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Soc2MooneyCh2.pptChapter 2:
Physical and Mental Health and Health Care
“America’s health care system is neither healthy, caring, nor a system.”
—Walter Cronkite
Learning Objectives (1 of 2)
Compare life expectancy and mortality in low, middle, and high-income countries, and identify ways in which globalization affects health and health care.
Describe the prevalence, impact, and causes of mental illness.
Explain how conflict theory, structural functionalism, and symbolic interactionism help us understand illness and health care.
Identify five lifestyle behaviors that influence health and give examples of how socioeconomic status, gender, race, and ethnicity affect health.
Learning Objectives (2 of 2)
Identify and describe the various types of private insurance plans and public health care insurance programs in the United States and differentiate between allopathic medicine and complementary and alternative medicine.
Critically evaluate health care in the United States on the dimensions of health insurance coverage, cost of health care, and adequacy of mental health care.
Describe efforts to improve health in low- and middle-income countries, fight the growing problem of obesity, improve mental health care, and increase access to affordable health care in the United States.
Discuss the complexity of factors that affect health and that must be addressed in order to improve the health of a society.
Chapter Outline
- The Global Context: Health and Illness around the World
- Mental Illness: The Hidden Epidemic
- Sociological Theories of Illness and Health Care
- Social Factors and Lifestyle Behaviors Associated with Health and Illness
- U.S. Health Care: An Overview
- Problems in U.S. Health Care
- Strategies for Action: Improving Health and Health Care
- Understanding Problems of Illness and Health Care
The Global Context: Health and Illness around the World
- Countries are often classified into one of three broad categories according to their economic status:
- Developed countries have relatively high gross national income and have economies made up of many different industries.
- Developing countries (less developed) have relatively low gross national income and their economies are much simpler.
- Least developed countries are the poorest countries of the world.
The Global Context: Health and Illness around the World
Life Expectancy and Mortality (1 of 4)
- Life expectancy refers to the average number of years individuals born in a given year can expect to live.
The Global Context: Health and Illness around the World
Life Expectancy and Mortality (2 of 4)
- Mortality is the incidence of death in a population.
- The leading cause of mortality, or death, worldwide is heart disease…followed by stroke and respiratory infections.
- In low income countries, the three top causes of death are respiratory infections, diarrheal diseases, and HIV/AIDS.
The Global Context: Health and Illness around the World
Life Expectancy and Mortality (3 of 4)
- Mortality Among Infants and Children
- Infant Morality Rate: The number of deaths of live-born infants under 1 year of age per 1,000 live births (in any given year).
- Under-5 Mortality Rate: Refers to the rate of deaths of children under age 5.
- Under-5 mortality rates range from an average of 153 in least developed nations to an average of 6 in industrialized countries.
The Global Context: Health and Illness around the World
Life Expectancy and Mortality (4 of 4)
- Maternal Mortality Rates:
- A measure of deaths that result from complications associated with pregnancy and childbirth.
- The most common causes of maternal death are hemorrhage, infection, high blood pressure during pregnancy and unsafe abortion.
What Do You Think?
Suppose that you or your partner had a 1 in 52 chance of dying from a pregnancy or childbirth-related cause—the same risk of maternal death that women in the least developed countries face. Would that knowledge affect your views about (1) having children? (2) using contraception? (3) policies to ensure access to safe abortion?
The Global Context: Health and Illness around the World
Globalization, Health, and Medical Care (1 of 2)
- Globalization is the growing economic, political, and social interconnectedness among societies throughout the world. It has eroded boundaries that separate societies, creating a “global village.”
- Global communications make it easier to monitor and control disease and share scientific knowledge and research findings.
- Increased travel and the expansion of trade and transnational corporations are linked to a number of health problems.
The Global Context: Health and Illness around the World
Globalization, Health, and Medical Care (2 of 2)
- Medical tourism:
- A growing multibillion dollar global industry, involves traveling, primarily across international borders, for the purpose of obtaining medical care.
