Schaefer10e ppt ch19

McGraw-Hill © 2007 The McGraw-Hill Companies, Inc. All rights reserved.

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SOCIOLOGYRichard T. Schaefer

Health andMedicine

19


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19. The Economy and Work

• Culture and Health• Sociological Perspectives on Health and

Illness• Social Epidemiology and Health• Health Care in the United States• Mental Illness in the United States• Social Policy and Health


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Culture and Health

• Culture contributes to differences in medical care and how health is defined• Culture also influences the relative incidence of a disease or disorder.


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Sociological Perspectives on Health and Illness

• Functionalist Approach– “Being sick” must be controlled so

that not too many people are released from their societal responsibilities

– Sick role: societal expectations about attitudes and behavior of a person viewed as being ill


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• Conflict Approach– Critical of growing role of medicine as

major institution of social control– The Medicalization of Society

• Interactionist Approach– Studies the roles played by health

care professionals and patients– Asserts patients may play an active

role in positive or negative health


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• Labeling Approach– The designations healthy and ill

generally involve social definition– Disagreements continue in the

medical community over whether a variety of life experiences are illnesses


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Figure 19-1. Infant Mortality Rates in Selected Countries, 2004

Source: Haub 2004


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Table 19-1. Major Perspectives on Health and Illness


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Social Epidemiology and Health

• Social Epidemiology and Health– Social epidemiology: study of

distribution of disease, impairment, and general health status across a population

– Incidence: number of new cases of a specific disorder occurring within a given population during a stated period of time, usually a year

– Prevalence: number of cases of a specific disorder that exist at a given time


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• Social Epidemiology and Health– Morbidity rates: disease incidence

figures presented as rates or number of reports per 100,000 people

– Mortality rate: incidence of death in a given population


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• Social Class– Studies show people in lower classes

have higher rates of mortality and disability• Crowded living conditions• Substandard housing• Poor diet• Stress• Unable to afford quality health care


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• Race and Ethnicity– Health profiles of racial and ethnic

groups reflect social inequality in U.S.• Poor economic and environmental

conditions manifested in high morbidity and mortality rates

• Gender– When compared with men, women

live longer


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Figure 19-2. Percentage of People without Health Insurance, 2001

Source: Haub 2002:23


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• Age– Most older people in U.S. have at

least one chronic illness• Older people vulnerable to certain types

of mental health problems• Older people use more health services

than younger people


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Health Care in the United States

• A Historical View– During the 1830s and 1840s, “self-

help” was emphasized• Strong criticism of “doctoring”

– Eventually, medical profession controlled the market for its services and the various organizations that govern medical practice, financing, and policymaking


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• Physicians, Nurses, and Patients– Physicians have position of

dominance in dealing with nurses and patients

• Alternatives to Traditional Health Care– Holistic medicine

• Therapies that consider the person’s physical, mental, emotional, and spiritual characteristics


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• The Role of Government– In 1965, government subsidized

health care programs• Medicare for the elderly• Medicaid for the poor

– Medicare had huge impact on health care system• Some hospitals “dumped” unprofitable

Medicare patients until practice was banned in 1987


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Figure 19-3. Availability of Physicians by State

Source: Bureau of the Census 2004:101


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Figure 19-4. Total Health Care Expenditures in the United States, 1970— 2014 (projected)

Sources:Center for Medicare and Medicaid Services 2005 (2005—2014 data); Health Care Financing Administration 2001 (1970—1990 data)


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Mental Illness in the United States

• Mental illness– Brain disorder that disrupts a person’s

thinking, feeling, and ability to interact with others

– People in U.S. traditionally maintained a negative and suspicious view of those with mental disorders


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• Theoretical Models of Mental Disorders– Medical Model: Mental illness rooted in

biological causes that can be treated through medical intervention

– Labeling Theory: Mental illness is not an “illness” since the individual’s problems arise from living in society and not from physical maladies

• Devalues mentally ill patients


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• Patterns of Care– Historical confinement of the insane

or mentally ill to public institutions– Community-based outpatient care

most prevalent now• Legislation has made it easier to commit

mentally-ill homeless involuntarily


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Social Policy and Health

• Financing Health Care Worldwide– The Issue

• Industrialized nations face issues related to the accessibility and affordability of health care

– The Setting• The U.S. is the only Western industrial

democracy that does not treat health care as a basic right


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• Financing Health Care Worldwide– Sociological Insights

• Conflict theorists suggest health care system resists basic change

– Those who receive substantial wealth and power through an existing institution have strong incentive to keep things as they are

• Health care system undergoing “corporatization”


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• Financing Health Care Worldwide– Policy Initiatives

• Major reforms occurring in U.S. without legislative reform

– As of 1997, managed care plans enrolled 85% of all workers, up from 52% in 1993

– There are growing concerns about the quality of health care provided by managed care plans


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Figure 19-5. Government Expenditures for Health Care, Selected Countries

Source: World Bank 2005a:100--102

Schaefer10e ppt ch19

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