1. Chapter 15: Health and Healthcare

2. Objectives (slide 1 of 3) 15.1 Defining Health 15.2 Global Health
Illustrate how culture-bound syndromes impact health in different cultures.
15.2 Global Health
Compare and contrast life expectancy and cause of death in high-, middle-, and low-income countries.
15.3 Health in the United States: Demographic Factors
Describe changes in life expectancy in the United States over the last century.
Identify demographic factors related to health and longevity.

3. Objectives (slide 2 of 3)
15.4 Health in the United States: Life Style Factors
Illustrate how life style choices affect health and life expectancy.
Describe important life style trends and their impact on morbidity and mortality.
15.5 Health Care in the United States
Distinguish scientific medicine from alternative medicine.
Analyze trends in health care costs.
Describe health care delivery systems in the United States
Discuss factors affecting both cost and quality of health care in the United States

4. Objectives (slide 3 of 3) 15.6 Global Health Care
Contrast spending on health care in the United States with other countries and identify some of the key differences in health care systems of different nations.
15.7 Theoretical Perspectives on Health and Health Care
Illustrate key differences in the theoretical perspectives of health and medicine.
15.8 Health Care: Future Possibilities
Identify likely trends in the future of health care.

5. Defining Health
Health: Defined by the World Health Organization (1946) as a state of complete mental, physical, and social well-being
Culture-bound syndrome: A conception of disease or ill health that is limited to a small number of cultures and is shaped by culture
Medical sociology: Focuses on the phenomena of health and illness, the social organization of health care delivery, and different access to medical resources
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Chapter 15: Health and Health Care
15.1 Defining Health
LO: Illustrate how culture-bound syndromes impact health in different cultures
Many people think of health as the absence of disease, but health is defined by the World Health Organization as a state of complete mental, physical, and social well-being. Conceptions of whether a person is healthy are thus, at least in part, social. What is thought to be healthy varies in different cultural contexts. Some medical and social scientists speak of culture-bound syndromes— conceptions of disease or ill health that are limited to a small number of cultures and are shaped by culture. Conceptions of health also change over time as we come to understand some of the causes of disease and recognize previous misconceptions. Regardless of culture and despite variations in precisely what is meant by being healthy, people the world over place great value on health.
This chapter examines the issues that are the focus of medical sociology. Medical sociology is a special area within sociology focusing on “the phenomena of health and illness, the social organization of health care delivery, and differential access to medical resources.” Chief among the concerns of medical sociology are the social determinants of health—“the circumstances in which people are born, grow up, live, work, and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.”

6. The Impact of Income on Health
Life expectancy: The average number of years people are expected to live
Infant mortality rate: An age-specific death rate; the number of deaths of infants younger than 1 year of age per 1,000 live births in a given year
Causes of death: Categories of reasons attributed for deaths on birth certificates
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15.2 Global Health
LO: Compare and contrast life expectancy and cause of death in high-, middle-, and
low-income countries
When it comes to health, the world looks very different for high-, middle-, and low-income countries. These differences can be seen in three widely used measures of health differences: life expectancies, infant mortality rates, and causes of death. Life expectancy is the average number of years people are expected to live. Infant mortality rate is the number of deaths of infants under 1 years of age per 1,000 live births in a given year. Causes of death are categories of reasons attributed for deaths on birth certificates. Figure 15-1 highlights the stark differences in the age at which people die in high-, middle-, and low-income countries. Forty percent of deaths in low-income countries are among children under than 15, while in high-income countries, those children account for only 1% of deaths.

7. Major Health Problems in Different Countries
Leading causes of death vary by income.
High-income countries (primarily chronic diseases):
Cardiovascular disease
Cancers
Diabetes
Dementia
Middle-income countries:
Chronic diseases TB
HIV/AIDS
Road traffic accidents
Low-income countries (primarily infections diseases):
Lung infections
Diarrheal diseases
Malaria and TB
Complications of pregnancy and childbirth
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Chapter 15: Health and Health Care
15.2 Global Health
LO: Compare and contrast life expectancy and cause of death in high-, middle-, and
low-income countries
Causes of death vary dramatically by income. In high-income countries, the most common causes are chronic diseases such as cardiovascular disease, cancers, diabetes, and dementia. In middle-income countries, like high-income countries, chronic diseases are the major killers. But middle-income countries also have additional leading causes of death in the form of tuberculosis (2.4%), HIV/AIDS (2.7%), and road traffic accidents (2.4%). In low-income countries, most people do not live long enough to be victims of chronic diseases. Instead, most die from infectious diseases including lung infections (11.3%), diarrheal diseases (8.2%), HIV/AIDS (7.8%), malaria (5.2%), and tuberculosis (4.3%). In low-income countries, leading causes of death also include complications of pregnancy and childbirth (8.7%; WHO 2011a). To put this in perspective, in low-income countries, the leading cause of death is infectious diseases, which account for 36.8% of deaths, while 8.7% of deaths are due to complications of pregnancy and childbirth. In middle-income countries, 14.9% of deaths are due to infectious diseases. In high-income countries, only 3.8% of deaths are due to the single infectious disease among the top 10 causes of death (lower respiratory infections). In both middle- and high-income countries, complications of pregnancy and childbirth are not among the top 10 causes of death. An infant born in a low-income country has a greater chance of dying from birth complications (5 out of 1,000) or prematurity and low birth weight (5 out of 1,000) than dying at a much older age of heart disease (10/1,000). Forty percent of the people born in a low-income country will die before the age of 15, compared to only 1% of people born in a high-income country, and only 17% in a low-income country can look forward to living to be 70, compared to 71% of people in a high-income country.
The major problems faced by low-income countries are problems that were solved decades ago in high- and middle-income countries through improved water supply, better sanitation, disease control, and inoculations. Therefore, many of the major efforts to improve health in low-income countries focus on delivering the resources and know-how to make these solutions available to those populations.

