SOCIAL SCIENCES & MEDICINE

SOCIAL SCIENCES & MEDICINEbyDr. Rizwan Saeed

NATURE AND MAGNITUDE OF THE PROBLEMS AFFECTING THE HEALTH OF COMMUNITYPROCESS OFMOBILISING & ENGAGING PUBLIC HEALTH

RESOURCESLOCALPROVINCIALNATIONALINTERNATIONAL

TO ASSURE THE CONDITIONS IN WHICH PEOPLE REMAIN HEALTHYTHAT SHOULD BE TAKENWHAT CAN BE DONEWHAT IS DONEACTIONS

SOCIAL AND POLITICAL SITUATIONS EXISTING AT PERTICULAR TIME AND PLACEDETERMINED BYSCIENTIFIC KNOWLEDGE RESOURCES AVAILABLE

Primary Health CareEssential Health CareMethods which are: Practical, Scientifically sound, and Socially acceptableTechnology made: Universally accessible to individuals and families in the community through their full participation andAt a Cost that : the community and country can afford to maintain at every stage of their development in the spirit of self determination Based on:

Pillars of Primary Health Care Equity Intersectoral Coordination Appropriate Technology Community participation

Primary Health Care Approach integrates at the Community level all the factors required for Improving the Health Status of the Population

Rows, ranks, class, layers

TierFacility/Services Outreach and Community-based Services Focus on Immunization, Sanitation, Malaria control, Maternal & Child, Health and Family PlanningFirstThe Primary Care Facilities include : Basic Health Units (BHU) & Rural Health Centres (RHCs) Mainly Preventive, Outpatient, and Basic Inpatient CareSecondThe Secondary Health Care Facilities include : Tehsil Headquarters Hospital District Headquarters Hospital for Outpatient, Inpatient and also Specialist CareThird Tertiary Care Hospitals located in the major cities for more specialized inpatient careFourth

Four Tiers of Public Sector

Four Tiers of Public SectorTierFacility/ServicesFirst Outreach and Community-based Services Focus on Immunization, Sanitation, Malaria control, Maternal & Child Health and Family PlanningSecond The Primary Care Facilities include : Basic Health Units (BHU) & Rural Health Centres (RHCs) Mainly Preventive, Outpatient, and Basic Inpatient CareThird The Secondary Health Care Facilities include : Tehsil Headquarters Hospital District Headquarters Hospital for Outpatient, Inpatient and also Specialist CareFourthTertiary Care Hospitals located in the major cities for more specialized inpatient care

SOCIAL SCIENCESSocial scienceis thefield of studyconcerned with society and human behaviors.

SOCIOLOGYSociologyis the scientific study ofsociety.

ObjectivesDoctors contribution Able to:Identify socio-economic factors Correlate these factors with various diseasesKnow various sociological terminologiesFind out the social structure of certain populationIdentify the deviant behavior especially childrenAble to diagnose and treat social problems

Topics in Medical Sociology:EpidemiologyPublic health efforts and other policy issuesFormal organizational aspects of healthcareSocial and cultural influences on health and illnessThe socialization of caregiversMicro-politics among practitioners in healthcareCaregiver-patient interaction

SOCIETY extended social group having a distinct culture and economic organizationCOMMUNITY group of people living in a particular areaSOCIAL STRUCTURE patterns of inter-relations between personsSOCIAL INSTITUTION organized complex pattern of behavior in which individuals participate in order to group interest.ROLE ASCRIBED (GIVEN BY VIRTUE OF SEX, AGE, BIRTH STATUS) & ACHIEVED (EDUCATION), SOCIALISM political theory advocating state ownership of industry

SOCIALIZATION SOCIAL INTERACTION & LEARNING PROCESS OF AN INDIVIDUAL (PRIMARY AGE 0-6 Yrs, SECONDARY 6 Yr+)SOCIAL STRESSFIELD STUDY Observation of People In-situ (in original)CASE STUDY method of exploring & analyzing the life of a social unit (unit can be person/family/group/institution) info ppl

