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Medical Psychology and Sociology: Foundations of Sociology

Psychological and sociologic models for understanding disease and health take into account human social interactions and their influences. What are the social influences on health preservation, development, and social stratification of disease? How do social inequality and social stratification influence health? What roles do occupation and unemployment have in health (and disease)? Which social demographics are important in medical practice? Answers to these questions are explored here.

Last updated: Aug 15, 2022

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Sociologic Influence on Health and Disease

With regard to disease and health, behavioral and psychological models focus on individuals. Sociologic models concentrate on the influence of social structures. The structure of a society, its economic system, and the organization of payment for health care (e.g., health insurance) all play important roles in the sociologic models. The most notable sociologic influence on health is the direct effect of low socioeconomic status on morbidity Morbidity The proportion of patients with a particular disease during a given year per given unit of population. Measures of Health Status and mortality Mortality All deaths reported in a given population. Measures of Health Status. Diseases are more prevalent in low-income populations with limited access to health care.

Norms and Behavior Deviating from the Norm

Norms are standards or behavior expected of each member of a social group. Compliant behavior is reinforced and rewarded; behavior that deviates from the norms is penalized. If an individual’s behavior in the workplace violates organizational norms (e.g., excessive absences) and is punished, such sanctions may harm a person’s physical and psychological state of health.

Sociostructural Factors

Social classes

A social class is a group of people who have a similar status in an economic system. An assessment of society members may be based on outer appearance, language, clothing, and occupation. Social classes have a hierarchy and are associated with different reputations in society.

The concept of social classes is key in the field of sociology. Class-related terms and models are based on education, income, and occupational class. This social class index, or meritocratic triad, is seen as an important resource with regard to life opportunities.

  • Educational class: defined by the level of education completed
  • Income class: defined by annual income
  • Occupational class: defined by occupational prestige

Attributed and acquired status: origin and personal contribution

Attributed status is based on an individual’s family or country of origin. Acquired status is the status that can be achieved by performance, skill, and effort.

The meritocratic principle states that positions and rewards should be distributed only on the basis of the performance of the person—not on their attributed status (e.g., gender Gender Gender Dysphoria, origin, parental home, or ethnic affiliation).

Social (vertical) mobility

The openness of a society can be perceived by examining the potential for social mobility. Under the prevailing circumstances, to what degree can a person influence their social position using their skill and effort?

The medieval estate-based society is as an example of a society with minimal social mobility. During times of recession, there may be a decrease in social mobility in industrial countries.

Social deprivation

Poverty, unemployment, homelessness, and belonging to a social fringe group (dissociated from mainstream culture) can result in societal exclusion and social deprivation. Social deprivation adversely affects health, independent of a person’s level of education and occupation.

Table: Important connections between status/class affiliation and health-related behavior
In lower social classes In higher social classes
In general, there is an instrumental attitude toward the body: “As long as everything works, I do not need to see a doctor.” The body has symbolic value; health is seen as a value in and of itself.
There is a higher tolerance Tolerance Pharmacokinetics and Pharmacodynamics of symptoms and more frequent nonadherence Nonadherence Clinician–Patient Relationship to medical treatment. Better access to health-related information exists.
Workers use cancer screening Screening Preoperative Care less frequently and have a higher risk of early disability Disability Determination of the degree of a physical, mental, or emotional handicap. The diagnosis is applied to legal qualification for benefits and income under disability insurance and to eligibility for social security and workman’s compensation benefits. ABCDE Assessment. Population groups with a higher status more frequently experience allergic and atopic diseases.
People have less prenatal care Prenatal care Prenatal care is a systematic and periodic assessment of pregnant women during gestation to assure the best health outcome for the mother and her fetus. Prenatal care prevents and identifies maternal and fetal problems that adversely affect the pregnancy outcome. Prenatal Care and less preventive screening Screening Preoperative Care for disease. Anorexia nervosa Anorexia Nervosa Anorexia nervosa is an eating disorder marked by self-imposed starvation and inappropriate dietary habits due to a morbid fear of weight gain and disturbed perception of body shape and weight. Patients have strikingly low BMI and diverse physiological and psychological complications. Anorexia Nervosa is more prevalent in the middle and higher classes.

