chapter 14 medicine: an anatomy of health and illness © pine forge press, an imprint of sage...

Chapter 14Chapter 14Medicine:Medicine:

An Anatomy of An Anatomy of Health and IllnessHealth and Illness

© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.


Medical intervention at the end of life

Medical futility: treatment fails to end total dependence on medical care

Active euthanasia: aiding dying individuals by prescribing or administering a lethal dose of drugs, only given to patients who request it, usually under legally-controlled conditions

Arguments in favor of euthanasiaArguments against euthanasia

Introduction


Health: a state of physical, mental, and social wellbeing or the absence of disease

Illness: the lack of health

Health, illness, and health care affect how individuals and groups carry out their lives at the micro, meso, and macro levels

Why is health a social issue?


At the micro level, health impacts our ability to carry out our responsibilitiesAt the meso level, health care institutions affect and are affected by other institutionsAt the macro level, health care practices and beliefs about illness are culturally determined

Global health issues include pandemics, bio-terrorism, distribution of immunizations and drugs

• Pandemic: a disease that is prevalent throughout an entire country and potentially around the world

Why is health a social issue?


Micro-level perspectivesSymbolic interaction & labeling theory

Illness is whatever the powerful (e.g., doctors) define and label it as

Medicalization: a shift to handling normal or deviant human issues in the health care system rather than family, legal, or religious arenas

Shapes our interpretation of the problem, who treats it and how, whether we hold individuals to blame

May be a shift from individual to expert control

Some issues have been de-medicalized

Health and Illness: Theories


Meso- and macro-level perspectivesFunctionalism

Trends in illness are linked to shifts in macro-level social conditionsNorms define what counts as illness and how to treat itThe health care system helps maintain the social structure and balance between individuals and institutionsIllness is not functional for society: the “sick role” is seen as deviant since it robs society of normal role functioning



Meso- and macro-level perspectivesConflict Theory

Differential access to health careAffected by people’s economic and social positions and by global inequality among rich and poor countries Results in variation in the illnesses people suffer

Role of profit motives in shaping health care

Doctors’ exercise of social control and differential treatment of patients based on social status



Meso- and macro-level perspectivesConflict Theory

Feminist theory:Gender is a key factor affecting health and illnessPatriarchal control of women carries over into health care systems, reinforcing dependence and submissionGlobal North women are profitable for health care systems: they have more and more expensive proceduresDefinitions of women’s bodies and “normal” biological experiences are key to patriarchy, as they have been used to “prove” women’s inferiority



Micro-level analysisWhat constitutes illness rests on socially defined symptoms and circumstances, not universally recognized bodily malfunctions

Parsons’ “sick role”: rights and obligations of those who are accepted as legitimately ill

Right to be excused from responsibilities until wellRight not to be faulted for illnessObligation to define illness as undesirable and not to prolong itObligation to seek competent help in getting well

The Status and Roles of the Sick Person


Social factors in health and illness

Cultural belief systems and health:Methods of treating illness are culturally determined

Definitions of mental illness vary across societies

Pain is universal, but the way it is perceived, explained, and reacted to is culturally determined



Social Factors in Health and Illness

Social predictors of individual health & illness:Age: older people need more medical intervention

Gender: Western women report and are treated for more health problems than men; men use more emergency services

Ethnic group: ethnicity affects socialization into health care behaviors and access to health care

Social status: wealthier individuals are more likely to seek medical help for illnesses early on, in part because they can afford it; lower-income people seek help later, in response to crises



Meso-level analysisTypes of national health care systems

National programs based on the philosophy of health care as a human right

Socialized medicine: government-supported consumer service with equal access to all citizens; the government owns most facilities and pays providers directly (e.g., Canada, Great Britain)Decentralized national health programs: government regulates but does not operate the health care system (e.g., France, Germany)

Modern Health Care Systems


Meso-level analysisTypes of national health care systems

Health care in the U.S.Fee-for-service: doctors and hospitals are paid for each service they perform, perform the services they deem necessary, and decide the price of services; financed by public and private sources

Health care in poor countries:Often patterned on former colonial systemsMay combine Western and indigenous medicine A struggle to provide basic health needs, sometimes aided by global health organizations



Hospitals as complex organizationsHospitals: places for the care and treatment of the sick and injured, and for provision of centralized medical knowledge and technology

Developed in response to urbanization and industrialization, which led to new health problems requiring systematized, rational care

Changed from places to die to places for healing

Now highly bureaucratized

Dual control by physicians and administrators is giving way to corporate, profit-oriented control in the U.S.



