What are the major indicators of global health inequity? Q:2- How is class related to health inequality? What are the limitations of class analysis?
Two major sociological theoretical perspectives on health and illness are: functionalism and Weberianism. Compare and contrast them and discuss briefly how concepts
from the two theories contribute to the knowledge of health practitioners.
Order Description
Assessment One – Essay covering Modules 1 & 2
NUR 210 Health Sociology Module 1
Learning Materials
Module One Sociology for Health Professionals
1.1 Content overview 1.2 What is Sociology? 1.3 Definition of health and illness. 1.4 The Biomedical model.
1.5 The sociological approach to the study of health and illness.
1.6 Understanding and explaining social phenomena
1.7 Theories, Discourses and Paradigms
1.8 Sociological concepts and theories 1.9 Historical Origins of Social Health 1.10 Social structural approaches: Societies as objective realities 1.11 The
functionalist perspective of health and illness
1.12 The Marxist perspective of health and illness 1.13 Interpretative approaches: Societies as subjective realities 1.14 The Symbolic Interactionist perspective of
health and illness 1.15 The Social Constructionist perspective of health and illness – The relativity of social reality 1.16 Feminist Perspectives
1.17 The Structure –Agency Continuum 1.18 The Sociology of health and illness: Defining the field
1.19 Blackboard activity
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Module One Sociology for Health Professionals
1.1- Content overview This first module explores the questions of ‘what is sociology?’ and ‘how is it relevant to the
health profession?’
This topic contains: ? An overview of Sociology ? An introduction to Health Sociology ? Online learning activity ? A reading list 1.2 -What is Sociology?
We begin this module by exploring the concept of sociology.
The simplest view of the academic discipline of sociology is that it is somehow concerned with the
understanding of human societies. However, this does not take us very far as most people feel they
know a good deal about the society in which they live because they experience it every day; this can
be described as ‘common-sense’ knowledge. Another approach would be to define sociology as a
research based study of society.
However, there are other academic disciplines such as history, politics, economics, anthropology and
social psychology that also have human society as the object of study. Probably the best way of
defining the contribution of sociology is by looking at the key questions that originally stimulated the
development of the academic discipline and which continue to underpin sociological research today:
What gives social life a sense of stability & order?
How does social change & development come about?
What is the nature of the relationship between the individual and the society in which they live?
To what extent does the society into which people are born shape their beliefs, behaviour, & life chances (including health outcomes)?
In other words, sociology looks at the social influences of politics, economy, religion, family, gender
roles and so on, and their impact or importance in understanding behaviour (Kellehear, 1990).
Sociology tries to understand the underlying patterns in the social world. Although other disciplines
do this also, Sociology has its own special way of doing it. Sociologists do not just describe the social
world but attempt to theorise, measure, analyse, interpret and test its subject matter. As Waters
and Crook (1993, p. 3) state, doing sociology is about approaching the familiar world with new eyes.
So why study health Sociology and how is it relevant to working as a health practitioner?
Health Sociology analyses the interaction between SOCIETY and HEALTH. Where medical research
might gather statistics on a disease, a sociological perspective on an illness can provide insight into
what external factors caused the demographics who contacted the illness to become ill.
An example of this is if we look at the table below. Life expectancy for both Indigenous men and
women is well below the average for non-Indigenous men and women. Health Sociology tries to look
at and analyse reasons why this might be so.
Understanding some of the underlying factors can help governments, policy makers and other
stakeholders to make positive changes.
The health industry like any other is embedded with a number of dominant values, assumptions and
processes which shape it. Sociology helps provide the language and tools to critically analyse and
reflect on these. Hence we will be looking at what the social determinants of health are in the
Australian context whilst critiquing the philosophy of primary health care and the dominance of the
medical model.
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To Van Krieken et al. Some aspects that can be the focus of sociology can include the examination of,
social, economic and political influences on the selected area which could be the local, national or
global setting (Van Krieken, R, Smith, P, Habibis, D, McDonald, K, Haralambos, M and Holborn, ,M
2000). Over the weeks this will certainly become evident.
When we look at health from a sociological perspective we take into account all of the social
influences such as politics, the economy, religion, culture, family, gender etc. that influence
behaviour and as a consequence health outcomes.
Readings
The following provide an overview of Sociology and lay the foundation for this unit. I strongly recommend that you read beyond the set text.
Set Text Germov, J (2014)Imagining Helath Problems as Social Issues. In J. Germov (Ed.), Second Opinion; An Introduction to Health Sociology, Melbourne: Oxford
University Press, pp.5-22 Germov, J (2014) Theorising Health: Major Theoretical Perspectives in Health Sociology. In J. Germov (Ed.), Second Opinion; An Introduction
to Health Sociology, Melbourne: Oxford University Press, pp.23-39 Heil,D., (2014) Wellbeing and WellnessIn J. Germov (Ed.), Second Opinion; An Introduction to Health
Sociology, Melbourne: Oxford University Press, pp.23-39 eReserve Kellahear, A. (1990). What is Sociology and why study it? (Chapter One). In A Kellehear (Ed.), Every
student’s guide to sociology: A quick and plain speaking introduction. South Melbourne: Thomas Nelson Australia. Van Krieken R. (2000). What is sociology? In Van
Krieken,R., Smith,P ,Habibis,D., McDonald,K, Haralambos,M. ,Holborn,M. (2000) Sociology: Themes and Perspectives (pp. 1-35). Frenchs Forest, N.S.W. Pearson Australia.
link: http://ereadings.cdu.edu.au/view/cdu:20848 Cockerham, W.C (2007). Medical Sociology. In Medical Sociology (10th ed) (pp. 1-20). Upper Saddle River, New Jersey:
Pearson Prentice Hall. Further Readings Schofield, T (2015). A Sociological Approach to Health Determinants Cambridge University Press, Australia, pp16-32 and 53-55,
Giddens, A., Sutton,P.(2014),Essential Concepts in Sociology, p 4-26, Polity,UK Jones,P., Bradbury, L. Boutillier,S.(2013) Introducing Sociology Second Edition,
Polity, pp1-103
1.3 -Definition of health and illness.
There is no uniform definition of health and illness.
Definition: Health. “…[S]tate of complete physical, mental, and social well-being and not merely the absence of disease, or infirmity” (WHO, 1946)
For example, it is dismissed as “patently absurd and unattainable” and “highly dangerous” given that it is deemed impossible to tell whether individuals or groups have
achieved this state, or for such a state to be measured or evaluated (Sax, 1990, p.1). Additionally, the reference to a state of “complete social well-being” is
claimed as “so freighted with individual interpretations that it alone renders the definition useless” (Hudson, 1993, p.45)
‘Historically, the word health appeared approximately in the year 1000 A. D. he word originally came
from Old English and it meant the state and the condition of being sound or whole. More precisely,
health was associated not only with the physiological functioning, but with mental and moral
soundness, and spiritual salvation, as well’ (Boruchovitch, E., Mednick, B, 2002).
