1. Sociological Perspectives on Health
Simon Corneau
Jean-François Roy

2. Sociological Perspectives on Health
« From a sociological point of view, factors contribute to the evaluation of a person as ‘healthy’ or ‘sick’. » (Schaefer & Smith, 2004).
Because health is relative, we can view it in a social context and consider how it varies in different situations or cultures.
Functionalist Approach
Interactionist Approach
Conflict Approach
Feminist Approaches

3. Functionalist Approach
Illness entails at least a temporary disruption in a person’s social interactions.
« Sickness » requires that one take on a particular social role, even if temporary ; the « sick role ».
The « sick » are expected to try to get well (e.g., seek medical care) and return to their normal activities.
Being sick must be controlled so that not too many people are released from their societal responsibilities at any one time.
An overly broad definition of illness would disrupt the workings of a society.

4. Inequities in Health Care Delivery Medicalization of Society
Conflict Approach
Conflict theorists seek to determine who benefits, who suffers, and who dominates at the expense of others in a given situation.
Inequities in Health Care Delivery
Medicalization of Society
A « brain drain » is contributing to the poor health of developing countries.
« Dumping » of unapproved or fraudulent drugs in developing countries.
There are inequities in health care delivery within Canada: northern and rural areas. There are global inequities: 25 doctors per 1000 in USA, less then 1 per 1000 in African nations.
Medicine has expanded its domain of expertise in recent decades. Once a problem is appropriated, it becomes difficult to view these issues as shaped by sociocultural factors.
Medicine maintains an absolute monopoly over many health care procedures. It places health care professionals such as chiropractors and nurse-midwifes outside the realm of acceptable medicine.

5. Interactionist Approach
Focus on micro-level study of the roles played by health care professionals and patients.
The patient is an active actor whose action can have a negative or positive impact on his health.
Interactionists also attempt to shed light on the « social meaning » of illness and how they affect one’s self-concept and social interaction; « labelling theory » focus on the effects of the social stigma of the illness (e.g., AIDS, women’s health, homosexuality).
Cultural differences in « social meanings » of illness and health care delivery.

6. Feminist Approaches
Health is an area of central concern for women. Women form the majority of health workers, of health care users and of caregivers.
Research on women’s health has focused on reproductive health issues, overshadowing a range of other health and illness issues; everything was related to the uterus and hormones.
There is still sexist bias in the health literature today (Janzen, 1998).
Feminists theorists also draw the attention on how multiple minority status intersects to produce varying levels of health and disease (ex : being black and being a lesbian).

7. Morbidity Rates and Populations
Sociologists find morbidity rates useful because they reveal that a specific disease occurs more frequently among one segment of a population then another.
Sexual Orientation
Health care services often assume a patient is heterosexual and create a situation where the patient is less likely to openly talk about health matters related to his sexual orientation, like sexual health or mental health (high rate of suicide among young gay men).
Age
Health is one of the overriding concerns of the elderly. Gender is most important in the study of health and aging since women live longer; yet elderly women receive little research attention. Social support is a key factor related to the health of older men and women.
Race and Ethnicity
Health profiles of many racial and ethnic minorities reflect social inequalities. The health of Canada’s First Nations reflects patterns of years of exclusion limiting their access to many of the social determinants of health like income, education and employment.
Social Class
Clearly associated with differences in morbidity and mortality rates. Why is class linked to health ? Crowded living conditions, substandard housing, poor diet, stress, limited education, workplace, etc.
Gender
Females have a life expectancy of 81,7 and males of 76,3. A difference attributed to behavioural factors (drinking and dangerous driving), occupational hazards (construction), and women’s tendency to seek health care services earlier and more often.

8. Social Capital
One of sociology’s main contributions has been to identify social capital as a determinant of health.
Many recent studies have explored the links between social capital and health. Social capital may contribute directly to health or may result in policies that are more supportive of healthy outcomes.

9. Social Capital
Social capital refers to the institutions, relationships and norms that shape the quality and quantity of a society’s social interactions.
(World Bank, 2001)

10. How is it Measured? Trust (in others, in institutions)
Social capital as a social determinant of health is measured with non-medical indicators. For example,
Key indicators
Trust (in others, in institutions)
Civic engagement (participation)
Social network (social support)
Social cohesion (sense of belonging)
Income distribution

11. Social Capital and Crime
3 dominant theoretical perspectives
1) Social disorganization: lack of social control
2) Anomie: weakening of behavioural norms
3) Strain theory: lack of opportunities
Geographic areas with ↑ levels of social capital have lower homicide rates. High homicide rates may undermine social trust and civic engagement and ↓ the stock of social capital (Rosenfeld et al., 2001).

12. Criminology and Health
Health status is affected by socioeconomic status → people from low socioeconomic classes are over-represented in prison → health condition is also affected by the prison context (they live and work with people carrying infectious diseases)
Areas of inquiry:
Utilization of prison health services
Consequences of confinement
Aging offenders
Policy level

13. Causes of Crime Conditions that make crime more likely:
Poverty (women)
Wealth (white-collar crime)
Drug abuse

14. Who are in Prisons ? Over-representation of native people
People of lower socioeconomic status (except for Martha Stewart)
Drug related crimes
People with mental health problems
Prevalence of unhealthy lifestyles: cigarette & alcohol abuse, drug abuse, poor diet, sexual promiscuity (Smith, 2002).

15. Healthy Prisons?
High prevalence of HIV/AIDS and Hep C, tuberculosis is coming back
Risk factors :
Consensual sexual activities
Prison rape
Drug injection
Tattooing
All these behaviours are prohibited by the prison code of conduct (affects likelihood of conditional release)
↑ Suicide rate
Self mutilation (women)
↑ level of stress (violence and power relations)

16. How to Explain this...
Deprivation model (Krebs, 2002) : what do you learn behind bars
Importation model (Krebs, 2002) : what do you bring with you in prison

17. How the System Reacts?
Condoms: can only be obtained through nurses, one at a time
No clean needles; bleach available only in some provinces
War on drugs (random testing)

18. That Means…
Inmates can become infected while in prison, becoming a threat to the general population when released.
CCS Mission: Protection of society

19. Questions (1) ?
Do people from lower socioeconomic classes really commit more crime, or are they just more often targeted by official formal control?
Can we really « rehabilitate » someone while in prison when we know that the person will return into the same socioeconomic conditions after incarceration (low stock of social capital)?
Is a punitive approach appropriate for drug related offences? (Rehab vs. Punishment)

20. Questions (2) ?
How would a functionalist analyze the medicalization of society?
How would a interactionist analyze AIDS ?
How would a conflict theorist analyze links between health and occupation?

21. Some Figures on Social Capital
Bowling alone : the collapse and revival of American community.
Robert D. Putnam (2000)

22. Source : Putnam, 2000.

23. Source : Putnam, 2000.

24. Source : Putnam, 2000.

25. Source : Putnam, 2000.

26. Source : Putnam, 2000.