1AA3 -Inner Structure of Health Care Systems.docx

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Health, Aging and Society
Geraldine Voros

Inner Structure of Health Care Systems 1AA3 September 13 , 2012 - The internal structures of health care systems are roughly the same across cultural boundaries, while the content varies with the social, cultural, and environmental circumstances of each system - Health care is described as a local cultural system composed of three overlapping parts: the popular, professional, and folk sectors 1. Popular Sector of Health Care - Least studied and most poorly understood - Can be thought of as a matrix containing several levels: individual, family, social network, and community beliefs and activities - Illness is first defined and health care activities are initiated in the popular culture arena - Typically lay people activate their health care by deciding when and whom to consult, whether or not to comply, when to switch between treatment alternatives, whether care is effective, and whether they are satisfied with its quality - The popular sector functions as the chief source and most immediate determinant of care - In cross-cultural studies, the popular sector has received far less attention than folk healing traditions - The popular sector is excluded from most studies dealing with “indigenous” healing traditions, yet it is for almost all societies the most active and widely used indigenous healing tradition - Self-treatment is the first therapeutic intervention resorted to by most people across a wide range of cultures - In the popular sector, individuals first encounter disease in the family - First initial steps: o Perceiving and experiencing symptoms o Labeling and valuating the disease o Sanctioning a particular kind of sick role (acute, chronic, impaired) o Deciding what to do and engaging in specific health care seeking behaviour o Applying treatment o Evaluating the effect of self-treatment and therapy obtained from other sectors of the health care system - The sick person and his family utilize beliefs and values about illness that are part of the cognitive structure of the popular culture - Family can disregard signs by considering them to be ordinary or natural - They can enter professional or folk sectors and within each can choose among a range of treatment alternatives - Once people decide to enter either the professional or folk sector, they encounter different sets of beliefs and values - The clinical realities of the different sectors and their components differ considerably - The power to create illness and treatment as social phenomena, to legitimate a certain construction of reality as the only clinical reality, is not equally distributed - The professional sector is paramount because social power is in large part a function of institutionalization and the professional sector Is heavily institutionalized - In each setting, his illness is perceived, labeled, and interpreted, and a special form of care is applied - Each arena has entrance and exit roles for rules. For example, the sick person enters the modern professional medical sector by establishing his patient hood in a clinic or hospital. Similarly, in the family or folk arenas, he must receive sanction from others for a particular type of sick role. He will also exit from the modern professional medical sector in a particular manner, as one who has been cured, remains ill, or is dying - Central hermeneutic problem in clinical transactions: there are different interpretations of clinical reality reflecting different symptoms of meanings, norms, and power. - Each of the health care system’s sectors can be supposed a “separate” culture - Most of the popular sector is not preoccupied with sickness and care but with “health” and “health maintenance” - Popular sector’s preventive and health maintenance functions have been neglected 2. Professional Sector of Health Care - Professional sector comprises the organized healing professions and is simply modern scientific medicine - In certain societies, there are also professionalized indigenous medical systems - The classical indigenous healing traditions have professionalized along lines similar to those of the modern medical profession - Modern medical profession, using legal and political means, gained professional dominance in the health care field by forcing all other healing traditions to disband, submit to its professional control, or retreat into quasi-legal folk fringe - Pharmacy and nursing received professional status only by submitting to the authority of the medical profession - Technological advances and prolific medical subspecialisation have combined to create many other health professions in the United States functioning under medical hegemony and severely restricted in scope of practice - The battle for professional independence is still going on - Increasing clinical responsibilities assumed by nursing practitioners and medical assistants give additional evidence of the changing character of the professional sector in the United States - Just
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