Transcript Health and Medicine

Health and Medicine
Health and Society
Health: A Global Survey
Health in the United States
The Medical Establishment
Theoretical Analysis of Health and
Medicine
Looking Ahead: Health and Medicine in
the Twenty-First Century
Health
• Health- is a state of complete physical, mental,
and social well being.
• According to the World Health Organization
(WHO)
• The major theme of this chapter:
• Health is as much a social as a biological issue
because well being and illness have their roots in
the organization of society.
Health and Society
• 1. Cultural patterns define health- Standards in
health vary from society to society. Today in the
U.S. the rich foods that people consume are
responsible for almost two-thirds of adults being
over weight.
• “Health” is sometimes a matter of having the same
disease as one’s neighbors.
• 2. What is considered healthy often is the same as
what people define as morally good. Members of
our society third a competitive way of life is
healthy because it fits our cultural mores.
• Thus, ideas about good health amount to a form of
social control that encourages conformity to
cultural norms.
• 3. Cultural standards of health have change over
time. In the early twentieth century, some
physicians warned women not to go to college
because higher education strained the female
brain. Others denounced masturbation as a danger
to health. Today, on both counts, we know
differently.
• 4. A society’s technology affects people’s health.
In poor countries infectious diseases are rampant
because of malnutrition and poor sanitation. As
industrialization raises living standards, people
become healthier. But industrial technology also
creates health hazards. High-income countries tax
the world’s resources and create pollution.
• 5. Social inequality affects people’s health. All
societies distribute resources unequally.
Therefore, some people are healthier than others.
This pattern starts at birth, with infant mortality
highest among the poor. Poor people also live
fewer years than rich people.
Health in History
• Many hunting and gathering people had fairly
healthful diets, eating a range of vegetation and,
when available lean meat.
• With the discovery of agriculture, food became
more plentiful.
• Social inequality also increased and the wealthy
had better health while the peasants and slaves
lived in crowded, unsanitary shelters.
• In the growing cities of medieval Europe, human
waste and other refuse piled up in the streets,
spreading infectious diseases and plagues that
periodically wiped out entire towns.
Health in Low-Income Countries
• The WHO reports that 1 billion people around the
world—one in six—suffer from serious illness
caused by poverty.
• In impoverished countries sanitary drinking water
is as hard to come by as a balanced diet. Unsafe
water is a major cause of the infectious diseases
that imperil both adults and children.
• Poverty breeds disease, which inturn undermines
people’s ability to work. When medical
technology curbs infectious disease, the
populations of poor nations soar. Without
resources to ensure the well being of the people
they have now, poor societies cal ill afford large
populations.
• Ultimately, programs to lower death rates in poor
countries will succeed only if they are coupled
with programs to reduce birth rates.
Health in High-Income Countries
• Industrialization dramatically changed patterns of
human health in Europe, although at first not for
the better. By 1800, as the Industrial Revolution
took hold, factories offered jobs that drew people
from all over the countryside.
• In 1854, for example, John Snow mapped the
street addresses of London’s cholera victims and
found they all drank contaminated water for the
well in Golden Square. Not long after that
scientists linked cholera to a specific bacterium
and developed a vaccine against the deadly
disease. Using scientific technology early
environmentalists campaigned against age-old
practices such as discharging raw sewage into
rivers used for drinking water.
• By the early twentieth century, death rates from
infectious diseases had fallen sharply.
• Now the leading cause of death in the U.S. is
Heart disease and stroke.
Who is Healthy?
Age, Gender, Class and Race
• Social epidemiology- the study of how health and
disease are distributed throughout a society’s
population.
• Women fare better in terms of health than men.
They have a slight biological advantage that
renders them less likely than men to die before or
immediately after birth. Our culture also promotes
masculinity and pressures men to be competitive,
repress emotions, and take up hazardous behaviors
such as the smoking of cigarettes and drinking
alcohol to access.
• Infant mortality—the death rate among children
under one year of age—is twice as high as poor
children vs. children from wealthy families.
• Poverty among African Americans— currently
three times the rate of whites— helps explain why
black people are more likely to die in infancy and,
as adults, are more likely to suffer the effects of
violence, drug abuse, and poor health.
• About 20 % of the U.S. population—more than 50
million people—cannot afford a healthful diet or
adequate medical care.
Cigarette Smoking
• The popularity of cigarettes peaked in 1960, when
almost 45 percent of U.S. adults smoked. By
1999, only 24 % percent of U.S. adults were still
lighting up.
