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13.5 End-of-Chapter Material
- A sociological approach emphasizes the relationship between health, medicine, and society. Our social backgrounds influence our health and access to health care, while the culture and social structure of a society influences its perceptions of health and illness and ways of healing.
- Sociological perspectives on health and illness fall into the functional, conflict, and interactionist approaches encountered in previous chapters. The functional view emphasizes the importance of health for a society’s stability and the roles that people play when they are sick. The conflict view stresses inequality in the quality of health and health-care delivery and efforts by physicians to monopolize the practice of medicine to increase their profits. According to the interactionist view, health and illness are social constructions subject to people’s and society’s interpretations. The interactionist view also studies how medical professionals and patients interact and the way professionals manage understandings of such interaction.
- Health and the quality of health care differ widely around the world and reflect global stratification. The earth’s poorest nations have extremely high rates of infant mortality and life-threatening diseases such as AIDS and very low life expectancy. Despite efforts of organizations like the World Health Organization, the poor health of the poor nations’ residents remains a serious problem.
- The United States ranks ahead of most of the world’s nations in most health indicators, and health in the United States has greatly improved in the last century. At the same time, the United States lags behind most other industrial nations in important health indicators such as infant mortality and life expectancy. Moreover, serious disparities exist within the United States in the social distribution of health, as evidenced by the study of social epidemiology.
- Social class, race and ethnicity, and gender all affect the quality of health. Poor people lack health insurance and access to health, face high amounts of stress, live in unhealthy social and physical environments, and are more apt to engage in unhealthy lifestyles. For all of these reasons, their health is worse than that of the nonpoor. African Americans, Hispanics, and Native Americans all fare worse than whites on many health indicators, in large part because of their poverty and history of discrimination. Women fare worse than men on several heath indicators, but men have lower life expectancies because of their higher rates of certain life-threatening illnesses. These rates are thought to be due to men’s biology, unhealthy lifestyles brought on by their masculine socialization, and unwillingness to seek medical treatment.
- Social factors also help explain different rates of mental illness. The poor have higher rates of mental disorders than the nonpoor because of the stress of poverty and other negative life conditions. Women are more likely than men to be depressed and to suffer from some other disorders, but men are more likely to have antisocial personality disorders with symptoms that make them a threat to others. Clear racial and ethnic differences in mental disorders have not been found, perhaps because the strong family bonds and religious faith of many minorities help protect them from disorders that would otherwise be expected from their poverty and discrimination. In looking at Mexican-Americans, there’s some evidence that living in American society raises the risks of mental disorders.
- The history of medicine reflects a move from religious and spiritual approaches to healing to scientific approaches. In prehistoric societies priests tried to appease the angry gods or chase away the evil spirits who were thought to cause physical and mental illness. Ancient civilizations made great advances in our understanding of health and illness, and the rise of scientific medicine beginning in the 1600s helped pave the path for today’s scientific approach.
- Despite these medical advances, health care in the United States today faces several problems. The United States is alone in not offering universal national health insurance; its absence is thought to help account for the country’s low ranking in the industrial world on major health indicators, as significant numbers of our poor and minorities lack health insurance. Managed care has also come under criticism for restricting coverage of important medical procedures and prescription medicines. Racial and gender bias in health care is another problem that has adverse effects on the nation’s health. Other quality-of-care problems include tired physicians, a lack of emergency-room physicians, and numerous mistakes made in hospitals. Disagreement over alternative medicine reflects the historic battle between the medical establishment and other healers, while self-referral and other issues raise important questions for medical ethics. Meanwhile, health-care fraud costs the nation some $100 billion annually and remains an important problem for the nation to address.
You have always had an interest in health care and 2 months ago received your license to work as a physician’s assistant after taking 2 years of courses beyond your BA. Having had a course in medical sociology, you learned about health-care disparities related to social class. Within a few weeks of receiving your license, you started working at a health-care clinic in a low-income neighborhood of a medium-sized city. Since then you have enjoyed your work because you’ve enjoyed helping the patients and think you are making a difference, however small, to improve their health.
At the same time, you have become troubled by comments from two of the physicians on staff, who have scorned their patients for having so many health problems and for waiting too long to come in for medical help. You realize that you could jeopardize your job if you criticize the doctors’ views to anyone in the office, but you also feel the need to say something. What, if anything, do you do? Explain your answer.