Chapter 18

Health, Health Care, and Disability

Quick Start Question

CHAPTER 18 Health, Health Care, & Disability
Quick-start question: Is affordable health care a human right?
Additional quick-start questions:
 Where do you currently receive the health care that you receive, and how is it paid for?
 Do you know anyone with, or do you yourself have, a disability? If so, what are the
challenges associated with it?

BRIEF CHAPTER OUTLINE

Health in Global Perspective

Health in the United States
Social Epidemiology
Health Effects of Disasters
Lifestyle Factors
Health Care in the United States
The Rise of Scientific Medicine and Professionalism
Medicine Today
Paying for Medical Care in the U.S.
Paying for Medical Care in Other Nations
Social Implications of Advanced Medical Technology
Holistic Medicine and Alternative Medicine
Sociological Perspectives on Health and Medicine
A Functionalist Perspective: The Sick Role
A Conflict Perspective: Inequalities in Health and Health Care
A Symbolic Interactionist Perspective: The Social Construction of Illness
A Postmodernist Perspective: The Clinical Gaze
Mental Illness
The Treatment of Mental Illness
Disability
Sociological Perspectives on Disability
Health Care in the Future

STUDENT LEARNING OBJECTIVES

LO1: Discuss the relationship between the social environment and health and illness.
LO2: Define social epidemiology and identify key demographic factors that are studied by social
epidemiologists.
LO3: Explain how the profession of medicine emerged in the United States.
 Health, Health Care, and Disability

LO4: Discuss how health care is paid for in the United States, including the provisions of the
2010 Affordable Care Act.
LO5: Compare how the United States pays for healthcare with how other nations provide health
services for their citizens.
LO6: Describe how advanced medical technology has changed the practice of medicine and the
cost of health services.
LO7: Explain how functionalist, conflict, symbolic interactionist, and postmodern approaches
differ in their analysis of health and health care.
LO8: Discuss what is meant by the term mental illness and explain why it is a difficult topic for
sociological research.
LO9: Discuss the concept of disability and identify key sociological perspectives on disability.

KEY TERMS: Defined at page number shown and in glossary

acute diseases, 543 infant mortality rate, 540
chronic diseases, 543 life expectancy, 540
deinstitutionalization, 567 managed care, 556
demedicalization, 563 medical–industrial complex, 562
disability, 567 medicalization, 563
drug, 545 medicine, 539
health, 539 sick role, 561
health care, 539 social epidemiology, 543
health maintenance organization (HMO), 556 socialized medicine, 558
holistic medicine, 560 universal health care, 558

CHAPTER OUTLINE
1. HEALTH IN GLOBAL PERSPECTIVE LEARNING
OBJECTIVE:
A) Sociology and everyday life: How much do you know about health, Discuss the
illness, and health care? (self quiz) relationship
B) The World Health Organization defines health as a state of complete between the
social
physical, mental, and social well-being. environment
C) Illness refers to an interference with health; like health, illness is and health and
socially defined and may change over time and between cultures. illness.
D) Health care is any activity intended to improve health.
E) Medicine, an institutionalized system for the scientific diagnosis,
treatment, and prevention of illness; is a vital part of health care.
F) Life expectancy refers to an estimate of the average lifetime of people
born in a specific year.
G) Infant mortality rate is the number of deaths of infants under 1 year
of age per 1,000 live births in a given year.
i) A large proportion of infant deaths occur in the first month of life.
ii) Reasons for low life expectancy and high infant mortality include
insufficient or contaminated food, lack of access to safe water,
inadequate sewage and waste disposal, and lack of qualified
Chapter 18

physicians and health care facilities.

H) Global health concerns include
i) Undiagnosed or untreated hypertension
ii) Obesity
iii) Maternal death
iv) Lack of adequate funds to pay for health care.
A) Sociology and everyday life: ANSWERS to the sociology quiz on
health, illness, and health care
I) Framing health issues in the media: It’s right for you! The framing of
drug ads
i) Television and Internet ads for drugs are bombarding consumers.
ii) Drug ads account for nearly $5 billion in annual advertising
dollars.
iii) Ads for drugs tend to use a ‘real person’ trope with a sympathetic
message, and intuitive statements that suggest a solution to
difficulties.
iv) Many ads don’t tell the whole story.
a) In some cases other drugs, or a non-drug option, may be more
effective than what is being marketed.
b) Other ads encourage people to ask their doctors for a specific
drug even though they may not be good candidates for the
treatment.
2. HEALTH IN THE UNITED STATES
A) Why are some people healthier than others in the U.S.? Is this due to
biology or environment?
B) Social epidemiology investigates disease agents, the environment, and LEARNING
the human host as sources of illness. OBJECTIVE:
i) Disease agents include insects, bacteria, and viruses. Nutrient Define social
epidemiology
agents include fats and carbohydrates. Chemical agents include and identify key
gases and pollutants in the air, as well as temperature, humidity, demographic
and radiation. factors that are
studied by
ii) The environment includes the physical, the biological, and the social
social. epidemiologists.
iii) The human host takes into account demographic factors like age,
sex, and race/ethnicity.
C) Age
i) Rates of illness and death are highest among the old and the
young.
ii) Mortality rates drop shortly after birth, and then begin rising
significantly again during middle age.
iii) After age 65, rates of chronic diseases (or illnesses that are long
term or lifelong and develop gradually or are present from birth)
and mortality increase rapidly.
iv) In contrast, acute diseases are illnesses that strike suddenly and
cause dramatic incapacitation and sometimes death.
v) The cost of caring for an aging population will increase as this
 Health, Health Care, and Disability

segment of the population increases.

