Sociology of Medicine Final Flashcards
What social effect does segregation have?
Limits social connections- people may become displaced due to gentrification and lose social networks
What economic effect does segregation have?
Segregation reinforces inequality and concentrates poverty.
What effect does segregation have on the physical environment?
-built environments: man-made settings constructed and operated for the purpose of human activity
-examples: dampness, overcrowding, lead, housing insecurity
What effect does segregation have on health behaviors and health outcomes?
-constrains the ability to engage in healthy behaviors (increased marking of tobacco, alcohol, fast food, less ability to exercise)
-leads to a concentration of infectious disease patterns
-constrains access to social networks that facilitate social mobility
-public disinvestment of city services creates harmful conditions
What effect does segregation have on access to care?
-lowers access to care (less access to transportation, long waiting times to be seen, little access to most advanced medical terminology, little time with providers due to provider time constraints, and urban clinics are more likely to be shut down)
What effect does segregation have on social networks?
-Segregation leads to a concentration of infectious disease patterns in the population
-segregation determines access to social network ties and resources that can facilitate social mobility, but networks don’t have equal access to resources
Gentrification
the process whereby the character of a poor urban area is changed by wealthier people moving in, improving housing, and attracting new businesses, typically displacing current inhabitants in the process.
Place stratification theory
-majority group preferences and discrimination constrain social and spatial mobility of minority group members
-political leaders more likely to disinvest in poor communities of color
-many commercial enterprises avoid this area (why food deserts exist)
Redlining
discriminatory practice in which financial services are withheld from neighborhoods that have significant numbers of racial and ethnic minorities
What is environmental racism?
subjection to disproportionate exposure to pollutants, the denial of access to ecological benefits, or both
Rural vs Urban Health
-rural communities have higher rates of morbidity (including chronic illness) and mortality (due to geographic isolation, and less access to healthcare providers)
how does network structure/position affect health?
-an individual’s health may be affected by connectivity to or isolation from others and their network position: (degree, closeness, betweenness, and centrality)
-network bridges: individuals that serve to connect previously unconnected groups (can be positive or negative (spread of disease or knowledge))
How does network size affect health?
-Smaller network sizes = increased isolation (loneliness leads to increased rates of morbidity and mortality)
-Network homophily (“birds of a feather flock together”)
-Network transitivity (“my friend’s friend is also my friend”)
How do social networks influence health?
-Positively or negatively affecting health behaviors
-Facilitating/regulating behaviors, setting norms, physical spread of pathogens or harmful/healthy substances (person-to-person or within group boundaries), spread of misinformation
-Furnishing tangible assistance (money, care, transport)
What social position is best at introducing groups to each other?
Betweenness
What is instrumental support?
Helping with tasks (running errands, helping with transportation, etc)
What is informational support?
Advice (what you would do in that situation)
What is affective support?
-Emotional support
-Those with strong social support care with stress better, and experience more positive health outcomes
-artificially created support networks (support groups) have been shown to benefit mental and physical health (Support groups offer informational, instrumental, and affective support)
What is social capital?