SOCIAL DEFENCECHILD LABOUR ACTSOCIAL MOBILITY CHANGE CASTE/RELEGIONSOCIAL DIFFERECIATION EDUCATION, INCOME, PURCHASING POWER, RELEGION, GEOGRAPHICAL, SOCIAL CLASS

FACTORS IN HEALTH AND DISEASECONCEPT OF ETIOLOGY & CURESUPERNATURAL CAUSESPHYSICAL CAUSESENVIRONMENTALFOOD HABITSMCHPERSONAL HYGIENESEX & MARRIAGE

SOCIAL EPIDEMIOLOGYSTUDY OF SOCIAL DISTRIBUTION & SOCIAL DETERMINANTS OF HEALTH

SOCIAL MEDICINE THE STUDY OF MEDICAL NEEDS OR MEDICAL CARE OF THE SOCIETY WITH THE KNOWLEDGE OF SOCIAL EPIDEMIOLOGY

ANTHROPOLOGYAnthropologyis the holistic "science of man," - a science of the totality of human existence. The discipline deals with the integration of different aspects of the Social Sciences,Humanities, andHuman Biology.

Socialization is a term used bysociologists,social psychologists,anthropologists,political scientistsandeducationaliststo refer to the lifelong process of inheriting and disseminatingnorms,customsandideologies, providing an individual with the skills and habits necessary for participating within his or her own society. Socialization is thus the means by which social and cultural continuity are attained

ECONOMICSEconomics is a social science that seeks to analyze and describe the production, distribution, and consumption of wealth

SOCIAL STRUCTURESocial structureis a term used in thesocial sciencesto refer topatterned social arrangementsin society that are bothemergentfrom and determinant of theactions of the individuals

(SOCIAL STRATIFICATION SOCIETY NORMS)

normative structure pattern of relations in given structure (organisation) betweennormsand modes of operations of people of varyingsocial positionsideal structure pattern of relations between beliefs and views of people of varying social positionsinterest structure pattern of relations between goals and desires of people of varying social positionsinteraction structure forms of communications of people of varying social positions

NORMSSocial normsare described bysociologistsas being laws that govern societys behaviors. Although these norms are not considered to be formal laws within society, they still work to promote a great deal ofsocial control

VALUESA personal or culturalvalueis anabsolute or relative ethical value, the assumption of which can be the basis for ethical action

CULTUREthe integrated pattern of human behavior that includes thought, speech, action, and artifacts and depends upon the human capacity for learning and transmitting knowledge to succeeding generations

ACCULTURATIONAcculturationexplains the process of cultural and psychological change that results following meeting (blend) between culturesGROUP LEVELPHYSICAL, BIOLOGICAL, POLITICAL, ECONOMIC, CULTURAL, SOCIALPSYCHOLOGICALBEHAVIOR, VALUES, IDENTITY, ADOPTION, ACCULTURATION STRESS

SOCIOLOGY OF HEALTH AND ILLNESSTheSociology of Health and Illness, alternatively theSociology of Health and Wellness, examines the interaction betweensocietyandhealth. The objective of this topic is to see how social life has an impact onmorbidityandmortality rate, and vice versa

MEDICAL SOCIOLOGYMedical sociologyis thesociologicalanalysis ofmedicalorganizationsandinstitutions; the production of knowledge and selection of methods, theactions and interactions of healthcare professionals, and the social or cultural (rather than clinical or bodily) effects of medical practiceHealth disparitiescommonly relate to typical categories such asclassandrace.

