SOCIOLOGIE VAN GEZONDHEID EN WELZIJN
INHOUDSOPGAVE
WELZIJN EN DE WELZIJNSZORG - EDWIN WOUTERS ........................................................................................ 6
HET BEGRIP WELZIJN ................................................................................................................................................. 6
Hedonistische welzijnsbenadering .................................................................................................................. 6
Eudaimonische welzijnsbenadering................................................................................................................. 7
Sen's capaciteitsbenadering ............................................................................................................................ 8
'Objectieve' welzijnsmaten .............................................................................................................................. 9
Multidimensionele welzijnsdefinitie ................................................................................................................ 9
WELZIJNSZORG ...................................................................................................................................................... 10
Welvaart als catalysator van welzijn? ........................................................................................................... 10
Doelen van de welzijnszorg ........................................................................................................................... 11
Vormen van zorg ........................................................................................................................................... 12
Ongelijkheid in de zorg .................................................................................................................................. 13
Afstemming van het zorgaanbod op de vraag .............................................................................................. 13
WELZIJNSZORG IN BELGIE EN VLAANDEREN ................................................................................................................. 15
Inleiding ......................................................................................................................................................... 15
Tekst welzijnszorg in België en Vlaanderen (zelfstudie) ................................................................................ 17
ROUND UP ............................................................................................................................................................ 17
Examenvraag................................................................................................................................................. 17
ZIEKTEMODELLEN - STEVEN VANDERSTICHELEN ............................................................................................ 18
BIOMEDISCHE MODEL ............................................................................................................................................. 18
Assumpties .................................................................................................................................................... 18
Kritiek ............................................................................................................................................................ 19
SOCIOLOGISCHE MODEL ........................................................................................................................................... 19
Centrale concepten........................................................................................................................................ 20
Sociology of/in medicine ............................................................................................................................... 20
Parsons sick role ............................................................................................................................................ 20
Fundamental cause theory ............................................................................................................................ 22
SAMENGEVAT ........................................................................................................................................................ 26
GEZONDE LEVENSSTIJLEN - STEVEN VANDERSTICHELEN ................................................................................ 27
ACHTERGROND ...................................................................................................................................................... 27
MICROBENADERINGEN ............................................................................................................................................ 27
Health belief model ....................................................................................................................................... 27
MULTILEVEL BENADERINGEN .................................................................................................................................... 31
Sociaal-ecologisch model .............................................................................................................................. 31
Health lifestyles model (cockerham) ............................................................................................................. 32
SAMENVATTEND .................................................................................................................................................... 40
SOCIOLOGIE VAN DE CHRONISCHE ZIEKTEN - EDWIN WOUTERS ................................................................... 41
, INLEIDING ............................................................................................................................................................. 41
Chronische ziekten ......................................................................................................................................... 41
Sociologie ...................................................................................................................................................... 41
BIOGRAPHICAL DISRUPTION ...................................................................................................................................... 42
Van zieke-rol naar 'biographical disruption'.................................................................................................. 42
Biographical disruption ................................................................................................................................. 43
Kritiek op 'biographical disruption'................................................................................................................ 43
Kritiek op “biographical disruption” revisited ............................................................................................... 44
'Biographical disruption' in de late moderniteit ............................................................................................ 44
Samenvatting ................................................................................................................................................ 44
NARRATIVE RECONSTRUCTION .................................................................................................................................. 45
Het chronische aspect ................................................................................................................................... 45
Narrative reconstruction ............................................................................................................................... 45
Illness accounts.............................................................................................................................................. 46
Samenvatting ................................................................................................................................................ 46
Kritiek ............................................................................................................................................................ 46
ILLNESS AS ADJUSTMENT .......................................................................................................................................... 47
Twee perspectieven samenvoegen ................................................................................................................ 47
Adjustment .................................................................................................................................................... 47
Samenvatting ................................................................................................................................................ 48
BELANGRIJKE THEMA'S ............................................................................................................................................ 48
Onzekerheid................................................................................................................................................... 48
