Sociology of Health and Illness PDF

Introduction to Sociology of Health and Illness Dr. Gbenga Adejare What is Health? The definition of health is not fixed, it is relative. According to World Health Organization (WHO), health does not mean a complete absence of disease or infirmity but a state of physical, ment...

Introduction to Sociology of Health and Illness Dr. Gbenga Adejare What is Health? The definition of health is not fixed, it is relative. According to World Health Organization (WHO), health does not mean a complete absence of disease or infirmity but a state of physical, mental and social wellbeing. Intro: Why Sociology of Health and Illness? All processes and procedures of medical sciences are rooted in social relations. Thus, sociology and health are closely connected, beginning with the view that medical practices and beliefs are intensely social. A large part of medical sociology involves interrogation of policies around the practice of medical science and uptake of medical inventions and interventions. Hence, policy sociology. Foucauldian Medical Gaze Michel Foucault posits that biomedical paradigms are built of stories told by patients - "The Birth of the Clinic" (1963) o The social distance between doctors and patients places doctors at a vantage position of authority. o Doctors sift information provided by patients as they deem fit – they use the relevant once for diagnosis, prognosis, and prescriptions. o The advancement of objectification and control of human (body) - 'docile body' o Institutionalization of medicine Sociological Approaches to Health and Illness Policy sociology: This is concerned with attempts to improve the delivery of health services through sociologically informed research: o Generating sociological data to help governments and health professionals develop policies that will improve people's health and wellbeing. Critical sociology: This examines the practices of multinational pharmaceutical companies, medical schools, and privately run, for-profit clinics and hospitals. o Healing is achieved through social means – “race,” gender, ethnicity, age, and class can greatly affect an individual's experience of medical professions.  The Sick Role Talcott Parsons (1902-1979) Four expectations of the sick role (or introduced the medical sociology patient role) term, the sick role (or patient Should be exempted from normal social role) in his book The Social responsibilities System (1951) Should be taken care of instead of having to take care of themselves Parsons argued, being sick came Are socially obligated to try to get well with four expectations Are socially obligated to seek technically Two expectations relate to what the sick person can expect from society competent help The other two identify what society Structural functionalism presumes social should expect of the sick person uniformity of experiences  E.L. Koos (1954) critiqued Parson’s view of the sick role What people thought and did about their health depending on their class. People in higher occupational groups were better able to afford to play the sick role Similar arguments against the uniformity of the sick role can be made based on gender, race, and age. E.g.: Society has different expectations for mothers than for fathers  Ivan Emke (2002) proposed five new expectations for Canadians in the sick role Patients in the New Economy are responsible for their own illnesses Illness is attributed to individual choices, such as smoking. drinking or not belonging to a health club Patient in the New Economy is instructed to tread lightly on the system,” and “patients in the New Economy are not to be trusted Patients are assumed to be abusing the system Escalating health care costs can be attributed to too many “unnecessary” visits to family doctors The Social Course of Disease A medical breakthrough of the nineteenth century was the realization that every disease has a natural course it goes through Get ill, experience symptoms, get well (or sicker) Medication can alleviate symptoms and speed up recovery A disease or disorder also goes through a social course The social interactions that a person goes through in the process of being treated Shaped by social factors such as ethnic background, culture, class, age, and sex of the people affected Orthodox and Complementary Medicine Biomedicine: orthodox or biomedicine involves the use of Western scientific principles in the diagnosis and treatment of illness and disease Uses physical tests to find purely physical entities, then applies purely physical medicines and therapies to counteract them. Alternative (or complementary) medicine falls outside orthodox or conventional biomedical practice Examples: acupuncture, yoga, massage therapy, home birth It is based on the notion that a person’s psychological, social, and emotional state affects their ability to fight diseases  Biomedicine has been criticized for approaching health from a reductionist perspective. Why? It atributes medical