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CHAPTER 2 Problems of Illness and Health Care LEARNING OBJECTIVES After reading this chapter, students should be able to: 1. Distinguish between developed, developing, and the least developed countries of the world and explain health disparities among these types of countries by measures of morbidity, life expectancy, and mortality. 2. Explain measurement of the health status of a population by “burden of disease,” the measure of “disability-adjusted life year” (DALY), and the leading causes for burden of disease worldwide. 3. Explain and give examples of how illness, health, and health care affect and are affected by other aspects of social life, according to the structural-functional perspective. 4. Explain and give examples of how the conflict perspective contributes to our understanding of illness and health care by its focus on wealth, status, power, and the profit motive. 5. Explain and give examples of how the symbolic interactionist perspective contributes to our understanding of illness and health care by its focus on meanings and labels and how these are learned through social interaction. 6. Describe worldwide patterns of HIV/AIDS, modes of transmission, and the devastating effects of the disease on poor countries, particularly areas of sub-Saharan Africa. 7. Describe at-risk populations for HIV/AIDS in the United States and explain factors that put these populations at greater risk for contracting the disease. 8. Describe patterns of obesity in the United States and explain how obesity is related to patterns of food consumption, cultural attitudes, and socioeconomic status. 9. Define mental illness and describe general kinds of mental disorders, the prevalence of mental disorders in the United States, and the negative effects of mental illness. 10. Explain biological and social causes of mental illness worldwide. 11. Report common health problems of college students and life-style factors that may explain these problems. 12. Explain the positive and negative effects of globalization on health, including the effects of increased travel and information technology, increased trade and transnational corporations, and international free trade agreements. 13. Explain how the social factors of social class, poverty, education, gender, race and ethnic minority status, and family and household factors affect physical and mental health.


Problems of Illness and Health Care 14. Describe differences between health care in the United States and other countries. 15. Describe the relative proportions of the American population who are covered by government health care plans versus private insurance and explain differences between traditional health insurance plans and health maintenance organizations, preferred provider organizations, and managed care in the United States. 16. Describe the provisions and recipients of America’s major publicly funded health programs of Medicare, Medicaid, the state Children’s Health Insurance Program, Workmen’s Compensation, and military health care and explain problems associated with each of these government programs. 17. Describe and explain the problems in the United States of inadequate health insurance coverage, including inadequate insurance for the poor and problems of health coverage related to increased longevity. 18. Explain the high costs of hospital services, doctors’ fees, medical technology, drugs, health insurance, and health care administration in the United States and the consequences of the high cost of health care for individuals and families. 19. Explain the managed care crisis. 20. Explain the problem of inadequate mental health care in the United States. 21. Explain differences in the strategies of selective primary health care and comprehensive primary health care and discuss the effectiveness of each of these kinds of strategies. 22. Describe and explain strategies for improving maternal and infant health. 23. Describe and explain strategies for preventing and alleviating HIV/AIDS. 24. Describe and explain strategies for fighting the problem of obesity. 25. Compare health care coverage in other industrialized countries with the United States and describe U.S. efforts toward health care reform. 26. Describe strategies to improve mental health care, including eliminating the stigma of mental illness and eliminating inequalities in health care coverage for mental disorders in contrast to other health disorders.


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KEY TERMS biomedicalization comprehensive primary health care deinstitutionalization developed countries developing countries epidemiological transition globalization health infant mortality rate

least developed countries life expectancy managed care maternal mortality rate Medicaid medicalization Medicare mental health mental illness morbidity mortality


needle exchange programs parity selective primary health care socialized medicine State Children’s Health Insurance Program (SCHIP) stigma under-5 mortality rate universal health care workers’ compensation

Problems of Illness and Health Care

CHAPTER 2 OUTLINE I. THE GLOBAL CONTEXT: PATTERNS OF HEALTH AND ILLNESS AROUND THE WORLD A. Classification of countries for international comparisons of health and illness. 1. Developed countries (high-income countries) have relatively high gross national income per capita and diverse economies made up of different industries. 2. Developing countries (middle-income countries) have relatively low gross national income per capita, and their economies are much simpler, often relying on a few agricultural products. 3. Least developed countries (low-income countries) are the poorest countries of the world. B. Morbidity, Life Expectancy, and Mortality 1. Morbidity refers to illnesses and diseases and the symptoms and impairments they produce. a. Measures of morbidity (1) Incidence: number of new cases of a specific health problem in a given population during a specified time period (2) Prevalence: total number of cases of a specific health problem in a population that exists at a given time b. Patterns of morbidity vary according to the level of development of a country. (1) In less-developed countries, where poverty and chronic malnutrition are widespread, infectious and parasitic diseases, such as HIV disease, tuberculosis, diarrheal diseases, measles, and malaria are much more prevalent. (2) In developed countries, chronic diseases are the major health threat. 2. Wide disparities in life expectancy—the average number of years individuals born in a given year can expect to live—exist between regions of the world. a. In 2005, Japan had the longest life expectancy (82 years), Swaziland had the lowest life expectancy (30 years), and 31 countries (primarily in Africa) had life expectancies of less than 50 years. b. As societies develop and increase the standard of living for their members, life expectancy increases and birthrates decrease. c. At the same time, the main causes of death and disability shift from infectious disease and high death rates among infants and women of childbearing age (owing to complications of pregnancy, unsafe abortion, or childbearing) to chronic, noninfectious illness and disease. (1) This shift is known as the epidemiological transition, whereby low life expectancy and predominance of parasitic and infectious diseases shift to high life expectancy and predominance of chronic and degenerative diseases. (2) As societies make the epidemiological transition, birthrates decline and life expectancy increases, so diseases that need time to develop, such as cancer, heart disease, Alzheimer’s disease, arthritis, and osteoporosis, become more common and childhood diseases, typically caused by infectious and parasitic diseases, become less common, as do pregnancy-related deaths and health problems. 3. Leading causes of mortality a. Today, the leading cause of mortality, or death, worldwide is cardiovascular disease (including heart disease and stroke), accounting for 30 percent of all deaths. b. In the United States, the leading cause of death for both women and men is heart disease, followed by cancer and stroke.


Full file at 2 4. Morality Rates Among Infants and Children a. Infant Mortality (1) The infant mortality rate, the number of deaths of live-born infants under 1 year of age per 1,000 live births (in any given year), provides an important measure of the health of a population. (a) In 2005, infant mortality rates ranged from an average of 97 in least developed nations to an average of 5 in industrialized nations. (b) In 2005, the U.S. infant mortality rate was 6 and 34 countries had infant mortality rates lower than that of the U.S. (2) One of the major causes of infant death worldwide is diarrhea, resulting from poor water quality and sanitation. b. Under-5 Mortality Rate: rate of deaths of children under age 5 (1) Under-5 mortality rates range from an average of 153 in least developed nations to an average of 6 in industrialized nations. (2) A major contributing factor to deaths of infants and children is undernutrition. (a) In the developing world, one in four children under age 5 is underweight. (b) For these nutritionally deprived children, common childhood ailments such as diarrhea and respiratory infections can be fatal. 5. Maternal Mortality Rates a. Maternal mortality rate, a measure of deaths that result from complications associated with pregnancy, childbirth, and unsafe abortion, also provides a sensitive indicator of the health status of a population. (1) Maternal mortality is the leading cause of death and disability for women age 15 to 49 in developing countries. (2) The three most common causes of maternal death are hemorrhage, infection, and complications related to unsafe abortion. b. Cross-national comparisons (1) Rates of maternal mortality show a greater disparity between rich and poor countries than any of the other societal health measures: only 1% occur in high-income countries. (2) Women’s lifetime risk of dying from pregnancy or childbirth is highest in sub-Saharan Africa, where 1 in 16 women dies of pregnancy-related causes, compared to 1 in 4,000 in developed countries. c. Factors contributing to high maternal mortality rates in less developed countries (1) Poor quality and inaccessible health care: most women give birth without assistance of trained personnel. (2) Malnutrition and poor sanitation (3) Higher rates of pregnancy and childbearing at early ages (4) Lack of access to family planning services and/or lack of support of male partners to use contraceptive methods such as condoms, frequently resulting in unsafe abortions. C. Patterns of Burden of Disease 1. Provides an indicator of the overall burden of disease on a population through a single unit of measurement that combines not only the number of deaths but also the impact of premature death and disability on a population. a. This comprehensive measure, the disability-adjusted life year (DALY), reflects years of life lost to premature death and years lived with a disability. b. 1 DALY is equal to 1 lost year of health life 2. Leading causes a. Worldwide, tobacco is the leading cause of burden of disease.


Problems of Illness and Health Care b. The top 10 risk factors that contribute to the global burden of disease are: underweight; unsafe sex; high blood pressure; tobacco; alcohol; unsafe water, sanitation, and hygiene; high cholesterol; indoor smoke from solid fuels; iron deficiency; and overweight.

