Full file at 2
CHAPTER 2
Problems of Illness and Health Care
LEARNING OBJECTIVES
After reading this chapter, students should be able to:
1.Distinguish between developed, developing, and the least developed countries of the world and explain health disparities among these types of countries by measures of morbidity, life expectancy, and mortality.
2.Explain measurement of the health status of a population by “burden of disease,” the measure of “disability-adjusted life year” (DALY), and the leading causes for burden of disease worldwide.
3.Explain and give examples of how illness, health, and health care affect and are affected by other aspects of social life, according to the structural-functional perspective.
4.Explain and give examples of how the conflict perspective contributes to our understanding of illness and health care by its focus on wealth, status, power, and the profit motive.
5.Explain and give examples of how the symbolic interactionist perspective contributes to our understanding of illness and health care by its focus on meanings and labels and how these are learned through social interaction.
6.Describe worldwide patterns of HIV/AIDS, modes of transmission, and the devastating effects of the disease on poor countries, particularly areas of sub-Saharan Africa.
7.Describe at-risk populations for HIV/AIDS in the United States and explain factors that put these populations at greater risk for contracting the disease.
8.Describe patterns of obesity in the United States and explain how obesity is related to patterns of food consumption, cultural attitudes, and socioeconomic status.
9.Define mental illness and describe general kinds of mental disorders, the prevalence of mental disorders in the United States, and the negative effects of mental illness.
10.Explain biological and social causes of mental illness worldwide.
11.Report common health problems of college students and life-style factors that may explain these problems.
12. Explain the positive and negative effects of globalization on health, including the effects of increased travel and information technology, increased trade and transnational corporations, and international free trade agreements.
13.Explain how the social factors of social class, poverty, education, gender, race and ethnic minority status, and family and household factors affect physical and mental health.
14.Describe differences between health care in the United States and other countries.
15.Describe the relative proportions of the American population who are covered by government health care plans versus private insurance and explain differences between traditional health insurance plans and health maintenance organizations, preferred provider organizations, and managed care in the United States.
16.Describe the provisions and recipients of America’s major publicly funded health programs of Medicare, Medicaid, the state Children’s Health Insurance Program, Workmen’s Compensation, and military health care and explain problems associated with each of these government programs.
17.Describe and explain the problems in the United States of inadequate health insurance coverage, including inadequate insurance for the poor and problems of health coverage related to increased longevity.
18.Explain the high costs of hospital services, doctors’ fees, medical technology, drugs, health insurance, and health care administration in the United States and the consequences of the high cost of health care for individuals and families.
19.Explain the managed care crisis.
20.Explain the problem of inadequate mental health care in the United States.
21.Explain differences in the strategies of selective primary health care and comprehensive primary health care and discuss the effectiveness of each of these kinds of strategies.
22.Describe and explain strategies for improving maternal and infant health.
23.Describe and explain strategies for preventing and alleviating HIV/AIDS.
24.Describe and explain strategies for fighting the problem of obesity.
25.Compare health care coverage in other industrialized countries with the United States and describe U.S. efforts toward health care reform.
26.Describe strategies to improve mental health care, including eliminating the stigma of mental illness and eliminating inequalities in health care coverage for mental disorders in contrast to other health disorders.
KEY TERMS
1
Full file at 2
biomedicalization
comprehensive primary
health care
deinstitutionalization
developed countries
developing countries
epidemiological
transition
globalization
health
infant mortality rate
least developed countries
life expectancy
managed care
maternal mortality rate
Medicaid
medicalization
Medicare
mental health
mental illness
morbidity
mortality
needle exchange programs
parity
selective primary health care
socialized medicine
State Children’s Health Insurance Program (SCHIP)
stigma
under-5 mortality rate
universal health care
workers’ compensation
1
Full file at 2
CHAPTER 2
OUTLINE
I.THE GLOBAL CONTEXT: PATTERNS OF HEALTH AND ILLNESS AROUND THE WORLD
A.Classification of countries for international comparisons of health and illness.
1.Developed countries (high-income countries) have relatively high gross national income per capita and diverse economies made up of different industries.
2.Developing countries (middle-income countries) have relatively low gross national income per capita, and their economies are much simpler, often relying on a few agricultural products.
3.Least developed countries (low-income countries) are the poorest countries of the world.
B.Morbidity, Life Expectancy, and Mortality
1.Morbidity refers to illnesses and diseases and the symptoms and impairments they produce.
a. Measures of morbidity
(1)Incidence: number of new cases of a specific health problem in a given population during a specified time period
(2)Prevalence: total number of cases of a specific health problem in a population that exists at a given time
b.Patterns of morbidity vary according to the level of development of a country.
(1)In less-developed countries, where poverty and chronic malnutrition are widespread, infectious and parasitic diseases, such as HIV disease, tuberculosis, diarrheal diseases, measles, and malaria are much more prevalent.
(2)In developed countries, chronic diseases are the major health threat.