Resources that accrue to individuals through social connections (reciprocity)
-characteristics of social networks from which individuals drae materials (goods, services)
-Bonding (within group) vs bridging (between groups)
Strength of weak ties
-weak ties are more common than strong ties
-brings networks into contact with each other (encourages information sharing between groups) (ex. social media connections)
Neoliberalism and health
-emphasis on a free market, individualism, etc…
-the goal is to reduce public expenditure and increase efficiency
-introduction of market mechanisms as a counterbalance to public sector growth
-other countries have constructed a tighter regulatory framework to constrain free markets
Social policies and health outcomes
-policies designed to affect the distribution and impact of unequal resources
-work on health directly limiting or broadening social/economic supports
-policy regimes fall under 3 categories (liberal (provides limited social welfare programs), conservative (provides social insurance funds that reward work performance/status), social democratic (guarantees universal benefits))
Hegemony
The processes by which dominant culture maintains its dominant position: The US and Europe are examples
Hybridization
In which existing local social/regional practices and values fuse with global ones
Global governance
Informal and diffuse- includes actors other than the formal government: promotes riles and establishes cooperative agreements… largely lacks authority to reinforce
-Actors in global governance are States (create intergovernmental org IGOs), IGOs are created and maintained by states, NGOs are voluntary organizations like the Red Cross, epistemic communities (emerge from national governments, research institutions, private industry, and academia), multinational corporations (race to the bottom))
Structural Adjustment Programs
Globalization and COVID-19
Examples of globalization
global labor force- “race to the bottom”
Migration and Health
Reasons for high pharmaceutical spending:
Pharmaceutical patents
-as long as a drug is under patent, only the company with the patent can sell the drug
-“Evergreening” is expanding patents by creating new formulations that only differ slightly from the original
-“pay for delay” pharmaceutical company with a brand name drug pays generic manufacturers to not enter the market
-New Molecular Entity (a patentable drug innovation
Interactions between pharmaceutical companies and researchers/physicians/FDA
-Some physicians can be paid by pharmaceutical companies to promote their drug
-FDA oversees the safety of pharmaceuticals in the US (but they make decisions on reported data and drug companies don’t have to report all data…)
Causes of the Opioid Epidemic in the US: Porter and Jick letter, “deaths of despair”
-Said that addiction was rare in patients treated with narcotics
Medicalization/ Pharmaceuticalization
Process by which deviant behavior, life behavior, problems of everyday living, and bodily/cognitive enhancement are reframed as medical concerns (pharmaceuticalization frames these as targets for pharmaceutical intervention)
Occupational segregation
-Vertical segregation: clustering of men at the top of occupational hierarchies and women at the bottom
-horizontal segregation: at the same occupation level men and women have different jobs
-women are 70% of global health workforce but only hold 25% of senior roles
-In medicine: women tend to pick different specialities that are “suitable” for family planning
Lack of diversity in medicine- causes and consequences
-Lack of women in certain specialties because they “don’t” allow time for families
-trans medical professionals are discriminated against
-Lack of POC doctors
Medical profession and expert authority:
-generally status and power of providers and patients are not equal
-providers act as authority to decide who is sick and who is well
-patients dependent on the expertise of providers
-providers act as gatekeepers to the sick role
-providers objectify and dehumanize the body
Drivers of high health care spending
Uninsured
-31.6 million of US residents were uninsured in 2020
-most uninsured people are low-income families and have at least one worker in the family
-people may lack insurance due to high costs, no access to coverage through a job, and poor adults in states that did not expand Medicaid
Underinsured
-individuals with insurance who still can’t pay medical bills
-20% of all insured individuals under 65, cant pay premiums or deductibles or copays, which occurs when insurers cap payments for or don’t cover certain procedures, can occur due to poverty
-receive less preventative care, diagnosed later, receive less therapeutic care, hospitalized for more avoidable conditions, less likely to have primary care
Types of health insurance
-Medicaid: covers all needy persons receiving cash assistance, including children under 6 and pregnant women with income under the poverty line.
CHIP: A Branch of Medicaid that covers children and teenagers whose families fall 200% under the poverty line
-Medicare: for individuals 65 or older or disabled people under 65 who receive SS. !Does not include prescription coverage!
-Private Insurance: Paid for by employer and/or individual
Affordable Care Act
-AKA Obama Care
-enacted in 2010 after years of attempting to pass healthcare reforms
-reflects a compromise between liberals and conservatives
-expanded health coverage, primarily expanding Medicaid
-minimum level of benefits set by the government must be included in all plans
-All employers with more than 50 employees must provide coverage or pay a penalty
Public health investment
There is little public health investment because public health typically focuses on prevention, improves statistical lives, achieves over the long term, and focuses on upstream causes.
Health literacy (insurance-specific)
Individual resilience
Community resilience
Equity
Equality
Gerrymandering
Disenfranchisement
Activism
Social Empathy