Wk: 4 Health Flashcards
Pre-modern health: Personalistic systems
The person feels ill due to being
cursed or engaging in forbidden behaviour wherein
enemies, gods or supernatural entities intend harm.
Pre-modern health: Naturalistic systems:
We seek balance and harmony within the person. The person is sick due to substances or forces within the person being out of balance.
* For example, the four humors of blood, yellow bile, black bile, and phlegm
Biomedicine definition?
The form of medicine that emerged in
Western modernity. Its characteristics include a
physical and theory-based model of the body
constructed through a scientific knowledge base.
The term is often expanded to include medical
institutions.
* Emerged over the last 300 years
The mind and body are separate and do not
influence each other except in regard to
psychological illness.
* The body is a machine made up of systems –
for example, the nervous and circulatory
systems. These systems are targeted in
scientific medical intervention rather than
the whole person.
* Biomedical knowledge is supported by social
structure – hospitals, clinics, a regulated
profession, the pharmaceutical industry and
research institutions rather than community
organisation
What is Medicalisation?
Medicalisation: The process in which medical
knowledge and power come to expand their sphere
of influence, often needlessly defining more and
more things as ‘medical issues’.
* Lockdowns and restrictions placed upon our
interactions with others can be seen as increased
medicalisation. Other examples include pregnancy
and recreational drug use.
What is Medical dominance?
A term referring to the power of medical institutions, professions and knowledge. This includes defining illness, controlling patients and
monopolising certain activities.
* Do the health benefits of medicalisation
lend to a loss of freedom?
* Do we lose power to engage in self-
reflection about our own being?
* Medicalisation limits our reflection upon the
processes of birth, pain, and death in a
holistic non-medical way. One could argue
that our ability to reflect upon our own lives
is limited by medical processes.
Key Theorist Foucault: The
Medical gaze. What is it?
Medical knowledge is a tool of
repression, shaping us based on
dominant discourses and subjecting
us to invasive treatments from
‘experts’ within repressive
institutions.
- It stems from broader Western trends
of discipline, surveillance, and control.
- The medical gaze interprets patients’
stories solely through a biomedical
lens, disregarding anything non-
biomedical.
- As a result, the patient’s voice and
humanity may be ignored and
devalued
Marxism: Health, Class and
Capitalism
In the health system, wage inequality and class dominance are prevalent.
* Doctors receive higher salaries compared to nurses, and nurses earn more than cleaners.
* Occupational mobility is limited.
* Core institutions and hospitals concentrate wealth, leading to reduced
market forces due to monopolisation by larger corporations.
* This results in the promotion of costly medical procedures, medicalisation,
and an expanding market.
* Certifying illness and health ultimately exercises control over citizens. For
example, providing a minimum level of health for the workforce ensures an
adequate supply of workers to meet the needs of the capitalist system
Feminism within health - a conflict theory:
- The modern medical system is run by men and serves male interests.
- The rule of men and women was once supported by religion but is now supported by science and traditional women healers have been marginalised
- Traditional skill areas have been appropriated (e.g., midwifery)
- Childbirth, diet and weight, mental wellbeing, ageing, beauty and menstruation are now seen as medical problems which results in women having less control over their own bodies.
- Women tend to be medicalised more than
men due to external markers of biological
processes (e.g., menstruation), are more
likely to come into contact with medical
system (e.g., more doctor visits), and are
more structurally vulnerable in a society
and medical system dominated by men - Outside of the professional medicine,
women have do a lot of the caring which
disrupts education, employment and self-
fulfillment. - Conflict theory: Men have maintained a
position in which they keep the more
prestigious jobs and the more higher paying
jobs. One could argue that this maintained
through men occupying higher ranking
positions.
Doctor-Patient Interaction, the Sick
Role and functionalism
- The doctor-patient interaction involves a cooperative interdependent cure-seeking relationship within a hierarchy.
- Health and effective care are vital for societal functioning.
- Sickness encompasses more than a physical state; it holds a functional social identity.
- The sick role within the doctor-patient interaction is defined as shared understandings about appropriate behavior for the sick,
including seeking improvement and following medical advice. - Being in the sick role relieves individuals from customary social obligations and expectations.
Illness affects societal function, underscoring the importance of maintaining health and embracing the sick role when necessary
Sickness is sanctioned deviance that has to be minimised.
* To reduce social disruption the role of the sick person
must be defined in their expectations, rights and
obligations when they wish to be relieved of normal
responsibility. This includes:
* Not wishing to be sick or to become sick while not
being held responsible for their condition
* Acknowledging illness as undesirable and taking
action to address it.
