sociology 36 hours

SOC 1020 Lecture Seven

Prof. D. Fasenfest HEALTH Health refers to the general mental, physical and emotional well-being of the population. Our understanding of health is culturally informed. What is healthy to us may be unhealthy to another culture. For example, there is a small tribe in Africa of which 99% of the members have a skin disorder called “Pinto”, named after the bean, that it resembles. An uncooked pinto bean has stripes and spots of brown mixed with white. The members of this tribe have hyper pigmented skin so that they resemble the markings on the bean. In this culture, if you are part of the 1% that doesn’t have this disorder (which is hereditary and recessive) you are considered less healthy, less attractive and less desirable as a marriage partner. If we picked that entire tribe up today and relocated them to Detroit, the 1% without the skin affliction would be considered healthier and more attractive. Medical sociologists are extremely important in our understanding of health. Social epidemiology is the practice of tracking the origin of disease. One of the most well-known and important examples of epidemiology in recent years is the discovery of how AIDS was being spread. The Centers for Disease Control (CDC) tracks any unusual outbreak of disease. With the AIDS epidemic, the alert came from an individual who was tracking the dispersal of antibiotics. She noticed that there were more treatments being prescribed in New York and Los Angeles for a rare form of pneumonia and alerted the proper individuals. At the same time, the tumor registry (a database for tracking cancers) showed an increase in Kaposi’s sarcoma, a rare form of skin cancer that was likely to be seen in older Mediterranean males. Another odd thing about the outbreak was that it was showing up in young men of all ethnic backgrounds, also in New York and L.A. This triggered a study by the CDC’s team of epidemiologists. An epidemiological team includes medical doctors, sociologists, psychologists, biologists, infectious disease experts and other disciplines as needed for the problem at hand. This team began to talk to individuals that were affected by these outbreaks. Over time they were able to trace this new infection back to a single individual, an airline steward. They were also able to determine that the disease was sexually transmitted and appeared to be limited to the homosexual population. Eventually, when it spread to others, the team was able to identify that it was carried in the blood and through breast milk, putting anyone who had received a transfusion at risk and showing that our blood supply was tainted. After a time, it also began to show up in the intravenous drug using population, as they shared needles and passed infected blood to one another. More recent examples of epidemiological cases are the recent SARS epidemic and the recent E Coli outbreak linked to tainted spinach. The sociologist on this team would be responsible for examining the behaviors of the infected parties and finding where their paths had crossed. For example, the SARs victims had either attended a recent religious convention in China or had close contact with someone who had. All of the victims of the E Coli outbreak had eaten raw spinach is some form in the preceding days.

Health, and health access is a function of income. Think about the things that we are advised to do to stay healthy. Watch our intake of calories and fat. Exercise daily. Lower our stress. Get regular physicals. Make healthy food choices. Obesity is currently an epidemic in our country and the poorer you are; the more likely you are to be obese. Often physicians argue that they don’t understand why we are having such a problem since healthy guidelines are well publicized. Those that are not obese are likely to blame the individual for their obesity. If you’ve gone grocery shopping lately, you should have noticed that chicken, the healthiest meat, is also the most expensive. Hamburger and organ meats (like liver) are the unhealthiest and the cheapest cuts available. Fresh fruits and vegetables are the most expensive and canned are the least expensive. Canned varieties also have the fewest nutrients. Eating healthy is the most expensive way to eat. What about exercising? Fitness magazines are always touting that everyone can walk and/or run so there is no excuse for not exercising. All you need is a good pair of shoes. That good pair of shoes is expensive close to $130. How does the individual in a poor neighborhood get out and walk or run? They likely work long hours and would have to go outside with inappropriate shoes in an unsafe neighborhood after dark. Researchers of childhood obesity urge parents to get their kids out on bicycles and ride bike trails…but those at highest risk—inner city and rural poor—cannot afford bikes or live near safe bike paths. Also, it is not only the poor in our society that are obese. The middle classes are also likely to be overweight. Long work hours mean that many of us don’t cook at home most nights. We stop for pizza or fast food on the way home and settle exhausted in front of our T.V. sets when we get home. Ever wonder why the commercials on evening television focus on beer and snack food—either store bought, or for home delivery or a quick trip through the drive through window. Along with the poor, elderly are more likely to be unhealthy. Partly this is because our bodies run down as we age. Our eyesight diminishes, our hearts tire out and our bones become more brittle. Since women live longer than men, females are more likely to have several health conditions as they age. Men on the other hand are more likely to have one health issue that kills them, like a heart attack or stroke. As mentioned above, as medicine improves our chances of living longer, we also need to expect a higher reliance on the medical profession to keep us going…and that requires a growing pharmaceutical industry, medical technology, hospitals as businesses, para-medical and medical technicians, in addition to more doctors and nurses. It is little wonder that health care costs are skyrocketing, insurance is a major concern, and industrial representatives and lobbyists press to keep us from doing anything that controls costs (for example, many of you may know people who buy drugs in Canada, where prices and profits are controlled—something that we cannot or will not do in this country as industry groups fight any legislation that would permit such across the board cost savings). We also have culturally induced behaviors that hurt our health. Smoking is one with Americans continuing to smoke regardless of the health and economic consequences of the behavior. One reason that people smoke is to self-medicate stress. Another is peer pressure, with teenager girls currently the group most at risk to smoke (and develop smoking related illnesses). Another is problem that is culturally driven is anorexia. The intense cultural pressure on females to be thin and physically perfect has created a near epidemic of eating disorders. Females as young as 9 and 10 reports that they want to lose weight or are on a diet. While the reality us that many of

