Chapter 14

1. Chapter 14 Health, Health Care, and Disability

2. Questions for you… Why is an affordable and accessible health care system such a vital component in a society? Is there a health care crisis in the United States, and worldwide? What are some of the current political debates regarding universal health care coverage in the United States? What are the arguments for, and against a universal plan?

3. Chapter Outline Health in Global Perspective Health in the United States Health Care in the United States Sociological Perspectives on Health and Medicine Disability Health Care in the Future

4. Health, Health Care, and Medicine Health is a state of physical, mental, and social well-being. Health care is any activity intended to improve health. Medicine is an institutionalized system for the scientific diagnosis, treatment, and prevention of illness.

5. Health in Global Perspective • Life expectancy • AIDS has cut life expectancy by: • 5 years in Nigeria • 18 years in Kenya • 33 years in Zimbabwe

6. Health Statistics Take a look at the link below from the National Center for Health Statistics to find information on health care concerns in the United States. http://www.cdc.gov/NCHS/

7. How Much Do You Know About Health, Illness, and Health Care? • True or False? • The primary reason that African Americans have shorter life expectancies than whites is the high rate of violence in central cities and the rural South.

8. How Much Do You Know About Health, Illness, and Health Care? • False. • The lower life expectancy of African Americans as a category is due to a higher prevalence of life-threatening illnesses, such as cancer, heart disease, hypertension, and AIDS. • It should be noted that African American males have the highest death rates from homicide of any racial–ethnic category in the United States.

9. How Much Do You Know About Health, Illness, and Health Care? • True or False? • Media coverage of chronic depression and other mental conditions focuses almost exclusively on these problems as “women’s illnesses.”

10. How Much Do You Know About Health, Illness, and Health Care? • False. • Until recently, chronic depression and other mental conditions were most often depicted as “female” problems. • However, in the late 1990s, male celebrities such as Mike Wallace, the news correspondent who is co-editor of 60 Minutes, have made the general public more aware of male depression.

11. Social Epidemiology • Study of the causes and distribution of health, and disease in a population: • Disease agents – insects, bacteria, nutrient agents, pollutants, and temperature. • Environment - physical, biological and social environments. • Human host - demographic factors such as age, sex, race, and ethnicity.

12. Demographic Factors: Age • Rates of illness and death are highest among the old and the young. • After age 65, rates of chronic diseases and mortality increase rapidly. • Chronic diseases are long term or lifelong, and develop gradually or are present from birth. • Acute diseases strike suddenly and cause dramatic incapacitation and sometimes death.

13. Demographic Factors: Sex Prior to the 20th century, women had lower life expectancy because of high mortality rates during pregnancy and childbirth. Women now live longer than men. For babies born in the United States in 2010, for example, life expectancy at birth is estimated to be 78.3 years, with 75.7 years for males and 80.8 years for females.

14. Demographic Factors: Race/Ethnicity and Social Class According to a study by the Stanford Center for Research in Disease Prevention, people have a higher survival rate if they live in better-educated or wealthier neighborhoods. Racial minorities are more likely to have incomes below the poverty line, and the poorest people receive less preventive care and less management of chronic diseases.

15. Lifestyle Factors: Alcohol and Tobacco Chronic heavy drinking or alcoholism can cause permanent damage to the brain or other parts of the body. Tobacco is responsible for about one in every five deaths in this country.

16. Lifestyle Factors: Illegal Drugs High doses of marijuana smoked during pregnancy can result in congenital abnormalities and neurological disturbances. Some studies found an increased risk of cancer and lung problems associated with marijuana because its smokers are believed to inhale more deeply than tobacco users. People who use cocaine over extended periods of time have higher rates of infection, heart problems, internal bleeding, hypertension and stroke.

17. Lifestyle Factors: Sexually Transmitted Diseases Sexual activity can result in the transmission of sexually transmitted diseases (STDs), including AIDS, gonorrhea, syphilis, and genital herpes. Prior to 1960, the incidence of STDs in this country had been reduced sharply by barrier-type contraceptives and the use of penicillin as a cure. In the 1960s and 1970s the number of cases of STDs increased rapidly with the introduction of the birth control pill, which led to couples being less likely to use barrier contraceptives.

18. Obesity in the United States

19. Polling Question • Do you currently smoke cigarettes? • Yes • No

20. The Flexner Report Abraham Flexner met with the leading faculty at the Johns Hopkins University School of Medicine to develop a model of medical education. The model included the belief that a medical school should be a research-oriented, laboratory facility that devoted all of its energies to teaching and research, not to the practice of medicine. He visited each of the 155 medical schools then in existence, comparing them with the model.

