Introduction and Definitions

The concept of social stratification and the concept of health embody two areas of research interest to social scientists. Social stratification is a commonly accepted term in the social sciences, particularly in examining of the ways that humans organize themselves into various cultural and social groupings. For the purposes of this discussion, social stratification is:

plurality of strata within a single society, with some sense of their internal identity, of their internal similarity, of their external differences vis a vis other strata...These qualities by which strata identify themselves and others, are frequently referred to by shorthand terminology such as wealth or poverty, or rulers or people, or workers or bosses. These terms refer to positions on particular distributions such as wealth. income, power and occupational role. The connections between positions of the individual on different distribution are of two sorts. One is.. .through life chances, opportunities to enter into a higher position on any distribution from lower position in that distribution. [The other is the ideal that].. .there is widely experienced aspirations to bring positions on a series of distributions into an appropriate correspondence with each other. (Shils, 1970, pp. 446-447)

The behavior of humans is not rooted in our genetic structure to the degree that it cannot be changed, modified, or otherwise channel behavior. As Krauss (1976, p. 3) states, "the way we act is based on the meaning we attach to things...physical objects, specific individuals, categories of persons and other activities such as commands and requests. The meanings are not intrinsic but social products." Social stratification is the term that describes the way humans group themselves, based on characteristics ascribed to one another or passed from one generation to the next. Such characteristics take on a life of their own in the day-to-day functioning of human beings within a cultural and social context.

Everything that humans do is part of a social construct, attaching meaning to the objects, people, and activities in which they engage. The meaning becomes part of the process by which places are created in the fabric of human organization. Each culture and social group emphasizes different components of the human existence. For some cultures, the critical element separating one person from another might be the family of origin. In another group, it could be access to wealth. And in yet another group, gender affiliation may determine where one is placed in that society. Religion, appearance, body type, and many other human attributes determine where one is placed. Also, each society differs on when the placement of that person is made, for example, such placements might be made across the life spectrum—at birth, at puberty, at adulthood, at old age.

Whatever the basis for classifying people into various groupings, such judgments are made in each society, and these classifications result in creating differential levels of human interaction. And these groupings are not equal for each person. As Tumin (1994, p. 47) commenting on the ubiquity of social inequality writes, "Every known society (above the band level of organization) distributes its scarce and demanded goods and services unequally. And there are attached to the positions which command unequal amounts of such goods and services certain highly morally tined evaluations of their importance to society."

The types of groups that result from the need to place individuals within a social hierarchy are complex in their manifestation. That is to say, one's position can change depending on the circumstance. Humans can play the roles of mother, father, husband, wife, sister, brother, lover, friend; each role carries certain responsibilities and can occur in activities outside of the family. Each group requires that individual members understand these various roles thrust upon them, and the expectation is that each person will fulfill certain responsibilities ascribed to those roles. The socialization process of each human within a culture does not always adequately prepare one to assume the responsibilities that accrue to these roles. Thus, the concept of social stratification offers researchers the opportunity to understand how people function within a given culture.

The area of health is one component of human existence. Each society has created a mechanism for explaining the changes to their biological functioning. The explanations for these changes range the gamut of possibilities. For example, in many Chinese groups the presence of energy bands within the body, called meridians, along with the balance of yin and yang dominate the explanation for health status. In Mexico, one can have a hot or cold illnesses based on humoral explanations. And in parts of Africa, the presence of witchcraft can explain many sicknesses that befall the individual. Because the world is changing as a result of globalization, and the interaction of cultures across previously closely guarded borders, many societies have adopted a mixture of explanations for changes in body function that include their own local explanation, plus the more Western explanation that focuses on disease at the cellular level.

The question is: How does social stratification in a group have an impact on issues of health? The definition of health, like the definition of social stratification, is not one on which researchers readily agree. The concept of health is not easily defined. Mascie-Taylor (1995, pp. 101-102), quoting Talcott Parsons, defines health as "the state of optimum capacity of an individual for the effective performance of the roles and tasks for which he has been socialized." The World Health Organization defines health as the state of complete physical, mental, and social well-being, and not merely the absence of disease (Brearley et al., 1978, p. 7). The American Heritage Dictionary describes health as the state of an organism with respect to functioning, disease, and abnormality; the state of an organism functioning normally without disease (Pickett et al., 2000). Health can also mean that the chakras are balanced, the absence of malevolent spirits, or the flow of positive Qi. These multiple definitions necessarily imply that cultural groups manage health on many levels, depending on what has been identified as having changed body function. Such management also connotes that defining the state of health of an individual may require multiple players, each with his/her role—the individual, the family, the health practitioner, and the care-givers. It is this mixture of local and other health practices that has created a health system structure worldwide. As Wilkerson (1996, p. 1) states, research findings focused attention on the wider features of the social and economic structure.. .we have, in effect, been learning about the interface the between the individual and society, and the structural factors on health; about how people are affected, by social position, by wealth and poverty, by job insecurity and un(/under) employment, by education, by social mobility; about why taller people move up the social hierarchy; about the importance of social networks . and about social organization of work.

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