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Health and Society
Chapter 11
You May Ask Yourself
The Rise of Medicine
• Why we think doctors are special:
• Universally valued product
• High moral calling to do good
• Professionalism
• Individual objectivity
• Impression management
Power of Doctors
• Doctors have the power to:
• construct their own pay rates.
• create demand for their products.
• regulate themselves.
• prescribe medications.
• “medicalize” conditions.
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
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.
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)
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
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.
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)
Fire-cupping
Fire cupping bruises
Coin rubbing
Health related PSAs
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
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.
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.
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
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.
US Infant Mortality Rates
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
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.
Marital Status
• Married people tend to live longer,
especially men.
• Reasons:
• Health as precursor for marriage.
• Marriage decreases unhealthy behaviors.
Sex and Health
• Women live longer than men.
• Reasons:
• Disease prevalence differences.
• Healthcare-seeking behaviors.
Sex & Race Combined
• Much more profound impact than either
factor alone.
• Reasons:
• Racism
• Lower SES
• More dangerous jobs
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.
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.
Global Health
• Waterborne Illnesses
• Malaria
• Vaccines
• AIDS

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Health and Society (Chapter 11, "You May Ask Yourself")

  • 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)
  • 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.
  • 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