Health and the Environment 19 Sociological Perspectives on Health and Illness Social Epidemiology and Health Health Care in the United States Mental Illness in the United States Sociological Perspectives on the Environment Environmental Problems Social Policy and the Environment: Environmentalism

A Look Ahead What are the people who cannot afford to drink bottled water supposed to do? Won’t the environment eventually threaten everyone no matter how much organic food they consume? What defines a healthy environment? How does health care vary between social classes and nations? 3

Sociological Perspectives on Health and Illness Health: “State of complete physical, mental, and social well-being, and not merely the absence of disease and infirmity” (Leavell and Clark 1965:14) Health is socially constructed, and we can view it in a social context 4

Figure 19-1: Infant Mortality Rates in Selected Countries Source: Haub 2010. 5

Functionalist Approach “Being sick” must be controlled so that not too many people are released from their societal responsibilities Sick role: Societal expectations about attitudes and behavior of a person viewed as being ill Physicians function as “gatekeepers” for the sick role 6

Conflict Approach Medicalization of society: Growing role of medicine as major institution of social control Greatly expanded domain of expertise Problems viewed using a medical model Retains jurisdiction over health care 7

Conflict Approach Inequalities in Health Care Glaring inequalities exist in health care Brain drain: Immigration to U.S. and other industrialized nation of skilled workers, professionals, and technicians Dramatic differences in infant morality rate: number of deaths of infants under 1 year-old per 1,000 live births in any year 8

Interactionist Approach Study roles played by health care professionals and patients Asserts patients may play an active role in positive or negative health 9

Labeling Approach The designations healthy and ill generally involve social definition Homosexuality noteworthy medical example of labeling Can view variety of life experiences as illnesses or not 10

Table 19-2: Sociological Perspectives on Health and Illness 11

Social Epidemiology and Health Social epidemiology: Study of distribution of disease, impairment, and general health status across a population Incidence: Number of new cases of specific disorder occurring within given population during a stated period of time, usually a year 12

Social Epidemiology and Health Prevalence: Number of cases of specific disorder that exist at a given time Morbidity rates: Disease incidence figures presented as rates or number of reports per 100,000 people Mortality rate: Incidence of death in a given population 13

Social Class People in lower classes have higher rates of mortality and disability Appear to be cumulative Less able to afford quality medical care Link between health and economic mobility 14

Race and Ethnicity Health profiles of racial and ethnic groups reflect social inequality in U.S. Poor economic and environmental conditions manifested in high morbidity and mortality rates African Americans have higher death rates Mexican Americans may use curanderismo: Form of holistic health care and healing 15

Gender Women experience higher prevalence of many illnesses but tend to live longer Lower rate of cigarette smoking Lower alcohol consumption Lower rate of employment in dangerous occupations Women more likely to seek treatment 16

Older people use more health services than younger people Age Most older people in U.S. have at least one chronic illness Older people vulnerable to certain types of mental health problems Older people use more health services than younger people 17

Figure 19-2: People Living with HIV Note: Data for the 33.3 million people (estimated range, 31.4–35.8 million) living with HIV at the end of 2009. Source: UNAIDS 2010:23. 18

Figure 19-3: Percentage of People without Health Insurance Source: Mach and Blumenthal 2010:2. 19

Research Today 19.1: The AIDS Epidemic Do the people you know take few risks sexually because of the danger of becoming infected with the AIDS virus? If not, why not? Aside from obvious humanitarian reasons, why should the U.S. help countries in the fight against AIDS? 20

Research Today 19.2: Medical Apartheid Do you know anyone who has experienced deliberately inferior or unethical medical treatment? What factors were involved? What, other than racism, might explain the behavior of the doctors who agreed to participate in experiments that violated their professional oaths? 21

Health Care in the United States Health care costs have skyrocketed In 2000, amount spent on health care equaled that spent on education, defense, prisons, farm subsidies, food stamps, and foreign aid combined 22

Figure 19-4: Total Health Care Expenditures in the U. S Figure 19-4: Total Health Care Expenditures in the U.S., 1970 – 2019 (Projected) Sources: Centers for Medicare and Medicaid Services 2010: Table 1 (2004–2019 data); Health Care Financing Administration 2001 (1970–1990 data). 23

A Historical View “Popular health movement” of the 1830s and 1840s AMA institutionalized authority through programs of education and licensing By 1920s, physicians controlled hospital technology, division of labor of health personnel, and other health professions 24

