Chapter 13: Medicine An Anatomy of Health and Illness Soc 100Dr. Santos

Introduction- Euthanasia Medical futility- treatment fails to end total dependence on medical care Medical futility- treatment fails to end total dependence on medical care Active euthanasia- aiding the dying individual by prescribing or administering a lethal dose of drugs to patients who request it, usually under legally-controlled conditions Active euthanasia- aiding the dying individual by prescribing or administering a lethal dose of drugs to patients who request it, usually under legally-controlled conditions Arguments in favor of euthanasia Arguments in favor of euthanasia Arguments against euthanasia Arguments against euthanasia

What is health? Health- a state of physical, mental, and social well being or the absence of disease Health- a state of physical, mental, and social well being or the absence of disease Illness- the lack of health Illness- the lack of health

Why is health a social issue? Micro- Health impacts our abilities to carry out other responsibilities Micro- Health impacts our abilities to carry out other responsibilities Meso- The institution of medicine impacts and is impacted by other institutions Meso- The institution of medicine impacts and is impacted by other institutions Macro- Beliefs about illness are culturally determined Macro- Beliefs about illness are culturally determined Global- Pandemics, bio-terrorism, the distribution of immunizations and drugs Global- Pandemics, bio-terrorism, the distribution of immunizations and drugs

Theoretical perspectives on health Symbolic interactionism and labeling theory Symbolic interactionism and labeling theory Illness is whatever the powerful (doctors) define and label it as Illness is whatever the powerful (doctors) define and label it as The labels applied can impact policies and treatments surrounding diseases The labels applied can impact policies and treatments surrounding diseases Medicalization- the shift from handling some forms of deviance and normal human functions at home or in the legal or religions arenas to the health care system Medicalization- the shift from handling some forms of deviance and normal human functions at home or in the legal or religions arenas to the health care system

Theoretical perspectives on health Functionalist Perspective Functionalist Perspective Social norms define what counts as illness and how to treat it Social norms define what counts as illness and how to treat it The health care system maintains the social structure and a balance between individuals and institutions The health care system maintains the social structure and a balance between individuals and institutions Illness is not functional for society Illness is not functional for society The sick role is seen as deviant since it “robs” society of normal role functioning The sick role is seen as deviant since it “robs” society of normal role functioning

Theoretical perspectives on health Conflict Perspective Conflict Perspective People’s economic and social positions in society affect their access to health care and the types of illnesses from which they suffer People’s economic and social positions in society affect their access to health care and the types of illnesses from which they suffer Global inequality Global inequality Is health care a right or a commodity? Is health care a right or a commodity?

Theoretical perspectives on health Feminist theory Feminist theory The patriarchal control of women carries over to health care systems and reinforces dependence, submission, and definitions of what is “illness” for women The patriarchal control of women carries over to health care systems and reinforces dependence, submission, and definitions of what is “illness” for women Western women are seen more often and their procedures are more expensive than men’s Western women are seen more often and their procedures are more expensive than men’s Women’s bodies and normal life cycles have been used historically to “prove” their inferiority and keep them out of some social positions Women’s bodies and normal life cycles have been used historically to “prove” their inferiority and keep them out of some social positions

Micro-level analysis: The sick role Parson’s sick role- the rights and responsibilities expected of ill people in order to be accepted as legitimately ill Parson’s sick role- the rights and responsibilities expected of ill people in order to be accepted as legitimately ill The sick person is excused from normal social responsibility in order to get well The sick person is excused from normal social responsibility in order to get well The illness is not the sick person’s fault The illness is not the sick person’s fault The sick person should not enjoy being sick and not malinger The sick person should not enjoy being sick and not malinger The sick person is expected to seek competent medical help in getting well The sick person is expected to seek competent medical help in getting well

Social factors in health and illness Illnesses and treatments are culturally determined Illnesses and treatments are culturally determined Group factors matter in health care Group factors matter in health care Age- older people need more preventative and acute care Age- older people need more preventative and acute care Gender- Western women report more health problems than men, receive more preventative care, and take more medications; men use emergency services more Gender- Western women report more health problems than men, receive more preventative care, and take more medications; men use emergency services more Ethnic groups- African Americans are less likely to be able to access health care and are less likely to use hospitals and clinics; infant mortality is much higher among minorities Ethnic groups- African Americans are less likely to be able to access health care and are less likely to use hospitals and clinics; infant mortality is much higher among minorities Social status- wealthier individuals are more likely to seek health care, in part because they can afford treatment, especially preventative treatment Social status- wealthier individuals are more likely to seek health care, in part because they can afford treatment, especially preventative treatment

