Sociology of health and illness
Content
Les 1: Introduction..................................................................................................................................4
MEDICAL SOCIOLOGY:........................................................................................................................4
HEALTH, DISEASE, ILLNESS, ….............................................................................................................4
Les 2: Models of Health and Illness........................................................................................................5
1. Biomedical model...........................................................................................................................5
2. Biopsychosocial model...................................................................................................................5
3. Evolutionary/ Darwinian model......................................................................................................6
4. Ecological model.............................................................................................................................7
5. Sociological model..........................................................................................................................8
Les 3: Social change and health............................................................................................................10
EPIDEMIOLOGICAL TRANSITIONS.....................................................................................................10
HUNTER-GATHERERS SOCIETIES...................................................................................................10
NEOLITHIC & 1ST EPIDEMIOLOGICAL TRANSITION........................................................................11
AGRICULTURAL SOCIETIES............................................................................................................11
INDUSTRIAL & 2ND EPIDEMIOLOGICAL TRANSITION......................................................................12
GLOBALIZATION & 3RD EPIDEMIOLOGICAL TRANSITION...............................................................13
EPIDEMIOLOGICAL TRANSITIONS.................................................................................................14
FUTURE COURSES.............................................................................................................................15
DEMOGRAPHIC TRANSITIONS & HEALTH.....................................................................................15
Les 4: (Bio)Medicalization.....................................................................................................................16
DEFINING AND THE HISTORY OF MEDICALIZATION..........................................................................16
What is medicalization?................................................................................................................16
The first generation......................................................................................................................17
The second generation.................................................................................................................18
The driving forces of the shift.......................................................................................................19
MEDICALIZATION: POSITIVE OR NEGATIEVE?...................................................................................23
Les 5: Health and the life course..........................................................................................................24
THE LIFE COURSE PERSPECTIVE........................................................................................................24
PRINCIPLE 1: Life-span development............................................................................................25
PRINCIPLE 2: Timing of outcomes.................................................................................................27
PRINCIPLE 3: Linked lives..............................................................................................................27
1
, PRINCIPLE 4: Time and place........................................................................................................27
PRINCIPLE 5: Agency versus structure..........................................................................................28
Life Course Transitions.....................................................................................................................28
Les 6: End of Life research....................................................................................................................30
Basics of death & dying.....................................................................................................................30
Social construction of death.........................................................................................................30
Death as prime mover in society..................................................................................................30
Epidemiology of dying......................................................................................................................30
Transitions over time....................................................................................................................30
Public health challenges...............................................................................................................31
Death & dying in contemporary society...........................................................................................32
The risk society & death...............................................................................................................32
Postmaterialism, individualism & death.......................................................................................32
Social death..................................................................................................................................33
Medicalisation of death................................................................................................................33
Revivalism of death......................................................................................................................34
Les 7: Diversity: ethnicity and health....................................................................................................37
Key concepts:....................................................................................................................................37
Large:............................................................................................................................................37
Robust:.........................................................................................................................................38
Persistent:.....................................................................................................................................38
Explanations:....................................................................................................................................38
1. Social selection and social drift.................................................................................................38
2. Access to and use of healthcare services..................................................................................38
3. Cultural-behavioral...................................................................................................................39
4. Psychosocial..............................................................................................................................39
5. Material approach....................................................................................................................40
6. Fundamental cause theory.......................................................................................................40
Policy implications............................................................................................................................41
Les 8: Diversity: social inequalities in health.........................................................................................43
Defining the subject..........................................................................................................................43
Examples.......................................................................................................................................44
Theories on the relation between migration and mental health......................................................46
1. Bhugra Model: 1st generation...................................................................................................46
2. Migration as a metaphor: 2nd generation..................................................................................46
2
, Pathways to care..............................................................................................................................47
BEHAVIORAL MODEL OF HEALTHCARE SERVICES USE (Andersen)...............................................48
Les 9: Health behaviours and lifestyles.................................................................................................50
Introduction......................................................................................................................................50
Health behavior models....................................................................................................................51
Health Belief Model (HBM)...........................................................................................................51
A theory of Health Lifestyles (Cockerham)...................................................................................52
Les 9b: a sociological enquiry into the social determinants of preventive healthcare practices: a
European comparison..........................................................................................................................55
Social inequalities in cancer screening:............................................................................................55
Fundamental cause theory (fct)........................................................................................................57
Link with diffusion of innovations (doi).........................................................................................58
Cultural health capital (CHC).............................................................................................................58
Les 10: Diversity: gender and health....................................................................................................61
Gender and health: burden..............................................................................................................61
Gender and evolution in mortality:..............................................................................................61
Gender and morbidity (ziektecijfer): burden................................................................................61
Explanations for a gender gap in common mental health problems................................................61
1. Artefactual factors....................................................................................................................61
2. Biological factors.......................................................................................................................61
3. Psychological factors.................................................................................................................62
4. Sociological factors...................................................................................................................62
Institutional context and women’s health: 2 case studies................................................................63
3
, Les 1: Introduction
MEDICAL SOCIOLOGY:
What is it about?