- Risks:
- Unregulated care
- May spread infectious disease
- May encourage black market organ sales
Medical Tourism
Many Americans cross the border into Mexico to obtain less expensive dental care.
Chicago Tribune/Getty Images
Mental Illness: The Hidden Epidemic (1 of 2)
- Mental health refers to the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity.
Mental Illness: The Hidden Epidemic (2 of 2)
- Mental Illness refers collectively to all mental disorders which are characterized by sustained patterns of abnormal thinking, mood, or behaviors that are accompanied by significant distress and/or impairment in daily functioning.
- It is a “hidden epidemic” because the shame and embarrassment associated with mental problems discourage people from acknowledging and talking about them.
Mental Illness: The Hidden Epidemic
Extent and Impact of Mental Illness
(1 of 2)
- Among the non-institutionalized population, as many as 1 in 5 U.S. adults experiences mental illness.
- 1 in 20 had a serious mental illness.
- Ages 4 to 17: 10% experience a major depressive episode.
- About half of all Americans will experience some form of mental disorder in their lifetime, with first onset usually occurring in childhood or adolescence.
Mental Illness: The Hidden Epidemic
Extent and Impact of Mental Illness
(2 of 2)
- Untreated mental disorders can lead to:
- poor educational achievement
- lost productivity
- unsuccessful relationships
- significant distress
- violence and abuse
- incarceration
- poverty
Mental Illness: The Hidden Epidemic
Causes of Mental Illness
- Stigma surrounding mental illness is partly due to misconceptions about their causes, such as the misconception that mental illness is caused by personal weakness, or results from engaging in immoral behavior.
Mental Illness: The Hidden Epidemic
Mental Illness among College Students
- Nearly one in four college students has been diagnosed or treated by a professional for a mental health problem within the past year
- 14 percent of college students were diagnosed or treated for anxiety,
- 12 percent for depression,
- and 6 percent for panic attacks
Mental Illness: The Hidden Epidemic
Mental Illness among College Students
| Mental Health Difficulty | Percentage |
| Felt so depressed it was difficult to function | 33 |
| Felt overwhelming anxiety | 54 |
| Felt very lonely | 59 |
| Felt things were hopeless | 46 |
| Seriously considered suicide | 8 |
| Intentionally cut, burned, bruised, or otherwise hurt yourself | 6 |
| NOTE: Percentages are rounded. SOURCE: Adapted from American College Health Association (2014). American College Health Association National College Health Assessment II: Reference Groups Executive Summary Spring 2014. Hanover, MD: American College Health Association. |
Sociological Theories of Illness and Health Care:
Structural-Functionalist Perspective
- According to the structural-functionalist perspective, healthcare is a social institution that functions to maintain the well-being of social members and, consequently, of the social system as a whole.
- It examines how changes in society affect health.
- It also draws attention to latent dysfunctions, or unintended and often unrecognized negative consequences of social patterns or behaviors.
Sociological Theories of Illness and Health Care:
Conflict Perspective
- The conflict perspective focuses on how wealth, status, and power influence illness and health care.
- It points to ways in which powerful groups and wealthy corporations influence health-related policies and laws through lobbying and financial contributions to politicians and political candidates.
- Criticizes the pharmaceutical and health care industry for placing profits above people.
Sociological Theories of Illness and Health Care:
Symbolic Interactionist Perspective (1 of 3)
- Symbolic interactionists focus on the following:
How meanings, definitions, and labels influence health, illness, and health care.
How such meanings are learned through interaction with others and through media messages and portrayals.
Sociological Theories of Illness and Health Care:
Symbolic Interactionist Perspective (2 of 3)
- Medicalization is defining or labeling behaviors and conditions as medical problems.
- Includes:
- A new phenomena defined as a medical problem in need of medical intervention such as post-traumatic stress disorder and attention-deficit/hyperactivity disorder.