Adherence ..................................................................................................................................................... 48
Stigma en schaamte ...................................................................................................................................... 48
Functionele beperkingen en kwaliteit van het leven ..................................................................................... 49
(BIO)MEDICALISERING - STEVEN VANDERSTICHELEN..................................................................................... 50
DEFINIERING EN DE GESCHIEDENIS VAN MEDICALISERING ................................................................................................ 50
DE EERSTE GENERATIE (18E - 19E EEUW).................................................................................................................... 51
Oorsprong (de opkomst van de geneeskunde en het medische model) ........................................................ 51
Medisch imperialisme.................................................................................................................................... 52
Iatrogenese ................................................................................................................................................... 52
TWEEDE GENERATIE (20E - 21E EEUW) ...................................................................................................................... 53
Veranderde sociale omstandigheden ............................................................................................................ 53
Optimalisatie ................................................................................................................................................. 53
Deprofessionalisering en deïnstitutionalisering ............................................................................................ 53
DE DRIJVENDE KRACHTEN ACHTER DE VERSCHUIVING...................................................................................................... 54
Shifting engines (conrad)............................................................................................................................... 54
Biomedicalisering (Clarke) ............................................................................................................................. 56
MEDICALIZATION: POSITIVE OR NEGATIVE? .................................................................................................................. 58
Positieve effecten van medicalisering ........................................................................................................... 58
Negatieve effecten van medicalisering ......................................................................................................... 58
MEDICALISERING VAN VROUWELIJKE GENITALE VERMINKING - JOLIEN INGHELS .......................................... 59
WAT IS VGV? ....................................................................................................................................................... 59
Prevalentie .................................................................................................................................................... 59
Bij wie - Leeftijd ............................................................................................................................................. 59
Door wie & waar ........................................................................................................................................... 59
De gevolgen van VGV .................................................................................................................................... 60
Beïnvloedende factoren op gevolgen ............................................................................................................ 60
2
, HOE KUNNEN WE VGV BEGRIJPEN? ........................................................................................................................... 61
Redenen......................................................................................................................................................... 61
Sociale norm .................................................................................................................................................. 61
Overgangsritueel ........................................................................................................................................... 61
Genderidentiteit ............................................................................................................................................ 62
Gezondheid.................................................................................................................................................... 62
Religie ............................................................................................................................................................ 62
SES ................................................................................................................................................................. 62
Traditie .......................................................................................................................................................... 63
WAT IS MEDICALISERING VAN VGV? .......................................................................................................................... 63
SOCIOLOGISCH PERSPECTIEF OP VGV MEDICALISERING .................................................................................................. 63
VGV: 2nd generation medicalization .............................................................................................................. 63
Drivers of medicalization applicable to the practice of FGC .......................................................................... 63
HET MORELE DILEMMA ROND DE MEDICALISERING VAN VGV .......................................................................................... 65
Medicalisering - Contra ................................................................................................................................. 65
Medicalisering - PRO ..................................................................................................................................... 65
Dr. Tatu Kamau vs. the ban on medicalized FGC for adults in Kenya ............................................................ 65
Beleidsdilemma ............................................................................................................................................. 66
De dualiteit van 'het westen' ......................................................................................................................... 66
Cosmetische vaginale chirurgie ..................................................................................................................... 66
Internationale opinie ..................................................................................................................................... 66
(BIO)MEDICALIZATION CONTINUED: HET ONEIGENLIJK GEBRUIK VAN VOORSCHRIFTPLICHTIGE
STIMULERENDE MEDICATIE ALS ‘LEERPIL’ BIJ VLAAMSE STUDENTEN - SARA DE BRUYN ................................ 67
MEDICALISERING: THEORETISCHE ACHTERGROND.......................................................................................................... 67
TOEPASSING MEDICALISERING: DOCTORAAT ................................................................................................................. 68
Studenten: kwantitatief................................................................................................................................. 68
Studenten: kwalitatief ................................................................................................................................... 69
Huisartsen ..................................................................................................................................................... 70
Wat kunnen deze resultaten in praktijk betekenen? ..................................................................................... 71
HEALTH SYSTEMS - EDWIN WOUTERS ........................................................................................................... 72
DEFINITIES EN CONCEPTEN ....................................................................................................................................... 72
Systeemdenken ............................................................................................................................................. 72
Wat zijn health systems? ............................................................................................................................... 72
Health care systems: interne determinanten ................................................................................................ 73
Omgeving: externe determinanten ............................................................................................................... 74
