13.1 Sociological Perspectives on Health and Health Care
Health refers to the extent of a person’s physical, mental, and social well-being. As this
definition suggests, health is a multidimensional concept. Although the three
dimensions of health just listed often affect each other, it is possible for someone to be
in good physical health and poor mental health, or vice versa.
Medicine refers to the social institution that seeks to prevent, diagnose, and treat
illness and to promote health in its various dimensions. This social institution in the
United States is vast, to put it mildly, and involves more than 11 million people
(physicians, nurses, dentists, therapists, medical records technicians, and many other
Finally, health care refers to the provision of medical services to prevent, diagnose,
and treat health problems.
Functionalism - Good health and eﬀective medical care are essential for the
smooth functioning of society. Patients must perform the “sick role” in order to
be perceived as legitimately ill and to be exempt from their normal obligations.
The physician-patient relationship is hierarchical: The physician provides
instructions, and the patient needs to follow them.
Conﬂict Theory - Social inequality characterizes the quality of health and the
quality of health care. People from disadvantaged social backgrounds are more
likely to become ill and to receive inadequate health care. Partly to increase their
incomes, physicians have tried to control the practice of medicine and to deﬁne
social problems as medical problems.
For a person to be considered legitimately sick, said Parsons, several expectations must
be met. He referred to these expectations as the sick role. First, sick people should not
be perceived as having caused their own health problem. If we eat high-fat food, become
obese, and have a heart attack, we evoke less sympathy than if we had practiced good
nutrition and maintained a proper weight. If someone is driving drunk and smashes into
a tree, there is much less sympathy than if the driver had been sober and skidded off the
road in icy weather.
Second, sick people must want to get well. If they do not want to get well or, worse yet,
are perceived as faking their illness or malingering after becoming healthier, they are no
longer considered legitimately ill by the people who know them or, more generally, by
Third, sick people are expected to have their illness confirmed by a physician or other
health-care professional and to follow the professional’s instructions in order to become
well. If a sick person fails to do so, she or he again loses the right to perform the sick
role. Parsons thus viewed the physician-patient relationship as hierarchical: the physician
gives the orders (or, more accurately, provides advice and instructions), and the patient
Parsons was certainly right in emphasizing the importance of individuals’ good health
for society’s health, but his perspective has been criticized for several reasons. First, his
idea of the sick role applies more to acute (short-term) illness than to chronic (long-
term) illness. Although much of his discussion implies a person temporarily enters a
sick role and leaves it soon after following adequate medical care, people with chronic
illnesses can be locked into a sick role for a very long time or even permanently. Second,
Parsons’s discussion ignores the fact, mentioned earlier, that our social backgrounds
affect the likelihood of becoming ill and the quality of medical care we receive. Third,
Parsons wrote approvingly of the hierarchy implicit in the physician-patient
relationship. Many experts say today that patients need to reduce this hierarchy by
asking more questions of their physicians and by taking a more active role in
maintaining their health.
The Conflict Approach:
Physicians may honestly feel that medical alternatives are inadequate, ineffective, or
even dangerous, but they also recognize that the use of these alternatives is financially
harmful to their own practices.
many hyperactive children are now diagnosed with ADHD, or attention deficit/
hyperactivity disorder. The definition of their behavior as a medical problem was very
lucrative for physicians and for the company that developed Ritalin, and it also obscured
the possible roots of their behavior in inadequate parenting, stultifying schools, or even
gender socialization, as most hyperactive kids are boys.
Although physicians are certainly motivated, as many people are, by economic
considerations, their efforts to extend their scope into previously nonmedical areas also
stem from honest beliefs that people’s health and lives will improve if these efforts
13.2 Global Aspects of Health and Health Care
International Disparities in Health and Illness:
The poorest nations suffer terribly. Their people suffer from poor nutrition, unsafe
water, inadequate sanitation, rampant disease, and inadequate health care. One disease
they suffer from is AIDS.
Infant mortality is greater in poor counties. Sanitation is poor in poor countries. North America, Western Europe, Australia, and New Zealand have much longer life
expectancies (75 years and higher) than Africa and Asia, where some nations have
expectancies below 50 years. The society we live in can affect our life span by more than
a quarter of a century.
