Chapter 18: Health, Illness and the Health Care System

(SOCIAAL) EPIDEMIOLOGY is the study of PATTERNS  OF ILLNESS in a society, but 
at root, "Disease" is a social construct.  
  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/influence).   
      -- 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?

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

                  LOW INCOME   MIDDLE   HIGH

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

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

Some other points:

--Infant mortality is the number one cause of deaths of infants under 1 year
of age. (trivia note: "infant mortality rate of robins is about 72 percent).
In some countries, infant mortality rate of humans approaches 20 percent:
(20 percent in Angola; 15 pct in Sierra Leonne, and 14 pct in low-income
nations). 

--Infant mortality in the US: About 6.5 per 1,000 births (second highest
mortality rate in the industrialized world, second only to Latvia)

--AIDS/HIV: In some countries, as many as 35 percent of population between
15 to 50 is infected (eg, Botswana) or South Africa (21 percent)

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

DRUGS
--Most destructive drug: Tobacco (marijuana in the middle)
--Substance abuse is costly (treatment, economically, enforcement)

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

MENTAL ILLNESS: (Develop in lecture)(see p 615 and know definitions)

KNOW THEORIES:

--FUNCTIONALISM: Health critical to social maintenance (KNOW PARSONS list: p 609
--CONFLICT THEORY: Inequalities of health care
--SYMBOLIC INTERACTION: Social Construction of illness

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