Introduction

What it means to be healthy can vary from culture to culture and is often connected with advances in technology and cultural patterns of race, class, gender, and sexual inequalities. In some cultures, larger body sizes are seen as a sign of healthiness as it indicates an individual has a preponderance of food. In other cultures, largeness is more closely associated with unhealthy lifestyles (e.g., lack of exercise, poor eating habits, etc.).  Sociologists have demonstrated that access, utilization, education, and practices related to health and well being are heavily influenced by (and often seemingly determined by) prevailing cultural norms, beliefs, and patterns that often have little or nothing to do with physiological health.

Health care (or healthcare) is an industry associated with the prevention, treatment, and management of illness along with the promotion of mental and physical well-being through the services offered by the medical and allied health professions. Healthcare is one of the world's largest and fastest-growing industries, consuming over 10 percent of gross domestic product of most developed nations. Medical Sociology is concerned with the distribution of healthcare services globally, in particular inequalities in healthcare, and how conceptions of health have changed over time.

Health Disparities

While technology has advanced the practice of medicine and generally improved health, not all people have the same access to health care or the same quality of health care. Health disparities are the "population-specific differences in the presence of disease, health outcomes, or access to health care" (source). Of particular interest to sociologists are the differences in health and quality of health care across racial, socioeconomic, ethnic, gender, and sexual groups.

In the United States, health disparities are well documented in racial minority populations such as African Americans, Native Americans, Asian Americans, and Hispanics. When compared to European Americans, these minority groups have higher incidents of chronic diseases, higher mortality, and poorer health outcomes. The cancer rate among African Americans is 10 percent higher than among European Americans and generally linked to the environmental conditions of predominantly racial minority neighborhoods. In addition, American adults of African and Hispanic lineage have approximately twice the risk of developing diabetes than American adults of European lineage, which often reflects the lack of access to quality foods and healthcare resources within predominantly racial minority neighborhoods. Minorities also have higher rates of cardiovascular disease, HIV/AIDS, and infant mortality than whites. There are also substantial differences in health based on social class or socioeconomic status, which have also been linked to neighborhood concentration and environmental effects.[2]

Researchers have also documented significant health disparities within gender and sexual minority populations in the United States.[7]

Self-Reported Health by Race-Ethnicity in 2012.png
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Self-Reported Health by Income in 2012.png

Disparities in Health Care

Reasons for disparities in access to health care are many, but can include the following:
  • Lack of insurance coverage. Without health insurance, patients are more likely to postpone medical care, more likely to go without needed medical care, and more likely to go without prescription medicines. Minority groups in the United States lack insurance coverage at higher rates than members of dominant groups.
  • Lack of a regular source of care. Without access to a regular source of care, patients have greater difficulty obtaining care, fewer doctor visits, and more difficulty obtaining prescription drugs. Compared to whites, minority groups in the United States are less likely to have a doctor they go to on a regular basis and are more likely to use emergency rooms and free or reduced rate, government subsidized clinics as their regular source of care.
  • Lack of financial resources. Although the lack of financial resources is a barrier to health care access for many Americans, the impact on access appears to be greater for minority populations.
  • Structural barriers. Structural barriers to health care include poor transportation, an inability to schedule appointments quickly or during convenient hours, and excessive time spent in the waiting room, all of which affect a person's ability and willingness to obtain needed care.
  • The health financing system. The Institute of Medicine in the United States says fragmentation of the U.S. health care delivery and financing system is a barrier to accessing care. Racial and ethnic minorities are more likely to be enrolled in health insurance plans which place limits on covered services and offer a limited number of health care providers.
  • Scarcity of providers. In inner cities, rural areas, and communities with high concentrations of minority populations, access to medical care can be limited due to the scarcity of primary care practitioners, specialists, and diagnostic facilities. In addition more private practices are putting limits on the number of medicaid and medicare patients that they will accept because these programs reimburse at a much lower percentage than private insurers. Finding physicians who accept Medicaid and Medicare is becoming increasingly difficult.
  • Linguistic barriers. Language differences restrict access to medical care for minorities in the United States who are not English-proficient.
  • Low Health literacy. This is where patients have problems obtaining, processing, and understanding basic health information. For example, patients with a poor understanding of good health may not know when it is necessary to seek care for certain symptoms. Similarly, they may not understand the medical jargon that is used by health professionals and, consequently, are unable to accurately follow medical instructions. While problems with health literacy are not limited to minority groups, the problem can be more pronounced in these groups than in whites due to socioeconomic and educational factors.
  • Lack of diversity in the health care workforce. Cultural differences between predominantly white health care providers and minority patients is also often cited as a barrier to health care. Only 4% of physicians in the United States are African American; Hispanics represent just 5%. These percentages are much lower than these groups' respective proportions of the United States population.
  • Provider discrimination. This is where health care providers either unconsciously or consciously treat certain racial and ethnic patients differently than they treat their white patients. Some research suggests that minorities are less likely than whites to receive a kidney transplant once on dialysis or to receive pain medication for bone fractures. Critics question this research and say further studies are needed to determine how doctors and patients make their treatment decisions. Others argue that certain diseases cluster by ethnicity and that clinical decision making does not always reflect these differences.

