Undocumented immigrants. Recall that the nation’s approximately 11 million undocumented immigrants are excluded from health insurance programs

The plan costs too much. Proponents of the plan acknowledge the high cost but argue that new revenues and cost savings will largely pay for the program. Opponents argue that those approaches together will fall far short, and that middle-income taxpayers will be called upon to make up the difference.

debates on health care reform, by the health insurance, pharmaceutical, and other for-profit health care businesses

Medical Fraud.

While the explanation for these shortages seems to be multifactorial, a key reason is that the involved drugs are generic, do not make as much money for pharmaceutical companies, and are not prioritized.

Pharmaceutical companies have given money to “experts” who then promote their drugs. About 25 percent of biomedical researchers in the United States who study drugs and may speak favorably about them have financial ties to the companies whose products they are studying. This is not illegal, but it is a clear conflict of interest. Studies show that researchers receiving industry funding are 3.5 times more likely to report a result that is favorable to the comp

The industry justification that the high prices for drugs is necessary to support company research and development is false. The average budget percent for research and development in pharmaceutical companies has been about 15–20 percent. Much of the basic research and development actually occurs in small companies that are then bought out by the large companies, and almost all R&D in the large companies is actually subsidized by the government.

cause they make less money for drug manufacturers per dosage, some manufacturers are decreasing their production. This has reduced the competition that has kept the price of generics lower and has led to rapidly escalating prices. Data from 2014 show that if there is only one manufacturer of a generic, it costs 88 percent as much as a brand name. However, if there are nine manufacturers, the cost is only 15 percent as much

Johnson & Johnson

“Big Pharma”—especially has been subject to much criticism. From 2014 to 2020, already very expensive drug prices rose 33 percent.

pay, leaving the poor and uninsured to an overburdened not-for-profit sector, and that physicians’ allegiance to patients would be usurped by their involvement in health-related profit-making ventures

Having an increasing number of older people in the population is certainly not unique to the United States. Most countries in the world are experiencing the same trend.

As one nears the end of life, extremely expensive high-technology care is often used to prolong life—sometimes for a matter of only days or weeks, and often in a painful or uncomfortable condition.

Children’s Health Insurance Program (CHIP)

Private health insurance companies began appearing in the mid-1800s, and they became the cornerstone of health care financing in the United States by the early 1900s

Traditionally, many medical providers held the view that women’s complaints were often related to emotional instability, that women exaggerate claims of the severity of medical symptoms, and that women are more demanding patients. Research has found that these views are still held by some physicians.

they lead to significant benefits to patients and to the health care system. Patients with lower levels of health literacy:

Patient activation describes “the skills and confidence that equip patients to become actively engaged in their health care” (Hibbard and Greene 2013:207). This entails having individuals assume greater responsibility for managing their own health and their own health car

First, physicians often “talk down” to patients, are abrupt with them, and discourage open communication.

edical School, argued that a broader approach could be incorporated without sacrificing attention to biomedical matters and that both are needed to provide optimal care. He emphasized that a full understanding of disease and illness and the formulation of proper treatment must include consideration of the patient, the social context in which he or she lives, and the health care system. This requires a biopsychosocial model (BSP

Allied Health Workers

One study of Canadian nurses conducted in the first year of the COVID-19 pandemic found high rates of post-traumatic stress disorder, anxiety, depression, and high emotional exhaustion.

Recruiting men into the profession offers opportunities both to address the nursing shortage and to diversify nursing’s ranks. In recent years, nursing associations, hospitals, and schools have actively sought to recruit men.

Accreditation (CAHEA)

y 1930, all but ten states required midwives to be registered. These regulations were partly responsible for the decline in midwifery, but other factors such as declining birth rates, restricted immigration, the increased number of hospital beds available for maternity cases, and a growing anxiety about the dangers of birth also contributed to the decline. However, midwifery was sustained by the needs of the urban and rural poor

American Gynecological Society was formed, followed by the American Association of Obstetricians and Gynecologists in 1888.

it attracted both white and Black women

Victorian sex roles.” Curing became the domain of men (as physicians), while caring was women’s work (as nurses).

was routinely restricted to men, physicians gained further advantage over women midwives and attempted to monopolize the birthing field.

Many midwives served on Southern plantations; some were slaves,

Curing Rather Than Caring.

Emphasis on the social determinants of health. In Chapter 3, the concept of social determinants of health was introduced. Although Rudolph Virchow and others in the mid-nineteenth century emphasized that social determinants and disparities are major influences on health and disease, only recently has medical education begun to reflect this importance. In part, this has been stimulated by the increasing prevalence of chronic diseases as causes of suffering and death and to the important influence on them of factors such as gender, race and ethnicity, income, education, and sexual orientation and gender identity.

For example, in 2021, Blacks were 12.4 percent of the population and 11.3 percent of first-year medical students. Hispanics were 16.3 percent of the population and 12.7 percent of first-year students. The percentage of first-year students for both groups was up significantly from previous years

Non-Hispanic Blacks were more likely than all other racial-ethnic groups to report that they probably or definitely would not get vaccinated.

Why is so little attention devoted to macro-level factors? At least three reasons seem important. First, using social policy and the force of laws to regulate individual behavior is viewed by some as contradicting the cultural value of individualism

Fast-food restaurants are often located near schools, and many students eat meals or snacks there. Students whose school is within half a mile of a fast-food restaurant consume more soft drinks, eat fewer fruits and vegetables, and are more likely to be overweight (

Yet most efforts are directed downstream at individual smokers rather than upstream at the tobacco industry.

cogently argues that with regard to preventive health actions, we have spent most of our time downstream being preoccupied with encouraging people to avoid risky behaviors while we have neglected the consumer products, physical structures, social structures, and media messages upstream that create and promote risky behaviors.

