Psychology SOC ASSIGNMENTS

1/18/24, 2:48 PM Chapter 2 Outline - Mooney-2: (Spring 2024) SOC 268 (1XYW) - Social Problems

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Chapter 2 Outline - Mooney-2 LECTURE OUTLINE

I. THE GLOBAL CONTEXT: HEALTH AND ILLNESS AROUND THE WORLD A. Classification of countries for international comparisons 1. Developed countries (high-income countries)—high gross national income and diverse economies made up of different industries. 2. Developing countries (middle-income countries)—low gross national income and simpler economies that rely on a few agricultural products. 3. Least developed countries (low-income countries)—poorest countries of the world. B. Life Expectancy and Mortality in Low-, Middle-, and High-Income Countries 1. Life expectancy—average number of year’s individuals born in a given year can expect to live—is used to measure the health of a population. a. In 2015, Japan had the longest life expectancy (84 years), Sierra Leone had the lowest (46 years), and 18 countries (primarily in Africa) had life expectancies less than 50 years. b. Leading causes of mortality (or death) i. Worldwide: cardiovascular disease (includes heart disease and stroke); accounts for the majority of all deaths. 3. Mortality Rates among Infants and Children a. Infant Mortality Rate—number of deaths of live-born infants under 1 year of age per 1,000 live births (in any given year)—is used to measure of the health of a population. i. In 2015, the mortality rate for children ranged from an average of 53 in least developed nations to 5 in industrialized nations. b. Under-5 Mortality Rate: rate of deaths of children under age 5 i. Range from an average of 153 in least developed nations to 6 in industrialized nations. ii. Major causes of infant and child deaths are diarrhea (from poor water quality and sanitation) and undernutrition. 4. Maternal Mortality a. Maternal mortality rate—a measure of deaths resulting from complications with pregnancy, childbirth, and unsafe abortion—is also used to indicate the health of a population. i. Maternal mortality is the leading cause of death and disability for women age 15 to 49 in developing countries. Ii. The most common causes are hemorrhage, infection, and complications related to unsafe abortion. b. Cross-national comparisons show greater disparity between rich and poor countries than other societal health measures: only 1% occur in high-income countries.

1/18/24, 2:48 PM Chapter 2 Outline - Mooney-2: (Spring 2024) SOC 268 (1XYW) - Social Problems

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c. High maternal mortality rates in less developed countries are related to poor quality and inaccessible health care, malnutrition, poor sanitation, higher rates of pregnancy, earlier childbearing ages, and lack of family planning services and support for contraception (often resulting in unsafe abortion). C. Globalization, Health, and Medical Care 1. Globalization is broadly defined as the growing economic, political, and social interconnectedness among societies throughout the world. a. Positive effects: globalized communications increase ability to monitor and report on outbreaks of disease, disseminate guidelines for controlling and treating disease, share scientific knowledge and research findings. b. Negative effects: travel, trade, and transnational corporations contribute to health problems. ii. Effects of travel: Increased business travel and tourism encourage the spread of disease, and obesity. c. Effects of trade and transnational corporations i. Transportation of goods contributes to pollution. ii. International trade includes harmful products, such as tobacco, alcohol, and fast foods. 2. Medical Tourism involves traveling, primarily across international borders, for purpose of obtaining medical care. a. Reasons for medical tourism is to seek treatment not available in their home country, avoid waiting periods for treatment, and/or to save money on the cost of the treatment. b. Many concerns of medical tourism include: spread of infectious diseases, services and products regulations, and the legality of human organ transplants donors and recipients. 3. Are Americans the Healthiest population in the World? 1. The U.S. is one of the wealthiest countries, but it is not one of the healthiest. a. Health systems are often unaffordable or inaccessible. b. Unhealthy behaviors due to drug abuse, violence, fewer people choosing to wear seat belts, traffic accidents and obesity. c. Social and Economic conditions which includes poverty, education, and lack of safety programs. d. Physical and social environment designed for sedentary lifestyles, food offerings in grocery stores and restaurants, high substance abuse and high-stress lifestyle contribute to an unhealthy nation.

II . MENTAL ILLNESS: THE HIDDEN EPIDEMIC A. What it means to be mentally healthy varies across cultures. 1. In the U.S., mental health is the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and cope with adversity.

