young male

masturbators to argue that semen was an "essential oil" and

"stimulus" that, when lost, would cause "a perceptible

redu ction of strength, of memory and even of reason; blurred

vision, all the nervous disorders, all types of gou t and

rheumatism, weakening of the organs of generation, blood inthe urine, disturbance of the appetite, headaches and a great

number of other disorders."


http://en.wikipedia.org/wiki/Rheumatism

http://en.wikipedia.org/wiki/Gout







Oanism (cont.)

1870, 7th Day Adventist founder Ellen G. White writes that “self-indulgence” will

lead to:

“numerous pains in the system, and various diseases, such as affection of the liver and

lungs, neuralgia, rheumatism, affection of the spine, diseased kidneys, and cancerous

tumors. Some of nature's fine machinery gives way, leaving a heavier task for theremaining to perform ... and there is often a sudden breaking down of the

constitution; and death is the result.”

“Females possess less vital force than the other sex, and are deprived very much of the

bracing, invigorating air, by their in-door life. The result of self-abuse in them is seenin various diseases, such as catarrh, dropsy, headache, loss of memory and sight, great

weak ness in the back a nd loins, affections of the spine, and frequently, inwa rd decay

of the head. Cancerous humor, which would lie dormant in the system their lifetime, is

inflamed, and commences its eating, destructive work. The mind is often utterly

ruined, and insanity supervenes.”Friday, November 18, 11

http://en.wikipedia.org/wiki/Death

http://en.wikipedia.org/wiki/Lungs

http://en.wikipedia.org/wiki/Neuralgia


http://en.wikipedia.org/wiki/Vertebral_column

http://en.wikipedia.org/wiki/Kidneys

http://en.wikipedia.org/wiki/Liver















http://en.wikipedia.org/wiki/Ellen_G._White

http://en.wikipedia.org/wiki/Ellen_G._White



Micromastia (small breast disease)

Micromastia, or breast hypoplasia, is a medical term describing

the postpubertal underdevelopment of a woman’s breast tissue.

Just as it is impossible to define ‘normal’ brea st size, there is noobjective definition of micromastia. Breast development is

commonly asymmetric and one or both breasts may be small.

This condition may be a congenital defect associated with

underlying abnormalities of the pectoral muscle, related to

trauma (typically surgery or radiotherapy) or it may be a more

subjective aesthetic description.


http://en.wikipedia.org/wiki/Surgery

http://en.wikipedia.org/wiki/Radiotherapy





http://en.wikipedia.org/wiki/Hypoplasia

http://en.wikipedia.org/wiki/Hypoplasia





Micromastia (cont.)

In 1983, American Society of Plastic and Reconstructive

Surgeons ran a $4 million public relations campaign promoting

breast implants by stating that they were “essential to women’smental health” and that flat-chestedness caused a “total lack of

well being.”

If “Health is a state of complete physical, mental, and social well- being and not merely the absence of disease or infirmity,” and

small breasts cause women to experience a lack of well-being,

then is micromastia a “real” disease?




Medicalization

The process of turning social phenomena, previously considerednormal or unproblematic, into medical problems

Pregnancy, birthing Medicalization of social deviance when medicine/science redefine what is normal or acceptable by attaching disease labels to certain behaviors or conditions

Medicalization of criminal behavior

1954 Durham v. U.S. “an accused is not criminally responsible if his unlawful act was the product of mentaldisease...”chemical castration




Sociology of Health Areas of Interest

(Social) Epidemiology – social factors shaping the incidence

and prevalence of disease

The sick role – from functionalist sociology

Doctor/patient relationship – from interactionist sociology

Health inequalities – conflict/feminist perspectives

Critique of the biomedical model – feminist/postmodern

perspectives






Anorexia Nervosa in (Social) Context

Sociocultural, Psychological, or Physiological/Neurological?

Patterns of culture interact with phys./psych. variables

Stages of Anorexia Nervosa

Recruitment (sociocultural+psychological)

Career (cultural + physiological/neurological)




The Sick Role

Responsibilities and privileges of the sick role:

sickness is a form of deviance from social norms, but

because it is not deliberate, the sick person is not heldresponsible

Sickness is legitimate grounds for being exempted fromnormal obligations (e.g., work, school, parenting)

The legitimacy of this exemption is dependent on the sick person’s intent to get well

The attempt to get well implies also seeking and

cooperating with competent help to treat the illness.Friday, November 18, 11



The Sick Role

If expected behaviors of the sick person are to: Act like you do not like the role.Seek help to get out of the role.

Then who gets to occupy the sick role?

People born with a physical disability?The chronically ill?The mentally ill?Pregnant or menstruating women? Women going throughmenopause?

How does society treat individuals whose disease is perceived as a result of lifestyle or other choices?

STDsLung cancer

Type II (obesity-related) diabetesFriday, November 18, 11



Doctor-Patient Interaction

The patient’s role: Answer questions.Don’t speak unless spoken to.

Don’t ask questions.Don’t offer diagnoses.

However, medical complaints are often cast as questions oras “candidate diagnoses.”

The doctor’s role: Ask questions.Make diagnosis.Offer treatment and prognosis.

Documents

Soc of Health and Illness Looking Upstream