Chapter 2: Physical and Mental Health

The Global Context: health and illness around the world

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The World Health Organization (WHO) describes health as the following: “a state of complete physical, mental and social well being.”

Social scientists classify countries in terms of the level of economic development: * Developed countries: high-income countries * Developing countries: middle-income countries * Least developed countries: low-income countries

Table 2.1: WHO 2013 “Life Expectancy by Country Income Level, 2011”

COUNTRY INCOME LEVEL LIFE EXPECTANCY
high 80
higher middle 74
lower middle 66
low 60
WORLD AVERAGE 70

Table 2.2: WHO 2012 “8 Leading Causes of Death by Country Income Level”

NUM LOW INCOME MIDDLE INCOME HIGH INCOME
1 respiratory infection heart disease heart disease
2 diarrheal diseases stroke/cerebrovascular diseases stroke & cerebrovascular diseases
3 HIV/AIDS chronic obstructive pulmonary diseases trachea, bronchus, lung cancers
4 heart disease respiratory infections Alzheimer and other dementias
5 malaria diarrheal disease respiratory infections
6 stroke/cerebrovascular diseases HIV/AIDS chronic obstructive pulmonary disease
7 tuberculosis road traffic accidents colon and rectum cancers
8 prematurity/low birth weight tuberculosis diabetes

Mortality among infants, children, and maternity

Table 2.3 UNICEF, 2012a: “Skilled Childbirth Assistance and Lifetime Risk of Maternal Mortality by Development Level”

TYPE OF COUNTRY % OF BIRTHDS ATTENDED LIFETIME RISK OF MATERNAL MORTALITY
least developed 46 percent 1 in 37
developing 66 percent 1 in 120
industrialized No data available * 1 in 4300
  • we can make an assumption but the data is simply not available for us to make a statement about this.
  • textbook assumes: 100% but this is not evidence based and used for sociological purposes only

Globalization, Health and Medical Care

  • Globalization is impacted by global travel and transportation
  • Positives:
    1. communication technology
    2. interconnectedness
    3. monitoring and guidelines (WHO, CDC)
    4. increased sharing of medical knowledge and research findings
    5. increased trade of medical care, health products, and services (medical tourism) Example: Steve Jobs traveled to Switzerland for special cancer treatment “Patients Beyond Borders” by Josef Woodman
  • Negatives:
    1. increased pollution from transportation using fossil fuels
    2. speed of disease spread (Ebola outbreaks, flues, respiratory type infections, etc.)

Thought Question:

  1. Are Americans the healthiest population in the world?

  2. What factors impact our health?

  3. The US is wealthy but not exactly healthy.

  4. What is globesity?
  • What are the root causes of globesity from a medical perspective?
  • What are the root causes of globesity from a sociological perspective?

Multiple explanations for U.S. Health disadvantage:

  1. Health systems: inaccessible or unaffordable due to large uninsured and underinsured population segments
  2. Unhealthy behaviors: stress, prescription and illegal drug addiction, risky behavior
  3. Social and economic conditions: stress, poverty, income inequality, education, public health campaigns
  4. Physical and social environment: lack of physical activity, unhealthy patterns of food consumption, higher rate of firearm deaths, higher rates of substance abuse, physical illness, and family violence

Mental Illness: the hidden epidemic

  • Relationship between mental and physical health
  • diabetes

  • cancer

  • Mental illness is hidden because of social stigmas associated with disease

  • Although untreated mental illness can result in violent behavior, the vast majority of people with mental illness are not violent and they are involved in only about 4 percent of violent crimes.

Causes of Mental Illness

Table 2.4: Mental Disorders Classified by the American Psychiatric Association

Disorder / Classification Brief Description
anxiety anxiety from phobias, panic attacks, or obsessive-compulsive behavior
dissociative splitting or dissociation of normal consciousness (amnesia or multiple personality)
childhood/adolescent/infant mental retardation, ADD/ADHD, stuttering
eating or sleeping anorexia, bulimia, insomnia
impulse control inability to control impulses (addiction)
mood emotional: major depression, bipolar, manic-depressive
organic mental dysfunctions of the brain (aging, brain damage)
personality maladaptive personality: paranoid and antisocial
schizophrenia/psychotic delusions and hallucinations
somatoform hypochondria
substance-related abuse of alcohol and/or drugs

College students and mental health statistic:

  • More than one in four college students has been diagnosed or treated by a professional for a mental health problem in the past year.

