Film analysis: health/medicine/environment
You have some choices here – the idea is to watch a film/documentary that has to do with Health, Medicine, the Environment or includes all of these. Find something that you have not already watched before and something that you are not familiar with.
- What did you watch and why did you pick that particular film/documentary (5 pts)?
- Take 2 points from the film/documentary (10 pts each) that you felt were significant and discuss why (approximately a paragraph for each point)
- then another paragraph about your overall thoughts on the topic (10 pts).
- Incorporate the vocabulary and concepts from the relevant chapters. Attach below
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Learning Objectives
19.1 The Social Construction of Health
Define the term medical sociology
Understand the difference between the cultural meaning of illness, the social construction of illness,
and the social construction of medical knowledge
19.2 Global Health
Define social epidemiology
Apply theories of social epidemiology to an understanding of global health issues
Understand the differences between high-income and low-income nations
19.3 Health in the United States
Understand how social epidemiology can be applied to health in the United States
Explain disparities of health based on gender, socioeconomic status, race, and ethnicity
Give an overview of mental health and disability issues in the United States
Explain the terms stigma and medicalization
19.4 Comparative Health and Medicine
Explain the different types of health care available in the United States
Compare the health care system of the United States with that of other countries
19.5 Theoretical Perspectives on Health and Medicine
Apply functionalist, conflict theorist, and interactionist perspectives to health issues
Figure 19.1 Medical personnel are at the front lines of extremely dangerous work. Personal protective clothing is essential for
any health worker entering an infection zone, as shown by these trainees for the UK’s National Health Service. (Photo
courtesy of DFID – UK Department for International Development/flickr)
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According to the World Health Organization and ABC Health News, on March 19, 2014 a “mystery”
hemorrhagic fever outbreak occurred in Liberia and Sierra Leone. This outbreak was later confirmed to be
Ebola, a disease first discovered in what is now the Democratic Republic of Congo. The 2014 outbreak
started a chain reaction in West Africa, sickening more than 8,000 people and leaving more than 4,000 dead
by October.
At the time of this writing, Ebola is national news in the United States, and certainly global news as well.
Infection of U.S. medical staff (both in West Africa and at home) has led to much fear and distrust, and
discussion of restrictions on flights from West Africa was one proposed way to stop the spread of the
disease. Ebola first entered the United States via U.S. missionary medical staff who were infected in West
Africa and then transported home for treatment. The case of Thomas Eric Duncan, who unwittingly imported
Ebola into the United States as he flew from Liberia to Texas in September 2014 to visit family, increased the
level of fear.
How do we best respond to this horrific virus? Restrict visitors from West Africa, enhance training and
protective gear for all U.S. medical workers and law enforcement? Many concerns surround this disease
and few agree upon the appropriate response. You can follow the progression of the outbreak at
http://abc7news.com/news/timeline-of-the-ebola-virus-in-america-/348789/.
The Ebola case brings many issues to the forefront. Are we in the cross-hairs of a large-scale Ebola
epidemic in the United States? Or are the few cases of infection (primarily of health professionals) as far as
the disease will spread in the United States? In the short term, how do we best prevent, identify, and treat
current and potential cases?
The sociology of health encompasses social epidemiology, disease, mental health, disability, and
medicalization. The way that we perceive health and illness is in constant evolution. As we learn to control
existing diseases, new diseases develop. As our society evolves to be more global, the way that diseases
spread evolves with it.
What does “health” mean to you? Do you believe that there are too many people taking medications in U.S.
society? Are you skeptical about people claiming they are “addicted” to gambling or “addicted” to sex? Can
you think of anything that was historically considered a disease but is now considered within a range of
normality? Or anything that has recently become known as a disease that before was considered evidence
of laziness or other character flaws? Do you believe all children should receive vaccinations? These are
questions examined in the sociology of health.
Sociologists may also understand these issues more fully by considering them through one of the main
theoretical perspectives of the discipline. The functionalist perspective is a macroanalytical perspective that
looks at the big picture and focuses on the way that all aspects of society are integral to the continued
health and viability of the whole. For those working within the functionalist perspective, the focus is on how
healthy individuals have the most to contribute to the stability of society. Functionalists might study the
most efficient way to restore “sick” individuals to a healthy state. The conflict perspective is another
macroanalytical perspective that focuses on the creation and reproduction of inequality. Someone applying
the conflict perspective might focus on inequalities within the health system itself, by looking at disparities
in race, ethnicity, gender, and age. Someone applying the interactionist perspective to health might focus on
how people understand their health, and how their health affects their relationships with the people in their
lives.
http://abc7news.com/news/timeline-of-the-ebola-virus-in-america-/348789/
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If sociology is the systematic study of human behavior in society, medical sociology is the systematic
study of how humans manage issues of health and illness, disease and disorders, and healthcare for both
the sick and the healthy. Medical sociologists study the physical, mental, and social components of health
and illness. Major topics for medical sociologists include the doctor/patient relationship, the structure and
socioeconomics of healthcare, and how culture impacts attitudes toward disease and wellness.
The social construction of health is a major research topic within medical sociology. At first glance, the
concept of a social construction of health does not seem to make sense. After all, if disease is a
measurable, physiological problem, then there can be no question of socially constructing disease, right?
Well, it’s not that simple. The idea of the social construction of health emphasizes the socio-cultural aspects
of the discipline’s approach to physical, objectively definable phenomena. Sociologists Conrad and Barker
(2010) offer a comprehensive framework for understanding the major findings of the last fifty years of
development in this concept. Their summary categorizes the findings in the field under three subheadings:
the cultural meaning of illness, the social construction of the illness experience, and the social construction
of medical knowledge.
The Cultural Meaning of Illness
Many medical sociologists contend that illnesses have both a biological and an experiential component,
and that these components exist independently of each other. Our culture, not our biology, dictates which
illnesses are stigmatized and which are not, which are considered disabilities and which are not, and which
are deemed contestable (meaning some medical professionals may find the existence of this ailment
questionable) as opposed to definitive (illnesses that are unquestionably recognized in the medical
profession) (Conrad and Barker 2010).