D) Sex
i) Prior to the twentieth century, women had lower life expectancies
than men because of high mortality rates during pregnancy and
childbirth.
ii) Today, women on average live longer than men. At birth, females
have lower mortality rates both in the prenatal stage and during
the first month of life.
iii) Gender roles and gender socialization appear to contribute to the
greater mortality rates for men: men are more likely to work in
dangerous occupations, engage in risky behavior, and put off
seeking medical treatment for health issues.
iv) While men have higher rates of mortality, women have greater
rates of chronic illness.
E) Race/ethnicity and social class
i) Some research points out that social class is a greater determinant
of health than race/ethnicity.
ii) Illness is also related to a person’s occupation.
iii) However, although Latino/as are more likely than non-Latino/as to
live below the poverty line, they have lower death rates from
heart disease, cancer, accidents, and suicide, and an overall lower
death rate.
a) Dietary factors may play a role
b) Social support and strong family life may also influence
morbidity and mortality
F) Health effects of disasters
i) Disasters have a detrimental effect on people’s health and well-
being, and contribute to higher rates of disability and mortality.
ii) The World Health Organization defines a disaster as “a sudden
ecological phenomenon of sufficient magnitude to require
external assistance” (Goolsby, 2011, in text p. 528)
iii) Disasters are classified as either natural or technological
a) Natural: earthquake, hurricane, tornado, flood, volcano
eruption, tsunami, etc. caused by nature
b) Technological: toxic spills, fires, nuclear crises, terror attacks,
etc., caused by human actions.
iv) Difference between disaster treatment and medical emergency
treatment:
a) Emergency services: maximal resources, small number people
b) Disaster services: limited resources, large number of people
vii) The World Health Organization is one organization leading the
drive for more effective disaster risk management for health related
concerns.
G) Sociology in global perspective: Medical crises in the aftermath of
disasters: from Alabama to Japan
i) Both Florence, Alabama and Kesennuma, Japan had
Chapter 18

difficulties taking care of the sick and injured after deadly natural
disasters in 2011
ii) In Japan, a powerful earthquake and tsunami devastated
much of the region and caused radiation leakage at earthquake-
damaged nuclear power plants.
Lifestyle factors
i) Drug use affects health in many ways.
a) A drug is any substance other than food or water which,
when taken into the body, alters its functioning in some way.
(1) Therapeutic use is when someone takes a drug for a
specific purpose such as reducing fever or controlling
cough.
(2) Recreational use is when someone takes a drug for no
purpose other than the pleasurable feeling or
psychological state caused by its use.
b) Nicotine (tobacco) is a toxic and dependency-producing
psychoactive drug that is more addictive than heroin.
Tobacco use is linked to cancer and other serious diseases.
c) The use of illegal drugs, like cocaine and marijuana, affect
the lifestyle and health of individuals.
ii) Alcohol is a commonly accepted drug used in the dominant
culture of the U.S.
a) Adults consume more beer on average than milk or coffee
b) Long-term heavy use of alcohol can damage the brain and
other parts of the body, and cause nutritional deficiencies,
cardiovascular problems, and alcoholic cirrhosis.
c) Alcoholism can be overcome with help of organizations such
as Alcoholics Anonymous.
iii) Nicotine (tobacco)
a) Nicotine is a toxic, dependency-producing psychoactive drug
more addictive than heroin.
b) It is a stimulant, and activates central nervous system receptors
to release adrenaline.
c) Tobacco use is responsible for about one in five deaths in the
U.S.
d) Nonsmokers can still be harmed by environmental tobacco
smoke from others’ smoking.
iv) Illegal drug use
a) Marijuana is the most extensively used illegal drug in the U.S.
(1) Massive numbers of young people report marijuana use
(2) Marijuana use during pregnancy can disrupt fetal
development and cause abnormalities.
(3) Marijuana use has been associated with increased cancer
risk in some studies.
b) Cocaine is also widely used, and can be inhaled, injected, or
smoked.
 Health, Health Care, and Disability

(1) Use of cocaine over extended periods is associated with

increased rates of infection, heart problems, internal
bleeding, stroke, hypertension, and other health
complications.
(2) Intravenous use of cocaine increases the risk of contracting
AIDS if the user shares needles with others.
v) Sexually transmitted disease
a) Sexual activity can result in the transmission of certain STDs,
including AIDS, gonorrhea, syphilis, and genital herpes.
b) Prior to the 1960s, barrier contraceptives had sharply reduced
incidence of STDs in this country.
c) Introduction of the pill in the 1960s and 1970s caused STD
rates to increase rapidly again.
d) Chlamydia, Gonorrhea and syphilis
(1) Chlamydia is the most commonly reported STD in terms
of new annual cases.
(2) Gonorrhea is the second most commonly reported STD in
the country.
(3) Untreated gonorrhea can spread to other areas of the body
beyond the genitals, including the brain or heart, and can
damage fertility or cause death
(4) .Syphilis can be contracted by kissing or coming into
intimate contact with someone who is infected, not just via
intercourse.
(5) Untreated syphilis can cause cardiovascular problems,
brain damage, or death.
(6) Both gonorrhea and syphilis of these conditions can
usually be cured with penicillin if they have not yet
spread.
f) AIDS
(1) Aids is caused by HIV.
(2) AIDS almost inevitably ends in death, but no one
actually dies of AIDS.
(3) AIDS reduces the body’s ability to fight disease.
(4) AIDS was first identified in 1981, and the total number
of AIDS related deaths in the U.S. through 1985 was
only 12,493.
(5) Current estimates of people living with HIV/AIDS in the
U.S. suggest that there are 1.1 million people living with
the virus.
(6) Worldwide, the number of people with HIV or AIDS
continues to increase.
(7) Africa is the most heavily affected area.
(8) HIV is transmitted through: unprotected or inadequately
protected intercourse with an infected partner, by sharing
contaminated needles, by exposure to blood or blood
Chapter 18