Examples of Health Disparities

Health disparities resulting from economic stratification are wide-ranging. Poorer women have reduced access to mammograms to detect breast cancer, even when they are better candidates for screening.[12] Wealthier people live longer than poorer people. Wealthier people in the U.S. today live about 4.5 years longer than poorer people (79.2 vs. 74.7, respectively).[13] Additionally, affluent and more educated people are more likely to take advantages of advances in medical science and technology and have seen a more rapid decline in smoking rates, which directly improves health.[13] Financial access to health care is not the only factor that affects health; poorer people are generally less likely to exercise, resulting in overall poorer health as well.[14] Poorer individuals also live in more dangerous neighborhoods and are more likely to eat unhealthy food  and engage in risky or unhealthy behavior, all of which contributes to poorer health.[13][15]

Health disparities based on race also exist. Affluent white women live 14 years longer in the U.S. (81.1 years) than poor black men (66.9 years).[13][18] There is also evidence that blacks receive less aggressive medical care than whites. Another contributor to the overall worse health of blacks is the incident of HIV/AIDS - the rate of new AIDS cases is 10 times higher among blacks than whites, and blacks are 20 times as likely to have HIV/AIDS as are whites.

Paying for Medical Care

Disparities in health care are often related to an individual's or a group's ability to pay for health care. This section discusses the costs of healthcare and the different approaches to health care that have been taken by governments around the world.

Health Insurance

Health insurance is a type of insurance whereby the insurer pays the medical costs of the insured if the insured becomes sick due to covered causes or accidents. The insurer may be a private organization or a government agency.

Private Insurance and Free-Market Health Care

Two types of health insurance have developed in modern society: private health insurance (or free-market) models and publicly funded health insurance models.

Private insurance refers to health insurance provided by a non-governmental organization, usually a privately owned or publicly traded corporation. Private insurance as the primary provider of health care in a developed nation is really only found in the United States. Even there, government plays a substantial role.

Advocates of the private model argue that this approach to health care has the following benefits:

  • A free market is better able to allocate spending where consumers value it the most.
  • Remarkable advances in medical technology have accompanied the free-market approach to health care. The opportunity to make money stimulates researchers in medical technology and pharmaceuticals.
  • Private industry is more efficient than government bloat and bureaucracy.

Critics of the private health insurance approach point to the following drawbacks: 

  • More than half of the people with chronic conditions in the US regularly skip pills and doctors' appointments for conditions like diabetes, heart disease, cancer, and depression because of the cost of the care.[24]
  • The private system ends up being more costly than publicly funded systems. The United States government spends more on health care than any other industrialized country.
  • Free market insurance models to operate inefficiently.  An individual is especially less likely to make rational choices about his/her own health care in an emergency.
  •  Doctors' salaries do tend to be much lower in public systems. For instance, doctors' salaries in the United States are twice those in Canada.
  • Many people are only willing to pay a doctor when they are sick, even though this care may be far more expensive than regular preventative care would have been.
  • Paperwork and bureaucracy can allow insurance companies to avoid payment of the claim or, at a minimum, greatly delay it.
  • Health insurance is often only widely available at a reasonable cost through an employer-sponsored group plan. Unemployed  and self-employed individuals have to pay more.

Publicly Funded Health Care

An alternative to private health insurance and the free-market approach to health care is publicly funded health care. Publicly funded medicine is health care that is paid wholly or mostly by public funds (i.e., taxes). Publicly funded medicine is often referred to as socialized medicine by its opponents, whereas supporters of this approach tend to use the terms universal healthcare, single payer healthcare, or National Health Services. It is seen as a key part of a welfare state.

