BSCI A213F Sociology of Health in Nursing PDF

BSCI A213F Sociology of Health in Nursing Topic 5: Health determinants and inequality 此相片 (作者: 未知的作者) 已透過 CC BY 授權 Social pattern of illness In any population, at any point in time, there will be a variety of different illn...

BSCI A213F Sociology of Health in Nursing Topic 5: Health determinants and inequality 此相片 (作者: 未知的作者) 已透過 CC BY 授權 Social pattern of illness In any population, at any point in time, there will be a variety of different illnesses. These illnesses often form patterns because of some biological characteristic of the disease process. The value of looking for patterns of illness is that if the distribution of a disease and a population characteristic (e.g. age, sex, height, blood group, religion, etc.) are similar then it suggests that the characteristic is a possible factor in the disease. As well as being related to mortality, class, age, ethnicity and sex are correlated with many other aspects of people's lives, which in their turn have suggested more complex factors in the aetiology of disease and cause of death. Gender and Health Defining Sex and Gender Different definitions: Sex: biological categories (male & female), with very specific physical differences and unchangeable (biological endowment). Gender: socially constructed categories of femininity (女性氣質) & masculinity (男性氣質) definitions of which vary over space and time. It is not a fixed aspect of our identity, but is fluid, negotiated on a daily basis. Gender refers to the cultural dimension of sex => femininity & masculinity: ways in which men and women are expected to behave, think and feel Feminist sociologists believe that this cultural interpretation of what men & women brings about gender division of labour justifying gender inequality leading to the disadvantages for women in patriarchal social order. Note that sex & gender differences are interlinked and constantly influence each other. Both are major factors shaping morbidity (發病率) and mortality (死亡率) of women and men. Gender, Power, and Inequality Social structure reflects gender differences in power → gender inequality Gender stratification A systematic and unequal distribution of power, resources and opportunities in society between women and men Patriarchy vs. matriarchy A social system dominated by men vs. such by women Discrimination and the glass ceiling at work Invisible barrier created by individuals and institutional sexism that prevents qualified women from advancing to higher levels of leadership and management Masculinity and Femininity Psychologists and clinicians are more likely to define women’s than men’s health problems as psychological, and definitions of mental health are often related to traditional notions of masculinity and femininity: healthy men are thought to be independent, logical and adventurous, and healthy women less aggressive, more emotional and easily hurt. Gender Norms, Roles & Stereotypes Gender norms refers to guidelines regarding proper behaviours, attitudes, & activities of men & women in relation to the way society perceives masculinity and femininity. Children learn proper behaviour for girls and boys through parents (family socialization), the media, peer groups, and other sources of socialization. E.g., gender norms for boys and girls: boys are expected to be tough, aggressive and assertive and girls should be submissive, caring and gentle. – When people don’t conform to gender norms, they will be sanctioned and criticized, e.g., assertive women are called “bitches” (she-devils) and “whores” (sluts) 蕩婦, while men who don’t appear or act masculine are called “sissies” 娘娘 腔or “wimps” Gender Norms, Roles & Stereotypes Gender roles are roles that men and women are expected to occupy in relation to their social statuses within social institutions. These roles incorporate specific gender norms (or even stereotypes) for individuals associated in particular with gender. How men and women play their gender roles? Masculine Scripts (playing masculinity, i.e., gender norms for men) Men are expected to: distance themselves from anything feminine. be occupationally or financially successful. be confident and self-reliant. Feminine Scripts (playing femininity, i.e., gender norms for women) Women are expected to offer emotional support to others. be physical attractive, not too competitive, a good listener and adaptable be good mothers and put the needs of others first. Gender Norms, Roles & Stereotypes Gender roles and gender division of labour in family & in employment market According to the functionalist view within the family: women are often expected to play the expressive role in relation to the ‘natural woman’ argument (i.e., being carers responsible for the affective needs & physical maintenance, such as cooking and cleaning within the family) men are expected to play the instrumental role (i.e., being breadwinners responsible for physical protection and financial security of the family). According to the functionalist view, at work particular occupations are considered as men’s jobs (firemen, policemen…) & women’s jobs (kindergarten teachers, nurses…) women are usually expected to do supportive jobs such as clerks or secretaries & men to be managers/executives. Gender Norms, Roles & Stereotypes Gender stereotypes (性別定型) are over- generalizations or exaggerations of gender characteristics and attributes which are considered inborn and fixed (but not so for sociologists), overlooking individual differences. In other