SOCI 384 201 Sociology of Health and Illness
Dr. Ethan Raker
M/W 9:30-11 AM
Office Hours - Wed @ 12-1 PM in Ponderosa Annex A 210
January
Jan 5
Introduction
Always do readings before class!
20% participation - engagement in class, in-class activities (solo, partner, or group of 4) / graded on effort
Reading checks
Start at the beginning of class
Hand-written
We will know the answer of the question before the class
Check to comprehend and class attendance
Office hours, engaging with the class, staying on task
35-45% midterm
February 25
Review before the midterm (February 23)
Exam in-class
MCQ, short answer, and long essay
35-45% final exam
Final paper analyzing the COVID-19 pandemic from a sociological perspective
Select a topic directly or indirectly related to COVID
Need topic approval
EXTRA CREDIT (2 PT) DUE DATE - April 16, 2026
NOTE: Whichever assignment you perform well on, you get a higher percentage weighting
Course Outline - Four Modules
Social position and health
Constructions of health
Environments and health
Approaches to health
Health Across Groups
In relation to COVID deaths, we see there is a racial disparity across mortalities between different ethnic groups
There is a higher number of deaths among BIPOC people compared to White people
Differences between deaths between men and women in Canada
The death across genders in Canada is roughly 51% males and 49% females
Mortality Across Place
We see differences between geographic spaces and mortality
In Sweden, we see 5% of boys will die between the ages of 15-60
95% of people will live past 16 years old
In Zimbabwe, we see 18/20 boys will die between the ages of 15-60
Jan 12
Health is your Wealth
The sociology of health and illness is described in two different suparts:
Research concerned with social consequences in illness, disease, disability and death
Institutionalized medical consideration of and social responses to illness and well-being
Started from a critique of the biomedical model of health
Integrated in public health policies today
How different illnesses and diseases are recognized and given social context in different institutions (i.e., health, family, culture) / it is culturally dependent (i.e., America vs Africa)
Disesases are recognized, diagnosed and treated across different institutions (i.e., hospitals)
We see health and illness as social processes
Biomedical Model of Health
Biomedical model of health - understand how different mechanisms cause diseases
Health is the absence of disease
Doctors realize there is a biological reason as to why people get sick, and it was not a curse or unfortunate circumstances
Doctrine of specific etiology - pasteur’s germ theory which says disease is caused by germs infecting the organs
The biomedical model is incomplete, doesn’t capture the full picture of what shapes health outcomes
Sociologists suggest that for short-term illnesses the biomedical model suffices
Long-term illnesses (i.e., diabetes) it fails to capture the reasons behind these illnesses
Critiques
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
Misunderstands chronic illness, pain syndromes, and unexplained symptoms
Individualistic - places responsibility onto patients (i.e., behaviour, lifestyle, etc)
Ignores political and economical determinants of health (policy, labor, markets, welfare states)
Limitations
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 - individual’s responsibility to cure their illness
Social Factors Shape Health
Social determinants of health - nonmedical factors that influence health outcomes
Upstream SDoH - factors that operate at a macro level / spatially or temporally distal from health care outcomes / policies, economy, culture
I.e., Smoking ban
Downstream SDoH - factors that operate at a micro level / individual-level
I.e., Financial status
Lifestyle choices are downstream
Health Lifestyle Theory
Many examples of lifestyles that emerge at the intersection of agency and structure
Veganism, trad wife, gym bro, clean girl, digital nomad, etc
Cockkerham’s article on lifestyle theory examines the gap between structure and agency on shaping health
Are health decisions largely a matter of individual choice or principally influenced by structure?
Agency - health behaviours as individual choices / lifestyles affect health/disease status
Public health models - banning smoking programs
Structure - societal factors shape the thoughts and behaviours of individuals / social and cultural contexts
Public health models - anti-smoking laws that place smokers as deviants
Cockerham rejects the idea that health behaviour is a matter of individual choice / demands we need a lifestyle theory
Structural conditions can act on individuals and shape their lifestyle patterns in particular ways
Agency lets people reject or modify lifestyle patterns, but structure limits the options that are available
Class constraints - SES, budgets, where we can shop, etc
Limits our health behaviours and our dispostions
Class circumstance shaped your decision
Agency-Structure Interplay
Life choices - agency / marked by evaluation, imagination and reconstruction
Life chances - structure / situations and contact that are shaped by four structural variables
Class
Race/ethnicity
Gender
Collectivities
Health lifestyles - collective patterns of health-related behaviours based on options available limited to life circumstances or chances
High-class people have higher belief that they can make lifestyle decisions that will have a positive impact on their well-being
Groups of people with similar class levels have similar health behaviours
I.e., High class people can afford gym memberships, organic food, therapy sessions, etc
Jan 14
SES and Health
Low SES people have higher mortality rates than high SES people
Why is there an SES gradient for morbidity and mortality?
