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Chapter 13

Social Problems Chapter 13 [COMPLETE] Notes - I 4.0ed this course

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University of Massachusetts Amherst

13.1 Sociological Perspectives on Health and Health Care Health refers to the extent of a person’s physical, mental, and social well-being. As this definition suggests, health is a multidimensional concept. Although the three dimensions of health just listed often affect each other, it is possible for someone to be in good physical health and poor mental health, or vice versa. Medicine refers to the social institution that seeks to prevent, diagnose, and treat illness and to promote health in its various dimensions. This social institution in the United States is vast, to put it mildly, and involves more than 11 million people (physicians, nurses, dentists, therapists, medical records technicians, and many other occupations). Finally, health care refers to the provision of medical services to prevent, diagnose, and treat health problems. Functionalism - Good health and effective medical care are essential for the smooth functioning of society. Patients must perform the “sick role” in order to be perceived as legitimately ill and to be exempt from their normal obligations. The physician-patient relationship is hierarchical: The physician provides instructions, and the patient needs to follow them. Conflict Theory - Social inequality characterizes the quality of health and the quality of health care. People from disadvantaged social backgrounds are more likely to become ill and to receive inadequate health care. Partly to increase their incomes, physicians have tried to control the practice of medicine and to define social problems as medical problems. For a person to be considered legitimately sick, said Parsons, several expectations must be met. He referred to these expectations as the sick role. First, sick people should not be perceived as having caused their own health problem. If we eat high-fat food, become obese, and have a heart attack, we evoke less sympathy than if we had practiced good nutrition and maintained a proper weight. If someone is driving drunk and smashes into a tree, there is much less sympathy than if the driver had been sober and skidded off the road in icy weather. Second, sick people must want to get well. If they do not want to get well or, worse yet, are perceived as faking their illness or malingering after becoming healthier, they are no longer considered legitimately ill by the people who know them or, more generally, by society itself. Third, sick people are expected to have their illness confirmed by a physician or other health-care professional and to follow the professional’s instructions in order to become well. If a sick person fails to do so, she or he again loses the right to perform the sick role. Parsons thus viewed the physician-patient relationship as hierarchical: the physician gives the orders (or, more accurately, provides advice and instructions), and the patient follows them. Parsons was certainly right in emphasizing the importance of individuals’ good health for society’s health, but his perspective has been criticized for several reasons. First, his idea of the sick role applies more to acute (short-term) illness than to chronic (long- term) illness. Although much of his discussion implies a person temporarily enters a sick role and leaves it soon after following adequate medical care, people with chronic illnesses can be locked into a sick role for a very long time or even permanently. Second, Parsons’s discussion ignores the fact, mentioned earlier, that our social backgrounds affect the likelihood of becoming ill and the quality of medical care we receive. Third, Parsons wrote approvingly of the hierarchy implicit in the physician-patient relationship. Many experts say today that patients need to reduce this hierarchy by asking more questions of their physicians and by taking a more active role in maintaining their health. The Conflict Approach: Physicians may honestly feel that medical alternatives are inadequate, ineffective, or even dangerous, but they also recognize that the use of these alternatives is financially harmful to their own practices. many hyperactive children are now diagnosed with ADHD, or attention deficit/ hyperactivity disorder. The definition of their behavior as a medical problem was very lucrative for physicians and for the company that developed Ritalin, and it also obscured the possible roots of their behavior in inadequate parenting, stultifying schools, or even gender socialization, as most hyperactive kids are boys. Although physicians are certainly motivated, as many people are, by economic considerations, their efforts to extend their scope into previously nonmedical areas also stem from honest beliefs that people’s health and lives will improve if these efforts succeed. 13.2 Global Aspects of Health and Health Care International Disparities in Health and Illness: The poorest nations suffer terribly. Their people suffer from poor nutrition, unsafe water, inadequate sanitation, rampant disease, and inadequate health care. One disease they suffer from is AIDS. Infant mortality is greater in poor counties. Sanitation is poor in poor countries. North America, Western Europe, Australia, and New Zealand have much longer life expectancies (75 years and higher) than Africa and Asia, where some nations have expectancies below 50 years. The society we live in can affect our life span by more than a quarter of a century. Health Care in Industrial Nations: Industrial nations throughout the world, with the notable exception of the United States, provide their citizens with some form of national health care and national health insurance. Although their health-care systems differ in several respects, their governments pay all or most of the costs for health care, drugs, and other health needs. Lessons