SOCI 384 201 Sociology of Health and Illness

Social Determinants of Health

Nonmedical factors that influence health outcomes.

Biomedical Model of Health

A model that describes health as the absence of disease, focusing on biological mechanisms.

Agency

Health behaviors as individual choices affecting health and disease status.

Structure

Societal factors that shape thoughts and behaviors of individuals.

Cockerham's Lifestyle Theory

Examines the gap between individual choices and societal influences on health.

Class Constraints

Social class limits health behaviors and options available to individuals.

Health Lifestyles

Collective patterns of health-related behaviors based on available life circumstances.

The sociology of health and illness is described in two different subparts:

• Research concerned with social consequences in illness, disease, disability and death 

• Institutionalized medical consideration of and social responses to illness and well-being

Biological reductionism

Simplifies sickness and illness to biological processes. Fails to consider social causes of disease (i.e., poverty).

Mind-body dualism

Treats psychological and social distress as less legitimate causes of illness compared to biological processes that makes people unwell

Individualistic

Places responsibility onto patients (i.e., behaviour, lifestyle, etc). It ignores political and economic determinants of health (policy, labor, markets, welfare states).

Limitations of the biomedical model

• A limited number of infectious diseases

• Persistence in chronic illness despite tons of investments

• Why do some people get infected, and others don’t

• Focus on the individual

  • Patient objectification

  • Victim blaming

Upstream SDoH

• Factors that operate at a macro level

• Spatially or temporally distal from health care outcomes

• Policies, economy, and culture

Downstream SDoH

• Factors that operate at a micro, individual level 

• I.e., financial status

• Lifestyle choices are downstream

Life choices

Related to agency and marked by evaluation, imagination, and reconstruction.

Life chances

Related to structure. Situations and contacts that are shaped by four structural variables.

Four structural variables

• Class

• Race

• Gender

• Collectivities

SES Gradient

The observation that individuals with lower socioeconomic status (SES) have higher morbidity and mortality rates compared to those with higher SES.

Fundamental Cause Theory

A theory developed by Link and Phelan stating that resources like knowledge, wealth, and power allow people to avoid risks and adopt protective strategies, maintaining health disparities even as specific diseases change.

Systematic Asymmetry

A core idea of Fundamental Cause Theory where the relationship between resources and health consistently operates in the same direction over time.

Massively Multiple Mechanisms

The concept that fundamental causes affect health through a diverse and ever-changing set of pathways or causes.

Means (Metamechanism)

The purposive use of resources like money, power, and knowledge to actively improve one's health outcomes.

Spillovers (Metamechanism)

Contextual factors and benefits a person receives simply by being in a high-resource environment or social circle without active effort.

Habitus (Metamechanism)

The internalized norms, dispositions, and unintentional lifestyles that shape an individual's health behaviors.

Institutions (Metamechanism)

The agentic action of social structures like the family or school system that influence health outcomes for individuals.

What were the mortality mechanisms during the Victorian Era

During the Victorian Era (1865-1910), mortality was primarily driven by infectious diseases (influenza, TB) due to tight living quarters and unsafe workplace conditions.

Empirical goal

To collect and analyze observable data to describe and measure real-world patterns in health, illness, and healthcare.

Theoretical goal

To develop or apply concepts and theories that explain and interpret empirical findings about health, illness, and healthcare.

Biological Determinism

The theory that differences in mortality and morbidity are purely based on biological factors, often tied to notions of racial superiority or inferiority.

W.E.B. DuBois

An academic scholar who rejected biological determinism and wrote about how racial discrimination affects the health of Black people.

Race as a Social Construct

The understanding of race as a socially-meaningful, categorical, and political construct rather than an objective biological category.

How Race Becomes Biology (C. Gravelee)

A theory suggesting that the social reality of racism has biological consequences and that racial disparities in health reinforce the public perception of race as biology.

Racism (Sociological Definition)

A system of categorization and devaluation of social groups that disempowers certain groups based on the idea of superiority.

Missing Racial Data in Canada

The lack of racial background information on patient identification forms, which makes it difficult to target resources and respond to health inequalities.

Race as a Medical Shortcut

The practice where doctors use a patient's race to make assumptions about diagnoses and interventions, as discussed by Dorothy Roberts.

Core ideas of FCT

• SES transfers into flexible resources 

• Resources can shape health regardless of the mechanisms at play

• Systematic asymmetry - operates in the same direction

• Massively multiple mechanisms - diverse set of causes

Williams & Sternthal (2010) brought 4 new contributions to the study of health and sociology:

• Misunderstand the biological understanding of race

• Focus on social structure and context

• Look at how racism affects health (i.e., structural, institutionalized, individual, etc)

• How does migration history affect health

Racism as a Fundamental Cause

The theory that systemic racism leads to health disparities by controlling access to flexible resources like prestige, power, and social connections, independent of SES.

Healthy Immigrant Effect (HIE)

An epidemiological finding where immigrants arrive with better health than the native-born population, but their health declines over time due to various social and environmental factors.

Salmon Bias

A phenomenon where immigrants who experience health or economic challenges return to their home country, leaving a "healthier" segment in the host country's statistics.

Negative Acculturation Effect

The process by which immigrants' health declines as they adopt unhealthy lifestyles of the host country, such as poor diets or sedentary habits.

Sex vs. Gender

Sex refers to biological characteristics (e.g., hormones, chromosomes), while gender refers to the social construction of roles, identities, and relations that impact health outcomes.

Health Survival Paradox

The observation that women generally report poorer health and higher morbidity rates throughout life, yet consistently live longer than men.

Relational Theory of Men’s Health

A theory by Courtenay (2000) suggesting health behaviors are used to construct and perform gender identities, often linking masculinity with high-risk or unhealthy actions.

