Social Problems
Darryl Hall
Department of Sociology
University of Nevada, Reno
Health and Medicine
• Medicine – the social institution that involves a society’s organized ways of dealing with sickness and injury
- Back in 1941, international “health experts” identified three components of health: physical, mental, and social. As symbolic interactionists stress, health is not an objective matter but, rather, a social construction that varies from culture to culture.
- The concern of sociologists is not to define “true” health or “true” illness; rather, it is to analyze the effects that people’s ideas of health and illness have on their lives, and even the ways in which people determine that they are sick.
• Social Epidemiology – the study of disease and disability patterns in a population
• One way to see how the physical health of Americans has changed is to compare the leading causes of death in two time periods. Many of the leading causes of death in 1900 (e.g., Tuberculosis and Diarrhea) are no longer leading causes of death today. Similarly, some leading causes of death today (e.g., Murder and Suicide) were not leading causes of death in 1900. These changes indicate that health is not only a biological event; it is also social, following the contours of social change.
Social Status and Health
• Infant mortality rates are twice as high for disadvantaged groups
- The poorest in America can die from diseases that strike children in countries like the Sudan and Lebanon
• African Americans are three times more likely to be poor compared to whites
- The poor suffer more disease, missed work, and the effects from addictive behaviors
• Whites can expect to live longer and be in better health
• Poverty also breeds stress and violence
- In 1994, 5,164 African American males died due to black on black homicide
Medicine in the United States
• Direct Fee System - The patient pays directly for services provided by the doctor
• Private Insurance - In 1999, fewer than half (43 percent) of Americans have health insurance paid for by a private employer
• Public Insurance Programs
- Medicare is available to people 65 years and older, younger people who are receiving Social Security disability benefits, and persons who need dialysis or kidney transplants
- Medicaid, which provides health care coverage for the poor, is administered by the states with matching funds from the federal government
- In total, 35% of Americans receive medical attention via some form of government program, including some with private care insurance
• Health Maintenance Organizations
- About 65 million people (about 24% of the population) are enrolled in Health Maintenance Organizations (HMOs)—private insurance organizations that provide medical care to subscribers for a fixed fee.
- In order to reduce costs, HMOs focus on preventative medicine, controlling the treatment process, and sometimes even refusing to pay for a treatment.
Socialized Medicine
• Almost 43 million people (about 15% of the population) have no medical coverage. The United States is the only industrialized country without national health insurance. Other countries, such as Canada, Great Britain, Sweden, Germany, and Italy, have national health insurance systems, also referred to as socialized medicine.
• Despite differences in how socialized medicine works in various countries, what is common to all systems of socialized medicine is that the government:
1) directly controls the financing and organization of health services
2) directly pays providers
3) owns most of the medical facilities
4) guarantees equal access to health care
5) allows some private care for individuals who are willing to pay for their medical expenses
Sociological Perspectives of Health
The Functionalist Perspective
• Functionalists argue that if society is to function well, its people need to be healthy enough to perform their normal roles. This means societies must set up ways to control sickness. One way they do this is to develop a system of medical care. Also, rules are developed to keep too many people from “being sick.”
• Sick role – a social role that excuses people from normal obligations because they are sick or injured, while at the same time expecting them to seek competent help and cooperate in getting well.
- Talcott Parsons pointed out that the sick role has four elements:
1) You are not responsible for being sick
2) You are exempt from your normal responsibilities
3) You don’t like the role
4) You will get competent help so you can return to your routines
The Symbolic Interactionist Perspective
• Symbolic Interactionists focus on (1) how meanings, definitions, and labels influence health, illness, and health care and (2) how such meanings are learned through interaction with others and through media messages
• Symbolic Interactionists see illness as socially constructed—that is, there are no diseases in nature. Instead, there are only conditions that social groups have come to define as illness or disease. For example, psychiatrist Thomas Szasz argued that what we call “mental illness” is no more than a label conferred on those individuals who are “different” (i.e., those who don’t conform to social definitions of appropriate behavior).
