Illness and the Health Care Crisis

1
Chapter 2

• Illness and the Health Care Crisis

2
Chapter Outline

• The Global Context Effects of Globalization on
  Heath
• Societal Measures of Health and Illness
• Sociological Theories of Illness and Health Care
• HIV/AIDS A Global Health Concern
• The Growing Problem of Obesity
• Mental Illness The Hidden Epidemic

3
Chapter Outline

• Life style Behaviors and Social Factors
  Associated with Health and Illness
• Problems in U.S. Health Care
• Strategies for Action Improving Health and
  Health Care
• Understanding Illness and the Health Care Crisis

4
Globalization

• Economic, political, and social
  interconnectedness among societies throughout the
  world.
• Positive Effects on Health
• Allows monitoring of diseases and sharing
  guidelines for controlling disease.
• Provides opportunities for establishing
  international health programs and agreements.
• Negative Effects on Health
• Increased tourism encourages the spread of
  diseases.

5
Measures of Longevity and Mortality by Region
2003
6
Measures of Longevity and Mortality by Region
2003
7
Morbidity

• Illnesses, symptoms, and the impairments they
  produce.
• Measures of morbidity are often expressed in
  terms of incidence and prevalence.
• Incidence - Number of new cases of a specific
  health problem.
• Prevalence - Total number of cases of a specific
  health problem.

8
Life Expectancy

• Average number of years individuals born in a
  given year can expect to live.
• Infant mortality - Number of deaths of live-born
  infants under 1 year of age.

9
Top Three Causes of Death by Age Group United
States, 2003
10
Top Three Causes of Death by Age Group United
States, 2003
11
Leading Causes of Death in theUnited States
2003.
12
Childbirth Assistance and Lifetime Chance of
Maternal Mortality
13
Epidemiological Transition

• The shift from a society characterized by low
  life expectancy and parasitic and infectious
  diseases to one characterized by high life
  expectancy and chronic and degenerative diseases.
• Epidemiologists study the social origins and
  distribution of health problems in a population
  and how patterns of health and disease vary
  between and within societies.

14
Patterns of Burden of Disease

• The overall burden of disease on a population
  through a unit of measurement that combines the
  number of deaths and the impact of premature
  death and disability on a population.
• The unit of measurement, the disability-adjusted
  life year (DALY), reflects years lost to
  premature death and years lived with a
  disability.
• 1 DALY is equal to 1 lost year of healthy life.
• Worldwide, tobacco is the leading cause of burden
  of disease.

15
Patterns of Burden of Disease

• Top 10 risk factors that contribute to the global
  burden of disease

• Underweight
• unsafe sex
• high blood pressure
• Tobacco
• Alcohol
• unsafe water and sanitation

• Hygiene
• High cholesterol
• indoor smoke from solid fuels
• iron deficiency
• overweight

16
Structural-Functionalist Perspective

• Health care functions to maintain well-being of
  individuals and society.
• High cost of medical care is necessary to entice
  people into medical profession.
• HIV/AIDS helped unite and mobilize gay rights
  activists.

17
Conflict Perspective

• Focuses on how wealth, status, and power
  influence illness and health care.
• Lack of status and power affects the health of
  women in many societies.

18
Symbolic Interactionist Perspective

• Focuses on
• how meanings, definitions, and labels influence
  health, illness, and health care and
• how such meanings are learned through interaction
  with others and through media messages and
  portrayals.

19
Medicalization

• Defining or labeling behaviors and conditions as
  medical problems.
• The concept of medicalization includes
• any new phenomena defined as medical problems in
  need of medical intervention
• post-traumatic stress disorder,
  attention-deficit/hyperactivity disorder
• normal conditions that have come to be defined
  as medical problems
• childbirth, menopause, and death.

20
Stigma

• Any personal characteristic associated with
  social disgrace, rejection, or discrediting.
• Symbolic interactionists focus on stigmatizing
  effects of being labeled ill.
• Individuals with mental illnesses, drug
  addictions, physical deformities and impairments,
  and HIV and AIDS are prone to being stigmatized.

21
HIV/AIDS A Global Health Concern

• HIV/AIDS is the leading cause of death among
  adults ages 1559 years worldwide.
• HIV/AIDS has killed more than 20 million people,
  and in 2004 nearly 40 million people worldwide
  were living with HIV infection.

22
HIV/AIDS A Global Health Concern

• HIV is transmitted through
• sexual intercourse
• sharing unclean intravenous needles
• perinatal transmission
• blood transfusions or blood products
• breast milk (rarely)
• Worldwide, the predominant mode of HIV
  transmission is through heterosexual contact.

23
Question

• How many sex partners have you had in the last 12
  months?
• None
• One
• Two or more

24
GSS National Data
25
HIV/AIDS in Africa and Other Regions

• In 2003 Africa was home to 2/3 of the worlds
  people living with HIV/AIDS.
• About 1 in 12 African adults has HIV/AIDS, and as
  many as 9 out of 10 HIV-infected people in
  sub-Saharan Africa do not know they are infected.

