Health, Health Care, and Disability

1
Chapter 18

• Health, Health Care, and Disability

2
Chapter Outline

• Health in Global Perspective
• Health in the United States
• Health Care in the United States

3
Chapter Outline

• Sociological Perspectives on Health and Medicine
• Mental Illness
• 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 refers to an estimate of the
  average lifetime of people born in a specific
  year.
• The infant mortality rate is the number of deaths
  of infants under 1 year of age per 1,000 live
  births in a given year.

6
Question

• _____ refers to the positive sense of complete
  well being while _____ refers to an interference
  with health.
• Healing disease
• Health healing
• Health illness
• Health care disease

7
Answer c

• Health refers to the positive sense of complete
  well being while illness refers to an
  interference with health.

8
Health in Global Perspective

• Life expectancy
• AIDS has cut life expectancy by
• 5 years in Nigeria
• 18 years in Kenya
• 33 years in Zimbabwe

9
How Much Do You Know About Health, Illness, and
Health Care?

• True or False?
• Health care in most high-income, developed
  nations is organized on a fee-for-service basis
  as it is in the United States.

10
How Much Do You Know About Health, Illness, and
Health Care?

• False.
• The United States is one of only two high-income,
  developed nations that do not have some form of
  universal health coverage. In the United States,
  health care has traditionally been purchased by
  the patient. In most other high-income nations,
  health care is provided or purchased by the
  government.

11
How Much Do You Know About Health, Illness, and
Health Care?

• True or False?
• It is extremely costly for employees to
  mainstream persons with disabilities in the
  workplace.

12
How Much Do You Know About Health, Illness, and
Health Care?

• False.
• Although disability expenditures nationwide may
  be costly, individual employers often find that
  they can accommodate the workplace needs of a
  worker with a disability for costs ranging from
  zero to several thousand dollars, thus opening up
  new opportunities for people previously excluded
  from certain types of jobs and careers.

13
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, and race/ethnicity.

14
Social Epidemiology

• Chronic diseases are illnesses that are long term
  or lifelong and that develop gradually or are
  present from birth.
• Acute diseases are illnesses that strike suddenly
  and cause dramatic incapacitation and sometimes
  death.

15
Demographic Factors Age

• Rates of illness and death are highest among the
  old and the young.
• Mortality rates drop shortly after birth and
  begin to rise significantly during middle age.
• After age 65, rates of chronic diseases and
  mortality increase rapidly.

16
Demographic Factors Sex

• Babies born in the U.S. in 2000 Life expectancy
  is 73.9 years for males and 79.4 years for
  females.
• Sociologist Ingrid Waldron notes that gender
  roles and gender socialization contribute to the
  difference in life expectancy
• Men are more likely to work in dangerous
  occupations, more likely to engage in risky
  behavior, and are less likely to see a doctor.

17
Demographic Factors Location

• 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.
• Reasons
• Availability of safe areas to exercise
• Grocery stores with nutritious foods
• Access to transportation, education, and good jobs

18
Question

• How physically active are you compared to your
  contemporaries?
• More active
• About average
• Less active

19
Demographic Factors Location

• People living where there are high levels of
  poverty and crime, or in remote rural areas have
  greater difficulty getting health care because
  most doctors prefer to locate their practice in a
  safe area.
• Although rural Americans make up 20 of the U.S.
  population, only 9 of the nations physicians
  practice in rural areas.

20
Demographic Factors Race and Ethnicity

• People of color are more likely to have incomes
  below the poverty line.
• People with lower incomes
• Receive less preventive care and less optimal
  management of chronic diseases.
• Are more likely to be employed in jobs that
  expose them to danger and illness.
• Are are more likely to live in areas that contain
  environmental hazards.

21
Question

• Do you agree or disagree
• The safety and health conditions where I work are
  good.

