Seminar: Inequality Flashcards
What is the Oxford English Dictionary of sociology?
The study of the development, structure and functioning of human society
How is sociology applied to healthcare?
The sociology of health and illness (Medical Sociology) applies the methods and theories of sociology to the health field
- Sociology studies peoples’ interactions with those engaged in medical occupations e.g. healthcare professional-patient relationships
- Sociology studies the way people make sense of illness e.g. illness versus disease
- Sociology studies the behaviour and interactions of health care professionals in their work setting e.g. professional values, interactions between health care professionals and other health care staff
Sociologists who studied professions in the 1950s identified what characteristics of professions as opposed to other occupations?
- Systematic theory
- Authority recognised by its clientele
- Broader community sanction
- Code of ethics
- Professional culture sustained by formal professional sanctions
Medicine incorporates all the above features
How does sociology play a role in health promotion?
Promoting healthy behaviour and preventing ill health is only possible if we understand the ways different groups in society operate e.g. men and women, rich and poor, young and old
Sociology provides health promotion with an analysis of the different groups in society
What is the role of the patient in the sick role?
The sick role exempts ill people from their daily responsibilities
Patient is not responsible for being ill and is regarded as unable to get better without the help of a professional
Patient must seek help from a healthcare professional
Patient is under a social obligation to get better as soon as possible to be able to take up social responsibilities again
What is the role of the healthcare professional in the sick role?
Professional must be objective and not judge patients morally
Professional must not act out of self-interest or greed but put patient’s interests first
He/she must obey a professional code of practice
Professional must have and maintain the necessary knowledge and skills to treat patients
Professional has the right to examine patient intimately, prescribe treatment and has wide autonomy in medical practice
Why can the sick role become complicated?
Role of doctor’s in this is potentially controversial as we are the ones who have to justify any significant level of sickness for e.g. with medical certificates for those needing to be off work.
There is, however, no way of knowing objectively whether someone is sick or not.
We often think of this, however, when someone is said to ‘adopt’ the sick role.
Where they are said to be receiving the benefits but not necessarily engaged with the responsibilities of the sick role.
Can lead to conflict – are they sick enough to miss work?
What are the different social classes according to National Statistics Socio-economic Classification (NS-SEC)?
1.1 Large employers and higher managerial and administrative occupations
- Larger numbers of employees and who delegate some of their managerial and entrepreneurial role to salaried staff. Higher managerial role involves general planning and supervision of operations on behalf of employer. Service relationship with the employer
1.2 Higher professional occupations
- Have a service relationship with their employer. Doctor, lawyer, scientist, clergy, teacher, OT, SALT, personnel officer, computer analyst, careers guide. This is regardless of whether employed, self employed or position of management
2 Lower managerial, administrative and professional occupations
- Attenuated service relationship with employer – tend to act under positions above. e.g. sales managers, technicians, nurses, midwives, radiographers, welfare and community workers, ship’s officers and immigration officers
3 Intermediate occupations
- Positions not involving general planning or supervisory powers, in clerical, sales, service and intermediate technical occupations civil service administrative officers and assistants, debt collectors, library assistants, secretaries, telephonists, medical technicians, dental nurses, flight attendants, driving instructors, data processing operators, routine laboratory testers, electrical engineers (not professional), installation and maintenance engineers.
4 Small employers and own account workers
- Small employers who remain essentially in direct control of their enterprises e.g. restaurants, hairdressers, local retail outlets, builders, electricians. Also self employed tradesmen who do not employ others
5 Lower supervisory and technical occupations
- Supervise others in same role e.g. foremen, reception supervisor
- Opportunities for promotion, payment of a salary as opposed to a weekly or hourly wage, greater work autonomy, e.g. electrical maintenance fitters, motor mechanics, cabinet makers, transport operatives
6 Semi-routine occupations
- the work involved requires at least some element of employee discretion and contract typified by short term and direct exchange of money for effort. E.g. educational assistants, security guards, postal workers, hospital porters, cooks, hairdressers, builders, carpenters, dressmakers
7 Routine occupations
- Even less opportunities for promotion, autonomy over work. These positions have the least need for employee discretion. E.g. Waiters and waitresses, bar staff, machinists, sorters, packers, railway station staff, road construction workers, building labourers, dockers, couriers, refuse collectors, car park attendants and cleaners
8 Never worked and long-term unemployed
How has the classification of social class change?
In 2001 the Office for National Statistics replaced ‘Social Class based on Occupation’ and ‘Socio-economic Groups’ with a new ‘Socio-economic Classification’ (SEC) for all official statistics and surveys.
How does the new SEC define classes?
The new SEC is an occupationally based classification but contains rules to provide coverage for the whole adult population. It is concerned not necessarily with income or skill level but relationship within an organisation, level of authority and autonomy as well as opportunity to progress and advance both in learning and within the organisation
Why has the NS-SEC been constructed?
