Contemporary Families An Equity Lens Textbook Chapter 3 Health and Health Care

. HEALTH AND HEALTH CARE HEALTH AND HEALTH CARE 71 HEALTH AND HEALTH CARE QUESTIONS As you read this chapter , consider the following questions . How do socially constructed ideas affect health ?

What is the advantage of understanding disparities related to social characteristics ( race , gender , Why are people with mental illness or abuse substance disorders less likely to get medical care and port ?

What are the challenges to all families being able to keep themselves healthy by meeting basic needs such as sleep , exercise and a good diet ?

What is the difference between a health care system and health insurance ?

How does family structure affect access to health insurance and health care ?

How do geography and income level overlap when it comes to health care access ?

What role does capitalism play in the opioid epidemic ?

Is health a human right ?

72 I HEALTH , WELLNESS , AND HEALTH , WELLNESS , SICKNESS , AND DISEASE Elizabeth Pearce and Amy It is health that is real wealth and not pieces of gold and silver . Mahatma Gandhi Health is the state of complete physical , mental and social and not merely the absence of disease or , as by the World Health Organization in its The organization goes on to state that families and communities are able to thrive when individuals are able to maintain health . Our ment , mental and emotional functioning , and spiritual lives all interact with our overall health . While the status of health is very real , it is also important to examine the aspects of health and illness that are socially constructed . Society shares an assumption of reality that creates a of both health and illness . Illness has a biological component , yet it also embodies an independent element that is experienced by the son and observed by those outside of the illness . Societies construct the idea of health differently from place to place , and over time . For example , many societies consider health and health care to be a human right that all human beings are entitled to , but this is not universally true . What is your viewpoint ?

The social construction of the idea of family , as discussed in the chapter of this text , plays a special role in the health of families in the United States . In all other industrialized countries , health care is considered a human right , and all individuals can access comparable care regardless of family status . But in the , health care insurance is accessed through a variety of systems , all of which have age , income , employment status , and family relationships as criteria . How do of family impact the access of any individual to health care ?

World Health Organization . 2005 , September 15 ) Constitution . Retrieved December 30 , 2019 , from about constitution HEALTH , WELLNESS , SICKNESS , AND I 73 Fig . Chalking the Universal Declaration of Human Rights 2015 by University of Essex Society informs the definitions for when an illness can be considered a disability , eligibility for insurance and medical coverage , what illnesses are perceived as legitimate , when the reality of an illness is questioned , and what illnesses are These social constructs can , in themselves , contribute to differentiation in vidual health as well as stereotypes , prejudice , and discrimination . Sociologist said , Stigma is a process by which the reaction of others spoils normal A disease or illness that is stigmatized is one in which there is some societal disapproval or questioning of the integrity of people who have the disease , which can also include medical professionals and the person with the disease themselves . 2015 , April 24 ) Introduction to Sociology 26 . Retrieved March , 2020 , from

74 HEALTH , WELLNESS , AND One or more interactive elements has been excluded from this version of the text . You can View them online here ?

The Khan Academy Medicine channel describes the interrelationship among stigma , self , and society in the seven minute video above . There are many socially stigmatized diseases which can include mental disorders , and other transmitted diseases , substance abuse disorders , skin conditions , and diseases that are less understood by the medical community , such as disorders and chronic fatigue syndrome . Individuals may be less likely to seek treatment when experiencing symptoms of a stigmatized condition . In the United States , where health insurance creates another layer of bureaucracy , less understood illnesses and treatments may not be covered by some insurance . Even if health care is accessed , there may be fewer social supports available , and greater chances of isolation and discrimination in the health care setting and beyond . Management of a ity because of the deterioration of health due to a stigmatized illness can prove to be a tremendous It is important to consider how marginalized groups experience health inequities , including those experienced due to the stigma and prejudices linked with the societal perception of illnesses . It is complicated to assess structural power overlaps with stigmatization in any scenario . For example , it is acknowledged men hold more power in the United States than do women or people who identify as binary . What role does that play in the diagnosis of real health concerns and the social construction of those concerns ?

We know that overwhelmingly men are the subjects of the majority of medical studies and research . That affects what is thought of as typical or Women have more often been told that their toms are all in your head or related to female While this is less common than in the past , it likely continues to play a part in the misdiagnosis of serious illness in women and people . We also know that women experience diseases such as myalgic chronic fatigue syndrome and in much higher numbers than do men . The medical community describes these syndromes in overly broad terms that make diagnosis difficult . We must ask ourselves , how do these multiple complex factors serve to to reinforce the existing power dynamic in the United States ?

What systemic changes in healthcare would reduce this inequity ?

