MCAT Behavioral Sciences Review - Kaplan Test Prep 2021–2022

11.3 Demographics
Social Structure and Demographics

LEARNING OBJECTIVES

After Chapter 11.3, you will be able to:

· Distinguish between race and ethnicity

· Describe symbolic ethnicity

· Describe fertility rate, birth rate, and mortality rate and how they shift during a demographic transition

· Recall examples of proactive and reactive social movements and how the two types of movements differ

Demographics refer to the statistics of populations and are the mathematical applications of sociology. Demographics can be gathered informally, such as a professor asking how many freshmen, sophomores, juniors, and seniors are in a given course, or may be gathered formally. For example, the United States Census Bureau gathers full demographic data about every individual in the country every ten years.

COMMON DEMOGRAPHIC CATEGORIES

Demographers can classify individuals based on hundreds of different criteria. The MCAT will not expect you to know advanced topics within demographics, but familiarity with some of the common demographic categories as well as their implications on society and healthcare are important. In this section, we’ll explore age, gender, race and ethnicity, sexual orientation, and immigration status.

Age

Aging is a inevitable process experienced by all people around the world. In this section we will explore the implications of an individual's age on healthcare, then dive deeper into its implications on society.

Considering an individual's age and cumulative life experiences when analyzing their personality, social status, health, and other social metrics is known as the life course perspective (sometimes referred to as the life course approach). For example, in healthcare, a psychiatrist may consider a patient's early life events and how those events continue to impact a patient's condition. Or perhaps a general practitioner chooses to conduct additional lung screenings on a patient who previously worked in a coal mine. In both these examples, the physician is incorporating the life course perspective into the treatment of the patient.

With the potentially large difference in the experiences between age cohorts, prejudice or discrimination based on a person's age can arise. This is known as ageism and can be seen at all ages. For example, young professionals entering the workplace are often viewed as being inexperienced, and their opinions and ideas may therefore be ignored or downplayed. Older individuals may be perceived as frail, vulnerable, or less intelligent, and may thus be treated with less respect.

In order to understand and analyze age-related differences, researchers can group individuals based on their age or birth year; these groupings are known as age cohorts (sometimes called generational cohorts). The utility of age cohorts goes beyond understanding the differences of an individual's life course, as they allow researchers to look at a population at a macroscopic level. An analysis of a population's distribution among its age cohorts can predict demographic shifts, such as an aging population, the shift from a developing to developed economy, or a stable population. We'll explore examples of each below.

REAl world

The demographic tool of age cohorts has woven its way into our everyday language. If you've heard terms like the Silent Generation, Baby Boomers, Generation X, Millennial (Generation Y), and Generation Z, then you've encountered age cohorts. These generational terms group individual by their birth year. However, age cohorts can be used to group individuals based on their current age, such as 0-14, 15-30, etc.

In the United States, many sociologists document a “graying of America” as the Baby Boomer generation ages. The term Baby Boomer stems from the large spike in fertility rates (birth rates) after World War II, or in other words, a "boom of babies." Due to the baby boom spanning from the 1940s to 1960s, over 70 million Americans will be 65 or older by 2030, representing nearly 20 percent of the population. Thus, the fastest-growing age cohort in the United States is the 85-or-older group. This has profound effects on healthcare: more than 40 percent of adult patients in acute care hospital beds are 65 or older. Considering this shift in demographics, government programs such as Medicare and Social Security will experience increased demand, which may result in the collapse of these programs.

This situation is an application of the dependency ratio, which is the ratio of the number of members of a population that are not in the workforce to the number of members that are in the workforce. This ratio depends on two components, the youth ratio and age dependency ratio. The youth ratio is defined by the number of people under the age of 15 divided by the number of people aged 15-65. The age dependency ratio is defined by the number of people over 65 divided by the number of people aged 15-65. Applied to societies, the dependency ratio quantifies the economic burden felt by the working age population (15-64) in order to support the portion of the population outside of the workforce (under 15 and over 65).

In contrast to the United States, developing countries, such as Uganda, see the reverse trend with 48% of the population being under the age of 15 years old, resulting dependency ratio of 0.5 (2% of the population is 65 years and over). This can be explained by the country's steadily dropping infant mortality rate over the last several decades. Forecasting the next 10 to 20 years for Uganda would predict a large proportion of the population entering the working-age age cohort. Although this may lead to an increase in the country's economic productivity, this demographic shift must be matched with job growth. If that does not occur, unemployment rates will increase, which can lead to civil unrest. This shift from developing to developed country is explained by d, covered later in this chapter.emographic transition theory

Finally, when a population's fertility rate and mortality rate remain relatively consistent over a long period of time, the distribution of the population among the age cohorts remains fairly constant. This is known as a stable population.

