Chapter 18: Health, Health Care, and Disability

Table of Contents

1. Health And Medicine
2. Sociological Perspectives On Health
3. Social Factors In Health: Age, Sex, And Social Class
4. Race, Class, And Health: Canada's Aboriginals
5. Disability
6. Social Development And Health: A Global Perspective
7. Approaches To Health Care
8. Health Care Issues In The Future

I. The Sociological Study Of Religion

1. At one time health was defined as the absence of disease. More recently, though, the definition has expanded. The World Health Organization now defines health as a state of complete physical, mental, and social well being. The definition of health will vary across cultures.

2. Medicine is an institutionalized system for the scientific diagnosis, treatment, and prevention of illness. It forms a vital part of the larger concept of health care, which is any activity intended to improve health. Health care has undergone much change recently. For instance, the field of preventative medicine-medicine that emphasizes a healthy lifestyle in order to prevent poor health, rather than medicine that simply focuses diagnosis and treatment-is receiving increasing attention.

II. Sociological Perspectives On Health

1. The Functionalist Perspective on Health: The Sick Role
   1. Talcott Parsons's work on the sick role is one of the most significant contributions to the sociology of health care from a functionalist approach. All societies have a sick role-patterns of behaviour defined as appropriate for people who are sick. There are four aspects to Parsons's model.
      1. The sick person is exempt from normal social responsibilities.
      2. The sick person is exempt from responsibility for his or her condition.
      3. The sick person must want to get well.
      4. The sick person should seek competent help and cooperate with health care practitioners to hasten his or her recovery.

2. Critics of the sick role argue that it places too much responsibility for illness on the sick people themselves, neglecting the fact that often the actions of other people may be the cause of someone's illness. Critics have noted that the sick role is more appropriate for those with acute illness rather than those with chronic illness.
   
   
2. Symbolic Interactionist Perspectives: The Social Construction of Illness
   1. Symbolic interactionists attempt to understand the specific meaning and causes that we attribute to particular events. In studying health, interactionists focus on the fact that the meaning that social actors give their illness or disease will affect their self-concept and their relationships with others.
      
      
   2. Medicalization refers to the process by whereby an object or a condition becomes defined by society as a physical or psychological illness. It usually entails the application of medical technology in the diagnosis and treatment of the condition. Issues surrounding medicalization are complex.
      1. In many cases, what was once defined as "badness" is redefined as "sickness," as in the case of disruptive behaviour of children in schools.

2. Just as conditions can be medicalized, they can also become demedicalized, as in the case of homosexuality.
   
   
3. Conflict Theory: Inequalities in Health Care
   1. The conflict approach considers the political and social forces that affect health and illness and the health care system and the inequities that result from these forces.
      1. Sociologists taking this approach might considering looking at the debate over the allocation of money for research and treatment of different diseases like AIDS and breast cancer.

III. Social Factors In Health: Age, Sex, And Social Class

1. Age
   1. Rates of illness and death are highest among the old and the young. One of the main implications of this is that the cost of health care will increase as the majority of Canadians grow older. For instance, there will be more cases of diseases that affect the elderly, such as senile dementia, many of which often require costly institutional care.
      
      
   2. Changes will have to be made in the way the health care system in Canada is organized and funded in order to accommodate demographic changes in the population.
      
      
2. Sex
   1. Prior to this century, men lived longer then women. Women now live longer than men. There are three reasons for this change: (1) men are more likely to work in dangerous occupations; (2) women are more likely to make use of health care; and (3) there are biological differences that contribute to higher survival rates for women.
      
      
   2. As the gender roles between men and women become less distinct, it is likely that this difference in mortality will decrease. Also, women are engaging more in activities that affect their health, such as smoking.
      
      
   3. Because women live longer, many believe that they are healthier. While men at every age have more fatal diseases, women have higher rates of nonfatal chronic conditions.
      
      
3. Social Class
   1. The poor have worse health than the rich. This is true in poor and rich countries.
      
      
   2. While poverty is correlated with poor health, government policy-like providing the poor with access to medical advice-can help reduce its effects.

3. However, medical care cannot compensate for the other disadvantages of poverty such as poor housing, hazardous employment, inadequate diet, greater exposure to disease, and the psychological stresses of poverty.

IV. Race, Class, And Health: Canada's Aboriginals

1. Health Problems Among Aboriginal People in Canada
   1. Aboriginal people have a history of serious health problems that begins with their early contact with Europeans. The epidemics that resulted from this early contact were dramatic, but death rates from diseases such as typhoid fever and puerperal fever caused by poor sanitation were also high.
      
