Published on March 20, 2014
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 bruises
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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