Sociology and health

1. Sociology and health

2. Session aims • To explore sociology as a discipline • To identify how sociology contributes to understandings of health and illness • To identify how society affects health

3. What is sociology? • The study of interactions between groups and individuals • The critical examination of everyday aspects of human life • The examination of the macro and micro aspects of society and their inter-relationship • The exploration of social processes and how society works • The use of theory as a tool to explain society

4. Thinking sociologically about society • Sociology has been called the science of society • Sociologists use their ‘sociological imagination’ when exploring society • The sociological imagination is about thinking beyond personal experience and challenging obvious explanations of human action (Mills 1970) • Thinking sociologically is also about using systematic enquiry (Jenkins 1996), and defamiliarising situations (Bauman and May 2001)

5. Theoretical perspectives • Functionalist theory • Society is seen as a functioning biological organism, with individuals acting as parts as they all have a role and function • Everyone does their bit to keep society running • Parson’s (1951) sick role theory • The medical profession manage the disruption caused by sickness • Patients adopt the sick role and can abstain from work and their usual responsibilities • To adopt the sick role patients have to desire to gain full health and return to work by seeking treatment

6. Theoretical perspectives • Symbollicinteractionist theory • Micro analysis, attempting to understand social experiences from the perspective of those experiencing them • Encounters and interactions are what creates meaning in the social world • Insiders perspectives focus upon the subjective experience of illness • Goffman’s (1963) work on stigma is important • Illness can lead to stigma and affects individual identity • Judgements about illness are value laden • Stigma can result from physical differences and social stereotyping • Many illnesses are associated with stigma including HIV/Aids, mental illnesses and Down’s Syndrome

7. Theoretical perspectives • Bury’s (1982) work discusses chronic illness as biographical disruption • Individual illness disrupts the life experience of the sufferer • Illness affects daily structures and taken for granted assumptions about everyday life • Sufferers have to deal with biographical disruption such as limiting work and their participation in normal activities such as family life and social events • Sufferers develop mechanisms to manage this disruption • Disruption leads to the destabilisation of identity especially at the onset of chronic illness

8. Theoretical perspectives • Marxist theory • Focuses upon the power of economics within society • Analyses the way in which capitalism works, based upon inequality and exploitation • Social class systems and hierarchy are central to political economy perspectives • What does this mean for understanding health? • Capitalism is detrimental to health • Health services exist to maintain individual health and ensure that people continue to work for capitalists (they maintain social order) • Medicine is a commodity, a product that can be bought and sold demonstrated through increasing commercialisation of health and increased medicalization – both increase profit

9. Theoretical perspectives • Feminist theory • Social structures are based upon inequalities between men and women • Men have greater power than women across social structures • Sociology has received criticism as a discipline for being ‘gender blind’ • What does this mean for understanding health? • The medical profession is male dominated • The growth of medical influence over women is considerable and has impacted upon their lives • Medicalization is part of wider processes of social control • The history of medical care and the surveillance of women is not always proven (Oakley 1993)

10. Theoretical perspectives • Social constructionist theory • Every aspect of the world has meaning and social significance • There are no universal truths • To say that something has been socially constructed means that it has been fashioned by society and made by humans • What does this mean for understanding health? • Health and illness are social constructions, demonstrated by changing interpretations and knowledge over time • Foucault’s (1976, 1979) work explores the gaze of the medical profession and associated control – this is seen in how medics define, treat and manage illness • Disability is a social construction – it is constructed by society as different and the disabled are excluded from society in many ways

11. Society as a determinant of health • Sociologists also show that society is an important influence on health and illness • Learning about society tells us about health, and learning about health tells us about society (Wilkinson 1996) • Health is ultimately determined by position within the social structure – society determines health in many ways

12. Social divisions and health • Social divisions relate to health – age, gender, class and ethnicity • There is a social gradient of health outcomes, with large differences existing based upon social divisions (Graham 2000) • Those in the lowest social classes are more likely to die at a younger age • Those in the lowest social classes are more likely to experience greater ill health across the life-span

13. Social Inequalities • There is a large amount of research showing the existence of health inequalities in the UK and more globally • The Black Report (1982) • The Health Divide (1988) • The Health of the Nation (1992) • The Acheson Report (1998) • Commission on the Social Determinants of Health (2008) • Fairer Society, Healthier Lives (2011)

14. Example health inequalities • In 2002 life expectancy in the UK for women was 80.4, but for men just 75.5 – a gender difference of 4.7 years (Gjonca et al 2005) • In 2007, South Asian men were 50% more likely to have a heart attack or experience angina than other men (Parliamentary Office of Science and Technology 2007). • 2010 National Statistics show that professional males live an average of 12.5 years longer than those in manual occupations. The age gap was 11.4 years for women (National Statistics 2010)

15. Sociologist explain Inequalities

16. How can sociologists explain inequalities? • The artefact and social selection explanations are largely discounted • The remaining explanations are still being researched and debated • The importance of place has been brought into the debate • Lay knowledge and experiences of health are also seen to be important (Popay et al 1998)

17. The social model of health • Sociologists see the social model of health as crucial in explaining health inequalities • There is however no single social model of health • The social model pays attention to social divisions, psycho-social determinants and social constructions of illness and disease • The social model encompasses the social determinants of health explanation of inequalities

18. Social determinants of health explanation • Material deprivation is a fundamental cause of ill health and disease • The poorest sections of society are denied what they need for good health (Wainwright 2009) • Inequality is bad for health in many ways – it causes shorter, unhealthier and unhappy lives (Wilkinson and Pickett 2009)

19. Sociological critique of health related practice • Sociology also offers criticisms of health promotion asking questions such as • What norms underpin practice? Do they recognise reality? • Are people always able to make a healthy choice given their social position? • Does health promotion socially control and regulate people? • Can health promotion be effective without wider social and political change?

20. Summary • Sociologists offer a range of critical interpretations about health, health-related behaviour and health care • Sociologists show that health is a contested concept • Sociologists show that health is socially influenced and determined • Sociologists contribute to understanding and explaining health inequalities • Sociologists show that lay perspectives are important in understanding health • Sociologists analyse health-related practice such as health promotion, critically questioning its role