2011 Life & Death in the USA: Medicine and Disease in Social Context
Here we provide downloadable mp3 files (and a few m4v files) of lectures from Sociology 190 for the previous year and for the current year (as they become available). The lectures for 2011 are keyed to the syllabus for 2011.
COURSE INTRODUCTION
We will briefly review the burden of illness and death in the U.S., touching on the costs, family effects, and implications for people's well-being and suffering. We will also review the leading causes of death and how they vary by certain socio-demographic attributes. We will note geographic variation in illness and mortality and also the relevance of circumstances of birth, (including in utero exposures, birthweight, birth order, parental occupation, etc.) to life-long health. In short, we will introduce the basic bio-social facts to be explored in the course. And we will introduce the tension between individualistic and collective perspectives on medical care. We will in particular consider the case of suicide and the extent to which it reflects individual decision-making or collective constraints.
Lecture I (mp3) | Lecture I (m4v)
WHAT MEDICAL CARE HAS AND HAS NOT ACHIEVED
What are the benefits of medical care? How much do doctors actually help people? What are the relative roles of curative and preventative maneuvers in the health of the public? On the population level, what have been the benefits of "big medicine"? We will consider how the nature of illness and death has changed over the last century in the U.S., as part of the "health transition." And we will introduce some ways of defining and measuring health other than mortality, including morbidity, physical functioning, and quality of life.
The Role of Medical Care
Lecture I (mp3) | Lecture I (m4v)
The Health Transition
Lecture II (mp3) | Lecture II (m4v)
THE SOCIAL DISTRIBUTION OF ILLNESS
We will examine how disease and survival are distributed by basic socioeconomic variables. What is the role of sex, race, ethnicity, education, income, marital status, and other social variables in patient preferences, patient risks, patient care, and health outcomes? What are the methodological challenges of demonstrating and interpreting differences in health outcomes and care? How do we distinguish the problem of unequal outcomes from that of unequal treatment, and what is the ethical implication of this difference?
Socioeconomic Status and Health
Lecture I (mp3) | Lecture I (m4v)
Unequal Treatment and Unequal Outcomes with Respect to Race and Ethnicity
Lecture II (mp3) | Lecture II (m4v)
THE SOCIAL CONSTRUCTION OF ILLNESS AND MEDICINE
How are the seemingly objective, natural or scientific concepts of "body," "illness," or "treatment" influenced and determined by social phenomena and the medical system itself? How does the way people come to view the world have concrete and measurable effects on their health? How do people cognitively construct medically relevant concepts, such as diagnostic categories, and how do these constructions in turn influence medical care and human experience? We will consider diverse examples, ranging from childbirth to plastic surgery to mental illness to cardiac care.
Lecture I (mp3) | Lecture I (m4v)
DEATH AND DYING
We will explore the nature of dying in the U.S. and what might be done to improve end-of-life care. We will consider the nature of a good death, how death affects family members, and where death occurs. We will examine how social policy or clinical arrangements affect the experience of dying. We will especially focus on the role of physician decision-making and on ethical aspects of terminal care, including decisions about euthanasia and life support withdrawal. During this set of sessions on the care of the terminally ill, we shall also begin to consider the process by which physicians are socialized to their role as doctors. How does physician training influence health care delivery and patient experience?
The Nature of Dying in the U.S.
Lecture I (mp3) | Lecture I (m4v)
Practical and Ethical Aspects of Care at the End of Life
Lecture II (mp3) | Lecture II (m4v)
IATROGENESIS AND MEDICAL ERROR
How common and serious are medical errors? What is the difference between harm, error, and maloccurrence? How do physicians cope with the inevitability of mistakes and harm? In what ways is "iatrogenesis" (doctor-caused injury) a widespread socio-medical phenomenon? Why does harm occur and what, if anything, can be done about it? What ethical and policy issues are raised by medical mistakes?
The Problem of Medical Harm
Lecture I (mp3) | Lecture I (m4v)
Socialization of Physicians with Respect to Medical Error
Lecture II (mp3) | Lecture II (m4v)
HEALTH BEHAVIORS
How do individuals' choices and behaviors affect individuals' health risks and health status? We will consider a range of health-related behaviors that are socially patterned and that can have dramatic effects on population health. We will also explore how health risks vary by socioeconomic status. For example, what kinds of variation are there in diet among different gender, ethnic, and age groups? What role does the physical and social environment play in what we eat?
