1. Illness and the Health Care Crisis
Chapter 2
Illness and the Health Care Crisis

2. Chapter Outline The Global Context: Effects of Globalization on Heath
Societal Measures of Health and Illness
Sociological Theories of Illness and Health Care
HIV/AIDS: A Global Health Concern
The Growing Problem of Obesity
Mental Illness: The Hidden Epidemic

3. Chapter Outline
Life style Behaviors and Social Factors Associated with Health and Illness
Problems in U.S. Health Care
Strategies for Action: Improving Health and Health Care
Understanding Illness and the Health Care Crisis

4. Globalization
Economic, political, and social interconnectedness among societies throughout the world.
Positive Effects on Health:
Allows monitoring of diseases and sharing guidelines for controlling disease.
Provides opportunities for establishing international health programs and agreements.
Negative Effects on Health:
Increased tourism encourages the spread of diseases.

5. Measures of Longevity and Mortality by Region: 2003
Life Expectancy
Infant Mortality
Under 5 Mortality
World 63 54 80
Industrialized countries 78 5 6
United States 77 7 8

6. Measures of Longevity and Mortality by Region: 2003
Life Expectancy
Infant Mortality
Under 5 Mortality
Developing countries 62 60 87
Least developed countries 49 98
155
Sub-Saharan Africa 46
104
175

7. Morbidity Illnesses, symptoms, and the impairments they produce.
Measures of morbidity are often expressed in terms of incidence and prevalence.
Incidence - Number of new cases of a specific health problem.
Prevalence - Total number of cases of a specific health problem.

8. Life Expectancy
Average number of years individuals born in a given year can expect to live.
Infant mortality - Number of deaths of live-born infants under 1 year of age.

9. Top Three Causes of Death by Age Group: United States, 2003
Age (years)
First
Second
Third
1-4
Unintentional injuries
Congenital/ chromosomal abnormalities
Cancer
5-14
15-24
Homicide
Suicide

10. Top Three Causes of Death by Age Group: United States, 2003
Age (years)
First
Second
Third
25-44
Unintentional injuries
Cancer
Heart disease
45-64
65 and older
Stroke

11. Leading Causes of Death in the United States: 2003.

12. Childbirth Assistance and Lifetime Chance of Maternal Mortality
% of Births Attended by Skilled Personnel
Lifetime chance of Dying from Maternal Mortality
More developed countries 99
1 in 2,800
Less developed countries 57
1 in 61
Sub-Saharan Africa 41
1 in 16

13. Epidemiological Transition
The shift from a society characterized by low life expectancy and parasitic and infectious diseases to one characterized by high life expectancy and chronic and degenerative diseases.
Epidemiologists study the social origins and distribution of health problems in a population and how patterns of health and disease vary between and within societies.

14. Patterns of Burden of Disease
The overall burden of disease on a population through a unit of measurement that combines the number of deaths and the impact of premature death and disability on a population.
The unit of measurement, the disability-adjusted life year (DALY), reflects years lost to premature death and years lived with a disability.
1 DALY is equal to 1 lost year of healthy life.
Worldwide, tobacco is the leading cause of burden of disease.

15. Patterns of Burden of Disease
Top 10 risk factors that contribute to the global burden of disease:
Underweight
unsafe sex
high blood pressure
Tobacco
Alcohol
unsafe water and sanitation
Hygiene
High cholesterol
indoor smoke from solid fuels
iron deficiency
overweight

16. Structural-Functionalist Perspective
Health care functions to maintain well-being of individuals and society.
High cost of medical care is necessary to entice people into medical profession.
HIV/AIDS helped unite and mobilize gay rights activists.

17. Conflict Perspective
Focuses on how wealth, status, and power influence illness and health care.
Lack of status and power affects the health of women in many societies.

18. Symbolic Interactionist Perspective
Focuses on
how meanings, definitions, and labels influence health, illness, and health care and
how such meanings are learned through interaction with others and through media messages and portrayals.

19. Medicalization
Defining or labeling behaviors and conditions as medical problems.
The concept of medicalization includes:
any new phenomena defined as medical problems in need of medical intervention
post-traumatic stress disorder, attention-deficit/hyperactivity disorder
“normal” conditions that have come to be defined as medical problems
childbirth, menopause, and death.

20. Stigma
Any personal characteristic associated with social disgrace, rejection, or discrediting.
Symbolic interactionists focus on stigmatizing effects of being labeled “ill.”
Individuals with mental illnesses, drug addictions, physical deformities and impairments, and HIV and AIDS are prone to being stigmatized.

21. HIV/AIDS: A Global Health Concern
HIV/AIDS is the leading cause of death among adults ages 15–59 years worldwide.
HIV/AIDS has killed more than 20 million people, and in 2004 nearly 40 million people worldwide were living with HIV infection.

