Health and its relationship to other social institutions

health and its relationship to other social institutions

At this point it might be asked why a theory of social institutions has, or ought Thus, arguably, for an entity to be. the Social Institutions and Gender Index (SIGI) and its five subindices Family Code, and goal 5 “Improve maternal. Educational Institutions: Social organizations dedicated to teaching skills and A social organization.

This view has fueled renewed interest in alternative medicine. We return later to these many issues for the social institution of medicine. The Sociological Approach to Health and Medicine We usually think of health, illness, and medicine in individual terms.

When a person becomes ill, we view the illness as a medical problem with biological causes, and a physician treats the individual accordingly. A sociological approach takes a different view. Unlike physicians, sociologists and other public health scholars do not try to understand why any one person becomes ill.

Instead, they typically examine rates of illness to explain why people from certain social backgrounds are more likely than those from others to become sick. Here, as we will see, our social location in society—our social class, race and ethnicity, and gender—makes a critical difference. A sociological approach emphasizes that our social class, race and ethnicity, and gender, among other aspects of our social backgrounds, influence our levels of health and illness.

The fact that our social backgrounds affect our health may be difficult for many of us to accept. We all know someone, and often someone we love, who has died from a serious illness or currently suffers from one. Sometimes they succeed; sometimes they fail. Whether someone suffers a serious illness is often simply a matter of bad luck or bad genes: In saying that our social backgrounds affect our health, sociologists do not deny any of these possibilities.

They simply remind us that our social backgrounds also play an important role Cockerham, Japanese families dislike disfiguring the bodies of the dead, even for autopsies, which are also much less common in Japan than other nations.

As culture changes over time, it is also true that perceptions of health and medicine may also change. As we will see, poor societies have much worse health than richer societies. At the same time, richer societies have certain health risks and health problems, such as pollution and liver disease brought on by high alcohol usethat poor societies avoid.

The degree of government involvement in health-care delivery also matters: Although illness is often a matter of bad luck or bad genes, the society we live in can nonetheless affect our chances of becoming and staying ill. Sociological Perspectives on Health and Medicine The major sociological perspectives on health and medicine all recognize these points but offer different ways of understanding health and medicine that fall into the functional, conflict, and symbolic interactionist approaches.

Together they provide us with a more comprehensive understanding of health, medicine, and society than any one approach can do by itself Cockerham, The physician-patient relationship is hierarchical: Conflict theory Social inequality characterizes the quality of health and the quality of health care. People from disadvantaged social backgrounds are more likely to become ill and to receive inadequate health care. Partly to increase their incomes, physicians have tried to control the practice of medicine and to define social problems as medical problems.

Symbolic interactionism Health and illness are social constructions: Physical and mental conditions have little or no objective reality but instead are considered healthy or ill conditions only if they are defined as such by a society.

Poor medical care is likewise dysfunctional for society, as people who are ill face greater difficulty in becoming healthy and people who are healthy are more likely to become ill.

For a person to be considered legitimately sick, said Parsons, several expectations must be met. He referred to these expectations as the sick role. First, sick people should not be perceived as having caused their own health problem. If we eat high-fat food, become obese, and have a heart attack, we evoke less sympathy than if we had practiced good nutrition and maintained a proper weight. If someone is driving drunk and smashes into a tree, there is much less sympathy than if the driver had been sober and skidded off the road in icy weather.

Second, sick people must want to get well. If they do not want to get well or, worse yet, are perceived as faking their illness or malingering after becoming healthier, they are no longer considered legitimately ill by the people who know them or, more generally, by society itself.

18.1 Understanding Health, Medicine, and Society

If a sick person fails to do so, she or he again loses the right to perform the sick role. Talcott Parsons wrote that for a person to be perceived as legitimately ill, several expectations, called the sick role, must be met. These expectations include the perception that the person did not cause her or his own health problem. If all of these expectations are met, said Parsons, sick people are treated as sick by their family, their friends, and other people they know, and they become exempt from their normal obligations to all these people.

Sometimes they are even told to stay in bed when they want to remain active. Physicians also have a role to perform, said Parsons. Parsons thus viewed the physician-patient relationship as hierarchical: First, his idea of the sick role applies more to acute short-term illness than to chronic long-term illness. Although much of his discussion implies a person temporarily enters a sick role and leaves it soon after following adequate medical care, people with chronic illnesses can be locked into a sick role for a very long time or even permanently.

Third, Parsons wrote approvingly of the hierarchy implicit in the physician-patient relationship. Many experts say today that patients need to reduce this hierarchy by asking more questions of their physicians and by taking a more active role in maintaining their health.

