Health, Illness, and Society: An Introduction in Medical Sociology

385 Pages·2023·6.774 MB·English

by  Steven E. Barkan

Health, Illness,
and Society
An Introduction to Medical Sociology
Updated Second Edition
STEVEN E. BARKAN
University of Maine
ROWMAN & LITTLEFIELD
Lanham • Boulder • New York • London
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Copyright © 2023 by The Rowman & Littlefield Publishing Group,
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First edition 2017. Second edition 2021.
All rights reserved. No part of this book may be reproduced in
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Library of Congress Cataloging-in-Publication Data Available
ISBN 9781538177648 (paperback) | ISBN 9781538177655 (epub)
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BRIEF CONTENTS
CHAPTER 1 Sociology and the Study of Health and Illness 1
CHAPTER 2 A Social History of Health and Illness 16
CHAPTER 3 Health Behavior 37
CHAPTER 4 Illness Behavior and the Illness Experience 60
CHAPTER 5 Social Causes of Health and Health Problems 85
CHAPTER 6 Global Disparities in Health and Disease 112
CHAPTER 7 Medical School and the Training of Physicians 132
CHAPTER 8 Physicians and Their Interaction with Patients 153
CHAPTER 9 Other Health Care Providers: Conventional
and Alternative 174
CHAPTER 10 Hospitals and Other Health Care Settings 196
CHAPTER 11 Health and Health Care in the World’s Wealthy
Democracies 219
CHAPTER 12 The U.S. Health Care System 243
CHAPTER 13 Health Care Reform: Obamacare and Beyond 270
CHAPTER 14 The COVID-19 Pandemic 298
CONTENTS
Preface to the Updated Second Edition xi
Preface xii
Acknowledgments xv
About the Author xvi
1 SOCIOLOGY AND THE STUDY OF HEALTH AND ILLNESS 1
LEARNING QUESTIONS 1
SOCIOLOGY AND MEDICAL SOCIOLOGY 3
Sociology’s Major Themes 3
The Sociological Imagination 5
Sociology’s Theoretical Traditions 5
THE SCOPE OF MEDICAL SOCIOLOGY 6
The Influence of the Social Environment 6
The Practice of Health Care 8
The Social Construction of Illness 8
RESEARCH METHODS IN MEDICAL SOCIOLOGY 10
Surveys 10
Qualitative Research 11
Experiments 12
Criteria of Causality 12
CONCLUSION 14
Summary | Giving It Some Thought | Key Terms 14
2 A SOCIAL HISTORY OF HEALTH AND ILLNESS 16
LEARNING QUESTIONS 16
HEALTH AND ILLNESS IN THE PREINDUSTRIAL WORLD 18
The Ancient Civilizations 18
The Middle Ages 20
THE RISE OF SCIENTIFIC MEDICINE 21
The Renaissance 21
The Eighteenth Century 23
The Nineteenth Century 23
Ethical Issues in Scientific Medicine 25
Contents v
SOCIAL EPIDEMIOLOGY YESTERDAY AND TODAY 28
The Industrial Revolution 28
The Beginning of Epidemiology: John Snow and Cholera 29
The Epidemiological Transition 30
Public Health 32
A Word about Rates 33
CONCLUSION 35
Summary | Giving It Some Thought | Key Terms 35
3 HEALTH BEHAVIOR 37
LEARNING QUESTIONS 37
WHAT IS HEALTH BEHAVIOR? 38
UNDERSTANDING HEALTH BEHAVIOR 39
Macro Factors 40
Micro Factors 40
THE SOCIAL CONTEXT OF HEALTH BEHAVIOR: SOCIAL CLASS,
RACE AND ETHNICITY, AND GENDER 42
Social Class 42
Race and Ethnicity 45
Gender 46
Illustrating the Effects of Social Class, Race and Ethnicity, and Gender 47
THE SOCIAL CONTEXT OF HEALTH BEHAVIOR: OTHER FACTORS 54
Social Relationships 54
Neighborhood Living Conditions 55
Sexual Orientation and Gender Identity 56
Religious Involvement 56
Corporate Practices 57
Public Policy 57
CONCLUSION 58
Summary | Giving It Some Thought | Key Terms 58
4 ILLNESS BEHAVIOR AND THE ILLNESS EXPERIENCE 60
LEARNING QUESTIONS 60
UNDERSTANDING ILLNESS 61
Illness as a Social Construction 62
Medicalization 63
ILLNESS BEHAVIOR 67
Stages of the Illness Experience 68
Self-Care 68
vi Contents
Help-Seeking Behavior 69
The Social Context of Help-Seeking Behavior 71
THE EXPERIENCE OF ILLNESS 75
The Sick Role 76
Coping with Illness 79
A Representative Study of the Illness Experience: Women with STDs 82
CONCLUSION 83
Summary | Giving It Some Thought | Key Terms 83
5 SOCIAL CAUSES OF HEALTH AND HEALTH PROBLEMS 85
LEARNING QUESTIONS 85
SOCIAL CONDITIONS AS FUNDAMENTAL CAUSES OF DISEASE 86
SOCIAL CONDITIONS AS FUNDAMENTAL CAUSES OF HEALTH
INEQUALITIES 88
Social Class 89
Race and Ethnicity 92
Gender and Sex 97
Age 99
Sexual Orientation and Gender Identity 100
OTHER SOCIAL CAUSES OF HEALTH AND HEALTH PROBLEMS 101
Social Stress 101
