Chapter 10

Health Care: Problems of
Physical and Mental Illness
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Chapter outline
Mental Illness
Health Care
• Life expectancy and infant mortality
• Diseases and Disability
• Defining
• Treatment
• Race, Class, Gender
Private Health Insurance
Medicare and Medicaid
Race, Class, Gender
• Functionalist
• Conflict
• Interactionist
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Health and Life Expectancy
 Health: state of complete physical, mental, and social
 This is a social issue as well as a biological issue.
 Life expectancy is an estimate of the average
lifetime of people born in a specific year
 1900 – expected to live to 47.3 years of age
 2005 – expected to live to 77.8 years of age
 Life expectancy varies by gender, race, social class
and overall health
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Infant Mortality
 Number of deaths of infants under one year of age per
1,000 live births
 Good indication of societies preventive medical care
 IMR higher in US than other high-income nations
 Rates vary significantly by race
 In 2004, IMR for African American infants was 13.2 per 1,000
live births
 In 2001, IMR for white infants was 5.7 per 1,000 live births
 Indicates unequal access to health care in US
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Copyright © Allyn & Bacon 2010
 Acute diseases
 Illnesses that strike suddenly and cause incapacitation
or death
Chicken pox, influenza, Lyme disease, and HIV
 Chronic diseases
 Long-term, develop gradually, or are present from birth
(e.g., arthritis, diabetes, heart disease)
 Caused by biological and environmental factors
 Some produce disabilities that increase health care costs
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 Disability: A restricted or total lack of ability to perform
certain activities as a result of physical limitations or the
interplay of these limitations, social responses, and the social
 54 million people in U.S. have 1 or more physical or mental
 This number is increasing due to:
 Today people survive with disability that would have died before
 Longer life expectancy means more likely to have chronic disease
 Those born with serious disabilities more like to survive today
due to medical advances
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AIDS Crisis
 Number of cases is rising annually
 Between 1,039,000 and 1,185,000 had AIDS/HIV in 2003
 Up to 40,000 new cases each year
 Males account for nearly ¾ of all cases
 Half of those infected are African American
 Higher rates for those between age 25 and 44
 Treatment is complex and costly, currently no cure
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Mental Health
 Considered a social problem because it affects a large number
of people
 1 in 4 adults suffer from a diagnosable mental disorder
 Difficult to define and identify mental disorders
 American Psychiatric Association’s (1994) Diagnostic and Statistical
Manual of Mental Disorders IV (DSM-IV)
 Lists of disorders changes and grows with each revision
 Severe mental illness (schizophrenia, bipolar disorder, major
depression) affect 1 out of 17 US adults some time in their lives
 Many direct and indirect costs of mental illness to our society.
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Copyright © Allyn & Bacon 2010
Race, class, gender and mental illness
 No significant differences in diagnosable mental
illness between African Americans and whites
 Racism does however impact the psychological well-being of
both African Americans and whites
 Social class is related to mental illness
 As SES increases for African Americans and whites, mental
disorders decrease
 Gender differences in Mental Illness:
 Women are diagnosed with depression more than men
 Men have higher rates of personality disorders (gambling,
drinking, etc.)
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Health Care Crisis
 Currently medical care is offered on fee for service basis
 Patients pay directly for treatment
 Expensive way of delivering health care because there are
few restrictions on how much providers can charge
 Private Health Insurance
 Pay the insurance company a premium and they pay the
provider directly
 Health care costs started spiraling with increase in
medical insurance programs in the 1960’s
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Today’s options
In order to reduce medical costs and demand many
insurance companies are offering options:
 Preferred Provider Organizations (PPOs)
 Doctors contract to treat insured patients for set fees
 Health Maintenance Organizations (HMOs)
 For a set monthly fee, an HMO provides total care
 Emphasis is on prevention
 Patients must use doctors and hospitals affiliated with HMO
 Managed Care
 Any system of cost containment that controls tests, procedures, and
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Medicaid and Medicare
 Public health insurance for people aged 65 and over
 Funded by social security payments
 Public health insurance for people who are poor and either
aged, blind, disabled, or pregnant
 Funded by federal and state governments
 Uninsured and underinsured:
 47 million Americans had no health insurance in 2006
 Some companies are cutting medical benefits
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Copyright © Allyn & Bacon 2010
Race, class, gender and health care
 Less preventive care and less optimal management of
chronic diseases are received by:
 People of color across class lines
 Low-income whites
 Much Gender inequality in health care:
 Women have been underrepresented in the medical
 Medical training, practice, and research are male-centered
 80% of doctors in U.S. are men today
 Women receive differential treatment for certain kinds of
medical problems
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Explanations of health care problems
 Functionalist:
 Illness is dysfunctional for society, keeps people from
fulfilling their roles.
 Problems in U.S. health care are due to macro-level
changes (e.g., high-tech medicine, over-specialization of
 Solutions
 Reorganize the whole healthcare system
 Cost containment needs to happen
 Managed care is the best answer
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Explanations of health care problems (cont.)
 Conflict:
 Health problems are rooted in capitalism and in the
medical-industrial complex
 Race-, class-, and gender-based inequities cause health
 Inequality in U.S. health care will be perpetuated by 3
High health care costs due to advanced services and expensive
medicine and technology
Abuse of existing systems by health care professionals who
overcharge, provide unnecessary services, or charge for
services never received
Aging population will put a strain on Medicare and Medicaid.
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Explanations of health care problems, cont.
 Symbolic Interactionist
 Communication problems between doctors and patients
create problems
 Can help this by increasing the number of family
practice Drs.
 Increase communication between dr. and patient
 People need to become more involved in health care
issues and reform
 People who have information and resources could work
on preventative care at home reducing need for some
high cost care.
Copyright © Allyn & Bacon 2010

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