Voices in Medical Sociology Contemporary and Historical Perspectives Edited by Cynthia T. Cook

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Voices in Medical Sociology Contemporary and Historical Perspectives

Edited by Cynthia T. Cook Florida A&M University

Bassim Hamadeh, Publisher Christopher Foster, Vice President Michael Simpson, Vice President of Acquisitions Jessica Knott, Managing Editor Stephen Milano, Creative Director Kevin Fahey, Cognella Marketing Program Manager Becky Smith, Acquisitions Editor Sarah Wheeler, Project Editor Erin Escobar, Licensing Associate

Copyright © 2012 by University Readers, Inc. All rights reserved. No part of this publication may be reprinted, reproduced, transmitted, or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information retrieval system without the written permission of University Readers, Inc. First published in the United States of America in 2012 by University Readers, Inc. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe.

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Printed in the United States of America ISBN: 978-1-60927-237-1

Contents

Introduction Unit One: Epidemiology Factors Associated with Infant Mortality

vii

1 3

Sheronika Denson

The Effects of Skilled Health Attendants on Reducing Maternal Deaths in Developing Countries: Testing the Medical Model

13

Cynthia T. Cook

Socio-cultural Factors Relating to Maternal Deaths in Sub-Saharan Africa

31

Cynthia T. Cook

Get the Frack Out of My Town: A Case Study in Health Activism

45

Jessica Smartt Gullion

Unit Two: Medical Ethics Ethical, Legal and Social Issues of Genetic Studies with African Immigrants as Research Subjects

51

53

Gordon Gong, Sade Kosoko-Lasaki, Gleb Haynatzki, Cynthia Cook, Richard L. O’Brien, and Lynne E. Houtz

John Moore v. The Regents of the University of California

63

Justice Edward Panelli

The Immortal Life of Henrietta Lacks by Rebecca Skloot

73

Book review by Lisa Margonelli

Bioethics: Who Owns the Body? Henrietta Lacks and Body Tissues

77

Keondra Brown

Understanding Female Genital Mutilation Patricia A. Broussard

87

iv | Voices in Medical Sociology: Contemporary and Historical Perspectives

Unit Three: Medicine and Culture Positive Therapeutic Effects of Intercessory Prayer in a Coronary Care Unit Population

99

101

Randolph C. Byrd

Voodoo Death: Voices From the Past

109

Walter Bradford Cannon

Sangomas: Problem or Solution for South Africa’s Health Care System

115

Cynthia T. Cook

“You Shouldn’t Kill a Fly with a Hammer”: Alternative Medicine: A Global Perspective

125

Kathleen Anangwe

Unit Four: Race/Ethnicity, Gender, Social Class, and Health Health Inequalities Among Latinos: What Do We Know and What Can We Do?

137

139

Lisa Cacari Stone and C. H. Hank Balderrama

The Health and Social Well-Being of Incarcerated Women and Their Children

147

Felecia Dix-Richardson

Power and Conflict Over Women’s Reproductive Health

159

Rachel S. Pienta

Organ Transplantation and the Poor

167

Jennifer M. Smith

Public Health Then and Now: The Tuskegee Syphilis Study, 1932 to 1972: Implications for HIV Education and AIDS Risk Education Programs in the Black Community

179

Stephen B. Thomas and Sandra Crouse Quinn

Satisfaction with and Perceived Cultural Competency of Healthcare Providers: The Minority Experience: Original Communication Cynthia T. Cook, Omofolasade Kosoko-Lasaki, and Richard O’Brien

193

Contents | v

Unit Five: Health Care Professionals The Doctor-Nurse Game Revisited

209 211

Leonard I. Stein, David T. Watts, and Timothy Howell

The Road to Family Medicine: One Female’s Experience

221

Loretta Patton-Greenidge

Where’s the Doctor?: PAs and NPs on the Front Lines of U.S. Healthcare

233

Darron Smith and Tasha Sabino

Self-Assessment of Cultural Attitudes and Competence of Clinical Investigators to Enhance Recruitment and Participation of Minority Populations in Research: Original Communication