Doelpopulatie ................................................................................................................................................ 74
SOCIOLOGIE: TYPOLOGIEËN ...................................................................................................................................... 75
Types health care systems ............................................................................................................................. 75
Typologie van mark G. Field .......................................................................................................................... 75
Typologie van William Cockerham ................................................................................................................ 76
Typologie van Claus Wendt ........................................................................................................................... 76
RECENTE ONTWIKKELINGEN ...................................................................................................................................... 79
Convergerende en divergerende trends ........................................................................................................ 79
Hervormingen................................................................................................................................................ 80
Globalisering: global health .......................................................................................................................... 81
PUBLIC HEALTH: ORGANISATIE (ONDERZOEKSVOORBEELD SCUBY) ..................................................................................... 81
Startpunt = model ......................................................................................................................................... 81
Background ................................................................................................................................................... 82
3
, Health service delivery................................................................................................................................... 83
Other health system elements: SCUBY objectives ......................................................................................... 84
Governance + Resources ............................................................................................................................... 84
Outcomes & Impact ....................................................................................................................................... 85
GEBRUIK GEZONDHEIDSZORG - STEVEN VANDERSTICHELEN ......................................................................... 88
EPIDEMIOLOGIE ..................................................................................................................................................... 88
Gender ........................................................................................................................................................... 88
Sociaal-economische status .......................................................................................................................... 89
Etniciteit ........................................................................................................................................................ 89
Asielzoekers en vluchtelingen ........................................................................................................................ 90
TERUGBLIK RELEVANTE THEORETISCHE KADERS ............................................................................................................. 90
Health belief model ....................................................................................................................................... 91
Cultural health capital ................................................................................................................................... 91
Health lifestyles theory .................................................................................................................................. 91
Parsons' sick role (1951) ................................................................................................................................ 92
BEHAVIORAL MODEL OF HEALTH SERVICE USE ............................................................................................................... 92
Behavioral model of health service use (Andersen)....................................................................................... 92
TOEGANG TOT MEDISCHE INNOVATIES ........................................................................................................................ 94
Ready-Willing-Able framework ..................................................................................................................... 94
Diffusion of innovation theory ....................................................................................................................... 96
STIGMA ................................................................................................................................................................ 99
Original labelling theory (Sheff, 1966)......................................................................................................... 100
Vormen van stigma ..................................................................................................................................... 102
SAMENVATTEND .................................................................................................................................................. 102
HEALTH AND THE LIFE COURSE - KATRIJN DELARUELLE ............................................................................... 103
INTRODUCTIE....................................................................................................................................................... 103
Ageing societies ........................................................................................................................................... 103
THE LIFE COURSE PERSPECTIVE ................................................................................................................................ 104
Principle 1: life span development............................................................................................................... 105
Principle 2: timing of outcomes ................................................................................................................... 111
Principe 3: linked lives ................................................................................................................................. 112
Principe 4: time and place ........................................................................................................................... 112
Principe 5: agency versus structure ............................................................................................................. 113
LIFE COURSE TRANSITIONS ...................................................................................................................................... 114
EXAMENVRAAG.................................................................................................................................................... 114
SOCIOLOGISCHE EN PUBLIC HEALTH PERSPECTIEVEN OP DE DOOD EN HET LEVENSEINDE .......................... 115
BASICS ROND DOOD & STERVEN .............................................................................................................................. 115
Sociale constructie van de dood .................................................................................................................. 115
De dood als aanjager van de samenleving .................................................................................................. 115
EPIDEMIOLOGIE VAN STERVEN ................................................................................................................................ 116
Transities over tijd ....................................................................................................................................... 116
Uitdagingen voor de toekomst .................................................................................................................... 120
DOOD & STERVEN IN DE HEDENDAAGSE SAMENLEVING ................................................................................................ 120
De risicosamenleving & de dood ................................................................................................................. 120
Postmaterialisme, individualisme & de dood .............................................................................................. 121
Sociale dood ................................................................................................................................................ 122
Medicalisering van de dood ........................................................................................................................ 123
