health and society chapter 16 lecture powerpoint © w. w. norton & company, 2008

Health and Society

Chapter 16

Lecture PowerPoint

© W. W. Norton & Company, 2008

The Rise (and Fall?) of the Medical Profession

You May Ask YourselfCopyright © 2008 W.W. Norton & Company, Inc.

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Why do doctors have power and prestige? Offer universally valued product—health and

longevity. limited numbers due to education, training

and regulation. Professionalism – collegiality, ethics, norms,

objectivity, relationship with patients Props and scripts assert power (waiting room,

diagnoses, prescriptions, instructions, etc.)

The Rise (and Fall?) of the Medical Profession


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Doctors traditionally had power to set own pay rates and recommended treatments and follow-up visits (“supplier-induced demand”).

Power increased with development of hospitals – doctors brought in patients

Recently have lost some control over setting fees Alternative medicine has expanded, leading to more regulation

of medical fields Technology allows nurses and technicians to do much of

doctors’ work

What Does It Mean To Be Sick?


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Talcott Parsons - concept of the sick role Rights: 1) not to perform social roles; 2) not to be held

accountable Obligations: 1) try to get better (or prevent getting sick; 2)

seek help follow doctor’s orders Places much responsibility on individual does not take account of social conditions that affect

health Money, access to care Cultural views of illness and treatment

What Does It Mean to Be Sick?


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illness is a social construct definitions, explanations change over place and time. Once thought to result from evil spirits, bad behavior,

symbolic issues (e.g. – heart disease = problems in love; back pain = someone betraying you)

Diagnosis of mental illness especially subjective

Diagnostic and Statistical Manual (DSM)


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standard categorization of mental disorders and definitions. reflects and influences how mental illness is understood and

treated. Defines “normal” and “abnormal” Early editions emphasized dynamic psychiatry (identifying

internal conflicts that produce mental illness). recent emphasis on diagnostic psychiatry (identifying

symptoms of specific underlying diseases and treating them w/medicine)

May have been influenced by pharmaceutical companies

The U.S. Health-Care System

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United States does not offer universal health care Four main types of health-care coverage in U.S:

Fee-for-service – pays for each visit/service Health maintenance organizations – pay per patient, regardless of

# of visits in a year Incentive to take more patients Incentive to emphasize prevention (less work for Dr.)

Medicare – mainly for over 65 Medicaid – for poor families, children

Some states have their own programs

Figure 16.1 | Medical Debt in America

The U.S. Health-Care System


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The Whitehall Study: social factors such as where you live, occupation, and income, especially relative to one’s own society, have a greater influence on health than health care and health-care systems.

Social factors and health


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Race: whites have best outcomes overall. Largest gaps are between whites and blacks.

Socioeconomic status: higher status people have better health

Gender: women are healthier, live longer Marital status: married people are healthier Family size: smaller families are healthier These are correlations, not causes.

Figure 16.3 | U.S. Infant Mortality

Figure 16.6 | U.S. Life Expectancy by Race

Figure 16.5 | U.S. Life Expectancy by Gender

Why people with higher socioeconomic status have better health:


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Selection – same people who are able to achieve also better equipped to care for themselves

Drift – health causes social position Social position causes health

Low SES: more stress, hopelessness Income can buy healthier lifestyle, better care Fundamental causes – wealthy people have more

resources, information – adapt quicker

health and society chapter 16 lecture powerpoint © w. w. norton & company, 2008

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