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Chapter 14Chapter 14Medicine:Medicine:
An Anatomy of An Anatomy of Health and IllnessHealth and Illness
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Medical intervention at the end of life
Medical futility: treatment fails to end total dependence on medical care
Active euthanasia: aiding dying individuals by prescribing or administering a lethal dose of drugs, only given to patients who request it, usually under legally-controlled conditions
Arguments in favor of euthanasiaArguments against euthanasia
Introduction
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Health: a state of physical, mental, and social wellbeing or the absence of disease
Illness: the lack of health
Health, illness, and health care affect how individuals and groups carry out their lives at the micro, meso, and macro levels
Why is health a social issue?
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
At the micro level, health impacts our ability to carry out our responsibilitiesAt the meso level, health care institutions affect and are affected by other institutionsAt the macro level, health care practices and beliefs about illness are culturally determined
Global health issues include pandemics, bio-terrorism, distribution of immunizations and drugs
• Pandemic: a disease that is prevalent throughout an entire country and potentially around the world
Why is health a social issue?
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Micro-level perspectivesSymbolic interaction & labeling theory
Illness is whatever the powerful (e.g., doctors) define and label it as
Medicalization: a shift to handling normal or deviant human issues in the health care system rather than family, legal, or religious arenas
Shapes our interpretation of the problem, who treats it and how, whether we hold individuals to blame
May be a shift from individual to expert control
Some issues have been de-medicalized
Health and Illness: Theories
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Meso- and macro-level perspectivesFunctionalism
Trends in illness are linked to shifts in macro-level social conditionsNorms define what counts as illness and how to treat itThe health care system helps maintain the social structure and balance between individuals and institutionsIllness is not functional for society: the “sick role” is seen as deviant since it robs society of normal role functioning
Health and Illness: Theories
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Meso- and macro-level perspectivesConflict Theory
Differential access to health careAffected by people’s economic and social positions and by global inequality among rich and poor countries Results in variation in the illnesses people suffer
Role of profit motives in shaping health care
Doctors’ exercise of social control and differential treatment of patients based on social status
Health and Illness: Theories
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Meso- and macro-level perspectivesConflict Theory
Feminist theory:Gender is a key factor affecting health and illnessPatriarchal control of women carries over into health care systems, reinforcing dependence and submissionGlobal North women are profitable for health care systems: they have more and more expensive proceduresDefinitions of women’s bodies and “normal” biological experiences are key to patriarchy, as they have been used to “prove” women’s inferiority
Health and Illness: Theories
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Micro-level analysisWhat constitutes illness rests on socially defined symptoms and circumstances, not universally recognized bodily malfunctions
Parsons’ “sick role”: rights and obligations of those who are accepted as legitimately ill
Right to be excused from responsibilities until wellRight not to be faulted for illnessObligation to define illness as undesirable and not to prolong itObligation to seek competent help in getting well
The Status and Roles of the Sick Person
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Social factors in health and illness
Cultural belief systems and health:Methods of treating illness are culturally determined
Definitions of mental illness vary across societies
Pain is universal, but the way it is perceived, explained, and reacted to is culturally determined
The Status and Roles of the Sick Person
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Social Factors in Health and Illness
Social predictors of individual health & illness:Age: older people need more medical intervention
Gender: Western women report and are treated for more health problems than men; men use more emergency services
Ethnic group: ethnicity affects socialization into health care behaviors and access to health care
Social status: wealthier individuals are more likely to seek medical help for illnesses early on, in part because they can afford it; lower-income people seek help later, in response to crises
The Status and Roles of the Sick Person
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Meso-level analysisTypes of national health care systems
National programs based on the philosophy of health care as a human right
Socialized medicine: government-supported consumer service with equal access to all citizens; the government owns most facilities and pays providers directly (e.g., Canada, Great Britain)Decentralized national health programs: government regulates but does not operate the health care system (e.g., France, Germany)
Modern Health Care Systems
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Meso-level analysisTypes of national health care systems
Health care in the U.S.Fee-for-service: doctors and hospitals are paid for each service they perform, perform the services they deem necessary, and decide the price of services; financed by public and private sources
Health care in poor countries:Often patterned on former colonial systemsMay combine Western and indigenous medicine A struggle to provide basic health needs, sometimes aided by global health organizations
Modern Health Care Systems
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Modern Health Care Systems
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Hospitals as complex organizationsHospitals: places for the care and treatment of the sick and injured, and for provision of centralized medical knowledge and technology
Developed in response to urbanization and industrialization, which led to new health problems requiring systematized, rational care
Changed from places to die to places for healing
Now highly bureaucratized
Dual control by physicians and administrators is giving way to corporate, profit-oriented control in the U.S.
