1 of 38

SocPop Revision Phase 1

Social perspectives:

Catherine Hale

2 of 38

Revision of year 1 Soc

Please use the SocPop revision guide to plan and guide your revision- it is on Moodle on the SocPop Theme Page

I have done a selective summary of the Soc especially the ones that I recorded/created- so you will need to revise the other Soc sessions on the revision guide that were delivered by Prof Harbinder Sandu, Dr Clare Blackburn and Dr Megha Singh

Using sample exam type questions – so you can test yourself as we go along

3 of 38

��TOPICS:��-What is Health, Disease and Illness?�-Person Centred Care�-Doctor-Patient Relationships�-Gender & Ethnicity�-Disability�-Carers and Caring

4 of 38

What is health disease and illness?

Catherine Hale

5 of 38

Sample Exam Question:

Define what is meant in medical sociology by each of the terms: disease, illness and sickness. (3 marks)

6 of 38

Dis-ease

A pathological process confirmed by signs and investigations – objective

Deviation from the biological norm

However, definitions of disease change over time as medical knowledge advances

Disease

7 of 38

Illness (not to be confused will ill-health):

A subjective experience or ‘feelings’
‘I feel ill’
Something personal
Symptoms are defined and responded to in different ways by different people
May be experienced in the absence of pathology

Sickness: a social role - adopted or assigned to people perceived to be ill

Illness and sickness

8 of 38

Mr Reed, age 52, works for a large company as a senior manager

he considers his job to be stressful and pay is performance related. He has been experiencing indigestion for 2 years. Despite this being severe at times, he hasn’t been to the doctor as he thinks it is probably just stress and he sees himself as healthy as he goes to the gym every day and plays 5-a-side football.

Q: What best describes Mr Reed’s viewpoint on

the definition of health?

An absence of illness
As an ability to function at home and work
As an ability to function at work
As wellbeing or an equilibrium
As physical and/or athletic fitness

Sample Exam Question

9 of 38

LAY VIEWS ON HEALTH

Health as absence of illness: If I am not sick I generally consider myself healthy

Health as functional ability: As long as I am able to carry out my daily functions (e.g. going to work, taking care of the household)

Health is wellbeing or equilibrium: My mind, body and spirit are all connected. All need to be in sync for good health

Health as physical and/or atheletic fitness: I am healthy because I am able to play sport and I keep fit by going to the gym

Age, gender, ethnicity and place in society (socio-economic position) shape views on health

If we want to make sense of how patient’s views about their illnesses and their help seeking behaviour, we need to give some consideration to how they think about their health

Because in general, it is when people think there health is lacking in some way that they may seek help. Research on how view their health indicates that health means different things to different people.

Affected by socio-economic group, age and gender

Absence of illness –

Functional ability – might have symptoms but as long as I can carry on then I’m healthy. Accommodate everyday illness like colds and virus – common in studies of working class women.

Largely a working class conception, but also held by the elderly, particularly those in poor health, were less likely to define health in terms of illness.

Equilbrium Closely linked to health as energy / vitality (Blaxter:1990). d'Houtaud & Field (1986) saw this as essentially a middle class concept.

10 of 38

Person Centred Care

Catherine Hale

11 of 38

Exam Question:

What are the four elements of person centred care? (2 marks)

12 of 38

Four principles of person-centred care

The Health Foundation (2014) Person-centre care made simple

13 of 38

Person Centred Care

Personalised care – a whole person approach; seeing the patient as a person; tailoring care to the person’s needs and desires

Enabling care – shared decision-making; supporting the person to self-manage

Co-ordinated care – across multiple episodes and over time; integrated to address the health, social and emotional needs of the patient

Dignity and respect – establish a rapport; give time and encouragement for the person to identify the issues they would like to discuss; demonstrate empathy by asking how the person is coping with their diagnosis and recognizing that it can be difficult to come to terms with the condition

14 of 38

Think about how person centred care and your sessions on Carers, Disability and Health and Illness may overlap

15 of 38

Doctor-patient relationships

Catherine Hale

16 of 38

Exam Question

What best describes a doctor-patient relationship where the decision making is made in an equal doctor-patient partnership?

