Sociology 1101--Ch 11
Sociology 1101--Ch 11 Socio 1101 (Lopez, Intro to sociology)
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Socio 1101 (Lopez, Intro to sociology)
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This 9 page Class Notes was uploaded by Isabella Bowling on Tuesday December 1, 2015. The Class Notes belongs to Socio 1101 (Lopez, Intro to sociology) at Ohio State University taught by Steven Lopez in Fall 2015. Since its upload, it has received 143 views. For similar materials see Introduction to Sociology in Sociology at Ohio State University.
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Date Created: 12/01/15
Sociology Ch 11 H EALTH AND SOCIETY What causes people to die changes over time but the group at greatest risk of dying from these afflictions those low in socioeconomic status stays the same Dr Farmer constant volunteer in Rwanda and Haiti Lobbying for cheaper drug prices for poorer countries and action and assistance for them from rich Western countries Demonstrated the linkages between poverty and illness in Infections and Inequalities 1999 The Rise of the Medical Profession IDoctors have enormous social power political power and prestige Comes from the ability to offer quothealth and longevity or at least claim to offer it They re intimate AND objective with patients Medical schools are limited in strict numbers and are limited with how many doctors can graduate each year 9 contributes to the prestige and selectivity of the field Doctors are assumed to answer to a higher moral calling eg the Hippocratic Oath9 obligates them to help in emergency situations and only in the patient s best interest a professional who violates the unstated ethic of getting the approval from peers ie other doctors by seeking the make a client happy at the expense of the esteem of hisher peers Ex If a professor cancels the final and gives everyone an A 9 students happy Other colleagues angry feel undermined may kick professor out of profession Trust is the most important factor in patients rating their doctor David Mechanic and Sharon Meyer Doctors may create excess demand for their services on the basis of knowing the more the patient comes in the more money the doctor receives The patients trusts that the doctor knows more about what s best for you asymmetry of information and keeps returning Doctors set their own pay control demand for services have prescription authority amp selfregulate AMA in charge ofjudging indicting and jailing doctors Very reluctant to take away licenses though because of the selfinduced shortage of doctors in the field the process by which problems or issues not traditionally seen as medical come to be framed as such Ex alcoholism used to be a problem of selfcontrol now accepted as a disease with genetic tendencies and biochemical aspects Culture of Biomedicine In ancient Rome medicine was a lowlevel occupation Only recently has medicine held such great power 9 the power comes from being able to actually offer health and longevity Technology and knowledge advances helped doctors go from observing to examining patients ILicensing allowed the states to define what types of medicine could be practiced gave doctors some legal power to sue for missed payments etc amp created limits on degrees awarded 9 higher wages and guaranteed constant employment for doctors Doctors gained power in social institutions ie hospitals because they came to supply the patients for the hospital because they controlled where the patient went to receive treatment Doctors Denouement IBy 1990 doctors authority began to decline because 1 Market forces infiltrated medicine healthcare became a political issue 2 Rise of external regulation Medical quotbill of rights now exist on top of AMA rules Also 1986 Emergency Medical Treatment and Active Labor Act ER must treatstabilize patient regardless of hisher ability to pay for services 3 Heterodoxy nontraditional medicine may be challenging authority of traditional medicine as more people explore alternatives such as acupuncture chiropractics and herbal medicine 4 Rise of technology many procedures no longer require a steady hand Drug companies also challenge medical community Doctors are victims of own technological innovation amp success 5 The internet patients can search their symptoms and become active consumers of health care challenging and questioning the opinions and judgments of the doctor The Sick Role the concept describing the social rights and obligations of a sick individual including 1 Right not to perform normal social roles depending on severity of illness 2 Right not to be held accountable for his or her condition 1 Obligated to try and get well 2 Obligated to seek competent help and comply with doctors orders Those who meet all rights amp obligations cannot be morallyjudged if they don t work when sick However today we put more emphasis on the individual rather than the social context We tend to hold the person at least partially responsible for their diseases rather than unaccountable as is presumed under right 2 eg notice if the person diagnosed w lung cancer continues to smoke 9 we don t feel as bad for them IBUT how many patients have access to help and resources to obtain it Unlimited time and money 9 more likely to seek treatments If you can t seek treatment because of lack of resources do you lose your rights as a sick person because you didn t fulfil your obligations What it means to be sick or healthy varies across time and place Ex A Hmong immigrant family has a daughter who was diagnosed by Western doctors as having epilepsy However in Hmong culture the seizures are seen as a high honor because they view them as periods in which her soul visited the spirit world The US Health Care System current model of insurance in which you pay a copay small sum on the services you need and the insurance covers the rest of your bill Causes perverse incentives 9 doctors encouraged to overtreat supplierinduced demand Drives up medical costs for everyone as insurance gets repeatedly billed medical provider receives a capitation a fee per person as opposed to a fee per treatment Was an attempt to hold down costs of insurance by paying doctors salary based on number of patients Patients still pay a copay each time