Chapter 4 – Sociology

Lecturer PowerPoint
Lecturer Lesson Plan
Additional Case Study
3 Papers
3 Websites
3 Media Articles
Learning Tasks Discussion
Issues you may have considered in relation to the Learning Tasks in the book…

Learning Task 1: Developing your sociological thinking about health

Power can be represented in a number of ways: dress, authoritarian management, and decision-making processes. Patients are regulated within the GP setting; for example, you may have thought about power dynamics from the very start of trying to gain access – receptionists may ask why you need an appointment when you telephone to book in. Were you triaged? Some surgeries now ask you to wait until you speak to a GP who will determine if a telephone consultation is sufficient, or if you need to visit in person.

Did you consider what is seen as appropriate behaviour if you are present at the surgery, e.g. how are you expected to conduct yourself in the waiting room? Do you obey these unspoken conventions and sit quietly, waiting until you are called in by the GP?

During the actual face-to-face contact with the GP, how are you expected to behave (e.g. to present your problem for discussion, to allow examination and to accept the diagnosis of the GP)? What happens if you do not follow conventions? Do you simply adhere to these expectations? Do you present yourself as a good patient, e.g. you have attempted self-care, you are always trying to be healthy in your daily life? Do you discuss your lay beliefs as well?

What are your expectations of the visit? Have you used the internet before you have accessed the GP and searched about your health/condition/illness and does this inform what you think the GP should do? Do you expect a prescription/some action/some advice/a referral? To what extent do you wish the GP to grant permission for you to inhabit the sick role?

Learning Task 2: Thinking about social influences upon health

Here you will have considered different levels of influence, such as the micro level that you can control, e.g. how much you exercise, whether you smoke, how much alcohol you consume and what you eat. How are your circumstances likely to affect the way that you make health choices, e.g. if you are financially facing difficulty you might eat less healthy foods as you will need to choose the most cost-effective option; perhaps you cannot afford a gym membership or are unable to exercise because it is unsafe to walk/run in the area where you live. This shows the relationship between the macro and the micro level. If you are unable to control your work, or even find employment, live in poor housing and have limited funds, this is likely to lead to poorer health. Social influences are inherently complex as are the determinants of health (revisit Dahlgren and Whitehead in chapter 13), so you may be more affluent but find that the stress of work leads to you having unhealthy coping mechanisms such as drinking too much alcohol every evening as you try to unwind.

Learning Task 3: Stigma and health: biographical disruption

Andrew’s experiences are typical of biographical disruption because his condition is disruptive to his everyday life. Whilst he is not visibly different to others and behaves in ways that are considered usual, his normal appearance (aside from sometimes looking unwell during treatment) means that he is not always perceived to be ‘sick’ by others. The negative reactions that he has experienced when disclosing his illness because of assumptions about causation have affected his identity and sense of self. He chooses to be more socially isolated as a result and can feel lonely which affects his mental wellbeing. Andrew has also had to deal with the issue of death and to consider this, given his diagnosis. This caused him further emotional distress and isolation as death is not openly discussed by many people. Being off work sick has also led to Andrew having less human contact and feeling more alone. He therefore develops coping mechanisms, e.g. not disclosing his condition to some people. Andrew is also likely to experience stigma as his condition is one that is generally associated with smoking, an activity that is increasingly stigmatized, as is the disease of lung cancer.

Learning Task 4: The social construction of disability

Have you ever considered how the able-bodied exclude those who are less able within society? Some places and buildings are completely inaccessible, depending upon the nature of the disability, and whilst disabled access may be improving and is regulated by law, it can still be limiting, e.g. there may only be one disabled access point to a building, the disabled toilets may be located in one area, etc. There are also different challenges depending upon the nature of the disability, e.g. loss of sight versus physical disablement requiring wheelchair use creates different needs; however, are these accounted for in generic provision and building adaptation? Furthermore, think about the attitudes of people and how they may themselves be exclusionary. The following compares the arguments for and against the idea that disability is the product of society, rather than a distinct medical condition.

Disability as the product of society
Disability can be interpreted as a social construction
Disability is part of the discourse of difference
Biomedical science is subject to fashions – is the medicalization of disability a trend?
Cultural differences exist in terms of symptom presentation and diagnosis
Health and illness are open to interpretation and can be subjective (see chapter 1)
Defining disability is difficult in some cases

Disability as a medical condition
People are biologically different to the rest of the population
To be disabled means having an abnormality within the function of the body
Disability is located within individuals
Some disabilities are congenital – they are biologically created

Multiple Choice Quiz

1. What statement best describes sociology?
a. It brings together private troubles and public issues
b. The analysis of social facts
c. The study of medical experts
d. The study of society

ANSWER

The correct answer is d: sociology is a discipline that studies all aspects of society. Answer a is part of the description of social policy described by C. Wright-Mills. Whilst social research is important within the discipline of sociology, answer b is not a full description of the discipline, and answer c describes just a small concern within sociology, not the entire focus of the discipline.

