Social and Community Perspectives

Formative Assessment Part 2

11th March 2003

1:30 to 2:15pm

1. Name the person who was commissioned by the government

to look into the problem of

inequalities and health. (1 mark)

• Sir Donald Acheson

2. When talking about inequalities in health, ‘health’ can be conceptualised

in different ways. Provide two examples of different ways of defining health, and

explain what is meant by each. (4 marks)

• Biomedicine - an absence of either disease or death (concentration on morbidity and mortality rates).

• World Health Organisation Health is a state of complete and physical, mental and social well-being not merely the absence of disease or infirmity”

(2 marks each)

3.      In 1980 the Black Report was published, identifying four explanations for inequalities in health. Briefly outline each one of these and identify which one they regarded as being most useful when explaining health inequalities between different

social groups? (5 Marks)

• Artefactual– Health and class are artificial variables, registrar

General’s classification is flawed and may be circular– Numerator/denominator bias – Lowest social class groups shrinking widens

apparent inequalities

• Social Selection– Health determines social class through a process of Health-

related social mobility – Healthy move up social hierarchy and unhealthy move down

(‘Downward drift’).

• Behavioural– Some evidences that serious illness in childhood can affect

occupational class, e.g people with mental health problems tend to drift down social ladder. However not explain all class gradient. e.g. children/women, different diseases

– Social class determines health through social class differences in health damaging/promoting behaviour

– Smoking, diet, exercise, alcohol consumption, infant feeding practices all vary by class.

• Materialist– Social class determines health through social class

differences in the material circumstances of life.– Material aspects of living conditions: income, housing, diet,

working conditions, pollution affect health. – Asset based measures - housing tenure, car ownership -

are strongly associated with mortality rates.– Type of employment and level of employment influence

health.

Materialist identified as being most important by BR(1 mark each & explanation plus 1 mark for identifying materialistic correctly)

4.      Men are more likely to die before women, but women are more likely to experience worse health compared to

men throughout their life. Briefly outline three reasons why this may be

the case. (6 marks)• Work: women are more likely than men

to be found in lower paid jobs, or in part-time work, both of which have been associated with poorer health experience. Historically, men were more likely to be located in dangerous and health damaging jobs e.g. mining

• Gender roles: women – caring – exposure to poor housing conditions. • Risk taking behaviour Men encouraged to engage in risk taking

behaviour• Smoking: Historically, men smoked more than women which

accounted for the greater number of lung cancer deaths in men. However, women have not given up smoking to the same extent as men, and as a result smoking related illness and death is becoming more common in women.

• Reproduction: Women more likely to become patients than men because of their reproductive capacity. Women may also suffer from iatrogenic illness as a result of prescribed medication

5. What is the process of consulting others before

consulting a doctor known as, and

who conceptualised it? (2 marks)

• Lay referral system – Freidson (I mark each)

6. Lay beliefs are influenced by a number of different factors. Briefly

outline three examples of things which might influence what people

belief about their health. (3 marks) • Idiosyncratic

• Media,

• Popular

• Expert models

• Alternative Models

• Personal history/biography

7. Zola identified ‘triggers’ to seeking medical care. List these five triggers,

providing a brief explanation or example of

each. (10 marks) • The occurrence of an interpersonal crisis e.g.

divorce/death• Perceived interference with social or personal

relations i.e. affecting social life in some way/unable to do things would usually do

• ‘Sanctioning’ e.g. pressure from others/lay referral• Perceived interference with vocational or physical

activity i.e. unable to work/affecting job in some way• A kind of ‘temporalizing of symptomatology’ e.g.

setting of deadline2 marks each for trigger and explanation

8.      In Parsons’ ‘sick role’ the patient has certain obligations and privileges, explain

what these are. (6 marks)

Patient’s privileges/rights:– Allowed to be exempt from normal social

obligations – In need of care and unable to get well on own

Patient’s obligations:– Must want to get better asap– Must seek and co-operate with technically

competent medical help– (1.5 marks each – less 0.5 if not able to identify

them correctly as privilege/obligation)

9. Briefly outline two shortcomings of Parsons’

conceptualisation (4 Marks) • Sick role = ‘ideal’ – temporary state, based on acute illness• People do not automatically enter sick role they may continue to

work and/or may not seek help for their symptoms.• Sick Role will vary according to different conditions. e.g. HIV,

lung cancer • Friedson (1970) – Extent to which rights and privileges of sick

role granted dependent upon the perceived seriousness of the disease and its legitimacy.

