society 469 midterm

sociological imagination

awareness of broader social forces that play an influence in the behavior of individuals in society

upstream/downstream metaphor

• upstream: social determinants

• downstream: individualized consequences

“manufacturers of illness”

individuals/groups who produce goods/services that also lead to morbidity and mortality

social structure

arrangement of relationships and roles that function to organize society

social institutions

specific systems within a social structure

examples of social institutions

government, education, family, religion, healthcare system

agency

individual’s ability to act independently and of their own free will

how are social structures related to agency?

social structures can enable or constrain one’s ability to exercise their own agency

downstream interventions

blame/focus on individuals while neglecting the role of “manufacturers of illness” in promoting unhealthy behaviors

political economy of illness

• the idea that our health is shaped by wealth and power, not just our biology

• economic systems, like capitalism, and political rules create unequal living conditions that make some people sicker than others

quasi health behaviors

• artificial needs created to maintain consumption

• vitamins, supplements, peptides, etc

social constructionism

social phenomena that isn’t discovered, but constructed through social interaction

illness as a social construct

experience with illness is shaped by cultural and moral values, interactions with others, and beliefs about what it means to be “sick” or “healthy”

disease

biomedical dimension of sickness

illness

subjective experience/sociocultural dimension of sickness

social construction of medical knowledge

production of medical knowledge influenced by social forces and can reflect/perpetuate existing forms of social inequality

illnesses are defined by who?

certain stakeholders and those in power

examples of illnesses being defined/framed by stakeholders and those in power

• big pharma and GAD

• drapetomania

• hysteria

hysteria

unacceptable behavior in women that “required” treatment

drapetomania

runaway slave disorder

diagnosis

how society determines there is a disease/condition

diagnosis as a process

• determining what’s normal/abnormal

• medicalization (delineating what’s in the realm of the medical profession)

• authorizing physicians to label and treat illnesses

medicalization

delineating what’s in the realm of the medical profession

diagnosis as a category

• helps sufferers obtain social services and legitamize suffering

• can unnecessarily pathologize human behavior (over-diagnosis, labeling/stigma)

proximal causes

risk factors of disease

examples of proximal causes

smoking, poor diet, substance abuse, lack of exercise

fundamental causes

social conditions that place people at risk of being at risk

fundamental cause criteria

1. persistently associated with disease despite changes in intervening mechanisms over time

2. involve access to flexible resources that can be used to avoid risk/minimize disease consequences

3. linked to multiple disease outcomes via multiple risk factors

intervening mechanisms

risk factors and protective factors

examples of intervening mechanisms

improvements in public health infrastructure

flexible resources

resources that help people avoid risks or minimize the consequences of multiple diseases

examples of flexible resources

social capital, social networks, money, knowledge, power

ethnography

participant observation, immersive research

Lucy and Freese (2005)

• 2 diabetes clinics (one served higher SES patients, other served lower SES patients)

• SES can affect success/implementation of diabetes treatment via:

  • organizational features (continuity of care)

  • external constraints (lack of insurance coverage, occupation, social network)

  • psychological factors (apparent lack of motivation with low SES, relative costs of complying)

Phelan and Link (2015)

• racism a fundamental cause of inequalities in health

racism as fundamental cause criteria #1: changes in intervening mechanisms linking racism to health inequality

• risk factors (enslavement, Jim Crow laws, segregation, cover forms of racism/discrimination)

• protective factors: white supremacist doctrine

• persists over time despite advances in racial equality

racism as fundamental cause criteria #2: involves access to flexible resources

• systemic ransom advantages white people through unequal allocation of flexible resources

• structural factors (overrepresentation/dominance in media, government, educational institutions, medicine)

• individual resources (wealth, power, prestige, social capital, freedom)

• social psychological advantages

psychological wage of whiteness

• describes the unearned, non-monetary societal benefits granted to working-class white people

• racial vs class solidarity

racial capitalism

racial hierarchy protects capitalism

Louie and DeAngelis (2023)

