19.1: The Experience of Illness

The Experience of Illness

Illness, sometimes considered another word for disease, refers to a state of poor health.

Learning Objectives

Examine the impact of illness in America and the prevalence of diagnosed illness among the population

Key Points

• Some scholars have maintained a distinction between illness and disease by describing illness as a patient’s subjective perception of an objectively defined disease.
• Epidemiology is the scientific study of factors affecting the health and illness of individuals and population.
• Behavioral medicine is an interdisciplinary field of medicine concerned with the development and integration of psychosocial, behavioral, and biomedical knowledge relevant to health and illness.
• The rise of scientific medicine in the past two centuries has altered or replaced many historic health practices.
• Mental illness is a broad generic label for a category of illnesses that may include affective or emotional instability, behavioral dysregulation, and/or cognitive dysfunction or impairment.

Key Terms

• scientific medicine: The rise of scientific medicine in the past two centuries has altered or replaced many historic health practices.
• behavioral medicine: Behavioral medicine is an interdisciplinary field of medicine concerned with the development and integration of psychosocial, behavioral and biomedical knowledge relevant to health and illness.
• epidemiology: The branch of a science dealing with the spread and control of diseases, computer viruses, concepts, etc. throughout populations or systems.

Introduction to Illness

Illness, sometimes considered another word for disease, is a state of poor health. Some scholars have maintained a distinction by describing illness as a patient’s subjective perception of an objectively defined disease. Conditions of the body or mind that cause pain, dysfunction, or distress can be deemed an illness. Sometimes the term is used broadly to include injuries, disabilities, syndromes, infections, symptoms, deviant behaviors, and atypical variations of structure and function. In other contexts these may be considered distinguishable categories.

Epidemiology

Epidemiology is the scientific study of factors affecting the health and illness of individuals and populations; it serves as the foundation and logic for interventions made in the interest of public health and preventive medicine. Behavioral medicine is an interdisciplinary field of medicine concerned with the development and integration of psychosocial, behavioral, and biomedical knowledge relevant to health and illness. According to evolutionary medicine, much illness is not directly caused by an infection or body dysfunction, but is instead a response created by the body. Fever, for example, is not caused directly by bacteria or viruses but by the body raising its normal temperature, which some people believe inhibits the growth of the infectious organism. Evolutionary medicine calls this set of responses “sickness behavior. ”

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.

Mental illness is a broad category of illnesses that may include affective or emotional instability, behavioral dysregulation, and/or cognitive dysfunction or impairment. Specific illnesses known as mental illnesses include major depression, generalized anxiety disorder, schizophrenia, and attention deficit hyperactivity disorder, to name a few.

Statistics show that more and more people are being diagnosed with mental disorders. The National Institute for Mental Health reports that over 40 million adults are diagnosed with an anxiety disorder in a given year, accounting for 18 percent of the population. Other disorders that are prevalent are ADHD (4 percent), mood disorders (9.5 percent) and and autism (1 percent, but quickly rising).

Researcher Test: A researcher studying a part of the human body in search for illness.

Gender and Health

Disparities in health services play out based on different systems of stratification, such as gender.

Learning Objectives

Examine the role gender plays in health care services, particularly for women

Key Points

• The World Health Organization defines gender as the result of socially constructed ideas about the behavior, actions, and roles a particular sex performs.
• Gender, and particularly the role of women, is widely recognized as vitally important to international development issues.
• Women’s dual responsibilities as carers and income earners leaves them suffering from time poverty, and thus unable to access health and education services.
• The Gender-related Development Index (GDI), developed by the United Nations, aims to show the inequalities between men and women in the following areas: long and healthy life, knowledge, and a decent standard of living.
• The Gender-related Development Index (GDI), developed by the United Nations, aims to show the inequalities between men and women in the following areas: long and healthy life, knowledge, and a decent standard of living.

Key Terms

• gender stratification: There are a number of ways in which health disparities play out based on different systems of stratification. Researchers also find health disparities based on gender stratification.
• World Health Organization: The World Health Organization (WHO) is a specialized agency of the United Nations (UN) that is concerned with international public health. It was established on April 7, 1948, with headquarters in Geneva, Switzerland, and is a member of the United Nations Development Group.
• international development: International development or global development is a concept that lacks a universally accepted definition, but it is most used in a holistic and multi-disciplinary context of human development—the development of greater quality of life for humans. It therefore encompasses foreign aid, governance, healthcare, education, poverty reduction, gender equality, disaster preparedness, infrastructure, economics, human rights, environment and issues associated with these.

