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
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
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
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