Transcript HEALTH AND MEDICINE

HEALTH
AND MEDICINE
UNDERSTANDING HOW SOCIAL
FORCES IMPACT WELL-BEING
WHAT’S MY
SOCIAL CLASS GOT
TO DO WITH MY
ILLNESS?
• HEALTH
– A STATE OF COMPLETE
PHYSICAL, MENTAL, AND
SOCIAL WELL-BEING
• FROM A SOCIOLOGICAL
PERSPECTIVE…
– HEALTH IS AS MUCH A
SOCIAL AS A BIOLOGICAL
ISSUE FOR SOCIOLOGISTS
• THINK IN TERMS OF THE
ORGANIZATION OF SOCIETY
• PEOPLE JUDGE THEIR HEALTH IN
RELATIVE TERMS
• PEOPLE PRONOUNCE AS “HEALTHY”
WHAT THEY HOLD TO BE MORALLY
GOOD
• CULTURAL STANDARDS OF HEALTH
CHANGE OVER TIME
• HEALTH RELATES TO A SOCIETY’S
TECHNOLOGY
• HEALTH RELATES TO SOCIAL
INEQUALITY
A GLOBAL PEEK AT
HEATH ISSUES
• LOW-INCOME COUNTRIES
– SEVERE POVERTY CUTS INTO LIFE
EXPECTANCY WHEN COMPARED TO RICH
COUNTRIES
• ONE IN SIX PERSONS IN THE WORLD SUFFER FROM
ILLNESSES DUE TO POVERTY
– A LACK OF TRAINING MEDICAL PROFESSIONAL
ALSO ADDS TO THE PROBLEM
• HIGH-INCOME COUNTRIES
– INFECTIOUS DISEASES ARE LESS OF A THREAT,
BUT CHRONIC CONDITIONS HAVE TAKEN THEIR
PLACE
• HEART DISEASE, CANCERS, AND STROKE
LEADING CAUSES OF DEATH
IN THE EARLY 1900s
• INFLUEZA AND
PNEUMONIA
• TUBERCULOSIS
• STOMACH/INTESTINAL
DISEASES
• HEART DISEASE
• CEREBRAL
HEMORRHAGE
• KIDNEY DISEASE
• ACCIDENTS
• CANCER
• DISEASE OF INFANCY
• DIPTHERIA
IN THE LATE 1990s
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HEART ATTACK
CANCER
STROKE
LUNG DISEASE
(NONCANCEROUS)
PNEUMONIA AND
INFLUENZA
ACCIDENTS
DIABETES
SUICIDE
KIDNEY DISEASE
CHRONIC LIVER DISEASE
AND CIRRHOSIS
HEALTH IN AMERICA
• SOCIAL EPIDEMIOLOGY
– HOW HEALTH AND DISEASE
ARE DISTRIBUTED
THROUGHOUT A SOCIETY’S
POPULATION
• LET’S EXAMINE ISSUES OF
HEALTH AS THEY ARE
RELATED TO VARIOUS
CATEGORIES OF PEOPLE
• DEATH IS SELDOM VISITED UPON
THE YOUNG THESE DAYS
– ACCIDENTS AND HIV/AIDS ARE TWO
EXCEPTIONS
• ACROSS THE LIFE CYCLE
– WOMEN FARE BETTER THAN MEN
• GENDER AS A HEALTH THREE
– MASCULINITY LINKED WITH
CORONARY PRONE BEHAVIOR
• TYPE “A” PERSONALITY TRAITS
• INFANT MORTALITY RATES ARE
TWICE AS HIGH FOR
DISADVANTAGED GROUPS
• AFRICAN AMERICANS ARE THREE
TIMES MORE LIKELY TO BE POOR
COMPARED TO WHITES
• WHITES CAN EXPECT TO LIVE
LONGER AND BE IN BETTER HEALTH
• POVERTY ALSO BREEDS STRESS AND
VIOLENCE
• MOST PREVENTABLE
HAZZARD TO HEALTH
• SMOKING IS NOW DEFINED
AS A MILD FORM OF
DEVIANT BEHAVIOR
• PEOPLE WITH LESS
EDUCATION TEND TO BE
SMOKERS
• LUNG CANCER IS NOW THE
LEADING CAUSE OF DEATH
AMONG WOMEN
• 430,000 MEN AND WOMEN
DIE PREMATURELY EACH
YEAR FROM TOBACCO
RELATED DISEASES
SMOKING
IMPACT OF THE BEAUTY MYTH
• EATING DISORDERS
– AN INTENSE INVOLVEMENT IN DIETING AND
OTHER FORMS OF WEIGHT CONTROL IN
ORDER TO BECOME VERY THIN
• 95% OF THOSE SUFFERING FROM
ANOREXIA AND BULIMIA ARE WOMEN
• THE BEAUTY MYTH TELLS WOMEN TO
EXAGGERATE THE IMPORTANCE OF
PHYSICAL ATTRACTIVENESS
• PRESSURES COME FROM SOCIETY,
PARENTS, THE MEDIA, AS WELL AS
WOMEN THEMSELVES
• GONORRHEA AND SYPHILIS
– 356,000 CASES OF GONORRHEA ANNUALLY
– 38,000 CASES OF SYPHILIS ANNUALLY
• GENITAL HERPES
– 20-30 MILLION ADULTS INFECTED
– THAT’S ONE IN SEVEN ADULTS!
