Social Structure and Demographics
There are three major trends that are changing our nation’s healthcare needs and our patient population. First, the increased diversity in the American population as a whole (from immigration, increased social and academic mobility, and interconnectedness through technology) puts us in front of patients whose thoughts and beliefs about health and well-being may be starkly different from our own. Second, increased access to healthcare through reform legislation has allowed millions of Americans to reach providers for the first time. Finally, our successes in medicine and public health have increased survival rates of many formerly fatal conditions and have enabled us to live longer. This leaves us with an aging population, in which individuals may be coping with multiple illnesses simultaneously.
To arm physicians of the future with the skills needed to take care of this population, many medical schools are increasing their coursework in interpersonal skills (Doctor—Patient Relationship; Doctoring; or Physician, Patient, and Society are such courses at various schools), as well as cultural sensitivity, the recognition and respect of differences between cultures, and research ethics. This is part of the biopsychosocial model of medicine described in Chapter 7 of MCAT Behavioral Sciences Review. Knowledge of the structure of society and how it shifts over time, as explained in this chapter, will enhance your ability to counsel patients. Unlike the old model of doctor knows best (often referred to as the paternalistic approach to medicine), today’s doctors must work together with patients to find solutions to their health problems. By working with patients on their own terms, you will be able to help maintain and improve their health status and begin to correct the health inequities that exist in today’s population. In the next chapter—the last of MCAT Behavioral Sciences Review—we will explore these inequities in resources, health status, and healthcare.
Sociology: Theories and Institutions
· Theoretical approaches provide frameworks for the interactions we observe within society.
o Functionalism focuses on the function of each component of society and how those components fit together. Manifest functions are deliberate actions that serve to help a given system; latent functions are unexpected, unintended, or unrecognized positive consequences of manifest functions.
o Conflict theory focuses on how power differentials are created and how these differentials contribute to the maintenance of social order.
o Symbolic interactionism is the study of the ways individuals interact through a shared understanding of words, gestures, and other symbols.
o Social constructionism explores the ways in which individuals and groups make decisions to agree upon a given social reality.
o Rational choice theory states that individuals will make decisions that maximize potential benefit and minimize potential harm; exchange theory applies rational choice theory within social groups.
o Feminist theory explores the ways in which one gender can be subordinated, minimized, or devalued compared to the other.
· Social institutions are well-established social structures that dictate certain patterns of behavior or relationships and are accepted as a fundamental part of culture. Common social institutions include the family, education, religion, government and the economy, and health and medicine.
· There are four key ethical tenets of American medicine.
o Beneficence refers to acting in the patient’s best interest.
o Nonmaleficence refers to avoiding treatments for which risk is larger than benefit.
o Respect for autonomy refers to respecting patients’ rights to make decisions about their own healthcare.
o Justice refers to treating similar patients similarly and distributing healthcare resources fairly.
· Culture encompasses the lifestyle of a group of people and includes both material and symbolic elements.
o Material culture includes the physical items one associates with a given group, such as artwork, emblems, clothing, jewelry, foods, buildings, and tools.
o Symbolic culture includes the ideas associated with a cultural group.
· Cultural lag refers to the idea that material culture changes more quickly than symbolic culture.
· A cultural barrier is a social difference that impedes interaction.
· Language consists of spoken or written symbols combined into a system and governed by rules.
· A value is what a person deems important in life.
· A belief is something a person considers to be true.
· A ritual is a formalized ceremonial behavior in which members of a group or community regularly engage. It is governed by specific rules, including appropriate behavior and a predetermined order of events.
· Norms are societal rules that define the boundaries of acceptable behavior.
· There is evidence that culture flows from evolutionary principles, and that culture can also influence evolution.
· Demographics refer to the statistics of populations and are the mathematical applications of sociology. One can analyze hundreds of demographic variables; some of the most common are age, gender, race and ethnicity, sexual orientation, and immigration status.
o Ageism is prejudice or discrimination on the basis of a person’s age.
o Gender is the set of behavioral, cultural, or psychological traits typically associated with a biological sex. Gender inequality is the intentional or unintentional empowerment of one gender to the detriment of the other.
o Race is a social construct based on phenotypic differences between groups of people; these may be either real or perceived differences.
o Ethnicity is also a social construct that sorts people by cultural factors, including language, nationality, religion, and other factors. Symbolic ethnicity is recognition of an ethnic identity that is only relevant on special occasions or in specific circumstances and does not specifically impact everyday life.
o Sexual orientation can be defined by one’s sexual interest toward members of the same, opposite, or both sexes.
o Immigration is the movement into a new geographic area. Emigration is the movement away from a geographic area.
