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Transcript
HEALTH AND MEDICINE UNDERSTANDING HOW SOCIAL FORCES IMPACT WELL-BEING WHAT’S MY SOCIAL CLASS GOT TO DO WITH MY ILLNESS? • HEALTH – A STATE OF COMPLETE PHYSICAL, MENTAL, AND SOCIAL WELL-BEING • FROM A SOCIOLOGICAL PERSPECTIVE… – HEALTH IS AS MUCH A SOCIAL AS A BIOLOGICAL ISSUE FOR SOCIOLOGISTS • THINK IN TERMS OF THE ORGANIZATION OF SOCIETY • PEOPLE JUDGE THEIR HEALTH IN RELATIVE TERMS • PEOPLE PRONOUNCE AS “HEALTHY” WHAT THEY HOLD TO BE MORALLY GOOD • CULTURAL STANDARDS OF HEALTH CHANGE OVER TIME • HEALTH RELATES TO A SOCIETY’S TECHNOLOGY • HEALTH RELATES TO SOCIAL INEQUALITY A GLOBAL PEEK AT HEATH ISSUES • LOW-INCOME COUNTRIES – SEVERE POVERTY CUTS INTO LIFE EXPECTANCY WHEN COMPARED TO RICH COUNTRIES • ONE IN SIX PERSONS IN THE WORLD SUFFER FROM ILLNESSES DUE TO POVERTY – A LACK OF TRAINING MEDICAL PROFESSIONAL ALSO ADDS TO THE PROBLEM • HIGH-INCOME COUNTRIES – INFECTIOUS DISEASES ARE LESS OF A THREAT, BUT CHRONIC CONDITIONS HAVE TAKEN THEIR PLACE • HEART DISEASE, CANCERS, AND STROKE LEADING CAUSES OF DEATH IN THE EARLY 1900s • INFLUEZA AND PNEUMONIA • TUBERCULOSIS • STOMACH/INTESTINAL DISEASES • HEART DISEASE • CEREBRAL HEMORRHAGE • KIDNEY DISEASE • ACCIDENTS • CANCER • DISEASE OF INFANCY • DIPTHERIA IN THE LATE 1990s • • • • • • • • • • HEART ATTACK CANCER STROKE LUNG DISEASE (NONCANCEROUS) PNEUMONIA AND INFLUENZA ACCIDENTS DIABETES SUICIDE KIDNEY DISEASE CHRONIC LIVER DISEASE AND CIRRHOSIS HEALTH IN AMERICA • SOCIAL EPIDEMIOLOGY – HOW HEALTH AND DISEASE ARE DISTRIBUTED THROUGHOUT A SOCIETY’S POPULATION • LET’S EXAMINE ISSUES OF HEALTH AS THEY ARE RELATED TO VARIOUS CATEGORIES OF PEOPLE • DEATH IS SELDOM VISITED UPON THE YOUNG THESE DAYS – ACCIDENTS AND HIV/AIDS ARE TWO EXCEPTIONS • ACROSS THE LIFE CYCLE – WOMEN FARE BETTER THAN MEN • GENDER AS A HEALTH THREE – MASCULINITY LINKED WITH CORONARY PRONE BEHAVIOR • TYPE “A” PERSONALITY TRAITS • INFANT MORTALITY RATES ARE TWICE AS HIGH FOR DISADVANTAGED GROUPS • AFRICAN AMERICANS ARE THREE TIMES MORE LIKELY TO BE POOR COMPARED TO WHITES • WHITES CAN EXPECT TO LIVE LONGER AND BE IN BETTER HEALTH • POVERTY ALSO BREEDS STRESS AND VIOLENCE • MOST PREVENTABLE HAZZARD TO HEALTH • SMOKING IS NOW DEFINED AS A MILD FORM OF DEVIANT BEHAVIOR • PEOPLE WITH LESS EDUCATION TEND TO BE SMOKERS • LUNG CANCER IS NOW THE LEADING CAUSE OF DEATH AMONG WOMEN • 430,000 MEN AND WOMEN DIE PREMATURELY EACH YEAR FROM TOBACCO RELATED