For instance, sociologist Erving Goffman (1963) described how social stigmas hinder individuals from fully
integrating into society. In essence, Goffman (1963) suggests we might view illness as a stigma that can
push others to view the ill in an undesirable manner. The stigmatization of illness often has the greatest
effect on the patient and the kind of care he or she receives. Many contend that our society and even our
healthcare institutions discriminate against certain diseases—like mental disorders, AIDS, venereal
diseases, and skin disorders (Sartorius 2007). Facilities for these diseases may be sub-par; they may be
segregated from other healthcare areas or relegated to a poorer environment. The stigma may keep people
from seeking help for their illness, making it worse than it needs to be.
Contested illnesses are those that are questioned or questionable by some medical professionals.
Disorders like fibromyalgia or chronic fatigue syndrome may be either true illnesses or only in the patients’
heads, depending on the opinion of the medical professional. This dynamic can affect how a patient seeks
treatment and what kind of treatment he or she receives.
The Social Construction of the Illness Experience
The idea of the social construction of the illness experience is based on the concept of reality as a social
construction. In other words, there is no objective reality; there are only our own perceptions of it. The social
construction of the illness experience deals with such issues as the way some patients control the manner
in which they reveal their diseases and the lifestyle adaptations patients develop to cope with their illnesses.
In terms of constructing the illness experience, culture and individual personality both play a significant role.
For some people, a long-term illness can have the effect of making their world smaller, more defined by the
illness than anything else. For others, illness can be a chance for discovery, for re-imaging a new self
(Conrad and Barker 2007). Culture plays a huge role in how an individual experiences illness. Widespread
diseases like AIDS or breast cancer have specific cultural markers that have changed over the years and
that govern how individuals—and society—view them.
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Today, many institutions of wellness acknowledge the degree to which individual perceptions shape the
nature of health and illness. Regarding physical activity, for instance, the Centers for Disease Control (CDC)
recommends that individuals use a standard level of exertion to assess their physical activity. This Rating of
Perceived Exertion (RPE) gives a more complete view of an individual’s actual exertion level, since heartrate
or pulse measurements may be affected by medication or other issues (Centers for Disease Control 2011a).
Similarly, many medical professionals use a comparable scale for perceived pain to help determine pain
management strategies.
Figure 19.2 The Mosby pain rating scale helps
health care providers assess an individual’s
level of pain. What might a symbolic
interactionist observe about this method?
(Photo courtesy of wrestlingentropy/flickr)
The Social Construction of Medical Knowledge
Conrad and Barker show how medical knowledge is socially constructed; that is, it can both reflect and
reproduce inequalities in gender, class, race, and ethnicity. Conrad and Barker (2011) use the example of
the social construction of women’s health and how medical knowledge has changed significantly in the
course of a few generations. For instance, in the early nineteenth century, pregnant women were
discouraged from driving or dancing for fear of harming the unborn child, much as they are discouraged,
with more valid reason, from smoking or drinking alcohol today.
SOCIAL POLICY AND DEBATE
Has Breast Cancer Awareness Gone Too Far?
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Figure 19.3 Pink ribbons are a ubiquitous
reminder of breast cancer. But do pink ribbon
chocolates do anything to eradicate the
disease? (Photo courtesy of
wishuponacupcake/Wikimedia Commons)
Every October, the world turns pink. Football and baseball players wear pink accessories.
Skyscrapers and large public buildings are lit with pink lights at night. Shoppers can choose from
a huge array of pink products. In 2014, people wanting to support the fight against breast cancer
could purchase any of the following pink products: KitchenAid mixers, Master Lock padlocks and
bike chains, Wilson tennis rackets, Fiat cars, and Smith & Wesson handguns. You read that
correctly. The goal of all these pink products is to raise awareness and money for breast cancer.
However, the relentless creep of pink has many people wondering if the pink marketing
juggernaut has gone too far.
Pink has been associated with breast cancer since 1991, when the Susan G. Komen Foundation
handed out pink ribbons at its 1991 Race for the Cure event. Since then, the pink ribbon has
appeared on countless products, and then by extension, the color pink has come to represent
support for a cure of the disease. No one can argue about the Susan G. Komen Foundation’s
mission—to find a cure for breast cancer—or the fact that the group has raised millions of dollars
for research and care. However, some people question if, or how much, all these products really
help in the fight against breast cancer (Begos 2011).
The advocacy group Breast Cancer Action (BCA) position themselves as watchdogs of other
agencies fighting breast cancer. They accept no funding from entities, like those in the
pharmaceutical industry, with potential profit connections to this health industry. They’ve
developed a trademarked “Think Before You Pink” campaign to provoke consumer questioning of
the end contributions made to breast cancer by companies hawking pink wares. They do not
advise against “pink” purchases; they just want consumers to be informed about how much
money is involved, where it comes from, and where it will go. For instance, what percentage of
each purchase goes to breast cancer causes? BCA does not judge how much is enough, but it
informs customers and then encourages them to consider whether they feel the amount is
enough (Think Before You Pink 2012).
BCA also suggests that consumers make sure that the product they are buying does not actually
contribute to breast cancer, a phenomenon they call “pinkwashing.” This issue made national
headlines in 2010, when the Susan G. Komen Foundation partnered with Kentucky Fried Chicken
(KFC) on a promotion called “Buckets for the Cure.” For every bucket of grilled or regular fried
chicken, KFC would donate fifty cents to the Komen Foundation, with the goal of reaching 8
million dollars: the largest single donation received by the foundation. However, some critics saw
the partnership as an unholy alliance. Higher body fat and eating fatty foods has been linked to
increased cancer risks, and detractors, including BCA, called the Komen Foundation out on this
apparent contradiction of goals. Komen’s response was that the program did a great deal to raise
awareness in low-income communities, where Komen previously had little outreach (Hutchison
2010).
What do you think? Are fundraising and awareness important enough to trump issues of health?
What other examples of “pinkwashing” can you think of?
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Social epidemiology is the study of the causes and distribution of diseases. Social epidemiology can
reveal how social problems are connected to the health of different populations. These epidemiological
studies show that the health problems of high-income nations differ greatly from those of low-income
nations. Some diseases, like cancer, are universal. But others, like obesity, heart disease, respiratory
disease, and diabetes are much more common in high-income countries and are a direct result of a
sedentary lifestyle combined with poor diet. High-income nations also have a higher incidence of
depression (Bromet et al. 2011). In contrast, low-income nations suffer significantly from malaria and
tuberculosis.
