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HLTB15H3 Chapter Notes -Theory Of Reasoned Action, Decisional Balance Sheet, Alcoholic Drink

Health Studies
Course Code
Iva Zovkic

of 8
Chapter 2: Social Factors in Illness and Response
Social variations in health: structural inequalities
Research literature has shown great variation in health status according to
socioeconomic factors, gender, culture, ethnic status and age
Investigators of social variations subscribe to positivist theories of society, which
emphasize the way in which society enables and constrains people.
Two main explanations which attempt to account for social variations in health and
mortality in developed nations
o Social causation hypothesis where factors associated with socioeconomic
statue influence health
o Selection hypothesis life course approach, poor health in childhood and
adolescence leads to lower socio-economic positions
One strong body of evidence indicates that longer-term unemployment leads to
adverse health effects
Some investigators measure socioeconomic status more broadly by incorporating
indicators of level of education, wealth, income, and unemployment status as well as
occupation (in the past, it was just occupation)
Psychosocial stress and responses to stress
Psychosocial stress can be defined as a heightened mind-body reaction to fear or
anxiety-arousing stimuli
As the product person’s capacity for self control, hardiness, self efficacy, and
Stress: biological response of individuals to the social environment acting upon him
or her
Measuring stress at certain life events, evaluation of meaning of stress
Cognitive and behavioral efforts to manage internal and external demands of the
stressful situation
Coping style is seen as one mediating factor in the link between stress and illness
and can be a moderating variable in relation to patient’s health outcomes after
Other factors that are identified as meditating factors personality, material
resources and social support
Model of Cognitive appraisal
o Primary assessment of situation as irrelevant, positive or stressful
o Secondary evaluation of coping resources and options
o Reappraisal which represents the fluid state of appraisal processes
o It is argued, the extent to which a person experience a situation as stressful
depend on their personal and environment coping resources and previous
Crisis Theory
o Theory postulates that individuals strive towards homeostasis and
equilibrium in their adjustment
Please Read Page 28
Buffers to Stress
Buffering hypothesis postulates that social support affects health by protecting the
person from the negative impact of stress via financial and/or emotional support
Main effect hypothesis
o Holds that it is the social support itself which is beneficial and reduces the
impact of the stressor and its absence acts as a stressor
Social support
o Availability of someone who offers comfort
o Emphasize satisfaction with available support
o Encompassed within broader concept of social capital
Social capital: community of reciprocal social support networks and resources and
is embodied in measures of social networks, social support and the availability of
community resources
Sociology, stress and the management of illness
Positivist sociologists focus on the social system itself as a potential source of stress
and consequent illness
Social interactionists concentrate on the concepts of self, the stress arising from
conflicting self images and the process of becoming discredited by others, with the
risk of consequential lowered self esteem (social stigma and illness)
Construction of dependency by society
o Structured dependency highly relevant to public policy-making
Stigma, normalization, and adjustment
Deviance when people perceive, interpret and respond to the behavior or
appearance as deviant
Consequences of labeling it really alters of how others think of you even if you are
diametrically the opposite of the label in reality
Feeling of invisibility or disdain by others
Stigma and normalization
One way of categorizing coping and adjustment processes is in relation to the
labeling of the person as ill and deviant and the amount of stigma (the social
reaction which leads to a SPOILT identity and label of deviant)
Minimization of stigma many motives
o Fear of losing employment
o Fear of social rejection
o Discrimination
Pragmatic adjustment minimize the impact of the condition on life while being
open about the condition when necessary
Quasi-liberated adjustment is where the sufferer openly informs others of his or her
condition in a manner which attempts o educate them
Concepts of passing, covering, and secret adjustment are common
Expectation of adjustment is unkind ad unfair stigmatized individual encouraged
to act so to imply neither that burden is heavy nor that bearing it has made him
different from us but at the same time they must be distant from us
It is a form of social control
The Sick Role and illness behavior
The Sick Role
Based on functionalist theory of society
Sick role treats sickness as a form of social deviance which has violated a norm of
behavior and is dysfunctional to society
Sick role people are given a chance to get better and return to normal social roles
Doctor legitimizes the status of sickness
Sick Role carries two rights and obligations for the sick person
o Exemption from normal social roles and responsibilities
o No blame for failure to fulfill them
o Individual must want to return to normal roles
o Must cooperate with health professionals with the aim of recovery
Therefore, sick role is functional for society because the individual is permitted to
break the rules but only if the obligations are met
Criticisms of the concept of the Sick Role
Deviance theory disputes that there is an automatic response to the breaking of
o Depends on how responsible the person is perceived to be for his or her
o Doesn’t explain what causes the deviant behavior itself, apart from other
people’s reaction to it and societal reaction alone cannot be a causative
Criticized for failing to take into account variation of cultural norms and human
behavior and failing to take chronic illness into consideration as well as stigmatizing
conditions such as mental illness more concealment than health seeking behavior
Illness Behavior
Illness Behavior aimed at seeking treatment seeking a doctor
Sick role behavior as activity aimed at recovery taking meds
Health behavior was defined in relation to action taken to MAINTAIN health and
PREVENT ill health
Social and Structural influences on illness behavior
Two approaches social and structural influences vs. psychological characteristics
of people
Women report more illness and have more medical consultations than men
Men have higher mortality patterns
It is more culturally acceptable for women to admit feeling ill, to report distress and
to seek help
Low SES = most at risk of ill health and least likely to use preventive services and
adopt healthy lifestyles
o Related to feelings of powerlessness, passivity, and fatalism
o Mistrust of modern medicine
o Less knowledgeable about how to access services and to communicate
effectively with doctors