Chapter 14Health, Medicine,

Disability and Aging

Chapter Outline

• Health and Medicine• Defining and Measuring Health• Health and Politics: The United States

in Comparative Perspective• Disability• Aging• Theories of Age Stratification• Social Problems of Elderly people

The Black Death

• In 1346, rumors reached Europe of a plague sweeping the East.

• The epidemic spread along trade routes to China and Russia.

• Within 2 years, the Black Death, killed 1/3 of Europe’s population.

• The plague still ranks as the most devastating catastrophe in human history.

Sociological Issues of Health, Medicine, and

Disability1. Health risks are always unevenly

distributed. 2. Health problems change over

time.3. Medical professions have gained

substantial control over health issues and promoted their own approach to well-being.

Leading Causes of Death, United States,

1900Cause % of Deaths

1. Pneumonia/influenza 11.8

2. Tuberculosis 11.3

3. Diarrhea/other intestinal 8.3

4. Heart disease 8.0

5. Stroke 6.2

Leading Causes of Death, United States,

1900

Cause % of Deaths

6. Kidney disease 5.2

7. Accidents 4.2

8.Cancer 3.7

9. Senility 2.9

10. Bronchitis 2.3

Leading Causes of Death, United States,

2001

Cause % of Deaths

1. Heart disease 28.9

2. Cancer 22.9

3. Stroke 6.8

4. Chronic lung disease 5.1

5. Accidents 4.0

Leading Causes of Death, United States,

2001

Cause % of Deaths

6. Diabetes 2.9

7. Pneumonia/influenza 2.6

8. Alzheimer disease 2.2

9. Kidney disease 1.6

10. Blood poisoning 1.3

Leading Causes of Death, United States,

2001

Cause % of Deaths

11. Suicide 1.2

12. Liver diseases 1.1

13. Homicide 0.8

14. High blood pressure 0.8

15. Lung inflammation 0.7

Life Expectancy, Selected Countries

Life Expectancy

• Maximum average human life span - average age of death for an entire population under ideal conditions.

• Life expectancy - average number of years a person can actually expect to live.

Social Causes of Illness and Death

• Human-environmental factors - Cancer causing pollutants in the air and water.

• Lifestyle factors - cigarettes, alcohol, drugs, diet, social isolation

• Public health and health-care systems - access to clean water, basic sewage, immunizations

Number of People with HIV/AIDS, 12/31/02

Health Indicators 1999–2002

United States Japan

Canada

Zambia

Physicians/

100K pop.279 193.2 229.1 6.9

Nurses/ 100K pop.

972 744.9 897.1 113.1

% Childrenimmunize

dagainst

measles

92 94 96 90

Reasons for Health Inequity

• The poor are more likely to be exposed to violence, high-risk behavior and environmental hazards.

• The poor cannot afford adequate health care.

Leading Causes of Death:

Ratios, 2000Female:

MaleAfrican American:

White

Heart disease 1.02 0.90

Cancer 0.90 0.94

Stroke 1.53 0.96

Lung disease 1.00 0.50

Accidents 0.52 1.08

Polling Question

• Do you currently smoke cigarettes?

A. YesB. No

Gender Inequalities in Health Care

• More research has focused on “men’s diseases” (cardiac arrest) than on “women’s diseases” (breast cancer).

• Women undergo fewer kidney transplants, various cardiac procedures, and other treatments than men.

Gender Inequalities in Health Care

• Women live longer than men and experience greater lifetime risk of functional disability and chronic illness and have a greater need for long-term care.

• There are 40% more poor women than poor men in the United States.

Prescription Drug Costs in 8 Rich Countries, 2002

Problems with HMOs

1. Some HMO’s avoid covering sick people and people who are likely to get sick to keep costs down.

2. Minimize the cost of treating sick people they can’t avoid covering.

3. Inflate diagnoses to maximize reimbursements.

4. Keep overhead charges high.

Administrative Costs as % of Health-Care

Spending

“HMOs Improve the Quality of Care,” 1998

Recent Challenges to Traditional Medical

Science• Patient Activism• Alternative Medicine - chiropractic

therapy, acupuncture, massage therapy, and various relaxation techniques

• Holistic Medicine - emphasizes disease prevention

Social Construction of Disability

• 400 years ago - Catholic Church declared left-handed people servants of the Devil and burned them at the stake.

• 19th century - Western scientists and reformers sought rehabilitation of the disabled.

Social Construction of Disability

• 1933 - Nazis engineered the sterilization and killing of the mentally “deficient” and the physically “deviant,” including the blind and the deaf.

• 1920s to 1970s - In America Native American women were subjected to federally funded forced sterilization.

Ablism

• Prejudice and discrimination against disabled people.– Historical example: Belief among

19th-century Western educators that blind people were incapable of high-level or abstract thought.

• Ablism involves the largely unintended neglect of the conditions of disabled people.

Age Stratification

• Sociologists call a category of people born in the same range of years an age cohort.

• Age stratification refers to social inequality between age cohorts.

• Gerontocracies were societies in which elderly men ruled.