products that carry the virus, or via mother-infant

transmission during pregnancy, birth or breastfeeding.
g) Staying healthy: diet and exercise
(1) Over the past several decades a dramatic improvement in
our understanding of food and diet has taken place.
(2) Many people have improved their diets and eat more
vegetables, fruits, and cereals and fewer saturated fats.
(3) Recent studies suggest that the percentage of overweight
adults and children is increasing.
(4) Regular exercise is also helpful at protecting health and
slowing aging.
3. HEALTH CARE IN THE UNITED STATES
H) The rise of scientific medicine LEARNING
OBJECTIVE:
i) Medicine had previously been viewed as more of an art than a Explain how the
science. profession of
ii) This resulted from several significant discoveries during the medicine
emerged in the
nineteenth century in areas such as bacteriology and United States.
anesthesiology.
iii) During this same period, people were beginning to believe that
almost any task could be done better with the use of scientific
methods.
iv) The Carnegie Foundation commissioned an official study of
medical education, which produced the “Flexner report.”
I) The Flexner Report
i) Flexner created a model of medical education.
ii) Those medical schools that did not fit the “model” were closed.
a) Only two of the African American medical schools survived.
b) Only one of the medical schools for women survived.
c) Because of this, white women and people of color were largely
excluded from medical education for the first half of the
twentieth century.
B) The professionalization of medicine
iii) Medicine has the following characteristics:
a) Abstract, specialized knowledge
b) Autonomy
c) Self-regulation
d) Authority
e) Altruism
J) With professionalization resulting from the Flexner Report, licensed
medical doctors gained control over the entire medical establishment.
K) Medicine today
i) Paying for health care has traditionally been on a fee-for-service
basis.
ii) Patients are billed individually for each service they receive.
a) This includes treatment by doctors, laboratory work, hospital
visits, other health-related expenses, and prescriptions
 Health, Health Care, and Disability

b) This payment is expensive.

c) Few restrictions are placed on the fees that doctors, hospitals,
and medical providers can charge.
d) The fee-for-service model has caused inequality of
distribution and a two-tier system of medical care.
e) Costs of health care are rising even during periods of
economic distress.
L) Paying for medical care in the U.S.
i) The 2010 Patient Protect and Affordable Care Act of 2010 health LEARNING
OBJECTIVE:
care reform law Discuss how
a) This major health care bill was signed into law in 2010 health care is
b) One of the central tenets in the law is the creation of a new paid for in the
United States,
insurance marketplace that lets individuals and families including the
without coverage, and small business owners, pool their provisions of
resources to increase buying power. the2010
Affordable Care
c) Private insurance companies will compete for their business. Act.
d) Reform was scheduled to occur in stages between 2010 and
2019.
e) The constitutionality of the Affordable Care Act has been
upheld by the Supreme Court.
ii) Private health insurance
a) Third party providers: health insurance research and
development of new products programs expanded in the
l960s.
(1) Third party providers pay large portions of doctor and
hospital bills for insured patients.
(2) Private health insurance plans are organized like other
large-scale, for-profit corporations.
(3) Some believe that a third party fee-for-service approach
is the best way to manage medical care, while others
argue that fee for service is outrageously expensive.
b) The U. S. has two nationwide public health insurance
programs:
(1) Medicare, for those sixty-five or older who are eligible;
Part A is hospital insurance, and Part B is medical
insurance.
(2) Medicaid, a jointly funded federal-state-local program,
makes health care more available to the poor.
(3) Both programs were in financial difficulty today when
the health care reform law passed in 2010
iii) Preventative Health Care Services
a) The Affordable Care Act provides more money for
penetrative care services.
iv) Health maintenance organizations
a) HMOs were created to provide workers with health coverage
by keeping costs down.
Chapter 18

(1) HMOs provide total care for a set monthly fee, with an
emphasis on prevention to avoid costly treatment later.
(2) In this model, doctors do not work on a fee-for-service
basis.
b) Concerns about HMOs include concern about physicians
being used as gatekeepers and preventing some patients from
obtaining referrals to specialists.
c) Critics also charge that HMOs whose physicians are paid on
a capitation basis (fixed amount per patient) encourage
doctors to under-treat patients.
v) Managed care
a) Managed care is any system of cost containment that closely
monitors and controls health care providers’ decisions about
medical procedures, diagnostic tests, and other services that
should be provided to patients.
b) In the U.S. one form of managed care is a preferred provider
organization, or PPO, where doctors and other medical
professionals enter into a contract with an insurer or third
party to provide care at a reduced rate to patients in different
plans.
c) Patients choose a primary-care physician from a list of
participating doctors.
d) Doctors must get approval before they perform any
procedures or admit a patient to a hospital (nonemergency).
e) The new health care reform law is meant to ensure that those
who lose their jobs, change jobs, move out of state, get
divorced, or are diagnosed with a serious illness, are still able
to receive care.
vi) The uninsured
a) About one-third of all U. S. citizens are uninsured or had
difficulty getting or paying for medical care in the last year.
b) Under the new health care reform, this situation will not
change significantly until 2014.
c) In 2014, states will open a health insurance exchange or
marketplace for the uninsured.
d) Children who are more likely to be uninsured are often in
poverty, are Hispanic (any race), and are not citizens of the
United States.
e) Rates of uninsured children would be even higher if not for
state-sponsored plans to insure children.
f) Every racial and ethnic group is affected by lack of health
insurance, but Latinos/as and African Americans are more
likely to be uninsured than white non-Hispanic Americans.
g) Many insured people have coverage through their employers..
C) Paying for medical care in other nations
vii) Canada
 Health, Health Care, and Disability

