13 Diversity in Health and Medicine

Introduction to Health and Medicine

DAY 1

Learning Objectives

  • Define social epidemiology
  • Apply theories of social epidemiology to an understanding of global health issues
  • Understand the differences between high-income and low-income nations

Social epidemiology is the study of the causes and distribution of diseases. Social epidemiology can reveal how social problems are connected to the health of different populations. These epidemiological studies show that the health problems of high-income nations differ greatly from those of low-income nations. Some diseases, like cancer, are universal. But others, like obesity, heart disease, respiratory disease, and diabetes are much more common in high-income countries and are a direct result of a sedentary lifestyle combined with poor diet. High-income nations also have a higher incidence of depression (Bromet et al. 2011). In contrast, low-income nations suffer significantly from malaria and tuberculosis.

How does health differ around the world? Some theorists differentiate among three types of countries: core nations, semi-peripheral nations, and peripheral nations. Core nations are those that we think of as highly developed or industrialized, semi-peripheral nations are those that are often called developing or newly industrialized, and peripheral nations are those that are relatively undeveloped. While the most pervasive issue in the U.S. healthcare system is affordable access to healthcare, other core countries have different issues, and semi-peripheral and peripheral nations are faced with a host of additional concerns. Reviewing the status of global health offers insight into the various ways that politics and wealth shape access to healthcare, and it shows which populations are most affected by health disparities.

Health in High-Income Nations

Obesity, which is on the rise in high-income nations, has been linked to many diseases, including cardiovascular problems, musculoskeletal problems, diabetes, and respiratory issues. According to the Organization for Economic Cooperation and Development (2011), obesity rates are rising in all countries, with the greatest gains being made in the highest-income countries. The United States has the highest obesity rate. Wallace Huffman and his fellow researchers (2006) contend that several factors are contributing to the rise in obesity in developed countries:

  1. Improvements in technology and reduced family size have led to a reduction of work to be done in household production.
  2. Unhealthy market goods, including processed foods, sweetened drinks, and sweet and salty snacks are replacing home-produced goods.
  3. Leisure activities are growing more sedentary, for example, computer games, web surfing, and television viewing.
  4. More workers are shifting from active work (agriculture and manufacturing) to service industries.
  5. Increased access to passive transportation has led to more driving and less walking.

Obesity and weight issues have significant societal costs, including lower life expectancies and higher shared healthcare costs.

High-income countries also have higher rates of depression than less affluent nations. A recent study (Bromet et al. 2011) shows that the average lifetime prevalence of major depressive episodes in the ten highest-income countries in the study was 14.6 percent; this compared to 11.1 percent in the eight low- and middle-income countries. The researchers speculate that the higher rate of depression may be linked to the greater income inequality that exists in the highest-income nations.

Health in Low-Income Nations

Children’s protruding bellies are shown here.
Figure 19.4 In low-income countries, malnutrition and lack of access to clean water contribute to a high child mortality rate. (Photo courtesy of Steve Evans/flickr)

In peripheral nations with low per capita income, it is not the cost of healthcare that is the most pressing concern. Rather, low-income countries must manage such problems as infectious disease, high infant mortality rates, scarce medical personnel, and inadequate water and sewer systems. Such issues, which high-income countries rarely even think about, are central to the lives of most people in low-income nations. Due to such health concerns, low-income nations have higher rates of infant mortality and lower average life spans.

One of the biggest contributors to medical issues in low-income countries is the lack of access to clean water and basic sanitation resources. According to a 2014 UNICEF report, almost half of the developing world’s population lacks improved sanitation facilities. The World Health Organization (WHO) tracks health-related data for 193 countries. In their 2011 World Health Statistics report, they document the following statistics:

  1. Globally, the rate of mortality for children under five was 60 per 1,000 live births. In low-income countries, however, that rate is almost double at 117 per 1,000 live births. In high-income countries, that rate is significantly lower than seven per 1,000 live births.
  2. The most frequent causes of death for children under five were pneumonia and diarrheal diseases, accounting for 18 percent and 15 percent, respectively. These deaths could be easily avoidable with cleaner water and more coverage of available medical care.
  3. The availability of doctors and nurses in low-income countries is one-tenth that of nations with a high income. Challenges in access to medical education and access to patients exacerbate this issue for would-be medical professionals in low-income countries (World Health Organization 2011).

DAY 2

 

Learning Objectives

  • Understand how social epidemiology can be applied to health in the United States
  • Explain disparities of health based on gender, socioeconomic status, race, and ethnicity
  • Give an overview of mental health and disability issues in the United States
  • Explain the terms stigma and medicalization

Health in the United States is a complex and often contradictory issue. One the one hand, as one of the wealthiest nations, the United States fares well in health comparisons with the rest of the world. However, the United States also lags behind almost every industrialized country in terms of providing care to all its citizens. The following sections look at different aspects of health in the United States.

Health by Race and Ethnicity

When looking at the social epidemiology of the United States, it is hard to miss the disparities among races. The discrepancy between black and white Americans shows the gap clearly; in 2008, the average life expectancy for white males was approximately five years longer than for black males: 75.9 compared to 70.9. An even stronger disparity was found in 2007: the infant mortality, which is the number of deaths in a given time or place, rate for blacks was nearly twice that of whites at 13.2 compared to 5.6 per 1,000 live births (U.S. Census Bureau 2011). According to a report from the Henry J. Kaiser Foundation (2007), African Americans also have higher incidence of several other diseases and causes of mortality, from cancer to heart disease to diabetes. In a similar vein, it is important to note that ethnic minorities, including Mexican Americans and Native Americans, also have higher rates of these diseases and causes of mortality than whites.

