1. © 2005 Pearson Education Canada Inc. Chapter 21 Health and Medicine

2. © 2005 Pearson Education Canada Inc. Health and Medicine Health is a state of complete physical, mental, and social well-being (WHO). Medicine is a social institution that focuses on combating disease and improving health.

3. © 2005 Pearson Education Canada Inc. Health and Society 1. Cultural patterns define health, e.g., definitions of mental illnesses. 2. “Healthy” is morally good. 3. Cultural standards of health change over time, e.g., education strains women, and smoking is now bad. 4. A society’s technology affects people’s health. 5. Social inequality affects people’s health, e.g., the rich live longer and are healthier than the poor.

4. © 2005 Pearson Education Canada Inc. Health: A Global Survey In ancient times people lived short lives, and little could be done to help them. Low-income Countries 1 in 6 suffer from serious illness due to poverty. Lowering death rates must be coupled with reducing birth rates. High-income Countries Main causes of death are chronic diseases, e.g., heart disease, cancer and stroke.

5. © 2005 Pearson Education Canada Inc. Health in Canada Social epidemiology: the study of how health and disease are distributed throughout the society Age and sex: death is rare for young, and men have higher death rates than women. Social class and race: – the higher the income, the longer the life span; – the lower the income, the lower the health status; and – Aboriginals are more at risk than the general population.

6. © 2005 Pearson Education Canada Inc. Cigarette Smoking From a high of 45% of the population in 1960, smoking has declined to 21.5% in 2000-01 ¼ of men’s and women’s deaths 35-84 years of age Laws mandating smoke-free environments are spreading rapidly. Restriction now to sporting and cultural events, except Montreal’s Grand Prix race.

7. © 2005 Pearson Education Canada Inc. Eating Disorders An intense form of dieting or other method of weight control to become very thin 95% who suffer are women Women want to be thinner than men say women should be. Result of gendered images of women’s roles and bodies is low self-esteem.

8. © 2005 Pearson Education Canada Inc. Sexually Transmitted Diseases Gonorrhea: 7195 cases in 2002 – Easily treated with antibiotics Genital herpes: possible prevalence of less than 1 in 7 – Treatable but incurable AIDS: Acquired immune deficiency syndrome – Caused by human immunodeficiency virus – HIV – Incurable, but controllable – Specific behaviours increase risk: unsafe sex and sharing needles

9. © 2005 Pearson Education Canada Inc. Ethical Issues: Confronting Death When does death occur? An irreversible state involving no response to stimulation, no movement or breathing, no reflexes, and no indication of brain activity Do people have a right to die? Euthanasia: assisting in the death of a person is against the law in Canada, e.g. Sue Rodriguez. Mercy killing? Robert Latimer was convicted of killing his child.

10. © 2005 Pearson Education Canada Inc. The Medical Establishment The rise of scientific medicine – Canadian Medical Association (CMA) was founded in 1867 – Doctors sought primary role in health care – Other healers, e.g., Chiropractic, naturopathy, midwifery, etc., kept tradition and occupied a lesser role, but are gaining in acceptance now. – Over-representation from rich backgrounds and until recently predominantly male..

11. © 2005 Pearson Education Canada Inc. Holistic Health An approach to health care that emphasizes prevention of illness and takes into account a person’s entire physical and social environment 1. Patients are people 2. Responsibility, not dependency on doctors 3. Personal, not institutional, treatment

12. © 2005 Pearson Education Canada Inc. Paying For Health: A Global survey Medicine in socialist societies, like China and the former Soviet Union. What existed used to be available to all. Now less so. Medicine in capitalist countries: Sweden (1891): Compulsory, comprehensive government medical care system offered to all– “socialized medicine”. (Cont’d)

13. © 2005 Pearson Education Canada Inc. Paying For Health Globally (Cont’d) Great Britain (1948): Duel system of public health services (national health service) for all citizens and may also purchase private services. Japan: Physicians have private practice and paid like much of Europe, combination of government programs (80% of costs) and private insurance. United States: No government operated program for all: government pays for less than half of total costs, a direct-fee system for others

14. © 2005 Pearson Education Canada Inc. Medicine in Canada Single-payer system since 1972 National principles: universality, portability, comprehensive coverage, and public administration. Expenditures now over 9% of GDP Criticism: less state-of-the-art technology than U.S., but mostly for rich People have long waits for care, but poor are not denied care.

15. © 2005 Pearson Education Canada Inc. Table 21-1

16. © 2005 Pearson Education Canada Inc. Structural-Functional Analysis Sick Role: patterns of behaviour defined as appropriate for people who are ill (Talcott Parsons) 1. Sick people are exempted from responsibilities. 2. But people must want to be well and 3. Do whatever is necessary to regain good health by cooperating with, for e.g., doctors. Critical evaluation: more appropriate for acute than chronic problems

17. © 2005 Pearson Education Canada Inc. Symbolic-Interaction Analysis Health and medical care are socially constructed Responses to illnesses can be based on social definitions, e.g., prejudice and AIDS Definitions of illness can affect how people feel. Gynecological exams are constructed to be professional and impersonal. Critical evaluation: Certain factors cause specific diseases and conditions whatever the definition.

18. © 2005 Pearson Education Canada Inc. Social-Conflict Analysis Inequality has consequences 1. Access to care: rural and Aboriginal people are at a disadvantage. 2. Profit motive: doctors have financial interests 3. Medicine as politics: in the past, doctors lobbied against some health providers. Critical evaluation: Advances made by scientific medicine to the health and well-being of people are minimized.