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NMDS111
www.endeavour.edu.au
Week 1
Introduction to Food,
Culture, Society and the
Individual & The Social
Determinants of Health
© Endeavour College of Natural Health www.endeavour.edu.au 2
Session Overview
The Social Determinants of Health
What is Sociology?
Where did Sociology come from?
Sociology and nutritional medicine management
Overview of factors which impact on food choices
Using social science perspectives and social theory to
understand food and nutrition issues
The value of qualitative research in nutrition
Burden of Disease
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External and internal causes of disease and ill health
(Australia’s Health, 2012)
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Global Burden of Disease
o This term relates to the overall burden of disease
created in a population. It measures both the mortality
and the disability rates caused by common health
problems.
o For example, the World Health Organisation (WHO) has
ranked ischaemic heart disease as the number one
cause of death in the world, while The Lancet (2015)
reported both major depression and lower back pain as
leading causes of disability globally.
(WHO, 2017; Vos et al., 2015)
5
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Global Burden of Disease
(WHO, 2017)
World: 2015. Both Sexes and all ages
1. Ischaemic Heart Disease
2. Stroke
3. Lower Respiratory Infections
4. Chronic Obstructive Pulmonary Disease
5. Trachea, Bronchus Lung
Cancers
6. Diabetes mellitus
7. Alzheimer Disease and other dementias
8. Diarrhoreal diseases
9. Tuberculosis
10. Road Injury
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National burden of disease, by disease group and sex, 2011
(AIHW, 2016)
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Only 5–10% of all cancer cases can be attributed to genetic defects, the
remaining 90–95% have their roots in the environment and lifestyle
(Anand et al., 2008)
Social Determinants of Health
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Social Determinants of Health
o The Social Determinants of Health are the conditions in
which people are born, grow, live, work and age,
including the health system. These circumstances are
shaped by the distribution of money, power and
resources at global, national and local levels, which are
themselves influenced by policy choices.
o The Social Determinants of Health are mostly
responsible for health inequities - the unfair and
avoidable differences in health status seen within and
between countries (WHO, 2017)
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Social Determinants of Health
11
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Social Determinants of Health
• Sociologists examine social distribution of health
between very large population groups based on certain
factors.
• General aim is to describe the differences in health
between each pair of groups, and to explain ‘why’ and
‘how’ they occur.
(Germov & Poole, 2015)
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Class & SES: The Difference?
• Class refers to a system of social inequality based on an
unequal distribution of wealth, status and power.
• Classes, such as working, middle and upper classes,
refer to real groups of people who share common class-
based values, interests and lifestyles.
• SES statistics group people into groups of high, medium
and low according to certain criteria (income, occupation
and education).
(Germov & Williams, 2017)
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Low, middle & high income countries
(World Bank, 2017)
14
2015 Gross National Income per capita US$
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Differences between health inequality
and health inequity
INEQUALITY is:
o Distributional, descriptive
o Cause may not be
preventable
o Describes health
differentials
INEQUITY IS:
o Unfairness in distribution
o Linked to social justice in
health
o Opportunity for
amelioration
o Reducing health
differentials
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Socioeconomic Status (SES)
• Social and economic disadvantage impacts upon people
throughout the life cycle – risk of serious illness and
premature death is doubled in those further down the
social gradient.
• Disadvantage has many forms and may be absolute or
relative.
• Having few family assets, having a poor education,
insecure employment, living in poor housing, trying to
bring up a family in difficult circumstances etc.
(SACOSS, 2008; Darmon & Drewnowski, 2008)
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Ten Tips for Better Health – Donaldson 1999
1. Don’t smoke. If you can, stop. If you can’t, cut down.
2. Follow a balanced diet with plenty of fruit and vegetables.
3. Keep physically active.
4. Manage stress by, for example, talking things through and making time to relax.
5. If you drink alcohol, do so in moderation.
6. Cover up in the sun, and protect children from sunburn.
7. Practice safer sex.
8. Take up cancer screening opportunities.
9. Be safe on the roads: follow the Highway Code.
10. Learn the First Aid ABC : airways, breathing, circulation.
(Donaldson, 1999)
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Ten Tips for Better Health – Gordon 1999
1. Don’t be poor. If you can, stop. If you can’t, try not to be poor for long.
2. Don’t have poor parents.
3. Own a car.
4. Don’t work in a stressful, low paid manual job.
5. Don’t live in damp, low quality housing.
6. Be able to afford to go on a foreign holiday and sunbathe.
7. Practice not losing your job and don’t become unemployed.
8. Take up all benefits you are entitled to, if you are unemployed, retired or sick or disabled.
9. Don’t live next to a busy major road or near a polluting factory.
10. Learn how to fill in the complex housing benefit/ asylum application forms before you become homeless and destitute.
(Gordon, 1999)
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SES and Health
• SES does not intrinsically cause disease or illness.