26
HIV/AIDS in Africa and Other Regions

• The second highest HIV prevalence rate is the
  Caribbean, where 23 of adults are infected with
  HIV.
• AIDS deaths have left 14 million orphans in the
  world, and by 2010 a projected 25 million
  children will be orphaned by HIV/AIDS.

27
HIV/AIDS in the United States

• An estimated 850,000 to 950,000 U.S. residents
  are infected with HIV, about 1/4 of whom are
  unaware of their infection.
• 70 of new HIV infections in the U.S. each year
  are among men and half are in people younger than
  25.

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HIV/AIDS in the United States

• Of new infections among men
• 60 were infected through heterosexual sex
• 25 through injection drug use
• 15 through heterosexual sex.
• Of new infections among women
• 75 were infected through heterosexual sex
• 25 through injection drug use.

29
HIV/AIDS in the United States

• In a study of 5 U.S. cities, 25 of men who have
  sex with men were infected with HIV.
• 48 of these men were not aware they were
  infected.
• In 2003 African Americans accounted for 42 of
  all people in the U.S. living with HIV/AIDS.
• In 2001 HIV/AIDS was the number one cause of
  death for African American women ages 2534.

30
Question

• What is the predominant mode of HIV transmission
  worldwide?
• heterosexual contact
• perinatal transmission
• homosexual contact
• intravenous drug use

31
Answer A

• Heterosexual contact is the predominant mode of
  HIV transmission worldwide.

32
The Growing Problem of Obesity

• Obesity is the second biggest cause of
  preventable deaths in the United.
• In 2005 a report published in the New England
  Journal of Medicine suggested that over the next
  50 years obesity will shorten the average U.S.
  life expectancy of 77.6 years by at least 2 to 5
  years

33
The Growing Problem of Obesity

• 64 of U.S. adults are overweight or obese.
• 1/4 of U.S. adults age 20 or older are obese.
• The percentage of U.S. adults who are obese
  increased from 19.4 in 1997 to 24.5 in 2004.
• Among youth ages 619, 16 are overweight.
• The percentage of children and adolescents who
  are overweight has more than doubled since 1970.

34
Mental Illness The Hidden Epidemic

• Mental illness refers collectively to all mental
  disorders, which are health conditions that are
  characterized by alterations in thinking, mood,
  and/or behavior associated with distress and/or
  impaired functioning and that meet specific
  criteria.
• Mental illness is a hidden epidemic because the
  shame and embarrassment associated with mental
  problems discourage people from acknowledging and
  talking about them.

35
Extent and Impact of Mental Illness

• One study found a 40 lifetime prevalence of any
  mental disorder in the Netherlands and the United
  States, a 12 lifetime prevalence in Turkey, and
  a 20 lifetime prevalence in Mexico.
• Annually, about 21 U.S. adults experience mental
  illness, and more than 14 of school-age children
  have mental health problems.

36
Extent and Impact of Mental Illness

• Untreated mental disorders can lead to
• poor educational achievement
• lost productivity
• unsuccessful relationships
• significant distress
• violence and abuse
• incarceration
• poverty

37
Extent and Impact of Mental Illness

• On any given day 150,000 people with severe
  mental illness are homeless, living on the
  streets or in public shelters.
• As many as 1 in 5 adults in U.S. prisons and as
  many as 70 of youth incarcerated in juvenile
  justice facilities are mentally ill.

38
Social Class and Poverty

• Poverty is associated with malnutrition, indoor
  air pollution, hazardous working conditions, lack
  of access to medical care, and unsafe water and
  sanitation .
• The percentage of Americans reporting fair or
  poor health is more than three times as high for
  people living below the poverty line as for those
  with family income at least twice the poverty
  threshold.

39
Poverty and Health

• People living below the U.S. poverty line are
  three times as likely to have serious
  psychological distress.
• Social selection - mentally ill individuals
  have difficulty achieving educational and
  occupational success and drift to the lower
  class.
• Social causation - lower-class individuals
  experience greater stress and this stress can
  reach the point where the individual can no
  longer cope with daily living.

40
Education and Health

• Individuals with low levels of education are more
  likely to engage in health-risk behaviors.
• Women with less education are less likely to seek
  prenatal care and are more likely to smoke during
  pregnancy.
• A national survey in India found that only 18 of
  illiterate women had heard of AIDS, compared to
  92 of women who had completed high school.

41
Family and Household Factors

• A study of adults in their 50s found that married
  people who live only with their spouse or with
  spouse and children had the best physical and
  mental health.
• Single women living with children had the lowest
  measures of health.
• Better health among married individuals results
  from the economic advantages of marriage and from
  the emotional support provided by most marriages.