they go to the doctor but the doctor has more incentive to keep you healthy so that you require less treatment and less visits 9 undertreatment of patients because they don t get much extra money each time you come in dominates the US market Insurance acquired through employers Insurance company s guess at how much health care a given firm s employees will consume and calibrate their premiums monthly charges copays patient s share of the bill and deductibles portion that patients have to pay all by themselves before the insurance kicks in accordingly f insurance company overshot 9 lose business to competitor with lower rates If they underestimated 9 suffered losses within the insurance company Easier to adjust for age and family composition in larger companies than smaller ones an issue that arises when it comes to individual insurance If one is healthy there is no incentive to get insurance but if one is ill or knows heshe will need a lot of health care resources for that year for another reason heshe might want to buy the best possible plan for that particular year So when individuals have choice they tend to sort themselves out by their own risk which they know better than the insurance company ever could this is the individual insurance market goes into a death spiral because only the sickest people by insurance 9 increased prices 9 further drive away healthy potential buyers Risk isn t spread insurance can t work properly if only the sickest participate Resoutions and given to the poorest and the oldest people Gives them health insurance but limited bc these people may not have access to the technology amp resources to take advantage of the insurance Also did not help spread risk for insurance companies Extensions added insurance must cover women s hospitalization for 48 hours after childbirth or 96 hours after Csection ER s had to treatstabilize patients regardless of ability to pay SCHIP effective in the late 90s to provide more money and statelevel assistance for children s health care Federal government matches state provided funding while allowing states to set own eligibility and control disbursement of funds aka quotObamacare requires everyone to have medical insurance 9 ensures that the risk will be spread for insurance ensures a healthy pool of buyers and lowers costs for all buyers Eliminated the variation in pricing or rejection from coverage based on preexisting medical conditions Intended to help the individualized insurance market Social Determinants of Health and Illness IMedical care amp health systems are NOT very important in predicting mortality rates life expectancy and quality of life IFactors like nutrition clean water lifestyle choices and social position are what better predict 1967 British researchers study the health of civil servants Examined the difference among men of different social classes in similar occupations civil service sector In the initial 10 years men with lower SES had much higher rates of common illnesses and ailments 9 higher mortality rates Lower SES men had more risk factors eg obesity higher stress and lower levels of physical activity IEven factoring out for prior health status men in lowest SES were twice as likely as men in higher SES to suffer from heart problems shows lower SES is the cause of issues not an effect This society has open access to healthcare for everyone and none of the participants were poor or undernourished and ALL have a sufficient salary to survive who you are where you live how much you earn and what you do for a living all play a major role in determining your health Shows that social forces effect illness in a general sense Whether you get the chicken pox acute condition or have lower back pain chronic condition will be affected by social forces death Social forces affect likelihood of an individual or group dying Socia stress 9 poorer outcomes The lower SES 9 more social stress 9 poorer outcomes through direct eg stress hormones released by body or indirect eg behavioral responses such as overeating and smoking means as related to their social position Whitehal study is controversial it doesn t address the possibility that underlying personality differences and skill sets could have led to both occupational and health differences or that health could directly determine the rank a person rose bc its effects on productivity Height the Relationship between Health and Society 2004 New Yorker magazine article that discussed how tall men benefit from their height They have higher income more political power and are luckier in love Spotlights economist John Komlos who has been investigating why Dutch are now tallest population in the world Height is determined by both genetics AND environmental conditions during infancy and childhood Ex Mayan populations study done where some Mayans immigrated to US had more access to better diet and after 15 years avg 394 inches taller than Mayans who stayed in Guatemala Equaity may be the key factor in height 9 the Netherlands have some of the best equality among their populations and better access to better healthcare 9 leading to most nutrients being maximized 9 tallest populations nequaity 9 creates stress 9 indirectly effects behavior 9 poor diet choices 9 not as much height Prenatal and Early Life Determinants process of inserting a needle into the uterus to extract fluid from amniotic sack surrounding the fetus Used to collect fetal DNA and run genetic screening for diseases before birth Ethical issues Should mother abort the child if it has incurable conditions like Down s syndrome What if knowing the sex of the baby will cause mothers to abort girls because males are more likely to return the investments when they grow up IBirth ratio of boy girl may be off at birth because the sperm with Y chromosome can travel faster than the ones with X chromosome This usually evens out because males have higher infant mortality rate and eventually flips because women outlive men in old age Some countries like China where they have a onechild policy are running the risk of having lack of marriage partners because there birth ratio is much higher from boys girls and higherorder births happening because women are doing in vitro fertilization where several zygotes are inserted into the uterus