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Chapter 1-12

hltb03 chapters 1-12.docx

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Health Studies
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Dan Silver

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PART 1: The Canadian health care system and the health status of Canadians Chapter 1: Sociology, Medicine, Health, and Illness: An overview Medical sociology covers a wide range of substantive areas and encompasses a diversity of issues pertaining to health and illness, medical institutions, the structure and organization of the health care sector, and the political, economic, and social determinants of the nature and composition of the health care delivery systems. th In the late 19 century, germ theory (associating specific bacteria to the etiology of a disease) was developed by Pasteur and Koch. Following the germ theory, a mechanistic view of the human body emerged. This approach ignores the social causes of much ill health This mechanistic conception brought about a shift from the consideration of illness as a breakdown of the total system to the notion that ill health could be caused by the malfunctioning of one particular part of the body machinery-in other words, localized pathology. As Navarro and others have argued, the form and nature of medicine is determined by class and power relations in the society and not by scientific imperatives. Allopathic medicine: the treatment of disease by conventional means; for example, by using drugs that have opposite effects to the symptoms. The ascendancy of scientific laboratory-based medicine and the dominant position of allopathic medicine in North America at the beginning of this century were aided by the publication of the Flexner report which is a report that was critical of the medical schools that did not have the facilities to teach laboratory-based scientific medicine. The Flexner report helped change modern medicine from quackery to responsible practice. The Flexner report supported by the medical profession and by philanthropic foundations, helped to consolidate the dominance of the allopathic practitioners and to establish laboratory-based scientific medicine as the norm for medical education and practice. The Dorland Medical Dictionary defines disease as a definite morbid process having a characteristic strain of symptoms-it may affect the whole body or any of its parts, and its etiology (the study of the causation of disease and disorders, especially of a specific disease), pathology (the science of bodily diseases; the symptoms of a disease), and prognosis may be known or unknown. According to parsons definition, health is this capacity to perform Clinical model attributes disease to the malfunctioning of the human body The reductionism model introduces the idea that the causes of disease lie in individual lifestyles and behaviors. Social medicine is primarily concerned with the conditions in society that produce illness and death Traditional epidemiology has searched for causes of morbidity and mortality that are amenable to medical intervention, historical materialistic epidemiology has found causes of disease and death that derive from social conditions Social epidemiology approach states that health and illness cannot be understood by referring only to biological phenomena and medical knowledge. Rather, human health and illness are embedded in economic, social and cultural contexts, and these factors play an important role in creating the social distribution of health and illness. Material and social conditions that produce illness and mortality include social class, economic cycles, socially produced stress, production processes, and working conditions. Engels and Virchow did a lot of research with focus on social and material conditions; For Engels, the roots of illness and early mortality of working-class people were embedded in the process of industrial production and social environment. His analysis focused on the links between environmental toxins, poor housing conditions, poor nutrition, industrial production, working conditions in mining and the textile industry, l various infectious diseases, pulmonary disorders, black lung disease, eye disorders, and other occupational diseases and injuries. Virchow focused on the social and economic deprivations of working-class life and linked working-class peoples higher morbidity and mortality to inadequate housing, poor nutrition, and inadequate clothing. These deprivations increased working-class susceptibility to disease and illness. While Engels focused his analysis mainly on structural contradictions of production and contradictions between profit and safety, Virchow focused on class inequalities in social distribution and the consumption of resources. Social variability in mortality rates and life expectancy among individuals and groups is produced by structurally produced inequalities, differential life chances, and qualitatively different experiences of social and economic determinants of health and illness. A significant portion of early research in medical sociology has been about the medical behavior of consumers of health care services and the social processes that influence the decisions of individuals to use medical services. A number of authors have identified sociopsychological, sociodemographic, and soico-economic variables to account for variability in health behavior and illness behavior. Others have analyzed the behavior of the providers of health services and the interaction among various interest groups within the health sector. It is estimated that only 10-15% of the increased longevity since 1900 is due to improvements in the health care system. The limitations of the existing system have also become apparent due to its inability to contend with the complexity of many contemporary chronic conditions. Illich provides considerable evidence of the ineffectiveness of momd3ern medicine in reducing morbidity and mortality. He takes the view that current medical practices does more harm than good. His analysis centers on three categories of iatrogenesis( the causing or inducing of a disease by a physician or medical treatment) o Clinical (eg. pain occurs from provision of medical care) o Social (eg. Health policies reinforce an industrial organization which generates dependency an ill health) o Structural (eg. Medically sponsored behavior and delusions restrict the vital autonomy of people by undermining their competency in growing up, caring for each other and aging) Illich attributes these iatrogenic effect to the industrialization, bureaucratization, and monopoly power of the medical profession, as well as the overmedicalization of life, which perpetuates an addictive dependency on medicine and medical institutions. He proposes that the solution therefore lies in debureaucratization, deindustrialization, and demonoopoilization. WAitzkin argues that the contradictions in medicine reflect contradictions of larger society, and they cannot be resolved by focusing on the health sector alone or on individual clinicians. Health in broader terms is defined as a state of complete physical, mental, emotional, and social well-being-not merely the absence of disease. Health education seems to be one of the central foci in achieving health for all Evidence shows that despite Canadas superior system, peoples health remains directly related to their economic status. In spite of this evidence, the social determinants have received little attention in Canadian health policy debates and remain marginalized in developing public policy due to the dominant paradigms of scientific medicine with their focus on biomedical health and individual lifestyle and behavioural determinants of health. Public policy plays an important role in determining the level of funding, organization, and delivery of health services. Public policy is also crucial in determining the quality of social determinants of health. READ THE SUMMARY AGAIN IF TIME PERMITS Chapter 2: Health care and health reforms: trends and issues Introduction Medicare is this system of universal, accessible, comprehensive and portable medical and hospital care insurance, publicly administered on a non-profit basis. some people worry as taxpayers that the cost of medicare and its sustainability and if whether it is draining public resources away from other areas of public policy, such as the post-secondary education, social services, national defense and security. Cost transfer initiatives have been taken to solve this problem but it is known to be not effective; -direct cost transfer (marketization): directly transferring costs from the public sector to the private sector -indirect cost transfer (downloading): involves having family, friends, and community organizations providing uncompensated care to individuals in need. Another main dimension of the perpetual crisis in health care
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