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Teaching Supplement  Chapter 20  Health and Medicine
CHAPTER 20
Health and Medicine
I. What is Health?
A. People Judge Their Health Relative to Others.
B. People Often Equate Health With Morality.
C. Cultural Standards of Health Change Over Time
D. Health and Living Standards are Interrelated.
E. Health Relates to Social Inequality.
II. Health: A Global Survey.
A. Health in Low Income Countries.
1. 1 in 5 people suffers from poverty-related illnesses.
2. Much illness arises from imbalanced diets and lack of clean drinking
water.
B. Health in High Income Countries.
1. Industrialisation initially worsened the health of the poor.
2. The rising standard of living and improved housing lead to improved
health for most people by the end of the 19th Century.
C. The Rise of the Medical Model or Scientific Way of Seeing Health.
1. Disease as the biological breakdown in individuals;
2. Diseases have specific causes;
3. Focus on the body rather than on general well-being;
4. Treatment administered within the medical environment;
5. Treatment viewed as scientifically neutral.
6. This model sometimes ignores factors which influence health but are
not biologically related, and has a false confidence the science is neutral.
II. Social Causes of Illness: Inequalities in Health.
A. Social Epidemiology: The Distribution of Health.
1. Quality of health care varies by social class, with a range of measures
from the time people wait for treatment, infant mortality, and life
expectancy improving as was looks up the class ladder - even in
post-industrial countries in Europe.
2. Health differs by ethnicity, in part because of different cultural
patterns like diet, sometimes as a result of overt racism and sometimes
since minorities are more likely to be poor.
3. Gender - women tend to live longer but are more likely to be ill.
4. Age - the youngest and oldest are most likely to be ill, and the aging
population will increase the health problems of the elderly.
B. The European Situation - Europeans are Among the Healthiest People.
C. Ethical Issues: Confronting Death.
1. Should people have a right to die, and should that right include
mercy-killing?
2. Should families and individuals foot the cost of expensive treatments
to prolong life.
3. Should the dying be separated from the living?
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Teaching Supplement  Chapter 20  Health and Medicine
III. Health Care Systems and Medical Establishments.
A. Medicine is a Social Institution Concerned With Combating Disease, While
Health Care is Any Activity Designed to Improve Health.
B. Comparative Health Care Systems.
1. Medicine in socialist societies is provided by the state and is in theory
but not practice equal for all. China also encourages traditional holistic
healing.
2. Medicine in capitalist societies is governed, at least in part, by profit
motives. While scientific medical facilities tend to be more advanced, the
distribution of health care is more unequal.
3. The UK attempts to reduce some of the imbalances through a state
sponsored national health service governed by a patient’s charter.
4. European countries generally place great emphasis on primary care.
5. Scandanavian countries have socialised medical systems which are
state controlled. Though Scandanavians pay high taxes to support this
system, they are among the healthiest in the world.
6. Health professionals in Canada operate as private practitioners, but are
paid a set fee by the government for care.
7. Japan, were people are generally healthy, operates a private insurance
and public assistance partnership for health care.
8. The United States provides aid for the poorest people, but most
Americans rely on private or employer-sponsored insurance. The US
boasts many of the most technologically advanced hospitals, but 15% of
the population has no health care.
C. Holistic, Alternative or Complementary Medicine is an Approach That
Emphasises Prevention of Illness and Takes Account of a Person’s Physical and
Social Environments.
1. Patients are whole people rather than sick parts.
2. The object of care is to make people responsible, not dependent.
3. Personal treatment provided.
IV. Theoretical Analysis of Health and Medicine.
A. Functional Analysis - Talcott Parsons Saw Medicine as Promoting Distinct
Roles.
1. The sick role.
a. Illness suspends routine responsibilities.
b. A person’s illness is not deliberate.
c. A sick person must want to be well.
d. An ailing person must seek competent help.
2. The doctor’s role, which is to make decisions and to hold authority
over patients.
3. Critical evaluation - this approach is culture dependent, applies better
to accute (cureable) and fatal illnesses than to chronic illnesses, and gives
people little responsibility for their own health.
B. Symbolic-Interaction Analysis Sees Health and Medical Care as Human
Constructions.
1. Diagnoses are partly cultural and not fully scientific.
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Teaching Supplement  Chapter 20  Health and Medicine
2. Western countries have medicalised health experiences.
3. Illness is socially constructed, and some illnesses (psychsomatic
disorders) have social rather than biological bases.
4. Treatment is socially constructed as health providers strive to
construct the “right” atmosphere for healing, which de-emphasises
sexual experience in particular.
5. Critical evaluation: While this approach highlights the interaction of
social and biological factors, some factors, such as lack of basic nutrition
and vaccination against measles, have a sound biological basis which is
not cultural.
C. Conflict Analysis Stresses Sociol Inequalities.
1. The access issue - the higher one’s class status, the more access to
better care.
2. The profit motive values those who can pay for treatment and places
financial concerns above health (both meaning those who can’t pay don’t
get treated and those who can are encouraged to pay for more than they
need).
3. Medicine is political, with medical excuses used to justify people’s
social rank.