II. SOCIOLOGICAL THEORIES OF ILLNESS AND HEALTH CARE A. Structural-Functionalist Perspective 1. Concerned with how illness, health, and health care affect and are affected by changes in other aspects of social life a. Modernization and industrialization have resulted in environmental pollution. b. HIV/AIDS helped unite and mobilize gay rights activists. c. Concern over the effects of exposure to tobacco smoke has led to legislation banning smoking in workplaces, restaurants, and bars in at least five states. 2. Views health care as a social institution that functions to maintain well-being of societal members and of the social system as a whole a. Illness is dysfunctional in that it interferes with people performing needed social roles. b. Society assigns a temporary and unique role to those who are sick: “the sick role.” c. The sick role carries the expectation that the person who is ill will seek competent medical advice, adhere to prescribed regimen, and return as soon as possible to normal role obligations. 3. Draws attention to latent dysfunctions, unintended and often unrecognized negative consequences of social patterns or behaviors a. A latent dysfunction of the widespread use of some drugs has led to drug-resistant germs. (1) For generations, the drug chloroquine was added to table salt to prevent malaria, but overuse led to drug-resistant strains of malaria. (2) Now the drug is useless to prevent malaria. b. The highly active antiretroviral therapy (HAART) is associated with an increase among HIV-positive young people in unprotected sex, multiple sexual partners, and use of illicit drugs, which thereby increases the opportunities to transmit the virus to others. B. Conflict Perspective 1. Focuses on how wealth, status, power, and the profit motive influence illness and health care a. Criticizes the pharmaceutical and health care industry for placing profits above people. (1) Power in our health care system has shifted from physicians, who are committed to putting their patients’ interests ahead of their own financial interests, to corporations that are legally bound to put their shareholders’ interests first. (a) Many decisions about how to allocate health care dollars have become marketing decisions. (b) Because the masses of people in developing countries lack the resources to pay high prices for medication, pharmaceutical companies do not see the development of drugs for diseases of poor countries as a profitable investment. (c) Ninety percent of the $70 billion invested annually in health research and development is focused on the 10 percent of the world’s population living in industrialized countries, where drugs are more profitable. (2) Profits also compromise drug safety. (a) Most pharmaceutical companies outsource their clinical drug trials to Contract Research Organizations in developing countries where trial subjects are plentiful, operating costs are low, and regulations are lax. i. Because CROs can complete a clinical trial in less time and with less expense than a pharmaceutical company can, they offer millions of dollars in increased revenue per drug. ii. The validity of the clinical trial results from CROs is questionable, because CROs can earn more money in royalties and future contracts when the clinical trials are favorable.


Full file at 2 b. The profit motive also affects health via the food industry. c. Powerful groups and wealthy corporations influence health-related policies and laws through contributions to politicians and political campaigns. (1) After Merck & Co. received FDA approval for its drug Gardasil, a vaccine that protects against the two strains of human papilloma virus, Merck campaigned to make Gardasil mandatory for all 11-12 year old girls. (2) Merck influenced state legislators to pass bills requiring the Gardasil vaccine and provided funding to Women in Government—a nonprofit organization of female state legislators who members helped introduce bills mandating the Gardasil vaccine for girls in about 20 states. d. The profit motive can also contribute to positive changes in the U.S. health care system. (1) Large corporations struggle to compete with other companies in countries where the burden of providing health insurance does not fall on the employer. (2) Concern for profit has led big business to join those calling for U.S. health care reform. 2. Conflict theorists also point to the ways health care and research are influenced by male domination and bias a. Some insurance policies cover Viagra (a male impotence drug) but not female contraceptives. b. The male-dominated medical community has been criticized for neglecting women’s health issues and excluding women from major health research studies. C. Symbolic Interactionist Perspective 1. Focuses on how meanings, definitions, and labels influence health, illness, and health care, and how such meanings are learned through social interaction and the media 2. Argues that there are no diseases in nature; there are only conditions that society has come to define as illness or disease. a. Medicalization: defining or labeling behaviors and condition as medical problems (1) Initially, medicalization was viewed as occurring when a particular behavior or conditions deemed immoral was transformed from a legal problem into a medical problem that required medical treatment. (2) The concept of medicalization has expanded to include: (a) Any new phenomena defined as medical problems in need of medical intervention, such as post-traumatic stress disorder, premenstrual syndrome, and attentiondeficit/hyperactivity disorder. (b) “Normal” biological events or conditions that have come to be defined as medical problems in need of medical intervention, including childbirth, menopause, and death. b. Conflict theorists viewed medicalization as resulting from the medical profession’s domination and pursuit of profits, whereas a symbolic interactions perspective suggests that medicalization results from the effort of sufferers to translate their individual experiences of distress into shared experiences of illness. 3. Recent theorists have observed a shift from medicalization to biomedicalization: the view that medicine cannot only control particular conditions but can also transform bodies and lives, such as receiving an organ transplant, artificial limbs, or becoming pregnant through reproductive technology.


Problems of Illness and Health Care 4. Definitions of health and illness vary over time and from society to society. a. In some countries, being fat is a sign of health and wellness; in others, it is a sign of mental illness. b. In some cultures, perceiving visions or voices of religious figures is considered normal religious experience, whereas such hallucinations are indicative of mental illness in some cultures. c. In the 18th and 19th centuries, masturbation was considered an unhealthy act; today, most health professional agree that masturbation is a normal, healthy aspect of sexual expression. 5. Draws attention to the effects that meanings and labels have on health behaviors and healthrelated policies. a. As tobacco sales have declined in developed countries, transnational tobacco companies have looked for markets in developing countries, using advertising strategies that depict smoking as an inexpensive way to buy into glamorous lifestyles of the upper or successful social class. b. In 2004, the Centers for Medicare and Medicaid Services decided to remove language in Medicare’s coverage manual that states that obesity is not an illness: labeling obesity as an illness means that treatment for obesity can be covered by Medicare. 6. Focuses on the stigmatizing effects of being labeled “ill” a. Stigma: any personal characteristic associated with social disgrace, rejection, or discrediting b. The stigma associated with poor health often results in prejudice and discrimination against individuals with mental illnesses, drug addictions, physical deformities and impairments, missing or decayed teeth, obesity, HIV infection and AIDS. c. A study of uninsured U.S. adults found that the stigma of lacking health insurance can affect treatment by medical providers. d. The stigma associated with health problems or lack of insurance implies that the individual, rather than society, is responsibility for his or her health.

III. HIV/AIDS: A GLOBAL HEALTH CONCERN A. One of the most urgent worldwide public health concerns is the spread of the HIV, which causes AIDS. 1. Prevalence a. HIV/AIDS has killed more than 20 million people. b. Nearly 40 million people worldwide were living with HIV infection in 2006. 2. HIV/AIDS Transmission a. HIV is transmitted through sexual intercourse, sharing unclean intravenous needles, perinatal transmission (from infected mother to fetus or newborn), blood transfusions or blood products, and, rarely, through breast milk. b. Worldwide, the predominant mode of HIV transmission is through heterosexual contact. B. HIV/AIDS in Africa and other regions 1. Incidence/Prevalence a. HIV/AIDS is most prevalent in Africa. (1) With slightly more than 10 percent of the world’s population, Africa is home to 60 percent of individuals affected with HIV. (2) About 1 in 12 African adults has AIDS, and 9 out of 10 HIV-infected people in subSaharan Africa do not know they are infected. b. Millions of people living in India and hundreds of thousands of people in China, the Mediterranean region, Western Europe, and Latin America suffer from HIV/AIDS. c. Eastern European countries and Central Asia are experiencing increasing rates of HIV infection, mainly from drug-injecting behavior and, to a lesser extent, unsafe sex. d. The second highest HIV prevalence rate is the Caribbean, where 2-3% of adults are


Full file at 2 infected with HIV. 2. The high rates of HIV in developing countries have devastating effects on societies. a. HIV/AIDS has reversed the gains in life expectancy made in sub-Saharan Africa, which peaked at 49 years in the late 1980s and fell to 46 years in 2005. b. The HIV/AIDS epidemic creates an enormous burden on the limited health care resources of poor countries. c. AIDS deaths have left millions of orphans in the world; by 2010 a projected 25 million children will be orphaned by HIV/AIDS d. AIDS-affected countries could become vulnerable to political instability as the growing number of orphans exacerbates poverty and produces masses of poor, young adults who are vulnerable to involvement in criminal activity and recruitment for insurgencies. C. HIV/AIDS in the United States 1. More than 1 million people in the United States are living with HIV/AIDS. a. In about 25 percent of these people the infection is undiagnosed, and they are unaware of their infection. b. 75 percent of new HIV infections in U.S. in 2005 were among men and 25 percent, among women. c. In a study of five U.S. cities, 25% of men who have sex with men were infected with HIV; nearly half were unaware of their infection. d. Among women with HIV/AIDS, the primary mode of transmission is through heterosexual contact, followed by injection drug use. 2. Nearly half of new HIV/AIDS diagnoses in 2005 were among African Americans, who make up about 13 percent of the U.S. population. a. Higher rates of HIV/AIDS among African Americans are partly due to the link between higher AIDS incidence and poverty: nearly one in four African Americans who live in poverty experience limited access to high-quality health care and HIV prevention education. b. A recent study of HIV transmission among African Americans in North Carolina found that women with HIV infection were more likely than noninfected women to be unemployed, to receive public assistance, to have had 20 or more lifetime sexual partners, or to have traded sex for drugs, money, or shelter. 3. Despite the widespread concern about HIV, many Americans—especially adolescents and young adults—engage in high-risk behavior. a. A national survey of college students found that only about half reported having used a condom the last time they had vaginal intercourse. b. Only 28 percent reported having used a condom the last time they had anal intercourse.

IV. THE GROWING PROBLEM OF OBESITY A. Obesity is increasingly being recognized as a major health problem throughout the industrialized world. 1. A national opinion poll found that 85 percent of adults in the U.S. believe that obesity is an epidemic. 2. The United States has the highest prevalence of obesity among the developed nations. 3. Effects a. Obesity can lead to heart disease, hypertension, diabetes, and other health problems.


