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Chapter 18 The Sociology of Health and Illness

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Title: Chapter 18 The Sociology of Health and Illness


1
Chapter 18 The Sociology of Health and Illness
2
The Sociology of Health and Illness
  • To understand why eating disorders have become so
    commonplace in current times, we should think
    back to the social changes analyzed earlier in
    the book. Anorexia actually reflects certain
    kinds of social change, including the effect of
    globalization.
  • Food production in the modern world has been
    globalized.
  • Decisions on what to eat are influenced by social
    relations.

3
The Sociology of Health and Illness
  • Women especially are judged by physical
    appearance, but feelings of shame about the body
    conform to social expectations.

4
The Sociology of Health and Illness
  • Women suffer more often from eating disorders
    than men for a number of reasons
  • Attractiveness for women.
  • The socially defined desirable body image for
    women is skinny, not muscular.
  • Women are judged as much by their appearance as
    by their accomplishments..

5
The Sociology of Health and Illness
  • According to Talcott Parsons, there are three
    pillars of the sick role
  • The onset of illness is unrelated to the
    individuals behavior or actions.
  • The sick person is entitled to certain rights and
    privileges, including withdrawal from normal
    responsibilities.
  • The sick person must work to regain health by
    consulting a medical expert agreeing to become
    a "patient."

6
The Sociology of Health and Illness Symbolic
Interactionism
  • Illness lived experience.
  • The ways people interpret the social world and
    the meanings they ascribe to it.

7
The Sociology of Health and Illness
  • In many industrialized societies over the last
    decade, there has been a surge of interest in the
    potential of alternative medicine.
  • -e.g., herbal remedies, acupuncture,
    reflexology, chiropractic treatments

8
The Sociology of Health and Illness
  • The World Health Organization predicts that
    within 20 years, depression will become the most
    debilitating disease in the world.

9
The Sociology of Health and Illness-Class
  • Richard Wilkinson (1996) Countries with most
    even distribution of income levels of social
    integration are the healthiest countries.
  • Education is positively related to preventative
    health behaviors. Better-educated people are
    significantly more likely to engage in aerobic
    exercise and to know their blood pressure, and
    are less likely to smoke or be overweight (Shea
    et al. 1991).
  • Poorly educated people tend to engage in more
    cigarette smoking they also tend to have more
    problems associated with cholesterol and body
    weight (Winkleby et al. 1992).

10
The Sociology of Health and Illness-Race
  • Life expectancy at birth in 2003 was about 80
    years for white females but just 76 years for
    black females.
  • It was 75 years for white males yet just 69 years
    for black males (National Center for Health
    Statistics 2005a).
  • About 58 percent of black households have no
    financial assets at all, almost twice the rate
    for white households (U.S. Bureau of the Census
    2005a). Median income of a black man is only 67
    percent of that of a white man (U.S. Bureau of
    the Census 2005b).
  • Rise in violent crime has accompanied the rise of
    widespread crack cocaine addiction, a cultural
    condition of poor African American neighborhoods
    plagued by high levels of unemployment (Wilson
    1996).

11
The Sociology of Health and Illness-Race
  • Some of the differences in black and white health
    go beyond economic causes to differences in
    cultural conditions.
  • Racial gaps in mortality. In 2002, a black person
    was 6 times more likely to be murdered than a
    white person (U.S. Bureau of Justice Statistics
    2004a). Homicide victimization rates for both
    whites and blacks peaked between 1993 and 1994.
    The murder rate for white males between 18 and 24
    years of age increased from 11.9 per 100,000 in
    1984 to a high of 17.8 in 1994. By 2002, the
    murder rate for young white men had declined to
    12.7 per 100,000.
  • For young black males, the murder rate increased
    by over 270 percent between 1984 and 1994 (from
    68 per 100,000 in 1984 to 183.5 in 1993). Since
    then the murder rate for blacks has declined to
    102.3 per 100,000, which is 805 percent higher
    than for whites and still over 150 percent higher
    than the murder rate for young black men in 1984
    (U.S. Bureau of Justice Statistics 2004b).

12
The Sociology of Health and Illness-Race
  • A higher prevalence of hypertension among
    blacksespecially black men.
  • Blacks smoking significantly more than whites.
    This may be due in some measure to cultural
    differences between blacks and whites, as well as
    the way in which the cigarette industry has
    deliberately targeted African Americans as a
    market.
  • Prevalence of hypertension among blacks has been
    greatly reduced. In the early 1970s, half of
    black adults suffered from hypertension. By 1994,
    however, roughly 36 percent of black adults
    between ages twenty and seventy-four suffered
    from hypertension (National Center for Health
    Statistics 2003).
  • Yet, by 2002 the share of black women with
    hypertension had increased again to almost 40
    percent (National Center for Health Statistics
    2005c)

13
The Sociology of Health and Illness-Race
  • In 1987, only 30 percent of white women and 24
    percent of black women aged forty and older
    reported having a mammogram within the past two
    years. By 2003, the share of white and black
    women were equal at 71 percent (National Center
    for Health Statistics 2005d).
  • Between 1983 and 2001, the proportion of blacks
    who had visited the dentist within the past year
    had increased from 39 percent to 58 percent,
    while the figure for whites increased from 57
    percent to 68 percent (National Center for Health
    Statistics 2005e).
  • Extensive programs of health education and
    disease prevention tend to work better among more
    prosperous, well-educated groups and in any case
    usually produce only small changes in behavior.
    Increased accessibility to health services would
    help, but probably to a limited degree. The only
    really effective policy option is to attack
    poverty itself, so as to reduce the income gap
    between rich and poor (Najman 1993).

