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Physical and Mental Health: (Some Discussion Points from Chapter 10):

Macionis introduces this chapter with three important assertions (p. 245):

A. “The United States remains the only high-income nation with no universal health care system.”

B. “In the world’s poorest nations, half of all children die before they reach age ten.”

C. “About half of all adults in the U.S. have symptoms of mental disorders at some time in their lives.”

Our text uses the UN, World Health Organization’s (WHO) definition of “health” “as a state of complete physical, mental, and social well-being.” According to WHO data one-sixth of the world’s population “suffer from serious illnesses” (p. 247). Generally speaking, people in high-income countries suffer from chronic illnesses while those in low-income nations suffer from acute illnesses.

I. Acquired Immunodeficiency Syndrome (AIDS)

A. Despite current concerns over bio-terrorism and biological weapons of mass destruction, AIDS is the most serious global health threat, world-wide. World Health Organization data from November, 2000 indicate that over 5 million new cases of AIDS were reported in the year 2000. World wide, over 40 million people were afflicted by 2003 (Macionis p. 249), Rates of infecton have surpassed even the worst predictions for the spread of this dreaded disease NY Times, 11-28-2000). The number of cases were 50 percent higher than experts predicted a decade ago. Over the past two decades, AIDS has killed approximately 22 million people world wide.

B. Africa has been worst-hit, with approximately 25 million people in sub-Saharan Africa being infected with AIDS. Infection rates are lower today, but only because so many people have the disease. In some countries one-third of all adults are infected! The WHO report also states that as a result of AIDS, South Africa—the strongest economy in the region—will experience a shrinking population by 2015 and that one-third of its skilled and un-skilled work force will be HIV positive by 2005. Today, according to one authority, 6,000 people die of AIDS every day—(almost the equivalent of two World Trade Center Attacks).

C. Today AIDS is growing most rapidly in Eastern Europe: As quoted from the U.N. World Health Organization web site < http://www.who.int/home-page/>,

D. The number of HIV infections in Eastern Europe is rising faster than anywhere else in the world according to a joint UNAIDS/WHO report. http://www.who.int/mediacentre/news/releases/2004/pr14/en/ “HIV is spreading rapidly throughout the entire Eastern European region with a quarter of a million new cases in this year alone,” said Dr Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS.

C. Although Macionis reports that the U.S. contains less than 5% of the world’s AIDS cases (p. 249), in this country AIDS is the leading killer of young adults between the aged 25 to 44 (Palen, p. 404). The U.S. Centers for Disease Control and Prevention, a young person in this country is infected every 30 minutes—That’s over 17,500 per year. http://www.cdc.gov/hiv/pubs/facts.htm> In the U.S. the cumulative number of AIDS deaths is estimated to be over 500,000. <http://www.cdc.gov/hiv/stats.htm> As Macionis points out, a higher proportion of America’s poor and minority populations (especially Blacks and Hispanics) die from AIDS because they are less likely to receive treatment.

II. Health care in the United States: Macionis points out that “The United States is the only high-income nation to rely on a direct fee system …in which patients or their insurers pay directly for the services of physicians and hospitals.” The American health care system provides excellent care for those who can afford it, but is far less successful in providing adequate health care for the lower portion of the population. It does an excellent job of addressing serious medical problems and a good job of addressing general medical needs—again for those who can afford it (Palen, 397). Access to care varies widely by socio-economic status and race. About 14% of the U.S. population lacks any form of health insurance (about 40 million people). Worst hit are the working poor who don’t qualify for MEDICAID, lack health insurance benefits from their jobs, and who don’t make enough money to pay for their own care. As a nation, the U.S. health care system, has the highest costs of any nation on earth—Over 1 Trillion Dollars per year which averages to $4,000. per person. How does this compare to other industrialized nations and why is it so expensive?

A. Macionis lists six reasons why health care is so expensive in the U.S. (p. 253)

1. The spread of private insurance

2. Specialization among physicians

3. More high technology

4. An aging population

5. A lack of preventative care

6. More lawsuits

III. Other related factors in U.S. health care

A. The U.S. health care system is focused on intervention, not prevention. As a result, it is excellent when it comes to highly expensive surgical procedures, etc., but it overlooks such things as educating the public about prenatal care, healthy lifestyle habits, etc., and providing cheap, affordable medical care that would prevent more expensive intervention later on.

B. Part of the problem is in the way the U.S. health care system is organized. All industrialized nations except the U.S. have implemented government-supported systems of health care. We have created a medical welfare system for two segments of the population—The elderly (MEDICARE) and the poor (MEDICAID). The rest of the population is on its own. Medical care in the U.S. is privately, not publicly, based.

C. In the U.S., several trends have operated to make our system “different.” The trend toward specialization (tied in with hospital-based medicine) has lead to a shortage of general practitioners and an overabundance of specialists—Why? Money. Specialists are paid much more. (In 1996, the average general practitioner in the U.S. earns $139,000 compared to $275,000 for surgeons (Parrillo, 193)).

D. The overabundance of specialists and surgeons has lead to excess of operations—(Remember the most commonly performed surgery in the U.S.—Caesarian Section?) Unnecessary surgery was a big issue in the early 1990’s when, for example, one study by the Rand Corporation found very high rates for unnecessary surgeries for three types of operations—The study concluded that only one-third of all carotid endarterectomies were performed in the interests of the patients. The rest were unnecessary (Parrillo, 193).

III. Describe how the three sociological perspectives—Functionalism, Conflict Theory, and Symbolic Interactionism approach the issue of health care in the U.S.

IV. Why does the U.S. have the highest infant mortality of all the industrialized nations listed.

V. Discuss why the poor experience; higher childhood death rates, significantly lower I.Q. scores, more learning disabilities, and higher drop out rates.

VI. Distinguish between Medicare and Medicaid and the coverage that they provide to their clientele. Which group of U.S. citizens gets the best public medical care in this country (and the world)? (Congress, the military, the poor, the elderly)

VII. What is a “mental disorder?” Look at the list of mental disorders on page 261—Which occur most frequently? (Some terms):

mental disorders: not coping with or responding rationally to the circumstances of everyday life—The terms “mental disorder” and “mental illness” are often used interchangeably, but “mental illness” is used more often to refer to those being treated by mental health practitioners, programs, or institutions (the mentally ill). (Palen, p. 408)

myth of mental illness: Myths are nonfactual beliefs that have social consequences. Psychiatrist Thomas Szasz, argues that mental illness is a myth or a fictitious construct. Mental illness is simply a problem of adjusting to life (Palen, p. 415)

neurosis: a mental disability that produces anxiety but does not prevent day-to-day operation—Neuroses involve anxiety that impairs functioning, but usually not so severely that hospitalization is required. (Palen, p. 410)

prevalence: the number of persons confined for mental illness in a population or sub-population—Serious mental disorders are most prevalent in lower-class populations. (Palen, pp. 421, 422)

psychosis: a serious mental illness that involves a sharp break with reality and prevents day-to-day operation. (Palen, p. 410)

VIII. Know and be able to describe the following: The Medical Model; The Social Construction of Mental Illness; The “Myth of Mental Illness”; The Sick Role;

IX. Discuss the treatment of mental illness from a historical perspective.

X. How are factors of race, age, sex, and marital status related to mental illness?

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