Past Podcasts

2014 Health & the Public: Medicine and Disease in Social Context

 

Here we provide links to lecture videos from last year are available. The lectures for 2014 are keyed to the syllabus for 2014.

 

COURSE INTRODUCTION

We will briefly review the burden of illness and death in the USA, touching on the costs, family effects, and implications for people’s well-being.  We will also review the leading causes of death and how they vary by certain socio-demographic attributes.  We will note geographic variation in illness and mortality and also the relevance of circumstances of birth, (including in utero exposures, birthweight, birth order, parental occupation, etc.) to lifelong health.  In short, we will introduce the basic biosocial facts to be explored in the course.  And we will introduce the tension between individualistic and collective perspectives on medical care.  We will in particular consider the case of suicide and the extent to which it reflects individual decision-making or collective constraints.

Lecture 1: Course Introduction

WHAT MEDICAL CARE HAS AND HAS NOT ACHIEVED

What are the benefits of medical care?  How much do doctors actually help people?  What are the relative roles of curative and preventative maneuvers in the health of the public?  On the population level, what have been the benefits of “big medicine”?  We will consider how the nature of illness and death has changed over the last century in the U.S., as part of the “health transition.”  And we will introduce some ways of defining and measuring health other than mortality, including morbidity, physical functioning, quality of life, and “utility.”  We will also begin to consider the major determinants of health at the population level.

 

Lecture 2: The Health Transition

 

Lecture 3: The Role of Medical Care

THE SOCIAL DISTRIBUTION OF ILLNESS

We will examine how disease and survival are distributed by basic socioeconomic variables.  What is the role of sex, race, ethnicity, education, income, marital status, and other social variables in patient preferences, patient risks, patient care, and health outcomes?  What are the methodological challenges of demonstrating and interpreting differences and inequalities in health outcomes and care?  How do we distinguish the problem of unequal outcomes from that of unequal treatment, and what is the ethical implication of this difference?

 

Lecture 4: Socioeconomic Status and Health

 

Lecture 5: Unequal Treatment and Unequal Outcomes with Respect to Race and Ethnicity

THE SOCIAL CONSTRUCTION OF ILLNESS AND MEDICINE

How are the seemingly objective, natural or scientific concepts of “body,” “illness,” or “treatment” influenced and determined by social phenomena and the medical system itself?  How does the way people come to view the world have concrete and measurable effects on their health?  How do people cognitively construct medically relevant concepts, such as diagnostic categories, and how do these constructions in turn influence medical care and human experience?  We will consider diverse examples, ranging from childbirth to plastic surgery to mental illness to cardiac care.

 

Lecture 6: The Social Construction of Illness and Medicine

DEATH AND DYING

We will explore the nature of dying in the U.S. and what might be done to improve end-of-life care.  We will consider the nature of a good death, how death affects family members, and where death occurs.  We will examine how social policy or clinical arrangements (e.g., with respect to hospice care) affect the experience of dying.  We will discuss the role of physician decision-making and begin to consider the process by which physicians are socialized to their role as doctors.

Lecture 7: The Nature of Dying in the U.S.

Lecture 8: Prognostication and Euthanasia

IATROGENESIS AND MEDICAL ERROR

How common and serious are medical errors?  What is the difference between harm, error, and maloccurrence?  What is a “therapeutic misadventure”?  How do physicians cope with the inevitability of mistakes and harm?  In what ways is “iatrogenesis” (doctor-caused injury) a widespread socio-medical phenomenon?  Why does harm occur and what, if anything, can be done about it?  What ethical and policy issues are raised by medical mistakes?

Lecture 9: Iatrogenesis and Medical Error

HEALTH BEHAVIORS

How do individuals’ choices and behaviors affect individuals’ health risks and health status?  We will consider a range of health-related behaviors that are socially patterned and that can have substantial effects on both individual and population health. We will also explore the role of broader social policies and environmental effects on individual outcomes.

Lecture 10: Obesity and Exercise

Lecture 11: Alcohol, Tobacco, and Firearms

RELIGION AND HEALTH

Religion has numerous instrumental and symbolic effects on physical and mental health, and numerous aspects of religion may be relevant, from affiliation to religiosity to observance.  Religious sentiments are also highly relevant to people’s choices regarding their own care, and their attitudes regarding medical advances.