• Rather there are exposures, behaviours and other
circumstances associated with a given socioeconomic
position that lead to health or illness.
• Material factors
• Behavioural (or ‘lifestyle) factors
• Psychosocial factors
(Lynch & Kaplan, 2000)
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SES and Health
• More disadvantaged groups suffer from higher rates of:
• Obesity
• Diabetes
• Cardiovascular disease
• Osteoporosis
• Dental caries
• Some forms of cancer.
• Direct link to nutrition and diet.
(Darmon & Drewnowski, 2008)
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SES as a measurable risk factor
• 1/6 of the burden of all disease is caused by SES
disadvantage
• “...the job you work in, as a measure of SES, is a better
predictor of CVD death than cholesterol levels, blood
pressure and smoking status combined”
• “...biological factors are less of a risk in developing
severe chronic diseases than dropping out of high
school”.
(Prof Adrian Bauman, Uni Syd, 2010)
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Pathways between lower SES and ill-health
o Physiological stress – cortisol levels + chronic stress
generates free radicals which can damage DNA
o Inflammatory responses – higher CRP levels—linked to
CVD and diabetes
o Changes in early brain development
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Equity in health
o Equity of access to health care, health promoting
environments and services
o Equity in the provision of care according to need
o Equal health care use for equal need
o Equal quality of care
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Social and economic (and sometimes
environmental) conditions that affect
people’s health
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Addressing the Social
Determinants of Health
o Collaborative efforts and multi-strategy solutions
including government agencies (policy), private sector
(not for profits etc), community initiatives, grass roots
organisation (advocacy bodies).
o What role do complementary medicine practitioners play
in addressing the social determinants of health?
(Jones, 2014)
What is sociology and
where did it come from?
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What is Sociology?
Max Weber, one of the three main "fathers of sociology,"
stated :
"Sociology.….is a science which attempts the
interpretive understanding of social action in
order thereby to arrive at a causal
explanation of its course and effects.“
(Weber, 2009)
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Sociologists cartoons and comics:
http://www.cartoonstock.com/directory/s/sociologist.asp
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What is Sociology?• Sociology examines
• How society is organised
• How it influences our lives
• How social change occurs
• It is the systematic study of human behaviour in social
context.
• Sociology is motivated by a desire to improve the social
world by charting a better course for society.
• By studying social patterns, links between social
organisation and behaviour are realised.
(Germov & Williams, 2017)
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How is sociology done?o Asking how a particular discipline investigates its topics
of interest is another way of asking about its
methodology and methods.
o Sociological investigations make use of different
research methods depending on their theoretical
orientations.
o While numerous theories inform how sociologists
approach and conceptualise their topics of interest, the
two orienting frameworks of positivism and
constructionism have been especially influential in
shaping how social research is done.
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Positivism versus Constructionism
o For sociologists, understanding and reporting how or
why people behave as they do involves analysing and
presenting reality.
o In practice, this means sharing with an audience a
convincing account of what was observed and its
meaning.
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Positivism versus Constructionism
o Both positivism and constructionism have to do with the
nature of reality or assumptions about what is real and
how it should be studied.
o Naturally, the average person takes reality for granted. In
the everyday world, we know what is real and do not
doubt its existence. This view of reality is based on
common sense or what everyone intuitively knows and
can agree on.
o It has been suggested that positivistic sociology is
grounded in common sense or a vision of social reality
that is based on self-evident truths that resemble
physical laws of nature.
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Positivistic sociologists
• View the methodological techniques of the physical
sciences, physics in particular, as the ideal model for
exploring the social world
• Aim to uncover universal laws that provide probable
causal explanations for human behavior, laws that
presumably hold true across time and place
• Are exclusively interested in empirical observations that
are described in the neutral or value-free language of
science
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Constructionists
• Constructionists are concerned with ‘how’ human
interaction helps to create social reality
• Constructionists believe that as human beings ‘we do
not find or discover knowledge, so much as we construct
or make it’.
• Constructionism can also be termed Symbolic
interactionism or interpretivism
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Constructionists
• Constructionism, is an alternative and a reaction to
positivism, and is predicated on the assumptions that our
knowledge of social reality is:
1. subjective
2. situationally and culturally variable; and
3. ideologically conscious.
