Chapter 10: Health, Illness, and Health Care Flashcards
Health
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
(World Health Organization, 1946)
Relavant Terms
Acute disease; Chronic disease Disability Ableism Obesity Mental disorder; Mental illness Life expectancy Infant mortality rate
Social Determinants of Health
Social determinants of health (SDH) are the economic and social conditions that shape the health of individuals, communities, and jurisdictions as a whole.
Factors in the Social Determinants of Health
Material Resources Access to housing clean water clean air food access to necessary drugs, immunizations and health care
Lifestyle smoking risky sexual practices drinking exercise
Family/community supportive mutual aide relationships stability/integration into community decision making authority privacy
Social-psychological stable secure employment supportive work relationships education coping abilities sense of coherence social readjustment emotional stability sense of efficacy
History of Medicare
prior to 1940s health care was based on ability to pay
1947 SK first province to set up a public insurance plan
1961 all provinces and territories established public insurance plans for in-hospital care; cost-sharing with feds
1968 SK first province to include doctors’ services outside hospitals; feds cost-share
1972 all provinces, territories join Canadian medicare is an interlocking set of 10 provincial and 3 territorial health insurance plans linked through adherence to national principles
1984 Canada Health Act
1990s massive cutbacks in federal transfers to provincial healthcare
cuts = from 50% (1960s) to ~ 38% (1970s) to ~ 15% or less (1990s)
2003 some re-investment
The National Principles of Canadian Medicare
Universality (all Canadians and residents in Canada are covered)
Accessibility (unimpeded by financial or other barriers)
Comprehensiveness (all medically necessary services)
Portability (across provinces, territories)
Public Administration (not-for-profit)
But changes to policy and funding cutbacks have eroded these national standards implications for social inequalities
Issues in Canadian Medicare
Coverage of Care Accessibility and wait times Costs of Care Supply and Demand of Health Care Professionals Quality of Care Use of Technology
Healthcare as a Public Good
Is health care an entitlement or a privilege?
A right of citizenship available to all or a commodity available to those who can pay?
Argument: patients ≠ consumers
Functionalism
Illness is a threat to a functioning society
“Sick role” = rights and responsibilities
Problems come from macro-level changes, eg. technology, pharmaceutical research, reduction of hospitals, increased consumer demand
Solutions lie in incremental changes to the system, eg. strengthening home care, more equitable drug coverage, alternative payment methods for doctors
Conflict Perspective
Problems are rooted in the capitalist economy in which medicine is a commodity for sale to the highest bidder.
Public health care is more equitable than private.
recognition of the social determinants of health
medical-industrial complex = health-related industries control the costs of the healthcare system
iatrogenesis = Medical problems caused by doctors and the health care system
Interactionism
Health problems and their solutions are socially constructed.
research: self-help; personal narratives of health and illness
Feminism
medicalization = treatment of a person’s natural condition as though it were an illness, eg. pregnancy
Symptoms and course of diseases can be different for men and women.
More attention needs to be paid specifically to women’s health.
Heath
is a state of complete physical mental and social well being(WHO)
Life Expectancy
An estimate of the average lifetime of perplexed born in a specific year, is relatively easy to measure - females 83.3 and makes 78.8
Health services accounts for 15% of the GDP in the US and 11.6% in Canada in 2012
Canadian live on average 3 years longer than an American
Infant Mortality Rate
The number of deaths of infants under one year of age per 1000 live births in a given year.
Important indicator of a countries preventative prenatal care, maternal nutrition, childbirth procedures and care for infants
Acute Diseases
Illnesses that strike suddenly and cause dramatic incapacitation and sometime death
Still common in canada and include chicken pox and some strains of influenza
Chronic Diseases
Illness that are long term or lifelong and that develop gradually or are present from birth
Manufacturers of illness - groups that promote illness causing behaviour eg. Smoking
Sex Gender and Indigenous Status
There is an inverse relation toon between age specific mortality and income
HIV diabetics and suicide highest rates
2nd quintile 12% richest, 3rd Quintile 21%, 4th quintile 35%, and 67% for the poorest quintile.
