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Chapter 14

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Alison Dunwoody

Health, Medicine and Age Intro ­ in 2010, Betty White became oldest person to host Saturday Night Live, winning an Emmy award for her performance ­ advancements in medical technologies and improved living conditions have increased life expentancy: o in Canada: average age is ~81 ­ are we living better though? o increased rate of obesity, diabetes, arthritis and other conditions o doctor shortages o long wait times o overburdened system ­ challenges to institution of medicine: system's principles of university don't always translate into practice. Sometimes people are left behind. ­ Canadians have one of the most envied health care systems in world ­ a long life without health is one few would welcome Culture, Society and Health ­ health affected by: biology, relationships, contexts, and significance of impact of culture and society, communities, access to health care, exposure to risks ­ definition of health from WHO: "a state of complete physical, mental and social well- being, and not merely the absence of disease and infirmity" o culture influences our belief of where we fall in the spectrum of perfect health on one side and death on the other ­ rural areas o CON: have to travel far to see doctor o PRO: avoid stresses, environmental risks that city people face ­ cultural preferences affect with treatments are sought o Japan: organ transplants are rare, do not like harvesting organs from brain-dead donors ­ research shows diseases also rooted in shared meaning of culture ­ culture bound syndrome: a disease or illness that cannot be understood apart from specific social context o means there is something particular about that culture that contributes to that malady ­ average Canadian woman: o 5 feet 3 inches o 153 pounds o wears size 14 dress ­ average model: o 5 feet 9 inches o 110 pounds o wears size 0 or 2 ­ anorexia nervosa: intense fear of becoming obese and a distorted image of one's body o is culture-bound syndrome o usually in teens or 20s o lose weight by self induced semi starvation o seen as healthy and beautiful VS ugly and lacking self discipline ­ until recently, researchers dealt with concept of culture-bound syndrome only in cross-cultural studies ­ medical practitioners now being trained to recognize cultural beliefs that re related to medicine: o ex. people from Central America consider pain a consequence of imbalance of nature o ex. Muslim women are concerned about modesty ­ culture can influence incidence of disease or disorder o in book The Scalpel and the Silver Bear, Dr. Lori Arviso Alvord, the first Navojo women to become surgeon, writes about depression and alcoholism on reserve o says diseases born out of historicla grief o rates of FASD- fetal alcohol spectrum disorder, heart disease and type 2 diabetes higher in First Nations communities than on national average Sociological Perspective on Health and illness ­ other people affect how we perceive own health and health of others ­ have to consider how society defines illness, what are consequences of ­ Illness and Social Order If too many people are sick at the same time; undercuts our collective ability to perform tasks necessary for the continued operation of society. We socially define what is “ill,” to limit mass spread of sickness.Sick role, refers to societal expectations about the attitudes and behaviour of a person labelled as ill  sick are obligated to attempt recovery  obligation arises from the sense of responsibility we have to perform our normal roles in society  also is motivated by the reality that we may well face sanctions from others for failing to return to those normal roles quickly  often look down on those who seem to get sick too easily o Exempt from normal tasks; physicians are gatekeepers of deciding who is sick (give the notes); doctor controls the resources the patient needs; employment tension also affects one’s willingness to be sick; (e.g. athletes will try to not be sick). o Young kids (unknowing) and old people (too weak already) are most vulnerable A Matter of Perspective THEORETICAL PERSPECTIVES ON HEALTH Functionalist: • health is important if society is to function smoothly; people must be able to perform their roles • the sick role excuses people from responsibilities, but only temporarily Conflict: • health is linked to social inequality; those with greatest power and resources have better access to required elements for health • differences in education, income, living conditions, and diet are linked to varying levels of health Feminist: • women are especially subjected to processes of medicalization • patriarchal assumptions and practices in health care system negatively affect women's health Interactionist: • individuals and societies define “health” • process of labelling has social consequences ­ POWER, RESOURCES, AND HEALTH o Sociologist Eliot Freidson (1970:5) religion can be linked to illness- approved monopoly on the right to define health and to treat illness. o “medicalization of society” to refer to the growing role of medicine as a major institution of social control o The Medicalization of Society Social control involves techniques and strategies for regulating behaviour in order to enforce the distinctive norms and values of a culture. More scientific explanations for gender and sexuality and cures make medicine more important in life; issue: medical model framework— once medical experts become influential in