Problems of Illness and Health Care b. A 2005 report suggests that over the next 50 years, obesity will shorten the average U.S. life expectancy by at least 2 to 5 years, reversing the mostly steady increase in life expectancy that has occurred over the past two centuries. 4. Incidence, Prevalence, and Trends in the United States a. Adults (1) The percentage of overweight (but not obese) adults has remained steady at 32-34 percent since the 1960s, but during that same period, the percentage of obese adults has jumped from 13 percent to 34 percent. (2) About 2/3 of U.S. adults are either overweight or obese. (3) The highest rate of obesity (51%) is among non-Hispanic black women. b. Youth (1) The percentage of overweight adolescents ages 12-19 has more than tripled since the 1970s, from 5 percent to 17 percent. (2) The percentage of overweight children ages 6-11 more than doubled since the 1970s, from 7 percent to 19 percent. B. Social and lifestyle causes: patterns of food consumption and physical activity 1. Physical activity a. U.S. adults (1) National survey data show that less than one-third of U.S. adults engage in regular leisure-time physical activity (defined as moderate activity for 30 minutes or more at least 5 times a week or vigorous activity for 20 minutes at least 3 times a week). (2) One in five U.S. adults report that they do not engage in any physical activity. b. U.S. youth (1) More than one-third of youth in grades 9-12 do not engage in regular vigorous physical activity. (2) Only one-third of high school students participate in daily physical education classes at school. 2. Food consumption a. Americans are increasingly eating out at fast food and other restaurants where foods tend to contain more sugars and fats than foods consumed at home. (1) In 1970, Americans spent 1/3 of their food dollars on food away from home; this amount grew to 39% in 1980, 45% in 1990, and 47% in 2001. (2) A national study revealed that young adults ages 18-27 consumed fast food on average 2.5 times per week. b. Fast food consumption is strongly associated with weight gain and insulin resistance, thus, increasing obesity and Type 2 diabetes. c. Consumption of snack foods and sugary soft drinks has also increased. (1) Among children ages 6 to 11 years, consumption of chips, crackers, popcorn, and/or pretzels tripled from the mid 1970s to the mid 1990s. (2) Consumption of soft drinks doubled during the same period. d. This changing pattern of food consumption, known as the nutrition transition, is contributing to a rapid rise in obesity and diet-related chronic diseases worldwide. C. Cultural attitudes also play a role in obesity 1. In Black American culture, a “full physique” is considered an ideal body type: Black women with more than ample hips and plenty of “junk in the trunk” are considered attractive. 2. Black women who are thin are criticized for being underweight. D. Obesity is also related to socioeconomic status. 1. In less developed countries, poverty is associated with undernutrition and starvation.


Full file at 2 2. In the U.S., being poor is associated with an increased risk of being overweight or obese. a. High-calorie processed foods tend to be more affordable than fresh vegetables, fruits, and lean meats or fish. b. For poor individuals, overeating may be a way of compensating for the material comforts they cannot attain.

V. MENTAL ILLNESS: THE HIDDEN EPIDEMIC A. What it means to be mentally healthy varies across and within cultures. 1. In the United States, mental health is the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and cope with adversity. 2. Mental illness refers collectively to all health conditions that are characterized by alterations in thinking, mood, or behavior associated with distress or impaired functioning and that meet specific criteria (such as level of intensity and duration) specified in the classification manual used to diagnose mental disorders. 3. Mental illness is a “hidden epidemic� because the shame and embarrassment of mental illness discourages people from acknowledging and talking about it. B. Extent and Impact of Mental Illness 1. Prevalence a. A study found a 40 percent lifetime prevalence of any mental disorder in Netherlands and the U.S., 12 percent in Turkey, and 20 percent in Mexico; on an annual basis, about one in five U.S. adults and children experience mental illness. b. 26 percent of U.S. adults have a diagnosable mental disorder in any given year. c. Mental disorders are the leading cause of disability of individuals ages 15-44. d. One out of six Americans admits that poor mental health or emotional well-being kept them from doing their usual activities at least once during the last month. e. 12 percent of Americans have visited a mental health professional in the past 12 months. 2. Effects a. Untreated mental disorders can lead to poor educational achievement, lost productivity, unsuccessful relationships, significant distress, violence and abuse, incarceration, and poverty. b. Half of students identified with emotional disturbances drop out of high school. c. On a given day, 150,000 people with severe mental illness are homeless, living on the streets or in public shelters. d. One in 5 adults in U.S. prisons and 70% of youth incarcerated in juvenile justice facilities are mentally ill. e. Suicide is the fourth leading cause of death worldwide among 15- to 44-year-olds. (1) In the U.S., suicide is the third leading cause of death among people ages 15-24. (2) Most suicides in the U.S. are committed by people with a mental disorder, most commonly a depressive or substance abuse disorder. f. In 2000, about half of the 1.7 million violent deaths that occurred in the world were the result of suicide; about 1/3 from homicide; and 1/5 from war injuries. g. Suicides outnumber homicides two to one every year in the United States. C. Causes of Mental Disorders 1. Some mental illnesses are caused by genetic or neurological pathological conditions.


Problems of Illness and Health Care 2. Social and environmental causes include poverty, history of abuse or other severe emotional trauma can also affect individuals’ vulnerability to mental illness and mental health problems. a. Iodine deficiency, common in poor countries, is believed to be the single most common preventable cause of mental retardation and brain damage. b. War within and between countries also contributes to mental illness: experts predict that 16% of service members serving in Iraq and Afghanistan will develop post-traumatic stress disorder. c. Depression, which can be caused by biochemical conditions, can also stem from cultural conditions, such as radical shifts in technology, changes in family and societal supports and networks and the commercialization of existence. 3. It may be safe to conclude that the causes of most mental disorders lie in some combination of genetic, biological, and environmental factors.

VI. SOCIAL FACTORS AND LIFESTYLE BEHAVIORS ASSOCIATED WITH HEALTH AND ILLNESS A. Globalization 1. Broadly defined as the growing economic, political, and social interconnectedness among societies throughout the world, globalization has eroded the boundaries that separate societies, creating a “global village.” 2. Globalization has both positive and negative effects. a. Positive: globalized communications enhances the capacity to monitor and report on outbreaks of disease, disseminate guidelines for controlling and treating disease, share scientific knowledge and research findings. b. Negative: aspects of globalization have been linked to health problems. 3. Effects of increased travel on health a. Increased business travel and tourism have encouraged the spread of disease, such as West Nile virus. (1) The West Nile virus first appeared in the U.S. in 1999 and has spread to all 48 contiguous states. (2) Before 1999, the West Nile virus had never before been found in the U.S. (3) The most likely explanation of how the virus got to the U.S. is that it was introduced by an infected bird that was imported or an infected human returning from a country where the virus is common. b. SARS (severe acute respiratory syndrome) was first diagnosed in South China in 2002. (1) Within months of diagnosis it spread to 29 countries. (2) It has infected thousands of individuals and killed more than 800. 4. Effects of increased trade and transnational corporations on health a. Increased transportation of goods by air, sea, and land contributes to pollution caused by the burning of fossil fuels. b. The expansion of international trade of harmful products, such as tobacco, alcohol, and fast foods, is associated with a rise in cancer, heart disease, stroke and diabetes. c. Transnational corporations set up shop in developing countries to take advantage of low wages and lax environmental and labor regulations. (1) Workers are often exposed to harmful working conditions that increase the risk of illness, injury, and mental anguish. (a) Workers often suffer exposure to toxic substances, lack safety equipment, are denied bathroom breaks (which leads to bladder infections)


Full file at 2 (b) Physical brutality is frequently used as a mechanism of control on the production floor of the factory (2) Transnational corporations are responsible for high levels of pollution and environmental degradation, which negatively impacts the health of entire populations. (3) The movement of factories out of the United States to other countries has resulted in significant losses of U.S. jobs in manufacturing and the textile and apparel industry, and unemployment contributes to mental and physical illness. 5. Effects of international free trade agreements on health a. The World Trade Organization (WTO) and regional trade agreements such as the North American Free Trade Agreement (NAFTA) establish rules aimed to increased international trade. b. These trade rules supercede member countries’ laws and regulations, including those governing public health, if those laws or regulations represent a barrier to trade. (1) The Methanex Corporation of Canada produces methanol, a gas additive. (a) When the state of California banned the use of MTBE because of its link to cancer, the Methanex Corporation initiated an approximately $1 billion lawsuit against the United States, claiming that California’s ban of MTBE violates Chapter 11 of NAFTA. (b) After a 5-year battle, a closed tribunal sided with California, causing supporters of NAFTA to say that U.S. trade agreements do not encroach on governments’ right to enforce health and environmental regulations. (2) Other companies have succeeded in suing governments under NAFTA rules: in 2000, U.S. Metaclad sued Mexico for $16 million because Mexico stopped the company from reopening a toxic waste dump that would contaminate people and the environment. c. The Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) mandates that all WTO member countries implement intellectual property rules that provide 20-year monopoly control over patented items, including medications. (1) TRIPS limits the availability of generic drugs, thus contributing to higher drug costs. (2) TRIPS affects access to medications for life-threatening diseases, such as HIV/AIDS, in low-income countries. B. Social Class and Poverty 1. Poverty is associated with malnutrition, indoor air pollution, hazardous working conditions, lack of access to medical care, and unsafe water and sanitation. 2. Half of the urban population in Africa, Asia, Latin America, and the Caribbean suffers from one or more diseases linked to inadequate water and sanitation. 3. The percentage of Americans reporting fair or poor health is considerably higher among persons living below the poverty line as for those with incomes at least twice the poverty threshold. a. In the U.S., poverty is associated with higher rates of health-risk behaviors such as smoking, alcohol drinking, being overweight, and physical inactivity. b. The poor in the U.S. are also exposed to more environmental health hazards. c. The poor in the U.S. have unequal access to and use of medical care. d. Members of the lower class tend to experience higher levels of stress and have fewer resources to cope with it—stress has been linked to a variety of physical and mental health problems, including high blood pressure, cancer, chronic fatigue, and substance abuse.