1/18/24, 2:48 PM Chapter 2 Outline - Mooney-2: (Spring 2024) SOC 268 (1XYW) - Social Problems

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2. Mental illness refers collectively to all mental disorders, which are health conditions that are characterized by sustained patterns of abnormal thinking, mood, or behavior associated with distress or impaired functioning on a daily basis. B. Mental illness is a “hidden epidemic.” 1. Shame and embarrassment discourage people from acknowledging it. 2. Negative stereotypes contribute to stigma. C. Extent and Impact of Mental Illness 1. 1 in 5 of U.S. adults experience a mental illness in a given year with 1 in 20 being severe. 2. 8% of youths experience major depression. 3. Untreated mental disorders can lead to poor educational achievement, lost productivity, unsuccessful relationships, significant distress, violence and abuse, incarceration, poverty, and suicide. D. Causes of Mental Illness 1. Stigma causes misperception about cause of mental illness a. People are often perceived as being weak or possessed. 2. Some mental illnesses are caused by genetic or neurological pathological conditions; most are caused by a combination of genetic, biological and environmental factors. a. Social and environmental causes include poverty, homelessness, sexual abuse, job loss, divorce, death, devastations from natural disasters, injuries, war. E. Mental Illness among College Students 1. 1 in 4 college students has been diagnosed or treated by a professional for a mental health problem within the past year. 2. 40% of college students do not report they have a mental health condition.

III. SOCIOLOGICAL THEORIES OF ILLNESS AND HEALTH CARE A. Structural-Functionalist Perspective 1. Concerned with how changes in society affect health and how health concerns may lead to social change. a. As societies develop—societal shift from low to high life expectancy, and parasitic infections to chronic and degenerative diseases. 2. Views health care as an institution that maintains the well-being of society and its members. a. Illness is dysfunctional because it interferes with people performing social roles. b. Society assigns a temporary “sick role” to those who are sick. 3. Latent dysfunctions are unintended negative consequences of social patterns or behaviors a. A latent dysfunction of the widespread use of some drugs has led to drug-resistance. b. May deter people from seeking treatment and prevent them from talking about violence. B. Conflict Perspective 1. Focuses on how wealth, power, and the profit motive influence illness and health care. a. Powerful groups and wealthy corporations influence health-related policies through

1/18/24, 2:48 PM Chapter 2 Outline - Mooney-2: (Spring 2024) SOC 268 (1XYW) - Social Problems

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lobbying and financial contributions to politicians. i. Health insurance and pharmaceutical companies have spent millions of dollars opposing national health insurance or public option plan. ii. The hiring of PR firms to sway public opinion away from health care reform is commonplace. b. Criticizes pharmaceutical and health care industries for placing profits above people. i. Patient need does not determine what drugs and devices get produced. Instead, profit does. • Health research and health care allocation is based on maximizing profit rather than meeting public need. ii. Profits compromise safety of workers and consumers. • Workers are exposed to dangerous working conditions • Companies ignore environmental concerns • The food industry places profit over safety 2. Analyzes ways health care and research are influenced. C. Symbolic Interactionist Perspective 1. Focuses on (1) how meanings, definitions, and labels influence health, illness, and health care, and (2) how meanings are learned through social interaction and media. 2. Argues no diseases exist in nature; society defines conditions as illness or disease through a process of medicalization. a. Medicalization: defining or labeling behaviors and condition as medical problems i. Initially, medicalization occurred when behaviors or conditions deemed immoral were transformed from legal problems into medical problems. ii. Medicalization has expanded to include (a) new phenomena defined as medical problems (premenstrual syndrome, attention deficit disorder), and (b) “normal” events defined as medical problems (childbirth, menopause, death). 3. Definitions of health and illness are socially constructed; they vary over time and across societies. 4. Meanings and labels can impact health behaviors and health-related policies 5. Focuses on the stigmatizing effects of being labeled “ill” a. Stigma: any personal characteristic associated with social disgrace, rejection, or discrediting b. Stigma associated with poor health or lack of health insurance implies that the individual

IV. SOCIAL FACTORS AND LIFESTYLE BEHAVIORS ASSOCIATED WITH HEALTH AND ILLNESS A. Socioeconomic Status and Health 1. Socioeconomic status refers to a person’s position in society based on that person’s level of educational attainment, occupation, and household income. a. Positive effects of a higher socioeconomic level: better health, less stress, live longer. b. Negative effects of a lower socioeconomic level: limits one’s access to better jobs, and

