Chapter 19: Health, Illness and the Health Care System

EPIDEMIOLOGY is the study of PATTERNS  OF ILLNESS in a society, but at 
root, "Disease" is a social construct.  Tonig ht, just an
  a) How we define it (physical, but not all; Alcoholism; etc)
  b) How we treat it
  c) How we respond to it

SO: Sociologists examine the SOCIAL BASES of all this

Some things to look at:

  1. What counts as disease/epidemics, etc?  (biological (germs);
     mental health (stress, etc); Job-related (accidents)

  2. Why are some qualities  considered "sick" and not others?
     (eg, "incorrrect thinking," inattention or partying;
     extremist  social thinking).

  3. How does disease affect the US?
      -- Social costs (some cost more than others, eg AIDS, etc)
      -- Social impact (leading cause of death:  1989: Heart disease, 
         Cancer, stroke and related disorders, accidents,  
          pneumonia/influenza).   
      -- In 1990: Pneumonia/influence;  tuberculosis;
         gastrocenteritis; heart disease; strokes

   4. Whose disease get attention?  Historically, primarily white
      males.  Others (gays, blacks, women) were secondary.  
      Partly sexism,  partly visibility and overt impact.   Stuff like 
      cycle-cell anemia,  health problems of the poor,  etc,  we're 
      understressed (mention H. Jack Geiger--food as "prescription")

    5. How we're organized to treat disease: What works?

       a) centralized health care (hospitals, etc) vs. decentralized care
       b) "Professionalization" vs. lay
       c) Reactive vs. proactive
       d) How we direct social resources toward it
       e) Political issues (eg, AIDS)

    6. The PHILOSOPHY of health care--is it a right or a
        privilege?

    7. THE CULTURE BOUND SYNDROME: this refers to disease or illness
       that cannot be understood apart from its specific social context.
       (eg, anorexia; bulemia)

World Wide, life expectancy is tied to class (income, etc):

                     LOW INCOME   MIDDLE   HIGH

Life expectancy        63(56)       67      77
(all and (low))

Malnutrition           30.8         15.5       under 5
per 1,000 (under 5)

---------------------

In the US, leading  cause of death is:
(other than natural causes):

--Heart, cancer (a close second). 
--Suicide and motor vehicle crashes about the same (22 v 19.7 per hun thou)
--AIDS about the same has  suicide, etc. Declining, but cases reported not
--Homicide is about 9 (blacks 8 times more likely)
--From all causes, black mortality rate is about twice that of whites

RACE/ETHNICITY/GENDER

Some points to ponder:
  --Some diseases (eg, sickle cell anemia) has a clear genetic basis.
But, most is environmental and social. Blacks, for example, have
much higher death/mortality rates from disease (and violence) than 
whites, especially heart, pneumonia, diabets and cancer.

--Race tends to shape disproportionate life-saving procedures used in
crises, which may contribute to Blacks's higher mortality rate from
heart attacks, kidney disease, and strokes.

--Women, in comparison with men, may live longer, but they experience
higher rates of many diseases.

--The elderly have far more chronic diseases

INSURANCE 

--Do we need health care/Universal coverage?

Who are the uninsured?
Children (under 15 = 16.1 pct)
Minorities (Hispanic's, 32.9, black 21.1)
Poor (2/3s under $24,000 and 1/3 under 14,000

As a health issue: Domestic violence

The medical costs of STREET CRIME were about $450 billion (1995 figures).
Of this cost, child abuse and domestic violence constituted about: ONE THIRD

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