Lecture 4 Sept. 27th.docx

th Sociology 3HH3: Sociology of Health Sept. 27 2012 Lecture 4: - Notes - Recap - Definition of Terms re: Population Health - Social Epidemiology & Epidemiology - Epidemiological Concepts - - Notes: th - Midterm October 18 st - Proposal November 1 Recap: - Limitations of medical models o Feminists etc.  Medical models alone did not create health o Biomed is effective for acute disease & Chronic  But does indicate that pop health requires analysis of the root of the problem – cause of this physical ill health  John McKinley – refocusing upstream  Image of an orthodox med physician at the river (last lect)  Suggests constant flow of sick people keeps docs so busy that they have no time to see who is upstream pushing the people into the water  Orthodox med predom focused on downstream care o But to create health you have to take an upstream perspective – why these people are in the river in the first place  Focus on social determinants of health o Prevention and maintenance  Stop people from getting ill o This will event reduce the strain on the med care system cause it will produce the amount of people demanding help o Social context of health  Objective: To make visible the connections in soc that give rise to disease Defining Terms in Regards to Population Health: - Disease, illness and sickness are 3 separate things - Disease o Biophysical state  Mainifested by changes and malfunctions in the human body  Biostructural disorders in the body’s tissues and organs  Physiological issues  Resides in person’s body  Process of growth and decline  Curable for the most part thru biomed processes (either now or in the future research) o Stages of disease (may not go thru all of them)  Susceptibility  Everyone in a pop is at risk – could get ill  What people are most susceptible to which diseases? o i.e. all people who smoke are more susceptible than others to Lung Cancer  Flukes – people who smoke and never get lung cancer, people who never smoke and do  Just because you are susceptible doesn’t mean you will def get disease  Presymptomatic stage  May have symptoms, may not  Still don’t define as disease – just feel something is off  Clinical disease  Disease begins to manifest recognizably  Symptoms begin to occur o Sometimes we seek help with doc, he defines what is wrong and tries to cure o Sometimes we define what is wrong and self medicate – cough meds etc. to try to cure  Recovery/Disability  Disease runs it course  Person can be healed, disease can be maintained, or the person doesn’t survive  These stages vary with the type of disease you have o Type of disease  Acute vs. Chronic  Acute o i.e. Appendicitis o A sharp change in health o Rapid onset, rapid conclusion o Biomed designed to cure acute disease  Great success with this  Not designed for long-term care  Specialized to this  Chronic o I.e. Parkinsons, Diabetes o Long term conditions that will not go away o Becoming more prominent in society o System not designed yet to care for this type o Not sick enough to be in a hospital, so attempt to maintain disease and slow down the progression as much as possible o May be known disease, unknown disease or may be multiple diseases (as with the elderly – natural degeneration of the body with old age – “dwindling”) o Most situations have no cure o A lot of these diseases relate to lifestyle choices  If we could get young people to change their lifestyle, most of these diseases wouldn’t even show up (i.e. Diabetes)  Can reduce chronic care but a lot of degenerative chronic diseases will still happen - Illness o Social/Psychological experience  Experience of being sick or diseased  Sense of not being right  Effects your social beh and interaction patterns  Don’t all experience disease in the same way  What is troubling the patient? What do they complain of? How/when/why was help sought after?  Different cultural groups complain of different symptoms o People experience illness in culturally defined ways o Different levels of tolerance o Different expressions of pain/emotions  People can be diseased with the absence of feeling ill  People can be not diseased but have a feeling of being ill  People can be diseased and have a feeling of being ill  Primarily about social needs  Social experience, relationships and the conduct that exists around the disease - Sickness o Both social and biophysical  Presence of the biophysical disease and the social experience of the illness  An experience affecting the nature of interactions with sick person and physical world  “Sick Role” concept by Parsons  Sickness a physical experience and social event - Terms help us understand there is a social component to health - Leads to a “Social Model of Health” o Understanding a Social Model of Health  Shift from sociology of med to sociology IN med  Wider focus than biomed  Biomed individualizes the health issue – YOU have lung cancer o Preoccupation with treating individuals has the potential to legitimatize a victim approach to illness  “Your poor health is the result of poor genetics”  Genetic fatalism o That’s just the way it is in my family, we just are obese  “Your poor health is the result of lifestyle choices”  BOTH of these make health YOUR PERSONAL problem o By ignoring the SOCIAL CONTEXT of health there is little acknowledgement of SOCIAL RESPONSIBILITY for making a better health situation  Health as a public issue  Discussions of public health, population health – health of the group  Social medicine  Early movement focused on infectious diseases i.e. cholera  Currently we have a wider model of social health o 3 dimensions of Social Model of Health  Social production & distribution  Outcome of our living and working conditions o Are they creating health or not? o Why are their clumps of ill health and of health? o Why are people in Norway more healthy? What are they doing that is different than us in North Amer?  Social Construction  Reflection of beliefs and norms and values of culture o What does your religion, ethnicity, politics teach you? o What are the notions of health?  Are they static? Changing?  Reflect our culture, politics, morality? o What do you believe is health?  Social Organization of Health Care & Med care  How do we organize, fund and utilize health and med services o How much do we spend on health, med, research?  Does the country fund it?  Science doesn’t change but the organization of med does o Leads to “Public Health” via Social Responsibility  Policy, economics, cult beliefs make a difference  Directs attn. to the prevention of illness  Focus on community participation and social concerns  Addresses living and working conditions  Health as a public responsibility Epidemiology & Social Epidemiology: - Epidemiology o The statistical study of patterns of disease in a population  Focus on bio factors  Focus on STATS o Objective is to understand patterns in order to maximize health effects o Count individual cases to form patterns  Once number reaches tipping pint – epidemic o Science of the cause and concrete distribution of the disease  Relation to public health practices o Gives us a clinical definition of the disease  Via biological profile of the disease – symptoms  Def doesn’t change  Valid and objectified based on scientific research o Proof that you have Disease A  Def ingrained in our social rules, procedures, institutions  Relates to our belief in the authority of the med profession to define and label a biological condition as a disease  If doesn’t fit into clinical def  You must be imagining it - Social epidemiology o Study of the dist of a disease within a population according to social factors 