words, gender stereotypes often obscure individual differences generating biases that apply to both men and women. Through socialization, people often develop stereotypical conceptions of both genders, and begin to use these conceptions to organize their knowledge and behaviours. Gender Roles and the Life Course Gender roles, responsibilities, and norms about culturally acceptable behavior are socially constructed, and vary across the life course and for different birth cohorts The health and other characteristics of women and men are influenced by their prior life course. E.g. women who quit their paid employment to raise children will lead to financial penalties both during their working life and in retirement because of lower private pension contributions Lone mothers suffering the huge financial penalties of parenthood Gender Roles and the Life Course Life course approach emphasizes the inter-linkage between phases of the life course, rather than seeing each phase in isolation. Gender inequalities in health within one life stage may be predicated on gender inequalities in another. For women in mid-life their health and well-being is influenced by their history of childbearing and their role as parents. Example: Increasingly, health during working life is structured according to position in the labor market, which itself is closely linked to earlier success in the educational sphere. Another Key Concept: Sexuality A person’s sexual desires, behavior and identity Can be either biologically based on sex characteristics or socially constructed Culture typically have a variety of norms and expectations regarding sexuality Appropriate age for sexual activity? Sex drive and reproduction → natural and normal sexual activity? So, homosexuality is unnatural (e.g., mental health problem)? Marginalization of LGBTI People and Its Impacts Normative construction of gender and social marginalization of lesbian, gay, bisexual, transgender, or intersex (LGBTI) (Willis & Elmer, 2011) Dominant understanding of sexual orientation and gender identity marginalize LGBTI people Normative construction of sexual orientation and gender identity produce patterns of illnesses specific to LGBTI people, e.g., HIV, monkeypox Sexual Identity Our sense of self as it relates to the type of sexual attraction we have for others Heterosexual Homosexual Bisexual Asexual 無性戀 Queer 酷兒 An umbrella term for anyone who is not heterosexual, gender-binary and/or heteronormative  Marginalization of LGBTI People and Its Impacts Heterosexism Discriminatory beliefs or practices that any other than heterosexuality is unhealthy, unnatural, and a threat to society, e.g., homophobia, transphobia Heteronormativity A generalized view that heterosexuality is the norm Heterosexual experience is the only perspective that is considered To what extent do you think that our health services exist in an environment of heteronormativity? Marginalization of LGBTI People and Its Impacts Pay more attention to the attitudes from healthcare professionals and frontline workers LGBTI people’s feelings of acceptance or rejection and the impacts of these personal feelings on their engagements in healthcare systems E.g., late attendance, under-screening, lack of confidence, under- utilization Strategic management of health information E.g., screening of doctors who are empathetic and considerate towards LGBTI people, disclosure of their sexuality in a planned manner, consciously withholding of their sexuality-related information if necessary Marginalization of LGBTI People and Its Impacts Higher victimization rates among LGBTI people in physical violence and abuse Some LGBTI individuals, due to fear of prejudice and discrimination, modify their daily activities Negative impacts on mental health, e.g., social isolation, anxiety, emotional distress Health-related needs of LGBTI people as they age? Lack of sociological studies of household composition, caring relationships and financial arrangements among LGBTI community (Harrison, 2005) 18 Reflective Discussion How can the sociological knowledge of sex and gender assist healthcare professionals to understand the health issues being faced by LGBTI people? Optional: Use your branch of nursing as an example Potential directions Health statistics and disparities among LGBTI populations LGBTI-specific health issues and needs across life course Social status of LGBTI Social interactions between LGBTI people and others Anymore? Gender and Health The phrase ‘women get sick and men die’, which historically has been central to research findings in the area of gender inequalities in health, still holds some truth, but it oversimplifies the complex relationship between gender and health. Mortality: Death rates for men are higher at all ages Morbidity: Women report more symptoms, limiting illness, use of medicine and doctor contacts. As a general pattern: Men compared to women have: greater mortality from heart disease shorter than average life expectancy higher rates of injury from accidents higher suicide rates (remember Durkheim’s study of suicide?) higher rates of alcohol abuse Gender and Health The main causes of lower life expectancy for men lie in higher death rates from coronary heart disease, lung cancer and chronic obstructive airways disease, accidents, homicides, suicides and AIDS (Miers 2000). Men are more likely to die of occupationally related illnesses, men engage in more physical risk-taking than women, and accidents and homicides have always been a feature of