HEALTH 107: Sociology of Activity, Health, and Well-Being

Sources and References

Primary textbook — John Germov (ed.), Second Opinion: An Introduction to Health Sociology (Oxford University Press). Supplementary texts — Jay Coakley & Peter Donnelly Sport in Society: Issues and Controversies (Canadian ed.); William Cockerham Medical Sociology; Michael Marmot The Status Syndrome; Susan Bordo Unbearable Weight; Erving Goffman Stigma. Online resources — Public Health Agency of Canada Social Determinants of Health reports; WHO Commission on Social Determinants of Health Closing the Gap in a Generation (2008).

Chapter 1: Sociology of Activity, Health, and Well-Being — A Discipline

Health is usually imagined as a private matter: a body that works or fails, a diagnosis printed on a chart, a jogging habit kept or abandoned. The sociology of activity, health, and well-being starts from a different premise. It insists that who gets sick, who stays well, who has time to play hockey, who ends up in a wheelchair at fifty, and who lives into their nineties are not random facts about individual bodies. They are patterned outcomes of how a society organizes work, money, gender, race, space, and power. To study these patterns is to study the collective conditions that shape embodied life.

The discipline draws on three older traditions that converge in the contemporary Canadian university. The first is medical sociology, which grew out of post-war American research on hospitals, doctor–patient interaction, and the sick role. William Cockerham, in Medical Sociology, traces how scholars moved from studying health care institutions to studying the social production of disease itself. The second tradition is the sociology of sport and leisure, given its most influential Canadian shape by Jay Coakley and Peter Donnelly, who argue in Sport in Society that games are never just games: they are sites where values, identities, and power relations are rehearsed. The third tradition is critical public health, represented by the WHO Commission on Social Determinants of Health and the Public Health Agency of Canada, which reframed population health as a question of social justice rather than lifestyle choice.

A sociological imagination, as C. Wright Mills famously described it, links private troubles to public issues. The private trouble of a diabetic neighbour in Regina becomes, through this lens, a public issue about food deserts, settler colonialism, income inequality, and provincial health budgets. The private trouble of a teenager who quits gymnastics becomes a public issue about how sport funnels girls toward thinness, how coaches wield authority, and how working-class families cannot afford the membership fees. Sociology does not deny that biology and personal choice matter. It denies that they are enough.

Three methodological commitments run through the course. First, the social is real: institutions, classes, racial formations, and gender orders exist independently of any individual and press on every body that passes through them. Second, health and activity are socially constructed as well as socially distributed. What counts as a disease, who counts as an athlete, and what counts as a healthy body are questions answered differently in different times and places. Third, sociology is reflexive: the researcher is not a neutral observer but a member of the same society being studied, and the tools of analysis are themselves products of that society’s history.

Chapter 2: Theoretical Lenses — Functionalism, Conflict, Interactionism, Feminism, Critical Race Theory

Sociologists approach health and activity through several competing frameworks. Each is best understood not as a final answer but as a way of asking questions.

Functionalism, descended from Emile Durkheim and refined by Talcott Parsons, views society as an organism whose parts work together to maintain stability. Health, in this view, is the capacity to perform one’s social roles; illness is a temporary breakdown that removes people from productive life. Parsons’s concept of the sick role captured how being ill is not merely biological but normative: the sick person is released from ordinary obligations but is expected to seek competent help and try to recover. Sport, for Parsons and his followers, functions to socialize children into cooperation, rule-following, and achievement orientation — all useful for a modern industrial economy. Functionalism is useful for seeing what stabilizes a social system, but critics point out that it tends to naturalize the status quo and to ignore whose interests that stability serves.

Conflict theory, descended from Karl Marx and Max Weber, asks who benefits. It treats society as an arena of competing groups with unequal resources. Applied to health, conflict theory sees illness as produced by capitalism’s drive to extract labour and profit: dangerous workplaces, polluted neighbourhoods, precarious employment, and a pharmaceutical industry that sells disease. Applied to sport, conflict theory studies how professional leagues concentrate wealth among owners while bodies of players are used up and discarded, and how municipal arenas are built with public money that could have gone to schools or affordable housing. Vicente Navarro, Howard Waitzkin, and more recently the political-economy-of-health school carry this tradition forward.