The changing professional status of health care employees

Hospitals as large, bureaucratic organizations:

Divisions of labor are extensive and specializedHierarchical systems are based on prestige and power, with physicians historically at the topNeed to coordinate many highly-skilled people



The changing professional status of health care employees

Changes confronting physiciansThough they are highly respected today, physicians’ authority is relatively recentCurrent challenges to physician authority

• Competition for profits• Decline in public trust• Increased specialization

Deprofessionalization: increasing control over physicians’ work by nonprofessional, outside forces


•Increasing outpatient care

•Increasing demands from insurance companies


The U.S. Health Care SystemThe best and worst in the worldBest:

Quality medical careTrained practitionersFacilitiesMedical technologyAdvances in medical research and therapies and in public health programs, e.g. to increase motor vehicle safety and reduce tobacco use



The U.S. Health Care SystemProblems

Access to healthcare• Maldistribution of services• Lack of family physicians

Healthcare costs and funding• Highest per-capita costs, which continue to grow• Managed care: an attempt to combine efficiency

and quality• Employers are shifting more health care costs onto

employees



The U.S. Health Care SystemProblems, cont.

Lack of health care security & the new Obama plan• Millions of Americans lack health coverage and health

security• The uninsured often rely on tax-funded public facilities• The 2010 health bill will cover many of these people, and

prevent denial of coverage due to pre-existing conditions• Still, the new plan will likely have unforeseen consequences

Other issues: inefficiency, competing interests, fragmentation




The U.S. Health Care System


The U.S. Health Care SystemPolicy issues and social reforms

Is health care a right that can’t be bought and sold, or a commodity to be purchased on the market, so competition can increase quality and reduce costs?

Recent proposals for reforming the U.S.’s market-based system

Revise the partly public, partly private systemVote in reforms one at a timePass a comprehensive reform package to provide national health insurance and government oversight



The U.S. Health Care SystemAccording to some, for a major social or health initiative to pass the U.S. Congress, three things are needed:

Common understanding of the problemGeneral agreement on the approach to solving the problemPositive political ramifications for legislators taking a position on the problem



The U.S. Health Care SystemPredicted trends:

Hospitals and public health officials will attempt to respond to the threat of bioterrorismHospitals will continue to grow, and will advertise and change their images to please clientsUse of computer technology will continue to increaseMedical advances will change how physicians and hospitals treat patientsEmployers will shift more health costs to employeesDebates about national health care will continue



The U.S. Health Care SystemMain challenges:

What should be done about the uninsured population?How can costs be controlled in a managed care system?How will the physician-patient relationship shift under new structures of health care?



National variation in health care practicesEach society’s health care system is shaped by its demographic makeup, value system, and financial statusFor example:

The needs of Global North countries, which have more elderly people, are different from those of Global South countries, with more childrenSome countries have far more doctors than othersChina: medicine in a Communist state

Health Care Around the Globe


Globalization of medical problemsInternational sale of body parts on the black marketInternational measures of national health

Infant mortalityLife expectancyNations vary in primary causes of death

Globalization and the mobility of diseaseTraditional and modern medical practices



Globalization and the mobility of diseaseThe density and mobility of the world’s population affects human health

Increased global travel can cause disease to spreadUse of land affects the number of rodents and insects, sanitation, contact between individualsIndoor circulated air can spread disease

Economic interests have an impact: Companies such as pharmaceutical firms may halt public health efforts that threaten their profitsTobacco companies market their products globally



Indigenous medicine: Traditional and modern medical

practicesMedical traditions spread with migration and can offer wisdom to one anotherPeople around the world rely on a variety of medical models and practitionersAllopathy (Western medicine) is dominant in the Global North, but alternatives are spreading

“Complimentary and Alternative Medicines” movement (CAM)


chapter 14 medicine: an anatomy of health and illness © pine forge press, an imprint of sage...

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anatomy of health

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