There are a many different definitions of health and illnesses which are often determined by who is
doing the defining and what perspective they are coming from. There is a number of cultural
perspectives and some of these encompass ideas of the spirit whilst others involve sorcery and/or
witchcraft or other non-human sources. In the contemporary Western framework, the dominant
perspective of health and illness is the biomedical model.
1.4 -The Biomedical model.
The biomedical model is based on the principal of scientific rationality. The body is viewed as a
machine and illness in viewed as a defect or malfunction. Illness is the result of the body part
involved failing to function properly, or is the result of germs or disease. The biomedical model
excludes social, psychological and behavioural aspects of illness. It reduces illness to something that
happens to a person’s “parts” rather than to the whole person.
In Module 5 looks we will look at the biomedical model in greater depth.
1.5- The sociological approach to the study of health and illness.
A sociological approach to health and illness is premised on the belief that health and illness must be
analysed in their social context. Health professionals using a sociological approach will recognise that
the patient/client is situated within a social context that will construct that person’s experiences, beliefs, knowledge, actions and interactions. Sociology assists
health professionals to recognise that
membership of a particular group in society (e.g. age, sex, family type etc) can influence experiences
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of illness and wellbeing. Sociologists therefore speak of the social distribution of health and illness.
In various sections of this study guide for example, you will note that there exist social patterns of
health and illness.
A common explanation for health inequalities is based on the belief that individuals are responsible
for what happens to them. In attempting to understand and explain health differences, a health
worker who uses a sociological approach will look beyond the individualistic explanations. Whilst
there is no denying that individual psychology may play an important role in determining an
individual’s health status, a sociological approach would lead us to examine the underlying social
causes of health and illness. A sociological approach to health and illness will also be concerned with
social processes and social relationships. Sociologists are interested in the processes whereby
certain groups gain and maintain control over others. They are also interested in the interaction
between health professionals and clients/patients.
Sociologists may also be concerned with differing beliefs about health and illness. As stated
previously, beliefs about the causes of illness vary greatly across cultures.
1.6- Understanding and explaining social phenomena
In an effort to answer the questions laid out in the “What is Sociology?” section, sociology pursues
an objective scientific approach attempting to explain why social life is not a random series of
events, but is structured and shaped by particular sets of rules (both obvious & hidden). This is not
to say that social structures determine human behaviour, rather that social structure is both the
ever-present condition for, and reproduced outcome of, intentional human agency or actions.
Like any other academic discipline, sociology is theory-based. That is, in order to understand how
societies work (or why particular bio-chemical processes occur), we must go beyond a simplistic
description of the phenomenon under investigation. Also like any other academic discipline which
has as its object of study the human and social world, the field of sociology consists of a range of
competing explanatory paradigms. Empirical research necessarily involves making assumptions
about the nature of social reality.
Sociology challenges both naturalistic and individualistic explanations of social phenomena. These
understandings arise as a consequence of growing up (`being socialised’) within a particular culture
and set of social structures, and can result in people seeing their everyday roles and behaviour as
being somehow `natural’. Equally, when looking at other people`s behaviour i.e. `unhealthy
lifestyles’ or lack of motivation; for example, the focus is all too often on particular individual
characteristics ignoring the social factors that influence such behaviour and beliefs.
1.7 -Theories, Discourses and Paradigms
Throughout this topic we will be referring to different theories, discourses and paradigms. In order
for you to grasp these concepts within the sociological context I have set below some general
defintions.
‘A theory is … a system of ideas that uses researched evidence to explain certain events and to show why certain facts are related’ (Germov, 2002, p. 13).
A discourse can be viewed as verbal communication and a formal treatment of a subject in written
and/or verbal communication. The notion of discourses is critical to our understanding of Sociology
and we will talk a bit more about them in later weeks. At this stage it is important to understand the
idea bought about by postmodernism that rejected the view that science provides a universal truth.
It challenged the notion of the unbiased, impartial writer. Rather,
“(C)ritical theory, poststructuralism, and postmodernism expose science’s apparent authorlessness
as one possible rhetorical stance among many” ( Agger, B. 1991, p.122).
According to Dictionary.com a paradigm is ‘a framework containing the basic assumptions. Ways of
thinking, and methodology that are accepted by members of a scientific community’ and a ‘cognitive
framework shared by members of a discipline or group’.
For many paradigms are viewed as self-perpetuating, Newman for example, views the dominant
medical paradigm, a search for causality dominates and all “ non-evidence based” phenomena is
ignored and each new health worker is acculturated into the paradigm ( in Picard, 2005).
1.8 -Sociological concepts and theories
These perspectives or schools of thought will be discussed in detail further into these study materials
but you should try to become familiar with them before you continue. The chapter by Van Krieken et
al (2000) is a good place to start exploring these theories in more depth
Within sociological theory, there exists a divide between those sociologists who argue that society
can be studied in an objective manner through identifying and examining the structures of society,
and those who argue for an interpretative or subjective approach to social phenomena more
focused on social actors. Structuralist approaches often tend to focus on the macro level (that of
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society) while subjectivist approaches tend to focus on the micro level of interaction (between
individuals). However, in more recent time’s a third position has developed which attempts to
breakdown this duality between the relative importance attached to social actors versus social
structures. These three approaches are explored in the next few pages.
1.9- Historical Origins of Social Health.
In the middle of the 19th century, with the industrial revolution came the spread of disease. This was
mainly due to huge influxes of people from country into the cities as this was where the work was
located. As a result housing became an issue and there was little to no regard for hygiene or
sanitation. As a result, preventable diseases like Cholera and Typhoid resulted in thousands of
deaths. It was through health sociology and Karl Marx that the linkage between poverty and working
class conditions were first articulated. Social legislation based on the principals of sanitation was
passed.
What this demonstrates for us is that theories are a product of the historical time, place and
specificity of the theorist.
Within Sociological analysis you need to ask;
? Why is this particular question being asked at this time? ? What are the structural paradigms that support the current structure? ? What cultural paradigms are
involved?
It is therefore important to critically analyse the phenomena from each of these
perspectives.
We are now going to look at some of theoretical approaches.
