Sociology for Health care Professionals

Sociology for Health care Professionals
Dr Kithsiri Edirisinghe MBBS , MSc, MD ( Medical Administration)

Course Objectives - SOCI 121
To obtain a clear picture of various social structures in the world, with a view to interact more efficiently when dealing with clients/ patients from different cultures. Sociology for health professionals IIHS 2011

Sociology for health professionals IIHS 2011
Society ???? Sociology for health professionals IIHS 2011

The Sociological Perspective
OBSERVATIONS ARE CERTAINLY IMPACTED BY THE PERSONAL PERSPECTIVES THROUGH WHICH PEOPLE COME TO VIEW THE WORLD 2 2 3 3 3 3 3

Why study SOCIOLOGY

COURSE DESCRIPTION Allocated total number of hours is 45hrs Methods of instructions - lectures, debates and group discussions Performances are evaluated by through quizzes, assignments and visas during the sessions. Term exam papers include MCQ, structured essays . Sociology for health professionals IIHS 2011

REFERENCES David,M.N.,Sociology-Exploring the Architecture of Everyday Life, 4th ed, Pine Forge, 2002 Roger, E., The ways of Religion-An introduction to the Major Traditions, Oxford, 1999 Sociology for health professionals IIHS 2011

The Topics

Introduction to Sociology Culture, Society and the Individual Family Marriage Socialization Gender and Sexuality Social Interaction and Everyday life Stratification and Class Structure Ethnicity and Race Deviance and Crime Education Religion Population Sociology for health professionals IIHS 2011

What is Sociology ttp:// Sociology for health professionals IIHS 2011

1. Introduction to Sociology
What is Sociology Definitions of Sociology Importance of Study Sociology Time allocated 02hrs

What is Sociology ? Sociology is the science (-ology) of society (socio-) “Sociology is an extended commentary on the experiences of daily life, an interpretation which feeds on other interpretations and is in turn fed into them” --Zygmunt Bauman Sociology for health professionals IIHS 2011

Origins of sociology Sociology for health professionals IIHS 2011

Sociology can help us make sense of our experiences by taking our accounts and sharing or comparing them with others. The sociological perspective is constituted of stories told by individuals and groups and shapes how we establish our worldviews Sociology for health professionals IIHS 2011

Sociology can help us make sense of our experiences by taking our accounts and sharing or comparing them with others. The sociological perspective is constituted of stories told by individuals and groups and shapes how we establish our worldviews We can examine social structures (patterns of organization that constrain human behavior) by observation of the sociological perspective. Social structures Sociology for health professionals IIHS 2011

Sociological Perspectives on Health and Illness
Sociology for health professionals IIHS 2011

a. Functionalist Approach “Being sick” must be controlled so that not too many people are released from their societal responsibilities Sick role: societal expectations about attitudes and behavior of a person viewed as being ill Sociology for health professionals IIHS 2011

b. Conflict Approach Critical of growing role of medicine as major institution of social control The Medicalization of Society Sociology for health professionals IIHS 2011

c. Interactionist Approach Studies the roles played by health care professionals and patients Asserts patients may play an active role in positive or negative health Sociology for health professionals IIHS 2011

d. Labeling Approach The designations healthy and ill generally involve social definition Disagreements continue in the medical community over whether a variety of life experiences are illnesses Sociology for health professionals IIHS 2011

Figure Infant Mortality Rates in Selected Countries, 2004 Source: Haub 2004 Sociology for health professionals IIHS 2011

Table Major Perspectives on Health and Illness Sociology for health professionals IIHS 2011

Activity 01 Discuss your views on sociology and its important to you and people around you ! You are requested to forward this before next Tuesday Sociology for health professionals IIHS 2011

2. Culture, Society and the Individual
What is culture Layers of culture SEVEN Elements of Culture Organization of a culture

What is culture??? Sociology for health professionals IIHS 2011

Definitions of culture

Culture “A system of values and norms that are shared
among a group of people and that when taken together constitute a design for living.” -Hofstede, Namenwirth and Weber- Sociology for health professionals IIHS 2011

A culture is….. “is complex totality which includes : Knowledge belief art law morals custom And any other capabilities and habits acquired by man as a member of society." Sociology for health professionals IIHS 2011

The Culture Layers of culture Culture and Society Is Culture Limited to Humans? Seven Elements of Culture Sociology for health professionals IIHS 2011

