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HEALTH CARE

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HEALTH CARE – LECTURE OUTLINE

Health Defined
History of Health Care
Main Causes of Death
Obesity
Social Epidemiology
Health Care: An International Comparison
Sociological Perspectives

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HEALTH CARE – LECTURE OUTLINE

Health Defined
History of Health Care
Main Causes of Death
Obesity
Social Epidemiology
Health Care: An International Comparison
Sociological Perspectives

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HEALTH DEFINED

Health: A state of complete physical, mental, and social well-being (World Health Organization -- WHO)

Not merely the absence of disease or infirmity

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HEALTH CARE – LECTURE OUTLINE

Health Defined
History of Health Care
Main Causes of Death
Obesity
Social Epidemiology
Health Care: An International Comparison
Sociological Perspectives

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PRACTICE VS. PROFESSION OF MEDICINE

Early practice was little more than folk remedies and home cures
Orthodox medicine in the 18th century involved bloodletting, use of leeches, and forced vomiting to purge the body of impure fluids.
The first medical school was established in 1765 in Philadelphia

Strong belief that doctors needed to dissect human corpses to learn about the human body
Many medical students became grave-robbers
April 13, 1788 - Anti-Dissection Riot

Medical practice in the North American colonies was little more than folk remedies and home cures. In the 18th century, orthodox medicine involved bloodletting, use of leeches, and forced vomiting to purge the body of impure fluids. �

Medicine started to become professionalized with the advent of licensing requirements. New York was the first to set up an examination and licensure program around 1760. Around the same time, there developed a movement to increase educational credentials. The first medical school was established in 1765 in Philadelphia. In these early medical schools, there was a strong belief that doctors needed to dissect human corpses to learn about the human body. However, none could be legally obtained, so they resorted to grave robbing. The public was opposed to grave robbing and public fury against this practice led to a two-day riot in 1788 known as the Anti-Dissection Riots.

Discussion (25): Have you tried alternative forms of medical treatment? What do you think of their usefulness?

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CAUSES AND CURES OF ILLNESS AND DISEASE

Four different schools of thought developed in contrast to orthodox medical science:

Hydropaths: Believed the body could be cleansed internally and externally by the use of water, natural foods, good hygiene, and exercise
Osteopaths: These physicians also rejected use of drugs and believed manipulation of the skeleton could improve health
Christian Scientists: Believed all illness was an illusion of the mind and did not really exist
Homeopaths: Believed that orthodox medical practices overmedicated and over-treated people

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Medicaid is designed to provide insurance for low-income individuals and families who meet certain qualifications. Not every person with low income is eligible for Medicaid. Medicaid serves poor people with special needs, including people who are blind, permanently disabled, pregnant, or who live in families with dependent children. The program is funded partially by the federal government and partially by each individual state. As shown in the figure above, in April 2021, 75.4 million people (16 percent of the population) were enrolled in Medicaid. In addition, 6.8 million children were enrolled in Children's Health Insurance Program (CHIP). CHIP was designed to cover uninsured children whose families did not qualify for Medicaid. A total of 82.3 million people (24.8 percent of the population) were enrolled in Medicaid or CHIP in April 2021.

Source: https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/downloads/april-2021-medicaid-chip-enrollment-trend-snapshot.pdf

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Affordable Care Act (2010)

Opened health insurance marketplaces, or exchanges, which offer premium subsidies to lower- and middle-income individuals
Expanded Medicaid eligibility with the help of federal subsidies (in states that chose this option)
Resulted in an estimated 20 million gaining coverage.