in hopes of increasing the chance of implantation Also women are taking more ovulationinducing drugs Ethical issues does a mom abort some of the embryos because of the risks that come with multiplebirths What about the risk for the low birth weight and prematurity with multiples Postnatal Health Inequalities Low birth weight 5le 802 or less at birth In 2011 rate of lowbirthweight babies 81 Can result from inadequate growth intrauterine growth restriction or prematurity Contributing factors Parenta birth weight Mother s health and nutritional status ndirectly the parental income eg mother needs resources to stay healthy ILowbirthweight babies suffer from lower average educational attainments lower SES and greater chance of giving birth to lowbirthweight babies Race in the US Whites 790 years African Americans 753 years Whites amp Hispanics 53 blacks 124 Asians 44 American Indians 85 What accounts for the differences Blacks are disproportionately poor in the US 9 higher stress levels 9 poorer health Blacks are more likely to be victims of overt and subtle forms of prejudice 9 high stress 9 high blood pressure and psychological issues 9 poorer health theory that suggests that the story of a man winning a race but then dying from exhaustion symbolizes the hardworking African American man Many blacks work extra hard to battle the negative stereotypes 9more stress9 health issues Socioeconomic Status SES Higher income 9 longer life expectancy Higher education 9 longer life expectancy WHY Resources and information leads to healthier habits eg smoke less eat healthier Also have more knowledge of healthcare system amp how to make choices that will affect their health BUT could better health have led to attaining higher education ie didn t miss as much school so better prepared for higher education The relationship between lower income amp higher morbidity is false not actually causal because other factors such as genetics amp biology affect both health amp SES Health causes social position If you don t have good health you may not be able to work so higher morbidity would lead to lower SES social status position determines health Being of lower SES causes higher morbidity and lower general health What factors could make this happen I Psychosocial interpretation relative status to those around you 9 leads to feelings of inadequacy low worth and stigma 9 stress poor choices 9 higher morbidity I Materialist interpretation socioeconomic factors cause differences in access to a healthy life 9 can t access healthy food gyms etc 9 higher morbidity I Fundamental Causes interpretation multiple and everchanging mechanisms exist by which SES affect health and what the causes have in common the greater ability of highSES individuals to make use of new information amp health resources as they become available eg n 1970s healthy diet changed from being red meats and eggs to larger focus on veggies 9 wealthy people were better at accessing this new information and changing their diets to match what was considered healthy economist at Princeton University Found that an extra year of schooling decreased individuals chances of dying by 36 in a given 10 year period studied elderly as Social Security Administration choose an arbitrary date for people to receive larger social security packages than those born after a certain date Found that those who received smaller packages compensated by working parttime longer 9 increased longevity bc of the mental amp physical benefits of being more socially connected Marital Status Married people men especially tend to live longer But being married doesn t necessarily CAUSE longer lives maybe healthier people do better on the marriage market 9 more marriages even though they would live long regardless Maybe marriage lowers risk for risky or unhealthy behavior 9 better health Gender IWomen in the US outlive men Women 811 years Men 763 years The gap is decreasing as more women seek higher education and better more stressful jobs Women are more likely to seek healthcare than men nteractions between race and gender White women 813 years Black men 721 years Nonwhites are more likely to face racism have low SES and work more dangerous jobs Family structure Larger family 9 higher child mortality rates Could be caused by division of resources eg African countries usually don t have enough food to feed all 8 children or lack of supervision eg Western cultures suffer more from child accidental deaths than food scarcity Kids spaced more closely together 9 higher child mortality Parental resources are more taxed when the children are born closely together eg buying everything back to back vs once then waiting to save up then making purchases again IFirstborns more likely to die young Possibly bc lack of parental experience or because they are usually unintended pregnancies so mom wasn t making the best choices when the fetus was developing because she didn t know she was expecting Firstborns that are also only children suffer from higher risk of death only because if the first born is severely ill or dies in infancy mom is less likely to have more children Sociology of Mental Health Used to be sane vs insane but now is seen as a spectrum created Diagnostic and Statistical Manual of Mental Disorder DSM in varying editions in order to standardize the canon of mental disorders and their definitions so that one person in Maine with certain symptoms would receive the same diagnosis as a person in Texas with those same symptoms First and second edition were a little vague and usually attributed causes such as life events to the diseases Only had about 60 diseases Third addition was largely diseases were not attributed to certain causes Making it primarily used for diagnosing and it was largely adopted as the medical model rather than a psychological model Today have the fifth edition Contains 400 distinct mental illnesses because of the insurance industry needing to have a diagnosis that quotfitsquot into a category focuses on identifying the internal conflicts that produce a mental illness Was replaced by the focuses on identifying symptoms of specific underlying diseases Sadness vs Depression symptoms of depression last longer than 2 weeks and often interfere with daily life and functioning What