A) Paternalistic
B) Consumerist
C) Informed
D) Shared
E) Doctor-led

17 of 38

Three main ideal types of patient-doctor relationships

Doctor-led

Partnership

Patient-led

Paternalistic

Shared

Informed

18 of 38

Paternalistic model

Patient is passive; answers the doctor’s questions

Information flow: largely from doctor to patient, often minimal information given

Doctor makes the decision about what is best for the patient: underlying assumption is that the doctor is best placed to make the decision

Expectation that patient will agree as ‘doctor knows best’

N.B. May be appropriate dependent on context, e.g. emergency

19 of 38

Shared model

Two way exchange of information between patient and doctor at all stages:

Both participants are seen as bringing expertise:

doctors bring medical expertise about diseases and treatments
patients bring personal expertise (but have some knowledge about their condition and treatment)
Each participant seen as having some limitations to their knowledge

Patient and doctor reach a decision together about best course of action/treatment:

Each reveal treatment preferences
Come to an agreement and decision on how to proceed

Depends on building a consensus on appropriate treatment

Challenge for doctors is to create an environment in which patient feels able to express treatment preferences
If disagreement, process becomes one of negotiation.

20 of 38

Informed model

Doctor communicates all relevant information and treatment options, and the risk and benefits, to patient

Doctor communicates sufficient information for patient to make an informed treatment decision - information giving is doctor’s key contribution

Patient is active and expects to make the decision

Decision making is sole prerogative of the patient

21 of 38

Consider context as well as patient preference

Patient preference should be taken into account

But consider context too!

A patient may wish to take more of a lead in some conditions and their management and may ask for a more paternalistic model in other situations

Also consider how psychological theories of behaviour change interact with models of doctor-patient relationships

22 of 38

Gender & Ethnicity

Catherine Hale

23 of 38

Exam Question:

When a person arrives to a new country they will begin a process of acculturation, they may have already started this process even before they arrived. Describe what this means. (1 mark)

24 of 38

Ethnicity: Acculturation

Acculturation refers to the process of taking on the cultures of the host country in which you arrive.

Types of Acculturation:

Assimilation: It is a process where a person becomes fully integrated into a new country where their language and culture resemble that of the host community
Integration: It is a process where a person takes on the cultural norms of the new country but also maintain their original culture or that of their parents
Separation: It is where a person maintains their original culture and rejects that of the country to which they have migrated.
Or Marginalisation: It is when a person rejects their original culture and the new culture
General current consensus that integration appears to be the most beneficial process of acculturation in terms of mental well-being for migrants

25 of 38

Disability

Catherine Hale

26 of 38

Exam Question

Identify and briefly describe the medical and social models of disability. (3 marks)

27 of 38

Common features:

Disability : intrinsic to the individual

Restrictions: attributed to physical or cognitive impairments

Interventions/services: changing or curing the disabled person

Medical/health care profession’s role: treatment and central

Medical model of disability

Traditionally, the aims of medicine have emphasised a desire to cure or effectively treat an individual’s symptoms or illness. The notion of a long-lasting or permanent impairment does not, therefore, always sit comfortably within medical training or in service design.

Disability : intrinsic to the individual – individual deficit
Restrictions experienced by disabled people are attributed to their individual characteristics – physical or cognitive impairments
Interventions/services tend to focus on changing or curing the individual with the deficit
The medical/health care profession’s role is central in treatment

Crucially there has been a challenge to the notion that a person’s impairment or medical condition is primarily responsible for any restrictions that they face and a much greater emphasis has been placed on the disabling role of contextual factors. It is now widely accepted that disability results from the interaction of individuals’ impairments and conditions with the context in which they live. This way of understanding childhood disability is reflected in international human rights conventions and the World Health Organisation’s approach to classifying health and disability. One implication of this approach is that any attempt to improve the situation for disabled children and their families through service provision and other means needs to be based on an understanding of children’s individual conditions, the environment in which they live and on the dynamic relationship between the two.