Social class gradients and explanatory hypotheses

Social class gradients are associated with risk factors for poor health, such as obesity Obesity Obesity is a condition associated with excess body weight, specifically with the deposition of excessive adipose tissue. Obesity is considered a global epidemic. Major influences come from the western diet and sedentary lifestyles, but the exact mechanisms likely include a mixture of genetic and environmental factors. Obesity and substance abuse (including tobacco and alcohol abuse). Social class and poverty also have a significant effect on the prevalence Prevalence The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. Measures of Disease Frequency of mental health disorders. Two theories explain the origin of these social class gradients: the social causation hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation and the social drift hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation

The social causation hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation (cause hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation)

The social causation hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation has received more evidence-based support than the drift hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation. This hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation states that individuals in a lower social class are at increased risk for developing certain diseases. The cause of the unequal distribution of health and disease is due to greater exposure to factors that endanger health (e.g., environmental pollution Pollution The presence of contaminants or pollutant substances in the air (air pollutants) that interfere with human health or welfare, or produce other harmful environmental effects. The substances may include gases; particulate matter; or volatile organic chemicals. Asthma, poor working conditions).

The social drift hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation ( selection Selection Lymphocyte activation by a specific antigen thus triggering clonal expansion of lymphocytes already capable of mounting an immune response to the antigen. B cells: Types and Functions hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation)

The social drift hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation argues in the opposite direction. This hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation states that the unequal distribution of health and disease exists because disease forces social relegation or does not allow social advancement. This social drifting is thus considered a consequence of a disease. The hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation states that mental illness causes one to drift further down in the social class, as has been observed with people with schizophrenia Schizophrenia Schizophrenia is a chronic mental health disorder characterized by the presence of psychotic symptoms such as delusions or hallucinations. The signs and symptoms of schizophrenia are traditionally separated into 2 groups: positive (delusions, hallucinations, and disorganized speech or behavior) and negative (flat affect, avolition, anhedonia, poor attention, and alogia). Schizophrenia.

Demographic Structure of Society

Age

Age is a common characteristic that we use to differentiate population subgroups. An age cohort is a group of subjects who have shared a particular event during a particular period. Generation names are based on when those individuals became adults (18–21 years of age).

Table: Age cohorts
Born in years Age range in 2022
WWII 1912–1927 95–110
Post-War 1928–1945 77–94
Baby Boomers 1946–1964 58–76
Generation X 1965–1980 42–57
Millennials (Gen Y) 1981–1996 26–41
Generation Z 1997–2015 7–25

The Baby-Boomer age cohort is associated with privilege among White individuals and with increasing affluence as compared with previous generations, in part owing to opportunities for better housing and education. Within this age group is a subgroup of adults over 65 who leave the workforce and have an increased reliance on the social security program. Since 1950, the percentage of the total US population over 65 has grown from 8% to 17%. 

The “Silent Generation” was born during the Great Depression (1929–1939) and WWII (1939–1945). Also called the “Post-War Generation,” this group includes people whose parents were traumatized during WWII and may have psychological issues related to their parents’ traumatization. 

By 2025, it is estimated that over 25% of the population will be over the age of 65. The dependency ratio examines the proportion of individuals typically not in the labor force and those typically in the labor force. This ratio is used to depict the number of individuals who are likely to be economically “dependent” on the support of others.

Dependency ratio

Image by Lecturio.

Age-related decline of physical health can impact:

The social significance of aging includes:

  • Increased need for professionals who specialize in this age cohort (care, prevention)
  • Age-friendly services
  • Realignment of societal views (e.g., cultural, social, and economic)

The life-course theory of aging is a process mediated by the factors shown in the figure.

Life-course theory of aging

Life-course theory of aging

Image by Lecturio.

There is a shift in age-related expectations with increased life expectancy Life expectancy Based on known statistical data, the number of years which any person of a given age may reasonably expected to live. Population Pyramids. Other theories of aging include:

  1. Age stratification: the hierarchical ranking of people into groups based on age; used to regulate appropriate behavior. According to this theory, age is conceptualized as both a process and a structure. In addition to physical aging, individuals experience a biopsychosocial process as they enter and exit social roles.
  2. Activity theory: also known as the implicit theory of aging. This theory holds that aging is considered “successful” when older adults engage in activities and social interactions and is in contrast with the disengagement theory, where aging is associated with inactivity. Specific activities and occupations are left behind with aging, and social interactions must be replaced.
  3. Disengagement theory: states that aging is unavoidable and associated with withdrawal from society, resulting in social isolation. This withdrawal leads to a more significant divide between individuals and society.