Lisa Berkman (2009) notes that this gap started to narrow during the Civil Rights movement in the 1960s, but it began widening again in the early 1980s. What accounts for these perpetual disparities in health among different ethnic groups? Much of the answer lies in the level of healthcare that these groups receive. The National Healthcare Disparities Report (2010) shows that even after adjusting for insurance differences, racial and ethnic minority groups receive poorer quality of care and less access to care than dominant groups. The Report identified these racial inequalities in care:

  1. Black Americans, American Indians, and Alaskan Natives received inferior care than White Americans for about 40 percent of measures.
  2. Asian ethnicities received inferior care for about 20 percent of measures.
  3. Among whites, Hispanic whites received 60 percent inferior care of measures compared to non-Hispanic whites (Agency for Health Research and Quality 2010). When considering access to care, the figures were comparable.

Health by Socioeconomic Status

Discussions of health by race and ethnicity often overlap with discussions of health by socioeconomic status, since the two concepts are intertwined in the United States. As the Agency for Health Research and Quality (2010) notes, “racial and ethnic minorities are more likely than non-Hispanic whites to be poor or near poor,” so many of the data pertaining to subordinate groups is also likely to be pertinent to low socioeconomic groups. Marilyn Winkleby and her research associates (1992) state that “one of the strongest and most consistent predictors of a person’s morbidity and mortality experience is that person’s socioeconomic status (SES). This finding persists across all diseases with few exceptions, continues throughout the entire lifespan, and extends across numerous risk factors for disease.” Morbidity is the incidence of disease.

It is important to remember that economics are only part of the SES picture; research suggests that education also plays an important role. Phelan and Link (2003) note that many behavior-influenced diseases like lung cancer (from smoking), coronary artery disease (from poor eating and exercise habits), and AIDS initially were widespread across SES groups. However, once information linking habits to disease was disseminated, these diseases decreased in high SES groups and increased in low SES groups. This illustrates the important role of education initiatives regarding a given disease, as well as possible inequalities in how those initiatives effectively reach different SES groups.

Health by Gender

Women are affected adversely both by unequal access to and institutionalized sexism in the healthcare industry. According a recent report from the Kaiser Family Foundation, women experienced a decline in their ability to see needed specialists between 2001 and 2008. In 2008, one quarter of females questioned the quality of her healthcare (Ranji and Salganico 2011). In this report, we also see the explanatory value of intersection theory. Feminist sociologist Patricia Hill Collins developed this theory, which suggests we cannot separate the effects of race, class, gender, sexual orientation, and other attributes. Further examination of the lack of confidence in the healthcare system by women, as identified in the Kaiser study, found, for example, women categorized as low income were more likely (32 percent compared to 23 percent) to express concerns about healthcare quality, illustrating the multiple layers of disadvantage caused by race and sex.

We can see an example of institutionalized sexism in the way that women are more likely than men to be diagnosed with certain kinds of mental disorders. Psychologist Dana Becker notes that 75 percent of all diagnoses of Borderline Personality Disorder (BPD) are for women according to the Diagnostic Statistical Manual of Mental Disorders. This diagnosis is characterized by instability of identity, of mood, and of behavior, and Becker argues that it has been used as a catch-all diagnosis for too many women. She further decries the pejorative connotation of the diagnosis, saying that it predisposes many people, both within and outside of the profession of psychotherapy, against women who have been so diagnosed (Becker).

Many critics also point to the medicalization of women’s issues as an example of institutionalized sexism. Medicalization refers to the process by which previously normal aspects of life are redefined as deviant and needing medical attention to remedy. Historically and contemporaneously, many aspects of women’s lives have been medicalized, including menstruation, pre-menstrual syndrome, pregnancy, childbirth, and menopause. The medicalization of pregnancy and childbirth has been particularly contentious in recent decades, with many women opting against the medical process and choosing a more natural childbirth. Fox and Worts (1999) find that all women experience pain and anxiety during the birth process, but that social support relieves both as effectively as medical support. In other words, medical interventions are no more effective than social ones at helping with the difficulties of pain and childbirth. Fox and Worts further found that women with supportive partners ended up with less medical intervention and fewer cases of postpartum depression. Of course, access to quality birth care outside the standard medical models may not be readily available to women of all social classes.

SOCIOLOGY IN THE REAL WORLD

Medicalization of Sleeplessness

A child asleep at his desk is shown here.
Figure 19.5 Many people fail to get enough sleep. But is insomnia a disease that should be cured with medication? (Photo courtesy of Wikimedia Commons)

How is your “sleep hygiene?” Sleep hygiene refers to the lifestyle and sleep habits that contribute to sleeplessness. Bad habits that can lead to sleeplessness include inconsistent bedtimes, lack of exercise, late-night employment, napping during the day, and sleep environments that include noise, lights, or screen time (National Institutes of Health 2011a).

According to the National Institute of Health, examining sleep hygiene is the first step in trying to solve a problem with sleeplessness.

For many people in the United States, however, making changes in sleep hygiene does not seem to be enough. According to a 2006 report from the Institute of Medicine, sleeplessness is an underrecognized public health problem affecting up to 70 million people. It is interesting to note that in the months (or years) after this report was released, advertising by the pharmaceutical companies behind Ambien, Lunesta, and Sepracor (three sleep aids) averaged $188 million weekly promoting these drugs (Gellene 2009).

