i. Introduction to Medical Sociology and its Role in Medicine�ii. Concepts in Medical Sociology�iii. Description of Human Population�iv. Human Organization and Systems

Prof. Haroun O. Isah

MBBS, MPH, FWACP, Cert. Stat. Epidemiol, Cert. APM

Department of Community Medicine

&

Primary Health Care

Bingham University, New Karu

Nasarawa State

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Introduction to Medical Sociology and its Role in Medicine�

Introduction

Sociology

• The study of the development, structure, and functioning of human society
• Scientific study of society, including patterns of social relationships, social interaction, and culture
• Study of social problems
• It’s about people

Medical Sociology

• A subfield of sociology
• It’s the sociological analysis of medical organizations and institutions; the production of knowledge and selection of methods, actions and interactions of healthcare professionals, and the social or cultural (rather than clinical or bodily) effects of medical practice

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Introduction: Medical Sociology

• Deals with:
• Organization and structure of health organizations
• Physician-patient relationships
• Socio-economic basis of the health care system
• The development of research and analytical skills to address issues facing health care providers and those needing health care
• the application of sociological knowledge and concepts to issues of health and illness
• Social aspects of illness
• the import that factors such as culture, organizational processes of health system and institutions, politics, economics as well as micro-level processes (socialization, identity formation and group process) have on
• On the disease and illness processes
• On the organization and delivery of health care.

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Roles of Medical Sociology

• Helps to identify and study social groups, and their activities of maintaining and preserving health, alleviating or curing diseases
• It is thus concerned with
• The social facets of health and illness
• Social function of health institutions and organizations
• The relationship of health care delivery to other social systems
• Social behavior of health personnel and consumers of health care
• Enables the understanding of relationships between health phenomena and social factors
• Enables the understanding and study of illness and medical care from sociological perspectives
• It helps to understand the various factors related with a healthy or ill person and not just the disease process itself and its specific etiology

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Contributions of Medical Sociology

• This is in two spheres
• Sociology in medicine
• Sociology of medicine
• The two toward understanding health issues from a preventive and promotive aspect

Through Sociology in Medicine

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• Analysis of etiology of health disorders
• Differences in social attitude towards health
• The recognition of relation of social variables like sex and age to the incidence of a specific health disorder
• Issues surrounding a medical problem

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Through Sociology of Medicine

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• Organization's role, relationships, norms, values and beliefs of medical practice as a form of human behavior
• Issues surrounding a medical setting and medical environment from a sociological perspective

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What Medical Sociology covers in Public Health

i. Social determinants and distribution of disease

ii. Attitudes and behavior of individuals and individuals in group settings towards health and illness and how these determine:

• Their concept of health and illness, their health seeking behavior and perceived health needs
• Their level of acceptance towards modern form of medicine
• Their acceptance or rejection of various health programs

iii. The (a) social environment of medicine and training of health personnel (b) relationship between health provider and consumer, and health-seeking and illness behavior of the consumer and (c) medical organizations in structural and functional manner

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Concepts in Medical Sociology

• Social Formation
• Society
• Roles
• Social Control Mechanism
• Socialization
• Societal and Social Change and Health

Social Formation

• Refers to a human society and its structure at any level such as a nation, city, university, or even a family with all its constituted complexities
• Also refers to all the social classes and how they are inter-related within a given society
• It includes its possessed inherent internal characteristics that confers on it its unique features
• Within a larger social formation, each of the smaller formations have effects on another, conferring on it a dynamic nature
• Based on its defined features and characteristics, each social formation exists in concrete form
• One defining element of a social formation is the tendency for a balancing act between what is rising with what is declining – this gives such its shape and the dynamic characteristics it assumes

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Society – 1/3

• This is an organization of member agents with its unique features, principally in the form social relationship between individuals within it
• A society is a vast network of relationships and these propel, direct and constrain individuals’ efforts
• The society unique features define the character of its members and this in turn confers on the society its dynamic nature
• The pattern of inter-relationship between individuals within a social system or helps such a society establish its social structure

