1. Copyright © Allyn & Bacon 2007 Chapter 10 Health Care: Problems of Physical and Mental Illness This multimedia product and its contents are protected under copyright law. The following are prohibited by law: Any public performance or display, including transmission of any image over a network; Preparation of any derivative work, including the extraction, in whole or in part, of any images; Any rental, lease, or lending of the program.

2. Copyright © Allyn & Bacon 2007 Health Care as a Social Problem Health is a social issue as well as a biological issue Life expectancy is an estimate of the average lifetime of people born in a specific year If born (male and female):  1900 – expected to live to 47.3 years of age  2001 – expected to live to 77.2 years of age Life expectancy varies by gender, race, social class and overall health

3. Copyright © Allyn & Bacon 2007 Infant Mortality Rate (IMR) Number of deaths of infants under one year of age per 1,000 live births  Good indication of societies preventive medical care IMR higher in US than other high-income nations Rates vary significantly by race  In 2001, IMR for African American infants was 14.0 per 1000 live births  In 2001, IMR for white infants was 5.7 per 1000 live births  Indicates unequal access to health care in US

4. Copyright © Allyn & Bacon 2007 Health Problems and High Health Care Costs Acute diseases  Illnesses that strike suddenly and cause incapacitation or death Chicken pox, influenza, Lyme disease, and HIV Chronic diseases  Long-term, develop gradually, or present from birth (e.g., arthritis, diabetes, heart disease)  Caused by biological and environmental factors  Some produce disabilities that increase health care costs

5. Copyright © Allyn & Bacon 2007 AIDS as an International Health Crisis Number of cases is rising annually  About 400,000 US citizens have AIDS  About 2 million US citizens are infected with HIV 75% of people worldwide are infected through heterosexual intercourse Treatment is complex and costly Ethical issues (e.g., issues related to testing) remain unresolved

6. Copyright © Allyn & Bacon 2007 Mental Health as a Social Problem Affects a large number of people Difficult to define and identify mental disorders  American Psychiatric Association’s (1994) Diagnostic and Statistical Manual of Mental Disorders IV (DSM- IV)  Homosexuality was once considered a mental disorder Severe mental illness (schizophrenia, bipolar disorder, major depression) affect about 15% of US adults some time in their lives

7. Copyright © Allyn & Bacon 2007 Race, Class, Gender and Mental Disorders No significant differences in diagnosable mental illness between African Americans and whites  Racism does impact the psychological well-being of both African Americans and whites Social class is related to mental illness  As SES increases for African Americans and whites, mental disorders decrease Women are diagnosed with depression more than men  Men have higher rates of personality disorders (gambling, drinking, etc.)

8. Copyright © Allyn & Bacon 2007 Kinds of Health Care Historically Available in the U.S. Fee for service  Patients pay directly for treatment Third-party, fee-for-service care  Patients paid premiums to insurance companies

9. Copyright © Allyn & Bacon 2007 New Types of Health Care in the U.S. Preferred Provider Organizations (PPOs)  Doctors contract to treat insured patients for set fees Health Maintenance Organizations (HMOs)  For a set monthly fee, an HMO provides total care  Emphasis is on prevention  Patients must use doctors and hospitals affiliated with HMO Managed Care  Any system of cost containment that controls tests, procedures, and services

10. Copyright © Allyn & Bacon 2007 Difference between Medicare and Medicare Medicare Public health insurance for people aged 65 and over Funded by social security payments Medicaid Public health insurance for people who are poor and either aged, blind, disabled, or pregnant  In 2003, about 45 million people in the US had no health insurance  About ¼ of these people were children Funded by federal and state governments

11. Copyright © Allyn & Bacon 2007 Figure 10.2: Distribution of Households Without Health Insurance, 2001, by Income. Source: Mills, 2002. Figure 10.3: Percentages of Households Without Health Insurance, 2001, by Income Source: Mills, 2002.

12. Copyright © Allyn & Bacon 2007 Race, Class, Gender and Health Care Less preventive care and less optimal management of chronic diseases are received by:  People of color across class lines  Low-income whites Women have been underrepresented in the medical profession Medical training, practice, and research are male- centered Women receive differential treatment for certain kinds of medical problems

13. Copyright © Allyn & Bacon 2007 Sociological Explanations for Health Care Problems Functionalist Illness and the sick role are dysfunctional for society Problems in U.S. health care are due to macro- level changes (e.g., high-tech medicine, over- specialization of doctors) Solutions  Reorganize the whole healthcare system  Managed care is the best answer

14. Copyright © Allyn & Bacon 2007 Sociological Explanations for Health Care Problems, Cont’d. Conflict Health problems are rooted in capitalism and in the medical-industrial complex Race-, class-, and gender-based inequities cause health problems Symbolic Interactionist Communication problems between doctors and patients create problems People need to become more involved in health care issues and reform