a) Canada has a universal health care system, in which all LEARNING

OBJECTIVE:
citizens receive medical care paid for by tax revenues. Compare how
b) These revenues are supplemented by insurance premiums the United
paid by all taxpaying citizens. States pays for
healthcare with
c) Administrative costs in Canada are only 10 percent, while how other
those in the U.S. are more than 20 percent. nations provide
d) This system does not constitute socialized medicine. health services
for their
viii) Great Britain citizens.
a) The British has long been a centralized, single-payer system
funded by general revenues.
b) Now, discussions are underway regarding decentralization of
health care.
c) The National Health Service Act of 1946 provided health
care services to be available at no charge to the entire
population.
d) This system is an example of socialized medicine.
e) Socialized medicine is a health care system in which the
government owns the medical care facilities and employs the
physicians.
f) Physicians are paid by the government, and receive a fixed
fee per patient regardless of how many times the patient is
seen.
g) Physicians may accept private patients, but such patients
rarely constitute more than a small fraction of a medical
practice.
h) A new plan to cut medical costs, avoid duplication of
services, and make the system less cumbersome, has been set
forward in the Health and Social Care Bill of 2011.
ix) People’s Republic of China
a) In the past two decades, the health care system in China has
become a complex mix of market-driven capitalism,
communism, and massive government spending.
b) After a lengthy civil war, in 1949 the Communist Party won
control of mainland China, and found a vast nation with one
billion people, most of whom lived in poverty and misery.
c) To deal with problems like malnutrition, short life
expectancies and high infant and maternal mortality rates,
China made use of physician extenders to provide health care.
d) Today, doctors who work in hospitals receive a salary; all
others work on a fee-for-service basis.
e) In urban areas, latest reports suggest that it is difficult to get
into a hospital even with insurance.
M) Social implications of advanced medical technology
i) The new technologies create options for people and society, LEARNING
OBJECTIVE:
but options that alter human relationships. Describe how
ii) The new technologies increase the cost of medical care. advanced
medical
Chapter 18

iii) The new technologies raise provocative questions about the technology has
changed the
very nature of life. practice of
N) Holistic medicine and alternative medicine medicine and
i) Holistic medicine and alternative medicine provide variations the cost of
health services.
from traditional (or orthodox) medical treatment.
ii) Holistic medicine focuses on prevention of illness and disease,
and aims at treating the whole person―body and mind―rather
than just the part or parts in which symptoms occur.
iii) Alternative medicine involves healing practices which take a
holistic approach inconsistent with dominant medical practices.
iv) Global communications networks have informed millions of
people about alternative medicines.
v) Some medical professionals are concerned that some
consumers may be misled and influenced to purchase bogus
products and services that might be dangerous.
4. SOCIOLOGICAL PERSPECTIVES ON HEALTH AND MEDICINE
H) A functionalist perspective: The sick role LEARNING
i) According to Talcott Parsons, the sick role is the set of OBJECTIVE:
patterned expectations that define the norms and values Explain how
functionalist,
appropriate for individuals who are sick and for those who conflict,
interact with them. symbolic
ii) The sick role has four characteristics: interactionist,
and postmodern
a) A person’s sickness is not deliberate. approaches
b) A sick person is exempted from responsibilities. differ in their
c) A sick person must want to get well. analysis of
health and
d) A sick person must seek competent help from a medical health care.
professional.
iii) Illness is dysfunctional for individuals and the larger society.
a) Sick people are unable to fulfill their necessary social roles.
b) It is important for the society to maintain social control over
people who enter the sick role.
iv) Critics point out that this model does not take into account racial-
ethnic, class, and gender variations in the way that people view
illness and interpret the role.
I) A conflict perspective: Inequalities in health and health care
i) Conflict theorists emphasize the political, economic, and social
forces that affect health and the health care delivery system.
ii) Medicine is a commodity that is produced and sold by the
medical-industrial complex.
a) The medical-industrial complex encompasses local
physicians and hospitals, as well as global health-related
industries such as insurance companies and pharmaceutical
and medical supply companies that deliver health care.
iii) Medical care is linked to people’s ability to pay and their
position within the class structure.
iv) The medically indigent are those individuals who do not earn
 Health, Health Care, and Disability

enough to afford private care but earn too much to qualify for
Medicaid; these people may fall between the cracks of the health
care system.
v) Physicians hold a legal monopoly over medicine. They can
inflate their fees.
vi) Clinics, pharmacies, laboratories, hospitals, insurance
companies, and many other corporations derive excessive profits
from the existing system of payment in medicine.
J) A symbolic interactionist perspective: The social construction of
illness
i) Interactionists focus on the meaning that actors give their
illness or disease and how this will affect their self-concept and
their relationship with others.
ii) In addition to the objective criteria for determining medical
conditions, the subjective component is very important.
iii) The term medicalization refers to the process whereby
nonmedical problems become defined and treated as illnesses or
disorders.
iv) Medicalization may occur on three levels:
a) The conceptual level
b) The institutional level
c) The interactional level
v) Medicalization is typically the result of a lengthy promotional
campaign, often culminating in legislation or other social policy
changes that institutionalize a medical treatment of a new
“disease.”
vi) This has been referred to as the “medicalization of deviance”
because it gives physicians and other medical professionals
greater authority to determine what is considered “normal” or
“acceptable.”
vii) Demedicalization refers to a problem that no longer retains its
medical definition.
K) Sociology works! Sociology sheds light on the physician-patient
relationship
i) The voice of medicine is the technical scientific attitude adopted
by many doctors in their communications with patients.
ii) This communication is generally abstract, neutral, and somewhat
distant.
iii) The voice of the lifeworld is the natural, everyday attitudes that
are expressed by patients when they talk to their physician in the
hope of gaining insight.
iv) Some sociologists suggest a constant struggle between these
voices.
v) Some sociologists advocate therapeutic communication where:
a) the physician engages in full and open communication with the
patient
Chapter 18

