HSC210 Health Sociology: Hierarchy and Power in Health Care

Hierarchy and power are intrinsic to the current health care system in Australia. Discuss this statement by drawing on sociological theories and concepts. Discuss how this may impact on you as a health practitioner.

Answer:

Introduction

Hierarchy and power are two concepts which greatly affect various fields across almost all countries. In this particular discussion, we will take Australian health care system into consideration. Further, to have a clear understanding of the same, we will discuss few key concepts of sociology and its perspectives, biomedical model of health, discussion about our two key concepts namely hierarchy and power, there definition and theories related to same and at the end how they are inherent in Australia’s present health care system and how they are reasons of disparities amongst different communities across Australia and a concluding note at the end. 

Explanation Of Sociology And The Role Of Perspectives

Sociology, contrary to psychology which is a study of individuals conduct and intellect, is the methodical study of society and groups and how an individual’s conduct depends on which society and group he or she is associated with. It comprises of forms of societal associations, communal interface, and ethnicity. This study hugely helps health practitioners globally in determining the health conditions affecting people in different locations. Thereby, helps in the determination of the correct course of treatment. There are several social factors including religion, race, gender, education etc that majorly affects the health of an individual. The sociology of health and illness determines the relationship between health and these societal factors. It has been proved by sociologists that position of an individual in the society, racial belief and other communal factors considerably impact the growth of diseases (Crossman, 2017). There has been a constant advancement in technology and economy, changes in insurance, which largely affects the health care facility available to an individual.

There are diverse approaches to sociological analysis which are commonly referred as perspectives. Firstly, the functionalist model perceives that for the society to perform proficiently, it is necessary to have good health and efficient health care as indicated by Talcott Parsons (Libraries, 2015). It emphasizes on the “sick role”. It further highlights that a sick person disrupts the performance of society as a whole, as he is unable to execute his responsibility as a member of the society (Lumen, 2014). Also, lack of proper health care worsens society’s functioning. Individuals to be regarded as sick should have the will to recover; their sickness should be well established by a medical practitioner and he should not be responsible for his own ill condition. This approach perceives hierarchical relationship between the sick person and medical practitioner. However, the said perspective was condemned on various grounds. Secondly, the conflict theory highlights the disparity between health quality and medical care services. There have been disparities in the society as far as race, customs, sex and social groups are concerned. Probability of individuals with pitiable conditions to fall sick is more and with poor medical services, it further worsens their condition. It also accentuates evaluation of efforts by medical practitioner to have dominance over their practice and of considering numerous society issues such as over eating problem as health issue. Further, the symbolic interactionist model underlines both health and sickness are socially built. It highlights that health conditions are clearly explicated as sick or healthy by the society at large. The approach also focuses on the interface between ill people and medical practitioner clearing that the medical practitioner exhibit their power of curative understanding by using composite medicinal language which are difficult for the common men to understand and usually they have to wait for practitioner to turn up. However, like other perspectives, this approach has also been criticized as certain severe medical issues still subsists despite of whether it is considered so by the general public or not. 

Biomedical Model Of Health 

There have been several models of illness and health. However, biomedical model is the most popular and governing model of health of the 20^th century (Wade & Halligan, 2004). Also referred as biomechanical model, the said model methodically evaluates health and explains that disease occur from causal aberration inside the individuals body. It considers health as without the presence of any disease. It exclusively highlights the biological causes in assessing a particular disease. In this model, an ill person is perceived as a body which is sick and is managed, investigated and medicated by the medical practitioners solely with their rationality and extrinsic evaluations (Smith, 2017). Hence, practitioners of health with proper understanding are obligated to cure the sick person in a background with existence of suitable medicinal equipments. Doctors hold a dominant position in the said model and greatest probable cure for the patient in a medically equipped environment is the major benefit of this model. However, health is recognized as the condition of being bodily, emotionally and communally robust and not simply the dearth of disease by the World Health Organization. This particular model is well established in today’s modern communities. However, there are certain disadvantages of the said model. It does not take into consideration social aspects such as standard of living and the financial system as a whole. There are several other factors other than biological that are responsible for an illness in individuals such as hierarchy and power that majorly affects a person’s health in today’s world. 