2-3 years exist between the indigenous people and population
Disability
Can be defined in several ways
Medical professionals tend to define it in terms of organically based impairments
Disability rights advocates define it as a disability that stigmatizes physical or health condition that stigmatizes or causes discrimination
Rose Weitz(2010) Diability Definition
Is a restricted or total lack of ability to perform certain activities as a result of physical or mental limitations or the interplay of these limitations, social responses and the social environment
Older people have more disabilities than young
Women have a higher prevalence of disability than men
Disability as a social Problem
Because among other problems people with disabilities have higher unemployment rates and lower incomes than those without disabilities
Ableism - prejudice and discrimination because of mental or physical disability
The number of people with disability increasing because of technology
HIV,AIDS
Can be a criminal and human rights issue
Acquired Immune Deficiency Syndrome
2012 - 25% of those who’s where aware of the disease
From 2011-2010 down and then it is like a rollercoaster
Causes - unprotected sex (61.4%)
Heterosexual contact (64.5%)
Injection drug use 29.9%)
Obesity
Is most prevalent in the US
Excess weight is linked to heart disease
A person with a BMI under 18.5 is considered underweight
18.6 - 24.9 is considered normal
One third of Canadians are overweight and 18.9% are obese
Middle aged people being most likely to be obese
Obesity: prejudices and discrimination
They would call this the equivalent of ableism
Mental Illness as a Social Problem
Most social scientists use mental disorder and illness interchangeably
Medical professionals distinguish between the two
Disorder - condition that makes it difficult to deal with normal life events
Illness - a condition that requires extensive treatment with medication, psychotherapy, and sometimes hospitalization
Mental Disorders
Change with every revision of the DSM
Homosexuality used to be a disorder - because of how we view disorders culturally
1/3 of Canadians experience some form of disorder or substance abuse disorder
Mental illness are affected by gender, age, class and indigenous status
Statistics on Mental Health
Females have the highest rate of mental illness
Shows that young people are more likely than older people to experience these problems
Shows men have higher rates of substance abuse disorder
People in the lower classes have higher rates of mental disorders
Mental Disorders and Class
Harley Dickinson (2022) this relationship could be explained by the downward drift hypothesis - people with mental illness are unable to function properly therefore getting an education nor keeping a job
suicide rates of First Nations youth 5 -6 times as great as for non-Indigenous youth
Suicides from Inuit youth are among the highest in the world
Treatment of Mental Illness
Deinstitutionalization is the practice of discharging patients from mental hospitals into the community - social scientists now see this as a problem
Total Institutionalizations - a place where people are isolated from he rest of society for a period of time and come under the complete control of officials who run the institution
“Crisis” in Canadian Health Care. Development of the National Health Care System
1957 - Hospital insurance and diagnostic Service Act
1966 - Medical Care Act - provided insurance- all provinces agreed
1972 - emphasized five principles - universality, accessibility, and reasonable access unimpeded by finances, comprehensive, probability
1984 - confirmed the five principles
1990s - government cut backs - only 26% of what had been
The Liberal Government and Health Care
Feb 2003 - Liberal government injected $35 billion into the health care system
This increased to $41 billion in the 2005 budget
Issues in Health Care
Accessibility and wait times
Electronic Health Records
Costs of Care - Hospitals $30 of costs - two tier system
Supply and Demand of Health Care Professionals
Canada gets a score of B in Health Care
Quality of Care
Functionalist Perspective on Health Care
Illness people cannot fulfill their appropriate social roles - when they become ill they cannot fulfill their everyday responsibilities to family, friends, and their employer - they adopt a sick role
They adopt a sick role - sick people are not responsible for their incapacity, they are exempted from their usual role and task obligations, they must want to leave the sick role and get well
Functionalist Perspective: Talcott Parsons
Illness as a form of deviance that must be controlled. Physicians are the logical agents of social control.
By certifying that a person is physically or mentally ill and by specifying how the ill person should behave, doctors use their professional authority to monitor people with illnesses, thereby granting them only a temporary reprieve from their usual social roles and responsibilities
Mental Illness: Functionalist Perspective
The duties of the sick person:
Maintaining health and managing illness
Engaging in routine self health management
Making use of health care resources
Believe that problems are in the Macrolevel changes
Functionalist Perspective Problems with the Health Care System
The development of high tech medicine
Overspecialization of doctors
Overdiagnosing of patients
Increased demand for healthcare by consumers
Disrupts the equilibrium of the system - there need to be improvements to wait times and such.
Conflict Perspective
Based on the assumption that healthcare is a common good the should be provided and regulated by the government just like highways,schools and national defence
The affordable health care act is making it possible for all those who want insurance to have it, even those with predicting conditions
Conflict Perspective: Medical Industrial Complex
The industry that produces and sells the health goods and services
Joel Lexchin (2002) - argues that when profit and health considerations come into conflict, profit is likely to be the primary consideration Eg. saying-arthritis drug benoxaprofen, where the company did not mention to the Canadian Health Protection Branch reviewing - the drug the eight deaths had occurred in Britain.
Conflict Perspective and inequalities on Race, Gender, income
Needs to be a more comprehensive approach to healthcare is implemented that not only includes healthcare, but also lifestyle and the environment will inequalities in health outcomes be eliminated
Iatrogenesis (Ivan Illich) Conflict Perspective
Cultural atrogenisis - when the system undermines a persons ability to take care of themselves
Coined the term to call attention to the unintended negative effects of doctors and suggest that the doctor parties relationship should demystified
Clinical iatrogenesis - when pain sickness and death result from medical care - Canada places 7th among 15 high income nations
Social iatrogenesis - occurs when the health care system creates dependency on the system eg. Home births
Interactionist Perspective
In the past people relied on doctors now they have google for self diagnosis - write a daily report on their condition so that friends can keep up with how they are doing with their condition.
Believe that many problems pertaining to health and illness in our society are linked to social factors that influence how people define our health care
Socially constructed notions of what is defined as “crisis”
Interactionsists like telehealth such as people learning whether or not they should see a doctor
Interactionist also concerned with how people construct their own health in order to be producers, rather than consumers of health (Karen Green 1985)
Regulatory - excersising
Preventative - eating well
Reactive self care - determining what to do when one feels ill
Restorative self care - medications or part compliance, self determination
Feminist Perspective: Concerned about the presence of women in the medical profession, the way that women are treated, social determinants of health
Examine the extent to which women are treated in a disadvantageous manner in health or healtcare processes like medicalization
Medicalization is treating a persons condition like it is an illness
Healing became “men’s work” and “women’s bodies” became a lucrative new territory for profit making