- Wide disparities in life expectancy—the average number of years individuals born in a given year can expect to live—exist between regions of the world.
a.In 2005, Japan had the longest life expectancy (82 years), Swaziland had the lowest life expectancy (30 years), and 31 countries (primarily in Africa) had life expectancies of less than 50 years.
b.As societies develop and increase the standard of living for their members, life expectancy increases and birthrates decrease.
c.At the same time, the main causes of death and disability shift from infectious disease and high death rates among infants and women of childbearing age (owing to complications of pregnancy, unsafe abortion, or childbearing) to chronic, noninfectious illness and disease.
(1)This shift is known as the epidemiological transition, whereby low life expectancy and predominance of parasitic and infectious diseases shift to high life expectancy and predominance of chronic and degenerative diseases.
(2)As societies make the epidemiological transition, birthrates decline and life expectancy increases, so diseases that need time to develop, such as cancer, heart disease, Alzheimer’s disease, arthritis, and osteoporosis, become more common and childhood diseases, typically caused by infectious and parasitic diseases, become less common, as do pregnancy-related deaths and health problems.
3.Leading causes of mortality
a.Today, the leading cause of mortality, or death, worldwide is cardiovascular disease (including heart disease and stroke), accounting for 30 percent of all deaths.
b.In the United States, the leading cause of death for both women and men is heart disease, followed by cancer and stroke.
4.Morality Rates Among Infants and Children
a.Infant Mortality
(1)The infant mortality rate, the number of deaths of live-born infants under 1 year of age per 1,000 live births (in any given year), provides an important measure of the health of a population.
(a)In 2005, infant mortality rates ranged from an average of 97 in least developed nations to an average of 5 in industrialized nations.
(b)In 2005, the U.S. infant mortality rate was 6 and 34 countries had infant mortality rates lower than that of the U.S.
(2)One of the major causes of infant death worldwide is diarrhea, resulting from poor water quality and sanitation.
b.Under-5 Mortality Rate: rate of deaths of children under age 5
(1)Under-5 mortality rates range from an average of 153 in least developed nations to an average of 6 in industrialized nations.
(2)A major contributing factor to deaths of infants and children is undernutrition.
(a)In the developing world, one in four children under age 5 is underweight.
(b)For these nutritionally deprived children, common childhood ailments such as diarrhea and respiratory infections can be fatal.
5. Maternal Mortality Rates
a.Maternal mortality rate, a measure of deaths that result from complications associated with pregnancy, childbirth, and unsafe abortion, also provides a sensitive indicator of the health status of a population.
(1)Maternal mortality is the leading cause of death and disability for women age 15 to 49 in developing countries.
(2)The three most common causes of maternal death are hemorrhage, infection, and complications related to unsafe abortion.
b.Cross-national comparisons
(1)Rates of maternal mortality show a greater disparity between rich and poor countries than any of the other societal health measures: only 1% occur in high-income countries.
(2)Women’s lifetime risk of dying from pregnancy or childbirth is highest in sub-Saharan Africa, where 1 in 16 women dies of pregnancy-related causes, compared to 1 in 4,000 in developed countries.
c.Factors contributing to high maternal mortality rates in less developed countries
(1)Poor quality and inaccessible health care: most women give birth without assistance of trained personnel.
(2)Malnutrition and poor sanitation
(3)Higher rates of pregnancy and childbearing at early ages
(4)Lack of access to family planning services and/or lack of support of male partners to use contraceptive methods such as condoms, frequently resulting in unsafe abortions.
C. Patterns of Burden of Disease
1.Provides an indicator of the overall burden of disease on a population through a single unit of measurement that combines not only the number of deaths but also the impact of premature death and disability on a population.
a.This comprehensive measure, the disability-adjusted life year (DALY), reflects years of life lost to premature death and years lived with a disability.
b.1 DALY is equal to 1 lost year of health life
2. Leading causes
a.Worldwide, tobacco is the leading cause of burden of disease.
b.The top 10 risk factors that contribute to the global burden of disease are: underweight; unsafe sex; high blood pressure; tobacco; alcohol; unsafe water, sanitation, and hygiene; high cholesterol; indoor smoke from solid fuels; iron deficiency; and overweight.
II.SOCIOLOGICAL THEORIES OF ILLNESS AND HEALTH CARE
A. Structural-Functionalist Perspective
1. Concerned with how illness, health, and health care affect and are affected by changes in other aspects of social life
a.Modernization and industrialization have resulted in environmental pollution.
b.HIV/AIDS helped unite and mobilize gay rights activists.
c. Concern over the effects of exposure to tobacco smoke has led to legislation banning smoking in workplaces, restaurants, and bars in at least five states.
2. Views health care as a social institution that functions to maintain well-being of societal members and of the social system as a whole
a.Illness is dysfunctional in that it interferes with people performing needed social roles.
b.Society assigns a temporary and unique role to those who are sick: “the sick role.”
c.The sick role carries the expectation that the person who is ill will seek competent medical advice, adhere to prescribed regimen, and return as soon as possible to normal role obligations.