• HIV/AIDS
– THE MOST DEADLY OF ALL STD’S
– TRANSMISSION IS THROUGH BLOOD, SEMEN, AND
BREAST MILK, AND NOT THROUGH CASUAL
CONTACT
– EDUCATION PROGRAMS ARE OF VITAL
IMPORTANCE SINCE PREVENTION IS THE ONLY
SAFEGUARD AGAINST HIV/AIDS
• WHEN IS A PERSON DEAD?
– WHEN AN IRREVERSIBLE STATE
INVOLVING
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NO RESPONSE TO STIMULATION
NO MOVEMENT OR BREATHING
NO REFLEXES, AND
NO INDICATION OF BRAIN ACTIVITY
– DO PEOPLE HAVE THE RIGHT TO DIE?
• 10,000 PEOPLE IN THE U.S.A. ARE IN A
PERMANENT “VEGETATIVE STATE”
• THOUSANDS FACE TERMINAL ILLNESSES THAT
WILL CAUSE HORRIBLE SUFFERING
• THE PERSONAL WISHES CONTAINED IN LIVING
WILLS ARE NOW ADHERED TO MORE OFTEN
• PASSIVE EUTHANASIA
– ACTIVELY SUPPORTING THE RIGHT TO DIE
• ACTIVE EUTHANASIA
– ASSISTING A PERSON TO DIE
• THE NETHERLANDS HAVE THE MOST LIBERAL LAWS
• STATE AND FEDERAL LAW
– IN 1997, OREGON VOTERS ENDORSED
LEGISLATION THAT ALLOWS DOCTORS TO
ASSIST PATIENTS IN TERMINAL CASES
– IN 1999, CONGRESS BEGAN DEBATING THE
PASSAGE OF A LAW THAT WOULD PROHIBIT
STATES FROM ADOPTING ALWS SIMILAR TO
OREGON’S STATE LAW
MEDICINE
• IT IS THE SOCIAL INSTITUTION
THAT FORCUES ON COMBATING
DISEASE AND IMPROVING HEALTH
• THE RISE OF SCIENTIFIC MEDICINE
– THE AMERICAN MEDICAL ASSOCIATION
WAS FOUNED IN 1847
• THE AMA IS A STRONG BODY WHEN IT
COMES TO LOBBYING AND PRESSURING
GROUIPS TO CONFORM TO ITS STANDARDS
– SCIENTIFIC MEDICINE BEGAN AS A
VERY CLASS-ORIENTED CAREER
• WOMEN AND RACIAL MINORITIES WERE
OFTEN EXCLUDED FROM MEDICAL SCHOOLS
• ONLY RECENTLY HAVE SCHOOLS
GRADUATED MORE WOMEN AND OTHER
MINORITIES
PRACTICING MEDICINE
THE HOLISTIC APPROACH TO MEDICINE
• PATIENTS ARE PEOPLE
– CONCERN FOR THE TOTAL ENVIRONMENT
IN WHICH THE PERSON LIVES
• RESPONSIBILITY, NOT DEPENDENCY
– FAVORING AN ACTIVE PATIENT ROLE
RATHER THAN A REACTIVE ROLE
• PERSONAL TREATMENT
– FAVORING A MORE PERSONAL
ENVIRONMENT IN WHICH TO PRACTICE
THE ART OF HEALING, SUCH AS THE
PERSON’S DWELLING
PAYMENT FOR SERVICES
A GLOBAL COMPARISON
• CHINA
– GOVERNMENT CONTROLS MOST HEALTH CARE OPERATIONS
• RECENT CLAIMS OVER GOVERNMENT INVOLVEMENT IN SELLING
ORGANS TAKEN FROM PRISON POPULATIONS
• RUSSIAN FEDERATION
– MEDICAL CARE IS IN TRANSITION, BUT IT IS HELD THE ALL