our children are overweight, diets can get out of control for the adolescent. Also, for the first time, we are seeing an increase in the number of males diagnosed with anorexia. For the most part, we practice western medicine in the U.S., relying on intervention from a trained physician. This may mean that we take drugs or have surgery. Either way, we go to the doctor when we are ill, and the hospital when we are very ill. Holistic medicine is also gaining popularity as an alternative for some and an addition to the health care needs of others. Holistic medicine focuses on prevention as well as treatment and takes into account the complete physical and social environment of the patient. So a patient being seen by a traditional physician for stress might be prescribed an anti-anxiety medication for the stress and another medication for high blood pressure. A holistic provider would try to identify the triggers for the stress in the person’s life and make recommendations on ways to reduce stress. They might teach the patient to meditate or recommend exercise. Drugs might also be prescribed, but they would more likely be the last choice of care than the first. The difference between “western” and holistic or culturally normed medical practices can be seen by the following parable: A village living close to a cliff has its members falling over and breaking bones or experiencing serious harm, and soon the local hospital is over crowded. Western medical practice is to advocate an expensive expansion in the hospital, building room for more beds and hiring more doctors and nurses to deal with the problem. Sustainable, culturally sensitive proposals call for building a fence at the top of the cliff. Now, this is somewhat simplistic, but the point is that once we come to rely on technology and “special” knowledge we forget that sometimes simpler and more effective solutions are possible. Despite the fact that we are one of the wealthiest countries in the world, our citizens have inadequate access to health care and we spend more money out of pocket than any other country of our economic status. What do you suppose it is like for the working poor to access health care? We tend to view the poor in society as lazy, but, they typically work longer hours and more than one job for lower wages than those in the middle class. If someone works two jobs, for example McDonald’s and Taco Bell, for the minimum wage they may be putting in more than 40 hours a week, but both jobs are part time and will have no health benefits. If they get sick, they will lose wages from work for the day. There little incentive to call in sick if it costs you in your current paycheck and may also result mean fewer hours scheduled later if you are seen as unreliable. People knowingly would not want someone with the flu preparing food and likely passing the bug along. In reality that is exactly what happens. The sick individual continues to work until the infection forces them to seek medical care, infecting others in the process. When they seek medical care, they not only lose the day’s wages, but also get an expensive bill they likely cannot afford to pay. They eventually return to work, deeper in debt, struggling harder to make ends meet with the missing wages. One remedy to this would be a non-punitive and comprehensive medicine system that provides preventive care as well as dealing with sick people (many insurers only pay for a remedy, not more than one general physical a year).. National health care or socialized medicine treats health care as a right of citizens rather than a privilege. In Canada for example, every citizen gets a medical card. It entitles them to treatment without fee for most of what ails them. This results in a healthier country with less out of pocket

