MEDICAL CARE
Physical and Mental Illness
Medicine as a Social Problem
• Not just biology
Social component
How do we define illness?
• Industrialization and lifestyle
Diseases of Affluence
• Iatrogenesis
Illness caused by medical care staff
If the number of Americans killed by medical errors
became an official classification of death, it would rank as number 6
in the top 10 leading causes of death
Medicine as a Social Problem
• Changing ideas about health and illness
Pregnancy
Definitions of “diseases”
• Environment and disease on a global level
How does environment affects human disease?
Human activities reshape environment and effect on
the diseases
Medicine as a Social Problem
• An explosion in medical costs
• Reasons for the explosion in costs
• Increase in the standard of living
• People living longer
• Development of expensive technology
• Treating Illness vs. Preventative Care
• Acceptance of medical care as a for profit commodity
Medicine for Profit
Medicine for profit = fee-for-service
• Two-tier system of medical care
• those who can afford insurance
• those who cannot
Medicine for Profit
Cesarean Delivery
• Why have cesarean births increased?
• Profit
• Convenience
• Technology
• A Feminist Controversy
• Central issue -- relative power of women
• Cedes woman’s power to doctor
• Can empower women
Physical Illness
Infant Mortality Rate (IMR)
Number of babies who die before 1 year of age, per 1,000 live births
Most accurate measures of a group’s health conditions
Japan 2.8
France 3.3
Germany 4.0
Spain 4.2
South Korea 4.3
Holland 4.7
Australia 4.8
Great Britain 4.9
Canada 5.0
Taiwan 5.4
Italy 5.5
United States 6.7
0.0 2.0 4.0 6.0 8.0
Physical Illness
Lower poverty is associated with better health
Lifestyle
may be more significant than poverty
the major cause of illness and death in high income countries
Heroic medicine
creates a need for specialists in the pursuit of profit
specialization has led to a shortage of primary care doctors
Mental Illness
Measuring mental illness
Experts argue that the rates of mental illness have increased
because people are experiencing more stress while their social
support systems are weaker
What are other possible reasons for the increase of mental
illness?
Data are inadequate because experts rarely agree on
definitions and classifications of mental illness
Mental Illness
The social nature of mental illness
How we define mental illness is a matter of dispute
Has a strong social influence
Mental health delivery
Made up of two parts
illness
medical delivery system
Mental Illness
Deinstitutionalization
• The release of hospitalized mental patients into the
community
• Plan was to support them with medication and community
health services
• In reality, few of the planned community centers were ever
built.
Symbolic Interactionism
• Meaning of symptoms and behavior
People from different backgrounds interpret symptoms differently
Use cultural symbols to determine what our symptoms mean
• The significance of definitions
Groups compete to get their view of health accepted
Conversion therapy
Definitions are socially created, developing out of social interaction
• Problems in communication
Different backgrounds and expectations often make it difficult for patients and
physicians to communicate with one another.
Functionalism
• Does society benefit?
Functionalists assume that customs or social institutions persist only if they
fulfill social needs.
• Whose needs are met by a health care system that is hospital-based and
oriented toward acute illnesses?
• Who benefits from allowing environmental diseases to flourish?
• What are the benefits of depersonalizing patients or of making childbirth
a rigorous medical procedure?
Functionalism
• Fee-for-service means profits
Difficult for doctors to make money if people are not sick.
That the system is functional for patients is indicated by rising
life expectancy and decreasing infant mortality rates.
Conflict
• Illness and health care
• clashes between interest groups
• controlled by the most powerful
• Poor are more often sick due to lack of
• sufficient income
• high-quality education
• Food
• Housing
• Jobs
• medical services
Conflict
• Medicaid
Viewing Medicaid as a first step to socialized medicine, the AMA fought
against its passage.
Congress designed Medicaid to satisfy the public’s criticism while still
providing profit for doctors.
• Colliding interests of doctors and patients
Two sorts of classes
Those who control medicine
those who receive treatment
In a capitalist system of production for profit, alienation of patient and
physician is like that of owner and worker.