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Social Problems CH9 & Reading Sociology P9.docx

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Social Problems: Chapter 9 Health Issues Robert Aronowitz & Framing Disease  Framing Disease: the ways we generally recognize, define, name, and classify disease states and assign them to a cause / a set of causes  Framing effects influence perceptions of health, illness, policies, etc. Thomas Dictum  What we believe to be true is true in its consequences Medical Sociology  The field of sociology that examines the social context of health, illness, and health care  Inequalities in health and healthcare are social problems as they require governmental and other large institutions‟ efforts to be solved Defining Health and Illness Biomedical View of Medicine  Health = passive = default = normal  Illness = active = problem in need of treatment  Emphasizes Western scientific principles as Western focus is on curing sick rather than preventing sickness from occurring first  Health is strictly defined in somatic terms Treating the Patient Rather than the Disease  TREND: Growing recognition that an illness‟s symptoms vary with individuals based on: o Personal history o Socio-economic conditions o Cultural background “Well-Being” and “Health”  Well-being: State of existence characterized by happiness, prosperity, satisfaction of basic human needs  Health: AS DEFINED BY WHO: a state of complete physical, mental, and social well-being Biopsychosocial View of Health and Illness  Health and disease are products of the interaction of body, mind, and environment (NOT JUST BIOLOGY ALONE) Measuring Health and Illness Epidemiology  Applied science that examines the causes, distribution, and control of disease in a population Life Expectancy  Average number of years remaining to a person at a particular age, given current age-specific mortality rates  Increased globally thanks to advances in medicine, publich health, and technology  Differences in life expectancy still exist between rich and poor nations  TREND: Gender gap of life expectancy is diminishing o Men gradually catching up to women Mortality Rates  Deaths per year per thousand people in a population  Maternal ~: number of deaths of women due to complications in pregnancy, childbirth, abortion  TREND: increase in availability of contraceptive technology = declining number of abortions  TREND: majority of induced abortions in Canada for women under 30  Infant ~: number of deaths of children under one year of age per 1o00 live births  Under-Five ~: number of deaths of children under five years of age per 1000 live births  All these rates serve as statistical indicators of population health, focusing on different age of society‟s members Morbidity Rate  Extent of disease in a population  Incidence: number of new cases in a given population in a given period of time  Prevalence: total number of cases of a disease in the population at a particular time  Endemic: constantly present in a population  Epidemic: local or national outbreak  Pandemic: international or global outbreak  TREND: morbidity rates vary according to social variables (ex. sex, racial grouping, class) Threats to Canadian and Global Health AIDS Pandemic  AIDS was labeled and dismissed as a disease for them rather than us o Limited to 3 socially marginalized populations: homosexuals, injection drug users, Haitians  TREND: leading cause of death globally among adults 15-59; overall 4 leading cause  TREND: Worldwide – heterosexual intercourse is primary mode of HIV transmission  TREND: Canada – Homosexual intercourse between 2 men primary mode of HIV transmission SARS, Pandemic Influenza, and the “Globalization” of Infectious disease  Malaria is almost exclusive to world‟s poorest nations  Tuberculosis is returning  SARS – product of globalization because it‟s rapid spread was promoted by international travel and trade  Globalization increases the risks of contracting communicable viruses  Thought that SARS was a forerunner to an even larger global pandemic, such as virulent influenza Mental Health and Mental Illness  Mental Health: ability of individuals to feel, think, act in ways that improve the quality of daily functioning, range and depth of social relations, and ability to adapt to life changes  Mental Disorder: alterations in thinking, mood, and/or behaviour associated with significant distress and impaired functioning over an extended period of time  Mental Illness: clinical diagnosis of mental disorder requiring medical/psychotherapeutic treatment  Mental disorders and illnesses are social problems because they interrupt the functioning of families, groups and other social institution  Unknown causes lead to public unease and stigmatization  Most mental illnesses arise from interaction of genetic/biological, psychological, and social/environmental factors  Development of mental illness through stress and breakdown of social order may arise over major social disruptions such as war or natural disasters  Individualistic nature and speeded up pace of life in modern industrialized societies erode traditional sources of social stability, such as family and religion  TREND: Unipolar depressive disorders make up largest category of fatal disabling conditions and are the rd 3 leading cause of lost years of productivity nd  TREND: Depression expected to become world‟s 2 leading cause of disability by 2020; large number of people rely on anti-depressants  TREND: 1 in 5 Canadians likely to have mental disorder at some time in their life  Co-morbidity: the predisposition of an