Topic Paper: Stratification & Health

Introduction to Medical Sociology What is Sociology? Sociology • The study of people • Society • Social structure • Social institutions • Culture Sociology of Health, Illness and Healthcare • Social causes and consequences of health, illness, and healthcare • Social forces affect – Likelihood of health and illness – Experience of illness – Health care providers – Health care system Sociological Perspective Emphasizes • Social patterns over individual behavior • Public issues over personal troubles • Social groups and institutions over individuals • Power: Ability to get others to do what one wants Sociologists study: • Who has power • How groups get power • Consequences of having or lacking power Critical Sociologists • Emphasize sources and consequences of power relationships • Explore how social institutions and beliefs support existing power relationships • Question the basic structure of society The Development of Medical Sociology Before Medical Sociology… • 1879, John Shaw Billings, physician who complied Index Medicus , wrote about “hygiene and medicine” • Te r m medical sociology first appeared in an article written in 1894 by Charles McIntyre on the importance of social factors in health Elizabeth Blackwell, 1821–1910 • first woman to get a medical degree, 1849 • Geneva Medical College, Geneva NY • Blackwell wrote on the importance of social factors in health in 1902 • Bernard Stern (1894-1956) is first sociologist to consider medicine • Writes Social Factors in Medical Progress, 1927 • Ta l c o t t Parsons is Stern’s student The Development of Medical Sociology Ta l c o t tParsons (1902- 1979) – Publishes The Social System in 1951 – Structural-functionalist perspective – The sick role The Development of Medical Sociology Practical application versus theory – Robert Straus (1957) notes division between sociology inmedicine and sociology ofmedicine What does it mean to be healthy?

Are you healthy? Defining health Defining Health World Health Organization (WHO) definition: – A state of complete physical, mental, and social well-being, and not merely the absence of disease or injury exercise • Sketch a sick person. • What is their state of being? • What do they need? • What is their relationship to the people around them? • What is their relationship to their normal obligations? • Do they have obligations specific to being sick? History of Ideas about Health • Premodernsocieties tended to rely on supernatural explanations of illness • Hippocrates of ancient Greece represents first attempt to base understanding of the body on rational thought; • recognizes contribution of the environment to human well-being • But still far from science of today Greek Humoral Theory • Body made up of Humors: • Black bile • Yellow bile • Blood • phlegm • Middle Ages (Western Europe): • Pockets of continued scientific study of medicine • Most people relied on supernatural explanations:

– Church: god, satan, witchcraft – Non-Judeo -Christian supernatural ezplanations Personalisticv. Naturalistic explanations of illness causation (Foster 1976) • Personalistic : some person or entity is the cause • Naturalistic: some system is out of balance – Greek Humoral …hot/cold – Ayurvedic – Chi Modern medicine and regulation of the body (late 18th century) – Michel Foucault (1973) The public’s health (19 th century) – Improvements in population’s health mainly due to improvements in diet, housing, public sanitation, and personal hygiene instead of medical innovations (McKeown1979; Porter 1997). Germ theory of disease (late 19 th -20 th century) • Biomedical approach: every disease has a specific pathogenic cause best treated by removing or controlling that cause “Whole person” health care (late 20 th -21 st century) – Transition from infectious to chronic diseases as leading causes of death (epidemiological transition) around mid -20 th century Re-emergent Infectious Diseases The Reemergence of Infectious Diseases Three epidemiological transitions in human history ( Armelagos and Harper 2010):

• First -occurred around 10,000 years ago – Human societies shifted from foraging (hunting and gathering) to agriculture – Marked by the emergence of novel infectious and nutritional diseases • Second -about 200 years ago – Improved nutrition and living standards, public health measures, and medical advances in developed societies led to a decline in infectious diseases and a rise in chronic and degenerative diseases • Third –beginning now – Resurgence of infectious diseases previously thought to be under control – The potential for the spread of infectious diseases has been significantly enhanced in today’s world by the globalization of trade and travel The Reemergence of Infectious Diseases West Nile virus – First appeared in New York City in the summer of 1999 The Reemergence of Infectious Diseases Sexually transmitted diseases – HIV/AIDS represents one of the greatest threats to worldwide health The Reemergence of Infectious Diseases Bioterrorism – Relatively new threat of infectious diseases – Takes place when people knowingly prepare biological agents or gases and use them to deliberately induce illness and death among other people Bioethics • Area of study focused on ethical decisions and practices with respect to medical care, research, and human’s rights over their bodies • Medical decisions can have profound social implications – May reflect discrimination and prejudice against particular social groups • Important cases of unethical behavior, spurring development of regulations:

– Nazi experiments – Tuskegee Syphilis Study in Alabama in 1932 • Institutional review boards (IRBs) responsible for oversight of research:

– Fully informed voluntary patient consent, acceptable risk–benefit ratios, guaranteed patient anonymity and confidentiality • Health Insurance Portability and Accountability Act (HIPAA) of 1996 – Regulates the handling of patient data and privacy Bioethics • Also concerned with controversial areas of medical practice and research:

– Funding of research by pharmaceutical companies – Practices such as “ghost-writing” academic articles on the use of medical interventions – Stem cell research – Use of human genetic material, including cloning – Abortion – Euthanasia – Reproductive technology