Health, Illness, and use of Care: The Impact of Social Factors: Volume 18

HIV and AIDS case surveillance continues to reflect the disproportionate impact of the epidemic on racial/ethnic minority populations, especially women, youth and children. The HIV antibody test is the standard method for identifying people with HIV and the primary prevention model to promote treatment and the reduction of HIV transmission. Given the incidence of HIV in women, it is important to understand the conditions under which women receive and interpret the results of their positive HIV antibody tests, in order to promote access to and continued health care. Our study demonstrates that how individuals are told the results of their HIV antibody test and what pre- and post-counseling is given, if any, can influence individuals' medical care and prevention of transmission of HIV to others. The important issue, it seems, for post-test counseling and accessing HIV health care is to address women's multiple social issues of poverty, drug rehabilitation, if needed, shame, and stigmatization of women with HIV, especially HIV positive mothers. Most women lack HIV education; they need referrals and assistance accessing and continuing health care, unless they have stable health care relationships. Analysis suggests, though the sample is too small to conclude, that issues of class, perhaps more than race/ethnicity and gender, though these are analyzed as interconnected, influence how women are told their results and their subsequent reactions and actions. Our study suggests that there may be little relationship between mandated state policies and counseling and testing practices. Policy sets standards. But how policies are implemented can be dependent on multiple conditions including counselors' training, resources of time, HIV knowledge, social support, knowledge of gender, race/ethnicity and social class, and women's social, cultural, emotional and physical health needs.

This chapter examines the existing research on breast cancer screening, diagnosis, and treatment. The authors identify social and demographic factors which may explain the decision making process of women diagnosed with breast cancer. Based on an examination of the existing research on breast cancer diagnosis and treatment, the authors have concluded that social and demographic factors, such as race, culture and ethnicity, age, socioeconomic status, social support, and quality of life, have varying influence on the decisions made by women diagnosed with breast cancer

This chapter uses a feminist social construction argument to question the use of sex categories in biomedical research. It is argued that dichotomous sex categories reflect social pressures to categorize and create difference, gender, as much or more than physical sex characteristics in bodies. Because a dichotomous categorization scheme is overlayed on a continuous physical phenomenon contradictions appear when sexual artifacts like hormones, genitalia, sexuality, sexual activity, and reproduction are attributed with causal status either in causing/curing, increasing/decreasing risk. The implications of this argument are illustrated using a content analysis of medical writing about cancer since 1900. Implications for definition of women's health and pan-sex biomedical research are discussed.

The relationships between women, health, and medicine are complex and contradictory. During the second-wave of the women's movement, feminists struggled to bring women's health issues to the fore. Today, their success is documented by the growing numbers of women practicing medicine, and by the increasing attention and resources devoted to women's health issues. Yet feminists remain critical of the highly gendered nature of medicine and its contribution to social inequalities. Feminists working both from within and outside the growing subfield of medical sociology have used one of its key concepts — medicalization — to explicate the negative consequences of institutional medicine for women.The continuing medicalization of women's lives is related to key ideas about the body and important trends in the structure of medicine, particularly the growing importance and sophistication of technology. The argument is made that some instances of medicalization, including women's legal punishment for fetal abuse and coerced sterilization, herald a new medico-legal alliance that impacts the poorest of women most severely. Feminists relate the growth of the public health paradigm of medicine to the emergence of the medico-legal alliance in that both rely on the power of the state and represent the continuing medicalization of women's lives. Based on these insights, the need for a continuing critical and feminist sociological understanding of medicine is stressed and possible lines of inquiry are set forth.

Despite evidence indicating that socioeconomic status is multidimensional, health behavior research frequently “controls for” education or income as monolithic indicators of SES. Education and income (as well as other SES indicators) tap different aspects of SES, are only moderately correlated, and can each independently influence behavior. The specific aims of this study were to: (1) describe and disaggregate the association between different indicators of socioeconomic status—educational attainment, employment status (as a proxy for occupational status), individual income, and household income—and multiple health behaviors; (2) examine the pattern of association between SES and health behaviors by gender; and (3) explore different hypotheses linking SES and health behaviors. In this study, like previous work, educational attainment had the most consistent relationship with different health behaviors, particularly among men. However an interesting pattern of associations between different dimensions of SES and different health behaviors emerged in multivariate analyses, as did several gender differences. Although fewer psychological resources (i.e. higher levels of depression and lower feelings of control) explained the SES disadvantage in terms of sedentary living, little evidence of mediation was found for other SES-health behavior linkages. Results from this study suggest that multiple aspects of socioeconomic disadvantage can undermine various behaviors related to health. Health interventions targeting lower status populations may need to incorporate specific strategies addressing different aspects of social class.

Socioeconomic status (SES) is a fundamental social cause of disease. The association of SES with chronic renal failure has received limited study. Older persons and blacks are at significantly increased risk for this health condition, which is also known as end-stage renal disease (ESRD). Among ESRD cases and controls aged 56-88, we investigated whether SES was predictive of ESRD, independent of subjects' race, sex, age, and history of diabetes. Our SES measure combined information about individuals' education and occupation. In race-specific logistic regression models, there was a trend for higher SES to be protective against ESRD. In a combined model, controlling for the effects of race, sex, age, and diabetes, the SES effect was statistically significant. Diabetes and hypertension, important ESRD risk factors, are also related to SES. The adverse “effect” of black race on a health outcome like ESRD may be expressed preferentially among economically disadvantaged persons. Improved understanding of race, SES, and age vis-à-vis a chronic condition such as ESRD requires studies in which cohort changes in health, resources, access to care, and service utilization are monitored longitudinally and analyzed using a life course perspective.