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Society – 2/3

• Each society has a social structure (complex of major institutions, groups, power structure and status), somewhat like the human body structure and a social organization i.e. how the society functions (like body physiology)
• Within each social institutions that make up the society, there exists an organized pattern of behavior by the people within it to further group interests, thereby defining how a society behaves or functions
• Such social institutions (which include for examples the family, educational and religious institutions, political parties and professional associations) define the rights and duties (collectively called roles) of their respective members
• Roles, social control mechanisms and socialization of each society and its component parts are what drive the society’s capacity to attain its desired profile

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Society – 3/3

• Roles
• Can either be ascribed or achieved
• Being ascribed mean they are “given” (for e.g. by virtue of sex, age and birth status), and being achieved mean they are “acquired” (for e.g. by virtue of education)
• An individual may perform many roles e.g. a man as a husband, father, employee, friend, son, brother, committee chairman etc
• Performing these roles enables and allows for inter-individual cooperation in many situations
• Social Control Mechanism
• Systems of ensuring behavior and orderliness in a society, and this is through rules (formal or informal)
• Vary with each group
• Vital for carrying out health programs
• Socialization
• Process through which an individual acquires culture and becomes a member of a social group. It can be through schooling or orientation program. Internship by a doctor is one such socialization, and this enables him/her become acceptable to the public at large as doctor.

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Societal and Social Change and Health – 1/3

• Importance of society is its capacity to influence health status as a result of the intricate relationship between it as a system and man
• Interaction is complex and unpredictable
• Improvement in wealth and income can influence health and vice versa
• Industrial revolution in Britain led to reduction in birth and death
• Our societal system which differ from the western world is attended with its own form of health pattern
• In the evolution of human system, there are attendant health implications
• In the spectrum of evolution of human system, three patterns are recognized: traditional, transition and modern societies

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Societal and Social Change and Health – 2/3

• Traditional society tends to be more stable and is characterized by continuity and unchanging patterns of social life

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• Transitional society is characterized by inherent changes with disappearing and appearing features, but with a capacity to cope with changes and clash of culture. Social stress is a common feature. This is conflict generated by new encounters and frustrations arising from societal changes

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• Modern societies – best adapted to assimilate rapid changes

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Societal and Social Change and Health – 3/3

• Social problems are features of any society especially one in transition or high flux. Major social problems include housing, marital challenges, population growth, demographic changes, and all these have their attendant public health implication
• Many forms of “social pathologies” are encountered and are linked to social conditions emanating from social changes. Poverty, crime, delinquency and vagrancy are such social pathologies

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Description of Human Population

• A population – summation of all the organisms of the same group or species who live in the same geographical area and have the capability of inter-breeding
• In Sociology, population refers to a collection of human beings.
• Its distribution means the pattern of where people live
• Population distribution worldwide is uneven ranging from sparsely to densely populated areas
• Sparsely populated areas
• Often difficult to live in
• Often have hostile environment e.g. desert, Antartica
• Densely populated areas
• Often habitable
• The measurement of the number of people in an area is referred to as population density and is obtained by dividing the number of people by the area and is expressed as the number of people per square km

• A number of factors influence population density
• Broadly these are physical and human factors
• Physical factors
• Relief i.e. shape and height of land
• Resources
• Climate
• Human factors
• Political
• Social
• Economics

• Population Change is a factor of disequilibrium between birth and death
• Increasing population results from birth > death
• Rapidly increasing population leads to population explosion, especially when it supersedes environmental carrying capacity, or unmatched by social infrastructures/services
• Improved health care, sanitation, socio-economic status, reduced mortality with attendant improved birth profile
• Life expectancy
• Average age a person can expect to live to in a particular area, and can be used as an indicator of the overall ‘health’ of a country. Serves also to indicate the standard of living in a country.
• Improved environmental status, socio-economic profile, reduced disease occurrence/improved health and human development results in increased/long life expectancy

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Human Organization and Systems

• Human System Dynamics
• Containers
• Differences
• Exchanges
• Inter-play of Human System Dynamic Conditions
• Key Aspects of Human Society

�Human organization and systems – 1/3�

• As a species, we are social beings who live out our lives in the company of other humans
• We organize ourselves into various kinds of social groupings (e.g. nomadic bands, villages, cities, and countries), and within each of these we work, trade, play, reproduce, and interact in many other ways
• Unlike other species, we combine socialization with deliberate changes in social behavior and organization over time
• Consequently, the patterns of human society differ from place to place, era to era and across cultures, making the social world a very complex and dynamic environment.