4
INHOUDSOPGAVE
WELZIJN EN DE WELZIJNSZORG - EDWIN WOUTERS ........................................................................................ 6
HET BEGRIP WELZIJN ................................................................................................................................................. 6
Hedonistische welzijnsbenadering .................................................................................................................. 6
Eudaimonische welzijnsbenadering................................................................................................................. 7
Sen's capaciteitsbenadering ............................................................................................................................ 8
'Objectieve' welzijnsmaten .............................................................................................................................. 9
Multidimensionele welzijnsdefinitie ................................................................................................................ 9
WELZIJNSZORG ...................................................................................................................................................... 10
Welvaart als catalysator van welzijn? ........................................................................................................... 10
Doelen van de welzijnszorg ........................................................................................................................... 11
Vormen van zorg ........................................................................................................................................... 12
Ongelijkheid in de zorg .................................................................................................................................. 13
Afstemming van het zorgaanbod op de vraag .............................................................................................. 13
WELZIJNSZORG IN BELGIE EN VLAANDEREN ................................................................................................................. 15
Inleiding ......................................................................................................................................................... 15
Tekst welzijnszorg in België en Vlaanderen (zelfstudie) ................................................................................ 17
ROUND UP ............................................................................................................................................................ 17
Examenvraag................................................................................................................................................. 17
ZIEKTEMODELLEN - STEVEN VANDERSTICHELEN ............................................................................................ 18
BIOMEDISCHE MODEL ............................................................................................................................................. 18
Assumpties .................................................................................................................................................... 18
Kritiek ............................................................................................................................................................ 19
SOCIOLOGISCHE MODEL ........................................................................................................................................... 19
Centrale concepten........................................................................................................................................ 20
Sociology of/in medicine ............................................................................................................................... 20
Parsons sick role ............................................................................................................................................ 20
Fundamental cause theory ............................................................................................................................ 22
SAMENGEVAT ........................................................................................................................................................ 26
GEZONDE LEVENSSTIJLEN - STEVEN VANDERSTICHELEN ................................................................................ 27
ACHTERGROND ...................................................................................................................................................... 27
MICROBENADERINGEN ............................................................................................................................................ 27
Health belief model ....................................................................................................................................... 27
MULTILEVEL BENADERINGEN .................................................................................................................................... 31
Sociaal-ecologisch model .............................................................................................................................. 31
Health lifestyles model (cockerham) ............................................................................................................. 32
SAMENVATTEND .................................................................................................................................................... 40
SOCIOLOGIE VAN DE CHRONISCHE ZIEKTEN - EDWIN WOUTERS ................................................................... 41
, INLEIDING ............................................................................................................................................................. 41
Chronische ziekten ......................................................................................................................................... 41
Sociologie ...................................................................................................................................................... 41
BIOGRAPHICAL DISRUPTION ...................................................................................................................................... 42
Van zieke-rol naar 'biographical disruption'.................................................................................................. 42
Biographical disruption ................................................................................................................................. 43
Kritiek op 'biographical disruption'................................................................................................................ 43
Kritiek op “biographical disruption” revisited ............................................................................................... 44
'Biographical disruption' in de late moderniteit ............................................................................................ 44
Samenvatting ................................................................................................................................................ 44
NARRATIVE RECONSTRUCTION .................................................................................................................................. 45
Het chronische aspect ................................................................................................................................... 45
Narrative reconstruction ............................................................................................................................... 45
Illness accounts.............................................................................................................................................. 46
Samenvatting ................................................................................................................................................ 46
Kritiek ............................................................................................................................................................ 46
ILLNESS AS ADJUSTMENT .......................................................................................................................................... 47
Twee perspectieven samenvoegen ................................................................................................................ 47
Adjustment .................................................................................................................................................... 47
Samenvatting ................................................................................................................................................ 48
BELANGRIJKE THEMA'S ............................................................................................................................................ 48
Onzekerheid................................................................................................................................................... 48