Problems of Illness and Health Care 4. Health problems also contribute to poverty. a. Health problems can limit one’s ability to pursue education or vocational training and to find or keep employment. b. The high cost of health care deepens poverty of those barely getting by and can financially devastate middle-class families. 5. Poverty and mental health a. People living below the U.S. poverty line are roughly five times as likely as those with incomes twice the poverty line to have serious psychological distress. b. Two explanations for the link between social class and mental illness: (1) The selection explanation suggests that mentally ill individuals have difficulty achieving educational and occupational success and thus tend to drift to the lower class, whereas the mentally healthy are upwardly mobile. (2) The causation explanation suggests that lower-class individuals experience greater adversity and stress as a result of their deprived and difficult living conditions, and this stress can reach the point at which the individual can no longer cope with daily living. C. Education: the strongest single predictor of good health. 1. The one social factor that researchers agree is consistently linked to longer lives in every country where it has been studied is education. 2. Individuals with low levels of education are more likely to engage in health-risk behaviors such as smoking and heavy drinking. 3. Women with less education are less likely to seek prenatal care and are more likely to smoke during pregnancy, which helps to explain low birth weight and infant mortality among children of less educated mothers 4. In some cases, lack of education means that individuals do not know about health risks or how to avoid them: a national survey in India found that only 18 percent of illiterate women had heard of AIDS, compared with 92 percent of women who had completed high school. D. Gender 1. Gender affects the health of both women and men. 2. Women in developing countries a. Women in developing countries have high rates of mortality and morbidity as a result of the high rates of complications associated with pregnancy and childbirth. b. The low status of women in many less developed countries results in their being nutritionally deprived and having less access to medical care than men have. 3. Sexual violence and gender inequality contribute to growing rates of HIV among girls and women. a. Increasing rates of HIV among women are due to the fact that many women, especially in African countries, do not have the social power to refuse sexual intercourse or to demand that their male partners use condoms. b. In the United States, at least one in three women has been beaten, coerced into sex, or abused in some way—most often by someone she knows. c. Woman battering is a major cause of injury, disability, and death among American women and women worldwide. 4. In the United States today, the life expectancy of women (80.4 years) is greater than that of men (75.2 years). a. Men tend to work in more dangerous jobs than women. b. Men are more likely than women to smoke cigarettes and use alcohol and drugs. c. Men are less likely than women to visit a doctor and to adhere to medical regimens.


Full file at 2 d. Beliefs about masculinity and manhood that are deeply rooted in culture play a role in shaping the behavioral patterns of men in ways that have consequences for their health. (1) Men are socialized to be strong, independent, competitive, and aggressive and to avoid expressions of emotion or vulnerability that could be construed as weakness. (2) Socialization to be aggressive leads to risky behaviors that contribute to men’s higher risk of injuries and accidents. 5. Gender and mental health a. The prevalence of mental illness is higher among U.S. women than among U.S. men: in 2005, women were more likely than men to have experienced serious psychological distress during the past 30 days. b. Men and women differ in the types of mental illness they experience. (1) Rates of mood and anxiety disorders are higher among women. (2) Rates of personality and substance-related disorders are higher among men. (3) Although women are more likely to attempt suicide, men are more likely to succeed, since they use deadlier methods. 6. Explanations for gender differences in mental health. a. Biological factors may account for some gender differences in mental health. (1) Hormonal changes during menstruation and menopause may predispose women to depression and anxiety, although evidence to support this explanation is insufficient at present. (2) High testosterone and androgen levels in males may be linked to the greater prevalence of personality disorders in men, but research is inconclusive. b. Gender roles may contribute to different types of mental disorders. (1) The unequal status of women and the strain of doing the majority of housework and child care may predispose women to experience greater psychological distress. (2) Women may be more likely to experience depression when their children leave home, because women are socialized to invest more in their parental role than men are. E. Racial and Ethnic Minority Status 1. In the U.S., racial and ethnic minorities are more likely than non-Hispanic whites to rate their health as fair or poor. 2. Minority health differences a. Black Americans (1) Black U.S. residents, particularly black men, have a lower life expectancy than whites. (2) Black Americans are more likely than white Americans to die from stroke, heart disease, cancer, HIV infection, unintentional injuries, diabetes, cirrhosis, and homicide. (3) Black Americans have the highest rate of obesity. (4) Blacks have the highest rate of infant mortality of all racial and ethnic groups, largely because of higher rates of premature birth and low birth weight. b. Youth from racial/ethnic minority backgrounds and low socioeconomic status are more likely to be overweight and to engage in less healthy behaviors. c. Compared to white Americans, Native Americans have higher death rates from motor vehicle injuries, diabetes, and cirrhosis of the liver (caused by alcoholism). d. Compared to non-Hispanic whites, Hispanics have more diabetes, high blood pressure, and lung cancer and are at a higher risk of dying from violence, alcoholism, and drug use.


Problems of Illness and Health Care e. Asian Americans typically have high levels of health. (1) This is due in large part to the fact that they have the highest levels of income and education of any racial or ethnic U.S. minority group. (2) Traditional Asian diets, which include lots of fish and vegetables, may also account for their higher levels of health. 3. Socioeconomic differences between racial and ethnic groups are largely responsible for racial and ethnic differences in health status. a. Racial and ethnic minorities are less likely to have insurance coverage. (1) Hispanic individuals are most likely to be uninsured (32.7%), followed by American Indian/Alaskan Natives (31.4%), Native Hawaiian/Other Pacific Islanders (21.7%), blacks (19.4%), Asians (16.1%), and non-Hispanic whites (10.7%). (2) Compared to the insured, the uninsured are less likely to get timely and routine care and are more likely to be hospitalized for preventable conditions. b. Minorities are more likely to live and work in environments where they are exposed to hazards such as toxic chemicals, dust, and fumes. c. Discrimination contributes to poorer health by restricting access to quality public education, housing, and health care. (1) A study at 658 U.S. hospitals found that black patients were much less likely than white patients to get basic diagnostic tests, clot-busting drugs, or angioplasties. (2) In a study of racial disparities in rates of undergoing nine different surgical procedures, whites had higher rates than blacks for all nine surgical procedures; by 2001, the racial differences narrowed significantly for only one of the nine procedures, remained unchanged for three of the procedures and increased significantly for five of the nine procedures. 4. Race, Ethnicity, and Mental Health a. Medical sociologist, William Cockerham, reported in 2005 that almost all of the data and research that currently record differences in mental disorder between races show there is little or no significant difference in general between whites and members of racial minority groups. b. Differences that do exist are often associated more with social class than with race and ethnicity. c. Some studies suggest that minorities have a higher risk for mental disorders, such as anxiety and depression, in part because of racism and discrimination, which adversely affect physical and mental health—in 2004, Hispanics were more likely to have experienced serious psychological distress during the past 30 days than blacks and whites. d. Minorities also have less access to mental health services, are less likely to receive needed mental health services, often receive lower quality mental health care, and are underrepresented in mental health research. F. Family and Household Factors 1. Married people have better health. a. A study found that married people who live only with their spouse or with spouse and children had the best physical and mental health, whereas single women living with children had the lowest measures of health. b. Other studies show that married adults are healthier and have lower levels of depression and anxiety compared to adults who are single, divorced, cohabiting, or widowed. c. Two explanations for the association between marital status and health are the selection and causation theories. (1) The selection theory suggests that healthy individuals are more likely to marry and to stay married. (2) The causation theory says that better health among married individuals results from the economic advantages of marriage and from the emotional support provided by most marriages—the sense of being cared about, loved, and valued.


Full file at 2 2. For children, living in a two-parent household is associated with better health outcomes—a Swedish study found children living with only one parent have a higher risk of death, mental illness, and injury than those in two-parent families, even when their socioeconomic disadvantage is taken into account.

VII. PROBLEMS IN U.S. HEALTH CARE A. Comparison of the United States and other countries 1. The World Health Organization’s first ever analysis of the world’s health systems found the U.S. spends a higher portion of its gross domestic product on health care than any other country, but ranks 37 out of 191 countries according to its performance. 2. France provides the best overall health care, followed by Italy, Spain, Oman, Austria, and Japan. 3. A more recent comparison of health care in six countries—Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States—found that the U.S. ranks last on dimensions of access, patient safety, efficiency, and equity. B. An Overview of U.S. Health Care 1. In 2005, 27% of Americans were covered by government insurance plans (Medicare, Medicaid, and military insurance) and 68% were covered by private insurance, most often employment based. 2. Traditional health insurance plans a. The insured choose their health care provider b. The insured is reimbursed by the insurance company on a fee-for-service basis c. The insured typically must pay an out-of-pocket deductible and a percentage of medical expenses until a maximum of out-of-pocket expense is reached (after which insurance will cover 100% of medical costs up to a limit) 3. Health maintenance organizations (HMOs) a. Prepaid group plans in which a person pays a monthly premium for comprehensive health care services b. HMOs attempt to minimize hospitalization costs by emphasizing preventive health care. 4. Preferred provider organizations (PPOs) a. Health care organizations in which employers who purchase group health insurance agree to send their employees to certain health care providers or hospitals in return for cost discounts. b. In this arrangement, health care providers obtain more patients but charge lower fees to buyers of group insurance. 5. Managed care: any medical insurance plan that controls costs through monitoring and controlling the decisions of health care providers a. In many plans, doctors must call a utilization review office to receive approval before they can hospitalize a patient, perform surgery, or order an expensive diagnostic test. b. HMOs are only one form of managed health care. c. Most Americans who have private insurance belong to some form of managed care plan. d. Recipients of Medicaid and Medicare may also belong to a managed care plan.


