Chapter 19: Sociology, Schaefer, 1995-2012

Health vs. Health Care Delivery

Organized in all societies (International Health Care Comparison, 2013)

Social/Cultural basis

1. Who is sick?
2. What to do about it?
3. Defining Disease-Cultural factors (Anorexia)
4. Medicalization of Society
5. Endemic vs. Epidemic (The Guinea worm)
6. Epidemiology (transmission of disease and modern society, impact of spread)
7. Acute vs. Chronic Illness
8. Causes: Germs, Lifestyle, Social Conditions
9. SES
10. Gender
11. Age
12. Race
13. Technology

Physical-Mental Health

Health Industry

Doctors-Hospitals-Insurance

Professionalization of Medicine

• Shaman
• Greeks: 4 humors (blood, bile, water, air)
• Role of the clergy as practitioners
• Physician as menace
• Renaissance (1400's)==>science
• New technology: microscope...germs
• Hospitals and specialized care
• Hand washing (Ignaz Semmelweis (Hungarian physician) advocated hand washing to prevent spread of infections in the 1850s. His work was ignored until the 1890s.)
• Pasteur and Bacteria (1850's)
• Doctors as germ seekers/fighters (or?)
• AMA: 1847
• Control of medical education (see also)
• Pharmacological revolutions
• Doctors and hospitals-post WWII: Insurance (see also)
• Now-deprofessionalization?

Sickness-Disease-Illness

Sick Role (What you are): Functionalism

• Deviance, but the individual is not held personally responsible.
• Relieved of social responsibilities
• Desire to get well
• Seek competent medical help

Doctors as "gatekeepers" for the "sick role": insure order, doctor as "parent."

Focus on acute vs. chronic illness

Other elements of the Functionalist perspective

• Freedom to choose
• Profit-competition-advances
• Self-correcting: emergence of HMO's, Medicare, Medicaid, Prescription drug plans, "Independent Living Centers."

Disease: What you have (Conflict: Interest Groups)

• Focus of the doctor as a scientist is on the objective reality of the disease
• Look for Signs and Symptoms
• Objective versus the subjective concerns of the patient
• Treat the disease vs. the person
• Expert knowledge
• Alienation (for patient)

Other Elements of the Conflict Perspective

• Health and Health Care as resource
  • In the early 1900s the Carnegie Corporation did an analysis of medical schools to determine which of them should receive funding. Their analysis led to:
    • the closing of three-quarters of the black medical schools in the country
    • the closing of most of the alternative medical schools that accepted female students
    • the creation of tough state licensing laws that made it impossible for midwives to deliver babies
• Fee-for-Service:
  • Profits: Driving force (21 graphs that show America’s health-care prices are ludicrous)
  • Two-tier system: pay for what you get.
  • Unequal distribution: Infant mortality, (race, and this), Males vs. females, Life expectancy
• Power to Heal = Power to exploit: Dependency
  • Responsibility for health- Professional vs. Individual
• Brain-Drain: lack of health care providers in developing nations
• Industry-Technology-Competition
  • Heroic Methods
  • Miracle Cures vs public health
  • Intervention vs. prevention
  • Duplication, Consolidation, and Costs
  • Artificial Scarcity
• Medicalization of Society (see also)
  1. Medicine as an institution of social control
     • Deviance: pharmacological solutions
     • Normalcy
  2. EDL: Medical Model--restricts access to discussion and decision-making
  3. Growth of institutions (12.5% of GDP in 1990--17.8% in 2015) and restrictions on who can provide care

Illness: How you feel (Interactionism: Symbols and Meaning)

• Patients concern
• Ethnic/cultural definitions: Italians, Jews, and WASPs: experience of pain (see more)
• What you do
• Allopathic vs. Chiropractic
• Herbs vs prescriptions

Other Elements of the Interactionist Perspective

• Socialization into medicine
• Doctor-Patient interaction (Doctor as God)
  1. Following orders
  2. Where's the problem
  3. Parents and kids
  4. Medical response and social characteristics
  5. Females, elderly, poor
  6. Doctor-Nurse Game (update, and another perspective)

• Designating as Sick: Social Impact
1. Stigma
2. Social consequences
3. Self-identity (AIDS)
4. Life experiences as illness: ADD, Sluggish Cognitive Tempo, Chronic Fatigue Syndrome, homosexuality (APA dropped in 1974)

Mental Illness (Medical vs Social Models)

• Szasz: Myth of Mental Illness (see also)
• Scheff: Social Learning and residual deviance
• Rosenhahn: Being Sane in Insane Places
  1. Retrospective interpretation

Disability: social roles and definitions

1. Blindness: The Making of Blind Men (Robert Scott)
2. Outsiders in a Hearing World (Paul Higgins)
3. Physical disability and access

• Government intervention: National Health Care-Affordable Care Act
• Costs (DRGs and Dumping)
• Alternative Medicine

Community

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Owner: Robert O. Keel rok@umsl.edu
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Last Updated: Monday, April 23, 2018 10:24 AM