## Learning Outcomes

- Define social structure and explain how it organizes roles, relationships, norms, and institutions.
- Distinguish macro-level and micro-level approaches to studying society.
- Compare functionalism, conflict theory, symbolic interactionism, social constructionism, exchange theory, and feminist theory.
- Identify major social institutions and explain how they shape behavior, opportunity, and health.
- Explain core culture concepts, including material culture, symbolic culture, subcultures, assimilation, and multiculturalism.
- Apply social structure concepts to MCAT-style examples involving education, family, religion, government, economy, and medicine.

## Medical College Admission Test (MCAT) Syllabus

In the Psychological, Social, and Biological Foundations of Behavior section, you have 59 questions in 95 minutes, with many questions linked to passages, graphs, or studies. Sociology makes up a substantial part of this section, and Foundational Concept 9 focuses on how cultural and social differences affect well-being. Subtopic 9A asks you to understand how social structure organizes society through theories, institutions, and culture.

- Social structure as patterned relationships, roles, norms, and institutions.
- Micro-level versus macro-level sociological analysis.
- Major theoretical approaches: functionalism, conflict theory, symbolic interactionism, social constructionism, exchange/rational choice theory, and feminist theory.
- Social institutions: education, family, religion, government, economy, health, and medicine.
- Culture: beliefs, values, norms, symbols, language, rituals, material culture, and symbolic culture.
- Cultural processes: culture lag, culture shock, assimilation, multiculturalism, subcultures, countercultures, diffusion, and cultural transmission.
- Health-related applications: medicalization, the sick role, illness experience, healthcare delivery, and social epidemiology.

## Test Your Knowledge

Attempt these questions before reading this article. If you find some difficult or cannot remember the answers, look more closely at that area during your revision.

1. How does a macro-level explanation of low vaccination rates differ from a micro-level explanation?
2. Which sociological theory best explains healthcare inequality as a result of unequal access to money, power, and social resources?
3. What is the hidden curriculum, and how might it reproduce social inequality?
4. How are material culture and symbolic culture different?
5. What rights and obligations are included in the sick role?

## Introduction

Social structure is the organized pattern behind social life. On the MCAT, this topic helps you move beyond explanations based only on individual choices. A passage may describe a patient missing appointments, a child performing poorly in school, or a community having low use of preventive care. The exam may ask whether the best explanation is personal motivation, social norms, institutional access, socioeconomic inequality, or cultural meaning.

This subtopic is especially useful for health-related passages because social structure affects exposure to risk, access to care, patient-provider interactions, and how illness is understood. For example, a person’s symptoms may be interpreted differently depending on family expectations, workplace rules, religious beliefs, insurance access, and medical labels.

> **Key Term: Social structure**
> Stable patterns of social relationships, roles, institutions, norms, and hierarchies that organize society and shape individual behavior.

### Social structure, levels of analysis, and sociological theories

A central MCAT skill is matching an example to the correct level of sociological explanation. A micro-level approach focuses on small-scale interactions, meanings, and face-to-face behavior. A macro-level approach focuses on large-scale systems, such as institutions, laws, class structure, education systems, and healthcare systems.

For example, suppose a study finds that patients from a certain community are less likely to attend follow-up appointments. A micro-level explanation might focus on communication between the physician and patient, such as whether the patient understood the instructions or trusted the provider. A macro-level explanation might focus on transportation access, work schedules, clinic location, insurance coverage, or historical mistrust shaped by institutional treatment.

> **Test Tip:**
> When an MCAT answer choice mentions “institutions,” “systems,” “class,” “power,” “social norms,” or “access,” it is usually pointing to a structural explanation rather than a purely individual one.

Functionalism views society as a system of parts that work together to maintain stability. Social institutions are understood by the functions they serve. Education transmits knowledge and social norms; family socializes children; religion can create shared values; medicine helps manage illness so people can return to their usual roles. Functionalism often asks, “How does this institution help society continue operating?”

> **Key Term: Functionalism**
> A macro-level theory that views society as an organized system whose institutions serve functions that help maintain stability and social order.

Conflict theory emphasizes competition over limited resources and unequal power. It is often used for passages about inequality in education, housing, employment, and healthcare. From this view, institutions may benefit dominant groups while disadvantaging others. For instance, if wealthy neighborhoods have better-funded schools and more clinics, conflict theory would focus on how resource distribution preserves inequality.

> **Key Term: Conflict theory**
> A macro-level theory that explains society through competition over power, status, and resources, often highlighting inequality between groups.

Symbolic interactionism is a micro-level theory focused on meanings created through interaction. It is useful for questions about labels, identity, patient-provider communication, stigma, and role expectations. For example, being labeled “noncompliant” by medical staff may affect how a patient is treated and how the patient views future care.

