Haworth Sociological Perspectives on Death and Dying

Introduction to Mortality Patterns

• Death is a certainty, often seen as a 'great leveller'.
• Experiences of death, dying, and loss are shaped by social environments and cultural factors.
• Structural influences: political, economic, technological, and governmental policies.
• Individual influences: cultural/religious identity, socio-economic status, attitudes towards gender, ethnicity, age, sexuality, disability.
• Mortality's character reflects social and cultural diversity.
• Demographics of mortality emphasize time, place, and disease.
• Socio-economic status is central to understanding mortality globally.

Socio-Economic Status and Mortality

• Most societies differentiate socio-economic status or social stratification.
• Western societies balance social class distinctions with equality before the law and social mobility.
• Social class impacts:
  • Housing, geographical and social mobility, school attended.
  • Educational qualifications, occupation, peer groups.
  • Health, access to medicine and care (public/private).
  • Behavior (e.g., smoking, high-risk behavior).
• Table 2.1: Life expectancy varies by social class.
  • Men in Social Class I live ~9.5 years longer than those in Class V in England and Wales (1992-1996).
  • Women in Social Class I live ~6.4 years longer than those in Class V in England and Wales (1992-1996).
• Explanations:
  • Greater life chances and better quality of life in higher socio-economic groups.
  • Increased risk of workplace accidents and related diseases (e.g., asbestosis) in lower classes.
  • Poor living conditions, environmental hazards.
  • Higher likelihood of sudden or violent deaths.
• Economic factors are key causal indicators of differential mortality rates; confirm social inequality.

Intersection of Social Class and Ethnicity

• Effects of social class and ethnicity are sometimes hard to distinguish.
• Both are often linked to low socio-economic status and culturally ascribed behavior.
• Socio-economic conditions for minority ethnic groups can be more damaging.
• Murray (2000) noted that some ethnic groups in the United States have health levels characteristic of a poor developing country.
• Aboriginal Australians and Torres Strait Islanders have significantly higher death rates $(<br /> ewline 13.3)$ vs. $(<br /> ewline 6.5)$ for non-Aboriginal Australians in 1993.
• Death for Aboriginal Australians is often public or exterior, linked to violence, poverty, isolation, and neglect.

Demographic Study of Mortality

• Began in Europe in the 16th century with the Bills of Mortality.
• The Bills of Mortality were the first attempts to register deaths and record differences in life expectancy between social groups.
• Bills used to monitor plague, warning wealthier classes to leave the city during outbreaks.
• Four major purposes of demographic study:
  • Identify mortality levels and trends.
  • Compare mortality between populations.
  • Identify patterns/trends in causes of death.
  • Identify social, economic, behavioral, and environmental influences.
• Mortality risks vary across the life course (higher in infancy/old age).
• Mortality measures:
  • Age at death, infant mortality, maternal mortality.
  • Crude death rate (annual deaths per 1,000 population).
  • Age-specific death rate (deaths per 1,000 by age group).
• Data Collection: registration systems gather data on cause of death by age and sex.

Global Mortality Patterns

• Significant increase in population over last 400 years due to declining mortality.
• Developed countries: gradual mortality reduction in the 20th century.
• Rapidly developing countries: sharp decline in mortality (e.g., Japan).
• Less developed countries: less dramatic decline, stark differences in life expectancy.
• Mortality rates are increasing in some African countries (due to AIDS epidemic).

Life Expectancy

• Dramatic decline in infant mortality and increased longevity are hallmarks of modernization.
• Life expectancy increased from ~55 years to mid- to late 70s in 20th century in developed nations.
• Table 2.2: Presents trends in life expectancy in selected OECD countries.
  • Japan had the greatest expectation of longevity for men in 1998 (77.2 years).
  • Hungary, Turkey and Korea had the lowest (66.1, 66.4 and 70.6 respectively).
• Radical shift due to:
  • Improved living standards (diet, housing).
  • Public health, medical technology.
  • Decline in infectious diseases.
• Life expectancy differs among ethnic groups in Western societies (e.g., white women in the USA live 5 years longer than black women).