Gender Gender Gender Dysphoria

Gender Gender Gender Dysphoria is the category to which an individual is assigned by self or others based on sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria. Gender Gender Gender Dysphoria includes the male and female division of a species, as differentiated by social and cultural roles and behavior, and also includes a classification of nonbinary persons based on an individual’s awareness or identity.

The term sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria refers to the biologic character or quality Quality Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps. Quality Measurement and Improvement that distinguishes males from females as expressed by the person’s gonadal and chromosomal characteristics.

Table: Considerations for determining the gender Gender Gender Dysphoria of an individual
Sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria Biologic factors Sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria assigned at birth
XX or XY chromosomes Chromosomes In a prokaryotic cell or in the nucleus of a eukaryotic cell, a structure consisting of or containing DNA which carries the genetic information essential to the cell. DNA Types and Structure, or intersex ( genotype Genotype The genetic constitution of the individual, comprising the alleles present at each genetic locus. Basic Terms of Genetics does not align with phenotype Phenotype The complete genetic complement contained in the DNA of a set of chromosomes in a human. The length of the human genome is about 3 billion base pairs. Basic Terms of Genetics)
Gender Gender Gender Dysphoria Identity The gender Gender Gender Dysphoria an individual identifies with:
Female Male
Expression The expression of gender identity Gender identity A person’s concept of self as being male and masculine or female and feminine, or ambivalent, based in part on physical characteristics, parental responses, and psychological and social pressures. It is the internal experience of gender role. Sexual Physiology to others through behavior and appearance:
Transgender Transgender Persons having a sense of persistent identification with, and expression of, gender-coded behaviors not typically associated with one’s anatomical sex at birth, with or without a desire to undergo sex reassignment procedures. Gender Dysphoria (a person whose gender identity Gender identity A person’s concept of self as being male and masculine or female and feminine, or ambivalent, based in part on physical characteristics, parental responses, and psychological and social pressures. It is the internal experience of gender role. Sexual Physiology is different from the sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria assigned at birth) Cisgender Cisgender Gender Dysphoria (a person whose gender identity Gender identity A person’s concept of self as being male and masculine or female and feminine, or ambivalent, based in part on physical characteristics, parental responses, and psychological and social pressures. It is the internal experience of gender role. Sexual Physiology corresponds to the sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria assigned at birth)

The term genderqueer refers to a gender identity Gender identity A person’s concept of self as being male and masculine or female and feminine, or ambivalent, based in part on physical characteristics, parental responses, and psychological and social pressures. It is the internal experience of gender role. Sexual Physiology that is other than conventionally male or female (also called nonbinary); it refers to an individual who identifies as neither male nor female.

This category includes:

  • Those who have an overlap of gender identity Gender identity A person’s concept of self as being male and masculine or female and feminine, or ambivalent, based in part on physical characteristics, parental responses, and psychological and social pressures. It is the internal experience of gender role. Sexual Physiology
  • No gender Gender Gender Dysphoria (i.e., androgynous)
  • Gender Gender Gender Dysphoria fluid: identifying as different genders at different times

Sexual orientation Orientation Awareness of oneself in relation to time, place and person. Psychiatric Assessment is an individual’s inherent attraction to a sexual partner of a certain gender Gender Gender Dysphoria.

The social construct of gender Gender Gender Dysphoria refers to social norms, expectations, and roles assigned to each gender role Gender role Social role encompassing a range of behaviors and attitudes that are considered acceptable based on perceived sex. Sexual Physiology and expected behavior in a society. There are social differences in biologic and psychological variations in health.

Race and ethnicity

Race is a socially defined category based on physical differences between groups of people. 

The racial formation theory looks at race as a socially constructed identity, where the content and importance of racial categories are determined by social, economic, and political factors. Historically, a race was a group of people identified as distinct from other groups because of supposed physical or genetic traits shared by the group. Most biologists and anthropologists do not recognize race as a biologically valid classification, in part because there is more genetic variation within groups than between groups.