> **Key Term: Symbolic interactionism**
> A micro-level theory that studies how people create, interpret, and modify meanings through social interaction.

Social constructionism argues that many categories and meanings are created and maintained by society rather than being fixed facts of nature. This does not mean they are imaginary or unimportant; socially constructed categories can have very real consequences. Race, gender roles, disability labels, illness categories, and ideas about “normal” behavior are common MCAT examples.

> **Key Term: Social constructionism**
> The view that social categories, meanings, and realities are created through social processes and shared interpretation.

Exchange theory, also called rational choice theory in many MCAT contexts, explains social behavior as the result of weighing costs and benefits. A patient may choose a treatment based on perceived side effects, cost, time, family approval, and expected benefit. This theory assumes people make choices based on rewards, risks, and available information, though real decisions are still shaped by social context.

Feminist theory analyzes gendered power relations and how institutions may produce or maintain gender inequality. In healthcare, this might appear as gender bias in diagnosis, unequal caregiving expectations, under-recognition of certain symptoms, or occupational segregation in medical labor.

> **Exam Warning:**
> Do not treat “social construction” as meaning “fake.” On the MCAT, socially constructed categories can strongly affect health, opportunity, identity, and treatment by institutions.

### Social institutions as organized systems of roles and norms

Social institutions are organized systems that meet major social needs. They create roles, rules, norms, and expectations. Major institutions include family, education, religion, government, economy, and medicine.

> **Key Term: Social institution**
> An organized and enduring social system that meets major societal needs and creates roles, norms, and patterns of behavior.

The family is a primary agent of socialization and a source of emotional, financial, and practical support. Family structures include nuclear families, extended families, single-parent families, blended families, cohabiting partners, same-sex parent families, and other household arrangements. MCAT questions should be answered using sociological functions and patterns, not personal assumptions about what a family “should” be.

Family also shapes health. It can affect diet, stress, caregiving, genetic risk awareness, health beliefs, and access to care. Kinship refers to socially recognized family relationships, which may include biological ties, marriage, adoption, or culturally recognized bonds. Family violence, including intimate partner violence, child abuse, and elder abuse, may be tested through links to stress, injury, reporting, and social support.

Education transmits knowledge, credentials, social norms, and expectations. It can create upward social mobility, but it can also reproduce inequality. School quality often varies by neighborhood, funding, class, and racial or ethnic segregation. Educational stratification refers to the unequal distribution of educational access, resources, or outcomes.

> **Key Term: Hidden curriculum**
> The unofficial lessons taught by schools, such as punctuality, obedience to authority, competition, conformity, and expected social behavior.

The hidden curriculum is not written in a syllabus, but students learn it through classroom routines and school expectations. For example, students may learn that speaking in a certain way is “professional,” that authority should not be challenged, or that competition is normal. Teacher expectancy effects can also matter: if teachers expect certain students to perform well, they may give more encouragement and harder material, contributing to a self-fulfilling prophecy.

Religion is another social institution. It can provide meaning, community, moral rules, rituals, and social support. Religiosity refers to the degree of religious belief or practice. Secularization is the process by which religion becomes less central in public life. Fundamentalism refers to strict adherence to traditional religious beliefs, often in response to perceived social change. MCAT questions may also contrast mainstream religious organizations with smaller breakaway groups or newer religious movements.

Government and economy are often tested together because both organize power and resources. Power is the ability to influence others or get others to act even when they resist. Authority is legitimate power. Traditional authority is based on custom, charismatic authority on personal qualities, and rational-legal authority on rules and laws. The economy organizes production, distribution, and consumption of goods and services. Division of labor refers to specialization of tasks, often associated with industrialization, job roles, and social class.

> **Test Tip:**
> If a passage asks why a social institution persists, functionalism may be relevant. If it asks who benefits, who lacks access, or how inequality is maintained, conflict theory is often the stronger choice.

### Health, medicine, illness, and social structure

Medicine is both a scientific field and a social institution. It defines roles such as physician, patient, nurse, caregiver, insurer, and administrator. It also creates norms about what counts as illness, who should be treated, and what kinds of treatments are legitimate.

> **Key Term: Medicalization**
> The process by which human conditions or behaviors become defined and treated as medical problems.

Medicalization is common in MCAT passages. For example, if ordinary shyness becomes increasingly diagnosed as a disorder and treated with medication, the best concept may be medicalization. This does not require the MCAT to say whether the diagnosis is right or wrong. The key issue is that a condition has been moved into the domain of medicine.

The sick role is a classic concept describing the social position of a sick person. A person in the sick role is usually considered not responsible for being ill and may be excused from normal obligations, such as work or school. However, the person is also expected to want to recover and to seek competent help. This concept is most useful when a passage discusses rights and expectations attached to being recognized as ill.