Disparities in Global Health

• Similar health advances not seen in non-industrialized countries.
• Table 2.3: Life expectancy statistics in less developed countries.
• Large health inequalities persist between developed and less developed countries.
• Female child in Japan might live to 84, while a girl born in Sierra Leone would, in 2002, have a life expectancy of only 35.7 years.
• Life expectancy globally increased by almost twenty years in the last half century, approximately $(<br /> ewline 46.5)$ in 1950-5 to approximate $(<br /> ewline 65.2)$ in 2002.
• Life expectancy is declining in some poorer countries (e.g., Botswana, Lesotho, Zimbabwe) due to AIDS.

Infant Mortality

• Expectation of death in old age in developed nations is recent.
• High infant mortality rates were common in previous centuries.
• Infant Mortality Rate (IMR): deaths of infants under 1 year old per 1,000 live births.
• IMR in England and Wales in 1909 was 120.
• Medical science, sanitation, and public health improvements decreased mortality rates and increased longevity.
• Upper/middle-class parents in Britain could expect children to outlive them by 1896; working-class parents by 1920s/30s.
• In Western developed societies in 1999, the IMR rate in the UK was $(<br /> ewline 5.78)$, in the USA $(<br /> ewline 6.33)$, with the lowest rate registered as $(<br /> ewline 3.80)$ in Finland.
• Table 2.4: World infant mortality rates³ (1999)
• Declining IMR indicates overall population well-being.
• High IMR linked to high birth rates and poverty.

Disparities in IMR

• Distinctions in IMR exist among socio-economic and ethnic groups.
• Related to mother's education, nutritional status, socio-economic status and ethnic identity.
• Haynatzka et al. (2002) emphasized the need to address high infant mortality rates among black people living in cities in the USA.
• In non-Western countries, infant mortality continues to claim a great number of lives in less developed societies.
• Kenya has a rate of approximately $(<br /> ewline 59.07)$ per 1,000 live births, Bangladesh is approximately $(<br /> ewline 69.68)$, and Pakistan is at an especially alarmingly high rate of $(<br /> ewline 91.0)$.
• IMRs in developed countries related to congenital disorders, low birth weight, 'sudden infant death syndrome' but also social factors.
• In less developed countries, high rates are attributed to poor health, sanitation, malnutrition, and poverty.
• In sub-Saharan Africa, causes are predominantly malnutrition, diarrhea, malaria, and lower respiratory tract infections.
• Wealth of a country determines resources for health measures and social services (e.g., immunization programs, welfare, education).
• Infant mortality rates have been correlated with maternal literacy.

Maternal Mortality

• Maternal Mortality Rate (MMR): reflects differences in life expectancy rates between wealthy and poorer societies.
• Table 2.5: Provides maternal mortality rates (MMR) in selected World Health Organization member states.
• MMR is defined as the number of deaths of women due to childbirth and complications of pregnancy for every $(<br /> ewline 100,000)$ births
• The highest MMR is in African countries where an average of one in seven women die from pregnancy-related causes.
• Asia, with 61% of the world's births, accounts for 55% of all maternal deaths.
• Women are dying because of lack of access to medical technology, ignorance of sanitation and nutritional requirements, and the vagaries of traditional labor and birthing practices
• Western developed countries, which now account for 11% of all births have a 1% maternal mortality rate
• For Western women the major risk of death as a consequence of pregnancy and childbirth is related to age
• Elderly people see death as a natural event.
• Death adopts a benign persona, visiting only those who, aged and frail, welcome its approach as a merciful release from the trials of life.
• Old age is the 'right time to die' may not be as straightforward as is generally assumed.
• Modern society has witnessed increased longevity and this has raised expectations that the life span will continue to be stretched.

Social and Cultural Implications

• Modern society has witnessed increased longevity and this has raised expectations that the life span will continue to be stretched.
• People may no longer think of death as appropriate at 65, 75 or even 85 years.
• Elderly people are likely to be left to deal with their fears and anxieties in private.
• Characterizing death in old age as easy and natural implies acceptance or resignation on the part of elderly people.
  Mainstream adult society is unable to contemplate old age and the inevitable decline into death.
• Infantalization of elderly people and a cultural emphasis on life as a cycle of death and rebirth.