22. HIV/AIDS: A Global Health Concern
HIV is transmitted through:
sexual intercourse
sharing unclean intravenous needles
perinatal transmission
blood transfusions or blood products
breast milk (rarely)
Worldwide, the predominant mode of HIV transmission is through heterosexual contact.

23. Question How many sex partners have you had in the last 12 months?
None
One
Two or more

24. GSS National Data Age <30 30-49 50 and up None 10.5% 10.4% 42.1%
60.3
75.4
53.7
Two or more
29.1
14.2
4.2

25. HIV/AIDS in Africa and Other Regions
In 2003 Africa was home to 2/3 of the world’s people living with HIV/AIDS.
About 1 in 12 African adults has HIV/AIDS, and as many as 9 out of 10 HIV-infected people in sub-Saharan Africa do not know they are infected.

26. HIV/AIDS in Africa and Other Regions
The second highest HIV prevalence rate is the Caribbean, where 2–3% of adults are infected with HIV.
AIDS deaths have left 14 million orphans in the world, and by 2010 a projected 25 million children will be orphaned by HIV/AIDS.

27. HIV/AIDS in the United States
An estimated 850,000 to 950,000 U.S. residents are infected with HIV, about 1/4 of whom are unaware of their infection.
70% of new HIV infections in the U.S. each year are among men and half are in people younger than 25.

28. HIV/AIDS in the United States
Of new infections among men:
60% were infected through heterosexual sex
25% through injection drug use
15% through heterosexual sex.
Of new infections among women:
75% were infected through heterosexual sex
25% through injection drug use.

29. HIV/AIDS in the United States
In a study of 5 U.S. cities, 25% of men who have sex with men were infected with HIV.
48% of these men were not aware they were infected.
In 2003 African Americans accounted for 42% of all people in the U.S. living with HIV/AIDS.
In 2001 HIV/AIDS was the number one cause of death for African American women ages 25–34.

30. Question What is the predominant mode of HIV transmission worldwide?
heterosexual contact
perinatal transmission
homosexual contact
intravenous drug use

31. Answer: A
Heterosexual contact is the predominant mode of HIV transmission worldwide.

32. The Growing Problem of Obesity
Obesity is the second biggest cause of preventable deaths in the United.
In 2005 a report published in the New England Journal of Medicine suggested that over the next 50 years obesity will shorten the average U.S. life expectancy of 77.6 years by at least 2 to 5 years

33. The Growing Problem of Obesity
64% of U.S. adults are overweight or obese.
1/4 of U.S. adults age 20 or older are obese.
The percentage of U.S. adults who are obese increased from 19.4% in 1997 to 24.5% in 2004.
Among youth ages 6–19, 16% are overweight.
The percentage of children and adolescents who are overweight has more than doubled since 1970.

34. Mental Illness: The Hidden Epidemic
Mental illness refers collectively to all mental disorders, which are health conditions that are characterized by alterations in thinking, mood, and/or behavior associated with distress and/or impaired functioning and that meet specific criteria.
Mental illness is a “hidden epidemic” because the shame and embarrassment associated with mental problems discourage people from acknowledging and talking about them.

35. Extent and Impact of Mental Illness
One study found a 40% lifetime prevalence of any mental disorder in the Netherlands and the United States, a 12% lifetime prevalence in Turkey, and a 20% lifetime prevalence in Mexico.
Annually, about 21% U.S. adults experience mental illness, and more than 14% of school-age children have mental health problems.

36. Extent and Impact of Mental Illness
Untreated mental disorders can lead to:
poor educational achievement
lost productivity
unsuccessful relationships
significant distress
violence and abuse
incarceration
poverty

37. Extent and Impact of Mental Illness
On any given day 150,000 people with severe mental illness are homeless, living on the streets or in public shelters.
As many as 1 in 5 adults in U.S. prisons and as many as 70% of youth incarcerated in juvenile justice facilities are mentally ill.

38. Social Class and Poverty
Poverty is associated with malnutrition, indoor air pollution, hazardous working conditions, lack of access to medical care, and unsafe water and sanitation .
The percentage of Americans reporting fair or poor health is more than three times as high for people living below the poverty line as for those with family income at least twice the poverty threshold.

39. Poverty and Health
People living below the U.S. poverty line are three times as likely to have serious psychological distress.
Social selection - mentally ill individuals have difficulty achieving educational and occupational success and drift to the lower class.
Social causation - lower-class individuals experience greater stress and this stress can reach the point where the individual can no longer cope with daily living.

40. Education and Health
Individuals with low levels of education are more likely to engage in health-risk behaviors.
Women with less education are less likely to seek prenatal care and are more likely to smoke during pregnancy.
A national survey in India found that only 18% of illiterate women had heard of AIDS, compared to 92% of women who had completed high school.