1.10 -Social structural approaches: Societies as objective realities
Social structural approaches to exploring social reality include those empiricist sociologists who
believe that an objective ‘science of society’ is possible in much the same way as a physical science
such as biology or physics. This empirical sociology seeks to explain the norms of social life in terms
of various identifiable linear causal influences. Social structural approaches would also include those
sociologists who see human society as being shaped by an underlying material social and economic
structure. These are structures that may not always be visible, but nevertheless are fundamental in
explaining social and individual processes.
In relation to health, a predominantly social structural approach would draw upon quantitative data
derived from social surveys, epidemiological studies and comparative studies in order to point to the
relative influence of societal structures and processes in determining health outcomes for social
groups.
Within the academic discipline of sociology, two major theoretical perspectives exist which seek to
analyse human societies utilising a social structural or systems approach. These perspectives are
structural functionalism and Marxism, and their very different organising principles are described in
relation to the social determination of health outcomes below. As a brief illustration of the two
approaches to structural analysis we will briefly examine the issue of poverty. The functionalist
explanation would set poverty in the context of social stratification and the unequal distribution of
rewards associated with complex economies where different tasks are performed by different
groups within society. Some groups are relatively less well off than others because they have less
skills and knowledge and so their contribution to the functioning of society is not as extensive as
other groups. Whilst the Marxist explanation would set poverty in the context of the class structure,
specifically the relationship of social groups within an capitalist system of economic production in
which there are the exploited and the exploiters (with some intermediate groups of managers and
supervisors).
1.11- The functionalist perspective of health and illness
This theoretical perspective stresses the essential stability and cooperation within modern societies.
They believe that the basis of an orderly society is the existence of common value systems that bind
its members together. Social events are explained by reference to the functions they perform in
enabling continuity within society. Society itself is likened to a biological organism in that the whole
is seen to be made up of interconnected and integrated parts; this integration is the result of a
general consensus on core values and norms. Through the process of socialisation we learn these
rules of society which are translated into roles. Thus, consensus is apparently achieved through the
structuring of human behaviour. Within medical sociology, this approach is essentially concerned
with the theme of the ‘sick role’, and the associated issue of illness behaviour. Talcott Parsons, the
leading figure within this sociological tradition, identified illness as a social phenomenon rather than
as a purely physical condition. Health, as against illness, being defined as:
‘The state of optimum capacity of an individual for the effective performance of the roles and tasks for which s/he has been socialised.’ (Parsons, 1951)
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Health within the Functionalist perspective thus becomes a prerequisite for the smooth functioning
of society. To be sick is to fail in terms of fulfilling one’s role in society; illness is thus seen as
‘unmotivated deviance’. The regulation of this sickness/deviance comes about through the
mechanism of the ‘sick role’ concept and the associated ‘social control’ role of doctors in allowing an
individual to take on a sick status
1.12 – The Marxist perspective of health and illness
A key assertion of the Marxist perspective is that material production is the most fundamental of all
human activities – from the production of the most basic of human necessities such as food, shelter
and clothing in a subsistence economy, to the mass production of commodities in modern capitalist
societies. Whether this production takes place within a modern or a subsistence economy, it
involves some sort of organisation and the use of appropriate tools; this is termed the ‘forces of
production’. Production of any type was recognised by Marx as also involving social relations. In
modern capitalist societies these ‘relations of production’ lead to the development of a division of
labour reflecting in the existence of different social classes. For Marx, it is these forces and relations
of production together that constitute the economic base (infrastructure) of society. The
superstructure of a society – the political, legal, educational, and health systems and so on, are
shaped and determined by this economic base.
The orientation of this approach as applied within medical sociology is towards the social origins of
disease. Health outcomes for the population are seen as being influenced by the operation of the
capitalist economic system at two levels.
First, at the level of the production process itself, health is affected either directly in terms of
industrial diseases and injuries, stress-related ill health, or indirectly through the wider effects of the
process of commodity production within modern societies. The production processes produce
environmental pollution, whilst the process of consuming the commodities themselves have long-
term health consequences such as eating processed foods, chemical additives, car accidents and so
on. Second, health is influenced at the level of distribution. Income and wealth are major
determinants of people’s standard of living – where they live, their access to educational
opportunities, their access to health care, their diet, and their recreational opportunities. All of these
factors are significant in the social patterning of health
Also known as conflict theory, this perspective on health and illness focusses on the role of the
medical profession and how working and living conditions in a capitalist society contribute to health
outcomes. They would argue for example that dangerous work environments and poor living
conditions result in higher morbidity rates in the working classes, hence they make the link
between low occupational status, power , income and poor health outcomes.
1.13 -Interpretative approaches: Societies as subjective realities
Sociologists within this wide tradition would argue that the social world cannot be studied in the
same way as the physical world because people:
‘Engage in conscious intentional activity and, through language, attach meanings to their
actions… [therefore] sociologists should be less concerned to explain behaviour than to
understand how people come to interpret the world in the way they do.’ (Taylor and Field,
1993, p.15)
In attempting to achieve this goal of interpretative understanding, reliance is placed on essentially
qualitative research methodologies in order to get as close as possible to the world of the subjects or
social actors being studied. In terms of health and illness, this interpretative approach focuses upon
the (symbolic) meanings of what it is to be ill in our society, and would not confine its interest in
health to what would be perceived as the closed world of clinical biomedicine (this would not rule
out the study of the interactions of clinicians themselves both with patients and with colleagues).
The following issues in health and illness are examples of the research focus of interpretative
sociology:
Within this interpretative sociological tradition two distinct perspectives stand out; symbolic
interactionism and social constructionism. These approaches will be outlined in relation to health
and illness below.
1.14- The Symbolic Interactionist perspective of health and illness
This perspective developed from a concern with language and the ways in which it enables us to
become self-conscious beings. The basis of any language is the use of symbols that reflect the
meanings that we endow physical and social objects with. In any social setting in which
communication takes place, there is an exchange of these symbols: that is, we look for clues in
interpreting the behaviour and intentions of others. Communication being a two-way process, this
interpretative process involves a negotiation between the parties concerned. The negotiated order
that develops therefore involves:
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‘People construct[ing] understandings of themselves and of others out of experiences they have and the situations they find themselves in. These understandings have
consequences in turn for the way in which people act, and the manner in which others react to them.’ (Aggleton, 1990, p. 91)
Interactionist sociology asserts that the social identities we possess are influenced by the reactions
of others. So if we demonstrate some abnormal or ‘deviant’ behaviour it is likely that the particular
label that is attached within a society at a particular time to this behaviour will then become
attached to us as individuals. This can bring about important changes in our self-identity. A disease
diagnosis could be one such label.
