Transcript HEALTH CARE IN THE U.S.

HEALTH CARE IN THE U.S.
A MACRO PROBLEM
U.S. CITIZENS
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Not as healthy as in other well developed nations
Major differences in health status by class & race
System organized to respond to problems, not prevent
them
Skyrocketing costs leave many unable to afford
treatment
AIDS & Elderly Population increasing demand on
inadequate system
INDICATORS USED BY SOCIOLOGISTS
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LIFE EXPECTANCY is how long the average person
born in a given year is expected to live.
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INFANT MORTALITY is the number of newborns who
die in a given year per live birth. The statistic
encompasses those who die before their first birthday.
LIFE EXPECTANCY
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In 1900 was 49 years
Today is 76 years
Represents a 50% increase
Reflects improvements in diet, personal hygiene,
housing, and public sanitation
Public health & social change measures reduced
mortality rates more than modern medical advances
INFANT MORTALITY RATE
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In 1900 was 143 per 1000
Recently has dropped to a little under 10 per 1000
Appears that U.S. population is has grown healthier
Reflects improved sanitation, nutrition, & medical
advances
Also changes in prenatal, neonatal, and obstetric
practices
1900’s - TODAY
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In 1900’s people regularly died from tuberculosis,
pneumonia & influenza
Children were hit hard by these diseases
With the development of immunizations & antibiotics
longevity increased
Today the principal causes of death are heart disease
and cancer
Previously people did not live long enough to contract
cancer
NATIONAL SURVEYS
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Conducted by the government since 1957
Asks respondents for assessment of their health & that of
members of their household
1990 ASSESSMENT
• Excellent or Very Good 69%
• Good
22%
• Fair or Poor
9%
This indicator is subjective and seems quite positive
However, we spend more per capita and comparison to other
nations is not favorable
EXAMPLES
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People born in Japan, Sweden, Norway, Switzerland,
Canada & the Netherlands live longer than those born
in the U.S.
Over 20 nations have lower infant mortality rates
One health care analyst stated “ The infant mortality
rate in several urban areas would qualify the United
States as a third world country.”
Something is very wrong when so many preventable
deaths occur
DATA
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Indicates that wealth and income distribution is unequal
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Situation has worsened since the 1980’s
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Direct correlation between health status and position in
society
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Lower in structure - Good health becomes less frequent
1993 FEDERAL SURVEY
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People were asked to assess their health and that of
their families
Higher Income Level (over $35,000)
• Excellent or Very Good
• Fair or Poor
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Lowest Income Level (under 10,000)
• Excellent or Very Good
• Fair or Poor
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78%
4%
48%
23%
Economic well-being clearly affects assessment
CLASS & HEATH STATUS CORRELATION
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Poverty, which correlates with inadequate nutrition and
difficulty obtaining access to medical care is one of the
reasons the U.S. ranks 24th in the world for infant
mortality
Rates are substantially higher among the poor
Overall life expectancy less at low lower of class
structure
To say that poverty kills is no exaggeration
INFECTIOUS DISEASES
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Took a major toll in early part of century
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Continue to take high toll on poor
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Routinely Diagnosed Among Poor Today
• Pneumonia & Influenza
• Tuberculosis & Diphtheria
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Arthritis also affects the poor more than others
1992 FEDERAL SURVEY
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Respondents asked how many days they or
members of their household found daily activities
restricted by chronic or acute conditions of
illness,injury, or impairment
Family Income Under $10,000 = 29 days
Family Income Over $35,000 = 10 days
Data shows direct correlation between income and
health status
DEBATE
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Can worse health of lower socioeconomic group be
attributed to conditions of poverty and the resultant
emotional stress they create?
OR
Do aspects of their lifestyle such as cultural values and
individual behavior account for the difference?
