Chapter 18 The Sociology of Health and Illness

1. Chapter 18 The Sociology of Health and Illness

2. The Sociology of Health and Illness • To understand why eating disorders have become so commonplace in current times, we should think back to the social changes analyzed earlier in the book. Anorexia actually reflects certain kinds of social change, including the effect of globalization. • Food production in the modern world has been globalized. • Decisions on what to eat are influenced by social relations.

3. The Sociology of Health and Illness • Women especially are judged by physical appearance, but feelings of shame about the body conform to social expectations.

4. The Sociology of Health and Illness Women suffer more often from eating disorders than men for a number of reasons; • Attractiveness for women. • The socially defined desirable body image for women is skinny, not muscular. • Women are judged as much by their appearance as by their accomplishments..

5. The Sociology of Health and Illness • According to Talcott Parsons, there are three pillars of the sick role: • The onset of illness is unrelated to the individual’s behavior or actions. • The sick person is entitled to certain rights and privileges, including withdrawal from normal responsibilities. • The sick person must work to regain health by consulting a medical expert & agreeing to become a "patient."

6. The Sociology of Health and Illness: Symbolic Interactionism • Illness = “lived experience.” • The ways people interpret the social world and the meanings they ascribe to it.

7. The Sociology of Health and Illness • In many industrialized societies over the last decade, there has been a surge of interest in the potential of alternative medicine. -e.g., herbal remedies, acupuncture, reflexology, chiropractic treatments

8. The Sociology of Health and Illness • The World Health Organization predicts that within 20 years, depression will become the most debilitating disease in the world.

9. The Sociology of Health and Illness-Class • Richard Wilkinson (1996): Countries with most even distribution of income & levels of social integration are the healthiest countries. • Education is positively related to preventative health behaviors. Better-educated people are significantly more likely to engage in aerobic exercise and to know their blood pressure, and are less likely to smoke or be overweight (Shea et al. 1991). • Poorly educated people tend to engage in more cigarette smoking; they also tend to have more problems associated with cholesterol and body weight (Winkleby et al. 1992).

10. The Sociology of Health and Illness-Race • Life expectancy at birth in 2003 was about 80 years for white females but just 76 years for black females. • It was 75 years for white males yet just 69 years for black males (National Center for Health Statistics 2005a). • About 58 percent of black households have no financial assets at all, almost twice the rate for white households (U.S. Bureau of the Census 2005a). Median income of a black man is only 67 percent of that of a white man (U.S. Bureau of the Census 2005b). • Rise in violent crime has accompanied the rise of widespread crack cocaine addiction, a cultural condition of poor African American neighborhoods plagued by high levels of unemployment (Wilson 1996).

11. The Sociology of Health and Illness-Race • Some of the differences in black and white health go beyond economic causes to differences in cultural conditions. • Racial gaps in mortality. In 2002, a black person was 6 times more likely to be murdered than a white person (U.S. Bureau of Justice Statistics 2004a). Homicide victimization rates for both whites and blacks peaked between 1993 and 1994. The murder rate for white males between 18 and 24 years of age increased from 11.9 per 100,000 in 1984 to a high of 17.8 in 1994. By 2002, the murder rate for young white men had declined to 12.7 per 100,000. • For young black males, the murder rate increased by over 270 percent between 1984 and 1994 (from 68 per 100,000 in 1984 to 183.5 in 1993). Since then the murder rate for blacks has declined to 102.3 per 100,000, which is 805 percent higher than for whites and still over 150 percent higher than the murder rate for young black men in 1984 (U.S. Bureau of Justice Statistics 2004b).

12. The Sociology of Health and Illness-Race • A higher prevalence of hypertension among blacks—especially black men. • Blacks smoking significantly more than whites. This may be due in some measure to cultural differences between blacks and whites, as well as the way in which the cigarette industry has deliberately targeted African Americans as a market. • Prevalence of hypertension among blacks has been greatly reduced. In the early 1970s, half of black adults suffered from hypertension. By 1994, however, roughly 36 percent of black adults between ages twenty and seventy-four suffered from hypertension (National Center for Health Statistics 2003). • Yet, by 2002 the share of black women with hypertension had increased again to almost 40 percent (National Center for Health Statistics 2005c)

13. The Sociology of Health and Illness-Race • In 1987, only 30 percent of white women and 24 percent of black women aged forty and older reported having a mammogram within the past two years. By 2003, the share of white and black women were equal at 71 percent (National Center for Health Statistics 2005d). • Between 1983 and 2001, the proportion of blacks who had visited the dentist within the past year had increased from 39 percent to 58 percent, while the figure for whites increased from 57 percent to 68 percent (National Center for Health Statistics 2005e). • Extensive programs of health education and disease prevention tend to work better among more prosperous, well-educated groups and in any case usually produce only small changes in behavior. Increased accessibility to health services would help, but probably to a limited degree. The only really effective policy option is to attack poverty itself, so as to reduce the income gap between rich and poor (Najman 1993).