How does health differ around the world? Some theorists differentiate among three types of countries: core
nations, semi-peripheral nations, and peripheral nations. Core nations are those that we think of as highly
developed or industrialized, semi-peripheral nations are those that are often called developing or newly
industrialized, and peripheral nations are those that are relatively undeveloped. While the most pervasive
issue in the U.S. healthcare system is affordable access to healthcare, other core countries have different
issues, and semi-peripheral and peripheral nations are faced with a host of additional concerns. Reviewing
the status of global health offers insight into the various ways that politics and wealth shape access to
healthcare, and it shows which populations are most affected by health disparities.
Health in High-Income Nations
Obesity, which is on the rise in high-income nations, has been linked to many diseases, including
cardiovascular problems, musculoskeletal problems, diabetes, and respiratory issues. According to the
Organization for Economic Cooperation and Development (2011), obesity rates are rising in all countries,
with the greatest gains being made in the highest-income countries. The United States has the highest
obesity rate. Wallace Huffman and his fellow researchers (2006) contend that several factors are
contributing to the rise in obesity in developed countries:
1. Improvements in technology and reduced family size have led to a reduction of work to be done in
household production.
2. Unhealthy market goods, including processed foods, sweetened drinks, and sweet and salty snacks
are replacing home-produced goods.
3. Leisure activities are growing more sedentary, for example, computer games, web surfing, and
television viewing.
4. More workers are shifting from active work (agriculture and manufacturing) to service industries.
5. Increased access to passive transportation has led to more driving and less walking.
Obesity and weight issues have significant societal costs, including lower life expectancies and higher
shared healthcare costs.
High-income countries also have higher rates of depression than less affluent nations. A recent study
(Bromet et al. 2011) shows that the average lifetime prevalence of major depressive episodes in the ten
highest-income countries in the study was 14.6 percent; this compared to 11.1 percent in the eight low- and
middle-income countries. The researchers speculate that the higher rate of depression may be linked to the
greater income inequality that exists in the highest-income nations.
Health in Low-Income Nations
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Figure 19.4 In low-income countries,
malnutrition and lack of access to clean water
contribute to a high child mortality rate. (Photo
courtesy of Steve Evans/flickr)
In peripheral nations with low per capita income, it is not the cost of healthcare that is the most pressing
concern. Rather, low-income countries must manage such problems as infectious disease, high infant
mortality rates, scarce medical personnel, and inadequate water and sewer systems. Such issues, which
high-income countries rarely even think about, are central to the lives of most people in low-income nations.
Due to such health concerns, low-income nations have higher rates of infant mortality and lower average life
spans.
One of the biggest contributors to medical issues in low-income countries is the lack of access to clean
water and basic sanitation resources. According to a 2014 UNICEF report, almost half of the developing
world’s population lacks improved sanitation facilities. The World Health Organization (WHO) tracks health-
related data for 193 countries. In their 2011 World Health Statistics report, they document the following
statistics:
1. Globally, the rate of mortality for children under five was 60 per 1,000 live births. In low-income
countries, however, that rate is almost double at 117 per 1,000 live births. In high-income countries,
that rate is significantly lower than seven per 1,000 live births.
2. The most frequent causes of death for children under five were pneumonia and diarrheal diseases,
accounting for 18 percent and 15 percent, respectively. These deaths could be easily avoidable with
cleaner water and more coverage of available medical care.
3. The availability of doctors and nurses in low-income countries is one-tenth that of nations with a high
income. Challenges in access to medical education and access to patients exacerbate this issue for
would-be medical professionals in low-income countries (World Health Organization 2011).
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Health in the United States is a complex and often contradictory issue. One the one hand, as one of the
wealthiest nations, the United States fares well in health comparisons with the rest of the world. However,
the United States also lags behind almost every industrialized country in terms of providing care to all its
citizens. The following sections look at different aspects of health in the United States.
Health by Race and Ethnicity
When looking at the social epidemiology of the United States, it is hard to miss the disparities among races.
The discrepancy between black and white Americans shows the gap clearly; in 2008, the average life
expectancy for white males was approximately five years longer than for black males: 75.9 compared to
70.9. An even stronger disparity was found in 2007: the infant mortality, which is the number of deaths in a
given time or place, rate for blacks was nearly twice that of whites at 13.2 compared to 5.6 per 1,000 live
births (U.S. Census Bureau 2011). According to a report from the Henry J. Kaiser Foundation (2007), African
Americans also have higher incidence of several other diseases and causes of mortality, from cancer to
heart disease to diabetes. In a similar vein, it is important to note that ethnic minorities, including Mexican
Americans and Native Americans, also have higher rates of these diseases and causes of mortality than
whites.
Lisa Berkman (2009) notes that this gap started to narrow during the Civil Rights movement in the 1960s,
but it began widening again in the early 1980s. What accounts for these perpetual disparities in health
among different ethnic groups? Much of the answer lies in the level of healthcare that these groups receive.
The National Healthcare Disparities Report (2010) shows that even after adjusting for insurance differences,
racial and ethnic minority groups receive poorer quality of care and less access to care than dominant
groups. The Report identified these racial inequalities in care:
1. Black Americans, American Indians, and Alaskan Natives received inferior care than White Americans
for about 40 percent of measures.
2. Asian ethnicities received inferior care for about 20 percent of measures.
3. Among whites, Hispanic whites received 60 percent inferior care of measures compared to non-
Hispanic whites (Agency for Health Research and Quality 2010). When considering access to care,
the figures were comparable.
Health by Socioeconomic Status
Discussions of health by race and ethnicity often overlap with discussions of health by socioeconomic
status, since the two concepts are intertwined in the United States. As the Agency for Health Research and
Quality (2010) notes, “racial and ethnic minorities are more likely than non-Hispanic whites to be poor or
near poor,” so many of the data pertaining to subordinate groups is also likely to be pertinent to low
socioeconomic groups. Marilyn Winkleby and her research associates (1992) state that “one of the
strongest and most consistent predictors of a person’s morbidity and mortality experience is that person’s
socioeconomic status (SES). This finding persists across all diseases with few exceptions, continues
throughout the entire lifespan, and extends across numerous risk factors for disease.” Morbidity is the
incidence of disease.