      
   2. Aboriginal people still die earlier than other Canadians. A major factor behind this is poverty, which affects health on many levels, such as adequate nutrition. Other factors are inadequate housing, crowding, and poor sanitary conditions. Aboriginal people also have a high rate of suicide and violent death
      
      
   3. The legacy of colonialism still affects Aboriginal people's health problems. The destruction of Native language and religion, the family breakdown by enforced attendance at residential schools, and the forced relocation of Native communities all have a serious negative impact on the health of Aboriginal people in Canada.
      
      
2. Aboriginal Healing Methods
   1. Aboriginal cultural and healing traditions are holistic and deal with the interactions between spirit, mind, and body. However, the Western medical model has been dominant in Native communities as it has in the rest of Canada. Currently, many traditional healing practices are becoming popular again.
      
      
   2. Holistic methods are important, in part, for the treatment of alcohol and drug problems, but also in the treatment of other illnesses and injuries.

V. Disability

1. Disability has existed in all societies throughout human history. How a particular society has dealt with disability differs on the basis of culture, values, and technology. In pastoral societies, the migratory life inherent in moving herds of animals to new pastures may have serious consequences for those with an immobilizing disability, for example.
   
   
2. An estimated 4.2 million persons in Canada have one or more physical or mental disabilities, and the number is increasing as medical advances make it possible for those who would have died from an accident or illness to survive (but with an impairment) and as life expectancies increase.
   
   
3. Environment, lifestyle, and working conditions may contribute to disability. Inhaling air pollution in automobile-clogged cities, smoking cigarettes, or working in second-tier labour market positions, for example, increase the likelihood of disability.

4. Many disability rights advocates argue that persons with a disability are kept out of the mainstream of society; they have been denied equal educational opportunities by being consigned to special classes or schools. Persons with disabilities must cope with living in a society that tends to stigmatize them.

VI. Social Development And Health: A Global Perspective

1. Poverty and colonialism have had an impact on health care issues on a global scale. For instance, the differences between poor and rich countries is dramatically reflected in infant mortality. Most deaths in less-developed countries are caused by infectious and parasitic diseases that are now rare in the industrialized world.
   
   
2. Health Care in Canada
   1. In 1998, Canada was ranked the best place in the world to live, in large part due to its health care system. However, some feel that the system may be wasting away because of budget cuts. Nevertheless, Canadians still value their health care system and are determined to ensure its survival.
      
      
   2. Canadians have not always had a universal health care system. Before the 1960s, health care was organized around a user pay system. By 1972, following developments in Saskatchewan, all provinces had coverage for hospital and medical services. Health care is a provincial responsibility, but each province must meet the five following requirements: (1) universality; (2) comprehensiveness; (3) accessibility; (4) portability; and (5) public administration.
      
      
   3. The health care system has been criticized for several reasons, primarily that it is costly and often focuses too much on hospitals and doctors. There tends to be an overemphasis on acute care and a lack of recognition of community care and preventative medicine.
      
      
3. Health Care in the United States
   1. The United States is the only industrialized country without a health care system that provides universal coverage to all its citizens. It is a mixture of private and public health care providers with no centralized control.

2. Despite the lack of universal coverage, per capita health care costs in the United States are much higher than in Canada

VII. Approaches To Health Care

1. Medical Model of Illness
   1. The medical model has been the predominant way of thinking about illness in Western industrialized societies. It has five basic assumptions: that illness is (1) deviation from normal; (2) specific and universal; (3) caused by unique biological forces; (4) similar to the breakdown of a machine whose parts can be repaired; and (5) defined and treated through a neutral scientific process.
      
      
2. Alternative Approaches
   1. Despite its many successes, modern medicine is losing some of its dominance. The cost crisis in Medicare has led the federal government to implement programs in support of an approach that emphasizes environment and lifestyle in health promotion.
      
      
   2. The popularity of the holistic health care movement is a further indication of the move toward a new definition of health. Advocates argue that the holistic model emphasizes the interdependence of body, mind, and environment.
      
      
   3. The holistic model also emphasizes the role of social factors in illness. Slowly, traditional practitioners are beginning to see the benefits of this approach.
      
      
   4. Alternative approaches will continue to challenge traditional medicine's preoccupation with illness and disease and its focus on treatment by conventional biomedical means. However, there have been some criticisms of the holistic approach. Consumers of health care will need to be sufficiently well informed about the variety and nature of the options available to make sound treatment choices in the future.

VIII. Health Care Issues In The Future

1. Health and health care have changed dramatically and will continue to change in the years to come.
   1. Scientific developments will improve the lives of many but will also create some very difficult social and ethical problems that will continue to be debated for years to come.
      
      
   2. Unless there is a shift in the economy, Canadians have likely seen the last of the major cuts to the health care system.
      
      
   3. While the health of Canadians will likely continue to improve in the future, at the global level there is great cause for concern. Improving the health of the world's population will require social change as well as improved ways of treating the sick.

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