SOCIAL CHANGESocial changerefers to an alteration in thesocial orderof asociety. It may refer to the notion ofsocial progressorsociocultural evolution, the philosophical idea that society moves forward bydialecticalorevolutionarymeans

Disease control phase (1880-1920)

Health promotional phase (1920-1960)Social engineering phase (1960-1980)Health for all phase (1981-2000AD)

TRADITION

AUTHORITY

EXPERIENCE

EXPERIMENT

Knowledge Sources

Other knowledge sourcesSensory can be defective / variationAgreement with others (inter-rater reliability)Expert opinion Delphi (can be wrong as well)Logical reasoning :Inductive reasoning F. Bacon observation based, this shows logic is not the only source of knowledgeobservation pattern hypothesis theory[Specific General]

B)Deductive Aristotle specific conclusions from general broad principlesAll human beings are mortal (major premise)Ali is a human being (minor premise)Theory hypothesis observation confirmation[General Specific]Limitations less role of observation and experience and deals with certain type & is a mental exercise

Inductive-deductive

observation pattern hypothesis Theory-Theory hypothesis observation confirmation

Scientific methods 5 stepsIdentify gap problemdefine problem more preciselyData collectionOrganize and analyze the dataInterpret data conclusion

EXPERIMENT

RANDOMISED CONTROL

DOUBLE BLIND

EVIDENCE-BASED MEDICINE

The customary beliefs, social forms, and material traits of a racial, religious, or social group

CULTURE

ACCULTURATIONAcculturationexplains the process of cultural and psychological change that results following meeting (blend) between culturesGROUP LEVELPHYSICAL, BIOLOGICAL, POLITICAL, ECONOMIC, CULTURAL, SOCIALPSYCHOLOGICALBEHAVIOR, VALUES, IDENTITY, ADOPTION, ACCULTURATION STRESS

NORMSSocial normsare described bysociologistsas being laws that govern societys behaviors. Although these norms are not considered to be formal laws within society, they still work to promote a great deal ofsocial control

VALUESA personal or culturalvalueis anabsolute or relative ethical value, the assumption of which can be the basis for ethical action

CUSTOMS ausualorhabitualpractice;typicalmodeofbehavior thelong- establishedhabitsortraditionsofasociety collectively;convention:customdictates goodmanners apracticewhichbylong- establishedusagehascometo havetheforceoflawSOCIAL CONTROL MECHANISMSINFORMAL BELIEFS, IDEOLOGIES, FOLKWAYSFORMAL LAW, EDUCATION

SOCIAL STRESSSocial stressisstressthat stems from ones relationships with others and from the social environment in general. A person experiences stress when he or she does not have the ability or resources to cope when confronted with an external stimulus (stressor), or when theyfearthey do not have the ability or resources.

SOCIAL FACTORS INFLUENCING THE HEALTH OF PEOPLE SOCIAL STRUCTURAL FACTORS PREDISPOSING FACTORS HEALTH OUTCOMEHEALTH

DEMOGRAPHICECONOMICPOLITICALLEGALRELIGIOUSEDUCATIONALTECHNOLOGICALCOMMUNICATIONSMIGRATIONURBANIZATIONLIFE EXPECTANCYMARRIAGEFERTILITYROLE OF WOMEN

CURRENT CIRCUMSTANCES(INCOME,FAMILY,HOUSING,EMPLOYEMENT,STRESSES,& CRISES, SOCIAL SUPPORT ETC.)INDIVIDUAL PREDISPOSITION(INHERITANCE, PERINATAL EVENTS,PREVIOUS ACCIDENTS OR ILLNESS, UPBRINGING,, CHILDHOOD NUTRITION,, ETC)

ECOLOGICAL PREDISPOSITIONS(COMMUNITY VALUES,SOCIALLY PRESCRIBED ROLES, LIFE STYLE,SUB-CULTURAL BEHAVIOR PATTERNS ETC.)

OPPORTUNITIES / SITUATIONS(ACCESS TO HEALTH SERVICES,EXPOSURE TO PATHOGENS, AVAILABILITY OF EDUCATION, FOOD, SANITATION, ALCOHOL, DRUGS, MARRIAGE, PARTNERS, ETC.

SOCIAL PATHOLOGYa study of social problems (as crime or alcoholism) that views them as diseased conditions of the social organismRELATION B/W DISEASE & SOCIAL CONDITIONasocialfactor,aspoverty,oldage,orcrime, thattendstoincreasesocialdisorganizationandinhibitpersonal adjustment.

