Problems of Illness and Health Care Fly.Doroteo.Culligan.Collier.Gerk
In this chapter problems of illness and health care are addressed in the United States and throughout the world. Taking a sociological look at health issues, we examine why some social groups experience more health problems than others and how social forces affect and are affected by health and illness.
Researchers, social scientist, politicians, and others classify countries into one of three categories according to their economic status. 1. Developed Countries –have relatively high gross national income per capita and have diverse economies made up of many different industries.
Developing Countries -have relatively low gross national income per capita, and economies are simpler, relaying on agriculture products.
3. Least Developed Countries –are the poorest countries in the world.
Patterns of health and illness reveal striking disparities among developed, developing, and least developed nations. This section focuses on health and illness from a global perspective, where descriptions of patterns of morbidity, life expectancy, mortality, and burden of diseases around the world.
Morbidity, Life Expectancy, and Mortality
Morbidity refers to illnesses, symptoms, and impairments they produce.
Measures of morbidity are often expresses in terms of the incidence and prevalence of specific health problems.
Incidence refers to the number of new cases of a specific health problem in a given population during a specified time period.
Morbidity, Life Expectancy, and Mortality…
-Prevalence refers to the total number of cases of a specific health problem in a population that exists at a given time.
Ex: The “incidence” of HIV infection worldwide was 4.3 million in 2006. In the same year the worldwide “prevalence” of HIV was nearly 40 million, meaning that nearly 40 million people world wide were living with HIV infection in 2006 (Joint United Nations Programme on HIV/AIDS 2006)
Patterns of morbidity vary according to the level of development of a country. Where poverty, chronic malnutrition are widespread in less developed countries, infectious and parasitic diseases, such as HIV diseases, tuberculosis, diarrhea diseases are more prevalant, than in developed countries.
Life expectancy is the average number of years that individuals born in a given year can expect to live.
Life Expectancy in: Developed Countries such as the United States is 80 year old
Developing Countries is 65 years old
Least Developing Countries such as Africa is less than 50 years old.
There are wide disparities in life expectancy, that exist between countries.
Graph Source: UNICEF(2006)
Infant Mortality Rate
Infant mortality rate is the number of deaths of live born infants under 1 year of age per 1,000 live births (in any given year).
In 2005 infant mortality rates ranged from an average of 97inleast developed nations to an average of 5 industrialized nations.
A major factor contributing to the deaths of infants and children is under nutrition. In the developing world one in four under age 5 is underweight.
Under 5 mortality rate refers to rate of deaths of children under 5 years old.
Rates range from an average of 153 in least developed nations to an average of 6 in industrialized countries.
Maternal Mortality Rate
Maternal mortality rate is the measure of deaths that result from complications associated with pregnancy, childbirth, and unsafe abortion.
Risks of dying from pregnancy or childbirth
-Developed Countries: 1 in 4,000
-Developing Countries: 1 in 61
-Sub-Saharan Africa: 1 in 16
High maternal mortality rates are also linked to malnutrition and poor sanitation and to higher rates of pregnancy and childbearing at early ages.
Tobacco is the leading cause of burden of disease world wide.
Tobacco has been called “the world’s most lethal weapon of mass destruction”
Top 10 risk factors that contribute to the global burden of diseases are:
underweight; unsafe sex; high blood pressure; tobacco; alcohol; unsafe water; sanitation, and hygiene; high cholesterol; indoor smoke from solid fuels; iron deficiency; and overweight.
Patterns of Burden of Disease
Sociological Theories of Illness and Health Care
Is concerned with how illness, health, and health care affect and are affected by other aspects of social life.
Focuses on how wealth, status, power, and the profit motive influence illness and health care.
Continued…Symbolic Interactions Perspective :
Focuses on how meanings, definitions, and labels, and influence health, illness and health care and how such meanings are learned through interaction with others and through media messages and portrayals.
HIV/AIDS: A Global Health Concern
One of the most urgent worldwide public health concerns is the spread of HIV
HIV/AIDS is the fourth leading cause of death in the world
#1 cause of death in Africa
HIV/AIDS effects on society
The high rates of HIV in developing countries has devastating effects on societies
The HIV epidemic creates an enormous burden on the limited health care resources in poor countries
HIV/AIDS in the U.S .
up to 950,000 infected with HIV in the U.S.
