Sociology in Modules Richard T. Schaefer

Sociological Perspectives on Health and Illness Health: “state of complete physical, mental, and social well-being, and not merely the absence of disease and infirmity” (Leavell and Clark) Health and illness are socially constructed Important to consider how health varies in different situations or cultures

Functionalist Perspective “Being sick” must be controlled so that not too many people are released from societal responsibilities Sick role: societal expectations about attitudes and behavior of a person viewed as being ill Physicians function as “gatekeepers” for the sick role

Conflict Perspective Medicalization of Society Growing role of medicine as major institution of social control Medicalization of Society Greatly expanded domain of expertise Problems viewed using a medical model Retains jurisdiction over health care

Conflict Perspective Inequities in Health Care Obvious inequities exist Brain drain: immigration to U.S. and other industrialized nations of skilled workers, professionals, and technicians Dramatic differences in infant morality rate: number of deaths of infants under one year old per 1,000 live births in given year

Figure 52-1: Infant Mortality Rates in Selected Countries 6

Interactionist Perspective Examines roles played by health care professionals and patients Asserts patients may play an active role in positive or negative health

Labeling Perspective Labeling theory attempts to explain why certain people viewed one way while others engaged in same behavior are not The designations healthy and ill generally involve social definition Homosexuality noteworthy medical example of labeling Can view variety of life experiences as illnesses or not

Table 52-1: Sociological Perspectives on Health and Illness 9

Social Epidemiology and Health Care in the United States Social epidemiology: study of distribution of disease, impairment, and general health status across a population Epidemiologists have taken on the new role of tracking bioterrorism Morbidity rates: disease incidence figures presented as rates or number of reports per 100,000 people Mortality rate: incidence of death in a given population

Figure 53.1: AIDS by the Numbers Worldwide 11

Social Class People in lower classes have higher rates of mortality and disability Effects appear to be cumulative Poor are less able to afford quality medical care Conflict theorists: capitalist societies care more about maximizing profits than they do about the health and safety of industrial workers

Figure 53-2: Percentage of Children without Health Insurance 13

Race and Ethnicity Health profiles of racial and ethnic groups reflect social inequality in U.S. Poor economic and environmental conditions manifested in high morbidity and mortality African Americans have higher infant mortality rates when compared to Whites Mexican Americans may use curanderismo: form of holistic health care and healing

Gender Women experience higher prevalence of many illnesses but tend to live longer Theorized reasons for longevity: Lower rate of cigarette smoking Lower alcohol consumption Lower rate of employment in dangerous occupations More likely to seek treatment

Age Most older people in U.S. have at least one chronic illness Older people vulnerable to certain types of mental health problems Older people use more health services than younger people

Health Care in the United States Health care costs have skyrocketed In 2000, amount spent on health care equaled that spent on education, defense, prisons, farm subsidies, food stamps, and foreign aid Expected to exceed $4.6 trillion in 2020

A Historical View “Popular health movement” of 1830s and 1840s emphasized preventive care and “self-help” AMA institutionalized authority through programs of education and licensing By 1920s, physicians controlled hospital technology, division of labor of health personnel, and other health professions Increasingly, patients turning to media for health care information

Figure 53-3: Total Health Care Expenditures in the U. S Figure 53-3: Total Health Care Expenditures in the U.S., 1970–2020 (Projected) 19

Physicians, Nurses, and Patients Physicians have held position of dominance with patients and nurses Leads to dehumanizing physician–patient encounters Publicity about malpractice suits and high medical costs further strained relationship Controlled interactions with nurses

Alternatives to Traditional Health Care At least one of three adults in U.S. attempts to maintain good health or respond to illness through alternative health care techniques Holistic medicine: therapies in which the health care practitioner considers person’s physical, mental, emotional, and spiritual characteristics

Figure 53-4: Use of Complementary and Alternative Medicine 22

The Role of Government 1946 Hill-Burton Act: first subsidies for building and improving hospitals 1965: Medicare and Medicaid established Programs greatly expanded federal involvement in health care financing 1983: government instituted cost-control program 2010: Affordable Care Act offered health insurance coverage for people of all ages

