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Study Guide 2_Midterm 1.docx

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Boston University
CAS SO 215
Joseph Harris

SO 215 Exam 1 – Study Guide Introduction: Sociological enterprise- is the effort to explore the relationship between individual biography and social structure. Medical Sociology - Focuses on the social causes and consequences of health and illness (not just US, can travel globally) o Social facets of health and disease o Social behavior of healthcare personnel and patients o Social functions of health organizations and institutions o Social patterns of utilization of health services o Relationship of healthcare systems to other social institutions o Politics of social policies related to health Why is medical sociology important? Health is not simply a matter of biology but involves a number of factors that are cultural, political, economic, and—especially– social in nature! Epidemiology: Epidemiology- Study of the origin and distribution of health problems of health problems in the population from the collection of data from many different sources • Primary focus not on the individual but on the health problems of social aggregates or large groups of people • One of the most important investigative fields in the study of health and disease • Applied widely to solve the world’s health problems Incidence- number of new cases of a specific health disorder occurring within a given population during a stated period of time Prevalence- total number of cases of a health disorder that exist at any given time (includes new and pre-existing) o Point prevalence: number of cases at a certain point in time (usually a particular day or week) o Period prevalence: total number during a specified period of time (usually a month or year) o Lifetime prevalence: number of people who have had the problem during their lifetime at least once Why is infant mortality rate useful? It can help show standard of living. The primary cause of death in US? Heart disease Why John Snow and 1854 cholera outbreak is important? • Acquaints you with the forefather of epidemiology and his approach • Involves investigation of our social world to find the answers – not until 1854 that foundation of modern epidemiology was established! • Disease has not just biological causes but social ones! • Shows how cultural change happens and one paradigm can replace another • Importance of socioeconomic status (class) 2010 Cholera outbreak in Haiti Struck nine months after January earthquake • First in the country’s recorded history • World’s largest cholera epidemic in recent decades • 7,000 deaths between mid-Oct 2010 to Jan 2012 • Suspected to be due to climatic changes initially • Evidence more conclusively points to human activity • Waste pits from a UN peacekeeping troop camp seeped into nearby river used by villagers • Genome sequencing confirmed close relationship between Nepalese and Haitian strains Disease Paradigms from Ghost Map: Miasma Theory and Contagen Theory SES and Health Social class: a category or group of people who have approximately the same amount of wealth, status, and power in a society • Classes are ranked in a hierarchical way • Class helps determine personal opportunities and life experiences • European model: focuses on a person’s occupation • American model: focuses on a broader measure of SES derived from ideas about social stratification put forward by Max Weber • Weber agreed with Marx that the basic source of class distinction was unequal distribution of goods and wealth • But Weber said that there was more to it than just wealth alone – status and power were important too • Whereas wealth is an objective dimension, status is subjective related to the esteem accorded by other people - status indicates person’s social prestige, which may or may not correspond to wealth Three main components of SES: • Income reflects spending power, housing, diet, and medical care • Occupation measures status, responsibility at work, physical activity, and health risks • Education reflects a person’s skills for acquiring positive social, psychological and economic resources such as good jobs, nice homes, health insurance, access to quality healthcare, and knowledge about healthy lifestyles Importance of Education to health - By every measure, American adults with college education enjoy better health than those with lower levels of education. The better-educated feel healthier, have less difficulty with common activities and tasks, more frequently feel vigorous and thriving, less often suffer aches, pains, and malaise, less often feel worried or depressed, carry fewer diagnoses of threatening or debilitating chronic disease, expect to live longer, and probably will live longer. SES as a “fundamental cause” for mortality: • Enduring association of low SES with illness, disability and death has led Link and Phelan to propose SES as a “fundamental cause” of mortality • Important because most in the past viewed SES as a contributing factor to poor health and mortality but not as a direct cause • And because diseases and risk factors that appeared to account for inequalities seen in earlier periods (i.e., deadly infectious diseases such as diphtheria, measles, typhoid fever, and tuberculosis fueled by overcrowding and poor sanitation in low socioeconomic status homes and communities) have been virtually eradicated in the developed world • However, its persistence points to SES having causal role • Four parts of theory • Influence multiple diseases (not limited to only one or a few diseases or health problems) • Affects disease outcomes through multiple pathways of risk (risk factors) • Involve access to resources that can be used to avoid risks or minimize the consequences of disease if it occurs • Be reproduced over time by replacing intervening mechanisms • SES meets all four criteria • “Flexible Resources” impacting theory: • The centrality of “flexible resources” to