14. The Sociology of Health and Illness-Gender • Women in the United States live longer than men. The gender gap in life expectancy was about 4.4 years in 1940, 7.7 years in 1970 and 5.4 in 2003 (Cleary 1987; National Center for Health Statistics 2005f). • In 1900, the leading cause of death was infectious disease, which struck men, women, and children equally. Since mid-century, however, heart disease and cancer have been the leading causes of death for American adults. Women’s mortality advantage depends on gender behavioral differences—smoking, drinking, and preventive health behaviors. • Men are more likely to smoke cigarettes, marijuana, drink that are associated with heart disease and various types of cancer. Likewise, higher proportions of men than (National Center for Health Statistics 2005g). • Male roles lead men to adopt the Coronary Prone Behavior Pattern, or Type A personality (i.e., persons who are competitive, impatient, ambitious, and aggressive) that are twice as likely as Type B personalities to suffer heart attacks (Spielberger et al. 1991).

15. The Sociology of Health and Illness-Gender • Despite the female advantage in mortality, most large surveys show women more often report poor health. Women have higher rates of illness from acute conditions and nonfatal chronic conditions, including arthritis, osteoporosis, and depressive and anxiety disorders. • There are two main explanations for women’s poorer health, yet longer lives: (1) Greater life expectancy and age brings poorer health, (2) women make greater use of medical services including preventive care (Centers for Disease Control and Prevention [CDC] 2003a). • In 2000, the average number of visits to physician offices, hospital emergency rooms, and hospital outpatient departments was 25 percent higher for women than for men. • Men may experience as many or more health symptoms as women, but men may ignore symptoms, may underestimate the extent of their illness, or may utilize preventive services less often (Waldron 1986).

16. The Sociology of Health and Illness-Social Technology • A social technology is a means by which we try to alter our bodies--for example, by dieting. • The socialization of nature--phenomena that used to be “natural,” or given in nature (such as reproduction), have become social: they depend upon our own social decisions.

17. Social Cohesion: The Key to Better Health? • Wilkinson (1996) argues that social factors—the strength of social contacts, ties within communities, availability of social support, a sense of security—are the main determinants of the relative health of a society. • Wilkinson notes a clear relationship between mortality rates and patterns of income distribution. Japan and Sweden are regarded as some of the most egalitarian societies in the world, enjoy better levels of health on average than do citizens of countries where the gap between the rich and the poor is more pronounced, such as the United States. • The widening gap in income distribution undermines social cohesion and makes it more difficult for people to manage risks and challenges. Heightened social isolation and the failure to cope with stress is reflected in health indicators.

18. The Developing World: Colonialism & the Spread of Disease • The English and French colonists brought the same diseases to North America (Dubos 1959). Before contact with the Europeans, levels of risk from infectious diseases were lower. There was always the threat of epidemics, drought, or natural disaster, but colonialism led to major changes in the relation between populations and their environments, producing harmful effects on health patterns. Smallpox, measles, and typhus, among other major maladies, were unknown to the indigenous populations of Central and South America before the Spanish conquest in the early sixteenth century. • The most significant consequence of the colonial system was its effect on nutrition and levels of resistance to illness as a result of the changed economic conditions involved in producing for world markets. In many parts of Africa in particular, the nutritional quality of native diets became substantially depressed as cash-crop production supplanted the production of native foods. • On the other hand, the importation of tobacco and coffee, together with raw sugar, which began increasingly to be used in all manner of foods, has had harmful consequences. Smoking tobacco, especially, has been linked to the prevalence of cancer and heart disease.