First half of the 20th century: medicine and sociology as separate disciplines
- Health issues are within the domain of physicians and biological sciences
- Durkheim, Weber, Marx: little attention for the role of medicine and health in society
After WWII: cooperation between physicians and sociologists
- Sociology in Medicine: sociological research that serves the needs and interests of medicine; the
goal is to provide solutions to medically defined problems (e.g., improve doctor-patient
relationships, detect social causes of disease) medical schools, public health schools … (they
introduced a social perspective in the medical field not what sociology of medicine is)
- Sociology of Medicine: sociological study of health, illness and institutions of health care, as a
means of understanding the society; the goal is to gain understanding of social life in general
(forerunners of medical sociology used sociological perspectives to study health issues)
Definition: Medical sociology (health sociology) = a theory oriented research field, committed to
explaining large-scale social transformations and their implications, as well as interactions in
everyday settings, as these are expressed in health and Illness
- It is about observing social processes and then linking medical factors to it Not in the other
direction
HEALTH, DISEASE, ILLNESS, ….
Health
- Absence of disease (medical world)
- State of complete physical, mental and social well-being and not merely the absence of disease
(WHO) (example: having no cancer, having close relations, feeling vital)
- Lay beliefs (general population): capacity to carry out daily activities; people can feel themselves
healthy, even if they suffer from chronic conditions (example: diabetes, arthritis … )
Disease: (een ziekte). An abnormality of the body or mind that causes discomfort, dysfunction,
distress or death to the person affected or those in contact with that person. (objective condition)
Syndrome: collection of signs or symptoms that occur together
Illness: (zich ziek voelen). Condition of poor health, experienced by a person (regardless of whether
he/she in fact has a disease). (experience, can be present without the presence of a disease)
Sickness: (ziek zijn). Social classification of someone deemed diseased, which can also occur
independently of the presence or absence of disease or illness (the public that says that person is sick
and that person not; this can be said even when a person doesn’t have a disease or is not ill)
4
Content
Les 1: Introduction..................................................................................................................................4
MEDICAL SOCIOLOGY:........................................................................................................................4
HEALTH, DISEASE, ILLNESS, ….............................................................................................................4
Les 2: Models of Health and Illness........................................................................................................5
1. Biomedical model...........................................................................................................................5
2. Biopsychosocial model...................................................................................................................5
3. Evolutionary/ Darwinian model......................................................................................................6
4. Ecological model.............................................................................................................................7
5. Sociological model..........................................................................................................................8
Les 3: Social change and health............................................................................................................10
EPIDEMIOLOGICAL TRANSITIONS.....................................................................................................10
HUNTER-GATHERERS SOCIETIES...................................................................................................10
NEOLITHIC & 1ST EPIDEMIOLOGICAL TRANSITION........................................................................11
AGRICULTURAL SOCIETIES............................................................................................................11
INDUSTRIAL & 2ND EPIDEMIOLOGICAL TRANSITION......................................................................12
GLOBALIZATION & 3RD EPIDEMIOLOGICAL TRANSITION...............................................................13
EPIDEMIOLOGICAL TRANSITIONS.................................................................................................14
FUTURE COURSES.............................................................................................................................15
DEMOGRAPHIC TRANSITIONS & HEALTH.....................................................................................15
Les 4: (Bio)Medicalization.....................................................................................................................16
DEFINING AND THE HISTORY OF MEDICALIZATION..........................................................................16
What is medicalization?................................................................................................................16
The first generation......................................................................................................................17
The second generation.................................................................................................................18
The driving forces of the shift.......................................................................................................19
MEDICALIZATION: POSITIVE OR NEGATIEVE?...................................................................................23
Les 5: Health and the life course..........................................................................................................24
THE LIFE COURSE PERSPECTIVE........................................................................................................24
PRINCIPLE 1: Life-span development............................................................................................25
PRINCIPLE 2: Timing of outcomes.................................................................................................27
PRINCIPLE 3: Linked lives..............................................................................................................27
1
, PRINCIPLE 4: Time and place........................................................................................................27
PRINCIPLE 5: Agency versus structure..........................................................................................28
Life Course Transitions.....................................................................................................................28
Les 6: End of Life research....................................................................................................................30
Basics of death & dying.....................................................................................................................30
Social construction of death.........................................................................................................30
Death as prime mover in society..................................................................................................30
Epidemiology of dying......................................................................................................................30
Transitions over time....................................................................................................................30
Public health challenges...............................................................................................................31
Death & dying in contemporary society...........................................................................................32
The risk society & death...............................................................................................................32
Postmaterialism, individualism & death.......................................................................................32
Social death..................................................................................................................................33