Symbolic interactionism, rooted in the Chicago School and developed by Herbert Blumer and Erving Goffman, zooms in on the meanings people attach to bodies, diagnoses, and performances. It asks how a pain becomes a “migraine,” how a diagnosis of schizophrenia reshapes a person’s sense of self, how a basketball team develops its locker-room rituals. Goffman’s Stigma is the indispensable text here: it describes how spoiled identities are managed in everyday encounters, how the visibly disabled or mentally ill learn to “pass,” and how the well-bodied learn to look away. Interactionism is strong on texture and experience and weaker on large-scale structures, which is why it is usually paired with one of the other lenses.

Feminist sociology insists that gender is not an afterthought but a basic axis along which health and activity are organized. Raewyn Connell, in Gender and Masculinities, shows how what she calls the gender order assigns different bodies, emotions, and life chances to men and women, and how masculinity itself is plural and hierarchical. Feminist health research has documented how women’s symptoms are dismissed by clinicians, how domestic labour exhausts women’s bodies, how reproductive medicine has alternately neglected and over-managed female physiology, and how sports such as ringette and artistic swimming were created as “appropriate” female activities so that hockey and football could remain male.

Critical race theory, developed in American legal studies and imported into sociology, treats race as a social creation with material consequences. It argues that racism is not merely individual prejudice but is embedded in laws, institutions, and taken-for-granted ways of seeing. In health research it drives attention to the medical exploitation of Black Americans, to the racialized organization of Canadian cities, and to the persistent gaps in life expectancy between white Canadians and racialized minorities. In sport it fuels questions about who is funnelled into which positions, which bodies are glorified, and how the stereotype of “natural athleticism” flattens racialized lives into spectacles.

Indigenous, postcolonial, and disability-studies frameworks extend these lenses further. The course treats theory pluralistically: a good sociological question usually draws on several at once.

Chapter 3: Sociology of Health and Illness — Medicalization and the Social Model

The conventional biomedical model imagines illness as a malfunction of tissues and treats the body as a machine. Sociologists do not deny the usefulness of this model for setting a broken femur or clearing an infection. They argue that it is incomplete, and they document two major ways in which the social organization of medicine itself shapes what we think of as health.

The first is medicalization. Coined by Irving Zola and developed by Peter Conrad, the term names the process by which human conditions that used to be handled by priests, families, or the person themselves become defined as medical problems to be managed by doctors. Shyness becomes social anxiety disorder. Restless children become candidates for ADHD medication. Ordinary sadness becomes clinical depression. Menopause becomes a hormone deficiency. The implications are double-edged: medicalization can legitimize suffering and make help available, but it can also pathologize normal variation, extend professional authority into private life, and funnel profits to pharmaceutical companies. Conrad’s later work emphasizes that the drivers of medicalization have shifted from doctors to biotechnology firms, consumers, and managed-care systems.

A related concept is healthism, introduced by Robert Crawford. Healthism is the ideology that individual health is a supreme personal duty, that illness reflects moral failure, and that the good citizen is one who exercises, eats clean, and self-monitors. Healthism can look like empowerment but it shifts responsibility for population health from governments and employers onto individuals who often lack the resources to comply.

The second response to biomedicine is the social model of health, which argues that the largest drivers of population health are not clinical services but the conditions of daily life — income, housing, education, employment, food, social support, and autonomy. The social model does not reject biology; it locates biology inside a social environment that switches genes on and off, inflames arteries, and wears down immune systems. The WHO Commission on Social Determinants of Health made this argument official in 2008 in Closing the Gap in a Generation, concluding that social injustice was killing people on a grand scale and that the remedies were political as much as clinical.

Sociologists also write about the experience of illness, following the tradition opened by Arthur Kleinman and Kathy Charmaz. Chronic illness is not a single event but a biographical disruption that forces people to rewrite the story of who they are. The painful knee that ends a runner’s self-image, the MS diagnosis that rearranges a family’s plans, the long-COVID fatigue that turns a confident worker into a petitioner at the disability tribunal — these experiences are where the social model meets the lived body.