What Is Mental Illness? Term mental illness should be reserved for disorder of the brain that disrupts thinking, feeling, and ability to interact with others In the U.S., mental illness traditionally viewed with suspicion Tragic shootings increase stigma against those with mental illness Despite stigma, more people seeking treatment

Theoretical Models of Mental Disorders Medical model: mental illness is rooted in biological causes that can be treated through medical intervention Social and cultural factors contribute to mental illness Controversy over publication of and reliance on DSM Labeling theory: some behaviors that are viewed as mental illnesses may not really be illnesses

Patterns of Care Government took early role in mental illness because of disruptions that it causes Community Mental Health Centers Act increased government intervention and provision of care Some states making it easier to commit mental patients to hospitals involuntarily Like physical illness, racial disparity with mental illness

Population Demography: The Study of Population Population studied by both natural and social scientists Fertility – the level of reproduction in a society Sociologists study social factors Fertility Mortality Migration Demography is the scientific study of population

Malthus’s Thesis and Marx’s Response Robert Malthus (1798)—the world’s population growing faster than food supply Must close the gap; postpone marriage Did not advocate birth control for religious reasons

Malthus’s Thesis and Marx’s Response Karl Marx believed overpopulation was linked to the unequal distribution of resources Neo-Malthusian view (Erlich) Birth control and sensible use of resources essential to control rising world population

Studying Population Today Census: counting of population Primary mechanism for collecting population information Vital Statistics: Records of births, deaths, marriages and divorces gathered through governmental registration system

Elements of Demography Birthrate: number of live births per 1,000 population in a given year Total Fertility Rate (TFR): the average number of children born alive to any woman Death Rate: number of deaths per 1,000 population in a given year

Elements of Demography Life expectancy: the median number of years a person can be expected to live under current mortality conditions Growth Rate: difference between births and deaths, plus difference between immigrants and emigrants per 1,000 population

World Population Patterns Demographic Transition Changes in birthrates and death rates that occur during a nation’s development, resulting in new patterns of vital statistics Typically takes place in three stages: Pretransition Transition Posttransition Pattern varies from nation to nation

Figure 55-1: Population Growth Rate in Selected Countries

Figure 55-2: Demographic Transition

The Population Explosion “Population bomb”—the momentum toward a growing world population is well established Population pyramid: special type of bar chart that shows the distribution of population by gender and age Illustrates population structure of a society

Table 55-1: Estimated Time for Each Successive Increase of 1 Billion People in World Population

Figure 55-3: Population Structure of Afghanistan, Italy, and the United States, 2014

Fertility Patterns in the United States Over past six decades, U.S. and other industrial nations experienced two different patterns of population growth First: high fertility and rapid growth Second: declining fertility and little growth

Fertility Patterns in the United States The Baby Boom High fertility in the U.S.; attributed to return of soldiers, general prosperity, societal pressure on women

Fertility Patterns in the United States Stable Population Growth U.S. continues to grow despite low total fertility rate Many more people in their childbearing years Immigration Zero population growth (ZPG): state of population in which the number of births plus immigrants equals the number of deaths plus immigrants

Population and Migration Migration: the relatively permanent movement of people, with the purpose of changing their place of residence Results from a variety of push factors Economics Bigotry Dislike of political regime Desire to reunite one’s family

Population and Migration International Migration Changes of residence across national boundaries Significant force in redistribution of world’s population in certain periods Internal Migration Migratory movements within a society vary Traditional society: seeking fertile soil, wild game Industrial society: job transfers, preferable climate

Sociological Perspectives on the Environment Environment people live in has noticeable effect on their health Increases in population, together with economic development, have serious environmental consequences

Human Ecology Human ecology: interrelationships between people and their spatial settings and physical environments Stresses trade-offs inherent in every decision that alters the environment

