American Sociology of Medicine

Talcot Parsons

• The organization of social relationships– Social structure

• Solidarity and stability– structural-functionalism & equilibrium

• Social system of interrelated social structures• Each plays a specific function in bringing about stability &

integration

• Focus on group processes• Realizing self-interests (conflict) vs. stability &

integration

Parsons and the Professions

• Human action (agency) understood with reference to normative standards (structure)

• Non-economic normative frameworks are essential esp. re: the professions (like medicine)

• Human beings act rather than respond – agency– Humans make sense of their world, interpret it, give it

meaning, make choices about their participations (agency)

Parsons on medicine• Medicine is not scientific

– Resistance to discoveries, fad in medical practices, elements of magic in medical treatment

• Glue ear -- One reason for the current epidemic in the rate of surgery for glue ear in children is that a shift in treatment has taken place from non-surgical to surgical methods.

• An historical review of the treatment of this condition reveals the existence of previous 'surgical epidemics' and the importance of two particular factors—technical developments, such as the design of tympanostomy tubes and the introduction of antibacterial drugs; and the lure of panaceas such as ionizing radiation.

• In addition, it reveals how medical practice is, like most human behaviour, subject to fashion.

• Despite this, there is a constant desire by practitioners to be adjudged 'scientific' in their work, and definitions of science are equally susceptible to change over time.

Parsons on medicine

• Medicine is not scientific– Placebo effect – drugs no straightforward

biochemical impact of body– Difficulty is showing a causal relationship between

a complaint, treatment, cure– Sick role is a “social” role & not primarily a

biological or physiological condition– Pain:

Social Roles, Health, Medicine

• Practitioners – local health care system• SICK ROLE & SICKNESS CAREER -- persons and

social systems• the concept of the sickness career

– a person as she or he becomes symptomatic, defined as sick, a patient, disabled, etc.

– person goes through over a period of time

• With disability/impairment -- last the entire lifetime of a person

Social labelling

• An illness label may ... mean that the individual so labeled becomes enmeshed within certain institutions that sustain the label rather than encourage its discard ... Alcoholics Anonymous is a prime example of an institution that prolongs the illness label in its formal ideology (the requirement that individuals publicly confirm that they are "alcoholics") as well as in its function. A large percentage of AA members' social lives centers on the organization and other members, thus isolating them from normal relationships and further strengthening their role as "al- coholics." [Waxler 1981:296-297]

Social Roles and the Social System: Rethinking Parsons

• Economic, social, and cultural capital• Access to labelling and social roles• A person is labeled in the course of social negotiations

between him/herself, doctor, healer, shaman, family, and others

• The outcome is influenced by each person’s beliefs and training and also by the social and organizational contexts in which the negotiation occurs

• Depending upon his or her social position the person may find de-labeling difficult, that continued illness, disease, disability is expected and therefore the symptoms continue

• Using medicine to look at total social system

Bourdieu: 3 types of capital• Economic capital: command over economic resources

(cash, assets). • Social capital: resources based on group membership,

relationships, networks of influence and support. • Cultural capital: forms of knowledge; skill; education;

any advantages a person has which give them a higher status in society, including high expectations.– E.g. Parents provide children with cultural capital, the

attitudes and knowledge that makes the educational system a comfortable familiar place in which they can succeed easily.

Definitions of Social Capital• In contrast to classical and neoclassical economic theory

– assumes society is made up of the sum of persons acting individually to achieve non-collective goals

• Social capital inheres the structure of relationships between persons and among persons. – the institutions, relationships and norms that shape the quality and quantity of

a society's social interactions.

• Social capital has a material base as well as a moral base.

• People have different amounts of social capital– depending on the actual or potential resources– depending upon the size of the network to which they are linked– depending on the amount of economic and cultural capital the members of

that network have.

• Social capital is never independent of the other forms of capital

With regard to social capital, studies increasingly show that communities supported by a substantial stock of social capital have better economic and social performance (Putnam, 2000).

Better health, health conditions, and health care.

Social Capital & Health in Canada

Canada, Health, & Inequalities

First Nations: Non-Medical Determinants of Health

• only 56.9% of homes were considered adequate in 1999--00.

• only 33.6% of communities had at least 90% of their homes connected to a community sewage disposal system.

• In 1999, 65 First Nations and Inuit communities were under a boil water advisory for varying lengths of time– communicable diseases such as giardiasis and

shigellosis (both acute infectious diseases characterized by diarrhea, fever and nausea) can be traced to poor water quality

Cultural Capital & Health

First Nations: Education