Obesity and Exercise
Lecture I (mp3) | Lecture I (m4v)
Alcohol, Tobacco, and Firearms
Lecture II (mp3) | Lecture II (m4v)
INEQUALITY, SOCIAL HIERARCHY, STRESS, AND SOCIAL SUPPORT
What do baboons in the Serengeti, civil servants in London, and actors in Hollywood have in common? How does relative position, and not just absolute position, matter to health? How can social structure be stressful? How can it be salubrious? What are the health consequences of stress and how might an individual's social support buffer the adverse effect of stress on health?
Social Inequality and Individual Health
Lecture I (mp3) | Lecture I (m4v)
Stress, Status, and Social Hierarchy
Lecture II (mp3) | Lecture II (m4v)
Social Support and the Health Benefits of Relationships
Lecture III (mp3) | Lecture III (m4v)
HEALTH AND SOCIAL NETWORKS
Can there be a non-biological transmission of disease? How does the health care delivered to one person affect the health of others? Does treating depression in parents prevent asthma in their children? Does weight gain or seatbelt use or drinking in those close to you directly affect your health? We will examine the difference between social support (measured at the individual level) and social networks (construed at the group level); and we will consider how illness and health-related phenomena (ranging from sexual practices to smoking to obesity to happiness) might spread within a social network and result in positive and negative "externalities." We will explore the evolutionary significance and biological basis for social network structure and function. We will also consider very new work involving interventions in online and offline networks to improve health. And we will introduce the idea of "computational social science."
Social Network Function
Lecture I (mp3) | Lecture I (m4v)
Social Network Structure
Lecture II (mp3) | Lecture II (m4v)
Social Network Interventions
Lecture III (mp3) | Lecture III (m4v)
SOCIAL CAPITAL
We will examine the very important concept of "social capital," first advanced by Coleman in 1988, and also the nature of "emergent" properties of social systems. How and why do groups of people come to have properties that do not inhere in the individuals themselves? And to what productive ends, both good and bad, might social capital be put — by individuals and by policymakers?
Lecture I (mp3) | Lecture I (m4v)
NEIGHBORHOOD EFFECTS ON HEALTH
We will consider how neighborhoods, as a particular form of collective social structure, may influence individual health. We will examine how local social capital and collective efficacy play a role in health. And we will examine how local physical infrastructure and medical resources affect health. In the process, we will examine geographic variation in a large variety of seemingly objective medical procedures, including the striking differences in care at the end of life and the wide-varying patterns of elective surgery across the U.S.. And we will consider the phenomenon of "physician induced demand" for medical care.
Lecture I (mp3) | Lecture I (m4v)
RELIGION AND HEALTH
Religion has numerous instrumental and symbolic effects on physical and mental health, and numerous aspects of religion may be relevant, from affiliation to religiosity to observance. Religious sentiments are also highly relevant to people's choices regarding their own care, and their attitudes regarding medical advances.
Lecture I (mp3) | Lecture I (m4v)
PUBLIC POLICY AND HEALTH AND HEALTH CARE
We will examine some macro and micro public policies that can affect individual and public health. As a powerful illustration, we will examine how society might respond to the emergence of new bio-technologies that promise to provide "super-human" enhancements to the human body, and we will consider moral aspects of these development as well as how society might regulate them. We will also consider the implications of lack of insurance for the health of over 46,000,000 Americans, a number slated to substantially decrease with the implementation of recent health reform legislation. We will close with a consideration of some illustrative individual, local, and national efforts to improve the health of the public, and with a recapitulation of the fundamental tension between individual and collective perspectives on health and health care.
Social Control of Individual Use of New Biotechnologies
Lecture I (mp3) | Lecture I (m4v)
Access to Health Care and Health Insurance, and a Selection of Policy Interventions
Lecture II (mp3) | Lecture II (m4v)
Public Health and Individual Experience
Lecture III (mp3) | Lecture III (m4v)