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Ch. 21 Health

Ch. 21 Health. Health, Illness and Wellbeing. What is health?. “a state of complete physical, mental, and social well-being” (WHO)

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Ch. 21 Health

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  1. Ch. 21 Health Health, Illness and Wellbeing

  2. What is health? • “a state of complete physical, mental, and social well-being” (WHO) • “a state of social, mental, emotional, and physical well-being that is influenced by a broad range of factors, including biology and genetics, personal health practices and coping skills, the social and physical environments, gender, socio-economic factors such as income and education, and cultural practices and norms” (Health Canada) • Note that: patterns of well-being and illness are rooted in the organization of society

  3. Health and Society • Cultural patterns define health • What is seen as healthy also reflects what is seen as morally good • Cultural standards of change over time • Technology affects people’s health • Social inequality affects people’s health, e.g., the rich live longer and are healthier than the poor

  4. Measures of health and illness • Life expectancy: 71.4 years average global life expectancy at birth in 2015 (WHO, 2016) • Global disparities • OECD nations: Japan 83.7; Canada 82.2; U.S. 79.3 • But…Ethiopia 64.8; Angola 52.4; Sierra Leone 50.1 • Mortality (death) rates: • linked to poverty • Infant mortality and under-5 mortality highest in developing world • Morbidity Rate: extent of disease measured by incidence and prevalence

  5. Top 10 Causes of Death 2015 (WHO 2016)

  6. Threats to health • High income countries: • health problems from air pollution, accidents • chronic diseases, e.g., heart disease, cancer and stroke • high cholesterol, high blood pressure and obesity • Low income countries: • poverty reduces life expectancy (1 in 6 have serious illness) • poor sanitation and unsafe water • HIV/Aids • Little or no health care

  7. HIV/AIDS • Approximately 36.7 million people living with HIV globally at the end of 2015 • Leading cause of death 15-59 worldwide • Drug resistant tuberculosis has become a global issue: new threat of superbug epidemic • HIV-associated tuberculosis increased 40% in Europe (WHO 2017) • New treatments (i.e. Highly Active Antiretroviral Therapy) can control progression of HIV but is costly • AIDS itself is fatal and necessitates lengthy hospital or hospice stays

  8. Top ten global risks to health according to WHO • Being underweight and malnutrition • Unsafe sex • High blood pressure • Tobacco consumption • Alcohol consumption • Unsafe water, sanitation and hygiene • Iron deficiency • Indoor smoke form solid fuels • High cholesterol • Obesity

  9. Health in Canada Social epidemiology: the study of health and disease as distributed throughout the society • Age and gender: death is rare for young, and men have higher death rates than women • Social class and race: • the higher the income, the longer the life span • the lower the income, the lower the health status • Aboriginals are more at risk than the general population for life span and infant mortality

  10. Health Issues: Cigarette Smoking • From a high of 45% of the population in 1960, smoking has declined to 17.7% in 2015 • 5.3 million Canadians • See Canada’s smoking rate falls slightly • Laws mandating • Smoke-free environments • No advertising at sporting and cultural events • Now looking at plain packaging • WHO considers smoking an important preventable cause of death

  11. Smoking rates in Canada(source: http://www.statcan.gc.ca/pub/82-625-x/2017001/article/14770-eng.htm)

  12. Health Issues: Socially Caused Eating Disorders and Body Image Problems Anorexia nervosa and bulimia: Intense forms of dieting or other method of weight control to be very thin • 95% who suffer from anorexia nervosa are women but is becoming a problem for men too (the new toward the “thin look” for men) • Women want to be thinner than men say women should be. • Result of gendered images of women’s roles and bodies is health risk and can result in loss of life • Men also suffer from “muscle dysmorphia”

  13. Health Issues: Sexually Transmitted Infections and Diseases • The Public Health Agency of Canada (2013) said reported rates of chlamydia, gonorrhea and syphilis have been steadily rising since the late 1990s. • Young Canadians have the highest reported rates of infections, but increasing numbers are occurring among middle-aged and older adults. • AIDS: Acquired immune deficiency syndrome • Cause is HIV, human immunodeficiency virus • 71,300 Canadians were living with HIV infection (including AIDS) in 2011 • Incurable, but controllable now • More effective antiretroviral treatments

  14. Health Issues: Obesity • In 2014, 20.2% of Canadians aged 18 and older, as obese (Statistics Canada, 2014) • rate of obesity among men increased to 21.8% in 2014 from 20.1% (in 2003, 16.0% of males obese). • Increases risk of heart disease, stroke and diabetes • People are eating more, diet is worse and exercising less • Lower-income people are more likely to be obese (can’t afford or lack of access to nutritious food) • Child obesity at highest level in Canada and U.S. (CBC News, 2015) • 13% of children and youth aged 3 – 19 years in Canada, 17% in U.S. Is a significant public health issue. • Children now developing adult onset diabetes • See also, Obesity in Canadian Adults, 2017