14
The Sociology of Health and Illness-Gender
  • Women in the United States live longer than men.
    The gender gap in life expectancy was about 4.4
    years in 1940, 7.7 years in 1970 and 5.4 in 2003
    (Cleary 1987 National Center for Health
    Statistics 2005f).
  • In 1900, the leading cause of death was
    infectious disease, which struck men, women, and
    children equally. Since mid-century, however,
    heart disease and cancer have been the leading
    causes of death for American adults. Womens
    mortality advantage depends on gender behavioral
    differencessmoking, drinking, and preventive
    health behaviors.
  • Men are more likely to smoke cigarettes,
    marijuana, drink that are associated with heart
    disease and various types of cancer. Likewise,
    higher proportions of men than (National Center
    for Health Statistics 2005g).
  • Male roles lead men to adopt the Coronary Prone
    Behavior Pattern, or Type A personality (i.e.,
    persons who are competitive, impatient,
    ambitious, and aggressive) that are twice as
    likely as Type B personalities to suffer heart
    attacks (Spielberger et al. 1991).

15
The Sociology of Health and Illness-Gender
  • Despite the female advantage in mortality, most
    large surveys show women more often report poor
    health. Women have higher rates of illness from
    acute conditions and nonfatal chronic conditions,
    including arthritis, osteoporosis, and depressive
    and anxiety disorders.
  • There are two main explanations for womens
    poorer health, yet longer lives
  • (1) Greater life expectancy and age brings
    poorer health,
  • (2) women make greater use of medical services
    including preventive care (Centers for Disease
    Control and Prevention CDC 2003a).
  • In 2000, the average number of visits to
    physician offices, hospital emergency rooms, and
    hospital outpatient departments was 25 percent
    higher for women than for men.
  • Men may experience as many or more health
    symptoms as women, but men may ignore symptoms,
    may underestimate the extent of their illness, or
    may utilize preventive services less often
    (Waldron 1986).

16
The Sociology of Health and Illness-Social
Technology
  • A social technology is a means by which we try to
    alter our bodies--for example, by dieting.
  • The socialization of nature--phenomena that used
    to be natural, or given in nature (such as
    reproduction), have become social they depend
    upon our own social decisions.

17
Social Cohesion The Key to Better Health?
  • Wilkinson (1996) argues that social factorsthe
    strength of social contacts, ties within
    communities, availability of social support, a
    sense of securityare the main determinants of
    the relative health of a society.
  • Wilkinson notes a clear relationship between
    mortality rates and patterns of income
    distribution. Japan and Sweden are regarded as
    some of the most egalitarian societies in the
    world, enjoy better levels of health on average
    than do citizens of countries where the gap
    between the rich and the poor is more pronounced,
    such as the United States.
  • The widening gap in income distribution
    undermines social cohesion and makes it more
    difficult for people to manage risks and
    challenges. Heightened social isolation and the
    failure to cope with stress is reflected in
    health indicators.

18
The Developing World Colonialism the Spread of
Disease
  • The English and French colonists brought the same
    diseases to North America (Dubos 1959). Before
    contact with the Europeans, levels of risk from
    infectious diseases were lower. There was always
    the threat of epidemics, drought, or natural
    disaster, but colonialism led to major changes in
    the relation between populations and their
    environments, producing harmful effects on health
    patterns. Smallpox, measles, and typhus, among
    other major maladies, were unknown to the
    indigenous populations of Central and South
    America before the Spanish conquest in the early
    sixteenth century.
  • The most significant consequence of the colonial
    system was its effect on nutrition and levels of
    resistance to illness as a result of the changed
    economic conditions involved in producing for
    world markets. In many parts of Africa in
    particular, the nutritional quality of native
    diets became substantially depressed as cash-crop
    production supplanted the production of native
    foods.
  • On the other hand, the importation of tobacco and
    coffee, together with raw sugar, which began
    increasingly to be used in all manner of foods,
    has had harmful consequences. Smoking tobacco,
    especially, has been linked to the prevalence of
    cancer and heart disease.