We want to understand the mechanisms:
Diets, access to healthcare, time constraints, stress, general knowledge, bias from the healthcare system, etc
Victorian Era
We are going back to 1865, looking at the lifestyles of taxpayers and common people living in Rhode Island
In 1910, located in Hamilton, ON we see the difference between high SES and low SES mortality rates
What are the mechanisms of mortality in 1910 and 1865?
Disease was a major influence on mortality rates, people caught influenza, polio, tuberculosis
This occurred because of tight living quarters
Work conditions were a second influence on mortality rates, unsafe work places (i.e., factories, etc)
This is a social mechanism
Other mechanisms:
Contaminated water, poor sanitation, crowded housing, substandard housing, lack of vaccines for TB, small-pox, cholera
Today, we have laws and technologies in place to keep people safe and maintain public health
Fundamental Cause Theory
Fundamental social cause - developed by Link and Phelan, resources (i.e., knowledge, wealth, power, prestige, networks) that shape people’s ability to avoid risk and adopt protective strategies, which reduces mortality and morbidity / fundamental causes have impacts on disease even when the profile of risk and protective factors change
People with more resources are going to use their resources to avoid risks and boost their health outcomes
I.e., High SES will use all their money or connections to get better health. If there is a virus going around they can afford to visit the doctor and purchase costly pharmaceuticals
Empirical goal - explains the relationship between SES and health despite changes in diseases/risk
Theoretical goal - change the focus on intervening mechanisms, because social factors can change and the relationship will continue
Social factors are fundamental causes if they fulfill these categories:
Related to important resource access
Affect multiple disease outcomes
Occur through various mechanisms
Linked to disease even when intervening mechanisms change
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
Cholesterol Example
High cholesterol and high blood pressure are two chronic health issues, and can lead to death
In the 1970s, high SES people consumed more fatty foods (i.e., animal products, butter, etc) and low SES people did not
After 1999, with the introduction of statins (i.e., medicine) the levels of cholesterol reduced for high SES folks because they could use their wealth to purchase the drug, whereas low SES people are unable to
This occurs despite no changes (or minimal changes) in diet between both class groups
FCT Expansion
Freese & Luftey expand on the FCT argument
They argue that resources are “ambiguous”
We have resources beyond individual purposive action
Agency
Individual action
There are resources that you receive from living in high SES areas, and being surrounded by more resources, that you do not have to work for on your own
They add 4 metamechanisms:
Means - use of resources to improve health (money, power, knowledge, capital, etc)
Spillovers - contextual factors
Habitus - norms, disposition, unintentional lifestyles
Institutions - agentic action of institutions, family, school, etc
I.e., Someone is at a party and they talk about a new drug with your friends, not something you actively seek out
Jan 19
Race and Racism in Healthcare
DuBois was an academic scholar who wrote about the racial discrimination of Black and white people in contemporary society
Biological determinism - posited that differences in mortality and morbidity is purely based on biological factors (i.e., superiority vs inferiority)
DuBois rejected this theory
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
Biological Understanding of Race
Provide nuance in how race operates in everyday life
Race is not an objective way to categorize people
We understand race as a socially-meaningful (everyday interactions), categorical (we put people into groups, in-group vs out-group), and a political construct (governments impose categories and make people pick racial buckets)
The way we classify race is arbitrary and depends on social and political context
Visible minority - non-white people
Different racial groups are South Asian, Chinese, Black, Filipino, Latin America, etc
How Race Becomes Biology by C. Gravelee
Social and biological realities have consequences for BIPOC communities
Social and cultural realities have consequences for BIPOC communities
There is a cultural history of a lack of access to health care opportunities
Race becomes biology in one of two ways:
Social reality of race and racism have biological consequencies
Racial disparities in health perpetuate the public’s understanding of race as biology
In a study on suicide rates, we see Indigenous people have higher suicide rate compared to white people
Many casual pathways that lead to this mental health gap
Differences in poverty, welfare removal, intergenerational traumauDU
Creates an incorrect view on the causes behind health inequlality
Race becomes biology can manifest in different ways!
Social Structure and Context
There are social and cultural contexts embedded in society which can shape health inequalities
We see Black people have a lower chance at life
How does racism affect health?