Behaviororbehaviour is the range of actions and mannerisms made byorganisms,systems, orartificial entitiesin conjunction with their environment, which includes the other systems or organisms around as well as the physical environment. It is the response of the system or organism to various stimuli or inputs, whetherinternal orexternal,consciousorsubconscious,overtorcovert, andvoluntaryorinvoluntary.

EMOTIONS

EMOTIONSEmotionsare the various bodily feelings associated withmood,temperament,personality,disposition, andmotivationand also withhormonessuch as dopamine, noradrenaline, and serotonin. Emotion is often the driving force behind motivation, positive or negative

health behavior an action taken by a person to maintain, attain, or regain good health and to prevent illness. Health behavior reflects a person's health beliefs. Some common health behaviors are exercising regularly, eating a balanced diet, and obtaining necessary inoculations.

LEARNINGLearningis acquiring new, or modifying existing,knowledge,behaviors,skills,values, orpreferencesand may involve synthesizing different types ofinformation.The ability to learn is possessed by humans, animals and somemachines.COGNITIVE KNOWLEDGEAFFECTIVEATTITUDEPSYCHOMOTOR SKILLS

STRUCTURAL-FUNCTIONALISMFUNCTION - the satisfaction of a need by an activity in which human beings cooperate, use artifacts, & consume goodsSocial structure or structure forms of associations (structure) found amongst human beingsSOCIETY as a bundle of interrelated institutionsinstitutions: a society's recurrent patterns of activity, such as religion, art, a kinship system, law, and family life. Institutions fulfill human needs: a functionEXAMPLE:The division of labor serves two functions: social integration & functional differentiationEQUILIBRIUM-FUNCTION-STRUCTURE

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Illness, disease, sickness, the sick roleillness is the subjective experience of ill healthdisease is the medically defined pathologysickness is the social role of those defined as diseased or illthe sick role refers to the set of rights and obligations that surround illness and shape the behaviour of doctors and patients

well-being: the state of being or doing well in life; happy, healthy, or prosperous condition; moral or physical welfare (of a person or community)

disease: a condition of the body, or of some part or organ of the body, in which its functions are disturbed or deranged; a morbid physical condition

sociological functionalism puts focus on the consequences instead of causes of empirical social phenomenamedicalization describes a process by which non-medical problems become defined and treated as medical problems, usually in terms of illness or disordersthe mode of production of material life determines the general character of the social, political and spiritual processes of life (Karl Marx, 1859)

Structure-function imagined

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Sociology of health: medicineFocus on medicineSocial aspects of medicine, health, diseaseSocial factors shaping medicineSocial labelling & social controlSick rolePatient-doctor relationshipDisease-illness distinctionMedicalization

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Social labellingOrder & disorder normal & abnormalSocial labeling & illness, disease, disabilityWho is to be called ill, diseased, disabled is determined by the individuals social position and societys norms rather than by universal and objectively defined signs and symptomsA person is labeled in the course of social negotiations de-labeling difficultAt each decision point it may be possible to return to the normal label

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STRUCTURE-FUNCTION & MEDICINEDoctor-patient relationshipInstitutional integrationInstitutions defined as a society's recurrent patterns of activityThe sick role (T. Parsons)Illness as a form of deviancePhysicians & return to equilibriumAlcoholism? Poverty related health issues?Compliance as solution?Local healthcare system

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Abnormality/Deviance & the Sick role (T. Parsons)Rights:The sick person is exempt from normal social roles. relative to the nature and severity of the illnessThe sick person is not responsible for his or her condition.An individuals illness is usually thought to be beyond his or her own controlA morbid condition of the body needs to be changed and some curative process apart from person will power or motivation is needed to get well.Obligations:The sick person should try to get well. The first two aspects of the sick role are conditional upon the third aspectThe sick person should seek technically competent help and cooperate with the physician.