CITIZENS HAVE A RIGHT TO MEDICAL CARE
• SWEDEN
– COMPULSORY GOVERNMENT MEDICAL CARE OFFERED TO ALL
• GREAT BRITAIN
– MIXTURE OF PRIVATE AND PUBLIC HEALTH SERVICES
• CANADA
– A SINGLE-PAYER GOVERNMENT PROGRAM, BUT, LIKE BRITAIN,
IT HAS A TWO-TIERED SYSTEM
• JAPAN
– DOCTORS OPERATE PRIVATELY, BUT THERE IS A COMBINATION
OF PRIVATE AND PUBLIC PROGRAMS
MEDICINE IN THE UNITED STATES
• DIRECT FEE SYSTEM
– THE PATIENT PAYS DIRECTLY FOR SERVICES PROVIDED BY
DOCTOR
• PRIVATE INSURANCE
– IN 1997, 61% OF AMERICANS HAD ACCESS TO MEDICAL CARE
BENEFITS
• PUBLIC INSURANCE PROGRAMS
– MEDICARE FOR THOSE OVER 65
– MEDICAID FOR THOSE IN POVERTY
– IN TOTAL, 36% OF AMERICANS RECEIVE MEDICAL ATTENTION VIA
SOME FORM OF GOVERNMENT PROGRAM, INCLUDING SOME WITH
PRIVATE CARE INSURANCE
• HEALTH MAINTENANCE ORGANIZATIONS
– AN ORGANIZATION THAT PROVIDES COMPREHENSIVE MEDICAL
CARE TO SUBSCRIBERS FOR A FIXED FEE
– BUT, WHO MAKES DECISIONS IN SUCH ORGANIZATIONS, DOCTORS
OR ACCOUNTANTS?
• SINGLE-PAYER PROGRAM IN THE FUTURE?
– INSURANCE WILL PROBABLY LOBBY AGAINST SUCH CHANGES DUE
TO SELF-INTERESTS
HOW TO MAKE SOCIOLOGICAL SENSE OF HEALTH AND HEALTH CARE
• STRUCTURAL-FUNCTIONAL ANALYSIS
– THE SICK ROLE AND THE PHYSICIAN’S ROLE
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ILLNESS SUSPENDS ROUTINE DUTIES
ILLNESS IS NOT DELIBERATE
A SICK PERSON MUST WANT TO GET WELL
A SICK PERSON MUST SEEK COMPETENT HELP
• SYMBOLIC-INTERACTION ANALSYIS
– WE SOCIALLY CONSTRUCT ILLNESS AS WE CONTINUE TO
INTERACT
• A DRAMATURLOGICAL ANALYSIS OF THE GYNECOLOGICAL
EXAMINATION CLEARLY SHOWS THE PROCESSES INVOLVED
• SOCIAL-CONFLICT ANALYSIS
– ISSUES OF:
• ACCESS, THE PROFIT MOTIVE, AND THE POLITICS OF MEDICINE
• INTERESTS OF ONE GROUP VERSUS OTHERS
THE FUTURE
• MOST PEOPLE ARE IN GOOD HEALTH IN AMERICA
– MANY DISEASES THAT WERE PROBLEMATIC HAVE BEEN
WIPED OUT
• PERSONAL INVOLVEMENT
– PEOPLE ARE MORE KNOWLEDGEABLE AND TAKING
MORE RESPONSIBILITY FOR THEIR OWN HEALTH
CONCERNS
• MARGINAL PEOPLE
– STILL NEED TO CARE MORE ABOUT THOSE GROUPS ON
THE ECONOMIC FRINGE
• IMPROVING HEALTH WORLD-WIDE
– INCREASING LIFE EXPECTANCY IS A MAJOR CHALLENGE
TO GLOBAL HEATLH ORGANIZATIONS
– COMBATING AND CONTROLING VIRUSES AND OTHER
DISEASE THAT ARE “OUT THERE”