the theory: the degree of money, knowledge, status, power, and social connections one has either protects health or causes premature mortality • These resources operate at both the individual and contextual levels • By shaping individual health behaviors • By conferring health-enhancing benefits that come through association • Their flexible use tells us why SES gradients tend to reproduce over time How do we address these disparities? • Advocate policies that encourage medical and health promoting advances while breaking the link between the advances and SES resources • May be accomplished by reducing disparities in SES resources or developing interventions that are more equally distributed Gender and Health Men and women differences in morbidity and mortality: • Women are biologically stronger at birth, less often exposed to danger and highly stressful occupations, more sensitive to their bodily states, and possibly enhance their life expectancy through increased use of medical services • By contrast, males are biologically disadvantaged: experience higher mortality rates from the prenatal and neonatal stages of life onwards • Gender differences display an inverse relationship between mortality and morbidity • Women tend to be sick more often than men • However, their health disorders are not as serious or life-threatening as those faced by men • However, women have a definite advantage over males on life expectancy (though men are slowly closing the gap) • Later in life, women tend to died of the same illness as men • Between 1961 and 1983, none of the nation’s 3,141 counties had a significant decline in life expectancy • From 1983 to 1999, life expectancy for about 19% of the nation’s women compared to 4% of men declined significantly • Loss of longevity of women in low-income counties is counter to trends in other Western countries • The life expectancy advantage in the US of white females was 80.6 to 75.7 in 2008 • Same advantage for black females: 76.8 vs 70.2 • No consistent differences in mental health between men and women except for two areas • Women have higher rates of mood (depression and elation) and anxiety disorders • Men have more personality disorders (impaired personality traits) and significantly higher rates of substance abuse disorders • But females’ tendencies towards depression and anxiety fall short of full-blown clinical diagnosis but nevertheless cause people to feel psychologically distressed • Women employed outside the home exhibit less psychological distress than housewives but more than employed men (the second shift) • But the advantage held by women in life expectancy was not always the case! Was nearly the same until about 1900. Then women began living longer and were the primary beneficiaries of modernization with respect to longevity • A few exceptions • But generally gender gap in wealthier countries ranges from 3.2-7.5 years and -1.8-4 years in poorer countries Smoking impact on males vs. females: • Smoking causes a woman to lose 14.5 years of life on average and men 13.5 years of life • Mortality rates for COPD are catching up to men • Lung cancer was eighth among cancer deaths for women in 1961 but moved up to first by 1986 (CHD still #1 killer of women overall though) • Important risk factor helping to explain the lessening gap between men and women in CHD (which is bad for women)! • Results of a 2011 Meta-analysis • Women smokers face a 25 per cent higher risk of developing heart disease compared with men • Women smokers have double the risk of lung cancer compared with their male counterparts • Toxins in cigarette smoke appear to affect women disproportionately, and the risk takes into account that women tend to get through fewer cigarettes than men. • Actual risk could be even higher for women because they smoke, on average, fewer cigarettes a day than men and in many countries the smoking epidemic in women started later than in men! Mckinley study of heart disease as well as ignored factors • Shouldn’t take production of health statistics for granted – there are indisputable differences in health that stem from a variety of factors but… • Health statistics are socially constructed and involve both the patients and the providers • Need to focus more attention on the provider/health system side of things • If we do, we find that there are significant differences in how men and women are treated • This may help account for disparity in heart disease • CHD is often overlooked or underdetected • Younger women have higher rate of silent heart attacks • Women are treated differently when they enter the health care system with CHD • Less likely to be referred to a cardiologist • Less likely to be hospitalized • Less likely to be prescribed medication or invasive treatment • Less likely to be referred for treadmill testing or echocardiography • The message of the article is that perhaps the gender gap in heart disease is much smaller than is currently assumed Does marriage have health benefits? • Has health benefits for both men and women (social, emotional, and economic support) • Quality of relationship with the spouse is especially important for maintaining a positive level of mental health • Because women live longer but show greater tendency towards anxiety and depression, they may be more impacted after the death of a spouse Race and Health Race in sociological view: • Race is a social construction, with almost no biological basis • Race represents the “confluence of biological factors and geographical origins, culture, economic, political and legal factors, as well as racism” (Williams 1996) • A century ago, many “white” Americans considered Jews and Irish people to be separate and inferior races • Similarly, contemporary Americans typically give individual “African Americans” that label if they have any known African ancestors, even if most of their ancestors are European Life expectancy among different ra
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