Within this perspective medicine too would be viewed as a social practice, and its claims to be an
objective science would be disputed. In the doctor-patient interaction, patient dissatisfaction can
result if the doctor too rigidly superimposes a pre-existing framework (disease categories) upon the
subjective illness experience of the patient. Symbolic interactionist focus on agency and how people
construct, interpret and give meaning. They contend that health and illness are subjective constructs
that vary over time and between cultures.
Foucault proposed that communication of any kind is influential in bringing the world into being. He
used the word discourse to refer to this social process and argued that it always involved power.
Discourses as such make reality.
‘ What is created through text- including and what is left out-creates the truth of reality for people,
shaping their behaviours and actions. Formal knowledges, such as the various branches and
modalities of science, are especially powerful discourses, but so, to, are religious and political beliefs.
Discourses in fact, are critical in bringing us into being as individual subjects with specific identities’
(Schofield, T.,2015,p.54)
1.15 -The Social Constructionist perspective of health and illness – The relativity of social reality
This sociological perspective derives from the phenomenological approach of Berger and Luckmann
(1967), who argue that everyday knowledge is creatively produced by individuals and is directed
towards practical problems. ‘Facts’ are therefore created through social interactions and people’s
interpretations of these ‘facts’. This essentially subjectivist approach embraces a number of very
different sociological paradigms, but what such paradigms do have in common in relation to health
and illness is a focus on the way we make sense of our bodies and bodily disturbances. Social
constructionism refuses to draw a distinction between scientific (medical) and social knowledge. Nor
would it ignore disease in favour of examining the illness experience; unlike the interactionist
perspective. Rather, it maintains that all knowledge is socially constructed. We are seen to come to
know the world through the ideas and beliefs we hold about it, so that it is our concepts and
categories which are the realities of the world.
Foucault (1973,1980,1985,1986) and the work of so-called post-structural social theorists are
included within this perspective, though their concerns are frequently different from those
researching within the tradition of phenomenology. Foucault is interested in power in itself, not as
reduced to an expression of some other conceptual starting point such as class, the state, gender or
ethnicity. He seeks to approach the relationship between agency and structure not through an
essentialist analysis but by using an ‘interpretative analytics’ of practices and discourses, discerning
the workings of power and knowledge in social relations. He tried to define the relationship between
language, social institutions, subjectivity and power.
In terms of health and illness, this Foucauldian approach to cultural constructionism draws attention
to the ways in which we experience ourselves and our bodies not in some naturalistic way, but in
what is termed a ‘symbolically mediated fashion’ – the body as a ‘field of discourse’. He looked at
how some discourses such as biomedicine for example, created meaning systems and have gained
the status of “truth” and hence are able to dominate how we continue to define and organise
ourselves as individuals and society as a whole. Other alternative discourses become marginalised as
a result.
1.16- Feminist Perspectives
Feminist perspectives in Sociology first emerged in the 1960s in response to the neglect of
gender issues and the sexist nature of many traditional sociological theories.
There are many different perspectives placed under the feminist banner. Despite this
diversity they all emphasise the importance of patriarchy and challenge biological
assumptions about the nature of women. They have made a major contribution to Health.
1.17 -The Structure –Agency Continuum
As you can see one of the key debates across sociology is between structure and agency that is what
is the degree in which human behaviour is determines or influenced by the structures, institutions,
systems and groups that surround them as compared with the ability of the individual to direct their
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own experience. This is not an either or phenomena but rather they are interdependent that is,
humans shape and at the same time are shaped by society.
1.18 -The Sociology of health and illness: Defining the field
Sociology brings two distinct focuses of analysis to the study of health and illness. At one level it tries
to ‘make sense of illness’, by applying sociological perspectives both to an analysis of the experience
of illness, and to the social structuring of health and disease. At this level, sociology makes an
important contribution to multi-disciplinary research into issues of interest to clinicians and other
health professionals, the development of health policy, and epidemiological studies. At a second
level, sociological enquiry can open doors to an understanding of the impact of wider social
processes upon the health of individuals and social groups. Such processes include social
inequalities, professional relationships, change and self-identity, knowledge and power, and
consumption and risk.
1.19- Question for discussions:
In order to get the most out of this subject and to learn from each other, students are encouraged to participate in Blackboard activities. Questions relevant to each
topic will be posed for each module.
Activity (Please Note: This is not graded. It is not an assessment and there is no word limit. Post your response on the Discussion Board Module
Q:1- Illness is simply a matter of bad luck, bad judgment, or bad genetics. Critically analyse this statement by applying a sociological imagination to explore the
social origins of illness?
Q:2- Critically discuss the limitations of the bio-medical model.
Q:3- Give an example of a sociological discourse and discuss how this relates to helath.
NUR 210 Health Sociology Module 2
Learning materials
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Module 2 The Social Distribution of Health and Illness
2.1 Content overview 2.2 What is Epidemiology?
2.3 Modern Medicine and Epidemiology
2.4 Social Stratification
2.5 Social Inequity
2.6 The Social Gradient of Health 2.7 Gender and Health and Illness
2.8 Aboriginal Health
2.9 Health and Age 2.10 Socio-economic status, inequality, health and education
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Module 2 The Social Distribution of Health and Illness
2.1 Content overview This second module explores how health and illness varies across the population.
This topic contains: ? The Social Distribution of Health and Illness ? Modern Medicine and Epidemiology ? Socio-economic status, health and Australian society. ? A
reading list ? On line learning activity
Readings
Set Text Broom, D., Germov,J. Global Public Health. In J. Germov (Ed.)( 2014), Second opinion; An introduction to health sociology, Melbourne: Oxford University
Press. Pp.63-81 Germov, J. (2014). Class, origins of health inequality. In J. Germov (Ed.), Second opinion: An introduction to health sociology, Melbourne: Oxford
University Press. Pp.81-101 Broom,D., Freij,M.,Germov,J. (2014). Gendered, In J. Germov (Ed.), Second opinion: An introduction to health sociology, Melbourne: Oxford
University Press.pp.123-146 Gray, D. and Saggers, S.Stearne,A. (2014). Indigenous health: The perpetuation of inequality. In J. Germov (Ed.), Second opinion: An
introduction to health sociology, Melbourne: Oxford University Press.pp.147-162
eReserve
Further Readings Australian Indigenous Health Info Net (2010). Overview of Australian Indigenous health status 2010, Edith Cowan University, WA online at
http://www.healthinfonet.ecu.edu.au/health-facts/overviews Australian Institute of Health and Welfare 2013. The health of Australia’s males: from birth to young
adulthood (0–24 years). Cat. no. PHE 168. Canberra: AIHW Australian Institute of Health and Welfare 2012. Australia’s health 2012. Australia’s health series no.13.