1/18/24, 2:48 PM Chapter 2 Outline - Mooney-2: (Spring 2024) SOC 268 (1XYW) - Social Problems

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better medical care. B. Gender and Health 1. Gender inequality contributes to lack of access to nutrition and health care for women and girls. a. Division of labor, sexual violence and domestic abuse contribute significantly to the health problems of women around the world. 2. In the U.S. today, women’s life expectancy (81 years) is greater than men’s (76 years). a. Men are more likely to work in dangerous jobs, smoke, use alcohol and drugs, and are Less likely to seek medical care. b. Cultural beliefs about masculinity and manhood negatively impact men’s health by encouraging risky behaviors and discouraging emotional expression. 3. Gender and mental health a. Women are more likely to have a mental disorder than men. b. Biological factors may explain gender differences in mental health, however evidence is inconclusive; gender roles may contribute. C. Race, Ethnicity, and Health 1. Many racial and ethnic minorities get sick at younger ages and die sooner than non-Hispanic whites. 2. Minority health differences a. Hispanic women and men live longer than either blacks or whites. b. Infant mortality rates depend on strong networks of family and community support. 3. Socioeconomic inequalities are largely responsible for racial/ethnic differences in health. a. Minorities are less likely to have health insurance, and more likely to be exposed to environmental toxins at work and home. b. Childhood experiences of minorities contribute to poorer health in adulthood. 4. Lifestyle variation contribute to health disparities. a. Native Americans have highest death rate from motor vehicle crashes because they have high rates of alcoholism and low rates of seatbelt usage. b. Black Americans have high rates of obesity in part because of diet that can only be partially accounted for by economic inequality. 5. Prejudice and discrimination cause stress. 6. Race, Ethnicity, and Mental Health a. No significant difference in mental disorders has been found between races, however minorities may be at higher risk due to racism and discrimination; minorities also have less access to mental health services and are underrepresented in research.

V. U.S. HEALTH CARE: AN OVERVIEW A. U.S. Health Care: An Overview 1. Traditional health insurance plans: insured choose health care provider, is reimbursed by the insurance company on a fee-for-service basis, and pay a deductible and percentage of medical expenses.

1/18/24, 2:48 PM Chapter 2 Outline - Mooney-2: (Spring 2024) SOC 268 (1XYW) - Social Problems

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2. Managed care: any medical insurance plan that controls costs through monitoring and controlling the decisions of health care providers (HMOs are one form). a. Doctors often receive approval before hospitalizing a patient, performing surgery, or ordering an expensive diagnostic test. B. Public Health Insurance Programs 1. Medicare: funded by the federal government and reimburses the elderly and the disabled for their health care a. Individuals contribute payroll taxes to Medicare throughout their working lives and become eligible for Medicare at 65. b. Medicare provides free hospital insurance but may require a deductible and copayment; drug and regular care coverage is optional and not free; long-term nursing home care, dental care, eyeglasses and other types of services are not covered. 2. Medicaid and SCHIP a. Medicaid: jointly funded by the federal and state governments to provide health care coverage for the poor i. Medicaid does not cover all poor people; eligibility rules and benefits vary from state to state. ii. Although all poor children are eligible, not all are enrolled. b. State Children’s Health Insurance Programs (SCHIP) i. Created to cover uninsured children from families with incomes too high for Medicaid but too low to afford private health insurance. ii. States receive matching federal funds to provide medical insurance to uninsured children. 3. Workers’ Compensation: an insurance program that provides medical and living expenses for work-related injuries or illnesses a. Not all employees acquire workers’ compensation insurance, even in states where it is legally required. b. Many with work-related illness or injuries do not apply for benefits for fear of getting fired, lack of awareness of coverage, or incentives given by employers for not filing claims. C. Complementary and Alternative Medicine (CAM) 1. The conventional or mainstream practice of medicine in Western nations is known as allopathic or complementary and alternative medicine (CAM). 2. Types of CAM include herbal and homeopathic remedies, dietary supplements, mediation, Pilates, yoga, tai chi, acupuncture, chiropractic care, massage therapy, Reiki and other energy work and the use of traditional healers. 3. More than 1/3 of U.S. adults use CAM to improve health and well-being. 4. Marijuana is a controversial form of CAM. a. In 1996, California classified marijuana as a legitimate medical compound. b. Medical marijuana is most frequently used to alleviate pain and muscle spasms,