Physicians, Nurses, and Patients Physicians have position of dominance with patients and nurses Leads to dehumanizing physician-patient encounters Publicity about malpractice suits and high medical costs further strained relationship Controlled interactions with nurses Increasingly, patients turning to media for health care information 25

Alternatives to Traditional Health Care At least one of three adults in U.S. attempts to maintain good health or respond to illness through alternative health care techniques Holistic medicine: Therapies in which the health care practitioner considers person’s physical, mental, emotional, and spiritual characteristics 26

Figure 19-5: Use of Complementary and Alternative Medicine Note: Data from 2007 survey, except for prayer data from 2002 survey. Source: Barnes et al. 2004, 2008. 27

1983: Government instituted cost-control program The Role of Government In 1946 Hill-Burton Action provided first subsidies for building and improving hospitals especially in rural areas 1965: Medicare and Medicaid established Programs greatly expanded federal involvement in health care financing 1983: Government instituted cost-control program 28

Mental Illness in the United States Medical illness: disorder of the brain that disrupts a person’s thinking, feeling, and ability to interact with others Shortcomings of U.S. mental health system Officials poorly prepared to detect mental health issues Mental health services limited in availability Stigma discourages people from seeking help 29

Theoretical Models of Mental Disorders Medical model: mental illness rooted in biological causes that can be treated through medical intervention Labeling theory: mental illness is not an “illness” since the individual’s problems arise from living in society Devalues mentally ill patients 30

Patterns of Care Mental illness has been a governmental concern longer than physical illness Confinement of the insane or mentally ill to public institutions 1963 Community Mental Health Centers Act increased federal government involvement in treatment of mentally ill Made it easier to commit mentally-ill homeless involuntarily 31

Sociological Perspectives on the Environment Environment people live in has noticeable effect on their health Increases in population, together with economic development, have serious environmental consequences 32

Human Ecology Human ecology: Interrelationships between people and their spatial settings and physical environments Stresses the trade-offs inherent in every decision that alters the environment Government policymakers and environmentalists must determine how to fulfill humans’ pressing needs while preserving the environment 33

Conflict View of the Environmental Resources of developing countries redistributed to core industrialized nations Ecological modernization: Alignment of environmentally favorable practices with economic self-interest through constant adaptation and restructuring Environmental justice: Legal claims that racial minorities are disproportionately subjected to environmental hazards 34

Environmental Problems Three broad areas of concern Air pollution Water pollution Global Warming 35

Sociology in the Global Community 19.2: The Mysterious Fall of the Nacirema Have you ever visited a foreign culture and been struck by something that seemed odd to you but perfectly normal to everyone else? If we could step back and take an objective look at what we are doing to the environment, would our society change for the better? 36

The Impact of Globalization Globalization can be good and bad for the environment Industrialization increased pollution Multinational corporations have incentive to carefully consider cost of natural resources Environmental refugees are one reflection of interplay between globalization and environment 37

Figure 19-6: Increase in Carbon Dioxide Emissions Source: Mufson 2007:6. 38

Environmentalism Looking at the Issue 1970: 25 million people turned out to observe first Earth Day Citizens marched on behalf of specific environmental causes Congress established the EPA The Clean Air, Clean Water, and Endangered Species acts followed 39

Environmentalism Looking at the Issue Earth Day now on calendars of city councils, zoos, and museums worldwide Increasingly, efforts to publicize concerns moving to Internet General public has mixed reaction to environmental issues Largest environmental organizations became increasingly bureaucratic 40

Environmentalism Applying Sociology Troubled that most powerful environmental organizations predominantly white, male-dominated, and affluent Conflict perspective: major organizations accept funding from powerful corporations including oil and chemical companies Environmental movement aroused resistance 41

Environmentalism Initiating Policy Economic downturn of 2008 a mixed blessing Reduced use of fossil fuels Established funds for creating green-collar jobs Environmentalism moved to a bigger stage People increasingly reluctant to ignore environmental issues 42

Figure 19-7: The Environment Versus the Economy Source: Jeffrey Jones 2011; see Saad 2010c in references. 43

Figure 19-8: Are U.S. Teens Green Enough? Note: Mean score for 15-year-old students’ knowledge of environmental issues 5 543. Source: Organisation for Economic Co-operation and Development 2009b:40 44