• Constructionists are more interested in the work or
practices that go into creating the social world and less
in its causes.
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Points of emphasis and commonality of
positivism and constructionism
(Marvasti, 2004)
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Social Change and Sociology
During the 17th and 18th century, four key factors are identified
as reshaping society which include:
1. A New Industrial Economy
2. The Growth of Cities
3. Political Change
4. A New Awareness of Society
(Macionis & Gerber, 2010)
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Origins of Sociology
• The 18th and 19th centuries saw an advance in science
and technology, which encouraged people to believe that
there could be a rational explanation for everything and
that scientific study could help solve all problems faced
by humans.
• Post-Newtonian physical sciences
• Post-Darwinian natural sciences
(BSA, 2017)
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Key contributors to sociology
o Auguste Comte (France 1798-1857)
• Key concepts: Positivism
o Harriet Martineau (England 1802-1876)
• First acknowledged female sociologist
• Social change theory
Picture from Public Domain:
http://commons.wikimedia.org/wiki/Auguste_Comte
Picture from Public Domain:
http://commons.wikimedia.org/wiki/Harriet_Marti
neau
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Origins of Sociology
• The great expansion of the discipline took place in the
USA during the mid-twentieth century.
• Moving from its original purpose as the ‘science of
society’, sociology has moved on to more reflexive
attempts to understand how society works and seeks to
provide insights into many forms of relationships, both
formal and informal.
(BSA, 2017)
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Three Classical Sociological
Perspectives
• Contemporary sociologists acknowledge three general
theoretical perspectives, or ways of looking at how
various social phenomena are related to one another-
developed from the three classical sociological
perspectives.
• These are the functionalist, the conflict and the
symbolic interactionist perspectives.
(Hughes et al., 2002)
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Three Classical Sociological
Perspectives• Karl Marx
He had an immense influence on
sociology.
He concentrated on the differences
between the class of people who
owned the factories of production,
the middle-class conformists, and
the class of people who had only
their labour to sell in return for
survival - the proletariat.
(Bartle, 2007)Picture taken from public domain:
http://commons.wikimedia.org/wiki/File:Karl_Marx.jpg
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The Conflict Perspective
• The conflict approach draws much of its inspiration from the
work of Karl Marx and argues that the structure of society
and the nature of social relationships are the result of past
and ongoing conflicts.
• Conflict theory typically leads to the suggestion that
eliminating privilege will lower the level of conflict and
increase total human welfare
(Hughes et al., 2002)
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Three Classical Sociological
Perspectives• Emile Durkheim
• Argued that we can look at rates
of behaviour and find explanations
outside the individuals who are
doing the acting.
• In contrast to Marx, Durkheim
stated that various characteristics
of social elements contribute to
the living and growing of society
and its institutions
(Bartle, 2007) Picture taken from public domain:
http://commons.wikimedia.org/wiki/File:Emile_
Durkheim.jpg
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The Functionalist Perspective
• The structural-functional or more simply functionalist
perspective views society as a system.
• They identify the structural characteristics and functions
and dysfunctions of institutions, and distinguish
between manifest functions and latent functions.
• Also typically assume that most members of a society
share a consensus regarding their core beliefs and
values. (Hughes et al., 2002)
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Three Classical Sociological
Perspectives
• Max Weber
• Also disagreed with
Marx and went in a
different direction
again.
• Helped understand
the meanings that
people put on their
actions and beliefs.
(Bartle, 2007) Picture taken from public domain:
http://commons.wikimedia.org/wiki/File:Veber.jpg
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The Symbolic Interactionist
Perspective
• Max Weber
• Rather than deny the importance of material factors, as
with Marx, and rather than deny the notion of social facts
external to individuals, as with Durkheim, he added that we
should look at ideas, especially the meanings we put onto
things, and the role of changes of ideas that contribute to
society and to social changes.
• From his analysis is derived the third main sociological
perspective; “symbolic interaction."
(Bartle, 2007)
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The Symbolic Interactionist
Perspective• Symbolic Interactionists contend that society is possible
because human beings have the ability to communicate
with one another by means of symbols.
• They say that we act toward people, objects, and events
on the basis of the meanings we impart to them.
• Consequently, we experience the world as constructed
reality.
(Hughes et al., 2002)
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The Sociological Perspective
• We can not see a society, a community or a family, and we
can not touch a society, a community or a family. It is far
too complex. It does not consist of people (that we can
see), but of beliefs and actions, and is a system; there is
no physical position from which we can see a society.
• An atomistic perspective implies that people are separate
individuals and that there is nothing beyond the individual.