• Definitions of health and illness vary over time and from society to society. In some countries, being fat is a sign of health and wellness; in others, it is an indication of mental illness or lack of self-control. Similarly, cigarette smoking was once defined as glamorous in the U.S.
The Conflict Perspective
• According to conflict theorists, people struggle over scarce resources, including medical treatment. They examine the relationship between class stratification (within and between societies) and the distribution of health care.
• Although it has humble origins, medicine has grown into the largest business and the only legal monopoly in the United States. This medical monopoly is so powerful that it not only wages national advertising campaigns to drum up customers but also lobbies all the state legislatures and the U.S. Congress.
• Conflict theorists also point to the existence of sexism and racism in medicine.
Issues in Health Care
1) Medical Care: A Right or a Commodity?
- A primary controversy in the US is whether or not medical care is a right or a privilege. If it is a right, then all citizens should have easy access to good medical care. If it is a privilege, then the rich will have access to one type of care, the poor to another. Currently, medical care is not the right of citizens, but a commodity to be sold at the highest price. Those with the money can buy better quality, while the poor and uninsured must go without.
- There has been a significant increase in the cost of medical care since the 1960s.
2) Social Inequality
- Sociologists have found an inverse correlation between mental problems and social class. The lower class bear many stresses that come with poverty; compared to middle- and upper-class Americans, the poor have less job security, lower wages, more unpaid bills and insistent bill collectors, more divorce, greater vulnerability to crime, more alcoholism, more violence, and more physical illness. Such conditions deal severe blows to people’s emotional well-being.
3) Malpractice Suits and Defensive Medicine
- Physicians frequently practice defensive medicine – medical practices done not for the patient’s benefit but in order to protect a physician from malpractice suits – adding several billion dollars to the nation’s annual medical bill.
4) Medical Incompetence
- Medical incompetence is extensive and fatal. The Institute of Medicine, a branch of the National Academy of Sciences, reports that each year between 44,000 and 98,000 Americans die at the hands of doctors. If the number of Americans killed by medical errors were an official classification of death, it would rank as one of the top ten leading causes of death.
5) Depersonalization: The Medical Cash Machine
- One of the main criticisms leveled against the medical profession is depersonalization – the practice of dealing with people as though they were cases and diseases rather than as individuals. People feel that the physician is impatiently counting minutes and tabulating dollars so that he or she can move to the next patient and make more money.
6) Conflict of Interest
- A physician may make hidden income by choosing one course of treatment instead of another or by referring a patient to a hospital, pharmacy, or medical supply company of which he or she is part owner. Some drug companies pay physicians to go on golf outings and river cruises. Others award doctors all-expense-paid trips to conferences. Such conflicts of interest make it difficult to know if a doctor has based a course of action on the patient’s best interest or on the best interest of the doctor.
7) Medical Fraud
- Two million Medicare claims are filed each day. Many physicians and medical suppliers have been guilty of outrageous fraud.
8) The Medicalization of Society
- Sociologists use the term medicalization to refer to the process of turning something that was not previously considered a medical issue into a medical matter (e.g., acne, anxiety, depression, balding, weight, small breasts, penile dysfunction, childbirth, wrinkles)
9) Misguided, Foolish, and Callous Medical Experiments
- At times, physicians and government officials behave so arrogantly that they callously disregard the health of the people they are sworn to protect (e.g., The Tuskegee Syphilis Experiment, The Cold War Experiments).
10) Sexism in Medicine
- On average, women outlive men by about six years. This difference is largely a result of how U.S. culture defines masculinity; because males are encouraged to be more individualistic and aggressive, they are at a higher risk for accidents, violence, and suicide.
- However, the health of women is harmed by their subordinate standing to men. Women have been traditionally ignored by medical researchers, and for years research on health issues was conducted on male subjects only.
- Physicians don’t always take women’s health complaints as seriously as they do men’s.
- Bias against women’s reproductive orders
