4 health and illness Flashcards
psychology
is the scientific study of people, the mind and behaviour.
applied and academic
anthropology
study of human culture
history
recording and interpretation of past events
sociology
is the study of social behaviour of society, including its origins, development, organisation, networks, and institutions.
epistemology
study of knowledge
ontology
the study of the nature of being. ontology considers whether facts are constructed in people’s minds or whether they exist in an external world.
Structural functionalism
MACRO
Auguste Comte
- society as objective reality
different components are interdependent, work together to promote stability
via socialisation–> learn rules of society
linked to positivism (1 objective reality)
quant approach
Parsons, Durkheim-> linked to this
Social conflict
macro
Marx
competition of resources
material production to generate wealth for society
–> different social classes
Interpretivism
micro
focused on how people interpret the world
-> small scale social interactions
behaviour and communication –>symbols–> influences persons interpretation of society
a) symbolic interprevitism: language as a way to become self-conscious beings
behaviour linked to others reactions
can get labelling/ stigma
b) social constructivist: all social knowledge constructed
positivism vs constructivism
positivism: one objective truth
constructivism: rejects one truth, each of use generate our won rules and models
sick role
Parsons
right:
- exempt from blame
- exempt from normal responsibilities
obligations:
- want to get better
- seek medical care
good: acute
weak:
- can blame individuals
- why seek medical care
- chronic
- end of life ?get better
doctor-patient relationship
Byrne & Long
doctor centered
- doctor led, patient passive
patient centered
- shared decision making, patient active
- improves compliance, self-care
Concepts of health
WHO: state of complete physical and mental wellbeing, bot absence of disease
Ottawa charter: resources for everyday life
Canguilhem: ability to adapt to environment
Huber: adapt and self manage
deviance
Becker
behaviour unacceptable within a particular society
sanctions
correction
punishment
treatment
parsons: illness deviance, doctor control
labelling
Lemert/Becker
Labelling occurs when individual attributes and characteristics are identified by others and given a negative label.
primary: behaviour before labelling has occurred (eg individual illness)
secondary: individual status once they have been labelled as deviant (eg doctor diagnosis)
-> leads to STIGMA
stigma
Goffman: attribute that is deeply discrediting within a particular social interaction
causes:
- inequality
-fear
- misinformation
consequences:
- felt stigma: shame. guilt
- enacted stigma: abuse, reduced access
address:
- virtuous cycle: action -> reduce felt - reduced enacted
tackle:
- legislation
- education
- language
- treatment
- public know exposure
- public know diagnosis
ICF definitions of impairment, disability and handicap
WHO ICF-11 (international classification of Functioning, Disability and Health)
impairment: bodily functions
disability to activities
handicap to social roles.
Marmot: social gradient in disability free LE
Barthel
hospital tool for activites of daily living
sociological approaches to disability
- parsons sick role
- Gerhardt:
- crisis model: label + stigma
- negotiation model: illness loss of self, need to maintain ‘normality’ focus on adaptation rather then deviant identity - Bury:
- Biographical disruption: loss of confidence and body and then social and self identity
- chronic illness result of shared experience with interaction of others –> ‘renegotiate’ relationships
good and bad aspects of illness
–> individual activily copes
- Active coping
- uses concept of ‘comeback’ (corbin and strauss)
- physical: medical rehab and treatement
- biographical: link past life to future life - Charmaz:
- bewiliderment: from diagnosis –> illness crisis-> why me, why now, what to do???
- - social model of disability
- people are disabled by societal bariers rather than impairements
- Socioeconomic context important: means of production in west continues disabiity
environment and culture changes
?no objective, can it all be overcome
iatrogenesis
disease caused by medicine
clinical: direct harm
social: overmedicalisation: C-sections
structural: medicine as spiritual coping
black report
on health inequality
- artefact
- social selection
-behavioural and cultural
- materialistic
whitehall study
social capital
value to social network: provide norms and sanctions
- bonding: strengthen links
- bridging: links outside group (networking)
micro, meso and macro level
Prof Chetty: opportunity atlas
social epidemiology
study of the social
determinants of the distribution of disease within
a population.
kaiser pyramid
shows majority of people self care, few complex people need professional care
Hospital as social institutions
Positive:
- employer
- purchaser
- community resource
- research facility
- education and training
bad:
-polluter
- isolation
Professionalism
Parsons: (doctor)
defined knowledge base
patients defer to doctors
self governing
exploit power
public service commitment
protection for pts against exploitation
other:
- qualifications
- professional body
- occupational closure
balance of clinical autonomy
revalidation
guidelines
cost
competition
management
Care seeking behaviour
- socio-cultural theory
mechanic
- visibility
-seriousness
-disruption
- frequency of symptoms
-tolerence
- knowledge
- denial
- competing needs
-interpretation
-availability of treatment
zola triggers
- interpersonal crisis
- perceived interference with activities
- sanctioning by others
- symptoms beyond a certain time
- economic theory
- income and economic agency - structural/ functional
- deviance - social network
- decisions made in consultation with network
Social justice
Fairness that extends beyond individual rights
- distributive : fair distribution
- procedural: how decisions made
- interactional: treat each other
- retributive: punish
- restorative
Distributive
- utilitarianism
- Rawl veil of ignorance
procedural
- consistent
- neutral
- can be corrected
- ethical
- all parties
equity vs equality
equity: fairness
- social justice
- vertical (unequal need unequal supply) Vs horizontal (same need same supply)
equality: same for all
Pritoritisation
outline principles Vs define practices
Tools:
- Save to invest
- PBMA (programme budgeting and marginal analysis)
- Multi-criteria decision analysis
deterministic sensitivity analysis
One or more parameters are manually changed (usually across a pre-specified range) and the results are analysed to determine to what extent the change has an impact on the output values.
often pre-specified
one way: one time
multi way: several parameters
probabilistic sensitivity analysis
also called stochastic
use distributions of parameters
eg use distribution generated in a clinical trial for an effect estimate
–> a cost effectiveness acceptability curve (CEAC)