It is important to remember that economics are only part of the SES picture; research suggests that
education also plays an important role. Phelan and Link (2003) note that many behavior-influenced diseases
like lung cancer (from smoking), coronary artery disease (from poor eating and exercise habits), and AIDS
initially were widespread across SES groups. However, once information linking habits to disease was
disseminated, these diseases decreased in high SES groups and increased in low SES groups. This
illustrates the important role of education initiatives regarding a given disease, as well as possible
inequalities in how those initiatives effectively reach different SES groups.
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Health by Gender
Women are affected adversely both by unequal access to and institutionalized sexism in the healthcare
industry. According a recent report from the Kaiser Family Foundation, women experienced a decline in their
ability to see needed specialists between 2001 and 2008. In 2008, one quarter of females questioned the
quality of her healthcare (Ranji and Salganico 2011). In this report, we also see the explanatory value of
intersection theory. Feminist sociologist Patricia Hill Collins developed this theory, which suggests we
cannot separate the effects of race, class, gender, sexual orientation, and other attributes. Further
examination of the lack of confidence in the healthcare system by women, as identified in the Kaiser study,
found, for example, women categorized as low income were more likely (32 percent compared to 23
percent) to express concerns about healthcare quality, illustrating the multiple layers of disadvantage
caused by race and sex.
We can see an example of institutionalized sexism in the way that women are more likely than men to be
diagnosed with certain kinds of mental disorders. Psychologist Dana Becker notes that 75 percent of all
diagnoses of Borderline Personality Disorder (BPD) are for women according to the Diagnostic Statistical
Manual of Mental Disorders. This diagnosis is characterized by instability of identity, of mood, and of
behavior, and Becker argues that it has been used as a catch-all diagnosis for too many women. She further
decries the pejorative connotation of the diagnosis, saying that it predisposes many people, both within and
outside of the profession of psychotherapy, against women who have been so diagnosed (Becker).
Many critics also point to the medicalization of women’s issues as an example of institutionalized sexism.
Medicalization refers to the process by which previously normal aspects of life are redefined as deviant and
needing medical attention to remedy. Historically and contemporaneously, many aspects of women’s lives
have been medicalized, including menstruation, pre-menstrual syndrome, pregnancy, childbirth, and
menopause. The medicalization of pregnancy and childbirth has been particularly contentious in recent
decades, with many women opting against the medical process and choosing a more natural childbirth. Fox
and Worts (1999) find that all women experience pain and anxiety during the birth process, but that social
support relieves both as effectively as medical support. In other words, medical interventions are no more
effective than social ones at helping with the difficulties of pain and childbirth. Fox and Worts further found
that women with supportive partners ended up with less medical intervention and fewer cases of
postpartum depression. Of course, access to quality birth care outside the standard medical models may
not be readily available to women of all social classes.
SOCIOLOGY IN THE REAL WORLD
Medicalization of Sleeplessness
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Figure 19.5 Many people fail to get enough
sleep. But is insomnia a disease that should
be cured with medication? (Photo courtesy of
Wikimedia Commons)
How is your “sleep hygiene?” Sleep hygiene refers to the lifestyle and sleep habits that contribute
to sleeplessness. Bad habits that can lead to sleeplessness include inconsistent bedtimes, lack of
exercise, late-night employment, napping during the day, and sleep environments that include
noise, lights, or screen time (National Institutes of Health 2011a).
According to the National Institute of Health, examining sleep hygiene is the first step in trying to
solve a problem with sleeplessness.
For many people in the United States, however, making changes in sleep hygiene does not seem
to be enough. According to a 2006 report from the Institute of Medicine, sleeplessness is an
underrecognized public health problem affecting up to 70 million people. It is interesting to note
that in the months (or years) after this report was released, advertising by the pharmaceutical
companies behind Ambien, Lunesta, and Sepracor (three sleep aids) averaged $188 million
weekly promoting these drugs (Gellene 2009).
According to a study in the American Journal of Public Health (2011), prescriptions for sleep
medications increased dramatically from 1993 to 2007. While complaints of sleeplessness during
doctor’s office visits more than doubled during this time, insomnia diagnoses increased more than
sevenfold, from about 840,000 to 6.1 million. The authors of the study conclude that
sleeplessness has been medicalized as insomnia, and that “insomnia may be a public health
concern, but potential overtreatment with marginally effective, expensive medications with
nontrivial side effects raises definite population health concerns” (Moloney, Konrad, and Zimmer
2011). Indeed, a study published in 2004 in the Archives of Internal Medicine shows that cognitive
behavioral therapy, not medication, was the most effective sleep intervention (Jacobs, Pace-
Schott, Stickgold, and Otto 2004).
A century ago, people who couldn’t sleep were told to count sheep. Now they pop a pill, and all
those pills add up to a very lucrative market for the pharmaceutical industry. Is this industry
behind the medicalization of sleeplessness, or is it just responding to a need?
Mental Health and
Disability
The treatment received by those defined as mentally ill or disabled varies greatly from country to country. In
the post-millennial United States, those of us who have never experienced such a disadvantage take for
granted the rights our society guarantees for each citizen. We do not think about the relatively recent nature
of the protections, unless, of course, we know someone constantly inconvenienced by the lack of
accommodations or misfortune of suddenly experiencing a temporary disability.
Mental Health
People with mental disorders (a condition that makes it more difficult to cope with everyday life) and people
with mental illness (a severe, lasting mental disorder that requires long-term treatment) experience a wide
range of effects.
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According to the National Institute of Mental Health (NIMH), the most common mental disorders in the
United States are anxiety disorders. Almost 18 percent of U.S. adults are likely to be affected in a single
year, and 28 percent are likely to be affected over the course of a lifetime (National Institute of Mental Health
2005). It is important to distinguish between occasional feelings of anxiety and a true anxiety disorder.
Anxiety is a normal reaction to stress that we all feel at some point, but anxiety disorders are feelings of
worry and fearfulness that last for months at a time. Anxiety disorders include obsessive compulsive
disorder (OCD), panic disorders, posttraumatic stress disorder (PTSD), and both social and specific
phobias.