masculine rather than feminine experience. Cigarette smoking has, hitherto, been a major cause of death among men (although in the 1990s male and female smoking rates in the UK began to even out), and men drink more than women. For example, King and McKeown (2003) report high levels of alcohol and substance misuse among (especially young) lesbian, gay and bisexual (LGB) people, and link this to the importance of pubs and clubs in LGB social life. Gender and Health The poorer aspects of men’s health are often associated with stereotypical male gender roles: trying to live up to a macho image and lifestyle, which is itself dangerous to health. From this perspective, much ill health among men is a consequence of lifestyle, which health professionals can address in their role as health educators. However, the challenge to change male behaviour and resist stereotypical masculinity is problematic because men’s experience (just like women’s) is affected by other aspects of their identity, such as age, dis/ability, ethnicity and so on. Explaining relations between gender and health Sara Arber and Hilary Thomas (2001) define 7 explanations to the gender differences in mortality and morbidity: 1. Biological explanation 2. Psychosocial explanation Cultural explanations: 3. Differential risk behaviour among male and female 4. Occupational and work-related factors 5. Social role and relationships 6. Unequal distribution of power and resource within the home 7. Social structural difference within society Explaining relations between gender and health Biological explanation Associated with genetic or hormonal differences between women and men play. It a direct role in explain some differences, such as breast cancer rate. This impacts health outcome rather than health inequities. range of gender differences in mortality identified.clearly demonstrates the importance of factors other than biology. Psychosocial explanation Highlights gender differences in personality and coping behaviors, which influence the experience and reporting of symptoms. The degrees level of femininity is associated to poor health. Explaining relations between gender and health Cultural explanations: Differential risk behaviour among male and female The higher levels of smoking and drinking among men are emphasized, including the adverse effects of binge drinking. Masculinity (being man or doing maleness) associated with risky activities and/or behaviours Masculinizing Practices – acting out manhood => behaving as man can lead to risk taking behaviour, e.g.: Being aggressive (being forceful, competitive, taking actions to win and be leaders..) Drunk Driving Use of drugs, such as alcohol, tobacco…. At risk sexual behaviours (leading to sexually transmitted infections, unplanned pregnancy) Doing extreme sports (skydiving, …etc.) However, over time and place, the relative rates of men and women drinking alcohol and smoking have altered in society change. Explaining relations between gender and health Cultural explanations: Occupational and work-related factors There are health hazards associated with both paid work and unpaid domestic work as the choices of occupation and family division of labour are gendered. Employment and educational levels are increasingly important health indictors, especially for women. Women who do paid work in communities where this is not the norm may be because “some male partners might use violence to punish women for transgressing gender norms on work and the perceived threat to the masculine role as breadwinner or power holder” (Weber et at., 2019, p.2464) Occupational factors also link with income level, Women in later life have lower income than do men, which is associated with the nature of their employment in the life course. The gender pay gap stands as 23% globally although girls have better academic performance than men (UN Women, 2018) Explaining relations between gender and health Cultural explanations: Occupational and work-related factors Gender-related difference to workplace exposures exits as a result of gender norms. Men are more likely to be exposed to fatal industrial injuries (致命工業傷害) acute injuries in dangerous occupation Some occupational groups merge into the definition of masculinity (e.g. building labourers, soldiers, firemen, sportsmen) and these occupational groups are more exposed to industrial injuries. Women are more likely to be exposed to chemicals in cleaning products, clothing dyes, textile dust and so on. Women are also more likely to be exposed to danger in domestic environments, which they undertake 2.6 times more unpaid and domestic work than do men. (UN Women, 2018) Explaining relations between gender and health Cultural explanations: Social role and relationships Gendered norms and expectation underpin the shape of social roles and relationships that impacts on health outcomes. Women in western countries often have better social networks than men, and can more easily rely on contact with close friends and relatives in times of crisis and stress. Marriage may provide a major source of social support, but in a differential way for men and women and across societies. In terms of social support, marriage may be good for men but less so for women. Men tend to rely more on their wife for social support and a confiding relationship, with divorced and widowed men reporting particularly poor health. Explaining relations between gender and health Cultural explanations: Social role and relationships Evidence from research also suggests