241

Richard L. O’Brien, Omofolasade Kosoko-Lasaki, Cynthia T. Cook, Judith Kissell, Frank Peak, and Ethel Hill Williams

Unit Six: Social Construction of Health and Illness Being Sane in Insane Places

255 257

D. L. Rosenhan

Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders by Herb Kutchins and Stuart A. Kirk

269

Book review by Cynthia T. Cook

Unit Seven: Global Health Global Health: Burden of Disease and Health Sector Reform in Ghana

273 275

LaFleur F. Small

Causes of Mortality for Sub-Saharan Africa

291

Cynthia T. Cook

U.S. Healthcare Reform

303

Jennifer M. Smith

Credits

309

An Introduction to Medical Sociology By Cynthia T. Cook

M

edical sociology is a sub-discipline of sociology, the scientific study of human society and group dynamics. Sociology as a discipline is concerned with social change, inequality, and how social factors affect our life chances or opportunities. Medical sociology, or the sociology of health and illness, is concerned with how social factors affect the health and well-being of a population, medicine as a social institution, and the etiology and treatment of disease, illness, and/or disability. Although the application of the social sciences to health care is not new, medical sociology as a sub-discipline of sociology is. It was not officially recognized as a section of the American Sociological Association until 1959 (Weiss & Lonnquist, 2009). Yet from its inception in the middle of the 20th century, it has contributed to our understanding of medicine as a profession and social institution, the sick role and illness experience, social construction of illness, social epidemiology, and health care organizations (Bird, Conrad, & Freemont, 2000) Although not always acknowledged, Emile Durkheim’s study on suicide was a major contributor to the discipline of sociology and the development of medical sociology. Durkheim’s 1897 study on suicide demonstrated the relationship between social factors and mental health. Through an examination of European death certificates, Durkheim found support for his theory that social integration was related to the suicide. He used social integration as a synonym for social support, and identified three measures: marital status, economic status, and religious affiliation. His data supported the thesis that married poor, Catholic males were less likely to commit suicide than single, rich, Protestant males. Why? A strong support group that consisted of family, friends, and religion served as a buffer for males in stressful situations. Today we know that a strong support group is not only important for the prevention of suicide, but for health and well-being in general. Patients with strong support groups have better health outcomes than those without. The Hispanic paradox may be an example of how a strong support group for low-income women with minimal access to prenatal care can produce a low

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infant and maternal mortality rate. Karl Marx is another classical sociologist who indirectly contributed to the development of medical sociology. Marx observed in the 19th century that the working class—the proletariat—were malnourished due to having to live on their low wages. He may have been the first classical sociologist to make the connection between social factors or social class and the health and well-being of the population. Unfortunately, he did not live to see that the economic system—capitalism—would improve the health and social well-being of the masses, albeit their life expectancy or mortality rate would still be related to their place in the economic order. The British Whitehall study (Marmot et al., 1984) illustrated the impact that social class has on the morbidity and mortality rates. The study conducted over a ten-year period (1969–1979) found a lower mortality rate among administrators and professionals and a higher rate among clerical and other low-status manual workers. These disparities existed in a country that has had socialized medicine or universal health care since 1948. Universal health care is not a panacea for reducing health disparities among the various social classes; it just makes health care accessible. Marx did not elaborate on the association between health and social class. In addition, he defined only two classes based on the means of production: the bourgeoisie, who own the means of production, and the proletariat, those who work for those who own the means of production. Max Weber, on the other hand, said social class was multidimensional. He said one needed to consider prestige, wealth, and power when assessing a person’s social class and not just one’s relationship to the means of production. Today, social class or socioeconomic status is based on a person’s education, income, and occupation. Like Marx, Weber did not make a direct relationship between health and social class. However, Weber recognized that social class was related to what one could consume, and one’s consumption is related to what one is able to buy, which in term is related to one’s health and well-being. That is, what one can afford to buy determines what one can consume, and this translates into lifestyles. We know that the more prosperous social classes have access to a healthy diet and adequate exercise, two factors that make for a healthy lifestyle, and a healthy lifestyle results in healthier and happier people. So both Max Weber and Karl Marx indirectly contributed to the early development of medical sociology in the 19th century and our understanding of the relationship of social class to health. The World Health Organization defines health as a “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” The American Heritage Dictionary (1992) defines it as “freedom from disease or abnormality.” Another definition of health might be one’s ability to function in one’s social environment. One could say that a person was in good health if they could hold a job, had friends and family, and could perform essential daily activities independently or with assistance. That is, if one could bathe, dress, prepare food, and eat independently or with minor assistance, he or she would be considered healthy. However, medical sociologists are not so concerned with defining health as they are with identifying