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Disease-Illness distinctionDISEASE as a bio-scientific conceptAbnormalities in the structure & function of body organs & systemsILLNESS -- lay conceptsIllnesses are experiences of disvalued changes in states of being & in social functionBiomedicine presses the practitioner to construct disease as the subject of study & treatment

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ATTITUDEAn attitude is a hypothetical construct that represents an individual's degree of like or dislike for an item. Attitudes are generally positive or negative views of a person, place, thing, or event

LIFE STYLEa lifestyle is the way a person lives

A set of behaviors, and the senses of self and belonging which these behaviors represent, are collectively used to define a given lifestyle. The term is defined more broadly when used in politics, marketing, and publishing.

ACTIVE

ACTIVE

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LAZYHEALTHY

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ALONE

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CELEBRATE

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Expensive cars

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Various phases in life of an individual , group , society nation historyPsycho-social studyCommunity diagnosisPublic health prevention & Mx measures /plans

PERSONALITYPersonalityis the particular combination of emotional, attitudinal, and behavioral response patterns of an individual.

PERSONALITY TYPES

GENERALLY 16 TYPESARTIST- GIVERDUTY FULFILLER- VISIONARYMECHANIC- EXECUTIVENURTUREPROTECTORIDEALISTSCIENTISTTHINKERGUARDIANPERFORMERINSPIRER

PHYSICALEMOTIONALINTELLIGENCEBEHAVIOR

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Valuethe assumption of which can be the basis for ethical action, honesty, courage, fairness, trust, respect & caring.NormsInformal laws that govern societys behaviorsCulturethe integrated pattern of human behavior that includes thought, speech, action, and artifacts. And depends upon the human capacity for learning and transmitting knowledge to succeeding generationsAttitudea hypothetical construct that represents an individual's degree of like or dislike for an item. Can be +ve or -ve

Medicalizationthe process by which health or behavior conditions come to be defined and treated as medical issues and thus become the subject of medical study, diagnosis,prevention, or treatment

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the process by which certain events or characteristics of everyday life become medical issuesThe process of medicalization typically involves changes in social culture / society

Medicalization

alcoholism,drug addictionandmental illness, were originally considered as moral, then legal, and now medical problemsMedicalization

How Can Sociology Help Us in Our Lives?Understanding social circumstances provides us a better chance of controlling them.Sociology provides the means of increasing our cultural sensitivities.We can investigate the consequences of adopting particular policy programs.Sociology provides self-enlightenment, offering groups & individuals an increased opportunity to alter the conditions of their own lives.

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EpidemiologyEpidemiology is the study of the extent and population-based spread of disease.Epidemiologists might examine genetic, biological and physical environmental factors in addition to social factors.

Some examples of the uses of epidemiology: AIDS, TB and other communicable diseasesHantavirus, "Mad Cow" and other animal-borne diseases Mental illness and its environmental correlates ... and many others. Epidemiology is an important tool for managing public health.

Epidemiology

Public Health Efforts and their Impact on Death and Disease Doctors treat "patients"; public health officers treat communities and societies. People tend to consider new medical "breakthroughs" in contributing to reductions in mortality and morbidity.However, public health and "social hygiene" efforts have contributed far more to health than have medical measures:In 1900, 44% of deaths in N America were due to 11 infectious diseases. By 1980, that figure was less than 5%. Nowadays, most deaths are due to the three major chronic conditions: heart disease, cancer and stroke.

The Organization of HealthcareHealthcare services serve two functions: Direct service functions, and supportive or ancillary functions.Direct Service:Individual, patient-based careCommunity-based careAncillary functions:FinanceSuppliersRegulationRepresentationResearchConsulting

Social and Cultural Impacts on Health All of these factors influence1. Differential exposure to pathogenic or salutary circumstances2. Vulnerabilty to disease3. Access to healthcare resources

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SOCIAL MEDICINEMan is not only a biological being but a social being, and disease has social causes, social consequences and social therapy.

Development of epidemiological methods and their application to the investigation of diseases.

Elucidates the role of social factors

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Social and Cultural Impacts on Health One's position in a social structure influences one's health in numerous ways.GenderSocioeconomic statusOccupationRace and ethnicityAge

The Economy and WorkCulture and HealthSociological Perspectives on Health and IllnessSocial Epidemiology and HealthHealth CareMental IllnessSocial Policy and Health

Culture and HealthCulture contributes to differences in medical care and how health is defined

Culture also influences the relative incidence of a disease or disorder.

