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Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved.

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1 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved.

2 Chapter 9: Physical and Mental Health Care

3 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Health Defined World Health Organization (WHO) Health A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity The sum of several different factors Physical, mental, social Mental Disorders Patterns of mood, thought, or behavior that cause distress and decrease the ability of a person to function

4 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. History of Health Care Medical care at the center of many social problems throughout US history U.S. health care always been seen as a luxury Sparking debate over who should have access to it Other arguments involve quality What constitutes “good” medical care?

5 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Practice vs. Profession of Medicine Early practice little more than folk remedies and home cures First medical school established in 1765 In Philadelphia to train doctors for the region Strong belief that doctors needed to dissect human corpses to learn about human body Many medical students became grave robbers April 13, 1788 Anti-Dissection Riot legal access to cadavers for medical purposes

6 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Causes and Cures of Illness and Disease Four different schools of thought developed in contrast to orthodox medical science: 1. Hydropaths: Believed body could be cleansed internally and externally by the use of water, natural foods, good hygiene, and exercise 2. Osteopaths: These physicians also rejected use of drugs and believe manipulation of the skeleton could improve health

7 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Continued 3. Christian Scientists Founded by Mary Baker Eddy Believe all illness was an illusion of the mind and did not really exist 4. Homeopaths Believe that orthodox medical practices overmedicated and over-treated people

8 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Social Epidemiology Social Epidemiologists Study distribution of diseases and health throughout a population and assess the social problems that occur Goal is to find links between certain social factors and physical and mental well-being

9 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Age and Health In US, death is rare among the young Improved life expectancy and longevity in the United States Elderly face wide variety of health problems not as prevalent in the past Arthritis, diabetes, heart and lung disease, and mental illness Limit activity; making work, socialization, and exercise difficult for seniors to pursue

10 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Childhood Obesity United States is witnessing disturbing trend in children’s health in recent years Rapid increase in childhood obesity 2006 study: Rise in obesity direct result of availability of energy-dense foods and drinks combined with lack of energy expenditure Kids are simply eating more calories than they’re burning

11 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved.

12 Gender and Health Gender plays significant role in life expectancy and types of health problems Life expectancy for women in the US is average of 80.4 years Expectancy for men is 75.2 years

13 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Continued Sociologists look for social factors to explain disparity Males more likely to take risks; abuse alcohol, drive aggressively, and perform other behaviors that can lead to early deaths More likely to accept dangerous work and make up a greater portion of the armed forces in wartime

14 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Continued Women more concerned with preventive maintenance of their health than men Twice as likely to get regular medical checkups Less likely to experience life-threatening illnesses and health problems Men should take notice of health practices of women and try to take better care of their health in order to live longer lives

15 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Social Class and Health Social class has major effect on health in US Quality of health care connected to one’s ability to pay for it Lack of access serious social problem for the poor Programs that help get access to health care poorly funded

16 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Continued Higher social class means greater access to health care Lower socioeconomic status leads to a lower likelihood of access to health care The higher one’s socioeconomic status, the more likely a person is to live longer, healthier, and happier Areas with high crime rate and drug problems also have negative effects on the health of inhabitants

17 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Race and Health Racial and ethnic inequality in health care is serious social problem in United States 2005 Average life expectancy of whites was 78.3 years, while African Americans were expected to live 73.2 years 24.9 percent of African Americans live below the poverty level, while only 8.3 percent of American whites are impoverished Access to and quality of health care are repeatedly shown to be affected by race

18 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Health Care: An International Comparison World Health Organization (WHO) Five criteria for a “good” and “fair” health system in 2000 1. Low infant mortality rates and high life expectancy 2. Fair distribution of good health (relatively even mortality and life expectancy rates across the country) 3. A high level of health care responsiveness 4. A fair distribution of responsiveness 5. A fair distribution of financing health care (health care costs are evenly distributed based on a person’s ability to pay)

19 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Continued WHO comparison of health systems in 191 countries United States first in responsiveness Respect for patients and prompt attention to their needs Ranked relatively low overall compared to other similarly wealthy nations US is only wealthy, industrialized, capitalist nation that doesn’t provide some form of universal health care Score lower than other countries in fairness of financing and citizen satisfaction Ranked 37th overall

20 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. National Scorecard on Health Care Performance National Scorecard on Healthcare Performance US spends 16% of gross domestic product on health care system, but doesn’t provide universal access Only 49% of American adults receive recommended preventive screening tests for their age and sex Only half of patients with congestive heart failure receive written discharge instructions regarding follow-up care after hospitalization

21 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Continued Nationwide, preventable hospital admissions for chronic health conditions such as diabetes and asthma twice as high as level achieved by best performing nations One-third of adults under 65 have problems paying medical bills, and many in serious debt due to health problems Only 17% of U.S. doctors use electronic medical records, compared with 80% of doctors in top three countries

22 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Continued Measuring quality of care and access to care Wide gap between those with low incomes who are uninsured and those with higher incomes and good insurance As part of total health care expenditures insurance administrative costs in the United States more than three times rate in countries with integrated payment systems

23 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Mental Health Classifications of mental illnesses relatively new and subject to change and adjustment Different subcategories of mental disorders Major depressive disorder Bipolar disorder Schizophrenia Obsessive compulsive disorder (OCD) Panic/anxiety disorders Eating disorders ADHD: Attention deficit hyperactivity disorder

24 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved.