Problems of Illness and Health Care 6. Medicare: funded by the federal government and reimburses the elderly and the disabled for their health care a. Individuals contribute payroll taxes to Medicare throughout their working lives and generally become eligible for Medicare when they reach 65, regardless of their income or health status. b. Medicare consists of four separate programs: (1) Part A is hospital insurance for inpatient care, which is free, but enrollees may pay a deductible and a copayment, and coverage of home health nursing and hospice care is limited. (2) Part B is voluntary and is not free; enrollees must pay a monthly premium as well as a copayment for services. (3) Medicare does not cover long-term nursing home care, dental care, eyeglasses, and other types of services, which is why many individuals who receive Medicare also enroll in Part C, which allows beneficiaries to purchase private supplementary insurance that receives payments from Medicare. (4) Part D is an outpatient drug benefit that is voluntary and requires enrollees to pay a monthly premium, meet an annual deductible, and pay coinsurance for their prescriptions. (a) Critics of the Medicare prescription drug benefit argue that the drug coverage is inadequate and complicated and fails to lower the cost of prescription drugs. (b) The Medicare prescription drug legislation provides billions of dollars in subsidies to HMOs and other managed care plans, paying them much more than it costs regular Medicare to provide the same services. (c) These private plans can elect to cover a limited number of drugs and deny coverage for other drugs. 7. Medicaid and SCHIP a. Medicaid: jointly funded by the federal and state governments to provide health care coverage for the poor (1) Medicaid does not cover all poor people; eligibility rules and benefits vary from state to state. (2) In many states, Medicaid provides health care only for the very poor who are well below the federal poverty level. b. State Children’s Health Insurance Programs (SCHIP) (1) Was created to expand health coverage to uninsured children, many of whom come from families with incomes too high to quality for Medicaid but too low to afford private health insurance. (2) States receive matching federal funds to provide medical insurance to uninsured children. c. Although all poor children are eligible for Medicaid, many of their parents are not. (1) States cannot receive matching federal funds to provide Medicaid to adults under age 65 without children, unless they are pregnant or disabled. (2) As a result, more than 40 percent of low-income adults without children are uninsured. d. It is estimated that nearly three-quarters of uninsured children are eligible for Medicaid or SCHIP, but are not enrolled. e. A recently enacted federal requirement that citizens supply documents to prove their citizenship and identity is likely to impede Medicaid enrollment.


Full file at 2 8. Workers’ Compensation a. Workers’ Compensation is an insurance program that provides medical and living expenses for people with work-related injuries or illnesses. (1) Employers pay a certain amount into their state’s workers’ compensation insurance pool, and workers injured on the job can apply to that pool for medical expenses and for compensation for work days lost. (2) In exchange for that benefit, workers cannot sue their employers for damages. b. Not all employees acquire workers’ compensation insurance, even in states where it is legally required. c. Many employees with work-related illness or injuries do not apply for workers’ compensation benefits. (1) They fear getting fired for making a claim. (2) They are not aware that they are covered by workers’ comp. (3) The employer offers incentives (i.e., bonuses) to employees when no workers’ comp claims are filed in a given period of time. d. Even when employees file a workers’ comp claim, the coverage the employee received rarely covers the cost of the employee’s injury or illness. (1) The typical scenario is one in which the workers’ comp insurance company delays accepting and paying the workers’ claim. (2) In the meantime, the injured employee racks up medical and other bills and then, in desperation, accepts a lump sum monetary settlement that does not come close to covering medical expenses or replacing lost wages. 9. Military Health Care a. Military health care includes Comprehensive Health and Medical Plan for Uniformed Services (CHAMPUS), Civilian Health and Medical Program of the Department of Defense and the Department of Veterans Affairs. b. Contrary to the common belief that one of the benefits of service in the military is health care coverage, 1.8 million, or one in eight non-elderly veterans lacked health care coverage in 2004. c. A series of Washington Post reports in 2007 brought attention to the abysmal conditions at Walter Reed Army Medical Center and military medical facilities and Veterans Administration (VA) hospitals around the country. (1) Walter Reed’s Building 18 was found to have mice, mold, and rot. (2) Soldiers and veterans around the country reported that their home post medical treatment facility was characterized by indifferent, untrained staff, lost paperwork, medical appointments that drop from computers, and long waits for consultations. (3) Other reports of military medical facilities described peeling paint, asbestos, overflowing trash, fruit fly infestations, no nurses, and lack of blankets and linens. d. Many veterans have complained that they have not received the benefits they deserve or that they have had long waits to get benefits. (1) The VA has a backlog of 400,000 benefit claims. (2) One veteran Marine from the Vietnam era said it took him 20 years to get the medical benefits he was entitled to. e. Mental health care for military personnel and military veterans is also inadequate. (1) In a report of the American Psychological Association, more than 3 of 10 soldiers met the criteria for a mental disorder, but far less than half of those in need (20-40 percent) sought help either because of the stigma of having mental health problems or because help was not available.


Problems of Illness and Health Care (2) There are not enough therapists to help families of those deployed and soldiers returning home form active duty. (a) About 40 percent of active duty psychologist slots in the military are vacant. (b) Vietnam vets whose post-traumatic stress has been triggered by images of war in Iraq are flooding the system for help and are being turned away. C. Inadequate Health Insurance Coverage 1. In 2006, 15.8% of the U.S. population (47 million) lacked health insurance. a. The number of uninsured Americans is expected to grow to 56 million by 2013. b. In a national poll, 95 percent of Americans indicated that the rate of uninsurance in the U.S. is a serious problem. 2. Disparities in Health Insurance Coverage a. Whites are more likely than racial and ethnic minorities to have health insurance. (1) Hispanics have the largest percentage of uninsured with one-third (32.7%) of Hispanics lacking insurance, followed by American Indians/Alaska Natives (31.4%), Native Hawaiians and other Pacific Islanders (21.7%), blacks (19.4%), and Asians (16.1%). (2) Only 10.7% of non-Hispanic whites lack insurance. b. Of all age groups, young adults ages 18-24 are the least likely to have health insurance; in 2006, nearly one in three young adults was uninsured. c. Health insurance status also varies by income and employment. (1) The higher an individual’s income, the more likely it is that the individual will have health insurance. (2) Employed individuals are more likely than unemployed individuals to be insured. (a) Employment is no guarantee of health insurance coverage. (b) In 2006, nearly 18 percent of full-time workers were uninsured. (3) More than two-thirds of the uninsured live in a household in the U.S. with one fulltime worker, and more than one-third of the uninsured in the U.S. have annual family incomes of more than $40,000. (4) Not all businesses offer health benefits to their employees. (a) In 2006, 61 percent of businesses offered health benefits to at least some of their employees. (b) This is down from 69 percent in 2000. (5) Even when employees offer health insurance, some employees are not eligible for health benefits because of waiting periods or part-time status. (6) Some employees who are eligible may not enroll in employer-provided health insurance because they cannot afford to pay their share of the premiums. 3. Inadequate Insurance for the Poor a. Medicaid (1) Medicaid eligibility levels are set so low that many low-income adults are not eligible. (2) Some states have waiting lists for Medicaid. (3) Because of the low reimbursement from Medicaid, many health care providers do not accept Medicaid patients. b. Although the number of uninsured children has fallen since SCHIP began in 1997, 30 percent of eligible children are not enrolled and remain uninsured. 4. Consequences of Inadequate Health Insurance a. An estimated 18,000 deaths per year in the U.S. are attributable to lack of health insurance. b. Individuals who lack health insurance are: (1) Less likely to receive preventive care (2) More likely to be hospitalized for avoidable health problems (3) More likely to have diseases diagnosed in the late stages c. In a study of individuals who experienced an unintentional injury or a new chronic health


Full file at 2 problems, uninsured individuals reported receiving less medical care and poorer short-term changes in health than those with insurance. d. Individuals without insurance experience more barriers to health care than individuals with insurance. (1) In a national poll, 6 in 10 adults without insurance said that someone in their household went without medical care because of cost. (2) In the same poll, one-quarter of those with insurance said that someone in their household had gone without a medical test or treatment because insurance would not pay for it. e. Because most health care providers do not accept patients who do not have insurance, many uninsured individuals resort to using the local hospital emergency room. (1) In a study of young adults with chronic health conditions, loss of health insurance resulted in decreased use of office-based physician services and a dramatic increase in visits to hospital emergency rooms. (2) A federal law called the Emergency Medical Treatment and Active Labor Act requires hospitals to assess all patients who come to their emergency rooms to determine whether an emergency medical condition exists and, if it does, to stabilize the patient before transferring him or her to another facility. (3) Uninsured hospital patients are almost always billed at a much higher cost than the prices negotiated by insurance companies. f. Individuals who lack dental insurance commonly have untreated dental problems, which can lead to or exacerbate other health problems: because they affect the ability to chew, untreated dental problems tend to exacerbate conditions such as diabetes or heart disease. D. The High Cost of Health Care 1. The U.S. spends more than twice as much per person for health care as other wealthy countries. a. Health care spending in the U.S. rose from $356 per person in 1970 to $6,697 in 2005 and is expected to rise to $12,320 by 2015. b. U.S. heath care spending as a share of gross domestic product (GDP) grew from 7.2 percent in 1970 to 16.0 percent in 2005 and is expected to reach 20 percent of GDP by 2015 . c. Virtually every other wealthy nation has better health care outcomes, as measured by life expectancy and infant mortality. 2. Causes of escalating health costs in the U.S. a. Increased longevity (1) Because of improved sanitation and medical advances, people are living longer today than in previous generations. (2) People older than age 65 use medical services more than younger individuals and are also more likely to take prescription medicine on a daily basis. (3) The average health care expense for the elderly U.S. population was $11,089 in 2002, compared with $3,352 per year for nonelderly adults (ages 19-64). (4) People are not only living longer, they are also spending more of their lives with chronic illnesses. (a) A century ago, the average adult in Western nations spent only 1 percent of his or her life in illness, but today the average adult spends more than 10 percent of his or her life sick.


