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McGill University
Sociology (Arts)
SOCI 390
Sarah Berry

SOCI 370 Midterm W1: Conceptualizing Gender/Health; Gendered health inequalities   Health - type of definition determines health measurement, research and service/care delivery, definitions are influenced by social, cultural and historical factors/context, and individual experience, two approaches to health; - Negative - state of being free from illness or injury, a person’s mental or physical condition, you don’t feel seek - Positive – state of complete physical, mental and social well-being not merely the absence of disease – depends on housing, gender, free from discrimination, feeling happy, being socially integrated into a community etc. Disease – (Kleinman) – problem from the practitioner’s perspective, alteration in biological structure/function, defined from outside of an individual Illness – (Kleinman) – lived experience of monitoring bodily processes, involves appraisal of those processes as expectable, serious or requiring treatment, can be experienced with the absence of disease label (i.e. you can feel healthy despite a disease label) Naturalist/Descriptive Approach to Health (negative) - Health and disease can be described in a value neutral manner in terms of deviation from typical levels of biological functioning see as objective; health is distinct from well being Normative approach to Health (positive) - Health and disease are value-laden, subjective, individual sense of well-being linked to psychological state, healthiness as an important resource, matters in terms of self-worth, employability, and relationships – not just happens to you, but use it in your social world Biomedical mode – assumptions: - Doctrine of specific etiology: belief that each disease is caused by a specific, potentially identifiable element o Addition or lack of particular element  ex. down syndrome – lack of chromosome  ex. diabetes – lack of protein to keep insulin levels rights  ex. strep throat – addition of bacteria into body o Continuous question for magic bullets: specific agents and their causal links to disease i.e. specific agents and their causal links to disease  ex. heavy reliance on pharmaceuticals  ex. “cure” for cancer o Criticisms  Quest for magical bliss – cure for cancer assumes there’s specific treatment that’ll solve disease, yet no one argument about what is causing cancer – too broad ex. life style, environment  Reinforce mind-body dualism – disease in body and there’s split between mind and body  Physical reductionism – illness broken down into disordered parts, focus on one part of body to learn about disease/illness – neglects to look at social body of how your entire body is situated  Machine metaphor – see it as dysfunctional parts, go into body and look at specific part that is causing illness, advanced medicine in some ways ex. focusing on eye has led to advances in health but fail to see whole person and the position they are in in the world  Regimen and control – focusing on part within body shows responsibility or that body, fails to recognize the body as political, socially and economically situated - How you measure disease depends on how you define it: o If health is absence of disease –negative approach  Mortality based measures (age adjusted mortality, maternal mortality ratio, child mortality rate, life expectancy, leading causes of death) – state of being subject to death  Morbidity based measures – implies sickness or disease (prevalence/incidence of disease, disability adjusted life years DALYs) – the relative incidence of a particular disease o If health is defined positively  Involves social meanings, experiences, context – depends on individual perceptions • Requires communication to convey how you’re feeling – ex. do you feel sick? Medicalization – process by which health and behavioural conditions com to be defined and treated as medical issues – defining a problem in medical terms using medical language to describe a problem, adopting medical framework or using medical intervention to treat it, process with patients and physicians xe. child birth, sexuality (homosexual used to be a disease, now it’s not -> demedicalization) ex. alcoholism - Reductionism/Individualism – focus on individual responsibility, don’t see social and political factors affecting it - Genetic essentialism/geneticization (genomania) – overly optimistic belief in genes and magic bullet approaches - Historical Perspective of sex/gender o Pre 1970s: sex, not gender – assumed biological determinism/essentialism- biology determines place in society (work roles, health outcomes) – some essence of male/femaleness that affect health outcomes o 1970s: gender as alternative to sex – challenge to innate differences, recognition of social conventions, expectations, roles ex. work roles – gender expectations affect health outcomes – double day Sex – biological designation – male or female – biological characteristics (anatomy, physiology-hormones) - Sexual dimorphism – different morphology between males and females/dichotomy/binary - Sex assignment beings early (PGD – test for x/y before put egg in), womb (ultrasounds), birth or sperm sorting Gender – less fixed than biology – masculinity or femininity – something we do, socially constructed roles, relationships, personality traits, attitudes, behaviors, values ex. how w dress, make up, how we interact with people ex. women smile more, affection greetings, close off their bodies, social structure – family roles, jobs, operates through institutions Examples of Caster Semenya and Michael Phelps used in class Sexuality – behaviours/activities that are supposed to produce erotic arousal/pleasure, hierarchies of sexualities - bi, hetero, homo – difference between desires and actions/behaviour - Heteronormativity – heterosexual most normal or natural form of sexuality - Heterosexism – discrimination based on non-heterosexual orientation - Orientation – something you can’t control vs. preference - something you choose vs status - ascribed to you Sociobiology – systematic study of biological basis for all forms of social behaviour, biology determines social behaviour - Reproductive success as primary goal – Darwinian natural selection – mechanism same for humans and animals - Sex behaviours – men = promiscuous, women = monogamous - Critiques: reductionist (sex isn’t straight forward), difficult to test empirically, conservative (supports status quo ex. binary bw men/women, androcentric, promotes male perspective on behaviour, generalized from animals ) Social constructionism – social structures/shaping of behaviours, choices, preferences – gender norms and stereotypes - Critical approach: analyses of scientific evidence, cross cultural comparisons, interdisciplinary research Biological sex – five elements of sex designation - Chromosomal sex (genetic sex) – 46 chromosomes, female = XX, male = XY o Variations: turner’s syndrome = XO (45C), females missing an X, ovaries may not develop, Klinefelter’s = XXY (47C), extra sex link chromosome, may have some level of breast enlargement - Gonadal sex – male testes, female ovaries, both, non or one or the other – homologous (develop from same tissue), inherent tendency to feminize, testis formation triggered by gene on Y chromosome - Hormonal sex – androgens (testosterone), estrogens (estrogen) – males and females produce both - Internal/reproductive sex – fetus has Wolffian (male) and Mullerian (female) duct system – both, neither, or one or the other, develop into male/female, depends on interaction of hormones th - External genital sex – 7 week of fetal development, visible external differences identifiable around 14 weeks How do we assign sex? - Multiple factors, complex, usually visual inspection, assume concordant variable e.g. if vagina, then mullerian system (uterus, fallopian tubes), ovaries and XX chromosomes – turners/klinefelters show not straight forward Intersexuality – ambiguously-sexed bodies ex. Turner/Klinefelter syndrome - Biomedical “fixes” – correct nature’s mistake – three main types of biomedical intervention - Assume binary sexes (male/female), heterosexual is normal, only certain behaviour for certain sexes o Prenatal o Surgical – phall-o-meter to see how long or short “it” is o Psychological – make sure accept idea of themselves as male/female - Cross cultural evidence shows many cultures accept intersexuality, Hawaii has 3 gender (mahu) rd o Social arrangements built around 3 gender ex. homosexual marriage, more complex than dichotomy - Kinsey research – continuum of sexuality from 0 = 100% heterosexual to 6 = 100% homosexual, x = no erotic attraction or activity, most people fit in middle – social norms, sexual scripts influence behaviour/desire Gendered and sexual patterns of health, illness and disease - Women supposed to live longer than men – narrowing as women go into work force, taking a toll - Women higher life expectancy yet men spend higher proportion of life in good health – quality vs. quantity - Heart attack, stroke, colorectal cancer higher in men – narrowing as well Explanations for gendered differences in life expectancy and disease - Biological - Social o Gendered division of labour – breadwinner vs. housewife, types of jobs (safety, health risks etc.) o Gendered expectations of masculinity/femininity – men’s lifestyle, more stressed, don’t seek care as fast o Women’s sexual health depends a lot on her partner, ability to control position ex. condom use o Gay men 6x more likely and lesbians 2x more likely than heterosexual counterparts to attempt suicide - Biological and social interact o Amplification – biological factors plus social factors work in same direction o Suppression – biological plus social factors work in opposite directions Masculinity, Femininity and Sex: An Exploration of their relative contribution to explaining gender differences in health – Annandale and Hunt - Conclude sex (male-female) differences traditionally found in research on gender and health may mask an association of femininity with poor health and masculinity with good health in both men/women - Previously women’s experience was ignored/misrepresented as it was forced into pre-defined male categories – women’s differential experience needs to be appreciated - Role-occupancy approach (health experience of men/women via gender role occupancy) can be problematic (1) assumes context and meaning of social roles are same for men and women (2) conceptualisation of social structure is static and understands departures from normative standards only in a framework of social deviance - More masculine ones had less depression, anxiety, even when controlling for life stress, maybe cause masculine characteristics are highly valued by society, women experience negative consequences of femininity and negative sanctions for stepping outside these feminine role expectations Gender Matters: An integrated model for understanding men’s and women’s health – Bird and Reiker - Biological factors may contribute to differences in men’s/women’s health, wide range of social processes can create, maintain or exacerbate underlying biological health differences - Single sex studies fail to provide a complete picture of similarities in men’s/women’s health/morbidity o Say study will have more power if group is homogenous – yet excluding women assumes importance about health is knowable by studying men o Randomizing groups does not show that effects are equally applicable to all subgroups presented – don’t know if differences due to social or biological factors - Limitation of biomedical paradigm: assumes disease have same symptoms and outcome across social circumstances and medicine is socially neutral science - Limitation of sociological paradigm: analysis of social context of health treats biology as socially neutral, says inherent biological differences between men and women are either minimal or largely irrelevant - Gender differences in opportunities shape men’s/women’s choices/expectations about social roles/role- related activities , effects exposure to risks (stress, role overload, occupational health problems –carpal tunnel, exposure to toxic chemicals), access to protective resources (Income, health/disability insurance, social support) - Ex. Biological explanation says women carry baby for 9 months – need better immune system, estrogen provides women a more flexible circulatory system that can carry a higher blood volume during pregnancy - Ex. Men smoke more, higher rate of risk taking behaviour, more likely to be violent, go to doctors less Gender, sexes, and health: what are the connections and why does it matter? – Kreiger - Gender – social construct regarding culture bound conventions, roles and behaviors for relations - Sex – biological construct, designated by biological characteristics in sexual reproduction, assigned in relation to secondary sex-characteristics, gonads or sex chromosomes – including male, female, intersexual and transsexual - Sexism – inequitable gender relations and refers to institutional and interpersonal practices whereby members of dominant gender groups accrue privileges by subordinating other gender groups and justify these practices via ideologies of innate superiority, difference or deviance - Sexuality – culture-bound conventions, roles and behaviours involving expression of sexual desire, power and diverse emotions, mediated by gender and other aspects of social position - Heterosexism – type of discrimination related to sexuality, constitutes one form of abrogation of sexual rights and refers to institutional and interpersonal practices whereby heterosexuals accrue privileges and discriminate against people who have or desire same-sex sexual partners and justify these practices via ideologies of innate superiority, difference or deviance - 12 examples of health issues – and sex/gender relations W2: Theorizing Gender and Health: Feminism and Women’s Heath Movement Classic/Early Contemporary Sociological Theory - Structural Functionalist – Durkheim o Individuals behaviours determined by social structure (macro) – social fact – broadly societal forces/social fact that drive social behaviour o Parsons and Sick Role – sickness as deviance, causes destruction in our normal roles (gender, work roles) so they have to be managed in certain ways, medicine best way – it’s a social institutional and its function is to help return us to our normal social roles - Conflict Theory – Marx o Economic institutions/forces as key drivers of social, individual functioning (macro) – economy determines our position/function in society o Alliance/association between ruling classes and medical profession ex. inequalities -> poor health -> dependency on medical system, pursuit of profit effects medicine (insurance/pharmaceutical companies, questions altruistic nature of health care system - Symbolic Interactionism o Weber  Protestant ethic and spirit of capitalism – change as combined force of individual actions (micro)  Social sciences different than natural/physical science – need different methods, have to talk to people because value individual perceptions of situation/disease/illness o Mead  Nature of self and intersubjectivity, what you think society expects of you and how you behave – generalized other: view the world’s expectation of you, personality not in born, develops over time based on socialization and personal experience o Goffman  Dramaturgical analysis – parallels to acting – front stage vs. back stage o Primary aims  Identify meaningful social action among social actors  Explore individuals' own interpretations of their lives and situations Portray individuals' perspectives of the world in their own language, on