SOCL 4451: The Sociology of Medicine Exam 1

Taught by Samuel Stroope Fall 2025

confirmation bias

What is the tendency to search for, interpret, favor, and recall information in a way that confirms or supports one’s prior beliefs and values

The Enlightenment

What intellectual movement occurred in the 17th and 18th century?

• emphases: reason, skepticism, tolerance of free speech, individual freedom

• Key figures: John Locke, Isaac Newton

• scientific inquiry based on the principles of this movement

Employer, individual purchase

What are the different sectors of the private healthcare insurance system in the U.S.?

employer (56%)

What type of insurance accounts for a majority of the American Healthcare system?

Medicare, Medicaid and CHIP, Veterans Affairs, Tricare, and Indian Health Service

What are the different sectors of the public healthcare insurance in the U.S.?

17%

What percentage of the U.S. population are covered through Medicare?

20%

What percentage of the U.S. population are covered by Medicaid and CHIP?

9%

What percentage of the U.S. population is uninsured?

32-41%

What percentage of people in Louisiana are covered primarily by Medicaid program?

Healthy Louisiana

________ is the primary Medicaid program in Louisiana that has different private health plans that help manage care benefits.

• private health plans include

  • Aetna

  • Amerihealth Caritas Louisiana

  • United Healthcare Community Plan

  • Amerigroup Louisiana

  • Louisiana Healthcare Connections

economic resources, social and political values, and historical experience

The implementation and policies regarding Medicaid reflects the national….

critical junctures

_____ are situations of uncertainty in which decisions of important actors are casually decisive for the selection of one path of institutional development over other possible paths.

• many healthcare systems for different countries were set in stone after WWII

• different points in history where lots of decisions are made at once and its really difficult to go back and change your mind.

path dependency

______ is a situation when a system or organization follows one possible path such that others become more difficult to adopt.

economic and military power and political stability

Europe developed their Health Services in the late 19th century (1800s) and expanded them gradually. Many Europeans receive comprehensive health insurance for all citizens of any income. What were their motivations?

80%

Greater than ____ of all health costs in the EU financed from public sources like direct or consumption tax. (does not include UK and Norway)

11% :: 17%

Europe expenditure on healthcare: ______ GDP :: U.S. expenditure on healthcare: ______ GDP

United States Model

What model is a mostly private health care system with public insurance and for-profit private insurance but no universal coverage?

• profit → unique part of system

• some public insurance: most covered privately

• low regulation of prices → lack of changes in prices

• no individual mandate to have health insurance

Bismarck model

What model is a mostly private healthcare system with both private and public insurance?

• ex. Japan, Germany, Netherlands, Switzerland, Belgium, France, US full-time workers <65

• multi-payer system

• payers generally private

  • funding: employer/employee tax, premiums, general tax

  • mostly non-profit but some for-profit

• providers are generally private

  • doctor’s office → private business

Beveridge model

What model is a mostly public healthcare system with public insurance (and some private) with universal coverage?

• payer typically the government

  • single payer* but also room for private insurance so has government and private payers

  • funded: taxes

    • supplemental private insurance (want private room/ faster waiting times)

    • fee or minimal cost at point of service

• providers typically public but some private

• regional administration; different administrations per area

• non-pure single payer systems

  • ex. Great Britain, Italy, Spain, Nordic

• Pure: Cuba, US Veterans Affairs, and Indian Health Service

• tight regulations → strong individual mandate for health insurance

  • strong (complete) government control of medical procedures and prices

National Health Insurance Model

What system is a mix of the Bismarck and Beveridge model?

• payer: public insurance

  • national or regional

• funding: everyone pays into

• providers: typically private (main difference from Beveridge model)

• ex. Canada, South Korea, Taiwan, Australia*, US Medicare/Medicaid/CHIP/Tricare

  • Australia → required to have insurance, 60% of hospitals are public, and ½ of population has private insurance to control their healthcare experience

• in some places private is allowed to compete with public insurance → private insurance market for certain types of services

mostly private hospitals and doctors, more flexible, public/ quasi public, pay premiums directly to healthcare

What makes the National Health Insurance model different from the Beveridge model?

• Beveridge

  • majority/ almost all public hospitals

  • doctors paid by government

  • less flexible

  • paid out of general taxes → part of national budget

Tommy Douglas

Who is known are the “father of Medicare” in Canada because he created the 1962 law in Saskatchewan?