41. Family and Household Factors
A study of adults in their 50s found that married people who live only with their spouse or with spouse and children had the best physical and mental health.
Single women living with children had the lowest measures of health.
Better health among married individuals results from the economic advantages of marriage and from the emotional support provided by most marriages.

42. Gender and Health
Gender discrimination and violence against women produce adverse health effects in girls and women worldwide.
Violence against women is a major public health concern:
At least one in three women has been beaten, coerced into sex, or abused in some way.
Sexual violence and gender inequality contribute to growing rates of HIV among girls and women.

43. Life Expectancy in the United States by Race and Sex
All Races
Black
White
Female
Male
79.9
74.5
76.1
69.2
80.5
75.4

44. Question
Do you have any health insurance, including Medicare or Medicaid?
Yes No

45. GSS National Data Age <30 30-49 50 and up Yes 75.4% 86% 92.7% No
24.6 14
7.3

46. U.S. Health Care
In the United States, health care is offered through various private and public means.
In 200;
27% of Americans were covered by government health insurance plans (Medicare, Medicaid, and military insurance)
68% were covered by private insurance, most often employment-based

47. Health maintenance organizations (HMOs)
Prepaid group plans in which a person pays a monthly premium for comprehensive health care services.
HMOs attempt to minimize hospitalization costs by emphasizing preventive health care.

48. Preferred provider organizations (PPOs)
Health care organizations in which employers who purchase group health insurance agree to send their employees to certain health care providers or hospitals in return for cost discounts.
Health care providers obtain more patients but charge lower fees to buyers of group insurance.

49. Managed Care
Any medical insurance plan that controls costs through monitoring and controlling the decisions of health care providers.
Doctors must call a utilization review office to receive approval before they can hospitalize a patient, perform surgery, or order an expensive diagnostic test.

50. Question
Medical and health insurance premiums should not be based on age of the recipient.
Strongly agree
Agree somewhat
Unsure
Disagree somewhat
Strongly disagree

51. Medicare
Medicare is funded by the federal government and reimburses the elderly and the disabled for their health care.
Medicare’s medical insurance program is not free; enrollees must pay a monthly premium as well as a copayment for services.
Medicare does not cover long-term nursing home care, dental care, eyeglasses, and other types of services.

52. Medicaid
Provides health care coverage for the poor, and is jointly funded by the federal and state governments.
Medicaid does not cover all poor people.
Eligibility rules and benefits vary from state to state, and in many states Medicaid provides health care only for the very poor who are well below the federal poverty level.

53. Question
The type of health insurance plan that tries to minimize hospitalization costs by emphasizing preventable health care is called what?
Medicare
a preferred provider organization
a health maintenance organization
Medicaid

54. Answer: C
The type of health insurance plan that tries to minimize hospitalization costs by emphasizing preventable health care is called a health maintenance organization.

55. SCHIP
In 1997 the State Children’s Health Insurance Program (SCHIP) was created to expand health coverage to uninsured children, many of whom come from families with incomes too high to qualify for Medicaid but too low to afford private health insurance.
States receive matching federal funds to provide medical insurance to uninsured children.

56. Barriers to Health Care by Insurance Status, 2003

57. Improving Health and Health Care
Two approaches :
Selective primary health care uses technocratic solutions to target a specific health problem, such as using immunization and oral rehydration therapy to promote child survival.
Comprehensive primary health care focuses on the broader social determinants of health, such as poverty and economic inequality, gender inequality, environment, and community development.

58. U.S. Health Care Reform
The U.S. is the only country in the industrialized world that does not guarantee health care to its citizens.

59. Socialized Medicine
In all systems of socialized medicine the government:
directly controls the financing and organization of health services,
directly pays providers
owns most of the medical facilities
guarantees equal access to health care
allows private care for individuals who are willing to pay for their medical expenses

60. Quick Quiz

61. 1. How does symbolic interactionism view health conditions such as mental illness?
As society's failure to meet the needs of the have-nots.
As a biological condition.
As a result of globalization.
As a label conferred on those who are different.

62. Answer: D
Symbolic interactionism views health conditions such as mental illness as a label conferred on those who are different.

63. 2. Medicalization refers to the trend in:
the increase in the number of new viruses that are found.
treating mental illness in hospitals.
turning normal events into medical events.
the growing hospitalization of HMO patients.

64. Answer: C
Medicalization refers to the trend in turning normal events into medical events.

65. 3. In developing countries, what is the leading cause of death and disability for women ages 15 to 49?
malnutrition and starvation
sexually transmitted diseases
maternal mortality
tobacco related deaths

66. Answer: C
In developing countries, the leading cause of death and disability for women ages 15 to 49 is maternal mortality.

67. 4. Which of the following is a new approach to measuring the health status of a population?
patterns of burdens of disease
infant mortality rates
maternal mortality rates
under 5 mortality rates

68. Answer: A
Patterns of burdens of disease is a new approach to measuring the health status of a population.