their own terms  o Doctor patient interaction – doctors as gate keepers to medical tests, specialities – power dynamic o Gendered dynamic if physician is man and patient is women, woman has different idea of what she is going through, compared to male understanding of female experience o Racialized groups, sexual orientation – different health outcomes based on interactions, experiences of same disease can be very different based on individual - Social Constructionist o Illness is not just a physical state, it’s a social phenomenon – disturbs social life  Social context can produce illness, social support changes experience Waves of Feminism - 1 wave – 1800s to early 1920s – suffragist – maternal feminists – fighting for rights within the home o Basic rights, equal rights ex. to vote, maternal – child welfare protections, temperance (alcohol) - 2 wave – mid 1960s – movements (civil rights etc.) – height of feminism o during WW2 women worked outside home, wanted to keep those jobs – talked about contraception, reproduction, abortion – challenged gendered ideologies o Boston Women’s Health Collective (1969) – women’s liberation conference, two publications – wanted to share research, talk about women’s bodies, talking about experiences (childbirth, menstruation) rd - 3 wave – 1990s – postmodern feminism – embrace differences o Margaret Sanger – fight for birth control, founder of Planned Parenthood o Avoid reduction of social/health issues to single factors, reject binary conception of gender (links to health), masculinity and health researchers (care seeking, depression in women) o Caught in interlocking matrix of oppression/domination Radical feminism – men oppress women under patriarchy (medicine as extension of this) - Reproduction key focus (primary way men oppressed women): wanted abortions (Roe v. Wade – 1973, Morgentaler -1988), control bodies, natural childbirth movement, alternative birthing methods, self help groups Liberal feminism – equal rights of citizenship, change through political and legal reform, extend rights of citizenship to women, see men and women as equals - Status on the Commission of Women (1970) – make birth control and abortion more available, more women doctors with background in women’s health, equal access to health services ex. prenatal care – terms of value Marxist/Socialist feminism – women exploited/oppressed under patriarchy/capitalism (Marxist more about economy) unequal position in workforce/domestic spheres affects health status - Economic position affects all other aspects of social life and health ex. second shift, stress and health Important themes in feminist theory - Medicalization and technology o Women's bodies a frequent target of medical intervention o Technology often a key component of medicalization o Interaction between patriarchy and capitalism o Demedicalization movements - Critique that all women were viewed as homogenous, not all white privileged women Gender and the social construction of illness: overview – Lorber, Moore, Jean - In every society, symptoms, pains and weaknesses considered sick shaped by cultural/moral values, experienced through interactions; in social circle, heath care professionals and influenced by beliefs about health and illness - Medical science sees disease as deviation from normal, specific cause, can be located in the body, same symptoms/outcomes in any situation, medicine is socially neutral application of scientific research to individuals o Normal depends on who is being compared to whom, diseases have environmental and social causes o Social experience of disease changes depending on personal story ex. broken leg to an athlete vs. me History of Women’s Health Movement of the 20 Century – Nicols nd - WHM emerged in 1960s/70s (2 wave) – primary goal to improve health care for women, then expanded o Sanger’s fight for women’s right to birth control, gain control of reproductive rights (success) o 1960s – wanted legal abortion – Roe v. Wade (1973) – legalized abortion  Came under attack in 1980s – restrictions on abortions o First self-help group – common theme of dissatisfaction with health care, reclaim power, getting control o Change childbirth practices – choice for expectant parents o 1986 – National Institute of Health - policy requiring inclusion of women in research – discriminated by:  Disease that affect women disproportionately were less likely to be studied  Women were less likely to be included in clinical trials  Women were less likely to be senior investigators conducting trials Gendering the Medicalization Thesis – Riska - Medicalization thesis – issue of the power of medicine to define and regulate social behaviour, Parsons – individual not held morally responsible, as a medical diagnosis could be found - Functionalist perspective - function of medicine to maintain division of labour, optimum working of society - Monopolization Thesis (Freidson) – medical profession protects its own source of knowledge it order to retain professional autonomy – emergence of elite, maintained monopoly of knowledge hence professional power - Restratification Thesis – medical profession had diversified in order to stay united and powerful vis-à-
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