Chapter 4: Social Determinants of Health

If one idea defines contemporary health sociology, it is the idea of social determinants. The Public Health Agency of Canada lists twelve: income and social status, employment and working conditions, education and literacy, childhood experiences, physical environments, social supports, healthy behaviours, access to health services, biology and genetics, gender, culture, and race or racism. The WHO version groups them under “structural” determinants (the political and economic arrangements that distribute power) and “intermediary” determinants (the living conditions these arrangements produce).

The evidence base is enormous. Richard Wilkinson and Kate Pickett, in their much-debated book The Spirit Level, show that more unequal rich countries have worse average health than more equal ones at the same level of GDP. Michael Marmot, in The Status Syndrome and The Health Gap, reports from his Whitehall studies of British civil servants: even within a single employer, with all members well-fed and insured, mortality rose steeply as one moved down the occupational ladder. The mechanism, Marmot argues, is control — those lower in the hierarchy have less say over their work, their time, and their lives, and this chronic stress is written into their cardiovascular systems.

In Canada, the social gradient is visible in almost every health indicator. Life expectancy varies by postal code more than it varies by most clinical interventions. Residents of the wealthiest urban neighbourhoods can expect to live several years longer than residents of the poorest. Indigenous Canadians face the steepest gaps, which Chapter 11 addresses separately. Refugees and recent immigrants often arrive healthier than the Canadian average but lose this “healthy immigrant effect” after a decade of stressful integration.

The social determinants framework has important political implications. If the biggest levers on population health are employment law, housing policy, income transfers, and early childhood programs, then ministers of finance and labour are really ministers of health. The framework also invites scepticism toward interventions that target individual behaviour without changing the conditions that produce it. Telling a shift worker to eat more vegetables, without addressing her wage, her two jobs, and the nearest grocery store being thirty minutes by bus, is a prescription for frustration on both sides of the clinical encounter.

Chapter 5: Gender, Sport, and Activity

Sport in its modern form was built by men, for men, as a school for masculinity. Nineteenth-century British boarding schools promoted rugby and cricket as character training for future soldiers and colonial administrators. North American colleges followed with football and baseball. Women were mostly excluded, and where they participated they were shepherded into modified versions — half-court basketball, field hockey, figure skating — judged less on force than on grace. Coakley and Donnelly, in Sport in Society, trace how these historical patterns still shape the gendered division of athletic labour.

The twentieth century saw significant gains. Canadian women competed at the 1928 Olympics, fought their way into professional marathons, and eventually into hockey. Legal changes, human-rights campaigns, and the Title IX revolution in the United States opened doors. By the early twenty-first century, participation rates of girls and women in organized sport approached those of boys and men in many Canadian settings. Yet several disparities persist. Media coverage of women’s sport remains a small fraction of men’s, even after accounting for audience. Prize money and salaries diverge sharply. Coaching and administration are still male-dominated. And the sexualization of female athletes — in uniform rules, camera angles, and sponsorship choices — continues to frame women’s bodies as objects as much as instruments.

Connell’s concept of hegemonic masculinity explains why change is so uneven. Hegemonic masculinity is the culturally exalted form of manhood that other masculinities, and all femininities, are measured against. In sport it prizes physical dominance, risk-taking, stoic endurance of pain, and emotional restraint. Boys learn these lessons through little league and high-school football; girls learn to fit inside, around, or against them. The cost to men is not trivial: chronic injury, concussions, substance abuse, and suicide rates among retired male athletes are all shaped by a training in denial that began in childhood.

Physical activity outside organized sport is also gendered. Women perform disproportionate amounts of unpaid caregiving, which is physically demanding but not counted as leisure activity. Their “free time” is fragmented and chaperoned. Fear of street harassment narrows women’s choices of running routes and times. The cultural association between exercise and weight loss has, for many women, fused health with a disciplinary project on the body, as Susan Bordo and Paula Saukko describe in texts we revisit in Chapter 12.

Chapter 6: Gender and Health

Gendered patterns in health extend far beyond sport. On average, Canadian women live several years longer than Canadian men but report more chronic illness, more disability, and more mental-health diagnoses. This apparent paradox — women sicker, men deader — has occupied health sociologists for decades. Part of the explanation is biological. Part is behavioural: men are more likely to smoke heavily, drink heavily, drive recklessly, work in dangerous jobs, and die by violence or suicide. Part is structural: women are more likely to be poor, to be caregivers under strain, and to face specific diseases such as breast and cervical cancer.