Medicalisation of death................................................................................................................33
Revivalism of death......................................................................................................................34
Les 7: Diversity: ethnicity and health....................................................................................................37
Key concepts:....................................................................................................................................37
Large:............................................................................................................................................37
Robust:.........................................................................................................................................38
Persistent:.....................................................................................................................................38
Explanations:....................................................................................................................................38
1. Social selection and social drift.................................................................................................38
2. Access to and use of healthcare services..................................................................................38
3. Cultural-behavioral...................................................................................................................39
4. Psychosocial..............................................................................................................................39
5. Material approach....................................................................................................................40
6. Fundamental cause theory.......................................................................................................40
Policy implications............................................................................................................................41
Les 8: Diversity: social inequalities in health.........................................................................................43
Defining the subject..........................................................................................................................43
Examples.......................................................................................................................................44
Theories on the relation between migration and mental health......................................................46
1. Bhugra Model: 1st generation...................................................................................................46
2. Migration as a metaphor: 2nd generation..................................................................................46
2
, Pathways to care..............................................................................................................................47
BEHAVIORAL MODEL OF HEALTHCARE SERVICES USE (Andersen)...............................................48
Les 9: Health behaviours and lifestyles.................................................................................................50
Introduction......................................................................................................................................50
Health behavior models....................................................................................................................51
Health Belief Model (HBM)...........................................................................................................51
A theory of Health Lifestyles (Cockerham)...................................................................................52
Les 9b: a sociological enquiry into the social determinants of preventive healthcare practices: a
European comparison..........................................................................................................................55
Social inequalities in cancer screening:............................................................................................55
Fundamental cause theory (fct)........................................................................................................57
Link with diffusion of innovations (doi).........................................................................................58
Cultural health capital (CHC).............................................................................................................58
Les 10: Diversity: gender and health....................................................................................................61
Gender and health: burden..............................................................................................................61
Gender and evolution in mortality:..............................................................................................61
Gender and morbidity (ziektecijfer): burden................................................................................61
Explanations for a gender gap in common mental health problems................................................61
1. Artefactual factors....................................................................................................................61
2. Biological factors.......................................................................................................................61
3. Psychological factors.................................................................................................................62
4. Sociological factors...................................................................................................................62
Institutional context and women’s health: 2 case studies................................................................63
3
, Les 1: Introduction
MEDICAL SOCIOLOGY:
What is it about?
First half of the 20th century: medicine and sociology as separate disciplines
- Health issues are within the domain of physicians and biological sciences
- Durkheim, Weber, Marx: little attention for the role of medicine and health in society
After WWII: cooperation between physicians and sociologists
- Sociology in Medicine: sociological research that serves the needs and interests of medicine; the
goal is to provide solutions to medically defined problems (e.g., improve doctor-patient
relationships, detect social causes of disease) medical schools, public health schools … (they
introduced a social perspective in the medical field not what sociology of medicine is)
- Sociology of Medicine: sociological study of health, illness and institutions of health care, as a
means of understanding the society; the goal is to gain understanding of social life in general
(forerunners of medical sociology used sociological perspectives to study health issues)
Definition: Medical sociology (health sociology) = a theory oriented research field, committed to
explaining large-scale social transformations and their implications, as well as interactions in
everyday settings, as these are expressed in health and Illness
- It is about observing social processes and then linking medical factors to it Not in the other
direction
HEALTH, DISEASE, ILLNESS, ….
Health
- Absence of disease (medical world)
- State of complete physical, mental and social well-being and not merely the absence of disease
(WHO) (example: having no cancer, having close relations, feeling vital)
- Lay beliefs (general population): capacity to carry out daily activities; people can feel themselves
healthy, even if they suffer from chronic conditions (example: diabetes, arthritis … )
Disease: (een ziekte). An abnormality of the body or mind that causes discomfort, dysfunction,
distress or death to the person affected or those in contact with that person. (objective condition)
Syndrome: collection of signs or symptoms that occur together
Illness: (zich ziek voelen). Condition of poor health, experienced by a person (regardless of whether
he/she in fact has a disease). (experience, can be present without the presence of a disease)
Sickness: (ziek zijn). Social classification of someone deemed diseased, which can also occur
independently of the presence or absence of disease or illness (the public that says that person is sick
and that person not; this can be said even when a person doesn’t have a disease or is not ill)
4