Meso-level analysis: Modern health care systems Types of national health care systems Types of national health care systems Socialized medicine- government-sponsored consumer service with equal access to all citizens; private care is available for an extra fee Socialized medicine- government-sponsored consumer service with equal access to all citizens; private care is available for an extra fee Decentralized national health programs- the government regulates health care but does not operate it Decentralized national health programs- the government regulates health care but does not operate it Developing countries often cannot provide health insurance or security and rely on a combination of Western and indigenous medicine Developing countries often cannot provide health insurance or security and rely on a combination of Western and indigenous medicine

Hospitals as complex organizations Urbanization and industrialization led to new health problems which required systematized, rational health care Urbanization and industrialization led to new health problems which required systematized, rational health care Hospitals share many of the same characteristics as other bureaucracies Hospitals share many of the same characteristics as other bureaucracies Health care systems are major employers in developed nations Health care systems are major employers in developed nations Clear divisions exist between physicians and administrators Clear divisions exist between physicians and administrators

Changing professional status of health care employees Hospitals differ from other formal organizations Hospitals differ from other formal organizations Divisions of labor more extensive and specialized Divisions of labor more extensive and specialized Hierarchical system of stratification is well established and visible Hierarchical system of stratification is well established and visible Physicians are facing new challenges as the health care system changes Physicians are facing new challenges as the health care system changes

Macro-level analysis: Health care and policy issues The U.S. health care system is one of the best and worst in the world The U.S. health care system is one of the best and worst in the world Achievements include increases in medical research and public health (e.g., motor vehicle safety, safer workplaces, clean drinking water) Achievements include increases in medical research and public health (e.g., motor vehicle safety, safer workplaces, clean drinking water)

Problems in the U.S. healthcare system Access to healthcare Access to healthcare Maldistribution of services Maldistribution of services Lack of family practice physicians Lack of family practice physicians Healthcare costs and funding Healthcare costs and funding Costs continue to escalate Costs continue to escalate Managed care attempts to be efficient and offer high quality care Managed care attempts to be efficient and offer high quality care Corporatization Corporatization

Problems in the U.S. healthcare system Lack of health care security Lack of health care security 46 million Americans (and climbing!) remain uninsured 46 million Americans (and climbing!) remain uninsured Insurance companies deny claims Insurance companies deny claims Pre-existing conditions can lead to denial of insurance or higher premiums Pre-existing conditions can lead to denial of insurance or higher premiums Racial and ethnic differences in coverage Racial and ethnic differences in coverage

Policy issues and social reforms in the U.S. health care system Is health care a human right or a market-driven system? Is health care a human right or a market-driven system? Current proposals for health care reform include: Current proposals for health care reform include: Revise the partly public, partly private system Revise the partly public, partly private system Vote in reforms one at a time Vote in reforms one at a time Pass a comprehensive reform package to provide national health insurance and government oversight and administration Pass a comprehensive reform package to provide national health insurance and government oversight and administration The high cost of prescription drugs The high cost of prescription drugs

Main challenges for the U.S. health care system What to do about the rising uninsured population? What to do about the rising uninsured population? How to control costs in a managed care system? How to control costs in a managed care system? What will be the physician-patient relationship under new structures of health care? What will be the physician-patient relationship under new structures of health care?

Health care around the world Each society organizes its health care around its culture and the demographic needs of its population Each society organizes its health care around its culture and the demographic needs of its population Great Britain- socialized medicine Great Britain- socialized medicine China- medicine in a Communist state China- medicine in a Communist state Nicaragua- revolutionary changes Nicaragua- revolutionary changes

Global medical problems International sale of body parts on the black market International sale of body parts on the black market How to increase life spans and decrease infant mortality? How to increase life spans and decrease infant mortality? The mobility of diseases with more people traveling globally The mobility of diseases with more people traveling globally Growing prevalence of tobacco use Growing prevalence of tobacco use

Indigenous medicine Medical practices spread with migration Medical practices spread with migration Various medical traditions can offer wisdom and compliment one another Various medical traditions can offer wisdom and compliment one another Allopathy- medicine practiced by the dominant groups of physicians in Western societies Allopathy- medicine practiced by the dominant groups of physicians in Western societies