b) the patient provides full and open information and feels free to
ask questions
c) a genuine rapport develops between doctor and patient
L) A postmodernist perspective: The clinical gaze
i) In The Birth of the Clinic, postmodernist Michel Foucault
questioned existing assumptions about medical knowledge and
the power that doctors have gained over other medical personnel
and everyday people.
ii) Foucault asserted that truth in medicine, like all other areas of
life, is a social construction.
iii) Foucault believed that doctors gained power through the
clinical, or observing, gaze which they use to gather information.
iv) Medical power advanced when it became possible to
categorize all illnesses within a definitive network of disease
classification.
v) The invention of new tests meant that doctors now had to
examine the naked body, listen to the heart, and run tests on
bodily fluids. LEARNING
5. MENTAL ILLNESS OBJECTIVE:
Discuss what is
H) Some analysts, such as Szasz, have argued that mental illness is a meant by the
myth, and that “mental illnesses” are actually individual traits or term mental
behaviors that society deems unacceptable, immoral, or deviant. illness and
explain why it is
I) Mental illness, a condition in which a person has a severe mental a difficult topic
disorder requiring extensive treatment, differs from a mental disorder, for
a condition that makes it difficult or impossible for a person to cope sociological
research.
with everyday life.
J) Nearly 20 percent of adults age 18 or over have experienced mental
illness.
K) Treatment of mental illness
i) According to Foucault, early in the period from 1500-1800,
mental illness was considered part of everyday life, and the
mentally ill were free to walk the streets.
ii) Beginning in the Renaissance and continuing into the 17th and
th
18 centuries, the mentally ill begin to be seen as a threat to
others, asylums were built, and the distinction between “insane”
and the rest of humanity developed.
iii) Substance-related disorders are the leading cause of
hospitalization for men between the ages of 15 and 44, and the
second leading cause for women in that age group.
iv) The introduction of new psychoactive drugs to treat mental
disorders and the deinstitutionalization movement have created
dramatic changes in how people with mental disorders are treated.
a) Deinstitutionalization refers to the practice of rapidly
discharging patients from mental hospitals into the
community.
b) Deinstitutionalization is now viewed as the problem by many
 Health, Health Care, and Disability

social scientists.
c) Involuntary admission to a mental hospital has always been
controversial, but remains the primary way that police officers,
judges, social workers, and other officials deal with those they
believe are mentally ill and inherently dangerous to self or
others.
d) Mental hospitals are a classic example of Goffman’s total
LEARNING
institution.
OBJECTIVE:
6. DISABILITY
Discuss the
H) Disability is a physical or mental impairment that substantially limits concept of
one or more major activities that a person would normally do at a given disability and
stage of life, and that may result in stigmatization or discrimination. identify
key sociological
i) Some involve physical conditions, while others involve mental perspectives on
abilities. disability.
ii) According to disability rights advocates, the social and
physical environment in which people live are contributing factors
to the extent to which a person may be considered “disabled.”
a) A disabling environment example is a building in which
elevator buttons or faucets on public restroom sinks are
located beyond the reach of a person using a wheelchair.
b) Advocates argue that disability must be considered in terms
of how society causes or contributes to the problem, not what
is “wrong” with the person.
iii) People who have a disability are often viewed or treated
differently by people, which can be isolating.
iv) An estimated 56.7 million Americans have some level of
disability, and about 38.3 million have a severe disability.
a) Anyone can become disabled, but some are more likely than
others: African Americans have higher rates than whites,
persons with lower incomes, and older persons are also more
likely to become disabled.
b) Environment, lifestyle, and working conditions may also
contribute to disability.
c) When an infant is born with a disability, the experience is
lifelong for both parents and children.
d) Among persons who acquire disabilities later in life, the
social significance of the disability can be seen in: their initial
response, how they view their situation and future, how the
disability affects their lives.
e) Generally, people react to disability with either avoidance or
vigilance.
I) Sociological perspectives on disability
i) The medical model suggests that people with disabilities become
chronic patients.
ii) Symbolic interactionists suggest that those with a disability
experience role ambiguity because many people equate disability
Chapter 18

with deviance.
a) Freidson suggests that how people are labeled results from:
their degree of responsibility for their impairment, the apparent
seriousness of their condition, and the perceived legitimacy of
the condition.
iii) Conflict theorists suggest that persons with a disability are
members of a subordinate group in conflict with those in power.
iv) Many working-age persons with a disability in the U.S. are
unemployed, and when persons with a severe disability are able to
find jobs they earn less than those without disabilities.
v) Census profiles: Disability and employment status
a) The U.S. Bureau of the Census asks about long-lasting
conditions such as physical, mental, or emotional conditions
that limit important basic activities.
b) They also ask whether people are working at a job or business.
c) For people ages 21 to 64, less than 50% of those with a
disability were employed, compared to nearly 80% of those
without a disability.
vi) Social inequalities based on disability
a) People with disabilities are often the objects of prejudice and
discrimination that interfere with their everyday lives.
b) Employment, poverty and disability are related.
(1) People may become economically disadvantaged as a
result of a chronic illness or disability.
(2) Poor people are less educated, and more likely to be
malnourished and have inadequate access to health care.
7. HEALTH CARE IN THE FUTURE
H) It is still too early to evaluate how the Affordable Care Law will affect
health care in this nation.
I) A key issue in the U.S. is how to prevent, reduce, and best treat
epidemics that affect all Americans.
i) The Obama administration has developed a national HIV/AIDS
strategy
ii) This is designed to reduce the number of people who become
infected, and to increase access to care and improve health
outcomes for those already infected.
J) Another major issue is the role of advanced technology and the role
that its use plays in the rising costs of medical care, as well as their
usefulness as tools for diagnosis and treatment.
i) Major stimulus for social change
ii) Even more accurate and quicker diagnosis likely
iii) May bring increased life expectancy
iv) Dysfunction related to technology is also possible
a) Side effects or unintended outcomes
b) Widening gulf in care between rich and poor
K) In developing nations, critical issues are preventive health care and
 Health, Health Care, and Disability

effective care delivery.

L) The World Health Organization and other groups must be heeded to
prevent global pandemics, or epidemics that spread across a wide
region, country, continent, or worldwide.