Ethnicity is an affiliation of people with a shared linguistic and cultural background. Ethnicity is a dynamic process that can change across generations.

  • Common language, ancestral, social, cultural, or national factors
  • Less statistically or concretely defined than racial groups

Social constructs of race and ethnicity can impact:

  • Level of and access to education
  • Employment opportunities and income 
  • Life expectancy Life expectancy Based on known statistical data, the number of years which any person of a given age may reasonably expected to live. Population Pyramids, overall health, access to health care, and health behaviors

Racialization or ethnicization is the process of assigning racial or ethnic identities to a group that did not identify itself as such:

  • Ascribed by the dominant group or population
  • The racialized group often gradually identifies with the ascribed identity.

Immigration status:

Immigration is the relocation of an individual to a country in which they are not a citizen to settle or reside there. Immigrants tend to move to more industrialized, economically sound, and politically stable countries. Immigration can have both positive and negative effects on both countries:

  • Can alleviate labor shortages in the recipient country
  • There may be exploitation of immigrants to optimize economic gain.
  • The recipient country will experience an increase in demand for goods and services.
  • The recipient country often experiences deterioration in the salary structures of the informal, rural, and urban sectors of the economy.

Occupation and Disease

In the long term, excessive workloads have a negative influence on health. Workers are more often affected by hard physical labor and shift work, which foster physical illness. Some occupations (e.g., in health care) impose significant psychological stress Psychological stress Stress wherein emotional factors predominate. Acute Stress Disorder on the employee in terms of responsibility, time pressure, and high expectations from patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship, colleagues, and family.

A person’s subjective impression of job insecurity is also a stress factor. Two models concerning the influence of stress on professional life have been developed. These models describe the connection between stress factors in professional life and the risk of cardiovascular diseases.

The job demand-control model

High amounts of demand + low controllability = high workload (e.g., assembly-line work)

A person’s workload can be described in the demand–control model in terms of 2 dimensions:

  • The amount and character of the demand
  • The controllability of the tasks

A 3rd dimension is social support. Strong social support can serve as a stress buffer and can compensate for high workloads.

Model of the occupational gratification crisis

High personal commitment + low gratification = high workload 

As the name suggests, the model of the occupational gratification crisis addresses the relationship Relationship A connection, association, or involvement between 2 or more parties. Clinician–Patient Relationship between occupational exertion and earned rewards (e.g., compensation Compensation Respiratory Acidosis, social recognition). Social support and attitudes such as life goals and psychological stability are buffers Buffers A chemical system that functions to control the levels of specific ions in solution. When the level of hydrogen ion in solution is controlled the system is called a ph buffer. Acid-Base Balance against occupational stress.

Ecologic Factors and Health

Table: Ecologic factors and health
Social Work situation, social class, family relations, housing situation, and social network
Cultural Cultural understanding of health and disease plays an important role and must be considered when working with individuals from cultures other than one’s own. Symbolism, religion, and moral concepts greatly influence the understanding of health and disease and their progress.
Natural Biologic, chemical, and physical circumstances are basic factors influencing health and disease. This influence is especially likely if illness accumulates following a long latency period (e.g., after exposure to radioactivity or chemical poisoning).
Technical Risks and injuries may result from technologic devices (e.g., motor vehicle accidents Motor Vehicle Accidents Spinal Cord Injuries). Conversely, technical achievements may impact the progress of disease (e.g., modern medical devices).

Economic Factors and Health

The economic and financial situation of a country greatly impacts an individual’s health. The structure of a health system is also fundamental to medical care Medical care Conflict of Interest. In the United States, for example, many people in lower social classes have little access to medical care Medical care Conflict of Interest. The enormous impact of economic factors on health can be seen in terms of life expectancy Life expectancy Based on known statistical data, the number of years which any person of a given age may reasonably expected to live. Population Pyramids when comparing highly industrialized countries and developing countries.

Average life expectancy Life expectancy Based on known statistical data, the number of years which any person of a given age may reasonably expected to live. Population Pyramids in 2020 (from World Bank Group data):

  • Japan: highest, 84.62 years
  • Germany: 80.94  years
  • United States: 77.28 years
  • Central African Republic: lowest, 53.68  years

Social Demography in Medicine

Demography is the science of population that combines elements from sociology, geography, medicine, and economics. Demography examines the life, growth, and decline of human populations.