from Other Societies: Although the United States spends more per capita than these nations on health care, it generally ranks much lower than they do on important health indicators. Of twenty-four wealthy democracies from North America, Western Europe, and certain other parts of the world the United States has the lowest life expectancy, the highest infant mortality, and the highest rates of obesity, adult diabetes, and HIV and AIDS. A fair conclusion from all the evidence is that US health lags behind that found in other wealthy nations because the latter provide free or low-cost national health care to their citizens and the United States does not. 13.3 Problems of Health in the US Health has improved in the US in regards to life expectancy, smoking, and the amount of lead in blood The Poor Status of American Health 14.5 percent of US households and almost 49 million Americans are “food insecure” (lacking sufficient money for adequate food and nutrition) at least part of the year; more than one-fifth of all children live in such households More than 8 percent of all infants are born at low birth weight (under 5.5 pounds), putting them at risk for long-term health problems; this figure has risen steadily since the late 1980s and is higher than the 1970 rate Social epidemiology - The study of how health and illness vary by social and demographic characteristics such as social class, race and ethnicity, and gender. Health disparities - Differences in health and illness according to social class, race and ethnicity, and gender. Health Disparities: Physical Health Social Class: Children and Our Future: As family income and levels of education rise, health improves. In almost every state, shortfalls in health are greatest among children in the poorest or least educated households, but even middle-class children are less healthy than children with greater advantages. • Children of poor mothers are more than twice as likely as children born to wealthier mothers to be born with low birth weight. • By the age of 9 months, poor children are already more likely to exhibit poor health and lower cognitive and socioemotional development. • By age 3, poor children are two-thirds more likely to have asthma than children whose families’ incomes are more than 150 percent of the poverty line. • Based on their parents’ reports, poor children are almost five times more likely (33 percent compared to 7 percent) to be in less than very good health (i.e., their parents rated their children’s health as poor, fair, or good rather than as very good or excellent). One reason is that poverty causes stress. Another reason is that they are more likely to experience food insecurity and, if they live in urban areas, be exposed to higher levels of lead and pollution. Low-income children also tend to watch television more often than wealthier children and for this and other reasons to be less physically active; their relative lack of physical activity is yet another reason for their worse health. Finally, their parents are much more likely than wealthier parents to smoke cigarettes; the secondhand smoke they inhale impairs their health. As is well known, many poor people lack medical insurance and in other respects have inadequate health care. These problems make it more likely they will become ill in the first place and more difficult for them to become well because they cannot afford to visit a physician or to receive other health care. A fourth reason is a lack of education, which, in ways not yet well understood, leads poor people to be unaware or unconcerned about risk factors for health and to have a fatalistic attitude that promotes unhealthy behaviors and reluctance to heed medical advice. Although it might sound like a stereotype, poor people are more likely to smoke, to eat high-fat food, to avoid exercise, to be overweight, and, more generally, not to do what they need to do (or to do what they should not be doing) to be healthy Race and Ethnicity: When we do not take gender into account, African Americans can expect to live about five fewer years than whites. Infant mortality is higher for races other than whites. African Americans are also more likely than whites to be overweight and to suffer from asthma, diabetes, high blood pressure, and several types of cancer. Why do such large racial and ethnic disparities in health exist? To a large degree, they reflect the high poverty rates for African Americans, Latinos, and Native Americans compared to those for whites. In addition, inadequate medical care is perhaps a special problem for people of color, thanks to unconscious racial bias among health-care professionals that affects the quality of care that people of color receive. Many of the foods that have long been part of African American culture are high in fat. Partly as a result, African Americans are much more likely than whites to have heart disease and high blood pressure and to die from these conditions In a significant finding, African Americans tend to have worse health than whites even among those with the same incomes. Several reasons explain this racial gap. One is the extra stress that African Americans of all incomes face because they live in a society that is still racially prejudiced and discriminatory. To some degree, racial differences in health may also have a biological basis. For example, African American men appear to have higher levels of a certain growth protein that may promote prostate cancer; African American smokers may absorb more nicotine than white smokers; and differences in the ways African Americans’ blood vessels react may render them more susceptible to hypertension and heart disease Environmental racism - Minorities tend to live in poor or urban areas that expose them to more chemicals and pollution which is bad for their health. Gender: Women outlive men by more than 6 yrs. At the same time, women have worse
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