In this chapter , we will examine the overall health of families in the United States , with attention to amongst families experiences with health , illness , injury and diseases as well as comparisons with other countries . We will describe the daily life factors and resources that affect health , including the effects of stigma , Sartorius , 2007 ) Stigmatized illnesses and health care . Croatian Medical Journal , 48 (

HEALTH , WELLNESS , SICKNESS , AND 75 prejudice and discrimination . We will look closely at how families access health care services , including the health care insurance system . We will discuss the question of health care as a human right . In Focus Lung Cancer , Stigma , and In a 2014 report , Addressing the Stigma of Lung Cancer , the American Lung Association ( ALA ) described how stigma can contribute to patients avoiding or delaying care when symptoms are experienced and how they may resist disclosing health information to providers . Patients could also experience fewer social supports , feel more distress related to the disease , experience additional conflicts in relationships , and receive lower quality of health care . The report then explained how stigma could be related to lung cancer being hard to detect early , and then being seen as a death sentence with little hope for survival . In addition to this , being labelled a smoker disease could contribute to society feeling that people with lung cancer are personally responsible for their disease , placing perceived shame and blame on those with the illness . In the survey conducted by the ALA , public knowledge regarding the prevalence and mortality of lung was lacking , as well as knowledge about the funding levels for research . Responders also did not have as much knowledge of factors other than smoking that play a part in the development of lung cancer , like genetics and occupational or environmental exposures . Lack of knowledge could play an important role in ing some of the negative associations and assumptions related to lung cancer .

76 HEALTH , WELLNESS , AND LUNG CANCER CAN AFFECT ANYONE ! in people know someone who has lung cancer Fig . This graphic , created by the Air Force Medicine Facebook group , raises awareness about the commonality of lung cancer , which can help reduce stigma related to the disease . Lung cancer stigma has real consequences . People with lung cancer may hide their condition , and experience anxiety and depression , while also holding a perception that healthcare providers are judgmental and biased towards them and would treat them differently as a result . Research , advocacy , and public policy are also dimensions in which stigma can have negative consequences for advancing progress toward the treatment of this disease . For instance , lung cancer kills far more people than any other cancer type and contributes to over 25 of all cancer deaths per year Yet , a study of research funding by cancer type determined that lung cancer ranked fourth in its level of funding and is underfunded in relation to its burden on Not . American Cancer Society . 2020 , January ) Lung cancer statistics How common is lung cancer . Benson , A . 2019 ) Comparison burden and organization ing reveals disparities in funding across cancer types . Journal of the National Comprehensive Cancer Network , 17 (

HEALTH . WELLNESS . AND DISEASE I 77 only are funding levels by stigma , but celebrities , community leaders , and volunteers may be less likely to lend their name or volunteer their time due to negative associations with this This example provides a way of analyzing how can be illustrated through the lens of the social construction of illness . The community , for instance , already face challenges in health care providers who are culturally competent and have adequate knowledge in If you couple this with the stigma related to a lung cancer diagnosis , then you are compounding the obstacles that stand in the way of receiving quality health care . One could also examine how socioeconomic status may further plicate this scenario by realizing that people living in poverty are more likely to have no health insurance , fore restricting access even Even geographical location , like living in a rural area , or in the Southern portion of the United States , will reduce accessibility to Every time an individual is grouped into a marginalized group , including illness status , it the effects of discrimination and resulting health . As you reading this section , notice if you blame or hold people more responsible knowing that they have lung cancer , than if they have another cancer such as breast or prostate cancer . What effect does the stigma itself have on people who are sick , and the healthcare that they receive ?

Then ask yourself if the stigmatization of lung cancer is a social problem . Rather than perceiving lung cancer as a personal problem does the of the illness combined with the stigmatization affect the of our society ?

Licenses and Open Content , Shared Previously Figure . Chalking the Universal Declaration of Human Rights 2015 by of Essex . Licensed under . American Lung Association . 2014 , April ) Addressing the stigma of lung cancer . Retrieved March , 2020 , from . Dept . and Human Services . Lesbian , gay , bisexual , and transgender health . Healthy People 2020 . Retrieved March , 2020 , from 31 . Census Bureau . 2019 , May 23 ) Who are the uninsured ?

Retrieved March , 2020 , from 20 . 2017 , October 31 ) Health Disparities Affect Millions in Rural Communities . Retrieved March , 2020 , from 78 I WELLNESS AND Figure . Lung Cancer Awareness by Steve Thompson Air Force Medicine . Public domain . Stigma Social and self Individuals and by Khan Academy and . Licensed under .