According to a study in the American Journal of Public Health (2011), prescriptions for sleep medications increased dramatically from 1993 to 2007. While complaints of sleeplessness during doctor’s office visits more than doubled during this time, insomnia diagnoses increased more than sevenfold, from about 840,000 to 6.1 million. The authors of the study conclude that sleeplessness has been medicalized as insomnia, and that “insomnia may be a public health concern, but potential overtreatment with marginally effective, expensive medications with nontrivial side effects raises definite population health concerns” (Moloney, Konrad, and Zimmer 2011). Indeed, a study published in 2004 in the Archives of Internal Medicine shows that cognitive behavioral therapy, not medication, was the most effective sleep intervention (Jacobs, Pace-Schott, Stickgold, and Otto 2004).

A century ago, people who couldn’t sleep were told to count sheep. Now they pop a pill, and all those pills add up to a very lucrative market for the pharmaceutical industry. Is this industry behind the medicalization of sleeplessness, or is it just responding to a need?

Mental Health and Disability

The treatment received by those defined as mentally ill or disabled varies greatly from country to country. In the post-millennial United States, those of us who have never experienced such a disadvantage take for granted the rights our society guarantees for each citizen. We do not think about the relatively recent nature of the protections, unless, of course, we know someone constantly inconvenienced by the lack of accommodations or misfortune of suddenly experiencing a temporary disability.

Mental Health

People with mental disorders (a condition that makes it more difficult to cope with everyday life) and people with mental illness (a severe, lasting mental disorder that requires long-term treatment) experience a wide range of effects.

According to the National Institute of Mental Health (NIMH), the most common mental disorders in the United States are anxiety disorders. Almost 18 percent of U.S. adults are likely to be affected in a single year, and 28 percent are likely to be affected over the course of a lifetime (National Institute of Mental Health 2005). It is important to distinguish between occasional feelings of anxiety and a true anxiety disorder. Anxiety is a normal reaction to stress that we all feel at some point, but anxiety disorders are feelings of worry and fearfulness that last for months at a time. Anxiety disorders include obsessive compulsive disorder (OCD), panic disorders, posttraumatic stress disorder (PTSD), and both social and specific phobias.

The second most common mental disorders in the United States are mood disorders; roughly 10 percent of U.S. adults are likely to be affected yearly, while 21 percent are likely to be affected over the course of a lifetime (National Institute of Mental Health 2005). Major mood disorders are depression, bipolar disorder, and dysthymic disorder. Like anxiety, depression might seem like something that everyone experiences at some point, and it is true that most people feel sad or “blue” at times in their lives. A true depressive episode, however, is more than just feeling sad for a short period. It is a long-term, debilitating illness that usually needs treatment to cure. And bipolar disorder is characterized by dramatic shifts in energy and mood, often affecting the individual’s ability to carry out day-to-day tasks. Bipolar disorder used to be called manic depression because of the way people would swing between manic and depressive episodes.

Depending on what definition is used, there is some overlap between mood disorders and personality disorders, which affect 9 percent of people in the United States yearly. The American Psychological Association publishes the Diagnostic and Statistical Manual on Mental Disorders (DSM), and their definition of personality disorders is changing in the fifth edition, which is being revised in 2011 and 2012. After a multilevel review of proposed revisions, the American Psychiatric Association Board of Trustees ultimately decided to retain the DSM-IV categorical approach with the same ten personality disorders (paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, antisocial personality disorder, borderline personality disorder, histrionic personality, narcissistic personality disorder, avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder. In the DSM-IV, personality disorders represent “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it” (National Institute of Mental Health). In other words, personality disorders cause people to behave in ways that are seen as abnormal to society but seem normal to them. The DSM-5 proposes broadening this definition by offering five broad personality trait domains to describe personality disorders, some related to the level or type of their disconnect with society. As their application evolves, we will see how their definitions help scholars across disciplines understand the intersection of health issues and how they are defined by social institutions and cultural norms.

White pills next to a pill bottle are shown here.
Figure 19.6 Medication is a common option for children with ADHD. (Photo courtesy of Deviation56/Wikimedia Commons)

Another fairly commonly diagnosed mental disorder is Attention-Deficit/Hyperactivity Disorder (ADHD), which statistics suggest affects 9 percent of children and 8 percent of adults on a lifetime basis (National Institute of Mental Health 2005). ADHD is one of the most common childhood disorders, and it is marked by difficulty paying attention, difficulty controlling behavior, and hyperactivity. According to the American Psychological Association (APA), ADHD responds positively to stimulant drugs like Ritalin, which helps people stay focused. However, there is some social debate over whether such drugs are being overprescribed (American Psychological Association). In fact, some critics question whether this disorder is really as widespread as it seems, or if it is a case of over diagnosis. According to the Centers for Disease Control and Prevention, only 5 percent of children have ADHD. However approximately 11 percent of children ages four through seventeen have been diagnosed with ADHD as of 2011.

Autism Spectrum Disorders (ASD) have gained a lot of attention in recent years. The term ASD encompasses a group of developmental brain disorders that are characterized by “deficits in social interaction, verbal and nonverbal communication, and engagement in repetitive behaviors or interests” (National Institute of Mental Health). As with the personality disorders described above, the Diagnostic and Statistical Manual on Mental Disorders’ description of these is in the process of being revised.

The National Institute of Mental Health (NIMH) distinguishes between serious mental illness and other disorders. The key feature of serious mental illness is that it results in “serious functional impairment, which substantially interferes with or limits one or more major life activities” (National Institute of Mental Health). Thus, the characterization of “serious” refers to the effect of the illness (functional impairment), not the illness itself.

Disability

A blue handicapped accessible sign is shown here.
Figure 19.7 The handicapped accessible sign indicates that people with disabilities can access the facility. The Americans with Disabilities Act requires that access be provided to everyone. (Photo courtesy of Ltljltlj/Wikimedia Commons)

Disability refers to a reduction in one’s ability to perform everyday tasks. The World Health Organization makes a distinction between the various terms used to describe handicaps that’s important to the sociological perspective. They use the term impairment to describe the physical limitations, while reserving the term disability to refer to the social limitation.

