SOCIOLOGY II

Sessions 17

Sociology of health
 • Describe the sociological perspective and
main concepts of health.
Learning • Identify the difference between sociology in
medicine and sociology of medicine.
Objectives • Understand how social changes have
historically affected the health of
populations.
 • Obesity: Excessive body weight, indicated by a body mass
index (EMI) over 30.

• Health: "A state of complete physical, mental, and social well-

being and not merely the absence of disease or infirmity."

BASIC • Sociology of the body: A field that focuses on how our bodies
are affected by social influences. Health and illness, for

CONCEPTS instance, are determined by social and cultural influences.

• Epidemiology: The study of the distribution and incidence of

desease and illness within a population.

• Health literacy: One's capacity to obtain, process, and

understand basic health information and services needed to
make appropriate health decisions.
Physical
aspects of
• 1 - are due to our genetic makeup.
our body,
• 2 - are a consequence of our personal
such as our choices.
body weight, • 3- are due to whether one can afford
resources such as a healthy diet, medicine,
how long we and health insurance.
live, and the • 4 - all of the above.
diseases we
suffer from:
1 - Social Factors and
Illness
• Illness is a social fact of life. Everyone experiences
illness sooner or later, and everyone eventually
must cope with illness among close friends and
relatives.
• To the ill individual, illness can seem a purely
internal and personal experience. But illness is
also a social phenomenon with social roots and
social consequences.
• Sociology aims to look at the role that social
factors play in fostering illness within societies
and in determining which groups in a given
society will experience which illnesses with which
consequences.
The Sociology of Health,
Illness, and Health Care:
An Overview
• Sociologists’ research into health, illness, and health care falls into
three main categories.
• First, some sociologists study how social forces promote health and
illness and why some social groups suffer more illness than others.
• For example, researchers have explored whether working
conditions in U.S. factories help explain why poorer Americans get
certain cancers more often than wealthier Americans.
• Similarly, sociologists can study how historical changes in social life
can explain changes in patterns of illness.
• To understand why rates of breast cancer have increased, for
example, researchers have studied the possible impact of
environmental pollution, increased meat consumption, and
women’s changing work lives.
• Second, instead of studying broad patterns of illness,
sociologists can study the experiences of people who live
with illness each day — exploring, for example, how illness
affects individuals’ sense of identity, relationships with
family, or ideas about what causes illness.
• Similarly, sociologists can study the experiences of health
care providers.
• Some sociologists have analyzed how doctors’ status and
power have shifted over time, and others have investigated
how power affects interactions among doctors, nurses, and
other health care workers.
• Still others have examined interactions between health care
workers and patients, asking, for example, how doctors
maintain control over patients or whether doctors treat
male and female patients differently.
• Third, sociologists can analyze the health care
system as a whole. Sociologists have examined
how health care systems have developed,
compared the strengths and weaknesses of
different systems, and explored how systems can
be improved.
• For example, some have studied how U.S. health
insurance companies can make it difficult for
people to get needed care, explored why
European countries do better than the United
States at providing health care to all who need it,
and examined whether European health care
policies could work in the United States.
2 - The scope and concerns of public health
• Definition of public health:
• Public health is the science and art of preventing disease, prolonging life, and promoting health through the
organized efforts of society.

• This definition underscores the broad scope of public health and the fact that public health is the result of all
of society’s efforts viewed as a whole, rather than that of single individuals.

• Goal of public health:

• The biologic, physical, and mental well-being of all members of society regardless of gender, wealth,
ethnicity, sexual orientation, country, or political views

