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Lecture 7

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William Magee

Class 7: SOC243 Recording: 130228_2 I. Overview of test next week and essay assignment II. Processes underlying self rated health and correlates of self rated health III. Identity and illness IV. Situating Self and Illness Experience in the context of discourses and institutional practices: Cancer discourses V. Return and Review/Discuss Quiz Test: 40mc, 20 short answers, 3 long answers (cumulative From start to week 7) Won’t curve up for the midterm (but at the end of semester) II. Processes underlying self-rated health, and correlates of self-rated health  Individual-level/clinical uses: if you were a doctor, would you ask your patient ‘ how are you feeling’?  Decision-making should be shaped by knowledge that self rated health can predict subsequent disease, and mortality above and beyond predictions based on clinical factors (i.e blood tests, etc.)  Consideration of self rated health reflects sensitivity to the patient’s perspective Reasons to be interested in self-rated health from the perspective of research  Comprehensiveness, inclusiveness and non-specificity  Practical advantages: more efficient in studies of population health  Telephone studies, population studies, etc.  Fundamental cause theory focuses on non-specific effects  By specifying a single health outcome of interest, researchers can focus on processes that influence health/illness, broadly defined o Can study processes than just the health itself (or numbers involved)  Self reports have to worry about the meaning of health, what people understand to be health, what they think of their own health Historical and cohort effects  Certain things are more medicalized or less medicalized over time  ‘In the future, new categories of health information may emerge to influence self-ratings of health. An example is provided by the changing role of genetic information.’  It’s not just that we’re understanding illnesses in new ways, but we’re understanding ourselves in new ways  Younger cohorts increasingly understand health behaviours as direct components of health status (i.e. I am healthy because I live a health lifestyle), and take those behaviours into account in their health evaluations  So there’s a shift in attitude towards being healthy  Cohort differences in definitions of health is another reason why it’s dangerous to compare health with a big age group cohorts Counter-intuitive effects of illness history and aging:  Prior illness experience: although someone who has a serious disease (i.e. breast cancer) will probably consider it as indicative of poor health, someone who has fully recovered from breast cancer may see the recovery as a positive component of their health  Self-rating becomes more complex as people age because people assess their health based on previous health status. Only compare themselves to people their age (from an abstract standard)  All these possibilities of comparing groups can lead to an age paradox  Age paradox: global self-rated health does not decrease with advancing age to the same extent as chronic conditions and disability increase. After objective health indicators are controlled, some studies find a negative correlation between age and poor health. ‘When asked to compare their health with that of age peers, old people give more possible ratings than the middle-aged.’  I.e. depression decreases as you age  Self-rated health varies with age and compares different age groups, but it has a relationship between death Self-related health and morality  Self rated health seems to be a stronger predictor of mortality to younger than in older age group sand in the young old than in old-old  Self-rated health, adjusted for age, shows a graded association with mortality, and this association is usually attenuated but seldom disappears when health indicators and demographic factors (i.e. objective measures) are taken into account.  Ask somebody in one oint of time, then the self-related health is easier for young people  When you’re older, can suddenly develop a life threatening illness already  Self-rated health is a stronger predictor in men than in women and in higher SES groups than lower o Why men and women why is it a stronger predictor?  Stronger predictor when the cause of death is a condition of which the respondent is likely to have known when giving the health assessment, such as alcohol/drug abuse than for things for people could not know Bauldry, et al 2012 ‘A life course model fo self-rated health through adolescence and young adulthood’ Social Science & Medicine75: 1311- 1320  ___________________________  Found that the relationship between age and (very similar related cohorts) s moderated by obesity  Graph: Third possibility, these people are responding to the mental health problems involved with being obese III. Identity and Illness  Stigma: an ‘attribute that is deeply discrediting…. [which] reduces people from a whole and usual person to a tainted discredited one. ‘ (Goffman 1963)  Illness-related stigma thus can influence identity
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