Health Issues

1
Health Issues

• Social construction and distribution of health,
  illness, and disease

2
Health and Social Order

• Definition of health is social
• What is considered healthy varies across
  cultures, classes, etc.
• Causes of health are social
• Class and gender lead to different levels of
  health, sickness, and rates of death
• Consequences of health are social
• Rates of sickness and death vary across time and
  place

3
Conventional, Complementary, and Alternative
Medicine

• Allopathic medicine treatment by means of
  opposites
• Naturopathic medicine treatment by natural
  remedies and procedures
• Chiropractic medicine treatment by spinal
  adjustment
• Homeopathic medicine treatment with similars

4
Social Theories of Health

• Structural-functionalist theory
• Conflict theory
• Symbolic-interactionist view
• Feminist view

5
Structural-functionalist

• Health normative status and behaviour
• Institutional forces in a stable society maintain
  health of the population
• Parsons the sick role is defined to prevent
  sickness from disrupting social life
• Institutionalizes a potentially deviant
  behaviour. It entails
• Rights (freedom from normal social roles and
  freedom from blame)
• Duties (to want to get well and to cooperate with
  technically competent help)

6
Conflict theory of health

• Ill health results from inequitable and
  oppressive economic conditions
• Engels, The Condition of the Working Class in
  England
• Filthy and noisy workplaces
• Crowded and unsanitary lodgings
• Morbidity and mortality rates were high
• Epidemics were common

7

• Graham women perform home health care work that
  protects health of their families. Their ability
  to do so varies with
• Educational resources
• Socio-economic resources
• Health resources
• Spiritual resources
• Emotional resources
• Financial resources

8
Symbolic-interactionist

• Medical conditions may be sociosomatic
• Stigma attached to diseases
• Changes in the meaning of illness
• Ill people no longer present themselves as
  passive recipients of diagnosis and treatment,
  but rather as experts (producers of health
  information and care)
• e.g., Internet discussion sites and support groups

9
Feminist view

• Gender creates different health and illness
  profiles, and different causes and average ages
  of death
• 1970s critique of medicalization of womens
  lives
• Claim that insufficient research attention is
  given to womens diseases
• e.g., breast cancer

10

• Influence of mass media on womens perceptions of
  their bodies and health
• Creates image of womens bodies as flawed
• Detracts attention from more frequent causes of
  death

11
Sociology of Health

• Levels of analysis
• Comparative (between societies and over time)
• Societal (comparisons of different classes,
  education levels, genders, religiosity,
  ethnicities, rural/urban locations, etc.)
• Socio-psychological
• Lifestyle (behaviours)
• Meaning of morbidity and mortality to individuals

12
Changes in Health of Canadians

• People are generally living longer and healthier
  lives today than in the past
• Improved nutrition
• Hygiene
• Birth control
• Medical interventions
• Vaccinations

13

• Leading causes of death in the 19th century
• Infectious and communicable diseases
• Leading cause of death in the 20th century
• Heart disease (declining dramatically, due to
  lifestyle changes)

14
Life Expectancy and PYLL

• Changes in life expectancy gap between genders
  are due to
• Decline in maternal mortality
• Greater likelihood of risk-taking behaviour among
  men
• PYLL (Potential Years of Life Lost)
• Takes into account average age of death for a
  given disease
• Most Potential Years of Life are lost to cancer
• Accidents and suicide are frequent causes of
  death of young people

15
Social Inequality and Health

• Poverty linked to lower life expectancy and
  higher likelihood of disability
• Canadian health policy does not invest in
  measures that would alleviate health consequences
  of poverty
• Relatively poor health and shorter lives of
  Aboriginal Canadians

16
Social Capital and Health

• Link between the degree of inequality and
  societal health outcomes
• Overall wealth of society has less influence on
  health than the degree of inequality
• Social cohesion (social capital, trust) mediates
  between social status and illness

17

• Perception of relative disadvantage causes
  damaging emotions
• e.g., anxiety, inferiority, shame, etc.
• Canadian social policies favour market dominance
  over state interventionthis exacerbates the
  degree of inequality

18
Existential Level of Analysis

• Illness as choice
• Illness as despair
• Illness as secondary gain
• Illness as communication
• Illness as statistical infrequency
• Illness as sexual politics

19
Principles of Canadian Medical Care System

• Universality to all residents
• Portability from one province to another
• Comprehensive coverage for all services requiring
  hospitalization
• Administration on a non-profit basis
• Accessibility redistribution to equalize access
  in all provinces

20
Population Aging and the Health Care System
21
Privatization

• 75 of Canadian health system is presently
  public, 25 is private
• This excludes physicians (private entrepreneurs,
  deriving most income from the state)
• Private elements of the system (insurance,
  long-term care, drugs) are dominated by
  multinational corporations

22

• Current argument
• A private health system would be more efficient
  and cost-effective, and less restrictive
• US research
• Private health facilities have high
  administrative costs, but do not provide
  higher-quality care than the public ones
• Interference by insurance companies is high

23
Medicalization

• Expansion of areas of life and person considered
  relevant to medicine
• Care of the whole person
• Absolute control over technical procedures by
  allopathic medical profession
• Maintenance of access to certain areas of life by
  the medical profession
• Definition of pregnancy and aging as medical
  problems

24

• Spread of medicines relevance to large portion
  of living
• Definition of criminality and alcoholism as
  addictions

25
Disease Mongering

• Definition of conditions for which effective
  drugs have been developed as diseases
• Agents pharmaceutical companies
• Goals
• To persuade physicians that the condition is a
  specific and treatable disease
• To create a need and desire among the public to
  use medication for the condition

26
Socio-economic Background of Medical Students

• Students whose fathers were physicians or have
  attended university are over- represented
• Students from rural areas are under-represented
• Gender structure has become more equal

27

• Aboriginal and black students are
  underrepresented
• Rising tuition fees since 1997
• Students come from families with increasingly
  high incomes