The sociology of men’s health, a relatively recent subfield, connects male mortality to the same hegemonic masculinity Connell analyzes. Norms that equate help-seeking with weakness, that prize toughness over self-care, and that insulate men from emotional intimacy contribute to late diagnoses, avoidable deaths, and the high suicide rates of middle-aged and older men. Rural men, Indigenous men, and recently unemployed men are particularly vulnerable.

Women’s health advocates have criticized medicine for a long history of treating the male body as the default research subject. Heart disease, for instance, was for decades described through the pattern of symptoms typical in men; women with different presentations were more likely to be sent home from emergency rooms. Reproductive health has the opposite problem: women’s bodies are over-managed in pregnancy and childbirth, under-studied for conditions such as endometriosis, and routinely pathologized around menstruation and menopause.

Transgender and gender-diverse Canadians face some of the steepest health inequities. Access to respectful primary care is uneven. Mental-health outcomes are strongly shaped by family acceptance, school climate, and legal recognition. Trans-Pulse Canada survey data consistently show that what looks like vulnerability to mental illness is better understood as the embodied residue of discrimination.

Intersectionality, a concept developed by Kimberlé Crenshaw, reminds us that gender never operates alone. The health of a low-income Black lesbian in Halifax is not simply the sum of “woman health,” “Black health,” and “queer health.” It is shaped by the specific combination, which produces experiences none of those categories would predict on its own.

Chapter 7: Race, Ethnicity, and Health Inequities

Race is biologically trivial and sociologically decisive. Modern genetics confirms that human genetic variation maps poorly onto the folk categories we inherited from European colonial projects. Yet racism — as ideology, practice, and institutional arrangement — has measurable effects on bodies. Sociologists study the pathway from race as a social category to race as a health outcome.

In Canada, racialized communities (excluding Indigenous peoples, discussed separately in Chapter 11) face multiple health disparities. Black Canadians experience higher rates of hypertension and diabetes, partly explained by income and neighbourhood effects and partly by the physiological toll of what public-health scholar Arline Geronimus called weathering — the accelerated biological aging produced by chronic exposure to discrimination. Chinese and South Asian Canadians navigate different mixes of risk, often shaped by post-migration stress, language barriers, and culturally mismatched health services. Refugees from war zones arrive with trauma histories that Canadian clinicians are only beginning to treat adequately.

Racism enters the clinic in subtler ways too. Studies have shown that racialized patients are more likely to have their pain under-treated, to be labelled non-compliant, and to receive less time with physicians. Implicit-bias research, though contested in its methods, has made it hard to pretend that Canadian medicine is race-neutral.

In sport and activity, racialized Canadians navigate both exclusion and stereotype. Certain sports — hockey being the obvious Canadian example — carry cultural codes and financial barriers that keep their player pools disproportionately white. Other sports, such as basketball and track, concentrate racialized athletes and produce the illusion of “natural” talent that obscures the social funnels responsible. Coakley and Donnelly document how scouts, coaches, and commentators map racial stereotypes onto positions and playing styles, a process that shapes careers from youth leagues up.

A sociological response to health and activity inequities therefore has to go beyond “cultural competence” training for individual clinicians and coaches. It has to address the distribution of income, housing, and safety, and it has to ask why institutions remain structured in ways that produce the disparities in the first place.

Chapter 8: Class, Income, and the Status Syndrome

Social class is the silent variable in most health disparities. Whether measured by income, occupation, or education, class is the single strongest non-biological predictor of how long a Canadian will live and how healthy those years will be. Marmot’s Whitehall studies, mentioned earlier, demonstrated that even among employed British civil servants with universal health coverage, each step down the occupational ladder corresponded to a measurable increase in mortality from heart disease and other causes. He called this the status syndrome: the damage inflicted by being at the bottom of a steep hierarchy, regardless of absolute material wealth.

Canadian data echo these findings. Low-income Canadians are more likely to smoke, to eat diets dominated by cheap energy-dense foods, to live in substandard housing, to work physically demanding jobs with little control, and to lose years of life to preventable disease. These patterns are not primarily about ignorance or will-power. They are about what a realistic life looks like when money is scarce, time is fragmented, and stress is constant.

