Health, Health Care, and Stratification

Sociologists think about health in two ways. They consider a person's physical and mental well-being. They also consider medicine, or the social institution that prevents or heals illness and injury. In a society, both the health of a population and the system for treating illness impact how the society functions. Individual health and the social institution of medicine both play a role in a person's opportunities for success and social mobility. Good health and access to medicine and treatment can have major consequences on a person's income, quality of life, and life expectancy.

Social stratification, the hierarchical arrangement of different groups in a society, impacts health. Quality of health is highly correlated to race and gender. It is also closely linked to socioeconomic status (SES), a combined measure of economic and social ranking based on a person's income, education, and occupation. In 1995 American sociologists Bruce Link and Jo Phelan proposed a theory of fundamental causes of disease, the idea that disadvantages associated with lower social status lead to poor health. Individuals of low socioeconomic status are exposed to more negative conditions, such as crime and crowded living conditions, leading to stress. They have less access to healthful food and less time to devote to healthful cooking. The combination of these factors means that these individuals are more likely to get chronic and acute illnesses. When they do get sick, these individuals lack the resources those in higher SES groups possess as a means of getting better. Individuals in higher social classes have the resources to protect themselves from getting sick and can return to good health faster when they do get sick. They have high-quality health insurance, making them more likely to obtain preventative checkups. Thus they can more often address health issues at earlier stages—before they become more serious and more difficult to treat.

Link and Phelan developed their theory based on the observation that the poor have significantly worse health than the wealthy. The link between socioeconomic status and health has been demonstrated in numerous studies. In the United States, low-income people report being in fair or poor health more often than wealthy people do. Poor adults have higher rates of heart disease, obesity, and cancer. The infant mortality rate for babies born to mothers without high school diplomas is higher than for those born to mothers who hold college degrees. A 2017 study found that in some parts of the United States infants whose mothers had fewer than 12 years of education were more than twice as likely to die as those born to mothers with more education. Children born into poor families are diagnosed with more physical and emotional issues. For example, a 2017 analysis found that poor children in the United States have higher rates of asthma and ADHD, or attention-deficit/hyperactivity disorder.

One reason that lower-income groups have worse health than higher-income groups is stress, which can have serious health consequences when experienced chronically. Multiple studies have shown a link between levels of stress and health. Chronic stress—constant stress that occurs for long periods of time—has a physical impact. It can affect almost every part of the body, including the cardiovascular system, the endocrine system, and the brain. Low-income people experience more stress about work, money, and a feeling of having little control over their lives. In addition to the physical effects of stress, the sense of a lack of control can influence behaviors. For instance, a 2018 study of American families found that low-income parents were more likely to grant their children's requests for junk food than high-income parents were. The researchers theorize that because low-income parents must usually refuse their children's requests because of financial constraints, they are more inclined to say yes when their children ask for relatively affordable treats, such as chips and candy. Low-income parents are less able to grant requests for relatively expensive toys, clothes, shoes, and vacations. Agreeing to requests for junk food is one of the few ways they can say yes to their children.

Living conditions also play a role in the connection between low socioeconomic status and health. Poor people tend to live in crowded conditions and more often live in or near areas with polluted air and water. Another factor is a lack of education about health. When this lack of education is combined with stress and difficult living conditions, unhealthful habits and lifestyles can develop. For example, low-income Americans are more likely to smoke than higher-income Americans. A 2017 study found that only 15 percent of Americans smoke cigarettes, but the majority of that group are low-income individuals and people who do not hold a college degree.

Race is another factor in structural inequality. One way to measure inequality in health is by looking at life expectancy in a society. In the United States, black men and women have lower life expectancy than people of other races. This is connected to structural inequalities that increase the likelihood that people of color are also of lower socioeconomic status. However, race can be a greater factor than socioeconomic status. For example, even middle-class and upper-class African Americans have higher rates of hypertension, which is known to be linked to stress. Health issues among Hispanic Americans are also in part linked to lower socioeconomic status. However, migration patterns influence the makeup of the Hispanic population in the United States. Hispanic immigrants who become ill often return to their countries of origin for care and remain there for the rest of their lives, impacting life expectancy data for Hispanics in the United States.

Both physical differences and gender inequality can impact how women and men experience health and illness. The life expectancy of women tends to be longer. However, women tend to suffer more serious health conditions, such as migraines, bone conditions, and immune diseases. Some studies show that health care providers do not treat pain in men and women the same, often leaving women's pain untreated or undertreated. Gender norms, expectations and patterns of behavior based on gender, also can play a role. Men and women have different patterns of help-seeking behavior. Women are more likely to consult with doctors when health issues or concerns arise.

Global stratification, inequalities among nations based on economic and political resources, can be seen in the different levels of health and illness around the world. Significant health disparities exist between high-income and low-income nations. These disparities are shown through measures such as average life expectancy, maternal mortality rates, infant mortality rates, deaths of children under five years old, numbers of people who cannot afford health care, numbers of doctors and other health care providers, and numbers of people facing hunger and hunger-related diseases. The highest life expectancies are found in wealthy nations such as Monaco, Japan, and Singapore. People in these nations, on average, live past age 80. The shortest life expectancies are found in low-income nations such as Afghanistan, Cambodia, and Chad, where on average people live to be just over 50. War and infant mortality rates play a significant role in life expectancy in some nations. For example, the average life expectancy in Afghanistan, around 51 years, is impacted by both war-related deaths and a very high infant mortality rate. Stresses on pregnant women related to poverty and war result in very low birth weights for babies, a major risk factor for infant mortality. Women in high-income countries are much more likely to have a skilled person present to attend and assist with birth. Another issue is the rate of girls (those under age 19) who give birth. Complications during pregnancy and childbirth are leading causes of death for girls under 19. These rates are much higher in low-income countries. In countries with less wealth and less infrastructure, people are more likely to die from treatable illnesses such as pneumonia, diarrhea, and malaria.

Sociologists use data from several sources to understand health and health care in different nations. The World Health Organization (WHO) is a part of the United Nations that studies and works to improve issues of health around the world. The WHO conducts research and publishes country profiles and reports. It also runs programs in different countries, aiming to improve outcomes and prevent disease and health emergencies. The World Bank also publishes data related to disease control, health systems, and issues including maternal health and child health. The Institute for Health Metrics and Evaluation at the University of Washington also conducts and publishes research about global health issues. Numerous privately funded groups work to combat global health disparities. Sociologists look at how forces including globalization, capitalism, war, climate change, and other issues impact health and health care in different countries. They also look at the ways that culture, racial and ethnic identity, gender roles, and other factors of social identity impact levels of health and wellness, access to care, and understandings of medicine in different countries and regions.