The NS-SEC has been constructed to measure the EMPLOYMENT RELATIONS AND CONDITIONS of occupations. These are central to showing the structure of socio-economic positions in modern societies and helping to explain variations in social behaviour and other social phenomena. It has also been reasonably validated both as a measure and as a good predictor of health, educational and many other outcomes.
Different employments offer different labour market situations and work situations. What does labour market situation and work situation mean?
Labour market situation equates to source of income, economic security and prospects of economic advancement.
Work situation refers primarily to location in systems of authority and control at work, although degree of autonomy at work is a secondary aspect.
However what is employment not the only determinant of?
Not the only determinant of life chances and not the only social influence on health
What are the social/socio-economic influences on our health?
A definition would be the collective set of conditions in which people are born, grow up, live and work. These include:
- Gender
- Ethnicity
- Physical environment / housing
- Education
- Employment
- Income / social status / financial security
- Health system
- Social environment
How does gender affect medical sociology?
Men have a higher mortality at every age
Women have a higher morbidity
Women consult more frequently in General Practice settings
Suicide rates in men are higher
Men more likely to exercise
Men more likely to be admitted to hospital due to alcohol effects
Men more likely to misuse drugs
Females more likely to receive Carer’s Allowance
How does ethnicity affect health?
South Asians living in Scotland have substantially higher rates of heart attacks than the general population, but they also have higher survival rates. Higher rates of CHD were seen among Pakistani and Bangladeshi groups, and lower rates among the Chinese population
Prevalence of type 2 diabetes is higher in South Asian populations.
Admissions for each ethnic group relative to the White Scottish group were lower among White Polish and Chinese groups, with higher rates in some Asian groups, White British and White Other.
There is greater prevalence of sickle cell disease in African origin groups.
Scottish data suggest that minority ethnic groups, with some exceptions such as Gypsy/Travellers, have better general health than the majority of the white population. These differences can vary by disease and ethnic group.
Mortality in Scotland is higher in the majority ethnic (white) population than in the black and minority ethnic population.
What is the relationship between ethnicity and alcohol?
JRF review of the literature 2010
There is diversity both within and between ethnic groups:
- Most minority ethnic groups have higher rates of abstinence and lower levels of drinking compared to people from white backgrounds
- Abstinence is high amongst South Asians, particularly those from Pakistani, Bangladeshi and Muslim backgrounds. But Pakistani and Muslim men who do drink do so more heavily than other non-white minority ethnic and religious groups
- People from mixed ethnic backgrounds are less likely to abstain and more likely to drink heavily compared to other non-white minority ethnic groups
- People from Indian, Chinese, Irish and Pakistani backgrounds on higher incomes tend to drink above recommended limits
- Over time generational differences may emerge
- Frequent and heavy drinking has increased for Indian women and Chinese men
- Drinking among Sikh girls has increased whilst second generation Sikh men drink less than first generation
People from some ethnic groups are more at risk of alcohol related harm, which?
Irish, Scottish and Indian men (and Irish and Scottish women) have higher rates of alcohol related deaths than the national average in England and Wales
Sikh men have higher rates of liver cirrhosis
People from minority ethnic groups have similar levels of alcohol dependence compared to the general population, despite drinking less
What is responsible for these differences between ethnicities?
Ethnicity includes social and cultural influences as well as genetic – as such there is some fluidity and change.
What is the relationship between ethnicity and seeking help for alcohol related problems?
What is needed?
Minority ethnic groups are under-represented in seeking treatment and advice for drinking problems
Problem drinking may be hidden among women and young people from South Asian ethnic groups in which drinking is proscribed
Greater understanding of cultural issues is needed in developing mainstream and specialist alcohol services
How do we deal with disparities in health?
Identify the potential barriers to the use of health services
- Patient level – language concerns, understanding the system, beliefs
- Provider level – understanding of the differences due to ethnicity, provider skills and attitudes
- System level – organisation of appointments and referrals
Culturally Competent Care
- Combination of attitudes, skills and knowledge that allows an understanding and therefore better care of patients with a different backgrounds to our own.
Recognising when we are being culturally incompetent!
How does housing affect health?
1 in 4 adolescents living in cold homes is at risk of multiple mental health problems compared to 1 in 20 living in warm homes
Children living in cold homes are more than twice as likely to suffer from a variety of respiratory problems than children living in warm homes
Excess winter deaths are almost 3x higher in the coldest quarter than in the warmest
What does employment provide?
Provides income and financial security; this obviously varies and relates in part to social class. (Deprivation is a major determinant of health inequalities)
Provides social contacts
Provides status in society
Provides a purpose in life
What is unemployment associated with?
Increased morbidity and premature mortality
What has the WHO stated with regards to finance and medical sociology?
The WHO argues that governments should protect people against financial risk in matters of health, whether the system is publically or privately financed
“And it should assure not only that the healthy subsidise the sick….., but also that the burden of financing is fairly shared by having the better-off subsidise the less well-off. This generally requires spending public funds in favour of the poor” (WHO 2000)
The WHO report judged each country’s health system against the most that it estimated could be achieved with its level of health service expenditure. It was possible for a relatively poor country to achieve a better result than a comparatively rich one
