Chapter 14

Health, Health Care, and Disability

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

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.

Health in Global Perspective

• Life expectancy– AIDS has cut life expectancy by:

• 5 years in Nigeria• 18 years in Kenya• 33 years in Zimbabwe

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.

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. Infant mortality rate

Demographic Factors: Sex

• Prior to the 20th century, women had lower life expectancies because of high mortality rates during pregnancy and childbirth.

• Women now live longer than men. • For babies born in the United States in 2003,

life expectancy at birth was 74.8 years for males and 80.1 years for females.

• What is recreational Use ?

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.

• People of color are more likely to have incomes below the poverty line, and the poorest people receive less preventive care and less management of chronic diseases.

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.

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.

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.

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.

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 people of color 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.

• Federal government and medical school

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.

• What happened with Professionalization

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.

• What is valid with a third party provider of health care ?

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.

• Universal health care

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 medical–industrial complex.

Sociological Perspectives on Health and Medicine

Interactionist: Social construction of illness

People socially construct “health” and “illness,” and how both should be treated.

Postmodernist:The clinical gaze

Doctors observe patients to gather information, thus appearing to speak “wisely.”

Increase in Cost of Health Care, 1970–2004

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).

Persons Not Covered by Health Insurance, by State

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.

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.

% of U.S. Population With Disabilities

Characteristic %

With a disability 20.8

Severe 13.7

Not severe 7.0

% of U.S. Population with Disabilities

Has difficulty or is unable to: %

See words and letters 3.5

Hear normal conversation 3.5

Have speech understood 1.2

Lift or carry ten pounds 6.9

Use stairs 9.2

Walk 9.4

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.

Disabilities and Employment Status