8. Demographics Demographics: The study of populations
Demographic characteristics: Characteristics of populations such as age, sex, race, and ethnicity
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Chapter 15: Health and Health Care
15.3 Health in the United States: Demographic Factors
LO: Describe changes in life expectancy in the United States over the last century
Demographics is the study of populations, and demographic characteristics are characteristics of populations such as age, sex, race, and ethnicity. In this section, we will examine how demographic characteristics are related to health in the United States.
Throughout the 20th century, death rates dropped substantially in most countries around the world. While these declines have been greatest in high-income nations, there have also been significant drops in death rates in most countries. As a result of decreased death rates, the life expectancy has increased substantially. As the figure shows, in the United States, the average life expectancy increased from 47.3 years in 1900 to 78.7 years in However, life expectancy varies by sex and race, with females living longer (81.1 years) than males (76.2 years) and whites living longer (79 years) than blacks (75.1 years). The life expectancy of American Indians and Alaska Natives is 5.2 years lower than the population as a whole. They have a 20% higher overall death rate, are six times more likely to die from alcohol-induced disease or tuberculosis, 2.8 times more likely to die from diabetes, 2.4 times more likely to die from unintentional injuries, 1.9 times more likely to die from homicide, and 1.8 times more likely to die from suicide when compared to the US population as a whole.
There is a tendency to assume that increased life expectancy is the result of the technological wonders of modern medicine. However, most of the increase in life expectancy occurred early in the 20th century as we made progress in simple public health and sanitation measures to clean up water supplies and halt the spread of infectious disease.

9. Social Epidemiology
Social epidemiology: The study of the distribution of mortality (death) and morbidity (disease) in a population
Epidemiology: Refers to an outbreak of a disease within a population
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Chapter 15: Health and Health Care
15.3 Health in the United States: Demographic Factors
LO: Describe changes in life expectancy in the United States over the last century
Social epidemiology is the study of the distribution of mortality (death) and morbidity (disease) in a population. Epidemiology is related to the term epidemic, which refers to an outbreak of a disease within a population.
John Snow is often credited with creating social epidemiology as a scientific discipline. Snow lived in London in the 1800s and became interested in stopping an outbreak of cholera in that city in At the time, the causes of cholera and how the disease was spread were not well understood. By plotting addresses of cholera victims on a street map, Snow found that most victims lived in a particular area of London. The next step was to determine what might be the cause of people in that area but not those in other areas contracting cholera. Eventually, Snow narrowed his suspicions to one source, a public water pump on Broad Street. Unable to convince authorities he was right, Snow secretly removed the Broad Street pump handle one night. People were no longer able to use the pump for water, and the spread of cholera stopped. Snow had not only helped us learn that contaminated drinking water was the source of cholera but also gave birth to the new science of epidemiology. Today, epidemiologists working in universities and health centers often use extensive health statistics collected by national agencies such as the Centers for Disease Control and Prevention (CDC) to identify correlates and causes of disease and death. That information is then often used to guide social policies aimed at improving health.

10. Health Demographics in the United States
Age
Sex
Race/ethnicity
Social Class
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Chapter 15: Health and Health Care
15.3 Health in the United States: Demographic Factors
LO: Identify demographic factors related to health and longevity
Epidemiologists have also identified a number of characteristics of populations that are correlated with health: age, sex, race/ethnicity, social class, disability, and mental illness.
Age: Death is rare for the young in the US, and when it occurs, it is primarily due to accidents or suicides. Chronic problems increase with age. Among noninstitutionalized elderly, 2/3 of men and women aged 65 or older have hypertension, 40% are obese, and 24.4% are in fair or poor health. Annual mortality rates increase with age. The leading causes of death for persons age 65 and over are heart disease, cancer, and chronic lower respiratory disease.
Sex: Women live longer than men, and the effect of sex on life expectancy is greater than that of race. While some of the higher death rates for men appear due to biological factors, there are clear social risk factors that disadvantage men since they engage in more risky behaviors. 93% of job-related deaths occur among men even though men constitute only 55% of the work force. Men also smoke more than women and suffer more smoking-related mortality and morbidity.
Race/Ethnicity: Whites live longer and experience less disease than blacks. Blacks experience higher rates of infant mortality and maternal deaths and have a life expectancy 4.3 years less than that of whites. While some diseases have a genetic or biological basis, social factors such as poverty or occupational health risks are the major cause of differences in health status among racial and ethnic groups. When race and education differences are combined, the effects are even greater. Hispanics display higher incidence rates for some diseases and often lack access to health care compared to whites, but they have a longer life expectancy by 2.4 years. Hispanics are least likely to have health insurance among ethnic groups, have higher rates of obesity, and, largely due to lack of insurance, are more likely to lack access to preventive care.
Social Class: Those in higher social classes tend to work in safer jobs and live in safer neighborhoods, have greater access to health care, better nutrition, and safe places to exercise. Social class influences life style choices that impact health, too. People who are less educated, living below the poverty line, or retired are less physically active. Studies of the impact of social class on health use measures of social class based on occupational status, income, wealth, education, and combinations of two or more. Low-income Americans have lower life expectancies than middle- and higher-income Americans. The poor are much more likely to report a number of chronic conditions when compared to the non-poor. They are 135% more likely to have a stroke, 81% more likely to have had a heart attack, 63% more likely to suffer from coronary heart disease, 75% more likely to have cancer, 57% more likely to have diabetes, and 22% more likely to suffer from arthritis.