HEALTH EQUITY I 79 HEALTH EQUITY Elizabeth Pearce Amy Jessica Hampton and Hannah Health in the United States is a lex to ic . One the one hand , as one of the wealthiest nations , the United States fares well in some health comparisons with the rest of the world . For example , most postoperative are less common in the than in comparable countries . And , as this chart shows , mortality rates for several cancers are lower . Mortality rates for breast , colorectal , and cervical cancers in the are lower than in comparable countries mortality rate per population malignant ol colorectaL and cervix , 2015 I sum I Comparable country mo Colon Rectum ant Breast Cervix uteri Notes Data to and ave seams per too 000 Am ' the uni . Fig . 33 . While there is debate over the best way to measure outcomes for cancer , the . typically performs better in both mortality rates and survival rates for breast cancer . In 2015 , the mortality rate for breast and cervical cancers in the US . was slightly lower than the comparable country average . For colorectal cancers , the US . has a mortality rate deaths per population , compared to the average rate of per in similar countries .

80 I HEALTH The overall comparative picture is more grim . The United States spends a great deal more public , private , and pocket funds per capita on health but also lags behind almost every industrialized country in terms of providing basic health and health care to all of its citizens . Adults in most comparable countries have quicker access to a doctor or nurse when they need care Percent of adults who made as or next day appointment when needed care , 2016 77 . I 67 ' sow . i 53 . i mar . 49 . ma . Fig . With the exception of Canada and Sweden , patients in the United States have a harder time making a appointment when in need of care . In 2016 , 51 of patients in the United States were able to make a appointment with a provider , compared to 57 of patients in similar countries . 2020 , 30 ) US . health care from a global perspective , 2019 Higher spending , worse outcomes ?

The Commonwealth Fund .

HEALTH EQUITY I 81 Hospital admissions for preventable diseases are more frequent in the than in comparable countries . Age standardized hospital admission rate per population for asthma congestive heart failure . hypertension , and diabetes . ages 16 and over . 2015 or nearest year I United sinus 550 300 750 200 150 so Hem Hypertension Austral . Belgian , and the US are from 2014 Diabetes are EON Fig . Hospital admissions for certain chronic diseases like circulatory conditions , asthma , and diabetes , can arise when prevention services are either not being adhered to or delivered . Hospital admission rates in the US . are in comparable countries for congestive , asthma , and complications due to diabetes . However , the US . has lower rates of hospitalization for hypertension than comparably wealthy countries do on average . In total across these four disease categories , the United States has a 37 higher rate of hospital admissions than the average of other countries .

82 HEALTH Potential years of Life Lost have fallen steadily in the and in comparable countries Overall potential year of lite lost per population , 19902017 States Comparable Average Fig . Premature deaths are measured in Years of Life Lost ( which is an alternative to overall mortality rate . It is measured by adding together the total number of years that people who died before a age ( eg . 70 ) would have lived it they had lived to that age . For example , a person who dies at age 45 would have a of 25 . As a measure , it provides more weights to deaths at younger ages . The US . and comparable countries have made progress in reducing over the last 25 years ( down 23 and 42 respectively ) although the US . continues to trail comparable countries by a significant margin ( in 2017 ) But these charts do not tell the entire story . The overall averages of health only compare the rates in the US . to the rates in other countries . Within the United States , groups are affected disproportionately in terms of access to health and health outcomes . These disparities are described next . Social of Health and Disparities Family and individual health is affected by the environments in which people live , work , learn , and play . While the focus here is health , these social of health also affect a wide range of quality of life factors . Social engagement , access to resources , safety and security are all impacted by the settings where families spend their time . Simply put , place matters when it comes to health . To read more about the Social of Health model , consult , Health disparities are linked to the social of health . They are preventable differences in the burden of disease , injury , violence , or opportunities to achieve optimal health that are experienced by socially

HEALTH EQUITY 83 disadvantaged Populations can be by factors such as race or ethnicity , gender , education or income , disability , geographic location ( rural or urban ) or sexual orientation . Health disparities are inequitable and are directly related to the historical and current unequal distribution of social , political , nomic , and environmental resources . Health disparities result from multiple factors , including ' Poverty ' Environmental threats ' Inadequate access to health care ' Individual and behavioral factors ' Educational inequalities Health disparities are also related to inequities in education . Dropping out of school is associated with ple social and health Overall , individuals with less education are more likely to experience a ber of health risks , such as obesity , substance abuse , and intentional and unintentional injury , compared with individuals with more education Higher levels of education are associated with a longer life and an increased likelihood of obtaining or understanding basic health information and services needed to make appropriate health At the same time , good health is associated with academic success . Higher levels of protective health . 2008 ) Community Health and Program Services ( CHAPS ) Health disparities among populations . Atlanta Department and Human Services . Mason , Hawkins , 2008 ) Adolescent school failure predicts later depression among girls . Journal Health , 43 ( Saner , A . 1997 ) youth Substance use and other concurrent . American Journal Health , 87 ( Department and Human Services . 2000 ) Healthy People 2010 objectives Educational and community based programs . McGee , Cao , Cooper , 1999 ) Socioeconomic status and morbidity in the last years oflife . Health , 89 ( Thun , Ward , Murray , 2008 ) Mortality from leading causes by education and race in the united states , 2001 . Medicine , 34 ( Goldberg , 2007 ) Education level , primary language , and comprehension of the informed consent process . Journal Research on Human Research Ethics ,