DIET CULTURE

Sociological Perspectives on Health and Illness1.Functionalist Approach

Being sick must be controlled so that not too many people are released from their societal responsibilitiesSick role: societal expectations about attitudes and behavior of a person viewed as being ill

Sociological Perspectives on Health and Illness2.Conflict Approach

Critical of growing role of medicine as major institution of social controlThe Medicalization of Society

Interactionist ApproachStudies the roles played by health care professionals and patientsAsserts patients may play an active role in positive or negative health

Sociological Perspectives on Health and Illness

Sociological Perspectives on Health and Illness4.Labeling Approach

The designations healthy and ill generally involve social definitionDisagreements continue in the medical community over whether a variety of life experiences are illnesses

Sociological Perspectives on Health and IllnessFigure 19-1. Infant Mortality Rates in Selected Countries, 2004Source: Haub 2004

Sociological Perspectives on Health and Illness

LANGUAGE

Knowing a patients language helps in :easy and comfortable doctor-patient interactionGood diagnosis & MxGood medical practiceHealth education

INDIVIDUAL RIGHTSEQUALITYFREEDOM OF SPEECH & EXPRESSIONRIGHT AGAINST EXPLOITATIONFREEDOM OF PRACTICE AND PROPOGANDA OF RELEGIONPROPERTY RIGHTSCONSTITUTIONAL RIGHTS

RESPONSIBILITY FOR HEALTHINDIVIDUALSOCIETYCOMMUNITY NORMSSTATE POLICY

SOCIAL ORGANIZATIONSFAMILYRELEGION & CASTETEMPORARY SOCIAL GROUPCROWD MOBHERDPERMANENT SPATIAL GROUPSVILLAGETOWNSTATEGOVT. ORGANIZATIONS

FAMILYAgroupofpeopleaffiliated byconsanguinity (blood relation), affinity, or co-residence. In most societies it is the principal institution for the socialization of children.

Anthropologists most generally classify family organization asMatrilocal(a mother and her children);Conjugal (a wife, husband, and children, also callednuclear family); andConsanguinal(also called an extended family) in which parents and children co-reside with other members of one parent's family.

FAMILY

FAMILY CYCLESTAGE OF FORMATIONSTAGE OF GROWTHSTAGE OF RECREATIONSTAGE OF DISINTEGRATION

ROLE OF FAMILY CARE , TRAINING, FINANCING, PROTECTION, EDUCATION,REGULATION OF SEXUAL BEHAVIOR & REPRODUCTION

Social Epidemiology and HealthSocial Epidemiology and Health

Social epidemiology: study of distribution of disease, impairment, and general health status across a populationIncidence: number of new cases of a specific disorder occurring within a given population during a stated period of time, usually a yearPrevalence: number of cases of a specific disorder that exist at a given time

Social Epidemiology and HealthSocial Epidemiology and Health

Morbidity rates: disease incidence figures presented as rates or number of reports per 100,000 peopleMortality rate: incidence of death in a given population or number of deaths per 100,000 people

Social Epidemiology and HealthSocial Class

Studies show people in lower classes have higher rates of mortality and disabilityCrowded living conditionsSubstandard housingPoor dietStressUnable to afford quality health care

Social Epidemiology and HealthRace and Ethnicity

Health profiles of racial and ethnic groups reflect social inequality in U.S.Poor economic and environmental conditions manifested in high morbidity and mortality ratesGenderWhen compared with men, women live longer

Social Epidemiology and HealthFigure 19-2. Percentage of People without Health Insurance, 2001Source: Haub 2002:23

Social Epidemiology and HealthAge

Most older people in U.S. have at least one chronic illnessOlder people vulnerable to certain types of mental health problemsOlder people use more health services than younger people

Rural health

Urban clinics

aging

Health Care in the United StatesA Historical View

During the 1830s and 1840s, self-help was emphasizedStrong criticism of doctoringEventually, medical profession controlled the market for its services and the various organizations that govern medical practice, financing, and policymaking