proposing and assessing relevant public policies—it becomes more difficult for common people to influence on decision making. o Second issue ▯ medical professionals define what is right/ wrong in medicine; midwives considered illegitimate childbirth people o Conflict theory ▯ Poor places are underserved; Canada has 9.8 family physicians per 10,000 people, thus prompting concerns about the “doctor shortage.” Africa has about 2 doctors per 10,000 people. o The supply of health care in poorer countries is further reduced by what is referred to as brain drain—the immigration to Canada and other industrialized nations of skilled workers, professionals, and technicians who are desperately needed in their home countries; but come to Canada for more money o The infant mortality rate is the number of deaths of infants under one year old per 1,000 live births in a given year.  This measure is an important indicator of a society's level of health care; it. reflects prenatal nutrition, delivery procedures, and infant screening measures. I.M> reflects unequal distribution of health care resources based on the wealth or poverty of various nations. Lower health care = reduced life expectancy ­ ­ o Labelling and Power As interactionist theorists have demonstrated, sometimes the power to label and the power to oppress go hand in hand. • Racism: the skin colour of Africans deviated from “healthy” white skin colouring because Africans suffered from congenital leprosy. • Africans escaping from White masters as an example of the “disease” of drapetomania (or “crazy runaways”). Remedy for disease to was to treat slaves kindly,.  Under Alberta's Sexual Sterilization Act, which came into effect in 1928, to stop reproduction of retards + minorities. Repealed in 1972 b/c its unconstitutional; AIDS is declared a master status; a spoiled identity ▯ failure of immune system, and people are vulnerable to all infections; 65,000 people today live with it; Aboriginals have high suspectibility to disease; • 33.2 million people are now infected; however, the disease is not evenly distributed. nations of sub-Saharan Africa—face the greatest challenge  Gay men and people who use injection drugs—were stigmatized in society for having high proportion of AIDS; • Homosexuality as a disease; removed in 1974; but we also have “gender identity disorders,” including those who are transgender and transsexual o NEGOTIATING CURES  Physicians tend to demand respect and patients may or may not follow doctor’s prescriptions; people try to self- cure with internet research  Working class are more submissive; middle class is more interactive with doctors ­ Social Epidemiology o Social epidemiology is the study of disease distribution, impairment, and general health status across a population; study of epidemics, focusing on how they started and spread. Contemporary epi also looks at injuries, drug addiction and alcoholism, suicide, and mental illness  Incidence: refers to the number of new cases of a specific disorder per year • For example, the incidence of AIDS in Canada in 2009 was 224 cases  prevalence refers to the total number of cases of a specific disorder that exist at a given time. • The prevalence of AIDS in Canada through 2008 was estimated at 65,000 cases o When disease incidence figures are presented as rates—for example, the number of reports per 100,000 people—they are called morbidity rates. o This is distinct from the mortality rate, which refers to the incidence of death in a given population. Useful because they can reveal whether a specific disease occurs more frequently among one segment of a population than another. o SOCIAL CLASS  Social class differences is that they appear to be cumulative. Little or no health care in childhood or young adulthood is likely to mean more illness later in life  Capitalist societies care more about maximizing profits than they do about the health and safety of industrial workers o RACE AND ETHNICITY  Disease may be through genetics but also environmental factors contribute to the differential rates of disease and death.  Morbidity rates are primarily influenced by social class and wealth, not race and ethnicity per se, but visible minorities and Aboriginal persons are disproportionately represented among the poor.  Tuberculosis infection rates are eight to ten times higher than among the general population  infant mortality is regarded as a primary indicator of health care.  Rates of obesity of children living on reserves are more than four times higher than the national average.  In 1979, the measured obesity rate in Canada was 13.8 percent. By 2009, that number had risen to 24.1 percent, and experts argue it continues to rise. Yet in 2008, a self-reporting study found that only 17 percent of Canadians identify as obese.  Hospitals have institutional discrimination; minorities receive inferior care due to cultural bias on the part of practitioners, language barriers, and cultural differences and expectations  Tuskegee syphilis study, 1930’s, doctors knowingly withheld treatment from Black men infected with syphilis in order to observe the progression of the disease.  Having to deal with the effects of racism may itself contribute to the medical problems of Blacks (Waitzkin 1986). The stress that results from racial prejudice and discrimination helps to explain the higher rates of hypertension found among African Americans (and Hispanics) compared to Whites. Hypertension—twice as common in Blacks as in Whites—is believed to be a critical factor in Blacks' high mortality rates from heart disease, kidney disease, and stroke  Aboriginal culture may have a medicine pouch by persons seeking the mercy and protection of the spirits. Sweat lodges are used for spiritual healing and purification. Freeing, body, mind, and spirit.  