conditions to a single factor treatable with single remedies It may fail to take into account the broader set of circumstances surrounding a person’s health or illness Ignores cultures of medicine (absolutist). Medicalization This refers to, according to Chang and Christakis (2002), the “process by which certain behaviours or conditions are defined as medical problems... and medical intervention becomes the focus of remedy and social control”. - It involves the process of describing people and things as pathological. Medicalization, cont’d Medicalization has been criticized as a form of reductionism that reduces complex medical conditions to biomedical causes without examining possible sociocultural or political factors The focus is on human body Oppressive sociopolical factors are often undernmined or minimized. Commodification of healthcare occurs when normal conditions are identified as diseases that can be treated with “commodity cures” Examples: drugs or procedures, PTSD Medicalization, cont’d Ivan Illich (1927 – 2002), pioneered criticing medicalization. Inroduced the notion of medicalization to sociology in the context of his critique of radical monopolie Situation in which professional control work is deemed socially important His concept of iatrogenesis refers to doctor-generated epidemics that avert people from preventing and treating their illnesses He was critical of the industrial society for the ills of stress, pollution, and dangers that make people sick. 3 Kinds of Iatrogenesis 1. Clinical iatrogenesis: This refers to ways in which diagnosis and cure can cause problems that are as bad or worse than the health problems they are meant to resolve. 2. Social iatrogenesis: This occurs when political conditions that “render society unhealthy” are hidden or obscured. 3. Cultural iatrogenesis: This entails how the knowledge and abilities of the medical community are extolled, and patients are given no credit for their recovery. Big Pharma “Big Pharma” describes large pharmaceutical companies, which profit from developing, manufacturing, and marketing drugs Example: Tamiflu, EpiPen, flu Vaccine Medicalization and Deaf Culture One group that has been particularly opposed to medicalization is the Deaf community They embrace the term Deaf (capitalized) and do not consider themselves disabled. Medicalization views deafness as an undesirable physical defect that must be “fixed.” Deaf culture’s anti-medicalization stance entails an opposition to hearing aids and cochlear implants Critical Issues in Medical Sociology Unemployment and Immigration of Doctors These challenges attract different stances. The Canadian healthcare system is currently facing a shortage of doctors in some communities Medical associations give higher status to Canads-trained doctors Immigrant doctors’ credentials are often considered insufficient Brain drain – the exodus of educated professionals erodes healthcare systems of their countries of origin Rural Communities E.g. 214 Ontario communities have been designated as “underserved” by the provincial ministry of health. The Racialization of Disease A disease becomes racialized when it is strongly associated with people of a particular racial or ethnic background, so that people of this background are treated negatively In 2003, the outbreak of severe acute respiratory syndrome, or SARS, affected Canadians of all races but became primarily associated with Asians Gender Relations in Medicine In the past, women were underrepresented in the profession. In recent times, the profession is become feminized: In 1959, women made up only 6% of medical school graduates By 1995 women made up half of those entering medical classes In 2004 the ratio of 55:45 female-to-male has now become the new normal Men and women specialize in different fields and practice medicine differently. Female doctors are more likely to: Enter family medicine Leave the profession sooner Work fewer hours and see fewer patients Women doctors are less likely to: Become surgeons Be sued for malpractice Join professional organizations The Inverse Care Law Dr Julian Tudor Hart (1927-2018) introduced the idea of the inverse care law. The law states that: The availability of good medical care tends to vary inversely with the need for it in the population served. In poor areas, where need is often highest, we are more likely to see doctor shortages, overworked doctors, and obsolete facilities and equipment.  Conclusion Health is a social a concept. Good health is relative to many factors, including biomedical, political factors, and individualized psychosocial factors. Potentially, people without disabilities can be considered temporarily able-bodied (TABS) given that aging and other unanticipated life events can lead to disability or a pathological situation True care proceeds from a place of empathy. Everyone must be responsible: "Combating the Mental Health Crisis on Canadian Campuses" _ CBS News "Make Heath Last" - Heart & Stroke Foundation