The second most common mental disorders in the United States are mood disorders; roughly 10 percent
of U.S. adults are likely to be affected yearly, while 21 percent are likely to be affected over the course of a
lifetime (National Institute of Mental Health 2005). Major mood disorders are depression, bipolar disorder,
and dysthymic disorder. Like anxiety, depression might seem like something that everyone experiences at
some point, and it is true that most people feel sad or “blue” at times in their lives. A true depressive
episode, however, is more than just feeling sad for a short period. It is a long-term, debilitating illness that
usually needs treatment to cure. And bipolar disorder is characterized by dramatic shifts in energy and
mood, often affecting the individual’s ability to carry out day-to-day tasks. Bipolar disorder used to be called
manic depression because of the way people would swing between manic and depressive episodes.
Depending on what definition is used, there is some overlap between mood disorders and personality
disorders, which affect 9 percent of people in the United States yearly. The American Psychological
Association publishes the Diagnostic and Statistical Manual on Mental Disorders (DSM), and their definition
of personality disorders is changing in the fifth edition, which is being revised in 2011 and 2012. After a
multilevel review of proposed revisions, the American Psychiatric Association Board of Trustees ultimately
decided to retain the DSM-IV categorical approach with the same ten personality disorders (paranoid
personality disorder, schizoid personality disorder, schizotypal personality disorder, antisocial personality
disorder, borderline personality disorder, histrionic personality, narcissistic personality disorder, avoidant
personality disorder, dependent personality disorder and obsessive-compulsive personality disorder. In the
DSM-IV, personality disorders represent “an enduring pattern of inner experience and behavior that deviates
markedly from the expectations of the culture of the individual who exhibits it” (National Institute of Mental
Health). In other words, personality disorders cause people to behave in ways that are seen as abnormal to
society but seem normal to them. The DSM-5 proposes broadening this definition by offering five broad
personality trait domains to describe personality disorders, some related to the level or type of their
disconnect with society. As their application evolves, we will see how their definitions help scholars across
disciplines understand the intersection of health issues and how they are defined by social institutions and
cultural norms.
Figure 19.6 Medication is a common option
for children with ADHD. (Photo courtesy of
Deviation56/Wikimedia Commons)
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Another fairly commonly diagnosed mental disorder is Attention-Deficit/Hyperactivity Disorder (ADHD),
which statistics suggest affects 9 percent of children and 8 percent of adults on a lifetime basis (National
Institute of Mental Health 2005). ADHD is one of the most common childhood disorders, and it is marked by
difficulty paying attention, difficulty controlling behavior, and hyperactivity. According to the American
Psychological Association (APA), ADHD responds positively to stimulant drugs like Ritalin, which helps
people stay focused. However, there is some social debate over whether such drugs are being
overprescribed (American Psychological Association). In fact, some critics question whether this disorder is
really as widespread as it seems, or if it is a case of over diagnosis. According to the Centers for Disease
Control and Prevention, only 5 percent of children have ADHD. However approximately 11 percent of
children ages four through seventeen have been diagnosed with ADHD as of 2011.
Autism Spectrum Disorders (ASD) have gained a lot of attention in recent years. The term ASD
encompasses a group of developmental brain disorders that are characterized by “deficits in social
interaction, verbal and nonverbal communication, and engagement in repetitive behaviors or interests”
(National Institute of Mental Health). As with the personality disorders described above, the Diagnostic and
Statistical Manual on Mental Disorders’ description of these is in the process of being revised.
The National Institute of Mental Health (NIMH) distinguishes between serious mental illness and other
disorders. The key feature of serious mental illness is that it results in “serious functional impairment, which
substantially interferes with or limits one or more major life activities” (National Institute of Mental Health).
Thus, the characterization of “serious” refers to the effect of the illness (functional impairment), not the
illness itself.
Disability
Figure 19.7 The
handicapped accessible
sign indicates that people
with disabilities can access
the facility. The Americans
with Disabilities Act
requires that access be
provided to everyone.
(Photo courtesy of
Ltljltlj/Wikimedia Commons)
Disability refers to a reduction in one’s ability to perform everyday tasks. The World Health Organization
makes a distinction between the various terms used to describe handicaps that’s important to the
sociological perspective. They use the term impairment to describe the physical limitations, while reserving
the term disability to refer to the social limitation.
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Before the passage of the Americans with Disabilities Act (ADA) in 1990, people in the United States with
disabilities were often excluded from opportunities and social institutions many of us take for granted. This
occurred not only through employment and other kinds of discrimination but also through casual
acceptance by most people in the United States of a world designed for the convenience of the able-
bodied. Imagine being in a wheelchair and trying to use a sidewalk without the benefit of wheelchair-
accessible curbs. Imagine as a blind person trying to access information without the widespread availability
of Braille. Imagine having limited motor control and being faced with a difficult-to-grasp round door handle.
Issues like these are what the ADA tries to address. Ramps on sidewalks, Braille instructions, and more
accessible door levers are all accommodations to help people with disabilities.
People with disabilities can be stigmatized by their illnesses. Stigmatization means their identity is spoiled;
they are labeled as different, discriminated against, and sometimes even shunned. They are labeled (as an
interactionist might point out) and ascribed a master status (as a functionalist might note), becoming “the
blind girl” or “the boy in the wheelchair” instead of someone afforded a full identity by society. This can be
especially true for people who are disabled due to mental illness or disorders.
As discussed in the section on mental health, many mental health disorders can be debilitating and can
affect a person’s ability to cope with everyday life. This can affect social status, housing, and especially
employment. According to the Bureau of Labor Statistics (2011), people with a disability had a higher rate of
unemployment than people without a disability in 2010: 14.8 percent to 9.4 percent. This unemployment
rate refers only to people actively looking for a job. In fact, eight out of ten people with a disability are
considered “out of the labor force;” that is, they do not have jobs and are not looking for them. The
combination of this population and the high unemployment rate leads to an employment-population ratio of
18.6 percent among those with disabilities. The employment-population ratio for people without disabilities
was much higher, at 63.5 percent (U.S. Bureau of Labor Statistics 2011).
SOCIOLOGY IN THE REAL WORLD
Obesity: The Last Acceptable Prejudice
Figure 19.8 Obesity is considered the last
acceptable social stigma. (Photo courtesy of
Kyle May/flickr)
What is your reaction to the picture above? Compassion? Fear? Disgust? Many people will look
at this picture and make negative assumptions about the man based on his weight. According to
a study from the Yale Rudd Center for Food Policy and Obesity, large people are the object of
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“widespread negative stereotypes that overweight and obese persons are lazy, unmotivated,
lacking in self-discipline, less competent, noncompliant, and sloppy” (Puhl and Heuer 2009).