To the extent that physicians do not always provide the best medical care, the hierarchy that Parsons favored is at least partly to blame. The Conflict Approach The conflict approach emphasizes inequality in the quality of health and of health-care delivery Conrad, As noted earlier, the quality of health and health care differ greatly around the world and within the United States.


As we will see, the evidence of inequities in health and health care is vast and dramatic. The conflict approach also critiques the degree to which physicians over the decades have tried to control the practice of medicine and to define various social problems as medical ones. Their motivation for doing so has been both good and bad. On the good side, they have believed that they are the most qualified professionals to diagnose problems and treat people who have these problems.


Call these component actions, level-one actions. Thus the individual members of the mortar squad jointly operate the mortar in order to realise the collective end of destroying enemy gun emplacements.

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That they present themselves as candidates is in part constitutive of the input to the voting mechanism. Voters vote for candidates. So there is interlocking and differentiated action the input. Further there is some result as opposed to consequence of the joint action; the joint action consisting of the actions of putting oneself forward as a candidate and of the actions of voting.

The result is that some candidate, say, Barack Obama is voted in the output. That there is a result is in part constitutive of the mechanism. That to receive the most number of votes is to be voted in, is in part constitutive of the voting mechanism.

Moreover that Obama is voted in is not a collective end of all the voters. Although it is a collective end of those who voted for Obama. However, that the one who gets the most votes—whoever that happens to be—is voted in is a collective end of all the voters, including those who voted for some candidate other than Obama.


Such goods or benefits are collective in character. The notion of a collective good in the context of a teleological account of social institutions is not that of a public good familiar in economics. Rather a collective good can be understood as a good Miller Note that the community in question is not necessarily the membership of a given nation-state or some other political community. Rather it is to be understood in terms of participation in an institutional arrangement and, therefore, relativised to the reach of the social institution in question.

But some social institutions, e. Accordingly, the participants and, therefore, contributors and bearers of joint rights to the collective goods in question, are not necessarily defined in terms of their membership of a nation-state or other political entity. If the end realised in joint action, and organisational action in particular, is not merely a collective end, but also a collective good, then moral properties may well be generated.

In the first place, the collective good might consist in an aggregate of basic human needs that have been met, as in the case of welfare institutions. But, arguably, such needs generate moral obligations; other things being equal, the desperately poor for example morally ought to be assisted by the ongoing, organised joint action of those able to assist. In the second place—at the, so to speak, production, as opposed to the consumption, end of joint action—the realisation of collective ends that are also collective goods may well generate joint moral rights.


Managers and workers in the factory—but not necessarily others—have a joint moral right to be remunerated from the sales of the cars that they jointly produced—and not simply on the basis of some contractual arrangement that they have entered into. That is, there is interdependence of moral rights with respect to the good.

Moreover, these moral rights generate correlative moral duties on the part of others to respect these rights. Naturally these prior joint right and duties can be, and are, institutionalised including by way of contract based legal rights and duties that to some extent respect the relative contributions made by the participants. This point about joint rights and correlative duties can be generalised across and among institutions so as to generate a web of interdependence and hence joint rights and duties.

Consider that the participants in any business rely on communication, transport, educational, security and other infrastructure directly provided by others and indirectly provided by all or most via taxes. Unlike the collective acceptance account the teleological account introduces moral deontology at the ground floor so to speak and tries to generate institutional deontology on the back of this prior moral deontology.


Indeed, Searle Searle Chapter 8 offers this kind of argument, including in relation to human rights. In this section the teleological account of social institutions has been elaborated. In the following section the so-called agent-structure question is addressed.


Social institutions - government, economy, health and medicine

On some accounts, function is a quasi-causal notion Cohen Chapter IXon others it is a teleological notion, albeit one that does not necessarily involve the existence of any mental states Ryan Chapter 8. While the structure, function and culture of an institution provide a framework within which individuals act, they do not fully determine the actions of individuals. There are a number of reasons why this is so. For one thing, rules, norms and ends cannot cover every contingency that might arise; for another, rules, norms and so on, themselves need to be interpreted and applied.

Moreover, changing circumstances and unforeseeable problems make it desirable to vest individuals with discretionary powers to rethink and adjust old rules, norms, and ends, and sometimes elaborate new ones. Inevitably, the individuals who occupy institutional roles are possessed of varying degrees of discretionary power in relation to their actions.

health and its relationship to other social institutions


health and its relationship to other social institutions

Indeed, senior public servants often exercise discretion in relation to the formulation of policies. Consider that Gordon Chase, the New York Health Services Administrator, conceived, developed and implemented, the methadone program in New York in the early s, notwithstanding political opposition to it Warwickp.