expenses. The criticism of this type of program centers on the concern that our taxes will increase to cover the added costs. This is true; however, many of us already pay huge contributions to our health care, easily $400+ a month or more deducted from our pay for family coverage if we have some. This doesn’t include the costs of co-pays and drugs. When compared to all the costs of medical care now we would likely pay less or usually no more than we already pay if health care was nationalized. Several studies have compared the benefits Europeans get for their higher taxes against the taxes and further out-of-pocket expenses Americans pay for all sorts of social services and it turns out Americans pay more for fewer services. Another criticism is that we will not be able to select our own doctors, or we will be wait listed for essential treatment. In reality, this is already true. Since the introduction of HMOs (Health Maintenance Organizations) and PPOs (preferred provider organizations) true choice in physician has been eliminated. Both of these insurance programs require you to see physicians who have agreed to a structured fee plan. In exchange for charging less for a procedure, the insurance company sends all of its patients to the doctor. Doctor salary increases accrue due to higher volume of patients offsetting the lower cost of procedures per patient. This also translates into less time for care as overbooked medical staff offer less personalized care. Just think about the time you wait in the outer office, and then in examining room, only to see you doctor for just a few minutes (often later than the appointment) as the doctor is in a hurry to get through the patient load for the day. Another problem with these plans is that pre-approval is required for procedures or there are strict rules on how and when to make a referral to a specialist. This means that your doctor examines you and decides what needs to be done. S/he then asks the insurance company for permission to do the procedure. The insurance company then decides if the treatment is warranted, even though they have not seen you and the decision maker may not even be a physician. Another reality of health care is that you are indeed put on a waiting list for treatment. Most of you have likely been to an ER and undergone the triage process. This means that the severity of your symptoms is ranked, and you are seen in order of severity, not arrival. If you need an organ transplant, you are also ranked by your need, and may be ranked by your age and lifestyle as well. If we have two equally needy patients, one a 17-year-old with their entire life ahead of them and one a 70-year-old, who will get the new heart? Does the new liver go to the hepatitis victim who was not responsible for their infection or the alcoholic who destroyed their liver? Celebrity status may bump you up the list. Mickey Mantle (a famous baseball player from the 50s and 60s), David Crosby (a member of an 80s group Crosby, Stills and Nash) and Larry Hagman (JR on Dallas, Major Nelson on I Dream of Jeannie) all needed liver transplants due to alcohol and substance use. Each was able to get a nearly immediate transplant due to celebrity and money. We cannot look at health without looking at the part we play as the patient. Talcott Parsons developed the theory of the Sick role. He argued that when we become a patient, we must first accept the fact that we are sick. This means that we change our behaviors to that of a sick person. We take time off from our regular activities, work, school, play. We seek medical treatment, and we actively work to get better. The temporary cessation of activities is an allowed deviance from our normal productivity that is socially acceptable. We are however given a time limit. If you continue to use this excuse to skip class or miss work, you will be labeled a

malingerer…someone who is lazy and avoiding work. The sick role has the expectation that you will get better—and works for just so long. I will end with a discussion of the COVID pandemic which has occupied so much of our world for the past two years. First, one can get a sense of the impact globally by looking at current data (regularly updated): https://www.worldometers.info/coronavirus/#countries Of course, data are only as good as those reporting accurately and completely. A comment by a recent President in the US suggested if we just stop testing we won’t have the virus—not a good solution, but it does speak to the viability of data reporting. A worker in Florida was fired for making public the incidence of COVID in that state kept by its Department of Health. Again, who benefits if we don’t have the information. The COVID pandemic pointed to the problems in the US health care system. First, a country comparison is worth exploring (see https://www.finder.com/healthcare-costs-by-country). The US generally has the most expensive per person cost of healthcare with one of the lowest qualities of health-related outcomes. Partly that is due to how our system functions. Of the 35 or so most industrial high-income countries only the US does not have a national healthcare system of one sort or another. Rather, we rely on private insurance schemes (for most people with insurance that means what is provided—if anything—by their employer), and for the very poor or elderly there are government programs but with various limitations and private costs. What COVID revealed was that when millions lost their jobs due to the shutdown during the height of the pandemic, suddenly a large segment of our society lost access to healthcare at the very moment when it was most needed. That helps explain why almost 90 million people contracted COVID in this country, more than double the next country in absolute terms (India). Fully 1 out of every 6 people who died from COVID lived in the US, perhaps the world’s richest country. Some countries tried to fully contain the disease through high levels of testing and isolation (China comes to mind as one of the more draconian efforts, but countries like Australia used similar strategies), which worked well at first, but once the virus entered those countries the spread was rapid and healthcare facilities were stressed. Others used high rates of vaccination plus testing and tracking (letting people know whether they came into contact with a COVID- infected person) which enabled those countries to manage both the spread of COVID and the impact on their healthcare system. The response in the US was idiosyncratic with lots of resistance to various recommendations like mask wearing, social distancing and limits to public gathering. As a result, the US had one of the highest rates of “super spreader events” where this highly infectious virus infected many people. We now have an uncomfortable relationship to COVID. With higher rates of vaccination even as people get infected the symptoms seem to be milder, almost flu-like. This has resulted in a more casual approach to prevention. What remains to be seen is what doctors are now calling “long COVID” or a pattern of lingering effects even as the immediate infection does not hospitalize as many people. The jury is out because there has not been a long time to study this effect—but reports are that impaired brain functions, long-term lung damage and other maladies can be traced to lingering impact of having had COVID.