Unit 2 Health Comm

Intersectionality Theory

A person’s social position emerges within the interface of micro-level personal identities and macro-level sociocultural patterns

Personal Identity

age, race, sexual orientation, physical abilities, education, etc.

Sociocultural variables

sexism, racism, power, resources, public policies, etc.

Socioeconomic status (SES)

social standing or class of group or individual — combination of education, income, and occupation

Link between SES and health

implicit biases, gaps in communication, structural inequities, limited access to health care, logisitcs

Racism

discrimination based on a person’s race

race is associated with life expectancy in the US — link between heath and race is social

Concordance

perception of similarities between self and another based on culture/ethnicity (ie. a black patient may confide more in a black doctor because they perceive them as “similar”)

Reasons people of different races may receive and respond to health care differently

• distrust of medical establishment

• high risk, low knowledge

• limited access to advanced medical facilities

• underrepresentation

• patient-caregiver communication

Language gap

When a doctor and patient do not speak the same language — growing in the US, more need for interpreters (often family members)

Sex

set of biological attributes primarily associated with physical and physiological features

Gender

Socially constructed identities, roles, expressions, and behaviors of women, men, or gender diverse people

Assumptions of sex/gender

Institutional notions of gender are heteronormative (ie. a form only lists male and female)

Disability dichotomy

• central vs avoided

• heroic vs tragic

People with invisible disabilities may encounter unique difficulties

The word disability is accepted and preferred

Phases of development of illness conceptialization

1. Pre-logical conceptualization

2. Concrete-logical

3. Formal-logic

Pre-logical conceptualization

Ages 2-6, define illness as caused by tangible, external agent

Concrete-logical conceptualization

Ages 7-10, differentiate between external causes and internal manifestations (ie. how germs get inside them)

Formal-logic conceptualization

Ages 11+, envision complex influence of agents not readily seen

Ageism

Discrimination based on a person’s age

Social beliefs about growing older have implications for identity

• feminine beauty is youthful

• getting older is a decline

Culture

A set of beliefs, rules, and practices shared by a group of people (assumptions suggest how to behave, expected roles, etc)

Ethnocentrism

The attitude that one’s own culture is better than others

Culturally sensitive approach

create health messages responsive to the values and beliefs of the culture

Culture-centered approach

voice of the community is central to articulating health problems and solutions

Cultural Conceptions of Health

1. Heath as organic

2. Health as harmonic balance

Health as organic

Assumes that health can be understood in terms of the presence or absence of physical indicators

• biomedical model

• Germ theory

• Limitations:

  • inability to account for conditions that can’t be verified

  • excludes social, spiritual, and psychological factors

  • oversimplification to classify people as sick or healthy

Health as harmonic balance

Health is a sense of overall well-being and equilibrium

• many cultures regard mind and body as tightly linked

• Biophilia hypothesis

• Thermal metaphors

• biopsychosociol/sociocultural models

• Conception of health in terms of energy

  • Karma: energy from deeds in past

  • Yin and yang: connected yet opposite elements

  • Qi: central life energy

Biophilia hypothesis

There are health/therapeutic value to living in harmony with nature

Yin and Yang

Yin = coolness

Yang = warmth

Imbalance = illness

Health condition as a social aspect

Positive and negative perception (ie. seizures, coma)

Health condition as a social liability

• Belief that illness is a curse (ie. HIV/AIDS, mental illness)

• Stigma

• sick people viewed as ignorant or lazy (ie. obesity, diabetes)

• role of victim

Stigma

social rejection in which a person is treated as dishonorable or ignored

Female identity and health

• assumed to be emotional

• assumed to be less powerful

• more likely to be victim to domestic/sexual violence

Male identity and health

• Expected to be stoic and strong

• Pressure to be a provider

• homicides

  • 4 times more likely to be murdered

Family roles and health communication

encourage health professionals to honor patients wishes about family involvement as much as possible

Battle metaphor of health

"combat” disease as an “invader,” “fight for your life,” be “strong”

• scientific perspective

• death represents defeat

CONTRAST

making “peace” with the body

• portrays the body as a place of natural harmony

Evidence supports both perspectives → they are not necessarily opposites

Roles

set of expectations that applies to people performing functions in the culture

Caregivers as mechanics / patients as machines

Biomedical model

• focus on finding a physical abnormality and fixing it

• does not encourage emotional communication

Paternalism

Caregivers as parents / patients as children

• doctors issue directives that patients are expected to obey

• high power distance (defer to those of greater status)

