Health and Society (Chapter 11, "You May Ask Yourself")
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Transcript of Health and Society (Chapter 11, "You May Ask Yourself")
Health and SocietyChapter 11
You May Ask Yourself
The Rise of Medicine
•Why we think doctors are special:
•Universally valued product
•High moral calling to do good
•Professionalism
•Individual objectivity
•Impression management
Power of Doctors
•Doctors have the power to:
•construct their own pay rates.
•create demand for their products.
•regulate themselves.
•prescribe medications.
•“medicalize” conditions.
Medicalization•Medicalization - the process by
which problems or issues not traditionally seen as medical came to be framed as such.
•Pregnancy and childbirth
•Alcoholism
•Depression
•Nutrition
Biomedical Culture•Historically, doctors weren’t
powerful.
•Rome - slaves, poor freedmen, or foreigners.
•England - rose from barber profession.
•Russia - payed about 75% of industrial workers’ wages.
Biomedical Culture•Reasons for Rise of Biomedical Culture
•Ability to offer “health” or actual increase in years lived.
•Exclusion of other health frameworks through licensing
• Legal authority through licensing
• Increased importance of larger institutions (like hospitals)
Decline of Doctors?
• Reasons for loss of power in recent years:
• Rise of HMOs
• Rise of external regulations
• Patient Bill of Rights (1998)
• EMTALA (1986)
• COBRA (1985)
• HIPAA (1996)
• Rise of other forms of medicine
• Improved technology
Being Sick...•The Sick Role (Talcott Parsons)
•Two Rights:
•Exemption from normal social roles
• Lack of accountability for illness
•Two Obligations:
•Try to get well.
•Seek the assistance of qualified individuals.
Social Construction of Illness
• Religious views and practices:
• Seizures, faith healing, fire-cupping, coin rubbing.
• Medicalization:
• Alcoholism (don’t blame the victim)
• Understanding of pathologies:
• Cancer, obesity, heart disease (blame the victim)
Fire-cupping
Fire cupping bruises
Coin rubbing
Health related PSAs
U.S. Healthcare System
•Types of Coverage:
•Fee-for-service
•Health Maintenance Organizations (HMOs)
•Public Insurance
•State Children’s Health Insurance Programs (SCHIP or KCHIP in Kentucky)
•Uninsured or Private Pay
Morbidity and Mortality
•Morbidity - illness in a general sense
•Mortality - death
• Whitehall Study:
• Men only
• Universal health access
• Who you are, where you live, how much you earn, and what you do for a living all impact health.
Born Unequal• Gender differences:
• More boys than girls born, but higher infant mortality for male babies.
• Sex ratios: 1.05 in US; 1.12 in China.
• Multiple Births
• IVF - multiple implanted embryos
• Ovulation increasing medications - more fertilized eggs.
Post-Birth Health Inequalities
• Low birth weight:
• Less than 5 pounds, 8 ounces.
•Caused by:
• Intrauterine growth restriction (IGR)
•Premature birth
•Prenatal health
•Mother’s health
Race and Health• Life expectancy
• Infant mortality
•Disease prevalence:
•African Americans - heart disease and cancer
•Native Americans - cirrhosis and suicide
•Hispanics - diabetes and HIV/AIDS
•Racism as possible cause.
US Infant Mortality Rates
Socioeconomic Status
• Selection theory - spurious relationship
•Drift explanation - health causes social position
• Social determinants - social status determines health
• Psychosocial - social class relative to those around them.
•Materialist - differential access to health is determined by SES.
• Fundamental - how social factors shape illness
Socioeconomic Status
• “Natural” Experiments through Policy Change
• Compulsory education - mid-1900s
• Each year of school decreased odds of death by 3.6%.
• Social Security policy - 1977
• Lower Social Security payments led to longer life.
• Due in part to continued workforce participation.
Marital Status
•Married people tend to live longer, especially men.
•Reasons:
•Health as precursor for marriage.
•Marriage decreases unhealthy behaviors.
Sex and Health
•Women live longer than men.
•Reasons:
•Disease prevalence differences.
•Healthcare-seeking behaviors.
Sex & Race Combined
•Much more profound impact than either factor alone.
•Reasons:
•Racism
•Lower SES
•More dangerous jobs
Family Structure• Larger families have higher childhood mortality.
• Supervision
• Closely-spaced families have higher childhood mortality.
• Supervision, maternal health.
• First-born children are more likely to die in childhood.
• Less experienced parents, unintended pregnancies, mortality “creates” firstborns.
Mental Health•Diagnostic Statistical Manual (DSM)
•DSM-I: 1952 - 60 disorders, standardized the canon
•DSM-II: social context was important
•DSM-III: removed social context, followed medical model
•DSM-IV: 400 disorders, necessary for medical billing and insurance reimbursement.
Global Health
•Waterborne Illnesses
•Malaria
•Vaccines
•AIDS