Jennifer L. Fackler, M.A. Health & Medicine

Health Health - a state of complete physical, mental, and social well- being (World Health Organization)mental Health is as much a social as a biological issue. Illnesses have their roots in society. Examples: Obesity, Environmentally-Influenced Cancers Society Shapes Health in 4 Major Ways 1. Cultural patterns define health. 2. Cultural standards of health change over time. 3. A society’s technology affects people’s health. 4. Social inequality affects people’s health.

Health: A Global Survey

High-Income Nations – people living in rich nations are far healthier than those living in poor countries Lower infant mortality rate and higher average life expectancy. Less infectious disease, but more chronic disease. Special Dangers: High-Fat Diet + Sedentary Lifestyle = Obesity  Heart Disease, Diabetes Low-Income Nations - 1B people suffer from serious illness because they’re poor High infant mortality and low life expectancy. Few chronic diseases, but many infectious diseases. Special Dangers: Poverty -- > Poor Sanitation, Malnutrition, Minimal Medical Care

Health in the United States

Leading Causes of Death in the US In 1900… Influenza and pneumonia Tuberculosis Stomach/intestinal diseases Heart disease Cerebral hemorrhage Kidney disease Accidents Cancer Disease of infancy Diphtheria In 2000… Heart disease Cancer Stroke Lung Disease Accidents Diabetes Pneumonia and influenza Alzheimer’s disease Kidney disease Blood disease

Who is healthy? Social Epidemiology – the study of how health and disease are distributed throughout a society’s population Examines the origin and spread of epidemic diseases and tries to understand how people’s health is tied to their physical and social environments. Example: There is a 20 year difference in LE among the richest and poorest US communities. Factors Include: Age Gender Social Class Race Predictions?

Age Death is now rare among young people. Accidents and AIDS are two exceptions.

Sex and Gender Strongly affect health status! Effects on Mortality & Morbidity: Women get sicker, but men die quicker. Biological Reasons Social Reasons? Masculinity: Risky & Aggressive  Men have higher death rates for accidents, suicide and violence. Controlling  “Coronary Prone Behavior” / Type A Personality. Independent & Strong  Don’t ask for help.

Social Class Link to health is strong and consistent! High SES   Morbidity & Mortality High SES Income Inequality Psychosocial Stresses Immune System Compromised Dangerous Stress Relievers Violent Behaviors Illness, Injuries, Deaths

How Social Class Affects Health Social Drift Theory: Illness  Poverty Poverty  Illness – How?  Stress &  Control Over Stress  Access to Health-Preserving Resources Work Conditions Environmental Conditions Housing Diet Health Care

Class & Race Infant mortality rates are twice as high and LE is lower for the poor. Why? Poverty condemns people to live in crowed unsanitary conditions that breed infectious disease. Poverty also breeds stress and violence. The intersection of Race & Class is central here! African Americans are three times more likely to be poor compared to whites. Life expectancy for white children born in 2000 is six years greater than for African Americans. Other Health Problems Kidney Failure Asthma

Life Expectancy of U.S. Children Born in 2005 Both gender and race have a powerful effect on life expectancy. Source: Kung et al. (2008).

Social Sources of Health & Illness

Social Sources of Premature Death What do you think is the largest cause of premature death in the US? Firearms Toxic Agents Medical Errors Alcohol Bacteria and Viruses Diet, Exercise, and Obesity Motor Vehicles Tobacco Sexual Behavior Illicit Drugs

Social Sources of Premature Death What do you think is the largest cause of premature death in the US? Firearms (1%) Toxic Agents (2%) Medical Errors (13%) Alcohol (4%) Alcohol Bacteria and Viruses (3%) Diet, Exercise, and Obesity (17%) Motor Vehicles (2%) Tobacco (18%) Sexual Behavior (1%) Illicit Drugs (1%)

Tobacco Most preventable hazard to health. By 2003, 22% of Americans smoked. Generally speaking divorced, separated, unemployed, under educated, military individuals are more likely to be smokers. 440,000 men & women die prematurely each year as a direct result of smoking. That number exceeds the combined death toll from alcohol, cocaine, heroin, homicide, suicide, auto accidents & AIDS. Why? Nicotine = Addictive, Hard to Quit Why do people start smoking? Advertising Peer Pressure Stress Trend: Declining

Diet, Exercise & Obesity 2/3 of US adults are overweight. Obesity  odds of developing many diseases. Social Causes of Obesity Lack of Physical Activity Poor Diet Poverty Cause of “Supersizing” Americans Biological Cravings Changes to WHAT & HOW MUCH We Eat Advertising Food-Industrial Complex The Obesity Myth? Obesity = Epidemic Dangers are Overstated CDC: 360k -> 112k Contrary Evidence Obesity vs. Fitness TREND: Increasing Percentage of Americans Who Are Overweight or Obese

Sexual Behavior Encouraged by social conditions. Economic Necessity Violence or Abandonment Minimal Hope for the Future “Sexual revolution” of the 1960’s saw a rise in STD rates; generated a sexual counter-revolution. Knowledge , but Access to Abortion and B/C but Access to Abortion and B/C  Types of STDs Gonorrhea & Syphilis  Easily treated with antibiotics Genital Herpes  Treatable but incurable AIDS – acquired immune deficiency syndrome Caused by human immunodeficiency virus – HIV. Incurable, almost always fatal. Specific behaviors increase risk: anal sex, sharing needles and drug use.