LECTURE IDEAS
Health Use your own health care provider documents to help students understand how
Maintenance complex the decision-making process can become when they begin working
Organizations and have to immediately make health care choices. Bring to class a sample of
the documents and membership packets that your university provides to its
employees.
Life Take a look at infant mortality and life expectancy tables such as the one at
Expectancy this web site (www.infoplease.com/ipa/A0004393.html) and discuss with
students the specific social conditions that contribute to these statistics being
what they are. Look at current events, history, economics, and weather patterns
to reach a more comprehensive understanding of the state of global health.
Paying for Paying for medical care is an important concern, as it affects individuals as
Health Care well as the societal resources and economy. Introduce students to the latest
issues related to health care in the news. Legislators continue to debate
solutions to rising health care costs There are a number of special interest
groups and lobbyists making news as well. Go into more depth about
alternative solutions that have been proposed here in the U.S. and investigate
those in place in other countries. There are strong points on both sides of the
debate.
Help your students become informed citizens and consumers. Find some news
sources, such as the following, for stories about the current political debate:
 www.abcnews.go.com/Politics/wireStory?id=3693421
Notes on Michel Foucault argued that medical personnel, especially doctors, practice a
Reading kind of primitive power over patients using what Foucault called “the clinical
Foucault's gaze.” This is an interesting topic for a class discussion on personal
The Birth of experiences with health care. Research on the Internet for more information
the Clinic about this topic.
The Discuss with your class the shift in the power to label from religious, family,
Medicalization or political institutions to the medical community. The medical community has
of Deviance escalating power to define deviance in our scientific culture. Does creating a
medical label for deviance remove historic stigmas associated with acting
outside of ordinary behaviors?
The Myth of Thomas Szasz argued that mental illness was a social construct rather than a
Mental Illness biological phenomenon. He challenged the authority of medical professionals
to diagnose and label individuals as “ill,” arguing it was a culturally bound act.
Szasz, Thomas. (1961). The Myth of Mental Illness: Foundations of a Theory
of Personal Conduct. New York: HarperCollins.

QUESTIONS FOR DISCUSSION

Chapter 18

1. What do sociologists mean when they say that health and illness are socially constructed?
Give an example.
2. Historically, how have people with disabilities been treated?
3. What is one relationship between race and health?
4. What is mental illness? Who decides the boundaries of mental illness and simple personality
quirks?
5. What are some major concerns about health and medicine in the U.S.?
6. What are some major concerns about health and medicine in the world today?
7. Why is health a global issue?
8. How do medical practices vary across national boundary lines?
9. Why are some people in the U.S. healthier than others?
10. What two groups in the U.S. are most prone to illness?
11. How do race/ethnicity, gender, and class affect illness and health?
12. Why do males have a shorter life expectancy than females?
13. What are some lifestyle choices that profoundly affect one's health in harmful ways? Do you
or any of your friends make these kinds of choices consistently?
14. What are the effects of alcohol consumption on health?
15. Can alcoholism be cured? What are some examples of the ways alcoholism has been
medicalized?
16. How harmful is nicotine use to health?
17. What illegal drug is most widely used in the U.S.?
18. What are some of the effects of high doses of marijuana? Of alcohol?
19. What are some of the more common sexually transmitted diseases in the U.S.?
20. What are some lifestyle choices that can contribute positively to good health? Why do you
think people don’t make these kinds of choices?
21. Historically, how did people become physicians in this country?
22. What are the major differences between health care systems in the U.S., Canada, Great
Britain, and China? Which of these systems is best and why?
23. How do people become physicians in this country today?
24. What effect did Flexner's study have on health care in this country?
25. How do people in this country pay for health care?
26. What are health maintenance organizations?
27. What kinds of problems are associated with managed care?
28. What are some social implications of advanced medical technology?
29. What is the essence of holistic medicine?
 Health, Health Care, and Disability

30. Describe the functionalist, conflict, symbolic interactionist, and postmodernist views on
health and medicine.
31. Why might some consider universal healthcare to be functional for society?
32. How would a conflict theorist view the efforts by some lawmakers to defund or repeal the
Affordable Care Act?
33. What is the difference between mental illness and mental disorder?
34. How are sex, race/ethnicity, and social class linked to mental illness?
35. What is deinstitutionalization, and how is it linked to advances in drug therapy? What are the
consequences of this for poor people?
36. What is disability, and how is the life of a person with a disability affected by social attitudes
and the social environment in which the person lives?
37. Why is the number of disabled people increasing?

STUDENT ACTIVITY IDEAS

Your students need to change gears and do something active every 20-30 minutes.
1. There are a number of health-related issues that college students deal with during this time in their
lives. Ask someone from your student health center to speak with the class regarding any of the following
issues. See if you can find ways to integrate content from this chapter with these issues:
Weight gain Exercise habits Eating disorders
Substance abuse Sleep Safe sex

2. An In-Depth Investigation: Have your students collect at least ten articles dealing with
current issues of health and health care found in the text, such as alcoholism, concerns about
diet and exercise, AIDS, current causes of death, the American health care system, the
profession of medicine (including doctors, nurses, and hospitals), health insurance, prepaid
health care, and health care in other countries. The articles can come from newspapers,
professional journals, magazines, etc. The students are to (1) collect the articles; (2) write a
summary explaining the message of each article; (3) write a personal reaction to each article;
(4) provide a conclusion and personal evaluation of the project, and (5) provide a
bibliographic reference for each article selected. Have the students submit the articles at the
appropriate time.

3. Discussion/Debate: Have students discuss and debate the topic: Health Care: Is It a Right or
a Privilege? In the organizing of this debate, raise the issue of a national health care system
for all Americans. Assign students specific roles to explore: doctors, nurses, AMA
representatives, and hospital administrators.

4. Interview: Have students interview someone who uses or practices alternative medicine,
holistic medicine, or folk medicine. Have them report on their interview during class time.
5. Class Project: Have your students work in small groups to develop a class presentation
about the essence of the American health care system. Have them respond to the following
questions:
Chapter 18

 Does our medical model of illness perpetuate our fee-for-service system?