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RESISTANCE TO UNIVERSAL HEALTH CARE IN THE UNITED STATES

National health care is viewed as a form of welfare, which threatens our freedom

The Constitution states that the power of the government must be limited

The working class and labor unions fail to support legislation that would provide universal health care
Private health insurance companies strongly oppose the idea of national health care

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HEALTH CARE – LECTURE OUTLINE

Health Defined
History of Health Care
Main Causes of Death
Obesity
Social Epidemiology
Health Care: An International Comparison
Sociological Perspectives

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DISEASES

Acute diseases are those with fairly quick onset

Sometimes dramatic and incapacitating
A person either dies or recovers
E.g., influenza, tuberculosis, and gastroenteritis

Chronic diseases progress over a long period of time

Often exist long before they are detected
E.g., heart disease and cancer

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HEALTH CARE – LECTURE OUTLINE

Health Defined
History of Health Care
Main Causes of Death
Obesity
Social Epidemiology
Health Care: An International Comparison
Sociological Perspectives

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HOW INEQUITY CONTRIBUTES TO OBESITY: From Living Context to Weight Outcomes

Historical, social, economic, physical, and policy contexts
Systematic effects on daily life and choices
Weight control and related contextual outcomes and effects on individuals

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Historical, social, economic, physical, and policy contexts

Legal risks and protections
Institutional racism and other forms discrimination
Political voice and voter registration
Economics (see next slide)
Employment and occupation (see next slide after Economics)
Education (see next slide after Employment and occupation)
Neighborhood/Locality (see next slide after Education)

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Economics

Debt
Poverty
Home ownership
Wealth-building/Inheritance
Health insurance
Minimum wage

Public assistance
Housing costs
Employment discrimination
Marketing
Cost of living

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Employment and occupation

Education attainment
Employment discrimination
Health insurance/Amenities
Physical demand of job/Sitting vs. standing
Job flexibility

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Education

School district
Neighborhood segregation
Housing discrimination
Public funding for schools
School quality
Higher-education access

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Neighborhood/Locality

Rurality
Jurisdiction
Public transportation
Distance to healthcare
Retail outlets
Food access
Racial segregation
Poverty rates
Wage deserts
Job access
Housing stock
School quality

After-school programs
Walking and biking infrastructure
Community centers
Neighborhood safety
Parks
Neighborhood resources (e.g., higher-education institution)
Policing and law enforcement
Stigma and interpersonal racism
Blight, community ecology

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Systematic effects on daily life and choices

Food-related (see next slide)
Physical activity-related (see slide after Food-related)
Resource limitations (see next slide after Physical activity related)
Chronic stress
Sleep health
Food security

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Food-related

Food access, affordability, appeal
Exposure to food advertising
Federal nutrition assistance
Food and nutrition literacy
Food norms
Dieting

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Physical activity-related

Options for safe, affordable recreation
Personal transportation
Public transportation
Exposure to violence
Activity norms
Exercise

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Resource limitations:

Discretionary time
Discretionary income
Income stability
Housing stability
Healthcare access

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Weight control and related contextual outcomes and effects on individuals

Food intake
Dietary quality
Child feeding and parenting
Physical activity
Sedentary behavior
Excess weight gain
Ability to lose weight
Ability to maintain weight
Body composition and fitness

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HEALTH CARE – LECTURE OUTLINE

Health Defined
History of Health Care
Main Causes of Death
Obesity
Social Epidemiology
Health Care: An International Comparison
Sociological Perspectives

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SOCIAL EPIDEMIOLOGY

Age and health
Gender and health
Social class and health
Education and health
Race and health

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SOCIAL EPIDEMIOLOGY

Age and health
Gender and health
Social class and health
Education and health
Race and health

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In the US, death is rare among the young and chronic activity limitation is low.

Almost 21,000 infants died in the United States in 2018. The five leading causes of infant death in 2018 were:

Birth defects.
Preterm birth and low birth weight.
Injuries (e.g., suffocation).
Sudden infant death syndrome.
Maternal pregnancy complications.

As the figure above shows, children and younger adults (44 and younger) are less likely to have chronic activity limitation. However, as we get older, we face a wide variety of health problems. Health problems the elderly experience include arthritis, diabetes, heart disease, lung disease, mental illness, and activity limitations (making work, socialization, and exercise difficult).

Along with age, income is related to chronic activity limitation. The poor are more likely to experience chronic activity limitation compared to the not poor.