individual with an illness to additional health conditions  Direct costs of treatment: psychological and social work services not covered by public health care  Indirect costs: lost productivity  Additional costs: psychic and social costs to family members caring for sick relatives  TREND: rates of most mental illness higher in women than men; though men more substance dependent  TREND: mental health poorer in marginalized ethnic and cultural groups o Seen higher suicide rates of Aboriginal communities, which is correlated with depression  Social Selection: a correlation suggesting but not proving causation, because a third, unmeasured factor is involved; also known as adverse selectivity  Social selection and downward drift hypotheses thought to explain link between mental disorders and social class o Propose that mental illnesses prevent some people from functioning effectively causing:  More unemployment  Poorer educational outcomes  Increased downward social mobility  Social causation: stresses associated with life in the lower social classes promote frustration and despair while eroding coping abilities, contributing to onset of mental health problems  Social causation theories also proposed to explain link between mental disorders and class International Comparisons: Swine Flu Vaccine  Health experts warned that the poor may lose out as wealthy countries corner strictly limited supplies  Advantage of affluence: majority of limited supplies will go to wealthy countries  WHO negotiated with vaccine producers to secure donations or sales at lower prices for developing countries  Rich countries were asked to donate some of their vaccine stock Obesity  TREND: obesity and excess weight increasing at alarming rate  Primary causes: energy-dense, nutrient-poor diet; sedentary lifestyles; large portion sizes; increased television viewing; urban environment favouring driving over walking  Body Mass Index (BMI): measure of “obesity”  weight (kg) divided by height (m) squared o Overweight if BMI < 25 o Obese if BMI < 30  TREND: Obesity rates increasing especially in Atlantic Canada and Prairie provinces o but after controlling for education and socio-economic status, province/region have not been identified as a separate risk factor for obesity  Direct Costs: health-care expenditure  Indirect Costs: economic output lost due to illness, injury-related work disability, premature death Structural Functionalist  Health is normative, maintained by social institutions o Allows person to function and benefit society  Health care is a social institution responsible for maintaining a society‟s members‟ well-being o Widespread illness can undermine a society and damage social, economic, and political infrastructure  Illness is a form of deviance that threatens the ability of the society to function  The ill must fulfill a “sick role” to allow them to temporarily withdraw from society to recuperate o Sick will not be blamed/at fault provided they try to get well  DURKHEIM: Suicide o We must explain personal health issues like suicide in social-structural terms Conflict Theory  Problems in delivery of healthcare result from capitalist economy o Sees medicine as a commodity that can be produced and sold  People struggle over scarce resources (medical treatments)  ENGELS: The Condition of the Working Class in England o Deplorable conditions of disadvantage in Manchester (ex. substandard housing, lack of sanitation, inadequate diet and clothing, harsh work environment, affected city‟s death rate  VIRCHOW: „father of modern pathology‟ o Root causes of typus epidemic due to regional poverty, poor education, inept gov‟t policies  Health, health care, and research are affected by wealth, status, and power Symbolic Interactionism  Unique meanings and experiences are associated with specific diseases and with being labeled as sick  What constitutes health or sickness varies from culture to culture and is constructed by groups that reflect their needs, values, and beliefs Feminist Theory  Gender and its social construction are important determinants of health  Women‟s health often has been defined and understood on the basis of a male model and male norms o Men have controlled women‟s bodies as physicians  Depression was viewed as women‟s mental health disability and a form of gendered incompetence  TREND: women‟s illnesses and health conditions are often considered more shameful than men‟s o ex. Menopause viewed by some doctors as psychiatric problems, owing to losses and lack of meaningful occupation Social Determinants of Health  The complex causal relationships between various social, economic, and political factors  Major improvements in populations health a result of improved socio-economic conditions, rather than improved individual behaviours  Health inequalities still exist where universal, publicly funded healthcare is provided o Access is not the problem  Materialist approach: disadvantaged populations suffer from higher levels of total exposure to negative conditions  Neo-materialist approach: material conditions important, also social structural contributors (income inequality, systemic racial and gender discrimination, cuts to government social spending)  Social comparison: health inequalities exist even among well-off people  WHITEHALL studies of British civil servants o Groups in question had similar jobs, similar class  difference in health status not due to material deprivation o Accumulated psychological stress, due to different opportunities and varying degrees of control over life decision, affected health o THUS, health policies must harmonize