Old Age and Societal Views

• Image of old age as a period associated with poverty, loss of control, failing health, disability and stigmatization.
• Culturally constructed link between old age and deterioration has stimulated stereotypical representations of later life that have induced fear and distancing of elderly people by younger generations
• Those with economic value focus resources and power on them, elderly people are frequently marginalized.
• The feminine poverty in later life is on the rise.
• Reliance on state support for pensions and welfare payments requires relinquishing primary control over financial decision-making.

Health and Ageing

• One experiences a failing health or chronic disability during old age.
• Quality of health in old age has become an even more important issue for older people than quantity of life.
• The effects of loss of economic status and poor health might result in individuals entering or being placed in care homes and this, too, will result in further loss of control over the quality of their life
• Experience of dying (Hockey, 1990).

Gender differences in ageing

• The life expectancy of men and women differs. (Table 2.2)
• There is a gradual shrinking of the gap
• Women typically live longer than men by roughly five years typically in OECD countries
• Male mortality in adulthood and in ‘early old age’ in Western societies tends to be ascribed to a greater incidence of heart disease than that found in women, and to be related to events that typically occur in the public domain (such as road fatalities and violence, often perpetrated by a stranger).
  Implication: old age is a largely gendered experience
• Widowhood, too, is more a female experience that a male one
• Older women therefore suffer serious structural disadvantages, meaning that they tend to approach their deaths feeling a greater sense of being alone and powerless in the world

AIDS and Demographics

• In sub-Saharan Africa, where the life expectancy rate has dropped dramatically over the last ten years, AIDS is the leading cause of death (see table 2.6)
• One will exceed to death even if they had malaria, tuberculosis, pneumonia and diarrhea
• It has been estimated that half of all 15-year-olds in Botswana, South Africa and Zimbabwe can expect to die of AIDS.
• The majority of deaths from AIDS occur in the 15-49 year age group.
• Infection and death rates have a resounding significance for individual health and well-being but also for the economic and social fabric of these African societies
• Epidemics throughout history have tended to target the weak and vulnerable, typically the very young and the older sectors of the population
• Contrast: the highest rate of death from AIDS falls upon the economically active members of society.
• There are economic and environmental dimensions for this problem

Suicide Demographics

*Suicide is a growing concern within modern, Western societies

• What is especially noticeable about patterns of suicide in these societies is that it is becoming characterized as a category of death that disproportionately singles out young males
• Rates of suicide differ dramatically across countries; second, that men and women are affected differentially; and finally, that suicide appears to fall heavily on young males.
• Durkheim's classic study, Suicide is significant
• Patterns of stability could be discerned from an examination of suicide rates in a range of countries. This stability in the rates led Durkheim to the conclusion that there were social and cultural factors at work here - suicide was not simply the result of individual psychological distress or disordered personalities, but was a consequence of social disorder
  Although his work has been heavily criticized for a focus on structural factors relating to suicide, and for neglecting aspects of agency, his insights into the impact of social change on individuals are relevant to an understanding of the demographic patterns of suicide. Durkheim alerted us to the social consequences of rapid economic change and restructuring. His argument was that one consequence of industrialization was the possibility of anomie. This refers to communities where social regulation has broken down
  Economic and globalization correlates

Male Suicide Rates and Factors

• It is clear from tables 2.7 and 2.8 that suicide rates are much higher for men than for women.
• Patterns of high male rates stable across all the countries considered
• High rate of suicide among male youth and young to mid-age adults; the high rates in countries such as Lithuania, Finland and the Russian Federation; and the increase in the rate in late old age for both men and women in Japan
• There has been a growing concern in many Western societies about the rising rates of male youth suicide.

Social Disruption and Prevention

• What is evident in suicide with masculinity, economic restructuring and a sense of lack of meaning in life.
• Where suicide has been associated with lack of meaning and loss of control over their destiny (Tatz, 2001).
• Japan has a high rate of suicide for men over the age of 75 and is the country with the highest rate of suicide for women in this age category