Risk-taking Hypothesis

The idea that gender socialization encourages men to embrace risky behaviors and underreport health issues to reinforce cultural ideals of toughness and power.

Flexible Resources

The underlying assets tied to SES (e.g., money, knowledge, power, prestige, social connections) can be used to protect health across different diseases and changing mechanisms.

Pattern 1: Women live longer than men

Women generally outlive men; in Canada, this gap averages approximately 5 years, with the disparity often being larger in lower class status groups.

Pattern 2: Women are more likely to be diagnosed as suffering from more ill health

Women are more likely to be diagnosed with ill health, including mood disorders, chronic conditions like arthritis or depression, and poor health reports in mid-to-late life.

Pattern 3: We see gender differences in major causes of death

There are distinct gender differences in mortality; men are more likely to die from accidents, cancers, and cardiovascular disease, while women are more likely to die from natural causes.

Pattern 4: Women utilize more health services

Across various racial and social groups, women utilize health services more frequently and are more likely to seek medical assistance than men.

We see racial differences in flexible resources:

• Prestige or status

• Power 

• Beneficial social connections

• Freedom (moving from slavery to mass incarceration/policing)

Why is the HIE paradoxical?

The immigrant health effect is paradoxical because when people enter the country we see many immigrants faces challenges like lower income, language barriers, and frustrations navigating the healthcare system which means they should have lower health outcomes, but HIE proves they do not.

HIE Explanations

• The host country sets standards to ensure immigrants have good health before entering the country

• Migrants are a self-selected segment of the original population. Migrants may have higher levels of resilience, grit, and mental well-being.

• Health declines overtime may be due to aging

• Living in Canada may improve health (i.e., clean water, clean air, food accessibility, housing, etc)

Health behaviours and outcomes differ based on intersecting factors such as;

• Toughness as a masculine ideal 

• High-class men: overwork, stress denial, and sleep deprivation

• Working-class men: physical endurance, dangerous labour, and pain tolerance

• Poor men: violence or bodily risk

Constructionist Perspectives

A viewpoint that splits the understanding of health into 2 levels: the biological disease and the social level.

Disease

The specific biological condition or pathology as defined by medical science.

Illness

The social meaning and context attached to a biological condition; how the condition is interpreted by society.

Sociological Model

A model that views health systems as socially constructed and emphasizes the influence of social environments on the body and mind.

Stigmatized Illnesses

Illnesses carrying cultural markers that devalue individuals, signaling to others that they are tainted or "less than full."

Norm Enforcement

A social mechanism where symptoms that are perceived as immoral, preventable, or abnormal trigger negative character judgments and social sanctions.

Contagion Avoidance

A reaction to illness, such as HIV or STIs, where fear of danger and infection dominates over moral judgment, leading people to distance themselves.

Contested Illnesses

Conditions characterized by medical uncertainty or lack of consensus, where doctors may be skeptical of patient symptoms (e.g., chronic fatigue syndrome).

Disabilities

Physical or mental impairments that are socially defined as abnormal and as reducing an individual's functioning within society.

Patienthood

The experience of an illness within clinical encounters, governed by structured medical norms and interactions with healthcare professionals.

Illness Experience

The everyday experience of living with a condition outside of the clinic, including how one manages daily routines and explains the illness to themselves.

Biographical Disruption

A rupture to a person's concept of self, social relationships, and resource use caused by the onset of a chronic illness.

Defining disorders: Appropriateness

Is the illness occurring under an appropriate circumstance based on the context?

Defining disorders: Proportionality

Is the illness proportional to the circumstance at play?

Defining disorders: Duration

Is there an appropriate amount of time for this illness to occur?

Transitions in medical sociology

• Social epidemiology - medical definitions have the same meaning across all groups

• Illness behaviour - determines what is considered a true mental health disorder

• Labelling/medicalization

Gene-enviroment interplay

Genes can be turned on or remain off based on social contexts. Supportive environments can limit genetic liabilities.

Epigenetics

Social factors can change gene expression throughout your lifetime (i.e., child abuse, sexual assault, pollutants).

Policy Interaction

Structural changes to limit health autonomy (i.e., the prohibition of tobacco and smoking has reduced the number of smokers; however, smokers today are predisposed to having a nicotine addiction. Policies can filter out people who are not predisposed to nicotine addiction).

Mental and physical disorders are shaped by ___________

social context, cultural norms, and institutional interests

What are the three lenses Horowitz uses to define mental disorders

• Natural response vs internal dysfunction

• Mismatch between genes and environment

• Culturally shaped harm

Natural response vs internal dysfunction

• Triggered by appropriate contexts (i.e., loss, fear, danger)

• Intensity is proportional to the environment

• Issue is resolved when the context solves itself and/or coping occurs

• Disorders emerge when the responses do not align with the context (i.e., sadness without loss). No underlying trigger/cause

• DSM shifted to symptom checklists but ignores social context

Mismatch Between Genes and Environment

• Certain conditions reflect normal human nature in new, and unnatural settings

• Phobias are functional because they work in a way to protect us (i.e., many phobias are evolutionary such as snakes, heights, flying, etc)

• There is concerns when people show fears about forces that are not natural to the environment (i.e., fear of olives, juice boxes, sinks, etc)

• Horowitz argues that obesity is not a dysfunction but rather a mismatch between our natural instincts and the food environment 

Culturally Shaped Harm

• Cultural context influence the extent to which harm experienced by people with mental dysfunction

• Harmful dysfunction - disorders are a failure of a biological function and impairment in a social setting

• WHO found that schizophrenic patients do better in less industrialized countries with strong support systems

• When disabled people are placed in supportive environments they may not experience their dysfunction as an impairment