Before the passage of the Americans with Disabilities Act (ADA) in 1990, people in the United States with disabilities were often excluded from opportunities and social institutions many of us take for granted. This occurred not only through employment and other kinds of discrimination but also through casual acceptance by most people in the United States of a world designed for the convenience of the able-bodied. Imagine being in a wheelchair and trying to use a sidewalk without the benefit of wheelchair-accessible curbs. Imagine as a blind person trying to access information without the widespread availability of Braille. Imagine having limited motor control and being faced with a difficult-to-grasp round door handle. Issues like these are what the ADA tries to address. Ramps on sidewalks, Braille instructions, and more accessible door levers are all accommodations to help people with disabilities.

People with disabilities can be stigmatized by their illnesses. Stigmatization means their identity is spoiled; they are labeled as different, discriminated against, and sometimes even shunned. They are labeled (as an interactionist might point out) and ascribed a master status (as a functionalist might note), becoming “the blind girl” or “the boy in the wheelchair” instead of someone afforded a full identity by society. This can be especially true for people who are disabled due to mental illness or disorders.

As discussed in the section on mental health, many mental health disorders can be debilitating and can affect a person’s ability to cope with everyday life. This can affect social status, housing, and especially employment. According to the Bureau of Labor Statistics (2011), people with a disability had a higher rate of unemployment than people without a disability in 2010: 14.8 percent to 9.4 percent. This unemployment rate refers only to people actively looking for a job. In fact, eight out of ten people with a disability are considered “out of the labor force;” that is, they do not have jobs and are not looking for them. The combination of this population and the high unemployment rate leads to an employment-population ratio of 18.6 percent among those with disabilities. The employment-population ratio for people without disabilities was much higher, at 63.5 percent (U.S. Bureau of Labor Statistics 2011).

SOCIOLOGY IN THE REAL WORLD

Obesity: The Last Acceptable Prejudice

A large man is shown here sitting on a beach with a young girl.
Figure 19.8 Obesity is considered the last acceptable social stigma. (Photo courtesy of Kyle May/flickr)

What is your reaction to the picture above? Compassion? Fear? Disgust? Many people will look at this picture and make negative assumptions about the man based on his weight. According to a study from the Yale Rudd Center for Food Policy and Obesity, large people are the object of “widespread negative stereotypes that overweight and obese persons are lazy, unmotivated, lacking in self-discipline, less competent, noncompliant, and sloppy” (Puhl and Heuer 2009).

Historically, both in the United States and elsewhere, it was considered acceptable to discriminate against people based on prejudiced opinions. Even after slavery was abolished in 1865, the next 100 years of U.S. history saw institutionalized racism and prejudice against black people. In an example of stereotype interchangeability, the same insults that are flung today at the overweight and obese population (lazy, for instance), have been flung at various racial and ethnic groups in earlier history. Of course, no one gives voice to these kinds of views in public now, except when talking about obese people.

Why is it considered acceptable to feel prejudice toward—even to hate—obese people? Puhl and Heuer suggest that these feelings stem from the perception that obesity is preventable through self-control, better diet, and more exercise. Highlighting this contention is the fact that studies have shown that people’s perceptions of obesity are more positive when they think the obesity was caused by non-controllable factors like biology (a thyroid condition, for instance) or genetics.

Even with some understanding of non-controllable factors that might affect obesity, obese people are still subject to stigmatization. Puhl and Heuer’s study is one of many that document discrimination at work, in the media, and even in the medical profession. Obese people are less likely to get into college than thinner people, and they are less likely to succeed at work.

Stigmatization of obese people comes in many forms, from the seemingly benign to the potentially illegal. In movies and television show, overweight people are often portrayed negatively, or as stock characters who are the butt of jokes. One study found that in children’s movies “obesity was equated with negative traits (evil, unattractive, unfriendly, cruel) in 64 percent of the most popular children’s videos. In 72 percent of the videos, characters with thin bodies had desirable traits, such as kindness or happiness” (Hines and Thompson 2007). In movies and television for adults, the negative portrayal is often meant to be funny. “Fat suits”—inflatable suits that make people look obese—are commonly used in a way that perpetuates negative stereotypes. Think about the way you have seen obese people portrayed in movies and on television; now think of any other subordinate group being openly denigrated in such a way. It is difficult to find a parallel example.

 

 

KEY TERMS

 

anxiety disorders
feelings of worry and fearfulness that last for months at a time
commodification
the changing of something not generally thought of as a commodity into something that can be bought and sold in a marketplace
contested illnesses
illnesses that are questioned or considered questionable by some medical professionals
demedicalization
the social process that normalizes “sick” behavior
disability
a reduction in one’s ability to perform everyday tasks; the World Health Organization notes that this is a social limitation
epidemiology
the study of the incidence, distribution, and possible control of diseases
impairment
the physical limitations a less-able person faces
individual mandate
a government rule that requires everyone to have insurance coverage or they will have to pay a penalty
legitimation
the act of a physician certifying that an illness is genuine
medical sociology
the systematic study of how humans manage issues of health and illness, disease and disorders, and healthcare for both the sick and the healthy
medicalization
the process by which aspects of life that were considered bad or deviant are redefined as sickness and needing medical attention to remedy
medicalization of deviance
the process that changes “bad” behavior into “sick” behavior
mood disorders
long-term, debilitating illnesses like depression and bipolar disorder
morbidity
the incidence of disease
mortality
the number of deaths in a given time or place
personality disorders
disorders that cause people to behave in ways that are seen as abnormal to society but seem normal to them
private healthcare
health insurance that a person buys from a private company; private healthcare can either be employer-sponsored or direct-purchase
public healthcare
health insurance that is funded or provided by the government
sick role
the pattern of expectations that define appropriate behavior for the sick and for those who take care of them
social epidemiology
the study of the causes and distribution of diseases
socialized medicine
when the government owns and runs the entire healthcare system
stereotype interchangeability
stereotypes that don’t change and that get recycled for application to a new subordinate group
stigmatization
the act of spoiling someone’s identity; they are labeled as different, discriminated against, and sometimes even shunned due to an illness or disability
stigmatization of illness
illnesses that are discriminated against and whose sufferers are looked down upon or even shunned by society
underinsured
people who spend at least 10 percent of their income on healthcare costs that are not covered by insurance
universal healthcare
a system that guarantees healthcare coverage for everyone

