1. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 1 SOCIOLOGY Richard T. Schaefer Health and Medicine 19

2. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 2 19. The Economy and Work Culture and Health Sociological Perspectives on Health and IllnessSociological Perspectives on Health and Illness Social Epidemiology and Health Health Care in the United States Mental Illness in the United States Social Policy and Health

3. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 3 Culture and Health Culture contributes to differences in medical care and how health is defined Culture also influences the relative incidence of a disease or disorder.

4. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 4 Sociological Perspectives on Health and Illness Functionalist Approach –“Being sick” must be controlled so that not too many people are released from their societal responsibilities –Sick role: societal expectations about attitudes and behavior of a person viewed as being ill

5. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 5 Sociological Perspectives on Health and Illness Conflict Approach –Critical of growing role of medicine as major institution of social control –The Medicalization of Society Interactionist Approach –Studies the roles played by health care professionals and patients –Asserts patients may play an active role in positive or negative health

6. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 6 Sociological Perspectives on Health and Illness Labeling Approach –The designations healthy and ill generally involve social definition –Disagreements continue in the medical community over whether a variety of life experiences are illnesses

7. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 7 Sociological Perspectives on Health and Illness Figure 19-1. Infant Mortality Rates in Selected Countries, 2004 Source: Haub 2004

8. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 8 Sociological Perspectives on Health and Illness Table 19-1. Major Perspectives on Health and Illness

9. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 9 Social Epidemiology and Health –Social epidemiology: study of distribution of disease, impairment, and general health status across a population –Incidence: number of new cases of a specific disorder occurring within a given population during a stated period of time, usually a year –Prevalence: number of cases of a specific disorder that exist at a given time

10. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 10 Social Epidemiology and Health –Morbidity rates: disease incidence figures presented as rates or number of reports per 100,000 people –Mortality rate: incidence of death in a given population

11. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 11 Social Epidemiology and Health Social Class –Studies show people in lower classes have higher rates of mortality and disability Crowded living conditions Substandard housing Poor diet Stress Unable to afford quality health care

12. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 12 Social Epidemiology and Health Race and Ethnicity –Health profiles of racial and ethnic groups reflect social inequality in U.S. Poor economic and environmental conditions manifested in high morbidity and mortality rates Gender –When compared with men, women live longer

13. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 13 Social Epidemiology and Health Figure 19-2. Percentage of People without Health Insurance, 2001 Source: Haub 2002:23

14. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 14 Social Epidemiology and Health Age –Most older people in U.S. have at least one chronic illness Older people vulnerable to certain types of mental health problems Older people use more health services than younger people

15. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 15 Health Care in the United States A Historical View –During the 1830s and 1840s, “self-help” was emphasized Strong criticism of “doctoring” –Eventually, medical profession controlled the market for its services and the various organizations that govern medical practice, financing, and policymaking

16. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 16 Health Care in the United States Physicians, Nurses, and Patients –Physicians have position of dominance in dealing with nurses and patients Alternatives to Traditional Health Care –Holistic medicine Therapies that consider the person’s physical, mental, emotional, and spiritual characteristics

17. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 17 Health Care in the United States The Role of Government –In 1965, government subsidized health care programs Medicare for the elderly Medicaid for the poor –Medicare had huge impact on health care system Some hospitals “dumped” unprofitable Medicare patients until practice was banned in 1987

18. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 18 Health Care in the United States Figure 19-3. Availability of Physicians by State Source: Bureau of the Census 2004:101

19. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 19 Health Care in the United States Figure 19-4. Total Health Care Expenditures in the United States, 1970— 2014 (projected) Sources:Center for Medicare and Medicaid Services 2005 (2005—2014 data); Health Care Financing Administration 2001 (1970—1990 data)

20. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 20 Mental Illness in the United States Mental illness –Brain disorder that disrupts a person’s thinking, feeling, and ability to interact with others –People in U.S. traditionally maintained a negative and suspicious view of those with mental disorders

21. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 21 Mental Illness in the United States Theoretical Models of Mental Disorders –Medical Model: Mental illness rooted in biological causes that can be treated through medical intervention –Labeling Theory: Mental illness is not an “illness” since the individual’s problems arise from living in society and not from physical maladies Devalues mentally ill patients

22. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 22 Mental Illness in the United States Patterns of Care –Historical confinement of the insane or mentally ill to public institutions –Community-based outpatient care most prevalent now Legislation has made it easier to commit mentally-ill homeless involuntarily

23. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 23 Social Policy and Health Financing Health Care Worldwide –The Issue Industrialized nations face issues related to the accessibility and affordability of health care –The Setting The U.S. is the only Western industrial democracy that does not treat health care as a basic right

24. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 24 Social Policy and Health Financing Health Care Worldwide –Sociological Insights Conflict theorists suggest health care system resists basic change –Those who receive substantial wealth and power through an existing institution have strong incentive to keep things as they are Health care system undergoing “corporatization”

25. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 25 Social Policy and Health Financing Health Care Worldwide –Policy Initiatives Major reforms occurring in U.S. without legislative reform –As of 1997, managed care plans enrolled 85% of all workers, up from 52% in 1993 –There are growing concerns about the quality of health care provided by managed care plans

26. McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 26 Social Policy and Health Figure 19-5. Government Expenditures for Health Care, Selected Countries Source: World Bank 2005a:100--102