Historically, both in the United States and elsewhere, it was considered acceptable to
discriminate against people based on prejudiced opinions. Even after slavery was abolished in
1865, the next 100 years of U.S. history saw institutionalized racism and prejudice against black
people. In an example of stereotype interchangeability, the same insults that are flung today at
the overweight and obese population (lazy, for instance), have been flung at various racial and
ethnic groups in earlier history. Of course, no one gives voice to these kinds of views in public
now, except when talking about obese people.
Why is it considered acceptable to feel prejudice toward—even to hate—obese people? Puhl and
Heuer suggest that these feelings stem from the perception that obesity is preventable through
self-control, better diet, and more exercise. Highlighting this contention is the fact that studies
have shown that people’s perceptions of obesity are more positive when they think the obesity
was caused by non-controllable factors like biology (a thyroid condition, for instance) or genetics.
Even with some understanding of non-controllable factors that might affect obesity, obese people
are still subject to stigmatization. Puhl and Heuer’s study is one of many that document
discrimination at work, in the media, and even in the medical profession. Obese people are less
likely to get into college than thinner people, and they are less likely to succeed at work.
Stigmatization of obese people comes in many forms, from the seemingly benign to the
potentially illegal. In movies and television show, overweight people are often portrayed
negatively, or as stock characters who are the butt of jokes. One study found that in children’s
movies “obesity was equated with negative traits (evil, unattractive, unfriendly, cruel) in 64 percent
of the most popular children’s videos. In 72 percent of the videos, characters with thin bodies had
desirable traits, such as kindness or happiness” (Hines and Thompson 2007). In movies and
television for adults, the negative portrayal is often meant to be funny. “Fat suits”—inflatable suits
that make people look obese—are commonly used in a way that perpetuates negative
stereotypes. Think about the way you have seen obese people portrayed in movies and on
television; now think of any other subordinate group being openly denigrated in such a way. It is
difficult to find a parallel example.
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Each of the three major theoretical perspectives approaches the topics of health, illness, and medicine
differently. You may prefer just one of the theories that follow, or you may find that combining theories and
perspectives provides a fuller picture of how we experience health and wellness.
Functionalism
According to the functionalist perspective, health is vital to the stability of the society, and therefore
sickness is a sanctioned form of deviance. Talcott Parsons (1951) was the first to discuss this in terms of the
sick role: patterns of expectations that define appropriate behavior for the sick and for those who take care
of them.
According to Parsons, the sick person has a specific role with both rights and responsibilities. To start with,
she has not chosen to be sick and should not be treated as responsible for her condition. The sick person
also has the right of being exempt from normal social roles; she is not required to fulfill the obligation of a
well person and can avoid her normal responsibilities without censure. However, this exemption is
temporary and relative to the severity of the illness. The exemption also requires legitimation by a
physician; that is, a physician must certify that the illness is genuine.
The responsibility of the sick person is twofold: to try to get well and to seek technically competent help
from a physician. If the sick person stays ill longer than is appropriate (malingers), she may be stigmatized.
Parsons argues that since the sick are unable to fulfill their normal societal roles, their sickness weakens the
society. Therefore, it is sometimes necessary for various forms of social control to bring the behavior of a
sick person back in line with normal expectations. In this model of health, doctors serve as gatekeepers,
deciding who is healthy and who is sick—a relationship in which the doctor has all the power. But is it
appropriate to allow doctors so much power over deciding who is sick? And what about people who are
sick, but are unwilling to leave their positions for any number of reasons (personal/social obligations,
financial need, or lack of insurance, for instance).
Conflict Perspective
Theorists using the conflict perspective suggest that issues with the healthcare system, as with most other
social problems, are rooted in capitalist society. According to conflict theorists, capitalism and the pursuit of
profit lead to the commodification of health: the changing of something not generally thought of as a
commodity into something that can be bought and sold in a marketplace. In this view, people with money
and power—the dominant group—are the ones who make decisions about how the healthcare system will
be run. They therefore ensure that they will have healthcare coverage, while simultaneously ensuring that
subordinate groups stay subordinate through lack of access. This creates significant healthcare—and health
—disparities between the dominant and subordinate groups.
Alongside the health disparities created by class inequalities, there are a number of health disparities
created by racism, sexism, ageism, and heterosexism. When health is a commodity, the poor are more likely
to experience illness caused by poor diet, to live and work in unhealthy environments, and are less likely to
challenge the system. In the United States, a disproportionate number of racial minorities also have less
economic power, so they bear a great deal of the burden of poor health. It is not only the poor who suffer
from the conflict between dominant and subordinate groups. For many years now, homosexual couples
have been denied spousal benefits, either in the form of health insurance or in terms of medical
responsibility. Further adding to the issue, doctors hold a disproportionate amount of power in the
doctor/patient relationship, which provides them with extensive social and economic benefits.
While conflict theorists are accurate in pointing out certain inequalities in the healthcare system, they do not
give enough credit to medical advances that would not have been made without an economic structure to
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support and reward researchers: a structure dependent on profitability. Additionally, in their criticism of the
power differential between doctor and patient, they are perhaps dismissive of the hard-won medical
expertise possessed by doctors and not patients, which renders a truly egalitarian relationship more elusive.
Symbolic Interactionism
According to theorists working in this perspective, health and illness are both socially constructed. As we
discussed in the beginning of the chapter, interactionists focus on the specific meanings and causes people
attribute to illness. The term medicalization of deviance refers to the process that changes “bad” behavior
into “sick” behavior. A related process is demedicalization, in which “sick” behavior is normalized again.
Medicalization and demedicalization affect who responds to the patient, how people respond to the patient,
and how people view the personal responsibility of the patient (Conrad and Schneider 1992).
Figure 19.11 In this engraving from
the nineteenth century, “King
Alcohol” is shown with a skeleton on
a barrel of alcohol. The words
“poverty,” “misery,” “crime,” and
“death” hang in the air behind him.
(Photo courtesy of the Library of
Congress/Wikimedia Commons)
An example of medicalization is illustrated by the history of how our society views alcohol and alcoholism.