As discussed in Chapter 3, the most common means of transmitting HIV are having unprotected sex and sharing contaminated needles. In addition to abstinence and condom use, the risk of HIV transmission can be reduced through pre-exposure prophylaxis or PrEP. Recommended for persons at high risk of HIV infection (e.g., persons with other STIs, those who have unprotected sex with multiple partners, injection drug users, and persons with an HIV positive partner) and taken most frequently as a daily pill, PrEP reduces the risk of infection through sex by 99 percent.

These beliefs can be influenced by several other factors, including demographic (age, gender, socioeconomic status, and race/ethnicity), sociopsychological (personality, peer, and reference group pressure), and structural (knowledge about the disease, prior contact with the disease).

The health belief model (HBM) provides a paradigm for understanding why some individuals engage in HPBs, while others behave in knowingly unhealthy ways. The model recognizes that, in making health decisions, individuals consider both health-related and non-health-related consequences of behavior.

eople in the lowest-income groups are also two to three times more likely to have a disability than people in higher-income groups. Between 2000 and 2015, rates of disability among the middle-aged (those 45–64 years)

Instead, race is an historical and social construct that captures differences in both the social circumstances faced by, and the social resources available to, various groups.

Racism leads to chronic stress for racial-ethnic minorities. The experience of racial discrimination is a source of everyday, chronic stress for racial-ethnic minorities that persists over the life course. The cumulative impacts of chronic stress caused by racism take a toll on the body, producing a higher burden of disease and death for racial minorities. This is sometimes referred to as a “weathering” effec

Due to persistent residential segregation, racial-ethnic minorities often live in neighborhoods with fewer recreational opportunities (which negatively impacts physical activity levels), fewer grocery stores and more fast food outlets (which negatively impacts nutrition), more advertisements for health-harming substances (such as liquor, cigarettes, and vaping products), less protection and more crime (including poorer police and fire protection and more violence), more toxic environments (which increases disease risk and poor birth outcomes), and fewer and more poorly equipped medical centers. These neighborhood differences expose racial-ethnic minorities and whites to vastly different structural opportunities that impact health

These resources include knowledge, money, power, prestige, and social connections

proximate risk factors

refer to health-related individual behaviors and include diet, exercise, use of tobacco and alcohol, control of stress, and other aspects of lifestyle.

tracing the origin of chronic degenerative diseases is more complicated. Most chronic degenerative diseases have multiple causes (many related to lifestyle)

spreading within unvaccinated subpopulations.

Worldwide travel increases the chances of a pathogen being contracted in one area and unwittingly transported to another.

This double disease burden is uneven across socioeconomic groups, with poorer communities suffering disproportionately from both infectious and chronic conditions, while wealthier communities use their greater resources to escape much of the morbidity and mortality from infectious disease

has proposed that a fifth stage—the Age of Obesity and Inactivity—has been underway for the last few decades.

most low-income countries today exceeds that.

medical records and databases (e.g., birth and death records, hospital admissions data), health-focused surveys, and experiments.

Epidemiologists scrutinize data on death and disease within populations searching for patterns or meaningful changes over time.

(e.g., gender, race, and social class), lifestyle, and the social and physical environment (e.g., exposure to toxic substances, participation in social networks, and social stress) as underlying factors of disease and illness

to learn what research has already been done

scientific method.

It then becomes possible to analyze relationships of cause and effect and thus to explain why something happens and to predict that it will happen again under the same conditions in the future.

More specifically, sociologists attempt to describe social patterns and then find cause-and-effect relationships that explain them

The Health Care Syste

he study of the ways that people perceive, interpret, and act in response to illness and disability

Epidemiology

creating greater need for researchers with organizational expertise.

The impact of modern psychiatry. The development of the field of psychiatry led to increased interest in the psychosociological basis for many diseases and illnesses and in the importance of effective interaction between patients and practitioners.

Changing patterns of disease and illness.

In 1915, Alfred Grotjahn published a classic work, Soziale Pathologie, documenting the role of social factors in disease and illness and urging development of a social science framework for reducing health problems. The term social medicine was coined to refer to efforts to improve public health.

etiology of disease,

We see how people’s social locations within various systems of social stratification (e.g., age, race, class, occupation) left some groups more susceptible to infection and death, while offering others significantly greater protection, thus contributing to the uneven social distribution of disease and death.

Mary’s is a case of vaccine hesitancy, and sociologists would look beyond her individual beliefs to understand how those beliefs are socially patterned and socially produced. For example, research supports the idea that persons who believe COVID-19 vaccines are unsafe are less likely to get vaccinated. But research also indicates that such beliefs are not random

However, sociology attempts to underst and these behaviors and experiences by placing them in their larger social context—that is, by looking for social patterns and examining the influence of the social forces impacting individual behavior and experience.

human behavior and experience is shaped by the groups, organizations, and institutions to which people belong.

It is the discipline with primary responsibility for studying social interaction among people, groups and organizations, and social institutions, and examining how these interactions influence and are influenced by the larger culture and social structure of society.

These are still open-ended questions, and sociologists will play an important role in answering them in the years to come.

overburdened health care system or when persons do not seek emergency care for other issues due to fear of infection). The WHO estimates over 15 million excess deaths globally from the pandemic in its first two years

mistrust of vaccines; and misinformation about medical and alternative treatments, the virus, and its health consequences, led to high mortality rates (rates of death) and even higher morbidity rates (rates of disease). By the end of May 2022, over two years into the pandemic and despite the availability of effective vaccines beginning in January 2021