(Bartle, 2007)
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The Sociological Perspective
• New levels of reality:
• The Sociological Imagination:
• Microsociology and Macrosociology:
• 3 Classical Sociological Perspectives
Conflict, Functionalist & Symbolic Interactionist
Perspective(Hughes et al., 2002)
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‘Sociological Imagination’
• Charles Wright Mills coined the term to describe the way
that sociological analysis is performed.
• He defined the Sociological Imagination as “a quality of
mind that seems most dramatically to promise an
understanding of the intimate realities of ourselves in
connection with the larger social realities”.
(Germov & Williams, 2017)
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‘Sociological Imagination’
Four part model
(Germov & Williams, 2017)
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Microsociology
• Microstructures are
the pattern of relatively
intimate social
relations formed during
face-to-face
interaction.
• Families, friendship
circles and work
associations are all
examples of micro-
sociological structures(Furze et. al., 2009)
http://upload.wikimedia.org/wikipedia/commons/a/a5/RPC_of_Australia_family_conf
erence.jpg
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Macrosociology
• Macrostructures are
overarching patterns of
social relations that lie
outside one’s circle of
intimates and
acquaintances.
• Macrosociology includes
classes, bureaucracies and
power systems such as
patriarchy
(Furze et al., 2009)http://t2.gstatic.com/images?q=tbn:ANd9GcSKPuY1rC0bXyXsZD2LeRH2
7rw7PYYTbj169O3AgW8N8952K2kf
Sociology of nutritional management
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Evolution of Diet
o Food and food supplements,
previously restricted to
geographical regions, are
now widely available
worldwide and the dietary
habits of individuals and
populations are now
determined by more than
food availability, technology
and science.
(Public domain, open source. Beans & bread)
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Evolution of Diet
(National Geographic, public domain, open source)
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Sociology of Food
o What determines what we choose to eat?
o Instinct, culture, religion, or science?
o How important is food for human health and what is
the role of culture and religion in health choices?
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Sociology of Food
The expanding sociological interest in food stems from, and
is a reflection of, the growing social and cultural
significance in affluent industrial societies.
This interest also arises from the attention to the details of
everyday life and the exclusions and inclusions relating to
food, providing useful insight into cultural differences.
(Scott & Marshall, 2009)
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Sociology of Food
• A sociological explanation of food habits examines the
role played by the underlying social environment in
which food is produced, distributed and consumed.
(Germov & Williams, 2017)
http://www.stopcorporateabuse.org/targeting-low-income-communities
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Sociology and Nutritional
Medicine Management
During the latter half of the 20th century, how, what, where,
when and with whom we eat has changed dramatically.
Diet is now identified as a key health-related behaviour and
studies on the many aspects of food and diet continue to
increase
Our eating habits and diets are influenced by broader
social, economic, technological and cultural shifts
(Food Matters, 2010)
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Sociology and Nutritional
Medicine Management
• The analysis of food allocation and consumption has been
used very effectively to illustrate the ways in which the
underlying dimensions of social differentiation (i.e. gender,
age and class) manifest themselves in the experiences of
everyday life.
• Also the analysis of the process of food production and
distribution has been used to highlight the workings of
capital-intensive, highly rationalised economic systems.
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Sociology and Nutritional
Medicine Management
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Factors Impacting on Food Choices
• Biological determinants
• Economic determinants
• Physical determinants
• Social determinants
• Psychological factors
(EUFIC, 2006)
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Factors Impacting on Food Choices
A critical review of the psychosocial basis of food
choice and identification of tools to effect positive
food choice
Whilst dietary advice to the general public is well established,
it is well documented that simply providing knowledge is not
enough to promote behavioural change; people have to be
motivated and supported to change their diets.
The challenge for health professionals, therefore, lies in
encouraging people to change their dietary behaviour to
encompass healthy eating messages and in supporting them
to maintain these changes.
(BNF, 2004)
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Introduction to theories
surrounding food
• The way we eat reflects an interplay between social
structure and human agency.
• Despite the similar physiological needs in humans, food
habits are not universal, natural or inevitable; they are
social constructions and significant variations exist.
• Among all the different ideas attached to foods at various
times and in various cultures, certain ideas recur
consistently. (Cussler & DeGive, 1970)
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Introduction to theories
surrounding food
• In Australia, Indigenous Aboriginal Australians consume
traditional food such as ‘bush foods’ which are not
consumed by white Australians such as witchetty grubs,
honey ants, galahs and turtles.
• Other cultures do not permit the consumption of alcohol
whereas others drink alcohol to excess.
