A review of the social issues surrounding health, wellness and access to healthcare, particularly in America. Appropriate for 100-level sociology courses. If you like it, feel free to use it! ---- "You May Ask Yourself" second edition (2011), D. Conley, W.W. Norton - Chapter 11 ---- *** This is only my "reworking" of pre-packaged PPT files included textbook published by W.W. Norton. Some materials copyright by W.W.Norton.

1. Health and Society
Chapter 11
You May Ask Yourself

2. The Rise of Medicine
• Why we think doctors are special:
• Universally valued product
• High moral calling to do good
• Professionalism
• Individual objectivity
• Impression management

3. Power of Doctors
• Doctors have the power to:
• construct their own pay rates.
• create demand for their products.
• regulate themselves.
• prescribe medications.
• “medicalize” conditions.

4. Medicalization
• Medicalization - the process by which
problems or issues not traditionally seen as
medical came to be framed as such.
• Pregnancy and childbirth
• Alcoholism
• Depression
• Nutrition

5. Biomedical Culture
• Historically, doctors weren’t powerful.
• Rome - slaves, poor freedmen, or
foreigners.
• England - rose from barber profession.
• Russia - payed about 75% of industrial
workers’ wages.

6. Biomedical Culture
• Reasons for Rise of Biomedical Culture
• Ability to offer “health” or actual increase in
years lived.
• Exclusion of other health frameworks
through licensing
• Legal authority through licensing
• Increased importance of larger institutions
(like hospitals)

7. Decline of Doctors?
• Reasons for loss of power in recent years:
• Rise of HMOs
• Rise of external regulations
• Patient Bill of Rights (1998)
• EMTALA (1986)
• COBRA (1985)
• HIPAA (1996)
• Rise of other forms of medicine
• Improved technology

8. Being Sick...
• The Sick Role (Talcott Parsons)
• Two Rights:
• Exemption from normal social roles
• Lack of accountability for illness
• Two Obligations:
• Try to get well.
• Seek the assistance of qualified individuals.

9. Social Construction of
Illness
• Religious views and practices:
• Seizures, faith healing, fire-cupping, coin rubbing.
• Medicalization:
• Alcoholism (don’t blame the victim)
• Understanding of pathologies:
• Cancer, obesity, heart disease (blame the victim)

10. Fire-cupping

11. Fire cupping bruises

12. Coin rubbing

13. Health related PSAs

14. U.S. Healthcare System
• Types of Coverage:
• Fee-for-service
• Health Maintenance Organizations (HMOs)
• Public Insurance
• State Children’s Health Insurance Programs
(SCHIP or KCHIP in Kentucky)
• Uninsured or Private Pay

15. Morbidity and Mortality
• Morbidity - illness in a general sense
• Mortality - death
• Whitehall Study:
• Men only
• Universal health access
• Who you are, where you live, how much you
earn, and what you do for a living all impact
health.

16. Born Unequal
• Gender differences:
• More boys than girls born, but higher infant
mortality for male babies.
• Sex ratios: 1.05 in US; 1.12 in China.
• Multiple Births
• IVF - multiple implanted embryos
• Ovulation increasing medications - more
fertilized eggs.

17. Post-Birth Health
Inequalities
• Low birth weight:
• Less than 5 pounds, 8 ounces.
• Caused by:
• Intrauterine growth restriction (IGR)
• Premature birth
• Prenatal health
• Mother’s health

18. Race and Health
• Life expectancy
• Infant mortality
• Disease prevalence:
• African Americans - heart disease and cancer
• Native Americans - cirrhosis and suicide
• Hispanics - diabetes and HIV/AIDS
• Racism as possible cause.

19. US Infant Mortality Rates

20. Socioeconomic Status
• Selection theory - spurious relationship
• Drift explanation - health causes social position
• Social determinants - social status determines
health
• Psychosocial - social class relative to those
around them.
• Materialist - differential access to health is
determined by SES.
• Fundamental - how social factors shape illness

21. Socioeconomic Status
• “Natural” Experiments through Policy Change
• Compulsory education - mid-1900s
• Each year of school decreased odds of death
by 3.6%.
• Social Security policy - 1977
• Lower Social Security payments led to
longer life.
• Due in part to continued workforce
participation.

22. Marital Status
• Married people tend to live longer,
especially men.
• Reasons:
• Health as precursor for marriage.
• Marriage decreases unhealthy behaviors.

23. Sex and Health
• Women live longer than men.
• Reasons:
• Disease prevalence differences.
• Healthcare-seeking behaviors.

24. Sex & Race Combined
• Much more profound impact than either
factor alone.
• Reasons:
• Racism
• Lower SES
• More dangerous jobs

25. Family Structure
• Larger families have higher childhood mortality.
• Supervision
• Closely-spaced families have higher childhood mortality.
• Supervision, maternal health.
• First-born children are more likely to die in childhood.
• Less experienced parents, unintended pregnancies,
mortality “creates” firstborns.

26. Mental Health
• Diagnostic Statistical Manual (DSM)
• DSM-I: 1952 - 60 disorders, standardized the
canon
• DSM-II: social context was important
• DSM-III: removed social context, followed
medical model
• DSM-IV: 400 disorders, necessary for medical
billing and insurance reimbursement.

27. Global Health
• Waterborne Illnesses
• Malaria
• Vaccines
• AIDS