Particular cultures may differ from laws of a country; e.g. female “circumcision,” otherwise known as female genital mutilation or women not allowed to expose their bodies to men o GENDER AND SEXUALITY  women experience a higher prevalence of many illnesses, although they do have a longer life expectancy; men are more likely to have parasitic diseases, whereas women are more likely to become diabetic—but as a group, women appear to be in poorer health than men.  Women's lower rate of cigarette smoking (reducing their risk of heart disease, lung cancer, and emphysema), lower consumption of alcohol (reducing the risk of auto accidents and cirrhosis of the liver), and lower rate of employment in dangerous occupations explain about one-third of their greater longevity than men. ▯ But their diseases aren’t often propery diagnosed so have a higher risk  Feminism: physiological changes such as pregnancy and menopause into “conditions” requiring medical surveillance and intervention. Women’s insecurity for issues has prompted medical companies to take advantage of this (e.g. Latisse, for small eyelashes) o MENTAL HEALTH  While women are diagnosed more often with mental illnesses  Canadian Mental Health Association, approximately 20 percent of Canadians will experience a mental illness in their lifetime, and at least 1 percent of the population is affected by a persistent and disabling form of mental illness. o DISABILITY  14 and 17 percent of adults report having some form of disability but not all persons with disabilities are “ill,” and illness is not always in and of itself disabling.  impairment anddisability: impairment is the loss of function; disability is the consequence of that impairment; disability seen as physical, but rather, is a consequence of social + cultural regulation;  Disability results from the interaction between person and environment;” attitudes are often the largest barriers to inclusion and social participation. ­ AGE o Most older people in Canada report having at least one chronic illness, o Older people are especially vulnerable to decline of brain function. Rates of dementia, Alzheimer's, and Parkinson's disease are on the rise in Canada. Health Care in Canada ­ The costs of health care have skyrocketed in recent decades, from $23 billion in 1980 to over $200 billion in 2011. About11 percent of its GDP on health care, with an average expenditure of US$4,400 per capita (OECD 2011). Health care has become a big business, changing the nature of relationships between doctors, nurses, and patients. ­ A HISTORICAL VIEW o Universal health system began in Saskatchewan; Premier Tommy Douglas in 1947 with a pilot project in the town of Swift Current, with full provincial coverage in medicine o 1958 --. First national hospital insurance plan o In 1966, the Medical Care Act was passed, providing universal health insurance to all Canadians; currently there is little support for disbanding our publicly funded system. ­ THE ROLE OF GOVERNMENT o Since 1984, health care in Canada has been structured according to the principles of the Canada Health Act.  In keeping with Douglas' ideals, this federal statute ensures that all Canadians have access to medical services on the basis of need, rather than the ability to pay.  Provinces and territories receive transfer payments from the federal government to administer and deliver their own programs in accordance with the act.  Some provinces charge additional health care premiums, calculated according to income, but non-payment of a premium does not result in restriction of access to care. o In addition to its role as overseer, the federal government directly delivers health services to select groups: the military, federal inmates, the RCMP, veterans, and Aboriginal peoples, though members of the latter three groups often use the general public system. All health needs of these groups are to be met by the federal government. ­ FIGURE 14-2 ­ ­ PHYSICIANS, NURSES, AND PATIENTS o Doctors placed much more emphasis on their technical abilities and clinical skills than on their abilities to be caring and sensitive” o nurses commonly take orders from physicians. Traditionally, the relationship between doctors and nurses has paralleled the male dominance of Canada: most physicians have been male, while virtually all nurses have been female. o Nurses have been expected to perform their duties without challenging the authority of men. “doctor–nurse game.” According to the rules of this game, the nurse must never openly disagree with the physician. When she has recommendations concerning a patient's care, she must communicate them indirectly, in a deferential tone. o 94 percent—are female (CIHI 2008). Women also tend to be concentrated in certain fields of medicine o Gender affects practice; female doctors spend longer with each patient, address patients' emotions, and encourage patient participation in the medical encounter ­ ALTERNATIVES TO TRADITIONAL HEALTH CARE o Interest has been growing in holistic (sometimes spelled wholistic) medical principles, first developed in China. o Holistic medicine refers to therapies in which the health care practitioner considers the person's physical, mental, emotional, and spiritual characteristics. The individual is regarded as a totality rather than