Problems of Illness and Health Care






(b) Today people survive illnesses, conditions, and injuries that would have killed them a generation ago. i. Infants born prematurely who would not have survived a generation ago are kept alive today in hospital incubators. ii. Individuals with HIV/AIDS are living longer today owing to the availability of new (and expensive) drugs. iii. Individuals with kidney disease are receiving dialysis treatment and kidney transplants. iv. Persons with heart disease are undergoing bypass surgery and other treatments that are extending their lives and their medical expenses. Costs of Hospital Services, Doctors’ Fees, and Medical Technology (1) High hospital costs and doctors’ fees are factors in the rising costs of health care; the average visit to the emergency room costs a little more than $1,000. (2) The use of expensive medical technology, unavailable just decades ago, also contributes to high medical bills. Cost of drugs (1) The U.S. pays 81% more for patented brand-name prescription drugs than Canada and six Western European nations. (2) The high prices that Americans pay for prescription drugs party explain why the pharmaceutical industry is among the most profitable industries in the United States. (3) Manufacturers argue that in other countries, where governments regulate prices, consumers pay too little for drugs. (a) U.S. drug prices are high claim drug-makers because of the high cost of researching and developing new drugs. (b) But most large drug companies pay substantially more for marketing, advertising, and administration than for research and development. High Costs of Health Insurance (1) From 2000-2006, health insurance premiums grew by 87 percent, far outpacing inflation (18 percent) and wage growth (20 percent). (a) In 2006, the average annual premiums for employer-sponsored coverage were $4,242 for an individual and $11,480 for a family. (b) Workers contributed, on average, $627 annually toward the cost of individual coverage and $2,973 toward family coverage. (2) With the rising cost of health insurance, companies are increasing the employees share of the cost, decreasing the benefits, or not providing insurance at all. (3) The cost of health care to businesses also affects the prices that consumers pay for goods and services. Costs of health care administration (1) Health care administration expenses are higher in the U.S. than in any other nation. (2) 15% of the money paid to private health insurance companies for premiums goes to administrative expenses, compared to only 4% of public insurance programs such as Medicare and Medicaid. (3) Insurance companies and for-profit HMOs spend between 20% and 30% of their budgets to cover the costs of stockholder dividends, lobbyists, huge executive salaries, marketing, and wasteful paperwork. Consequences of the High Cost of Health Care for Individuals and Families (1) One study found that medical bills were a contributing factor in about half of all U.S. bankruptcies. (a) Ironically, many individuals who cannot pay their medical bills also cannot afford to file for bankruptcy, which can cost more than $1,000. (b) Some individuals and families cope with medical debt by taking out home equity loans, cashing out retirement accounts, and using credit cards.


Full file at 2 (2) Many individuals forgo needed medicine or medical care when they cannot afford to pay for it. (a) In a national sample of U.S. adults, more than one-third said that in the past year they did not fill a prescription because of the cost, cut pills in half, or skipped doses to make a medication last. (b) Forgoing medicine or medical care often exacerbates the medical condition, leading to even higher medical costs or death. (3) A more drastic measure involves breaking the law to receive free medical care in prison. g. Having insurance does not guarantee that one is protected against financial devastation resulting from illness or injury. (1) Many families may not be uninsured, but they are underinsured. (a) Thanks to rising deductibles, hefty co-payments, and caps on total reimbursement, some patients diagnosed with a chronic illness are finding that they cannot afford to fill all of the prescriptions that their doctor gives them. (b) Others realize that when ICU care for a child with cancer costs $49,000 per day, a family can exceed a million-dollar cap on coverage in a matter of months. (2) According to Families USA, the middle-class, those with college degrees, decent jobs, health insurance—the group of people who feel secure and well-protected—are at high, and often highest, risk of being left penniless when serious illness strikes. (a) In a 2005 study that found that half of U.S. bankruptcies are attributable, at least in part, to medical bills, most of those bankrupted (75 percent) were bankrupted when they first became sick or injured. (b) One cause of the high rate of medical bankruptcy among the insured is the high cost of co-payments, deductibles and exclusions. (3) The link between coverage and employment means that insurance is often lost when workers lose their jobs because of medical problems: although the COBRA law allows people to continue their insurance coverage when they lose a job, the premiums for continued coverage are unaffordable (often $10,000 a year or more). h. It is no surprise that when a 2006 Gallup poll asked Americans to name the “most important financial problem facing your family today” the most frequently cited answer was health care costs. i. When a national sample of U.S. adults was asked to identify the most important problem in health or health care for the government to address, the most frequent response was the high cost of health care. E. The Managed Care Crisis 1. In an attempt to control medical care costs, in the last few decades, the U.S. health care system has seen a dramatic rise in managed care. 2. Americans are concerned about reduced quality of health care resulting from the emphasis on cost containment in managed care. a. Surveys found more people have said that managed care plans do a “bad job” than a “good job” in serving customers. b. In a survey of physicians, the majority responded that managed care has negative effects on the quality of patient care because of limitations on diagnostic tests, length of hospital stay, and choice of specialists.


Problems of Illness and Health Care F. Inadequate Mental Health Care 1. Since the 1960s, U.S. mental health policy has focused on reducing costly and often neglectful institutional care and on providing more humane services in the community. a. This movement, known as deinstitutionalization, has largely failed to live up to its promises. (1) Only 1 in 5 U.S. children with mental illness is identified and receives treatment. (2) Fewer than half of adults with a serious mental illness received treatment or counseling for a mental health problem in the last year. b. Reasons for not seeking treatment include the stigma associated with mental illness, fear and mistrust of treatment, cost of care, and lack of access to services. 2. Mental health services are often inaccessible, particularly in rural areas. 3. In most states, services are available from “9 to 5” and are closed on weekends when many people with mental illness experience the greatest need. 4. Across the nation, people with severe mental illness end up in jails and prisons, homeless shelters, and hospital emergency rooms. 5. Many children with untreated mental disorders drop out of school or end up in foster care or the juvenile justice system. a. As many as 70 percent of youths incarcerated in juvenile justice facilities have mental disorders. b. In a survey of 367 colleges and universities in the U.S. and Canada, 92 percent of counseling center directors believe that the number of college with severe psychological problems has increased in recent years, yet only 58 percent of colleges and universities offer psychiatric services on campus. 6. Given the increasing growth of minority populations, another deficit in the mental health system is the inadequate number of mental health clinicians who speak the client’s language and who are aware of cultural norms and values of minority populations. 7. The mental health system is also plagued by inadequate federal and state funding of public mental health centers, which results in rationing care to those most in need; thus, people must “hit bottom” before they can receive services.

VIII. STRATEGIES FOR ACTION: IMPROVING HEALTH AND HEALTH CARE A. There are two broad approaches to improving health care: selective primary health care and comprehensive primary health care. 1. Selective primary health care: using technocratic solutions to target a specific health problem, such as immunization and oral rehydration therapy to promote child survival 2. Comprehensive primary health care: focuses on broader social determinants of health, such as poverty and economic inequality, gender inequality, environment, and community development 3. Targeting specific health problems may be necessary, but not sufficient for achieving long-term health gains; only where health interventions are embedded within a comprehensive health care approach, including attention to social equity, health systems, and human capacity development, can real and sustainable improvements in health status be seen. B. Improving Maternal and Infant Health 1. Access to family planning services, skilled birth attendants, affordable methods of contraception, and safe abortion services are important determinants of the well-being of mothers and their children. a. Family planning reduces maternal mortality simply by reducing the number of unintended pregnancies. b. Spacing births two to three years apart decreases infant mortality significantly. c. Since 1960 contraception use among married couples in developing countries has increased from 10-15% to 60%, but there are still millions of women who do not have access to contraception. d. Although most reproductive health programs focus exclusively on women, some reach out


Full file at 2 to men with services and education that enable them to share in the responsibility for reproductive care. 2. In many developing countries, women’s lack of power and status means they have little say over their reproductive health a. Men make the decisions about whether or when their wives (or partners) will have sexual relations, use contraception, or use health services; thus, improving the status and power of women is important in improving their health. b. Promoting women’s education increases the status and power of women, exposes women to information about health issues, and also delays marriage and childbearing. C. HIV/AIDS Prevention and Alleviation Strategies 1. As of this writing, there is no vaccine to prevent HIV infection; there are strategies available to help prevent and treat HIV/AIDS. 2. HIV/AIDS Education and Access to Condoms a. Alleviating HIV/AIDS requires educating populations about how to protect against HIV and providing access to male and female condoms. b. Many people throughout the world remain uninformed or misinformed about HIV/AIDS. (1) At least 30 percent of young people in a survey of 22 countries had never heard of AIDS, and in 17 countries surveyed only half of adolescents could name a single method of protecting themselves against HIV. (2) A survey of U.S. adults shows that significant numbers do not know how HIV is transmitted. (3) The survey above also showed that 12% of U.S. adults did not know that there are drugs that can lengthen the lives of those with HIV and that more than half did not know that a pregnant woman with HIV can take medication to reduce the risk of her baby being born with HIV infection. c. HIV/AIDS education occurs in a variety of ways, including through media and public service announcements, faith-based groups, health care providers, and schools. (1) Nearly 100% of U.S. parents of junior or senior high school students believe that HIV/AIDS is an appropriate topic for school sexuality programs. (2) With the HIV infection rate growing among the older than 50 population, HIV/AIDS education also takes place in some senior centers. d. Some HIV/AIDS education is based on the ABC approach (1) A = Abstain: young people who have not started sexual activity should be encouraged to abstain from or delay sexual activity to prevent HIV and other sexually transmissible infections as well as unwanted pregnancy. (2) B = Be faithful/reduce partners: after individuals become sexually active, returning to abstinence or remaining faithful to the uninfected partner are the most effective ways to avoid HIV infection. (3) C = Use condoms: people who have a sexual partner of unknown HIV status should be encouraged to practice correct and consistent use of condoms.