• This definition or goal emphasizes equity and the range of public health interests as encompassing not just
the physical and biological, but also the mental well-being of society.
The United Nation’s Millennium
Development Goals
The United Nation’s Millennium
Development Goals, the slogan of which is
‘Health for All’, depict public health as
being concerned with more than the mere
elimination of disease and placing public
health issues as a fundamental
component of development.
To achieve the World Health Organization
(WHO) goal of ‘health for all’, it is essential
to bring to bear many diverse disciplines to
the attainment of optimal health, including
the physical, biological, and social sciences.
The field of public health has adapted and
applied these disciplines for the
elimination and control of disease, and the
promotion of health.
Functions of public health
Public health is concerned with the
process of mobilizing local,
state/provincial, national, and
international resources to assure the
conditions in which all people can be
healthy
In order to ensure the health of the
population, it is necessary to
formulate, promote, and enforce
sound health policies to prevent and
control disease, and to reduce the
prevalence of factors impairing the
health of the community.
Public health identifies, measures,
and monitors health needs and trends
at the community, national, and
global levels through surveillance of
disease and risk factor (e.g. smoking)
trends.
These include policies requiring
reporting of highly transmissible
diseases and health threats to the
community and control of
environmental threats through the
regulation of environmental hazards
(e.g. water and air quality standards
and smoking).
Analysis of these trends and the
existence of a functioning health
information system provides the
essential information for predicting or
anticipating future community health
needs.
It is important to recognize that
influencing politics and policies is an
essential function of public health at
the local, national, and global levels.
Functions of public health
• 1. Prevent disease and its progression, and injuries.
• 2. Promote healthy lifestyles and good health habits.
• 3. Identify, measure, monitor, and anticipate community health needs (e.g. surveillance).
• 4. Investigate and diagnose health problems, including microbial and chemical hazards.
• 5. Formulate, promote, and enforce essential health policies.
• 6. Organize and ensure high-quality, cost-effective public health and healthcare services.
• 7. Reduce health disparities and ensure access to healthcare for all.
• 8. Promote and protect a healthy environment.
• 9. Disseminate health information and mobilize communities to take appropriate action.
• 10. Plan and prepare for natural and man-made disasters.
• 11. Reduce the impact of interpersonal violence and aggressive war.
• 12. Conduct research and evaluate health-promoting/ disease-preventing strategies.
• 13. Develop new methodologies for research and evaluation.
• 14. Train and ensure a competent public health workforce.
Public health policies
• There is an urgent need around the world for strong public health
leaders to promote the health of populations, particularly the poor
and vulnerable. Unfortunately, calls for stronger and better leadership
are often taken as imprecise and unachievable demands.
• How would you proceed to address these issues? Would you be able
to think on your feet and respond promptly and effectively to the
health needs of your populace? In other words, are you capable of
being a public health leader?
Leadership is not the same as
management
• There is a distinction between leadership and management. Leadership
has to do with the visionary activities of setting direction, while
management has to do with the controlling tasks associated with
implementation.
• Leadership is fundamentally about influence. Academic thinking about
leadership has evolved from a focus on the characteristics of the
individual leader to a more complex understanding of the dynamic
interaction between leaders and followers in specific contexts. But there is
no established ‘science of leadership’, as there is in medicine.
• Public health leaders need to be able to imagine and create evidence-
based change. They need to be able to influence and lobby key actors for
support of their public health agenda. They must operate across
disciplinary and organizational boundaries, and they must be skilled at
developing and working through diverse teams.
• Leaders are not simply born. Public health leaders can be developed by
means of team-based training, mentoring, and repeated practice of
leadership skills at all levels and all types of public health organizations.
The aspiring health leader can create her or his path to leadership.
• Public health challenges are often politically and procedurally complex
and do not lend themselves to simple medical or technical solutions. A set
of guiding principles will help the leader to define appropriate actions.
Public health governance system
 • Underlying the bulk of the public health problems of the world is the
issue of poverty.
• More than half of the world’s population lives below the
3- internationally defined poverty line, and 22 per cent of the
population in developing countries lives on less than US $1.25 per

Contemporary day (World Bank 2012).

• Although the majority of the world’s poor live in developing
health issues countries, there are many poor living in the wealthiest countries of
the world — underscoring the disparity of wealth between the poor
and the rich in all countries.
• In the United States, 39.8 million Americans were living below the
official poverty level in 2008. The proportion was highest among
African Americans (24.7 per cent) and Hispanic Americans (23.2 per
cent). Unfortunately, the disparity between the rich and the poor is
increasing within countries (US Census Bureau 2009).
• Poverty causes a cascade of problems leading to poor health. It is
incumbent on public health to work to reduce the impact of these
disparities to ensure that all members of the global society share in a
healthy quality of life.
 • 1. Human ‘demographic change’ by which persons begin to live in previously uninhabited remote areas of the world and are
exposed to new environmental sources of infectious agents, insects, and animals.

• 2. People living in close proximity to domestic animals, poor animal husbandry in many parts of the developing world leading
to zoonotic infections.

Factors
• 3. Breakdowns of sanitary and other public health measures in overcrowded cities and in situations of civil unrest and war.

• 4. Economic development and changes in the use of land, including deforestation, reforestation, and urbanization.