Cat. no. AUS 156. Canberra: AIHW. Cockerham, W.C (2007) Epidemiology (Chapter 2) in Medical Sociology (10 th edition) Pearson Prentice Hall, Upper Saddle River, New
Jersey, pp. 21-41. Holborn, M.,(2015) Contemporary Sociology, Polity, UK, pp6-34 National Agenda for a Multicultural Australia. Australian Government, Department of
Immigration.http://www.immi.gov.au/media/publications/multicultural/agenda/agenda89/australi.htm Scambler,G. (2012). Health inequalities. Sociology of Health &
Illness, 34(1), 130–146. http://onlinelibrary.wiley.com/doi/10.1111/j.1467-9566.2011.01387.x/pdf Schofield, T (2015). A Sociological Approach to Health Determinants,
Cambridge University Press, Australia, pp.60-80
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2.2 What is Epidemiology?
Epidemiology is defined as the study of the incidence and distribution of morbidity and mortality in
order to identify the role of nonbiological factors in sickness and health ( Jary & Jary, 1991, Collins
Dictionary of Sociology, Harper Collins, Glasgow)
Epidemiology is concerned with the distribution of disease in society. Epidemiologists are concerned
with patterns of disease and are therefore interested in identifying groups that are at risk of disease.
Epidemiologists are also interested in analysing the effect of certain interventions.
Epidemiology usually relies on the collection and analysis of large bodies of statistical data. Data is
available from a number of sources including medical records, surveys, census data etc.
According to Abdel Omran (1974 in Haralambos, van Krieken, Smith and Holborn, 1998, p. 183) there
are three significant stages in social development that affect the kinds of diseases experienced by
people.
Stage 1:The age of pestilence and famine is characterised by frequent epidemics and
famines. It is associated with pre-industrial, agricultural societies with high rates of
mortality.
Stage 2:The age of receding pandemics is characterised by transition. With social and
economic development as well as improvements in health care and sanitation, epidemics
and famine receded in importance as major health risks, while industrial diseases,
malignancies and cardiovascular diseases increased. Most western societies went through
this stage during the 18 th and 19 th centuries but most third world nations are still in this
transition stage.
Stage 3: The age of degenerative and man-made (sic) diseases is characterised by the
prevalence of cardiovascular disease, stroke, cancers, occupational hazards, drug addiction,
mental illness and geriatric conditions. It is associated with advanced social and economic
development.
There has been a marked reduction in the modern world of communicable diseases with a corresponding increase in what many refer to as lifestyle diseases.
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2.3 – Modern Medicine and Epidemiology
Morbidity refers to the state of being diseased or unhealthy within a population whilst mortality is
the term used for the number of people who died within a population.
The status of modern medicine rests, in part, on claims to have reduced mortality rates. A closer
examination of mortality rates throughout the history of the modern world reveals that the
eradication of many communicable diseases was a result of improved sanitation, better water
supplies, increased knowledge of basic hygiene, better nutrition and knowledge of nutrition, and
reduced family size.
Infectious or communicable diseases do remain a serious problem in the developing world and
among certain disadvantaged groups within developed or first world societies.
The major causes of death in the developed world (e.g. Australia) are related to modern living.
Causes of death however vary among age groups (e.g. the major cause of death in young Australians
aged 15 to 24 in 2011-13 was suicide), gender groups (i.e. women continue to outlive men), ethnic
and cultural groups (Australian Aboriginals have a much higher mortality rate than non-Indigenous
Australians) and social classes (i.e. those of the lowest socio-economic groups in Australia have
higher standardised death rates). With decreased mortality rates there is a corresponding increase in
morbidity rates.
Morbidity rates do vary across and between social/population groups but in general in the modern
world, the level of affluence of a particular society also influences these rates. While these materials
provide an overview on this issue, the readings for this module explore this topic in much more
detail.
2.4- Social Stratification
Stratification refers to the ranking of social groups. To Macionis, ‘Sociologists use the term social
stratification to refer to a system by which categories of people in a society are ranked in hierarchy’
(1991, p.234).
All known societies have some form of stratification system. In capitalist societies such as Australia,
one form of stratification is class. In Australia we may hear the terms upper class, middle class,
working class and underclass. An individual’s social position will often determine their educational
background. A person’s educational background will often determine their occupation. Their
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occupation will determine, partially at least, their income levels and standard of living. An example
of an exception to this theory is the mining industry in Australia. When mining was booming the
demand for labour outstripped the market hence wages were raised to meet demand.
There is much evidence to suggest that the social class of a person will determine their health status.
Both males and females of low-income households have poorer health (higher morbidity rates) than
those from more affluent households. Mortality rates differ between occupational groupings. In
general, manual labourers have higher mortality rates than members of professional groups.
2.5- Social Inequity
Social inequity is characterised by the existence of unequal opportunities and rewards for different
people in society dependent upon their social position and/or status. It contains structured and
recurrent patterns of unequal distribution of goods, services, opportunities, rewards and
punishments.
To Germov (2014), social class is a position in a system or structural inequality based on the unequal
distribution of power, wealth, income and status. People who share a class position typically share
similar life chances. There are also several explanations for social inequity in health which Germov
describes in Chapter 5 of your set text Second Opinion (2014) 2.6 -The Social Gradient of Health
The social gradient of health is a continuum of health inequity from high to low, where the poorest
people experience the worst health outcomes and as the gradient of wealth rises, so does the health status. This is also the case when looking globally at health
outcomes.
The Australian Institute of Health and Welfare (AIHW) is a major national agency, which provides
reliable, and relevant information and statistics on Australia’s health and welfare. Much of the
information is available on line. http://www.aihw.gov.au
2.7- Gender and Health and Illness
According to Waters and Cook (1993) Gender is the social interpretation of assumed biological sex differences.
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Unquestionably, there are differences in the health and illness experiences of males and females.
Sex specific health problems do exist and some of these may be related to differing reproductive
functions and others to differences in lifestyles. Biological explanations of health differences have
often historically been used as justification for unequal treatment. Biological differences were
evoked historically as the rationale for exclusion of women from higher education for example. The
theory that biology made women unfit for education was most eloquently put in relation to higher
education, since this occupied the period of women’s lives when their biology ‘ought’ to have
precedence. One book published in America in 1873 by an ‘expert’, Dr Edward H. Clarke, went
rapidly through seventeen editions and set forth the argument that education directly caused the
uterus to atrophy (Oakley, 1981, p. 121).
Although this may appear to us an outmoded belief, contemporary ideas do little to dispel the myth
that women’s biology determines their psyche. Such as the following ‘joke’ from South Park:
“I’m sorry, Wendy, but I just don’t trust anything that bleeds for five days and doesn’t die”.