Problems of Illness and Health Care e. Providing education that advocates condom use and providing youth with access to condoms are controversial topics. (1) Many conservatives believe that promoting use of condoms sends the “wrong message” that sex outside marriage is OK. (a) Under the Bush administration, federal support for “abstinence-only” education programs, which promote abstinence without teaching basic facts about contraception or providing access to contraception, has expanded rapidly. (b) Abstinence-only programs are criticized for failing to provide youth with potentially life-saving information. (c) 80% of the abstinence-only curricula contains false, misleading, or distorted information about reproductive health. (2) Another controversy involves the question of whether to provide condoms to prison inmates. (a) Vermont, Mississippi, Canada, most of Western Europe, and parts of Latin America allow condom distribution in prison. (b) A deputy at the Los Angeles Sheriff’s Department, which allows only homosexual inmates to receive condoms, stated, “We’re not promoting sex; we’re promoting health. 3. HIV Testing a. Another strategy to curb the spread of HIV involves encouraging individuals to get tested for HIV so that they can modify their behavior to avoid transmitting the virus and so they can receive early medical intervention, which can slow or prevent the onset of AIDS. (1) An estimated one-fourth to one-third of HIV-infected Americans do not know they are infected. (2) About half of Americans report every having been tested for HIV b. Many individuals who have been diagnosed with HIV infection continue to engage in risky behaviors, such as unprotected anal, genital, or oral sex and needle sharing. 4. The Fight Against HIV/AIDS Stigma and Discrimination a. The HIV/AIDS stigma stems from societal views that people with HIV/AIDS are immoral and shameful. b. The stigma associated with HIV/AIDS results in discrimination that can lead to loss of employment and housing, social ostracism and rejection, and lack of access to medical care. (1) A survey of 1,000 physicians and nurses in Nigeria found that 1 in 10 admitted to refusing care for an HIV/AIDS patient or had denied HIV/AIDS patients admission to a hospital. (2) 20 percent in the survey believed that people living with HIV/AIDS have behaved immorally and deserved their fate. c. The stigma surrounding HIV/AIDS has also led to acts of violence against people perceived to be infected with HIV. d. The HIV/AIDS stigma can deter people from getting tested for the disease, can make them less likely to acknowledge their risk of infection, and can discourage those who are HIVpositive from discussing their HIV status with their sexual and needle-sharing partners. (1) Former South African president Nelson Mandela’s announcement in 2005 that his son had died of AIDS was a public attempt to fight the stigma associated with HIV/AIDS.


Full file at 2 (2) The Miss HIV Stigma Free beauty pageant, first held in Botswana in 2002, where more than one-third of adults are infected with HIV, combats the stigma by showing that HIV-infected individuals need not be ashamed and that with treatment they can lead productive lives. e. Fighting anti-gay prejudice and discrimination is also important in efforts to support the well-being of individuals diagnosed with HIV/AIDS. (1) In Africa, where about one-half of the nations have laws that criminalize same-sex behavior, fear of arrest drives gay African further underground, making them more difficult to reach for HIV interventions. (2) Fear of arrest prevents people from attending meetings or socializing in locations where their sexual identities become suspect. 5. Needle Exchange Programs a. Injection drug use accounts for most HIV cases in China, Russia, Iran, Afghanistan, Nepal, the Baltic states, and all of Central Asia as well as much of Southeast Asia and South America. b. To reduce transmission of HIV among injection drug users, their sex partners, and their children, some countries and U.S. communities have established needle exchange programs, which provide new, sterile syringes in exchange for used, contaminated syringes (1) Many needle exchange programs provide drug users with a referral to drug counseling and treatment, HIV testing and screening for other sexually transmissible diseases, hepatitis vaccinations, and condoms. (2) Needle exchange has been endorsed as an effective means of HIV prevention by the American Medical Association, the American Public Health Association, and the World Health Organization. (3) Needle-exchange programs also protect public health by providing safe disposal or potentially infectious syringes. c. Availability (1) In Canada, sterile injection equipment is available in pharmacies and needle exchange programs. (2) In the U.S., most states prohibit the sale of sterile needles without a prescription. (3) In 2004, 184 needle exchange programs were operating in 36 states, but less than half received public funding from local and/or state government. (4) The United States is the only country in the world to explicitly ban the use of federal funds for needle exchange. d. The great irony in HIV/AIDS prevention is that we know how to prevent HIV transmission and it is neither technically difficult nor expensive. (1) Most HIV transmission can be stopped by the widespread use of condoms and clean needles. (2) Implementing these strategies, however, conflicts with religious and cultural beliefs and threatens the political power structure. 6. Financial and Medical Aid to Developing Countries a. Life-extending treatment for individuals infected with HIV is not affordable for many people in the developing world. (1) Only 20 percent of the people who need HIV/AIDS drugs have access to them. (2) Fewer than 10 percent of HIV-positive pregnant women are getting antiretroviral therapy that could not only extend their lives but also reduce the risk of transmitting HIV to their babies.


Problems of Illness and Health Care b. Developing countries, those hardest hit by HIV/AIDS, depend on aid from wealthier countries to help provide medications, HIV/AIDS education programs, and condoms. (1) In 2002, the United Nations helped to create the Global Fund to fight AIDS, Tuberculosis, and Malaria. (2) The biggest obstacle to fighting AIDS in Africa may not be lack of money but lack of health care personnel. (a) The shortage of doctors and nurses in developing countries is partly due to the mass emigration of health professionals to wealthy countries. (b) Reducing emigration by improving working conditions and wages for health workers in developing countries is important to the fight against HIV/AIDS. D. Fighting the Growing Problem of Obesity 1. Reducing and preventing obesity requires encouraging people to eat a diet with sensible portions of high-fiber fruits and vegetables and minimal sugar and fat and to engage in regular physical activity. 2. Strategies to achieve these goals include: a. Restrictions on advertisements (1) The food industry spends an enormous amount of money advertising to children. (2) In response to concerns about childhood obesity, Ireland has banned advertising of candy and fast food on television, Great Britain has banned junk-food advertising on children’s television programming, and Sweden and Norway prohibit advertising that targets children. (3) In the 1970s and 1980s, the U.S. Federal Trade Commission considered restrictions on junk-food advertising aimed at children, but those efforts were opposed by the food and advertising industries. b. Public education (1) France requires that advertisements promoting processed, sweetened, or salted food and drinks on television, radio, billboards, and the Internet must include one of four health messages: “For your health, eat at least five fruits and vegetables a day,” “For your health, undertake regular physical activity,” “For your health, avoid eating too much fat, too much sugar, too much salt,” or, “For your health, avoid snacking between meals.” (2) Because many Americans do not know how many calories, fat grams, sodium, etc. is in the food they eat, consumers are encouraged to read the nutritional labels on packaged foods. (a) Proposed federal legislation includes the Menu Education and Labeling (MEAL) Act. (b) If passed, it would require all chain restaurants to list nutritional information for all meals on the menu. c. School nutrition and physical activity programs (1) Some schools are implementing nutrition programs that restrict the availability of “junk food” and provide nutrition education to students. (a) In 2004 Arkansas became the first state to pass legislation banning vending machines from elementary schools. (b) In 2007, Alabama became the second state (following Mississippi) to ban soft drinks from elementary and middle schools (diet sodas are allowed in high schools) (Leech 2007). (2) At least 16 states have passed legislation restricting the use of vending machines in schools and 24 states have recess/physical activity requirements.


Full file at 2 (3) One study of 5,200 fifth graders found that students from schools that participated in school-based healthy eating programs exhibited lower rates of overweight and obesity, had healthier diets, and reported more physical activities than students from schools without nutrition programs. (4) Proposed federal legislation (a) Proposed federal legislation to combat obesity includes the Child Nutrition Promotion and School Lunch Protection Act of 2006, which would redefine what are considered “foods of minimal nutritional value� and restrict the sale of such foods in schools. (b) The Childhood Obesity Reduction Act would create a Congressional Council to Combat Childhood Obesity; this council would provide grants to schools to develop and implement programs to increase exercise and improve nutritional choices. d. Interventions to treat obesity (1) Interventions include weight-loss or fitness clubs, nutrition and weight-loss counseling, weight-loss medications, and surgical procedures. (2) In 2004 the U.S. Department of Health and Human Services announced that the Centers for Medicare and Medicaid Services would remove language in Medicare’s coverage manual that states that obesity is not an illness: classifying obesity as an illness means that treatment for obesity, ranging from joining weight-loss or fitness clubs to surgeries and counseling, can be covered by Medicare. (3) The proposed Medicaid Obesity Treatment Act would require Medicaid coverage of prescription drugs to treat obesity. (4) Some private insurers also cover treatment for obesity; at least 7 states require it. E. U.S. Federal and State Health Care Reform 1. The U.S. is the only industrialized country that does not have any mechanism for guaranteeing health care to its citizens. 2. Other countries, such as Canada, Great Britain, Sweden, Germany, and Italy, have national health insurance systems, also referred to as socialized medicine and universal health care. a. Socialized medicine, or universal health care, refers to a state-supported system of health care delivery in which health care is purchased by the government and sold to the consumer at little or no additional cost. b. In all systems of socialized medicine, the government: (1) Directly controls the financing and organization of health services (2) Directly pays providers (3) Owns most of the medical facilities (4) Guarantees access to health care (5) Allows private care for individuals who are willing to pay for their medical expenses c. Most countries with national health insurance allow or encourage private insurance as an upgrade to a higher class of service and a fuller range of services. d. To the extent that health care is rationed in countries with national health insurance, rationing is done on the basis of medical need, not ability to pay. 3. The goals of health-reform efforts in the United States generally fall into one of three categories: a. Creation of a universal health program b. Expansion of existing government health insurance programs c. Implementing tax incentives and other strategies to make private insurance more affordable.


Problems of Illness and Health Care 4. Federal Health Care Reform a. Since 1912, when Theodore Roosevelt first proposed a national health insurance plan, the idea of health care for all Americans has been advocated by the Truman, Nixon, Carter, and Clinton administrations. b. In a 2007 poll, more than two-thirds (64 percent) of U.S. adults said that the federal government should guarantee health care coverage for all Americans, and nearly half (49 percent) said they would be willing to pay $500 or more per year in taxes so that all Americans could have health insurance. c. The proposed National Health Insurance Act which would expand Medicare to every U.S. resident. (1) This would create a single payer system in which a single tax-financed public insurance program replaces private insurance companies. (2) Under this plan, every U.S. resident would be issued a national health insurance card, would receive all medically necessary services (including prescription drugs and longterm care), would have no copayments or deductibles, and would see the doctor of his or her choice. (3) If this plan is adopted, it is estimated to save enough on administrative costs to provide coverage for all the uninsured and to substantially help the underinsured. d. The insurance industry, not surprisingly, opposes the adoption of such a system because the private health insurance industry would be virtually eliminated. e. At the federal level, Representative Pete Stark (D-California) proposed an amendment to the U.S. Constitution to guarantee health care as a right for every American. 5. State-Level Health Care Reform a. Massachusetts passed landmark legislation requiring residents to be insured, similar to the requirement that all automobiles must be insured. (1) The remaining Massachusetts population must buy private insurance (using pretax dollars) through their employers or through a new state agency—the Commonwealth Care Health Insurance Connector. (2) The uninsured face tax penalties (a) They lose their personal exemption. (b) By 2008, they pay a penalty equal to half of what health insurance premiums would have cost. (3) Employers who don’t provide health insurance face annual penalties: $295 per worker. b. Other states, including Vermont, Maine, Minnesota, Illinois, Pennsylvania, Michigan, Hawaii, and California, have also taken steps to increase health insurance coverage of their residents. c. Some states have increased benefits to Medicaid clients who demonstrate healthy behavior, such as showing up for doctor’s appointments, getting their children immunized, or following disease management programs. d. Arizona, Kansas, Montana and West Virginia offer tax credits to small businesses that offer insurance to their employees. e. Arkansas, New Mexico and Oklahoma offer small businesses and the uninsured discounted coverage through the state. F. Strategies to Improve Mental Health Care 1. Most mental disorders can be successfully treated with medications and/or psychotherapy or counseling, yet nearly half of all Americans who have a severe mental illness do not seek treatment.


