CH. 13. Health Flashcards
1
Q
Health
A
HEALTH – the state of being free of illness or injury.
ILLNESS – A disease or period of sickness affecting the body or mind.
- The disadvantaged in societies suffer illness at far greater rates than do the wealthy – because they are exposed to health problems more often and are less likely to have health insurance.
MEDICAL MODEL – To cure diseases, we consult with doctors, use medications, and adopt physical strategies such as resting.
- It is helpful to think of:
- disease as the thing that affects the body, and
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illness as the social environment that accompanies the disease.
- Social and environmental factors place people at greater risk for the disease.
- This view helps us understand the interaction between the sick individual and society.
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Why are some illnesses seen as the fault of the individuals who contract them?
- Individuals don’t have total control over the conditions that place them at risk.
- Medical treatment is often seen as the solution to these problems. Instead, we should look at societal causes and focusing on preventing the illness from occurring in the first place?
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Treatment is not simply a method of curing illness. It incorporates wider social expectations about appropriate social behavior (e.g. not sharing needles) of both the sick person and others who interact with them.
- EX: Consider depression. If the medical profession links this illness directly to serotonin level and other bodily symptoms, why do we treat it differently from other physical illnesses?
SOCIAL BEHAVIOR – Itself may be labeled as a disease.
MEDICALIZATION – defining social behavior as a medical problem.
- Recent additions and amendments to the Diagnostic and Statistical Manual of Mental Disorders (DSM) medicalize behaviors that traditionally were never thought to be illnesses or medical problems.
- EXCORIATION DISORDER – Obsessive-compulsive skin picking.
- HOARDING DISORDER – packing your home full of so much shit, you can’t move within it.
- There is an increasing scope of MEDICALIZATION in the DSM that it stated were “clearly based on social norms, with ‘symptoms’ that all rely on subjective judgments.” The diagnoses “reflect current normative social expectations.”
- EX: Since this diagnosis was added to the DSM, the U.S. Food and Drug Administration (FDA) has approved a drug called Addyi for low sexual desire among premenopausal women. The medicalization cycle is complete here: There is a diagnosis and a medical treatment to address it.
- Pharmaceutical companies have become increasingly important agents in the medicalization of life (because it is profitable to them).
- The labeling of certain behaviors as illnesses may exceed the traditional functions of medicine and may reflect prevailing norms and prejudices.
2
Q
Characteristics of a Medicalized Society
A
MEDICALIZED SOCIETY – One in which we explain social problems in medical terms.
- EX: Responding to social encounters with heavy drinking is deemed a disease.
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EX: Being exceedingly shy may be labeled as “social anxiety disorder.”
- Research regarding the prevalence and incidence of ADHD reveals how, as societies develop over time, certain behaviors may become medicalized.
FOUR GENERAL POINTS OF MEDICALIZED BEHAVIOR:
- Medicine sets the limits of normal behavior and defines people as sick who fall outside these limits.
- It labels the deviant and the nonconformist as sick. The medicalization of society exceeds the diagnosis and treatment of physical conditions and extends into the labeling and control of social and behavioral deviance.
- So the way medical problems are produced is the result of social factors.
- The way we assert social issues as medical problems has great significance:
- It makes illness the fault of the individual’s behavior and independent of their existence in a wider social environment.
- EX: Obesity is often conceptualized as a problem with that person’s will or morality, regardless of the environmental influences (e.g. where they live may not provide healthy food or safe places to exercise).
- MEDICALIZATION makes these problems appear to be products of nature—of genetics, of biological dysfunction, or of innate characteristics of individuals and IGNORES Societal factors. Thus it puts the problems beyond political and social interventions and solutions.
**^^* THIS IS THE PROBLEM WITH MEDICALIZATION *^^**
- Medical solutions to social problems give additional power to health care providers and systems, and individuals who refuse treatment may face being labeled as “bad patients” who are at fault for continuing to experience their conditions.
- IMPORTANT >>> It deems medical issues to be largely the consequences of personal choice, rather than recognizing that disease and illness occur within a framework of hierarchical social structures and broader governmental policies.
3
Q
Two False Assumptions About Health
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TWO FALSE ASSUMPTIONS ABOUT HEALTH:
- FALSE - Genetics explains illness and disease to the exclusion of social factors.
- FALSE - People have control over the factors that make them ill.
- We must think of disease as being as much a SOCIAL PROCESS as a BIOLOGICAL PRODUCT OF NATURE.
- Illness and disease are the products of biology, genetic risk factors, and personal behaviors.
- However, all these factors operate within social arrangements that heavily influence both who gets ill and what makes them ill.
4
Q
FALSE - Genetics Alone Explains Disease
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GENETICS ALONE DO NOT EXPLAIN DISEASE – Genetic explanations are offered regularly for a range of conditions and illnesses, including obesity, drug addiction, and alcoholism.
- There is no evidence for a genetic contribution to what are actually cultural practices such as drug use, nor any scientific justification for making negative moral evaluations couched in the language of medical science.
- The categorization of such behaviors as illnesses thus lies not in science but in a social evaluation of them.
