Medical Sociology – Flashcards
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Views aspects of society (even the bad parts) as essential and necessary for a functional system - sick or inferior in poverty, take low wage jobs
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Functionalism
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Society is in a constant pattern of struggle between powerful and oppressed - The poor have less access
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Conflict Theory
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Focuses on day to day interactions between people; how we use and interpret symbols (doctor v. nurse) - The poor make bad lifestyle choices and are treated differently by healthcare professionals
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Interactionism
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What impact does society/social structure have on interactions - What things limit our chance?
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Synthesis
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The study of health care as it is institutionalized in society, and of health, illness and its relationship to social factors - Medicine/Illness often come from social structures - Examines medicine as a social institution within the society as a whole
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Sociology of Medicine
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Sociological contributions to the practice of medicine - Social patterns, dynamics, changes, tensions, etc. within medical institutions
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Sociology IN Medicine
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- The Relationship between the social environment and health, illness (Social epidemiology, social stress) - Health and Illness Behavior (health behavior trends, how people work to get healthier, experiencing disability, etc.) - Health Care Practitioners (how different medical professionals interact/deal with patients, alternative medicine, doctor-patient relationship) - The Health Care System (health care delivery, social effects of health care technology)
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Major Topics in Medical sociology
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Sociological perspective gain knowledge about the world we live in because it studies groups and people in their role (social context) and how social influences connect their patterns. - How we see ourselves in this, our health, and what we learn about the world around us affect/influence our decisions
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How does the sociological imagination relate to medical sociology?
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A comprehensive study of all the medical schools in the United States and Canada to determine their quality of medical education. - Many medical schools shut down bc they knew they wouldn't meet the standards of the report - Reduced the number from 155 to 31 and suggested that medical schools be subjected to formal regulation of curriculum
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Know some influence of the Flexner Report on professionalism of physician
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Grade Trade of 1910: the government gave the AMA almost near-exclusive rights to regulate medicine in the country. With the powerful knowledge supplied by the germ theory of disease and the organizational legitimacy provided by the states and fed gov, the power of the AMA was secured. - AMA then institutionalized scientific medicine as the foundation of America's healthcare system as opposed to being controlled and regulated by the government
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WHat was the power shift by the Great Trade of 1910 and the AMA?
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Easy to fall in to belief in medical authority bc doctors had the hospitals, money, and power over their practice -- people look to them and think they are working in the public's best interest. Wanted to gain public acceptance through social control from laws and power from culture. Also the new licensing las and restricted entry into reformed med schools made it a more
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Starr's Perspective on medical authority
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There is a conflict theory present because not everyone had the same power in society due to the fact that powerful groups in society agreed with doctors; when doctors received power from the AMA, they are not operating entirely from a place of care for all people, they had power and used power from other people to gain professionalism, which is what mattered most to them
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Navarro's Perspective on Medical Authority
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Influence of social and cultural factors on the risk of death and disease - Focus movement from microorganisms, to personal, to sociocultural factors
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What is social epidemiology> What is the role that it plays in medical sociology? ****
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Age of pestilence & famine ... pre 1800s - Unclean drinking water, lack of nutrition, life expectancy of 24 years old Age of receding pandemics... early 1800s and early 1900s - Germ theory, gained knowledge, improvements in public health Age of degenerative diseases, diseases of human origin ... mid 1900s - What kinds of work we do, how we treat each other - Low infection rates - Live longer & could live sicker - Life expectancy around 70
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What is the epidemiological transition noted by Omran?
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Less economically developed countries have higher rates of infectious disease -- double burden Several infectious disease have become resistant to antibiotics - Malaria 2M infected, 600k killed - Diphtheria 200k - TB 2 B infections - Hospital acquired infections - 1/3 death
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The impact of increase of infectious disease
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Projections, Reflects the average number of years that a person born in a given year can be expected to live
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Life Expectancy
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Number of deaths in a population
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Mortality
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Amount of disease and other impairments within a population
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Morbidity
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Number of cases during a specific unit of time
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Crude death rate
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Life Ex- Average is 70 ww; 78 in industrialized, 67 in developing; low income 7 years less than wealthy (Class > race), whites live 5 years longer than blacks, hispanics lower than everyone, women 80/75 men Mortality- 2-3 women a day in childbirth in US
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What are the trends in life expectancy and mortality?
