Transcript Ch09_LPPT - Napa Valley College

Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved.
Chapter 9:
Physical and Mental
Health Care
Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved.
Health Defined

World Health Organization (WHO)
• Health
 A state of complete physical, mental, and
social well-being and not merely the
absence of disease or infirmity
 The sum of several different factors
• Physical, mental, social
• Mental Disorders
 Patterns of mood, thought, or behavior that
cause distress and decrease the ability of a
person to function
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History of Health Care

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Medical care at the center of many social
problems throughout US history
U.S. health care always been seen as a
luxury
• Sparking debate over who should have access
to it

Other arguments involve quality
• What constitutes “good” medical care?
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Practice vs. Profession of Medicine
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Early practice little more than folk remedies and
home cures
First medical school established in 1765
• In Philadelphia to train doctors for the region
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Strong belief that doctors needed to dissect
human corpses to learn about human body
• Many medical students became grave robbers

April 13, 1788 Anti-Dissection Riot
• legal access to cadavers for medical purposes
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Causes and Cures of Illness and Disease

Four different schools of thought developed in
contrast to orthodox medical science:
• 1. Hydropaths:
 Believed body could be cleansed internally and
externally by the use of water, natural foods, good
hygiene, and exercise
• 2. Osteopaths:
 These physicians also rejected use of drugs and
believe manipulation of the skeleton could improve
health
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Continued
• 3. Christian Scientists
 Founded by Mary Baker Eddy
 Believe all illness was an illusion of the mind
and did not really exist
• 4. Homeopaths
 Believe that orthodox medical practices
overmedicated and over-treated people
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Social Epidemiology

Social Epidemiologists
• Study distribution of diseases and health
throughout a population and assess the social
problems that occur
• Goal is to find links between certain social
factors and physical and mental well-being
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Age and Health

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In US, death is rare among the young
Improved life expectancy and longevity in
the United States
• Elderly face wide variety of health problems
not as prevalent in the past
 Arthritis, diabetes, heart and lung disease,
and mental illness
 Limit activity; making work, socialization,
and exercise difficult for seniors to pursue
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Childhood Obesity

United States is witnessing disturbing
trend in children’s health in recent years
• Rapid increase in childhood obesity

2006 study:
• Rise in obesity direct result of availability of
energy-dense foods and drinks combined with
lack of energy expenditure
 Kids are simply eating more calories than
they’re burning
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Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved.
Gender and Health

Gender plays significant role in life
expectancy and types of health problems
• Life expectancy for women in the US is
average of 80.4 years
• Expectancy for men is 75.2 years
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Continued

Sociologists look for social factors to
explain disparity
• Males more likely to take risks; abuse alcohol,
drive aggressively, and perform other
behaviors that can lead to early deaths
• More likely to accept dangerous work and
make up a greater portion of the armed forces
in wartime
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Continued

Women more concerned with preventive
maintenance of their health than men
• Twice as likely to get regular medical checkups
 Less likely to experience life-threatening
illnesses and health problems

Men should take notice of health practices
of women and try to take better care of
their health in order to live longer lives
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Social Class and Health

Social class has major effect on health in
US
• Quality of health care connected to one’s
ability to pay for it

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Lack of access serious social problem for
the poor
Programs that help get access to health
care poorly funded
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Continued
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Higher social class means greater access to
health care
Lower socioeconomic status leads to a lower
likelihood of access to health care
The higher one’s socioeconomic status, the more
likely a person is to live longer, healthier, and
happier
Areas with high crime rate and drug problems
also have negative effects on the health of
inhabitants
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Race and Health

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Racial and ethnic inequality in health care is
serious social problem in United States
2005
• Average life expectancy of whites was 78.3 years, while
African Americans were expected to live 73.2 years
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24.9 percent of African Americans live below the
poverty level, while only 8.3 percent of American
whites are impoverished
Access to and quality of health care are
repeatedly shown to be affected by race
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Health Care: An International Comparison