Full file at 2 2. Two areas for improving mental health care in the United States are eliminating the stigma associated with mental illness and improving health insurance coverage for treating mental disorders. a. Eliminating the stigma of mental illness (1) Fearing the negative label of “mental illness” and the social rejection and stigmatization associated with mental illness, individuals are reluctant to seek psychological services. (2) In a study of 274 eighth graders, boys were more likely than girls to associate stigma with mental health service use. (a) 40% of boys compared with 23% of girls agreed with the statement, “Seeing a counselor for emotional problems makes people think you are weird or different.” (b) In the same study, more boys than girls (38% versus 23%) reported that they were not willing to use mental health services, most frequently citing the reason that they were “Too embarrassed by what other kids would say.” b. Reducing stigma may be achieved through encouraging individuals to seek treatment and making treatment accessible and affordable. (1) The surgeon general’s report on mental health explains that effective treatment for mental disorders promises to be the most effective antidote to stigma. (2) Effective interventions help people to understand that mental disorders are not character flaws but are legitimate illnesses that respond to specific treatments, just as other health conditions respond to medical interventions. c. The National Alliance for the Mentally Ill (NAMI) has a StigmaBusters campaign. (1) The public submits instances of media content that stigmatize individuals with mental illness to StigmaBusters (2) NAMI then investigates and conveys their concerns to media organizations and corporations, urging them to avoid stigmatizing portrayals of mental illness. d. Another tool to reduce the stigma of mental illness is public education. (1) A NAMI campaign called “Real Men, Real Depression” includes print, television, and radio public service announcements. (2) Breaking the Silence, a curriculum for elementary, middle, and high schools available through NAMI, uses true stories, activities, a board game, and posters to debunk myths about mental illness and sensitize students to the pain that words such as psycho and schizo and frightening or comic media images of mentally ill people can cause. 3 . Eliminating Inequalities in Health Care Coverage for Mental Disorders a. Federal Laws (1) The Mental Health Parity Act of 1996 mandated equality between mental health care insurance coverage and other health care coverage —a concept known as parity. (2) The 1996 law only provided partial parity for the annual and lifetime limits between mental health coverage and medical/surgical coverage. (3) The more recent Mental Health Parity Act of 2007 extends parity by including deductibles, co-payments, out-of-pocket expenses, covered hospital days and covered outpatient days; however, the law does not require insurers to provide mental health coverage, only parity. (4) The federal parity laws do not apply to employers with fewer than 50 employees. b. Some states have enacted mental health parity laws, but many of these laws do not address substance abuse, are limited to the more serious mental illnesses, or apply only to government employees.

ACTIVITIES AND ASSIGNMENTS Chapter 2: Problems of Illness and Health Care 61

Problems of Illness and Health Care

STUDENT PROJECTS Family Health History Instruct students to develop a family health history that describes the past or current health problems of their siblings, children, parents, grandparents, aunts, or uncles. Ask the students to identify social factors that contributed to the health problems of their family members. Such social factors may include stress, workplace conditions, gender role socialization, environmental hazards, socioeconomic factors, and cultural beliefs. Students may present their findings orally to the class and in a written report. Local, State, and National Health Organizations Ask students to identify a local, state, or national health organization (such as the American Cancer Society or a local mental health center) that addresses a specific type of health problem. Instruct the students to obtain information regarding the goals of the organization, the efforts of the organization to reach these goals, sources of funding for the organization’s activities, whether this organization is part of a larger state, national, or international organization, and an assessment of how successful this organization has been in reaching its goals. Request the students to discuss these factors orally in class discussion and submit their ideas in a written paper. Learning from Others’ Personal Stories of Health Problems Instruct students to find a personal story in the newspapers, magazines, internet, or by interviewing a personal acquaintance of someone who has suffered or is currently suffering from a health problem. Request the students to complete the following sentence: The most important thing I learned from reading the personal story [of the health problem the student chose] is.......� Request the students share the personal story and what they learned from it in a class discussion. Stigmatization of Illness or Disability Instruct each student to interview either (1) someone who suffers from a chronic physical or mental illness or disability that is stigmatized in our society or (2) a close family member of someone who is stigmatized because of illness or disability. Some possible illnesses or disabilities include HIV/AIDS, mental illness, alcoholism or other drug addiction, or physical deformities. In the interview, the student should ask: (a) what kinds of people tend to react negatively to the illness or disability; (b) what particular actions of these people suggest they think negatively about the ill or disabled person; (c) how these actions make the person feel about themselves; (d) how these feelings have affected their social interactions.

CLASSROOM ACTIVITIES Stigmatizing Mental Illness The instructor or students should bring to class examples of media (television, movies, magazines, newspapers, billboards) that they believe stigmatizes mental illness. Then divide the students into small groups and request them to discuss ways in which the examples stigmatize the mentally ill and the effects this kind of stigmatization may have on public attitudes and the mentally ill.


Full file at 2 Issues Regarding Prevention of HIV/AIDS and Other Sexually Transmitted Diseases Divide students into small groups and assign each group an issue related to sexually transmitted diseases, such as promotion of sexual abstinence among youth versus comprehensive sex education or free distribution of condoms. Request the students to choose a side on the issue and brainstorm arguments for that side. Then have a representative of each group present the group’s arguments to the class. After all sides related to an issue have been presented, open the debate for further class discussion. Global Health Hazards Divide students into small groups and assign each group a current world health hazard. Instruct the students to brainstorm how globalization may have contributed to this health hazard and possible strategies for prevention of the hazard. Strategies for Improving Health Divide the class into small groups and assign each group a particular health problem in the U.S, such as obesity, anorexia-bulimia, AIDS, heart disease, cancer, or infant mortality (which is higher among the poor and minorities). Request the student groups to divide up the labor to research outside of class current government initiatives to solve the health problem. Then have the student groups meet in class to critically discuss the potential effectiveness of these programs and brainstorm other strategies to improve the health problem. The instructor can then ask each group to report on their ideas to the class. Debating Universal Health Care Coverage Request the students to research arguments for and against universal health care coverage and then ask them to each take a stand on the issue. (Note: this project can be combined with the internet assignment regarding universal health care coverage below). Then divide the class into small groups based on their stand on the issue and ask each group to compile a list of their arguments. Each group should then select one or two representatives to represent their stand in a class debate on the issue.


Problems of Illness and Health Care

INTERNET ASSIGNMENTS Mental Illness and Other Social Problems Instruct students to go to the following web page of the NAMI (The Nation’s Voice on Mental Illness): Instruct the students to select a social problem discussed on the web site or its links and then describe how that social problem relates to mental health problems. Also request the students to make recommendations regarding how to reduce the effects of the social problem on mental health. Have the students submit their information in a written paper and/or share their ideas in a class discussion. Search the Internet for Information about a Health Condition Instruct the students to search the internet for information about causes, prevention, and treatment of a particular illness of interest to them. Request the students to summarize their information in a written report and/or share what they learned in a class discussion. Raising Awareness of the Public Health Effects of Global Trade Instruct the students to search the website of the Center for Policy Analysis on Trade and Health ( for concerns regarding the effects of global trade on public health. Request the students to report to the class or in a written assignment on one of these concerns and current organizational or legislative efforts to address the problem. Health Information for Travelers Instruct students to go to the Travelers’ Health page of the Centers for Disease Control and Prevention at: Request the students to choose a travel destination at this site and describe important information regarding the health risks for traveling to that destination. Request them also to find ways to minimize these health risks. Have the students report their findings to the class. Universal Health Care Coverage Instruct each student to search the web for a politician (either a current political official or candidate for political office) who favors universal health care coverage and a politician who opposes universal health care coverage. Request the students to write a report stating: (1) for the politician who favors universal health care, their arguments why the U.S. needs universal health care coverage and any specific plans for universal coverage that he or she has proposed; (2) for the politician who is opposed to universal health care, his or her arguments against universal health care coverage and any alternative plans to alleviate health care problems that he or she has proposed.


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INFOTRAC EXERCISES Strategies for Health Prevention Instruct students to use InfoTrac College Edition at to find three articles about a controversial strategy for health prevention, such as needle exchange programs. Request the students to submit an outline of the opposing viewpoints presented in the articles and to state how the information in the articles they found has influenced their own views. HIV Prevention Instruct students to use InfoTrac College Edition at to find at least three articles that describe programs or strategies to prevent HIV transmission. Request the students to summarize the articles and share their findings in a class discussion on HIV prevention. Obesity Instruct the students to use InfoTrac College Edition at to find at least three articles that discuss the problem of obesity—either its incidence or prevalence, causes, effects on people’s lives, or strategies to reduce obesity. Request the students to summarize the articles and share their findings in a class discussion on obesity.


Problems of Illness and Health Care


Solution manual understanding social problems 6th edition mooney  

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