1. SOCIOLOGY OF HEALTH

2. STRUCTURAL-FUNCTIONALISM FUNCTION - the satisfaction of a need by an activity in which human beings cooperate, use artifacts, & consume goods Social structure or structure – forms of associations (structure) found amongst human beings SOCIETY as a bundle of interrelated institutions institutions: a society's recurrent patterns of activity, such as religion, art, a kinship system, law, and family life. Institutions fulfill human needs: a function EXAMPLE: – The division of labor serves two functions: social integration & functional differentiation EQUILIBRIUM-FUNCTION-STRUCTURE

3. Structure-function imagined

4. Sociology of health: medicine Focus on “medicine” Social aspects of medicine, health, disease Social factors shaping medicine – Social labelling & social control – Sick role – Patient-doctor relationship – Disease-illness distinction – Medicalization

5. Social labelling Order & disorder – normal & abnormal Social labeling & illness, disease, disability – Who is to be called ill, diseased, disabled is determined by the individual’s social position and society’s norms rather than by universal and objectively defined signs and symptoms A person is labeled in the course of social negotiations de-labeling difficult At each decision point it may be possible to return to the normal label

6. STRUCTURE-FUNCTION & MEDICINE Doctor-patient relationship – Institutional integration Institutions defined as a society's recurrent patterns of activity – The “sick role” (T. Parsons) Illness as a form of “deviance” – Physicians & return to equilibrium – Alcoholism? Poverty related health issues? – Compliance as solution? – Local healthcare system

7. Abnormality/Deviance & the Sick role (T. Parsons) Rights: – The sick person is exempt from “normal” social roles. relative to the nature and severity of the illness – The sick person is not responsible for his or her condition. An individual’s illness is usually thought to be beyond his or her own control A morbid condition of the body needs to be changed and some curative process apart from person will power or motivation is needed to get well. Obligations: – The sick person should try to get well. The first two aspects of the sick role are conditional upon the third aspect – The sick person should seek technically competent help and cooperate with the physician.

8. Disease-Illness distinction DISEASE — as a bio-scientific concept – Abnormalities in the structure & function of body organs & systems ILLNESS -- lay concepts – Illnesses are “experiences” of disvalued changes in states of being & in social function Biomedicine presses the practitioner to construct disease as the subject of study & treatment

9. medicalization the process by which health or behavior conditions come to be defined and treated as medical issues the process by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors and other health professionals to engage with, study, and treat The process of medicalization typically involves changes in social attitudes and terminology, and usually accompanies (or is driven by) the availability of treatments

10. Challenging medicine: theoretically Medico-centricism – Disease and mortality are problematic and require medical intervention Focus on disease (not illness) – obscures social conditions and experience – Focus on disease and the right that professionals have vis a vi individuals – Patient’s fault if there are problems Critical theory

11. Critical Theory, Social Structure, Medicine Questions about the neutrality/objectivity of medicine, use of technology, science Ideology -- a system of shared beliefs that legitimize particular behavioral norms & values at the same time they claim & appear to be based on empirical truths ideologies transform power (potential influence) into authority (legitimate control)

12. Medicine & Social Structure: critical theoretical perspective E.g. compliance as ideology transforms physician’s theories about the proper behavior of patients into a series of research strategies, research results, & potentially coercive interventions that appear appropriate & that reinforce physicians authority over health care

13. Science, Medicine, Social Structure: critical theoretical perspective Science names the structure of situations in such a way that the attitude contained toward them is one of disinterestedness its style is restrained, spare, resolutely analytic – objectifies moral sentiment Science is diagnostic, critical, dimension of culture Social control Objectivity? - actively concerned with the establishment & defense of patterns of belief & value

14. The social production of health Shift from disease focus of medicine Shift from focus on medicine Same emphasis on power, inequality, social relationships/organization/structure Social characteristics play a predominant role in determining sickness and health status Occupation related to health Social position: class, ethnicity, gender, age disease & feelings of sickness not determined solely by underlying biology

15. Society and health Correlations: number of operations performed and proximity of number of surgeons in the area – Available technology Class, environment, residence, distributions of cancer Drapetomania, Gambling, alcoholism, learning disabilities, childbirth & medicialization The social need argument -- ?