if the depression is the result of a huge life event eg September 11 2001 Wouldn t depression be a normal reaction to life s trauma Overdiagnosing depression and lumping appropriatelysaddened individuals with those who suffer from a serious mental illness may dilute attention and resources Power of a Pill Now that mental illness is seen as an organic disease all you need is a pill to fix it right Drugs can and do help people but often drugs are over or missprescribed Some illnesses would be treated better with therapy but insurances don t usually cover the therapy So many patients just get prescribed a drug to treat the symptoms Global Health Poverty and Health Cause vs Effect US is tied for 33rcl place in terms of life expectancy on the global scale with Colombia amp Qatar leading cause of death worldwide More than 780 million don t have access to clean water and 16 million dieyear from diarrhea alone majority under age 5 There s an effective feedback loop poor countries have more health problems because they re poor and they are poor because they have so many health problems eradication of this disease is number one on the World Health Organization s list Before antibiotics its morbidity rates were so high it could wipe out entire villages African mosquitoes target humans they ve evolved this way 9 more of an issue in SubAfrican regions bc they are populationdense amp lack an animalcrop mixed system Malaria has fatally drained out productivity in Africa 9 stop in development So controlling amp eliminating malaria are prerequisites for further economic development ssue antibioticresistant strains of malaria gonorrhea etc are reemerging bc of the practice of adding antibiotics to animal feed amp failure to finish prescribed course of antibiotics Vaccines development of vaccines is important to eradicating diseases The Age of AIDS Acquired Immunodeficiency Syndrome AIDS had first case reported in 1981 and thought to be a disease of gay men not true though AIDS killed more than 25 million people worldwide within 25 years after the first case African Americans men and women amp homosexual men are at highest risk of infection HIV is carried in bodily fluids so can be transmitted through shared needles unprotected sex and mothertoinfant exchanges More prevalent among poorer populations especially on the global scale Drugs are available to prevent HIV from becoming fullblown AIDS but access is limited and the resources such as good nutrition and clean water affect its effectiveness Housing for Health Could providing homes to the mentally ill actually improve their condition New York University psychiatrist who pioneered the Housing First project and Pathways to Housing project that provided housing to individuals wo having them jump through hoops Permanent housing leads to individuals making better choices for themselves Forcing them to quotget clean in order to keep housing at a sense of permanency 9 individuals don t feel incentive to change 2006 studies participants that have permanent housing and those who did not The ones who had housing had less ER visits less incarceration amp improved psychologically with their conditions Specific to this study was alcoho9 they drank a lot less by the end of the study Money spent on housing and counseling actually saves money in the long run 9 rather than tax forjail Sociology Lec Week 13 POPULATION DEMOG RAPHY Three interrelated problems population energy and climate the study of human population dynamics Fertility the amount of children being born Mortality the rate of deaths Migration the movement in and out of a population IAII populations naturally expand What keeps them in check Natura checks food supply war disease etc Cultura influences on fertility marriage timing birth control technology religious beliefs etc Growth was very slow until recently now there is a HUGE decline in mortality rates World average annual growth rate US 03 EuropeSingapore Negative growth Uganda Nicaragua More than 3 Population Theories 1798 The growing population exceeds food production 9 natural checks occur famine death etc Thomas Malthus believed population can never escape subsistence level poverty True for most of human history BUT industrial civilization has temporarily escaped the trap ndustria revolution caused a huge decline in the mortality rates because Saniation improvements clean water access improved public health a better food supply from Green Revolution and improved medicine Birth rates declines to match mortality rate leading to a new stability True of industrialized nation because of the preference of smaller families 9 more children survive now transition of farm to urban areas not as many hands needed amp old age pensions ILimitations 1 Industrialized nations fall below the replacement rates 2 Malthusian trap continues to characterize less developed nations PROBLEM Population Issues Birth rate is low 9 US birth rate is currently BELOW replacement 21 childrenwoman Immigration is the only factor preventing population decline Don t necessarily need higher birth rates though because immigration takes up slack Demographic transition doesn t limit growth in developing nations There s some cultural lag If a nation is very populous the lag has huge impacts eg India The poor masses are not being helped or made poorer therefore high population growth has continued in 3rel world countries Without broadbased prosperity children are the only wealth and security a family has Solutions to Population Explosion 1 Family Planning Very effective but don t work if people don t wantuse it or can t afford it 2 Discourage large families China s successful and controversial quotone child policy They have restrictive sexual norms delayed marriage etc Penaties large finesjob loss housing loss There s a disenfranchisement of quotoverquota children 9 overcrowded orphanages 3 Development amp Equality quotCairo Plan Encourage more education and more equality among genders and SES Birth rate declines naturally as we educate people especially women Successfu examples Iran and Kenya Educate toward low birth preferences 9 counseling free condoms services eg vasectomy sterilization Presence of economic roles for women outside home
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