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Concept: Max Weber

167

In Spain, the new National Classification of Occupations (Clasificación Nacional de Ocupaciones [CNO-2011]) is substantially different to the 1994 edition, and requires adaptation of occupational social classes for use in studies of health inequalities. This article presents two proposals to measure social class: the new classification of occupational social class (CSO-SEE12), based on the CNO-2011 and a neo-Weberian perspective, and a social class classification based on a neo-Marxist approach. The CSO-SEE12 is the result of a detailed review of the CNO-2011 codes. In contrast, the neo-Marxist classification is derived from variables related to capital and organizational and skill assets. The proposed CSO-SEE12 consists of seven classes that can be grouped into a smaller number of categories according to study needs. The neo-Marxist classification consists of 12 categories in which home owners are divided into three categories based on capital goods and employed persons are grouped into nine categories composed of organizational and skill assets. These proposals are complemented by a proposed classification of educational level that integrates the various curricula in Spain and provides correspondences with the International Standard Classification of Education.

Concepts: Sociology, Social class, Marxism, Max Weber, Relations of production

28

Context  Health care research generally, and medical education research specifically, make increasingly sophisticated use of social science methods, but these methods are often detached from the theories that are the substantive core of the social sciences. Enhanced understanding of theory is especially valuable for gaining a broader perspective on how issues in medical education reflect the social processes that contextualise them. Methods  This article reviews five social science theories, emphasising their relevance to medical education, beginning with the emergence of the sociology of health and illness in the 1950s, with Talcott Parsons' concept of the ‘sick role’. Four turning points since Parsons are then discussed with reference to the theory developed by, respectively, Harold Garfinkel, Michel Foucault and Pierre Bourdieu, and what is called the ‘narrative or dialogical turn’. In considering these, the author argues for a theory-grounded research that relates specific problems to what Max Weber called the ‘fate of our times’. Conclusions  The conclusion considers how medical education research can critique the reproduction of a discourse of scarcity in health care, rather than participating in this discourse and legitimating the disciplinary techniques that it renders self-evident.

Concepts: Health care, Sociology, Science, Anthropology, Social sciences, Michel Foucault, Max Weber, Talcott Parsons

27

Professional specialisation is broadly considered to result from increased complexity in professional knowledge and to be linked to specialist education, formalised credentials and registration. However, the degree of formal organisation may vary across professions. In healthcare, although medical specialisation is linked to rigorous selection criteria, formal training programmes and specialist registration, some forms of specialisation in the allied health professions are much less formal. Drawing on Weber’s concept of charismatic authority, the establishment of a specialist role in podiatry, the ‘diabetes specialist podiatrist’, in the absence of codified or credentialed authority, is explored. ‘Charismatic’ leaders in podiatry, having attracted a following of practitioners, were able to constitute a speciality area of practice in the absence of established career pathways and acquire a degree of legitimacy in the medical field of diabetology.

Concepts: Health care, Medicine, Sociology, Management, Healthcare occupations, Authority, Charismatic authority, Max Weber

25

Within social hierarchies, low social status is associated with increased vigilance, hostile expectations, and reactive aggression. We propose that societal devaluation is common across many low social status groups and produces a sense of threatened social worth. Threatened social worth may lead those of low status to be more vigilant towards social threats, thereby increasing the likelihood of hostile attributions and endorsement of aggression. Integrating theory on belongingness, social rejection, and stigma compensation, two studies test a sequential process model demonstrating that threatened social worth mediates the relationship between status, hostile attributions, and endorsement of aggression. Employing a relative status manipulation, Study 2 reveals a causal effect of status and highlights the importance of perceptions of low social status on threatened social worth. These data demonstrate the role of social worth in explaining the link between status and hostility and have implications for research in the social, health, and developmental domains.

Concepts: Sociology, Interpersonal relationship, Aggression, Social rejection, Social status, Anger, Social stratification, Max Weber

22

Among social animals, subordinate status or low social rank is associated with increased caloric intake and weight gain. This may reflect an adaptive behavioral pattern that promotes acquisition of caloric resources to compensate for low social resources that may otherwise serve as a buffer against environmental demands. Similarly, diet-related health risks like obesity and diabetes are disproportionately more prevalent among people of low socioeconomic resources. Whereas this relationship may be associated with reduced financial and material resources to support healthier lifestyles, it remains unclear whether the subjective experience of low socioeconomic status may alone be sufficient to stimulate consumption of greater calories. Here we show that the mere feeling of lower socioeconomic status relative to others stimulates appetite and food intake. Across four studies, we found that participants who were experimentally induced to feel low (vs. high or neutral) socioeconomic status subsequently exhibited greater automatic preferences for high-calorie foods (e.g., pizza, hamburgers), as well as intake of greater calories from snack and meal contexts. Moreover, these results were observed even in the absence of differences in access to financial resources. Our results demonstrate that among humans, the experience of low social class may contribute to preferences and behaviors that risk excess energy intake. These findings suggest that psychological and physiological systems regulating appetite may also be sensitive to subjective feelings of deprivation for critical nonfood resources (e.g., social standing). Importantly, efforts to mitigate the socioeconomic gradient in obesity may also need to address the psychological experience of low social status.

