1. Sociology, Eleventh Edition HEALTH AND MEDICINE

2. WHAT IS HEALTH? Sociology, Eleventh Edition

3. 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 has roots in the organization of society. Sociology, Eleventh Edition

4. SOCIETY SHAPES THE HEALTH OF PEOPLE IN 4 MAJOR WAYS 1.Cultural patterns define health. Standards vary. What is considered “healthy” is what people hold to be morally good. Ex. homosexuality is “sick” 2.Cultural standards of health change over time. Ex. smoking 3.A society’s technology affects people’s health. 4.Social inequality relates to health. Ex. Rich = healthier Sociology, Eleventh Edition

5. HEALTH: A GLOBAL SURVEY Sociology, Eleventh Edition

6. HEALTH IN HISTORY With only simple technology, our ancestors could do little to improve health. Hunters and gatherers – food shortages  abandoning children. ½ died by 20; few lived until 40. Agriculture – food more plentiful; elites better health than peasants & slaves. Medieval Europe – human waste piled up in streets, spreading infectious diseases and plagues periodically wiped out entire towns. Sociology, Eleventh Edition

7. HEALTH IN LOW-INCOME COUNTRIES In the poorest countries, most people die before reaching their teens. One billion people (globally) have serious illnesses due to poverty. Poor sanitation, malnutrition and minimal medical care  makes infectious diseases the most common cause of death. When medical technology does control infectious disease, the populations of poor nations rise. Sociology, Eleventh Edition

8. HEALTH IN HIGH-INCOME COUNTRIES Industrialization  overcrowded cities  poor sanitation. Factories polluted the air. Accidents in the workplace became common. Industrialization  gradually improved health. Better nutrition & safer housing. Industrialization  increase in infectious diseases like the flu & chronic diseases. Today, infectious disease is less of a threat, concentrate on chronic illnesses, such as cancer, heart disease and stroke. Sociology, Eleventh Edition

9. HEALTH IN THE UNITED STATES Sociology, Eleventh Edition

10. NATIONAL MAP 21-1 (P. 554) HEALTH ACROSS THE UNITED STATES AVERAGE HEALTH VARIES FROM PLACE TO PLACE THROUGHOUT THE U.S. THIS MAP SLOWS THE RESULTS OF A SURVEY THAT ASKED PEOPLE ACROSS THE COUNTRY ABOUT THEIR PERSONAL HEALTH, INCLUDING THEIR SMOKING HABITS, NUTRITIONAL DIET, AND FREQUENCY OF ILLNESS. LOOKING AT THE MAP, WHAT PATTERN DO YOU SEE? CAN YOU EXPLAIN IT? SOURCE: AMERICAN DEMOGRAPHICS, OCTOBER 2000, P. 50. REPRINTED WITH PERMISSION FROM AMERICAN DEMOGRAPHICS. © 2004 BY CRAIN COMMUNICATIONS, INC.

11. 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 Sociology, Eleventh Edition

12. WHO IS HEALTHY? Social epidemiology – how health and disease are distributed throughout a society’s population. Factors include Age Gender Social class Race Sociology, Eleventh Edition

13. 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  stress & heart disease “Coronary prone behavior” Sociology, Eleventh Edition

14. CLASS & RACE Infant mortality rates are twice as high for the poor as for the wealthy. The poorest in America can die from diseases that strike children in countries like the Vietnam and Nigeria. African Americans are three times more likely to be poor compared to whites. Poverty condemns people to live in crowded unsanitary conditions that breed infectious disease. Life expectancy for white children born in 2000 is six years greater than for African Americans. Poverty also breeds stress and violence. Sociology, Eleventh Edition

15. FIGURE 21-1 (P. 556) LIFE EXPECTANCY OF U.S. CHILDREN BORN IN 2003 BOTH GENDER AND RACE HAVE A POWERFUL EFFECT ON LIFE EXPECTANCY. SOURCE: HOYERT, KUNG, & SMITH (2005).

