Chapter 14: Health and Illness

Why Study Health and Illness? Our bodies are social objects— it is important to understand the role that health (and illness) plays in our lives as social beings. Health (and illness) are social constructs. What it means to be healthy or sick is determined by a society! In sociology, the purpose of studying health and illness isn’t to treat or cure people like a doctor might. Instead, sociologists try to understand health and illness in a social context. For example, in Victorian times, being overweight was a sign of social status. Now obesity is considered a disease. How has our understanding of weight shaped this change? Whereas peasants were thin because they were underfed, now young women strive to achieve a similar physique. What norms have shifted to accommodate these new outlooks? How will these norms shift in the future? http://commons.wikimedia.org/wiki/File:Waynewalters.jpg

Types of Illnesses Acute diseases have a sudden onset, may be briefly incapacitating, and are either curable or fatal. The developing world) Chronic diseases develop over a longer period of time and may not be detected until symptoms occur later in their progression. The industrialized World) Acute diseases can come from viruses or germs, and can become ailments like the flu or a cold. Chronic diseases can come from environmental factors or lifestyle choices, and can include things like obesity or cancer. http://commons.wikimedia.org/wiki/File:US_Navy_080902-N-9123L-002_Cryptologic_Technician_%28Collections%29_3rd_Class_Brittany_Gonzales_delivers_a_posy_bunch_to_a_Royal_Melbourne_Hospital_patient.jpg

Approaches to Medical Treatment Curative or crisis medicine is the kind of health care that treats a problem after it has already started. Preventative medicine is a kind of health care that tries to prevent or delay a problem. This can include making lifestyle changes. Which kind of medical treatment do you think is most common in the United States? Do you have insurance? If so, does it pay for a gym membership (preventative)? Would it pay for medication to help you lose weight (curative)? Many people believe that preventative medicine would have an initial cost, but would save a lot of money in the long run. What are some reasons that we don’t invest more in preventative medicine? http://en.wikipedia.org/wiki/File:No_Smoking.svg

Approaches to Medical Treatment (cont’d) Palliative care is the kind of health care that focuses on symptom and pain relief—it is not intended to provide a cure. This is typically used for critically ill or dying patients. Hospice is a familiar provider of palliative care. Sometimes there are treatments available, but the expected outcomes are so poor or modest that people prefer to forgo the treatment and pursue a better quality of life for their time remaining. Palliative care makes this possible.

Social Construction of Health and Illness Medicalization is the process where some issues that used to be seen as personal problems are redefined as medical issues. We’ve already mentioned obesity and weight issues. For those of you who are psychology majors, or if you have taken an abnormal psychology course, think about the Diagnostic and Statistical Manual of Mental Disorders (DSM). Homosexuality used to be considered a mental illness. Now, caffeine addiction is listed as diagnosable. People used to have babies at home, whereas now there are doctors, nurses, midwives, offices, wings, and entire hospitals dedicated to the birthing of babies!

Epidemiology Epidemiology is the study of disease patterns to understand illnesses, how they spread, and how to treat them. An epidemic happens when a significantly higher than expected number of cases of a disease occurs within a population. A pandemic is when a higher than expected number of cases of a disease also spans a large geographic region, as in multiple countries or continents. Infections are often spread by vector organisms like mosquitoes or ticks. Epidemiology is interesting for many reasons aside from the actual health and illness of people. For instance, how are epidemics or pandemics portrayed in the media? http://en.wikipedia.org/wiki/File:Mosquito-feeding.jpg

Social Inequality, Health, and Illness Epidemiologists and sociologists have noticed a trend: not all people have equal access to health or health care. We’ll talk more about some of the inequalities in upcoming slides.