58 countries with universal health care in 2009.


This approach to health care is the most common and popular among developed (and developing) nations around the world today. The majority of developed nations have publicly funded health systems that cover the great majority of the population.

Proponents of publicly funded medicine cite several advantages over private insurance or free-market approaches to health care:

  • Publicly funded approaches provide equality in matters of life and death.
  • Publicly funded health care reduces contractual paperwork.
  • Publicly funded health care facilitates the creation of uniform standards of care.
  • Publicly funded health care may help reduce illnesses associated with job loss.
  • Public systems cost society less than private systems.

Critics of publicly funded health care point out the following disadvantages:

  • A greater likelihood of lower quality health care than privately funded systems.
  • Less motivation for medical innovation and less motivation for society's most skilled people to become doctors, because of less financial reward.
  • Price no longer influences the allocation of resources, thus removing a natural self-corrective mechanism for avoiding waste and inefficiency.
  • Health care workers' pay is often not related to quality or speed of care. Thus very long waits can occur before care is received.
  • Publicly funded medicine is a form of socialism.
  • People are afraid that they can't choose their own doctor. The state chooses for them.

Parallel Public/Private Systems

Almost every country that has a publicly funded health care system also has a parallel private system, generally catering to the wealthy. Every nation either has parallel private providers or its citizens are free to travel to a nation that does, so there is effectively a two-tier healthcare system that reduces the equality of service.

Behavior and Environmental Influences on Health

While the rising cost of health care is debated, some contributing causes are accepted. Aging populations require more health care as a result of increased life expectancy. Advances in medical technology have arguably driven up the prices of procedures, especially cutting edge and experimental procedures. Poor health choices also increase health care costs by increasing disease and disability. The following sections explore some of the ways behaviors and environment can impact human health.

Smoking

Smoking is the single most preventable risk to health. The main health risks from tobacco smoking pertain to diseases of the cardiovascular system: myocardial infarction (heart attack); diseases of the respiratory tract, such as Chronic Obstructive Pulmonary Disease (COPD) and emphysema; and cancer, particularly lung cancer and cancers of the larynx and tongue.

Alcohol

Alcoholism is a dependency on alcohol characterized by craving (a strong need to drink), loss of control (being unable to stop drinking despite a desire to do so), physical dependence and withdrawal symptoms, and tolerance (increasing difficulty of becoming drunk).

If a person cannot refuse alcohol in the presence of others, insists on drinking alcohol excessively for fear of alienation and neglect, or feels they cannot socially interact with others unless under the influence then this person is considered socially dependent on the substance. Social dependence, though not physically threatening in early stages, can lead to physical dependence if the person cannot control their urges and more so their reasons for drinking.

The social problems arising from alcoholism can include loss of employment, financial problems, marital conflict and divorce, convictions for crimes such as drunk driving or public disorder, loss of accommodation, and loss of respect from others who may see the problem as self-inflicted and easily avoided. Alcoholism affects not only the addicted but can profoundly impact the family members around them. Children of alcoholics can be affected even after they are grown. This condition is usually referred to as The Adult Children of Alcoholics Syndrome. Al-Anon, a group modelled after Alcoholics Anonymous, offers aid to friends and family members of alcoholics.

Fetal alcohol exposure is the most common preventable cause of birth defects in the United States. It can cause mental retardation, facial deformities, stunted physical and emotional development, behavioral problems, memory deficiencies, attention deficits, impulsiveness, an inability to reason from cause to effect; a failure to comprehend the concept of time; and an inability to tell reality from fantasy. Secondary disabilities develop over time because of problems fitting into the environment. No amount of alcohol during any stage of pregnancy is absolutely safe.

Obesity

Obesity is a condition in which body fat is far higher than a healthy level. While cultural and scientific definitions of obesity are subject to change, it is accepted that excessive body weight predisposes to various forms of disease, particularly cardiovascular disease.

In several human cultures, obesity is (or has been) associated with attractiveness, strength, and fertility. Obesity functions as a symbol of wealth and success in cultures prone to food scarcity. Well into the early modern period in European cultures, it still served this role. Contemporary cultures which approve of obesity, to a greater degree than European and Western cultures, include African, Arabic, Indian, and Pacific Island cultures. The implication of these cultural variations in attitudes toward obesity is that ideal body shape is culturally relative. In Western cultures, obesity has come to be seen more as a medical condition than as a social statement.