16. CIGARETTE SMOKING Most preventable cause of death. By 2003, 22% of Americans smoke. Generally speaking divorced, separated, unemployed, in the military & less schooling a person has tend to be smokers. 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. Sociology, Eleventh Edition http://www.youtube.com/watch?v=x4c_wI6kQyE

17. DISCUSSION QUESTION Do you agree with city-wide indoor smoking bans? What are the pros/cons? Should a ban be implemented at a state or national level? Sociology, Eleventh Edition

18. MYTH OF BEAUTY The beauty myth tells women to exaggerate the importance of physical attractiveness to the point of risking their health. Stereotypes in the US… Slender=successful, attractive Overweight=lazy, sloppy & even stupid Most college women believe “guys like thin girls”. Pressures come from society, parents, the media, as well as women themselves. Sociology, Eleventh Edition http://www.youtube.com/watch?v=XpaOjMXyJ Gk http://www.youtube.com/watch?v=iYhCn0jf46U

19. EATING DISORDERS An intense form of dieting or other unhealthy methods of weight control driven by the desire to be very thin. Few women meet our unrealistic standards of beauty and develop a low self-image. 95% of those suffering from anorexia and bulimia are women, white and affluent.

20. OBESITY Two-thirds of U.S. adults are overweight, making it the most widespread health problem in the US related to eating. Obesity can limit physical activity and it raises the risk of a number of serious diseases. Social causes of obesity Lack of physical ability Poor diet The typical US diet involves too much salty and fatty food. Sociology, Eleventh Edition

21. NATIONAL MAP 21-2 (P. 559) OBESITY ACROSS THE UNITED STATES ACCORDING TO THE GOVERNMENT, TWO-THIRDS OF U.S. ADULTS ARE OVERWEIGHT, MEANING THAT THEY ARE AT LEAST 10 POUNDS OVER A HEALTHY WEIGHT. ABOUT HALF OF ALL OVERWEIGHT PEOPLE ARE CLINICALLY OBESE, WHICH MEANS THEY ARE AT LEAST THIRTY POUNDS OVERWEIGHT. THIS MAP SHOWS THE SHARE OF THE POPULATION THAT IS OBESE FOR COUNTIES ACROSS THE U.S. LOOKING AT THE MAP, WHAT CAN YOU SAY ABOUT THE REGIONS THAT HAVE THE HIGHEST RATES OF OBESITY? SOURCE: TIME (JUNE 4, 2004). COPYRIGHT © 2004 TIME, INC. REPRINTED BY PERMISSION.

22. 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 (affects about 50 million or 1/5 of US adults). AIDS – acquired immune deficiency syndrome Caused by human immunodeficiency virus – HIV Early stages – no symptoms Incurable, almost always fatal Specific behaviors increase risk: anal sex, sharing needles and drug use Sociology, Eleventh Edition

23. FIGURE 21-2 (P. 562) TYPES OF TRANSMISSION FOR REPORTED U.S. AIDS CASES AS OF 2003 THERE ARE SEVERAL WAYS IN WHICH PEOPLE CAN BE INFECTED WITH HIV. SOURCE: CENTERS FOR DISEASE CONTROL AND PREVENTION (2004).

24. Sociology, Eleventh Edition GLOBAL MAP 21-1 (P. 561) HIV/AIDS INFECTION OF ADULTS IN GLOBAL PERSPECTIVE 64% 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. ALL OF SOUTHEAST ASIA ACCOUNTS FOR ABOUT 17% OF GLOBAL HIV INFECTIONS. IN CAMBODIA, 2 TO 3 PERCENT OF PEOPLE AGED 15 TO 49 ARE NOW INFECTED. ALL OF NORTH AND SOUTH AMERICA TAKEN TOGETHER ACCOUNT FOR 8% OF GLOBAL HIV INFECTIONS. IN THE U.S., 0.6% OF PEOPLE AGED 15 TO 49 ARE INFECTED. THE INCIDENCE OF INFECTION IN MUSLIN NATIONS IS EXTREMELY LOW BY WORLD STANDARDS. SOURCE: POPULATION REFERENCE BUREAU (2003, 2005); AND UNITED NATIONS (2004); MAP PROJECTION FROM PETERS ATLAS OF THE WORLD (1990).