* Accepting help, particularly from medical
professionals.
* Hence why you are required to obtain a medical
certificate when you need an extension
Erving Goffman and the Asylum (linked to
symbolic interactionism)
Goffman studied how people use
interactions, procedures, and
situational definitions in the health
system.
* Symbolic Interactionism and
Labelling Theory propose that
social groups define deviance by
establishing rules and applying
them to individuals, labeling them
as outsiders.
* The mentally ill, having violated
societal norms, are often reported
to authorities like the police or
doctors, resulting in labeling and
exclusion
Admission to a total institution involves
the removal of the old identity and
imposition of a new one through a rite
of passage. This includes taking away
personal clothing, providing
institutional clothes, taking
photographs, and showing living
quarters – all symbolic interaction
- Identity within the institution is
strengthened by rigorous rules and
fixed schedules
What is total institution?
A total institution is a formal
organization characterised by
hierarchy, closed boundaries, and
strict regulations, and the hospital can
be considered one.
- Leaving the institution depends on
compliance motivated by sanctions
and rewards, such as eventual release
What is the Rosenhan experiment?
Rosenhan’s famous study attempted to demonstrate the unreliable nature of psychiatric diagnosis in the 1970s and how poorly patients were treated in psychiatric hospitals.
What is Julis Roth: Moral Evaluations (Roth,
1972)?
- A study of how American hospital emergency
rooms and how the ‘social worth’ of patients
affects their treatment. - Young, wealthy, middle-class, and white patients
were considered more deserving of care. - Older individuals, minorities, those with poor
living conditions, and welfare recipients were
seen as undeserving and taking advantage of
taxpayer funds. - Cases perceived as minor, difficult to diagnose, or
manageable in outpatient clinics received less
attention compared to those requiring surgery. - Psychiatric cases, venereal and gynecological
problems, as well as drug-related issues, faced
stigma and unpopularity.
Let’s talk about hospitals!
- Hospitals have a dual structure of power and
authority: bureaucratic/managerial personnel
and professional/medical personnel which
sometimes leading to conflict. - The less powerful, such as nurses, are thus
subject to these contrasting forces (e.g.,
finish on time vs stay on until the procedure
is completed). - Hospitals are a negotiated order. A situation in
which social conduct is determined not so much
by formal rules as by informal understandings
shared by people in a setting. For hospitals,
rules can not be precise enough to cover every
contingency (e.g., what to do in an emergency). - However, some may have more power than
others in this negotiation process.
Hospital criticisms?
- Hospitals are expensive and more
focus could be placed on
preventative or community medicine. - Some argue there is a sense of
patient alienation that involves
degradation and petty rules. - High levels of iatrogenesis wherein
illness arises as a result of medical
procedures. For e.g., side effects
and infections.
Seeing and Not Seeing the Doctor
- People experience symptoms of illness more
than they see the doctor. Instead, we go to
the pharmacy, rest, wait it out, or ignore the
problem. - 50% of Australians have at least one of 8
long lasting health conditions (AIHW,
2018a). - The majority of us (85%) see a GP once or
twice (RACGP, 2018). - We often believe that seeing a doctor will
not lead to improvement.
Barriers to seeing the doctor?
- Cost
- Ethnic, class-based and cultural
difficulties - Lack of information on
available services - Geographical distance
- Fear of looking stupid, wasting
the doctors time, and
embarrassment
So, when so we see the doctor?
When the benefits outweigh the barriers.
* Zola (1973):
* Social factors determine when we see the
doctor which include:
* Interpersonal crisis
* Our medical condition interferes
with interpersonal relations
* Sanctioning of the sick person,
* An interference in ability to conduct
work
* Perceived implication of sickness
Intended consequences of Medicare?
- To cover the cost of treatment in public hospitals
- To subsidise the cost of health services and medications
- To ensure all Australians have access to access to healthcare
Unintended consequences of Medicare?
- Initially, it was expected that 50% of Australians would retain private health care, but only 31% did.
- Health costs continue to rise each year.
- Who covers this cost? We do.
- Treatment becomes delayed.
- People don’t receive adequate timely care.
What is Epidemiology?
The study of the distribution of
disease through populations. This is
often a quantitative activity involving
large data sets. Epidemiologists ask:
* What is the distribution?
* Who the disease any why?
* Has there been an increase or
decrease?
* Which interventions are effective?
What are causes of death?