25 Gender and Race in Mental Health Men and women suffer from differing types of mental disorders Females tend to experience more internalizing problems such as anxiety and/or depression Males tend to externalize problems, leading to aggression, substance abuse, and delinquency

26 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Continued Simple explanation is socialization Men socialized to express dominance and power over others Results in increased levels of externalization Women socialized early into subordination Results in higher levels of depression and anxiety in response to difference in power White women have higher rates of internalization problems than women of color White women are socialized into stricter subordinate roles

27 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Income and Mental Health Income and social class affect mental health in same way as physical health Children who come from low-income homes experience higher rates of childhood depression as well as antisocial behavior disorders Children who live entire childhood in poverty have higher rates of developing both of these mental health issues

28 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Mental Health Care Several categories of mental health practitioners Psychiatrists, psychologists, and social workers/counselors Primary difference is level of education Psychiatrists have an MD Psychologists have a PhD Social workers/counselors have at least a bachelor’s and in some cases a master’s degree

29 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Continued Only psychiatrists allowed to prescribe medication Psychologists and counselors provide psychotherapy Treatment without drugs Psychologists provide diagnostic testing to determine patients’ levels of functioning Assess whether there is improvement or deterioration of conditions

30 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Continued Establishing comfortable, honest relationship with patients is primary goal of therapists Psychotherapy designed to help patients develop coping strategies and healthy behaviors Can reduce possibility of future illness and improve quality of life

31 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Perception of Mental Illness Historically, mentally ill had to endure harsh treatment Mental illness widely misunderstood and misinterpreted 1950s, American social scientists General community largely uninformed about current psychiatric medical knowledge and based opinions on negative stereotypes and misinformation

32 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Continued Prevailing view Mental problems not uncontrollable illnesses, but rather a character flaw Public perception shifted from one of fear and disdain to something resembling tolerance and understanding Not complete acceptance Society recognizes mental illness as a disease and not a moral deficiency

33 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. The Myth of Mental Illness Dispute about diagnosis and treatment of mental illness The Myth of Mental Illness, Dr. Thomas Szasz These illnesses are often misdiagnosed and used as a means of social control Paula Caplan agrees with Szasz DSM (Diagnostic and Statistical Manual of Mental Disorders) Standard text used by health professionals in US to classify mental illnesses

34 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Continued DSM relies heavily on personal ideology and political maneuvering Caplan only woman on committee to revise DSM Premenstrual dysphoric disorder (PMS) was included as a “mental illness” Despite the lack of evidence It would be only mental illness to happen monthly for a set number of days Caplan suggests that men would never accept such a diagnosis for themselves

35 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Functionalism: The Medicalization of the American Society Functionalist perspective examines how health and health care affect people’s lives Talcott Parsons Sick Role Made up of expected behaviors and responsibilities appropriate for someone who is ill

36 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Continued Control and respect doctors given led to the Medicalization of America Idea that medical community is at center of many aspects of society Prevailing belief in US that we can find a pill for every problem Ads for prescription drugs only make the problem worse Research shown that consumers go to doctors requesting pills they’ve seen on television

37 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Conflict Theory: Making a Profit Conflict theorists point to lack of access 1 in 6 people in US have no health care insurance US is only Western nation not providing some form of government-funded health care Sociologist Jill Quadagno (2004) Number of structural barriers exist American medical care is a for-profit business Invasion of government not welcome by those who make their living off the current system

38 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Continued Two groups have most to lose from government- run health care Insurance companies and medical professionals Reap high profits Hold secure markets for their businesses under current system Make this money at expense of that 1 person in 6 who cannot afford to go to the doctor The poor pay these professionals’ salaries with their lives

39 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Symbolic Interactionism Terms such as “right” and “privilege” Make the difference when it comes to method of health care If health care is a right Government must do something to make sure it’s fairly and equally provided to all citizens If it’s a privilege Government need not do anything Health care can be entirely privatized Right now, American health care is established more as a privilege than a right

40 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Health Care in the United States 40% of Americans satisfied with health care system US spends more money per person on health care than any other country Not everyone has health insurance National insurance Cover all children and the millions of adults who can’t afford to pay – Doesn’t Exist Fewer employers offering health benefits

41 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Continued Why U.S. government resistant to provide universal health care: The Constitution states power of the government must be limited National health care viewed as a form of welfare, which threatens our freedom The working class and labor unions fail to support legislation that would provide universal health care Private health insurance companies strongly oppose idea of national health care

42 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved.

43 National Health Care for the Elderly: Medicare One segment of population guaranteed governmental health care The elderly Medicare Government-run social insurance program that provides health coverage for elderly Americans Available to citizens over age of 65 who have paid Medicare taxes for at least 10 years or to spouses of people who have paid Medicare taxes

44 Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved. Continued Medicaid Designed to provide insurance for low-income individuals and families who meet certain qualifications Income determines eligibility Program is funded partially by the federal government and partially by each individual state Not every person with low-income eligible for Medicaid Other requirements Some include age, pregnancy, physical disabilities, and citizenship status


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