1/18/24, 2:48 PM Chapter 2 Outline - Mooney-2: (Spring 2024) SOC 268 (1XYW) - Social Problems

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and conditions associated with cancer, weight loss and anorexia in patients with AIDS. c. Adverse effects of medical marijuana are dizziness and anxiety and paranoia. d. Concerns of using marijuana are: impairment of memory and frequent use of marijuana by adolescent users as well as accidental food consumption among children.

VI. PROBLEMS IN U.S. HEALTH CARE A. Inadequate Health Insurance Coverage 1. 31 European countries and Canada have national health insurance systems that provide universal health care. a. Government controls finances and organization of health services b. Government directly pays providers c. Government owns most of medical facilities d. Guarantees universal access to health care e. Allows for private care if people want to pay f. Allows people to supplement for higher class service i. In 2014, 15.4.7% of the U.S. population (48 million) lacked health insurance. ii. Disparities in Health Insurance Coverage (a). Whites are more likely than racial and ethnic minorities to have health insurance; Hispanics have the largest percentage of uninsured. (b). Young adults ages 19-34 are least likely to have health insurance; in 2012 nearly ¼ were uninsured. (c). Individuals who are employed and have higher incomes are more likely to be insured than those with lower incomes and the unemployed; however, in 2012, 15.5% of full-time workers were uninsured. 2. Inadequate Insurance for the Poor a. Medicaid eligibility levels are so low that many low-income adults are not eligible. b. Many health providers do not accept Medicaid, and some states have long wait lists. 3. Consequences of Inadequate Health Insurance a. An estimated 45,000 deaths per year in the U.S. are attributable to lack of health insurance. b. Those without health insurance are less likely to receive preventive care, more in likely to be diagnosed in the later stages of disease, and more likely to require hospitalization for avoidable problems. c. Because most providers do not accept patients without insurance, many resort to using an emergency room. B. The High Cost of Health Care

1/18/24, 2:48 PM Chapter 2 Outline - Mooney-2: (Spring 2024) SOC 268 (1XYW) - Social Problems

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1. The U.S. spends far more on health care than any other industrialized nation. a. Virtually every other wealthy nation has better health care outcomes, as measured by life expectancy and infant mortality. 2. Causes of escalating health costs in the U.S. a. It is widely believed that increased longevity: people are living longer and spending more of their lives with chronic illness than in the past. b. High Costs of Hospital Services, Doctors’ Fees, and Medical Technology The use of expensive medical technology, unavailable just decades ago, also contributes to high medical bills. c. Cost of drugs d. The U.S. pays 50% more for brand-name prescription drugs than comparable nations. Drug manufacturers claim high prices result from the high cost of research and development, however most large drug companies spend substantially more on marketing, advertising and administration than research and development. e. Cost of Health Insurance i. Between 2000 and 20112, average insurance premiums have increased 97%. ii. With rising costs, employers are increasing employee contributions, decreasing benefits, or not providing insurance at all. iii. Health care administration expenses are six times higher in the U.S. than Western European nations. 3. Consequences of the High Cost of Health Care for Individuals and Families a. Medical bills result in financial hardship with 1/3 of U.S. household reported problems paying medical bills b. Many forgo needed medical care when they cannot afford it. C. Inadequate Mental Health Care 1. Since the 1960s, U.S. mental health policy has focused on deinstitutionalization, which emphasizes reducing costly and often neglectful institutional care and on providing more humane services in the community. 2. Many who need mental health services do not receive care due to costs, lack of access (particularly in rural areas), and inconvenient hours. 3. People with severe mental illness end up in jails and prisons, homeless shelters, and hospital emergency rooms; children often drop out of school or end up in foster care or the juvenile justice system.