> **Key Term: Sick role**
> A socially recognized role in which an ill person is excused from normal duties, is not blamed for illness, and is expected to seek help and try to recover.

Illness experience refers to the subjective experience of symptoms, diagnosis, treatment, stigma, identity change, and interaction with healthcare workers. Two patients with the same diagnosis may have different illness experiences depending on social support, culture, cost of care, stigma, and how providers communicate with them.

Healthcare delivery is shaped by institutions. Access to insurance, clinic location, wait times, language services, provider bias, and health literacy can affect outcomes. Social epidemiology studies how social factors influence disease distribution. For instance, if asthma rates are higher in areas with poor housing quality and air pollution, a social epidemiological approach would examine how neighborhood, class, policy, and environmental exposure shape disease patterns.

Health and medicine are also tied to culture. A patient may interpret symptoms through religious beliefs, family experience, traditional healing practices, or prior discrimination. A culturally competent provider should not assume that every member of a group has the same beliefs; instead, the provider should ask respectful questions and avoid stereotyping.

> **Exam Warning:**
> Avoid answer choices that blame health outcomes only on individual choices when the passage gives structural barriers such as cost, transportation, insurance, discrimination, housing, or education.

### Culture, symbols, and cultural change

Culture includes shared beliefs, values, norms, language, symbols, rituals, practices, and objects. It tells people what is expected, what is meaningful, and what is considered acceptable. On the MCAT, culture is often tested in relation to patient beliefs, communication, stigma, group identity, and social change.

> **Key Term: Culture**
> The shared beliefs, values, norms, language, symbols, practices, and material objects of a group.

Material culture refers to physical objects created or used by a group, such as clothing, buildings, technology, medical tools, books, smartphones, or religious objects. Symbolic or nonmaterial culture refers to meanings, values, language, rituals, norms, and beliefs. A stethoscope is material culture; the meaning attached to the white coat as a sign of medical authority is symbolic culture.

Language is a major part of culture because it shapes communication and social meaning. Symbols are objects, gestures, sounds, or images that carry shared meaning. Rituals are repeated behaviors with symbolic value, such as graduation ceremonies, religious services, or hospital routines around consent and discharge.

Culture shock is the disorientation people may feel when entering an unfamiliar culture. Culture lag occurs when nonmaterial culture, such as laws or norms, does not keep pace with material or technological change. For example, telemedicine technology may spread quickly, while norms about privacy, licensing, and patient-provider boundaries take longer to adjust.

> **Key Term: Culture lag**
> A gap that occurs when material culture changes faster than nonmaterial culture, such as norms, values, or laws.

Assimilation occurs when a minority group adopts features of the dominant culture, often losing some original cultural traits. Multiculturalism supports the recognition and preservation of multiple cultural traditions within a society. Subcultures are groups with distinct norms within a larger society, such as medical students, skateboarders, military families, or religious communities. Countercultures are subcultures that actively oppose dominant norms.

Cultural transmission is the passing of cultural knowledge from one generation or group to another. Cultural diffusion is the spread of cultural traits from one society or group to another. Mass media and popular culture can speed diffusion by spreading language, fashion, health messages, and social norms across large populations.

In MCAT passages, culture may appear in patient-provider communication. For example, one culture may value direct eye contact as respectful, while another may view it as rude in certain settings. One family may make medical decisions collectively, while another may prioritize individual autonomy. The best answer is usually one that recognizes cultural context without making rigid assumptions.

## Key Point Checklist

This article has covered the following key knowledge points:

- Social structure refers to stable patterns of roles, relationships, norms, institutions, and hierarchies.
- Micro-level analysis focuses on interactions and meanings; macro-level analysis focuses on institutions and large-scale systems.
- Functionalism asks how institutions contribute to stability and social order.
- Conflict theory focuses on competition over power, status, and resources.
- Symbolic interactionism explains behavior through shared meanings and face-to-face interaction.
- Social constructionism explains how categories and meanings are created through social processes.
- Social institutions include family, education, religion, government, economy, health, and medicine.
- The hidden curriculum consists of unofficial school lessons such as obedience, punctuality, and conformity.
- Medicalization occurs when conditions or behaviors become defined and treated as medical problems.
- The sick role includes exemption from normal duties plus an expectation to seek help and try to recover.
- Culture includes material objects and symbolic elements such as beliefs, values, language, rituals, and norms.
- MCAT questions often reward structural explanations when passages describe barriers such as cost, access, discrimination, or institutional rules.

## Key Terms and Concepts

- Social structure
- Functionalism
- Conflict theory
- Symbolic interactionism
- Social constructionism
- Social institution
- Hidden curriculum
- Medicalization
- Sick role
- Culture
- Culture lag


Foundational concept 9: Cultural and social differences - 9A: Understanding social structure