11. Disability
Disability: A reduced ability to perform tasks expected of a normal person at that stage in life
Stigma: A distinctive social characteristic or attribute identifying its owner as socially unacceptable or disgraced
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Chapter 15: Health and Health Care
15.3 Health in the United States: Demographic Factors
LO: Identify demographic factors related to health and longevity
A disability is a reduced ability to perform tasks commonly expected of a person at that stage in life. Not all disabilities are apparent. People with chronic illness or disabilities can have enormous burdens in their lives, taxing both them and loved ones emotionally, physically, and financially. There are three types of “work” they face:
“everyday work” of daily living such as maintaining relationships, a career, and a household.
“illness work”—visiting the physician, getting treated, managing pain, dealing with insurance claims, etc.
“biographical work,” as they have to both incorporate the illness into their own lives and explain it to others.
All of this is made far more difficult when such people are victims of a stigmatized condition such as AIDS and psychological disorders, cancer, or alcoholism. Stigma was first defined by sociologist Erving Goffman (1963) as a distinctive, strongly negative label that marks the person as socially unacceptable or disgraced. Stigmatized people are generally treated poorly by others. Treatment by others can be particularly harsh if the person is viewed as in part to blame due to a character flaw, such as sexual promiscuity in the case of AIDS or lack of self-control when it comes to being overweight.
Disability is socially constructed. The reduced ability to perform tasks expected of a normal person in one society may be different from those in another society or in a different time and place. The extent to which a disability affects a person’s life is affected by the larger society. This is the premise behind the Americans with Disabilities Act. This act prohibits discrimination on the basis of disability in employment, state and local government, public accommodations, commercial facilities, transportation, and telecommunications. The idea is that, where possible, reasonable accommodations should be made to permit people with disabilities to accomplish the tasks of everyday life on their own.

12. Mental Illness and Psychological Disorders
Psychological disorder: A psychological condition that is deviant, may cause harm to oneself or others, and may cause psychological distress
Psychological disorders are the leading cause of disability in the United States and Canada for people ages
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Chapter 15: Health and Health Care
15.3 Health in the United States: Demographic Factors
LO: Identify demographic factors related to health and longevity
The terms mental illness and mental or psychological disorder are often used interchangeably. Mental health professionals use the term psychological disorder to describe what most of us think of when we hear the term mental illness: a psychological condition that is deviant, may cause harm to oneself or others, and may cause psychological distress. About one in every four adults is estimated to suffer from a diagnosable psychological disorder in the United States. Psychological disorders are the leading cause of disability in the United States and Canada for people ages 15 to 44. A great majority of the psychiatric and psychological professions study mental illness and psychological disorders in terms of a combination of chemical, biological, environmental, psychological, and social factors. In contrast, some sociologists argue that mental illnesses are merely behaviors or traits deemed unacceptable, deviant, or immoral by the larger society. Serious psychological disorders are highly stigmatizing.

13. Health in the United States: Life Style Factors
Life style behaviors contribute greatly to health. These include eating habits, smoking, the use of alcohol, unprotected sexual activity, drug abuse, and other factors. Diseases related to life styles kill more people than communicable diseases, and more than 1/7th of our gross domestic product (GDP) is spent attempting to cure diseases which could be prevented by changes in life style.
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Chapter 15: Health and Health Care
15.4 Health in the United States: Life Style Factors
LO: Illustrate how life style choices affect health and life expectancy
Life style behaviors contribute greatly to health. These include eating habits, smoking, the use of alcohol, unprotected sexual activity, drug abuse, and other factors. Diseases related to life styles kill more people than communicable diseases, and more than 1/7th of our gross domestic product (GDP) is spent attempting to cure diseases which could be prevented by changes in life style. Life style-related activities cause more than 1 million deaths per year. Some of the life style issues most often focused on by the media, such as unprotected sex and drug abuse cause fewer deaths than the top three life style issues: smoking, diet/exercise and alcohol. Table 15-2 provides additional detail, including both estimated costs and estimated deaths. Some life style factors have their major impact on costs, while others have greater impact on deaths. Smoking ranks at the top of the list of life style hazards in deaths, but the estimated costs of alcohol are number one even while less than a fifth as many people die from alcohol-related hazards than from smoking-related hazards. HIV/AIDS-related deaths are much less common (8,352), having dropped considerably as medications have helped many with HIV to live much longer and have reduced the spread of the disease. In some cases, estimated costs are not available, and in all cases, it is difficult to encompass all costs and all deaths.

14. Smoking
Smoking rates vary dramatically by gender, age, race/ethnicity, education, and poverty status.
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15.4 Health in the United States: Life Style Factors
LO: Describe important life style trends and their impact on morbidity and mortality
Smoking is the top preventable cause of death in the United States, causing about one out of every five deaths in the United States each year. More deaths are caused each year by tobacco than all the deaths from alcohol use, motor vehicle injuries, illegal drug use, HIV, suicides, and murders combined. Roughly 433,000 people die each year from smoking-related diseases such as cancer, heart and blood-vessel diseases, and respiratory disorders. This includes 49,400 deaths per year from secondhand smoke exposure. On average, adults who smoke cigarettes die 14 years sooner than nonsmokers, and cigarette smoking results in
5.1 million years of potential life lost in the United States annually. Efforts to reduce the death toll due encounter pushback from the tobacco industry. Tobacco is a big business in the United States. In 2010, more than 303 billion cigarettes were purchased in the United States, 13.3 billion cigars, and more than 122 million pounds of smokeless. In 2008, the tobacco industry spent $10.5 billion on advertising and promotional expenses in the United States.
Despite industry resistance, progress has been made in reducing smoking. In 1965, when the US Surgeon General’s Report first suggested a link between smoking and lung cancer, 52% of US adult men and 32% of adult women smoked. But the rising concerns over the health risks of smoking have cut this rate dramatically to 21.5% for men and 17.3% for women. Figure 15-4 summarizes smoking rates for different groups. Roughly 20 to 22% of adults under 65 smoke compared to 9.5% of adults 65 and older. Asians and Hispanics are much less likely to smoke than are whites, blacks, and particularly American Indians. Smoking is much more common among the less well educated and people living below the poverty line, and declines markedly with education, with 45% of adults with a GED degree smoking compared with fewer than 10% of college graduates. Roughly one third of people living below the poverty line (28.9%) smoke, compared to only 18.3% of those living above the poverty line.