Pierre Bourdieu’s essay “Sport and Social Class” (1978) and his larger project in Distinction clarify why activity itself is classed. Bourdieu argued that different classes develop different habitus — embodied dispositions that make certain sports, foods, and leisure practices feel natural and others feel foreign. Working-class sports tend to emphasize strength, collective identification, and use of the body as an instrument (boxing, hockey, soccer). Middle-class sports emphasize health maintenance, individual achievement, and the body as a project to be disciplined (running, yoga, cycling). Elite sports emphasize space, equipment, and social connection (golf, tennis, sailing, skiing). These are not absolute categories, but the patterns repeat across countries and decades. The classed body is produced long before any doctor sees it.

The pandemic decade sharpened class analysis in health sociology. COVID-19 killed disproportionately among essential workers — cleaners, personal support workers, meat-packing employees — who could not work from home. The pandemic also revealed how fragile public health infrastructure had become under decades of austerity. Writing in 2024 and 2025, sociologists of health increasingly connect chronic inequality to acute crisis: a society that tolerates large gradients in ordinary years cannot suddenly close them when a virus arrives.

Chapter 9: Age and the Life Course

Health sociology has moved from treating age as a variable to treating the life course as a process. Chances accumulate. The child who grows up in a warm apartment with food security, parents with time to read to her, and a safe park to play in starts life with reserves she will draw on decades later. The child who grows up in food insecurity, exposed to lead paint, shuttled between schools, and watched by no adult at 5 p.m. starts with deficits that later interventions can mitigate but rarely erase. Epidemiologists call these biological embedding effects; sociologists emphasize that they are produced by deeply social arrangements.

Childhood is also when activity patterns are installed. Organized sport participation depends on family income, parental time, transportation, and neighbourhood facilities. Canadian surveys show that children from higher-income families are more likely to participate in structured physical activity and more likely to carry that participation into adulthood. Unstructured play, once the default in post-war Canada, has diminished under a combination of screen time, parental fear of risk, and the conversion of public space into private space.

Adolescence is when identity experiments around the body become intense. Young people negotiate peer hierarchies through sport, clothing, weight, and appearance. Eating disorders, described further in Chapter 12, tend to emerge here. So does the transition from “moving because it is fun” to “moving because I have to” — a shift that loses many young women to long-term inactivity.

Adult life brings the long plateau where work, caregiving, and sleep compete for time. Physical activity tends to decline; chronic conditions begin to accumulate; social networks thin. Middle-aged Canadians are at the point where decades of accumulated class, gender, and racial advantage or disadvantage start to show in bodies.

Older adulthood is the subject of the sociology of aging, a field enlivened by Canadian scholars such as Anne Martin-Matthews. It asks how people construct meaningful lives in the face of declining strength, how institutions such as long-term care have been structured to the convenience of the state rather than the dignity of residents, and how ageism — the under-studied cousin of racism and sexism — shapes what older bodies are allowed to do in public. The pandemic exposed Canadian long-term care as a site of preventable mass death, a scandal whose sociological explanation runs through decades of privatization, low wages for care workers, and a culture that treats frail elders as disposable.

Chapter 10: Disability, Ableism, and Inclusive Activity

Disability studies challenges the medical definition of disability as a deficit in the individual body. The social model of disability, developed by Michael Oliver and colleagues in 1970s Britain, distinguishes between impairment (a physiological variation) and disability (the social exclusion produced when environments, institutions, and attitudes fail to accommodate variation). A person who uses a wheelchair is not disabled by her spinal-cord injury alone; she is disabled by the staircase at the entrance, the absent ramps, the narrow doorways, and the bus driver who refuses to lower the lift. Fix the environment and much of the disability evaporates.

Critical disability studies extends this analysis. It questions which impairments get recognized, how diagnostic categories are produced, and how “normal” bodies are constructed through the exclusion of disabled ones. Scholars such as Rosemarie Garland-Thomson and Canadian writer Eliza Chandler document how public space, schools, workplaces, and sports implicitly assume a default body — upright, continent, speaking, seeing, hearing — and penalize those who differ.