A. Three Layers of culture
Principle Cultural traditions that distinguish your specific society. language, traditions, and beliefs that set each of these peoples apart from others. Sinhaleese , Tamils , Muslims Subculture – Subculture of the main culture - their language, food, and other traditions Tamils – Jaffna & Indians Sinhalese – Upcountry and low country Learned behavior - Cultural universals. These are learned behavior patterns that are shared by all of humanity collectively. No matter where people live in the world, they share these universal traits. Sociology for health professionals IIHS 2011

SEVEN Elements of culture
1. Language. 2. Norms 3. Values 4. Beliefs and ideologies. 5. Social Collectives. 6. Cultural Integration. & Statuses 7. ROLES Sociology for health professionals IIHS 2011

1. Language Sociology for health professionals IIHS 2011

Elements of culture Language. Language is a set of symbols used to assign and communicate meaning. It enables us to name or label the things in our world so we can think and communicate about them. Sociology for health professionals IIHS 2011

2. Norms Sociology for health professionals IIHS 2011

2. Norms Norms as humanly created rules for behavior. The production of norms. The need for orderly, stable, predictable interactions . “Social rules that govern people’s actions toward one and another” Sociology for health professionals IIHS 2011

2. Types of Norms Folkways Mores Taboos Rituals Sociology for health professionals IIHS 2011

a. Folkways routine conventions of everyday life actions of little moral significance dress code, eating habits, time orientation, rituals, etc. violating folkways will not be considered evil or bad Sociology for health professionals IIHS 2011

b. Mores. Mores are norms of morality. Breaking mores, like attending church in the nude, will offend most people of a culture. Mores, in sociology, are any given society's particular norms, virtues, or values. Sociology for health professionals IIHS 2011

c. Taboos. A taboo is a strong social prohibition (or ban) relating to any area of human activity or social custom that is sacred and or forbidden based on moral judgment, religious beliefs and or scientific consensus. Breaking the taboo is usually considered objectionable or abhorrent by society. Sociology for health professionals IIHS 2011

d. Rituals. A ritual is a set of actions, performed mainly for their symbolic value. It may be prescribed by a religion or by the traditions of a community. The term usually excludes actions which are arbitrarily chosen by the performers. Sociology for health professionals IIHS 2011

3. Values

3. Values Form the bedrock of a culture Provide the context for establishing and justifying a society’s norms and attitudes toward: individual freedom democracy truth and justice honesty loyalty social obligations role of women love and sex marriage Sociology for health professionals IIHS 2011

4. Beliefs and ideologies.

Beliefs Beliefs are the things members of a culture hold to be true. They are the "facts" accepted by all or most members. Beliefs are not limited to religious statements, but include all the things a people know and accept as true, including common sense everyday knowledge. Sociology for health professionals IIHS 2011

b. Ideologies Ideologies are integrated and connected systems of beliefs. Sets of beliefs and assumptions connected by a common theme or focus. They are often are associated with specific social institutions or systems and serve to legitimize those systems.Some prominent American ideologies. Sociology for health professionals IIHS 2011

5. Social Collectives. Social collectives such as groups, organizations, communities, institutions, classes, and societies are also collectively produced symbolic social constructions. Social collectives are symbolic entities. They are defined into existence when people define themselves as a group or are defined as a group by others. They can and do become reified over time, such that they are seen and treated as real objective entities. However, they remain fundamentally symbolic entities and as such can be renegotiated and redefined. Sociology for health professionals IIHS 2011

6.Cultural Integration. & Statuses
Cultural integration refers to how interconnected, complimentary, and mutually supportive the various elements of culture are: Diversity, complexity, and integration. Variation within modern mass cultures. Diversity in historical and cultural traditions. Subcultures. Counter-cultures. Local cultures. Sociology for health professionals IIHS 2011

7. Roles Roles are norms specifying the rights and responsibilities associated with a particular status. The term role is often used to mean both a position in society and role expectations associated with it. Roles define what a person in a given status can and should do, as well as what they can and should expect from others. Roles provide a degree of stability and predictability, telling how we should respond to others and giving us an idea of how others should respond to us. Roles are negotiated and produced during interaction, and often become reified over time. However, roles can be renegotiated and changed. Role set, role strain, role conflict, and role transition.Roles, identity, and the self. Sociology for health professionals IIHS 2011

B. Norms “Social rules that govern people’s actions toward one and another” Mores norms seen as central to the functioning of a society have much greater significance than folkways violating mores can bring serious retribution theft, adultery, incest, cannibalism Sociology for health professionals IIHS 2011

Characteristics of Culture
Learned behavior through: observation sharing and transferring Accumulation of solutions to common problems by: accident learning borrowing (Cultural Diffusion) All elements are interrelated Composed of explicit and implicit layers Dynamic and evolutionary Sociology for health professionals IIHS 2011