Caregivers as spiritualists / patients as believers

• a religious-like faith in caregivers

• placebo effects

• The success of a spiritual ceremony is often said to rely on the patient’s faith in the healer and the greater spiritual force that has accepted the healer as a medium

• ie. Jesus is the “great physician,” shamans will the illness out of people

Health consumerism

Patients/shoppers pay caregivers/doctors to provide information and carry out wishes → Caregivers as providers / patients as consumers

Caregivers and patients as partners

• Patients and caregivers assume roles of roughly equal power

• identify mutually satisfying solutions

• cooperate as peers

Holistic Care

emphasizes overall physical and emotional well-being with an emphasis on maintaining health (ie. acupuncture, meditation, cupping, chiropractic, etc)

Advantages of holistic care

• low cost methods and technology

• based on simple principles

• more personal

• focus on health maintenance and prevention

Disadvantages of holistic care

• many supplements are not thoroughly researched

• scams

• environmental threats (endangered plant species associated with popular herbal remedies)

• lack of communication to physician

Coping

the process of managing stressful situations

• Problem solving: changing what can be changed

• Emotional adjustment: adapting to what cannot be changed

Health self-efficacy

A persons belief that they can successfully manage their health

• Internal locus of control → belief that people control their own destinies

  • good health = good behavior

  • you can control your health

  • North American ideal

• External locus of control → belief that events are controlled by outside forces, more fatalistic

  • you have no control over your health

  • lower self-efficacy

Crisis

an occurrence that exceeds a person’s normal coping ability

• things that seem out of control; natural disaster, pandemic, etc

• highlight a turning point in someones life

Normalcy

the sense that things are comfortable, predictable, and familiar

Social support

behaviors that communicate that a person is valued and cared for

Direct effect model

social support is helpful even when we are not experiencing notable stressors

• argument that social support always has heath benefits

Buffering hypothesis

social support helps buffer people from negative effects of stressful events

• only see health benefits of social support during a stressful event

Link between social ties and good health

Learn from others, physical benefits (sleep, blood pressure), support decision making

Quality of relationship has more health benefits than the quantity

Instrumental support

Performing tasks and favors (ie. lawn work, meals, rides)

Informational support

Providing information (ie. research, sharing findings)

Esteem support

Make a person feel valued/competent (ie. encouraging words)

Emotional support

acknowledge/understand what a person is feeling to cope with change

Social Network Theory

We experience strong ties with people whose social networks overlap with our and weak ties with people whose social networks don’t overlap as much

Strong ties

People in our inner circle; provide support, emotional connection, shared background

Weak ties

People in our outer circle; help establish normalcy, new information/perspective

Ring theory

Highlights best way to support someone/act in a health crisis

• direct comfort inwards (towards the center of the crisis), dump (complaints, struggles) outwards (away from the center of the crisis)

Oversupport

excessive/unnecessary help

Overhelping

Too much instrumental support

Overinforming

forcing information/overload

Overempathizing

overdone emotional contagion (where you feel emotions too similar to the other persons)

Family caregiver profile

Average:

• 2/3 women

• Roughly 40

Sandwich generation

People responsible for taking care of older/aging adults while raising kids at the same time

Family Medical Leave Act (1993)

Jobs in the US legally required to protect employees who take leave to care for their family during a health crisis

• 12 week max

• not always paid

Life at all costs

End of life experience

Death as the enemy of life

• life = victory

• death - defeat

• medicine = savior

Death with dignity

Maintain dignity, comforting surroundings with loved ones. A “good death”

Hospice

• organization that provides support for dying individuals and their families

• provides palliative care (keep a person comfortable and fulfilled at the end of life)

Delivering bad news

Foreshadow (give people a chance to prepare), appropriate setting, acknowledge emotions, follow-up

Advance-care directives

describe in advance the medical care someone wants to receive if they become too ill to communication

• legal document → “Living Will”

• Durable power of attorney/medical proxy

Imperatives

Terms like should/should not, ought/ought not

Terms we use to express commands/directives to perform certain actions/strive to attain character traits

Imperatives are moral (categorical) or prudential (hypothetical)

Levels of moral judgement

1. Supreme/universal principle

   • Act X is morally right if and only if ___

2. General moral rules

   • All acts of type A are morally right/wrong

3. Particular moral judgements

   • Specific act Y is morally right/wrong