Chapter 10 Medical Care: Physical and Mental Illness

1. Chapter 10 Medical Care: Physical and Mental Illness

2. The Problem In Sociological Perspective • Not just biology • Social component • Industrialization and lifestyle • Greater affluence • Iatrogenesis • Illness caused by medical care staff • Changing ideas about health and illness

3. The Social Organization of Medicine as a Social Problem • An explosion in medical costs • Reasons for the explosion in costs

4. Medicine for profit: a two-tier system of medical care • Medicine for profit is also known as a fee-for-service system. Two-tier system of medical care: • one for those who can afford insurance • another for those who cannot

6. Medicine for profit: cesarean delivery • Why have cesarean births increased? • Profit • Convenience • Technology • Preference • A Feminist Controversy • Central issue is the relative power of women

8. Physical Illness as a Social Problem • Life expectancy and infant mortality • Determines how healthy or ill a society is as a whole. • Infant Mortality Rate (IMR) • Number of babies who die before 1 year of age, per 1,000 live births • Lifestyle • Heroic an Preventive Medicine • Quick care: Emergency Rooms and Drugstores • Uneven Distribution of Doctors

11. Mental Illness as a Social Problem • Measuring mental illness • The social nature of mental illness • How we define mental illness is a matter of dispute

12. A two-tier system of mental health delivery • the illness • the medical delivery system • Deinstitutionalization • The release of hospitalized mental patients into the community

13. Symbolic Interactionism • Determining the meaning of symptoms and behavior • People from different backgrounds interpret health & illness differently • The significance of definitions • Views and meanings of health and illness change • Conflicting Referral Networks • Depersonalization

14. Functionalism • Customs or social institutions fulfills social needs. • Free-for-Service Means Profits • It is difficult for doctors to make money if people are not sick • A self-correcting system

16. Conflict Theory • Argues that the U.S. medical system is not self-correcting. • The poor are more often sick—they lack sufficient income and high-quality education, food, housing, jobs, and medical services

17. Medicaid • Colliding Interests of Doctors and Patients • Doctors represent the dominant class • Patients are the subordinate class • Women’s Reproductive Organs • Hysterectomies

18. An Overview of Physical Health Problems • Historical changes in health problems • 6 of the 10 leading causes of death have remained the same according to Figure 10-9. • Several of the top killers in both centuries are caused primarily by lifestyle and environmental pollution.

20. Infectious diseases • The decline in infectious diseases • Stronger immunities, clean water, better food • The resurgence of infectious diseases • Develop new strains that are resistant

21. How Disease Is Related to Behavior and Environment: the Case of HIV/Aids • Background • Example of the relationship between behavior, environment, and disease • The disease no longer discriminates • A global epidemic • 30 million people have died • 33 million people around the world are infected now • 3 million more people are being infected each year

22. HIV/Aids in the United States Antiretroviral drugs (ARVs) Halt the progression of AIDS Combination of ARVs and education caused AIDS deaths in the U.S. to decrease Race/ethnicity—higher rates of HIV/AIDS Ominous changes HIV virus mutates rapidly .

24. Social Inequalities in Physical Illness • Poverty and health • Economic factors largely determine who will be healthy and who will be sick • Occupational health hazards • lower-class working environments • Reducing Inequalities: Health Care Reform

25. Social Inequalities in Mental Illness • Social class and mental illness • People’s emotional well-being declines with decreases in social class. • Four explanations for the greater emotional problems of the poor: • The Drift Hypothesis • The Genetic Hypothesis • The Socialization Hypothesis • The Environmental Hypothesis

27. Social Class Differences in Mental Health Care Different types of therapies Consequences of ability to pay Type of therapy tied to a person’s ability to pay, not illness Talk therapy Pharmaceutical straitjacket

29. Prepaid Medical Care: The Example of Managed Care • Managed Care • Health Maintenance Organization (HMO) • The positive side • Profits and a conflict of interest

30. Physician Assistants • Strategy for controlling costs Training Physicians • Medical schools graduate about 16,000 physicians a year. • Home health care • Less expensive and often more humane • Preventative Medicine

31. DomiciliaryCare • Home health care, or domiciliary care • Treatment given within a patient’s home • Less expensive and often more humane • May involve profiteering • Another approach: create domiciliary programs for mentally ill

32. Preventive Medicine • Preventable deaths • Three types of preventive medicine: • Primary prevention • Secondary prevention • Tertiary prevention • Food and health • Proper nutrition and exercise • Immunizations • Preventing drug abuse and homicide • Eating ourselves to death