with social policies as health status is closely and subtly related to social environment Key Social Determinants of Health in Canadian Society 1. Early Life: benefits of healthy development begin at earliest stages of life; parenting education, good nutrition 2. Education: educational attainment in adolescent and early adulthood useful in dealing with problems; literacy is a sensitive predictor of health status 3. Food Security: inability to acquire or consume a an adequate diet quality or uncertainty that one can do so 4. Housing: shortage of affordable rental housing cause people to settle for substandard housing conditions (or rent a costly apartment) 5. Employment Security and Work Conditions: women an ethnic minorities fill unskilled manual labour and service industry positions 6. Income Inequality: as one moves up income hierarchy, health status improves; health inequalities exist along the entire income spectrum, even among the richest members of society 7. Social Exclusion: marginalization of some groups in society from economic, social, cultural, and political resources that affect quality of life 8. Aboriginal Status: higher-than-average rates of mortality, infant mortality, suicide, infectious disease, etc; more likely to smoke, abuse alcohol and drugs, etc; less likely to get immunized, exercise 9. Social Safety Net: unemployment insurance benefits, welfare payments, publicly managed pensions, universal healthcare access, support services provided by the state; reduce negative health effects of unemployment, poverty, racial and social exclusion and other social problems 10. Healthcare Services: unequal access to healthcare prevalent among poor and marginalized people Claims-Making and the Social Construction of Health Issues  Social construction perspective reveals ways in which health messages are delivered to us  Messages were selectively delivered and stressed individual blame for health (ignore social determinants)  Medicalization: medical profession comes to be viewed as relevant to non-medical aspects of life  Some authors see media and medical and pharmaceutical industries as medicalizing phenomena (ex. sleep disorders, aggressive behaviour in teens, physical inactivity) as they stand to profit from it  Many supposed health problems have more to do with social / cultural issues than actually health risks Solutions: Public Health Promotion Population Health Perspective  Framework for understanding health and illness in society, highlights importance and benefits of preventive health care (most effective to improve social health indicators but also most economically effective) Primary Prevention  Steps people take to prevent a disease from occurring 1. Immunization 2. Well-functioning public health infrastructure 3. Prudent use of antimicrobial medicines 4. Improving the social determinants of health  Health promotion especially important in developing world to control outbreaks of communicable diseases (ex. AIDS education among sex workers)  Effective public health delivery means adapting to local circumstances and recognizing that the target individuals are whole human beings o Myanmar: women found with condom are imprisoned o Laos: female brothel-owners given incentives to provide condoms and sex education to staff  lead to higher rates of condom usage  Information-sharing between governments is important to ensure early detection and response to control communicable diseases Improving Health in the Developing World: Millennium Development Goals  UN adopted Millennium Development Goals to co-ordinate efforts to eliminate poverty and improve global health by 2015  Goals address population health needs, and issues that affect population health o They address the related issues of peace, security, fundamental freedoms and human rights  5 diseases - pneumonia, diarrhea, malaria, measles, and AIDS - account for over half of all deaths globally among children under 5  Can be prevented with inexpensive interventions  encouraging breast feeding, providing medicines, etc.  Meeting the Goals is slowed by lack of funds o Some countries have not met their goals but are committing to doing so by 2015 o Canada has not commit to the goal, arguing it would be fiscally irresponsible  Meeting Goals also slowed by bias in health research o 90/10 research gap: 90% of global spending on medical and pharmaceutical research aimed at finding treatments for diseases that only affect 10% of wealthiest population Healthcare Reform in Canada  Debate over healthcare reform focuses on access and role of for-profit health services in Canada‟s supposedly universal system  Healthcare access in underserviced areas (esp. northern, remote, Aboriginal communities, northern poor communities, francophone communities in English-speaking Canada) in need of improvement  Efforts underway to reduce bureaucratic obstacles that immigrants face in getting a licence to practice medicine in Canada  can station them in the underserviced areas  Telehealth: use of computer and communication technologies to aid healthcare delivery o Good for sending images, electronically from rural/remote locations for review o Video conferencing for consultation, assessments, observations, etc. Waiting Times: How Long is Too Long?  State must pay for treatment in another jurisdiction if doctors cannot provide timely treatment in home province  concerns healthcare providers  Our society cannot afford to provide immediate, high-quality care to everyone who needs it Causes of Waiting Times  Demography of Waiting: Too many
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