HEALTH AND MEDICINE

UNDERSTANDING HOW SOCIAL FORCES IMPACT WELL-BEING

• 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

WHAT’S MYWHAT’S MYSOCIAL CLASS GOTSOCIAL CLASS GOTTO DO WITH MYTO DO WITH MYILLNESS?ILLNESS?

• 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 A GLOBAL PEEK AT HEATH ISSUESHEATH 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

• INFLUEZA AND PNEUMONIA

• TUBERCULOSIS

• STOMACH/INTESTINAL DISEASES

• HEART DISEASE

• CEREBRAL HEMORRHAGE

• KIDNEY DISEASE

• ACCIDENTS

• CANCER

• DISEASE OF INFANCY

• DIPTHERIA

• HEART ATTACK• CANCER• STROKE• LUNG DISEASE

(NONCANCEROUS)• PNEUMONIA AND

INFLUENZA• ACCIDENTS• DIABETES• SUICIDE• KIDNEY DISEASE• CHRONIC LIVER DISEASE

AND CIRRHOSIS

LEADING CAUSES OF DEATHIN THE EARLY 1900s IN THE LATE 1990s

HEALTH IN AMERICAHEALTH 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

SMOKING• 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

IMPACT OF THE BEAUTY MYTHIMPACT 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 • 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

MEDICINEMEDICINE• 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 MEDICINEPRACTICING 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

THE HOLISTIC APPROACH TO MEDICINETHE HOLISTIC APPROACH TO MEDICINE

PAYMENT FOR SERVICESPAYMENT FOR SERVICESA GLOBAL COMPARISONA 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

• 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 FUTURETHE 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”