15. Diet, Exercise, and Nutrition
Sociology of the body: The study of how our bodies are shaped by our social experiences, values, and culture, as well as ways in which our bodies affect those experiences
Weight categories are based on BMI.
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15.4 Health in the United States: Life Style Factors
LO: Describe important life style trends and their impact on morbidity and mortality
Sociologists only recently began to realize the importance of the ways in which our bodies are shaped by our social experiences, values, and culture, as well as ways in which our body affects those experiences. This field of research is called the sociology of the body.
The United States is in the middle of an obesity epidemic. Roughly 60% of US adults are overweight. More than one-third (37.5%) of US adults and nearly 17% of children and adolescents are obese. In Table 15-3, we see the standards for common weight categories. Obesity increases risks for a range of serious diseases, and leads to roughly 216,000 deaths a year (physical inactivity leads to 191,000). Obesity has significant social consequences as well, often leading to employment discrimination, teasing, and insults.
Obesity is related to race and ethnicity, with non–Hispanic blacks having the highest rates of obesity (44.1%), then Mexican Americans (39.3%) and all Hispanics (37.9%), and lowest rates for non–Hispanic whites (32.6%). It tends to be lower for women with more education and/or higher incomes. For non–Hispanic black and Mexican-American men, obesity is lower for those with higher incomes, but not for those with higher education. While there are many factors that contribute to the epidemic, there is also evidence that structural characteristics of the food industry play a role by manipulating salt, sugar, and fat to take advantage of human biochemistry in order to make and sell foods that stimulate our appetites. Higher prices are often charged for less fattening food because people are willing to pay more for “healthy” food. The poor also face the unavailability of free places to exercise safely in many communities, and the lack of grocery stores where healthy food can be obtained.
Physical activity has more impact on health than does almost any other life style factor. People who are physically active for 7 hours a week have a 40% lower risk of dying early than people with less than 30 minutes of activity a week. Regular physical activity helps people control their weight, helps build and maintain muscle mass and strength, reduces the risk of cardiovascular diseases, lowers blood pressure, improves cholesterol levels, reduces the risk of Type 2 diabetes, reduces the risk of some cancers, strengthens bones and muscles reducing the loss of bone density that comes with age, reduces the chance of falls, improves mental health, and helps maintain the ability to perform the activities of daily living.

16. Eating Disorders
Eating disorder: An extreme effort to control weight through unhealthy means
Anorexia nervosa: An intense fear of becoming fat and a distorted image of one’s own body, leading someone to drastically reduce body weight through starving
Bulimia nervosa: Binge eating followed by self-induced vomiting
Binge eating disorder: Occurs when the person engages in recurrent binge eating (eating too much at a sitting)
Muscle dysmorphia: A condition in which males see themselves as smaller than they are and work very hard to gain muscle mass
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Chapter 15: Health and Health Care
15.4 Health in the United States: Life Style Factors
LO: Describe important life style trends and their impact on morbidity and mortality
Eating disorders are extreme efforts to control weight through unhealthy means. These include anorexia nervosa—an intense fear of becoming fat and a distorted image of one’s own body, leading someone to drastically reduce body weight through starving—and bulimia nervosa— the practice of binge-eating followed by self-induced vomiting. A third eating disorder is binge eating disorder, in which the person engages in recurrent binge eating. Unlike bulimia, a person with binge eating disorder does not purge and, hence, is often overweight and feels a loss of control over eating. Much of the research on eating disorders argues they are related to a cultural norm of thinness. This “cult of thinness” encourages women to believe that thinness is essential to being attractive. These eating disorders are seen by many sociologists as the product of a patriarchal culture that inculcates the importance of thinness to women on a daily basis through the media, family, and colleagues. Eating disorders are often “gendered,” having greatest impact on women. However, other research suggests they are also raced and classed. White, middle-class women experience eating disorders in very different ways than African-American women or Latina women. Sociologist Becky Thompson (1992) found that eating disorders are not limited to middle-class white women but are strategies used to cope with a wide range of trauma and stress, including poverty, physical violence, and sexual abuse. Anorexia nervosa occurs 10 times as often in females as in males.
While men are less likely than women to be diagnosed with eating disorders, some men’s distorted body image is similar to that for females, and they work very hard to become thin. Other males have muscle dysmorphia, in which males see themselves as smaller than they are and work very hard to gain muscle mass. This becomes particularly unhealthy when males resort to use of steroids or other dangerous drugs to increase muscle mass.
The National Institute of Mental Health estimates that for at least some time in their life, 2.8% of US adults (3.5% of females and 2.0% of males) will suffer from binge eating disorder, 0.6% of adults will suffer from anorexia nervosa (.9% of females and .3% of males), and 0.6% of adults will suffer from bulimia nervosa (1.5% of females and 0.5% of males).

17. Alcohol and Drugs Alcohol Drugs
Binge drinking: Consuming four or more alcoholic drinks per occasion for women or five or more for men
Reported use of marijuana and cocaine by college students both dropped significantly between 1980 and 2010.
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15.4 Health in the United States: Life Style Factors
LO: Describe important life style trends and their impact on morbidity and mortality
An extensive study published in 2011 examined data regarding the costs of excessive alcohol consumption in the United States. That study concluded that excessive alcohol consumption leads to an average of 79,000 premature deaths each year, increased disease, property damage, motor vehicle accidents, alcohol-related crime, and lost productivity. The economic costs of excessive drinking were $223.5 billion in Nearly half the cost was borne by the government. Almost 3/4 of the costs were due to binge drinking—consuming four or more alcoholic drinks per occasion for women or five or more for men. The great majority of total costs (72%) were losses in workplace productivity, 11% due to health care required as a result of excessive drinking, 9% to criminal justice expenses, and 6% to motor vehicle accidents resulting from driving impaired. Nearly 2/3 of college students report using alcohol in the last 30 days and more than a third (37%) report binge drinking during the last two weeks. Since 1980, however, drinking by college students has dropped from 81.8% to 65%. Nevertheless, the percentage of college students reporting engaging in binge drinking in the last two weeks only dropped from 43.9% to 37%. These trends, along with trends in cigarette smoking and drug abuse on college campuses, are displayed in Figure 15-6.
Reported use of marijuana and cocaine by college students both dropped significantly between 1980 and In 2010, college students were about as likely to smoke marijuana as they were to smoke cigarettes, and they were less likely to smoke either one than their parents were 30 earlier. However, the rate of use of marijuana reported by high school seniors in 2010 was more than twice that for college students. As can be seen in Figure 15-7 after marijuana, prescription and over-the-counter medications account for most of the commonly abused drugs among high school seniors. Drug abuse is a global problem. It places a heavy financial burden on societies in terms of treatment, productivity loss, and drug-related crime. Worldwide consumption of illegal drugs is well below levels of tobacco and alcohol.