16. Society and health Social relations of sickness which produce forms and distributions of sickness in society Sickness is the process through which worrisome behavioral and biological signs, particularly ones originating with disease, are given socially recognizable meanings resulting in socially significant outcomes Sickness is a process for socializing disease and illness The social order is embedded in medical beliefs

17. Society and health choices & forms of medical interventions & transactions are determined by sickness (not illness or disease) Medicine continues to divorce disease from its social relations of production – Ignoring power differentials that originate and reside in arrangements between social groups and classes Symbols of healing are equated with power Medicine is an ideological practice

18. EPIDEMIOLOGICAL -- HEALTH TRANSITIONS complex change in patterns of health and disease the interactions between these patterns and the demographic, economic, and sociological determinants and consequences.

19. Transitions & Disease Profiles pestilence and famine receding pandemics degenerative and man-made diseases

20. Life Expectancies as Measure of Health Transitions

21. From Infectious to Chronic Diseases

22. 10 leading causes of death in US 1900 1.Influenza and pneumonia 2.Tuberculosis 3.Gastritis 4.Diseases of the Heart 5.Cerebrovascular Disease 6.Chronic Nephritis 7.Accidents 8.Cancer 9.Certain diseases of infancy 10.Diptheria 1998 1. Heart Diseases (31.4% ) 2. Cancer (23.3%) 3. Cerebrovascular diseases (6.9%) 4. COPD (4.7%) 5. Accidents (4.1%) 6. Pneumonia and Influenza (3.7%) 7. Diabetes (2.7%) 8. Suicide (1.3%) 9. Diseases of Arteries (1.2%) 10. Nephritis (1.1%)

24. Ten leading causes of death (2000) Developed countries 1.IHD 22.6% 2.CVD 13.7% 3.Lung Ca. 4.5% 4.Respiratory infections 3.7% 5.COPD 3.1% 6.Colon Ca 2.6% 7.Stomach Ca 1.9% 8.Self-inflicted injuries 1.9% 9.Diabetes 1.7% 10.Breast Ca 1.6% Developing countries 1.IHD 9.1% 2.CVD 8.0% 3.Respiratory infections 7.7% 4.HIV/AIDS 6.9% 5.Perinatal conditions 5.6% 6.COPD 5% 7.Diarrhoeal diseases 4.9% 8.Tuberculosis 3.7% 9.Malaria 2.6% 10.Road accidents 2.5% Beaglehole and Yach. Lancet 2003

25. Demographic Transitions and Health Decreased fertility rates Decreased infant mortality rates Increased life expectancies at birth Reflect shifts in social and economic patterns Changes in health conditions Changes in health care

26. Population and demographic changes

27. Human Determinants of Transitions technological change alterations in the environment alterations in food type, availability, production, preparation, and consumption alterations in patterns of energy expenditure interplay of environmental factors and the genetic pool of a community

28. Epistemological Framework of Epidemiological Transitions

29. MULTIPLE EPIDEMIOLOGIC TRANSITIONS recent resurgence of infectious disease mortality marks a third epidemiologic transition characterized by newly emerging, re- emerging, and antibiotic resistant pathogens in the context of an accelerated globalization of human disease ecologies

30. Human Determinants of Transitions REDUX technological change alterations in the environment alterations in food type, availability, production, preparation, and consumption alterations in patterns of energy expenditure interplay of environmental factors and the genetic pool of a community Social inequality? Where is it?

31. “SOCIAL FORCES AND PROCESSES EMBODIED AS BIOLOGICAL EVENTS” THE CRITICAL PERSPECTIVE Paul Farmer: “Inequality itself constitutes our modern plague – inequality is a pathogenic force” “Social inequalities often determine both the distribution of modern plagues and clinical outcomes among the afflicted”