1. Health, Health Care, and Disability
Chapter 18
Health, Health Care, and Disability

2. Chapter Outline Health in Global Perspective
Health in the United States
Health Care in the United States

3. Chapter Outline Sociological Perspectives on Health and Medicine
Mental Illness
Disability
Health Care in the Future

4. Health, Health Care, and Medicine
Health is a state of physical, mental, and social well-being.
Health care is any activity intended to improve health.
Medicine is an institutionalized system for the scientific diagnosis, treatment, and prevention of illness.

5. Health in Global Perspective
Life expectancy refers to an estimate of the average lifetime of people born in a specific year.
The infant mortality rate is the number of deaths of infants under 1 year of age per 1,000 live births in a given year.

6. Question
_____ refers to the positive sense of complete well being; while _____ refers to an interference with health.
Healing; disease
Health; healing
Health; illness
Health care; disease

7. Answer: c
Health refers to the positive sense of complete well being; while illness refers to an interference with health.

8. Health in Global Perspective
Life expectancy
AIDS has cut life expectancy by:
5 years in Nigeria
18 years in Kenya
33 years in Zimbabwe

9. How Much Do You Know About Health, Illness, and Health Care?
True or False?
Health care in most high-income, developed nations is organized on a fee-for-service basis as it is in the United States.

10. How Much Do You Know About Health, Illness, and Health Care?
False.
The United States is one of only two high-income, developed nations that do not have some form of universal health coverage. In the United States, health care has traditionally been purchased by the patient. In most other high-income nations, health care is provided or purchased by the government.

11. How Much Do You Know About Health, Illness, and Health Care?
True or False?
It is extremely costly for employees to “mainstream” persons with disabilities in the workplace.

12. How Much Do You Know About Health, Illness, and Health Care?
False.
Although disability expenditures nationwide may be costly, individual employers often find that they can accommodate the workplace needs of a worker with a disability for costs ranging from zero to several thousand dollars, thus opening up new opportunities for people previously excluded from certain types of jobs and careers.

13. Social Epidemiology
Study of the causes and distribution of health, and disease in a population:
Disease agents – insects, bacteria, nutrient agents, pollutants, and temperature.
Environment - physical, biological and social environments.
Human host -demographic factors such as age, sex, and race/ethnicity.

14. Social Epidemiology
Chronic diseases are illnesses that are long term or lifelong and that develop gradually or are present from birth.
Acute diseases are illnesses that strike suddenly and cause dramatic incapacitation and sometimes death.

15. Demographic Factors: Age
Rates of illness and death are highest among the old and the young.
Mortality rates drop shortly after birth and begin to rise significantly during middle age.
After age 65, rates of chronic diseases and mortality increase rapidly.

16. Demographic Factors: Sex
Babies born in the U.S. in 2000: Life expectancy is 73.9 years for males and 79.4 years for females.
Sociologist Ingrid Waldron notes that gender roles and gender socialization contribute to the difference in life expectancy:
Men are more likely to work in dangerous occupations, more likely to engage in risky behavior, and are less likely to see a doctor.

17. Demographic Factors: Location
According to a study by the Stanford Center for Research in Disease Prevention people have a higher survival rate if they live in better educated or wealthier neighborhoods.
Reasons:
Availability of safe areas to exercise
Grocery stores with nutritious foods
Access to transportation, education, and good jobs

18. Question
How physically active are you compared to your contemporaries?
More active
About average
Less active

19. Demographic Factors: Location
People living where there are high levels of poverty and crime, or in remote rural areas have greater difficulty getting health care because most doctors prefer to locate their practice in a “safe” area.
Although rural Americans make up 20% of the U.S. population, only 9% of the nation’s physicians practice in rural areas.

20. Demographic Factors: Race and Ethnicity
People of color are more likely to have incomes below the poverty line.
People with lower incomes:
Receive less preventive care and less optimal management of chronic diseases.
Are more likely to be employed in jobs that expose them to danger and illness.
Are are more likely to live in areas that contain environmental hazards.

21. Question Do you agree or disagree:
The safety and health conditions where I work are good.

22. GSS National Data Income Low Middle High Agree 87.3% 90.8% 93.3%
Disagree
12.7%
9.2%
6.7%

23. Lifestyle Factors: Alcohol
For alcoholics, health effects include:
nutritional deficiencies resulting from poor eating habits
cardiovascular problems such as enlargement of the heart muscle
high blood pressure,
Stroke
cirrhosis - scar tissue that chokes off blood vessels in the liver and destroys liver cells

24. Question
In the past year, have you had more than 5 alcoholic drinks in a sitting?
Yes No

25. Lifestyle Factors: Nicotine
The nicotine in tobacco is a toxic, dependency-producing psychoactive drug that is more addictive than heroin.
Tobacco is responsible for about 1 in every 5 deaths in this country.