18. Firearms
In 2010, there were 30,923 deaths from firearms in the United States.
Firearm-related deaths are due to:
Suicides (19,308)
Assaults (11,015)
Accidents (600)
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15.4 Health in the United States: Life Style Factors
LO: Describe important life style trends and their impact on morbidity and mortality
In 2010, there were 30,923 deaths from firearms reported in the United States. Most firearms-related deaths were due to suicides (19,308) or assault (11,015), while 600 were from accidents. Firearms are related to health because they are nearly as much of a risk as drug abuse (37,792 deaths) and motor vehicles (35,080). An individual’s chances of dying from an accident or assault involving a firearm can be influenced by whether the person spends time in situations where firearms are more likely to be present, and the most likely death by firearms comes from suicide. It should be pointed out that suicide rates in the United States are 16.6 per 100,000 persons for men and 4.0 per 100,000 for women. This is slightly lower than average suicide rates in Organization for Economic Cooperation and Development (OECD) countries of 17.6 for men and 5.2 for women even though there is generally much greater access to guns in the United States. Thus, evidence suggests that suicide may not be more common in the United States, but when it occurs, it is more likely to involve use of a firearm.

19. Unsafe Sex and Sexually Transmitted Diseases
HPV (human papillomavirus): The most commonly sexually transmitted infection
AIDS (acquired immune deficiency syndrome): The final stage of HIV infection in which people have badly weakened immune systems
HIV (human immunodeficiency virus): A lentivirus that weakens the immune system, leading AIDS.
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Chapter 15: Health and Health Care
15.4 Health in the United States: Life Style Factors
LO: Describe important life style trends and their impact on morbidity and mortality
Sexually transmitted diseases (STDs) are infectious diseases transmitted through sexual activity. These include gonorrhea, syphilis, chlamydia, genital herpes, human papillomavirus (HPV), and most notably AIDS. About
1,308,000 cases of chlamydia, 309,000 cases of gonorrhea, and 13,000 cases of syphilis were reported in the United States in Chlamydia cases increased by 5.1% from 2009 to 2010 and represent the largest number of cases ever reported to CDC for any STD. Chlamydia and gonorrhea can be cured with antibiotics, but some strains of the microorganisms that are resistant to antibiotics are becoming increasingly common. Genital herpes is caused by a virus that infects one in seven US adults (about 20 to 30 million people) and is incurable. In 2010, there were 232,000 new cases of genital herpes reported in initial visits to physicians’ offices in the United States. HPV (human papillomavirus) is the most common sexually transmitted infection, including more than 40 types. Nearly a quarter of the population in the United States has some form of HPV infection. Most people have no noticeable symptoms and do not realize they have it. In 2010, 376,000 cases of genital warts were reported in initial visits to physicians’ offices in the United States.
AIDS (acquired immune deficiency syndrome), the final stage of HIV infection in which people have badly weakened immune systems, was first recognized in 1981 and is by far the most serious of STDs. Currently, AIDS is still incurable. However, there are medications that make it possible to live with the disease, dramatically prolonging the lives of those infected, and that reduce the transmission of the virus. AIDS is caused by a human immunodeficiency virus (HIV) that attacks the white blood cells, causing the victim’s immune system to be ineffective against a wide range of infectious diseases. Untreated AIDS victims die of one of those infectious diseases in a matter of a few years. With treatment, people can live much longer—even decades—with HIV before they develop AIDS.

20. Motor Vehicle Accidents
Vehicular accidents are more likely when the driver is:
Distracted
Impaired
Very young or very old
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15.4 Health in the United States: Life Style Factors
LO: Describe important life style trends and their impact on morbidity and mortality
In 2009, there were 35,080 deaths due to motor vehicle accidents, while more than 2.3 million adult drivers and passengers were treated in emergency rooms as a result of being injured in motor vehicle accidents. One study estimated the cost of crash-related deaths and injuries to be $70 billion in Accidents are more likely when there is distracted driving, impaired driving, or very young or very old drivers. Distracted driving leading to fatal crashes increased from 7% in 2005 to 11% in Common distractions include cell phones (25% of US drivers “regularly or fairly often” talk on their cell phones while driving) and texting or ing (9% of US drivers do this “regularly or often” while driving). In 2009, more than 5,400 people died and 448,000 people were injured in accidents involving a distracted driver; more than 1,000 deaths involved cell phones. Nearly one-third of car crash deaths involve an alcohol-impaired driver. Motor vehicle crashes are the leading cause of death for US teens, accounting for one-third of deaths. In 2009, teens ages 16 to 19 were four times more likely to crash than older drivers. Figure shows accident rates by age group. In 2009, the overall accident rate was 8 per 100 licensed drivers, while for teen drivers it was 20. Crashes occur most often for males, teens driving with teen passengers, and newly licensed teens. Motor vehicle accidents are far higher than in the United States in countries such as South Africa, India, and Egypt. Poor roads, lack of vehicle maintenance, less driver education, and lax enforcement of traffic laws contribute to the higher death and accident rates in lower-income countries.

