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SOCI 3820 (21)

ch 12, 13, 14, 15 word .doc

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York University
SOCI 3820
Eric Mykhalovskiy

Sanzanna’s Notes Hi guys, here are the notes for the chapters in the textbook. If you haven’t had the chance to read the chapters, then I suggest that in addition to these notes you also read the chapter summary and the terms’ definitions for each chapter. Happy Studying! Chapter 12: Medicine, Medical Dominance and Public Health Origins- Early societies attributed illness to spiritual/supernatural causes (evil, spirits, god, and sorcerer). Shaman used prayers, spell and sacrifices in an attempt to heal the ill person. Then Hipocrates (father of medicine) argued that disease had natural causes (humoral theory). Later, Christianity attributes illness as a result of sin/punishment. In the medieval era, religious dogma dominated the concept of illness/healing (based in monastery and controlled by church). The renaissance period marks the beginning of the scientific approach to medicine. Medical specialization became more common. Medical service was geared for the wealthy. Many intellectual discoveries in the field of biology/medicine was made during this time. In the nineteenth century, along with medical discovery came the concept of social health, now known as public health and pharmacology was established. In the 20 century, medicine and the biomedical approach gained legitimacy. Scientific Medicine- Biomedicine or allopathic medicine has a scientific method of treating illness. Explanation of illness as a malfunction of the body’s biological systems. It holds five assumptions: 1. Determinants of illness are primarily biological- focus on etiology and eliminate social factors. Each disease has a specific cause that can be diagnosed by specific medical tests. 2. Biomedicine uses the engineering model of the body- different parts coming together : the body as a machine metaphor 3. Health care is primarily about curing illness/disability- focus on acute care and patients= cases. Thus patients are treated as cases rather than as a unique individuals. 4. Medicine is scientific- allegedly, allopathic medicine is considered superior - assumption on experimental and empirical data. There is also an assumption that patients with same illness will have the same pattern of development. 5. The doctor is he authority/expert- holds power and is the ultimate labeler. Ascendency of Medical Dominance- that medicine has the most power in the health profession despite its limited numbers, to control its own work and that of other health care workers and have influence over health policy and hospital organization. Emergence in Canada- The first hospital was founded in Quebec in the 17 century, but it was rarely used for medical procedures. 19 and early 20 century marked the skepticism of medical procedures. Hospitals were mainly the place for chronically ill, poor and dying patients. Hospitals were considered a dangerous and poor hygienic place: middle class and wealthy were treated at home or at doctor offices. Licensing for medical practices emerged in 1870 but physicians did not have hegemonic control over the medical system mid 20 century. Fist med school was created in 1824 and was later collaborated with McGill. Soon more emerged and added respectability and means of controlling curriculum and entrance to the th profession. By the early 20 century, pharmacies stopped prescribing meds in accordance that physicians will not supply meds to patients; this was the beginning of physicians controlling pharmacology. Soon nurses were also controlled and the profession was considered a subordinate one. Due to their social origins, university affiliations, connection with the wealthy and political figures, physicians were able to gain dominance by absorbing completing professions, marginalizing them or granting them legitimacy in exchange of subordinate status. Dominance progressed as the nation’s political situations changed and needed the support of the health care system (depression, WWII) until the introduction of government health insurance in 1960s. This ability of the medical profession to unify and attain professional dominance over competing healthcare professions was strengthened by it’s connections to the elite groups and the state; and these powerful connections allowed them to maintain their hegemonic position (dominance or power of one social group over another). Challenges- Emergence of the welfare state promised a government hospital insurance plan marked the decline of the medical dominance. In 1966, the MEDICAL CARE ACT was in place and laid foundation of MEDICARE (control over fees/billing). Other health professionals are constantly in a battle to gain power and dominance in the health field (nurses, optometrists, psychologist, chiros). These occupations have been professionalized and have their own licensing bodies. Women’s Health Movement criticized the physician approach to child mid and legitimized midwifery. Even within physician there is conflicting view on the approach to the biomedical model. Media attention to unsuccessful medical stories, the accessible internet, higher education and growing public skepticism about the medical system has set back the medical dominance. Medicine Today- Primary health care are provided by family/general physicians. There has been a little improvement on the diversity of social class between the physicians and an increasing amount of women now pursue this career (feminization of the physician workforce). Public Health and Health Promotion- WHO has defined health to be a complete physical, mental and social well-being and not merely the absence of disease or illness. Current focus is on health promotion, public health and preventive approaches. Medical schools are also encouraged to include these in their curriculum and place a focus on the =social determinants of health. Medicine also has an individualistic and materialistic approach which results in victim blaming. Though government policies emphasize the importance of social determinants, they have not been successful at implementing social programs to facilitate change (no equity). Chapter 13: Canadian Health Care System In the past, two most important powerful groups in the health care system were docs and politician, and they still are. When it comes to the cost of healthcare, there is a class between values and ideologies about whether health care is an unalienable human right to which every citizens entitled to or whether it is a commodity where whoever can afford it purchases it. Development of Medicare- During the Great Depression, doctor’s income declined dramatically since patients were unable to pay their bills, thus the government has to put in place a medical relief plan to help pay for doctor’s salary and other medical expenses. After this, there was a renewed interest in a national health insurance plan. After WWII, Canada came out with a commitment to human rights and this laid the foundation of a social welfare state. In 1957, the government developed the Hospital and Diagnostic Services Act which covered half of hospital services on condition that it is provided to everyone equally. Tommy Douglas is the founder of Medicare as we know it today and it took birth in Saskatchewan. Douglas continued to fight for a universal health-care program that would further extend health coverage. Douglas outlined five basic principles: prepayment, universal coverage, high quality services all over, coverage that it government sponsored publically administered and acceptable coverage to both the providers and receivers. These five principals became the model for Canada’s Medical Care Act in 1966. The Medical Care Act set out four criteria: universality, comprehensiveness, public administration and portability. This act was opposed by Canadian Medical Association due to the decision to ban extra billing. Health Care System and Delivery- 70% of expenditure on health care come from public funds. Approx. 1 million people receive primary and supplementary health care services directly from the federal government. 10.1% of Canada’s GDP(2007) is used towards health expenditure a
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