Transcript Chapter 10
Health Care: Problems of
Physical and Mental Illness
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Chapter outline
Health
Mental Illness
Health Care
Sociological
Explanations
• Life expectancy and infant mortality
• Diseases and Disability
• AIDS
• Defining
• Treatment
• Race, Class, Gender
•
•
•
•
Private Health Insurance
HMO/PPO
Medicare and Medicaid
Race, Class, Gender
• Functionalist
• Conflict
• Interactionist
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Health and Life Expectancy
Health: state of complete physical, mental, and social
well-being.
This is a social issue as well as a biological issue.
Life expectancy is an estimate of the average
lifetime of people born in a specific year
1900 – expected to live to 47.3 years of age
2005 – expected to live to 77.8 years of age
Life expectancy varies by gender, race, social class
and overall health
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Infant Mortality
Number of deaths of infants under one year of age per
1,000 live births
Good indication of societies preventive medical care
IMR higher in US than other high-income nations
Rates vary significantly by race
In 2004, IMR for African American infants was 13.2 per 1,000
live births
In 2001, IMR for white infants was 5.7 per 1,000 live births
Indicates unequal access to health care in US
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Copyright © Allyn & Bacon 2010
Disease
Acute diseases
Illnesses that strike suddenly and cause incapacitation
or death
Chicken pox, influenza, Lyme disease, and HIV
Chronic diseases
Long-term, develop gradually, or are present from birth
(e.g., arthritis, diabetes, heart disease)
Caused by biological and environmental factors
Some produce disabilities that increase health care costs
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Disability
Disability: A restricted or total lack of ability to perform
certain activities as a result of physical limitations or the
interplay of these limitations, social responses, and the social
environment.
54 million people in U.S. have 1 or more physical or mental
disabilities.
This number is increasing due to:
Today people survive with disability that would have died before
Longer life expectancy means more likely to have chronic disease
Those born with serious disabilities more like to survive today
due to medical advances
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AIDS Crisis
Number of cases is rising annually
Between 1,039,000 and 1,185,000 had AIDS/HIV in 2003
Up to 40,000 new cases each year
Males account for nearly ¾ of all cases
Half of those infected are African American
Higher rates for those between age 25 and 44
Treatment is complex and costly, currently no cure
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Mental Health
Considered a social problem because it affects a large number
of people
1 in 4 adults suffer from a diagnosable mental disorder
Difficult to define and identify mental disorders
American Psychiatric Association’s (1994) Diagnostic and Statistical
Manual of Mental Disorders IV (DSM-IV)
Lists of disorders changes and grows with each revision
Severe mental illness (schizophrenia, bipolar disorder, major
depression) affect 1 out of 17 US adults some time in their lives
Many direct and indirect costs of mental illness to our society.
Copyright © Allyn & Bacon 2010
Copyright © Allyn & Bacon 2010
Race, class, gender and mental illness
No significant differences in diagnosable mental
illness between African Americans and whites
Racism does however impact the psychological well-being of
both African Americans and whites
Social class is related to mental illness
As SES increases for African Americans and whites, mental
disorders decrease
Gender differences in Mental Illness:
Women are diagnosed with depression more than men
Men have higher rates of personality disorders (gambling,
drinking, etc.)
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Health Care Crisis
Currently medical care is offered on fee for service basis
Patients pay directly for treatment
Expensive way of delivering health care because there are
few restrictions on how much providers can charge
Private Health Insurance
Pay the insurance company a premium and they pay the
provider directly
Health care costs started spiraling with increase in
medical insurance programs in the 1960’s
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Today’s options
In order to reduce medical costs and demand many
insurance companies are offering options:
Preferred Provider Organizations (PPOs)
Doctors contract to treat insured patients for set fees
Health Maintenance Organizations (HMOs)
For a set monthly fee, an HMO provides total care
Emphasis is on prevention
Patients must use doctors and hospitals affiliated with HMO
Managed Care
Any system of cost containment that controls tests, procedures, and
services
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Medicaid and Medicare
Medicare
Public health insurance for people aged 65 and over
Funded by social security payments
Medicaid
Public health insurance for people who are poor and either
aged, blind, disabled, or pregnant
Funded by federal and state governments
Uninsured and underinsured:
47 million Americans had no health insurance in 2006
Some companies are cutting medical benefits
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Copyright © Allyn & Bacon 2010
Race, class, gender and health care
Less preventive care and less optimal management of
chronic diseases are received by:
People of color across class lines
Low-income whites
Much Gender inequality in health care:
Women have been underrepresented in the medical
profession
Medical training, practice, and research are male-centered
80% of doctors in U.S. are men today
Women receive differential treatment for certain kinds of
medical problems
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Explanations of health care problems
Functionalist:
Illness is dysfunctional for society, keeps people from
fulfilling their roles.
Problems in U.S. health care are due to macro-level
changes (e.g., high-tech medicine, over-specialization of
doctors)
Solutions
Reorganize the whole healthcare system
Cost containment needs to happen
Managed care is the best answer
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Explanations of health care problems (cont.)
Conflict:
Health problems are rooted in capitalism and in the
medical-industrial complex
Race-, class-, and gender-based inequities cause health
problems
Inequality in U.S. health care will be perpetuated by 3
things:
High health care costs due to advanced services and expensive
medicine and technology
Abuse of existing systems by health care professionals who
overcharge, provide unnecessary services, or charge for
services never received
Aging population will put a strain on Medicare and Medicaid.
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Explanations of health care problems, cont.
Symbolic Interactionist
Communication problems between doctors and patients
create problems
Can help this by increasing the number of family
practice Drs.
Increase communication between dr. and patient
People need to become more involved in health care
issues and reform
People who have information and resources could work
on preventative care at home reducing need for some
high cost care.
Copyright © Allyn & Bacon 2010