Social Relationships and Social Support 103
Religion 106
Neighborhood Living Conditions 106
Environmental Pollution and Hazards 108
Unsafe Products and Workplaces 108
Interpersonal Violence and Handgun Violence 109
CONCLUSION 110
Summary | Giving It Some Thought | Key Terms 110
6 GLOBAL DISPARITIES IN HEALTH AND DISEASE 112
LEARNING QUESTIONS 112
UNDERSTANDING GLOBAL INEQUALITY 113
Categorizing Global Inequality 114
Measuring World Poverty 115
Explaining Global Inequality 116
DIMENSIONS OF GLOBAL HEALTH DISPARITIES 116
Malnutrition and Hunger 117
Children’s Health 118
Contents vii
Women’s Health 118
Environmental Pollution and Hazards 119
Substandard Health Care 122
HIV and AIDS 123
DOCUMENTING GLOBAL HEALTH DISPARITIES 124
Life Expectancy 125
HIV/AIDS 125
Tuberculosis 126
Child Mortality 126
Child Underweight 127
Maternal Mortality 128
Natural Disaster Deaths 128
Births Attended by Skilled Health Personnel 130
CONCLUSION 130
Summary | Giving It Some Thought | Key Terms 130
7 MEDICAL SCHOOL AND THE TRAINING OF PHYSICIANS 132
LEARNING QUESTIONS 132
DEVELOPMENT OF MEDICAL SCHOOLS AND MEDICAL
EDUCATION 133
Medical Education in Early America 134
Nineteenth-Century Developments 134
The Flexner Report 137
MEDICAL SCHOOLS TODAY 138
Sociodemographic Profile of U.S. Medical Students 139
A Brief Look at Medical School Faculty 143
THE LIVES AND EXPERIENCES OF MEDICAL STUDENTS 144
Stress, Fatigue, and Burnout 145
The Socialization of Medical Students 149
CONCLUSION 151
Summary | Giving It Some Thought | Key Terms 152
8 PHYSICIANS AND THEIR INTERACTION WITH PATIENTS 153
LEARNING QUESTIONS 153
THE PROFESSION OF MEDICINE 154
The Practice of Medicine in Early America 155
Impact of the American Medical Association 156
The Downside of Professionalization 157
Decline of the Medical Profession’s Dominance 159
Medical Malpractice 160
viii Contents
A PROFILE OF PHYSICIANS TODAY 162
Types of Physicians 163
The Physician Shortage 163
Women Physicians 165
PHYSICIAN-PATIENT INTERACTION 167
Models of Physician-Patient Interaction 167
Gender, Race and Ethnicity, and Physician-Patient Interaction 168
CONCLUSION 172
Summary | Giving It Some Thought | Key Terms 172
9 OTHER HEALTH CARE PROVIDERS: CONVENTIONAL AND
ALTERNATIVE 174
LEARNING QUESTIONS 174
MAINSTREAM HEALTH CARE 175
Nurses and Nursing 175
Other Mainstream Health Care Providers 184
COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) 188
Prevalence of CAM 189
Sociodemographic Characteristics and CAM Use 190
Effectiveness of CAM 190
CONCLUSION 194
Summary | Giving It Some Thought | Key Terms 194
10 HOSPITALS AND OTHER HEALTH CARE SETTINGS 196
LEARNING QUESTIONS 196
HOSPITALS 197
A Brief History of Hospitals 197
Hospitals in the United States Today 202
Problems with U.S. Hospitals 205
OTHER HEALTH CARE SETTINGS 211
Ambulatory Care Facilities 211
Nursing Homes 213
Home Health Care and Hospice Care 215
CONCLUSION 217
Summary | Giving It Some Thought | Key Terms 217
11 HEALTH AND HEALTH CARE IN THE WORLD’S WEALTHY
DEMOCRACIES 219
LEARNING QUESTIONS 219
Contents ix
THE HEALTH CARE SYSTEMS OF WEALTHY DEMOCRACIES 220
Models of Health Care Systems 222
The Health Care Systems of Selected Nations 224
COMPARING THE WEALTHY DEMOCRACIES 232
Comparing Health in Wealthy Democracies 232
Comparing Health Care in Wealthy Democracies 236
Explaining the U.S. Health Disadvantage 238
CONCLUSION 241
Summary | Giving It Some Thought | Key Terms 241
12 THE U.S. HEALTH CARE SYSTEM 243
LEARNING QUESTIONS 243
THE U.S. HEALTH CARE “SYSTEM” 244
U.S. HEALTH CARE BY THE NUMBERS 245
The Cost of Health Care 245
Sources of Health Care Spending 245
Sponsors of Health Care Spending 247
Health Care Employment 248
Health Care Visits 249
Health Insurance 249
PROBLEMS IN U.S. HEALTH CARE DELIVERY 252
Fragmentation and Lack of Coordination 252
Health Insurance Coverage: Uninsurance and Underinsurance 254
Social Inequalities in Health Care Delivery 255
The High Cost of Health Care 261
Waste in Health Care Spending 266
CONCLUSION 268
Summary | Giving It Some Thought | Key Terms 268
13 HEALTH CARE REFORM: OBAMACARE AND BEYOND 270
LEARNING QUESTIONS 270
ORIGINS OF U.S. HEALTH INSURANCE 271
The Progressive Era 272
The Great Depression and the New Deal 273
The 1940s and 1950s 274
The 1960s: Medicare and Medicaid 275
The 1970s and 1980s 275
1990s–2008 276