Health and Medicine Macionis, Sociology, Chapter Twenty-one

Health A state of complete physical, mental, and social well-being (World Health Organization) Health is as much a social as a biological issue for sociologists Illness have their roots in the organization of society

Society Shapes the Health of People in 5 Major Ways Cultural patterns define health What is considered “healthy” is what people hold to be morally good Cultural standards of health change over time A society’s technology affects people’s health Social inequality relates to health

Leading Causes of Death: U.S.A. 1900 Influenza and pneumonia Tuberculosis Stomach/intestinal diseases Heart disease Cerebral hemorrhage Kidney disease Accidents Cancer Disease of infancy Diphtheria 2000 Heart disease Cancer Stroke Lung disease (non-cancerous) Accidents Diabetes Pneumonia and influenza Alzheimer’s disease Kidney disease Blood disease

Who Is Healthy? Social epidemiology – how health and disease are distributed throughout a society’s population Factors include Age Gender Social class Race

Age & Gender Death is now rare among young people Accidents and AIDS are two exceptions Across the life course, women fare better than men Men have higher death rates for accidents, suicide and violence Our cultural conception of masculinity pressures men “Coronary prone behavior”

Class and Race Infant mortality rates are twice as high for poor as for wealthy The poorest in America can die from diseases that strike children in countries like the Vietnam and Lebanon African Americans are three times more likely to be poor compared to whites Poverty condemns people to live in crowed unsanitary conditions that breed infectious disease Life expectance for white children born in 2000 is six years greater than for African Americans Poverty also breeds stress and violence

Cigarette Smoking Most preventable hazard to health 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

Obesity Two-thirds of U.S. adults are overweight Obesity can limit physical activity and it raises the risk of a number of serious diseases Social causes of obesity Cultural forces encourage fast food Lack of physical ability Poor diet

Sexually Transmitted Diseases “Sexual revolution” of the 1960’s saw a rise in std rates; Generated a sexual counter-revolution 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

Global Map 21-1 HIV/AIDS Infection of Adults in Global Perspective 63% of all global HIV infections are in sub-Saharan Africa. In countries such as Botswana and Swaziland, more than one-third of people between the ages of 15 and 49 are infected with HIV/AIDS. This very high infection rate reflects the prevalence of other sexually transmitted diseases and infrequent use of condoms, two factors that promote transmission of HIV. Source: Population Reference Bureau (2003, 2005); and United Nations (2004); map projection from Peters Atlas of the World (1990).

The Medical Establishment The social institution focuses on combating disease and improving health The rise of scientific medicine AMA – American Medical Association founded in 1847 By early 1900’s state boards agreed to certify only AMA approved M.D.s & D.O. (Osteopaths) on one level Other healers kept tradition but occupy lesser role Chiropractors, herbalists, midwives, etc.

Holistic Medicine Patients are people Responsibility, not dependency Holistic medicine – an approach to health care that emphasizes prevention of illness and takes into account a person’s entire physical and social environment Patients are people Concern for the environment in which the person lives and their lifestyle Responsibility, not dependency Favors an active approach to health encouraging patients take health-promoting behaviors Personal treatment Favoring a more personal relaxed environment, such as the person’s home

Medicine in Socialist Societies China Government controls most health care operations “Barefoot doctors” in rural areas, traditional healing arts, acupuncture, medicinal herbs and holistic concern Russian Federation Medical care is in transition, but it is held the all citizens have a right to basic medical care Tax funds are used to provide care Disparities in medical care increase among segments of the population

Medicine in Capitalist Societies Sweden (1891) Compulsory, comprehensive government medical care system offered to all “socialized medicine” Great Britain (1948) Duel system of public health services (national health service) for all citizens and may also purchase private services Canada (1972) A single-payer model for all citizens government program (insurance company) But, like Britain , purchase private services Japan Physicians have private practice Paid like much of Europe, combination of government programs (80% of costs) and private insurance

Medicine in the U. S. Direct fee system The patient pays directly for services provided by doctor and hospitals Private insurance 60% of Americans have access to medical care benefits through their work or union 8% purchase private coverage on their own 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 Health maintenance organizations An organization that provides comprehensive medical care to subscribers for a fixed fee Preventive approach to health; makes a profit if subscribers stay healthy

Future of Health and Medicine Increase the improvements in U.S. Health Individuals taking responsibility of their own health Double standard of health between rich and poor people Health problems are greater in low-income countries

“The pessimist complains about the wind, the optimist expects it to change, the realist adjusts the sails.” – William Arthur Ward