The obvious implication is that anyone who bleeds for five days each month and doesn’t die, i.e. a
woman, must have something wrong with them. Women’s menstrual cycle continues to be the
justification for women’s exclusion from certain roles and particular spheres. The image of women
as the weaker sex is reproduced in contemporary portrayal of ‘real life’, as witnessed in the half
hourly soap operas we are socialised into accepting as our modern guides to the good life.
Sociological studies have revealed the sexualised pathways relegated to individuals labelled
criminally deviant. Males are more likely to be channelled through the criminal justice path whereas
females labelled criminally deviant are exited via the medical justice exit point. In other words the
bad man is bad, but the bad woman is mad. Often, the selection of treatment or discipline
modalities is directly related to beliefs about women’s biology. She must have been experiencing
some hormonal difficulties at the time. Male biology has also been used to justify certain
behaviours. Uncontrollable sexual desire has been cited repeatedly in defence of rape.
Stratification by gender is common to many societies. The roles expected of males and females are
often clearly prescribed. These roles reflect beliefs about femininity and masculinity.
Despite attempts to gain equality, women, in contemporary Australian society, remain primarily
responsible for unpaid labour. They remain the primary child carers and continue to be marginalised
in the workforce. Women continue to dominate the nurturing professions (e.g. childcare, nursing,
primary school teaching etc.) whereas men are predominant in the traditional masculine
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occupations (e.g. science based occupations). Gender is one determinant of health status. In
advanced capitalist societies, including Australia, women continue to have a higher life expectancy
than men. There is some evidence to suggest that the differences between male and female life
expectancy is lessening.
This graph sourced from the UN 2010 plots hours per day of housework performed on average by
sex and region.
Haralambos (1998) argues that women are subject to greater
medicalisation of their lives than men. Medicalisation refers to the process through which aspects of
your life become defined as medical issues requiring medical intervention by experts. Menopause is
an example of this.
To Schofield (2015), the health toll on women and children in regards to men’s violence is critically
important. ‘According to the Australian Human Rights Commission ( 2012,p.7), ‘domestic and family
violence is the leading contributor to death, disability and illness in women aged 15-44 years. It is
responsible for more of the disease burden than….smoking and obesity’. Worldwide. Men’s violence
has affected at least one out of every three women from beatings, sexual coercion and physical
abuse’ (Schofield, 2015,p.77)
Feminist commentators have also expressed concern at the male monopolisation of contraception.
The increasing medicalisation of all aspects of female existence has further alienated women from
their own bodies, it is argued. The medicalisation of menopause and menstruation are just two
examples. Both of these female experiences have become pathologised and as such, require medical
intervention.
This increasing medicalisation of all aspects of social existence is highlighted in feminist analyses of
female sexuality. Lupton reports on a study undertaken of general gynaecology texts (Scully and
Bart, 1981 in Lupton, p. 138) that found a pattern of concern for the patient’s husband that was
greater than concern expressed for the female patient. Textbooks continued to claim the vaginal
orgasm as the norm with the consequential labelling of women not experiencing it as sexually
deficient.
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Globally women bear a disproportionate burden of the world’s poverty, many have little to no
access to education or health care. Generally women outlive men, and in western society visit the
doctor more regularly, take over the counter and prescription drugs more regularly and are over-
represented in hospital admission rates.
Some theorists argue that the difference in doctor visitation rates may be explained as a response of
women’s enhanced willingness to report illness. Others argue that this data is reflective of genuine
differences in illness rates for women. Still others argue that the best explanation lies in the way the
medical system treats and defines the two sexes. As Dorothy Broom (2002, p. 104, in Germov, J (ed.)
2002) reports, there is evidence to indicate that the male body has been viewed within scientific
medicine as the normal body.
An alternative view is that the higher rates of illness reported by women are a reflection of their
different and unequal social roles and social positions. Psychosomatic illnesses, for example, may
simply reflect a response by women to a patriarchal society and the poor social status related to
being relegated to repetitious, menial and alienating labour.
Feminist concern with the monopolisation of women’s health by a profession dominated by males
has been commonly expressed in the last three decades of the twentieth century. The issue of the
control of women’s bodies has dominated feminist health literature for well over two decades.
While women have historically articulated discontent at what they believed was encroachment by
males in the women’s health arena, this protest has become increasingly commonplace and
acceptable in the 20th century.
The male control over women’s bodies is particularly notable in childbirth. Prior to World War II, the
majority of women gave birth at home. Hospital births were rare. By the mid-1980s, 99% of all births
in Britain occurred in hospitals (Stanworth, 1987, in Lupton, 1994, p. 148). Childbirth became
increasingly medicalised and technological intervention in birth (e.g. anaesthesia, forceps, caesarean
sections) became commonplace. Although the World Health organisation in the 1980s saw no
justification for a Caesarean section rate of 10 to 15%, the Australian average was 20% of all live
births.
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2.8- Aboriginal Health
Aboriginal Australians have the worst health outcomes of any other group. Mortality rates are the
highest of any group. ‘For the Aboriginal and Torres Strait Islander population born in 2010–2012,
life expectancy was estimated to be 10.6 years lower than that of the non-Indigenous population for
males (69.1 years compared with 79.7) and 9.5 years for females (73.7 compared with 83.1)’ ( ABS, 2014).
The Australian Institute of Health and Welfare provides the following summary of Aboriginal health
status.
They had higher age–specific death rates at virtually every age than other Australians,
especially between 25–54 years, when Aboriginal death rates are five to seven times higher.
Between 1988–94 Aboriginal men, but not women, experienced decreases in mortality rates
from circulatory diseases, infections, injuries and mental illness.
Death rates from diabetes in 1997–2010 were 5.4 times higher for Aboriginal people as
compared with other Australians.
Infant mortality was three to five times higher than that for the overall population.
Aboriginal women were twice as likely to have low birth weight babies.
Aboriginal women remain at 3 times the risk of maternal death with sepsis specific cause of
death , although their childbirth rates are 3% of the total births in Australia.
Aboriginal Australians are admitted to hospitals at a greater rate than are non-Aboriginal
Australians. According to Territory Health Services Annual Report 1999–2000, the gap in life
expectancy between Aboriginal and non-Aboriginal people has widened over the past twenty years.
The gap over this period increased from 16 to 18 years and 18 and 19 years respectively (Territory
Health Services 2000, p. 99).
The most common reason for hospitalisation of Indigenous patients in the same period was dialysis.
The second major reason for admission to hospital was, for males, injury and for females, pregnancy
and childbirth. Respiratory diseases, digestive diseases, circulatory diseases, mental disorders and
diseases of the skin and subcutaneous tissues, were other important causes of hospitalisation for
Indigenous Australians.