Ableism, like racism and sexism, operates at several levels. Interpersonal ableism includes staring, patronizing speech, and the refusal to take disabled adults seriously. Institutional ableism is built into inaccessible buildings, employment discrimination, and benefit systems that trap disabled Canadians below the poverty line. Internalized ableism is the shame disabled people are taught to feel about their own bodies.

Inclusive activity is a growing field of practice and research. The Paralympic movement has raised the visibility of disabled elite athletes, although critics note that it can also create a narrow “supercrip” narrative that praises individual exceptionalism while leaving ordinary inaccessible environments untouched. Sledge hockey, wheelchair basketball, and parasports across the Canadian system offer genuine opportunities but remain under-funded compared to able-bodied equivalents. Everyday activity inclusion — accessible gyms, trails, swimming pools, and drop-in programs — is the less glamorous but more consequential frontier.

Goffman’s Stigma remains the classic text on the everyday management of disability. He describes how people with “spoiled identities” learn to pass, to cover, or to “come out” strategically, and how the non-stigmatized contribute to the dance by looking away, overcompensating, or asking well-meaning but intrusive questions. Sixty years on, the choreography he described is still recognizable in classrooms, clinics, and arenas across Canada.

Chapter 11: Indigenous Health and Well-Being in Canada

No topic is more central to Canadian health sociology than the health of First Nations, Inuit, and Métis peoples. Statistical summaries are devastating: life expectancy several years below the Canadian average, infant mortality higher, suicide rates among Indigenous youth among the highest in the industrialized world, and rates of diabetes, tuberculosis, and HIV far above non-Indigenous benchmarks. The temptation is to read these numbers as “Indigenous people are unhealthy.” The sociological obligation is to read them as “Canadian colonial arrangements are making Indigenous people unhealthy.”

The Truth and Reconciliation Commission’s 2015 report and its Calls to Action make the mechanisms visible. Residential schools systematically separated children from parents, language, and ceremony, producing intergenerational trauma whose effects on mental and physical health ripple through descendants. Forced relocations, broken treaties, flooded territories, and the Sixties Scoop continued the separation through other means. Environmental racism — boil-water advisories on dozens of reserves decades after clean water was declared a right — expresses colonial neglect in directly physiological form.

The medical system has often been part of the harm. Coerced sterilization of Indigenous women continued into the 1970s in some jurisdictions and has been documented as recently as the 2010s. Indigenous patients report ongoing racism in Canadian hospitals, a reality made undeniable by the death of Joyce Echaquan in a Quebec hospital in 2020 while staff mocked her on video. The Indigenous Services Canada evacuation system still routinely removes pregnant women from northern communities weeks before delivery, cutting them off from family and ceremony at a crucial moment.

Indigenous health scholars such as Margo Greenwood and Charlotte Reading insist that any honest accounting has to include not only these harms but also the assets Indigenous communities have retained and rebuilt. Land-based healing, community-run wellness centres, revitalized ceremony, and Indigenous-led research protocols are central to contemporary responses. The First Nations Health Authority in British Columbia is an important institutional example: a jurisdictional transfer that puts decision-making closer to the communities whose health is at stake.

Sport and activity carry similar dual stories. Organized hockey has been both a site of harm — Indigenous boys in residential schools were sometimes trained for the benefit of outside teams — and a site of pride and community building. Lacrosse, Canada’s summer national sport, is Haudenosaunee in origin and has been revived as a vehicle for cultural continuity. The North American Indigenous Games bring thousands of athletes together in ways that resist the framing of Indigenous people as defined by deficit.

Reconciliation in health requires more than cultural competence courses. It requires honouring treaty rights, closing the funding gap between Indigenous and non-Indigenous services, and relinquishing control to Indigenous communities over their own institutions. Sociology’s role is to keep the colonial context visible when it is easier to look away.

Chapter 12: Body, Embodiment, and Body Image

Sociology’s “embodiment turn” insists that bodies are not merely vehicles for social meaning; they are where social meaning takes flesh. Food, exercise, clothing, medication, surgery, and pain are all practices through which societies produce particular kinds of bodies.