3.Draws attention to latent dysfunctions, unintended and often unrecognized negative consequences of social patterns or behaviors
a.A latent dysfunction of the widespread use of some drugs has led to drug-resistant germs.
(1)For generations, the drug chloroquine was added to table salt to prevent malaria, but overuse led to drug-resistant strains of malaria.
(2)Now the drug is useless to prevent malaria.
b.The highly active antiretroviral therapy (HAART) is associated with an increase among HIV-positive young people in unprotected sex, multiple sexual partners, and use of illicit drugs, which thereby increases the opportunities to transmit the virus to others.
B. Conflict Perspective
1. Focuses on how wealth, status, power, and the profit motive influence illness and health care
a.Criticizes the pharmaceutical and health care industry for placing profits above people.
(1)Power in our health care system has shifted from physicians, who are committed to putting their patients’ interests ahead of their own financial interests, to corporations that are legally bound to put their shareholders’ interests first.
(a)Many decisions about how to allocate health care dollars have become marketing decisions.
(b)Because the masses of people in developing countries lack the resources to pay high prices for medication, pharmaceutical companies do not see the development of drugs for diseases of poor countries as a profitable investment.
(c)Ninety percent of the $70 billion invested annually in health research and development is focused on the 10 percent of the world’s population living in industrialized countries, where drugs are more profitable.
(2)Profits also compromise drug safety.
(a)Most pharmaceutical companies outsource their clinical drug trials to Contract Research Organizations in developing countries where trial subjects are plentiful, operating costs are low, and regulations are lax.
i.Because CROs can complete a clinical trial in less time and with less expense than a pharmaceutical company can, they offer millions of dollars in increased revenue per drug.
ii.The validity of the clinical trial results from CROs is questionable, because CROs can earn more money in royalties and future contracts when the clinical trials are favorable.
b.The profit motive also affects health via the food industry.
c.Powerful groups and wealthy corporations influence health-related policies and laws through contributions to politicians and political campaigns.
(1)After Merck & Co. received FDA approval for its drug Gardasil, a vaccine that protects against the two strains of human papilloma virus, Merck campaigned to make Gardasil mandatory for all 11-12 year old girls.
(2)Merck influenced state legislators to pass bills requiring the Gardasil vaccine and provided funding to Women in Government—a nonprofit organization of female state legislators who members helped introduce bills mandating the Gardasil vaccine for girls in about 20 states.
d.The profit motive can also contribute to positive changes in the U.S. health care system.
(1)Large corporations struggle to compete with other companies in countries where the burden of providing health insurance does not fall on the employer.
(2)Concern for profit has led big business to join those calling for U.S. health care reform.
2.Conflict theorists also point to the ways health care and research are influenced by male domination and bias
a.Some insurance policies cover Viagra (a male impotence drug) but not female contraceptives.
b. The male-dominated medical community has been criticized for neglecting women’s health issues and excluding women from major health research studies.
C. Symbolic Interactionist Perspective
1. Focuses on how meanings, definitions, and labels influence health, illness, and health care, and how such meanings are learned through social interaction and the media
2.Argues that there are no diseases in nature; there are only conditions that society has come to define as illness or disease.
a.Medicalization: defining or labeling behaviors and condition as medical problems
(1)Initially, medicalization was viewed as occurring when a particular behavior or conditions deemed immoral was transformed from a legal problem into a medical problem that required medical treatment.
(2)The concept of medicalization has expanded to include:
(a)Any new phenomena defined as medical problems in need of medical intervention, such as post-traumatic stress disorder, premenstrual syndrome, and attention-deficit/hyperactivity disorder.
(b)“Normal” biological events or conditions that have come to be defined as medical problems in need of medical intervention, including childbirth, menopause, and death.
b.Conflict theorists viewed medicalization as resulting from the medical profession’s domination and pursuit of profits, whereas a symbolic interactions perspective suggests that medicalization results from the effort of sufferers to translate their individual experiences of distress into shared experiences of illness.
3.Recent theorists have observed a shift from medicalization to biomedicalization: the view that medicine cannot only control particular conditions but can also transform bodies and lives, such as receiving an organ transplant, artificial limbs, or becoming pregnant through reproductive technology.
4.Definitions of health and illness vary over time and from society to society.
a.In some countries, being fat is a sign of health and wellness; in others, it is a sign of mental illness.
b.In some cultures, perceiving visions or voices of religious figures is considered normal religious experience, whereas such hallucinations are indicative of mental illness in some cultures.
c.In the 18th and 19th centuries, masturbation was considered an unhealthy act; today, most health professional agree that masturbation is a normal, healthy aspect of sexual expression.
5.Draws attention to the effects that meanings and labels have on health behaviors and health-related policies.
a.As tobacco sales have declined in developed countries, transnational tobacco companies have looked for markets in developing countries, using advertising strategies that depict smoking as an inexpensive way to buy into glamorous lifestyles of the upper or successful social class.
b.In 2004, the Centers for Medicare and Medicaid Services decided to remove language in Medicare’s coverage manual that states that obesity is not an illness: labeling obesity as an illness means that treatment for obesity can be covered by Medicare.