Of men infected,60% infected by same-sex contact
Of women infected, 75% infected by heterosexual contact
Despite the concern, many Americans still engage in high-risk sexual behavior
2 of 3 American adults are obese or overweight
Obesity related diseases are $147 billion dollar medical burden every year
Childhood obesity has tripled over the last 30 years
Effects on Society
Obesity epidemic brought on by food-driven society
"Obesity in America is similar to the 800 pound Gorilla in the room. We all see it. We all know it’s a problem. But we are all too scared or too lazy to create or execute a solution that will get rid of it."
Mental Illness: The Hidden Epidemic
Performance of mental function, resulting In productive actives, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity.
Health conditions categorized by alterations in thinking mood and/or behavior
Extent and Impact of Mental Illness
U.S 26% have some type of mental disorder
Only 121% visit mental health professionals
Untreated mental disorder-
Poor Educational achievement
Violence & Abuse
4 th leading cause of death worldwide
U.S- 3 rd leading caused of death sages 15-24 (90% because of mental disorder)
For everyone one homicide there is two suicides
Causes of Mental Disorders
Neurological pathological conditions
Social & Environmental influences:
History of abuse
Social Factors and Lifestyle Behaviors Associated with Health and Illness
Globalization; The Negatives and Positives
increased travel and the expansion of trade and transnational corporations have been linked to a number of health problems.
globalized communications technology has enhanced the capacity to monitor and report on outbreaks of disease, disseminate guidelines for controlling and treating disease, and share scientific knowledge and research findings.
Effects of Increased Travel on Health
Increased business travel and tourism have encouraged the spread of disease, such as the potentially fatal West Nile virus. The most likely explanation of how the virus got to the United States is that it was introduced by an infected bird that was imported or n infected human returning from a country where the virus is common.
Effects of Increased Trade and Transnational Corporations on Health
Transportation of goods by air, sea, and land contributes to pollution caused by the burning of fossil fuels.
Expansion of international trade of harmful products (tobacco, alcohol, processed or “fast” foods, etc.) is associated with a worldwide rise in cancer, heart disease, stroke, and diabetes.
Effects of International Free Trade Agreements on Health
The World Trade Organization (WTO) and regional trade agreements [like North American Free Trade Agreement (NAFTA)] establish rules aimed to increase international trade. These rules supersede member countries’ laws and regulations, including those governing public health, if those laws or regulations create a barrier to trade.
Social Class and Poverty
Poverty is associated with malnutrition, indoor air pollution, hazardous working conditions, lack of access to medical care, and unsafe water and sanitation.
In the U.S., poverty is associated with higher rates of health-risk behaviors such as smoking, alcohol drinking, being overweight, and being physically inactive.
The high cost of health care not only deepens the poverty of people who are already barely getting by, but also can financially devastate middle-class families.
Poverty and Mental Health
People living below the U.S. poverty line are roughly five times as likely as those with incomes twice the poverty line to have serious psychological distress.
Two explanations for the link between social class and mental illness are the causation explanation and the selection explanation:
Causation explanation : suggests that lower-class individuals experience greater adversity and stress as a result of their deprived and difficult living conditions, and this stress can reach the point at which the individual can no longer cope with daily living.
Selection explanation : suggests that mentally ill individuals have difficulty achieving educational and occupational success and thus tend to drift to the lower class, whereas the mentally healthy are upwardly mobile.
Lack of education means that individuals do not know about health risks or how to avoid them.
Individuals with low levels of education are more likely to engage in health-risk behaviors such as smoking and heavy drinking. Women with less education are less likely to seek prenatal care and are more likely to smoke during pregnancy; which helps explain why low birth weight and infant mortality are more common among children of less educated mothers
The low status of women in many less developed countries results in their being nutritionally deprived and having less access to medical care than men have. Although women are more susceptible to HIV infection for physical and biological reasons, increasing rates of HIV among women are also due to fact that many women, especially in African countries, do not have the social power to refuse sexual intercourse and/or to demand that their male partners use condoms.