SOCIOLOGIST – Rather than view illness as an individual problem, they analyze illness by social factors such as ethnicity, socioeconomic status, age, and gender to better understand how broader patterns of social inequality result in health inequalities—both Illness (morbidity) and Death (mortality).
- By reducing the explanation of disease to biology alone, the genetic explanation systematically excludes sociological explanations and deflects our attention from the ways in which social life shapes our experience of disease.
- This view comes from BIASED SOCIAL CONSTRUCTION variables of politics, economics, gender roles, and social marginalization on the basis of race and ethnicity.
5
Q
FALSE - Poor Lifestyle Choices
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POOR LIFE CHOICES are INFLUENCED by SOCIETY – The second flawed assumption is that people adopt lifestyles that make them sick, freely making bad choices about diet, smoking, and exercise, and are therefore individually responsible for their conditions.
- However, from a social problems perspective, remember that individual lifestyles are themselves socially patterned and that those lower down in the stratification system can make fewer choices about the foods they consume, the exercise they take, and even their smoking and drinking habits.
6
Q
Common Features of FALSE Assumptions
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COMMON FEATURES – These flawed assumptions have two common features:
- First, they FALSELY claim that when an individual becomes diseased, it is a problem of the individual’s own body and unique biology.
- Health and illness are heavily determined by patterns of social inequality.
- Second, even if lifestyle behaviors were the sole cause of disease, extensive studies have shown that it is almost impossible for people to change their lifestyles on their own and in isolation from their social circumstances.
- The social factors that predispose people to adopt unhealthy lifestyles—work stress, for example—are often ignored in treatment plans that focus on individual-level causes like diet, cholesterol, or drinking.
7
Q
Patterns and Trends
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PATTERNS AND TRENDS:
WHO GETS SICK?:
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People from disadvantaged backgrounds choose to smoke more, drink more, and exercise less, choices leading to biological changes that cause disease, damage health, and lead to shorter lives.
- Sociologists’ argument is that disease is NOT caused by purely biological factors and individual choices. On the contrary, individual lifestyle choices are shaped socially.
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People from lower socioeconomic backgrounds drink more, smoke more, eat less healthy diets, and exercise less than those in higher socioeconomic groups. But these decisions are not made in a vacuum and should not be considered pure choices.
- Rather, a wide range of mediating social factors intervenes between the biology of disease, individual lifestyle, and the social experience to shape and produce disease.
- These factors range from standards of housing and workplace conditions to emotional and psychological experiences at work and at home, to men’s and women’s social and gender roles, to membership in status groups based on ethnicity.
- Rather, a wide range of mediating social factors intervenes between the biology of disease, individual lifestyle, and the social experience to shape and produce disease.
STATUS GROUP – Social groups that are either negatively or positively privileged – also shape the experience of health within a population.
- EX: Landlords who neglect apartments place children at risk for asthma because of their exposure to molds and cockroaches, known asthma triggers.
- EX: Employers who allow substandard working conditions can make workers more likely to get sick (including textile factory workers) or injured on the job (such as meatpacking factory workers).
- SOCIAL GRADIENT OF HEALTH – sliding scale where your socioeconomic status shapes your exposure to health problems.
Growing Inequality and Its Impact on Health:
- Who gets sick, when we die, and what we die of are closely linked to wider patterns of inequality in society.
- Poor people have a much higher mortality rate than do those at the top. They suffer from more chronic illness, and their children weigh less at birth and have shorter bodies.
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Inequalities in access to health services.
- Countries with relatively minor differences between the richest and poorest are the healthiest.
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GINI COEFFICIENT – Index measuring the level of inequality in society:
- A coefficient of zero indicates total equality and a coefficient of one indicates total inequality.
- Age at death and cause of death are all linked to social class
8
Q
Women’s Experience of Health
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WOMEN”S EXPERIENCE OF HEALTH:
- United States in 2013, women’s life expectancy was 81.2 years and men’s 76.4.
- There is an underlying theme in the literature that women’s health problems are aberrations from male norms.
- In Western cultures, where aging is negatively perceived and womanhood is strongly associated with fertility, menopause is overwhelmingly understood as a problem requiring medical treatment.
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Several factors explain women’s higher rate of medical diagnosis:
- childbirth
- prenatal care
- birth control
- Women are encouraged to have Pap smears for cervical cancer and mammograms for breast cancer detection.
- Women are also overrepresented in health statistics as a consequence of their caretaker roles for children.
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women and men are socialized to experience and report their bodily sensations differently – where women are more likely to consult doctors based on how they feel, whereas men are more likely to avoid consultation with doctors.
- Men are less likely than women to be diagnosed as suffering from stress or depression and more likely to be diagnosed as having physical ailments
9
Q
Men’s Experience of Health
A
MEN’S EXPERIENCE OF HEALTH:
- Still not the norm for women to engage in contact sports, reckless driving, and other displays are traditionally associated with masculinity.
- Construction and other jobs, such as mining, that require significant manual labor continue to be dominated by men.
- The mere fact of performing demanding physical labor for 8 hours a day over many years creates stress and injuries.