In recent times they have increasingly been housed in large bureaucratic organisations in which their professional autonomy has evidently diminished somewhat. So certain categories of individual institutional actors have discretionary powers and a reasonable degree of autonomy in the exercise of their institutional duties. However, it is not only the individual actions of institutional actors that are not fully determined by structure, function and culture.



Accordingly, it is likely that many individual and collective discretionary judgments will be ones that do not contribute to the realisation of the institution's purposes, even if they do facilitate the narrow self-interest of individuals and factional elements.



Such conflict might take the form in part of ongoing demonstrations that disrupt classes, and thereby prevent lectures and tutorials from being held. Granted that institutional actors have a degree of discretionary power, nevertheless, they are constrained by institutional structure, and specifically the role structure, of the role that they occupy.

As is often pointed out, institutional structure also enables the action of institutional actors. Police officers, for example, have significant powers not possessed by ordinary citizens. However, a question arises as to the nature of the relationship between institutional structure and the agency of institutional actors. More specifically, a question arises as to whether or not one of these is logically prior to the other or whether neither is. Thus some theorists, e.

The proposition of structuralists such as Althusser is that institutional structures in the sense of a structure of social roles and social norms are a basic, non-reducible feature of the world and the actions, values, self-images and the like of individual human agents must conform to these structures because individual agency, properly understood, is in fact constituted by such structures. Social reality is wholly compromised of individual human agents and their ongoing, patterned interactions; there is no structure as such.


In relation to this issue Anthony Giddens Giddens and has attempted to reconcile the felt reality of individual agency with the apparent need to posit some form of institutional structure that transcends individual agency. According to Giddens, structure is both constituted by human agency and is the medium in which human action takes place Giddensp.


So the structure consists of: But it means, secondly, that this repetition over time of the related actions of many agents provides not just the context, but the framework, within which the action of a single agent at a particular spatio-temporal point is performed. Structure qua framework constrains any given agent's action at a particular spatio-temporal point. In addition, and as Giddens is at pains to point out, structure qua framework enables various actions not otherwise possible, e.


However, it has been suggested by, for example, Roy Bhaskar Bhaskar By way of support for this proposition Bhaskar claims that people do not marry to reproduce the nuclear family or work to reproduce the capitalist system.


For example, members of a business might have the maximisation of profit as an explicit collective end, even if the reproduction of the company was not intended by anyone. But it is the former, and not the latter that is in question. What is the evidence for the former in relation to Bhaskar's chosen examples? It is plausible to assume that in the typical case of a nuclear family in a contemporary western setting the couple married in order to, i.





Now consider a set of such companies. Arguably—given these fairly plausible assumptions—each of owner and manager of any of these companies has—jointly with the others—an implicit and much of the time latent collective end to reproduce the market system.

Further, there are institutions, such as schools and churches, and policymaking bodies, such as governments, that are explicitly engaged in the enterprise of reproducing a variety of social institutions other than themselves. Doubtless, unintended consequences—or, more precisely, consequences not aimed at as an end—have an important role in the life and for that matter, the death, of institutions Hirschman More specifically, habitual action is a necessary feature of individual and collective—including institutional—life; and each single action performed on the basis of a habit, contributes in turn, and often unintentionally, to the maintenance and reinforcement of that habit.


Moreover, it is consistent even with a teleological explanation of the reproduction of social institutions, since the establishment and periodic justificatory review of habits are themselves susceptible to teleological explanation. In this section we have addressed the so-called agent-structure Question.

Let us now turn in the final section of this entry to a specific normative aspect of institutions, namely their conformity or lack of it with principles of distributive justice. Social Institutions and Distributive Justice Justice is an important aspect of many, if not all, social institutions. Market economies, salary and wage structures, tax systems, judicial systems, prisons, and so on are all in part to be evaluated in terms of their compliance with principles of justice.



Although the concept of a right and the concept of justice in this sense are distinct, violations of rights are typically acts of injustice and vice-versa. Moreover, the concept of justice is itself multi-dimensional. Thus it is a principle of penal justice, but not distributive justice, that the guilty be punished and the innocent go free. Distributive justice is essentially a relational phenomenon to do with the comparative distribution of benefits and burdens as among individuals or groups, including the distribution of rights and duties but not restricted to the distribution of rights and duties, e.

These are also instances of rights violations.

Health Care: A Social Institution by Kurt Nicholson on Prezi






If the latter, Is it the institutional structure of a society or the global institutional structure? Famously, John Rawls addressed and privileged the question of the distributive justice of the structure of institutions in a given liberal democratic society Rawls and Arguably, this is a somewhat narrow focus, whatever one thinks of the specific account of distributive justice that Rawls elaborated in relation to the structure of institutions at the societal level.