Table 2.5 “Percentage of College Students Experiencing Selected Mental Health Difficulties in the Past 12 Months”

  • From page 37 in your textbook
MENTAL HEALTH DIFFICULTY PERCENTAGE
felt so depressed it was difficult to function 31
felt overwhelming anxiety 51
felt very lonely 57
felt things were hopeless 45
seriously considered suicide 7

Table 2.6 “Comparison of Reasons For Disclosure of Mental Illness by College Students”

Num. Reasons for Disclosure Reasons for Not Disclosing
1 Receive accommodations Fear or concern for for the impact of disclosure
2 Receive clinical services No opportunity to disclose
3 Role model to reduce stigma Diagnosis does not impact academic performance
4 Educate students, staff, faculty Lack of knowledge to secure accommodations
5 Avoid disciplinary action/fin. aid Mistrust of medical confidentiality

Self and Society: warning signs for mentall illness

NUM. WARNING SIGNS YOU SOMEONE YOU ARE CONCERNED ABOUT
1 marked personality change
2 inability to cope with problems daily activities
3 strange or grandiose ideas
4 excessive anxieties
5 Prolonged depression and apathy
6 Marked changes in eating patterns
7 Marked changes in sleeping patterns
8 Thinking or talking about suicide/harming oneself
9 Extreme mood swings (high or low)
10 Abuse of alcohol or drugs
11 Excessive anger, hostility, or violent behavior

Sociological Theories of Illness and Health Care

  1. Structural-Functionalist Perspective
  • Examines how how changes in society affect health.
  • Latent dysfunctions: overuse of antibiotics (e.g. antibacterial gel)
  • Unintended consequences: New York Law and mental health patients w/ guns
  1. Conflict Perspective
  • How wealth, status, power and the profit motive influence illness and health care
  • Profits above people (example: Michael Moore documentary “Sicko”)
  • Worker safety
  • Environmental laws
  1. Symbolic Interactionist Perspective
  • How meanings, definitions, and labels influence health, illness, and health care
  • How such meanings are learned through interaction with others and through media messages and portrayals.
  • Medicalization and conceptualization
  • Health communication and public health campaigns

Social Factors and Lifestyle Behaviors Associated with Health and Illness

  1. Socio-economic status and health
  • personal level based on educational, occupation and household income
  • does this impact your ability to seek out medical or mental health services?
  • does stress go up or down for low-income and obtaining medical or mental health services?
  1. Gender and Health
  • some societies see women and girls as socially inferior…they are denied equal access to nutrition and health
  • would multiple roles impact a woman’s health (student, spouse, mother, etc?)
  • do men experience different stressors or express them differently?
  1. Race, ethnicity and health

Table 2.7 “Life Expectancy at Birth by Race and Gender: United States 2010”

Gender White Black Hispanic
Female 81.3 78 83.8
Male 76.5 71.8 78.5

Problems in U.S. healthcare

WHO ranked America as 37 out of 191 countries according to health care performance

  • Top country: France
  • followed by: Italy, Spain, Oman, Australia and Japan

A study by Davis et al. 2007 investigating six countries: Australia, Canada, Germany, New Zealand, United Kingdom, and the United States.

  • America ranked last on dimensions of: access, patient safety, efficiency, and equality

U.S. Health Care: an overview

A combination of public (state and federal options) and private insurance for the population

  1. Medicare is funded by the federal government and reimburses the elderly and people with certain disabilities for their health care.
  • Part A: hospital insurance for inpatient care (may have deductible and/or co-payment)
  • Part B: supplementary medical insurance program (pay for physician, outpatient, other services)
  • Part C: beneficiaries to purchase private supplementary insurance that receive payments from medicare
  • Part D: Outpatient drug benefit that is voluntary and requires enrollees to pay a monthly premium, meet an annual deductible, and pay coinsurance for prescriptions
  1. Military Health Care:
  • CHAMPUS: Civilian Health and Medical Program of the Uniformed Services
  • CHAMPVA: Civilian Health and Medical Program of the Department of Veterans Affairs
  • care provided by the Department of Defense and the Department of Veterans Affairs
  1. Worker’s Compensation:
  • Insurance program that provides medical and living expenses from work related injuries or illnesses
  • Employers pay into the state worker’s fund
  • Many avoid this because of:
    • fear of getting fired for making a claim
    • unaware that they are covered by worker’s comp
    • the employer offers incentives (bonuses) when employees do not file worker’s comp for a period of time

The human side: testimony from medical marijuana patients

Table 2.8 “States with the year of legalized medical marijuana (September 2013)”

State Year Legalized State Year Legalized State Year Legalized
Alaska 1998 Hawaii 2000 New Hampshire 2013
Arizona 2010 Illinois 2013 New Jersey 2010
California 1996 Maine 1999 New Mexico 2007
Colorado 2000 Massachusetts 2012 Oregon 1998
Connecticut 2012 Michigan 2008 Rhode Island 2006
DC 2010 Montana 2004 Vermont 2004
Delaware 2011 Nevada 2000 Washington 1998

Strategies for action: improving health and health-care

  • Stories from patient narratives: Chron’s, M.S.
  • How has sociological perspectives changed about marijuana….What about medical marijuana or legalizing marijuana?

