Table Of Content

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 Acquisitions Editor: Alyssa Palazzo Acquisitions Assistant: Samantha Delwarte Sales and Marketing Inquiries: textbooks@ rowman . com Credits and acknowledgments for material borrowed from other sources, and reproduced with permission, appear on the appropriate pages within the text. Published by Rowman & Littlefield An imprint of The Rowman & Littlefield Publishing Group, Inc. 4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706 www .rowman .com 86-90 Paul Street, London EC2A 4NE Copyright © 2023 by The Rowman & Littlefield Publishing Group, Inc. First edition 2017. Second edition 2021. All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without written permission from the publisher, except by a reviewer who may quote passages in a review. British Library Cataloguing in Publication Information Available Library of Congress Cataloging-in-Publication Data Available ISBN 9781538177648 (paperback) | ISBN 9781538177655 (epub) ∞ ™ The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI/NISO Z39.48-1992. 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