that women are more likely to admit illness (possibly they not expected to ‘act tough’ in terms of gender expectation) & are have higher consultation rates over a lifetime, especially when we take into account the visits related to menstruation, pregnancy, childbirth, post-natal care and menopause. Medicalization of women’s bodies: the process through which women’s biological conditions are defined & treated as medical conditions, for example: women’s bodies are thought to be susceptible to illness ( 女性 被 理 解 為 容 易 生 病 ) as menstruation (月經) thought to have sapped their energy, making them necessary to rest more; childbirth is considered a condition which requires confinement (坐月) ; menopause (更年期) is considered a condition which requires medical attention (not so for men) Explaining relations between gender and health Cultural explanations: Social role and relationships Doctors are more likely to diagnose women as ‘ill’ ’ due to gender stereotypes. Furthermore, women appear to find it easier and more socially acceptable to discuss their own health, and there may also be important psychosocial factors, such as how men and women evaluate symptoms. Explaining relations between gender and health Cultural explanations: Social role and relationships This construction of women’s health as poor has consequences for men. There is an implicit assumption that men’s health is ‘good’. The result of this is that men’s poor health remains invisible and differences between men are not considered. The seeking of professional help for both physical and mental health needs is gendered, and it is well known that men are generally less likely to seek professional help than women. Men’s denial of illness can be so strong that even the pain associated with a heart attack can be ignored so that the victim will not be seen as weak or effeminate. Explaining relations between gender and health Cultural explanations: Unequal distribution of power and resource within the home Gender inequality is common is the domestic sphere. More women in full time paid employment but they also take up most household chores (Second Shift/double burden) Arlie Hochschild (1990) found full-time working women spent 3 hours a day doing housework whilst their husbands spend the equivalent of 17 minutes. Brayfield (1992) found even in dual-career families (雙職家庭, i.e., both husband and wife had paid work), women still carried major responsibility for domestic tasks. Career women were still viewed by and large as ‘wives & mothers’ (not so much as working career women). Most domestic work was still managed by the wives though a fair proportion of routine and physical labour in the family was done by foreign domestic workers Explaining relations between gender and health A study in five European Countries (2016) found that: Source: Klenner & Y. Lott (eds), 2016 Explaining relations between gender and health Cultural explanations: Unequal distribution of power and resource within the home Housework and care-work are still predominantly female tasks: Housework conventionally as ‘women’s work’ assuming that women are ‘by nature’ better at doing housework. ‘Ideology of motherhood’ => women should enjoy their domestic work and be fulfilled by their role as carers and nurturers within the family. Consequence Double burden for working women (paid work and domestic unpaid work) or the imposed pressure of having to choose between either family making or career development Lack of leisure time for women: David Morley (1992) says: ‘women see the home as a place of work, men a place of leisure’. Women have considerably less leisure and free-time because of domestic work burden. Marriage improves men’s health but worsens women’s Poorer health for women under 40 with children Paid work outside the home beneficial for all women without children women over 40 with children Explaining relations between gender and health Cultural explanations: Unequal distribution of power and resource within the home The inter-household distribution of power, money and labour disadvantage women. Women disproportionately carry out most of the domestic work with less control over domestic resources. Women spend relatively more of their personal income on household goods (especially food) than men. They are more likely to be responsible for maintain the material and psychosocial environments of the home and wellbeing of those who live there, which cause adverse health consequences. Explaining relations between gender and health Cultural explanations: Social structural differences within society Arber and Thomas (2001) believe it is the most important reason on gender inequality on health. “Women in most societies are more likely than men to be poor, have less education, and live in disadvantaged material circumstances” (Arber & Thomas, 2001,p. 104) The feminization of poverty in the US and UK has been widely acknowledged and is associated with lone motherhood and older women. Explaining relations between gender and health Median monthly income (LFPR) Year Male Female 2006 11,000 (69.2) 8,500 (52.4) 2011 13,000 (67) 9,500 (53.4) 2016 16,890 (68.4) 12,000 (54.5) 2020 20,900 (66.2) 16,200 (54.2) Source: C&SD, 2021 37 Class and Health Inequality Social stratification Social stratification (社會分層): ranking system in societies ◼ People in society are divided into categories of ranking ordering ◼ The ranking ordering of these categories is founded on the relative possession or non-possession of some attributes/characteristics such as income, wealth, occupation, religion, race, education, heredity, etc. ◼ In other words, members of societies are categorized and ranked in hierarchies according to the above attributes/characteristics. ◼ 2 types of attributes: Ascribed attributes: characteristics which are acquired at birth (e.g. being born into a royal family) and there is little people can do to acquire or remove such characteristics/attributes. Achieved attributes: characteristics which can be achieved through individual efforts, such as educational qualifications, wealth…etc. ◼ Societies can then be stratified along the line of race, gender, religion, wealth……..  