 

SECTION SUMMARY

 

19.1 The Social Construction of Health

Medical sociology is the systematic study of how humans manage issues of health and illness, disease and disorders, and healthcare for both the sick and the healthy. The social construction of health explains how society shapes and is shaped by medical ideas.

19.2 Global Health

Social epidemiology is the study of the causes and distribution of diseases. From a global perspective, the health issues of high-income nations tend toward diseases like cancer as well as those that are linked to obesity, like heart disease, diabetes, and musculoskeletal disorders. Low-income nations are more likely to contend with infectious disease, high infant mortality rates, scarce medical personnel, and inadequate water and sanitation systems.

19.3 Health in the United States

Although people in the United States are generally in good health compared to less developed countries, the United States is still facing challenging issues such as a prevalence of obesity and diabetes. Moreover, people in the United States of historically disadvantaged racial groups, ethnicities, socioeconomic status, and gender experience lower levels of healthcare. Mental health and disability are health issues that are significantly impacted by social norms.

19.4 Comparative Health and Medicine

There are broad, structural differences among the healthcare systems of different countries. In core nations, those differences include publicly funded healthcare, privately funded healthcare, and combinations of both. In peripheral and semi-peripheral countries, a lack of basic healthcare administration can be the defining feature of the system.

19.5 Theoretical Perspectives on Health and Medicine

While the functionalist perspective looks at how health and illness fit into a fully functioning society, the conflict perspective is concerned with how health and illness fit into the oppositional forces in society. The interactionist perspective is concerned with how social interactions construct ideas of health and illness.

 

 

19.1 The Social Construction of Health

1. 

Who determines which illnesses are stigmatized?

  1. Therapists
  2. The patients themselves
  3. Society
  4. All of the above

2. 

Chronic fatigue syndrome is an example of _______________.

  1. a stigmatized disease
  2. a contested illness
  3. a disability
  4. demedicalization

3. 

The Rating of Perceived Exertion (RPE) is an example of ________________

  1. the social construction of health
  2. medicalization
  3. disability accommodations
  4. a contested illness

19.2 Global Health

4. 

What is social epidemiology?

  1. The study of why some diseases are stigmatized and others are not
  2. The study of why diseases spread
  3. The study of the mental health of a society
  4. The study of the causes and distribution of diseases

5. 

Core nations are also known as __________________

  1. high-income nations
  2. newly industrialized nations
  3. low-income nations
  4. developing nations

6. 

Many deaths in high-income nations are linked to __________________

  1. lung cancer
  2. obesity
  3. mental illness
  4. lack of clean water

7. 

According to the World Health Organization, what was the most frequent cause of death for children under five in low-income countries?

  1. Starvation
  2. Thirst
  3. Pneumonia and diarrheal diseases
  4. All of the above

19.3 Health in the United States

8. 

Which of the following statements is not true?

  1. The life expectancy of black males in the United States is approximately five years shorter than for white males.
  2. The infant mortality rate for blacks in the United States is almost double than it is for white.
  3. Blacks have lower cancer rates than whites.
  4. Hispanics have worse access to care than non-Hispanic whites.

9. 

The process by which aspects of life that were considered bad or deviant are redefined as sickness and needing medical attention to remedy is called:

  1. deviance
  2. medicalization
  3. demedicalization
  4. intersection theory

10. 

What are the most commonly diagnosed mental disorders in the United States?

  1. ADHD
  2. Mood disorders
  3. Autism spectrum disorders
  4. Anxiety disorders

11. 

Sidewalk ramps and Braille signs are examples of _______________.

  1. disabilities
  2. accommodations required by the Americans with Disabilities Act
  3. forms of accessibility for people with disabilities
  4. both b and c

12. 

The high unemployment rate among the disabled may be a result of ____________.

  1. medicalization
  2. obesity
  3. stigmatization
  4. all of the above

19.4 Comparative Health and Medicine

13. 

Which public healthcare system offers insurance primarily to people over sixty-five years old?

  1. Medicaid
  2. Medicare
  3. Veterans Health Administration
  4. All of the above

14. 

Which program is an example of socialized medicine?

  1. Canada’s system
  2. The United States’ Veterans Health Administration
  3. The United States’ new system under the Patient Protection and Affordable Care Act
  4. Medicaid

15. 

What does the individual mandate provision of the 2010 U.S. healthcare reform do?

  1. Requires everyone to buy insurance from the government
  2. Requires everyone to sign up for Medicaid
  3. Requires everyone to have insurance or pay a penalty
  4. None of the above

16. 

Great Britain’s healthcare system is an example of ______________

  1. socialized medicine
  2. private healthcare
  3. single-payer private healthcare
  4. universal private healthcare

17. 

