Health and Society Chapter 16 Lecture PowerPoint © W. W. Norton & Company, 2008

The Rise (and Fall?) of the Medical Profession You May Ask Yourself Copyright © 2008 W.W. Norton & Company, Inc. 2  Why do doctors have power and prestige?  Offer universally valued product—health and longevity.  limited numbers due to education, training and regulation.  Professionalism – collegiality, ethics, norms, objectivity, relationship with patients  Props and scripts assert power (waiting room, diagnoses, prescriptions, instructions, etc.)

The Rise (and Fall?) of the Medical Profession You May Ask Yourself Copyright © 2008 W.W. Norton & Company, Inc. 3  Doctors traditionally had power to set own pay rates and recommended treatments and follow-up visits (“supplier- induced demand”).  Power increased with development of hospitals – doctors brought in patients  Recently have lost some control over setting fees  Alternative medicine has expanded, leading to more regulation of medical fields  Technology allows nurses and technicians to do much of doctors’ work

What Does It Mean To Be Sick? You May Ask Yourself Copyright © 2008 W.W. Norton & Company, Inc. 4  Talcott Parsons - concept of the sick role  Rights: 1) not to perform social roles; 2) not to be held accountable  Obligations: 1) try to get better (or prevent getting sick; 2) seek help follow doctor’s orders  Places much responsibility on individual  does not take account of social conditions that affect health  Money, access to care  Cultural views of illness and treatment

What Does It Mean to Be Sick? You May Ask Yourself Copyright © 2008 W.W. Norton & Company, Inc. 5  illness is a social construct  definitions, explanations change over place and time.  Once thought to result from evil spirits, bad behavior, symbolic issues (e.g. – heart disease = problems in love; back pain = someone betraying you)  Diagnosis of mental illness especially subjective

Diagnostic and Statistical Manual (DSM) You May Ask Yourself Copyright © 2008 W.W. Norton & Company, Inc. 6  standard categorization of mental disorders and definitions.  reflects and influences how mental illness is understood and treated.  Defines “normal” and “abnormal”  Early editions emphasized dynamic psychiatry (identifying internal conflicts that produce mental illness).  recent emphasis on diagnostic psychiatry (identifying symptoms of specific underlying diseases and treating them w/medicine)  May have been influenced by pharmaceutical companies

The U.S. Health-Care System 7  United States does not offer universal health care  Four main types of health-care coverage in U.S:  Fee-for-service – pays for each visit/service  Health maintenance organizations – pay per patient, regardless of # of visits in a year  Incentive to take more patients  Incentive to emphasize prevention (less work for Dr.)  Medicare – mainly for over 65  Medicaid – for poor families, children  Some states have their own programs

Figure 16.1 | Medical Debt in America

The U.S. Health-Care System You May Ask Yourself Copyright © 2008 W.W. Norton & Company, Inc. 9  The Whitehall Study: social factors such as where you live, occupation, and income, especially relative to one’s own society, have a greater influence on health than health care and health-care systems.

Social factors and health You May Ask Yourself Copyright © 2008 W.W. Norton & Company, Inc. 10  Race: whites have best outcomes overall. Largest gaps are between whites and blacks.  Socioeconomic status: higher status people have better health  Gender: women are healthier, live longer  Marital status: married people are healthier  Family size: smaller families are healthier  These are correlations, not causes.

Figure 16.3 | U.S. Infant Mortality

Figure 16.6 | U.S. Life Expectancy by Race

Figure 16.5 | U.S. Life Expectancy by Gender

Why people with higher socioeconomic status have better health: You May Ask Yourself Copyright © 2008 W.W. Norton & Company, Inc. 14  Selection – same people who are able to achieve also better equipped to care for themselves  Drift – health causes social position  Social position causes health  Low SES: more stress, hopelessness  Income can buy healthier lifestyle, better care  Fundamental causes – wealthy people have more resources, information – adapt quicker