Discussion: Think now about your health. Has age impacted it? Post your comments to our discussion board.

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SOCIAL EPIDEMIOLOGY

Age and health
Gender and health
Social class and health
Education and health
Race and health

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Life expectancy is increasing in the United States. The figure above shows life expectancy by sex from 2000 to 2020. Note the significant decline in life expectancy in 2020.

In 2020, life expectancy at birth for the total U.S. population was 77.3 years, declining by 1.5 years from 78.8 in 2019. Life expectancy at birth for males was 74.5 years in 2020, representing a decline of 1.8 years from 76.3 years in 2019. For females, life expectancy declined to 80.2 years, decreasing 1.2 years from 81.4 years in 2019.

Even though women live longer than men, they experience higher rates of nonfatal chronic conditions. Men, on the other hand, experience higher rates of fatal illness and die more quickly than women when illness occurs.

https://www.cdc.gov/nchs/data/vsrr/vsrr015-508.pdf

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EXPLAINING GENDER DIFFERENCES IN HEALTH

Biology
Traditional sex-role definitions

Males are more likely to take risks, abuse alcohol, smoke, drive aggressively, and perform other behaviors that can lead to early deaths

Dangerous work and military service
Preventative maintenance
Women are twice as likely to get regular medical checkups
Education

e.g., cancer self-detection

Gender plays a significant role in life expectancy and types of health problems. Sociologists look for social factors to explain this disparity. Here is a list of explanations: 1) Biology. Though this is not a social factor, it seems that biologically men actually have more frail bodies than women. 2) Traditional sex-role definitions. Men are socialized to be more aggressive, violent, risk-taking, and self-reliant. These characteristics may lead to unhealthy behaviors. For example, males are more likely to take risks, abuse alcohol, smoke, drive aggressively, and perform other behaviors that can lead to early deaths. 3) Dangerous work and military service. Men are more likely to accept dangerous work as well as make up a greater portion of the armed forces in wartime. 4) Preventative maintenance. We find that women are more concerned with preventive maintenance of their health than men. Women are also twice as likely as men to get regular medical checkups. And related to regular checkups, women are less likely to experience life-threatening illnesses and health problems. 5) Education. Men are less educated about health. Though by the age of 75, men die of cancer at twice the rate of women, there is little education for men in cancer self-detection and prevention.

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SOCIAL EPIDEMIOLOGY

Age and health
Gender and health
Social class and health
Education and health
Race and health

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SOCIAL CLASS AND HEALTH

Those who are lower on such things as income, educational achievement, and occupational status have higher rates of:

Death
Cancer
Heart disease
Diabetes
High blood pressure
Arthritis
Infant mortality

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SOCIAL CLASS AND HEALTH

Those lower on the socioeconomic ladder have worse health than those above. This relationship has been attributed to:

Hazardous working conditions
Areas with high crime rates and drug problems also have negative effects on the health of inhabitants
Poor neighborhoods exposed to pollution
Inadequate and unsafe housing
Diet
Access to health care
Programs that help to give access to health care are poorly funded

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SOCIAL EPIDEMIOLOGY

Age and health
Gender and health
Social class and health
Education and health
Race and health

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EDUCATION AND HEALTH

The higher your education, the better your health
Schooling might be a more important correlate to good health than is one’s occupation or income.
Educated individuals are more likely to:

Practice a healthier lifestyle
Visit their primary physicians more
Use new medical technologies or medicines.
Be aware of the health consequences of smoking and drinking.
Transmit their healthier lifestyle to their children.