2. Which sociologist developed the concept of the sick role?
a. Max Weber
b. Karl Marx
c. Talcott Parsons
d. Emile Durkheim

ANSWER

The correct answer is d.

3. What term is used to describe the construction of chronic fatigue syndrome, ADHD and Gulf War syndrome as medical problems requiring diagnosis, treatment and cure?
a. Medicalization
b. Iatrogenesis
c. Diagnosis
d. Stigma

ANSWER

The correct answer is a. Medicalization is a concept that describes the way in which human conditions come to be understood as medical conditions and problems. Iatrogenesis describes sickness and illness generated by doctors and medical activity. Diagnosis refers to the identification of illness in a medical context. Stigma refers to Goffman’s description of the negative labels and understandings of certain illnesses and conditions.

4. Which theoretical perspective is concerned with health as a commodity that can be bought and sold?
a. Feminism
b. Postmodernism
c. Symbolic interactionism
d. Marxism

ANSWER

The correct answer is d. Marxist theorists focus upon health as a requirement for the functioning of society in order to ensure that capital continues to make money. Health is something that can be bought too, with those in richer and more powerful positions being better able to do that. Feminists are concerned with gender inequalities and gender relationships; postmodernist perspectives are concerned with exploring truth and the social construction of reality; and symbolic interactionists are concerned with social interactions that take place at the level of individuals.

5. According to the social model of health, how is disability conceptualized?
a. As an individual problem due to the physical limitations of people
b. A problem for people caused by bodily malfunctions
c. A problem for people because of how society is organized
d. A problem for people because of bodily mechanisms

ANSWER

The correct answer is c: the social model of disability identifies negative attitudes to disability, as well as barriers at the societal level, as the key issue for those who are classified as disabled. Answers a, b and d focus upon the individual body and how it functions, which is more aligned with medical understandings and the medical model.

6. Which of the following is NOT an explanation for the existence of health inequalities?
a. The artefact explanation
b. The psychosocial explanation
c. The lifestyle explanation
d. The functionalist explanation

ANSWER

The correct answer is d: the functionalist explanation/theory is not one that tries to explain the existence of health inequalities. As a theory it is concerned with how society functions and operates effectively. Answer a is an explanation for the existence of inequalities, which suggests that the measurement of differences used to determine morbidity and mortality are methodologically flawed therefore inequalities are an artefact. The psychosocial explanation is one that focuses upon explaining inequalities by looking at the psychological and social factors which predispose people to higher risks in relation to their health. The life-style explanation suggests that individual choices determine health inequalities.

7. Which of the following is NOT a health inequality?
a. Sick patients experience biographical disruption
b. Men dying at a younger age than women
c. Poorer people having lower life expectancy than richer people
d. Those in lower social classes accessing doctors less often

ANSWER

The correct answer is a: the concept of biographical disruption is used to explain and understand the experiences of those suffering from chronic illness rather than explaining inequalities. A focus group is a research method. The population is a term that refers to groups of people or organisms which live in a specific location. Respondents are those who respond to the invitation to participate in research; not all individuals in a sample necessarily respond.

8. Chronic illness can result in which of the following?
a. Self-help
b. Biographical disruption
c. The sick person working with the medical profession
d. Medicalization

ANSWER

The correct answer is b: the concept of biographical disruption is used to describe the way in which individuals deal with the consequences and experiences of chronic illness. Self-help refers to self-guided improvement in a number of ways for example, educationally or economically rather than simply referring to health; medicalization refers to the process of how everyday illnesses become understood as medical conditions and would have to precede a diagnosis rather than follow on from one.

9. Goffman’s concept of stigma does not include which of the following?
a. Judgements about health reflecting norms and values
b. Identity being negatively affected
c. Social and physical aspects
d. An analysis of political economy aspects

ANSWER

The correct answer is d: political economy perspectives such as Marxist theories are not concerned with stigma, rather they focus upon economies of the state. Answer c is incorrect as stigma, according to Goffman, does involve both social and physical aspects: as well as appearing to be different, which leads to physical stigma, labelling can also result in social stigma.

10. The sociology of health promotion critically analyses which of the following?
a. The norms and values underpinning health promotion as a discipline
b. Health inequalities
c. The medical model of disability
d. Individual lifestyle choices such as smoking and drinking

ANSWER

The correct answer is a: sociology asks questions about whether the norm and values of health promotion realistically take account of people’s everyday lives enough to be effective. Both sociology and health promotion study health inequalities within their own disciplinary boundaries, rather than the sociology of health promotion focusing upon inequalities as well. Whilst the medical model is of concern to both sociologists and health promoters, it is not specifically focused upon within sociological analyses of health promotion. Answer d is also incorrect, since the sociological analysis of health promotion asks questions about the need for change at higher levels such as social and political change.

