INTRODUCTION TO MEDICAL SOCIOLOGY FOR BIOMEDICAL STUDENTS

1. INTRODUCTION TO MEDICAL SOCIOLOGY FOR BIOMEDICAL STUDENTS Kai-Lit Phua, PhD FLMI Associate Professor School of Medicine & Health Sciences Monash University Malaysia Campus

2. Biographical details Kai-Lit Phua received his BA (cum laude) in Public Health & Population Studies from the University of Rochester and his PhD in Sociology from Johns Hopkins University. He also holds professional qualifications from the insurance industry. Prior to joining academia, he worked as a research statistician for the Maryland Department of Health and Mental Hygiene and for the Managed Care Department of a leading insurance company in Singapore. He was awarded an Asian Public Intellectual Senior Fellowship by the Nippon Foundation in 2003.

3. Lecture notes: http://phuakl.tripod.com/phuakl1.html Click on Medical Sociology A or Medical Sociology B

4. Learning Objectives • To gain an understanding of sociology as a social science discipline • To appreciate the usefulness of sociology in solving biomedical and public health problems • To be introduced to a number of major sociological/epidemiological variables

5. What is “Sociology”? • Sociology is one of the social sciences • Sociologists study human societies, human behaviour in groups, and how individual behaviour is shaped by social institutions and socio-economic forces • Examples of social institutions: family, school, religion, legal system • Historically, sociology is associated with the challenge of responding to social problems arising from industrialisation and urbanisation in W. Europe

6. What is “Medical Sociology”? • A better term for it is “Sociology of Health and Illness” • Using the sociological way of thinking to study or solve biomedical/public health problems 1. Sociology of medicine 2. Sociology in medicine

7. Sociology of Medicine • This approach focuses on theory and concepts • An example would be the famous book by Eliot Freidson called “Professional Dominance” i.e. a study of why and how doctors are dominant in the health professions and health institutions • Another example would be Paul Starr’s book called “The Social Transformation of American Medicine” which predicted erosion of this dominance with the rise of corporate medicine

8. Sociology in Medicine • This approach focuses on applications and solving problems using sociological knowledge • An example would be David Mechanic’s studies of “illness behaviour” • Another example would be studies of “adherence” (“compliance”)

9. Major Sociological Concepts Useful to Biomedical Students Ethnicity (“race”) Class (social class) Gender (“sex”) Age Region (geographical location) Education (educational attainment) Marital status Religion Other e.g. sexuality/sexual orientation

10. Ethnicity (“race”) & Health • How does membership in a particular ethnic group affect one’s health? Example: health of indigenous peoples and ethnic minorities • Measuring health at the population level: Morbidity (sickness) rates Disability rates Mortality (deaths) rates Life expectancy • Culture, health and disease e.g. nutrition patterns, other health-related behaviour • Culture-bound illnesses

11. Class (social class) & Health • Social class differences in health (the “social class gradient in health”) : People in the lower classes tend to have poorer health than people in the upper classes Marmot’s “Whitehall studies” of British civil servants document the existence of a health gradient by civil service rank Note: Sometimes, “SES” (Socio Economic Status) is used instead of “Class”

12. Gender (“sex”) & Health • Gender versus biological sex • Gender, socialisation and health • Cervical cancer – related to biological sex • Lung cancer • Substance abuse (tobacco, alcohol, illegal drugs) • Sexually-transmitted infections (STIs) e.g. HIV/AIDS • Injuries from risk-taking behaviour • Body image and eating disorders

13. Age & Health • The life cycle and health: Before birth (fetus) Infant Child Teenager Young adulthood Middle adulthood Old age

14. Region & Health • Geographical location and health: Rural versus Urban Urban slums versus Desirable urban areas Poor country versus rich country Physical characteristics/weather of region

15. Education & Health • Educational level and health: • Less educated people tend to have poorer health than better educated people • Female education is associated with lower infant mortality rate

16. Marital Status & Health • Marital status and health: • Marriage is good for mental health (for most people) • People living alone (single people, the widowed, elderly living by themselves) tend to have poorer health

17. Religion & Health • Religious values and health: Religious beliefs can affect health-related behaviour e.g. diet, smoking, drinking, sexuality, seeing the doctor (including the psychiatrist) and seeking medical care e.g. Jehovah’s Witness and blood transfusion

18. Other concepts(more advanced) • Medicalisation: What used to be a social problem gets redefined as a “medical problem” to be treated by doctors and other health professionals e.g. alcoholism, domestic violence, compulsive gambling • Demedicalisation: An example would be homosexuality no longer being classified as a mental disorder by the American Psychiatric Association in the 1970s

19. THE END THANK YOU