Racism - categorization of social groups that devalues, disempowers, and opportunities / based off an idea of certain racial groups superior over others
Racism is a fundamental cause
Racism advantages some people by giving resources and control of government
It is historic, and contemporary
I.e., Health and racism can be shaped by residence status, where you live, lack of access
Initially, they looked at how _____ influences ____
Racism is a fundamental cause because:
Racism is a FC because of differences in education, occupational prestige, and changing times related to slavery, displacement, job discrimination, etc
Global News Video
BIPOC people are more likely to have higher mortality of COVID-19 related issues (i.e., deaths, sickness, etc)
We see there is a health inequality between racial groups
Patient identification forms do not have a place to write your racial background in Canada
When we ignore the racial data it has real consequences on racial groups
It makes it difficult to respond and target resources
Health advocates are saying we need racial identification systems in healthcare
Ted Talk: Dorothy Roberts
What are researchers identifying when studying health outcomes in relation to race
Where else in medicine is race used to make illegitimate biological studies
Doctors use race as a shortcut, for assuming interventions for diseases, conditions, diagnoses, etc
Jan 21
Race, Nativity & Health
Racism as FC
Racism as fundamental cause
Systemic racism has many replaceable mechanisms which leads to racial differences in health outcomes
SES explains many differences in health across racial groups, when we look at white vs non-white people
They suggest racism creates additional inequalities that SES does not capture
We see racial differences in flexible resources and SES status
Some flexible resources and SES overlap (i.e., disposable cash to use in the healthcare setting, higher education, etc)
We see racial differences in flexible resources:
Prestige or status (honor or deference linked to a specific person/social status, white people have higher prestige than Black people, which can shape each group’s health outcomes)
Power
Beneficial social connections
Freedom (moving from slavery to mass incarceration/policing)
Migration and Nativity
Over the past century, Canada has seen an increase in foreign-born citizens
Healthy immigrant effect - epidemiological finding where immigrants tend to have greater health than their native born counterparts, but over time as they stay in the country their health declines and ends up matching or worsening the native born population
What are the potential explanations:
Immigrants are more likely to have better health before coming to a new country because you need to pass certain medical tests in order to be permitted into a country
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
These factors are believed to affect adverse health outcomes
Some scholars label this the “immigrant health paradox”
Healthy Immigrant Effect - Explanations
The government places certain standards to ensure immigrants have good health before they enter the country
They add certain points on your PR documents if you are younger and have better health
Individual factors show how migrants are a self-selected segment of the original population / migrants may have higher levels of resilience, grit, and mental well-being
Salmon bias - newcomers who face health, economic, or social issues are more likely to return to their home country, which means those who choose to stay are usually more resilient and have a positive health selection
This bias shows how people with worse health usually choose to leave which means they are no longer apart of the foreign born population
Negative acculturation effect - health of foreign born people becomes similar to native people may be a function of immigrants adopting the unhealthy practices of the host country
I.e., Eating junk food, drinking, unhealthy diets, high costs for gyms
Discrimination due to nativism - prejudices against immigrants by native people
Xenophobia
I.e., Fear and paranoia exacerbated by the media
According to Dean and Wilson study, health declines over time were due to stress and aging but not necessarily because of the two dominant explanations explained by HIE theory
Participants explain how living in Canada has improved their health (i.e., clean water, clean air, food accessibility, housing, etc)
Reading Check
In your own words, define the relational theory of men’s health in three sentences.
Jan 26
Gender Constructions of Health
Sex - biological sex characteristics, ordinal (intersex), aspects of sex can be biological determinants of heath (i.e., uterus, testosterone)
Gender - social constructing of relationships / performed by roles and identity work / social experiences in society (gender roles) can impact health (SDoH)
Four Patterns of Gender Health
Women live longer than men
In every single birth cohort we see women outlive men, on average about 5 years in Canada
Class status shows that lower classes have a larger gender gap between women and men
Women are more likely to be diagnosed as suffering from more ill health
More likely to suffer from mood disorder
In mid-late life, women are more likely to report poor health
Early in life, women are more likely to be hospitalized
Later in life, when men reach out for help they are more likely to die in the next 24 months
Women suffer from chronic conditions which can lead to long-term sufferings (i.e., depression, arthritis, reproductive cancer, cardiovascular disease
Health survival paradox - women are more likely to have poor health outcomes during life, however, women live longer than men
What are the mechanisms that drive this phenomenon?