Human organization and systems – 2/3

• Human organization and systems seek to:
• Examine organizational, community and social systems through various study approaches (which can be in management, systems theory, and related social sciences)
• Provide insight into how human beings and human systems live and work together for their mutual benefit and mutual well-being thereby helping to answer such key questions as:
• How great human organizations are built?
• How can human organizations be assisted to develop their potential?
• How can the relationship of people and organizations to the changing business, social, and political climate be maximized?
• How can the structures, processes and leadership that help organizations thrive in the face of today’s challenging environment be developed or facilitated to develop? 

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Human organization and systems – 3/3

• A critical nature of a human organization is its complex and dynamic nature. However, despite this complex profile, it is fluid/dynamic i.e. subject to change
• Such changes emerge from the interplay of the (i) visible hand of the organization interveners (e.g., the leader, the management, or the change agent) and (ii) invisible hand of the self-organizing force developed within the organization.
• The goal is to synthesize the principles that govern the creation, the existence and the change processes of a human organization system
• This is possible because the constituent members of a human organization have the will to act on their own.

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Human System Dynamics

• It’s recognized that the human system is inherently dynamic
• Human beings tend to organize themselves - kids on playgrounds, street gangs, people at parties, cliques, teams, corporations, committees, and families
• Three conditions influence the self-organizing processes in human systems
• Containers
• Differences
• Exchanges

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Containers

• These are conditions or factors that bound the system i.e. draw the elements of a system together or hold it together into a cohesive system
• Containers may be
• Physical e.g., offices, houses, city limits);
• Psychological (e.g., powerful ideas or charismatic leaders);
• Connections based on affinities (e.g., gender, race, culture).
• Many different containers may be at play to influence the patterns in any given human system, and often they are massively entangled or intricately interwoven.
• Patterns in a team can be influenced by for e.g. meeting place, purpose, past friendships or professional relationships, reporting structures, professional disciplines, and other bounding factors but may or may not be relevant to the work of the group

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Differences – 1/2

• Peculiarities of the different components/parts of a system
• Articulate patterns that influence and are influenced by individual and group behaviors. Every human system consists of an enormous number of differences e.g. power, age, gender, experience, role, language, race or ethnicity, stature, hair color
• Some, and not all of these differences are relevant at any particular place or time
• Differences that are relevant within any container may be formal or informal, explicit or implicit, permanent or temporary, physical or metaphysical

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Differences – 2/2

• A difference in a system may refer to various parameters e.g., height or weight, or it may refer to a distinction within one parameter e.g., short or tall
• Differences manifest patterns and are key to understanding human systems
• They also influence change in systems because a difference establishes an asymmetry that motivates and builds energy for changing the very pattern it represents, for example, a difference in financial status not only gives information about a society, it also has the potential to move the market toward productive activity or to move the society toward reform

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Exchange

• This is trade-off i.e. give and take phenomenon that occurs within a given system
• An exchange may involve the transfer of information, energy, money, force, or material.
• Creates change over time in a complex system using the relevant differences
• As participants in a self-organizing system, people talk and listen, give and take, and act and observe each other.
• They share their stories, inform one another of their needs, and together they establish patterns of being and behavior.

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Inter-play of Human System Dynamic Conditions – 1/2

• These conditions arise naturally and are always present for human systems, but they can be influenced through intentional interventions.
• They are not independent of each other.
• A change in one affects both of the others, as well as the emergent pattern in the system
• Because the conditions determine the degrees of freedom or constraint, they can be shifted to affect changes in system patterns and behaviors. Small or few containers tend to speed up self-organizing processes, while more or larger containers slow the process down

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Inter-play of Human System Dynamic Conditions – 2/2

• An overabundance of differences slows self-organizing; while too few establish a pattern quickly
• Systems with many and/or very tight exchanges self-organize quickly, and fewer or weaker exchanges tend to slow down the self-organizing process.
• Because containers, differences, and exchanges are many and varied , a system’s response to a change in any given situation cannot be predicted or controlled
• On the other hand, careful observation, thoughtfulness, and iterative adaptive action can allow individuals and groups to engage with complex adaptive human systems in ways that shift persistent patterns of meaning and action

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Key Aspects of Human Society – 1/2

