Health and Wellness Challenges

December 19, 2011

UNIT 4: Social Challenges

Health Impairing Behaviours

Health, Well-Being and the Social Sciences

• Health and well-being – important to all societies and individuals– healthcare is an important field of study

• Variety of factors affect health and well-being of individuals and societies– how we live our lives– the conditions within our society that affect our access to

healthcare– changes in societal values – changes in our approach to ethical issues related to health

care

Social Sciences

• View health as a significant factor in human well-being – different approaches to studying health

• The differing approaches have lead to several sub-disciplines – medical anthropology– medical sociology– health or clinical psychology.

Health Care and Anthropology• Two main approaches1. Focus on small, kinship-based cultures known as

domestic-scale cultures. – tend to be very healthy– often isolated and have low population densities,

allowing them to avoid the viruses that thrive in dense populations in other parts of the world

– members of these societies are often physically active and eat high fibre, low-fat diets.

• The health related aspects of domestic-scale cultures are often the exact opposite of the health related aspects of people living in modern, industrialized societies.

2. Focus on health status of people living in modern, industrialized societies

– Frequently note connection between the declining social cohesion of these modern societies, the increasing gap between rich and poor and an increase in morbidity.

– There also appears to be a connection between the level of stress and the increase in the incidence of disease.

Health Care and Psychology

• Clinical or health psychologists believe that it is the individual rather than society that determines a person’s health.

• Focus on two specific healthcare areas: clinical practice and research.

• Use both in their efforts to help people identify and address the lifestyle choices that are making them unhealthy.

Health Care and Sociology • Sociologists study the effect that social

structures, allocation of resources and social practices have on human health.

• For example, they might look at what governments and society can do to encourage people to live a healthier lifestyle.

Does more money need to be allocated to health care?

• Some sociologists have made the argument that more money for healthcare is not the answer. – Unhealthy lifestyles account for more than half of the

premature deaths in Canada. (“Canadian Health Insurance: Lessons for the United States”, United States Governmental Accounting Office, 1991).

• What is needed is less of a focus on medical intervention (using medicine to cure our illnesses) and more of a focus on addressing the health-impairing behaviours in society.

Health-Impairing Behaviours• What are health-impairing behaviours?

– Smoking – Alcohol and drug abuse– Obesity – Sedentary lifestyles– Risky sexual practices.

• Social scientists will also focus on health impairing issues like the prevalence of depression among the elderly and bottle feeding rather than breast feeding for infants. – Some behaviours individually driven– Others have roots in lifestyles encouraged by our society

• Effect both individuals and society. – Eg. smoking can cause lung cancer in smokers, but second hand smoke also

affects non-smokers. • Society is affected when resources are allocated to deal with the

illnesses, diseases and lost productivity caused by smoking.

Research and the Social Sciences

Social science researchers use a variety of sources to research these issues and other topics. Their sources generally fall into two categories:

1. Primary Sources2. Secondary Sources

Examples of PRIMARY Sources • Diaries • Letters • Photographs • Art • Maps • Video and film • Sound recordings • Interviews • Newspapers • Magazines • Published first-hand accounts, or • Stories • Studies • Raw Statistics • Experiments • Observations

Examples of SECONDARY Sources • Textbooks • Biographies • Published stories • Research Reports • Movies of historical events • Art • Music recordings • Analyses of Statistics • Web sites • Case Studies

So why do some items appear in both lists?

…Because certain kinds of research are both primary and secondary. What makes the difference is when the research was created and how it is used.

• Here is a brief checklist that will help you to tell the difference between primary and secondary sources:

Primary Sources are: Secondary Sources are: • created at the time of an event or very soon after; • created by an eye witness to an event; • are often one-of-a-kind or rare

• created after an event • often use primary sources • express opinions or arguments about a topic

Health and Wellness Challenges

December 19, 2011

UNIT 4: Social Challenges

Barriers to Health Care

Barriers to Health Care

• Globally, adequate health care is something for which only the wealthy have assurance. Many developing nations struggle with providing adequate health care for their citizens. The HIV/AIDS crisis has crippled the health care budgets of many African nations and has severely strained the budgets of many international aid agencies like the Red Cross, The World Health Organization (WHO) and Doctors without Borders.

• US - wealthy and developed country – sharp divide between the health care available to wealthy

citizens and what the middle class or those living at or below the poverty level can access.

• Canada – universal health care– Medicare, as it was originally known, was created with the

intention of providing equal, barrier-free access to health care for all Canadians.

• Tommy Douglas is considered the Father of our Medicare system.

• Why did Tommy Douglas believe that a government sponsored health care system was the way for Canada to go?

• http://archives.cbc.ca/health/health_care_system/topics/90-419/

Medicare and the Canada Health Act

Canada’s health care system is described in the Canada Health Act and it is governed by five underlying principles.

1.Public Administration – system must be governed on a not-for-profit basis by province and territories

2.Comprehensiveness – all medically necessary procedures provided by doctors and hospitals must be insured

3. Universality – all insured persons must be provided with medical coverage on an equal basis, subject to same rules, conditions and terms

4. Portability – coverage must be available to all Canadians even when they move within Canada or travel outside the country

5. Accessibility – must no be impeded by financial or any other barriers

Sounds like a good plan…

• System which ensures that all Canadians have free access to the health care they need, when they need it.