Gender

Sex and gender are not synonymous terms. Sex is biologically determined. In most species, including humans, the biological female is defined as the one that produces the larger gamete and carries offspring. Gender refers to a society's notions of femininity and masculinity. Gender is therefore a socially constructed set of ideas about what it means to be male or female in a given culture. A culture's ideas about gender usually include expected behavioral traits associated with each biological sex. These expected behavioral traits are known as gender roles. As such, gender roles are also social constructs. Once an individual understands these socially constructed behavioral expectations, an individual can adopt behaviors that project the gender that individual wishes to portray, which is known as their gender identity.

Gender segregation is the separation of individuals based on perceived gender. Such segregation includes divisions of male, female, and gender-neutral bathrooms, or separating male and female sports teams. Differences between genders and the phenomenon of gender segregation do not necessarily imply inequality, although inequality can occur. Gender inequality is the intentional or unintentional empowerment of one gender to the detriment of others. In the presence of gender inequality, gender stratification may occur. Gender stratification is defined as any inequality in access to social resources that is based on gender, and is an example of social stratification in general, which will be studied in Chapter 12 of MCAT Behavioral Sciences Review. To illustrate the difference between gender segregation and gender stratification: Single-sex schools are an example of gender segregation. Children enrolled in such schools do not necessarily receive unequal qualities of education. However, if there is a systemic difference in resource allocation between single-sex schools, the result is uneven access to resources, leading to gender stratification.

Race and Ethnicity

The definition of race has changed through recent history, and continues to change. The term originally referred to speakers of a common language, and later indicated national origin. However, the term has also historically been used to denote certain shared phenotypic similarities between people. The five racial categories currently recognized by the U.S. Census exemplify these shifting definitions of race. These categories are: white, black, Asian, American Indian or Alaskan native, and Native Hawaiian / Pacific Islander. Observe that some of these racial categories, like white and black, describe phenotypic similarities, while other categories, like American Indian and Pacific Islander, are based on national origin. Furthermore, no other country uses these same five racial labels, and in fact the officially recognized races differ in each country. So, there is no uniform agreement about racial categories; rather each society generates its own racial labels, making race a social construct.

If race is not consistently defined, then why do sociologists concern themselves with this concept? The answer is that racial labels, though socially constructed, do materially affect the lives of people through institutionalized practices of preference and discrimination. In order to define race more scientifically, sociologists specify that the term race refers to socially constructed groupings of people based specifically on inherited phenotypic characteristics. Note that the human history of migration and mixing of populations means that there are few if any genetically isolated people left on earth. So sociologists recognize that scientifically categorizing people by genetic differences is not possible. Nevertheless, societies continue to generate racial labels based on perceived phenotypic differences, and so sociologists study how each society treats its socially defined racial groups.

An important takeaway from the above discussion is that sociologists narrow the definition of the term race to refer specifically to attempts to group people by phenotypic difference. However, sociologists recognize that societies also group people by shared language, cultural heritage, religion, and/or national origin. The term sociologists use for these types of groupings is ethnicity. While certain ethnicities are often associated with certain racial labels, race and ethnicity are distinct. Here is an illustration of the difference: African American individuals, African immigrants, and West Indian immigrants speak different languages and express different cultural norms. These three groups represent three different ethnicities. However, due to some phenotypic similarities shared by some members of these groups, individuals in these groups would generally be given the same racial label. Like race, ethnicity is also a social construct, in that ethnic labels and the criteria for inclusion in a certain ethnic group change from society to society and change over time.

Real World

Certain racial and ethnic groups have higher incidence of specific health problems. For example, the Chinese population accounts for a disproportionate number of chronic hepatitis B infections and liver cancer. Mediterranean and African populations have a significantly higher rate of hemoglobinopathies (diseases related to hemoglobin). Ashkenazi Jews have a higher rate of autoimmune diseases. Certain Native American populations are associated with gallbladder and biliary tree diseases. Being of a particular race or ethnicity is not necessary for the development of any disease, but may certainly be associated with increased risk.