Cultural Diffusion Up to 90% of all cultures have their major origins from elsewhere When two different cultures interact: selective process two-way process borrowed items will be reinterpreted Sociology for health professionals IIHS 2011

Culture, Society and Nation States
Society is a group of people who share a common culture No one-to-one correspondence between society and a nation nation states are political creations many cultures can co-exist within a nation state similarity among people is both a cause and effect of national boundaries Nations composed of several cultures with no super-ordinate and uniting values are likely to split apart Nations break up and yield smaller units allowing national cultures to emerge and solidify Sociology for health professionals IIHS 2011

Determinants of Culture
Fig: 3.1 Sociology for health professionals IIHS 2011

Social structure Sociology for health professionals IIHS 2011

Social Structure A society’s basic social organization Two Dimensions
Degree to which basic social unit is the “individual vs. the group “ Degree to which society is stratified into “classes or castes” Sociology for health professionals IIHS 2011

a. Individualism Often prevalent in Western societies Not only reflected in the political and economic organizations How people perceive themselves and relate to each other in social and business settings Social status of an individual is not a function of where they work but their individual performance Often expressed in a high degree of entrepreneurship and managerial mobility Makes team building more difficult Sociology for health professionals IIHS 2011

b. The Group Often prevalent outside Western societies Social status of an individual is determined by the standing of the group to which they belong to as much by their individual performance Often expressed in a high degree of group affiliation and the lack of managerial mobility Sociology for health professionals IIHS 2011

Social Stratification
All societies are stratified on a hierarchical basis into social categories (social strata) Typically defined on the basis of: family background occupation Income Culture differ from each other with regard to the: degree of social mobility between social strata significance attached to social strata in business Sociology for health professionals IIHS 2011

Social Mobility The extent to which individuals can move out of the social strata into which they are born Two Major Types Caste System Class System Sociology for health professionals IIHS 2011

Caste System Most rigid form of stratification Closed system in which social position is determined by the person’s family Change is usually not possible for entire life Caste position carries with is a specific occupation Sociology for health professionals IIHS 2011

Class System Less rigid form of social stratification Open system where social mobility is possible both upward or downward Person’s social position by birth can be changed through their achievements or luck Degree of social mobility varies by society Sociology for health professionals IIHS 2011

Class Consciousness When people tend to perceive themselves in terms of their class background which shapes their relationships with members of other classes Where class consciousness is high, the way individuals from different classes work together may be very prescribed and strained Sociology for health professionals IIHS 2011

Religion “System of shared beliefs and rituals concerned
with the realm of the sacred” Shapes attitudes toward work and entrepreneurship Relationship between religion, ethics and society is subtle and complex Hazardous to make sweeping generalizations! Sociology for health professionals IIHS 2011

Ethical Systems “Set of moral principles or values used to guide and shape behavior” Can affect the cost of doing business in a country Sociology for health professionals IIHS 2011

World Religions Map 3.1 Sociology for health professionals IIHS 2011

Religion and Economic Implications
Christianity “Protestant Work Ethic & the Spirit of Capitalism” Islam favors legitimate profit and market-based systems important to keep one’s word or contractual obligations no payment or receipt of interest (mudarabah, murabaha) Sociology for health professionals IIHS 2011

Religion and Economic Implications
Hinduism ascetic, non-material principles inhibit entrepreneurship caste system plays a role Buddhism little emphasis on entrepreneurial behavior Confucianism loyalty, reciprocal obligations, and honesty in dealings Sociology for health professionals IIHS 2011

Education Can be a source of national competitive advantage provides a pool of skilled and educated workers Key determinant for location of FDI Impacts the kind of products/services that are consumed and the related promotional programs Education can be a source of social classes Sociology for health professionals IIHS 2011

Adult Literacy Rates Map 3.3 Sociology for health professionals IIHS 2011

Language “Enables people to communicate with each other and
structures the way we perceive the world” Spoken verbal cues language structures our perception of world Unspoken body language personal space

Spoken Mother Language

Non-Spoken Language 70% of all communication Nonverbal cues: eyebrows fingers/thumbs hand gestures feet personal space body gestures Sociology for health professionals IIHS 2011

Culture and the Workplace
Study on the relationship between culture and the workplace by Geert Hofstede 40 countries 100,000 individuals

Hofstede’s Cultural Dimensions
Four Dimensions of Culture Power Distance Individualism versus Collectivism Uncertainty Avoidance Masculinity versus Femininity Sociology for health professionals IIHS 2011