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healthy lifestyles that contribute to low morbidity, mortality, and high life expectancy. The Health Belief Model (Rosenstock, 1966) attempts to explain why people engage in healthy behavior and to identify the social factors or situations that encourage them to do so. The model stipulates that four conditions must be met for people to change their behavior: 1) Perceived susceptibility; 2) Perceived seriousness; 3) Perceived benefits of taking action and barriers to taking action; 4) Cues to action. (Rosenstock, 1966) The “sick role” of Talcott Parsons (1951) predates the health belief model and seeks to explain how people are supposed to behave who are identified or self-identify as sick. Parsons’s sick role is composed of four parts or stages. The first is that the sick person is excused from his or her normal activity based on the fact that s/he is sick. Second, the sick person is not responsible for his/her illness. Third, the sick person must want to get well and not seek secondary gain from the illness, i.e., prolong the illness so he or she does not have to go to work or school. And fourth, the individual must seek competent medical help. Parsons made a major contribution to the subfield of medical sociology when he developed the concept of the “sick role.” However, it is not a grand theory. The sick role appears to apply only to acute or short-term illness. And some individuals with acute illnesses do not have the luxury to take on the sick role based on their socioeconomic status; a person’s social class or occupation may prevent him or her from taking time off from work or seeking competent medical care due to lack of health insurance. (The Patient Protection and Affordable Care Act may remedy this when it is fully enforced in 2014.) In addition, chronic illnesses, like diabetes and hypertension, do not require individuals to take on the sick role, but simply to comply with the doctor’s orders. The sick role was Parsons’s segue into deviant behavior. Someone who is ill has deviated from the norm because he or she is not able to carry on their daily activities, something that most people can do. The sick role requires you to seek competent medical care; medicine is the social institution that is entrusted to provide that care. Doctors are the social control agents because they are the only ones (at least until recently) who can certify that someone is ill and not malingering; their role is to provide curative and preventive care. Thus, the sick person is deviant and needs the physician to make him “normal” or restore his health in order to shed his deviant status and become a productive member of society again. However, there may be some deviant statuses that are permanent. Erving Goffman (1963) applies the term “stigma” to those individuals who have a visible physical abnormality or who are mentally ill. Someone with a physical deformity would stand out; we would recognize immediately that he is different from the rest of the group via his use of a wheelchair, crutches, or simply the absence of a limb. A mental deformity is