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Non-insulin dependent diabetes mellitus (NIDDM) is also a significant health problem for Indigenous
people. The likely prevalence of NIDDM among Indigenous people is between 10 to 30%, which is
about 2 to 4 times that among non-Indigenous Australians. Alcohol consumption and family violence
are also significant issues with consequences for the health and well-being of Indigenous Australians.
Locational disadvantage can also have an impact on an individual’s ability to seek assistance and
resources when necessary.
A large proportion of the Northern Territory’s Aboriginal population resides on remote
communities. Access to specialised medical services may mean travelling long distances and
relocating to alien environments, further contributing to the social isolation already resulting from
membership of a marginalised group. We will be taking a further look into Aboriginal health in the
next module.
2.9 –Health and Age
Age is another determinant of health and cuts across other social variables such as social class,
ethnicity and gender. In the discussion on social class and gender it was noted that major cause of death varied across age groups.
The impact of age upon health status will be mediated by other social variables, such as gender,
social class and ethnicity. Across all age groups, the most socially disadvantaged experience the
worst health.
Ageism according to Grbich ( 2004,p. 120), refers to the systematic stereotyping of older people
because of their age.
To some extent an analysis of the health of Australia’s aged population reflects the status of the
elderly. In many cultures social status increases with age but Australia, similarly to other western
highly industrialised nations, attaches greater status to youth. The elderly are perceived to be
unproductive and a burden on society. The labelling of the elderly as senile and dependent has
serious implications for the way the elderly view themselves and are viewed by others. The grouping
together of the elderly in this fashion conceals the diversity among Australia’s aged population.
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Like other industrialised nations, Australia’s population is an ageing population. The challenges of an
increasingly aged population for Australian society have been thoroughly documented. Increased
longevity (life expectancy) coupled with higher rates of morbidity is noted trends throughout the
developed world. The health and illness experiences of Australia’s aged population are not
homogenous however and must be viewed in the context of the interrelationship between age,
gender, socio-economic status, race and ethnicity.
Although most elderly people manage to remain at home rather than enter institutional care, the
need for institutional care has increased significantly and is likely to continue to do so. This of course
has economic implications for governments and there is some evidence to suggest that
governments, including the Australian government, are leaning more toward increasing the
provision of home care services than increasing spending on institutional care. Whilst this may
appear an attractive approach, the ideology of community embedded within these policies is
questionable.
Notions of community care carry connotations of neighbourhoods in which people have the time
and motivation to help one another, and especially to be willing to care for the sick and needy in
their midst. Instead, modern suburbia can be isolating, with people being divided by traffic, urban
developments and poor public transport .
Quite often, home care demands that family members assume the caring role. Historically this role
has been undertaken primarily be women. With increasing numbers of women entering the paid
labour force, the likelihood that women can continue to assume the caring role for the elderly is
questionable.
Health service delivery to the elderly rural and remote population is hampered by what some
theorists refer to as urban bias. This bias ignores key dynamics of lifestyle and community
characteristics. Such problems are compounded by insufficient critical mass, distance and dispersed
demand (Dunn and Williams, 1997).
There is some evidence to suggest that people leave the Northern Territory when they retire to
move to urban areas where services are available and accessible. In fact, the vast majority of older
Australians live in large inland cities or reside on Australia’s coastal regions. Older Australians who
remain residing in rural and remote regions may benefit from ageing in place but may be
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disadvantaged in that their needs in terms of service provision are rarely met (Knapman, p. 131 in
Grbich).
In rural areas, older people share with younger people the disadvantages that result from a
centralised, hospital based and technology oriented health system (Knapman, p. 131). Health service
delivery to the elderly rural and remote population is hampered by what some theorists refer to as
urban bias. This bias ignores key dynamics of lifestyle and community characteristics. Such problems
are compounded by insufficient critical mass, distance and dispersed demand (Dunn and Williams,
1997).
Although the majority of young people in Australia experience relatively good health, some
significant health issues have been identified. Injury is the leading cause of death for 12 to 24 year
olds with two-thirds of all deaths attributed to some form of injury, including accidents and suicide.
There are about three male deaths to every one female death among young Australians. Rates of
depressive disorders are three times higher for young females than for young males. Males have a higher rate of substance use disorders. According to AIHW (2013,
p.Vi),
‘There were 52 deaths per 100,000 males aged 0–24, nearly twice that among females of the same
age (30 per 100,000). Males were nearly 3 times as likely to die from land transport accidents, the
major cause of death for males aged 1–24.
About 6% of males aged 14–19 smoke tobacco daily and are less likely than females of the same age to do so. More than 2 in 5 (43%) males aged 14–19 were at risk of
injury resulting from a single occasion of drinking alcohol.
Males aged 0–24 were more likely to be hospitalised for injury, and more likely to die from injury, than females of the same age.
Chlamydia is the most commonly notified infectious disease among young males. More than half (53%) of chlamydia notifications among males were for those aged 15–24.
1 in 4 (23%) males aged 16–24 had experienced symptoms of a mental disorder, and 4 in every ,1000 males aged 18–24 had been diagnosed with a psychotic disorder. In
spite of this, rates of help seeking among young males are low (13%).
About 193,400 males aged 0–24 (8%) have a disability, and about 78,000 accessed selected disability services.
Youth from lower socio-economic groups were more likely to die younger and more likely to be
hospitalised than those from higher socio-economic groups. Young people living in rural and remote
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areas have generally poorer health compared with those living in metropolitan areas. Both death
rates and hospitalisation rates increase with increasing remoteness.
1.10 Socio-economic status, inequality, health and education
A significant indicator of the existence of social class is the distribution of wealth. In Australia for
example, there exists big differences in the income levels of the population. A very small proportion
of the population owns a very large proportion of the wealth. Poverty and the accompanying social
disadvantage is strongly correlated to ill health and early mortality. Poor social and economic
circumstances affect health throughout life and people who are closer to the poverty line are at
twice the risk of serious illness and premature death. The social gradient of health aligns material
disadvantage with other areas that affect health such as insecurity, anxiety and social disadvantage
(Wilkinson and Marmott, (eds.),1999).
In every social category, the healths of the poor are significantly worse than that of their more
affluent neighbours. Within the Australian context, the association between the health of Indigenous
Australians and their comparable disadvantage cannot be overestimated. Likewise, wealthier
overseas born Australians experience significantly greater health than their poorer counterparts.
Workplace injury is a significant problem in Australian society with over two-thirds of a million
Australians suffering a work-related injury or illness each year (Industry Commission 1995, cited in
Burdess, 1995, in Grbich, 1999). Workplace injuries primarily occur in working class occupations.