A. Power Distance Dimension focused on how a society dealt with the fact that people are unequal in physical and intellectual capabilities High Power Cultures societies that let inequalities (power and wealth) grow over time Low Power Cultures societies that tried to play down such inequalities Sociology for health professionals IIHS 2011

B. Individualism versus Collectivism
Dimension focused on the relationship between the individual and his/her fellows within a culture Individualistic Societies loose ties between individuals individual achievement & freedom highly valued Collectivist Societies tight ties between individuals tend to be more relationship oriented Sociology for health professionals IIHS 2011

C. Uncertainty Avoidance
Dimension measured the extent to which different cultures socialized their members into accepting ambiguous situations and tolerating uncertainty High Uncertainty Cultures job security, career patterns, retirement benefits are very important need for rules and regulations and clear instructions and tight control from superior are important Low Uncertainty Cultures readiness to take risks and less resistance to change Sociology for health professionals IIHS 2011

D. Masculinity versus Femininity
Dimension focused on the relationship between gender and work roles Masculine Cultures sex roles were sharply differentiated and traditional ‘masculine values” were cultural ideals Feminine Cultures sex roles were less sharply distinguished and little differentiation was made between gender in the same job Sociology for health professionals IIHS 2011

Work-Related Values for 20 Countries

Problems with Hofstede’s Findings
Assumes one-to-one relationship between culture and the nation-state His research may have been culturally bound Survey respondents were from a single industry (computer) and a single company (IBM) Findings are becoming dated ( ) Revised his initial research and included a fifth dimension “Confucian dynamism” attitudes towards time, persistence, “face”, tradition Sociology for health professionals IIHS 2011

Cultural Change Culture is not a constant; it evolves over time
American values toward the role of women American college students values about work and careers Japan moves toward greater individualism in the workplace and is impacted by aging society

Cultural Change Effects of economic advancement and globalization
Economic progress is accompanied by a shift in values away from: collectivism towards individualism “traditional values” towards “secular rational values” “survival values” towards “self-expression” and “well-being” values

Changing Values Sociology for health professionals IIHS 2011

Managerial Implications
Culture and competitive advantage Which nations might be competitors Which nations might be a resource (HR, R &D) Which nations might be a market (early adopters) Which nation might be a production site Culture and business ethics Many ethical principles are universal, others are culturally bound Cross cultural literacy Observe and study foreign cultures Sociology for health professionals IIHS 2011

3. Family Characteristics of Family Family Patterns Forms of Family Time allocated 03hrs Sociology for health professionals IIHS 2011

What is family Sociology for health professionals IIHS 2011

Murdock and the Nuclear Family
‘A people whose marriages and families are weak can have no solid institutions.’ Michael Novak For Functionalists such as Murdock, the Nuclear Family is a universal feature of human societies the world over. After carrying our case studies into 250 human societies for his anthropological work ‘Social Structure,’ he proposed that this family type is biologically ‘natural.’

Definition of Marriage Forms of Marriage - Time allocated 02hrs -

5. Socialization Socialization Development in children Resocialization Time allocated 04hrs Sociology for health professionals IIHS 2011

6. Gender and Sexuality Sexual Differentiation Sex Vs Gender Gender roles over the Life span Social Inequalities between Men and Women Feminist Theories Time allocated 06hrs Sociology for health professionals IIHS 2011

7. Social Interaction and Everyday life
Civil Inattention Non Verbal Communication Face and culture Social rules and Talk Encounters Impression managemen Time allocated 04hrs Sociology for health professionals IIHS 2011

8. Stratification and Class Structure
Social Stratification Basic Systems of Stratification Theories of Stratification Time allocated 03hrs Sociology for health professionals IIHS 2011

9. Ethnicity and Race Ethnicity Racism Prejudice and Discrimination Stereotypes and Scapegoats Time allocated 03hrs Sociology for health professionals IIHS 2011

Norms, Conformity Social Control Deviance Crimes Time allocated 04hrs
10. Deviance and Crime Norms, Conformity Social Control Deviance Crimes Time allocated 04hrs Sociology for health professionals IIHS 2011

Deviance Sociology for health professionals IIHS 2011

11. Education Development of Literacy and Schooling Origins of Development of Education System Functions of Education Consequences of Education Time allocated 04hrs Sociology for health professionals IIHS 2011

Education Can be a source of national competitive advantage provides a pool of skilled and educated workers Key determinant for location of FDI Impacts the kind of products/services that are consumed and the related promotional programs Education can be a source of social classes Sociology for health professionals IIHS 2011

Adult Literacy Rates Map 3.3 Sociology for health professionals IIHS 2011

Education Parsons argued that the Family acts as a ‘bridge’ between the individual and wider society. Within the family we gain ‘ascribed’ status- we are judged in terms of our status as brother, sister, daughter etc… Education provides Secondary socialisation – now we are judged on ‘achieved’ status. Our conduct is measured against universal values. Schools must operate on meritocratic principles. For Parsons, Ability + Effort = Merit.