- Life expectancy is increasing due to a
reduction in mortality rates. - Less deaths due to cholera, typhoid,
plagues and tuberculosis. - Less deaths due to improved
sanitation, water supply, hygiene,
diet and reduced family size. - Lesser deaths are largely due to
improved social and economics not
biomedicine. - The leadings causes of death, in order,
are heart disease, stroke, dementia and
cancer (AIHWa). - Are we living past our used by date?
What Affects Morbidity?
- Morbidity: The condition of suffering from a disease or medical condition
- Mortality: Death but usually referred to as ‘morality rate’
- Higher social grouping is linked to better health (for e.g., having higher socioeconomic status).
Lower socioeconomic status individuals have higher levels of almost every major illness associated with morbidity and mortality due to:
* Diet
* Access to medical services
* Knowledge of health
* Smoking and drinking rates
* Competence and assertiveness in doctor interactions
* Exposure to environmental pollution and general risk
What is Morbidity?
The condition of suffering from a disease or medical condition
What is Mortality?
Death but usually referred to as ‘morality rate’
Wealth as it relates to health?
- Wealth buffers against poor health
- Lower wealth is associated with higher
rates of health problems. - Lower-income individuals are more likely
to experience health transitions from
good to poor. - Income disparity significantly influences
health outcomes. - Those in the top 20% of wealth tend to
have better overall health and fewer
health transitions. - Economic capital has effect through social
capital (for e.g., if you have economic capital
you likely have greater social connections to
protect one’s health) - Social capital alongside belonging and trust
buffers against poor mental health and
psychological well-being
What would a conflict theorist say in regards to wealth vs. health?
- A conflict theorist would see access to quality
healthcare as a scarce resource that is
unequally distributed throughout groups in
society. Hopeful U.S citizens would like to
think this may bring public health care for all
in the future. Concerned Australians are
worried that we are moving towards greater
privatsation of health care.
Gender as it relates to health?
- Women have a longer life expectancy than men
- Australian life expectancy for men is currently 80.4 and 84.6 for women.
Why?
* Men are more likely to engage in risky behaviour such as alcohol and drug consumption, driving fast, and being exposed to toxins and hazards in the workplace.
* Men are more likely to die a young violent death.
* Women tend to get sick more often (medicalization?)
* This result may reflect women seeking help more
often than men or how the medical system responds to gender and illness.
Male life expectancy is increasing more than women’s due to changes in gender culture. Masculinity is symbolically changing in reference to health
Ethnicity and migration as it refers to health?
- Around the world minority and migrant
groups tend to have poorer than average
health. - Non-English speakers tend to have poorer
health than Anglo-Australians - Low-status
- Health-endangering employment
- Crowded housing
- Information interpretation
- Prejudice
- Exclusion from the policy process
- Traditional beliefs
- Transport problems
- Need to run a small business
- Coming from vulnerable backgrounds
Migrants tend to have higher levels of
health than non-migrants.
Indigenous peoples as it relates to health?
- Indigenous people in Australia have the poorest health compared to other groups, showing health patterns similar to those in developing nations.
- The life span of Indigenous people is 8-9 years shorter than that of non-Indigenous children.
- Infant mortality for Aboriginal and Torres Strait Islander babies is twice as high as for non-Indigenous babies during 2016-2017.
- Rates of disabilities, stress, and kidney disease are
significantly higher among Indigenous Australians
compared to non-Indigenous individuals. - The burden of disease is 2.5 times higher for Indigenous populations.
- Indigenous adults experience hospitalization for dialysis at a rate 14 times higher than non-Indigenous adults.
- Chronic diseases like circulatory, respiratory
issues, and diabetes are significant causes of
mortality. - Morbidity and mortality rates are influenced
by higher smoking, alcohol consumption, and
poor diet rates. - Rural communities face challenges due to
geographical isolation from essential services. - Policies should prioritise social and economic
justice, considering the historical impact of
colonization and conquest. - Land rights are crucial for indigenous
individuals, providing economic stability and
spiritual sustenance, and reinstating their
cultural significance.
What is the new public health?
The New Public Health is a term encompassing various local-level initiatives promoting prevention over cure and informing people about
risks and unhealthy behaviors. It includes:
- Focus on physical infrastructure, social support, social capital, behavior, and lifestyles to prevent disease and promote health
- Concern with all health threats, including the environment, workplace health, mental health, and chronic diseases.
- Advocacy for legislation and policy changes supporting public health.
- Emphasis on equity and social justice as explicit goals.
- A multidisciplinary approach centered on community and prevention rather than individual care.
- Targeting specific populations at risk, such as women in regard to breast cancer.