© Endeavour College of Natural Health www.endeavour.edu.au 68
Introduction to theories
surrounding food
• Food is a basic concern for all human societies.
• “Tell me what you eat and I’ll tell you who you are” (from
the French) and “You are what you eat” (from the
German), point also to issues such as the relationships
of human populations or social groups to their
environment, the symbolic construction of cultures, and
the social relations and social structures of societies.
© Endeavour College of Natural Health www.endeavour.edu.au 69
Sociology and Research
1. Formulate question
2. Review existing literature
3. Select method
4. Collect data
5. Analyse data
6. Report results
(Furze et al., 2009)
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Sociology and Research
o Sociological evidence falls into two main groups:
quantitative and qualitative.
o As theoretical orientations positivism and
constructionism have considerable methodological
implications for sociological research.
o Quantitative research involves the use of
methodological techniques that represent the human
experience in numerical categories, statistics.
o Qualitative research provides detailed description and
analysis of the quality, or the substance, of the human
experience.
o However, there is much overlap between the two, both in
practice and theory. (Gregory, 1995)
© Endeavour College of Natural Health www.endeavour.edu.au 71
Qualitative and Quantitative Methods
o “We are not faced, then, with a stark choice between
words and numbers, or even between precise and
imprecise data; but rather with a range from more to less
precise data.… [O]ur decisions … should depend on the
nature of what we are trying to describe, on the likely
accuracy of our descriptions, on our purposes, and on
the resources available to us; not on ideological
commitment to one methodological paradigm or
another.”
(Hammersley 1992: 163, as cited in Silverman 2000: 12)
© Endeavour College of Natural Health www.endeavour.edu.au 72
Sociology and Research
o Quantitative research provides precise, quantitative,
numerical data and research findings can be generalised
to the wider population when the data are based on
random samples of sufficient size.
o Qualitative research provides context and meaning, the
how’s and why’s.
o Each method has its strengths and limitations. Mixed
method approach is often used.
© Endeavour College of Natural Health www.endeavour.edu.au 73
Summary
Following this lecture you should be able to:
• Describe the societal influences on health
• Define Sociology
• Discuss the origins of sociology
• List the societal factors that influence nutritional
management of a client.
• Explain the factors which impact on food choices.
• Discuss social science perspectives and social theory
in relation to food and nutrition issues.
• Identify settings where qualitative research is valuable
© Endeavour College of Natural Health www.endeavour.edu.au 74
References• Australian Institute of Health and Welfare. (2016). Australia’s health series 15. Canberra: AIHW
49-61
• Bartle, P. (2007). Dr Phil’s Home Page for Sociology. Retrieved from
http://www.scn.org/cmp/modules/index.htm
• Bauman, A. (2010). University of Sydney - School of Public Health.
• BNF. (2004). A critical review of the psychosocial basis of food choice and identification of tools to
effect positive food choice’, British Nutrition Foundation. Retrieved from
http://www.foodbase.org.uk/results.php?f_report_id=167
• BSA. (2017). What is Sociology? Origins of Sociology. The British Sociological Association.
Retrieved from https://www.britsoc.co.uk/what-is-sociology/origins-of-sociology/
• Cussler, M., & De Give, M.L. (1970). Twix the cup and the lip: Psychological and sociocultural factors
affecting food habits. Washington, DC: Consortium Press.
• Darmon, N., & Drewnowski, A. (2008). Does social class predict diet quality?. Am J Clinical Nutrition,
87, 1107-17.
• Donaldson, L. (1999). Ten tips for better health. Saving Lives: Our Health Nation. London, UK:
Stationery Office. Retrieved from
https://healthpolicysocialjustice.wordpress.com/linksarticles/tips-for-better-health/
• Elyada, O (n.d.). The Raw and the Cooked: Claude Levi-Strauss and the hidden structures of myth,
retrieved from http://art-gallery.haifa.ac.il/raw-cooked/pdf/elyada-e.pdf
• EUFIC. (2014). The Determinants of Food Choice. European Food Information Council .
Retrieved from http://www.eufic.org/article/fr/page/RARCHIVE/expid/review-food-choice/
© Endeavour College of Natural Health www.endeavour.edu.au 75
References• EUFIC. (2006). The Determinants of Food Choice. European Food Information Council. Retrieved
from http://www.eufic.org/en/healthy-living/article/the-determinants-of-food-choice
• Food Matters. (2010). Food Matters: A Sociological Case Study of Food and Eating Across the Life
Course in York c. 1945-2010’. Retrieved from http://blogs.cim.warwick.ac.uk/foodmatters/
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