Education and ‘Role Allocation’
Schools must instil the value of achievement by rewarding those who succeed, and the value of equality of opportunity, so that all who make the necessary commitments will succeed. Hence, the best people will go on to fill the most important positions This represents achieved status in action. Can you think of any reservations you might have with Parsons?

11. Religion What is Religion Characteristics of Religion Major Religions of the World Time allocated 03hrs Sociology for health professionals IIHS 2011

Religion “System of shared beliefs and rituals concerned
with the realm of the sacred” Shapes attitudes toward work and entrepreneurship Relationship between religion, ethics and society is subtle and complex Hazardous to make sweeping generalizations! Sociology for health professionals IIHS 2011

Ethical Systems “Set of moral principles or values used to guide and shape behavior” Can affect the cost of doing business in a country Sociology for health professionals IIHS 2011

World Religions Map 3.1 Sociology for health professionals IIHS 2011

12. Population Statistical measures Agriculture & Industrial revolution The third world, developing world Population Growth, Environment and Poverty Time allocated 04hrs Sociology for health professionals IIHS 2011

Table Major Perspectives on Health and Illness

Social Epidemiology and Health
Social epidemiology: study of distribution of disease, impairment, and general health status across a population Incidence: number of new cases of a specific disorder occurring within a given population during a stated period of time, usually a year Prevalence: number of cases of a specific disorder that exist at a given time

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

Social Class Studies show people in lower classes have higher rates of mortality and disability Crowded living conditions Substandard housing Poor diet Stress Unable to afford quality health care

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 rates Gender When compared with men, women live longer

Figure Percentage of People without Health Insurance, 2001 Source: Haub 2002:23

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
A Historical View During the 1830s and 1840s, “self-help” was emphasized Strong criticism of “doctoring” Eventually, medical profession controlled the market for its services and the various organizations that govern medical practice, financing, and policymaking

Physicians, Nurses, and Patients Physicians have position of dominance in dealing with nurses and patients Alternatives to Traditional Health Care Holistic medicine Therapies that consider the person’s physical, mental, emotional, and spiritual characteristics

The Role of Government In 1965, government subsidized health care programs Medicare for the elderly Medicaid for the poor Medicare had huge impact on health care system Some hospitals “dumped” unprofitable Medicare patients until practice was banned in 1987

Figure Availability of Physicians by State Source: Bureau of the Census 2004:101

Figure Total Health Care Expenditures in the United States, 1970— 2014 (projected) Sources:Center for Medicare and Medicaid Services 2005 (2005—2014 data); Health Care Financing Administration 2001 (1970—1990 data)

Mental Illness in the United States
Brain disorder that disrupts a person’s thinking, feeling, and ability to interact with others People in U.S. traditionally maintained a negative and suspicious view of those with mental disorders

Theoretical Models of Mental Disorders Medical Model: Mental illness rooted in biological causes that can be treated through medical intervention Labeling Theory: Mental illness is not an “illness” since the individual’s problems arise from living in society and not from physical maladies Devalues mentally ill patients

Patterns of Care Historical confinement of the insane or mentally ill to public institutions Community-based outpatient care most prevalent now Legislation has made it easier to commit mentally-ill homeless involuntarily

Social Policy and Health
Financing Health Care Worldwide The Issue Industrialized nations face issues related to the accessibility and affordability of health care The Setting The U.S. is the only Western industrial democracy that does not treat health care as a basic right

Financing Health Care Worldwide Sociological Insights Conflict theorists suggest health care system resists basic change Those who receive substantial wealth and power through an existing institution have strong incentive to keep things as they are Health care system undergoing “corporatization”

Financing Health Care Worldwide Policy Initiatives Major reforms occurring in U.S. without legislative reform As of 1997, managed care plans enrolled 85% of all workers, up from 52% in 1993 There are growing concerns about the quality of health care provided by managed care plans

Figure Government Expenditures for Health Care, Selected Countries Source: World Bank 2005a:

Thank you ! Sociology for health professionals IIHS 2011

Sociology for Health care Professionals

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