Inadequate Health Insurance Coverage

Components of goverment universal health care

  1. paid for by government funded by taxes or social security contributions
  2. government directly controls the financing and organization of health services
  3. owns most of the health facilities (Canada is the exception)
  4. guarantees universal access to health care
  5. allows private care for individuals willing to pay for their medical expenses
  6. allows individuals to supplement their national health care with private insurance as an upgrade to a higher class of service and a larger range of services (Cockerham 2007: Quadagno 2004)
  7. rationing of health care is done based on medical need and not ability to pay

Components of the American system of medical care

  1. prior to the ACA (Affordable Care Act) 48 million people or 15.4 % did not have health care insurance
  2. employed individuals and those with higher incomes are more likely to have medical/health insurance
  3. employees may not be eligible in employer based group insurance plans
  4. employees may not be able to afford the premiums
  5. employees may not be offered a medical/health insurance plan

Consequences of inadequate health insurance

  1. 45,000 deaths per year in the U.S. are attributable to lack of health insurance (page 48)
  2. focus is not on prevention which increases costs
  3. lack of access to physicians or specialists due to financial reasons
  4. increases the chance that a person without insurance will go to the emergency room (increase costs)
  5. increased costs due to aging population, obesity, prescription drugs, insurance fees
  6. lack of ability to pay for needed
  7. deinstitutionalization of mental health care services

Strategies for Action: Improving Health and Health Care

  • Selective primary health care (prevention)
  • Comprehensive primary health care focuses on broader social determinants of health (poverty and economic issues) as well as many other concerns (see key words)

Fighting the Growing Problem of Obesity

  • School nutrition and physical activity programs
  • Regulation of food marketing to youth
  • Local and state anti-obesity policies
  • Workplace wellness programs
  • Public education and awareness (health communication)

Social problems research up close: texting healthy lifestyle messages to teens

  • Health Communication techniques using sociology, psychology, communication, public health, and evidence based (quantitative and qualitative approaches)

http://www.naccenters.org/news-and-events/news?new_id=ffacf29b-b766-42b6-80cb-7ed5e9f06ac7 * Message delivery of healthy messages to teens based on health campaign strategies * Promoting health and wellness through campaigns

Strategies to improve mental health care

  • eliminating the stigma of mental illness
  • improving access to mental health care
  • mental health support for college students

Animals and society: improving mental health through animal-assisted therapy

  • growing trend in mental health services (Animal Assisted Therapy (AAT)
  • individuals may or may not be allergic to an animal

U.S. Federal Health Care Reform: the Affordable Care Act of 2010

  • Establishing an “individual mandate” that requires U.s. citizens and legal residents to have health insurance or pay a penalty (waivers are granted for financial hardship)
  • Creating health insurance exchanges: online marketplaces where consumers can shop for, compare, and enroll in insurance plans.
  • Providing tax credits to businesses that provide insurance to their employees
  • Requiring health insurance plans to provide dependent coverage for children up to age 26
  • Prohibiting health insurance plans from placing lifetime limits on the dollar value of coverage; restricting annual limits on coverage, prohibiting insurers from canceling coverage except in cases of fraud; and prohibiting denial of insurance due to pre-existing conditions
  • Requiring insurance companies to use a certain percentage of the premiums they collect on medical care, as opposed to administrative expenses and profits
  • Expanding Medicaid to cover more low-income individuals/families
  • Providing discounts on brand name prescription drugs and free preventative services and annual wellness exams for Medicare enrollees, and raising Medicare premiums for some higher income seniors

Understanding problems of illness and health care

  • Health care has most likely improved over the past half-century but the gap in health care between the rich and poor remains wide
  • Sociology looks at social solutions (federal, state, and local)
  • Improving public health

How can we study health and mental illness: Applications to course project and thought questions

  • How does physical health relate to the course project?

  • How does the ability to seek medical care out relate to our course project?

  • How does mental health relate to the course project?

  • How is the homeless community impacted by mental and/or physical health at the micro level?

  • How is the homeless community impacted by mental and/or physical health at the macro level?

