Chapter 14 Health, Medicine, Disability and Aging

Chapter Outline Health and Medicine Defining and Measuring Health Health and Politics: The United States in Comparative Perspective Disability Aging Theories of Age Stratification Social Problems of Elderly people

The Black Death In 1346, rumors reached Europe of a plague sweeping the East. The epidemic spread along trade routes to China and Russia. Within 2 years, the Black Death, killed 1/3 of Europe’s population. The plague still ranks as the most devastating catastrophe in human history.

Sociological Issues of Health, Medicine, and Disability 1.Health risks are always unevenly distributed. 2.Health problems change over time. 3.Medical professions have gained substantial control over health issues and promoted their own approach to well-being.

Leading Causes of Death, United States, 1900 Cause% of Deaths 1. Pneumonia/influenza Tuberculosis Diarrhea/other intestinal Heart disease Stroke6.2

Leading Causes of Death, United States, 1900 Cause% of Deaths 6. Kidney disease Accidents4.2 8.Cancer Senility Bronchitis2.3

Leading Causes of Death, United States, 2001 Cause% of Deaths 1. Heart disease Cancer Stroke Chronic lung disease Accidents4.0

Leading Causes of Death, United States, 2001 Cause% of Deaths 6. Diabetes Pneumonia/influenza Alzheimer disease Kidney disease Blood poisoning1.3

Leading Causes of Death, United States, 2001 Cause% of Deaths 11. Suicide Liver diseases Homicide High blood pressure Lung inflammation0.7

Life Expectancy, Selected Countries

Life Expectancy Maximum average human life span - average age of death for an entire population under ideal conditions. Life expectancy - average number of years a person can actually expect to live.

Social Causes of Illness and Death Human-environmental factors - Cancer causing pollutants in the air and water. Lifestyle factors - cigarettes, alcohol, drugs, diet, social isolation Public health and health-care systems - access to clean water, basic sewage, immunizations

Number of People with HIV/AIDS, 12/31/02

Health Indicators 1999–2002 United StatesJapanCanadaZambia Physicians/ 100K pop Nurses/ 100K pop % Children immunized against measles

Reasons for Health Inequity The poor are more likely to be exposed to violence, high-risk behavior and environmental hazards. The poor cannot afford adequate health care.

Leading Causes of Death: Ratios, 2000 Female: Male African American: White Heart disease Cancer Stroke Lung disease Accidents

Polling Question Do you currently smoke cigarettes? A.Yes B.No

Gender Inequalities in Health Care More research has focused on “men’s diseases” (cardiac arrest) than on “women’s diseases” (breast cancer). Women undergo fewer kidney transplants, various cardiac procedures, and other treatments than men.

Gender Inequalities in Health Care Women live longer than men and experience greater lifetime risk of functional disability and chronic illness and have a greater need for long-term care. There are 40% more poor women than poor men in the United States.

Prescription Drug Costs in 8 Rich Countries, 2002

Problems with HMOs 1. Some HMO’s avoid covering sick people and people who are likely to get sick to keep costs down. 2. Minimize the cost of treating sick people they can’t avoid covering. 3. Inflate diagnoses to maximize reimbursements. 4. Keep overhead charges high.

Administrative Costs as % of Health-Care Spending

“HMOs Improve the Quality of Care,” 1998

Recent Challenges to Traditional Medical Science Patient Activism Alternative Medicine - chiropractic therapy, acupuncture, massage therapy, and various relaxation techniques Holistic Medicine - emphasizes disease prevention

Social Construction of Disability 400 years ago - Catholic Church declared left-handed people servants of the Devil and burned them at the stake. 19th century - Western scientists and reformers sought rehabilitation of the disabled.

Social Construction of Disability Nazis engineered the sterilization and killing of the mentally “deficient” and the physically “deviant,” including the blind and the deaf. 1920s to 1970s - In America Native American women were subjected to federally funded forced sterilization.

Ablism Prejudice and discrimination against disabled people. –Historical example: Belief among 19th- century Western educators that blind people were incapable of high-level or abstract thought. Ablism involves the largely unintended neglect of the conditions of disabled people.

Age Stratification Sociologists call a category of people born in the same range of years an age cohort. Age stratification refers to social inequality between age cohorts. Gerontocracies were societies in which elderly men ruled.

Child Poverty by Race and Ethnicity

Median Income and Percent Poor

Age Stratification: Functionalist Theory Age stratification reflects the importance of each age cohort’s contribution to society. –In preindustrial societies, the elderly were important for knowledge and wisdom. –With industrialization, function of the elderly became less important and their status declined.