Moreover workplace deaths occur primarily among blue collar or working class occupational groups.
Working class or manual jobs are generally more hazardous than professional or managerial
occupations. Manual workers are often exposed to environmental hazards (e.g. chemicals, excessive
exposure to natural environmental hazards such as sun exposure), poor working conditions, tedious
repetitive tasks, stresses related to the disproportionate reward to the workload ratio, increased risk
of accident and injury, and to the alienation caused through a workplace organisation that is
disempowering and alienating.
It is not uncommon to attribute the health status of a population group to some deficit shared by its
members. This victim blaming is often perpetuated in the popular media. The circumstances of the
individual or group are attributed to some failing on their behalf. Individualistic explanations ignore
the structural determinant of people’s existence. Instead, the reasons for ill health or premature
death are attributed to either a flaw in the individual’s personality, or a result of some biological
deficiency. These explanations do little in the way of explaining why significant differences in health
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and illness experiences are evident across different groups in society. In other words, they fail to
adequately explain why the poor in general, as a whole suffer greater ill health and earlier death
than those who are not poor. Globally, vast differences in health are evident between the third
world or underdeveloped nations and those belonging to the first world or the developed nations.
These patterns cannot adequately nor simply be contributed to biological, behavioural or
psychological differences.
Sociologists writing from a consensus perspective tend to share some aspects of the victim-blaming.
These sociologists do not necessarily believe that inequality cannot be eradicated but their beliefs
about how best to achieve equality may differ sharply to sociologists who theorise from the conflict
perspective. The consensus view often focuses upon the need to educate the poor, to promote
health through campaigns aimed at raising awareness and changing behaviours. Health education
campaigns are increasingly common, and from a cynical viewpoint could be said to further
perpetuate the myth that individuals are solely responsible for their life experiences. By way of
contrast, Conflict theorists argue that the health of an individual or group is primarily determined by
their social position. The structural determinants of health override individual psychology in
determining health and illness experiences.
Workplace injury is a significant problem in Australian society with over two-thirds of a million
Australians suffering a work-related injury or illness each year (Industry Commission 1995, cited in
Burdess, 1995, in Grbich, 1999). Workplace injuries primarily occur in working class occupations.
Moreover workplace deaths occur primarily among blue collar or working class occupational groups.
Working class or manual jobs are generally more hazardous than professional or managerial
occupations. Manual workers are often exposed to environmental hazards (e.g. chemicals, excessive
exposure to natural environmental hazards such as sun exposure), poor working conditions, tedious
repetitive tasks, stresses related to the disproportionate reward to the workload ratio, increased risk
of accident and injury, and to the alienation caused through a workplace organisation that is
disempowering and alienating. From an individualistic perspective, we may ask why it is that people
remain in occupations that have little reward and high-risk health implications. Why don’t these
people just get a better, less risky job? A sociological perspective will remind us of the relationship
between income and status, education and occupation, occupation and wellbeing.
In our society, the occupation of an individual is largely determined by their educational attainment.
Professions that reap the greatest rewards generally also demand the greatest educational
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commitment. To become a nurse in the Northern Territory, for example, one must commit to
university study for either a two year (accelerated) program or the standard three years of study. To
become a medical professional one must commit to the education system for a significantly longer
period. To become a labourer on a building site, or operate a checkout at the local supermarket,
little education is often required. Longer years of education and training usually translate into
greater income levels on workplace entry.
Sociologists from a conflict perspective would argue that entry into and participation in, educational
institutions is not distributed equally. Inequalities are socially reproduced across generations. A child
from a working class family will generally find it more difficult to achieve the educational standards
required of high status occupations. This has little to do with so-called intelligence or ability but
much to do with structural factors.
Bowles and Gintis (1976) for example argue that schools reproduce social inequality by two means:
1. Schools prepare students for participation in the workplace; the workplace is characterised by
authoritarian relationships as are schools; the workplace is stratified and so are schools.
2. Schools prepare students differently depending upon their social origins (e.g. those from more
affluent backgrounds have access to better schools; middle class students are more articulate and
political to ensure adequate resources in their schools; schools stream students and frequently do so
on the basis of tests which have built in class and gender bias.
Thus, disadvantage in education results in disadvantage in employment. Disadvantage in
employment results in lower incomes and less autonomy at work or less stable employment/poor
employment prospects. Disadvantage in wealth and income leads to such things as inadequate
housing, inadequate sanitation etc., that in turn lead to poorer health status.
Sociologists from the symbolic interactionist perspective argue that inequality is not natural but
results from social labelling. Individuals who are different become stereotyped and labelled.
Inequality therefore results from difference.
To Jary and Jary ( 1991) a Stereo type is;
A set of inaccurate, simplistic generalisations about a group of individuals which enables others to
categorise members of this group and treat them routinely according to these expectations. Thus
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stereotypes of racial, social class and gender groups are commonly held and lead to the perception
and treatment of individuals according to unjustified preconceptions.
Feminist sociologists have noted that income and wealth distribution is correlated to gender. In most
societies, males have greater status, more valued occupations and greater incomes and wealth.
Feminist analyses of poverty note the feminisation of poverty, a term used to describe the increasing
prevalence of poverty amongst women. Although as with all perspectives there is great divergence
in thought amongst feminist sociologists, generally they agree that the gender of an individual will
be correlated to their status, their incomes, occupations etc.
Disadvantage has many forms and may be absolute or relative. It can include; having few family
assets, having a poorer education during adolescence, becoming stuck in a dead-end job or having
insecure employment, living in poor housing and trying to bring up a family in difficult circumstances.
These disadvantages tend to concentrate among the same people and their effects on health are
cumulative. The longer people live in stressful economic and social circumstances, the greater the
physiological wear and tear they suffer, and the less likely they are to enjoy a healthy age (Wilkinson
and Marmott, 1999)(Haralambos et al, p. 185)
In rural and remote areas, older people share with younger people the disadvantages that result
from a centralised, hospital based and technological orientated health system ( Knapman,
1999,p.131).
.
2.11 -Question for discussions:
In order to get the most out of this subject and to learn from each other, students are encouraged to participate in Blackboard activities. Questions relevant to each
topic will be posed for each module.
Activity (Please Note: This is not graded. It is not an assessment and there is no word limit. Post your response on the Discussion Board Module
Q:1- What are the major indicators of global health inequity? Q:2- How is class related to health inequality? What are the limitations of class analysis? Q:3-Reflect
on what class you belong to. Do you believe class has influenced your beliefs, lifestyle and life chances?
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