PEOPLE AND HEALTH TODAY
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Increased interest in health maintenance and improved
fitness
Decrease in cigarette smoking
Decrease in hard liquor consumption
Dietary changes (less red meat, more grains, fruits, and
vegetables
Monitoring weight, blood pressure, and cholesterol
Limiting exposure to sun and use of sunscreens
U.S. HEATH TODAY
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Despite media publicity, not all segments of the
population are equally involved in the previously
mentioned changes
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Tens of millions of poor and near-poor are largely
outside of or not engaged in such activity
“BLAMING THE VICTIM”
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Implies that lower income groups are responsible for
their lower life expectancy and higher infant mortality
Could be healthier if they made lifestyle changes
Does not take into account the quality of the
environments to which they are exposed
Bluntly put, the more $, the less exposure to
hazards and stresses that adversely affect your
health
WORK ENVIRONMENT
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Lowest paying jobs tend to be most physically taxing
and involve hazardous exposure
STATISTICS
• 14,000 Employees die each year
• 100,000 Die prematurely
• 400,000 Suffer occupationally related illness
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Many of these tragedies are preventable
Employers do not take preventive steps
Negligence inflicted on low wage and status workers
LOW-WAGE WORKERS
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Less Job Security
Seasonal Positions
Subject to Downsizing
Unemployment related to health
• cardiovascular difficulty
• ulcers
• affordability of health care
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Resulting in more than 40 million Americans
without health insurance to pay for treatment
LOW-INCOME LIVING CONDITIONS
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Bring home hazardous substances on clothing & body
Exposure may endanger family members
Live in areas with high concentration of air pollution
• Urban dwellers
• High risks for lung cancer & respiratory disease
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Little concern for health and safety by landlords
• Disease from rat & insect infested property
• Lead poisoning from paint chips
• Sanitation problems, fires & accidents
LOW-INCOME HOUSING SHORTAGE
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Serious shortage of affordable housing so residents
hesitate to complain or relocate
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Many families double and triple up to afford shelter
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Overcrowded conditions cause stress which lowers
immunity and facilitates the spread of infectious
diseases
ALCOHOL & DRUG ABUSE
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Used as coping mechanism by lower income
Life is permeated with threat of criminal victimization
Filthy environment leads to depression
Sense of isolation& alienation from rest of society
Provides escape, but negative ramifications
• Well-being endangered
• Domestic violence (often, but not always linked)
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Drugs include amphetamines, cocaine and PCP
Usage is considered major public health issue
HOMES
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Place of emotional & nutritional replenishment
Low-income
• insufficient food
• inability to afford nutritionally balanced diet
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Health Concerns
• Obesity due to high starch & carbohydrate diet
• Absence of food especially for pregnant women and children
THE HOMELESS
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Estimated at 2-3 million
Beset by serious health problems resulting from:
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Malnutrition
Stress & Fatigue
Infectious diseases
Unsanitary conditions & Poor personal hygiene
Injuries relate to accident or violence
Exposure to environmental threats
Increasing numbers of women & children
THOSE WITH AIDS
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Too ill to work
Evicted from dwellings
Shunned by family & friends
Society fails to provide housing for all its members
Homeless, in general, can do little about their situation
Health problems are organized into existence at low
levels of the class structure
LIFESTYLE CHANGES NEEDED
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Home, work, and neighborhood environments that are
hostile to psychological, and physical well-being need to
improve
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Exercise alone will not greatly improve health problems
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The hungry will eat whatever they can obtain, not be
considered about cholesterol levels
THE AFFLUENT
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Can afford to take steps to avoid minor maladies
Can afford to exercise at health clubs
Can afford to wear designer sunglasses
Many with low- incomes are struggling to survive in
their environments
Until changes are made, sharp class differences in
health status will continue unabated
HEALTH AND RACE
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People of color disadvantage in our society
Health status correlated to race as well as class
Infant Mortality twice as high for African Americans
LIFE EXPECTANCY
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White Female
African American female
White Male
African American
80.3 years
74.8 years
73.7 years
65.8 years
LIFE EXPECTANY RATE
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Between 1984 and1991 the life expectancy of African
American males went down, thereafter it turned around
Rate is lowered by higher infant mortality among African
Americans
African Americans have higher death rates than whites
from almost all causes
Rate may reflect disproportionate number of African
American with low income or that race exacts an
additional toll