3. I. Medical model of disease
A. Looks only at biological aspects of disease
1. Tremendous advances in last 100 years (artificial
organs) (40% of the people that go to doctors do
not get the right treatment. it maybe
psychological, cultural etc)
2. Used by most health professionals
3. But ignores social aspects of disease
a. Example: offset problem
4. II. Myth that more medical care is always
better
A. Example: Iatrogenic disease (disease caused
by the treatment) (15% of the ppl get a bacterial
infection in the hospital, mostly MRSA)
B. majority of medical treatments have never
been scientifically tested - fact eg. hormone
replacement therapy to reduce the symptoms
of menopause and ppl thought that it
prevented heart disease but it infact increased
the chances of heart disease and the chances
of cancer
5. III. Myth that medical care can cure every disease
A. Self limiting diseases (come and go by themselves and the
best medicine cannot cure eg common cold) (flu epidemic
killed the most people (20 mil) in reported history- we do not
know if the virus changed or if the humans adapted or did it
kill all the vulnerable people)
1. Diseases that go away by themselves
2. Diseases that modern medicine cannot cure
6. IV. Huge increase in average lifespan in the US
A. Lifespan increased from age 40 to 77 in 20th
century
1. Not due to advances in medical science (best
one Asprin, but did not keep more people alive)
(advances in clean water, and best one clean
food, the invention of refrigeration) clean air
2. Mostly due to advances in nutrition and public
health (the big increase is the decrease in infant
mortality)
7. V. Great success in reducing acute infectious
diseases
A. Effective vaccines available for many infectious
diseases (mumps, measels, chicken pox, polio,
small pox and treatments for malaria and tb)
(vaccinations for chicken pox is not as good)
B. But new infectious diseases are appearing as fast
as the old ones disappear
8. VI. Little progress in reducing "diseases of
civilization“
A. Chronic diseases (disease for the rest of ur life)
such as heart disease, cancer relatively high in the
US, stroke, diabetes, blocked arteries
B. Other killers - obesity, smoking, drinking, stress,
lifestyle, environmental pollution,
B. Caused mostly by unhealthy lifestyle
C. Caused in part by environmental pollution
D. Caused a little bit by genetics
9. VII. Study of morbidity (illness)
A. Epidemiology
1. The distribution of health and illness in a
population
2. Illness is not evenly distributed in the
population
B. Etiology
1. What causes illness (an etiologist studies what
causes the disease)
10. C. Gender example: women report more illness than
men
1. Theories: (women are sicker then men)
a. Women more likely to notice minor problems
b. Women more willing to report health problems
(men have the macho factor)
c. If you control for reproductive problems, there
would be no sex difference
d. Women really are sicker
11. VIII. Study of mortality (death)
A. Death is not evenly distributed in the population
B. Example: women live longer than men (by about
10 years)
C. Theories:
a. Genetic
b. Women lead less stressful lives
c. Women seek medical treatment for minor
problems before they become life threatening
12. IX. Study of patient help seeking
A. How people:
1. Perceive a health problem
2. Define a problem
3. Decide to seek help
4. Decide what kind of help to get (bar tenders are
therapists)
13. X. Study of utilization of treatment services
A. Medical treatment does not always go to those who
need it most
1.
Example: small area variations in surgery in
Vermont (only 8 hospitals in all of Vermont)
(some areas of vermont have a lot more hospital
beds per person than other areas)
B. Fads in medical treatment
1. Example: tonsillectomies (vary between 13 and
151 /10,000 ppl in different hospitals)
14. XI. Doctor-patient relationships
A. Good communication between doctors and
patients is crucial to effective diagnosis and
treatment
B. But good communication takes time and costs $$
(doctors listen on an avg of 1.8 mins)
15. XII. Traditional medical treatment vs. alternative
healers
A. Alternative healers are increasingly popular (cz
they are cheaper and are more pleasant and more
satisfying)
B. A short list:
1. Self-help groups
2. Chiropractic medicine (ease neck, back and
shoulder pain... mostly massage)
3. Dietary and exercise groups (Weight Watchers)
4. Religious groups and faith healers
16. XIII. Organization of medical care
A. Complex, changing fast
B. Alphabet soup of treatment options:
1. HMO (health maintenance organization)
2. PPO (preferred provider organization)
3. IPO (individual provider organization)
C. Managed Care
17. Stephen Hansell, Ph.D.
Department of Sociology
Institute for Health Research
http://sakai.rutgers.edu
shansell@rci.rutgers.edu
609-203-2830