a collection of interrelated organ systems. Treatment methods include massage, chiropractic medicine, acupuncture (which involves the insertion of fine needles into surface points), respiratory exercises, and the use of herbs as remedies. Nutrition, exercise, and visualization may also be used to treat ailments that traditionally are addressed through medication or hospitalization o Practitioners may or not be doctors; Practitioners of holistic medicine do not necessarily function totally outside the traditional health care system. Becomes important with widespread recognition of the value of nutrition and the dangers of overreliance on prescription drugs o World Health Organization (WHO) has begun to monitor the use of alternative medicine around the world. According to the WHO, 80 percent of people who live in the poorest countries in the world use alternative medicine, from herbal treatments to the services of a faith healer; treatments are largely unregulated, even though some of them can be fatal. For example, Kava Kava, an herbal tea used in the Pacific Islands to relieve anxiety, can be toxic to the liver in concentrated form. Other alternative treatments have been found to be effective in the treatment of serious diseases, such as malaria and sickle-cell anemia. o Aging and Society ­ cultural presuppositions related to aging were limiting people's opportunity. In so doing, she contributed to the movement to change our cultural perceptions about what it means to be elderly and opened up more opportunities for older citizens. ­ Like gender stratification, age stratification varies from culture to culture. One society may treat older people with reverence, while another sees them as unproductive and “difficult.” The Sherpas—a Tibetan-speaking Buddhist people in Nepal—live in a culture that idealizes old age. Almost all elderly members of the Sherpa culture own their homes, and most are in relatively good physical condition. Typically, older Sherpas value their independence and prefer not to live with their children. Among the Fulani of Africa, however, older men and women move to the edge of the family homestead. Since that is where people are buried, the elderly sleep over their own graves, for they are viewed socially as already dead ­ ­ “Being old” is a master status that commonly overshadows all others in this country. Once people have been labelled “old,” the designation has a major impact on how others perceive them, and even on how they view themselves. Negative stereotypes of the elderly contribute to their position as a minority group subject to discrimination. The inevitability of being old makes it a unique master status; about 7 percent of the world's population is old. There are more old people now because of better medical practices. Perspectives on Aging ­ There are no clear-cut definitions for different periods of the aging cycle in Canada. old age has been regarded as beginning at 65, which corresponds to the retirement age for many workers, but not everyone in Canada accepts that definition. ­ gerontology—the study of the sociological and psychological aspects of aging and the problems of the aged. It ­ DISENGAGEMENT THEORY o disengagement theory, which implicitly suggests that society and the aging individual mutually sever many of their relationships. Emphasizes that passing social roles on from one generation to another ensures social stability. o Conflict ▯ implication that older people want to be ignored and put away—and even more to the idea that they should be encouraged to withdraw from meaningful social roles. Instead; society forces the elderly into an involuntary and painful withdrawal from the paid labour force and from meaningful social relationships. older employees find themselves pushed out of their jobs  Many people express both the desire and financial necessity to keep working. Increasing numbers are moving into “bridge jobs”—employment that spans the period between the end of their career and their retirement.  Unfortunately, the elderly can easily be victimized in such bridge jobs. older employees do not want to end their working days as minimum-wage jobholders engaged in activities unrelated to their careers ­ ACTIVITY THEORY o In 2010, at the age of 89, Hazel McCallion was elected to her 12th consecutive term as mayor of Mississauga, Ontario. o Often seen as the opposite of disengagement theory, activity theory suggests that those elderly people who remain active and socially involved will be best adjusted. Proponents of this perspective acknowledge that a 70-year-old person may not have the ability or desire to perform various social roles that he or she had at age 40. Yet they contend that old people have essentially the same need for social interaction as any other group. o Admittedly, many activities open to the elderly involve unpaid labour for which younger adults may receive salaries. ­ AGEISM AND DISCRIMINATION o ageism to refer to prejudice and discrimination based on a person's age. For example, we may choose to assume that someone cannot handle a rigorous job because he is “too old,” or we may refuse to give someone a job with authority because she is “too young.” o Critics argue that neither disengagement nor activity theory answers the question of why social interaction must change or decrease in old age. The low status of older people is seen in prejudice and discrimination against them, in age segregation, and in unfair job practices—none of which are directly
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