Slide 1
SOCIOLOGY
Richard T. Schaefer
19
McGraw-Hill
Health and
Medicine
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 2
19. The Economy and Work
• Culture and Health
• Sociological Perspectives on Health and
Illness
• Social Epidemiology and Health
• Health Care in the United States
• Mental Illness in the United States
• Social Policy and Health
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 3
Culture and Health
• Culture contributes to differences in
medical care and how health is defined
• Culture also influences the relative
incidence of a disease or disorder.
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 4
Sociological Perspectives on
Health and Illness
• Functionalist Approach
– “Being sick” must be controlled so that not
too many people are released from their
societal responsibilities
– Sick role: societal expectations about
attitudes and behavior of a person viewed
as being ill
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 5
Sociological Perspectives on
Health and Illness
• Conflict Approach
– Critical of growing role of medicine as
major institution of social control
– The Medicalization of Society
• Interactionist Approach
– Studies the roles played by health care
professionals and patients
– Asserts patients may play an active role in
positive or negative health
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 6
Sociological Perspectives on
Health and Illness
• Labeling Approach
– The designations healthy and ill generally
involve social definition
– Disagreements continue in the medical
community over whether a variety of life
experiences are illnesses
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 7
Sociological Perspectives on
Health and Illness
Figure 19-1. Infant Mortality Rates in Selected Countries, 2004
Source: Haub 2004
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 8
Sociological Perspectives on
Health and Illness
Table 19-1. Major Perspectives on Health and Illness
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 9
Social Epidemiology and Health
• Social Epidemiology and Health
– Social epidemiology: study of
distribution of disease, impairment, and
general health status across a population
– Incidence: number of new cases of a
specific disorder occurring within a given
population during a stated period of time,
usually a year
– Prevalence: number of cases of a specific
disorder that exist at a given time
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 10
Social Epidemiology and Health
• Social Epidemiology and Health
– Morbidity rates: disease incidence
figures presented as rates or number of
reports per 100,000 people
– Mortality rate: incidence of death in a
given population
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 11
Social Epidemiology and Health
• Social Class
– Studies show people in lower classes have
higher rates of mortality and disability
• Crowded living conditions
• Substandard housing
• Poor diet
• Stress
• Unable to afford quality health care
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 12
Social Epidemiology and Health
• Race and Ethnicity
– Health profiles of racial and ethnic groups
reflect social inequality in U.S.
• Poor economic and environmental conditions
manifested in high morbidity and mortality
rates
• Gender
– When compared with men, women live
longer
McGraw-Hill
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Slide 13
Social Epidemiology and Health
Figure 19-2. Percentage of People without Health Insurance, 2001
Source: Haub 2002:23
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 14
Social Epidemiology and Health
• Age
– Most older people in U.S. have at least one
chronic illness
• Older people vulnerable to certain types of
mental health problems
• Older people use more health services than
younger people
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 15
Health Care in the United States
• A Historical View
– During the 1830s and 1840s, “self-help”
was emphasized
• Strong criticism of “doctoring”
– Eventually, medical profession controlled
the market for its services and the various
organizations that govern medical practice,
financing, and policymaking
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 16
Health Care in the United States
• Physicians, Nurses, and Patients
– Physicians have position of dominance in
dealing with nurses and patients
• Alternatives to Traditional Health Care
– Holistic medicine
• Therapies that consider the person’s physical,
mental, emotional, and spiritual characteristics
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 17
Health Care in the United States
• The Role of Government
– In 1965, government subsidized health
care programs
• Medicare for the elderly
• Medicaid for the poor
– Medicare had huge impact on health care
system
• Some hospitals “dumped” unprofitable
Medicare patients until practice was banned in
1987
McGraw-Hill
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Slide 18
Health Care in the United States
Figure 19-3. Availability of Physicians by State
Source: Bureau of the Census 2004:101
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Slide 19
Health Care in the United States
Figure 19-4. Total Health Care Expenditures in the United States,
1970— 2014 (projected)
Sources:Center for Medicare and Medicaid Services 2005 (2005—2014 data); Health Care
Financing Administration 2001 (1970—1990 data)
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 20
Mental Illness in the United States
• Mental illness
– Brain disorder that disrupts a person’s
thinking, feeling, and ability to interact
with others
– People in U.S. traditionally maintained a
negative and suspicious view of those with
mental disorders
McGraw-Hill
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Slide 21
Mental Illness in the United States
• Theoretical Models of Mental Disorders
– Medical Model: Mental illness rooted in biological
causes that can be treated through medical
intervention
– Labeling Theory: Mental illness is not an
“illness” since the individual’s problems arise from
living in society and not from physical maladies
• Devalues mentally ill patients
McGraw-Hill
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Slide 22
Mental Illness in the United States
• Patterns of Care
– Historical confinement of the insane or
mentally ill to public institutions
– Community-based outpatient care most
prevalent now
• Legislation has made it easier to commit
mentally-ill homeless involuntarily
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 23
Social Policy and Health
• Financing Health Care Worldwide
– The Issue
• Industrialized nations face issues related to
the accessibility and affordability of
health care
– The Setting
• The U.S. is the only Western industrial
democracy that does not treat health care
as a basic right
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 24
Social Policy and Health
• Financing Health Care Worldwide
– Sociological Insights
• Conflict theorists suggest health care system
resists basic change
– Those who receive substantial wealth and power
through an existing institution have strong incentive
to keep things as they are
• Health care system undergoing
“corporatization”
McGraw-Hill
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Slide 25
Social Policy and Health
• Financing Health Care Worldwide
– Policy Initiatives
• Major reforms occurring in U.S. without
legislative reform
– As of 1997, managed care plans enrolled 85% of all
workers, up from 52% in 1993
– There are growing concerns about the quality of
health care provided by managed care plans
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.
Slide 26
Social Policy and Health
Figure 19-5. Government Expenditures for Health Care, Selected
Countries
Source: World Bank 2005a:100--102
McGraw-Hill
© 2007 The McGraw-Hill Companies, Inc. All rights reserved.