22
GSS National Data
Income Low Middle High
Agree 87.3 90.8 93.3
Disagree 12.7 9.2 6.7
23
Lifestyle Factors Alcohol

• For alcoholics, health effects include
• nutritional deficiencies resulting from poor
  eating habits
• cardiovascular problems such as enlargement of
  the heart muscle
• high blood pressure,
• Stroke
• cirrhosis - scar tissue that chokes off blood
  vessels in the liver and destroys liver cells

24
Question

• In the past year, have you had more than 5
  alcoholic drinks in a sitting?
• Yes
• No

25
Lifestyle Factors Nicotine

• The nicotine in tobacco is a toxic,
  dependency-producing psychoactive drug that is
  more addictive than heroin.
• Tobacco is responsible for about 1 in every 5
  deaths in this country.

26
Question

• Do you currently smoke cigarettes?
• Yes
• No

27
Lifestyle Factors Illegal Drugs

• Studies found an increased risk of 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,
  stroke, and neurological disorders.
• Intravenous cocaine users who share needles are
  also at risk for contracting AIDS.

28
Question

• Have you used illegal drugs (e.g. marijuana,
  cocaine, pills)?

29
GSS National Data
Income Low Middle High
Yes 4.6 3.8 1.1
No 95.4 96.2 98.9
30
Lifestyle Factors Sexually Transmitted Diseases

• Sexual activity can result in transmission of
  AIDS, gonorrhea, syphilis, and genital herpes.
• The Department of Health and Human Services
  estimates that in 2002, a total of 42 million
  people had HIV/AIDS.
• 14 of all new cases worldwide are children.
• Children under age 15 account for about 610,000
  AIDS-related deaths each year.

31
Question

• The most extensively used illegal drug in the
  United States is
• ecstasy
• cocaine
• marijuana
• heroin

32
Answer c

• The most extensively used illegal drug in the
  United States is marijuana.

33
Adults and Children Living with HIV/AIDS
34
Question

• ____ are illnesses that strike suddenly, cause
  dramatic incapacitation, and sometimes death.
• Chronic diseases.
• Disabilities.
• Epidemics.
• Acute diseases.

35
Answer d

• Acute diseases are illnesses that strike
  suddenly, cause dramatic incapacitation, and
  sometimes death.

36
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.

37
The U.S. Health Care System

• Health Maintenance Organizations provide total
  care with an emphasis on prevention.
• Managed care monitors and controls health care
  providers' decisions, insurance company has the
  right to refuse to pay for treatment.

38
Paying for Medical Carein Other Nations

• Canada has a universal health care system - A
  health care system in which all citizens receive
  medical services paid for by tax revenues.
• Britain has socialized medicine - A health care
  system in which the government owns the medical
  care facilities and employs the physicians.

39
Increase in Cost of Health Care, 19702000
40
Persons Not Covered by Health Insurance, by State
41
Question

• Do you have any health insurance, including
  Medicare or Medicaid?

42
GSS National Data
Income Low Middle High
Yes 75.1 86.5 94.7
No 24.9 13.5 5.3
43
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).

44
Holistic Medicine

• An approach to health care that focuses on
  prevention of illness and disease and is aimed at
  treating the whole personbody and mindrather
  than just the part or parts in which symptoms
  occur.

45
Question

• Socialized medicine is found in which country or
  countries?
• the United States
• Canada
• Great Britain
• both Canada and Great Britain

46
Answer c

• Socialized medicine is found in Great Britain.

47
A Functionalist Perspective The Sick Role
(Talcott Parsons)

• According to the functionalist approach, it is
  important for people to be healthy and contribute
  to society.
• Sickness is viewed as deviant behavior.
• The sick role is the set of patterned
  expectations that defines the norms and values
  appropriate for individuals who are sick and for
  those who interact with them.

48
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.

49
Conflict Perspective The Medicalindustrial
Complex

• According to conflict theorists, problems in U.S.
  health care are rooted in the capitalist economy,
  which views medicine as a commodity that is
  produced and sold by the medical industrial
  complex.
• The medicalindustrial complex encompasses
  physicians and hospitals as well as insurance
  companies and pharmaceutical and medical supply
  companies.

50
Symbolic Interactionist Perspective Social
Construction of Illness

• According to symbolic interactionists, we
  socially construct health and illness and how
  both should be treated.
• AIDS victims are often blamed for promiscuous
  sexual conduct or intravenous drug use,
  regardless of how they contracted HIV.
• The social definition of the illness leads to the
  stigmatization of individuals who suffer from the
  disease.