- Normal conditions that are defined as medical problems such as childbirth, menopause, and death.
- Symbolic interactionists also focus on the stigmatization of individuals who are in poor health or who lack health insurance.
- A stigma refers to any personal characteristic associated with social disgrace, rejection, or discrediting.
- Symbolic interactionists focus on stigmatizing effects of being labeled “ill.”
- Individuals with mental illnesses, drug addictions, physical deformities and impairments, and HIV and AIDS are prone to being stigmatized.
Sociological Theories of Illness and Health Care:
Symbolic Interactionist Perspective (3 of 3)
What Do You Think?
People who have used indoor tanning devices, such as tanning beds, have a 59% increased risk of developing melanoma—a potentially fatal form of skin cancer. In 2014, the FDA changed its label for tanning devices from “low-risk” to “moderate-risk” and ruled that such devices must carry a “black box” warning label, visible to consumers, stating that the device should not be used by people under age 18 (Willingham 2014). Do you think that seeing a warning label on tanning devices will change people’s behavior, dissuading them from using tanning devices? Why or why not?
Social Factors and Lifestyle Behaviors
Socioeconomic Status and Health (1 of 2)
- Socioeconomic status refers to a person’s position in society based on that person’s level of educational attainment, occupation, and household income.
- Poverty is associated with malnutrition, indoor air pollution, hazardous working conditions, lack of access to medical care, and unsafe water and sanitation.
Social Factors and Lifestyle Behaviors
Socioeconomic Status and Health (2 of 2)
- Individuals with low levels of education are more likely to engage in health-risk behaviors.
- Women with less education are less likely to seek prenatal care and are more likely to smoke during pregnancy.
- In some cases, lack of education means that individuals do not know about health risks or how to avoid them.
Social Factors and Lifestyle Behaviors
Gender and Health (1 of 2)
- Gender discrimination and violence against women produce adverse health effects in girls and women worldwide.
- In many societies, women and girls are viewed and treated as socially inferior, and are denied equal access to health care.
- Gender inequality also exposes women to sexual and domestic abuse. In the U.S., at least one in three women has been beaten, coerced into sex, or abused.
Social Factors and Lifestyle Behaviors
Gender and Health (2 of 2)
- In the United States today, the life expectancy of U.S. women (81 years) is greater than that of U.S. men (76 years).
- The lower life expectancy in men is caused by several factors:
- A more dangerous work environment
- Men engage in riskier behavior
Social Factors and Lifestyle Behaviors
Race, Ethnicity, and Health (1 of 2)
- U.S. racial and ethnic minorities are more likely than non-Hispanic whites to rate their health as fair or poor.
- Non-Hispanic black men and women have higher rates of heart disease and associated complications.
- The highest rates of obesity are among black Americans, followed by Hispanics.
Social Factors and Lifestyle Behaviors
Race, Ethnicity, and Health (2 of 2)
- Health disparities among racial/ethnic minorities is largely due to differences in income, education, housing, and access to health care.
- Health disparities are sometimes explained by differences in lifestyle behaviors.
- Another factor could be the stress resulting from prejudice and discrimination.
- Finally, regarding mental health, research finds no significant difference among races in their overall rates of mental illness.
U.S. Health Care: An Overview
- In the United States, there is no one health care system; rather, health care is offered through various private and public means.
- Most insurance companies control costs through managed care, which involves monitoring and controlling the decisions of health care providers.
U.S. Health Care: An Overview
Public Health Insurance Programs (1 of 2)
- Medicare is funded by the federal government and reimburses the elderly and people with certain disabilities for their health care.
- Medicaid, which provides health care coverage for the poor, is jointly funded by the federal and state governments.
U.S. Health Care: An Overview
Public Health Insurance Programs (2 of 2)
- Medicaid, which provides health care coverage for the poor, is jointly funded by the federal and state governments.