21. The Flexner Report As a result of the Flexner report (1910), all but two African American medical schools were closed, and only one medical school for women survived. As a result, white women and other minorities were largely excluded from medical education for the first half of the 20th century. Until the civil rights movement and the women’s movement of the 1960s and 1970s, most physicians were white, male, and upper- or upper-middle class.

22. Paying for Medical Care in the U.S. Private Health Insurance: cited as the main reason for medical inflation, gives doctors and hospitals an incentive to increase costs. Public Health Insurance: projections call for Medicaid spending to double and Medicare spending to triple in the next few years.

23. The U.S. Health Care System Health Maintenance Organizations: provide total care with an emphasis on prevention. Managed care: monitors and controls health care provider decisions, insurance companies have the right to refuse to pay for treatment.

24. Increase in Cost of Health Care, 1993–2009

25. Implications of Advanced Medical Technology Create options that alter human relationships (prolonging life after consciousness is lost). Increase the cost of medical care. Raise questions about the very nature of life (invitro fertilization, cloning, stem cell research).

26. Persons Not Covered by Health Insurance, by State

27. Holistic and Alternative Medicine Holistic medicine focuses on prevention of illness and disease and is aimed at treating the whole person rather than just the part or parts in which symptoms occur. Alternative medicine includes healing practices inconsistent with dominant medical practice.

28. Paying for Medical Carein Other Nations • Canada • A universal health care system—a health care system in which all citizens receive medical services paid for by tax revenues. • These revenues are supplemented by insurance premiums paid by all taxpaying citizens. • Great Britain • The National Health Service Act of 1946 provides for all health care services to be available at no charge to the entire population. • the government sets health care policies, raises funds and controls the medical care budget, owns health care facilities, and directly employs physicians and other health care personnel.

29. Paying for Medical Carein Other Nations • China • With a lack of both financial resources and trained health care personnel, China needed to adopt innovative strategies in order to improve the health of its populace. • One such policy was developing a large number of physician extenders and sending them out into the cities and rural areas to educate the public regarding health and health care and to treat illness and disease.

30. The Sick Role The sick are not responsible for their condition. The sick are temporarily exempt from their normal role obligations. The sick must want to get well. The sick must seek help from a medical professional to hasten their recovery.

31. Polling Question • How physically active are you compared to your contemporaries? • More active • About average • Less active

32. Sociological Perspectives on Health and Medicine

33. Sociological Perspectives on Health and Medicine

34. Disability Disability refers to a reduced ability to perform tasks one would normally do at a given stage of life and that may result in or discrimination. Estimated 49.7 million people in the U.S. have one or more physical or mental disabilities. Less than 15% of persons with a disability are born with it. Accidents, disease, and war account for most disabilities in this country.

35. % of U.S. Population With Disabilities

36. Functionalist Perspective on Disability • The medical model of disability: • People with disabilities become chronic patients under the supervision of doctors and other medical personnel, subject to a doctor’s orders or a program’s rules, and not to their own judgment. • From this perspective, disability is deviance.

37. Symbolic Interactionist Perspective on Disability People with a disability experience role ambiguity because many people equate disability with deviance. By labeling individuals with a disability as “deviant,” others avoid them or treat them as outsiders. Society marginalizes people with a disability because they have lost old roles and statuses and are labeled as “disabled” persons.

38. Labeling the Disabled • How disabled people are labeled results from three factors: • their degree of responsibility for their impairment • the apparent seriousness of their condition • the perceived legitimacy of the condition.

39. Conflict Perspective on Disability Persons with a disability are members of a subordinate group in conflict with persons in positions of power in the government, the health care industry, and the rehabilitation business, all of whom are trying to control their destinies. In a capitalist economy, when disabilities are defined as a social problem and public funds are spent on them, rehabilitation becomes a commodity.

40. Disabilities and Employment Status

41. Quick Quiz

42. 1. An institutionalized system for the scientific diagnosis, treatment, and prevention of illness is: • health care • medicalization • medicine • social epidemiology

43. Answer: C An institutionalized system for the scientific diagnosis, treatment, and prevention of illness is medicine.

44. 2. The study of the causes and distribution of health, disease, and impairment throughout a population is called: • social etiology • sociobiology • social epidemiology • biosociology

45. Answer: C The study of the causes and distribution of health, disease, and impairment throughout a population is called social epidemiology.

46. 3. HMO stands for: • health maintenance organizations • health managed-care organizations • health management obstetricians • human managed organizations

47. Answer: A HMO stands for health maintenance organizations.

48. 4. On the average, male workers with severe disabilities make ________ of what their co-workers make. • 75 percent • 25 percent • 90 percent • 50 percent

49. Answer: D On the average, male workers with severe disabilities make 50 percent of what their co-workers make.

50. 5. Social class is a better indicator of health problems than race or ethnicity. • False. • True.