DISEASES SMOKING IMPACT OF THE BEAUTY MYTH • EATING DISORDERS – AN INTENSE INVOLVEMENT IN DIETING AND OTHER FORMS OF WEIGHT CONTROL IN ORDER TO BECOME VERY THIN • 95% OF THOSE SUFFERING FROM ANOREXIA AND BULIMIA ARE WOMEN • THE BEAUTY MYTH TELLS WOMEN TO EXAGGERATE THE IMPORTANCE OF PHYSICAL ATTRACTIVENESS • PRESSURES COME FROM SOCIETY, PARENTS, THE MEDIA, AS WELL AS WOMEN THEMSELVES • GONORRHEA AND SYPHILIS – 356,000 CASES OF GONORRHEA ANNUALLY – 38,000 CASES OF SYPHILIS ANNUALLY • GENITAL HERPES – 20-30 MILLION ADULTS INFECTED – THAT’S ONE IN SEVEN ADULTS! • HIV/AIDS – THE MOST DEADLY OF ALL STD’S – TRANSMISSION IS THROUGH BLOOD, SEMEN, AND BREAST MILK, AND NOT THROUGH CASUAL CONTACT – EDUCATION PROGRAMS ARE OF VITAL IMPORTANCE SINCE PREVENTION IS THE ONLY SAFEGUARD AGAINST HIV/AIDS • WHEN IS A PERSON DEAD? – WHEN AN IRREVERSIBLE STATE INVOLVING • • • • NO RESPONSE TO STIMULATION NO MOVEMENT OR BREATHING NO REFLEXES, AND NO INDICATION OF BRAIN ACTIVITY – DO PEOPLE HAVE THE RIGHT TO DIE? • 10,000 PEOPLE IN THE U.S.A. ARE IN A PERMANENT “VEGETATIVE STATE” • THOUSANDS FACE TERMINAL ILLNESSES THAT WILL CAUSE HORRIBLE SUFFERING • THE PERSONAL WISHES CONTAINED IN LIVING WILLS ARE NOW ADHERED TO MORE OFTEN • PASSIVE EUTHANASIA – ACTIVELY SUPPORTING THE RIGHT TO DIE • ACTIVE EUTHANASIA – ASSISTING A PERSON TO DIE • THE NETHERLANDS HAVE THE MOST LIBERAL LAWS • STATE AND FEDERAL LAW – IN 1997, OREGON VOTERS ENDORSED LEGISLATION THAT ALLOWS DOCTORS TO ASSIST PATIENTS IN TERMINAL CASES – IN 1999, CONGRESS BEGAN DEBATING THE PASSAGE OF A LAW THAT WOULD PROHIBIT STATES FROM ADOPTING ALWS SIMILAR TO OREGON’S STATE LAW MEDICINE • IT IS THE SOCIAL INSTITUTION THAT FORCUES ON COMBATING DISEASE AND IMPROVING HEALTH • THE RISE OF SCIENTIFIC MEDICINE – THE AMERICAN MEDICAL ASSOCIATION WAS FOUNED IN 1847 • THE AMA IS A STRONG BODY WHEN IT COMES TO LOBBYING AND PRESSURING GROUIPS TO CONFORM TO ITS STANDARDS – SCIENTIFIC MEDICINE BEGAN AS A VERY CLASS-ORIENTED CAREER • WOMEN AND RACIAL MINORITIES WERE OFTEN EXCLUDED FROM MEDICAL SCHOOLS • ONLY RECENTLY HAVE SCHOOLS GRADUATED MORE WOMEN AND OTHER MINORITIES PRACTICING MEDICINE THE HOLISTIC APPROACH TO MEDICINE • PATIENTS ARE PEOPLE – CONCERN FOR THE TOTAL ENVIRONMENT IN WHICH THE PERSON LIVES • RESPONSIBILITY, NOT DEPENDENCY – FAVORING AN ACTIVE PATIENT ROLE RATHER THAN A REACTIVE ROLE • PERSONAL TREATMENT – FAVORING A MORE PERSONAL ENVIRONMENT IN WHICH TO PRACTICE THE ART OF HEALING, SUCH AS THE