The Role of Gender in Health

Immunization for Babies: Immunizations from various diseases have improved health worldwide.

Gender is a range of characteristics used to distinguish between males and females, particularly in the cases of men and women and the masculine and feminine attributes assigned to them. Depending on the context, the discriminating characteristics vary, from sex to social role to gender identity. The World Health Organization defines gender as the result of socially constructed ideas about the behavior, actions, and roles a particular sex performs. Assigning gender involves taking into account the physiological and biological attributes assigned by nature followed by socially constructed conduct. The social label of being classified into one or the other sex is obligatory to the medical stamp on the birth certificate.

There are a number of ways in which health disparities play out based on different systems of stratification. Researchers also find health disparities based on gender stratification. One study found that women are less likely than men to be recommended for knee replacement surgery, even when they have the same symptoms. While it was unclear what role the sex of the recommending physicians played, the authors of this study encouraged women to challenge their doctors in order to get care equivalent to men.

Gender, and particularly the role of women, is widely recognized as vitally important to international development issues. This often means a focus on gender-equality, ensuring participation, but includes an understanding of the different roles and expectations of the genders within the community. As recognized by the United Nations, women’s dual responsibilities as carers and income earners leaves them suffering from time poverty, and thus unable to access health and education services. The Gender-related Development Index (GDI), developed by the United Nations, aims to show the inequalities between men and women in the following areas: long and healthy life, knowledge, and a decent standard of living.

Race and Health

Health disparities refer to gaps in the quality of health and healthcare across racial and ethnic groups.

Learning Objectives

Discuss the health disparities in the United States based on race and the implications for racial minorities

Key Points

• Race and health research, often done in the United States, has found both current and historical racial differences in the frequency, treatments, and availability of treatments for several diseases.
• In multiracial societies such as the United States, racial groups differ greatly in regard to social and cultural factors such as socioeconomic status, healthcare, diet, and education.
• There is a controversy regarding race as a method for classifying humans. The continued use of racial categories has been criticized.
• Apart from the general controversy regarding race, some argue that the continued use of racial categories in health care, and as risk factors, could result in increased stereotyping and discrimination in society and health services.

Key Terms

• life expectancy: The amount of time one is expected to live.
• multiracial societies: In multiracial societies such as the United States, racial groups differ greatly in regard to social and cultural factors, such as socioeconomic status, healthcare, diet, and education.
• Health disparities: Health equity refers to the study of differences in the quality of health and health care across different populations.

The Role of Race in Health

Health disparities refer to gaps in the quality of health and healthcare across racial and ethnic groups. Race and health research, often done in the United States, has found both current and historical racial differences in the frequency, treatments, and availability of treatments for several diseases. This can add up to significant group differences in variables such as life expectancy. Many explanations for such differences have been argued, including socioeconomic factors, lifestyle, social environment, and access to preventive health-care services, among other environmental differences.

In multiracial societies such as the United States, racial groups differ greatly in regard to social and cultural factors such as socioeconomic status, healthcare, diet, and education. There is also the presence of racism which some see as a very important explaining factor. Some argue that for many diseases racial differences would disappear if all environmental factors could be controlled for. Race-based medicine is the term for medicines that are targeted at specific ethnic clusters, which are shown to have a propensity for a certain disorder. Critics are concerned that the trend of research on race specific pharmaceutical treatments will result in inequitable access to pharmaceutical innovation, and smaller minority groups may be ignored.

Health disparities based on race also exist. Similar to the difference in life expectancy found between the rich and the poor, affluent white women live 14 years longer in the U.S. (81.1 years) than poor black men (66.9 years). There is also evidence that blacks receive less aggressive medical care than whites, similar to what happens with women compared to men. Black men describe their visits to doctors as stressful, and report that physicians do not provide them with adequate information to implement the recommendations they are given.

Another contributor to the overall worse health of blacks is the incident of HIV/AIDS; the rate of new AIDS cases is ten times higher among blacks than whites, and blacks are 20 times as likely to have HIV/AIDS as are whites. Health disparities are well documented in minority populations such as African Americans, Native Americans, Asian Americans, and Latinos. When compared to European Americans, these minority groups have higher incidence of chronic diseases, higher mortality, and poorer health outcomes. Minorities also have higher rates of cardiovascular disease, HIV/AIDS, and infant mortality than whites. American ethnic groups can exhibit substantial average differences in disease incidence, disease severity, disease progression, and response to treatment.