During the nineteenth century, people who drank too much were considered bad, lazy people. They were
called drunks, and it was not uncommon for them to be arrested or run out of a town. Drunks were not
treated in a sympathetic way because, at that time, it was thought that it was their own fault that they could
not stop drinking. During the latter half of the twentieth century, however, people who drank too much were
increasingly defined as alcoholics: people with a disease or a genetic predisposition to addiction who were
not responsible for their drinking. With alcoholism defined as a disease and not a personal choice,
alcoholics came to be viewed with more compassion and understanding. Thus, “badness” was transformed
into “sickness.”
There are numerous examples of demedicalization in history as well. During the Civil War era, slaves who
frequently ran away from their owners were diagnosed with a mental disorder called drapetomania. This has
since been reinterpreted as a completely appropriate response to being enslaved. A more recent example is
homosexuality, which was labeled a mental disorder or a sexual orientation disturbance by the American
Psychological Association until 1973.
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While interactionism does acknowledge the subjective nature of diagnosis, it is important to remember who
most benefits when a behavior becomes defined as illness. Pharmaceutical companies make billions
treating illnesses such as fatigue, insomnia, and hyperactivity that may not actually be illnesses in need of
treatment, but opportunities for companies to make more money.
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anxiety disorders
feelings of worry and fearfulness that last for months at a time
commodification
the changing of something not generally thought of as a commodity into something that can be bought and
sold in a marketplace
contested illnesses
illnesses that are questioned or considered questionable by some medical professionals
demedicalization
the social process that normalizes “sick” behavior
disability
a reduction in one’s ability to perform everyday tasks; the World Health Organization notes that this is a
social limitation
epidemiology
the study of the incidence, distribution, and possible control of diseases
impairment
the physical limitations a less-able person faces
individual mandate
a government rule that requires everyone to have insurance coverage or they will have to pay a penalty
legitimation
the act of a physician certifying that an illness is genuine
medical sociology
the systematic study of how humans manage issues of health and illness, disease and disorders, and
healthcare for both the sick and the healthy
medicalization
the process by which aspects of life that were considered bad or deviant are redefined as sickness and
needing medical attention to remedy
medicalization of deviance
the process that changes “bad” behavior into “sick” behavior
mood disorders
long-term, debilitating illnesses like depression and bipolar disorder
morbidity
the incidence of disease
mortality
the number of deaths in a given time or place
personality disorders
disorders that cause people to behave in ways that are seen as abnormal to society but seem normal to
them
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private healthcare
health insurance that a person buys from a private company; private healthcare can either be employer-
sponsored or direct-purchase
public healthcare
health insurance that is funded or provided by the government
sick role
the pattern of expectations that define appropriate behavior for the sick and for those who take care of
them
social epidemiology
the study of the causes and distribution of diseases
socialized medicine
when the government owns and runs the entire healthcare system
stereotype interchangeability
stereotypes that don’t change and that get recycled for application to a new subordinate group
stigmatization
the act of spoiling someone’s identity; they are labeled as different, discriminated against, and sometimes
even shunned due to an illness or disability
stigmatization of illness
illnesses that are discriminated against and whose sufferers are looked down upon or even shunned by
society
underinsured
people who spend at least 10 percent of their income on healthcare costs that are not covered by insurance
universal healthcare
a system that guarantees healthcare coverage for everyone
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There are broad, structural differences among the healthcare systems of different countries. In core nations,
those differences might arise in the administration of healthcare, while the care itself is similar. In peripheral
and semi-peripheral countries, a lack of basic healthcare administration can be the defining feature of the
system. Most countries rely on some combination of modern and traditional medicine. In core countries
with large investments in technology, research, and equipment, the focus is usually on modern medicine,
with traditional (also called alternative or complementary) medicine playing a secondary role. In the United
States, for instance, the American Medical Association (AMA) resolved to support the incorporation of
complementary and alternative medicine in medical education. In developing countries, even quickly
modernizing ones like China, traditional medicine (often understood as “complementary” by the western
world) may still play a larger role.
U.S. Healthcare
U.S. healthcare coverage can broadly be divided into two main categories: public healthcare (government-
funded) and private healthcare (privately funded).
The two main publicly funded healthcare programs are Medicare, which provides health services to people
over sixty-five years old as well as people who meet other standards for disability, and Medicaid, which
provides services to people with very low incomes who meet other eligibility requirements. Other
government-funded programs include service agencies focused on Native Americans (the Indian Health
Service), Veterans (the Veterans Health Administration), and children (the Children’s Health Insurance
Program). A controversial issue in 2011 was a proposed constitutional amendment requiring a balanced
federal budget, which would almost certainly require billions of dollars in cuts to these programs. As
discussed below, the United States already has a significant problem with lack of healthcare coverage for
many individuals; if these budget cuts pass, the already heavily burdened programs are sure to suffer, and
so are the people they serve (Kogan 2011).
The U.S. Census (2011) divides private insurance into employment-based insurance and direct-purchase
insurance. Employment-based insurance is health plan coverage that is provided in whole or in part by an
employer or union; it can cover just the employee, or the employee and his or her family. Direct purchase
insurance is coverage that an individual buys directly from a private company.
With all these insurance options, insurance coverage must be almost universal, right? Unfortunately, the
U.S. Census Current Population Survey of 2013 shows that 18 percent of people in the United States have
no health insurance at all. Equally alarming, a study by the Commonwealth Fund shows that in 2010, 81
million adults were either uninsured or underinsured; that is, people who pay at least 10 percent of their
income on healthcare costs not covered by insurance or, for low-income adults, those whose medical
expenses or deductibles are at least 5 percent of their income (Schoen, Doty, Robertson, and Collins 2011).
The Commonwealth study further reports that while underinsurance has historically been an issue that low-
income families faced, today it is affecting middle-income families more and more.
Why are so many people uninsured or underinsured? Skyrocketing healthcare costs are part of the issue.
Many people cannot afford private health insurance, but their income level is not low enough to meet
eligibility standards for government supported insurance. Further, even for those who are eligible for
Medicaid, the program is less than perfect. Many physicians refuse to accept Medicaid patients, citing low
payments and extensive paperwork (Washington University Center for Health Policy, n.d.).
