HEALTH CARE IN THE U.S.

1. HEALTH CARE IN THE U.S. A MACRO PROBLEM

2. U.S. CITIZENS • Not as healthy as in other well developed nations • Major differences in health status by class & race • System organized to respond to problems, not prevent them • Skyrocketing costs leave many unable to afford treatment • AIDS & Elderly Population increasing demand on inadequate system

3. INDICATORS USED BY SOCIOLOGISTS • LIFE EXPECTANCY is how long the average person born in a given year is expected to live. • INFANT MORTALITY is the number of newborns who die in a given year per live birth. The statistic encompasses those who die before their first birthday.

4. LIFE EXPECTANCY • In 1900 was 49 years • Today is 76 years • Represents a 50% increase • Reflects improvements in diet, personal hygiene, housing, and public sanitation • Public health & social change measures reduced mortality rates more than modern medical advances

5. INFANT MORTALITY RATE • In 1900 was 143 per 1000 • Recently has dropped to a little under 10 per 1000 • Appears that U.S. population is has grown healthier • Reflects improved sanitation, nutrition, & medical advances • Also changes in prenatal, neonatal, and obstetric practices

6. 1900’s - TODAY • In 1900’s people regularly died from tuberculosis, pneumonia & influenza • Children were hit hard by these diseases • With the development of immunizations & antibiotics longevity increased • Today the principal causes of death are heart disease and cancer • Previously people did not live long enough to contract cancer

7. NATIONAL SURVEYS • Conducted by the government since 1957 • Asks respondents for assessment of their health & that of members of their household • 1990 ASSESSMENT • Excellent or Very Good 69% • Good 22% • Fair or Poor 9% • This indicator is subjective and seems quite positive • However, we spend more per capita and comparison to other nations is not favorable

8. EXAMPLES • People born in Japan, Sweden, Norway, Switzerland, Canada & the Netherlands live longer than those born in the U.S. • Over 20 nations have lower infant mortality rates • One health care analyst stated “ The infant mortality rate in several urban areas would qualify the United States as a third world country.” • Something is very wrong when so many preventable deaths occur

9. DATA • Indicates that wealth and income distribution is unequal • Situation has worsened since the 1980’s • Direct correlation between health status and position in society • Lower in structure - Good health becomes less frequent

10. 1993 FEDERAL SURVEY • People were asked to assess their health and that of their families • Higher Income Level (over $35,000) • Excellent or Very Good 78% • Fair or Poor 4% • Lowest Income Level (under 10,000) • Excellent or Very Good 48% • Fair or Poor 23% • Economic well-being clearly affects assessment

11. CLASS & HEATH STATUS CORRELATION • Poverty, which correlates with inadequate nutrition and difficulty obtaining access to medical care is one of the reasons the U.S. ranks 24th in the world for infant mortality • Rates are substantially higher among the poor • Overall life expectancy less at low lower of class structure • To say that poverty kills is no exaggeration

12. INFECTIOUS DISEASES • Took a major toll in early part of century • Continue to take high toll on poor • Routinely Diagnosed Among Poor Today • Pneumonia & Influenza • Tuberculosis & Diphtheria • Arthritis also affects the poor more than others

13. 1992 FEDERAL SURVEY • Respondents asked how many days they or members of their household found daily activities restricted by chronic or acute conditions of illness,injury, or impairment • Family Income Under $10,000 = 29 days • Family Income Over $35,000 = 10 days • Data shows direct correlation between income and health status

14. DEBATE • Can worse health of lower socioeconomic group be attributed to conditions of poverty and the resultant emotional stress they create? • OR • Do aspects of their lifestyle such as cultural values and individual behavior account for the difference?