Lecture 12: Religion and Health

 

INEQUALITY, SOCIAL HIERARCHY, STRESS, AND SOCIAL SUPPORT

 

What do baboons in the Serengeti, civil servants in London, and actors in Hollywood have in common? How does relative position, and not just absolute position, matter to health?  How can social structure be stressful?  How can it be salubrious?  What are the health consequences of stress and how might an individual’s social support buffer the adverse effect of stress on health?

 

Social Inequality and Individual Health

Lecture 13

 

 

Stress, Status, and Social Hierarchy

Lecture 14

 

 

Social Support and the Health Benefits of Relationships

Lecture 15

 

 

HEALTH AND SOCIAL NETWORKS

 

Can there be a non-biological transmission of disease?  How does the health care delivered to one person affect the health of others?  Does treating depression in parents prevent asthma in their children?  Does weight gain or seatbelt use or drinking by those close to you directly affect your health?  We will examine the difference between social support (measured at the individual level) and social networks (construed at the group level); and we will consider how illness and health-related phenomena (ranging from sexual practices to smoking to obesity to emotions) might spread within a social network and result in positive and negative “externalities.”  We will explore the evolutionary significance and biological basis for social network structure and function.  We will consider very new work involving interventions in online and offline networks to improve health, including a variety of experiments in this area.  We will also evaluate some of the ethical implications of using network methods to target interventions.  And we will introduce the idea of computational social science and of big data.

 

Social Network Function

Lecture 16

 

Social Network Structure

Lecture 17

 

Social Network Interventions

Lecture 18

 

SOCIAL CAPITAL

 

We will examine the very important concept of “social capital,” first advanced by Coleman in 1988, and also the nature of “emergent” properties of social systems.  How and why do groups of people come to have properties that do not inhere in the individuals themselves?  And to what productive ends, both good and bad, might social capital be put — by individuals and by policymakers?

 

Social Capital

Lecture 19

 

NEIGHBORHOOD EFFECTS ON HEALTH

 

We will consider how neighborhoods, as a particular form of collective social structure, may influence individual health.  We will examine how local social capital and collective efficacy play a role in health.  And we will examine how local physical infrastructure and medical resources affect health.  In the process, we will examine geographic variation in a large variety of seemingly objective medical procedures, including the striking differences in care at the end of life and the widely varying patterns of elective surgery across the U.S.  And we will consider the phenomenon of “physician-induced demand” for medical care.

 

Neighborhood Effects on Health

Lecture 20

 

BEHAVIOR GENETICS, GENE-ENVIRONMENT INTERACTIONS, AND SOCIAL EPIGENETICS

 

We will consider the cutting-edge field of biosocial science and in particular focus on the ways in which our genes are in conversation with our social environment.  To what extent does our genetic makeup influence our behaviors?  To what extent do our genes increase or decrease our risk for illness given particular environmental exposures?  What are the biological bases of resilience?  And how does the social environment come to regulate our genome?  How do social exposures “get under our skin”? How are they literally embodied?

 

Behavior Genetics, Gene-Environment Interactions, and Social Epigenetics

Lecture 21

 

PUBLIC POLICY AND HEALTH AND HEALTH CARE

 

We will examine some macro and micro public policies that can affect individual and public health. As a powerful illustration, we will examine how society might respond to the emergence of new bio-technologies that promise to provide “super-human” enhancements to the human body, and we will consider moral aspects of these developments as well as how society might regulate them.  We will also consider the implications of lack of insurance for the health of over 46,000,000 Americans, a number slated to substantially decrease with the implementation of recent health reform legislation.  We will close with a consideration of some illustrative individual, local, and national efforts to improve the health of the public, and with a recapitulation of the fundamental tension between individual and collective perspectives on health and health care.  And we will discuss what a new era of “big data” can offer public policy as it relates to health and health care.