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Proximate risk factors for disease- health related behaviors and lifestyle; diet, exercise, seatbelt use, safe sex, use of medical care, firearms, etc. Fundamental causes of disease patterns- SES, social inequality, racism, built environment, social network, political power
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Social determinants of health
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Health related behaviors and lifestyle - interaction between these two
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Proximate Risk Factors for Disease
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Underlying social conditions/resources - Social inequality, SES -- Relate to health in two ways: 1. Shape health through participation in proximate ways 2. Providing access to important resources
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Fundamental Causes of Disease Patterns
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IMR has declined since the 90s (improvements in SES, housing, nutrition, water) -- 1.5 times higher for below the poverty line -- black babies 2x as likely to die before 1
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What is the infant mortality trend and how does it vary by race and social class
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- 1in4 infant deaths occurred in low income POC neighborhoods - 8 hot spots in CBUS where IMR is very high
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CPH guest speakers
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Prevalence & Incidence
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What are the measurement techniques that measure disease and illness in a population
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disease, impairment, accident, number of new cases added to population within a given period (AIDs within 12 months)
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Incidence
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Total # of cases of a condition present at a given time (current number of people living with AIDs)
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Prevalence
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W = higher life expectancy W = 5 years more than B W & B = Leading cause cancer, but B die earlier
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Differences in mortality and morbidity for race & ethnicity
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Those resources inherent in social relations which facilitate collective action; social capital resources include trust, norms, and networks of association representing any group which gather consistently for a common purpose
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Social capital theory
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Fundamental : aspects of social context/structure that influence exposure and response to illness/injury and multiple proximate risk factors (underlying social conditions) -- Decisions to cut resources - like planned parenthood Example: NAs bad sugar
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Interrelationship of risk factors and fundamental causes of disease
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Explanation for the reasons for disease patterns
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Etiology
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How our social positions can impact our health such as our physical environment, social environment, and individual lifestyle choices
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Causal pathways
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The importance of equitable distribution of income & wealth The importance of public & community health (focus on public health rather than medical tech) The importance of lifestyle & behavioral factors (link to infectious disease in developing --> safe drinking water)
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Health Transition
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Not all aspects of the population are considered, therefore the results are not applicable to the entire population
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How has underrepresentation impacted medicine and research
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#2 world killer - Higher with AA & low SES - Asian, Hispanic lower than white - 90% environmentally related Trends - ^^ in survival rates (early detection, improved treatments) - Overall decline for all races - Recent leveling off due to drop in lung cancer in men
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Incidence, Mortality & Trends: Cancer
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#4 world killer - Death rate higher among AA & Hispanics - Mostly male to male; rising hetero Trend - Hope to transition to chronic
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Incidence, Mortality & Trends: HIV
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Leading cause of kidney failure - High in hispanics Trend - detection of prediabetes, lifestyle interventions
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Incidence, Mortality & Trends: Diabetes
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5.3 M people suffer from this - Half are 85 and older - Most directly genetic - Chronic and degenerative - Prevalence will grow w/out a cure/prevention methods - Use of antibody to clear plaques? (new intervention)
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Incidence, Mortality & Trends: Alzheimer's
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General Adaptation Syndrome Stage one: response to situation: alarm (sympathetic branch of autonomic nervous system is activated) - adrenal release cortisol, fight or flight Stage two: Deal with situation, action/adaptation (parasympathetic NS of the ANS counteracts with the changes in 1) Stage three: aftermath/exhaustion - depleted resources during 2 - exhaustion occurs if there is a continued stressor - stress is produced voluntarily or involuntarily
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GAS
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A state of imbalance within a person which may cause the physiological fight or flight response
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Stress
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A modern or normal psychological stress interpreted as being beneficial for the experiencer
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Eustress
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Initial circumstance of stressor Individual analysis and appraisal Appraisal of the situation through social roles and interaction Coping with the initial stressor and its repercussions
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Model of stress? **
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Way social environment influences our self image - According to this theory, we come to see ourselves as we believe other people see us
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Cooley's "looking glass self" **
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Social conditions can be unhealthy when people are forced to respond to conditions not of their own choosing; how different issues affected small v. large groups (particularly suicide) - Anomic Suicide: sudden social changes induce a chronic lack of regulation, loss of moral compass - Altruistic Suicide: People too well integrated into a group that enables suicide -- People who feel the stress of needing to feel connected to a group (cults, terrorist groups, etc.)
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Durkheim's role of social regulation/integration's impact on mental health
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Accelerating rate of change: new technology Accessibility, decline in privacy, brain on Pressure of immediacy, changing times, multitasking Overstimulation
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Cell phones a social stressor? *** p99
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Life events = "acute" interpretations of events that occur throughout the course of life; whether or not the event is anticipated Chronic Strain = stressors that are built into our daily lives (enduring problems within social roles) Daily Hassles = Stressful experiences that we have that can overlap both acute and chronic
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Know the difference between life events, chronic strain, daily hassles
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Stress or strain experienced by an individual when incompatible with the behavior or expectations associated with a single social role
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Role Strain
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Overload associated with role (too much work) Conflict with role sets (stress within relationships --parent/child) Interrole conflict (being a boss & mother) Role Captivity (being in an unwanted role) Role Restructuring (changes within a long-standing role-- death of spouse)
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Types of Role Strain
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Symbolic Interactionism: "Social Construction" of reality focuses on small-scale, everyday patterns of social interaction Thomas Theorem - If situations are defined as real, they are real in their consequences People are affected by events only to the extent of which they are perceived
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How does social construction of reality impact stress and appraisal? Symbolic interactionism/Thomas Theore
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Psychological resources - Positive self esteem, internal control, hardiness (problems are challenged) Cognitive techniques (interpretation) - Denial, Acceptance, Challenge Behavioral techniques - what do we do about it - hide? get drunk? map out a plan?
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Mediators of stress: coping & social techniques
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Naturally we have a social support system that surrounds us at all times as in times of stress - Having a constant support system at all times is very important to handle and manage stress
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Main effects Model
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You can have a good support system but its how they react when you are stressed - how they react when needed - the support system that surrounds you in times of stress - social support benefits occur only when stressed - Useful resources when needed, as a response
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Buffering Effects Model
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Lower SES means more stressful events/environments, accumulation of stressors over time
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Exposure Hypothesis
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Events have greater impact due to lack of financial resources, poor coping strategies, less social support
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Vulnerability Hypothesis
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Even when class is controlled, still a predictor - Buffer effect of ethnic identiy Social toxins: stress related to actual disparities in physical health outcomes - Shorter telomeres - High allostatic load during pregnancy --> high IMR and CVD (wear and tear on the body grows over time)
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Stress & Race
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Women have higher rates of psychological distress/depression - Stress associated with roles
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Stress & Gender
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Physical/sexual victimization, lack of social resource, chronic strains; linked to mental health outcomes
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Stress & Sexual Orientation
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Married people report less stress than those who are not married - Why???? married people have higher quality, more supportive relationships, receive more emotional support, more likely to experience economic well-being Men receive more health from marriage
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Marriage & Stress