Health Care in Industrial Nations:
Industrial nations throughout the world, with the notable exception of the United
States, provide their citizens with some form of national health care and
national health insurance. Although their health-care systems differ in several
respects, their governments pay all or most of the costs for health care, drugs, and other
Lessons from Other Societies:
Although the United States spends more per capita than these nations on health care, it
generally ranks much lower than they do on important health indicators. Of twenty-four
wealthy democracies from North America, Western Europe, and certain other parts of
the world the United States has the lowest life expectancy, the highest infant mortality,
and the highest rates of obesity, adult diabetes, and HIV and AIDS.
A fair conclusion from all the evidence is that US health lags behind that found in other
wealthy nations because the latter provide free or low-cost national health care to their
citizens and the United States does not.
13.3 Problems of Health in the US
Health has improved in the US in regards to life expectancy, smoking, and the amount
of lead in blood
The Poor Status of American Health
14.5 percent of US households and almost 49 million Americans are “food
insecure” (lacking sufficient money for adequate food and nutrition) at least part of the
year; more than one-fifth of all children live in such households
More than 8 percent of all infants are born at low birth weight (under 5.5 pounds),
putting them at risk for long-term health problems; this figure has risen steadily since
the late 1980s and is higher than the 1970 rate
Social epidemiology - The study of how health and illness vary by social and
demographic characteristics such as social class, race and ethnicity, and gender. Health disparities - Differences in health and illness according to social class, race and
ethnicity, and gender.
Health Disparities: Physical Health
Children and Our Future:
As family income and levels of education rise, health improves. In almost every state,
shortfalls in health are greatest among children in the poorest or least educated
households, but even middle-class children are less healthy than children with greater
• Children of poor mothers are more than twice as likely as children born to
wealthier mothers to be born with low birth weight.
• By the age of 9 months, poor children are already more likely to exhibit poor
health and lower cognitive and socioemotional development.
• By age 3, poor children are two-thirds more likely to have asthma than children
whose families’ incomes are more than 150 percent of the poverty line.
• Based on their parents’ reports, poor children are almost five times more likely
(33 percent compared to 7 percent) to be in less than very good health (i.e., their
parents rated their children’s health as poor, fair, or good rather than as very
good or excellent).
One reason is that poverty causes stress. Another reason is that they are more likely to
experience food insecurity and, if they live in urban areas, be exposed to higher levels of
lead and pollution.
Low-income children also tend to watch television more often than wealthier children
and for this and other reasons to be less physically active; their relative lack of physical
activity is yet another reason for their worse health. Finally, their parents are much
more likely than wealthier parents to smoke cigarettes; the secondhand smoke they
inhale impairs their health.
As is well known, many poor people lack medical insurance and in other respects have
inadequate health care. These problems make it more likely they will become ill in the
first place and more difficult for them to become well because they cannot afford to visit
a physician or to receive other health care.
A fourth reason is a lack of education, which, in ways not yet well understood, leads poor
people to be unaware or unconcerned about risk factors for health and to have a
fatalistic attitude that promotes unhealthy behaviors and reluctance to heed medical
advice. Although it might sound like a stereotype, poor people are more likely to smoke, to eat
high-fat food, to avoid exercise, to be overweight, and, more generally, not to do what
they need to do (or to do what they should not be doing) to be healthy
Race and Ethnicity:
When we do not take gender into account, African Americans can expect to live about
five fewer years than whites.
Infant mortality is higher for races other than whites.
African Americans are also more likely than whites to be overweight and to suffer from
asthma, diabetes, high blood pressure, and several types of cancer.
Why do such large racial and ethnic disparities in health exist? To a large degree, they
reflect the high poverty rates for African Americans, Latinos, and Native Americans
compared to those for whites. In addition, inadequate medical care is perhaps a special
problem for people of color, thanks to unconscious racial bias among health-care
professionals that affects the quality of care that people of color receive.
Many of the foods that have long been part of African American culture are high in fat.
Partly as a result, African Americans are much more likely than whites to have heart
disease and high blood pressure and to die from these conditions
In a significant finding, African Americans tend to have worse health than whites even
among those with the same incomes. Several reasons explain this racial gap. One is the
extra stress that African Americans of all incomes face because they live in a society that
is still racially prejudiced and discriminatory.
To some degree, racial differences in health may also have a biological basis. For
example, African American men appear to have higher levels of a certain growth protein
that may promote prostate cancer; African American smokers may absorb more nicotine
than white smokers; and differences in the ways African Americans’ blood vessels react
may render them more susceptible to hypertension and heart disease
Environmental racism - Minorities tend to live in poor or urban areas that expose them
to more chemicals and pollution which is bad for their health.
Women outlive men by more than 6 yrs.
At the same time, women have worse