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HLTB15H3 (41)


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Health Studies
Iva Zovkic

HLTB15 WINTER 2013 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 mastery  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 Coping  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 treatment  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 experiences  Crisis Theory o Theory postulates that individuals strive towards homeostasis and equilibrium in their adjustment Please Read Page 28 HLTB15 WINTER 2013 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 Adjustment  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 HLTB15 WINTER 2013 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 rules o Depends on how responsible the person is perceived to be for his or her deviance 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 model  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 HLTB15 WINTER 2013 o Social and cultural distance between doctors and patients in low SES reinforces reluctance  Cost benefit approach o Different costs and benefits involved in the use of services, as perceived by people of different social backgrounds  Time  Money  Distance  Control of life – can they take time off work?  Predictive model of health seeking o Predisposing – sociodemographic variables, attitudes and beliefs o Enabling – income, access, availability o Need – supposedly the most predictive factor o All of these combined influence a persons’ decision to use services Psychological influences on illness behavior  Seeking professional help dependent on values, models of health behavior and culture  Illness behavior is a learned response o Visibility, recognisability or perpetual salience of symptoms o Perceived seriousness of symptoms o Extent to which symptoms disrupt family, work or social activities o Frequency of appearance or recurrence o Symptoms and their persistence o Tolerance threshold of those expose to the symptoms o Available information, knowledge and cultural assumptions and understandings of evaluator o Perceptual needs which lead to autistic psychological processes o Needs competing with the response to illness o Competing interpretations of the symptoms o Availability of and physical proximity to treatment o Psychological and financial costs of taking action Interactionist approach  Argue that demographic and psychological variables are just a tiny aspect of the larger picture and more emphasis must be put on areas of social interaction and role and the meaning of situations to individuals CHAPTER 3: MODELS OF HEALTH BEHAVIOUR Health Lifestyles  Health lifestyles
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