Modern Health Care Systems
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
The changing professional status of health care employees
Hospitals as large, bureaucratic organizations:
Divisions of labor are extensive and specializedHierarchical systems are based on prestige and power, with physicians historically at the topNeed to coordinate many highly-skilled people
Modern Health Care Systems
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
The changing professional status of health care employees
Changes confronting physiciansThough they are highly respected today, physicians’ authority is relatively recentCurrent challenges to physician authority
• Competition for profits• Decline in public trust• Increased specialization
Deprofessionalization: increasing control over physicians’ work by nonprofessional, outside forces
Modern Health Care Systems
•Increasing outpatient care
•Increasing demands from insurance companies
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
The U.S. Health Care SystemThe best and worst in the worldBest:
Quality medical careTrained practitionersFacilitiesMedical technologyAdvances in medical research and therapies and in public health programs, e.g. to increase motor vehicle safety and reduce tobacco use
Modern Health Care Systems
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
The U.S. Health Care SystemProblems
Access to healthcare• Maldistribution of services• Lack of family physicians
Healthcare costs and funding• Highest per-capita costs, which continue to grow• Managed care: an attempt to combine efficiency
and quality• Employers are shifting more health care costs onto
employees
Modern Health Care Systems
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
The U.S. Health Care SystemProblems, cont.
Lack of health care security & the new Obama plan• Millions of Americans lack health coverage and health
security• The uninsured often rely on tax-funded public facilities• The 2010 health bill will cover many of these people, and
prevent denial of coverage due to pre-existing conditions• Still, the new plan will likely have unforeseen consequences
Other issues: inefficiency, competing interests, fragmentation
Modern Health Care Systems
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Modern Health Care Systems
The U.S. Health Care System
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Modern Health Care Systems
The U.S. Health Care System
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
The U.S. Health Care SystemPolicy issues and social reforms
Is health care a right that can’t be bought and sold, or a commodity to be purchased on the market, so competition can increase quality and reduce costs?
Recent proposals for reforming the U.S.’s market-based system
Revise the partly public, partly private systemVote in reforms one at a timePass a comprehensive reform package to provide national health insurance and government oversight
Modern Health Care Systems
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
The U.S. Health Care SystemAccording to some, for a major social or health initiative to pass the U.S. Congress, three things are needed:
Common understanding of the problemGeneral agreement on the approach to solving the problemPositive political ramifications for legislators taking a position on the problem
Modern Health Care Systems
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
The U.S. Health Care SystemPredicted trends:
Hospitals and public health officials will attempt to respond to the threat of bioterrorismHospitals will continue to grow, and will advertise and change their images to please clientsUse of computer technology will continue to increaseMedical advances will change how physicians and hospitals treat patientsEmployers will shift more health costs to employeesDebates about national health care will continue
Modern Health Care Systems
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
The U.S. Health Care SystemMain challenges:
What should be done about the uninsured population?How can costs be controlled in a managed care system?How will the physician-patient relationship shift under new structures of health care?
Modern Health Care Systems
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
National variation in health care practicesEach society’s health care system is shaped by its demographic makeup, value system, and financial statusFor example:
The needs of Global North countries, which have more elderly people, are different from those of Global South countries, with more childrenSome countries have far more doctors than othersChina: medicine in a Communist state
Health Care Around the Globe
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Globalization of medical problemsInternational sale of body parts on the black marketInternational measures of national health
Infant mortalityLife expectancyNations vary in primary causes of death
Globalization and the mobility of diseaseTraditional and modern medical practices
Health Care Around the Globe
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Health Care Around the Globe
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Globalization and the mobility of diseaseThe density and mobility of the world’s population affects human health
Increased global travel can cause disease to spreadUse of land affects the number of rodents and insects, sanitation, contact between individualsIndoor circulated air can spread disease
Economic interests have an impact: Companies such as pharmaceutical firms may halt public health efforts that threaten their profitsTobacco companies market their products globally
Health Care Around the Globe
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Indigenous medicine: Traditional and modern medical
practicesMedical traditions spread with migration and can offer wisdom to one anotherPeople around the world rely on a variety of medical models and practitionersAllopathy (Western medicine) is dominant in the Global North, but alternatives are spreading
“Complimentary and Alternative Medicines” movement (CAM)
Health Care Around the Globe
© Pine Forge Press, an Imprint of SAGE Publications, Inc., 2011.
Health Care Around the Globe