- The State Children’s Health Insurance Program (SCHIP) provides health coverage to children without insurance, many of whom come from families with income too high to qualify for Medicaid but too low to afford private health insurance.
Problems in U.S. Health Care
- In a comparison of health care in 11 wealthy nations, the US ranked last. Despite the fact that health care spending, both per person and as a percentage of gross domestic product, is considerably higher in the US than in the other countries.
Problems in U.S. Health Care
Medicare
- Medicare is funded by the federal government and reimburses the elderly and the disabled for their health care.
- Medicare’s medical insurance program is not free; enrollees must pay a monthly premium as well as a copayment for services.
- Medicare does not cover long-term nursing home care, dental care, eyeglasses, and other types of services.
Problems in U.S. Health Care
Medicaid
- Provides health care coverage for the poor, and is jointly funded by the federal and state governments.
- Medicaid does not cover all poor people.
- Eligibility rules and benefits vary from state to state, and in many states Medicaid provides health care only for the very poor who are well below the federal poverty level.
- SCHIP (State Children’s Health Insurance Program) – provides health insurance to children.
Problems in U.S. Health Care
Workers’ Compensation
- Worker’s Compensation (workers’ comp) is an insurance program that provides medical and living expenses for people with work-related injuries or illnesses.
Problems in U.S. Health Care
Complementary and Alternative Medicine
- Complementary and alternative medicine (CAM) refers to a broad range of health care approaches, practices, and products that are not considered part of conventional (allopathic) medicine.
- Includes herbal and homeopathic remedies, dietary supplements, meditation, Pilates, yoga, tai chi, acupuncture, chiropractic care, message therapy, Reiki and other energy work, and the use of traditional healers.
Problems in U.S. Health Care
Inadequate Health Insurance Coverage
- Universal Health Care – a system of health care, typically financed by the government that ensures health care coverage for all citizens.
- In 2014, 10.4% of Americans (33 million people) did not have health care coverage.
The High Cost of Health Care
- Health spending in the US is far greater than in other industrialized countries.
- Yet nearly every other country has better health outcomes, as measured by life expectancy and infant mortality.
Problems in U.S. Health Care
The High Cost of Health Care
Factors in Escalating Medical Costs
- Several factors have contributed to escalating medical costs:
- Increased longevity
- Cost of hospital services and medical technology
- Cost of prescription drugs
- Cost of health insurance
- Expensive medical technologies
The High Cost of Health Care
Inadequate Mental Health Care
- The fragmented system of mental health care leaves many people with mental health problems to fall through the cracks.
- Nearly one-third of the 10 million U.S. adults with serious mental illness in 2013 did not receive any mental health services in the past year.
- Mental health services are often inaccessible, especially in rural areas.
Strategies for Action:
Improving Health and Health Care
- Selective primary health care focuses on using specific interventions to target specific health problems, such as promoting condom use to prevent HIV infections.
- Comprehensive primary health care focuses on the broader social determinants of health, such as poverty and economic inequality, gender inequality, environment, and community development.
Strategies for Improving Health and Health Care
Improving Health in Low- and Middle-Income Countries
- Declines in maternal mortality can be attributed to several factors:
- Deliveries by skilled health workers
- Contraceptive Use
- Family Planning Services
- Decline in Child Marriage
- Education and Income
- Immunization Programs
Childbearing at an early age involves higher risks for women and infants.
Strategies for Improving Health and Health Care
Improving Maternal and Child Health
Hector Conesa/Shutterstock.com
Strategies for Improving Health and Health Care
HIV/AIDS Prevention and Alleviation Strategies
- Currently, there is no vaccine to prevent HIV infection. A number of other strategies are available to help prevent and treat HIV/AIDS:
- HIV/AIDS Education and Access to Condoms
- HIV Testing and Treatment
- Fighting Against HIV/AIDS Stigma and Discrimination
- Needle Exchange Programs
- Financial and Medical Aid to Developing Countries
Strategies for Improving Health and Health Care
Fighting the Growing Problem of Obesity
- In general, reducing and preventing obesity requires encouraging people to eat a diet with sensible portions, with lots of high-fiber fruits and vegetables, and with minimal sugar and fat.
