SOC101: Introduction to Sociology

On March 19, 2014, a "mystery" hemorrhagic fever outbreak occurred in Liberia and Sierra Leone. This outbreak was later confirmed to be Ebola, a disease first discovered in what is now the Democratic Republic of Congo. The 2014-2016 outbreak sickened more than 28,000 people, leaving more than 11,000 dead.

The outbreak was personally tragic and terrifying for the people in West Africa. In much of the rest of the world, the outbreak increased tensions but did not change anyone's behavior. Infection of U.S. medical staff (both in West Africa and at home) led to fear and distrust, and restrictions on flights from West Africa was one proposed way to stop the spread of the disease. Ebola first entered the United States via U.S. missionary medical staff who were infected in West Africa and then transported home for treatment. Several other Ebola outbreaks occurred in West Africa in subsequent years, killing thousands of people.

Six years after the massive 2014 epidemic, the people of West Africa faced another disease, but this time, they were not alone. The Coronavirus pandemic swept across the globe in a matter of months. While some countries managed the disease far better than others, it affected everyone. Highly industrialized countries, such as China, Italy, and the United States, were early centers of the outbreak. Brazil and India had later increases, as did the U.K. and Russia. 

Most countries took measures that were considered extreme – closing their borders, forcing schools and businesses to close, and transforming their people's lives. Other nations went further, completely shutting down at the discovery of just a few cases. And some countries had mixed responses, typically resulting in high rates of infection and overwhelming losses of life. For example, political leaders and large swaths of the population rejected measures to contain the virus in Brazil and the United States. By the time vaccines became widely available, those two countries had the highest numbers of coronavirus deaths worldwide.

Did the world learn from the Ebola virus epidemic? Or did only parts of it learn? Before the United States faced the worst COVID-19 outbreak in the world, the government shut down travel, as did many European countries. This was certainly an important step, but other measures fell short; conflicting messages about mask-wearing and social distancing became political weapons amid the country's Presidential election, and localized outbreaks and spikes of deaths were continually traced to gatherings that occurred against scientific guidance. Brazil's president actively disputed medical opinions, rejected any travel or business restrictions, and was in conflict with many people in his own government (even his political allies); with Brazil's slower pace of vaccination compared to the U.S., it saw a steep increase in cases and deaths just as the United States' numbers started to decline.

Both those opposed to heavy restrictions and those who used them to fight the disease acknowledge that the impacts went far beyond physical health. Families shattered by the loss of a loved one had to endure the pain without relatives supporting them at funerals or other gatherings. Many who recovered from the virus had serious health issues, while others who delayed important treatments had larger problems than they normally would have. Fear, isolation, and strained familial relationships led to emotional problems. Many families lost income. Learning was certainly impacted as education practices went through sudden shifts. The true outcomes will likely not be fully understood for years after the pandemic is under control.

So now, after the height of the coronavirus pandemic, what does "health" mean to you? Does your opinion of it differ from your pre-COVID attitudes? Many people who became severely ill or died from COVID-19 had other health issues (known as comorbidities), such as hypertension and obesity. Do you know people whose attitudes about their general health have changed? Do you know people who are more or less suspicious of the government and more or less likely to listen to doctors or scientists? What do you think will be the best way to prevent illness and death should another pandemic strike?

Medical sociology is the systematic study of how humans manage health and illness, disease and disorders, and healthcare for the sick and the healthy. Medical sociologists study health and illness's physical, mental, and social components. Major topics for medical sociologists include the doctor/patient relationship, the structure and socioeconomics of healthcare, and how culture impacts attitudes toward disease and wellness.

The Social Construction of Health

The social construction of health is a major research topic within medical sociology. At first glance, the concept of a social construction of health does not seem to make sense. After all, if disease is a measurable, physiological problem, then there can be no question of socially constructing disease, right? Well, it's not that simple. The idea of the social construction of health emphasizes the socio-cultural aspects of the discipline's approach to physical, objectively definable phenomena.

Sociologists Conrad and Barker offer a comprehensive framework for understanding this concept's major findings of the last fifty years of development. Their summary categorizes the findings in the field under three subheadings: the cultural meaning of illness, the social construction of the illness experience, and the social construction of medical knowledge.

The Cultural Meaning of Illness

Many medical sociologists contend that illnesses have both a biological and an experiential component and that these components exist independently of each other. Our culture, not our biology, dictates which illnesses are stigmatized and which are not, which are considered disabilities and which are not, and which are deemed contestable (meaning some medical professionals may find the existence of this ailment questionable) as opposed to definitive (illnesses that are unquestionably recognized in the medical profession).

For instance, sociologist Erving Goffman described how social stigmas hinder individuals from fully integrating into society. In essence, Goffman suggests we might view illness as a stigma that can push others to view the ill in an undesirable manner. The stigmatization of illness often greatly affects the patient and the kind of care they receive. Many contend that our society and even our healthcare institutions discriminate against certain diseases – like mental disorders, AIDS, sexually transmitted diseases, and skin disorders. Facilities for these diseases may be sub-par; they may be segregated from other healthcare areas or relegated to a poorer environment. The stigma may keep people from seeking help for their illness, making it worse than it needs to be.