Age Stratification: Conflict Theory Age stratification stems from competition and conflict. Young people may participate in a revolutionary overthrow and seize power. The elderly may organize politically to decrease disadvantages and increase advantages in life.

Age Stratification: Symbolic Interactionist Focus on the meanings people attach to age- based groups and age stratification. One study examined movies from –Young people were portrayed as leading active, vital lives. –Elderly women were portrayed as unattractive, unfriendly, and unintelligent.

Elderly as % of U.S. Population, 1900–2050

Polling Question The government should pay for all prescription medication for the elderly in our society. A. Strongly agree B. Agree somewhat C. Unsure D. Disagree somewhat E. Strongly disagree

A Shortage of Caregivers In 2001, home-care agencies and nursing homes employed 2.1 million caregivers in the United States. The U.S. Bureau of Labor Statistics expects a 58% rise in demand for such workers between 1998 and 2008.

A Shortage of Caregivers Workers are hard to find and hard to keep: –The work is difficult and pays little. –Government requires 2 weeks of preemployment training for direct-care aides but Congress’s 1996 welfare reform discourages such training for former welfare recipients.

Ageism Ageism is prejudice and discrimination based on age. Examples: –Elderly men are stereotyped as “grumpy” and elderly women as “haggard”.

Euthanasia Involves a doctor prescribing or administering medication or treatment that intended to end a terminally ill patient’s life. Public opinion polls show about 2/3 of Americans favor physician-assisted euthanasia.

Euthanasia Between 33% and 60% of American doctors say they would be willing to perform euthanasia if it were legal. Nearly 30% of American doctors have received a euthanasia request, but only 6% say they complied.

Elderly and Poverty Among the elderly, poverty is most common for: –those 85 and older –Women –African Americans –people living alone –people living in rural areas.

People Who Died under Oregon’s Death with Dignity Act Physician-Assisted Suicide Other Deaths Average Age 6974 RaceWhite 97 Asian 31 Other 02 SexMale 5550 Female 4550

People Who Died under Oregon’s Death with Dignity Act Marital Status Physician-Assisted Suicide Other Deaths Married4749 Widowed2233 Divorced2514 Never Married64

Quick Quiz

1. Life expectancy is: a. the average age at death of the members of a population b. the maximum human life span c. the maximum average human life span d. the mortality rate e. the fertility rate

Answer: a Life expectancy is the average age at death of the members of a population.

2. Which of the following is not a major social cause of illness and death? a. human-environmental factors b. lifestyle factors c. factors related to the public health system d. factors related to the health care system e. none of these choices (that is, all the factors listed above are major social causes of illness and death)

Answer : e All the factors listed below are major social causes of illness and death: –human-environmental factors –lifestyle factors –factors related to the public health system –factors related to the health care system

3. What strategies do health maintenance organizations (HMOs) use to maximize profits? a. They avoid covering sick people and people who are likely to get sick. b. Their doctor-compensation formulas reward doctors for withholding treatments that are unprofitable. c. They keep overhead charges high. d. All of these choices.

Answer: d Health maintenance organizations (HMOs) use the following strategies to maximize profits: –They avoid covering sick people and people who are likely to get sick. –Their doctor-compensation formulas reward doctors for withholding treatments that are unprofitable. –They keep overhead charges high.

4. Disabled people are incapable of performing within the range of "normal" human activity. a. True b. False

Answer : a Disabled people are incapable of performing within the range of "normal" human activity.

5. Ablism involves: a. curing disabilities to the extent possible through medical and technological intervention b. prejudice and discrimination against disabled people c. the largely unintended neglect of the conditions of disabled people d. prejudice and discrimination against disabled people, and the largely unintended neglect of the conditions of disabled people

Answer: d Ablism involves prejudice and discrimination against disabled people, and the largely unintended neglect of the conditions of disabled people.

6. Which of the following theories explains age stratification in terms of competition for power and wealth between age cohorts? a. functionalist theory b. conflict theory c. symbolic interactionism d. essentialist theory e. postmodern theory

Answer: b Conflict theory explains age stratification in terms of competition for power and wealth between age cohorts.

7. _________________ is prejudice and discrimination against elderly people.

Answer: ageism Ageism is prejudice and discrimination against elderly people.

8. _________________ involves a doctor prescribing or administering medication or treatment that is intended to end a terminally ill patient's life.

Answer: euthanasia Euthanasia involves a doctor prescribing or administering medication or treatment that is intended to end a terminally ill patient's life.