 

Social Control of Individual Use of New Biotechnologies

Lecture 22

 

A Selection of Policy Interventions

Lecture 23

 

Public Health and Individual Experience

Lecture 24

 

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2013 Life & Death in the USA: Medicine and Disease in Social Context

 

Here we provide links to last year’s lecture videos for Sociology 126 (when it was taught at Harvard as Sociology 190).  The lectures for 2013 are keyed to the syllabus for 2013.

 

COURSE INTRODUCTION

 

We will briefly review the burden of illness and death in the USA, touching on the costs, family effects, and implications for people’s well-being.  We will also review the leading causes of death and how they vary by certain socio-demographic attributes.  We will note geographic variation in illness and mortality and also the relevance of circumstances of birth, (including in utero exposures, birthweight, birth order, parental occupation, etc.) to lifelong health.  In short, we will introduce the basic biosocial facts to be explored in the course.  And we will introduce the tension between individualistic and collective perspectives on medical care.  We will in particular consider the case of suicide and the extent to which it reflects individual decision-making or collective constraints.

 

Course Introduction

Lecture 1

 

 

WHAT MEDICAL CARE HAS AND HAS NOT ACHIEVED

 

What are the benefits of medical care?  How much do doctors actually help people?  What are the relative roles of curative and preventative maneuvers in the health of the public?  On the population level, what have been the benefits of “big medicine”?  We will consider how the nature of illness and death has changed over the last century in the U.S., as part of the “health transition.”  And we will introduce some ways of defining and measuring health other than mortality, including morbidity, physical functioning, quality of life, and “utility.”

 

The Health Transition

Lecture 2

 

 

The Role of Medical Care

Lecture 3

 

 

THE SOCIAL DISTRIBUTION OF ILLNESS

 

We will examine how disease and survival are distributed by basic socioeconomic variables.  What is the role of sex, race, ethnicity, education, income, marital status, and other social variables in patient preferences, patient risks, patient care, and health outcomes?  What are the methodological challenges of demonstrating and interpreting differences and inequalities in health outcomes and care?  How do we distinguish the problem of unequal outcomes from that of unequal treatment, and what is the ethical implication of this difference?

 

Socioeconomic Status and Health

Lecture 4

 

 

Unequal Treatment and Unequal Outcomes with Respect to Race and Ethnicity

Lecture 5

 

 

THE SOCIAL CONSTRUCTION OF ILLNESS AND MEDICINE

 

How are the seemingly objective, natural or scientific concepts of “body,” “illness,” or “treatment” influenced and determined by social phenomena and the medical system itself?  How does the way people come to view the world have concrete and measurable effects on their health?  How do people cognitively construct medically relevant concepts, such as diagnostic categories, and how do these constructions in turn influence medical care and human experience?  We will consider diverse examples, ranging from childbirth to plastic surgery to mental illness to cardiac care.

 

The Social Construction of Illness and Medicine

Lecture 6

 

 

DEATH AND DYING

 

We will explore the nature of dying in the U.S. and what might be done to improve end-of-life care.  We will consider the nature of a good death, how death affects family members, and where death occurs.  We will examine how social policy or clinical arrangements (e.g., with respect to hospice care) affect the experience of dying.  We will discuss the role of physician decision-making and begin to consider the process by which physicians are socialized to their role as doctors.

 

Death and Dying

Lecture 7

 

 

IATROGENESIS AND MEDICAL ERROR

 

How common and serious are medical errors?  What is the difference between harm, error, and maloccurrence?  How do physicians cope with the inevitability of mistakes and harm?  In what ways is “iatrogenesis” (doctor-caused injury) a widespread socio-medical phenomenon?  Why does harm occur and what, if anything, can be done about it?  What ethical and policy issues are raised by medical mistakes?

 

Death and Dying

Lecture 8

 

 

HEALTH BEHAVIORS

 

How do individuals’ choices and behaviors affect individuals’ health risks and health status?  We will consider a range of health-related behaviors that are socially patterned and that can have substantial effects on both individual and population health. We will also explore the role of broader social policies and environmental effects on individual outcomes.

 

Obesity and Exercise

Lecture 9

 

 

Alcohol, Tobacco, and Firearms

Lecture 10

 

 

RELIGION AND HEALTH

 

Religion has numerous instrumental and symbolic effects on physical and mental health, and numerous aspects of religion may be relevant, from affiliation to religiosity to observance.  Religious sentiments are also highly relevant to people’s choices regarding their own care, and their attitudes regarding medical advances.