Stratification is a ranking order that forms the basis for the distribution of scarce resources within a system of unequal rewards: Those who are at the top of the ranking system tend to Social have greater access to scarce resources (or better life chances) & thus command more respect (status) and stratification power than those who are at the lower end of the system leading to social inequalities, i.e., the unequal sharing of resources and social rewards. Social stratification system/s: a continuum of ‘openness’ to ‘closedness’ according to how easy or difficult it is for members of society to change their social statuses (social positions). Closed and Open Society Closed society – within a ‘closed’ stratification system that means there is little chance for people to change their ranking, power and status are more likely to be determined by ascribed characteristics. ◼ Individuals are born with certain characteristics and thus enter into a specific stratum. ◼ Therefore, their positions within the social structure are determined at birth but not through any individual efforts. Open society – more ‘open’ stratification system in which people have some chance to improve their socio-economic statuses, i.e., some social mobility (movement from one class to another) through, e.g., education, individuals’ efforts…etc., i.e., achieved attributes) 41 Dimensions of Social Stratification Social class (社會階級) refers to groupings of people with similar levels of wealth (perhaps similar lifestyle as well), power, and prestige. ◼ Wealth refers to assets, i.e., the value of everything the person owns, for example, in the US, 1 % of the population control one-third of wealth ◼ Income refers money earned through salaries, investment returns, or other capital gains, for example, in HK, the top 10% highest earning households took up more than 40% of the annual total household income in HK. ◼ Power is the ability to control the behaviour of others, with or without their consent. Sources of power: one’s power can be based on sheer physical force, the possession of special skills or types of knowledge, particular social status, personal characteristics, or custom and tradition. ◼ Prestige is the respect, honour, recognition, or courtesy an individual receives Common factors determine the prestige a person receive : occupation, education, family background, and area of residence are common factors in our society.  Monthly household income in HK (2022 Q4, HKD) 100,000 OR ABOVE 8.00% 80,000 OR ABOVE 12.26% 60,000 OR ABOVE 20.04% 40,000 OR ABOVE 36.79% 30,000 OR ABOVE 48.82% 20,000 OR ABOVE 63.46% 15,000 OR ABOVE 72.03% 10,000 OR ABOVE 79.52% 0 OR ABOVE 100.00% 0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00% Source: C&SD, 2023. https://www.censtatd.gov.hk/en/web_table.html?id=130-06605A# Social Mobility Upward vs. downward Vertical vs. horizontal Inter-generational vs. intra- generational Intra-generational mobility: Change in social position during a person’s lifetime Inter-generational mobility: Upward or downward social mobility of children as compared to their parents 44 Reflective Discussion Should a medical doctor get higher income and a higher social status than others, e.g., nurse, teacher, technicians? Why or why not? Income and Inequality: Is Social Inequality Necessary? Conservative - YES Radical - NO It maintains the order and It intensifies conflicts and stability (“status quo” 現狀) of contradictions in our society society Unjust and unfair for the upper Not only unavoidable, but class to exploit the lower class entirely just and fair for some people to get higher rewards than others Functionalist Perspective: Stratification for Effective role Allocation and Performance Functionalists argue that stratification is functional and thus beneficial for the operation & survival of society because : 1. Tasks/roles with different levels of importance for the survival of society 2. Social consensus over what roles are more important. 3. All tasks/roles have to be done/filled up by members of society and it is best for society to have the best people for the most important tasks. 4. Stratification is the consequence of the unequal distribution of rewards to attract the most suitable people to take up the most important tasks for society: greater rewards (both financial reward and social respect) for more qualified people to fill more important positions/tasks 5. Functionalists argue that stratification is inevitable (無可避免) because the need for effective role allocation and performance is universal (exists in all societies) as suggested by Davis and Moore (1945) in Some Principles of Stratification.  