What group created the Millennium Development Goals?

  1. UNICEF
  2. The Kaiser Family Foundation
  3. Doctors Without Borders
  4. The World Health Organization

19.5 Theoretical Perspectives on Health and Medicine

18. 

Which of the following is not part of the rights and responsibilities of a sick person under the functionalist perspective?

  1. The sick person is not responsible for his condition.
  2. The sick person must try to get better.
  3. The sick person can take as long as she wants to get better.
  4. The sick person is exempt from the normal duties of society.

19. 

The class, race, and gender inequalities in our healthcare system support the _____________ perspective.

  1. conflict
  2. interactionist
  3. functionalist
  4. all of the above

20. 

The removal of homosexuality from the DSM is an example of ____________.

  1. medicalization
  2. deviance
  3. interactionist theory
  4. demedicalization

 

FURTHER RESEARCH

 

19.1 The Social Construction of Health

Spend some time on the two web sites below. How do they present differing views of the vaccination controversy? Freedom of Choice is Not Free: Vaccination News: http://openstax.org/l/vaccination_news and Shot by Shot: Stories of Vaccine-Preventable Illnesses: http://openstax.org/l/shot_by_shot

19.2 Global Health

Study this map on global life expectancies: http://openstax.org/l/global_life_expectancies. What trends do you notice?

19.3 Health in the United States

Is ADHD a valid diagnosis and disease? Some think it is not. This article discusses this history of the issue: http://openstax.org/l/ADHD_controversy

19.4 Comparative Health and Medicine

Project Mosquito Net says that mosquito nets sprayed with insecticide can reduce childhood malaria deaths by half. Read more at http://openstax.org/l/project_mosquito_net

19.5 Theoretical Perspectives on Health and Medicine

Should alcoholism and other addictions be medicalized? Read and watch a dissenting view: http://openstax.org/l/addiction_medicalization

 

REFERENCES

 

Introduction to Health and Medicine

ABC News Health News. “Ebola in America, Timeline of a Deadly Virus.” Retrieved Oct. 23rd, 2014 (http://abcnews.go.com/Health/ebola-america-timeline/story?id=26159719).

Centers for Disease Control. 2011b.“Pertussis.” The Centers for Disease Control and Prevention. Retrieved December 15, 2011 (http://www.cdc.gov/pertussis/outbreaks.html).

Conrad, Peter, and Kristin Barker. 2010. “The Social Construction of Illness: Key Insights and Policy Implications.” Journal of Health and Social Behavior 51:67–79.

CNN. 2011. “Retracted Autism Study an ‘Elaborate Fraud,’ British Journal Finds.” CNN, January 5. Retrieved December 16, 2011 (http://www.cnn.com/2011/HEALTH/01/05/autism.vaccines/index.html).

Devlin, Kate. 2008. “Measles worry MMR as vaccination rates stall.” The Telegraph, September 24. Retrieved January 19, 2012 (http://www.telegraph.co.uk/news/uknews/3074023/Measles-worries-as-MMR-vaccination-rates-stall.html).

Sugerman, David E., Albert E. Barskey, Maryann G. Delea, Ismael R. Ortega-Sanchez, Daoling Bi, Kimberly J. Ralston, Paul A. Rota, Karen Waters-Montijo, and Charles W. LeBaron. 2010. “Measles Outbreak in a Highly Vaccinated Population, San Diego, 2008: Role of the Intentionally Undervaccinated.” Pediatrics 125(4):747–755. Retrieved December 16, 2011 (http://www.pediatricsdigest.mobi/content/125/4/747.full).

World Health Organization. 2014. “Global Alert and Response.” Retrieved Oct. 23rd 2014 (http://www.who.int/csr/disease/ebola/en/).

Zacharyczuk, Colleen. 2011. “Myriad causes contributed to California pertussis outbreak.” Thorofar, NJ: Pediatric Supersite. Retrieved December 16, 2011 (http://www.pediatricsupersite.com/view.aspx?rid=90516).

19.1 The Social Construction of Health

Begos, Kevin. 2011. “Pinkwashing For Breast Cancer Awareness Questioned.” Retrieved December 16, 2011 (http://www.huffingtonpost.com/2011/10/11/breast-cancer-pink-pinkwashing_n_1005906.html).

Centers for Disease Control. 2011a. “Perceived Exertion (Borg Rating of Perceived Exertion Scale).” Centers for Disease Control and Prevention. Retrieved December 12, 2011 (http://www.cdc.gov/physicalactivity/everyone/measuring/exertion.html).

Conrad, Peter, and Kristin Barker. 2010. “The Social Construction of Illness: Key Insights and Policy Implications.” Journal of Health and Social Behavior 51:67–79.

Goffman, Erving. 1963. Stigma: Notes on the Management of Spoiled Identity. London: Penguin.

Hutchison, Courtney. 2010. “Fried Chicken for the Cure?” ABC News Medical Unit. Retrieved December 16, 2011 (http://abcnews.go.com/Health/Wellness/kfc-fights-breast-cancer-fried-chicken/story?id=10458830#.Tutz63ryT4s).

Sartorius, Norman. 2007. “Stigmatized Illness and Health Care.” The Croatian Medical Journal 48(3):396–397. Retrieved December 12, 2011 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080544/).

Think Before You Pink. 2012. “Before You Buy Pink.” Retrieved December 16, 2011 (http://thinkbeforeyoupink.org/?page_id=13).

“Vaccines and Immunizations.” 2011. The Centers for Disease Control and Prevention. Retrieved December 16, 2011 (http://www.cdc.gov/vaccines/default.htm).