Susan Bordo’s Unbearable Weight is a landmark feminist analysis of how Western culture, since at least the 1980s, has trained women to experience their bodies as projects requiring constant management. Bordo reads advertising, film, and clinical literature together to show how slenderness has become a moral category, how hunger has been reframed as evidence of character, and how eating disorders concentrate in a gendered way because they express, in extreme form, demands placed on all women. Paula Saukko’s The Anorexic Self adds a narrative dimension: the women she interviews describe their disorders not as deviance but as attempts to build a coherent self inside impossible expectations.

Men are not exempt from the disciplinary gaze, though the content differs. Research on muscle dysmorphia and the rise of the lean-muscular ideal shows that men increasingly experience body dissatisfaction, use anabolic steroids, and restrict food in the service of visibility. The Instagram and TikTok era accelerated these pressures for both genders, producing forms of body surveillance that earlier sociologists could not have anticipated.

Fat studies, a more recent field, challenges the medical consensus that higher body weight is straightforwardly unhealthy. Scholars such as Deb Burgard and Sonya Renee Taylor argue that weight stigma causes a significant share of the outcomes blamed on fat itself: avoidance of medical care, chronic stress, and disordered eating. The Health at Every Size movement proposes that behaviours such as movement, nourishing food, and restful sleep are the relevant targets of health promotion, regardless of the scale.

Embodiment also includes less visible practices: cosmetic surgery, skin-lightening cream, hair straightening, binding, tucking, tattooing, and piercing. Each of these tells a story about how bodies are being read and what they are being asked to say. The sociology of the body is at its best when it resists both naive celebration (“my body, my choice”) and moralistic alarm (“society has failed”). It asks instead what the practice means, to whom, under what conditions, and with what consequences.

Chapter 13: Media and the Cultural Politics of Health

Canadians learn most of what they know about health from media. Newspaper health sections, television cooking shows, fitness influencers on Instagram, viral TikTok videos about intermittent fasting, novelty diet books, and algorithmic feeds that reward outrage all contribute to what sociologists call the cultural politics of health: the contested field where images, stories, and scientific claims compete to shape public understanding.

Media representations of health are not neutral. They systematically favour dramatic individual stories over the slow statistics of population health. They amplify claims that match existing biases about who is virtuous (the runner, the clean eater, the recovered addict) and who is not (the fat person, the smoker, the “non-compliant” patient). They repeat racialized and gendered tropes: the Black basketball player as naturally gifted, the white quarterback as cerebral, the female gymnast as delicate, the male soldier as stoic.

Public-health communication struggles inside this environment. Evidence-based messages about vaccination, harm reduction, or the social determinants of health have to compete with viral misinformation and sponsored content. The COVID-19 pandemic was a dark tutorial in how rapidly an information environment can splinter. Sociologists of health now pay close attention to media literacy as a health determinant in its own right.

Sport media is a specialized terrain. Coakley and Donnelly devote substantial attention to how broadcasting choices, commentary, and highlight reels construct particular visions of athletic bodies and athletic virtue. The absence of women’s sport from prime-time coverage is not a neutral reflection of audience preference; it is the result of editorial decisions that then shape audience preference. The racialization of commentary, with its tired vocabulary of “natural athleticism” and “intangibles,” actively reproduces stereotypes. Even the camera angles chosen during women’s beach volleyball matches encode assumptions about what female bodies are for.

Fitness culture on social media deserves its own sociological attention. Influencers with no clinical training reach millions of young Canadians with advice on eating, supplementation, hormones, and training. Algorithms reward content that provokes and polarizes, which means the loudest voices often promote the most extreme practices. Research on “fitspiration” content documents measurable negative effects on body image and exercise motivation in young women, even when the content is nominally positive.

The healthy response is not to retreat to pre-digital nostalgia. It is to cultivate critical media literacy — to ask who produced a health message, who benefits from it, what it leaves out, and whose bodies it is organized around.

Chapter 14: Policy, Power, and the State

Sociologists of health insist that the biggest determinants of population health are political. Whether Canadians live in a society with decent minimum wages, affordable housing, paid sick leave, quality child care, accessible public transit, clean water, and universal health insurance is determined in legislatures and cabinets, not in clinics. Policy is the name for the mechanism by which collective decisions are made about these things, and power is the name for the unequal capacity to influence those decisions.