21. Health Care in the United States
Scientific Medicine
Holistic/Eastern Medicine
Medicine: The social institution that focuses on maintaining health and preventing or treating disease
Alternative medicine: Approaches to medicine that fall outside scientific medicine
Holistic medicine: Medicine that considers the whole person, including physical, mental, and spiritual needs, and is an alternative to scientific medicine
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15.5 Health Care in the United States
LO: Distinguish scientific medicine from alternative medicine.
Medicine is the social institution that focuses on maintaining health and preventing or treating disease. Early on, medical schools had very different philosophies of medicine, not all of which were based on science. The Flexner Report of 1910, which recommended raising the admissions standards, was a watershed for medicine, leading to the professionalization of medicine and the accreditation of medical schools. Control of medical schools through accreditation was followed by efforts to make medicine a monopoly. Laws were passed making it illegal for anyone to practice medicine who was not a graduate of an approved medical school. Competing modes of health care became illegal, and medicine consolidated its hold over health care. Physicians tried to exclude other professions from the practice of health care of any sort—including chiropractors, osteopaths, and midwives. Medicine became something practiced only by white Anglo-Saxon Protestant males, and for most of the rest of the century, medical schools rarely admitted women or members of minorities. The rise of scientific medicine in the United States corresponded to the rejection of alternative forms of medicine, including holistic medicine from indigenous American Indians and Eastern medicine. Holistic medicine and Eastern medicine are examples of the kinds of health care that in the United States have often been relegated to a marginal role due to the dominance of the Western technologically oriented medicine. The dominant position of scientific medicine in the United States leads to many forms of alternative medicine (approaches to medicine that fall outside scientific medicine) being denied coverage in health insurance plans and established institutions within scientific medicine. Holistic medicine emphasizes the whole person, including physical, environmental, emotional, social, and spiritual. Practitioners often have little or no separation between medicine and the spiritual and religious belief systems that underlie health and healing. Treatments include acupuncture, nutritional supplements, natural diet and herbal remedies, and homeopathic remedies. Traditional Chinese medicine is another form of alternative medicine often criticized by scientific medical proponents. One current in Chinese medicine views disease symptoms as possible reflections of an imbalance of yin and yang, with some symptoms (such as heat sensations, night sweats, dry mouth, and rapid pulse) suggesting too little yin, and other symptoms (such as aversion to cold, cold limbs, slow pulse) suggesting too little yang.

22. The Economics of Health Care
Issues in US health care costs:
Aging population
New technology
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Chapter 15: Health and Health Care
15.5 Health Care in the United States
LO: Analyze trends in health care costs.
People the world over value life and health so much we would sacrifice almost anything to get and keep it. As a result of our unwillingness to ration health care, health care costs in the United States are rising faster than any other sector of the economy.. Figure displays national health expenditures per capita in the United States, from 1960 to In 1970, total health care spending in the United States was $75 billion, or $356 per capita and 7.2% of the gross domestic product (GDP). By 2010, the United States spent $2.6 trillion on health care, or $8,402 per person, and 17.9% of the GDP. In the decade between 2000 and 2010 alone, per-capita health care expenditures increased by roughly 70%. Several factors have been cited as contributing to health care costs, including the aging of the US population and the higher costs of health care for the elderly, rising obesity, and increases in the prevalence of some diseases. Another oft-cited reason for increasing costs is the high cost of new health care technologies such as transplants, CT scans, and open-heart surgery. One effort to assess the impact of technology on health care costs is an analysis of the contribution of different factors to the costs of health care. That report identified several factors that influence rising health care costs. Roughly half of the increase in health care costs during the past several decades was associated with new technological advances that expanded the capabilities of medicine. While new technologies can sometimes reduce costs, many advances involve ongoing treatment for chronic conditions that require considerable costs where there once were none. Some technological advances have led to increased costs even when at first blush the technology seemed likely to reduce costs. For example, coronary angioplasty costs less than open-heart surgery and involved far less trauma. However, it could be used on patients who would have foregone the trauma and risk of open-heart surgery, spending for heart disease patients increased after angioplasty was introduced.

23. Preventive Care Cost-saving measures reduce eventual expenditures.
Cost-effective measures lead to increased benefits in the form of quality-adjusted life year (QALY), a measurement of 1 for one additional year of life at optimal health, but between 0 and 1 for an additional year of life with an adverse condition causing pain or reducing participation in activities.
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Chapter 15: Health and Health Care
15.5 Health Care in the United States
LO: Analyze trends in health care costs.
While we repeatedly spend hundreds of thousands of dollars trying to save patients through technology, we often overlook less dramatic but much more cost-effective preventive measures. For example, studies show that for every dollar spent on childhood immunization, $10 is saved in later medical costs. The basic logic of the preventive care argument is that it costs less to educate people and encourage them to live healthy life styles, thus avoiding expensive health problems. However, the Robert Wood Johnson Foundation summarized three nationwide studies of preventive medicine and found that only two preventive measures—childhood immunizations and health education on the use of low-dose aspirin—were cost-saving measures that actually reduce eventual expenditures. In addition, alcohol screening and counseling was found to be cost saving in the two studies that included it, and tobacco screening and prevention and motor vehicle safety counseling were found to be cost saving in one study. Most other preventive measures cost more than the savings they produce, so additional preventive care is unlikely to significantly reduce health care costs. Many other preventive health care measures do not actually save money but are cost-effective measures. That is, they lead to increased benefits in the form of additional quality-adjusted life years (QALY). A QALY would be 1 for one additional year of life at optimal health, but between 0 and 1 for an additional year of life with an adverse condition causing pain or reducing participation in activities. Several screening interventions were found to be cost effective, including screening for hypertension, cholesterol, colorectal cancer, breast cancer, and HIV. Cost effectiveness of treatments, as measured by QALYs, is sometimes used to ration health services in order to keep costs down and maximize the improvement in quality of life per dollar spent.