Conflict Perspective Growing share of human and natural resources of developing countries redistributed to core industrialized nations Industrialized nations of North America and Europe account for 12% of population but responsible for 60% of worldwide consumption Schnaiberg: “treadmill of production”

Figure 56-1: Projected Greenhouse Gas Emissions 47

Ecological Modernization Ecological modernization: proponents focus on alignment of environmentally favorable practices with economic self-interest through constant adaptation and restructuring Macro level: reintegrating industrial waste back into the production process Micro level: reshaping individual lifestyles

Environmental Justice Environmental justice: legal strategy based on claims that racial minorities are subjected disproportionately to environmental hazards Poor people and people of color more likely to be victimized by everyday consequences of built environment

Environmental Issues Air and water pollution; climate change Among U.S. citizens: Environmental issues not seen as pressing Balk at proposed solutions 2013 national survey: 41% thought global warming exaggerated

Air Pollution More than 1 billion worldwide exposed to potentially health-damaging air People willing to change behavior for short periods, but not long-term

Water Pollution Dumping has made many bodies of water unsafe for drinking, fishing, swimming Exxon Valdez Deepwater Horizon Basic water supply a problem in many countries

Climate Change Climate change: an observable alteration of the global atmosphere that affects natural weather patterns over several decades or longer Global warming: significant rise in earth’s surface temperatures that occurs when industrial gases like carbon dioxide turn planet’s atmosphere into virtual greenhouse Kyoto Protocol; U.S. not a signatory

The Impact of Globalization Globalization can be good and bad Industrialization increased pollution Allows multinationals to reap resources of developing countries for short-term profit Multinational corporations have incentive to carefully consider cost of natural resources Environmental refugees: people who have been displaced by rising seas, destructive storms, expanding deserts, water shortages, and high levels of toxic pollutants

Social Policy and the Environment: Environmentalism 1970: 25 million people turned out to observe first Earth Day Citizens marched on behalf of specific environmental causes Congress established EPA The Clean Air, Clean Water, and Endangered Species acts followed

Social Policy and the Environment: Environmentalism Looking at the Issue Earth Day now on calendars of city councils, zoos, and museums worldwide Increasingly, efforts to publicize concerns moving to Internet General public has mixed reaction to environmental issues Question the scientific arguments behind theory of global warming

Social Policy and the Environment: Environmentalism Applying Sociology Many troubled that most powerful environmental organizations predominantly White, male-dominated, and affluent Conflict perspective: Disproportionate exposure of poor and minorities to environmental pollutants can act as disincentive for others to take action Many environmental movements do not include the poor and minorities

Social Policy and the Environment: Environmentalism Initiating Policy Economic downturn of 2008 a mixed blessing Reduced use of fossil fuels Federal government established funds for creating green jobs Environmentalism moved to bigger stage People increasingly reluctant to ignore environmental issues

Figure 56-2: The Environment Versus Energy Production 59

Figure 56-3: Are U.S. Teens Green Enough? 60

Research Today 53-1: Health Care, Retail Style Have you ever been treated at an in-store clinic? If so, were you satisfied with the care you received? What about the price you paid—was it reasonable? Evaluate the emergence of clinics from a functionalist and then a conflict perspective. On balance, do you think these clinics are a benefit to society?

Research Today 53-2: Women as Physicians and Surgeons In your own experience, have you noted a gender difference in the way doctors communicate with patients? Explain. Why is the quality of a doctor’s communication with patients important? What might be the benefit of female physicians’ superior communication style?

Sociology in the Global Community 55-1: Population Policy in China Does any government, no matter how overpopulated a country is, have a right to sterilize people who do not voluntarily limit the size of their families? Why or why not? What do you think has been the most dramatic consequence of the one-child policy?

Taking Sociology to Work Lola Adedokun, Independent Consultant, Health Care Research What social issue or problem do you feel passionate about, and how can sociology help to address it? Adedokun is a self-starter who created her own major and is now pursuing a career on her own. Have you ever considered creating your own career path, rather than relying on large institutions to map your future? What might be the benefits of such an approach? The drawbacks?