• 5. Climate changes cause changes in geography of agents and vectors.

contributing •

•
6. Changing human behaviours, such as increased use of child-care facilities, sexual and drug-use behaviours, and patterns of
outdoor recreation.

to the
7. Social inequality.

• 8. International travel and commerce that quickly transport people and goods vast distances.

• 9. Changes in food processing and handling, including foods prepared from many different animals and transported great

emergence
distances.

• 10. Evolution of pathogenic infectious agents by which they may infect new hosts, produce toxins, or adapt by responding to
changes in the host immunity (e.g. influenza, HIV).

or re-
• 11. Development of resistance of infectious agents such as Mycobacterium tuberculosis and Neisseria gonorrhoeae to
chemoprophylactic or chemotherapeutic medicines.

• 12. Resistance of the vectors of vector-borne infectious diseases to pesticides.

emergence •

•
13. Immunosuppression of persons due to medical treatments or new diseases that result in infectious diseases caused by
agents not usually pathogenic in healthy hosts (e.g. leukaemia patients).

14. Deterioration in surveillance systems for infectious dis- eases, including laboratory support, to detect new or emerging

of infectious
disease problems at an early stage.

• 15. Illiteracy limits knowledge of prevention strategies.

diseases
• 16. Lack of political will—corruption, other priorities.

• 17. Biowarfare/bioterrorism—an unfortunate potential source of new or emerging disease threats (e.g. anthrax and letters).

• 18. War, civil unrest—creates refugees, food and housing short- ages, increased density of living, etc.

• 19. Famine.
Global distribution of non-communicable
diseases (NCDs)

•NCDs include cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and eyesight conditions,
the prevalence of which all increase with age.
4 - Determinants of health and disease
• The determinants of health are classically categorized into
behavioural factors, impacts of the natural environment, genetic
determinants, and social determinants, but these overarching
categories mask the complexity and diversity of, and interaction
between, the drivers of health and disease.
• These fundamental determinants have acted, and interacted, within
populations in complex ways throughout history.
Determinants of health and disease
• Specific cultural practices, for instance, can make a population more or less susceptible to
disease. Similarly, economic conditions are major determinants of health. Countries that
experienced increasing prosperity during the twentieth century achieved better housing,
reduced crowding, improved water and food quality, and reduced dangerous working
conditions. These improvements have contributed to reduced rates of a multitude of
diseases—e.g. diarrhoea, tuberculosis (TB), occupational respiratory diseases— and have
led to dramatically increased lifespan and better health.

• As economic conditions improve, opportunities arise to invest in relatively inexpensive

