1. Health and Medicine =Health and Society =Health: A Global Survey =Health in the United States =The Medical Establishment =Theoretical Analysis of Health and Medicine =Looking Ahead: Health and Medicine in the Twenty-First Century

2. Health Health- is a state of complete physical, mental, and social well being. According to the World Health Organization (WHO) The major theme of this chapter: Health is as much a social as a biological issue because well being and illness have their roots in the organization of society.

3. Health and Society 1. Cultural patterns define health- Standards in health vary from society to society. Today in the U.S. the rich foods that people consume are responsible for almost two-thirds of adults being over weight. “Health” is sometimes a matter of having the same disease as one’s neighbors. 2. What is considered healthy often is the same as what people define as morally good. Members of our society third a competitive way of life is healthy because it fits our cultural mores. Thus, ideas about good health amount to a form of social control that encourages conformity to cultural norms.

4. 3. Cultural standards of health have change over time. In the early twentieth century, some physicians warned women not to go to college because higher education strained the female brain. Others denounced masturbation as a danger to health. Today, on both counts, we know differently. 4. A society’s technology affects people’s health. In poor countries infectious diseases are rampant because of malnutrition and poor sanitation. As industrialization raises living standards, people become healthier. But industrial technology also creates health hazards. High-income countries tax the world’s resources and create pollution.

5. 5. Social inequality affects people’s health. All societies distribute resources unequally. Therefore, some people are healthier than others. This pattern starts at birth, with infant mortality highest among the poor. Poor people also live fewer years than rich people.

6. Health in History Many hunting and gathering people had fairly healthful diets, eating a range of vegetation and, when available lean meat. With the discovery of agriculture, food became more plentiful. Social inequality also increased and the wealthy had better health while the peasants and slaves lived in crowded, unsanitary shelters. In the growing cities of medieval Europe, human waste and other refuse piled up in the streets, spreading infectious diseases and plagues that periodically wiped out entire towns.

7. Health in Low-Income Countries The WHO reports that 1 billion people around the world—one in six—suffer from serious illness caused by poverty. In impoverished countries sanitary drinking water is as hard to come by as a balanced diet. Unsafe water is a major cause of the infectious diseases that imperil both adults and children.

8. Poverty breeds disease, which inturn undermines people’s ability to work. When medical technology curbs infectious disease, the populations of poor nations soar. Without resources to ensure the well being of the people they have now, poor societies cal ill afford large populations. Ultimately, programs to lower death rates in poor countries will succeed only if they are coupled with programs to reduce birth rates.

9. Health in High-Income Countries Industrialization dramatically changed patterns of human health in Europe, although at first not for the better. By 1800, as the Industrial Revolution took hold, factories offered jobs that drew people from all over the countryside.

10. In 1854, for example, John Snow mapped the street addresses of London’s cholera victims and found they all drank contaminated water for the well in Golden Square. Not long after that scientists linked cholera to a specific bacterium and developed a vaccine against the deadly disease. Using scientific technology early environmentalists campaigned against age-old practices such as discharging raw sewage into rivers used for drinking water. By the early twentieth century, death rates from infectious diseases had fallen sharply. Now the leading cause of death in the U.S. is Heart disease and stroke.

11. Who is Healthy? Age, Gender, Class and Race Social epidemiology- the study of how health and disease are distributed throughout a society’s population. Women fare better in terms of health than men. They have a slight biological advantage that renders them less likely than men to die before or immediately after birth. Our culture also promotes masculinity and pressures men to be competitive, repress emotions, and take up hazardous behaviors such as the smoking of cigarettes and drinking alcohol to access.

12. Infant mortality—the death rate among children under one year of age—is twice as high as poor children vs. children from wealthy families. Poverty among African Americans— currently three times the rate of whites— helps explain why black people are more likely to die in infancy and, as adults, are more likely to suffer the effects of violence, drug abuse, and poor health. About 20 % of the U.S. population—more than 50 million people—cannot afford a healthful diet or adequate medical care.

13. Cigarette Smoking The popularity of cigarettes peaked in 1960, when almost 45 percent of U.S. adults smoked. By 1999, only 24 % percent of U.S. adults were still lighting up.