 

Religion and Health

Lecture 11

 

 

INEQUALITY, SOCIAL HIERARCHY, STRESS, AND SOCIAL SUPPORT

 

What do baboons in the Serengeti, civil servants in London, and actors in Hollywood have in common? How does relative position, and not just absolute position, matter to health?  How can social structure be stressful?  How can it be salubrious?  What are the health consequences of stress and how might an individual’s social support buffer the adverse effect of stress on health?

 

Social Inequality and Individual Health

Lecture 12

 

 

Stress, Status, and Social Hierarchy

Lecture 13

 

 

Social Support and the Health Benefits of Relationships

Lecture 14

 

 

HEALTH AND SOCIAL NETWORKS

 

Can there be a non-biological transmission of disease?  How does the health care delivered to one person affect the health of others?  Does treating depression in parents prevent asthma in their children?  Does weight gain or seatbelt use or drinking by those close to you directly affect your health?  We will examine the difference between social support (measured at the individual level) and social networks (construed at the group level); and we will consider how illness and health-related phenomena (ranging from sexual practices to smoking to obesity to emotions) might spread within a social network and result in positive and negative “externalities.”  We will explore the evolutionary significance and biological basis for social network structure and function.  We will consider very new work involving interventions in online and offline networks to improve health.  We will also evaluate some of the ethical implications of using network methods to target interventions.  And we will introduce the idea of computational social science.

 

Social Network Function

Lecture 15

 

 

Social Network Structure

Lecture 16

 

 

Social Network Interventions

Lecture 17

 

 

SOCIAL CAPITAL

 

We will examine the very important concept of “social capital,” first advanced by Coleman in 1988, and also the nature of “emergent” properties of social systems.  How and why do groups of people come to have properties that do not inhere in the individuals themselves?  And to what productive ends, both good and bad, might social capital be put — by individuals and by policymakers?

 

Social Capital

Lecture 18

 

 

NEIGHBORHOOD EFFECTS ON HEALTH

 

We will consider how neighborhoods, as a particular form of collective social structure, may influence individual health.  We will examine how local social capital and collective efficacy play a role in health.  And we will examine how local physical infrastructure and medical resources affect health.  In the process, we will examine geographic variation in a large variety of seemingly objective medical procedures, including the striking differences in care at the end of life and the wide-varying patterns of elective surgery across the U.S.  And we will consider the phenomenon of “physician-induced demand” for medical care.

 

Neighborhood Effects on Health

Lecture 19

 

 

BEHAVIOR GENETICS, GENE-ENVIRONMENT INTERACTIONS, AND SOCIAL EPIGENETICS

 

We will consider the cutting-edge field of biosocial science and in particular focus on the ways in which our genes are in conversation with our social environment.  To what extent does our genetic makeup influence our behaviors?  To what extent do our genes increase or decrease our risk for illness given particular environmental exposures?  What are the biological bases of resilience?  And how does the social environment come to regulate our genome?  How do social exposures “get under our skin”? How are they literally embodied?

 

Behavior Genetics, Gene-Environment Interactions, and Social Epigenetics

Lecture 20

 

 

PUBLIC POLICY AND HEALTH AND HEALTH CARE

 

We will examine some macro and micro public policies that can affect individual and public health. As a powerful illustration, we will examine how society might respond to the emergence of new bio-technologies that promise to provide “super-human” enhancements to the human body, and we will consider moral aspects of these developments as well as how society might regulate them.  We will also consider the implications of lack of insurance for the health of over 46,000,000 Americans, a number slated to substantially decrease with the implementation of recent health reform legislation.  We will close with a consideration of some illustrative individual, local, and national efforts to improve the health of the public, and with a recapitulation of the fundamental tension between individual and collective perspectives on health and health care.

 

Social Control of Individual Use of New Biotechnologies

Lecture 21

 

 

Access to Health Care and Health Insurance, and a Selection of Policy Interventions

Lecture 22

 

 

Public Health and Individual Experience

Lecture 23

 

 

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