Heirarchy And Power –Discussion, Theories And Evidence Related To Both Concepts 

Hierarchy is defined as the categorization of collection of individuals in accordance with their financial, societal and professional position in the society. Individuals are divided on the basis of race, religion, class, ethnicity and many more factors which in turn have great impact on the health and services provided to individuals in these distinct categories. Firstly, we will discuss social dominance theory which was developed by Sidanius and Pratto in the year 1999. The theory describes the source of societal hierarchies and how these classifications boost certain groups and adversely affect people in particular groups (Moss, 2016). According to this theory, there are dominant and subordinate groups and there exists inequality in both these groups. There are three different arrangement of hierarchy in all developed economies on the basis of age, gender and subjective reasons such as ethnic group, race, rank, belief and faith. There are five key determinants of this theory. To start with, governing groups possess dominance over other minor groups. Also societal background greatly impacts these groups. It is more prevalent in males than females and is affected by traits of people and socialization happenings. We further discuss Karl max’s theory of socialism which classifies individuals in society into three groups namely upper, middle and lower class (Heirarchystructure, 2017). Normally known as the Marxist Social Hierarchy, the said theory explains that the wealthiest individuals owning land belongs to upper class, individuals who work for upper class and sells their talent in return of money comprises of middle class. Lastly, less earning group with no property comprised the lower class. There have been discrepancies amongst all these groups as far as health and health care services are concerned.

Weber described power as the capacity of a person or collection of people to accomplish their objective despite of opposition from other groups who attempts to avert them from achieving the same (Cook, 2013). In Weber’s social power theory, power takes two forms of being authoritative and the other one is through force. Further, lawful authority is of three kind namely charismatic authorities wherein a person possesses such authority owing to appealing qualities, traditional authority wherein power is possessed owing to custom and is conceded on inheritance grounds and lastly regal-legal authority wherein the authority is given owing to certain set of regulations and the individual is empowered with authority through a procedure. Moving forward, there are three models of power which describes communal and opinionated power. Firstly, as per the pluralist model, power is dispersed amid numerous groups and there are two groups namely insider group who has more dominance such as worker, agricultural and practiced groups and the outside groups such as grassroots activists and political action committees. This model particularly brings out the political aspect of power in society and relates to functionalist perspective that we discussed above. Secondly, in elite models, power in democratic economies such as Australia is linked with wealth. C. Wright Mills power elite theory is the most popular one in which the government, military and well established business holds a dominant position in leading society for their own self concerns and ignores the concerns of others. Lastly, Marxist approach of power describes that there is restricted amount of power which can be exercised by few people at a single point in time. As per him, there are two classes- ruling and working class, wherein the latter is subjugated by the former in capitalism.

Hence, all the theories related to these concepts namely hierarchy and power proves that they affect health and health care system of every economy. 

Australian Health Care System 

Australia has a diverse culture. There are different groups with differences in race, culture, ethnicity, education and language. There is a significant inequality between several groups as far as health and health care services are concerned. Medicinal profession holds a governing position in the Australian health care system. Even today, most of the doctors in pastoral Australia works individually and are not working publically owing to such dominance. There should be impartiality in providing health care services throughout Australia as per the Australian Health Care Agreement (Kenny, 2014). Conversely, huge disparities exist between distinct groups. Diverse political parties who hold highest position in hierarchy as discussed in above theory, prevalent in Australia have diverse views and enforce powers when it comes to medical services. There is not always clarity in relevant position of the Common Wealth, the state and territory government who are responsible for funding and ruling of health care in Australia. Medicare which is a nationalized plan for ensuring liberated and low cost medical services is the accountability of the Commonwealth. Major funding is the Commonwealth responsibility. However, other related activities of managing and regulation of services is state and territory responsibility. Private sector also accounts for significant position by taking care of around one third of total medical expenses. Also, nonprofit organizations accounts for important position by taking care of old age services.