We see gender differences in major causes of death
Men are more likely to die from accident based causes, cancers, cardiovascular disease
Women are more likely to die from natural causes (because something needs to kill you)
Women utilize more health services
Across racial groups, we still see women are more likely to seek medical assistance than men
Courtenay (2000)
Relational theory of men’s health - health-related beliefs and behaviours are shaped by femininity and masculine identities and values / interacts with social structure and gender across and within groups
High-risk behaviour (i.e., boxing, powerfighting, etc) signifies masculinity and instruments for power and status
Actions of constructing masculinity are overwhelmingly unhealthy
Cultures of masculinity shape directly and indirectly health behaviours, and it is reinforced by men
We have cultural beliefs about manhood:
Men are independent, self-reliant, strong and tough
Men don’t need help
Need for sex, behaviour and dominance
Health-related behaviour
Binge-drinking
Lack of seatbelt use
Smoking
Risk-taking hypothesis - gender socialization shapes health through risk-taking behaviours / hegemonic masculinity
Adopt unhealthy behaviours (i.e., not sleeping)
Underreporting health issues
Risky activities (i.e., drinking and driving)
Reinforce cultural beliefs that men are “powerful” and taking care of your health is feminine
Doing health is a way of doing gender
Men perform gender in many ways such as refusing to take sick leave, insisting men do not need sleep, boasting drinking does not impact driving ability
Construct masculinities by embracing risk
Health behaviours and outcomes differ based on intersecting factors such as race, ethnicity, age, class, education, sexuality, etc
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
Masculinity is straining the doing of health, whilst simultaneously constructing it
Jan 28
Health as a Social Construct
Constructionist perspectives split health into two levels
Biological disease
Social level
We attach meanings to illnesses, these are not inherent
Medical knowledge and response are influenced by social and cultural contexts, institutions, and timeline
Biomedical model - individual pathology / causes of illness / acute, infectious diseases
Doesn’t do a good job of explaining any other aspect of health (i.e., chronic, mental health, etc)
Sociological model - social environments and people’s bodies/minds
Health systems are socially constructed
Society decides what certain conditions are like
Disease - biological condition
Illness - social meaning of condition
Social Construction of Illness
Cultural meanings of illness
Stigmatized illnesses - cultural markers that are devalued / signals to others you are tainted and discounted / these illnesses are seen as “less than full”
Norm enforcement - behaviours trigger norm enforcement / rule-breaking behaviours are seen as dangerous, immoral and tied to negative character traits / applied to illnesses which symptoms are not normal or preventable
Contagion avoidance - stay away to stay health / marked by meanings of danger / fear dominates over moral judgement / infectious diseases (HIV, STI) are marked by these types of meanings / illnesses are not mutually exclusive, they fit in various categories
Mental illness
HIV
STIs
Contested illnesses - questioned by some medical professionals / some doctors may say “it’s just in your head” / this impacts what types of treatments people receive
Medical uncertainty or lack of medical consensus
Hard to detect using standard diagnostic tools
Skepticism of medical authorities
Tensions between patient knowledge and medical expertise
Feminist theorists argue contested illnesses are gendered, and they are usually feminized
Disabilities - separate impairment from disability / physical or mental impairments that are socially defined as abnormal and reducing functioning
Some conditions are defined as disabilities over time
ADHD, deafness, autism, blind, etc
Illness Experiences as Socially Constructed
How are illnesses embodied and lived?
Patienthood - experiences of an illness within clinical encounters with doctors / structured, clear norms /
Illness experience - everyday, outside of the clinic / living with an illness / how does it change daily routines / how do we explain our illnesses to ourselves and other people
Biographical disruption
This can change our relationship with the body
Rupture to concept of self
Disrupt social relationships and change our resource use
Feb 2
Midterm
Midterm study guide is on Canvas
Check the key terms!
Edit my flashcards
Go to office hours to look at the updated slides
Defining Disorders
Researchers examine if an illness is a dysfunction
An illness is seen as a breakdown of natural or normal response to stress/unprecedented contexts
Appropriateness - is the illness occurring under an appropriate circumstance based on the context
Proportionality - is the illness proportional to the circumstance at play
Duration - is there an appropriate amount of time for this illness to occur
History of Medical Disorders
The first sociologists ignored biological influences on social phenomena
Biology was lumped into eugenics in the mid 20th century
There were several 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 -
Biology and Social Environments
Gene-environment 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., 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
Contextual Approach
Mental and physical disorders are not only biological
They are shaped by social context, cultural norms, and institutional interests
Definitions of disorders are influenced by biology and environment
When we understand context we can differentiate between a normal response to life events and a genuine dysfunction
This is significant in mental health studies because there is a lack of objective markers of disorder
I.e. In physical health, objective markers are when organs stop working (i.e., kidney failure, heart stops pumping) / although, for mental health
Horowitz uses three lenses to define how we look at mental disorders
Natural response vs internal dysfunction
Mismatch between genes and environment
Culturally shaped harm
Natural Response vs Internal Dysfunction
Differentiate between natural responses and internal dysfunction
Normal psychological mechanisms should activate under proportional context
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
This begs the questions:
How do we differentiate normal sadness with depression?
Illness should only be labelled a disorder when
I.e., bereavement exemption for major depressive disorder
Normal psychological responses look like;
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
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
Unhealthy lifestyles because people are consuming fatty, junk foods
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