Social Inequality, Health, and Illness (cont’d.) Socioeconomic status (SES) impacts people’s ability to access better heath care, tests and medications, and also to afford better nutrition. Higher SES individuals often live longer and feel better than lower SES individuals. Food deserts are poor, urban neighborhoods without grocery stores. This makes finding healthy food options difficult. Have you ever heard of a concierge doctor? These doctors charge especially high fees (and sometimes annual membership fees), but they guarantee one-on-one time with patients. They sometimes provide a direct cell number to call in emergencies, and offer other services like consultations with teachers to help them understand the needs of the children they tend. Wouldn’t it be nice if everyone could access a service like this, regardless of income?

Social Inequality, Health, and Illness (cont’d.) Race and gender are compounded by income, as minorities and women are more likely to be in poverty. Minorities are more likely to be exposed to harmful surroundings; men are more likely to hold hazardous jobs. Deprivation amplification occurs when the risks we already have because of our background or heredity are amplified by social factors. For instance, African Americans are at a greater risk for high blood pressure than other groups. Social factors, like living in a food desert, can increase stress and deny access to healthy food, which amplifies the risk for high blood pressure.

Medicine as a Social Institution The American Medical Association, through its standards and regulations, transmits norms and values of medicine and medical knowledge. regulates, licenses, and legitimizes practitioners. polices itself and encroachment on its power. Oftentimes, people who are medically trained in other countries have too many obstacles to come to the United States and begin practicing. Do other cultures treat medical conditions differently than we do in the United States? Of course. Couldn’t we learn something from bringing these different ideas in and incorporating them into the options that people in the United States have? However, due to tight regulations from the American Medical Association (AMA), these models are often omitted from health-care options in the United States.

Medicine as a Social Institution (cont’d.) Doctor-patient relations are greatly influenced by the structure of the institution. The way that we interact with doctors is what gives them status and power—the norms of the situation emerge from the way we behave! Think of your last doctor visit. Ask students to describe a typical office visit. How long did they wait? How long did they spend with the doctor? How comfortable are they asking questions? Were they able to negotiate the price of their treatment? Did they understand the reasons for the medications they were prescribed? Why are our interactions with doctors different than our interactions with teachers, used car salespeople, or fast-food restaurant workers?

Medicine as a Social Institution (cont’d.) The sick role describes actions and attitudes expected from someone who is ill. Functionalist Talcott Parsons suggests that being sick is a form of deviance (it’s different from the norm). You often get excused from your normal responsibilities, but you have new responsibilities, like seeking treatment and trying to get better. We tend to feel sympathetic for a person who stays home from work because she has the flu. We tell her to stay home, eat chicken soup, and feel better soon. However, what do we do when a person calls out of work every Monday? We might begin to assume that he’s “faking it” or is doing something over the weekend that is preventing him from getting up and coming in to work on Monday mornings. When we start feeling like the illness is in the person’s control (“if you’d stop partying on the weekend, you’d be fine on Monday morning…”) then the sick role no longer applies. The sick role is also more difficult when a person’s illness is not visible—for instance, if a person is clinically depressed, people may say, “Things aren’t that bad, just go to work and deal with it.”

Issues in Medicine and Health Care Health Care Reform is a current issue that we hear a lot about in the media. The premise is that we need to provide better, more affordable health care to all people. Problems Who pays for this? Is it ethical to force people to purchase insurance or take care of themselves? Health care reform isn’t new; even Richard Nixon was interested in such reform, in the 1970s. While most people believe fundamentally that all people deserve to have access to health care, there are debates about how to fund programs, who should be covered, and what other programs should be cut or eliminated if we aren’t able to fund everything.

Issues in Medicine and Health Care (cont’d.) One reason for health care reform is to eliminate rescission—a policy that allows insurance companies to cancel people’s coverage after they get sick. The idea of insurance is that we pay for something that we don’t need now to ensure that we’ll have access to coverage when we need it later. Many people are frustrated when they pay insurance premiums for years without having to use the coverage, only to find out that when they need the coverage later, their policy gets canceled and they have no insurance benefits. http://commons.wikimedia.org/wiki/File:US_Navy_040203-N-4182M-001_National_Naval_Medical_Center_physician,_Capt._David_Thompson_performs_an_ear_tube_surgery_on_a_young_hospital_patient.jpg

Issues in Medicine and Health Care (cont’d.) Cultural competence refers to acknowledgment of a person’s cultural background as part of the treatment process. This is important because a patient’s beliefs will shape his or her approach to health care. For instance, if you’re from a culture that believes that taking pills will steal a person’s soul, you’re probably not going to take the medication that your doctor prescribes if it comes in a pill form. Understanding the patient’s background can help a doctor treat the person effectively.