Summary: Social Causes of Illness & Health  Tendency to Blame Individuals for Their Health But health is inherently social! Marshall Becker (1993) on Health Habits: They are acquired within groups. Supported by powerful elements in general society. Extremely difficult to change. Personal behavior is the not the primary determinant of health status. Intervention must focus society rather than the individual. In other words… Public Issues > Personal Troubles C. Wright Mills – Sociological Imagination

Death & Dying

Ethics & Death 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.” What about mercy killing? Thousands face terminal illnesses that will cause horrible suffering. “Right to die” a person with an incurable disease has a right to forego treatment which may prolong their life. “Active” euthanasia a person may enlist the services of a physician to bring on a quick death.

The Medical Establishment

The social institution that focuses on combating disease and improving health.

Paying for Medical Care: The U.S. The U.S. is the only modern, post-industrial country that does NOT provide universal health care. Direct Fee System - patient pays directly for services provided by doctor and hospitals Private Insurance One Type: HMOs Provides comprehensive medical care to subscribers for a fixed fee Preventive approach to health; makes a profit if subscribers stay healthy Few programs pay all medical costs Public Insurance Programs Medicare for those over 65, Medicaid for those in poverty and for veterans. 27% of Americans receive medical attention via some form of government program, though many also have some private insurance.

Extent of Socialized Medicine in Selected Countries The governments of most high-income countries pay a greater share of their people’s medical costs than the U.S. government does. Sources: U.S. Census Bureau (2008) and World Bank (2008).

Theoretical Analysis

S-F Analysis Illness is dysfunctional because it reduces people’s abilities to perform their roles. Medicine is society strategy to keep its members healthy. Society responds to this dysfunction by providing medical care and allowing people a sick role. Talcott Parsons’ Sick Role – releases people from everyday obligations, but requires certain behavior in return. Illness suspends routine duties. A sick person must want to get well. A sick person must seek competent help.

S-I Analysis Society is a complex and changing reality. Thus health and medicine are socially constructed by people in everyday interaction. The Social Construction of Illness – Health is not an objective fact, but a negotiated outcome. Illness Example: Poor societies see malnutrition as normal and rich societies give minimal thought to the harmful effects of a rich diet. Response Example: Sniffles Before Vacation vs. Midterm Exam Psychosomatic Disorders: How people define a medical situation may actually affect how they feel (Thomas Theorem!). The Social Construction of Personal Identity Surgery and illness can greatly affect people’s social identity. Surgery Ex: Losing a Limb, Plastic Surgery, Hysterectomy Illness Ex: Cancer, AIDS

S-C Analysis Points out the connection between health and inequality. Some tie medicine to the operation of capitalism. Feminists link medicine to sexism and gender stratification. Most S-C attention has gone to 3 main issues: 1. Access to medical care. 2. The effects of the for-profit motive. 3. The politics of medicine.

S-C Analysis 1. Access to Care Health is important to everyone, but requiring people to pay for medical care means that the richest people have the best health. S-C theorists point out that capitalism provides excellent health care for the rich but at the expense of the rest of the population. 2. Profit Motive The profit motive turns doctors, hospitals, and pharmaceutical companies into multi-billion dollar corporations. The drive for profit encourages unnecessary tests and surgery and a reliance on expensive drugs instead of a focus on improving people’s lifestyles and living conditions. Medical care should be motivated by a concern for people, not profits.

S-C Analysis 3. Medicine as Politics Scientific medicine often takes sides on significant social issues despite claiming neutrality. Examples: Excluding Women from Medicine, Opposing Gov’t Medical Programs, Supporting Discrimination with “Scientific Opinions” Scientific medicine focuses on explaining illness in terms of bacteria and viruses, ignoring the damaging effects of poverty, racism, and sexism.

Theoretical Analysis

Health & Medicine: Looking Ahead

H&M: Looking Ahead Most members of our society take health and long life for granted. More people in the US are taking responsibility for their health. But there remain grounds for concern such as smoking & obesity. The US also offers good health to the rich but has high rates of disease for the poor because of our capitalist medical system. Health problems, however, are far greater in low-income nations than in the US. World LE is on the rise though! Yet hundreds of millions of people lack medical attention, adequate food, and safe water. Any questions?