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: Mar 29, 2023
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 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.
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.
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).
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.
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.
| 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 Anorexia The lack or loss of appetite accompanied by an aversion to food and the inability to eat. It is the defining characteristic of the disorder anorexia nervosa. Anorexia Nervosa nervosa is more prevalent in the middle and higher classes. |
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 use disorder (including tobacco and alcohol use disorder Alcohol use disorder Alcohol is one of the most commonly used addictive substances in the world. Alcohol use disorder (AUD) is defined as pathologic consumption of alcohol leading to impaired daily functioning. Acute alcohol intoxication presents with impairment in speech and motor functions and can be managed in most cases with supportive care. Alcohol Use Disorder). 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.
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).
| 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.
Age-related decline of physical health can impact:
The social significance of aging includes:
The life-course theory of aging is a process mediated by the factors shown in the figure.
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:
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.
| 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 Gender Gender Dysphoria identity 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 Gender Gender Dysphoria identity 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 Gender Gender Dysphoria identity 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 Gender Gender Dysphoria identity 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:
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 Gender Gender Dysphoria role and expected behavior in a society. There are social differences in biologic and psychological variations in health.
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.
Social constructs of race and ethnicity can impact:
Racialization or ethnicization is the process of assigning racial or ethnic identities to a group that did not identify itself as such:
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:
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.
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:
A 3rd dimension is social support. Strong social support can serve as a stress buffer and can compensate for high workloads.
High personal commitment + low gratification = high workload
As the name suggests, the model of the occupational gratification crisis addresses the 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.
| 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). |
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):
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.
Terms:
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:
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.
Expansive pyramid
Overall shape is an upright pyramid, with a broad base.
Describes a population with:
High fertility rate
High mortality rate
Low life expectancy
Each age group is smaller than the age group before it.
Indicates fast growth of the population, with small share of older
people
Seen in developing countries
Constrictive pyramid
Overall shape is an inverted pyramid, with a narrow base.
Describes a population with:
Low fertility rate
Low mortality rate
High life expectancy
Narrowing at the bottom of the graph indicates that the population is shrinking.
Large share of the population is aging.
Seen in wealthy, industrialized, developed countries (high literacy, good access to birth
control and healthcare) rate
Stationary pyramid
Overall shape is a rectangle, tapering at the top.
Describes a population with:
Low fertility rate
Low mortality rate
High life expectancy
Almost equal percentages in the age groups
Indicates slow growth of the population
Seen in developed countries
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:
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.
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.
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