1. Health, Health Care, and Disability
Chapter 14
Health, Health Care, and Disability

2. Chapter Outline Health in Global Perspective
Health in the United States
Health Care in the United States
Sociological Perspectives on Health and Medicine
Disability
Health Care in the Future

3. 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.

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

5. 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.

6. Demographic Factors: Age
Rates of illness and death are highest among the old and the young.
After age 65, rates of chronic diseases and mortality increase rapidly.
Chronic diseases are long term or lifelong and develop gradually or are present from birth.
Acute diseases strike suddenly and cause dramatic incapacitation and sometimes death. Infant mortality rate

7. Demographic Factors: Sex
Prior to the 20th century, women had lower life expectancies because of high mortality rates during pregnancy and childbirth.
Women now live longer than men.
For babies born in the United States in 2003, life expectancy at birth was 74.8 years for males and 80.1 years for females.
What is recreational Use ?

8. Demographic Factors: Race/Ethnicity and Social Class
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.
People of color are more likely to have incomes below the poverty line, and the poorest people receive less preventive care and less management of chronic diseases.

9. Lifestyle Factors: Alcohol and Tobacco
Chronic heavy drinking or alcoholism can cause permanent damage to the brain or other parts of the body.
Tobacco is responsible for about one in every five deaths in this country.

10. Lifestyle Factors: Illegal Drugs
High doses of marijuana smoked during pregnancy can result in congenital abnormalities and neurological disturbances.
Some studies found an increased risk of cancer and 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 and stroke.

11. Lifestyle Factors: Sexually Transmitted Diseases
Sexual activity can result in the transmission of sexually transmitted diseases (STDs), including AIDS, gonorrhea, syphilis, and genital herpes.
Prior to 1960, the incidence of STDs in this country had been reduced sharply by barrier-type contraceptives and the use of penicillin as a cure.
In the 1960s and 1970s the number of cases of STDs increased rapidly with the introduction of the birth control pill, which led to couples being less likely to use barrier contraceptives.

12. The Flexner Report
Abraham Flexner met with the leading faculty at the Johns Hopkins University School of Medicine to develop a model of medical education.
The model included the belief that a medical school should be a research-oriented, laboratory facility that devoted all of its energies to teaching and research, not to the practice of medicine.
He visited each of the 155 medical schools then in existence, comparing them with the model.

13. The Flexner Report
As a result of the Flexner report (1910), all but two African American medical schools were closed, and only one medical school for women survived.
As a result, white women and people of color were largely excluded from medical education for the first half of the 20th century.
Until the civil rights movement and the women’s movement of the 1960s and 1970s, most physicians were white, male, and upper- or upper-middle class.
Federal government and medical school

14. 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.
What happened with Professionalization

15. 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.
What is valid with a third party provider of health care ?

16. Holistic and Alternative Medicine
Holistic medicine focuses on prevention of illness and disease and is aimed at treating the whole person rather than just the part or parts in which symptoms occur.
Alternative medicine includes healing practices inconsistent with dominant medical practice.
Universal health care

17. 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.

18. 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.”

19. Increase in Cost of Health Care, 1970–2004

20. 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).

21. Persons Not Covered by Health Insurance, by State

22. 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.

23. 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 or discrimination.
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.

24. % of U.S. Population With Disabilities
Characteristic %
With a disability
20.8
Severe
13.7
Not severe
7.0

25. % of U.S. Population with Disabilities
Has difficulty or is unable to: %
See words and letters
3.5
Hear normal conversation
Have speech understood
1.2
Lift or carry ten pounds
6.9
Use stairs
9.2
Walk
9.4

26. Labeling the Disabled
How disabled people are labeled results from three factors:
their degree of responsibility for their impairment
the apparent seriousness of their condition
the perceived legitimacy of the condition.

27. Disabilities and Employment Status