51
Medicalization

• The process whereby nonmedical problems become
  defined and treated as illnesses or disorders
• Three levels
• conceptual - the use of medical terminology to
  define the problem
• institutional - physicians are supervisors of
  treatment
• Interactional - when physicians treat patients
  conditions as medical problems

52
Demedicalization

• The process whereby a problem ceases to be
  defined as an illness or a disorder.
• Examples
• Removal of homosexuality from the list of mental
  disorders compiled by the American Psychiatric
  Association.
• Redefining childbirth and menopause as natural
  processes rather than as illnesses.

53
Question

• The subjective component of medicalization and
  demedicalization reflects the major concern of
  the interactionist perspective of health.
• True
• False

54
Answer True

• The subjective component of medicalization and
  demedicalization reflects the major concern of
  the interactionist perspective of health

55
Sociological Perspectives on Health and Medicine
Functionalist The sick role People who are sick are exempt from obligations, but must want to get well and seek competent help.
Conflict Inequalities in health and health care Problems in health care are rooted in the capitalist system, exemplified by the medicalindustrial complex.
56
Sociological Perspectives on Health and Medicine
Interactionist Social construction of illness People socially construct health and illness, and how both should be treated.
PostmodernistThe clinical gaze Doctors observe patients to gather information, thus appearing to speak wisely.
57
Mental Illness

• Mental illness - a condition in which a person
  has a severe mental disorder requiring extensive
  treatment with medication, psychotherapy, and
  sometimes hospitalization.
• Mental disorder - a condition that makes it
  difficult or impossible for a person to cope with
  everyday life.

58
The Treatment of Mental Illness
Deinstitutionalization

• Deinstitutionalization refers to rapidly
  discharging patients from mental hospitals into
  the community.
• The theory was that patients rights were being
  violated due to involuntary commitment to
  hospitals, where they remained for an extended
  time.
• Critics argue that deinstitutionalization
  exacerbated problems associated with inadequate
  care for people with mental illness.

59
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 stigmatization or
  discrimination against the person with
  disabilities.
• 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.

60
of U.S. Population with Disabilities
Characteristic
With a disability 23.0
Severe 14.8
Not severe 8.3
61
of U.S. Populationwith Disabilities
Has difficulty or is unable to
See words and letters 3.7
Hear normal conversation 3.8
Have speech understood 1.1
Lift or carry ten pounds 7.3
Use stairs 9.5
Walk 9.4
62
of U.S. Populationwith Disabilities
Has difficulty or needs assistance with
Getting around inside the house 1.8
Getting in/out of bed or a chair 3.0
Taking a bath or shower 2.4
Dressing 1.7
Eating 0.7
Getting to or using the toilet 1.1
63
Question

• In contemporary industrial societies, disability
  often can be attributed to
• epidemics related to poor sanitation and
  overcrowding.
• urban density and poverty.
• environment, lifestyle, and working conditions.
• employment in high stress jobs in the primary
  tier of the labor market.

64
Answer c

• In contemporary industrial societies, disability
  often can be attributed to environment,
  lifestyle, and working conditions.

65
Social Inequalities Based on Disability

• Workers with a severe disability earn 50 (men)
  and 64 (women) of what workers without
  disabilities earn.
• Only 26 of Latinos/as with a severe disability
  are employed those who work earn 80 of what
  non-Latino white persons with a severe disability
  earn.

66
Living With a Disability

• Strategies
• Avoidance - deny condition to maintain hopeful
  images of the future and elude depression.
• Vigilance - actively seek knowledge and treatment
  so they can respond to the changes in their
  bodies.

67
Quick Quiz
68

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

69
Answer C

• An institutionalized system for the scientific
  diagnosis, treatment, and prevention of illness
  is medicine.

70

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

71
Answer C

• The study of the causes and distribution of
  health, disease, and impairment throughout a
  population is called social epidemiology.

72

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

73
Answer A

• HMO stands for health maintenance organizations.

74

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

75
Answer d

• On the average, male workers with severe
  disabilities make 50 percent of what their
  co-workers make.

76

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

77
Answer b

• Social class is a better indicator of health
  problems than race or ethnicity.