• Three types of legitmacy:• Condtional• Unconditionally legitimate• Illegitimate

10.      Stigma’ is a concept frequently referred to in relation to disability and

chronic illness. explain what is meant by ‘felt’ and ‘enacted’ stigma? (2 marks)

Felt stigma is when a person perceives that others see them/react differently to them on the basis of their illness or disability. Enacted stigma is when other people actually treat a person differently as a result of the their illness or disability – they may view them differently, or respond to them differently. (1 mark each)

11. Which of the terms ‘discreditable’ or ‘discredited’ is most applicable to Ruth?

Explain your answer. (3 marks)

Both terms may apply to Ruth, although when she is out the term ‘discredited’ may be more appropriate. Goffman saw those who had a ‘discredited’ stigma as being those who had a condition which is visible e.g physical disfigurement, or use of wheelchair as in Ruth’s case. Those who have a ‘discreditable’ stigma are those who have a condition which although not immediately visible would, if discovered, cause others to react to them in a negative way e.g HIV. This may apply to Ruth when she isn’t using her wheelchair.

12. Many people would define Ruth as ‘disabled’. What would someone

adopting a ‘medical model’ understand

by the term ‘disability’? (3 marks) The medical model views disability as a restriction or lack (resulting from an impairment) of ability to perform an activity in a manner or within the range considered normal for a human being. It assumes that being disabled is the result of flaws, malfunction etc. in the body (albeit aggravated by prejudice, stigma and so on) It sees the answer to disability in medical terms - surgery, rehabilitation, prevention etc.

13. What would someone adopting a ‘social model’

understand by the term ‘disability’? (3 marks) Oliver (1990), who is a key advocate of the ‘social model of disability’ argues that disability is the disadvantage or restriction of activity caused by a contemporary social organisation which takes no or little account of people who have physical impairments and thus excludes them from the mainstream of social activities. This model emphasises that disability is a result of social organisation rather than bodily impairment. It seeks to identify and remove ‘barriers’ rather than changing /adapting people’s bodies It sees the answer to disability in the social organisation of society

14. Briefly discuss three advantages and three

disadvantages to using this approach (12 marks) Advantages: • Able to uncover information which is difficult to get at or may be

sensitive in nature• Allows the research team to focus on why individuals

behave/react in the way they do • Explores respondents’ own experience as they themselves

perceive it• Data collected is ‘rich’ in detail • Generates ideas, hypotheses and future research questions• Strength of this approach lies in its validity – closeness to the

truth • Location – perhaps get more people agreeing to take part

because of convenience?

Disadvantages: • Location - interviewing in the hospital may be a problem

– people feel coerced? Worried that what they say may be repeated to doctors/other staff?

• Only a relatively small number of people can be interviewed using this approach compared to a more structured survey

• Problems of reliability.• Costly in terms of time and funds - conducting

interviews, transcribing and analysing. • More difficult to replicate than more standardised

research tools.

Perceptions of personal risk may affect whether a patient consults a practitioner. Briefly explain in what ways Beck believes risks faced in

today’s ‘Risk Society’ is different to risks experienced historically. You should use one example to illustrate the point you are making.

• Historically risk was external: it came from the natural world e.g. droughts, famines, it was personal, observable, obvious, overt. In modern societies, by contrast Beck and others argue that risk is manufactured or uncertainty. It is created by the impact of knowledge/technology on natural world: environmental/health risks. Risk of this kind is global, impersonal, unobservable. e.g. nuclear, chemical, genetic. In our risk society everyday life breaking free of tradition/custom. The advances we experience from technology have created benefits but also risks which are difficult to measure

• Examples:• Risk-taking behaviour e.g smoking or sexual

behaviour. People may know what they’re doing is health damaging but not admit to such behaviour to a doctor, or not perceive that they at ‘risk’ e.g. not a ‘member’ of a ‘risk group’.

• Heart disease – over-simplified health promotion messages. Not fit the simplistic criteria given in campaigns and make sense of symptoms experienced in a different way.