14. Some 430,000 men and women die prematurely each year as a direct result of cigarette smoking, which exceeds the combined death toll from alcohol, cocaine, heroin, homicide, suicide, automobile accidents and AIDS. Smokers also suffer from more minor illnesses such as the flu, and pregnant women who smoke increase the likelihood of spontaneous abortions, prenatal death, and low-birth weight babies. Even non- smokers who are exposed to cigarette smoke have a higher risk of smoking-related diseases.

15. Eating Disorders An Eating disorder– an intense from of dieting or other unhealthy method of weight control driven by the desire to be very thin. Research shows that most college-age women believe 1. “guys like girls thin,” 2. being thin is critical to physical attractiveness, and 3. they are not as thin as men would like. Our idealized image of beauty leads many young women to diet to the point of risking their health.

16. Sexually Transmitted Diseases Sexual activity can transmit more than fifty kinds of infections, or venereal diseases. Because many people in our culture associate sex with sin, they regard venereal disease not only as illnesses but also as marks of immortality. During the “sexual revolution” of the 1960’s infection rates rose as people began sex activity earlier and had a greater number of partners. As a result STDs are an exception to the decline of infectious diseases in the U.S. In the late 1980’s STDs especially— AIDS—generated a sexual counter-revolution that discouraged casual sex.

17. Gonorrhea and Syphilis Gonorrhea and syphilis are caused by microscopic organisms that are almost always transmitted by sexual contact. About 360,000 cases of gonorrhea and 36,000 cases of syphilis were recorded in 1999. Gonorrhea and syphilis can be cured easily with antibiotics such as penicillin. Therefore neither disease is a major health problem in the U.S

18. Genital Herpes Genital herpes is a virus that infects as many as 45 million adults in the U.S. Herpes is incurable. People with genital herpes may exhibit no symptoms or they may experience periodic, painful blisters on the genitals accompanied by fever and headache. Although not fatal to adults, it can be deadly to newborns, and a woman with active genital herpes can transmit the disease during a vaginal delivery. Therefore women with herpes, usually give birth by Cesarean section.

19. AIDS The most serious of all sexually transmitted diseases is acquired immune deficiency syndrome, or AIDS. Identified in 1981, it is incurable and almost always fatal. AIDS is caused by the human immunodeficiency virus (HIV), which attacks white blood cells, the core of the immune system. AIDS renders a person vulnerable to a wide range of other diseases that eventually cause death.

20. Ethical Issues Surrounding Death The ability to prolong the lives of terminally ill people is forcing us to confront a number of ethical issues surrounding death and the rights of the dying.

21. When Does Death Occur? Medical and legal experts in the U.S. now define death as an irreversible state involving no response to stimulation, no movement or breathing, no reflexes, and no indication of brain activity.

22. Do People Have a Right to Die? Federal law requires hospitals, nursing homes, and other medical facilities to honor a patient’s desire if spelled out in a “living will.”

23. What about Mercy Killing? Euthanasia- assisting in the death of a person suffering from an incurable disease. Euthanasia poses ab ethical dilemma, being at the same time an act of kindness and a form of killing The right to die is one of today’s most difficult questions.

24. Supporters of active euthanasia—allowing a dying person to enlist the services of a physician to bring on a quick death—argue that there are circumstances that make death preferable to life. Critics counter that permitting active euthanasia invites abuse. They fear that patients will be pressured to end their lives in order to spare family members the burden of caring for them or the high cost of hospitalization.

25. The Medical Establishment Medicine is the social institution that focuses on combating disease and promoting health. In agrarian societies, health practitioners, including herbalists and acupuncturists, play a central part in improving health. In industrial societies, medical care falls to specially trained and licensed healers, from anesthesiologists to X-ray technicians.

26. The Rise of Scientific Medicine The American Medical Association (AMA) was founded in 1847 and symbolized the growing acceptance of a scientific medicine.

27. Holistic Medicine Holistic Medicine- an approach to health care that emphasizes prevention of illness and takes into account a person’s entire physical and social environment. 1. Patients are people Holistic practitioners extend the bounds of conventional medicine, taking an active role in combating poverty, environmental pollution, and other dangers to public health.

28. 2. Responsibility, not dependency Practitioners encourage health-promoting behavior. Holistic favors an active approach to health rather than a reactive approach to illness. 3. Personal treatment Holistic practitioner’s locations favor, as much as possible, a personal and relaxing environment such as a home. Holistic care does not oppose scientific medicine but shifts the emphasis from treating disease toward achieving the greatest well-being for everyone.