Causes of Obesity

Obesity is generally a result of a combination of factors:

Although many people may have a genetic propensity towards obesity, it is only with the reduction in physical activity and a move towards high-calorie diets of modern societies that it has become so widespread. Obesity in the United States is more common among poorer segments of society. The people most likely to develop obesity tend to have the lowest access to quality foods and often lack access to many of the resources (e.g., stoves, cooking utensils, transportation to healthier grocery stores, electricity, etc.) necessary for taking advantage of quality foods. However, obesity is not limited to low-income people. Since 1980 obesity has been increasing in all segments of society. Possible factors include:

  • Food costs less as a portion of income than ever before.
  • Food commercials on television increase the odds of childhood obesity.[36]
  • A greater percentage of the population spend most of their workday behind a desk or computer.
  • More two income households mean that one parent no longer remains home to cook, increasing the number of restaurant and take-out meals. Meanwhile, restaurants competing for market share have increased portion sizes.
  • Urban sprawl and commuting by car may mean less walking and less time for cooking.[37]
  • Obesity tends to flourish as a disease of affluence in countries which are developing and becoming westernised.

The Evolution of Health Care and Medicine

All human societies have beliefs that provide explanations for, and responses to, childbirth, death, and disease. Throughout the world, illness has often been attributed to witchcraft, demons, or the will of the gods, ideas that retain some power within certain cultures and communities. However, the rise of scientific medicine in the past two centuries has altered or replaced many historic health practices while granting others legitimacy in the public consciousness.

Folk Medicine

Folk medicine refers collectively to procedures traditionally used for treatment of illness and injury, aid to childbirth, and maintenance of wellness. It is a body of knowledge distinct from modern, scientific medicine but may coexist in the same culture. It is usually unwritten and transmitted orally until someone collects it. Folk medicine is sometimes associated with quackery when practiced practiced fraudulently, yet it may also preserve important cultural tradition from the past.

Herbal medicine is an aspect of folk medicine that involves the use of gathered plant parts to make teas, poultices, or powders that purportedly effect cures. Many effective treatments adopted by physicians over the centuries were derived from plants. Attention has been paid to the folk medicine of indigenous peoples of remote areas of the world in the interest of finding new pharmaceuticals.

Alternative Medicine

Alternative medicine describes methods and practices used in place of, or in addition to, conventional or scientific treatments. There is some debate as to what is included under the label "alternative," as these practices include things as far ranging as: spiritual, metaphysical, or religious treatments; Eastern and Asian traditional treatments; and a variety of unproven treatments, like acupuncture, chiropractic, healing-touch, and homeopathy.

Western Medicine

Western medicine approaches health care from two angles. The first, the medical model, focuses on the eradication of illness through diagnosis and effective treatment. The second, the social model, focuses on changes that can be made in society and in people's own lifestyles to make the population healthier. Western, scientific medicine has proven uniquely effective at treating and preventing some diseases while wholly inadequate in treating others. It is increasingly widespread and more widely accepted than other forms of medicine, but researchers cannot ascertain whether this is due to results, concerted political and economic campaigns to stigmatize other approaches, or some combination of both. Despite its issues and problem areas, most researchers believe that Western scientific medicine is the most effective contributor to the health of humans in the world today.

Recognizing the complexity of these issues, it is important for all people to learn about various aspects of health and well being, methods of critical thinking and decision making, and ways to keep abreast of ongoing developments within and between western-science and alternative medical traditions, practices, problems, benefits, and limitations. In so doing, people may ascertain the best health-related practices for themselves and the people they care about while also pushing both of these medical traditions toward greater regulation, oversight, integration, and care practices for all people.

Additional Reading

  • The New York Times recently invited a professor of bioethics to discuss the ethics of rationing healthcare. This article would serve as a very good launching point for discussing the ethics of universal healthcare. http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html
  • At this website, you may read the entire Affordable Care Act, or use the tabs to find the information most useful to you. Of particular interest are the timeline and the Key Features for the law, as well as the young adult section of the website (young adult defined as anyone under the age of 26) because it will probably have most of the changes that will directly effect most college students. Keep in mind this is the official site for the law, which means two important things: (1) it is constantly checked for accuracy by researchers so you will be getting the proper information about the law and changes, and (2) it is regularly updated as new developments, decisions, or time marks pass during the roll out of the law. http://www.healthcare.gov/law/index.html


Further examples

Rosich, Katherine and Janet Hankin. 2010. “Executive Summary: What Do We Know? Key Findings from 50 Years of Medical Sociology.” Journal of Health and Social Behavior, Extra Issue, 51:S1-S9.