24. Who Pays and Who Has Access?
Third-party payer: Someone other than the health care provider or the patient who pays for the service
Fee-for-service: A method of payment in which providers are paid for each visit, each operation, and so on
Health maintenance organization (HMO): A prepaid health care plan that delivers comprehensive care to members through designated providers
Managed care: A program in which physicians no longer have complete freedom to decide what services are provided to patients but must first approve those services for payment with a third-party payer
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Chapter 15: Health and Health Care
15.5 Health Care in the United States
LO: Describe health care delivery systems in the United States.
Discuss factors affecting both cost and quality of health care in the United States.
Most health care in the United States is paid for by third-party payers— someone other than the patient or the health care provider—such as the government or private insurance companies. In 2010, only 11.6% of national health expenditures in the United States were paid by the patient directly. 32.7% were paid by private health insurers, 35.7% were paid by federal and state government funding of Medicare and Medicaid, and the final 20% was paid by other third-party payers, public insurance programs, and investments. Insurance coverage affects the amount of care received and the health outcomes. Differential access to health care based on the ability to afford health insurance turns out to be a form of de facto rationing of health care. Traditionally, most health care in the United States has been paid for in a fee-for-service plan in which providers are paid for each visit, each operation, and so on. Critics argue that a fee-for-service plan encourages rising health care costs and unnecessary services by rewarding providers who perform more operations, see more patients, and so on. To combat rising health care costs and to provide better care, an alternative method of payment was first developed shortly after World War II. This is a health maintenance organization (HMO)—a prepaid health care plan delivering comprehensive care to members through designated providers. In an HMO, clients are charged a fixed fee each year. The HMO gives providers an incentive to reduce costs and to keep patients healthy through preventive care to keep costs down in the future. Another effort to reduce health care costs is managed care— programs in which physicians no longer have complete freedom to decide what services are provided to patients but must first approve those services for payment with the insurance provider. Unfortunately, both HMOs and managed-care plans raise the possibility that providers will refuse to provide or pay for treatments that patients (and even physicians) feel are necessary. And, despite the rapid rise of both HMOs and managed-care plans, health care costs continue to rise at an alarming rate in the United States.
There have also been several attempts by the federal government to implement federally funded health care in the United States. While some form of universal health coverage was often the goal of such reform, these efforts have been met with significant resistance and the resulting systems have been limited to only some segments of the population.

25. Health Care Costs Around the World
The United States spends considerably more per capita on health care than other Western industrialized countries
In 2010, the United States spent 17.6% of GDP and $8,233 per capita for health. This was roughly 60% higher than the next-highest per-capita expenditures of Norway ($5,400) and Switzerland ($5,300).
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Chapter 15: Health and Health Care
15.6 Global Health Care
LO: Contrast spending on health care in the United States with other countries and identify
some of the key differences in health care systems of different nations.
The United States spends considerably more per capita on health care than other Western industrialized countries. Figure displays both per-capita health expenditures and percentage of GDP for selected countries in In 2010, the United States spent 17.6% of GDP and $8,233 per capita for health. This was roughly 60% higher than the next-highest per-capita expenditures of Norway ($5,400) and Switzerland ($5,300). The real surprise, however, comes when we examine how well the United States health care system performs when compared to those of other nations. In two widely used measures of health care, the United States lags behind many other countries. In 2011, the United States ranked 41st in the world in infant mortality rates, and in 2012 the United States ranked 50th in the world in life expectancy. A study funded by the Commonwealth Fund compared the US health system to those of 12 other industrialized nations, examining more than 1,200 health system measures. That study found that even though health care spending in the United States is much higher than in other countries, the United States has fewer hospital beds, physicians, and hospital and patient visits than the other countries. The United States is particularly high compared to the other countries on utilization and spending for prescription drugs and diagnostic imaging. Regarding outcome measures, the researchers found that the United States compared favorably on five-year cancer survival, in the middle on in-hospital case-specific mortality, and lower than other countries on hospital admissions for chronic conditions, including diabetes.

26. Different Health Care Systems
In universal health care, health care is regarded as a right and is available to everyone.
Socialized medicine: A health care system in which the government owns most of the medical facilities and employs most of the physicians
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Chapter 15: Health and Health Care
15.6 Global Health Care
LO: Contrast spending on health care in the United States with other countries and identify some of the key differences in health care systems of different nations.
There are important differences between the American health care system and that of other countries, differences that help explain some of the problems that are unique or exacerbated for the United States. Many other countries have some form of universal health care, in which health care is regarded as a right of citizens and available to all. In many cases, other countries have some form of socialized medicine— a health care system in which the government owns most of the medical facilities and employs most of the physicians. Those health care systems take many forms, “from single-payer, to mandated private insurance, to creative public/private hybrids.

27. Functionalist Perspective: The Sick Role
The structural functional view sees medicine as an institution having positive functions for society.
Sick role: A set of societal expectations for the behavior and attitudes of someone who is ill
Variations:
Conditional sick role
Incurable disease/terminal illness
Illegitimate role
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Chapter 15: Health and Health Care
15.7 Theoretical Perspectives on Health and Health Care
LO: Illustrate key differences in theoretical perspectives of health and medicine.
In the structural-functional view, medicine is seen as an institution having positive functions for society by helping people to fulfill their normal daily obligations. From that perspective, sociologist Talcott Parsons (1951) argued illness is a form of deviance that is dysfunctional to society because it disrupts normal functions. Illness presents a problem for social control because it provides people with a free pass to ignore their usual obligations. As a result, it was necessary to come up with a careful mix of expectations for how people behave when they are sick that can take into account when people really cannot function normally without giving them license to stop working altogether. This is the sick role, a set of expectations for how someone who is ill should behave. Sick people are granted greater freedoms than other people because they are (1) exempted from normal day-to-day responsibilities and (2) not blamed for their condition. There are also two additional obligations: (3) The sick person is obligated to try to get well and (4) the sick person should seek competent help. A person is allowed to take advantage of the freedoms of the sick role only so long as he or she is also fulfilling the responsibilities of trying to get well and seeking competent help.
Eliot Freidson (1970) elaborated on Parsons’ concept of the sick role to identify three variations:
the conditional sick role, which only applies temporarily when a person suffers from a condition that is likely to be cured
the case of an incurable disease or terminal illness where there is no reasonable expectation that the person will get well. Someone with a permanent disability, for example, should work within his or her capabilities to perform his or her duties but is not expected to do more than that.
an illegitimate role in which the illness is stigmatized or the person is viewed as largely responsible for it
The sick role does not work equally well for all people and all types of illness. In addition, people differ greatly in their tendency to adopt the sick role. Finally, not everyone is able to take on the sick role even when they are ill.