World Health Organization (WHO)
• Five criteria for a “good” and “fair” health system in
2000
 1. Low infant mortality rates and high life expectancy
 2. Fair distribution of good health (relatively even
mortality and life expectancy rates across the
country)
 3. A high level of health care responsiveness
 4. A fair distribution of responsiveness
 5. A fair distribution of financing health care (health
care costs are evenly distributed based on a person’s
ability to pay)
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Continued

WHO comparison of health systems in 191
countries
• United States first in responsiveness
 Respect for patients and prompt attention to their
needs
• Ranked relatively low overall compared to other similarly
wealthy nations

US is only wealthy, industrialized, capitalist
nation that doesn’t provide some form of
universal health care
• Score lower than other countries in fairness of financing
and citizen satisfaction
• Ranked 37th overall
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National Scorecard on Health Care
Performance

National Scorecard on Healthcare
Performance
• US spends 16% of gross domestic product on
health care system, but doesn’t provide
universal access
• Only 49% of American adults receive
recommended preventive screening tests for
their age and sex
• Only half of patients with congestive heart
failure receive written discharge instructions
regarding follow-up care after hospitalization
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Continued
• Nationwide, preventable hospital admissions
for chronic health conditions such as diabetes
and asthma twice as high as level achieved by
best performing nations
• One-third of adults under 65 have problems
paying medical bills, and many in serious debt
due to health problems
• Only 17% of U.S. doctors use electronic
medical records, compared with 80% of
doctors in top three countries
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Continued
• Measuring quality of care and access to care
 Wide gap between those with low incomes
who are uninsured and those with higher
incomes and good insurance
• As part of total health care expenditures
insurance administrative costs in the United
States more than three times rate in countries
with integrated payment systems
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Mental Health
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Classifications of mental illnesses relatively new
and subject to change and adjustment
Different subcategories of mental disorders
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•
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•
•
•
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Major depressive disorder
Bipolar disorder
Schizophrenia
Obsessive compulsive disorder (OCD)
Panic/anxiety disorders
Eating disorders
ADHD: Attention deficit hyperactivity disorder
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Gender and Race in Mental Health

Men and women suffer from differing
types of mental disorders
• Females tend to experience more internalizing
problems such as anxiety and/or depression
• Males tend to externalize problems, leading to
aggression, substance abuse, and delinquency
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Continued
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Simple explanation is socialization
• Men socialized to express dominance and power over
others
 Results in increased levels of externalization
• Women socialized early into subordination
 Results in higher levels of depression and anxiety in
response to difference in power

White women have higher rates of internalization
problems than women of color
• White women are socialized into stricter subordinate
roles
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Income and Mental Health
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Income and social class affect mental
health in same way as physical health
Children who come from low-income
homes experience higher rates of
childhood depression as well as antisocial
behavior disorders
• Children who live entire childhood in poverty
have higher rates of developing both of these
mental health issues
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Mental Health Care

Several categories of mental health
practitioners
• Psychiatrists, psychologists, and social
workers/counselors

Primary difference is level of education
• Psychiatrists have an MD
• Psychologists have a PhD
• Social workers/counselors have at least a
bachelor’s and in some cases a master’s
degree
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Continued
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Only psychiatrists allowed to prescribe
medication
Psychologists and counselors provide
psychotherapy
• Treatment without drugs

