Chapter Summary

CHAPTER 10: HEALTH CARE: PROBLEMS OF PHYSICAL AND MENTAL ILLNESS

Health is a state of complete physical, mental, and social well-being. The social aspect of health is often overlooked, but can affect one’s physical and mental state.

Americans spend more than a trillion dollars a year on health care, an average of $3,800 per person. But this generous expenditure does not ensure a long life expectancy for all Americans. As with many statistics, the “average” is often misleading. There is a considerable difference in the life expectancy of whites compared to African Americans and women to men. Another comparative statistics is the infant mortality rate in the United States which is higher than in many other high-income nations. As with life expectancy, a number of factors affect the infant mortality rate, including race, class, and the ability to obtain quality medical care.

Life expectancy has actually increased worldwide, albeit the increase is significantly smaller in low-income nations. One reason for this is the technological advances in medicine that have totally eliminated many acute diseases in some parts of the world and seriously curtailed them in others. Chronic diseases, illnesses that are long term or life long, have actually increased in high-income nations. One reason is based on the manufacturers of disease and another is a consequence of living longer. Chronic diseases produce disabilities that restrict one’s ability to perform certain functions in society.

Although it has reached epic proportions in some parts of the world, AIDS qualifies as a crisis in the United States. It is estimated 400,000 people in the United States have AIDS and about 2 million have the HIV virus. Although referred to as the “gay disease,” AIDS is transferred through not only homosexual encounters, but any sexual encounter in which bodily fluids are shared. It is also transferred through sharing needles and syringes and blood transfusions. The World Health Organization estimates that 75 percent of the people who are infected with HIV worldwide contracted the disease through heterosexual intercourse. The treatment of AIDS is a complex and expensive process utilizing drug cocktails and protein inhibitors. Prevention is a more practical course of action which has been the focus of public service campaigns to practice safer sex and the free distribution of condoms and new syringes to drug addicts.

Mental illness is a social problem because of the number of people it affects, the difficulty of defining and identifying mental disorders, and the ways in which mental illness is treated. Although the terms mental illness and mental disorder are often used interchangeably, many medical professionals distinguish between them. Mental disorder refers to a condition that makes it difficult or impossible for a person to cope with everyday life. Mental illness is a condition that requires extensive treatment with psychotherapy, medication, and sometimes hospitalization. Psychologists often use the Diagnostic and Statistical Manual of Mental Disorders (4th edition) to classifying mental disorders. Severe mental illnesses include schizophrenia, bipolar affective disorder, and major depression. It typically affects fewer than 15 percent of all Americans at some time in their lives.

Even though people with mental disorders usually do not seek profession treatment, the leading cause of hospitalization among men ages 15 to 44 is mental disorders. For women between in the same age group it is the second leading cause of hospitalization, with childbirth being the number one reason. Although most treatment for mental illness is done on an outpatient basis, the most severe cases need to be treated in total institutions. A total institution is a facility isolated from the rest of society that keeps the patient out of society and at the same time society away from the patient. Such treatment is a desperate measure, however, and only used for the most severe cases of mental disorders. There has been a trend for the past several decades to deinstitutionalize the mentally ill and provide treatment in alternative, community based programs. Although successful in some cases, severe cases of mental illness contribute more to social problems when taken out of a controlled setting. If an individual is determined to be a threat to himself or herself or a threat to others he or she may be involuntarily committed to an institution for evaluation and treatment as needed.

Social class, sex, age, and religion are among the variables that have been correlated to mental illness. Additional research is required, however, to make generalizations on the exact nature of these relationships.

Medical care in the United States is provided on a fee-for-service basis. The cost of medical care has spiraled, especially with the development of the health insurance industry. Various insurance programs have been developed in an effort to manage health care costs and to make health care available. Among these programs are preferred provider organizations and health maintenance organizations. Public health insurance program include Medicare for people over 65 and Medicaid for those who are poor and aged, blind, disabled, or pregnant. Even with private health providers, Medicare, and Medicaid there are approximately 45 million people in the United States with no health insurance. Approximately one-fourth of these are children. There is also unequal access to health care based on race, class, and gender.

The belief in what is the primary cause of health care problems in the United States depends on the sociological perspective one supports. Functionalists believe the problems in U.S. health care are due to macrolevel changes, such as the development of high-tech medicine, over- specialization of doctors, erosion of health insurance coverage, and an increased demand for health care by consumers. The solutions to these problems are either a reorganization of the health care system or a system of managed care. The capitalist approach is rooted in the assumption that problems in health care delivery are rooted in the capitalist economy. Symbolic interactionists believe that many problems pertaining to health care and illness are linked to social and cultural factors that influence how people define physical illness and mental illness.