Marxist Perspective Capitalism: economic system in which the means of production are held largely in private hands and the main incentive for economic activity is the accumulation of profits. Radical alternative to functionalism ◼ Basis of social stratification & inequalities: class – one’s position within society is determined by one’s class position ◼ Individuals’ class position is dependent upon whether they own any means of production which refers to instruments of labour such as tools, factory, machinery as well as subjects of labour such as natural resources and raw materials through which owners derive their wealth). ◼ According to Marx, class is not only about social division but also about social conflict Marx’s two-class model in capitalist society: With the ownership of the means of production, capitalists buy and control the labour power of the working class => control over what to produce and how to produce Without any means of production, workers can only sell their labour to capitalists for their livelihood => lose their autonomy during the time period of work Marxist Perspective ◼ Relations of production between the 2 classes: mutual dependence but antagonistic: conflicts between the 2 classes because of the oppression & exploitation of the capitalist class against the working class (in which the former get the ‘full fruits’ of the labour of the latter). ◼ Exploitation: ◼ owners of the means of production, i.e., the capitalist class (who do not produce anything at all dominate the production process & get the surplus value (i.e., profit) produced by the working class. ◼ Working class without the means of production force to enter the relations of production in a disadvantageous fashion => being waged workers who don’t receive the ‘full fruits’ of their labour (which refers to the end value of their products) but only wages for their subsistence (only a portion of the value of the end products). ◼ Exploitation can be intensified by the attempts made by the capitalists to increase the productivity of workers without increasing labour costs, e.g., work long hours, deskilling through mechanization (turn workers to machine tenders ◼ Increase the productivity of workers but also make life harder for them=> losses in skills & creativity in the production process & perhaps some workers may become redundant (lose their jobs) Marxist Perspective ◼ For the Marxist perspective: stratification is only functional/good for a specific class, i.e., the capitalist class who are at the top of the social hierarchy (whereas the functionalist believe that the whole society can benefit from stratification). ◼ To maintain and justify their position at the top, the ruling class, i.e., capitalist class develop an ideology to justify their dominance within the stratification order and this is what is called ruling class ideology (for example, the belief that the capitalist system is just and fair) The ‘ruling class ideology’ often misleads the working class into believing that their welfare depends on very much on the stability of the existing social order. Consequently, the wc may even support laws against their own interests and make sacrifices that benefit the capitalist class. False class consciousness: Working class fail to recognise their own situation of being exploited and oppressed => accept the legitimacy of the capitalist social order & their own fate within society => never consider to challenge the capitalist system and thus remaining ‘class-in-itself’ but not ‘class-for-itself). Marxist Perspective Marx argued that: Class conflict (between the two classes) as motor of social change: ◼ class polarization and pauperization : the Working class situation is likely to get worse => They have been made more miserable by the exploitation of the capitalist class (who push for max. of profit even in times of economic downturn) Extreme polarization (階級兩極化) between the 2 classes and pauperization of the working class would make them (i.e., the working class) realize what is in their interests (i.e., gaining class consciousness) => enter into conflict with the capitalist class. The working class would organize themselves into a potent social-political force to push for its interests and fight back (class struggle), ultimately leading to a socialist revolution with a seizure of capitalist state power=> Class-for-itself ◼ Marx’s optimist view of social change (removal of capitalism to be replaced by a communist society) Weberian perspective on class Weberian’s conception of class: class position was NOT ONLY determined by: ◼ ownership of the means of production (as in the Marxist framework) BUT ALSO ◼ market situations and employment conditions (degree of employment security, promotion prospect, and career path, etc…). In other words, Weber’s idea of stratification: take into account a person’s credentials and marketable skills (including one’s education level and training), apart from the ownership/non-ownership of the means of production. ◼ 4 major class groupings in capitalist society: i) propertied upper class; ii) propertyless white-collar people – middle class who have certain skills of marketable value; iii) petty bourgeoisie or small business owners; iv) manual working class. Weberian perspective on class ◼ Diversification of classes & expansion of the middle class (more than 2 classes as suggested by Marx with an increasing significant middle class) Weber acknowledged the increasing dominance of the propertied upper class & the decline of the petty bourgeoisie due to severe competition in a capitalist society BUT at the same time, he expected a proliferation of the white-collar and professional categories in an increasingly rationalized and bureaucratic modern world. ◼ Mobilization potentials of the working class is not to be overestimated : The more diverse class structure can weaken the solidarity and revolutionary consciousness of the propertyless groups (i.e., propertyless white-collar workers and manual working class) with different life chances: Some chance for social mobility, especially for working class to be middle class goverment’s moderation between trade unions and the capitalist class as well as social provisions and welfare making some improvements over workers’ conditions No certainty for the working class to form a ‘class for itself’ (i.e., a class with members coming together for collective actions to fight for their own interests) as class is just one of the many criteria (alongside gender, race..etc) for social division and stratification Class and health inequality  Linking poverty to Social Class and Health ◼ Many research studies showed that health inequalities=> people in lower social classes tended to experience poorer health at all stages of their life and that the health gap between the rich and the poor are widening. The poor tend to have higher mortality and morbidity rates. Questions: ◼ Why are poor people not as healthy and are more likely to die? ◼ How can we explain the differences? Social Class and Health ◼ Despite the implementation of public healthcare systems designed to reduce health inequalities in many societies, these inequalities still persist. ◼ Recognition of health inequalities but there is an ongoing debate as to how to explain these differences. ◼ Major theoretical explanations class differences in health: Natural or health selection explanation Cultural or behavioral explanation Structural or materialist explanation Psychosocial explanation Life-course explanation Natural or Health Selection Explanation This explanation originates from the Social Darwinist idea=> impacts of ‘natural selection’ on health. ◼ class differences as consequence of human biological differences, i.e., the more healthy people are, the more they are able and likely to move up the social ladder. In a nutshell, social mobility is dependent on health. Drift hypothesis: Good or bad health (natural selection) determines one’s class position: people suffer from ill health first and then drop down in the social class hierarchy as illness with resultant disability would lead to unemployment, demotion and thus cause the decline in social class => this is what is called ‘drift hypothesis’ which explains that less healthy people tend to drift down the social hierarchy. ◼ BUT little data and evidence to support the ‘drift hypothesis’ => relatively few sick professionals (middle class people) experience downward occupational changes (Townsend and Davison, 1990) & the impact of ill-health leading to downward mobility for men in their later middle age is very slight. ◼ While illness may cause a drop in living standard and class level for some individuals (e.g., mental illness), too few people suffer from downward social mobility due to ill-health and (there isn’t an obvious pattern or trend for people to slip down the social ladder because they are not healthy) thus it’s difficult to explain health differences among different social classes in term of ‘natural selection’. (Wilkinson, 1997) Cultural or Behavioral Explanation Cultural explanation in terms of lifestyles: ◼ ‘Class’ (also racial minorities & ethnic status groups) does bring about illness because different classes demonstrate different lifestyle preferences and behaviours that affect health (some people’s life style preference are not healthy at all) Lifestyle preferences and behaviours that could affect people’s health conditions include such things as: consumption of harmful commodities (processed, refined foods, tobacco, alcohol) leisure and exercise use of preventive health measures such as contraception and practice 'safe sex' prenatal monitoring Vaccination Cultural explanation: explain health inequality in terms of the different lifestyle adopted by different social classes. Cultural or Behavioral Explanation Implications of cultural/behavioural explanation=> ◼ The poor are to be blamed for their ill-health because lifestyle behaviours are the result of a number of free-choice decisions made by individuals (i.e., lifestyle choices are voluntary and normally people are expected to engage in the ones that are healthy). i.e., people with lower socio-economic positions tend to harm themselves and their children by adopting health-damaging and reckless lifestyles. Suggestion of ‘culture of poverty’ => people in the poorer classes choose to live for today, i.e., to ignore preventive health guidelines, indulge themselves in smoking and eating fatty, rich foods, all the while lying around on the couch and neglecting to exercise Can you agree with the above argument? Cultural or Behavioral Explanation More sophisticated explanation: different perception of the body by different classes (Shilling 1993): ◼ Lower social classes tend to see the body in terms of what it enables them to do, such as to work or to look after children. It doesn’t bother them if it continues to function (work) as usual. Behaviour such as smoking or drinking that may have long term impacts on health will not be seen as problematic as long as the body still functions. ◼ Higher social class tend to see the body as an end in itself, i.e., it is something for them to work on and they tend to place high value on it and therefore, they tend to do more to take care of it and