Burdette, Amy and Terrence Hill. 2008. “An examination of processes linking perceived neighborhood disorder and obesity.” Social Science & Medicine 67:38-46.

Ross, Catherine and John Mirowsky. 2000. “Does Medical Insurance Contribute to Socioeconomic Differentials in Health?” The Milbank Quarterly 78:291−321.

Busfield, Joan. 2006. “Pills, Power, People: Sociological Understandings of the Pharmaceutical Industry.” Sociology 40(2):297-314.

Rier, David A. 2000. “The missing voice of the critically ill: a medical sociologist’s firstperson account.” Sociology of Health & Illness 22(1):68-93.

Smith, Allen and Sherryl Kleinman. 1989. “Managing Emotions in Medical School.” Social Psychology Quarterly, 52:6-69.

Chrisler, Joan and Paula Caplan. 2002. “The Strange Case of Dr. Jekyll and Ms. Hyde: How PMS became a Cultural Phenomenon and Psychiatric Disorder.” Annual Review of Sex Research 13:274-306.

““But we have to do Something”: Surgical Correction of Atypical Genitalia.” by Katrina Roen

Akers, Aletha Y., Melvin R. Muhammad, and Giselle Corbie-Smith. 2011. “‘When you got nothing to do, you do somebody’: A community’s perceptions of neighborhood effects on adolescent sexual behaviors.” Social Science & Medicine 72:91-99.

Winterich, Julie A. 2003. Sex, Menopause, and Culture: Sexual Orientation and the Meaning of Menopause for Women’s Sex Lives. Gender & Society 17(4): 627-642.

Elson, Jean. 2003. Hormonal Hierarchy: Hysterectomy and Stratified Stigma. Gender & Society 17(5): 750-770.

Brubaker, Sarah Jane. 2007. Denied, Embracing, and Resisting Medicalization: African American Teen Mothers’ Perceptions of Formal Pregnancy and Childbirth Care. Gender & Society 21(4): 528-552.

Kelly, Kimberly, and Linda Grant. 2007. State Abortion and Nonmarital Birthrates in the Post-Welfare Reform Era: The Impact of Economic Incentives on Reproductive Behaviors of Teenage and Adult Women. Gender & Society 21(6): 878-904.

Discussion Questions[edit]

  • What does it mean to be healthy?
  • Would you prefer private or public health care?
  • What do you think is contributing to the prevalence of obesity in many countries?
  • How long have we had science-based medical treatments?

References[edit]

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  43. ↑ Jump up to:a b Willmsen, Christine, and Michael J. Berens. 2007. “Public never warned about dangerous device.” The Seattle Times, November 19 http://seattletimes.nwsource.com/html/localnews/2004022178_miracle19m2.html (Accessed April 13, 2008).
  44. Jump up↑ Imrie, Robert. 2008. “Parents Pick Prayer Over Doctor, Girl Dies.” AOL News, March 28 http://news.aol.com/health/story/ar/_a/parents-pick-prayer-over-doctor-girl/20080327161309990002 (Accessed April 13, 2008).
  45. ↑ Jump up to:a b Busfield, Joan. 2006. “Pills, Power, People: Sociological Understandings of the Pharmaceutical Industry.” Sociology 40(2):297-314.
  46. ↑ Jump up to:a b Brody, Jane E. 2008. “Potential for Harm in Dietary Supplements.” The New York Times, April 8 http://www.nytimes.com/2008/04/08/health/08brod.html (Accessed April 13, 2008).
  47. Jump up↑ “Memory Supplements Forgettable, Says CSPI.” http://www.cspinet.org/new/200705041.html (Accessed April 13, 2008).
  48. Jump up↑ Sulik, Gayle. 2012. Pink Ribbon Blues: How Breast Cancer Culture Undermines Women's Health. Oxford University Press.
  49. Jump up↑ Beyerstein, Barry L. n.d. “Why Bogus Therapies Often Seem to Work.” quackwatch.org. http://www.quackwatch.org/01QuackeryRelatedTopics/altbelief.html (Accessed April 13, 2008).
  50. ↑ Jump up to:a b Sulik, Gayle. 2012. Pink Ribbon Blues: How Breast Cancer Culture Undermines Women's Health. Oxford University Press.

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