• Some 430,000 men and women die prematurely
each year as a direct result of cigarette smoking,
which exceeds the combined death toll from
alcohol, cocaine, heroin, homicide, suicide,
automobile accidents and AIDS. Smokers also
suffer from more minor illnesses such as the flu,
and pregnant women who smoke increase the
likelihood of spontaneous abortions, prenatal
death, and low-birth weight babies. Even nonsmokers who are exposed to cigarette smoke have
a higher risk of smoking-related diseases.
Eating Disorders
• An Eating disorder– an intense from of dieting
or other unhealthy method of weight control
driven by the desire to be very thin.
• Research shows that most college-age women
believe
• 1. “guys like girls thin,”
• 2. being thin is critical to physical attractiveness,
and
• 3. they are not as thin as men would like.
• Our idealized image of beauty leads many young
women to diet to the point of risking their health.
Sexually Transmitted Diseases
• Sexual activity can transmit more than fifty kinds
of infections, or venereal diseases. Because many
people in our culture associate sex with sin, they
regard venereal disease not only as illnesses but
also as marks of immortality. During the “sexual
revolution” of the 1960’s infection rates rose as
people began sex activity earlier and had a greater
number of partners. As a result STDs are an
exception to the decline of infectious diseases in
the U.S. In the late 1980’s STDs especially—
AIDS—generated a sexual counter-revolution that
discouraged casual sex.
Gonorrhea and Syphilis
• Gonorrhea and syphilis are caused by microscopic
organisms that are almost always transmitted by
sexual contact.
• About 360,000 cases of gonorrhea and 36,000
cases of syphilis were recorded in 1999.
• Gonorrhea and syphilis can be cured easily with
antibiotics such as penicillin. Therefore neither
disease is a major health problem in the U.S
Genital Herpes
• Genital herpes is a virus that infects as many as 45
million adults in the U.S. Herpes is incurable.
People with genital herpes may exhibit no
symptoms or they may experience periodic,
painful blisters on the genitals accompanied by
fever and headache.
• Although not fatal to adults, it can be deadly to
newborns, and a woman with active genital herpes
can transmit the disease during a vaginal delivery.
Therefore women with herpes, usually give birth
by Cesarean section.
AIDS
• The most serious of all sexually transmitted
diseases is acquired immune deficiency syndrome,
or AIDS. Identified in 1981, it is incurable and
almost always fatal.
• AIDS is caused by the human immunodeficiency
virus (HIV), which attacks white blood cells, the
core of the immune system. AIDS renders a
person vulnerable to a wide range of other
diseases that eventually cause death.
Ethical Issues Surrounding Death
• The ability to prolong the lives of terminally ill
people is forcing us to confront a number of
ethical issues surrounding death and the rights of
the dying.
When Does Death Occur?
• Medical and legal experts in the U.S. now define
death as an irreversible state involving no
response to stimulation, no movement or
breathing, no reflexes, and no indication of brain
activity.
Do People Have a Right to Die?
• Federal law requires hospitals, nursing homes, and
other medical facilities to honor a patient’s desire
if spelled out in a “living will.”
What about Mercy Killing?
• Euthanasia- assisting in the death of a person
suffering from an incurable disease. Euthanasia
poses ab ethical dilemma, being at the same time
an act of kindness and a form of killing
• The right to die is one of today’s most difficult
questions.
• Supporters of active euthanasia—allowing a dying
person to enlist the services of a physician to bring
on a quick death—argue that there are
circumstances that make death preferable to life.
Critics counter that permitting active euthanasia
invites abuse. They fear that patients will be
pressured to end their lives in order to spare
family members the burden of caring for them or
the high cost of hospitalization.
The Medical Establishment
• Medicine is the social institution that focuses on
combating disease and promoting health.
• In agrarian societies, health practitioners,
including herbalists and acupuncturists, play a
central part in improving health.
• In industrial societies, medical care falls to
specially trained and licensed healers, from
anesthesiologists to X-ray technicians.
The Rise of Scientific Medicine
• The American Medical Association (AMA) was
founded in 1847 and symbolized the growing
acceptance of a scientific medicine.
Holistic Medicine
• Holistic Medicine- an approach to health care that
emphasizes prevention of illness and takes into
account a person’s entire physical and social
environment.
• 1. Patients are people
• Holistic practitioners extend the bounds of
conventional medicine, taking an active role in
combating poverty, environmental pollution, and
other dangers to public health.
• 2. Responsibility, not dependency
• Practitioners encourage health-promoting
behavior. Holistic favors an active approach to
health rather than a reactive approach to illness.
• 3. Personal treatment
• Holistic practitioner’s locations favor, as much as
possible, a personal and relaxing environment
such as a home.
• Holistic care does not oppose scientific medicine
but shifts the emphasis from treating disease
toward achieving the greatest well-being for
everyone.