26. Question
Do you currently smoke cigarettes?
Yes No

27. Lifestyle Factors: Illegal Drugs
Studies found an increased risk of lung problems associated with marijuana because its smokers are believed to inhale more deeply than tobacco users.
People who use cocaine over extended periods of time have higher rates of infection, heart problems, internal bleeding, hypertension, stroke, and neurological disorders.
Intravenous cocaine users who share needles are also at risk for contracting AIDS.

28. Question
Have you used illegal drugs (e.g. marijuana, cocaine, pills)?

29. GSS National Data Income Low Middle High Yes 4.6% 3.8% 1.1% No 95.4%
96.2%
98.9%

30. Lifestyle Factors: Sexually Transmitted Diseases
Sexual activity can result in transmission of AIDS, gonorrhea, syphilis, and genital herpes.
The Department of Health and Human Services estimates that in 2002, a total of 42 million people had HIV/AIDS.
14% of all new cases worldwide are children.
Children under age 15 account for about 610,000 AIDS-related deaths each year.

31. Question
The most extensively used illegal drug in the United States is:
ecstasy
cocaine
marijuana
heroin

32. Answer: c
The most extensively used illegal drug in the United States is marijuana.

33. Adults and Children Living with HIV/AIDS

34. Question
____ are illnesses that strike suddenly, cause dramatic incapacitation, and sometimes death.
Chronic diseases.
Disabilities.
Epidemics.
Acute diseases.

35. Answer: d
Acute diseases are illnesses that strike suddenly, cause dramatic incapacitation, and sometimes death.

36. Paying for Medical Care in the U.S.
Private Health Insurance: cited as the main reason for medical inflation, gives doctors and hospitals an incentive to increase costs.
Public Health Insurance: projections call for Medicaid spending to double and Medicare spending to triple in the next few years.

37. The U.S. Health Care System
Health Maintenance Organizations: provide total care with an emphasis on prevention.
Managed care: monitors and controls health care providers' decisions, insurance company has the right to refuse to pay for treatment.

38. Paying for Medical Care in Other Nations
Canada has a universal health care system - A health care system in which all citizens receive medical services paid for by tax revenues.
Britain has socialized medicine - A health care system in which the government owns the medical care facilities and employs the physicians.

39. Increase in Cost of Health Care, 1970–2000

40. Persons Not Covered by Health Insurance, by State

41. Question
Do you have any health insurance, including Medicare or Medicaid?

42. GSS National Data Income Low Middle High Yes 75.1% 86.5% 94.7% No
24.9%
13.5%
5.3%

43. Implications of Advanced Medical Technology
Create options that alter human relationships (prolonging life after consciousness is lost).
Increase the cost of medical care.
Raise questions about the very nature of life (invitro fertilization, cloning, stem cell research).

44. Holistic Medicine
An approach to health care that focuses on prevention of illness and disease and is aimed at treating the whole person—body and mind—rather than just the part or parts in which symptoms occur.

45. Question Socialized medicine is found in which country or countries?
the United States
Canada
Great Britain
both Canada and Great Britain

46. Answer: c
Socialized medicine is found in Great Britain.

47. A Functionalist Perspective: The Sick Role (Talcott Parsons)
According to the functionalist approach, it is important for people to be healthy and contribute to society.
Sickness is viewed as deviant behavior.
The sick role is the set of patterned expectations that defines the norms and values appropriate for individuals who are sick and for those who interact with them.

48. The Sick Role The sick are not responsible for their condition.
The sick are temporarily exempt from their normal role obligations.
The sick must want to get well.
The sick must seek help from a medical professional to hasten their recovery.

49. Conflict Perspective: The Medical–industrial Complex
According to conflict theorists, problems in U.S. health care are rooted in the capitalist economy, which views medicine as a commodity that is produced and sold by the medical– industrial complex.
The medical–industrial complex encompasses physicians and hospitals as well as insurance companies and pharmaceutical and medical supply companies.

50. Symbolic Interactionist Perspective: Social Construction of Illness
According to symbolic interactionists, we socially construct “health” and “illness” and how both should be treated.
AIDS victims are often blamed for promiscuous sexual conduct or intravenous drug use, regardless of how they contracted HIV.
The social definition of the illness leads to the stigmatization of individuals who suffer from the disease.

