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Lecture 2

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Department
Health, Aging and Society
Course
HLTHAGE 1AA3
Professor
Geraldine Voros
Semester
Fall

Description
Monday, 17 September, 2012▯ ▯ Medical Considerations▯ ▯ Brain tickler▯ ▯ 1. Five year old child with cleft palate ($5,000)▯ 2. Teenager (15 years old) with a fatal cancer that has an expensive treatment ($10,000 min)▯ 3. An eighty year old farmer requires a hip replacement ($5,000)▯ 5. A middle aged teacher has cataracts on both eyes to be removed ($5,000)▯ ▯ You only have $20,000. Which one do you choose? ▯ ▯ Three Important Contemporary Approaches In Social Sciences▯ ▯ 1. The Positive Approach/ The Structural Functionalist Approach▯ • Compete - societies and three stages of development▯ a. Theological Stage▯ b. Metaphysical Stage▯ c. Positive Stage/ Structural Functionalist Stage▯ • Durkheim▯ - Need to look at social facts objectively▯ - Observe the patterns▯ - Patterns of regularity can be studied▯ - You are entitled to your own opinion▯ ▯ 2. The Critical Approach/ Conflict Approach (“no person left behind” rule)▯ - Macro level▯ - From the conflict paradigm (critical approach) health and illness are viewed as professional constructs that result from power struggles between competing interest groups (Segall and Fries 2011) ▯ - One group tries to improve their status at the expense of less powerful groups (exploitation)▯ - Researchers feel the need to advocate for social justice on behalf of those less fortunate▯ - They advise moral constitution (this is why we have health care for all) ▯ - Conflict health sociologists question how organized medicine attained and maintained it its position of dominance in the health care field▯ - They question how physicians acquired exclusive rights to diagnose and treat disease, prescribe medication, do surgery etc. And had these “rights” made legal by legislation▯ - The medical profession pre-empted competitors such as midwives, homeopaths, chiropractors▯ ▯ ▯ 3. The Interpretive Approach/ Symbolic Interactionist Perspective, Grounded Theory▯ - Symbolic interactionists understand health and illness as interpersonal meanings since others▯socially construct their reality given their lived experiences and interactions with - This is a more microscopic look at the individual and their “human agency” - ability to determine their lives, define their situation and define themselves in relation to others▯ - They want to interpret the way people react to a situation (dying with cancer VS. LIVING with cancer)▯ - Keep asking questions▯ Family ▯ 5 Paradigms of society:▯ In every society there is:▯ Education Religion (i.e, Canada, McMaster)▯ ▯ ▯ ▯ ▯ ▯ ▯ ▯ Politics Economics▯ ▯ ▯ Health ▯ Did the brain tickler work for our class? If we had a strict orthodox group of people, we would have ranked the 5 people exactly the same. Was stigma, empathy involved?▯ We might have thought that the 80 year old man deserved to go 3 or 4 since he has already passed his life expectancy and other still have a future. If we look at it from a political POV, we need all hands on deck. He is helpful to the global community▯ ▯ Or the teacher, who is needed to teach young students. What if the teacher was a child molester? We do not know. Should we know? ▯ • The original Paradigm was a 5 pointed star. ▯ • The sixth that we added was health care. ▯ • From an institutions and roles perspective - health and illness can be understood as social roles (i.e the sick role- Parsons and non medical sick role - others build on Parsons work)▯ • Health concept evolves - illness care, health promotion, lay beliefs, formal care, health ▯ behaviors. ▯ • People who are sick are exempt from regular roles but are expected to view their illness as undesirable and should try to get better. ▯ • They must seek out professional help and follow their instruction. ▯ • It is an obligation to make use of the health opportunities that are available. ▯ • No excuse for ignorance, you should be well informed.▯ ▯ Medico-centric approach: health approach that we use. Allowing physicians to lead us in health care. They tell us what we have and instruct us on how to get better. The human beings role is to comply.▯ ▯ Social Construction of Reality▯ ▯ • Health care systems are socially and culturally connected▯ • Universal health care is part of our social reality as canadians▯ Does it play a part in our being one of the best places in the world to live?▯ • The social reality of universal health health care an ingrained value in our society▯ • It becomes our social reality on two levels:▯ • a. The external interpersonal environment we are situated in (norms, communication with others)▯ b. Our own internal intra psychic space▯ • Kleinman’s two diagrams figure 3 on page 8 of the courseware and figure 2 on page 5 of the courseware become the focus of or discussion▯ • Kleinman also tells us that the USA’s healthcare is broken up into many different social circles▯ • Obamacare, Obama wants the healthcare to be more collective rather than the plural view▯ ▯ Universal Healthcare: ▯ • Tommy Douglas▯ • 10 year old almost lost his leg because he was too poor to have the surgery to keep it▯ • He grew up and started universal healthcare▯ • He believed that it should not be losing limb or life just because you are not rich enough▯ ▯ Figure 3: Local health care system: internal structure▯ ▯ Three Sectors: Popular, Professional and Folk▯ 1. Popular sector▯ •Least studied and most poorly understood▯ •Participants are lay person and non professionals, non specialists▯ •Illness is first defined here and health care activities are initiated▯ •70-90% of illness is taken care of here▯ •Individual, family, social, community based▯ ▯ ▯ •5 Steps: illness first encountered in the family:▯ 1. Perceiving and experiencing symptoms▯ 2. Labeling and evaluating the disease▯ 3. Sanctioning a particular kind of sick role▯ 4. Deciding what to do and engaging in specific health care-seeking behavior▯ 5. Applying treatment and therapy from other sectors of the health care system▯ • Preoccupied with health maintenance not illness▯ ▯ Special form of care is applied in each of the sectors. Different sectors lead to different languages. Communication across the sectors is a problem. Each sectors is like a separate “culture”. Popular culture is concerned with health and health maintenance.