World Health Organization. .n.d. “Definition of Health.” Retrieved December 12, 2011 (http://www.who.int/about/definition/en/print.html).

World Health Organization: “Health Promotion Glossary Update.” Retrieved December 12, 2011 (http://www.who.int/healthpromotion/about/HPR%20Glossary_New%20Terms.pdf).

19.2 Global Health

Bromet et al. 2011. “Cross-National Epidemiology of DSM-IV Major Depressive Episode.” BMC Medicine 9:90. Retrieved December 12, 2011 (http://www.biomedcentral.com/1741-7015/9/90).

Huffman, Wallace E., Sonya Kostova Huffman, AbebayehuTegene, and KyrreRickertsen. 2006. “The Economics of Obesity-Related Mortality among High Income Countries” International Association of Agricultural Economists. Retrieved December 12, 2011 (http://purl.umn.edu/25567).

Organization for Economic Cooperation and Development. 2011. Health at a Glance 2011: OECD Indicators. OECD Publishing. Retrieved December 12, 2011 (http://dx.doi.org/10.1787/health_glance-2011-en).

UNICEF. 2011. “Water, Sanitation and Hygiene.” Retrieved December 12, 2011 (http://www.unicef.org/wash).

World Health Organization. 2011. “World Health Statistics 2011.” Retrieved December 12, 2011 (http://www.who.int/gho/publications/world_health_statistics/EN_WHS2011_Part1.pdf).

19.3 Health in the United States

Agency for Health Research and Quality. 2010. “Disparities in Healthcare Quality Among Racial and Ethnic Minority Groups.” Agency for Health Research and Quality. Retrieved December 13, 2011 (http://www.ahrq.gov/qual/nhqrdr10/nhqrdrminority10.htm)

American Psychological Association. 2011a. “A 09 Autism Spectrum Disorder.” American Psychiatric Association DSM-5 Development. Retrieved December 14, 2011.

American Psychological Association. 2011b. “Personality Traits.” American Psychiatric Association DSM-5 Development. Retrieved December 14, 2011.

American Psychological Association. n.d. “Understanding the Ritalin Debate.” American Psychological Association. Retrieved December 14, 2011 (http://www.apa.org/topics/adhd/ritalin-debate.aspx)

Becker, Dana. n.d. “Borderline Personality Disorder: The Disparagement of Women through Diagnosis.” Retrieved December 13, 2011 (http://www.awpsych.org/index.php?option=com_content&view=article&id=109&catid=74&Itemid=126).

Berkman, Lisa F. 2009. “Social Epidemiology: Social Determinants of Health in the United States: Are We Losing Ground?” Annual Review of Public Health 30:27–40.

Blumenthal, David, and Sarah R. Collins. 2014 “Health Care Coverage under the Affordable Care Act—a Progress Report.” New England Journal of Medicine 371 (3): 275–81. Retrieved December 16, 2014 (https://owl.english.purdue.edu/owl/resource/717/04/).

Fox, B., and D. Worts. 1999. “Revisiting the Critique of Medicalized Childbirth: A Contribution to the Sociology of Birth.” Gender and Society 13(3):326–346.

Gellene, Denise. 2009. “Sleeping Pill Use Grows as Economy Keeps People up at Night.” Retrieved December 16, 2011 (http://articles.latimes.com/2009/mar/30/health/he-sleep30).

Hines, Susan M., and Kevin J. Thompson. 2007. “Fat Stigmatization in Television Shows and Movies: A Content Analysis.” Obesity 15:712–718. Retrieved December 15, 2011 (http://onlinelibrary.wiley.com/doi/10.1038/oby.2007.635/full).

Institute of Medicine. 2006. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington DC: National Academies Press.

Jacobs, Gregg D., Edward F. Pace-Schott, Robert Stickgold, and Michael W. Otto. 2004. “Cognitive Behavior Therapy and Pharmacotherapy for Insomnia: A Randomized Controlled Trial and Direct Comparison.” Archives of Internal Medicine 164(17):1888–1896. Retrieved December 16, 2011 (http://archinte.jamanetwork.com/article.aspx?articleid=217394).

James, Cara et al. 2007. “Key Facts: Race, Ethnicity & Medical Care.” The Henry J. Kaiser Family Foundation. Retrieved December 13, 2011 (http://www.kff.org/minorityhealth/upload/6069-02.pdf).

Moloney, Mairead Eastin, Thomas R. Konrad, and Catherine R. Zimmer. 2011. “The Medicalization of Sleeplessness: A Public Health Concern.” American Journal of Public Health101:1429–1433.

National Institute of Mental Health. 2005. “National Institute of Mental Health Statistics.” Retrieved December 14, 2011 (http://www.nimh.nih.gov/statistics/index.shtml).

National Institutes of Health. 2011a. “Insomnia.” The National Institute of Health. Retrieved December 16, 2011 (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001808/).

National Institutes of Health. 2011b. “What is Autism Spectrum Disorder (ASD)?” National Institute of Mental Health. Retrieved December 14, 2011 (http://www.nimh.nih.gov/health/publications/a-parents-guide-to-autism-spectrum-disorder/what-is-autism-spectrum-disorder-asd.shtml).

Phelan, Jo C., and Bruce G. Link. 2001. “Conceptualizing Stigma” Annual Review of Sociology 27:363–85. Retrieved December 13, 2011 (http://www.heart-intl.net/HEART/Legal/Comp/ConceptualizingStigma.pdf).

Phelan, Jo C., and Bruce G. Link. 2003. “When Income Affects Outcome: Socioeconomic Status and Health.” Research in Profile:6. Retrieved December 13, 2011 (http://www.investigatorawards.org/downloads/research_in_profiles_iss06_feb2003.pdf).

