Chapter 18
Health, Health Care, and Disability
• Health is __________________________________
• 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: refers to an estimate of the average lifetime of people born in a specific year
AIDS results in higher mortality rates in some nations.
• Infant mortality rate: the number of deaths of infants under one year of age per 1,000
live births in a given year
• ____% of all babies born in low-income countries die before their first birthday
• Women in lower income nations are _____times more likely to die from childbirth or
complications from childbirth than women in more affluent nations
Improvements in Recent Years
• Life expectancy is more than 70 in 146 countries
• The percentage of the world's population with access to safe water has risen substantially
• Infant mortality and mortality rates for children under age five have declined
Social Epidemiology: Study of the causes and distribution of health, and disease in a population
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Disease agents: insects, bacteria, nutrient agents, pollutants, and temperature
Environment: ______________________________________________________
Human host: demographic factors such as age, sex, and race/ethnicity
Chronic diseases are illnesses that are long-term or lifelong
• Develop gradually or are present from birth
• Acute diseases
are________________________________________________________________
 Rates of illness and death are highest among the old and the young
 Mortality rates drop shortly after birth and begin to rise significantly during middle age
 After age 65, rates of chronic diseases and mortality increase rapidly
Sex
• Babies born in the U.S. in 2013: overall life expectancy is 78.7 years> 76.3 years for
males and 81.1 years for females
• Gender roles and gender socialization contribute to the difference in life expectancy:
Men are more likely to work in dangerous occupations, more likely to engage in risky
behavior, and are less likely to see a doctor
Race and Ethnicity
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Life expectancy for African American males is estimated at 71.6 years as compared to 78.9 for
Hispanic Males. Life expectancy is 77.8 for African American females compared to 83.7 for
Hispanic females.
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People of color are more likely to have incomes below the poverty line which means they don’t
have income to pay for medical care.
Occupation
People with lower incomes:
• Receive less preventive care and less optimal management of chronic diseases
• Are more likely to be employed in jobs that expose them to danger and illness
• Are more likely to live in areas that contain environmental hazards
Drug Use and Abuse
• A drug is any substance_________________________________________
ALCOHOL: Issues include:
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Can cause permanent brain damage with chronic use
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Nutritional deficiencies resulting from poor eating habits
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Cardiovascular problems such as enlargement of the heart muscle
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High blood pressure and Stroke
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Cirrhosis: scar tissue that chokes off blood vessels in the liver and destroys liver cells
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Younger men ages 18-49 are the heaviest drinkers. Whites drink more than other races
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DUIs, Family Violence, Rapes, and other violent acts
Tobacco: Issues include: The nicotine in tobacco is a toxic, dependency-producing
psychoactive drug that is more addictive than heroin
 Tobacco is responsible for about one in every five deaths in this country
Illegal Drugs (SEE HANDOUT FOR MORE INFORMATION)
• Studies found an increased risk of 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, stroke, and neurological disorders
• Intravenous cocaine users who share needles are also at risk for contracting AIDS
• Meth is fastest growing illegal drug of choice; creates a high with increased energy, sex drive;
staying awake for days. Causes numerous medical problems including loss of teeth, marks on
face and arms caused by feeling of itching and things crawling under the skin, weight loss.
• Use of illegal drugs is a major factor in child abuse and neglect cases
Diseases (SEE HANDOUT FOR MORE INFORMATION)
CDC shows that there are 20 million new cases of STDs each year. Sexual activity can result in
transmission of AIDS, gonorrhea, syphilis, and genital herpes
Currently an estimated 34 million people worldwide are living HIV/AIDS. In the US, HIV is
most common in gay males but in Sub-Saharan Africa, HIV is most common in heterosexuals;
more half of patients are women-contracted thru heterosexual contact with men.
Paying for Medical Care in the U.S.