▯ ▯ 2. Professional Sector of Health Care:▯ Organized healing professionals▯ • • Modern scientific medicine▯ • Also some professionals indigenous medical systems▯ • Freidson describes how allopathic medicine gained dominance and marginalized other healing traditions▯ • Reference to the Flexner Report of 1910 where by the empowerment was achieved▯ • Recent rise in technology, prolific medical sub-specialization and establishment of para-professionals - all have been licensed as subsidiary▯ • Increasing clinical responsibilities assumed by nurse practitioners and medical assistants▯ • “indigenization” = the cultural re-patterning of professional clinical care to a greater or lesser degree i.e RCSI delivery methods▯ • “popularization” = certain of the aspects of professional care, such a scientific health concepts, are altered and diffused after they enter the popular health sector▯ (Washing hands and singing happy birthday)▯ • The professional sector is the most powerful and dominant▯ • Research by physicians and public health personnel, in most instances, is a systematically limited to problem-frames defined by biomedicine; the solutions offered fit professionally sanctioned-frames and are evaluated from that standpoint▯ • Professional dominance a self fulfilling prophecy - they embrace data/research which supports their professional orientation ▯ • Medical/ professional ideology - blind conviction▯ • Professional sector devalues the popular culture and folk culture▯ • Biological aspects first order, psycho, social, and cultural aspects second order▯ • Professional insensitivity is fostered in both undergraduate and postgraduate medical education▯ In reality - one must look at the patients’ “whole” body, feelings, values, illness and • treatments▯ • Professional sector is not the “only” or “true” view but one among a RANGE▯ ▯ ▯ ▯ 3. Folk Sector of Health Care▯ • Folk medicine shades into two other sectors▯ • Folk sector both sacred and secular (in two parts)▯ • Sacred = shaman - ritual curing▯ • Secular = herbalism, special systems of exercise - yoga▯ • Folk sector is expanding to the broader health system▯ ▯ Health care systems as forms of social and symbolic reality▯ **ART DUERKSEN▯ > had a stroke did a triathalon▯ ▯ The Paradigm: Points To Consider▯ • How we incorporate the folk, popular and professional options in our lives as we effect human agency related to our well being • Individuals differ in their conscious understanding and acceptance of social norms and in the degree to which they follow those norms in actual practice • These differences determine the different choices we make with regard to our possible illness and what we might do about it • How we think about our illness, how our families respond to us and our illness and how practitioners respond to us and our illness are all part of our social reality • Kleinman distinguishes between two aspect of social reality 1. The social cultural world is social reality per say 2. The bridging reality that links the social cultural world with the psychological and biological/physical reality is termed the symbolic reality • The symbolic reality makes sense out of that inner experience • It helps shape personal identity in accordance with social cultural norms • The symbolic meanings influence basic psychological processes, such as attention, state of consciousness, perception, cognition, affect, memory, motivation • It is less certain how the symbolic reality connects the social environment with the psychological process (inner experience- flip the switch • This introduces the need to speak to Alternative Therapies such a touch, music, art, imagery, religious/spiritual etc. • How do they relate? Women Healers and Patients • Health and health care position of leadership • Both in europe and in western society, women the original “healers” or “doctors” • Men exercise a well thought out plan to to suppress women healers • Men wanted to be the dominant professionals in the health care field • Executed an “active takeover” Why did this happen? • Men’s dream of controlling “healing” (medicine) and related institutional organizations • Men’s view and women’s views differ regarding health and health care – extrinsic vs. Intrinsic ▯ Subservience of Women • Historically women healers formally recognized as early as 476 A.D. – 1450 A.D. • 1300’s -1600’s men initiated and carried out the manipulated suppression of women healers • Ruling class: both political and religious elements create an aura of contamination around women – better known as the “witch craze” • Women healers seen as a threat: • Politically • Religiously • Sexually/(sexism) ▯ The Witch Craze • calculated ruling class campaign of terror Western Society and the Displacement of Women Healers • New Jersey experience • People’s medicine and women healers • Rise of the regular doctor • Medical methods of male “regular doctors” and “irregular female healers” • Role of the rising American business establishment – t
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