prevent illness. Policy implication: Health policy interventions which focus on lifestyles choices such as smoking or drinking originate from the cultural/behavioural explanation of health inequalities. Cultural or Behavioral Explanation Critiques: This type of explanation is criticized to have: ◼ ‘Blame the victims’, i.e., blame the poor for their ill-health because of their unhealthy choices or lifestyle. ◼ Overlooks the impacts of the social structure upon the lifestyle choices of individuals. Life style choices should always be considered together with the social context within which individuals making choices and the constraints that impede the behaviour of the people in different social positions i.e., bad health behaviour might well be rational responses to cope with difficult circumstances such as poor housing and harsh work conditions..etc.. ◼ There is also no evidence that the lower classes or minorities tend uniformly to fail to practice good health habits. Structural or Materialist Explanation Structural/materialist explanation emphasizes on economic and associated sociocultural factors in the distribution of health and well-being. ◼ In other words, whether one is healthy is more related to one’s social and material circumstances. ◼ Wilkinson (1997) argues that poverty is the most important determinant of health as people in lower socio-economic class statuses continue to be disadvantaged in terms of the risks to ill-health. Links between material/economic deprivation and health: ◼ Being poor can affect the type of food and/or shelter one can afford and thus make one vulnerable to physical illness. ◼ Lack of finance can also make people feel losing control over their own circumstances and cause much emotional and psychological stresses that lead to ill-health. Structural or Materialist Explanation Employment:  Lower status jobs (usually linked to high rates of mortality and illness, partly due to higher incidents of accidents and injury in manual work;  Higher incidents of unemployment among those in lower social and economic status => greater stress and anxiety and thus adversely affect their health conditions. ◼ Housing: Poor housing locations can bring problems related to crime, noises, pollution, ventilation, dampness, risk of fire all of which can affect health. ◼ Access to healthcare information and services: where you live (further away from health facilities), working hours can affect people’s access to information on healthy choices (diets/lifestyle), to welfare and healthcare services. ◼ However, note that those who support the cultural/behavioural explanation object to the materialist explanation on the grounds that many current health problems such as cancers are associated with high-risk activities (e.g., smoking) which can be avoidable. Psychosocial Explanation Inequality and social status can affect health in two main ways: lack of social cohesion and lack of self-esteem. Unequal societies are less cohesive and so are social divisive, which result in people feeling more isolated and lack social support. As contemporary ways and conditions of life produce social stresses that affect social classes unevenly, and members of these groups have uneven access to material and personal resources to manage these stresses → lower class people feel less able to control their circumstances and reinforce anxiety and stress. Such stresses do not only affect mental well-being. They also affect the body through the cardiovascular, endocrine and immune systems. Life-course Explanation Life-course approach see a person’s biological status as a marker of their past social position and, through the structured nature of social processes, as liable to selective accumulation of future advantage or disadvantage. A person’s past social experiences become written into the physiology and pathology of their body. Source: Palisano at el., 2017 Life-course Explanation People who are already socially disadvantage often endure an accumulation of disadvantage. Example The influences of body can be shaped by political and economic context of a person’s life. Critical time and experiences such as serious illness interact with other events with the result that they may have long term consequence This approach can be especially instructive in explaining how structural disadvantage, racism and patriarchal processes combine to impact over time. Source: UCLA Center for Healthier Children, Families and Communities Reference Arber, S., & Thomas, H. (2001). From women’s health to a gender analysis of health. From W. C. Cockerham (Eds.), The Blackwell companion to medical sociology, (pp. 94-113). Blcakwell Armstrong, D. L. (2015). An outline of sociology as applied to medicine. Elsevier. Cooke, H., & Philpin, S. M. (2008). Sociology in Nursing and Healthcare E-Book. Elsevier Health Sciences. Cockerham, W. C. (2017). Medical sociology. Routledge. Denny, E., Earle, S., & Hewison, A. (Eds.). (2016). Sociology for nurses. John Wiley & Sons. Nettleton, S. (2021). The sociology of health and illness. Polity. Palisano, R. J., Di Rezze, B., Stewart, D., Rosenbaum, P. L., Hlyva, O., Freeman, M.,... & Gorter, J. W. (2017). Life course health development of individuals with neurodevelopmental conditions. Developmental Medicine & Child Neurology, 59(5), 470-476. Ridsdale, B., Gallop, A., Hall, I., & High Holborn, L. O. N. D. O. N. (2010, March). Mortality by cause of death and by socio-economic and demographic stratification 2010. In International Congress of Actuaries 2010.