42
Gender and Health

• Gender discrimination and violence against women
  produce adverse health effects in girls and women
  worldwide.
• Violence against women is a major public health
  concern
• At least one in three women has been beaten,
  coerced into sex, or abused in some way.
• Sexual violence and gender inequality contribute
  to growing rates of HIV among girls and women.

43
Life Expectancy in the United States by Race and
Sex
44
Question

• Do you have any health insurance, including
  Medicare or Medicaid?
• Yes
• No

45
GSS National Data
46
U.S. Health Care

• In the United States, health care is offered
  through various private and public means.
• In 200
• 27 of Americans were covered by government
  health insurance plans (Medicare, Medicaid, and
  military insurance)
• 68 were covered by private insurance, most often
  employment-based

47
Health maintenance organizations (HMOs)

• Prepaid group plans in which a person pays a
  monthly premium for comprehensive health care
  services.
• HMOs attempt to minimize hospitalization costs by
  emphasizing preventive health care.

48
Preferred provider organizations (PPOs)

• Health care organizations in which employers who
  purchase group health insurance agree to send
  their employees to certain health care providers
  or hospitals in return for cost discounts.
• Health care providers obtain more patients but
  charge lower fees to buyers of group insurance.

49
Managed Care

• Any medical insurance plan that controls costs
  through monitoring and controlling the decisions
  of health care providers.
• Doctors must call a utilization review office to
  receive approval before they can hospitalize a
  patient, perform surgery, or order an expensive
  diagnostic test.

50
Question

• Medical and health insurance premiums should not
  be based on age of the recipient.
• Strongly agree
• Agree somewhat
• Unsure
• Disagree somewhat
• Strongly disagree

51
Medicare

• Medicare is funded by the federal government and
  reimburses the elderly and the disabled for their
  health care.
• Medicares medical insurance program is not free
  enrollees must pay a monthly premium as well as a
  copayment for services.
• Medicare does not cover long-term nursing home
  care, dental care, eyeglasses, and other types of
  services.

52
Medicaid

• Provides health care coverage for the poor, and
  is jointly funded by the federal and state
  governments.
• Medicaid does not cover all poor people.
• Eligibility rules and benefits vary from state to
  state, and in many states Medicaid provides
  health care only for the very poor who are well
  below the federal poverty level.

53
Question

• The type of health insurance plan that tries to
  minimize hospitalization costs by emphasizing
  preventable health care is called what?
• Medicare
• a preferred provider organization
• a health maintenance organization
• Medicaid

54
Answer C

• The type of health insurance plan that tries to
  minimize hospitalization costs by emphasizing
  preventable health care is called a health
  maintenance organization.

55
SCHIP

• In 1997 the State Childrens Health Insurance
  Program (SCHIP) was created to expand health
  coverage to uninsured children, many of whom come
  from families with incomes too high to qualify
  for Medicaid but too low to afford private health
  insurance.
• States receive matching federal funds to provide
  medical insurance to uninsured children.

56
Barriers to Health Care byInsurance Status, 2003
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Improving Health and Health Care

• Two approaches
• Selective primary health care uses technocratic
  solutions to target a specific health problem,
  such as using immunization and oral rehydration
  therapy to promote child survival.
• Comprehensive primary health care focuses on the
  broader social determinants of health, such as
  poverty and economic inequality, gender
  inequality, environment, and community
  development.

58
U.S. Health Care Reform

• The U.S. is the only country in the
  industrialized world that does not guarantee
  health care to its citizens.

59
Socialized Medicine

• In all systems of socialized medicine the
  government
• directly controls the financing and organization
  of health services,
• directly pays providers
• owns most of the medical facilities
• guarantees equal access to health care
• allows private care for individuals who are
  willing to pay for their medical expenses

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Quick Quiz
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• 1. How does symbolic interactionism view health
  conditions such as mental illness?
• As society's failure to meet the needs of the
  have-nots.
• As a biological condition.
• As a result of globalization.
• As a label conferred on those who are different.

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Answer D

• Symbolic interactionism views health conditions
  such as mental illness as a label conferred on
  those who are different.

63

• 2. Medicalization refers to the trend in
• the increase in the number of new viruses that
  are found.
• treating mental illness in hospitals.
• turning normal events into medical events.
• the growing hospitalization of HMO patients.

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Answer C

• Medicalization refers to the trend in turning
  normal events into medical events.

65

• 3. In developing countries, what is the leading
  cause of death and disability for women ages 15
  to 49?
• malnutrition and starvation
• sexually transmitted diseases
• maternal mortality
• tobacco related deaths

66
Answer C

• In developing countries, the leading cause of
  death and disability for women ages 15 to 49 is
  maternal mortality.

67

• 4. Which of the following is a new approach to
  measuring the health status of a population?
• patterns of burdens of disease
• infant mortality rates
• maternal mortality rates
• under 5 mortality rates

68
Answer A

• Patterns of burdens of disease is a new approach
  to measuring the health status of a population.