Sociology of health and disease

• Social determinants

  A good diet and adequate food supply are central for promoting health and wellbeing
• Shortage of food or lack in variety

  Can cause malnutrition and deficiency-related diseases
• Excess intake of the same type of food

  Contributes to: cardiovascular diseases, diabetes, cancer, degenerative eye diseases, obesity and dental cavities/tooth decay
• Access to good, affordable food makes more difference to what people eat than health education
• The main dietary difference between different social classes is the source of nutrients
• The foods available to economically disadvantaged society has a high fat intake (satisfies hunger) but offers little nutrition, and they substitute cheaper processed foods for fresh food
• Individuals living on low incomes (young families, elderly people and the unemployed), are least able to eat well
• Despite dietary goals to prevent chronic diseases with emphasis on eating more fresh fruits and vegetables, Legumes and less processed starchy foods, animal fat, refined sugars and salt, social and economic conditions result in a social gradient in diet quality that contributes to health inequalities
• Abuse encompasses different forms of addiction

  • Substance addiction (alcohol, drugs, caffeine, pain medication, inhalants)
  • Behavioural addiction (internet, gambling, shopping, food, exercise, gaming/video games, sex/pornography, plastic surgery)
• Substance-dependent individuals

  Have an 'aching emptiness', and constantly seeking something outside themselves to "curb an insatiable yearning for relief, comfort or fulfilment"
• Research indicates that trauma (abuse, neglect, traumatic event) is often the underlying cause of addictions
• Individuals who have experienced trauma are at an increased risk of developing an addiction
• Addiction is only a consequence, substance abuse is often misinterpreted as moral weakness of the individual/society/group of people
• Because addiction worsens the inequalities in health, it is therefore crucial for healthcare professionals to understand the social roots of addictions and be able to comprehend underlying social causes
• How addiction affects health

  • Liver damage/failure
  • Lung disease
  • Stroke
  • Seizures
  • Mental health conditions
  • Memory, attention and decision-making problems
  • Brain damage
• Media plays a central role in society, its importance is evident in the amount of time people spend watching television, surfing the internet (YouTube, Facebook, Instagram, Pinterest, etc), listening to music, and/or reading newspapers and magazines
• How media influences health

  • Media can allow for health issues to be discussed on public and policy agendas
  • Provoke debates on ethical practices in healthcare and medicine
  • Convey information and advice on health matters
  • Promote and challenge stereotypes of certain disease/illnesses (i.e., mental health conditions)
  • Cultivate an understanding of health and illness and support ideas about what constitutes appropriate health/illness promoting behaviours
  • Play a key role in short-term 'health scares'
• Healthcare providers can be flooded with enquiries after a health 'scare' or news about a 'miracle cure' of a disease
• Media messages shape social norms, attitudes and behaviour
• The impact of information being conveyed vary depending on the amount and type of information communicated and how much the public (audience) trusts the source
• Individuals may respond to the same message quite differently depending on context and social factors
• As healthcare providers, that you don't assume to know or predict how patients will make sense of health-related information
• Culture

  A set of shared history, beliefs, traditions, values, rituals, religion, food and music preference, attitudes, etc., that guide behaviour
• These set of shared beliefs can be transmitted inter-generationally and can influence one's thinking and actions
• Culture is applicable to all races regardless of colour/ancestral history
• Culture is also applicable to the shared values, beliefs, and norms established in common social groupings (such as individuals trained in the same profession or youth who belong to the same gang)
• How culture impacts health

  • It affects individuals perceptions of health, illness and death
  • Beliefs about causes of a disease or illness
  • Past experiences of being healthy or ill
  • How illness and pain are experienced and expressed
  • Where, when and how individuals seek help
  • The types of treatment practices patients prefer
  • How individuals respond to recommendations for lifestyle change
  • Treatment adherence
• Why study the links between culture and health?

  • To determine patterns of health and illness due to socio-cultural factors
  • Determine if individuals follow cultural practices that increase their risk of ill-health
  • Influence healthcare policy-makers and service planners and advocate for healthcare improvements
  • To develop appropriate healthcare interventions
• Life contains a series of critical transitions

  • Emotional and material changes from early childhood
  • The move from primary, secondary and tertiary education
  • Starting work
  • Leaving home and starting a family
  • Changing jobs or facing possible redundancy
  • Eventually retirement
• Each of these changes can affect health status of individuals, by pushing people into wellbeing or onto a disadvantaged trajectory
• People with a history of limited resources are at the greatest risk in each life transition
• This means, welfare policies and programmes must address both psychosocial and material needs (both are source of anxiety and insecurity)
• Illness narratives and identity

  How identity shifts in the face of an illness
• Case study with a diagnosis of multiple sclerosis

  • 23-year-old female student
  • Training to become a doctor/therapist/pharmacist
  • Diagnosed with multiple sclerosis
  • Good athlete
  • Excel in school
  • Hard worker
  • Dreams of succeeding in life
• Consider

  1. Her identity before the diagnosis

  2. Facing her new identity (after the diagnosis)

  3. Bodily reactions in response to the diagnosis

  4. Emotional response

  5. Thought processing

  6. Family/societal response

  7. Future prospects

  8. Meaning-making

  9. Type of questions wondering about?

  10. Stage of the illness

  11. Treatment options
• Multiple Sclerosis (MS)

  • Lifelong, incurable, degenerative disorder that affects the brain and spinal cord
  • Causes: Unknown, Body immune system attacks its own tissues
  • Main symptoms: fatigue, difficulty walking, vision problems, problems controlling the bladder, numbness or tingling, muscle stiffness and spasms, problems with balance and co-ordination, problems with thinking, learning and planning
• Case study illness narratives

  • May view her illness in vastly different ways
  • View her life as one with a downward trajectory
  • Illness offers an opportunity for personal growth
  • Experience a breakdown in emotions and physical body
  • Loss of identity as an active athlete
  • Illness can serve as an epiphany/a wake-up call
• Illness narrative

  • Allows her to re-write the self-narrative
  • She may narrate herself as a failure (especially when illness interrupts education)
  • She may narrate herself as a woman with choice (positively or negatively live with the disease, though she was given no choice in getting the disease)
  • She may resist to become a medical "case" study
  • Negotiating for balance of being healthy and ill
• Actively engage in strategies to manage her illness

  1. Freeing her mind of the constraints of the past, and

  2. Forging a new life based on different principles (focused on self-development and pleasure)
• Illness

  • Constitutes a disruption and a discontinuation of an ongoing life process
  • Daily life is obstructed or blocked
  • Causes us to revise what is changeable and re-examine our lives in the light of our ill-health
  • Acute illness has only a temporary significance in our lives
  • Chronic illness usually changes the very foundation of our lives because the illness creates new and different life conditions