Puhl, Rebecca M., and Chelsea A. Heuer. 2009. “The Stigma of Obesity: A Review and Update.” Nature Publishing Group. Retrieved December 15, 2011 (http://www.yaleruddcenter.org/resources/upload/docs/what/bias/WeightBiasStudy.pdf).

Ranji, Usha, and Alina Salganico. 2011. “Women’s Health Care Chartbook: Key Findings from the Kaiser Women’s Health Survey.” The Henry J. Kaiser Family Foundation. Retrieved December 13, 2011 (http://www.kff.org/womenshealth/upload/8164.pdf).

Scheff, Thomas. 1963. Being Mentally Ill: A Sociological Theory. Chicago, IL: Aldine.

Szasz, Thomas. 1961. The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. New York, NY: Harper Collins.

U.S. Census Bureau. 2011. “Statistical Abstract of the United States: 2012.” 131st ed. Washington, DC. Retrieved December 13, 2011 (http://www.census.gov/compendia/statab).

U.S. Bureau of Labor Statistics. 2011. “Persons with a Disability: Labor Force Characteristics News Release.” Bureau of Labor Statistics. Retrieved December 14, 2011 (http://www.bls.gov/news.release/disabl.htm).

Winkleby, Marilyn A., D. E. Jatulis, E. Frank, and S. P. Fortmann. 1992. “Socioeconomic Status and Health: How Education, Income, and Occupation Contribute to Risk Factors for Cardiovascular Disease.” American Journal of Public Health 82:6.

19.4 Comparative Health and Medicine

Anders, George. 1996. Health Against Wealth: HMOs and the Breakdown of Medical Trust. Boston: Houghton Mifflin.

Centers for Disease Control and Prevention. 2014 “Attention Deficit/Hyperactivity Disorder (ADHD) Data and Statistics.” Retrieved October 13, 2014 (http://www.cdc.gov/ncbddd/adhd/data.html)

Docteur, Elizabeth, and Robert A. Berenson. 2009. “How Does the Quality of U.S. Health Care Compare Internationally?” Timely Analysis of Immediate Health Policy Issues 9:1–14.

Kaiser Family Foundation. 2011. “Health Coverage of Children: The Role of Medicaid and CHIP.” Retrieved December 13, 2011 (http://www.kff.org/uninsured/upload/7698-05.pdf).

Kaiser Family Foundation. 2010. “International Health Systems: Canada.” Retrieved December 14, 2011 (http://www.kaiseredu.org/Issue-Modules/International-Health-Systems/Canada.aspx).

Klein, Ezra. 2009. “Health Reform for Beginners: The Difference between Socialized Medicine, Single-Payer Health Care, and What We’ll Be Getting.” The Washington Post, December 14. Retrieved December 15, 2011 ( http://www.bloomberg.com/news/2011-12-15/don-t-let-death-panels-kill-a-better-way-to-die-commentary-by-ezra-klein.html).

Kogan, Richard. 2011. “Program Cuts Under a Balanced Budget Amendment: How Severe Might They Be?” Center on Budget and Policy Priorities. Retrieved December 15, 2011 (http://www.cbpp.org/cms/?fa=view&id=3619).

Pear, Robert. 2011. “In Cuts to Health Programs, Experts See Difficult Task in Protecting Patients.” The New York Times, September 20. Retrieved December 13, 2011 (http://www.nytimes.com/2011/09/21/us/politics/wielding-the-ax-on-medicaid-and-medicare-without-wounding-the-patient.html).

Schoen, C., M.M. Doty, R.H. Robertson, and S.R. Collins. 2011. “Affordable Care Act Reforms Could Reduce the Number of Underinsured U.S. Adults by 70 Percent.” Health Affairs 30(9):1762–71. Retrieved December 13, 2011 (http://www.commonwealthfund.org/Publications/In-the-Literature/2011/Sep/Reduce-Uninsured.aspx).

Uchiyma, T., M. Kurosawa, Y. Inaba. 2007. “MMR-Vaccine and Regression in Autism Spectrum Disorders: Negative Results Presented from Japan.” Journal of Autism and Deviant Disorders 37(2):210–7.

U.S. Census. 2011. “Coverage by Type of Health Insurance: 2009 and 2010.” U.S. Census Bureau, Current Population Survey, 2010 and 2011 Annual Social and Economic Supplements. Retrieved December 13, 2011 (http://www.census.gov/hhes/www/hlthins/data/incpovhlth/2010/table10.pdf).

U.S. Census. 2011. “CPS Health Insurance Definitions.” Retrieved December 13, 2011 (http://www.census.gov/hhes/www/hlthins/methodology/definitions/cps.html).

Washington University Center for Health Policy. n.d. “Health Care Access for Medicaid Patients—Physicians and Dentists Interview Study.” Retrieved December 15, 2011 (http://healthpolicy.wustl.edu/Content/HealthCareAccess.html?OpenDocument).

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World Health Organization. 2014. “Ebola Virus Disease Fact Sheet, Updated September 2014.” Retrieved October 19, 2014 (http://www.who.int/mediacentre/factsheets/fs103/en/).

19.5 Theoretical Perspectives on Health and Medicine

Conrad, Peter, and Joseph W. Schneider. 1992. Deviance and Medicalization: From Badness to Sickness. Philadelphia, PA: Temple University Press

Parsons, Talcott. 1951. The Social System. Glencoe, IL: Free Press.

Scheff, Thomas. 1963. “The Role of the Mentally Ill and the Dynamics of Mental Disorder.” Sociometry 26:436–453.

 

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