• faced a lot of backlash, had privatized system prior (path dependency)

• people who were upset: healthcare insurance agencies, members of public, and doctors

• American Medical Association also opposed and did not want pay cut

1971

When was Medicare enacted in all of Canada?

Out of Pocket model

What model has no mass medical care system with some private and public insurance and care with no universal coverage?

• urban with economic means/well-connected: private insurance/ pay directly for reliable care

• public/charitable care options may exist; significant access and quality issues

  • may have untrained doctors practicing without proper safeguards

• much of the population has little access and insufficient means

• ex. Cambodia, India, Central African Republic, uninsured in U.S.

rising costs, aging populations, acute shocks

What are some of the challenges to healthcare systems worldwide/ external issues to the U.S.?

high prices, national spending, medical debt/bankruptcy, and uninsured going without care

What are some of the serious problems in the U.S. internal to the system?

provider services (prices are sky high and unregulated), provider administrative activities, and provider salaries (specialties are paid higher)

What are the top problems/ contributors of U.S. healthcare spending?

sources of U.S. healthcare spending

What are these sources contributing to?

• provider services: high prices that are unregulated

• provider administrative activities

• provider salaries: specialists are paid higher

• insurance administrative activities

• prescription drug costs

• medical technology/equipment: providers adapt newest tech

• for-profit element: maximize return to share holder

• utilization: we have a high level of people using system

comprehensive benefits, innovation in payment, chronic care coordination, mental health care, innovation in care delivery, and access to innovative drugs

What areas is the U.S. good at compared to other healthcare systems? (there are 6)

social factors

Only about 10% of contribution to premature death comes from health care. What accounts for the largest portion of contribution (60%)?

• includes: social circumstances, behavioral patterns, environmental exposure

medical sociologist

_____ study the social factors that shape health. The American public generally recognizes the idea that social factors influence health.

minimized

In behavioral medicine, public health, and epidemiology, social factors are _____ with the exception of stress.

• thought of as an indirect, secondary cause of illness

exposure, susceptibility, and disease course/ outcome

How do social factors shape health?

• social factors have a direct causal effect on health

• social conditions are needed to bind a person to the disease → therefore, causal

smoking

What is associated with more diseases than any health-related lifestyle behavior?

• 10 years shorter life expectancy

• rates have declined 

  • 45% 1950s → 20% recent decades

• Low SES people are more likely to participate

  • occupation, education, social network, income, and general wealth

becoming a smoker, continued smoking, regular smoker, addicted smoker, and smoking cessation

What are Hughes 5 stages of smoking?

• start to finish of the behavior are social 

biomedical model

What model states that every disease has a specific pathogenic origin whose treatment can best be accomplished by removing or controlling its cause using medical procedures (e.g., a drug)?

• ex. measles line graph → shows that availability of drug/vaccine declines disease rates

• limits for addressing chronic disease

  • limited access

  • social conditions and behaviors

epidemiological transition

What theory claims that there is a replacement of infectious disease with chronic diseases as major threats to health?

age of pestilence and famine, age of receding epidemics, and age of degenerative and human-made diseases

What are the three ages of the epidemiological transition theory?

early times to 1800s

At what time did the age of pestilence and famine occur?

• infectious and parasitic diseases

1800s to 1960s

At what time did the age of receding epidemics occur?

• better living conditions and medical treatment

• infectious and parasitic disease are controlled

1960s to present

At what time did the age of degenerative and human-made diseases occur?

• availability of resources and treatment now killing us

• less exercise required now but that can lead to other issues

• chronic disease

• social factors become more prominent

• possible 4th stage “age of mixed causes”

  • chronic and emerging infectious disease

experience of illness, social patterning of population health and disease, and causation of health and disease

What do social factors of health impact?

social determinants of health

What is the condition in which people are born, grow, work, live, and age, and the set of forces and systems shaping the conditions of daily life (WHO)?

• social factors → causation of health and disease

fundamental cause theory

What theory says that social conditions can be fundamental causes of disease and mortality?

• by Link and Phelan

impact multiple diseases, impact through multiple pathways, occurs over time, and affect access to health-protective flexible resources

What are the 4 criteria a cause must meet to be considered a fundamental cause by the FCT?

social conditions

What are factors that involve a person’s relationship with other people?

flexible resources

_______ are broadly useful across times and places.

• when a new risk emerges, or a new protective factor is discovered, they shape who benefits and who is harmed

• can limit choices (avoid risks)

• can expand choices (health promotion)

• individual people use resources to get healthy outcomes

• resources can provide access to salutary contexts

  • ex. neighborhoods, occupations, marriages

collective health agency

What is the collective resource pooling when people in such contexts push for good circumstances in the context called?