Infant mortality is another place where racial disparities are quite evident. In fact, infant mortality rates are 14 of every 1000 births for black, non-Hispanics compared to 6 of every 1000 births for whites. Another disparity is access to health care and insurance. In California, more than half (59 percent) of Hispanics go without health care. Also, almost 25 percent of Latinos do not have health insurance, as opposed to 10 percent of Whites.

There is a controversy regarding race as a method for classifying humans. The continued use of racial categories has been criticized. Apart from the general controversy regarding race, some argue that the continued use of racial categories in health care, and as risk factors, could result in increased stereotyping and discrimination in society and health services. There is general agreement that a goal of health-related genetics should be to move past the weak surrogate relationships of racial health disparity and get to the root causes of health and disease. This includes research which strives to analyze human genetic variation in smaller groups across the world.

Percentage Without Insurance, Based on Race: Age-sex adjusted percent of persons of all ages without health insurance coverage, by race/ethnicity, United States, 2004

Social Class and Health

Social class has a significant impact on one’s physical health, ability to receive adequate medical care and nutrition, and life expectancy.

Learning Objectives

Discuss the role social class plays in access to adequate health care and health inequality

Key Points

• While gender and race play significant factors in explaining healthcare inequality in the United States, socioeconomic status is the greatest determining factor in an individual’s level of access to healthcare.
• Social determinants of health are the economic and social conditions, and their distribution among the population, that influence individual and group differences in health status.
• They are risk factors found in one’s living and working conditions (such as the distribution of income, wealth, influence, and power), rather than individual factors (such as behavioral risk factors or genetics) that influence the risk for a disease, injury, or vulnerability to disease or injury.
• Social determinants of health are the economic and social conditions, and their distribution among the population, that influence individual and group differences in health status.
• Health inequality is the term used in a number of countries to refer to those instances whereby the health of two demographic groups (not necessarily ethnic or racial groups) differs despite comparative access to health care services.

Key Terms

• social determinants of health: The economic and social conditions that influence individual and group differences in health status.
• health inequality: The unequal distribution of environmental health hazards and access to health services between demographic groups, including social classes.

The Role of Social Class in Health

A person’s social class has a significant impact on their physical health, their ability to receive adequate medical care and nutrition, and their life expectancy. While gender and race play significant factors in explaining healthcare inequality in the United States, socioeconomic status is the greatest determining factor in an individual’s level of access to healthcare.

Individuals of lower socioeconomic status in the United States experience a wide array of health problems as a result of their economic status. They are unable to use health care as often, and when they do it is of lower quality, even though they generally tend to experience a much higher rate of health issues. Furthermore, individuals of lower socioeconomic status have less education and often perform jobs without significant health and benefits plans, whereas individuals of higher standing are more likely to have jobs that provide medical insurance. Consequently, they have higher rates of infant mortality, cancer, cardiovascular disease, and disabling physical injuries.

Social determinants of health are the economic and social conditions, and their distribution among the population, that influence individual and group differences in health status. They are risk factors found in one’s living and working conditions (such as the distribution of income, wealth, influence, and power), rather than individual factors (such as behavioral risk factors or genetics) that influence the risk for a disease, injury, or vulnerability to disease or injury. According to some viewpoints, these distributions of social determinants are shaped by public policies that reflect the influence of prevailing political ideologies of those governing a jurisdiction.

Health inequality is the term used in a number of countries to refer to those instances whereby the health of two demographic groups (not necessarily ethnic or racial groups) differs despite comparative access to health care services. Such examples include higher rates of morbidity and mortality for those in lower occupational classes than those in higher occupational classes, and the increased likelihood of those from ethnic minorities being diagnosed with a mental health disorder.

Education and Health

Health literacy is an individual’s ability to read, understand and use healthcare information to make decisions about treatment.

Learning Objectives

Demonstrate the impact of health literacy on access to and understanding of health care issues, especially for certain social groups

Key Points

• Health literacy is of continued and increasing concern for health professionals, as it is a primary factor behind health disparities.
• 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.
• Reading level, numeracy level, language barriers, cultural appropriateness, format and style, sentence structure, use of illustrations, scope of intervention, and numerous other factors will affect how easily health information is understood and followed.
• The mismatch between a clinician’s level of communication and a patient’s ability to understand can lead to medication errors and adverse medical outcomes.
• Health care professionals (doctors, nurses, public health workers) can also have poor health literacy skills, such as a reduced ability to clearly explain health issues to patients and the public.
• The eHealth literacy model is also referred to as the Lily model. This model includes basic literacy, computer literacy, information literacy, media literacy, science literacy, and health literacy.