Generative behavior and its determinants

Terms:

  • Fertility: the number of live births
  • Birth rate Birth rate The number of births in a given population per year or other unit of time. Population Pyramids: the number of live births in a given period, divided by the average population in the same period
  • Fertility rate Fertility rate Births per 1,000 women of childbearing age (aged 15–44) in a given year. Population Pyramids: the number of live births per 1,000 women of a certain age interval at a given point in time
  • Nuptiality: marriage and divorce behavior within a population
  • Mortality Mortality All deaths reported in a given population. Measures of Health Status: the number of deaths in a population
  • m (death rate): the proportion of deaths in a given period, divided by the average population in the same period
  • Perinatal mortality Mortality All deaths reported in a given population. Measures of Health Status: the number of deaths between the 28th week of pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care and the 1st week of life per 1,000 live births and stillbirths
  • Lethality: a measure of the deadliness of a given disease
  • L (lethality rate): the number of people who died in a given period divided by the number of sick people in the same period
  • Gender Gender Gender Dysphoria proportion: the numerical relationship Relationship A connection, association, or involvement between 2 or more parties. Clinician–Patient Relationship of men to women in the population
  • Share of the elderly dependency ratio Dependency ratio Ratio between dependents and the working group. Population Pyramids: the number of people over age 65 per 1,000 persons in the age bracket 15–64
  • DALY (disease-adjusted life-years): aims to measure the importance of diseases in a society. The DALY measure describes the length of time (in years) spent in ill health or time that is lost due to premature Premature Childbirth before 37 weeks of pregnancy (259 days from the first day of the mother’s last menstrual period, or 245 days after fertilization). Necrotizing Enterocolitis death.

Demographic aging

A population pyramid is a way to visualize two variables: age and sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria, within a population at a given time. Note the following when it comes to the interpretation of a population pyramid:

  • Left: male, right: female
  • Vertical axis: age in years (youngest at the bottom to oldest at the top)
  • Horizontal axis: number of people per age group (in thousands)

There are 3 main trends in populations that determine the shapes of the 3 classic population pyramids Population pyramids A population pyramid graphically illustrates the age and gender distribution of a given population. The shape of the pyramid conveys details about life expectancy, birth, fertility, and mortality rates. Population Pyramids.

  1. The expansive pyramid Expansive pyramid Population Pyramids: indicates both high fertility and high mortality Mortality All deaths reported in a given population. Measures of Health Status rates among younger members, so a sharp triangle shape is
    created. Expansive pyramids mean Mean Mean is the sum of all measurements in a data set divided by the number of measurements in that data set. Measures of Central Tendency and Dispersion that the population does not increase much in total number and there are many young people in the
    population (also called a “youth bulge”), as in the graph shown for Nigeria. See image below.
  2. The constrictive pyramid Constrictive pyramid Population Pyramids: when there is a lower mortality rate Mortality rate Calculated as the ratio of the total number of people who die due to all causes over a specific time period to the total number of people in the selected population. Measures of Health Status with the fertility rate Fertility rate Births per 1,000 women of childbearing age (aged 15–44) in a given year. Population Pyramids remaining constant. These population pyramids Population pyramids A population pyramid graphically illustrates the age and gender distribution of a given population. The shape of the pyramid conveys details about life expectancy, birth, fertility, and mortality rates. Population Pyramids are
    wider in the middle of the graph as the population has high numbers of middle-aged and elderly people and fewer young people. Germany is an
    example of this type of population. See image below.
  3. The stationary pyramid Stationary pyramid Population Pyramids: a population with low mortality Mortality All deaths reported in a given population. Measures of Health Status and low fertility rates. These graphs have a square or “pillar” shape rather than a
    pyramid one. These population pyramids Population pyramids A population pyramid graphically illustrates the age and gender distribution of a given population. The shape of the pyramid conveys details about life expectancy, birth, fertility, and mortality rates. Population Pyramids represent a stable population that will not change significantly barring any sudden changes
    to fertility or mortality Mortality All deaths reported in a given population. Measures of Health Status rates. The U.S.A. is an example of this type of population. See image below.