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not as obvious, and health care professional are still wrestling with the concept of what is normal behavior or sanity. Edwin Lemert (1951, 1967) would probably agree that what is defined as a physical or mental illness is a labeling process by those in a position of power or authority to do so. He was concerned with deviant behavior, how two people can be engaged in the same behavior and one person gets labeled as a deviant and the other as an upstanding citizen. Primary deviance is when you engage in deviant behavior but no one knows you have broken the rules or the laws but you, so you’re not sanctioned. Secondary deviance is when you have broken the law and everyone knows and labels you as a criminal or deviant. Illness or disease is similar: If people know you are sick, they expect you to play the role, not come to work to infect your coworkers and not to go partying. However, if it is a chronic illness, no one knows, so no one expects you to take on the sick role, unless you are looking for some secondary gain and make your illness known. So whenever a difficult assignment comes up, you can remind your coworkers of your illness. The medicalization of deviance (Conrad, 1975) and/or the medicalization of everyday life are concerned with medicine as a social institution and social control agent. Behavior that used to be labeled as morally deficient is now placed under the control of medicine. Obesity, alcoholism, hyperkinesia, stealing/kleptomania, and gambling are now considered to be diseases that are treated by a health care professional. No longer do we say the person has no will power—instead, he or she has an illness that must be treated by a physician with medication and/or therapy. For example, posttraumatic stress disorder (PTSD) was the diagnosis originally given to soldiers returning from Vietnam who were “shell-shocked” or had battle fatigue. In previous wars, no medical or professional care was provided; the men were usually told to “man up” and get on with their lives. However, health care professionals providing counseling to Vietnam veterans needed a diagnosis in order to be paid by their health insurance carrier (Kutchins & Kirk, 1997); thus, the social construction of an illness or the medicalization of deviance. Today PTSD is used as a diagnosis for women who have been raped or battered. These women require physical and mental treatment, and no longer remain quiet about their sexual assault, something that was expected in earlier generations. The medicalization of everyday life has physicians validating the birth of a child, the death of a loved one, who is fit to work, who is disabled, and who can return to work. We have given physicians control over our physical and mental behavior. However, physicians are now sharing this responsibility and authority with mid-level practitioners. Today physician assistants and nurse practitioners practice medicine; they diagnose and treat patients, and in many states prescribe medication. In addition, physicians and physician extenders no longer have a blank check. Third-party payers—insurance companies—manage and/or monitor the treatment and care of their policyholders, and may even dictate the type of care the patient may receive. Medical sociology, or the sociology of health and illness, is concerned with every aspect of health care, from the etiology of disease to the conflict among health care

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professionals. In this text, I expose students to the new voices in medical sociology while familiarizing students with previous concerns in the field. I think students and instructors will appreciate this new approach to studying medical sociology. This new way of study includes personal memoirs, book reviews, and legal cases, along with “blast-from-the-past” articles. The articles should stimulate discussion about our health care system and what can be done to deliver quality care at reasonable cost.

References American Heritage Dictionary of the English Language, 3rd edition. 1992. Boston: Houghton Mifflin Company. Bird, Chloe E., Peter Conrad, and Allen M. Fremont. 2000. “Medical Sociology at the Millennium” in Handbook of Medical Sociology, edited by Chloe E. Bird, Peter Conrad, and Allen M. Fremont, 5th edition. Upper Saddle River, NJ: Prentice Hall. Conrad, Peter. 1975. “The Discovery of Hyperkinesis: Notes on the Medicalization of Deviant Behavior,” Social Problems (23):12–21. Goffman, Erving. 1963. Stigma: Notes on the Management of a Spoiled Identity. Englewood Cliffs, NJ: Prentice Hall. Kutchins, Herb, and Stuart A. Kirk. 1997. Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorder. New York: Free Press. Lemert, Edwin M. 1951. Social Pathology. New York: McGraw-Hill. ——— 1967. Human Deviance, Social Problems, and Social Control. Englewood Cliffs, NJ: Prentice Hall. Marmot, M. G., M. J. Shipley, and G. Rose. 1984. “Inequalities in Death—Specific Explanations of General Patterns,” Lancet, 83:1003–6. Parsons, Talcott. 1951. The Social System. Glencoe, IL: The Free Press. Rosenstock, Irwin M. 1966. “Why People Use Health Services,” Milbank Memorial Fund Quarterly, 44:94–127. Weiss, Gregory L., and Lynne E. Lonnquist. 2012. The Sociology of Health, Healing, and Illness. 7th edition. Upper Saddle River, NJ: Prentice Hall.