Contested illnesses are those that are questioned or questionable by some medical professionals. Disorders like fibromyalgia or chronic fatigue syndrome may be true illnesses or only in the patients' heads, depending on the medical professional's opinion. This dynamic can affect how patients seek treatment and what kind of treatment they receive.

The Social Construction of the Illness Experience

The idea of the social construction of the illness experience is based on the concept of reality as a social construction. In other words, there is no objective reality, only our own perceptions of it. The social construction of the illness experience deals with issues such as how some patients control how they reveal their diseases and the lifestyle adaptations patients develop to cope with their illnesses.

In terms of constructing the illness experience, culture, and individual personality both play a significant role. For some people, a long-term illness can make their world smaller, more defined by the illness than anything else. For others, illness can be a chance for discovery, for re-imaging a new self. Culture plays a huge role in how an individual experiences illness. Widespread diseases like AIDS or breast cancer have specific cultural markers that have changed over the years and that govern how individuals – and society – view them.

Today, many institutions of wellness acknowledge the degree to which individual perceptions shape the nature of health and illness. For instance, the Centers for Disease Control (CDC) recommends that individuals use a standard level of exertion to assess their physical activity. This Rating of Perceived Exertion (RPE) gives a more complete view of an individual's actual exertion level since medication or other issues may affect heart rate or pulse measurements. Similarly, many medical professionals use a comparable scale for perceived pain to help determine pain management strategies.

Figure 19.2 Pain Assessment Tool. The Mosby pain rating scale helps healthcare providers assess an individual's level of pain. What might a symbolic interactionist observe about this method?

The Social Construction of Medical Knowledge

Conrad and Barker show how medical knowledge is socially constructed; that is, it can both reflect and reproduce inequalities in gender, class, race, and ethnicity. Conrad and Barker use the example of the social construction of women's health and how medical knowledge has changed significantly in the course of a few generations. For instance, in the early 19th century, pregnant women were discouraged from driving or dancing for fear of harming the unborn child, much as they are discouraged, with a more valid reason, from smoking or drinking alcohol today.

Social Policy and Debate

Has Breast Cancer Awareness Gone Too Far?

Figure 19.3 Pink ribbons are a ubiquitous reminder of breast cancer. But do pink ribbon chocolates do anything to eradicate the disease?

Every October, the world turns pink. Football and baseball players wear pink accessories. Skyscrapers and large public buildings are lit with pink lights at night. Shoppers can choose from a huge array of pink products. In 2014, people wanting to support the fight against breast cancer could purchase any of the following pink products: KitchenAid mixers, Master Lock padlocks and bike chains, Wilson tennis rackets, Fiat cars, and Smith & Wesson handguns. You read that correctly. All these pink products aim to raise awareness and money for breast cancer. However, the relentless creep of pink has many people wondering if the pink marketing juggernaut has gone too far.

Pink has been associated with breast cancer since 1991 when the Susan G. Komen Foundation handed out pink ribbons at its 1991 Race for the Cure event. Since then, the pink ribbon has appeared on countless products, and then, by extension, the color pink has come to represent support for a cure for the disease. No one can argue about the Susan G. Komen Foundation's mission – to find a cure for breast cancer – or the fact that the group has raised millions of dollars for research and care. However, some people question if, or how much, all these products really help in the fight against breast cancer.

The advocacy group Breast Cancer Action (BCA) positions itself as a watchdog of other agencies fighting breast cancer. They accept no funding from entities, like those in the pharmaceutical industry, with potential profit connections to this health industry. They've developed a trademarked "Think Before You Pink" campaign to provoke consumer questioning of the end contributions made to breast cancer by companies hawking pink wares. They do not advise against "pink" purchases; they just want consumers to be informed about how much money is involved, where it comes from, and where it will go. For instance, what percentage of each purchase goes to breast cancer causes? BCA does not judge how much is enough, but it informs customers and encourages them to consider whether they feel it is enough.

BCA also suggests that consumers ensure that the product they are buying does not actually contribute to breast cancer, a phenomenon they call "pinkwashing." This issue made national headlines in 2010 when the Susan G. Komen Foundation partnered with Kentucky Fried Chicken (KFC) on a "Buckets for the Cure" promotion. For every bucket of grilled or regular fried chicken, KFC would donate fifty cents to the Komen Foundation, with the goal of reaching 8 million dollars: the largest single donation received by the foundation. However, some critics saw the partnership as an unholy alliance. Higher body fat and eating fatty foods have been linked to increased cancer risks, and detractors, including BCA, called the Komen Foundation out on this apparent contradiction of goals. Komen's response was that the program did a great deal to raise awareness in low-income communities, where Komen previously had little outreach.

What do you think? Are fundraising and awareness important enough to trump issues of health? What other examples of "pinkwashing" can you think of?

Source: Tonja R. Conerly, Kathleen Holmes, Asha Lal Tamang; OpenStax, https://openstax.org/books/introduction-sociology-3e/pages/19-1-the-social-construction-of-health
This work is licensed under a Creative Commons Attribution 4.0 License.