Theory of demographic shift

During nationwide industrialization, shifts in the generative structure of the population occur. Although this theory originates from the 1920s, it still influences epidemiologic thinking. The 5 stages describe the transformation Transformation Change brought about to an organism’s genetic composition by unidirectional transfer (transfection; transduction, genetic; conjugation, genetic, etc.) and incorporation of foreign DNA into prokaryotic or eukaryotic cells by recombination of part or all of that DNA into the cell’s genome. Bacteriology of aspiring societies: initially, high birth and death rates dominate. In the course of industrialization and modernization, the birth rates stagnate, the population shrinks, and life expectancy Life expectancy Based on known statistical data, the number of years which any person of a given age may reasonably expected to live. Population Pyramids increases. The United States, Germany, and most other industrialized countries are in stage 5.

The 5 stages of demographic transformation Transformation Change brought about to an organism’s genetic composition by unidirectional transfer (transfection; transduction, genetic; conjugation, genetic, etc.) and incorporation of foreign DNA into prokaryotic or eukaryotic cells by recombination of part or all of that DNA into the cell’s genome. Bacteriology:

  1. Pre-transformative stage:
    • High birth rates
    • High death rates
    • Slight growth with a high “population turnover”
  2. Early transformative stage:
    • Slow decrease in death rates
    • Continually high birth rates
    • Overall population growth
  3. Mid-transformative stage:
    • Death rates decrease further.
    • Birth rates slowly decrease.
    • Population growth reaches its peak.
  4. Late transformative stage:
    • Birth rates decrease further.
    • Population growth also decreases.
  5. Post-transformative stage:
    • Birth and death rates decrease further.
    • Population growth is roughly constant.

Changes in the disease spectrum: epidemiologic transition

Epidemiologic transition describes the changes in disease frequency and causes of death. In modern societies, chronic degenerative diseases rather than infectious diseases tend to dominate. Consequences for medical practice include implementing rehabilitative measures rather than curative ones. Medical treatment aims not only to cure the patient but often also to preserve the quality Quality Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps. Quality Measurement and Improvement of life. Demographic aging impacts both health and social politics. One of the goals is the compression Compression Blunt Chest Trauma of morbidity Morbidity The proportion of patients with a particular disease during a given year per given unit of population. Measures of Health Status—seeking to “compress” diseases and disabilities into the shortest possible period immediately before death. Thus, good health should be maintained in older adults to keep the high costs of chronic diseases down.

Society in change: the law of contraction and the consequences for medicine

The law of contraction describes the historical tendency toward smaller families. This sociologic thesis was developed in the context of a background where the government takes over more tasks relating to social security, formerly a function of the nuclear family. The law of contraction can indeed explain certain changes; however, the nuclear family often still forms the most important social and financial network. The number of 1- and 2-person households is increasing in the United States, and fewer multigenerational households exist than in past decades. Often, both partners within a family work outside the home. One consequence of the health system is the changing way in which things are being organized for sick people and older adults. There is an increasing need for hospital beds, nursing and retirement homes, and child care Child care Child and adolescent care is the area of healthcare dedicated to individuals who are beyond the immediate neonatal age through adulthood. These individuals do not present a uniform group, but are a series of patient populations, each with evolving healthcare needs (both preventive and pathologic) unique to them. Child and Adolescent Care provisions.

References

  1. Jenkins, R. (2002). Foundations of Sociology, pp. 1–14. doi:10.1007/978-1-349-87835-2_1
  2. Spencer, M. (1996). Foundations of modern sociology. Scarborough: Prentice-Hall Canada.
  3. Rejeski, W.J., & Fanning, J. (2019). Models and theories of health behavior and clinical interventions in aging: a contemporary, integrative approach. Clinical Interventions in Aging, 14, 1007–19.  doi: 10.2147/CIA.S206974
  4. Johnson, A.A., Shokhirev, M.N., & Shoshitaishvili, B. (2019). Revamping the evolutionary theories of aging. Ageing Research Reviews, 55, 100947. doi: 10.1016/j.arr.2019.100947
  5. McMullin, J.A. (2000) Diversity and the State of Sociological Aging Theory. The Gerontologist. 40(5), October 2000, pp. 517–530. https://doi.org/10.1093/geront/40.5.517
  6. The World Bank. (2020). Life expectancy at birth, total (years). https://data.worldbank.org/indicator/SP.DYN.LE00.IN?end=2020

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