4. Critical evaluation: the approach highlight the politics of medicine, but
ignores many of the improvements in the provision of care and general
health in capitalist societies.
D. The Social Body.
1. Boundarie between human bodies, nature, and technologies have
begun to dissolve, and social action, such as plastic surgery, is being
used to transform bodies.
2. Some seek to map the human genome to be able to genetically
programme better people.
3. Growing numbers of people are cyborgs - humans with mechanical
parts, such as pacemakers.
V. Looking Ahead: Health in the Twenty-First Century.
A. Health Care Costs Will Increase.
B. Care Will Shift from Hospitals to Communities.
C. More Emphasis on Primary Health Care.
D. Patients Will Increasingly Become Consumers as Well as Taking a More
Active Role in Their Own Diagnosis and Treatment.
E. Recent Epidemics Like AIDS Will Have Cures but New Epidemics Will
Arise.
Chapter Objectives
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Seeing the Bigger Picture
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Teaching Supplement  Chapter 20  Health and Medicine
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Transparencies Accompanying Text
T??? Figure: Global Distribution of
the Main Cuases of Death.
T??? Table: Infant Mortality by Social
Class.
T???
Map: The Availability of
Physicians in Global Perspective.
T??? Map: HIV Infection of Adults in
Global Perspective.
Pop Quiz
1) What are two main differences
between health in low income and high
income countries?
expect in the next century?
4) Give an example of groups of people
who have differential access to health
care, and briefly describe some of those
differences.
2) What is holistic medicine?
3) What are two health trends we might
Essay Titles
1) Where should governments draw the
line for expensive medical treatments
which they will fund and those which
they will not fund?
5) Do people have a right to die? Should
doctors assist suicide in some
circumstances? If so, which?
6) To what extent have the actions of
industrialised countries contributed to
the lower standard of health in low
income countries?
2)
Can
internal
markets
and
profit-related
incentives
improve
publically provided health care?
3) Are the holistic and scientific
approaches
to
health
care
complimentary, or does one offer a
better approach than the other?
7) Why is mental illness stigmatised?
8) Does genetic screening promote
improved health or allow the isolation
of people with the predisposition to
some illnesses by employers, insurance
companies, and health care providers?
4) Should the medical profession treat
people whose behaviour damages their
health (like smokers, drug abusers, the
obese, etc.) differently from other
patients? If so, how?
9) Does the quality of health care in
your country differ across the social
classes? Discuss.
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Teaching Supplement  Chapter 20  Health and Medicine
medical profession encourages people
to adopt a “sick role”? Discuss.
10) Do you agree with Parsons that the
Chapter 20 Supplemental Material
Social Power and Disease Research: The Case of Malaria
Malaria is the most common disease in tropical countries, and kills millions of
people each year. The disease is carried from person to person by mosquitos, which
require fresh water in which to bread. The main reason for the disease to be kept
within the tropical belt is that the mosquito cannot survive the cold of a temperate
climate during winter. Some accuse people in developed countries of devoting few
resources to finding cures and treatments for malaria, as research budgets for this illness
are significantly lower than for illnesses, such as HIV, cancer, and heart disease which
are common in post-industrial and industrial countries. Malaria has made little impact
on Europe - at least so far.
Currently there is no known cure for malaria. The only treatments presently
available are designed to work as a proflolactics for short periods, which a cynic might
reason for the holidays of westerners. The amount of money invested in research and
development may slowly change though as global warming extends the range of the
mosquito in to the more developed countries. One resent article by Maurice Chittenden
suggested that London may come under threat as mosquitos are prospering in
increasingly large numbers.
Source
Chittenden, Maurice. “Hot Summers Raises Danger of Malaria Coming to Britain” The
Sunday Times 8 June, 1997, p. 1.
Discussion Questions
1. How should intentional bodies such
as the World Health Organisation
encourage pharmaceutical companies to
invest
more
money
into
the
development of treatments to fight
Malaria.
2. What other diseases can you think
of that like Malaria don’t seam to
received the attention of the Drug
companies
Chapter 20 Supplemental Material
Public Funding of Expensive Medical Treatment: the Case of Multiple Sclerosis
Current medical consensus is that the neurological syndrome, Multiple Sclerosis
(Multiple Scaring) of the brain of the caused by the body’s immune system attacking the
brain cells. This can cause varying symptoms such as numb portions of the body,
vision problems to loss off mussel control. Multiple Sclerosis (MS) is the most
common neurological disease in the Europe affecting approximately 1 in 200 people,
although only about 30% ever progress to needing a walking aid or requiring a wheel
chair, as the stereotypical sufferer does.
Although MS was first identified as a syndrome in the 1860’s by Frenchman
doctor Dr Charcot very little progress has been made in the treatment of the syndrome
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Teaching Supplement  Chapter 20  Health and Medicine
until the last 10 years, when the current suspected cause has been identified. As a
result, several new drugs have been developed to fight MS, although the best currently
available, Beta Interferon (which suppresses the immune system) only slows the course
of MS down by 30% for some patients, it is a source of hope.