- Some of the strategies include:
- Restrictions and Advertisements
- Local and state antiobesity policies
- Workplace wellness programs
- Public Education and awareness
What Do You Think?
Military service men and women may be awarded the Purple Heart medal if they are wounded or killed in military action. Those wounds must be physical—emotional wounds such as PTSD do not qualify.
Do you agree with the Department of Defense? Or do you think veterans with PTSD should be eligible to receive the Purple Heart medal?
Strategies for Improving Health and Health Care
Strategies to Improve Mental Health Care
- Two areas for improving mental health care in the United States are eliminating the stigma associated with mental illness and improving access to mental health programs.
- Eliminating the Stigma of Mental Illness
- Improving Access to Mental Health Care
Strategies for Improving Health and Health Care
The Affordable Care Act of 2010
- In March 2010, the Patient Protection and Affordable Care Act (PPACA), commonly referred to as the Affordable Care Act or “Obamacare,” was passed by Congress and signed into law by President Obama.
- Just a few of the many provisions of the recent health care reform legislation includes:
- Establishing an “individual mandate”
- Creating health insurance exchanges
- Providing tax credits to business that provide insurance
- Expanding Medicaid
- Providing discounts on brand-name drugs and free preventative services
What Do You Think?
One provision of the ACA requires insurance plans to cover the cost of contraceptives. However, in 2014, the Supreme Court ruled that Hobby Lobby and other closely held for-profit companies may choose not to pay for coverage of birth control in their workers’ health plans if the company’s owner has religious objections. Do you agree with the Court’s ruling? What if the company’s owner had a religious objection to other health services, such as blood transfusions or vaccinations?
Understanding Problems of Illness and Health Care
- Although human health has probably improved more over the past half-century than over the previous three millennia, the gap in health between rich and poor remains wide, and the very poor suffer appallingly.
- Poverty may be the most powerful social factor affecting health, but other social factors that affect health include globalization, increased longevity, family structure, gender, education, race, and ethnicity.
Quick Quiz
1. How does symbolic interactionism view health conditions such as mental illness?
As society's failure to meet the needs of the have-nots.
As a biological condition.
As a result of globalization.
As a label conferred on those who are different.
Answer: D
- Symbolic interactionism views health conditions such as mental illness as a label conferred on those who are different.
Quick Quiz
2. Medicalization refers to the trend in:
the increase in the number of new viruses that are found.
treating mental illness in hospitals.
turning normal events into medical events.
the growing hospitalization of HMO patients.
Answer: C
- Medicalization refers to the trend in turning normal events into medical events.
Quick Quiz
3. In developing countries, what is the leading cause of death and disability for women ages 15 to 49?
malnutrition and starvation
sexually transmitted diseases
maternal mortality
tobacco related deaths
Answer: C
- In developing countries, the leading cause of death and disability for women ages 15 to 49 is maternal mortality.
Quick Quiz
4. Which of the following is a new approach to measuring the health status of a population?
patterns of burdens of disease
infant mortality rates
maternal mortality rates
under 5 mortality rates
Answer: A
- Patterns of burdens of disease is a new approach to measuring the health status of a population.
Quick Quiz
What is the predominant mode of HIV transmission worldwide?
heterosexual contact
prenatal transmission
homosexual contact
intravenous drug use
Answer: A
- Heterosexual contact is the predominant mode of HIV transmission worldwide.
Quick Quiz
The type of health insurance plan that tries to minimize hospitalization costs by emphasizing preventable health care is called what?
Medicare
a preferred provider organization
a health maintenance organization
Medicaid
Answer: C
- The type of health insurance plan that tries to minimize hospitalization costs by emphasizing preventable health care is called a health maintenance organization.