Symbolic ethnicity describes a specific connection to one’s ethnicity in which ethnic symbols and identity remain important, even when ethnic identity does not play a significant role in everyday life. For example, many Irish Americans in the United States celebrate “Irishness” only one day per year: St. Patrick’s Day. In all other facets of life, these individuals’ Irish-American ethnicity does not play a significant role. Other examples include attending folk festivals, visiting specific cultural locales for holidays, or participating in an ethnic pride rally.

It is important to consider how race and ethnicity may affect one’s ability to receive proper health care. The Agency for Healthcare Research and Quality (AHRQ), a government agency, reports that race and ethnicity influence a patient’s chance of receiving many specific procedures and treatments. Whether due to conscious or unconscious bias, there is evidence that different races are not always offered the same level of care escalation in a medical emergency.

Bridge

Many public health outreach efforts are aimed at closing the gap in health disparities between populations. Health and healthcare disparities are discussed in Chapter 12 of MCAT Behavioral Sciences Review.

On the other hand, there are a number of public health outreach projects that target at-risk racial or ethnic populations through education, screening, and treatment. These specific strategies are geared to close gaps in health disparities. Many large university health systems run free clinics in local neighborhoods and may target specific populations; for example, some of these clinics will staff Spanish-speaking doctors and medical students to cater to the Hispanic immigrant population.

Sexual Orientation

Sexual orientation can be defined as the direction of one’s sexual interest. In scientific and healthcare communities, sexual orientation has historically been divided into three categories:

· Heterosexual: attraction to individuals of the opposite sex

· Bisexual: attraction to members of both sexes

· Homosexual: attraction to individuals of the same sex

Sexual orientation involves a person’s sexual feelings and may or may not be a significant contributor to that person’s sense of identity. It may or may not be evident in the person’s appearance or behavior. Disclosure of minority sexual orientations, sometimes called coming out of the closet, is a major milestone in the absorption of sexuality into one’s identity. This disclosure has also been shown to have therapeutic effects: coming out is associated with decreases in depressive and anxious symptoms linked to cortisol levels and stress.

Human sexuality continues to be an important area of research for psychologists, sociologists, and biologists alike, but evidence shows that sexuality is likely more fluid than previously believed. Alfred Kinsey was a pioneer in this area, and—in addition to a number of other models and publications—described sexuality on a zero to six scale, with zero representing exclusive heterosexuality and six representing exclusive homosexuality. When ranked on this Kinsey scale, few people actually fell into the categories of zero and six, with a significant proportion of the population falling somewhere between the two.

Sexual and gender identity minorities are often grouped together under the umbrella term LGBT (lesbian, gay, bisexual, and transgender). In some cases, this acronym has been expanded to include other self-definitions of sexuality and sexual identity, including Q (queer or questioning), I (intersex), or A (asexual).

Several health disparities have been recognized within the LGBT community. The most significant historical disparity is HIV, which disproportionately affected gay men in urban environments during the early 1980s. While the prevalence of HIV is still slightly higher in men who have sex with men (MSM), it exists in all populations. Efforts to encourage safe sex and increase screening have helped to slow the epidemic of HIV, as has increased awareness of those with HIV/AIDS with projects like the AIDS Memorial Quilt, shown in Figure 11.6. Within the healthcare system, lesbians receive less screening for cervical cancer and may not be screened for other sexually transmitted infections. Transgender individuals have multiple areas of increased risk, including off-label or unsupervised use of “street hormones” without proper counseling on their side effects.

Figure 11.6. The AIDS Memorial Quilt

Mental health disparities are also common in the LGBT community. LGBT youth are at significantly higher risk for bullying, victimization, and violence, and have higher rates of suicide. In adults, the LGBT population has a higher prevalence of depression and anxiety than their heterosexual counterparts; gay men have an increased rate of eating disorders as compared to heterosexual men. A host of campaigns and outreach efforts have begun to target these disparities.

Immigration Status

According to the US Census Bureau, the nation’s total recent immigrant population is growing rapidly; it was quantified at 40.4 million in 2011 and is expected to increase by roughly 20 million in the next two decades. This tells us that immigrants, whether documented or undocumented, are interwoven into every social structure and institution in the United States. The nativity of immigrant populations changes over time; in the most recent census, the largest proportions of immigrants had emigrated from Mexico, the Caribbean, and India. Generational status refers to the place of birth of a specific person or that person's parents. For instance, first generation refers to someone who is born outside of their place of residence. Second generation refers to a person that has at least one parent that is foreign-born.