PERSON’S DWELLING PAYMENT FOR SERVICES A GLOBAL COMPARISON • CHINA – GOVERNMENT CONTROLS MOST HEALTH CARE OPERATIONS • RECENT CLAIMS OVER GOVERNMENT INVOLVEMENT IN SELLING ORGANS TAKEN FROM PRISON POPULATIONS • RUSSIAN FEDERATION – MEDICAL CARE IS IN TRANSITION, BUT IT IS HELD THE ALL CITIZENS HAVE A RIGHT TO MEDICAL CARE • SWEDEN – COMPULSORY GOVERNMENT MEDICAL CARE OFFERED TO ALL • GREAT BRITAIN – MIXTURE OF PRIVATE AND PUBLIC HEALTH SERVICES • CANADA – A SINGLE-PAYER GOVERNMENT PROGRAM, BUT, LIKE BRITAIN, IT HAS A TWO-TIERED SYSTEM • JAPAN – DOCTORS OPERATE PRIVATELY, BUT THERE IS A COMBINATION OF PRIVATE AND PUBLIC PROGRAMS MEDICINE IN THE UNITED STATES • DIRECT FEE SYSTEM – THE PATIENT PAYS DIRECTLY FOR SERVICES PROVIDED BY DOCTOR • PRIVATE INSURANCE – IN 1997, 61% OF AMERICANS HAD ACCESS TO MEDICAL CARE BENEFITS • PUBLIC INSURANCE PROGRAMS – MEDICARE FOR THOSE OVER 65 – MEDICAID FOR THOSE IN POVERTY – IN TOTAL, 36% OF AMERICANS RECEIVE MEDICAL ATTENTION VIA SOME FORM OF GOVERNMENT PROGRAM, INCLUDING SOME WITH PRIVATE CARE INSURANCE • HEALTH MAINTENANCE ORGANIZATIONS – AN ORGANIZATION THAT PROVIDES COMPREHENSIVE MEDICAL CARE TO SUBSCRIBERS FOR A FIXED FEE – BUT, WHO MAKES DECISIONS IN SUCH ORGANIZATIONS, DOCTORS OR ACCOUNTANTS? • SINGLE-PAYER PROGRAM IN THE FUTURE? – INSURANCE WILL PROBABLY LOBBY AGAINST SUCH CHANGES DUE TO SELF-INTERESTS HOW TO MAKE SOCIOLOGICAL SENSE OF HEALTH AND HEALTH CARE • STRUCTURAL-FUNCTIONAL ANALYSIS – THE SICK ROLE AND THE PHYSICIAN’S ROLE • • • • ILLNESS SUSPENDS ROUTINE DUTIES ILLNESS IS NOT DELIBERATE A SICK PERSON MUST WANT TO GET WELL A SICK PERSON MUST SEEK COMPETENT HELP • SYMBOLIC-INTERACTION ANALSYIS – WE SOCIALLY CONSTRUCT ILLNESS AS WE CONTINUE TO INTERACT • A DRAMATURLOGICAL ANALYSIS OF THE GYNECOLOGICAL EXAMINATION CLEARLY SHOWS THE PROCESSES INVOLVED • SOCIAL-CONFLICT ANALYSIS – ISSUES OF: • ACCESS, THE PROFIT MOTIVE, AND THE POLITICS OF MEDICINE • INTERESTS OF ONE GROUP VERSUS OTHERS THE FUTURE • MOST PEOPLE ARE IN GOOD HEALTH IN AMERICA – MANY DISEASES THAT WERE PROBLEMATIC HAVE BEEN WIPED OUT • PERSONAL INVOLVEMENT – PEOPLE ARE MORE KNOWLEDGEABLE AND TAKING MORE RESPONSIBILITY FOR THEIR OWN HEALTH CONCERNS • MARGINAL PEOPLE – STILL NEED TO CARE MORE ABOUT THOSE GROUPS ON THE ECONOMIC FRINGE • IMPROVING HEALTH WORLD-WIDE – INCREASING LIFE EXPECTANCY IS A MAJOR CHALLENGE TO GLOBAL HEATLH ORGANIZATIONS – COMBATING AND CONTROLING VIRUSES AND OTHER DISEASE THAT ARE “OUT THERE”