Additional Case Study: The sociology of risk and health: vaccination uptake

Sociological research has focused upon notions of risk since Beck’s (1986) book was published with the title ‘Risk Society’ in 1986. Beck (1986) argued that modern society is dominated by technical risk. Research has since moved on to focus upon risk in relation to health and physical/mental illness, crime, regulation, social inequality, the media and global issues.

Perceived risks associated with vaccinations have been documented for many years across a range of countries. In the UK, concerns emerged with the MMR vaccination being linked to autism following the publication of claims made by Dr Andrew Wakefield in 1998. These claims have been largely discredited and there are many published peer-reviewed articles highlighting the safety of vaccinations. Despite this, the WHO (2019) reports evidence of vaccination hesitancy in more than 90% of countries across the world and notes the role of the media in spreading concerns about these vaccine-related ‘risks.’ Bond and Nolan (2011) analysed perceptions of risk linked to vaccinations and found that the health messages used to promote the importance of vaccination are perceived as irrelevant or unbelievable by some people. They argue that there is a need to understand how people perceive risks and use these to inform their decision making.

Vaccination remains most effective when all participate as this ensures herd immunity (WHO 2019), so ironically those who believe that vaccinations are risky are in turn placing themselves at more risk of contracting infectious diseases. Risks in this sense can be understood as a social construction based upon changing societal understandings: now that some populations have less experience of the dangers of infectious diseases, does this affect the ways in which people understand the threats to health associated with such conditions? Risk perceptions are linked to understandings of science, and discourses of distrust abound as post-structuralists note. How do media platforms link to the questioning of evidence? Who owns the media, and what interests are being served here? Marxist theorists would argue that this is about commercial power. In analysing the perceived risks of vaccination uptake, it is also worth paying attention to structure and agency – individual agency is evidently used by those who choose to non-immunize.

References

Beck, U. (1986) Risk Society. London, Sage.

Bond, Nolan (2011) Making sense of perceptions of risk of diseases and vaccinations: A qualitative study combining models of health beliefs, decision-making and risk perception. BMC Public Health 11, 1, 943

WHO (2019) Vaccine hesitancy: a generation at risk. The Lancet 3, pp. 281.

3 Papers

Busfield, J. (2017) The concept of medicalisation reassessed. Sociology of Health and Illness 39, 5, pp. 759-774. LINK
In this paper, Busfield presents her reassessment of the concept of medicalization in response to criticisms within the sociological literature. The paper provides a history of the concept, so it is a useful introduction, and concludes with the argument that medicalization remains relevant.

Smith, K.E. and Anderson, R. (2018) Understanding lay perspectives on socio-economic health inequalities in Britain: a meta-ethnography. Sociology of Health and Illness 40, 1 pp. 146-170. LINK
This paper presents research findings that illustrate how people living in socio-economically disadvantaged circumstances understand how this affects their health. Exploring lay perspectives and individual agency, the paper discusses shame and stigma in relation to health inequalities.

Mik-Meyer, N. and Obling, A. R. (2012) The negotiation of the sick role: general practitioners’ classification of patients with medically unexplained symptoms. Sociology of Health and Illness 34, 7, pp. 1025–1038. LINK
This article talks about how the sick role is a social process in which GPs not only use traditional biomedical diagnostic tools, but they also draw upon their own opinions in order to decide whether a patient is legitimately sick (or not). Doctors are therefore gatekeepers of legitimacy. The findings are based upon a qualitative study conducted in Denmark.

3 Websites

1. British Sociological Association
This association promotes sociology and is the public face of British sociology. It has a specific section for students, including various resources and a number of study groups who convene to explore specific topics within the discipline such as gender and the sociology of death and dying.

2. Sociology 9th edition
This is the website for Sociology by Anthony Giddens and Philip W. Sutton. It houses a range of tools and resources linked to the book. Content is listed according to chapters (each is summarized), there is a section for lecturers, assignment guides and links to a range of other sociological content.

3. Sociology Central
This is a website for teachers and students of A-level Sociology. There are several different sections containing resources such as PowerPoint slides and film material, blogs and links to other websites.

3 Media Articles

1. ‘It’s nothing like a broken leg’: why I’m done with the mental health conversation
This article touches upon the concept of stigma. Despite increasing health awareness campaigns linked to mental health, the article author who has lived experience argues that this is not a helpful approach.

2. A pill for loneliness? If only it were that simple
Loneliness is increasingly receiving both research and media attention in the UK. Researchers in the USA are exploring the possibility of developing medication to treat loneliness. Here the author argues that the causes are social, and therefore treatment in the form of medication is not the answer. This discussion relates to the medicalization of social problems.

3. The Medicalization of Misbehaviour
In a 45-minute Radio 4 programme, a panel of people debate newly defined medical disorders and how these are being used to classify negative behaviours. This programme again touches upon the medicalization debates.