The approval of use of Beta Interferon in Britain has been a slow, and prompted
by several court cases brought by people with MS. Initially as reported by journalist
Liz Hunt, patients won the right to receive this £10000 on the NHS. This case got
interferon onto the NHS prescribed drugs list, although many Health Authorities,
including Cambridgeshire and several in the north of England and Scotland refused to
allow neurologists to prescribe of the drug on the grounds of cost. Courts thus far have
not supported health authorities which plead poverty as an excuse for refusing to
prescribe interferon, though future court action may transpire.
This drug, as with many other experimental and expensive treatments for
conditions from cancer to infertility to the removal of tattoos in the currently overstretched NHS has brought funding of the service in the public arena. With discussion
on whether to ration or disallow the funding of certain treatments or to increase taxes in
an increasingly anti tax nation.
Sources
Hunt, Liz, “Beta patient wins right to a brighter future £10000 a year MS Drug to be
widely available”, The Independent, (5/10/95) pp. 9.
Luesby, Jenny, “NHS spends £100m on overpriced drug”, Financial Times, (15/2/96)
pp. 11
Dyer, Clare, “Courts to rule on denial of expensive drugs on NHS”, The Guardian
(10/4/97) pp. 6.
Discussion Questions
1. Should governments pay for
experimental and expensive drug
treatments? Where should health
authorities be able to draw the line of
what they will fund and what they will
not fund?
2. Should Health care be rationed as
ever more expensive drugs come onto
the market, or should the government
intervene in the cost of new
medications?
Chapter 20 Supplemental Material
The Face of AIDS in Asia
The AIDS virus appears to be taking a different path in Asia than it has in Africa
or Europe and North America. Because of social changes in many of the rapidly
developing economies of Asia, the disease will probably make the continent home to the
largest number of HIV-infected people on the planet by 2000, displacing Africa and far
outstripping North America and Europe. Estimates suggest that between 30 and 120
million infected individuals will be in Asia at the turn of the century. In 1993, there
were about 14 million people infected worldwide.
Research on the spread of AIDS in Asia has been limited. Embarrassed by the
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Teaching Supplement  Chapter 20  Health and Medicine
problem, a number of governments have stifled or prevented studies to determine the
extent of HIV infection. Thailand, however, has allowed both research and the
development of the most active intervention programs in all of Asia. AIDS arrived in
Thailand in 1984 and has grown at a staggering rate since that time. The infection rate is
three times higher than in the United States, primarily via heterosexual transmission and
intravenous drug use.
Many highrisk behaviors have exacerbated the infection rate. Intravenous heroin
users have a 35 percent infection rate. Many adult men have sex with prostitutes as the
culture encourages men to have many sexual partners before and after marriage. Women
are expected to be virgins before marrying their husbands and then remain faithful
during marriage. In effect, only a small pool of the female population is sexually
available for men, which eases transmission. Estimates suggest that about 25 percent of
the country's prostitutes are infected. Two AIDS researchers wrote to a Bangkok
newspaper, stating that "for Thai women, the most important risk factor for HIV
infection is marriage." The worst infection rate is probably among females from thirteen
to twenty years old. Unlike Europe and North America, homosexual transmission is not
a major source of new infections.
Researchers suggest that other factors in the spread of AIDS are also important.
Thailand and other parts of Asia have become the destination of "sexual tourists" from
Europe, North America, Australia, Korea, Japan, and other wealthier nations. These
tourists seek prostitutes. Pedophilic tourists have increasingly exposed young girls and
women to HIV. Also, many unmarried young people are moving from rural areas to
cities to take advantage of the booming economy, and young unmarried Thais tend to
engage in the most highrisk behavior.
Studying the rate that the AIDS virus is spreading is facilitated by AIDS testing
conducted by several important institutions in Thailand. All new military recruits, for
example, are tested, and the data from various testing sites show that between 3 and 18
percent are already infected. Pregnant women, tested upon admission for their births,
show a 14 percent infection rate. Present trends suggest that, out of Thailand's total
population of sixty million, somewhere between two and four million individuals will
be infected with the AIDS virus by 2000. Health care costs relating to AIDS could
consume as much as 10 percent of the gross domestic product by that time.
Unfortunately, prevention programs have shown little effect to date. The sex industry, a
major source of new transmission across Asia, is often under the protection of organized
crime or the local government.
Cambodia, Myanmar, and India have similar forces in play and may be at
comparable levels of infection. Indonesia, the Philippines, and China may also become
hot spots for AIDS, although they show low levels of infection at this time. Korea and
Japan seem to be less at risk and AIDS transmission should proceed more slowly there.
Sources
"Is a New AIDS Pattern Emerging in Asia?" Population Today (December 1994)p.5.
Branigin, William. "Asia Faced with AIDS Catastrophe." Washington Post (December
2,1993) pp. A1, A38.
Discussion Questions
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Teaching Supplement  Chapter 20  Health and Medicine
1) Why is AIDS growing so quickly in
Asia? How does the spread of AIDS
there differ from its transmission in
Europe?
cultural expectations of women could be
changed to decrease the spread of
AIDS? Should the behavior of men be
changed? Is it ethnocentric to consider
such changes? If so, how could changes
be made that are not ethnocentric?
2) Is it reasonable to believe that
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