 Why do we not address the social causes of illness?
 Why do we not have a national health care system similar to Great Britain?
 Could we, if we wanted to, provide health care efficiently to all of those who do not have
insurance and cannot afford to pay for health care?
HMOs: Use your own health care provider documents to help students understand how
complex the decision making process can become when they begin working and have to
immediately make health care choices. Bring to class a sample of the documents and
membership packets that your university provides to its employees.

6. The Center for Science in the Public Interest has created a Fact Sheet on College Binge
Drinking. Ask students to use the site to create a handout on the subject. Send students to
your college/university counseling center for more information on this important health
issue. Consider asking students to explore other health related issues using resources and
personnel from your Student Affairs department.

7. Upon watching Sicko, a film by Michael Moore, generate a discussion with students using
the accompanying Web site, http://www.michaelmoore.com/sicko/index.html, that includes
facts to back up information from the film, links and resources, and a meaningful list of
things students can do to get involved.

8. The Americans With Disabilities Act: Title I of the Americans with Disabilities Act of
1990, which took effect July 26, 1992, prohibits private employers, state and local
governments, employment agencies, and labor unions from discriminating against qualified
individuals with disabilities in job application procedures, hiring, firing, advancement,
compensation, job training, and other terms, conditions, and privileges of employment. An
individual with a disability is a person who:
 Has a physical or mental impairment that substantially limits one or more major life
activities
 Has a record of such an impairment
 Is regarded as having such an impairment
Introduce your students to federal legislation related to citizens with disabilities. This web
site contains a documents section where you can read and copy dozens of pages containing
related regulations and frequently asked questions: www.jan.wvu.edu/links/adalinks.htm

9. Guest Speaker: Invite a professional employee (such as a doctor, nurse, doctor's assistant,
etc.) of a health maintenance organization to discuss the essence of the program. Have some
questions prepared in advance to ask your guest speaker. For example, why is it said that
HMOs may provide a better, less costly system? Do HMOs really focus on preventative
medicine? How? What is the role of your guest in the HMO? In case of necessary
hospitalization of the patient, where is the patient sent? What about the criticism that HMOs
deny Americans a long-held, value-free choice of doctors and hospitals? What about the
criticism that managed care has practiced deceptive "cost shifting" by negotiating discounts
with hospitals, for example, but forcing the hospitals to charge other insurers more.
 Health, Health Care, and Disability

10. Design Healthcare System: After watching Sick Around the World, have students design
their own ideal healthcare system taking costs into account and present them to the class.
Students can then vote on the proposal that they think would have the best chance of actually
getting passed in the United States.

11. Healthcare History: For all of the problems in healthcare, some things have gotten better
over time. Have your students interview someone 60 years old or older and ask them how
their experiences with doctors and hospitals have changed over time and report back to class.

INTERNET ACTIVITIES

1. The National Institutes of Health is one of eight agencies that are part of the Department of
Health and Human Services; in turn, it consists of over twenty-five agencies, such as the
National Institute of Allergy and Infectious Diseases, the National Institute on Alcohol
Abuse and Alcoholism, and the National Institute of Drug Abuse.
www.nih.gov

2. Information about The National Comorbidity Survey referred to in the text is available
from this web site. From here students can access survey instruments used in the national
study.
www.hcp.med.harvard.edu/ncs

3. The Sick Role: Download this handout on Talcott Parsons’ concept of the social
construction of expectations and actions related to being sick. Ask students to apply this idea
to friends or family members who have a long-term illness.
http://people.bath.ac.uk/ssxlw/1parsons.doc

4. To explore one of the major medical and health research institutions in the U.S., visit the web
site for the Centers for Disease Control and read about the CDC, its facilities, mission,
people, budget, data, and statistics. The CDC collects data on a wide range of topics,
including cancer rates, AIDS rates, violence, and rare illnesses (e.g., Ebola and Hanta
viruses).
www.cdc.gov

5. The U.S. Department of Justice has a Web site with information about the Americans with
Disabilities Act. From this web site students can explore the federal regulations that govern
providing equal access to people with physical disabilities. Draw attention to examples of the
impact of this type of legislation with your own campus buildings.
www.usdoj.gov/crt/ada/adahom1.htm

6. Health problems in other countries are often linked to poor sanitation and hygiene. To learn
more about these kinds of diseases, including the guinea worm, which causes internal
injuries and permanent, disfiguring scarring, visit the web site for the World Health
Organization. Be sure to note some of the differences between the kinds of diseases the
CDC focuses on compared to the World Health Organization.
http://www.who.int/en/
Chapter 18

7. The Department of Health and Human Services is a federal agency that provides
information on numerous government programs, including Medicare and Medicaid, and the
State Children’s Health Insurance Program, as well as medical fraud.
http://www.hhs.gov/

8. The National Institute of Mental Health (also belongs to the NIH), provides information
on mental illness, child and adolescent violence, and rural mental health.
www.nimh.nih.gov

9. The National Institutes of Health now has a National Center for Complementary and
Alternative Medicine. This group focuses on the effectiveness and complementarity of
alternative medicines and treatments used in conjunction with more standard measures.
http://nccam.nih.gov/

10. Prescription Drug Advertising: Ask each student to analyze a number of popular websites
for a week logging on several times each day. As a class, analyze the advertisements for
prescription drugs in the magazine. What are the ads saying? Who are they targeting? How
do they differ? Use this as a springboard into a discussion about whether this kind of
advertising is a good thing.