· A fertility rate is the average number of children born to a woman during her lifetime in a population. A birth rate is relative to a population size over time, usually measured as the number of births per 1000 people per year.
· A mortality rate is the average number of deaths per population size over time, usually measured as the number of deaths per 1000 people per year.
· Migration refers to the movement of people from one geographic location to another.
· Demographic transition is a model used to represent drops in birth and death rates as a result of industrialization.
· Social movements are organized to either promote (proactive) or resist (reactive) social change.
· Globalization is the process of integrating a global economy with free trade and tapping of foreign labor markets.
· Urbanization refers to the process of dense areas of population creating a pull for migration or, in other words, creating cities.
Answers to Concept Checks
1. Manifest functions are actions that are intended to help some part of a system. Latent functions are unintended, unstated, or unrecognized positive consequences of these actions on society.
Primary Thesis or Idea
Each part of society serves a function; when these functions work together correctly, society overall can function normally
Power differentials are created when groups compete for economic, social, and political resources; these differentials contribute to the maintenance of social order
Humans communicate through words, gestures, and other symbols to which we attach meaning
Individuals and groups make decisions to agree upon a given social reality
Rational choice theory
Individuals will make decisions that maximize potential benefit and minimize potential harm
Explores the ways in which one gender can be subordinated, minimized, or devalued compared to the other
Act in the patient’s best interest
Do no harm; avoid interventions where the potential for harm outweighs the potential for benefit
Respect for autonomy
Respect patients’ decisions and choices about their own healthcare
Treat similar patients with similar care; distribute healthcare resources fairly
1. Material culture focuses on the artifacts associated with a group: the physical objects, such as artwork, emblems, clothing, jewelry, foods, buildings, and tools. Symbolic culture focuses on the ideas and principles that belong to a particular group.
2. A value is what a person deems to be important; a belief is what a person deems to be true. While these terms are often used interchangeably in everyday life, they have specific definitions in the social sciences.
1. Race is based on phenotypic differences between groups of people. Ethnicity is based on common language, religion, nationality, or other cultural factors.
2. Symbolic ethnicity is recognition of an ethnic identity on special occasions or in specific circumstances, but not during everyday life.
3. Fertility rate is the average number of children a woman has during her lifetime in a population. Birth rate is the number of births in a population per unit time, usually measured as births per 1000 people per year. Mortality rate is the number of deaths in a population per unit time, usually measured as deaths per 1000 people per year.
4. During demographic transition, both the mortality and birth rate decrease.
5. Proactive social movements are in favor of a specific social change. Reactive social movements run against a specific social change.
· Behavioral Sciences Chapter 6
o Identity and Personality
· Behavioral Sciences Chapter 8
o Social Processes, Attitudes, and Behavior
· Behavioral Sciences Chapter 9
o Social Interaction
· Behavioral Sciences Chapter 10
o Social Thinking
· Behavioral Sciences Chapter 12
o Social Stratification
· Biology Chapter 12
o Genetics and Evolution
Discrete Practice Questions
1. Which of the following best describes a manifest function?
1. An intended positive effect on a system
2. An intended negative effect on a system
3. An unintended positive effect on a system
4. An unintended negative effect on a system
2. Studying why a nod means “yes” in many cultures is most representative of which of the following sociological concepts?
1. Demographic transition
2. Expectancy theory
3. Symbolic interactionism
4. Demographic shift
3. Which of the following ethical principles states that physicians should avoid using treatments with greater potential for harm than benefit?
4. A Cuban-American man living in the United States has the dominant physical features of a black man. He speaks Spanish, prefers Latin foods, and listens to Latin music. His preferences are best defined through which of the following attributes?
4. I only
5. II only
6. II and III only
7. I, II, and III
5. A patient who resides in the United States says, “I love you,” and hugs his doctor after every routine visit. This behavior violates:
1. personal beliefs.
2. patient autonomy.
3. social values.
4. social norms.
6. Which of the following demographics can be measured in events per 1000 people per year?
1. Birth rate
2. Fertility rate
3. Mortality rate
4. I only
5. I and III only
6. II and III only
7. I, II, and III
7. Because there are more than 500 Native American tribes, there are several different healing practices among them. Some tribes may have ceremonies that include chanting, singing, body painting, dancing, and even use of mind-altering substances to persuade the spirits to heal the sick person. These ceremonies are examples of:
1. latent functions.