19. HIV/AIDS • In 2005 alone, over 3 million people worldwide died from AIDS-related illnesses (UNAIDS 2005a). • Using middle-range estimates, about 720,000 people are living with HIV/AIDS in Europe, 1.2 million in North America, 2.1 million in Latin America and the Caribbean, and nearly 26 million in sub-Saharan Africa (Global Map 18.1). • The majority of people affected in the world today are heterosexuals. In 2005, about half are women. In sub-Saharan Africa, young women are more than 2.5 times more likely than men to be infected with HIV/AIDS. Worldwide, at least 4 HIV infections are contracted heterosexually for every instance of homosexual spread. • In the U.S., over 43,000 new infections in 2005 and nearly half of these were in southern states. Of these, nearly half were in African Americans, who constitute less than 12 percent of the total population. African American women are 8 times more likely to be infected with HIV than white women, and HIV/AIDS is now the leading cause of death among African American women aged twenty-five to thirty four in the United States (UNAIDS 2003; 2005a & b).

20. HIV/AIDS • The United Nations Joint Program on HIV and AIDS reports that African Americans are half as likely to be receiving antiretroviral treatment (UNAIDS 2005b). • Stigmatization of people with HIV/AIDS remains a major barrier to successful treatment programs. Stigma draws on preexisting prejudices to justify scapegoating and blaming in victimized people. • The stigma that associates HIV positive status with sexual promiscuity and immorality results in an avoidance of HIV/AIDS prevention and treatment programs. Clearly, the statistics cited above demonstrate that HIV/AIDS is not a “gay disease.” • In the United States, about a quarter of people living with HIV/AIDS do not know that they are infected (UNAIDS 2005b). Because such a large group exists is the high level of fear and denial associated with being diagnosed as HIV positive. Discrimination is also seen at the level of government health care planning (UNAIDS 2003).

21. HIV/AIDS • In countries heavily affected by the HIV/AIDS epidemic, only 5 percent of pregnant women receive health-care services aimed at preventing mother-to-child HIV transmission (UNAIDS 2005d). Worldwide, the parents of an estimated 15 million children have died as a result of HIV/AIDS; twelve million of these are in sub-Saharan Africa alone (Global Map 18.1). • The decimated population of working adults combined with the surging populations of orphans sets the stage for massive social instability, as economies break down and governments are unable to provide for the social needs of orphans who become targets for recruitment into gangs and armies who train them to fight as soldiers. • World Health Organization suggests that more than 2/3 of people living in urban areas in developing countries draw their water from sources that fail to meet minimal safety standards. About 17/2 common water-related diseases in developing nations could either be cut by half or eradicated altogether simply by the provision of ready supplies of safe water (Doyal and Pennell 1981). Only about 1/4 of the city residents in developing countries have water-borne sewage facilities; some 30 percent have no sanitation at all. These conditions provide breeding grounds for diseases such as cholera (Dwyer 1975).

22. Human Sexuality • Sexual practices are primarily learned behaviors • Sexual practices vary over time & across cultures.

23. Human Sexuality: Orientation • In the West, Christianity has been important in shaping sexual attitudes. In societies with rigid sexual codes, double standards & hypocrisy are common. The gulf between norms & actual practice can be tremendous. • One’s sexual orientation results from an interplay between biological factors & social learning. • Homophobia = an aversion or hatred of homosexuals & their lifestyles

24. Human Sexuality: Kinsey • Kinsey found that almost 70 % of men had visited a prostitute & 84% had had premarital sexual experience. • Among women, about 50% had had premarital sexual experience, although mostly with their prospective husbands. • Alfred Kinsey and his co-researchers conducted the first major sexual behavior investigation in the United States in the 1940s and 1950s. This research faced condemnation from religious organizations, and his work was denounced as immoral in the newspapers and in Congress.

25. Human Sexuality: Lillian Rubin • In the late 1980s, Lillian Rubin found that sexual behavior and attitudes over the past 30 years have changed. • Sexual activity typically begins at a younger age than for the previous generations, and there is still a double standard. • Women expect and actively pursue sexual pleasure in relationships.

26. Human Sexuality: Edward Laumann (1994) • Sexual conservatism among Americans. • Of their subjects, 83 percent had had only one partner in the preceding year. • Of the married people, 96 percent had had only one partner in the preceding year. • Only 10 percent of women and less than 25 percent of men reported having an extramarital affair during their lifetime.

27. Sexuality and Procreative Technology • Americans average only three sexual partners during their entire lifetime. • More than 95% of Americans getting married today are sexually experienced. • For hundreds of years, the lives of most women were dominated by childbirth and child rearing. • Differential access to genetic engineering may lead to the emergence of a biological underclass.