VII. STRATEGIES FOR ACTION: IMPROVING HEALTH AND HEALTH CARE A. Improving Health in Low- and Middle-Income Countries 1. Selective primary health care: using specific interventions to target specific health problems. 2. Comprehensive primary health care: focuses on broader social determinants of health, such as poverty and economic inequality, gender inequality, environment, and community

1/18/24, 2:48 PM Chapter 2 Outline - Mooney-2: (Spring 2024) SOC 268 (1XYW) - Social Problems

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development. 3. The last decade has seen great strides in infant and maternal health. a. Declines in maternal mortality attributable to: percentage of deliveries attended by skilled health care workers, contraceptive use, family planning, decline in child marriages, increased education and income-producing opportunities for women and immunization programs b. Family planning reduces maternal mortality by reducing unintended pregnancies and increasing spacing between births, which decreases infant mortality. c. Improving women’s status can improve health by giving women more control over reproductive lives. d. Improving maternal and infant health in low-income countries would cost only $44 per/person per year. B. Fighting the Growing Problem of Obesity 1. Reducing obesity requires encouraging improved diet and regular physical activity. 2. Strategies to achieve these goals include: a. Restrictions on advertisements i. The food industry spends an enormous amount of money advertising to children; some European countries ban this practice; similar efforts were made in the 1970s and 80s, but were opposed by food and advertising industries b. Public education i. Proposed federal legislation includes the Children’s food and Beverage Initiative Act. c. School nutrition and physical activity programs i. Several states have legislation restricting vending machines in schools and have recess/physical activity requirements. ii. Some federal legislation has been proposed to address child obesity. d. Local and State Antiobesity Policies i Complete Street Policies e. Workplace and Wellness Programs ii. Interventions include weight-loss or fitness clubs, nutrition and weight-loss counseling, weight-loss medications, and surgical procedures. f. Public Education and Awareness i. 2010 Let’s Move Imitative C. Strategies to Improve Mental Health Care 1. Eliminating the stigma of mental illness a. Training to identify signs of mental illness b. Negative portrayals of mental illness in media should be studied. c. Review “new rules’ dealing with mental illness. 2. Improving access to Mental Health Care a. Many who seek help do not go to a mental care specialist. b. 2010 Affordable Care Act includes funds for institutions to recruit students pursuing

1/18/24, 2:48 PM Chapter 2 Outline - Mooney-2: (Spring 2024) SOC 268 (1XYW) - Social Problems

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graduates degrees in mental and behavioral health. c. incorporating mental health screening as a standard health procedure with insurance coverage. 3. Mental Health for College Students. a. Ensure students know location of services and accommodations for the students. b. Provide information on clubs such as NAMI. c. Enlist help with therapy dogs. D. The Affordable Care Act of 2010 1. Universal health care has been advocated by the Roosevelt, Truman, Nixon, Carter, Clinton, and Obama administrations. a. U.S. health reform goals generally fall into one of three categories: Creation of a universal health program, expansion of existing government programs, and making private insurance more affordable through tax credits or deductions or other means. 2. Affordable Care Act (aka “Obama care”) a. Establishes individual mandate to have health insurance b. Creates health insurance exchanges c. Provides tax credits to businesses that provide insurance to employees d. Dependent coverage to age 26 e. No lifetime limits F. limited administration expenses and profits g. Expansion of Medicaid h. Discounts on prescription drugs i. Free preventative services 3. Benefits of health care reform have been debated but estimates are that it will expand to cover an additional 32 million people by 2019. 4. Opponents claim it will add to deficit, but official estimates show that in long-term it will reduce the deficit. E. The Debate over Single-Payer Health Care 1. Some still advocate for a single-payer health system where private insurance companies are eliminated. a. United States National health Care Act aims to expand Medicare to all U.S. citizens b. Opponents argue that it would be a “government takeover” of healthcare c. Many health care professionals would prefer a single payer system to increase care and reduce complexity and administration

VIII. UNDERSTANDING PROBLEMS OF ILLNESS AND HEALTH CARE A. Overall human health has improved greatly over the last 50 years, but significant disparities still exist. 1. Wealthy countries have the ability to step in and help (e.g., malaria) B. Social factors impacting health include poverty, globalization, increased longevity, family structure, gender, education, and race or ethnicity

1/18/24, 2:48 PM Chapter 2 Outline - Mooney-2: (Spring 2024) SOC 268 (1XYW) - Social Problems

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C. A sociological view of health looks at both the causes and consequences of health problems. D. Studying social problems is, essentially, the study of health problems.