Leonardi, M., Bickenbach, J., Ustun, TB.,Kostenjsek, N., Chatterji, S., MHADIE Consortium (2006) The definition of disability. What’s in the name? The Lancet, 368, 1219-1221.

United Nations (2008) Convention on the Rights of Persons with Disabilities and Optional Protocol.http://www.un.org/disabilities/documents/convention/convoptprot-e.pdf

World Health Organisation (2007) International Classification of Functioning Disability and Health – Children and Young People. Geneva: WHO.

28 of 38

Individualises the issue of disability
Negative /disempowered image
‘Personal tragedy’
Medicine defines and controls disabled people

Criticisms of medical model

Places power in the hands of the medical profession

Disabled people’s movement has challenged this view of disability
Crucially there has been a challenge to the notion that a person’s impairment or medical condition is primarily responsible for any restrictions that they face
Disabled people’s movement campaigned to raise the issue of the disabling role of contextual factors
They objected to the view that being disabled was a personal tragedy; they fought very hard for the recognition that their lives were not a tragedy – their were worth living.

by raising the personal experience of disabled people as the primary source of knowledge
Crucially there has been a challenge to the notion that a person’s impairment or medical condition is primarily responsible for any restrictions that they face
Identifying disability as a public issue rather than private issue suggests it needs socio-political responses

29 of 38

Common features

Disability is extrinsic to individual - social, attitudinal and physical barriers prevent people with impairments from participating in society to the same extent as other people

Problem primarily caused by by the way society is organised

Public issue: needs socio-political responses

Social model of disability

30 of 38

Social model: distinction between impairment

and disability

Bodily, mental or intellectual limitation or condition

Impairment

Disability

(1) Loss or of limitation of opportunities to take part in society on equal basis (2) because of the way society is organised

31 of 38

Advantages:

Disability is not seen as an inevitable consequence of living with impairment
Emphasises the need to remove physical, attitudinal and social barriers to full social participation
Calls for social and political change rather individual adaptation

Disadvantages

Can fail to acknowledge the significance of impairments for individuals

Social model:

32 of 38

Carers and Caring

33 of 38

Exam Question

What is one advantage and one disadvantage of being identified as a carer? (2 marks)

34 of 38

Possible advantages

Identify need for services

Recognition of work

and contribution of carers

Sense of identity – more likely

to attend support groups etc.

Carer: What’s in a word?

Possible disadvantages

Only seen in terms of being a carer

Lock people into a role they do not want

May prefer to define themselves as a son, daughter, partner, wife, husband, mother, etc

Undermines person being cared for

Terminology is problematic –’caregiver’ preferable?

35 of 38

Who cares: A few numbers

6.8 million informal carers (10% UK adults)

58% female /42% male

Peak age 50-59

800,000 young carers (under 18)

Adult children (33%) , partners, parents, other relatives , friends

Partners most likely to be in same household-

Average age is 12 years. May be looking after a parent or siblings

Disproportionate numbers from BAME groups

1 million caring for more than one person

1 million providing 50 hours of care or more

2 million working as well as caring

36 of 38

Carers are often patients too.
Report poorer mental and physical health than non-carers 72% report mental ill health and 61% physical ill-health as result of (Carers UK 2018)
Injuries due to manual handling
Lack of time to care for own health –don’t prioritise
There is an interaction between health of the carer and cared for
Lack of support for carers may contribute to unplanned hospital admissions, prolonged hospital stays and delays in discharging patients

Experience and impact of informal caring

1. Health

37 of 38

Difficulty accessing holidays, leisure pursuits and other social activities
May be harder to maintain relationships and social networks
May get few or no breaks from caring responsibilities

2.Social consequences

https://www.youtube.com/watch?v=gHQ6hQ3SQUM�

38 of 38

SocPop Revision Phase 1

Finally look at the Revision Guide to cover Soc Topics I haven’t covered in this session!