- Men tend to delay visiting doctors and to underreport pain or other symptoms in medical encounters.
- Thus men’s reactions to ill health may well be to protect their socially determined sense of gender identity from threats.
10
Q
Socioeconomic and Occupational Differences
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SOCIOECONOMIC AND OCCUPATIONAL DIFFERENCES:
- A person in a lower socioeconomic demographic has greater exposure to stress and hardship and more limited access to valuable resources such as food, housing, health care, and medical knowledge.
- Members of lower socioeconomic groups are also more vulnerable to the worst effects of urbanism: slum dwellings, poor ventilation, garbage, and overcrowding.
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Exposed to the unregulated labor market of sweatshops and home work.
- The poor pay higher cash costs; have less access to informal sources of financial assistance, such as friends and family; and depend on insecure incomes. Ironically, the poorer you are, the more it costs you to live.
- Cancer is one of the leading causes of work-related deaths in the United States, contributing to a much higher proportion of fatalities than workplace accidents or injuries.
- It is increasingly recognized that the health of the individual worker does not necessarily have to be physically at risk for the impact of capitalist employment practices to make themselves felt.
- Lack of autonomy at work, lack of control over the production process, and separation from fellow workers—the key components to Marx’s account of alienation—are all causes of disease.
11
Q
How Race and Ethnicity Influence Health
A
HOW RACE AND ETHNICITY INFLUENCE HEALTH – Racism affects minority racial populations directly in three ways:
- INSTITUTIONAL RACISM (policies and procedures that reduce access to housing, education, employment, and other life opportunities).
- CULTURAL RACISM (policy environments that involve stereotypes and are hostile to policies).
- INTERPERSONAL RACIAL DISCRIMINATION (which causes psychosocial stress and may alter behavioral patterns, increasing health risks)
12
Q
The Government: Obamacare
A
THE GOVERNMENT: OBAMACARE:
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Health care in industrialized nations has traditionally been provided by the government – called UNIVERSAL HEALTH CARE – but NOT in the US.
- 47% of people have employment-based private insurance,
- 7% had individual private insurance,
- 33% had government-financed insurance (such as Medicare for elderly people or Medicaid for low-income people)
- 13% remained uninsured = 44 million people
The US DOES NOT HAVE UNIVERSAL HEALTH CARE.
- Patient Protection and Affordable Care Act (ACA) of 2010 – known as “OBAMACARE” – first and biggest step toward Universal Health Care in America. Provided the following:
- The new law stipulates that all U.S. citizens are to have health insurance by 2014 or pay a penalty.
- Companies with 50 or more employees are required to provide health insurance to their employees.
- Those who do not have coverage can shop for insurance through so-called health insurance marketplaces that make private plans comparable and accessible.
- Young people are now able to stay on their parents’ insurance plans until they are 26 years old.
- This legislation changed the regulation of insurance companies, which now must insure everyone, including those who have preexisting conditions.
- Before the passage of this law, 44 million people in the United States did not have any form of health insurance (ObamaCare Facts, 2013).
13
Q
Medical-Industrial Complex
A
MEDIAL-INDUSTRIAL COMPLEX – The medical-industrial complex is a large and growing network of private corporations engaged in the business of supplying health care services to patients for profit. This gives them undue power to determine how medical care is seen and distributed.
- In the 1970s and 1980s, the private sector purchased many independent hospitals and health services, and chains of related services were forged together under large corporate structures.
- HORIZONTAL INTEGRATION – Broad ownership across an industry or industries – giving a broad and dominant market share to a single company (or several large companies).
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VERTICAL INTEGRATION – Owning all aspects of an industry from the bottom retail level to the highest levels of production.
- EX: Health Industry companies will own walk-in clinics, hospitals, labs and also control the referral networks and insurance outlets. They would control health providers to funnel consumers through health networks, referring patients to affiliated specialists, radiologists, pathologists, and hospitals.
- Community family doctors have been replaced by larger clinics.
- Company directors and managers have a duty to exercise their powers in the best interests of their companies on behalf of their shareholders’ financial interests.
- In contrast, governments’ interest in health care is to promote the public good.
- Thus the goals of public and private enterprise are at odds in the context of health care.
14
Q
Pharmaceutical Companies
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PHARMACEUTICAL COMPANIES:
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Expenditures on prescription medicines account for approximately 15% of the U.S. gross national product.
- Because they are private companies seeking to further their profits, pharmaceutical companies actually benefit from a sicker society.
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Pharmaceutical advertising to consumers is another form of:
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MEDICALIZATION, the definition and treatment of social issues as medical problems.
- Pharmaceutical advertising can change our social perceptions of what it is to be healthy and what is normal behavior or bodily function.
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MEDICALIZATION, the definition and treatment of social issues as medical problems.
15
Q
Alternative Practitioners
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ALTERNATIVE PRACTITIONERS:
- “Alternative” medicine shares many of the characteristics of orthodox medicine: focusing on the individual rather than on social factors as the source of disease and increasingly depending on a wide range of preparations marketed by multinational drug companies.
