health and society (chapter 11, "you may ask yourself")

Health and SocietyChapter 11

You May Ask Yourself

The Rise of Medicine

•Why we think doctors are special:

•Universally valued product

•High moral calling to do good

•Professionalism

•Individual objectivity

•Impression management

Power of Doctors

•Doctors have the power to:

•construct their own pay rates.

•create demand for their products.

•regulate themselves.

•prescribe medications.

•“medicalize” conditions.

Medicalization•Medicalization - the process by

which problems or issues not traditionally seen as medical came to be framed as such.

•Pregnancy and childbirth

•Alcoholism

•Depression

•Nutrition

Biomedical Culture•Historically, doctors weren’t

powerful.

•Rome - slaves, poor freedmen, or foreigners.

•England - rose from barber profession.

•Russia - payed about 75% of industrial workers’ wages.

Biomedical Culture•Reasons for Rise of Biomedical Culture

•Ability to offer “health” or actual increase in years lived.

•Exclusion of other health frameworks through licensing

• Legal authority through licensing

• Increased importance of larger institutions (like hospitals)

Decline of Doctors?

• Reasons for loss of power in recent years:

• Rise of HMOs

• Rise of external regulations

• Patient Bill of Rights (1998)

• EMTALA (1986)

• COBRA (1985)

• HIPAA (1996)

• Rise of other forms of medicine

• Improved technology

Being Sick...•The Sick Role (Talcott Parsons)

•Two Rights:

•Exemption from normal social roles

• Lack of accountability for illness

•Two Obligations:

•Try to get well.

•Seek the assistance of qualified individuals.

Social Construction of Illness

• Religious views and practices:

• Seizures, faith healing, fire-cupping, coin rubbing.

• Medicalization:

• Alcoholism (don’t blame the victim)

• Understanding of pathologies:

• Cancer, obesity, heart disease (blame the victim)

Fire-cupping

Fire cupping bruises

Coin rubbing

Health related PSAs

U.S. Healthcare System

•Types of Coverage:

•Fee-for-service

•Health Maintenance Organizations (HMOs)

•Public Insurance

•State Children’s Health Insurance Programs (SCHIP or KCHIP in Kentucky)

•Uninsured or Private Pay

Morbidity and Mortality

•Morbidity - illness in a general sense

•Mortality - death

• Whitehall Study:

• Men only

• Universal health access

• Who you are, where you live, how much you earn, and what you do for a living all impact health.

Born Unequal• Gender differences:

• More boys than girls born, but higher infant mortality for male babies.

• Sex ratios: 1.05 in US; 1.12 in China.

• Multiple Births

• IVF - multiple implanted embryos

• Ovulation increasing medications - more fertilized eggs.

Post-Birth Health Inequalities

• Low birth weight:

• Less than 5 pounds, 8 ounces.

•Caused by:

• Intrauterine growth restriction (IGR)

•Premature birth

•Prenatal health

•Mother’s health

Race and Health• Life expectancy

• Infant mortality

•Disease prevalence:

•African Americans - heart disease and cancer

•Native Americans - cirrhosis and suicide

•Hispanics - diabetes and HIV/AIDS

•Racism as possible cause.

US Infant Mortality Rates

Socioeconomic Status

• Selection theory - spurious relationship

•Drift explanation - health causes social position

• Social determinants - social status determines health

• Psychosocial - social class relative to those around them.

•Materialist - differential access to health is determined by SES.

• Fundamental - how social factors shape illness

Socioeconomic Status

• “Natural” Experiments through Policy Change

• Compulsory education - mid-1900s

• Each year of school decreased odds of death by 3.6%.

• Social Security policy - 1977

• Lower Social Security payments led to longer life.

• Due in part to continued workforce participation.

Marital Status

•Married people tend to live longer, especially men.

•Reasons:

•Health as precursor for marriage.

•Marriage decreases unhealthy behaviors.

Sex and Health

•Women live longer than men.

•Reasons:

•Disease prevalence differences.

•Healthcare-seeking behaviors.

Sex & Race Combined

•Much more profound impact than either factor alone.

•Reasons:

•Racism

•Lower SES

•More dangerous jobs

Family Structure• Larger families have higher childhood mortality.

• Supervision

• Closely-spaced families have higher childhood mortality.

• Supervision, maternal health.

• First-born children are more likely to die in childhood.

• Less experienced parents, unintended pregnancies, mortality “creates” firstborns.

Mental Health•Diagnostic Statistical Manual (DSM)

•DSM-I: 1952 - 60 disorders, standardized the canon

•DSM-II: social context was important

•DSM-III: removed social context, followed medical model

•DSM-IV: 400 disorders, necessary for medical billing and insurance reimbursement.

Global Health

•Waterborne Illnesses

•Malaria

•Vaccines

•AIDS