and widely distributed public health interventions. Examples include the provision and
disinfection of water supplies, or the fortification of foodstuffs—flour and other grain
products being most common—with micronutrients.
 Environmental health versus economic
development and inequality
• Historically, the early stages of national economic development begin with
resource extraction and resource-rich developing countries are often courted by
industrial countries and their multinationals for access to their raw materials,
along with their inexpensive labour, weak environmental regulations, and sites
for hazardous waste disposal.
• Maintaining good governance in the face of an influx of new wealth, generated by
a small number of industrial agents, can be challenging, and political processes
have been observed to be manipulated by vested interests.
• Weak governance during boom-bust cycles can render public services such as
schools, transportation, and healthcare ineffective and at times non-existent.
 Ageing and urbanization
• Ageing and urbanization are occurring simultaneously in many settings, raising
unique public health challenges and illustrating the dynamic, multi-scale nature
of the global determinants of health. China, for instance, is experiencing a
demographic age shift as a result of declining fertility and increasing life
expectancies. Fertility has declined nearly 70 percent since 1950 and life
expectancy reached 73 years in 2010.
• The health determinants unique to ageing populations are interacting with those
that accompany the urbanization experience described earlier. China’s urban
populations have lower fertility and longer life expectancy on balance. Addressing
the public health effects of these complex interactions between urbanization and
population ageing will require approaches and policies that differ from traditional
modes of strengthening social security.
 Health risks and benefits of urbanization
• No major social, environmental, or behavioural change is with- out
health impacts, both positive and negative, and examining the
benefits, alongside health risks, is essential.
• Returning to urbanization, the phenomenon in low- and middle-
income countries (LMICs) is frequently characterized as essential to
future prosperity, while at the same time a threat to health and, in
the case of unplanned urban expansion and sprawl, harmful to local
and global environmental quality.
 Health risks and benefits of urbanization
• For instance, the urban poor can suffer greater morbidity and mortality from
infectious diseases than the rural poor, an indication of the substandard living
conditions and poor services in some urban areas, such as a near-complete lack
of sanitation facilities and a wide variety of barriers to accessing health services in
cities.
• Greater access to improved water and sanitation facilities, healthcare
infrastructure, and nutritional opportunities are examples and with decades of
rapid urbanization ahead for most LMICs, a comprehensive characterization of
the health benefits is needed, alongside extensive research on adverse effects. An
analysis of both the health risks and benefits of urbanization can help in the
development of strategies to alleviate the ills of urban living, while maximizing
the health benefits urban settings offer.
 Poverty, • Poverty has long been a concern in public health. Not
only do the poor generally suffer higher burdens of
disease, but during periods of infectious epidemics or
justice, and pandemics they are perceived as posing a risk to the
non-poor as well. Recent studies even suggest that high
health poverty and disease rates together can contribute to
social unrest and ‘failed’ (or failing) states.
5 - Reducing • Well-being is profoundly impacted by many social and
economic determinants. Clearly, access to basic needs
such as food, water, shelter, education, decent
health employment, safe working conditions, and so on are
crucial to health. But even many higher-order needs
inequalities in such as social inclusion, involvement in governance
issues such as policy development (e.g. on human
developing rights and gender equity), the right to critique unfair
administration, or participate in the exercise of political
countries power are also important.
Water and sanitation
• While diseases associated with poor water and sanitation
are now comparatively unknown in higher-income
countries, they still impose a heavy burden elsewhere,
especially among young children, the infirm, the poor, the
immunocompromised, and the displaced.
• The World Health Organization (WHO) estimates that
diarrhoeal diseases alone are responsible for 1.5 million
deaths annually, including 760,000 among children under
5 years (WHO 2013).
• Diarrhoea is the third leading cause of deaths of children
<5 years in low-income countries, accounting for 11% of
the overall disease burden in this population.
Improvements in water, sanita- tion, and hygiene have
the potential to reduce this disease burden by an
estimated 58%
Food and nutrition
• Environmental determinants of variations in disease rates include food
and nutrition as one of the primary determinants.
• In the developing world, numerous nutrient deficiency diseases persist
and now coexist with the increasing incidence of diet-related chronic
diseases.
• Developing societies now bear the ‘double burden’ of malnutrition
with the emergence of the so-called ‘diseases of affluence’ amidst
persisting undernutrition in their populations.
• Changes in the rates and patterns of nutritional disease and their
contribution to premature death within a population depend largely
on the environmental factors, which include changes in social and
economic conditions, the implementation of immunization
programmes, improvements in women’s social and educational status
within the society, and changes in agriculture and food systems and in
the availability of food.
• These changes have been influenced in recent times by globalization
and the increasing global trade and the remarkable advances and
changes in agricultural practices and the food systems that affect
individual diets and lifestyles.
Emerging epidemic
• Most developing countries, particularly those in rapid developmental transition,
are in the midst of a demographic and epidemiological transition.

of obesity and diet-

• Economic development, industrialization, and globalization are accompanied by
rapid urbanization.

related chronic
• These developmental forces are bringing about changes in the social capital of
these societies as well as increasing availability of food and changing lifestyles.

diseases and the

• The changes in food and nutrition are both quantitative and qualitative; there is
not only access to more than adequate food among some sections of the
population, but also a qualitative change in the habitual diet.

‘double burden’ of • Lifestyle changes contribute to a reduction in physical activity levels. The
essence of these changes is captured by the term ‘nutrition transition’ which
malnutrition in accompanies the demographic and epidemiologic transition in these countries.
• The poor consumer resistance and inadequate regulation compromises food
developing societies safety and increases contaminants in the food chain. In addition the
deterioration of the physical environment, particularly the increase in levels of
environmental pollution, contributes to the health burden.
Access to healthcare • In general terms, ‘access to healthcare’ is said
to exist when individuals or families can
mobilize the resources they need to preserve
and population health or improve their health.
• At the simplest level, having access to
healthcare may be judged in terms of the
availability of services.
• This may include the geographical proximity
or physical accessibility of services.
• Availability may also encompass the supply of
services in terms of the numbers of doctors,
nurses, or hospital beds per 1000 population.
Thank you for your attention
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