A Sociological Perspective on Health

COVID-19 & SOCIETY

Why is health a social issue?
Health
A state of physical, mental, and/or social wellbeing

The absence of disease or illness

Why does health matter?

Impacts our ability to interact with all other social institutions

Health and wellbeing is caused by a mix of biological, social phenomenon

Everyday life is shaped by our health, health of networked others, health of our community

Medical sociology
Study of how humans manage issues related to health/illness, disease, disorder, and health care
systems

Social Construction of Health

If disease is a measurable, physiological problem—how can it be socially constructed?

Social construction
Cultural meaning of illness

Illness experiences

Medical knowledge

Social Construction of Health

If disease is a measurable, physiological problem—how can it be socially constructed?

Social construction
Cultural meaning of illness Stigmatization of disease
Illness experiences
Impacts patient and kind of care they
Medical knowledge
receive

Society and health care institutions

discriminate against certain diseases

Contested illnesses
Questioned by medical professionals

Influences how a patient seeks treatment

and what kind of treatment they receive
Social Construction of Health
If disease is a measurable, physiological problem—how can it be socially constructed?

Social construction
Cultural meaning of illness

Illness experiences Constructing illness experiences

Medical knowledge
Culture norms

Individual personality
Social Construction of Health
If disease is a measurable, physiological problem—how can it be socially constructed?

Social construction
Cultural meaning of illness

Illness experiences

Medical knowledge Inequalities

Medical knowledge can reproduce
inequalities by gender, class, race/
ethnicity, etc.

Medicalization
Some behaviors, etc. that are culturally
and/or biologically related have been
medicalized in the past
Health Inequalities
Social class, gender, and race/ethnicity are important determining factors in understanding health
inequalities and disparities

Examples
Health behaviours

Insurance coverage

Exposure to unhealthy environments

Social Determinants of Health

Socioeconomic
Status
MACRO LEVEL Education, Income, Employment

Health
Outcomes

Sociodemographic
Characteristics
Age, Sex, Marital Status,
Race/Ethnicity, Nativity
Risk Factors
Exercise, BMI, Smoking, Stress, MICRO LEVEL
Health Insurance, Health Care
Access
Physical Health Indicators by Income Group
BRFSS (CDC, 2016)
Middle income
High income

Low income

(middle 50% of income (top 20% of income High vs. Low gap
(<200% of poverty line)
distribution) distribution)

Obesity 32.0 27.9 21.7 10.3

Diabetes 16.1 10.1 6.7 9.4

Hypertension 36.4 29.0 23.6 12.8

High cholesterol 29.3 26.4 25.3 4.0

Heart attack 7.2 3.5 2.2 4.9

Ashma 15.9 10.5 9.2 6.7

Cancer 7.7 6.9 6.0 1.7

Migraine headaches 18.7 10.2 7.5 11.1

Flu 2.7 1.2 1.0 1.8

Cold 7.0 4.7 4.3 2.7

Positive Health Behaviors by Income Group
BRFSS (CDC, 2016)

Middle income
High income

Low income

(middle 50% of income (top 20% of income High vs. Low gap
(<200% of poverty line)
distribution) distribution)
Proper servings of fruits
45.2 57.3 59.0 13.8
and veggies
Exercise 30 minutes or
38.8 51.3 56.3 17.5
more, three days per week
Smoke 31.9 20.2 11.9 20.1
Access to Health Care by Income Group
BRFSS (CDC, 2016)

Middle income
High income

Low income

(middle 50% of income (top 20% of income High vs. Low gap
(<200% of poverty line)
distribution) distribution)

Have personal doctor 68.5 82.3 89.1 20.5

Uninsured 23.4 13.4 4.7 18.7

Not enough money for
35.5 16.4 6.4 29.0
health care
Easy to get medicine 83.8 94.0 97.2 13.4

Visited dentist 44.3 68.6 82.5 38.2

Additional Years of Life Expectancy at Age 65 for Individuals by Earnings
Stanford Center for the Study of Inequality, 2017

24
23
22
21
20
19
18
17
16
15
14
1975 1980 1985 1990 1995 2000 2005 2010 2015
Why Individuals Lack Health Insurance
National Health Interview Survey (2018)

Cost too high 45

Lost/change job 23
Lost Medicaid 12
Not offered by employer 10
Change in family status 9
Do not need 2
0 12.5 25 37.5 50
 Characteristics of the Uninsured
Current Population Survey (2018)
Not working
10% >400%
5%

1+ Part-time
16%
<100%
201-400% 34%
31%
1+ Full-time
74%
100-200%
30%

Family Work Status Family Poverty Status

 Impact of Insurance on Access to Regular Care
National Health Interview Survey (2018)
Uninsured Public Private
49
No usual source of care 12
12
23
Postponed care due to cost 6
9
20
Went without care due to cost 3
8
18
Postponed/did not get perscription due to cost 4
6
0 12.5 25 37.5 50
Per Capita COVID-19 Cases in Detroit, MI
Sources: City of Detroit, US Census Bureau
1500
1000

r= 0.46**
500
0

0 20 40 60 80 100
% Black in Zip Code

rawct Fitted values

Per Capita COVID-19 Cases in Detroit, MI
Sources: City of Detroit, US Census Bureau
1500
1000
500

r= –0.53**
0

20000 30000 40000 50000 60000

Median Household Income

rawct Fitted values

Racial/Ethnic Differences in Hospitalizations (Per 100,000)
Sources: Centers for Disease Control & Prevention (March 1–September 5, 2020)

400

332 339 341

300

200

100
98
73
0
NH White NH Asian/PI Hispanic/Latino NH Black Indigenous
Racial/Ethnic Differences in Deaths (Per 100,000)
Sources: Centers for Disease Control & Prevention (March 1–September 5, 2020)

100

92
88
75

50
59

39 38
25

0
NH White NH Asian/PI Hispanic/Latino NH Black Indigenous
Analyzing Data with a Social Determinants Framework

Socioeconomic
Status
MACRO LEVEL Education, Income, Employment

Health
Outcomes

Sociodemographic
Characteristics
Age, Sex, Marital Status,
Race/Ethnicity, Nativity
Risk Factors
Exercise, BMI, Smoking, Stress, MICRO LEVEL
Health Insurance, Health Care
Access
Racial/Ethnic Differences in COVID-19 Risk Factors
2018 Behavioral Risk Factor Surveillance System Estimates

40

34
30

27
20
21 20

10 12

0
NH White NH Asian/PI Hispanic/Latino NH Black Indigenous
Racial/Ethnic Differences in COVID-19 Risk Factors & Uninsured Rates
2018 Behavioral Risk Factor Surveillance System Estimates

40
Risk factors
Uninsured
34
30

27
20
21 22
20 19

10 12 11
8 7
0
NH White NH Asian/PI Hispanic/Latino NH Black Indigenous
 Attitudes About Medical Science & COVID-19
Pew Research Center (2020)
43
Confidence in medical science 45
35
68
Positive view of medical research 67
53
75
Positive view of medical doctors 68
61
63
Benefits of experimental procedures outweigh risks 53
41
74
Would get vaccine if available today 74
54
0 20 40 60 80

White Hispanic/Latino Black