Concepts: Nutrition, Socioeconomic status, Food, Sociology, Social class, Social status, Social stratification, Max Weber

15

Americans may be more narcissistic now than ever, but narcissism is not evenly distributed across social strata. Five studies demonstrated that higher social class is associated with increased entitlement and narcissism. Upper-class individuals reported greater psychological entitlement (Studies 1a, 1b, and 2) and narcissistic personality tendencies (Study 2), and they were more likely to behave in a narcissistic fashion by opting to look at themselves in a mirror (Study 3). Finally, inducing egalitarian values in upper-class participants decreased their narcissism to a level on par with their lower-class peers (Study 4). These findings offer novel evidence regarding the influence of social class on the self and highlight the importance of social stratification to understanding basic psychological processes.

Concepts: Sociology, Narcissistic personality disorder, Social class, Narcissism, Social stratification, Social mobility, Working class, Max Weber

12

Individuals with lower social status have been reported to express more anger, but this evidence comes mostly from Western cultures. Here, we used representative samples of American and Japanese adults and tested the hypothesis that the association between social status and anger expression depends on whether anger serves primarily to vent frustration, as in the United States, or to display authority, as in Japan. Consistent with the assumption that lower social standing is associated with greater frustration stemming from life adversities and blocked goals, Americans with lower social status expressed more anger, with the relationship mediated by the extent of frustration. In contrast, consistent with the assumption that higher social standing affords a privilege to display anger, Japanese with higher social status expressed more anger, with the relationship mediated by decision-making authority. As expected, anger expression was predicted by subjective social status among Americans and by objective social status among Japanese. Implications for the dynamic construction of anger and anger expression are discussed. (PsycINFO Database Record © 2013 APA, all rights reserved).

Concepts: United States, Sociology, Culture, All rights reserved, Western culture, Social status, Social mobility, Max Weber

10

Despite a well-established social gradient for many mental disorders, there is evidence that individuals near the middle of the social hierarchy suffer higher rates of depression and anxiety than those at the top or bottom. Although prevailing indicators of socioeconomic status (SES) cannot detect or easily explain such patterns, relational theories of social class, which emphasise political-economic processes and dimensions of power, might. We test whether the relational construct of contradictory class location, which embodies aspects of both ownership and labour, can explain this nonlinear pattern. Data on full-time workers from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 21859) show that occupants of contradictory class locations have higher prevalence and odds of depression and anxiety than occupants of non-contradictory class locations. These findings suggest that the effects of class relations on depression and anxiety extend beyond those of SES, pointing to under-studied mechanisms in social epidemiology, for example, domination and exploitation.

Concepts: Epidemiology, Sociology, Exploitation, Social class, Social status, Social stratification, Marxism, Max Weber

4

Adverse early life experience and development may have long-term health consequences, but later environmental conditions may perhaps protect against the effects of such early life adversities. The aim was to investigate whether cause-specific and overall mortality rates among adoptees are associated with the age at which they were transferred to the adoptive family and whether the social class of the adoptive family modifies this association.

Concepts: Epidemiology, Sociology, Family law, Adoption, Max Weber, Relations of production

2

Research addressing social class and dementia has largely focused on measures of socioeconomic status as causal risk factors for dementia and in observed differences in diagnosis, treatment and care. This large body of work has produced important insights but also contains numerous problems and weaknesses. Research needs to take account of the ways in which ageing and social class have been transformed in tandem with the economic, social and cultural coordinates of late modernity. These changes have particular consequences for individual identities and social relations. With this in mind this article adopts a critical gaze on research that considers interactions between dementia and social class in three key areas: (i) epidemiological approaches to inequalities in risk (ii) the role of social class in diagnosis and treatment and (iii) class in the framing of care and access to care. Following this, the article considers studies of dementia and social class that focus on lay understandings and biographical accounts. Sociological insights in this field come from the view that dementia and social class are embedded in social relations. Thus, forms of distinction based on class relations may still play an important role in the lived experience of dementia.

Concepts: Sociology, Social class, Social status, Social stratification, Social classes, Max Weber, Modernity, Relations of production