01:920:101 Chap.10 Health, Illness and the Social Gradient
Health, Illness and the Social Gradient
The health block starts from a contrast the lecture draws between doctors and sociologists. A doctor focuses on why this patient became ill now and treats symptoms. A sociologist looks at populations, asks how social contexts shape health behaviours and outcomes, and searches for structural problems that affect many outcomes at once. Medical sociology and social epidemiology are the two approaches that follow.
The lecture then compares the United States with other high-income countries. It spends far more of its economy on health than the OECD average, it is the one high-income country without guaranteed coverage, its life expectancy at birth is three years below the OECD average, and it has the highest infant and maternal death rates among the countries shown.
The review sheet asks why, and the chapter explains the answer in terms of upstream causes. The social gradient is the key concept: health improves at every step up the income and status ladder, not only between the poorest and everyone else.
Social determinants of health, including income, wealth, neighbourhood, education, power and race, explain the gradient, and the lecture shows how they work socially, through safety, time and the cost of healthy food, and biologically, through the stress hormone cortisol. The recitation for this topic uses path diagrams that link an upstream factor to a health outcome, such as neighbourhood conditions and childhood asthma.
The chapter reproduces that structure as a figure and closes with gender and health, including how masculinity norms can affect men's health. Health items on Exam 2 include several marked as needing specific numbers, such as the difference in life expectancy between the lowest and highest income groups and how the United States compares with other countries on spending and life expectancy.
Keep those figures in your notes document. The explanatory items reward naming both a social and a biological route from a social determinant to an outcome, and distinguishing upstream from downstream policies.
What this chapter covers
- 01
Doctors and sociologists on illness
- 02
Medical sociology and social epidemiology
- 03
U.S. spending, coverage and life expectancy
- 04
The social gradient in health
- 05
Social determinants, upstream and downstream
- 06
Stress, cortisol and the body
Worked example · free
Building a social determinants path diagram
- 1Upstream factor: economic inequality and low income.
- 3Mechanisms: chronic stress with low control; costly healthy food and less time to exercise.
- 2Outcome and policy: hypertension; income support acts furthest upstream.
Key terms
- Social epidemiology
- The study of how social conditions, culture, time and place shape patterns of health and illness across populations.
- Social gradient
- The pattern in which health improves step by step with each rise in income or social status.
- Social determinants of health
- The conditions in which people are born, live, work and age, such as income, neighbourhood and education, that shape health.
- Medical sociology
- The study of health care as a social institution, including how care is delivered and paid for.
- Cortisol
- A stress hormone that, at persistently high levels, is associated with infection risk, faster ageing and wear on the body.
Health, Illness and the Social Gradient FAQ
Why does the United States have lower life expectancy despite high spending?
Spending mostly pays for treatment after illness appears. Health is produced earlier, by income, housing, education and access to coverage, and the United States leaves more people exposed to those risks while being the one high-income country without guaranteed coverage.
How can low social status change the body?
The lecture explains that persistent stress combined with low control produces high levels of cortisol, which is associated with more infections, changes in brain structure, faster ageing and general wear and tear.
What is the difference between upstream and downstream determinants of health?
Upstream determinants are root social conditions such as income, housing and education. Downstream determinants are closer to the illness, such as individual behaviour and medical treatment. Upstream policies change the conditions that produce disease.
What does the river parable teach about health?
It describes people endlessly rescuing drowning people downstream without asking why they keep falling in upstream. Sociologists use it to argue that treating illness is not enough; policy must change the conditions that cause it.
Exam move
Draw three path diagrams from memory, each with an upstream factor, two mechanisms and an outcome, and label one policy for each as upstream or downstream. Add the life-expectancy figures from the slides to each path you draw.
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