Considering the number of immigrants, there are often barriers that affect interactions with social structures and institutions. The complex organization of the United States healthcare system is starkly different from those of most other nations, and this may present a barrier to understanding for immigrants. Language barriers may also make it difficult for immigrants to access healthcare or to take control of their healthcare decisions; telephone translation services have been created to help facilitate the conversation between clinician and patient. Racial and ethnic identity may be more pronounced in first-generation immigrants, and the same biases and prejudices against certain racial and ethnic minorities might be compounded by the individual’s immigrant status; this interplay between multiple demographic factors—especially when it leads to discrimination or oppression—is termed intersectionality. Finally, undocumented status presents a major barrier for many immigrants to access healthcare for fear of reporting and deportation.

DEMOGRAPHIC SHIFTS AND SOCIAL CHANGE

Since 1950, the United States population has roughly doubled. In addition to increasing in size, the makeup of the American population has changed significantly. The average age in the United States has increased, and the population is continuing to become more racially and ethnically diverse. These are examples of demographic shifts: changes in the makeup of a population over time. These shifts can be measured by considering the population density, which counts the number of people per square kilometer of land area.

Population projections attempt to predict changes in population size over time, and can be assisted by historical measures of growth, understanding of changes in social structure, and analysis of other demographic information. To aid in the construction of population projections, population pyramids provide a histogram of the population size of various age cohorts, as shown in Figure 11.7.

Figure 11.7 U.S. Population Pyramid, 2014 Surplus occurs when one sex has a larger population than the other.

Fertility, Mortality, and Migration

The increased population of the United States is due to a number of factors that center around fertility, mortality, and migration. Fertility rate refers to the average number of children born to a woman during her lifetime in a population. In many parts of the world, fertility rate is the primary driver of population expansion; for example, in many parts of Africa, the average fertility rate is between four and eight children per woman, as seen in Figure 11.8. In the United States, fertility rates have trended downward over time; in 2013, the rate was still above two, indicating that fertility rates were still contributing to population growth.

Figure 11.8 Fertility Rates around the World, 2013 Based on data from the CIA World Factbook; measured in children born per woman in the population

Key Concept

Demographic statistics:

· Fertility rate = children per woman per lifetime

· Birth rate = children per 1000 people per year

· Mortality rate = deaths per 1000 people per year

· Migration rate = immigration rate minus emigration rate

Mortality rates refer to the number of deaths in a population per unit time. Usually, this rate is measured in deaths per 1000 people per year. With advancements in healthcare and access, the mortality rate in the United States has dropped significantly over the past century. However, mortality rates are a significant brake on population growth in many parts of the world, as demonstrated in Figure 11.9. The decreased mortality rate in the United States is one contributor to the increase in average age of the population, as is a decreased fertility rate. In addition, the aging of the Baby Boomer generation, one of the largest generations in United States history, increases this average age. Both birth and mortality rates can be reported in multiple forms: the total rate for a population, the crude rate (adjusted to a certain population size over a specific period of time and multiplied by a constant to give a whole number), or age-specific rates.

Figure 11.9. Mortality Rates around the World, 2009Based on data from the CIA World Factbook; measured in deaths per 1000 individuals per year.

Finally, migration is a contributor to population growth. Immigration is defined as movement into a new geographic space, whereas emigration is movement away from a geographic space. As described earlier, the United States continues to have larger net immigration than emigration, driving an increase in the population size. Immigration also increases the racial and ethnic diversity of the United States, as do increased mobility within the country and increases in intermarriage between different races and ethnicities. Migration can be motivated by both pull factors, which are positive attributes of the new location that attract the immigrant, and push factors, which are negative attributes of the old location that encourage the immigrant to leave.

Key Concept

The United States population is getting bigger, older (average age has increased), and more diverse (through immigration, mobility, and intermarriage).

Demographic Transition Theory

While demographic shift refers to general changes in population makeup over time, demographic transition is a specific example of a demographic shift that occurs as a country as the country develops from a preindustrial to an industrial economic system. Demographic transition has been seen in the United States since the Industrial Revolution and is currently occurring in many developing countries. Demographic transition theory explains this link between economic development and demographic shift in four stages:

· Stage 1: Preindustrial society; birth and death rates are both high, resulting in a stable population.

· Stage 2: Economic progress leads to improvements to healthcare, nutrition, sanitation, and wages, causing a decrease in death rates. Thus, total population increases.

· Stage 3: Improvements in contraception, women’s rights, and a shift from an agricultural to an industrial economy cause birth rates to drop. For example, with an industrializing society, children must go to school for many years to be productive in society and may need to be supported by parents for a longer period of time than was formerly the case. Thus families have fewer children, and birth rates drop. As birth and death rates equalize, population growth hits an inflection point and begins to level off.