This study explored HIV-positive patients' preferences and beliefs about physician gender, sexual orientation, and race/ethnicity. In-depth interviews were conducted with 28 HIV-positive patients, including 15 men and 13 women. Results showed that over half (54%) of respondents had a preference regarding physician gender. Of these respondents, 60% (six women and three men) preferred to have women as their providers. Forty-three percent of respondents had a preference regarding physician sexual orientation. Of these eight men and four women, most (75%) stated that they preferred to see a homosexual health care professional as compared to a heterosexual one. Fewer respondents (18%) had a preference regarding physician race/ethnicity; however, all of those who had a preference regarding physician race/ethnicity stated that they preferred to see Caucasian physicians. Results suggest that physician gender, sexual orientation, and race/ethnicity are not neutral characteristics in the health care setting. Rather, these are dynamic variables that may have important implications for physician-patient relationships in HIV/AIDS care. Patients are most apt to receive optimal health care when they are able to find a physician with the sociodemographic characteristics that they prefer.

This chapter is about the work that patients do to present themselves to their doctors as certain kinds of patients. The concept of “the task of doing: ‘being a good patient’“ is used to emphasize that patient self-presentation in medical interactions is not a static patient attribute but is rather a dynamic activity that patients and doctors negotiate during the medical encounter. Data segments of doctor-patient symptom-reporting interactions from a conventional and an unconventional medical setting are used to examine how differences in patient symptom reports in the two settings are linked to differences in the ways the patient and doctor orient to “the task of doing: ‘being a good patient’.” The analysis of these data segments suggests further that asymmetry in interaction in conventional settings limits, while mutuality in the unconventional setting promotes, the transfer of information between doctor and patient.

This chapter explores the relationship between hospice home care and the recent trend toward dehospitalization. Hospice home care nurses are increasingly responsible for attending to their employing organization's bottom line, in addition to patient care. Their concern for helping patients achieve the good death thus intersects, and sometimes competes, with their employing organization's interest in controlling patients' access to costly hospital and other acute care. I describe several of the ways in which nurses in this study control home hospice caregivers' abilities to support terminally ill patients' death at home: (1) through their assessments of patient and caregiver appropriateness and competence; (2) by appealing to the caregiver's emotional connection to the patient in order to encourage commitment to the goal of death at home and; (3) by normalizing the idea of death at home. I argue that, through their work of training hospice caregivers to adapt and maintain the value of staying at home, hospice home care nurses provide a subtle, yet significant, new mechanism for dehospitalizing terminally ill patients. Moreover, the work of hospice home care nurses is shifting our understanding of what constitutes a “good death”.

In this chapter, we begin to clarify the role played by corporate capital in the development of the United States health care system. To do so we explore the role of capital, more generally, in health care expansion and we broaden the traditional focus on capital within the private sector to include public expenditures and subsidies as part of a system of capital flows that constrains corporate development. We consider government subsidies and health insurance reimbursement practices as capital formation mechanisms and we investigate the history of health care funding in this context. We understand the development of the U.S. health care system as driven by the interaction between the public and private sectors: Actions of the state create constraints on private investment and subsequent private investment decisions create equally compelling constraints on future public policy. We view the rise of corporate capital as a constrained consequence of these earlier dynamics. Moreover, we suggest that government spending patterns can have as profound an effect on corporate development as legislative activity and we believe this is has important implications for the development of health care systems.

The objective of this chapter was to advance the medical sociology theoretical literature on health lifestyle behaviors. This study investigated the influence of mid-life adult statuses (gender, marital status, parenthood, presence of children in the home, and employment status) and functional health status (general physical health, general mental health, vitality, and social functioning) on selected health-related behaviors. These behaviors included preventive medicine behaviors (routine physical exams, cholesterol checks, and blood pressure checks), risk-taking behaviors (driving above the speed limit, smoking, and consuming alcohol), health promoting behaviors (exercising, sleeping well, and relaxing), and medication usage (using prescribed medicines, over-the-counter medicines, and herbal supplements). The data were gathered through the Warren County Health Survey, a telephone survey of a randomly selected sample of residents from a county in Kentucky. Logistic regression was used to analyze the data. Results indicated that having children at home, being married, being fifty years old or older, and possessing better mental health and social functioning statuses were associated with a greater likelihood of practicing better health-related behaviors. In contrast, being both male and aged 49 and younger were correlated with a greater likelihood of engaging in poorer health-related behaviors. Based on these results, the authors offered several testable, theoretical propositions for future research to test the relationships between mid-life adult health statuses, functional health statuses, and health-related behaviors in other community-based samples.

In the continuing debate among health care providers, policy makers, and medical sociologists, on reforming the delivery of health care, it is necessary to address the social as well as the medical management of services provided to those whose special health care needs have thus far been inadequately met: chronically ill persons. Through analysis of data collected as part of a larger study concerning the experiences of non-hospitalized chronically ill persons, uncertainty, a key characteristic of chronic illness was identified as causing the most problems to ill persons and to those delivering their health care. This uncertainty factor, a nonmedical yet illness related problem was mentioned by all respondents much more than their medical difficulties, financial burdens, and their frustrations with health care professionals. This chapter focuses on the impact uncertainty has for chronically ill persons and particularly, the problems it creates for those treated in managed care programs.