Psychologists provide diagnostic testing to
determine patients’ levels of functioning
• Assess whether there is improvement or
deterioration of conditions
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Continued
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Establishing comfortable, honest
relationship with patients is primary goal
of therapists
Psychotherapy designed to help patients
develop coping strategies and healthy
behaviors
• Can reduce possibility of future illness and
improve quality of life
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Perception of Mental Illness
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Historically, mentally ill had to endure
harsh treatment
Mental illness widely misunderstood and
misinterpreted
1950s, American social scientists
• General community largely uninformed about
current psychiatric medical knowledge and
based opinions on negative stereotypes and
misinformation
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Continued
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Prevailing view
• Mental problems not uncontrollable illnesses,
but rather a character flaw
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Public perception shifted from one of fear
and disdain to something resembling
tolerance and understanding
Not complete acceptance
• Society recognizes mental illness as a disease
and not a moral deficiency
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The Myth of Mental Illness
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Dispute about diagnosis and treatment of mental
illness
The Myth of Mental Illness, Dr. Thomas Szasz
• These illnesses are often misdiagnosed and used as a
means of social control

Paula Caplan agrees with Szasz
• DSM (Diagnostic and Statistical Manual of Mental
Disorders)
 Standard text used by health professionals in US to
classify mental illnesses
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Continued
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DSM relies heavily on personal ideology and
political maneuvering
Caplan only woman on committee to revise DSM
Premenstrual dysphoric disorder (PMS) was
included as a “mental illness”
• Despite the lack of evidence
• It would be only mental illness to happen monthly for a
set number of days

Caplan suggests that men would never accept
such a diagnosis for themselves
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Functionalism: The Medicalization of the
American Society
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Functionalist perspective examines how
health and health care affect people’s lives
Talcott Parsons
Sick Role
• Made up of expected behaviors and
responsibilities appropriate for someone who is
ill
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Continued
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Control and respect doctors given led to the
Medicalization of America
• Idea that medical community is at center of many
aspects of society

Prevailing belief in US that we can find a pill for
every problem
• Ads for prescription drugs only make the problem worse

Research shown that consumers go to doctors
requesting pills they’ve seen on television
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Conflict Theory: Making a Profit

Conflict theorists point to lack of access
• 1 in 6 people in US have no health care insurance
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US is only Western nation not providing some
form of government-funded health care
Sociologist Jill Quadagno (2004)
• Number of structural barriers exist
 American medical care is a for-profit business
 Invasion of government not welcome by those who
make their living off the current system
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Continued
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Two groups have most to lose from governmentrun health care
• Insurance companies and medical professionals
 Reap high profits
 Hold secure markets for their businesses under
current system
 Make this money at expense of that 1 person in 6
who cannot afford to go to the doctor

The poor pay these professionals’ salaries with
their lives
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Symbolic Interactionism

Terms such as “right” and “privilege”
• Make the difference when it comes to method of health
care

If health care is a right
• Government must do something to make sure it’s fairly
and equally provided to all citizens

If it’s a privilege
• Government need not do anything
• Health care can be entirely privatized

Right now, American health care is established
more as a privilege than a right
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Health Care in the United States
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40% of Americans satisfied with health
care system
US spends more money per person on
health care than any other country
• Not everyone has health insurance

National insurance
• Cover all children and the millions of adults
who can’t afford to pay – Doesn’t Exist

Fewer employers offering health benefits
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Continued
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Why U.S. government resistant to provide
universal health care:
• The Constitution states power of the
government must be limited
 National health care viewed as a form of
welfare, which threatens our freedom
• The working class and labor unions fail to
support legislation that would provide
universal health care
• Private health insurance companies strongly
oppose idea of national health care
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Copyright © 2011 Pearson Education, Inc., Upper Saddle River, NJ 07458. All rights reserved.
National Health Care for the Elderly:
Medicare

One segment of population guaranteed
governmental health care
• The elderly

Medicare
• Government-run social insurance program that
provides health coverage for elderly Americans

Available to citizens over age of 65 who
have paid Medicare taxes for at least 10
years or to spouses of people who have
paid Medicare taxes
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Continued
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Medicaid
• Designed to provide insurance for low-income
individuals and families who meet certain qualifications
• Income determines eligibility
• Program is funded partially by the federal government
and partially by each individual state
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Not every person with low-income eligible for
Medicaid
Other requirements
• Some include age, pregnancy, physical disabilities, and
citizenship status
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