19
HIV/AIDS
  • In 2005 alone, over 3 million people worldwide
    died from AIDS-related illnesses (UNAIDS 2005a).
  • Using middle-range estimates, about 720,000
    people are living with HIV/AIDS in Europe, 1.2
    million in North America, 2.1 million in Latin
    America and the Caribbean, and nearly 26 million
    in sub-Saharan Africa (Global Map 18.1).
  • The majority of people affected in the world
    today are heterosexuals. In 2005, about half are
    women. In sub-Saharan Africa, young women are
    more than 2.5 times more likely than men to be
    infected with HIV/AIDS. Worldwide, at least 4 HIV
    infections are contracted heterosexually for
    every instance of homosexual spread.
  • In the U.S., over 43,000 new infections in 2005
    and nearly half of these were in southern states.
    Of these, nearly half were in African Americans,
    who constitute less than 12 percent of the total
    population. African American women are 8 times
    more likely to be infected with HIV than white
    women, and HIV/AIDS is now the leading cause of
    death among African American women aged
    twenty-five to thirty four in the United States
    (UNAIDS 2003 2005a b).

20
HIV/AIDS
  • The United Nations Joint Program on HIV and AIDS
    reports that African Americans are half as likely
    to be receiving antiretroviral treatment (UNAIDS
    2005b).
  • Stigmatization of people with HIV/AIDS remains a
    major barrier to successful treatment programs.
    Stigma draws on preexisting prejudices to justify
    scapegoating and blaming in victimized people.
  • The stigma that associates HIV positive status
    with sexual promiscuity and immorality results in
    an avoidance of HIV/AIDS prevention and treatment
    programs. Clearly, the statistics cited above
    demonstrate that HIV/AIDS is not a gay disease.
  • In the United States, about a quarter of people
    living with HIV/AIDS do not know that they are
    infected (UNAIDS 2005b). Because such a large
    group exists is the high level of fear and denial
    associated with being diagnosed as HIV positive.
    Discrimination is also seen at the level of
    government health care planning (UNAIDS 2003).

21
HIV/AIDS
  • In countries heavily affected by the HIV/AIDS
    epidemic, only 5 percent of pregnant women
    receive health-care services aimed at preventing
    mother-to-child HIV transmission (UNAIDS 2005d).
    Worldwide, the parents of an estimated 15 million
    children have died as a result of HIV/AIDS
    twelve million of these are in sub-Saharan Africa
    alone (Global Map 18.1).
  • The decimated population of working adults
    combined with the surging populations of orphans
    sets the stage for massive social instability, as
    economies break down and governments are unable
    to provide for the social needs of orphans who
    become targets for recruitment into gangs and
    armies who train them to fight as soldiers.
  • World Health Organization suggests that more than
    2/3 of people living in urban areas in developing
    countries draw their water from sources that fail
    to meet minimal safety standards. About 17/2
    common water-related diseases in developing
    nations could either be cut by half or eradicated
    altogether simply by the provision of ready
    supplies of safe water (Doyal and Pennell 1981).
    Only about 1/4 of the city residents in
    developing countries have water-borne sewage
    facilities some 30 percent have no sanitation at
    all. These conditions provide breeding grounds
    for diseases such as cholera (Dwyer 1975).

22
Human Sexuality
  • Sexual practices are primarily learned behaviors
  • Sexual practices vary over time across cultures.

23
Human Sexuality Orientation
  • In the West, Christianity has been important in
    shaping sexual attitudes. In societies with rigid
    sexual codes, double standards hypocrisy are
    common. The gulf between norms actual practice
    can be tremendous.
  • Ones sexual orientation results from an
    interplay between biological factors social
    learning.
  • Homophobia an aversion or hatred of homosexuals
    their lifestyles

24
Human Sexuality Kinsey
  • Kinsey found that almost 70 of men had visited
    a prostitute 84 had had premarital sexual
    experience.
  • Among women, about 50 had had premarital sexual
    experience, although mostly with their
    prospective husbands.
  • Alfred Kinsey and his co-researchers conducted
    the first major sexual behavior investigation in
    the United States in the 1940s and 1950s. This
    research faced condemnation from religious
    organizations, and his work was denounced as
    immoral in the newspapers and in Congress.

25
Human Sexuality Lillian Rubin
  • In the late 1980s, Lillian Rubin found that
    sexual behavior and attitudes over the past 30
    years have changed.
  • Sexual activity typically begins at a younger age
    than for the previous generations, and there is
    still a double standard.
  • Women expect and actively pursue sexual pleasure
    in relationships.

26
Human Sexuality Edward Laumann (1994)
  • Sexual conservatism among Americans.
  • Of their subjects, 83 percent had had only one
    partner in the preceding year.
  • Of the married people, 96 percent had had only
    one partner in the preceding year.
  • Only 10 percent of women and less than 25 percent
    of men reported having an extramarital affair
    during their lifetime.

27
Sexuality and Procreative Technology
  • Americans average only three sexual partners
    during their entire lifetime.
  • More than 95 of Americans getting married today
    are sexually experienced.
  • For hundreds of years, the lives of most women
    were dominated by childbirth and child rearing.
  • Differential access to genetic engineering may
    lead to the emergence of a biological underclass.
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