Further, various groups especially the Indigenous community in Australia is still facing inequalities because of hierarchy and power. Pitiable housing infrastructure, lack of employment, lack of awareness, racial discrimination, gender biasness, difference in beliefs and values all these socio economic factors accounts for poor health of this community as compared to others. There have been proofs that people living in lower rural areas are badly impacted with diseases than those residing in metropolitan areas. Poor access to health services is also a cause of deteriorating health in different communities. Hence, it is proved that hierarchy and power plays vital role in Australian health care system. Customs and geographical location, environmental factors, access to medical services greatly affects health of individuals. As explained in above theories that authority and power resides in few groups and the higher management, t clearly applies in Australia’s health care system as all decisions regarding funding, regulation is taken by high political class with their own interests in mind and hence, proof is the inequality between young and aged, men and women and various other groups. There are few women politicians in Australia which proves our point. Moreover, Indigenous males face higher death and morbidity rates as compared to other males. Suicidal deaths in young males are common. Young Australians are faced with household brutality, ignorance, child paucity and addiction to tobacco as a result of hierarchy and power.

We can further discuss the role of hierarchy and power in relation to tobacco use and smoking policy implemented in Australia. Tobacco has been the principal cause of deaths and hospitalization in Australia. Tobacco smoking has been considered as the major reason behind poorer health and cause of several persistent ailments amongst Indigenous people with around 12% of the whole lumber of ailment and accounting for around one fifth of total deaths (Purcell, 2015).Smoking rates are higher in people suffering from mental illness, who are unemployed, who live in underprivileged locations, Indigenous people and amongst prisoners. This information clearly shows that people who belong to lower class are highly impacted with the tobacco use and in turn the most impacted ones when it comes to suffering from diseases related to same. Although continuous steps has been taken by the Australian government including the federal, state and territory government in reducing the use of tobacco by banning smoking in flights, development of National Tobacco Strategy, banning smoking in enclosed public areas, smoke free dining laws in Victoria and communications campaign. Still there is inequality as far as tobacco control efforts are concerned amongst different groups on the basis of socio economic factors, cultural and political factors which is clear from the fact that people resides in lower rural areas in Victoria accounts for 17.5% and people residing in higher metropolitan areas accounts for 11.1% of normal smoking rates. Smoking amongst prisoners despite of efforts has increased over a period of time. However, the current trend and efforts with regards to taxation has proved to have a positive impact on overall reduction in tobacco use and should be followed to reduce disparities amongst various groups.

Overall Critical Depth 

From the above discussion we conclude, hierarchy and power have a major role in Australian health care system. There are inequalities amongst various groups on the basis of race, culture, ethnicity, employment, political in Australia which we have clearly highlighted. Medical dominance is prevalent. Hierarchy and power greatly affects and impacts people’s health which is evident from the facts discussed above. Because of these two, diverse communities including Indigenous, aged people, males and females, mentally disabled people etc suffer greatly in terms of health as well as in other fields. 

References:

Libraries.  (2015). 21 Sociological Perspectives on Health and Health Care. Retrieved from https://open.lib.umn.edu/socialproblems/chapter/13-1-sociological-perspectives-on-health-and-health-care/

Lumen. (2014). Sociological Perspectives on Health and Illness

Retrieved from https://courses.lumenlearning.com/boundless-sociology/chapter/sociological-perspectives-on-health-and-illness/

Wade, D.T & Halligan, P.W. (2004). Do biomedical models of illness make for good healthcare systems? Retrieved form https://www.ncbi.nlm.nih.gov/pmc/articles/PMC535463/

Smith, W. (2017). What is Biomedical Model of Health Retrieved from https://www.allassignmenthelp.co.uk/blog/what-is-biomedical-model-of-health/

Moss, S. (2016). Social Dominance Theory. Retrieved from https://www.sicotests.com/psyarticle.asp?id=237

Heirarchystructure. (2017). Marxist Social Heirarchy. Retrieved from https://www.hierarchystructure.com/marxist-social-hierarchy/

Cook, S. (2013). Weber’s definition of power. Retrieved from https://sociologytwynham.com/2013/06/04/webers-definition-of-power/

Kenny, A. (2014). Medical Dominance And Power: A Rural Perspective. Retrieved from https://www.tandfonline.com/doi/abs/10.5172/hesr.13.2.158

Purcell, K. (2015). Evidence review: Addressing the social determinants of inequities in tobacco use. Retrieved from file:///C:/Users/hp/Downloads/HealthEquity-Tobacco%20review.pdf