Chapter 10 Medical Care Physical and Mental Illness

Chapter 10 Medical Care: Physical and Mental Illness Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

The Problem In Sociological Perspective • Not just biology § Social component • Industrialization and lifestyle § Greater affluence • Iatrogenesis § Illness caused by medical care staff • Changing ideas about health and illness Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

The Social Organization of Medicine as a Social Problem • An explosion in medical costs • Reasons for the explosion in costs Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

• Medicine for profit: a two-tier system of medical care § Medicine for profit is also known as a fee-for-service system. Two-tier system of medical care: 1. one for those who can afford insurance 2. another for those who cannot Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

• Medicine for profit: cesarean delivery • Why have cesarean births increased? § Profit § Convenience § Technology § Preference • A Feminist Controversy § Central issue is the relative power of women Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Physical Illness as a Social Problem • Life expectancy and infant mortality § Determines how healthy or ill a society is as a whole. • Infant Mortality Rate (IMR) • Number of babies who die before 1 year of age, per 1, 000 live births • Lifestyle • Heroic an Preventive Medicine • Quick care: Emergency Rooms and Drugstores • Uneven Distribution of Doctors Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Mental Illness as a Social Problem • Measuring mental illness • The social nature of mental illness § How we define mental illness is a matter of dispute Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

• A two-tier system of mental health delivery 1. the illness 2. the medical delivery system § Deinstitutionalization • The release of hospitalized mental patients into the community Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Symbolic Interactionism • Determining the meaning of symptoms and behavior § People from different backgrounds interpret health & illness differently • The significance of definitions § Views and meanings of health and illness change • Conflicting Referral Networks • Depersonalization Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Functionalism • Customs or social institutions fulfills social needs. • Free-for-Service Means Profits § It is difficult for doctors to make money if people are not sick • A self-correcting system Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Conflict Theory • Argues that the U. S. medical system is not self- correcting. • The poor are more often sick—they lack sufficient income and high-quality education, food, housing, jobs, and medical services Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

• Medicaid • Colliding Interests of Doctors and Patients § Doctors represent the dominant class § Patients are the subordinate class • Women’s Reproductive Organs § Hysterectomies Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

An Overview of Physical Health Problems • Historical changes in health problems § 6 of the 10 leading causes of death have remained the same according to Figure 10 -9. § Several of the top killers in both centuries are caused primarily by lifestyle and environmental pollution. Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

• Infectious diseases § The decline in infectious diseases § Stronger immunities, clean water, better food § The resurgence of infectious diseases • Develop new strains that are resistant Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

How Disease Is Related to Behavior and Environment: the Case of HIV/Aids • Background § Example of the relationship between behavior, environment, and disease § The disease no longer discriminates • A global epidemic § 30 million people have died § 33 million people around the world are infected now § 3 million more people are being infected each year Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

• HIV/Aids in the United States § Antiretroviral drugs (ARVs) • Halt the progression of AIDS • Combination of ARVs and education caused AIDS deaths in the U. S. to decrease § Race/ethnicity—higher rates of HIV/AIDS • Ominous changes § HIV virus mutates rapidly. Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Social Inequalities in Physical Illness • Poverty and health • Economic factors largely determine who will be healthy and who will be sick • Occupational health hazards § lower-class working environments • Reducing Inequalities: Health Care Reform Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Social Inequalities in Mental Illness • Social class and mental illness § People’s emotional well-being declines with decreases in social class. • Four explanations for the greater emotional problems of the poor: § The Drift Hypothesis § The Genetic Hypothesis § The Socialization Hypothesis § The Environmental Hypothesis Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

• Social Class Differences in Mental Health Care § Different types of therapies • Consequences of ability to pay § Type of therapy tied to a person’s ability to pay, not illness § Talk therapy § Pharmaceutical straitjacket Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Prepaid Medical Care: The Example of Managed Care • Managed Care § Health Maintenance Organization (HMO) • The positive side • Profits and a conflict of interest Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Physician Assistants • Strategy for controlling costs Training Physicians • Medical schools graduate about 16, 000 physicians a year. • Home health care § Less expensive and often more humane § Preventative Medicine Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Domiciliary Care • Home health care, or domiciliary care § Treatment given within a patient’s home § Less expensive and often more humane § May involve profiteering § Another approach: create domiciliary programs for mentally ill Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved

Preventive Medicine • Preventable deaths • Three types of preventive medicine: § Primary prevention § Secondary prevention § Tertiary prevention • Food and health § Proper nutrition and exercise • Immunizations • Preventing drug abuse and homicide • Eating ourselves to death Social Problems: A Down-To-Earth Approach, Tenth Edition by James M. Henslin © 2011 Pearson Education, Inc. All rights reserved