Canada’s public health care system, built through the 1960s by efforts associated with Tommy Douglas and the Saskatchewan precedent, is often cited as a national achievement. Sociologically, it has been a mixed story. It has prevented the worst American outcomes — medical bankruptcy, routine rationing by price — but it covers only doctors and hospitals, leaving pharmaceuticals, dental care, vision, and mental health as patchworks that reproduce class and racial inequalities. Ongoing debates about pharmacare, dental care, and mental-health funding are, at bottom, debates about whose suffering counts as legitimately public.

The state is also the largest producer of health-relevant conditions through laws and programs that are not labelled “health.” Labour law shapes workplace injury. Housing policy shapes exposure to mould, cold, and overcrowding. Agricultural subsidies shape the price of fresh produce versus ultra-processed food. Transportation investment shapes whether walking and cycling are realistic daily options. Immigration policy shapes the stress and precarity of newcomers. Sociologists of health argue that any credible public health strategy has to intervene at these upstream points, not merely mop up downstream with clinical services.

Power, in the sociological sense, is not only who holds office. It is also who sets the agenda and who frames the terms. The pharmaceutical industry, the food industry, the fossil fuel industry, and the health insurance industry all deploy substantial resources to shape what counts as an acceptable policy option. Studies of lobbying, advertising, and strategic philanthropy reveal how public health debates are shaped behind the scenes. A sociological perspective on policy cannot separate the formal process from these informal ones.

Critical public health scholars such as Dennis Raphael argue that Canadian policy debates remain dominated by an individualist frame that emphasizes lifestyle and medical care, while the structural determinants remain harder to put on the agenda. Changing this, Raphael and others suggest, requires not only better evidence but also stronger coalitions between researchers, unions, community organizations, Indigenous nations, and social movements.

Chapter 15: Health Activism and Social Change

If power distributes health unevenly, then reclaiming power is part of any serious project to improve health. Sociologists have long studied health-related social movements, and recent decades have produced a rich literature on how ordinary people organize to defend and extend their well-being.

The women’s health movement of the 1970s, symbolized by the collectively written Our Bodies, Ourselves, demanded that women be treated as authorities on their own bodies. It changed clinical training, textbook content, and the everyday expectations patients brought into offices. The disability rights movement, centred in part on the “Nothing About Us Without Us” slogan, transformed laws, buildings, and curricula across North America. The HIV/AIDS activism of ACT UP and allied groups compressed what would have been decades of drug-approval change into a few urgent years and established that patients could be legitimate participants in clinical research design. Indigenous-led movements such as Idle No More have linked environmental justice and health justice in ways that mainstream public health is still learning to absorb.

Contemporary movements include the fight for safe consumption sites, the push for decriminalization of drug use as a public health strategy, harm-reduction programs run by people who use drugs, climate-and-health coalitions, fat-liberation groups, Mad Pride and psychiatric-survivor organizing, and trans-health advocacy. Each of these illustrates a basic sociological point: communities affected by a health issue often have knowledge, solidarity, and legitimacy that credentialled experts lack, and the partnerships between them can produce change neither could achieve alone.

Sport, too, has become a terrain of activism. Athletes have kneeled, sat, raised fists, and walked out to protest racism, sexism, and economic injustice. The collective bargaining of professional women’s teams has pushed pay equity onto broader agendas. Youth athletes have gone public about abusive coaches and complicit institutions, leading to Canada-wide reckonings in gymnastics, hockey, and soccer. These moments can look like individual heroism but are sociologically best read as the visible tip of longer organizing processes.

Effective activism for health, the literature suggests, shares several features. It names problems as structural rather than individual. It builds coalitions across communities that powerful actors would prefer to keep divided. It mixes insider advocacy with outsider pressure. It produces and uses evidence without letting evidence exhaust politics. It takes care of its members so that activists themselves do not burn out.

For a student of HEALTH 107, the invitation is twofold. First, to learn how to see the social patterns behind personal troubles — why your roommate’s asthma, your uncle’s heart attack, your own relationship with exercise, and the Indigenous neighbour whose water has not been drinkable for twenty years are connected through the structures this course examines. Second, to recognize that sociological knowledge is never only academic. It is also a resource for the imagination of a different Canada — one in which health is distributed more justly, activity is available to all bodies, and well-being is understood as a collective achievement rather than a private prize. Sociology cannot build that Canada on its own. It can, and should, help Canadians build it together.