Healthcare in the United States is a complex issue, and it will only get more so with the continued
enactment of the Patient Protection and Affordable Care Act (PPACA) of 2010. This Act, sometimes called
“ObamaCare” for its most noted advocate, President Barack Obama, represents large-scale federal reform
of the United States’ healthcare system. The PPACA aims to address some of the biggest flaws of the
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current healthcare system. It expands eligibility to programs like Medicaid and CHIP, helps guarantee
insurance coverage for people with pre-existing conditions, and establishes regulations to make sure that
the premium funds collected by insurers and care providers go directly to medical care. It also includes an
individual mandate, which requires everyone to have insurance coverage by 2014 or pay a penalty. A
series of provisions, including significant subsidies, are intended to address the discrepancies in income
that are currently contributing to high rates of uninsurance and underinsurance. In 2012 the U.S. Supreme
Court upheld the constitutionality of the PPACA’s individual mandate. According to Blumenthal (2014), 20
million people in the United States have gained health insurance under PPACA. This lowers the number of
uninsured people to 13 percent.
Figure 19.9 Many people in the United States
worry that governmental oversight of
healthcare represents a federal overstepping
of constitutional guarantees of individual
freedom. Others welcome a program that they
believe will make healthcare accessible and
affordable to everyone. (Photo courtesy of
Fibonacci Blue/flickr)
The PPACA remains contentious. The Supreme Court ruled in the case of National Federation of
Independent Businesses v. Sebelius in 2012, that states cannot be forced to participate in the PPACA’s
Medicaid expansion. This ruling has opened the door to challenges to the PPACA in Congress and the
Federal courts, some state governments, conservative groups and independent businesses. A concern to
public health officials is fear among some parents that certain vaccines such as the measels, mumps, and
rubella (MMR) vaccine are linked to higher risk of autism. According to Uchiyama et al (2007), there is no link
between the MMR and autism. However fear of this perceived link pushes some parents to refuse the MMR
vaccine for their children.
An additional issue in U.S. healthcare has been the push to legalize marijuana in some states. As of this
writing, twenty-three states and the District of Columbia allow the use of medical cannabis (Borgelt 2013).
Marijuana reform appears to partly be the repackaging of marijuana from a drug to a “medicine.” Medical
evidence has demonstrated positive responses in treatment of a variety of illnesses, from some cancers to
glaucoma and epilepsy. Concerns regarding cost and long term effects of the PPACA continue to be
discussed at various societal levels.
Healthcare Elsewhere
Clearly, healthcare in the United States has some areas for improvement. But how does it compare to
healthcare in other countries? Many people in the United States are fond of saying that this country has the
best healthcare in the world, and while it is true that the United States has a higher quality of care available
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than many peripheral or semi-peripheral nations, it is not necessarily the “best in the world.” In a report on
how U.S. healthcare compares to that of other countries, researchers found that the United States does
“relatively well in some areas—such as cancer care—and less well in others—such as mortality from
conditions amenable to prevention and treatment” (Docteur and Berenson 2009).
One critique of the Patient Protection and Affordable Care Act is that it will create a system of socialized
medicine, a term that for many people in the United States has negative connotations lingering from the
Cold War era and earlier. Under a socialized medicine system, the government owns and runs the system.
It employs the doctors, nurses, and other staff, and it owns and runs the hospitals (Klein 2009). The best
example of socialized medicine is in Great Britain, where the National Health System (NHS) gives free
healthcare to all its residents. And despite some U.S. citizens’ knee-jerk reaction to any healthcare changes
that hint of socialism, the United States has one socialized system with the Veterans Health Administration.
It is important to distinguish between socialized medicine, in which the government owns the healthcare
system, and universal healthcare, which is simply a system that guarantees healthcare coverage for
everyone. Germany, Singapore, and Canada all have universal healthcare. People often look to Canada’s
universal healthcare system, Medicare, as a model for the system. In Canada, healthcare is publicly funded
and is administered by the separate provincial and territorial governments. However, the care itself comes
from private providers. This is the main difference between universal healthcare and socialized medicine.
The Canada Health Act of 1970 required that all health insurance plans must be “available to all eligible
Canadian residents, comprehensive in coverage, accessible, portable among provinces, and publicly
administered” (International Health Systems Canada 2010).
Heated discussions about socialization of medicine and managed-care options seem frivolous when
compared with the issues of healthcare systems in developing or underdeveloped countries. In many
countries, per capita income is so low, and governments are so fractured, that healthcare as we know it is
virtually non-existent. Care that people in developed countries take for granted—like hospitals, healthcare
workers, immunizations, antibiotics and other medications, and even sanitary water for drinking and
washing—are unavailable to much of the population. Organizations like Doctors Without Borders, UNICEF,
and the World Health Organization have played an important role in helping these countries get their most
basic health needs met.
Figure 19.10 This map shows the countries where malaria is known to occur. In low-income countries, malaria is still a
common cause of death. (Photo courtesy of the CDC/Wikimedia Commons)
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WHO, which is the health arm of the United Nations, set eight Millennium Development Goals (MDGs) in
2000 with the aim of reaching these goals by 2015. Some of the goals deal more broadly with the
socioeconomic factors that influence health, but MDGs 4, 5, and 6 all relate specifically to large-scale health
concerns, the likes of which most people in the United States will never contemplate. MDG 4 is to reduce
child mortality, MDG 5 aims to improve maternal health, and MDG 6 strives to combat HIV/AIDS, malaria,
and other diseases. The goals may not seem particularly dramatic, but the numbers behind them show how
serious they are.
For MDG 4, the WHO reports that 2009 infant mortality rates in “children under 5 years old in the WHO
African Region (127 per 1000 live births) and in low-income countries (117 per 1000 live births) [had
dropped], but they were still higher than the 1990 global level of 89 per 1000 live births” (World Health
Organization 2011). The fact that these deaths could have been avoided through appropriate medicine and
clean drinking water shows the importance of healthcare.
Much progress has been made on MDG 5, with maternal deaths decreasing by 34 percent. However, almost
all maternal deaths occurred in developing countries, with the African region still experiencing high numbers
(World Health Organization 2011).
On MDG 6, the WHO is seeing some decreases in per capita incidence rates of malaria, tuberculosis,
HIV/AIDS, and other diseases. However, the decreases are often offset by population increases (World
Health Organization 2011). Again, the lowest-income countries, especially in the African region, experience
the worst problems with disease. An important component of disease prevention and control is
epidemiology, or the study of the incidence, distribution, and possible control of diseases. Fear of Ebola
contamination, primarily in Western Africa but also to a smaller degree in the United States, became
national news in the summer and fall of 2014.