• The Patient Protection and Affordable Care Act: Passed in 2010
• Was designed to help provide insurance for people who were not covered at work or had not been
able to afford insurance
• Supposed to provide for annual wellness visits for men, women and children
• People are required to have Health Coverage or pay a penalty for not having coverage
• Very high deductibles $6000 is common
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Private Health Insurance:
Paid often by businesses or agencies for their employees
cited as the main reason for medical inflation
Gives doctors and hospitals an incentive to increase costs
Public health insurance: Medicare (elderly) and Medicaid (children & people on assistance)
 These two programs account for ¼ of all federal spending
 The cost of these programs is likely to double in the next decade unless significant changes
are made
A Functionalist Perspective: The Sick Role (Talcott Parsons)
• According to the functionalist approach:
• It is important for people to be healthy and contribute to society
• Sickness is viewed as deviant behavior
• The sick role is the set of patterned expectations that defines the norms and values
appropriate for individuals who are sick and for those who interact with them
• The sick ________________________________________
• The sick are temporarily exempt from their normal role obligations
• The sick must _________________________________
• The sick must seek help from a medical professional to hasten their recovery
Conflict Perspective:
• Focus on _________________________________________________________________
• Problems in U.S. health care are rooted in the capitalist economy, which views medicine as a
commodity that is produced and sold by the medical–industrial complex
• The medical–industrial complex encompasses physicians and hospitals as well as insurance
companies and pharmaceutical and medical supply companies
• The quality of care that people receive is based on their ability to pay for services; everyone
does not get the same quality of services or access to the same physicians, medications
Symbolic Interactionist Perspective: Social Construction of Illness
• We socially construct “health” and “illness” and how both should be treated
• The social definition of the illness leads to the stigmatization of individuals who suffer from the
disease
• AIDS victims are often blamed for promiscuous sexual conduct or intravenous drug use, regardless
of how they contracted HIV ; smokers are blamed for having lung cancer and alcoholics are blamed
for liver failure
Mental Illness
• Mental illness: a condition in which a person has a severe mental disorder requiring
extensive treatment with medication, psychotherapy, and sometimes hospitalization
• Mental disorder: a condition that makes it difficult or impossible for a person to
cope with everyday life
• Neurotic Disorders: Mental imbalance that causes or results in distress. Examples
such as Depression, Anxiety or OCD
• Psychotic Disorders: Mental state that impairs thought, perception and judgment.
Involves hallucinations (seeing or hearing things that are not real) and delusions
(thoughts of being invincible, having super powers or grand ideas). Examples such as
Schizophrenia, brain tumors, Alzheimer's, Syphilis, or Parkinson's disease. Bipolar
and Depression can have episodes of psychosis.
• Drug Use such as Meth, Cocaine, and LSD can cause hallucinations or delusions.
The Treatment of Mental Illness: Deinstitutionalization
• Deinstitutionalization refers to rapidly discharging patients from mental hospitals into the
community (1970’s)
• Belief that patients’ rights were being violated due to involuntary commitment to
hospitals, where they remained for an extended time
• Critics argue that deinstitutionalization exacerbated problems associated with
inadequate care for people with mental illness
• Tried to treat mental illnesses with outpatient therapy but people don’t often return for
treatment.
Race, Class, Gender, and Mental Disorders
• African Americans report psychological distress or demoralization more frequently than white Americans
Might be attributable to lingering effects of racism
• Cultural factors my be important in determining rates of mental disorders; Strong, extended families may
provide individuals with social support
• Rates of mental disorders decrease as social class increases
• Women are much more likely to be diagnosed as depressed than men
• Learned helplessness theory suggests that people become depressed when they cannot control their lives
Disability: A reduced ability to perform tasks one would normally do at a given stage of life
• May result in stigmatization or discrimination
• Estimated 56.7 million people in the U.S. have one or more physical or mental disabilities
• African Americans have higher rates than whites; people with lower incomes have higher rates;
as age increases so does the chance of developing a disability
• Less than 15% of persons with a disability are born with it
• Accidents, disease, and war account for most disabilities in this country