• as proportion of Black residents increases, white residents are more likely to perceive neighborhoods as dangerous

• low SES whites reported perceptions of increased status when living near more Black neighbors

racism as fundamental cause criteria #3: linked to multiple disease outcomes via multiple risk factors

• multiple disease outcomes

  • race related to all major disease outcomes

  • many of these persist even when SES/education is accounted for

• multiple risk factors

  • stress (experiences of discrimination)

  • lower quality healthcare

  • residential segregation

SES

• social class

• dimensions include wealth, occupation, cultural capital/education

status crystallization

dimensions of SES (wealth, occupation, education) are highly correlated

most common measurement of SES

educational attainment

why is education the most common measurement of SES?

• cultivates skills/cognitive abilities that support good health

• doesn’t decline during periods of poor health

• can be measured for those outside of the labor force

gold standard of sociologist’s health measurements

mortality rate

ways that sociologists measure health:

• mortality rate

• self-rated health

• health behaviors

• specific medical conditions

• biomarkers

biomarkers

• biological markers of metabolic, cardiovascular, or immune functioning

• can help identify underlying biological risk factors before disease manifests

mechanisms linking SES to health

• neighborhood SES

• material resources and material deprivation

• income inequality and relative deprivation

• human capital

• social capital

• cultural capital

• diffusion of innovation/FCT

• life course

income inequality

increases in income inequality lead to lower levels of social cohesion, cooperation, social investment, and social welfare system

relative deprivation

lower SES individuals with lower status jobs compare themselves to higher SES peers leading to frustration, stress, and adverse health

cultural capital (Bourdieu)

• resources classes use to signal membership, set boundaries around preferences, and distinguish themselves

• education is a major way to gain cultural capital

• certain health behaviors associated with different levels of cultural capital (pilates, yoga, healthy eating, etc)

cultural health capital

knowledge regarding how to navigate the healthcare system

life course

• early exposure to social disadvantages relates to poor health later in life

• cumulative advantage/disadvantage

dejure vs defacto

• dejure: by law

• defacto: in reality

importance of SES reform

improving socioeconomic conditions will improve population health for everyone

biological construction of race

innate physiological/genetic differences between races

race

hierarchical classification system based on skin color that is created/maintained by those in power to uphold white supremacy and justify subordination of other racial groups

Thomas Theorem

if people define situations as real, they are real in their consequences

why was race invented?

• justify enslavement of African people by settler-colonialists looking for a source of cheap labor

• capitalism deeply tied to racism

Omi and Winant’s “Racial Formation in the US”

race-making is a sociohistorical process influences by social, economic, and political forces

the human genome project

• humans over 99.9% genetically identical

• more genetic variation within racial groups than between them

• variations in physical appearance exist due to environmental adaptations

racial essentialism

• belief in fundamental biological differences between races

• gives idea of race more legitimacy

• used by whites in power to justify the continued enslavement and mistreatment of Black people

Linnaeus’ racial taxonomy

• took species of homosapiens and divided them into 4 geographical categories/racial categories

• more categories added over time

immigration

moving to live in receiving/host country

emigration

leaving a particular country

nativity

distinction between people born outside of the country in which they’re living and people who are living in the country in which they’re born

health selection

immigration of especially health individuals to a destination country, as well as emohration of especially unhealthy individuals back to their home countries

immigrant incorporation

extent to which immigrants are socially, economically, and culturally integrated into their host society

major reasons for immigration (most prevalent to least)

• family reunification

• refugees

• employment needs

• diversity

why do people immigrate?