Adherence ..................................................................................................................................................... 48
Stigma en schaamte ...................................................................................................................................... 48
Functionele beperkingen en kwaliteit van het leven ..................................................................................... 49
(BIO)MEDICALISERING - STEVEN VANDERSTICHELEN..................................................................................... 50
DEFINIERING EN DE GESCHIEDENIS VAN MEDICALISERING ................................................................................................ 50
DE EERSTE GENERATIE (18E - 19E EEUW).................................................................................................................... 51
Oorsprong (de opkomst van de geneeskunde en het medische model) ........................................................ 51
Medisch imperialisme.................................................................................................................................... 52
Iatrogenese ................................................................................................................................................... 52
TWEEDE GENERATIE (20E - 21E EEUW) ...................................................................................................................... 53
Veranderde sociale omstandigheden ............................................................................................................ 53
Optimalisatie ................................................................................................................................................. 53
Deprofessionalisering en deïnstitutionalisering ............................................................................................ 53
DE DRIJVENDE KRACHTEN ACHTER DE VERSCHUIVING...................................................................................................... 54
Shifting engines (conrad)............................................................................................................................... 54
Biomedicalisering (Clarke) ............................................................................................................................. 56
MEDICALIZATION: POSITIVE OR NEGATIVE? .................................................................................................................. 58
Positieve effecten van medicalisering ........................................................................................................... 58
Negatieve effecten van medicalisering ......................................................................................................... 58
MEDICALISERING VAN VROUWELIJKE GENITALE VERMINKING - JOLIEN INGHELS .......................................... 59
WAT IS VGV? ....................................................................................................................................................... 59
Prevalentie .................................................................................................................................................... 59
Bij wie - Leeftijd ............................................................................................................................................. 59
Door wie & waar ........................................................................................................................................... 59
De gevolgen van VGV .................................................................................................................................... 60
Beïnvloedende factoren op gevolgen ............................................................................................................ 60
2
, HOE KUNNEN WE VGV BEGRIJPEN? ........................................................................................................................... 61
Redenen......................................................................................................................................................... 61
Sociale norm .................................................................................................................................................. 61
Overgangsritueel ........................................................................................................................................... 61
Genderidentiteit ............................................................................................................................................ 62
Gezondheid.................................................................................................................................................... 62
Religie ............................................................................................................................................................ 62
SES ................................................................................................................................................................. 62
Traditie .......................................................................................................................................................... 63
WAT IS MEDICALISERING VAN VGV? .......................................................................................................................... 63
SOCIOLOGISCH PERSPECTIEF OP VGV MEDICALISERING .................................................................................................. 63
VGV: 2nd generation medicalization .............................................................................................................. 63
Drivers of medicalization applicable to the practice of FGC .......................................................................... 63
HET MORELE DILEMMA ROND DE MEDICALISERING VAN VGV .......................................................................................... 65
Medicalisering - Contra ................................................................................................................................. 65
Medicalisering - PRO ..................................................................................................................................... 65
Dr. Tatu Kamau vs. the ban on medicalized FGC for adults in Kenya ............................................................ 65
Beleidsdilemma ............................................................................................................................................. 66
De dualiteit van 'het westen' ......................................................................................................................... 66
Cosmetische vaginale chirurgie ..................................................................................................................... 66
Internationale opinie ..................................................................................................................................... 66
(BIO)MEDICALIZATION CONTINUED: HET ONEIGENLIJK GEBRUIK VAN VOORSCHRIFTPLICHTIGE
STIMULERENDE MEDICATIE ALS ‘LEERPIL’ BIJ VLAAMSE STUDENTEN - SARA DE BRUYN ................................ 67
MEDICALISERING: THEORETISCHE ACHTERGROND.......................................................................................................... 67
TOEPASSING MEDICALISERING: DOCTORAAT ................................................................................................................. 68
Studenten: kwantitatief................................................................................................................................. 68
Studenten: kwalitatief ................................................................................................................................... 69
Huisartsen ..................................................................................................................................................... 70
Wat kunnen deze resultaten in praktijk betekenen? ..................................................................................... 71
HEALTH SYSTEMS - EDWIN WOUTERS ........................................................................................................... 72
DEFINITIES EN CONCEPTEN ....................................................................................................................................... 72
Systeemdenken ............................................................................................................................................. 72
Wat zijn health systems? ............................................................................................................................... 72
Health care systems: interne determinanten ................................................................................................ 73
Omgeving: externe determinanten ............................................................................................................... 74
