MT1 Flashcards
Early assumptions in soc in medicine
1) The patient is the problem - not complying with med advice
2) Health is an indv concern
Talcott Parsons
Structural Functionalism - society is based on large structures that have smaller roles within them that give people a place and sense of purpose within society
Critique - Only says what works in society; no call for change
4 Characteristics of Doctors
4 Characteristics of doctors
1) Universalism - treat all patients the same
2) Neutrality - no judgement, just get patient well
3) Collective orientation - no excessive self interest/greed; only act for the good of society
4) Functional Specificity - Job is to heal the body; No advising on other matters
Sociology of medicine
Medicine as an enterprise and the affects it has on society
2 Claims of sociology of medicine
1) Disease is not just biological
2) Medicine’s status as a science is dubious (healing has happened historically and cross culturally in other ways and the mechanism of healing healing is always legitimized; Medicine is subject to myths, fads, religion; Placebo Affect)
Parsons - Social Roles and health
Social roles have an affect on health - some people get more sick than others (diff stresses)
We can voluntarily enter into sickness - Placebo Affect opposite for varying reasons
Sick Role - own responsibilities and expectations
Concept:
Disease is social but authority over it is given to medicine - it appeals to a system that assumes that disease is biological
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Symbolic Interactionist Paradigm
Max Weber;
Challenge to Struc Funct; Micro perspective
Social Construction - we make our social reality through interpretations of interactions
Eg. negotiated order in hospitals
Stigma = social distancing /judgement based on a percieved characteristic of a person
Illness is defined as deviance (mentally ill)
Deviance is defined as illness (homosexuality)
Labelling = what makes a deviant behaviour considered that way is how we react to it
Conflict/Materialist Paradigm
Marx and Engels;
Macro perspective with micro implications;
Economic inequality determines health inequality;
Medicine is a form of social control that favours the upper class;
1. Disease is impose on people by inequitable organization of society
2. Disease is preventable through better living conditions
3. Medicine’s focus on the individual helps capitalism through: (a) investments in health care sector; (b) self care industries
Medicalization of society
Many things are under medical control - more and more things being seen as unhealth or in need of medical regulation.
Health has social value - good people are healthy and unhealthy people are lazy
Patriarchy (medicine)
Ruled by men. Privileges men and makes the standard of health male
Science is associated with male traits, patients are associated with female traits
Liberal Feminsm
Gender perspective.
Women have equal powers of rational reasons to men and should therefore me given the same rights;
Downplay biological differences;
‘Add women and stir’ - give women access to the structure of patriarchy, no call for change
Radical Feminism
Sex perspective.
Romanticization of female body and criticism of maleness;
Men control female bodies through sex, sexual violence, and now in medicine too.
Patriarchy is intrinsic to the health care system (midwives, cosmetic surgery, gynocology, doctor/nurse relat)
Solutions: opt out of health care; self examination; midwives
Materialist/Socialist Feminism
Marxism meets radical feminism;
Original form of oppression is social class.
Capitalism and patriarchy work together.
Women are objectified and controlled by men through medical capitalism (cosmetic surgery)
Men’s and women’s natures are made by their circumstances;
Wages for housework
***Male and female bodies are different, but what is made of this difference is social. Gender determines our understanding of sex.
Postmodern Feminism
Focuses on differences among women - intersectionality of oppression.
No such thing as society free biology
Opposes binaries
Gendering of health (certain conditions associated with certain genders)
Foucault main claims
Knowledge is power
Our ways of thinking change historically
Power relationships are interactional, not direct.
Foucault Phase 1
There is a power relationship between doctor and patient (but this is okay)
Objectifying perspective of the clinical gaze. Bypassing the patient’s subjective experience to go into the body and seek out information that the patient doesn’t have
Foucault Phase 2
Shifts in styles of surveillance (prison systems). We no survey ourselves
Medicine is an agent of surveillance that helps the state oversee and govern the pop
Anatomopolitics and biopolitics are two ways of translating knowledge into power.
Discourse
A framework of thinking that tells us what we maythink reasonably
Foucault Phase 3
Relationships of power of bleak so we reclaim our agency and find freedom in self care. Defining our own bodies and achieving self actualization.
2 positions on health inequality
- MATERIALIST = marxist; health is a community responsibility; we should go for equality of condition because social stratification has a -ve affect on health
- NEO-LIBERAL = equality is inevitable and gives society a sense of motivation to move up; reduce role of state in providing services and instead introduce equality of opportunity; health is an individual responsibility
Black Report 4 explanations
1) measurement artifact
2) Social selection - health determines class
3) Culture of poverty = bad health
4) Materialist/structuralist - social structures have indirect and direct consequences on health. Poor have less life control, more stress, less access to food and shelter
Problems with workers compensations
1) commodifies health
2) Narrow definitions of illness
McKeowen thesis
decline is mortality in 1800s is due to better living conditions
Challenges in linking env illness to health
- Latency periods
- Physician training
- Risk assessment
- Burden of proof
Toxic culture
We have a toxic culture where we have unquestioned production of hazardous substances and this is accepted as a side affect of progress. We have chronic stress and substandard housing, exploitative work conditions
Types of social support
Instrumental
emotional
Durkheim
Social bonds keep us healthy
Concept: Reciprocal relationship between poor health and social connection
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Hidden health care system
Costs to caregivers - unpaid give 80% of care, women, middle aged, employed as well
Increasing burden of care -
BCP, more women in workforce, less childbearing couple, more geographic dispersion all mean there are less young relatives;
Longer lives, less disease mean older elderly;
Not enough room in elderly homes, privatization makes them expensive;
Basic Principles of Medicare
1) Universality - provided to all/no discrimination
2) Comprehensiveness - all medically necessary services covered
3) Portability - covered when you move provinces
4) Non-Profit admin - subject to audit too
5) Accessibility - regardless of financial status or geography
Hall Report
Reccomends extension of coverage after all provinces sign on for hospital coverage
Medical Care Act
Pearson Gov;
Hall says health care is one of the best in the world; warns about extra billing and user fees threatening accessibility
Canada Health Act
Trudeau Gov;
Add accessibility, transfer payments, costs governed in half by gov;
2 Conditions: Information and recognition
2 Provisions: No extra billing or user fees
Decline in gov investment in medical care
Mulroney decreases funding, Chretien introduces block Social and Health care transfer payments;
Romanow report
Health care in canada is defining
Reform should not hurt the vulnerable
Renew gov investment
Health care is a community responsibility
Medicine’s authority derived from
Social and cultural authority
Medicine’s authority is held by (3)
Affiliation with science
Standardization
Monopolization (Code of ethics, state protection, attacks on competitors)
Attack on midwifery (4)
Lack of organization
Class
Natural Model
Gender - Medicine associated with educated men of science
Golden age of medical power
expansion, escalation of prices, unnecessary testing and surgeries
Professional Dominance Theory
Freidson
Autonomy and Dominance
Difficult to prevent misuse of medical power - only doctors can evaluate doctors
Proletarianization theory
Decline of medical power
Movement to large scale health facilities where people with less training are given smaller jobs which decreases physician monopoly and cost of health care.
Critique: underestimates loss of control of doctors
Deprofessionalization theory
Haug - loss of
1) Knowledge monopoly
2) Public faith
3) Work autonomy/dominance