• young adults (sometimes with children) seeking a better life in the US

  • tend to be healthy, motivated, and seeking work

  • usually more highly educated than those who don’t migrate

• young adults (sometimes with children) fleeing war/political crises

  • health/education not as much of a factor

• older adults reuniting with family members

  • health/education not as much of a factor

healthy migrant effect

successful migrants tend to be the healthiest people from their country of origin

salmon bias (selective out-migration)

older, sicker migrants likely returning to their country of origin makes the remaining migrant population in the receiving country appear healthier

immigrant health advantage

1st-generation immigrants tend to have better health and longevity than their US-born peers

Hispanic Health Paradox (HHP)

Hispanic immigrants have mortality outcomes similar to or better than native-born white Americans despite having a similar socioeconomic profile to Black Americans

Hummer, et al (2007)

evidence for paradox using infant mortality rate

erosion of health advantage

• obesity and disability rates increase with duration in the US

• protections from high educational attainment disappear with time

generational erosion

• immigrant health affect for Latino/a immigrants doesn’t seem to be passed down to the next generation

  • many health issues tend to be worse in 2nd or 3rd generations

underlying mechanisms of health advantage erosion

• effects of acculturation

  • immigrants’ health tends to deteriorate as they adopt harmful health behaviors and adapt to host country

• adapting to America’s racialized social system

* patterns of health erosion depend on multiple factors (race/ethnicity, skin tone, age, undocumented status, policy context)

sex vs gender

• sex: biologically constructed

• gender: socially constructed

  • changes over time

  • gender is a performance

socialization

lifelong process of learning and internalizing societal norms, beliefs, and values

how do we learn gender norms?

agents of socialization

gender essentialism

• sex is the same as gender

• biological differences between genders (men are stronger/smarter, women are weaker/dumber)

certain health behaviors associated with masculinity and femininity

• masculinity: suppressing medical needs and refusing to acknowledge pain

• femininity: making doctors appointments, positive health behaviors

cultural idea of men as healthy and women as the “sicker” gender

• men receive less physician attention

• men not encouraged to monitor health as much as women

• men don’t inherently seek help

structural sexism

systematic gender inequality in power and resources manifest in a given gender system

levels of structural sexism

• institutional

  • political and economic

  • limits women’s access to material resources, quality healthcare, and increased exposure to violence

• interactional

  • social relations and behavior patterns

  • marital dyads and violence, gendered division of labor

• individual

  • perceptions and identities

  • internalized gender roles/norms which become embodied

intersectionality

theoretical framework for understanding how intersecting social statuses place individuals within a larger “matrix of domination” comprising interlocking systems of oppression and privilege that often compound on one another to create unique experiences of inequality

Add Health

• national longitudinal study of adolescent to adult health

• started at UNC

Hargrove, et al (2020)

• depressive symptoms decrease across adolescence before increasing in late 20s/early 30s

• racial/ethnic minorities reported more depressive symptoms than whites

• women reported more depressive symptoms than men

racialized heteropatriarchy

structural co-occurence and interaction of race, gender, and sexuality based discrimination that together unfairly allocate power and resources to cis, heterosexual white men and oppress women, LGBTQ+ people, and/or non-white people

heteropatriarchy

system that privileges cis men and heterosexuality which serves to reinforce dominancy of “traditional” heterosexuality, including women’s subservient role in the household

physical neighborhood disorder

• abandoned buildings, graffiti, filth, disrepair signal breakdown of social order/control

• lack of safe outdoor spaces to engage in positive health behaviors

• unsafe housing

• exposure to environmental hazards

social neighborhood disorder

• crime, loitering, public drinking/drug use, conflicts, police presence signal breakdown of social order/control

• increased crime leads to anxiety, vigilance, avoidance of outdoors

• lack of social connection/cohesion among neighbors

social ties and support networks

• improve health (directly and as stress buffers)

• mechanisms linking social ties and support networks to health outcomes

social influence/comparison

health behaviors modeled by peers

social control

surveillance and policing of certain behaviors by others in network (ex: HOA, neighborhood watch)

perceived social support availability

support there when you need it that helps cushion the effects of acute stressors

social closure mechanism

white people “protecting” their resources (ex: redlining)

McKinlay, 1975

• political economy of illness

• upstream/downstream

• manufacturers of illness

• quasi-health behaviors

• role of the food industry in illness and chronic disease

• many public health interventions place responsibility on the individual