Physical and Mental Illness Chapter 10 Medical Care: Physical and Mental Illness

The Problem In Sociological Perspective Not just biology Social component Industrialization and lifestyle Greater affluence Iatrogenesis Illness caused by medical care staff Changing ideas about health and illness

The Social Organization of Medicine as a Social Problem An explosion in medical costs Reasons for the explosion in costs

Medicine for profit: a two-tier system of medical care Medicine for profit is also known as a fee-for-service system. Two-tier system of medical care: one for those who can afford insurance another for those who cannot

Medicine for profit: cesarean delivery Why have cesarean births increased? Profit Convenience Technology Preference A Feminist Controversy Central issue is the relative power of women

Physical Illness as a Social Problem Life expectancy and infant mortality Determines how healthy or ill a society is as a whole. Infant Mortality Rate (IMR) Number of babies who die before 1 year of age, per 1,000 live births Lifestyle Heroic an Preventive Medicine Quick care: Emergency Rooms and Drugstores Uneven Distribution of Doctors

Mental Illness as a Social Problem Measuring mental illness The social nature of mental illness How we define mental illness is a matter of dispute

A two-tier system of mental health delivery the illness the medical delivery system Deinstitutionalization The release of hospitalized mental patients into the community

Symbolic Interactionism Determining the meaning of symptoms and behavior People from different backgrounds interpret health & illness differently The significance of definitions Views and meanings of health and illness change Conflicting Referral Networks Depersonalization

Functionalism Customs or social institutions fulfills social needs. Free-for-Service Means Profits It is difficult for doctors to make money if people are not sick A self-correcting system

Conflict Theory Argues that the U.S. medical system is not self-correcting. The poor are more often sick—they lack sufficient income and high-quality education, food, housing, jobs, and medical services

Colliding Interests of Doctors and Patients Medicaid Colliding Interests of Doctors and Patients Doctors represent the dominant class Patients are the subordinate class Women’s Reproductive Organs Hysterectomies

An Overview of Physical Health Problems Historical changes in health problems 6 of the 10 leading causes of death have remained the same according to Figure 10-9. Several of the top killers in both centuries are caused primarily by lifestyle and environmental pollution.

Infectious diseases The decline in infectious diseases Stronger immunities, clean water, better food The resurgence of infectious diseases Develop new strains that are resistant

How Disease Is Related to Behavior and Environment: the Case of HIV/Aids Background Example of the relationship between behavior, environment, and disease The disease no longer discriminates A global epidemic 30 million people have died 33 million people around the world are infected now 3 million more people are being infected each year

HIV/Aids in the United States Antiretroviral drugs (ARVs) Halt the progression of AIDS Combination of ARVs and education caused AIDS deaths in the U.S. to decrease Race/ethnicity—higher rates of HIV/AIDS Ominous changes HIV virus mutates rapidly . 22

Social Inequalities in Physical Illness Poverty and health Economic factors largely determine who will be healthy and who will be sick Occupational health hazards lower-class working environments Reducing Inequalities: Health Care Reform

Social Inequalities in Mental Illness Social class and mental illness People’s emotional well-being declines with decreases in social class. Four explanations for the greater emotional problems of the poor: The Drift Hypothesis The Genetic Hypothesis The Socialization Hypothesis The Environmental Hypothesis

Social Class Differences in Mental Health Care Different types of therapies Consequences of ability to pay Type of therapy tied to a person’s ability to pay, not illness Talk therapy Pharmaceutical straitjacket 27

Prepaid Medical Care: The Example of Managed Care Health Maintenance Organization (HMO) The positive side Profits and a conflict of interest

Physician Assistants Training Physicians Home health care Strategy for controlling costs Training Physicians Medical schools graduate about 16,000 physicians a year. Home health care Less expensive and often more humane Preventative Medicine

Domiciliary Care Home health care, or domiciliary care Treatment given within a patient’s home Less expensive and often more humane May involve profiteering Another approach: create domiciliary programs for mentally ill

Preventive Medicine Preventable deaths Three types of preventive medicine: Primary prevention Secondary prevention Tertiary prevention Food and health Proper nutrition and exercise Immunizations Preventing drug abuse and homicide Eating ourselves to death