HEALTH CARE
Rich countries spend more than poor countries. Main concerns are provision and effective use of health care.
PROVISION OF HEALTH CARE
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Private health care
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Available to the rich, people insured with employers. There's no private emergency system in the UK so everyone uses the NHS.
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Allocation of NHS Resources
Spending depends on social policy and market forces, it's on curative rather than preventive, hospital rather than community care, acute beds rather than geriatric and psychiatric beds.
Geographical Inequalities
Blamed on poor access to care and industrial pollution. Studies in East London were Harrison (Hackney) and Skrimshire (Newham).
The Uses of Health Care
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Middle classes get sick less, use more preventative care, family planning, seek earlier treatment, antenatal care, cancer screening and immunization, get longer consultations and can communicate well.
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Ethnic minorities may be disadvantaged when cultural differences are not recognised e.g. language. Not strong evidence, and many Asian patients have Asian doctors. Gender and class also influence relationships between doctors and patients.
ILLICH
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Illich criticised health care providers and drug companies for the 'medicalisation of life'
He used the term Iatrogenic illness to describe any illness caused by medical care. He distinguished three types:-
Clinical iatrogenesis, harmful medical intervention, incompetant or unnecessary surgery, side-effects and accidents in hospitals.
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Social iatrogenesis, medicalisation of life, moral and social issues, like abortion or mercy killings are technical issues left to doctors rather than politicians and priests.
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Cultural iatrogenesis, giving up independence and relying on 'experts' to control their lives.
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HEALTH CARE AND MENTAL ILLNESS
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Interactionalists say there are only labels of mental illness, and doctors just label.
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Lemert said there's primary and secondary mental illness, and the secondary is just labeling. He said paranoia perhaps had a biological cause, and that social misfits were excluded from society and so produced increasingly deviant behaviour.
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Goffman's 'Asylums' describes the 'career' of the mental patient, where hospitals exert total control, and so the patient starts hoarding food or other rational responses which were labelled lunacy.
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Szasz said psychiatry is a form of social control, and pointed out that madness is a legal definition. Deviance is seen as illness rather than resistance.
A Critical View
Positivists use Durkhiem's suicide approach to identify social causes of mental illness. They accept the biomedical model but emphasise social causes. Taylor used Durkheim's concept of integration to explain higher rates of mental illness amongst the unemployed and divorced.