• These are fundamentals that shape any human system
• These are seven :
• Cultural effects on human behavior
• The organization and behavior of groups
• The processes of social change
• Social trade-offs
• Forms of political and economic organization
• Mechanisms for resolving conflict among groups and individuals
• National and international social systems
• Cultural effects on behavior – The effect of social experiences and circumstances and their influence on the ways in which people develop and are shaped within the context of their inherited genetic potential
• Group behavior - how people as a group think of themselves and how others think of them based on social and cultural settings into which they are born (people voluntarily join groups based on shared occupations, beliefs, or interests)

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Key Aspects of Human Society – 2/2

• Social Change – societal internal forces influence directions onto which a people move e.g. government attempt to engineer social change by means of policies, laws, incentives, or coercion
• Social trade-offs – principles of choices among alternative benefits and costs. Social trade-offs are not always economic or material. Sometimes they arise from choices between our private rights and the public good
• Political and Economic system
• Social conflicts - conflict between people or groups often arises from competition for resources, power, and status. May arise from social change
• Global interdependence – Globalization. Interdependence may be through a wide variety of formal and informal arrangements

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Family Health and its relationship to illness; Problems of childhood, adolescence, adult and the aged

�The Family: Brief Overview�

• Consists of biologically related individuals living together and eating from a common kitchen
• Primary unit in all societies
• The epidemiological unit of the society
• Reflect the culture of the larger society
• Determines the behavior and attitude of its members
• A unit for providing a comprehensive care – medical/socio-economic, protection etc
• Types: nuclear, extended and three generational

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Functions of the Family

• Residence – home for its members
• Division of labor
• Reproduction and child rearing
• Socialization – transfer point of civilization
• Economic function
• Social care e.g. giving status to its members, protection from assaults and insults, regulating marital activities of its members, regulating to a certain extent of political, religious and general social activities and regulating sex relations through incest through taboos

Family in health and disease

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Family Role towards Health

• Ensuring health of everyone
• Support and maintaining healthy living
• Healthy relationship
• Maintaining health
• Healthy offspring
• Family size
• Child bearing
• Socialization
• Personality formation
• Stabilization of adult personality e.g. during stress and strain of life – injury, illness, births, deaths, tension, emotional upset etc.

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Family Role in Disease

• Care of the sick and injured, of women during pregnancy and child birth and care of the aged and the handicapped
• Familial susceptibility to disease – congenital disorders etc.
• Broken family
• Problem families – those lagging behind the community
• Support in illness

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Problems of childhood, adolescence, adult and the aged

Problems of childhood

• Congenital and hereditary diseases
• Infections principally the 6 killer diseases for which immunizations have been directed at
• Malnutrition – marasmus, kwashiorkor, marasmic-kwashiorkor and micro-nutrient disorders
• Domestic accidents – physical, chemical/liquid and electrical
• Abuse – forced labour, sexual and slavery, street begging and hawking

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Problems of adolescence

• Biomedical illness – illnesses that started during childhood or have been acquired or have manifested during adolescence. Could be related to growth or developmental (precocious or delayed puberty and short stature)
• Consequences of risk taking behavior – unintended injuries (RTA), intended injuries (violence, homicide, suicide), STIs, substance abuse
• Nutritional problems – malnutrition or under-nutrition, micronutrient deficiency, obesity and eating disorder
• Reproductive health problems – teenage pregnancy related problems, abortion related problems, menstrual problems and reproductive tract infections
• Mental disorders – substance abuse, violence, depression and suicide, other psychiatric disorders and learning disorders

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Problems of adults

• Stress-related disorders
• Accidents - Automobile
• Occupational disorders
• Infections
• Sexual and reproductive health issues – mainly among the females
• Substance abuse – alcohol
• Psychiatric disorders

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Problems of the Aged

• Problems due to ageing process - decreased vitality, structural reduction
• Problems associated with long-term illness - Degenerative disorders of CVS, Cancer, Accidents, Diabetes, Diseases of locomotor system (articular and non-articular), Respiratory diseases (chronic bronchitis, emphysema), GUT disorders (prostate enlargement, urinary disorders)
• Psychological problems – mental changes e.g. worry, doubt, fear, anxiety and self-distrust, impaired memory, rigidity of outlook and dislike of changes, sexual adjustments
• Reduced standard of living due to reduced income – has social and mental consequences

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