  • Can the sociological perspectives (structure-function, conflict, symbolic interactionist) work together to convey a message about a population we are concerned with?

Review:

  1. How does the World Health Organization define health?
  2. What are some major differences in the health of populations living in high-income countries compared with the health of populations living in low-income countries?
  3. How has globalization affected health worldwide?
  4. Are Americans the healthiest population in the world?
  5. Why is mental illness referred to as a “hidden epidemic?”
  6. How common is mental illness in the United States?
  7. Which theoretical perspective criticizes the pharmaceutical and health care industry for placing profits about people? (conflict)…explain
  8. What are three main social factors that are associated with health and illness?
  9. How does health care in the United States compare with that of many other high-income countries?
  10. What is the difference between selective primary health care and comprehensive primary health care?

Key Terms: Glossary with page numbers

  • Affordable Care Act (ACA), pg. 59:
    • Health care reform legislation that President Obama signed into law in 201, with the goal of expanding health insurance coverage to more Americans; also known as the Patient Protection and Affordable Care Act
  • Allopathic medicine, pg. 46:
    • the conventional or mainstream practice of medicine, also known as Western medicine
  • Complementary and alternative medicine (CAM), pg. 46:
    • refers to a broad range of health care approaches, practices, and products that are not considered part of conventional medicine
  • Comprehensive primary health care, pg. 51
    • an approach to health care that focuses on the broader social determinants of health such as poverty and economic inequality, gender inequality, environment, and community development
  • Deinstitutionalization, pg. 50
    • the removal of individuals with psychological disorders from mental hospitals and large residential institutions to outpatient community mental health centers
  • Developed countries, pg. 27
    • countries that have relatively high gross national income per capita, also known as high
      -income countries
  • Developing countries, pg. 27
    • countries that have relatively low gross national income per capita, also known as less developed or middle-income countries
  • Globalization, pg. 30
    • the growing economic, political, and social interconnectedness among societies throughout the world
  • Globesity, pg. 30
    • the high prevalence of obesity around the world
  • Health, pg. 27
    • according to the World Health Organization (WHO), health is defined as: a state of complete physical, mental and social well-being
  • Infant mortality, pg. 29
    • deaths of live-born infants under 1 year of age
  • Least developed countries, pg. 27
    • the poorest countries in the world
  • Life expectancy, pg. 28
    • the average number of years that individuals born in a given year can expect to live
  • Managed care, pg. 45
    • any medical insurance plan that controls costs through monitoring and controlling the doctors of health care.
  • Maternal mortality, pg. 29
    • deaths that result from complications associated with pregnancy, childbirth and unsafe abortion
  • Medicaid, pg. 45
    • a public health insurance program jointly funded by the federal and state governments, that provides health insurance coverage for the poor who meet eligibility standards
  • Medicalization, pg. 40
    • defining or labeling behaviors and conditions as medical problems
  • Medical tourism, pg. 30
    • a global industry that involves traveling primarily across international borders for the
      purpose of obtaining medical care
  • Medicare, pg. 45
    • a federally funded program that provides health insurance benefits to the elderly, disabled, and those with advanced kidney disease
  • Mental health, pg. 35
    • the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people and the ability to adapt to change and to cope with adversity
  • Mental illness, pg. 35
    • refers collectively to all mental disorders which are characterized by sustained patterns of abnormal thinking, mood (emotions), or behaviors that are accompanied by significant distress and/or impairment in daily functioning
  • Mortality, pg. 28
    • death
  • Parity, pg. 57
    • in health care, a concept requiring equality between mental health care insurance coverage and other health care coverage
  • Selective primary health care, pg. 51
    • an approach to health care that focuses on using specific interventions to target specific health problems.
  • Single-payer health care, pg. 80
    • a health care system in which a single tax-financed public insurance program replaces private insurance companies
  • Socioeconomic status, pg. 41
    • a person’s portion in society based on the level of educational attainment, occupation and income of that person or that person’s household
  • State Children’s Health Insurance Program (SCHIP), pg. 45
    • a public health insurance program, jointly funded by federal and state governments, that
      provides health insurance coverage for children whose families meet income eligibility standards
  • Stigma, pg. 36
    • a discrediting label that can negatively affect an individual’s self-concept and disqualify that person from full social acceptance social acceptance
  • Under-5 mortality, pg. 29
    • deaths of children under age five
  • Universal health care, pg. 48
    • a system of health care, typically financed by the government, that ensures health care coverage for all citizens.
  • Workers’ compensation, pg. 46
    • also known as workers’ comp, an insurance program that provides medical workers’ compensation and living expenses for people with work-related injuries or illnesses