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SOCIAL EPIDEMIOLOGY

Age and health
Gender and health
Social class and health
Education and health
Race and health

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SOCIAL EPIDEMIOLOGY

Age and health
Gender and health
Social class and health
Education and health
Race and health

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HEALTH CARE – LECTURE OUTLINE

Health Defined
History of Health Care
Main Causes of Death
Obesity
Social Epidemiology
Health Care: An International Comparison
Sociological Perspectives

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Total Health spending, US dollars/capita, 2020 or latest available

United States 10 948.5
Switzerland 7 138.1
Norway 6 748.4
Germany 6 730.9
Netherlands 6 298.5
Austria 5 899.1
Sweden 5 753.6
Ireland 5 604.2
Denmark 5 477.6
Belgium 5 458.4

Russia 1 850.3
Bulgaria 1 842.0
Costa Rica 1 599.8
Colombia 1 276.2
Turkey 1 266.9
Mexico 1 133.0
South Africa 1 103.5
China 810.8
Indonesia 336.7
India 257.4

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Length of hospital stay, Acute care, Days, 2020 or latest available

Japan 16.000
Portugal 9.300
Russia 9.100
Canada 7.700
Germany 7.500
Italy 7.500
Luxembourg 7.400
Korea 7.300
Costa Rica 7.100
Switzerland 6.900

Iceland 5.500
United States 5.500
France 5.400
Hungary 5.400
Sweden 5.400
Israel 5.200
Netherlands 5.000
New Zealand 4.700
Australia 4.600
Turkey 4.100

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Life expectancy at birth (WHO 2019)

Japan 84.3
Switzerland 83.4
South Korea 83.3
Singapore 83.2
Spain 83.2
Cyprus 83.1
Australia 83
Italy 83
Israel 82.6
Norway 82.6

Chile 80.7
Peru 79.9
Maldives 79.6
Colombia 79.3
Panama 79.3
Czechia 79.1
Estonia 78.9
Croatia 78.6
Turkey 78.6
United States 78.4

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LIFE EXPECTANCY AND PER CAPITA GDP

Gapminder

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Countries With The Best Health Care Systems, 2021

South Korea
Taiwan
Denmark
Austria
Japan
Australia
France
Spain
Belgium
United Kingdom
Netherlands
Finland
Thailand
Czech Republic
Norway

New Zealand
Germany
Switzerland
India
United Arab Emirates
Israel
Portugal
Canada
Singapore
Ecuador
Greece
Argentina
Sweden
Mexico
United States

Here is a more recent ranking of health care systems by Ceoworld. Note that the US ranks relatively low compared to other highly industrialized countries. Again, though the US spends much more on health care than any other country, our health care ranking does not match the spending.

Discussion: Given how much we spend on health care, why do you think our health care ranking is not at the top? Post your comments to our discussion board.

Here is how they ranked the countries:

The Health Care Index is a statistical analysis of the overall quality of the healthcare system, including health care infrastructure; health care professionals (doctors, nursing staff, and other health workers) competencies; cost (USD p.a.per capita); quality medicine availability, and government readiness. It also takes into consideration other factors including, environmental, access to clean water, sanitation, government readiness on imposing penalties on risks such as tobacco use, and obesity. The ranking looks at 89 countries around the world on five different health variables.

Source: https://ceoworld.biz/2021/04/27/revealed-countries-with-the-best-health-care-systems-2021/

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HEALTH CARE – LECTURE OUTLINE

Health Defined
History of Health Care
Main Causes of Death
Obesity
Social Epidemiology
Health Care: An International Comparison
Sociological Perspectives

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FUNCTIONALISM: THE MEDICALIZATION�OF THE AMERICAN SOCIETY

The control and respect doctors are given led to the “medicalization” of America (see next slide)

Prevailing belief in the U.S. that we can find a pill for every problem

Ads for prescription drugs only make the problem worse.

Research has shown that consumers go to doctors requesting pills they’ve seen on television

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Medical model of illness

Illness is an objective label: All educated people agree on what is normal and what is illness. Example: Female sexual dysfunction (FSD) is a biological disease characterized by a lack of sexual responsiveness.
Illness is nonmoral: Conditions and behaviors are labeled illness scientifically, without moral considerations or consequences. Example: Labeling FSD an illness and labeling individuals as having FSD are neutral biological statements that do not reflect moral judgements of the condition or individual.
Illness is an apolitical label. Example: FSD was first identified by doctors through scientific research.