• ex. good schools, safe parks, reduced crime, good medical facilities

socioeconomic status

What has been a particular concern to the fundamental cause theory?

• checks all the fundamental cause boxes

• we have an education gap in life expectancy

  • widening gap

  • widening from Bachelors degree improvement and non-Bachelors degree stagnation

unit of analysis

What is the entity being studied called (ASSR)?

• most common is people

families, high schools, corporations, religious congregations, cults, governments, counties, nations, or people

What are some different types of units of analysis (ASSR)?

ecological fallacy

What occurs when a researcher incorrectly concludes that ecological or contextual factors directly influence individual-level experiences, where group-level data are used to make claims about individual-level processes (ASSR)?

• using data from one type of unit to draw conclusions about another type of unit

use data/observations from one level to draw conclusions based on that level of analysis only

To avoid the ecological fallacy, researchers should… (ASSR)

the health care system, health behaviors, and the built environment

What are the three explanations as to why the U.S. population health has fallen so far behind its high-income counterparts thought of as proximate determinants of health (HH3)? 

social inequality, social policy, and culture

What are the three distal reasons that the US population health has fallen behind its high-income counterparts (HH3)?

health care system and health behaviors

Emphasis on these two proximate determinants of health in research are due to being easier to compare and measure across countries rather than explain the argument that health care and behaviors are more important than structural determinants. What two factors are often focused on in research literature (HH3)?

not providing universal, publicly funded system of health care

Why is the United State unique among high-income countries (HH3)?

Veterans Health Administration

What system in the US is similar to the UK’s National Health service that is government-run, funded through taxes, that provides care to all British citizens (HH3)?

Medicare, Medicaid, and the Children’s Health Insurance Program

What U.S. health system is similar to Canada’s national health insurance program that pays for health care from private providers for all Canadians (HH3)?

socioeconomic status (SES)

What are differences between individuals and groups in the possession of highly valued societal resources, most importantly educational attainment, occupational status, income, and wealth called (HH5)?

social class

What Marxist based idea is based upon an individual’s relationship to the means of production (HH5)?

economic status, social standing, and political power

What are the three important components of social stratification outlined by Weber (HH5)?

health and longevity

Weber developed the idea that individuals actively utilize their class, status, and power to improve their “life chances.” What are two critical components of life chances (HH5)?

educational attainment

What is the most often-utilized measure of socioeconomic stats in the U.S. studies of population health?

• because it does typically does not change when individuals experience declines in their physical or mental health

False

Individuals who have a low income or who live in a household with low income simply have far greater monetary resources to protect their health (HH5). T/F

material; psychological

Individuals may experience poorer ______ conditions when living with low income, but also individuals who have low income while living in a wealthy society may also experience poorer ________ conditions of relative deprivation when comparing themselves with their wealthier counterparts (HH5).

wealth

Which is more unequally distributed in American society, wealth or income?

no wealth

15% of U.S. families have ______.

$40,000

40% of American families have less than ________ in wealth.

inequality

Since the 1970s, American social stratification have resulted in the highest-ever levels of income and wealth ______ in American history.

de-unionization, changes in the way corporations are governed, tax policies favor high earners and the wealthy, and federal spending on income transfers has been redistributed away from the poorest people to those with higher incomes

What specific institutional changes and circumstances have led to such widening in the U.S. distribution of income and wealth in recent decades?

True

The United States is experiencing the widest gap in SES disparities in key measures of population health ever documented. T/F

1980s

When did the association between health and education become strong?

the accumulation of socioeconomic resources across the life course

Why do the SES differences in health tend to be small in young adulthood but grow larger in middle adulthood and early old age?

childhood and adult SES

What are important predictors of old age functional health in the United States?

relationship between socioeconomic status and health

the issue of multiple mechanisms

Why is a policy or programmatic focus on single mechanisms not enough to reduce or eliminate SES disparities in health?

technological advances, rapid availability of health-enhancing information, and advanced medicine giving humans more control over health

Why have social factors like SES become especially more important in modern societies?

it could be genetics, family background, or infant and child health characteristics

What are some critiques of using SES as a fundamental cause of population health or other reasons for the strong-association between SES and health over the life course?

researchers cannot use experimental designs in this area of study

Why is the scientific work on the causal effect of SES on health extremely difficult?