· Stage 4: An industrialized society; birth and death rates are both low, resulting in a relative constant total population.

A model of demographic transition can be seen in Figure 11.10.

Figure 11.10. Demographic Transition

Recently, sociologists have described a fifth stage of demographic transition theory in which birth rates continue to drop and fall below the death rate, resulting in a decline of total population. Japan and Germany are currently experiencing demographic shifts expected in this theorized fifth stage.

Key Concept

During demographic transition, mortality rate drops before birth rate. Therefore, the population grows at first while mortality rate is dropping, and then plateaus as the birth rate decreases as well.

Malthusian theory focuses on how the exponential growth of a population can outpace growth of the food supply and lead to social degradation and disorder. For example, some theorists predict that demographic transition among third-world nations might cause growth in the world's population to outpace the world's ability to generate food. The resulting hypothetical mass starvation is called the Malthusian catastrophe. This result is similar to the death phase of bacterial growth, when resources in the environment have been depleted, as described in Chapter 1 of MCAT Biology Review.

Social Movements

Social movements are organized either to promote or to resist social change. These movements are often motivated by a group's perceived relative deprivation, which is a decrease in resources, representation, or agency relative to the whole of society, or relative to what the group is accustomed to from the past. Social movements that promote social change are termed proactive; those that resist social change are reactive. Members of social movements work to correct what they perceive as social injustices. Some examples of proactive movements include the civil rights movement, women’s rights movement, gay rights movement, animal rights movement, and environmentalism movement. Some examples of reactive movements include the white supremacist movement, counterculture movement, antiglobalization movement, and anti-immigration movement. To further their goals, social movements may establish coordinated organizations. For example, some organizations associated with the proactive movements above include the National Association for the Advancement of Colored People (NAACP), American Civil Liberties Union (ACLU), Human Rights Campaign (HRC), Humane Society, and Greenpeace. Social movements may also seek to share their message through the media and demonstrations. Political involvement is also common through lobbying and donations.

Globalization

Globalization is the process of merging of the separate nations of the world into a single sociocultural entity, and is a relatively recent phenomenon spurred on by improvements in global communication technology and economic interdependence. Globalization leads to a decrease in the geographical constraints on social and cultural exchanges and can lead to both positive and negative effects. For example, the availability of foods (especially produce) from around the world during the entire calendar year can only be accomplished through trade with an extremely large number of world markets. However, significant worldwide unemployment, rising prices, increased pollution, civil unrest (particularly in unindustrialized or undemocratic nations), and global terrorism are negative effects of globalization.

Traditionally, the health sector has been organized at the national, state, or local level, but this is beginning to change. Groups such as the World Health Organization (WHO), the American Red Cross, and Doctors Without Borders supply aid to populations in need around the globe. Many medical schools are also increasing opportunities for medical students to complete rotations in other countries.

Urbanization

Urbanization refers to dense areas of population creating a pull for migration. In other words, cities are formed as individuals move into and establish residency in these new urban centers. Urbanization is not a new phenomenon; ancient populations established cities in Jerusalem, Athens, Timbuktu, and other locations. The economic opportunities offered in cities and creation of a large number of “world cities” has fueled an increase in urbanization during the last few decades. Currently, more than half of the world’s populations live in what are considered urban areas. Sociologists and other professionals have found links between urban societies and health challenges related to water sanitation, air quality, environmental hazards, violence and injuries, infectious diseases, unhealthy diets, and physical inactivity.

Cities are rarely homogenous with respect to their population makeup. Most cities have areas that are more socioeconomically well-off and others that are more impoverished. Ghettoes are defined as areas where specific racial, ethnic, or religious minorities are concentrated, usually due to social or economic inequities. In the most extreme cases, slums may be formed. A slum, as shown in Figure 11.11, is an extremely densely populated area of a city with low-quality, often informal housing and poor sanitation.

Figure 11.11. Slum in Jakarta, Indonesia

MCAT Concept Check 11.3:

Before you move on, assess your understanding of the material with these questions.

1. What is the difference between race and ethnicity?

2. What is symbolic ethnicity?

3. Define the following demographic statistics:

o Fertility rate:

o Birth rate:

o Mortality rate:

4. During demographic transition, what happens to the mortality rate? To the birth rate?

o Mortality rate:

o Birth rate:

5. What are the two types of social movements? How do they differ?

o

o