11. The current era of globalization has brought its own health risks just as all other eras of
increased international contact have. Have students explore some of the issues presented by
the Center for Policy Analysis on Trade and Health and report back to the class. How are
these issues the same or different than previous eras of globalization?
www.cpath.org

VIDEO SUGGESTIONS

1. Sicko
Michael Moore sets out to investigate the American health care system. Moore sheds light on
the complicated medical affairs of individuals in local communities. (2007, 123 minutes)

2. Thin
This film chronicles six months in the lives of four women undergoing treatment for eating
disorders in this revealing documentary. Powerful and haunting, the film follows four
anorexics ranging from age 15 to 30 as they undergo therapy sessions, endure daily weigh-
ins, and battle with staff at a Florida treatment center. With unprecedented access, Greenfield
captures the stark realities of eating disorders from multiple angles. (2006, 60 minutes)

3. Ethics in Healthcare: The Insured and the Uninsured Insight Media

In this program, former Secretary of Health and Human Services Tommy Thompson
addresses the ethical issues surrounding the provision of comprehensive health care coverage
to all Americans. He also makes a case for invigorating U.S. foreign policy through the use
of medical diplomacy. (2008, 45 minutes)
 Health, Health Care, and Disability

4. Dangerous Prescriptions PBS Frontline

As medications play an ever-increasing role in modern health care, the importance of FDA
approval to consumers, it would seem, has never been greater. For many consumers, the
phrase "FDA approved" signifies that a drug or product is completely safe and without risk.
But just how much does the average American know about the FDA approval process and
what it can―and cannot―do? How good is the FDA's system for identifying drugs that don't
work or cause harm? And what happens when a harmful product makes its way into
consumers' hands? Frontline investigates the FDA and drug safety, and questions whether the
current system is adequate for protecting the public. (2003, 60 minutes)

5. The Other Drug War PBS Frontline

As Congress seems closer than ever to passing a new Medicare prescription drug benefit for
seniors, this film investigates the conflict between major pharmaceutical companies and
American consumers, who now pay the highest drug prices in the world. Through interviews
with legislators, scientists, consumers, and industry leaders, Frontline examines how states
like Maine and Oregon have moved to control escalating prescription drug costs in the face
of strong opposition from the pharmaceutical industry, which argues reducing drug prices
will ultimately reduce the number of new innovative drugs they will develop. (2003, 60
minutes)

6. Sick Around the World PBS Frontline

Four in five Americans say the health care system needs fundamental change. Can the U.S.
learn anything from the rest of the world about how to run a health care system, or are these
nations so culturally different that their solutions would not be acceptable? (2008, 60
minutes)

7. Sick Around America PBS Frontline

Frontline investigates the health care system in the United States and searches for some
answers to its many problems. (2009, 60 minutes)

8. Diet Wars PBS Frontline

Americans spend $40 billion a year on books, products, and programs designed to do one
thing: help us lose weight. From Atkins to Ornish and Weight Watchers to the Zone, today's
dieters have a dizzying array of weight loss programs from which to choose—yet the
underlying principles of these diets are often contradictory. Is low fat better than low carb? Is
Atkins the answer? And has the USDA Food Pyramid done more harm than good? In "Diet
Wars," Frontline examines the great diet debate. (2004, 60 minutes)

9. Young and Uninsured

Almost two thirds of America’s young people voted for Obama. This clip suggests that
Obama was trying to tap into their support to pass health care reform. The argument is that
people under 30 may not think they need health care coverage, but they do. (2:18 minutes)
10. Ethics and Healthcare: A Conversation About Costs and Coverage Insight Media
This program addresses ethical issues in health care. The film examines such issues as
escalating health care costs; the growing gap between those who can afford health care and
Chapter 18

those who cannot; and the actual and the potential roles of government, the insurance
industry, and the pharmaceutical industry. (2008, 43 minutes)

11. Supersize Me Kathbur Pictures

Two out of three Americans are overweight or obese, but where does personal responsibility
end and corporate responsibility take over? On the heels of recent lawsuits against
McDonald's, director Morgan Spurlock takes a hilarious and often terrifying look at the
effects of fast food on the human body. Spurlock spends a month of eating nothing but
McDonald's food, ordering everything on the menu at least once and "super-sizing" his order
if asked. (2004, 100 minutes)

ADDITIONAL RESOURCES FOR INSTRUCTORS

Baer, Hans A., Merril Singer, and Ida Susser. (2003). Medical Anthropology and the World
System. Westport: Praeger.
Bartlett, Donald and James Steele. (2004). Critical Condition: How Health Care in America
Became Big Business–and Bad Medicine. New York: Doubleday.
Boston Women's Health Book Collective. (2005). Our Bodies, Ourselves for the New Century: A
Book By and For Women. New York: Touchstone Publishers.
Conrad, Peter. (2007). The Medicalization of Society: On the Transformation of Human
Conditions into Treatable Disorders. Baltimore: The Johns Hopkins University Press.
Freund, Peter E.S. and Meredith B. McGuire. (2002). Health, Illness, and the Social Body: A
Critical Sociology. Upper Saddle River Prentice Hall.
Gabe, Jonathan and Mike Calnana. (2009). The New Sociology of the Health Service. New York:
Routledge.
Glass, John E. and Kathy S. Stolley. (2009). HIV/AIDS. Westport: Greenwood Publishing
Group.
Herzlinger, Regina. (1999). Market-Driven Healthcare: Who Wins, Who Loses in the
Transformation of America's Largest Service Industry. New York: Perseus Books Group.
Hutton, James G. (2005). The Feel-Good Society: How the “Customer” Metaphor is
Undermining American Education, Religion, Media, and Healthcare. West Paterson:
Pentagram Publishing.
Perry, Abbie. (1998). Sociology: Insights in Health Care. San Diego: Singular Publishing Group.
Szasz, Thomas. (1961). The Myth of Mental Illness: Foundations of a Theory of Personal
Conduct. New York: HarperCollins.
Weiss, Gregory and Lynne E. Lonnquist. (2008). The Sociology of Health, Healing, and Illness.
Upper Saddle River: Prentice Hall.
Weitz, Rose. (2009). The Sociology of Health, Illness, and Health Care: A Critical Approach.
Belmont: Wadsworth Publishing.