Gender and Mental Health:
The prevalence of mental illness is higher among U.S. women than among U.S. men. Although women are more likely to attempt suicide, men are more likely to succeed at it because they use deadlier methods .
Racial and Ethnic Minority Status
In the United States, racial and ethnic minorities are more likely than Non-Hispanic whites to rate their health as fair or poor.
Youth from racial/ethnic minority backgrounds and low socioeconomic status are more likely to be overweight and to engage in less healthy behaviors.
less likely to have health insurance. The uninsured are less likely to get timely and routine care and are more likely to be hospitalized for preventable conditions.
Race, Ethnicity, and Mental Health
Studies suggest that minorities have a higher risk for mental disorders in part because of racism and discrimination, which adversely affect physical and mental health.
Problems in U.S. Health Care
U.S ranks 37 out of 191 according to health care performance
inadequate health insurance coverage
High cost of medical care and insruance
The manage care crises
Inadequate mental health care
Inadequate Health Insurance Coverage
The higher an individual’s income, the more likely it is that the individual will have health insurance.
Employed individuals are more likely than unemployed individuals to be insured.
Some employees are not eligible for health benefits because of waiting periods or part-time status.
Medicaid eligibility levels are set so low that many low-income adults are not eligible.
18,000 deaths per year in the U.S are attributable to lack of health insurance.
The High Cost of Health Care
People are living longer, even the ones with chronic illnesses
New technology, is getting more expensive
The United States pays 81% more for patented brand-name prescription drugs than Canada and six Western European nations.
Drug companies charge high prices because they can get away with it!
Strategies for Action: Improving Health and Health Care
Two approaches to improving health of populations
Selective Primary Health: An approach to health care that focuses on using specific interventions to target specific health problems.
Comprehensive Primary Health Care: An approach to health care that focuses on the broader social determinants of health.
Improving Maternal and Infant Health
Pregnancy and childbirth are major causes of death in developing countries.
Nearly half the world's pregnant women have no access to skilled care at childbirth.
In developing countries, women lack power and men make the decisions.
Improving Maternal and Infant Health…
IMPROVING STATUS AND POWER OF WOMEN IS AN IMPORTANT STRATEGY IN IMPROVING THEIR HEALTH.
Funding improves infant health
Providing basic health services for mothers and infants in low-income countries is only $3 per person.
HIV/AIDS Prevention and Alleviation Strategies
Getting Tested- 1/4 to 1/3 of HIV infected Americans do not know they are infected
Discrimination can deter people from getting tested for the disease, and make them less likely to acknowledge their risk for infection and can
Needle Exchange Program- People get new needles to reduce the amount of transmitting HIV
Fighting the Growing Problem of Obesity
Restrictions on advertisements
School nutrition and physical activity programs
Intervention to treat obesity
Fighting the Growing Problem of Obesity
Encourage people to eat a diet with sensible portions, with lots of high-fiber fruits and vegetables and with minimal sugar and fat, and engage in regular physical activities.
US Federal and State Health Care Reform
The US is the only country in the industrialized world that does not have any mechanism for guaranteeing health care to citizens.
Patient Protection and Affordable Care Act- signed into law March 23, 2010: would provide coverage for uninsured and help substantially the underinsured
Insurance industry opposes adoption of a system
Strategies to Improve Mental Health Care
A way to reduce this percent is to eliminate the stigma of mental illnesses
encourage individuals to seek treatment
make treatment accessible and affordable
Understand Problems of Illness and Health Care
Poor countries need funding and rich countries have it
Malaria gets very little public attention but it is a big problem in Africa
Choices individuals make are influenced by social, economic and political forces that must be taken into account
It is necessary to not overlook social causes of health problems
Prevention of war can help protect public health
"What is the leading cause of burden of disease?"
Why is mental disorders described as the “Hidden Epidemic”?
Answer: because the shame and embarrassment associated with mental problem discourage people from acknowledging and talking about them
How many Americans do not have access to health care?