3. cultural barriers.
4. social movements.
8. Over the last few decades, the United States population has become:
1. bigger, older, and more diverse.
2. bigger, younger, and more diverse.
3. smaller, older, and less diverse.
4. smaller, older, and more diverse.
9. Which of the following is NOT an example of material culture?
1. Traditional African clothing
2. Japanese cuisine
3. American values
4. Native American sand paintings
10. During which stage of demographic transition are both birth rates and mortality rates low?
1. Stage 1
2. Stage 2
3. Stage 3
4. Stage 4
11. Shortly after a state legalizes gambling in casinos, a formal coalition forms to oppose the building of any casinos in the major cities of the state. This scenario includes:
1. conflict theory.
2. social institutions.
3. a social movement.
4. I only
5. I and III only
6. II and III only
7. I, II, and III
12. A young adult male claims to have had sexual relationships mostly with other men, although he has been attracted to women at times. What would be his most likely score on the Kinsey scale?
13. Which of the following demographic variables is known to be biologically determined?
4. Sexual orientation
14. Which of the following would contribute to increasing population growth over time?
1. A fertility rate less than 2
2. An immigration rate larger than emigration rate
3. An increase in mortality rate
4. A decrease in birth rate
15. Urbanization can cause all of the following negative effects EXCEPT:
1. decreased opportunity for social interaction.
2. increased transmission of infectious disease.
3. decreased air quality and sanitation.
4. increased rates of violent crime.
Discrete Practice Answers
1. AA manifest function is an intended positive effect on a system. A latent function is an unintended positive effect on a system, (C). A negative effect on a system, (B) and (D), is termed a dysfunction.
2. CSymbolic interactionism studies how individuals interact through a shared understanding of words, gestures, and other symbols. A nod is thus a symbol in many cultures that signifies “yes.”
3. DThe principle of nonmaleficence states that physicians must not only act in their patient’s best interest (beneficence, (B)), but must also avoid treatments where the potential for harm outweighs the potential for benefit.
4. CAlthough one’s dominant physical features are associated with race, this man’s preferences are those of Latino ethnicity and culture. Ethnicity is a social construct that considers language, religion, nationality, and cultural factors. Culture relates to a group’s way of life; the preferences listed in the question are examples of material and symbolic culture.
5. DIn the United States, it is not a common practice to say, “I love you,” and hug one’s physician after each routine checkup; therefore, this behavior could be considered deviant, going against the social norm. Values, (C), are what an individual deems to be important.
6. BBoth birth rate and mortality rate can be measured per 1000 people per year. Fertility rate is measured in number of children per woman during her lifetime.
7. BRituals are formalized ceremonial behaviors in which members of a group or community regularly engage. Therefore, these activities are examples of rituals performed for healing.
8. AWith a decrease in mortality rate and a higher immigration rate than emigration rate, the United States population continues to grow, with an increasing average age and increasing racial and ethnic diversity.
9. CMaterial culture includes any cultural artifact—objects to which we assign meaning. Values are ideas, which are associated with symbolic culture.
10. DDuring demographic transition, both birth rates and mortality rates are high in stage 1, (A). Mortality rates drop during stage 2, (B), and then birth rates drop during stage 3, (C). In stage 4, both birth rates and mortality rates are low.
11. DIn this scenario, a group is fighting for social power, which is an aspect of conflict theory. Further, this group is an example of a reactive social movement because it is running counter to social change. The fact that gambling had been legalized implies the involvement of the government, a social institution.
12. CThis man is describing his sexuality as mostly homosexual, although he has also had some heterosexual attractions. The Kinsey scale scores a 6, (D), as exclusively homosexual. A score of 3 would equate to bisexuality. Thus, this man would likely score a 4 or 5.
13. BSex is determined by one’s genotype, and therefore is biologically determined. Gender, (A), may or may not match biological sex and therefore is not biologically determined. Ethnicity, (C), is a social construct that sorts people by cultural factors, and therefore is not biologically determined. Sexual orientation, (D), may have some biological component, but the relative role of biology and environment is not yet known.
14. BIf the immigration rate in a geographic area is larger than the emigration rate, then there is a larger influx than efflux of people. This will increase the population of that area.
15. AUrbanization is the migration of people into urban centers to create cities. The increased population density should provide additional opportunities for social interaction, not decreased opportunities.
Consult your online resources for additional practice.