51. Medicalization
The process whereby nonmedical problems become defined and treated as illnesses or disorders:
Three levels:
conceptual - the use of medical terminology to define the problem
institutional - physicians are supervisors of treatment
Interactional - when physicians treat patients’ conditions as medical problems

52. Demedicalization
The process whereby a problem ceases to be defined as an illness or a disorder.
Examples:
Removal of homosexuality from the list of mental disorders compiled by the American Psychiatric Association.
Redefining childbirth and menopause as natural processes rather than as illnesses.

53. Question
The subjective component of medicalization and demedicalization reflects the major concern of the interactionist perspective of health.
True
False

54. Answer: True
The subjective component of medicalization and demedicalization reflects the major concern of the interactionist perspective of health

55. Sociological Perspectives on Health and Medicine
Functionalist: The sick role
People who are sick are exempt from obligations, but must want to get well and seek competent help.
Conflict: Inequalities in health and health care
Problems in health care are rooted in the capitalist system, exemplified by the medical–industrial complex.

56. Sociological Perspectives on Health and Medicine
Interactionist: Social construction of illness
People socially construct “health” and “illness,” and how both should be treated.
Postmodernist: The clinical gaze
Doctors observe patients to gather information, thus appearing to speak “wisely.”

57. Mental Illness
Mental illness - a condition in which a person has a severe mental disorder requiring extensive treatment with medication, psychotherapy, and sometimes hospitalization.
Mental disorder - a condition that makes it difficult or impossible for a person to cope with everyday life.

58. The Treatment of Mental Illness: Deinstitutionalization
Deinstitutionalization refers to rapidly discharging patients from mental hospitals into the community.
The theory was that patients’ rights were being violated due to involuntary commitment to hospitals, where they remained for an extended time.
Critics argue that deinstitutionalization exacerbated problems associated with inadequate care for people with mental illness.

59. Disability
Disability refers to a reduced ability to perform tasks one would normally do at a given stage of life and that may result in stigmatization or discrimination against the person with disabilities.
Estimated 49.7 million people in the U.S. have one or more physical or mental disabilities.
Less than 15% of persons with a disability are born with it.
Accidents, disease, and war account for most disabilities in this country.

60. % of U.S. Population with Disabilities
Characteristic %
With a disability
23.0
Severe
14.8
Not severe
8.3

61. % of U.S. Population with Disabilities
Has difficulty or is unable to: %
See words and letters
3.7
Hear normal conversation
3.8
Have speech understood
1.1
Lift or carry ten pounds
7.3
Use stairs
9.5
Walk
9.4

62. % of U.S. Population with Disabilities
Has difficulty or needs assistance with: %
Getting around inside the house
1.8
Getting in/out of bed or a chair
3.0
Taking a bath or shower
2.4
Dressing
1.7
Eating
0.7
Getting to or using the toilet
1.1

63. Question
In contemporary industrial societies, disability often can be attributed to:
epidemics related to poor sanitation and overcrowding.
urban density and poverty.
environment, lifestyle, and working conditions.
employment in high stress jobs in the primary tier of the labor market.

64. Answer: c
In contemporary industrial societies, disability often can be attributed to environment, lifestyle, and working conditions.

65. Social Inequalities Based on Disability
Workers with a severe disability earn 50% (men) and 64% (women) of what workers without disabilities earn.
Only 26% of Latinos/as with a severe disability are employed; those who work earn 80% of what non-Latino white persons with a severe disability earn.

66. Living With a Disability
Strategies:
Avoidance - deny condition to maintain hopeful images of the future and elude depression.
Vigilance - actively seek knowledge and treatment so they can respond to the changes in their bodies.

67. Quick Quiz

68. 1. An institutionalized system for the scientific diagnosis, treatment, and prevention of illness is:
health care
medicalization
medicine
social epidemiology

69. Answer: C
An institutionalized system for the scientific diagnosis, treatment, and prevention of illness is medicine.

70. 2. The study of the causes and distribution of health, disease, and impairment throughout a population is called:
social etiology
sociobiology
social epidemiology
biosociology

71. Answer: C
The study of the causes and distribution of health, disease, and impairment throughout a population is called social epidemiology.

72. 3. HMO stands for:
health maintenance organizations
health managed-care organizations
health management obstetricians
human managed organizations

73. Answer: A
HMO stands for health maintenance organizations.

74. 4. On the average, male workers with severe disabilities make ________ of what their co-workers make.
75 percent
25 percent
90 percent
50 percent

75. Answer: d
On the average, male workers with severe disabilities make 50 percent of what their co-workers make.

76. 5. Social class is a better indicator of health problems than race or ethnicity.
False.
True.

77. Answer: b
Social class is a better indicator of health problems than race or ethnicity.