  15. The medicalization of obesity:Is obesity a disease? • Canadian Medical Association says “yes” • 56% of Canadians agreed (National Post 2016) • Estimated 10 million Canadians on a diet • Should obesity be medicalized? • Is correlated with heart disease, stroke, asthma, etc. • But not a cause. (correlation is not causation) • However, as a disease qualifies for treatment and insurance funding, in addition to insurance coverage • Also, lessens the stigmatization of obesity being a “personal failing” (ie obese people less likely to get job interviews, have to pay more for seats on some airlines, etc.) • New treatment: “engineered bulimia” • insert tube with porthole into upper stomach and drain 30% of food after eating

  16. Obesity as a global issue • According to the WHO, “Overall, about 13% of the world's adult population were obese in 2014 and 39% of adults were overweight. The worldwide prevalence of obesity more than doubled between 1980 and 2014” (www.who.int/mediacentre/factsheets/fs311/en/) • Pandemic of metabolic syndrome:high blood pressure, high blood sugar, excess body fat, and abnormal cholesterol levels. • WHO estimates that “by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 6% in men and 9% in women.” • Global obesity map

  17. Fighting obesity around the globe • In Russia, some vending machines offer free subway tickets in exchange for 30 squats done within two minutes (Trevor Mogg, Digital Trends 2013) • In Japan, corporations are required to do “flab checks”: a waistline of over 33.5” for men and 31” for women and are fined by levying higher health care costs. Obesity causes metabolic syndrome: 13 million Japanese suffer from metabolic syndrome, while another 14 million are at risk. • In Stockholm Sweden, VW has built a Piano Staircase to make taking the stairs more fun. • A recent Beijing survey showing that 1 in 10 men and 1 in 8 boys now obese in China blamed increasing obesity on fast food like KFC and sedentary lifestyles. Dance classes have been made mandatory for Chinese students and “fit” students will be given preference in case of a tie on university entry exams.

  18. Mental Illness • What is it? • a wide range of mental health conditions • disorders affecting mood, thought and behaviour • ongoing signs and symptoms cause frequent stress and affect the ability to function • Who is affected? • Everyone, directly or indirectly, at some time – ie through a family member, friend or colleague • People of all ages, educational levels, occupations, incomes, and cultures • In Canada, 1 in 5 will personally experience mental illness at some point in their lives (in the U.S. 1 in 4)

  19. Mental illness and mental health • See Canadian Mental Health Association • Causes?: According to the CMHA, it is caused by a “complex interplay of genetic, biological, personality and environmental factors…” • Often starts in childhood or adolescence • Many suffer more than one form (co-morbidity) • Serious illness (schizophrenia, bipolar mood disorder, major depression) affects up to 6%

  20. Socio-demographic factors • Race/ethnicity factors primarily due to the stresses of racism (i.e. Feagin & Sikes, 1994) • Class: higher among lower class (Williams et al. 1992, Weitz, 2007) but disagreement whether class causes or is caused by mental illness • Social stress framework: stress related to lower class life leads to more mental disorders • Social drift framework: mental disorders cause downward drift in social class • Gender: depression higher (2x) for women, but personality disorders greater for men • Difference linked to differential gender socialization

  21. Prevalence in Canada • 20% of Canadians have a mental disorder • Major depression (8%), bipolar disorder (1%), schizophrenia (1%), anxiety disorders (5%) • Mental disorders and suicide • 15-24 year olds – 24% of all deaths • 2nd only to accidents • 3rd highest in industrialized world • about 4,000/yr in Canada • 25-44 year olds – 16% of all deaths

  22. Health Care in Canada • A publicly funded health care system paid by combination of taxes and premiums • Medicare operates according to 5 basic principles: universality, comprehensiveness, portability, accessibility, and public administration (not for profit) • See “Canada’s Health Care System” • But increasing costs, long wait times, shortage of health care professionals • Dental and prescription meds not covered for all • Many “minor” areas not covered (ie vision, physio, counselling) • Can lead to long term health issues

  23. Theoretical perspectives • Structural Functionalist • Illness is a threat to a smoothly functioning society • Prevents members from fulfilling social roles • Parson’s “sick role” • Conflict Theory • Economic and social inequality in health status • Health care delivery rooted in the capitalist system, produced and sold by the medical-industrial complex • Symbolic Interactionism • Health and illness are social constructions • Social-cultural factors influence how people define and experience physical and mental health

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