28. Conflict Perspective: Social Inequality (slide 1 of 2)
The conflict perspective argues that:
Quality of health care in the United States is less than in many other countries.
This is due to inequality, limiting access to health care for the uninsured poor.
The domination of health care by the medical profession allows them to maximize profits at the expense of the rest of society.
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Chapter 15: Health and Health Care
15.7 Theoretical Perspectives on Health and Health Care
LO: Illustrate key differences in theoretical perspectives of health and medicine.
Researchers who take the conflict theory view of health and medicine argue that, as one of the few countries in the world without universal health care, health care in the United States is very unequal. They argue that (1) the quality of health care in the United States, as measured by infant mortality rates, is not as good as that in many other countries despite costing considerably more, (2) there is glaring inequality of access to health care in the United States, and (3) the US medical profession and the system of insurers, hospitals, and pharmaceutical companies has achieved a position of power in our capitalist economy permitting them to control medical work and the prices charged for that work to maximize profits at the expense of the rest of society.

29. Conflict Perspective: Social Inequality (slide 1 of 2)
Infant Mortality Rates for Selected Countries
Means test: A qualification procedure to determine whether someone’s wealth and income are sufficiently low to qualify them for some form of federal support
Two-tier medical system: Provides one level of care for the rich and a lesser level of care for the poor
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Chapter 15: Health and Health Care
15.7 Theoretical Perspectives on Health and Health Care
LO: Illustrate key differences in theoretical perspectives of health and medicine.
Variations in infant mortality rates are often used as an index of quality of health care around the world. The infant mortality rate is an age-specific death rate, the number of deaths of infants under 1 year of age per 1,000 live births in a given year. Table 15-4 shows the infant mortality rates for 2011 for selected countries around the world. The United States ranks 41st in the world, but it spends more per capita on health care than other countries. Conflict theorists argue this is due to inequities in access to health care.
The United States is one of the few Western industrialized countries that does not view health care as a right of all its citizens and does not have some form of national health insurance. We can expect to see continued inequity in access to medical care in the United States for the foreseeable future. Medicaid is a means-tested program. It only covers people who meet a means test— a qualification procedure to determine whether someone’s wealth and income are sufficiently low to qualify them for some form of federal support. Minorities are more likely to be uninsured than whites. Lack of insurance has strong negative impacts on a person’s health. Uninsured adults are more than twice as likely to report being in fair or poor health than those with private insurance, and almost half of uninsured nonelderly adults have a chronic condition. Uninsured nonelderly adults are far less likely than insured adults to have preventive care and screenings so they are more often diagnosed in later stages of diseases such as cancer and die earlier than those with insurance. Because of these stark differences in access to health care, many argue that the United States has a two-tier medical system providing one level of care for the rich and a lesser level of care for the poor.
The conflict view highlights inequalities in health care, particularly those related to race and social class. However, the conflict perspective does not help us understand the importance of health care for the society as a whole or the ways in which people interpret illness and interact to provide treatment.

30. Symbolic Interactionism
Symbolic interactionism views physical and mental health as statuses that must be achieved through negotiation and collaboration with others.
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Chapter 15: Health and Health Care
15.7 Theoretical Perspectives on Health and Health Care
LO: Illustrate key differences in theoretical perspectives of health and medicine.
As addressed by symbolic interactionism, physical and mental health are not predetermined social statuses but are statuses that must be achieved through negotiation and collaboration with others. Symbolic interactionism identifies ways in which both illness and its treatment are socially constructed. The doctor–patient relationship and communication is an area in which numerous studies have examined differences based on age, gender, social class, race, and ethnicity. Evidence indicates that doctor–patient interaction is affected by patient gender and social class, physical attractiveness, and difficult versus easy patients.
Earlier we noted that some sociologists argue that mental illness is a myth. For example, Szasz argues that ADHD (attention-deficit hyperactivity disorder) was “invented” rather than discovered, while others argue ADHD is a socially constructed explanation of behaviors that do not meet prescribed social norms but are not of themselves necessarily pathological. As evidence of the arbitrariness of the diagnosis, its critics often point out that ADHD is diagnosed roughly three to four times as often in the United States based on the DSM IV criteria as compared to the ICD 10 diagnostic criteria advocated by the World Health Organization.
The interactionist view helps us see how health, illness, and treatments of illness must be socially constructed. This opens the door to understanding how nonmedical factors that influence the process of negotiation and defining the situation can influence a person’s health and illness behavior. However, it would be a mistake to think that there is no objective component to this process. The more severe the symptoms of a disease are, the less flexibility there is for social construction of the situation.

31. Health Care: Future Possibilities
Three trends in health care are likely to continue in the future:
Continued increases in the use of technology
Rising costs
The domination of the health care system by physicians
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Chapter 15: Health and Health Care
15.8 Health Care: Future Possibilities
LO: Identify likely trends in the future of health care.
So, what should be expected for health care in the future? On one hand, it seems likely that both in the United States and throughout the world there will be continued increases in the costs of health care. As health improves and people live longer, populations age and the larger proportion of elderly have higher health care costs. Most countries—particularly the United States—have shown little ability to rein in health care costs to grow no faster than the rest of the economy. If health care costs continue to outpace the rest of the economy, it may lead to a crisis in which countries lack the economic resources or the political will to continue. Exponential increases in the costs of health care cannot be sustained indefinitely, so we should expect continuing discussions and efforts to control costs. Here in the United States, it seems likely there will be continued controversy over how health care is provided and paid for and continued inequalities of access.
In an ever more rationalized society like that of the United States, scientific medicine’s near-monopoly over health care is likely to continue over the long term. In the short term, the Affordable Health Care Act will make health care accessible to millions of people who lacked health insurance before. That will lead to a dramatic increase in the need for primary health care providers. This will further increase the power of physicians in the health care system. If the Affordable Health Care Act leads to increased use of other health professionals such as nurse practitioners or physician assistants instead of physicians, then it might reduce the monopoly power that physicians have over health care.
Continuing improvements in technology seem likely to produce new advances in medicine. But it is not clear whether most new technologies will reduce costs or generate revenues for the companies that produce them. Substantial reductions in the costs of health care seem unlikely so long as there are so many inducements for health system participants to maximize their own profits.