Doelpopulatie ................................................................................................................................................ 74
SOCIOLOGIE: TYPOLOGIEËN ...................................................................................................................................... 75
Types health care systems ............................................................................................................................. 75
Typologie van mark G. Field .......................................................................................................................... 75
Typologie van William Cockerham ................................................................................................................ 76
Typologie van Claus Wendt ........................................................................................................................... 76
RECENTE ONTWIKKELINGEN ...................................................................................................................................... 79
Convergerende en divergerende trends ........................................................................................................ 79
Hervormingen................................................................................................................................................ 80
Globalisering: global health .......................................................................................................................... 81
PUBLIC HEALTH: ORGANISATIE (ONDERZOEKSVOORBEELD SCUBY) ..................................................................................... 81
Startpunt = model ......................................................................................................................................... 81
Background ................................................................................................................................................... 82
3
, Health service delivery................................................................................................................................... 83
Other health system elements: SCUBY objectives ......................................................................................... 84
Governance + Resources ............................................................................................................................... 84
Outcomes & Impact ....................................................................................................................................... 85
GEBRUIK GEZONDHEIDSZORG - STEVEN VANDERSTICHELEN ......................................................................... 88
EPIDEMIOLOGIE ..................................................................................................................................................... 88
Gender ........................................................................................................................................................... 88
Sociaal-economische status .......................................................................................................................... 89
Etniciteit ........................................................................................................................................................ 89
Asielzoekers en vluchtelingen ........................................................................................................................ 90
TERUGBLIK RELEVANTE THEORETISCHE KADERS ............................................................................................................. 90
Health belief model ....................................................................................................................................... 91
Cultural health capital ................................................................................................................................... 91
Health lifestyles theory .................................................................................................................................. 91
Parsons' sick role (1951) ................................................................................................................................ 92
BEHAVIORAL MODEL OF HEALTH SERVICE USE ............................................................................................................... 92
Behavioral model of health service use (Andersen)....................................................................................... 92
TOEGANG TOT MEDISCHE INNOVATIES ........................................................................................................................ 94
Ready-Willing-Able framework ..................................................................................................................... 94
Diffusion of innovation theory ....................................................................................................................... 96
STIGMA ................................................................................................................................................................ 99
Original labelling theory (Sheff, 1966)......................................................................................................... 100
Vormen van stigma ..................................................................................................................................... 102
SAMENVATTEND .................................................................................................................................................. 102
HEALTH AND THE LIFE COURSE - KATRIJN DELARUELLE ............................................................................... 103
INTRODUCTIE....................................................................................................................................................... 103
Ageing societies ........................................................................................................................................... 103
THE LIFE COURSE PERSPECTIVE ................................................................................................................................ 104
Principle 1: life span development............................................................................................................... 105
Principle 2: timing of outcomes ................................................................................................................... 111
Principe 3: linked lives ................................................................................................................................. 112
Principe 4: time and place ........................................................................................................................... 112
Principe 5: agency versus structure ............................................................................................................. 113
LIFE COURSE TRANSITIONS ...................................................................................................................................... 114
EXAMENVRAAG.................................................................................................................................................... 114
SOCIOLOGISCHE EN PUBLIC HEALTH PERSPECTIEVEN OP DE DOOD EN HET LEVENSEINDE .......................... 115
BASICS ROND DOOD & STERVEN .............................................................................................................................. 115
Sociale constructie van de dood .................................................................................................................. 115
De dood als aanjager van de samenleving .................................................................................................. 115
EPIDEMIOLOGIE VAN STERVEN ................................................................................................................................ 116
Transities over tijd ....................................................................................................................................... 116
Uitdagingen voor de toekomst .................................................................................................................... 120
DOOD & STERVEN IN DE HEDENDAAGSE SAMENLEVING ................................................................................................ 120
De risicosamenleving & de dood ................................................................................................................. 120
Postmaterialisme, individualisme & de dood .............................................................................................. 121
Sociale dood ................................................................................................................................................ 122
Medicalisering van de dood ........................................................................................................................ 123
4