Health Care in the United StatesPhysicians, Nurses, and Patients

Physicians have position of dominance in dealing with nurses and patientsAlternatives to Traditional Health CareHolistic medicineTherapies that consider the persons physical, mental, emotional, and spiritual characteristics

Health Care in the United StatesThe Role of Government

In 1965, government subsidized health care programsMedicare for the elderlyMedicaid for the poorMedicare had huge impact on health care systemSome hospitals dumped unprofitable Medicare patients until practice was banned in 1987

Health Care in the United StatesFigure 19-3. Availability of Physicians by StateSource: Bureau of the Census 2004:101

Health Care in the United StatesFigure 19-4. Total Health Care Expenditures in the United States, 1970 2014 (projected)Sources:Center for Medicare and Medicaid Services 2005 (20052014 data); Health Care Financing Administration 2001 (19701990 data)

ILLNESS BEHAVIOR

Mental Illness in the United StatesMental illness

Brain disorder that disrupts a persons thinking, feeling, and ability to interact with othersPeople in U.S. traditionally maintained a negative and suspicious view of those with mental disorders

Mental Illness in the United StatesTheoretical Models of Mental Disorders

Medical Model: Mental illness rooted in biological causes that can be treated through medical interventionLabeling Theory: Mental illness is not an illness since the individuals problems arise from living in society and not from physical maladiesDevalues mentally ill patients

Mental Illness in the United StatesPatterns of Care

Historical confinement of the insane or mentally ill to public institutionsCommunity-based outpatient care most prevalent nowLegislation has made it easier to commit mentally-ill homeless involuntarily

Social Policy and HealthFinancing Health Care WorldwideThe Issue

Industrialized nations face issues related to the accessibility and affordability of health careThe SettingThe U.S. is the only Western industrial democracy that does not treat health care as a basic right

Social Policy and HealthFinancing Health Care WorldwideSociological Insights

Conflict theorists suggest health care system resists basic changeThose who receive substantial wealth and power through an existing institution have strong incentive to keep things as they areHealth care system undergoing corporatization

Social Policy and HealthFinancing Health Care WorldwidePolicy Initiatives

Major reforms occurring in U.S. without legislative reformAs of 1997, managed care plans enrolled 85% of all workers, up from 52% in 1993There are growing concerns about the quality of health care provided by managed care plans

Social Policy and HealthFigure 19-5. Government Expenditures for Health Care, Selected CountriesSource: World Bank 2005a:100--102

HOSPITAL SOCIOLOGYDOCTOR-PATIENT RELATIONSHIPDOCTOR-DOCTOR RELATIONSHIPDOCTOR-PARAMEDICAL STAFF RELATIONSHIPDOCTOR-NURSE RELATIONSHIPSOCIAL STRUCTURE OF HOSPITALMEDICAL CARESICK ROLE

The Socialization of Caregivers Focus on doctors: Student doctors acquire knowledge to accomplish "hypothesis testing" in medical encounters.

The Socialization of Caregivers Medical school is thus a period of socialization in which students acquire new competencies.What about informal socialization?Doctors learn about professional hierarchies.Doctors learn to think of patients "objectively," ie:"Don't let emotions get in the wayThe patient is an "object," an organism that provides dataDoctors acquire sense of selves in the world

Medical Micropolitics Medical care is NOT doctor care.NursesPhysiotherapistsCounsellorsVolunteersOrderliesDoctors are "team leaders. The "Doctor-Nurse Game": How nurses orient to doctors to perform work but still preserve hierarchy

Caregiver-Patient Interaction Focus on Doctor-PatientHypothesis-testing approach: Doctor asks questions; patient answers. Medical interviewing instruction reinforces this.

Caregiver-Patient Interaction Patient's role:Answer questions.Don't speak unless spoken to.Don't ask questions.Don't offer diagnoses.However, medical complaints are often cast as questions or as "candidate diagnoses."Doctors SHOULD learn to listen and to encourage questioning and talk on patients' part.

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