• Unfortunately, this isn’t always the case. Some barriers to universal health care still exist in Canada.– Location in Canada – kind of health care and how

quickly– Ethnic and language barriers can also make it

difficult for some people to access medical assistance.

What are the barriers to health care in Canada?

• Ethnic minorities in Canada can face challenges in accessing adequate health care, occasionally struggling even to make their health care concerns understood. There is a frequent lack of understanding of the traditional health practices of ethnic minorities and a lack of familiarity with the circumstances of immigrants’ lives before they came to Canada.

What are the barriers to health care in Canada?

• Aboriginal communities, especially in remote parts of Canada, are experiencing severe health crises.

• Both off-reserve and on-reserve Aboriginal communities report a higher incidence of depression, diabetes rates (almost 35%), and other chronic disease rates than the Canadian population.

• Underlying social problems and a lower general standard of living have also contributed to the aboriginal health care crisis. The provinces, federal government, and Aboriginal leaders continue to work to address the crisis and to provide possible long term solutions that will remove these barriers to good health.

• Health care – not entirely about access to medical help– also about having the means to maintain a healthy

lifestyle – economic factors can be a barrier to good health

• poverty can do more damage to a person’s health than smoking, drinking or lack of exercise according to a Statistics Canada study.

• Access to basic drugs, a balanced diet, and even adequate shelter can all contribute to a person’s well being.

• The effect of poverty on the health of Canadian children can be especially serious. According to a 2000 study by the United Nations Children’s Fund (UNICEF), 15.5% of Canadian children (those under 18) live in poverty. And even when those children have the necessities of life, they suffer from being excluded from normal childhood activities like sports and field trips.

• Barriers to health care also exist for disabled Canadians. These barriers include everything from physical access to health care facilities to challenges in the attitude and support received from health care staff. Maintaining a healthy lifestyle can also prove a challenge for Canadians with disabilities, many of whom live at or below the poverty line.

Challenge and Change

• Obviously, these barriers need to be removed so that all Canadians can have equal access to adequate health care. The challenge lies in deciding how to balance the limited health care resources Canada has, and how to effect change without placing too much of a strain on existing resources.

• One solution that has been proposed is to allow some privatization of the health care system. Don Copeman is the owner of a private clinic, The Copeman Health care Centre.

• In a recent article in Maclean’s magazine he discussed the huge potential market for private health care in Ontario where almost 1 ½ million people do not have a family doctor. "The public system will never be able to afford the provision of comprehensive, preventive health services that we offer," he said. "Governments don't have the funding to provide these services and politically it's unfathomable. They would literally have to find billions of new health care dollars and the public is no longer willing to accept an ever- increasing tax burden."

• Canadians are not as appalled by the idea of private health care as they once were. A recent poll found that 51% of Canadians approved of the idea of private family doctors.

• But not everyone agrees. A bill (Bill 11) introduced in the Alberta Legislature and designed to bring private health care to Alberta brought numerous protests. Some of the most vocal protesters were from Tommy Douglas’ family, including his daughter Shirley and his grandson, actor Keifer Sutherland.

Keifer Sutherland and his mother Shirley Douglas defend Medicare

1. What, according to Keifer Sutherland, did Tommy Douglas say defined us as Canadians?

2. What does Keifer Sutherland say is one of the things that people say makes Canada a great country?

3. Sutherland argues that this is not a political issue. What type of issue does he say it is?

link

New Technologies

• There have been numerous attempts over the last few years to reduce or eliminate some of the barriers to health care in Canada. These attempts have included physician recruitment incentives, the hiring of more nurse practitioners, the establishment of a Northern Medical School in northern Ontario, and the creation of satellite medical campuses in other areas.

• But it is in the area of technology that we see the biggest change in the delivery of health care. And it is often technology that can break down barriers. Use the Internet to research one of the following health care technologies. Then write a brief report outlining the technology, how it has improved the health care system, and how it has helped break down barriers in the health care system. What effect might the use of these technologies have on cultural communities, on society, and on individuals?

• Telemedicine• Digital Imaging• Information Technology (electronic medical

records, for example)• Video Conferencing and Webcasting• PDAs (Personal Digital Assistant) and other

hand held devices• Health Care Interpreter Network ( U.S.)

What is Progress?

“Progress has never been a bargain… you have to pay for it. Sometimes I think there’s a man who sits behind a counter and says, 'You can have a telephone but you lose privacy and the charm of distance. Madame, you may have the vote but at a price. You lose the right to retreat behind your powder puff and your petticoat. Mister, you may conquer the air but the birds will lose their wonder and the clouds will smell of gasoline.’”

Jerome Lawrence and Robert E. Lee, Inherit the Wind, 1955

• Progress is something that people find difficult to define and a common definition is almost impossible to agree upon. Webster’s Dictionary defines progress as “to advance to a higher, better, more advanced stage.” The general concept is that progress should improve our lives in some way. But what one person defines as better, another might say isn’t an improvement at all.