Why is it not, for example, important to focus on the application of principles of distributive justice in relation to the global structure of, say, political and economic institutions? At any rate, our concern here is with the application of the concept of distributive justice at the institutional level though not necessarily only with respect to the structure of institutions within a given society, let alone liberal democratic society.



More specifically, a social entity or relation among social entities is not per se just or unjust, notwithstanding that in ordinary speech social entities and their relations to one another are said to be just or unjust, e. Given this individualistic conception of justice and of moral properties more generally how is a distinction to be maintained between the application of principles of distributive justice at an institutional level, on the one hand, and at an individual level, on the other?

Quite simply, by helping ourselves to the concept of an institutional role occupant and the relations, actions and effects on role occupants qua role occupants. Institutional role occupants are individual human persons. However, they are individual human persons who happen to occupy one or more institutional roles, including in contemporary nation-states the role of citizen.


health and its relationship to other social institutions

Accordingly, an institution is in some respect or on some occasion unjust in one of two main ways, intra-institutionally unjust and externally institutionally unjust. An institution is in some respect or on some occasion intra-institutionally unjust if a role occupant s of this institution qua role occupant s of this institution: For example, a company in which the CEO's salary is 50 times the wage of the lower echelon workers is prima facie unjust in respect of its system of rewards.

An institution is in some respect or on some occasion externally unjust if a role occupant s of this institution qua role occupant of this institution: Accordingly, the unjust actions of, and unjust relations among, ordinary human beings are actions and relations at the individual non-institutional level by virtue of not being acts of, and relation among, individuals qua institutional role occupants.

Thus if a group of wealthy entrepreneurs buy a large but allowable number of tickets to soccer matches in some national league and then sell them at grossly inflated prices to wealthy soccer fans again, this is allowable then arguably there has been an injustice to the relatively impoverished soccer fans who would otherwise have been able to afford these tickets and attend the matches of their beloved home teams.

However, these are not acts of injustice at the institutional level, since there are no institutional actors involved in this injustice. So if the members of an apartheid government refuse to enact legislation giving the vote to currently unenfranchised blacks then this is an institutional injustice. Note also that on this way of drawing the distinction it does not matter whether the institution in question is an intra-societal institution, e.


I suggest that such cases are not cases of the injustice of institutions per se, but rather of the injustice of the absence of institutions. Such cases point to the need to make a threefold, rather than a merely twofold, distinction in this area: It might further be argued that a crucial factor in all this has been ignored, namely, groups of individuals, e.

The application of principles of distributive justice at the institutional level is, or ought to be, in large part the application of such principles not so much to individuals per se, but to groups whose members are known to be, say, systemically discriminated against. Doubtless, much injustice is group-based. To the extent that institutional actors are themselves guilty of group-based injustice, e. However, there is a further point at issue here. Group-based injustices can exist primarily at the individual level rather than primarily at the institutional level.




On the other hand, if such group-based injustices are in fact the result of the practices or structures of institutions taken individually or collectively within the society then they would constitute injustices at the institutional level.

For example, if the quality of educational preparation necessary to become a doctor or lawyer was in fact only available to the very rich, then arguably the educational institutions themselves are unjust, i. In many societies socio-economic group-based injustices exist at both the individual and the institutional level.


There is a category of institutions in respect of which the distinction between group-based individual injustices and injustices at the institutional level collapses, namely, institutions that have as a defining purpose to redress large-scale distributive injustices in the wider society, i. The assumption here is that the institutional end of government goes beyond protecting human rights to, for example, life and liberty, and providing necessary means to the realisation of those rights, e.


On the other hand, minimalist conceptions of the institution of government might stop short of advocating a major role for government in applying principles of distributive justice in the wider society. A further question that arises here pertains to the putative obligation of governments to protect the human rights of citizens of other states or for that matter, non-citizens.


Perhaps ironically, a conception of the institution of government that is minimalist in respect of the nature of its obligations, i. Naturally, other things are not equal, e. On the other hand, Australia might be reasonably expected to intervene to protect the human rights of the East Timorese. Some Blake have argued: The latter claim b is open to question Anderson No doubt citizens subject to the coercive authority of a government have a moral right to political rights, e. However, it is difficult to see why citizens being subject to the coercive authority of a government willingly or, for that matter, unwillingly generates a moral obligation on the part of the government in question to apply principles of distributive justice—specifically, the controversial Rawlsian difference principle—to the interactions among the citizens.