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Sociological model of illness

Illness is a subjective category: Educated people sometimes disagree on what should be labeled illness. Example: Female sexual dysfunction (FSD) is a label given to women who are distressed by their lack of sexual responsiveness with their current sexual partner.
Illness is a moral category: Conditions and behaviors are labeled illness when they are considered bad (deviant). Example: We label sexual nonresponsiveness an illness because we find it repugnant, and we typically look down on those who have FSD.
Illness is a political label: Some groups have more power than others to decide what is an illness and who is ill. Example: The concept of FSD was promoted by pharmaceutical companies to sell drugs.

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Sick role (Talcott Parsons): Expected behaviors and responsibilities appropriate for someone who is ill

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CONFLICT THEORY: MAKING A PROFIT

American medical care is a for-profit business (Jill Quadagno, 2004)

The U.S. is the only Western nation not providing some form of government-funded health care.
A number of structural barriers exist

Insurance companies and medical professionals have the most to lose from government-run health care

Lack of access

http://www.nytimes.com/interactive/2014/10/29/upshot/obamacare-who-was-helped-most.html?_r=0&abt=0002&abg=0

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The table summarizes the two views on medical dominance:

1) The professional dominance model argues that doctors have a high level of prestige, that the public defers to their medical judgment, and that patients feel loyalty to their doctors. The decline in dominance model argues that there has been a deprofessionalization of the medical profession. That is, there has occurred a decline in public confidence and respect for doctors, the public questions the medical judgment of their doctors, and patients feel little loyalty to their doctors.

2) The professional dominance model argues that doctors still hold a strong economic position. The decline in dominance model argues that doctors have become economically vulnerable, and the power of the American Medical Association (AMA) has declined.

3) The professional dominance model argues that doctors set their own working conditions. The decline in dominance model argues that doctors’ working conditions are now being set by corporate employers.

4) The professional dominance model argues that only doctors supervise doctors. The decline in dominance model notes that increasingly doctors are being supervised by nonmedical administrators and review boards.

5) The professional dominance model argues that doctors supervise and control other health care occupations. The decline in dominance model observes that other healthcare occupations are gaining considerable independence from medical control.

6) The professional dominance model argues that doctors act solely or largely based on their clinical judgment. The decline in dominance model argues that doctors’ clinical autonomy is constrained by corporate or governmental guidelines.

Discussion: Which model fits best what you have observed? Post your comments to our discussion board.

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SYMBOLIC INTERACTIONISM

Terms such as “right” and “privilege” make the difference when it comes to method of health care

If healthcare is a right, government must do something to make sure it’s fairly and equally provided to all citizens
If it’s a privilege, government need not do anything

Health care can be entirely privatized

Right now, American health care is established more as a privilege than a right

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APPROACHES TO DISEASE

Curative or crisis medicine: treating people’s illnesses after they become ill.

Effective approach with such infectious diseases as influenza, pneumonia, or diphtheria
With chronic diseases, much damage has already been done by the time symptoms manifest themselves

Preventative medicine: changes in lifestyle or other steps that help avoid the occurrence of disease.

There are two approaches to disease which can be called curative or crisis medicine and preventative medicine. Curative or crisis medicine refers to treating people’s illnesses after they become ill. Crisis medicine is an effective approach with such infectious diseases as influenza, pneumonia, or diphtheria, in which medical measures introduced after a person becomes ill can often return the person to complete health. With chronic diseases, however, much damage has already been done by the time symptoms manifest themselves and medical intervention occurs.

Preventative medicine refers to changes in lifestyle or other steps that help avoid the occurrence of disease. To date in the U.S., preventive medicine has had a considerably lower priority than has crisis-oriented medicine.

Discussion: What have you seen in the medical field? Have you seen more crisis medicine or preventative medicine? Post your comments to our discussion board.

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HEALTH CARE – LECTURE OUTLINE

Health Defined
History of Health Care
Main Causes of Death
Obesity
Social Epidemiology
Health Care: An International Comparison
Sociological Perspectives