Child Poverty by Race and Ethnicity

Median Income and Percent Poor

Age Stratification: Functionalist Theory

• Age stratification reflects the importance of each age cohort’s contribution to society.– In preindustrial societies, the elderly

were important for knowledge and wisdom.

– With industrialization, function of the elderly became less important and their status declined.

Age Stratification:Conflict Theory

• Age stratification stems from competition and conflict.

• Young people may participate in a revolutionary overthrow and seize power.

• The elderly may organize politically to decrease disadvantages and increase advantages in life.

Age Stratification: Symbolic Interactionist

• Focus on the meanings people attach to age-based groups and age stratification.

• One study examined movies from 1940-1980.– Young people were portrayed as

leading active, vital lives.– Elderly women were portrayed as

unattractive, unfriendly, and unintelligent.

Elderly as % of U.S. Population, 1900–2050

Polling Question

• The government should pay for all prescription medication for the elderly in our society.A. Strongly agreeB. Agree somewhatC. UnsureD. Disagree somewhatE. Strongly disagree

A Shortage of Caregivers

• In 2001, home-care agencies and nursing homes employed 2.1 million caregivers in the United States.

• The U.S. Bureau of Labor Statistics expects a 58% rise in demand for such workers between 1998 and 2008.

A Shortage of Caregivers

• Workers are hard to find and hard to keep:– The work is difficult and pays little. – Government requires 2 weeks of

preemployment training for direct-care aides but Congress’s 1996 welfare reform discourages such training for former welfare recipients.

Ageism

• Ageism is prejudice and discrimination based on age.

• Examples:– Elderly men are stereotyped as

“grumpy” and elderly women as “haggard”.

Euthanasia

• Involves a doctor prescribing or administering medication or treatment that intended to end a terminally ill patient’s life.

• Public opinion polls show about 2/3 of Americans favor physician-assisted euthanasia.

Euthanasia

• Between 33% and 60% of American doctors say they would be willing to perform euthanasia if it were legal.

• Nearly 30% of American doctors have received a euthanasia request, but only 6% say they complied.

Elderly and Poverty

• Among the elderly, poverty is most common for:– those 85 and older– Women– African Americans– people living alone– people living in rural areas.

People Who Died under Oregon’s Death with Dignity

ActPhysician-

Assisted SuicideOther

Deaths

Average Age 69 74Race White 97 97

Asian 3 1Other 0 2

Sex Male 55 50Female 45 50

People Who Died under Oregon’s Death with Dignity

ActMarital Status

Physician-Assisted Suicide

Other Deaths

Married 47 49

Widowed 22 33

Divorced 25 14

Never Married 6 4

Quick Quiz

1. Life expectancy is:a. the average age at death of the

members of a populationb. the maximum human life spanc. the maximum average human

life spand. the mortality ratee. the fertility rate

Answer: a

• Life expectancy is the average age at death of the members of a population.

2. Which of the following is not a major social cause of illness and death?a. human-environmental factorsb. lifestyle factorsc. factors related to the public health

systemd. factors related to the health care

systeme. none of these choices (that is, all the

factors listed above are major social causes of illness and death)

Answer : e

• All the factors listed below are major social causes of illness and death:

– human-environmental factors– lifestyle factors– factors related to the public

health system– factors related to the health

care system

3. What strategies do health maintenance organizations (HMOs) use to maximize profits?a. They avoid covering sick people and

people who are likely to get sick.b. Their doctor-compensation formulas

reward doctors for withholding treatments that are unprofitable.

c. They keep overhead charges high.d. All of these choices.

Answer: d

• Health maintenance organizations (HMOs) use the following strategies to maximize profits:

– They avoid covering sick people and people who are likely to get sick.

– Their doctor-compensation formulas reward doctors for withholding treatments that are unprofitable.

– They keep overhead charges high.

4. Disabled people are incapable of performing within the range of "normal" human activity.

a. Trueb. False

Answer : a

• Disabled people are incapable of performing within the range of "normal" human activity.

5. Ablism involves:a. curing disabilities to the extent

possible through medical and technological intervention

b. prejudice and discrimination against disabled people

c. the largely unintended neglect of the conditions of disabled people

d. prejudice and discrimination against disabled people, and the largely unintended neglect of the conditions of disabled people

Answer: d

• Ablism involves prejudice and discrimination against disabled people, and the largely unintended neglect of the conditions of disabled people.

6. Which of the following theories explains age stratification in terms of competition for power and wealth between age cohorts?

a. functionalist theoryb. conflict theoryc. symbolic interactionismd. essentialist theorye. postmodern theory

Answer: b

• Conflict theory explains age stratification in terms of competition for power and wealth between age cohorts.

7. _________________ is prejudice and discrimination against elderly people.

Answer: ageism

• Ageism is prejudice and discrimination against elderly people.

8. _________________ involves a doctor prescribing or administering medication or treatment that is intended to end a terminally ill patient's life.

Answer: euthanasia

• Euthanasia involves a doctor prescribing or administering medication or treatment that is intended to end a terminally ill patient's life.