15. PEOPLE AND HEALTH TODAY • Increased interest in health maintenance and improved fitness • Decrease in cigarette smoking • Decrease in hard liquor consumption • Dietary changes (less red meat, more grains, fruits, and vegetables • Monitoring weight, blood pressure, and cholesterol • Limiting exposure to sun and use of sunscreens

16. U.S. HEATH TODAY • Despite media publicity, not all segments of the population are equally involved in the previously mentioned changes • Tens of millions of poor and near-poor are largely outside of or not engaged in such activity

17. “BLAMING THE VICTIM” • Implies that lower income groups are responsible for their lower life expectancy and higher infant mortality • Could be healthier if they made lifestyle changes • Does not take into account the quality of the environments to which they are exposed • Bluntly put, the more $, the less exposure to hazards and stresses that adversely affect your health

18. WORK ENVIRONMENT • Lowest paying jobs tend to be most physically taxing and involve hazardous exposure • STATISTICS • 14,000 Employees die each year • 100,000 Die prematurely • 400,000 Suffer occupationally related illness • Many of these tragedies are preventable • Employers do not take preventive steps • Negligence inflicted on low wage and status workers

19. LOW-WAGE WORKERS • Less Job Security • Seasonal Positions • Subject to Downsizing • Unemployment related to health • cardiovascular difficulty • ulcers • affordability of health care • Resulting in more than 40 million Americans without health insurance to pay for treatment

20. LOW-INCOME LIVING CONDITIONS • Bring home hazardous substances on clothing & body • Exposure may endanger family members • Live in areas with high concentration of air pollution • Urban dwellers • High risks for lung cancer & respiratory disease • Little concern for health and safety by landlords • Disease from rat & insect infested property • Lead poisoning from paint chips • Sanitation problems, fires & accidents

21. LOW-INCOME HOUSING SHORTAGE • Serious shortage of affordable housing so residents hesitate to complain or relocate • Many families double and triple up to afford shelter • Overcrowded conditions cause stress which lowers immunity and facilitates the spread of infectious diseases

22. ALCOHOL & DRUG ABUSE • Used as coping mechanism by lower income • Life is permeated with threat of criminal victimization • Filthy environment leads to depression • Sense of isolation& alienation from rest of society • Provides escape, but negative ramifications • Well-being endangered • Domestic violence (often, but not always linked) • Drugs include amphetamines, cocaine and PCP • Usage is considered major public health issue

23. HOMES • Place of emotional & nutritional replenishment • Low-income • insufficient food • inability to afford nutritionally balanced diet • Health Concerns • Obesity due to high starch & carbohydrate diet • Absence of food especially for pregnant women and children

24. THE HOMELESS • Estimated at 2-3 million • Beset by serious health problems resulting from: • Malnutrition • Stress & Fatigue • Infectious diseases • Unsanitary conditions & Poor personal hygiene • Injuries relate to accident or violence • Exposure to environmental threats • Increasing numbers of women & children

25. THOSE WITH AIDS • Too ill to work • Evicted from dwellings • Shunned by family & friends • Society fails to provide housing for all its members • Homeless, in general, can do little about their situation • Health problems are organized into existence at low levels of the class structure

26. LIFESTYLE CHANGES NEEDED • Home, work, and neighborhood environments that are hostile to psychological, and physical well-being need to improve • Exercise alone will not greatly improve health problems • The hungry will eat whatever they can obtain, not be considered about cholesterol levels

27. THE AFFLUENT • Can afford to take steps to avoid minor maladies • Can afford to exercise at health clubs • Can afford to wear designer sunglasses • Many with low- incomes are struggling to survive in their environments • Until changes are made, sharp class differences in health status will continue unabated

28. HEALTH AND RACE • People of color disadvantage in our society • Health status correlated to race as well as class • Infant Mortality twice as high for African Americans • LIFE EXPECTANCY • White Female 80.3 years • African American female 74.8 years • White Male 73.7 years • African American 65.8 years

29. LIFE EXPECTANY RATE • Between 1984 and1991 the life expectancy of African American males went down, thereafter it turned around • Rate is lowered by higher infant mortality among African Americans • African Americans have higher death rates than whites from almost all causes • Rate may reflect disproportionate number of African American with low income or that race exacts an additional toll