• Often people will evaluate progress in terms of their concept of an ideal world. If it makes the world a better place, it is progress.

• The difficulty lies in the multiple visions we have of what makes the world a better place.

• Take the Blackberry. It is a remarkable communications device that allows users to stay in “electronic” touch anytime, anywhere. In 2006, there are 6.2 million subscribers to the Blackberry network. In fact, its use is so widespread that when there was a possibility that the network would be shut down, there was talk that the shutdown might bring the U.S. Congress to a standstill. Also there is the talk is of Blackberry “orphans” - children who are competing for their parent’s attention, not with their siblings, but with these electronic devices that their parents can’t seem to put down.

Is this progress?

• Perhaps from an economic standpoint it is progress, but what would a psychologist or sociologist have to say about the effect that a parent working 24/7 might have on that parent, his/her children, and society in general?

Technological Progress

• Technology frequently drives progress and subsequently societal change. The invention of the printing press made reading accessible to all, rather than just to academics and clerics. Technological advances in agriculture and transportation transformed early civilizations and continue to transform societies today.

• Opponents refer to them as “Frankenfood”, but genetically modified food crops have made it possible for farmers to grow crops in small spaces and in less than perfect conditions. These genetically modified foods are frequently immune to pesticides and disease and can be altered to provide far more nutrients than “natural” foods.

• In the field of health care, technology is responsible for many innovations. Largely due to technology, people are living longer and living more active lives. Preterm babies that might not have had a chance to live thirty years ago are now surviving.

• Doctors can now perform operations remotely. It will even be possible one day for doctors on the ground to conduct medical procedures on astronauts in space.With technological progress, there is a price to pay and ethical considerations to address. What are the possible long term effects of eating “Frankenfoods”? Is it progress, some ask, to preserve life at all costs?

Theories about Change and Technology

• Traditional theories about social change maintain that change within a society begins with the individual who interacts with other members of society to share his or her ideas. If society accepts these new ideas, society adapts to them. These ideas might include new technology.

• Technological Determinism is a theory about change touted by social scientists like Thorstein Veblen and Marshall McLuhan. This theory suggests that change begins not with individuals but with technology itself. These theorists see technology taking on a life of its own after it is introduced. The Blackberry (cell-phone, email or IM) phenomena would appear to support this theory.

Coping with Change

• While there is no doubt that technology has improved lives, it also has lead to additional stresses.

1. Overdependence on technology. 2. Negative side effects of a given technology. For example, the

Internet provides us with free and easily accessible research sources, but it has also allowed hate propaganda and pornography to flourish.

3. The speed at which technological change occurs and our ability, or inability, to keep up with it. There is no question that the rate of change in general has increased rapidly, especially in the last one hundred years. And that speed is reflected in other aspects of society. We have become impatient, unable to wait for an answer – in an age when a computer can bring us an answer in a mere matter of seconds.

Technologically Induced Stress

• So progress frequently requires a trade-off. We must give up something in order to take advantage of something new.

• How do individuals and societies cope with the stresses caused by technology and change?

• In the 1960s, sociologist William Ogburn devised the theory of cultural lag to explain how societies and individuals dealt with technological advances and the changes they bring. He suggested that there were three stages to acceptance of new technology. These stages are invention (the technology is created), discovery (people discover the new technology) and diffusion (the spread and acceptance of the new technology).

• Ogburn further suggested that this acceptance will be slowed by society’s natural resistance to change. In fact, people, he argued, cope with technological change in two very different ways. Some people will accept the new technology while others will reject it completely and do everything they can to prevent it from changing their society.

• Regardless of which group an individual belongs to, most social scientists agree that the key to dealing with technological change is to create some distance between themselves and the technology. Just as human beings need rest from work and time to regenerate, they also need time away from the pressures of technological change.

Ethical Issues in Health Care

Making Choices

• An article in Maclean’s magazine reported on a new issue in healthcare – the issue of whether or not people with self-destructive vices like overeating, smoking, drinking or drug use are owed the same level of attention that other patients receive.

• An increasing number of doctors are turning away these patients or placing them lower on waiting lists.

• It is a complex issue. • Doctors claim that they are doing the right

thing. With finite funds available for healthcare, why waste money on procedures that are unlikely to make a difference? For others, this is an issue of discrimination.

• Healthcare in Canada is supposed to be available to everyone. But does it make ethical sense to treat people who refuse to stop hurting themselves?

• In a poll that accompanied the article, Maclean’s reported that 80% of Canadians believed that people have a responsibility to do their part to stay healthy. But only 27% of those polled believed that people who do not take care of themselves should be placed lower on the priority list for healthcare.

Changing Medical Ethics • Over their careers, doctors will be asked to make

numerous ethical choices . Some of these choices are easy, but others will require doctors to weigh personal ethics against the rights of their patients, or the rights of individuals against the common good.

• To further complicate matters, what is and is not acceptable in medicine and research has changed over time. It is far less acceptable now, for instance, to use human subjects in medical experiments.

The Issues

• Handout Questions Due Wednesday