Key Terms

• the eHealth literacy model: The eHealth literacy model is also referred to as the Lily model, which incorporates the following literacies, each of which are instrumental to the overall understanding and measurement of eHealth literacy: basic literacy, computer literacy, information literacy, media literacy, science literacy, health literacy.
• language barrier: A figurative phrase for the difficulties faced when people who have no language in common attempt to communicate with each other.
• Health literacy: Health literacy is an individual’s ability to read, understand and use healthcare information to make decisions and follow instructions for treatment.

Health literacy is an individual’s ability to read, understand, and use healthcare information to make decisions and follow instructions for treatment. Health literacy is of continued and increasing concern for health professionals, as it is a primary factor behind health disparities. 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.

There are many factors that determine the health literacy level of health education materials or other health interventions. Reading level, numeracy level, language barriers, cultural appropriateness, format and style, sentence structure, use of illustrations, scope of intervention, and numerous other factors will affect how easily health information is understood and followed. The mismatch between a clinician’s level of communication and a patient’s ability to understand can lead to medication errors and adverse medical outcomes. The lack of health literacy affects all segments of the population, although it is disproportionate in certain demographic groups, such as the elderly, ethnic minorities, recent immigrants and persons with low general literacy. Health literacy skills are not only a problem in the public. Health care professionals (doctors, nurses, public health workers) can also have poor health literacy skills, such as a reduced ability to clearly explain health issues to patients and the public.

Due to the increasing influence of the internet for information-seeking and health information distribution purposes, eHealth literacy has become an important topic of research in recent years. The eHealth literacy model is also referred to as the Lily model, which incorporates the following literacies, each of which are instrumental to the overall understanding and measurement of eHealth literacy: basic literacy, computer literacy, information literacy, media literacy, science literacy, health literacy.

Directors of Global Smallpox Eradication Program: Three former directors of the Global Smallpox Eradication Program read the news that smallpox had been globally eradicated in 1980.

Women in Medicine

Historically and in many parts of the world, women’s participation in the profession of medicine has been significantly restricted.

Learning Objectives

Analyze the role women play in the medical field and how gender parity affects women’s choices when it comes to medicine

Key Points

• Women’s informal practice of medicine in the role of caregivers and in the allied health professions has been widespread.
• The practice of medicine remains disproportionately male overall. In industrialized nations, the recent parity in gender of medical students has not yet trickled into parity in practice.
• Most countries now guarantee equal access by women to medical education. However, not all ensure equal employment opportunities, and gender parity has yet to be achieved within the medical specialties around the world.

Key Terms

• parity: Equality; comparability of strength or intensity.

The Role of Women in Medicine

Historically and in many parts of the world, women’s participation in medicine (as physicians, for instance) has been significantly restricted, although women’s informal practice of medicine in the role of caregivers and in the allied health professions has been widespread. Most countries of the world now guarantee equal access by women to medical education, although not all ensure equal employment opportunities. Gender parity has yet to be achieved within the medical specialties around the world.

At the beginning of the twenty-first century in industrialized nations, women have made significant gains, but have yet to achieve parity throughout the medical profession. Women’s participation in medical professions was limited by law and practice during the decades while medicine was professionalizing. However, women kept practicing medicine in the allied health fields (nursing, midwifery), making significant gains in medical education and medical work during the 19^th and 20^th centuries. Women continue to dominate nursing in the 20^th century. In 2000, 94.6% of registered nurses in the United States were women.

The practice of medicine remains disproportionately male overall. In some industrialized nations, women have achieved parity in medical school. Since 2003, women have formed the majority of the U.S. medical student body. However, they have yet to achieve parity in practice. In many developing nations, neither medical school nor practice approach gender parity. Moreover, there are skews within the medical profession. For example, some medical specialties like surgery are significantly male-dominated, while other specialties are or becoming significantly female-dominated.

Monique Frize, née Aubry (born 1942) is a Canadian academic and biomedical engineer known for her expertise in medical instrumentation and decision-support systems: At the beginning of the 21st century, women in industrialized nations have made significant gains, but have yet to achieve parity throughout the medical profession. In some industrialized countries, women have achieved parity in medical school. Women have formed the majority of the United States medical student body since 2003. In 2007-2008, women accounted for 49% of medical school applicants and 48.3% of those accepted. According to the American Association of Medical Colleges (AAMC) 48.3% (16,838) of medical degrees awarded in the US in 2009-10 were earned by women, an increase from 26.8% in 1982-3.

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