25. ETHICS & DEATH When is a person dead? When an irreversible state involving no response to stimulation, no movement or breathing, no reflexes, and no indication of brain activity. Do people have the right to die? 10,000 people in the U.S.A. Are in a permanent “vegetative state”. Euthanasia (mercy killing) – assisting in the death of a person suffering from an incurable disease. Living wills help clear up the situation. Sociology, Eleventh Edition

26. TERRI SCHIAVO What about mercy killing? Thousands face terminal illnesses that will cause horrible suffering. “Right to die” - a person with an incurable disease has a right to forgo treatment which may prolong their life. “Active” euthanasia - a person may enlist the services of a physician to bring on a quick death. Belgian twin brothers http://www.yout ube.com/watch? v=htZagt1Szcw

27. THE MEDICAL ESTABLISHMENT Sociology, Eleventh Edition

28. THE RISE OF SCIENTIFIC MEDICINE Medicine - 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 doctors. M.D.s & D.O. (Osteopaths) on one level Other healers kept tradition but occupy lesser role. Chiropractors, herbalists, midwives, etc. US doctors typically use scientific medicine.

29. HOLISTIC MEDICINE Holistic medicine – 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 Concern for the environment in which the person lives and their lifestyle. 2.Responsibility, not dependency Favors an active approach to health encouraging patients take health-promoting behaviors. 3.Personal treatment Favoring a more personal relaxed environment, such as the person’s home. Sociology, Eleventh Edition

30. MEDICINE IN SOCIALIST SOCIETIES Socialized medicine – medical systems are owned and operated by the government. China Government controls most health care operations. “Barefoot doctors” in rural areas, traditional healing arts, acupuncture, medicinal herbs and holistic concern. Russian Federation Tax funds are used to provide care. Disparities in medical care increase among segments of the population. Sociology, Eleventh Edition

31. 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 practices. Paid like much of Europe, combination of government programs (80% of costs) and private insurance.

32. FIGURE 21-3 (P. 568) EXTENT OF SOCIALIZED MEDICINE IN SELECTED COUNTRIES OF ALL HIGH-INCOME COUNTRIES, THE U.S. HAS THE SMALLEST PERCENTAGE OF GOVERNMENT-PROVIDED MEDICAL CARE. SOURCE: U.S. CENSUS BUREAU (2004) AND WORLD BANK (2005).

33. MEDICINE IN THE U. S. Direct fee system The patient pays directly for services provided by doctor and hospitals. Private insurance 60% 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 - over 65, Medicaid - poverty and for veterans. 27% 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.

34. THEORETICAL ANALYSIS OF HEALTH AND MEDICINE Sociology, Eleventh Edition

35. STRUCTURAL FUNCTIONAL ANALYSIS Talcott Parsons’ the sick role Illness suspends routine duties. A sick person must want to get well. A sick person must seek competent help. The doctor patient relationship as hierarchical. Criticisms of Parsons’ approach: It says little about prevention. It places doctors rather than people in charge of health It assumes sick people can afford to take time off from work.

36. SYMBOLIC INTERACTION ANALYSIS Focuses on the meaning people attach to health and illness We socially construct our ideas of health and illness; how we define it becomes real. We socially construct our ideas of treatment. Likely to cover psychosomatic disorders. Sociology, Eleventh Edition

37. SOCIAL CONFLICT ANALYSIS Focuses on how patterns of health and illness are seen mostly as a product of social inequality. Issues of: Limited access, the profit motive, and the politics of medicine Interests of one group versus others. Capitalism fails to support human health because quality of care is dependent on income. Sociology, Eleventh Edition

38. FIGURE 21-4 (P. 571) SELF-ASSESSMENT OF PHYSICAL HEALTH BY FIRST- YEAR COLLEGE STUDENTS, 1985-2004 SINCE 1985, A SMALLER SHARE OF STUDENTS HAVE DESCRIBED THEIR HEALTH AS “ABOVE AVERAGE.” SOURCE: ASTIN ET AL. (2002) AND SAX ET AL. (2004).

39. HEALTH AND MEDICINE: LOOKING AHEAD Sociology, Eleventh Edition

40. 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. Sociology, Eleventh Edition