Issues in Medicine and Health Care (cont’d.) Other options Complementary medicine describes treatments, practices, or products that can be used in conjunction with conventional Western medicine. This could include taking an herbal supplement in addition to a prescribed medication. Another example could be a man who takes a medication for hypertension, but also practices yoga every morning to help with stress.

Issues in Medicine and Health Care (cont’d.) Alternative medicine describes treatments, practices, or products that can be used instead of conventional Western medicine. Some people may find that acupuncture relieves their symptoms (like a headache, for instance) better than a medication, so they use alternative medicines. It is difficult to learn about alternative medicines because they’re not commonly practiced by Western physicians and may be limited by the AMA.

Issues in Medicine and Health Care Integrative medicine combines conventional medicine with complementary practices that are proven to be safe and effective. This is becoming more popular; however, there are still relatively few studies being conducted on complementary and alternative forms of medicine. Additionally, insurance providers are less likely to pay for nonconventional services, so patients seeking these kinds of treatment are often left to pay for them out-of-pocket.

Issues in Medicine and Health Care In an effort to eliminate disorders, eugenics is an attempt to manipulate the gene pool to improve humans through medical science. In using processes like eugenics, it is important to consider bioethics—the moral or ethical issues related to scientific or medical advancements. Those who have heard of eugenics are most familiar with the term in the context of the Holocaust—when doctors or scientists sought to create the “perfect race.” However, eugenics also has a long and troubling history in the United States. What may have begun with good intentions (eliminating a disease or genetic trait that caused people trouble) became a call for forced sterilization, forced removal of individuals from society, and institutionalization of individuals due to poor genetic makeup or undesirable characteristics. We now have advanced technology that allows us to perform genetic testing or to see embryos at early stages of development. If we see something troubling, what should we do? As individuals we might have an opinion about this, but as sociologists, it’s not our job to answer this question. Rather, we want to understand the social implications for having this technology and for the people who have to make these decisions.

So What? Why Study Health and Illness? Understanding the link between social structures and the individual helps us understand process and health outcomes. Thinking about our values and cultural context helps us understand the way people perceive the health of individuals, society, and the planet. You can remind students of the discussion earlier in the semester about the sociological imagination. Point out that thinking about social and historical context as well as biographical experience helps us to understand social life.

Do you have health insurance? yes no Chapter 14: Participation Questions Do you have health insurance? yes no These questions can be used with “clickers,” cell phones, or other audience response systems to increase participation in your classes. They can also be used to encourage discussion without technological input.

Chapter 14: Participation Questions The last time you went to the doctor, was it for curative medicine or preventive medicine? Curative: I needed treatment for something that was bothering me. Preventive: I wanted to find out how to prevent or avoid a problem that might occur in the future. These questions can be used with “clickers,” cell phones, or other audience response systems to increase participation in your classes. They can also be used to encourage discussion without technological input.

Chapter 14: Participation Questions According to the World Health Organization, health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Knowing this, would you call yourself healthy? yes no These questions can be used with “clickers,” cell phones, or other audience response systems to increase participation in your classes. They can also be used to encourage discussion without technological input.

Chapter 14: Participation Questions Have you ever called out of work or skipped a class by saying that you were sick even though you were not? yes no These questions can be used with “clickers,” cell phones, or other audience response systems to increase participation in your classes. They can also be used to encourage discussion without technological input.

This concludes the Lecture PowerPoint presentation for Chapter 14