10 . 11 . 12 . 13 . 14 . 15 . 84 I HEALTH and lower levels of health risk behaviors have been associated with higher academic grades among high school Health risks such as teenage pregnancy , poor dietary choices , inadequate physical activity , physical and emotional abuse , substance abuse , and gang involvement have a impact on how well . 1011121314 students perform in school . Health by Race and Ethnicity When looking at the social epidemiology of the United States , it is hard to miss the disparities among races . The discrepancy between Black and White Americans shows the gap clearly in 2008 , the average life expectancy for White males was approximately years longer than for Black males compared to . An even stronger disparity was found in 2007 the infant mortality , which is the number of deaths in a given time or place , rate for Blacks was nearly twice that of Whites at compared to per live births . According to a report from the Henry . Kaiser Foundation , African Americans also have higher incidence of several other diseases and causes of mortality , from cancer to heart disease to diabetes . In a similar vein , it is important to note that ethnic minorities , including Mexican Americans and Native Americans , also have higher rates of these diseases and causes of mortality than Whites . Kann , McManus , Michael , Lee , A . 2017 ) behaviors and academic achievement among high school states , 2015 . Morbidity and Mortality Weekly Report , 66 ( 35 ) Choi , 2007 ) Academic achievement and problem behaviors among Asian Islander American adolescents . nal and Adolescence , 36 ( Shore , Brett , Wright , 2008 ) Decreased scholastic achievement in overweight middle school students . 16 ( MacDonald , Fischer , 2002 ) Risk factors and behaviors associated with adolescent violence and aggression . 26 ( A , Mitchell , Dawson , Hacker , A . 2009 ) Is there a between physical and academic achievement ?

Positive results from public school children in the united states . Journal Health , 79 ( Field , Diego , Sanders , 2001 ) Exercise is positively related to adolescent relationships and academics . Adolescence , 36 ( 141 ) 105 . Census Bureau . 2011 ) Statistical Abstract of the United States 2012 . ed . Washington , et al . 2007 ) Key facts Race , ethnicity medical care . The Henry . Kaiser Family Foundation .

HEALTH 85 Lisa notes that this gap started to narrow during the Civil Rights movement in the , but it began widening again in the early 19805 . What accounts for these perpetual disparities in health among ethnic groups ?

Much of the answer lies in the level of healthcare that these groups receive . Even after adjusting for insurance differences , racial and ethnic minority groups receive poorer quality of care and less access to care than dominant groups Racial inequalities in care include . Black Americans , Native Americans , and Alaskan Natives received inferior care than White Americans for about 40 percent of measures . Asian ethnicities received inferior care for about 20 percent of measures . Among Whites , Hispanic Whites received 60 percent inferior care of measures compared to panic Whites . When considering access to care , the were comparable . Health by Socioeconomic Status ( SES ) Discussions of health by race and ethnicity often overlap with discussions of health by socioeconomic status , since the two concepts are intertwined in the United States . As the Agency for Health Research and Quality ( 2010 ) notes , racial and ethnic minorities are more likely than Whites to be poor or near poor , 19 so many of the data pertaining to subordinate groups is also likely to be pertinent to low groups . Marilyn and her research state that one of the strongest and most consistent of a person morbidity and mortality experience is that person socioeconomic status ( SES ) This persists across all diseases with few exceptions , continues throughout the entire lifespan , and extends across numerous risk factors for Morbidity is the incidence of disease . It is important to remember that economics are only part of the SES picture research suggests that cation also plays an important role . and Link note that many diseases like lung 17 . 2009 ) Social epidemiology Social of health in the united states are we losing ground ?

Annual Review of Public Health , 30 ( 18 . Agency for Healthcare Research and Quality . 2010 ) The 2010 National Healthcare Disparities Report . footnote Agency for Healthcare Research and Quality . 2010 ) The 2010 National Healthcare Disparities Report . 20 . Frank , 1992 ) Socioeconomic status and health How education , income , and occupation contribute to risk factors for cardiovascular disease . Health , 82 ( 21 . Jo , Link , 2003 ) When income affects outcome Socioeconomic status and health . Research in ,

86 HEALTH EQUITY cancer ( from smoking ) coronary artery disease ( from poor eating and exercise habits ) and AIDS initially were widespread across SES groups . However , once information linking habits to disease was disseminated , these diseases decreased in high SES groups and increased in low SES groups . This illustrates the important role of education initiatives regarding a given disease , as well as possible inequalities in how those initiatives effectively reach different SES groups . Health by Gender Women are affected adversely both by unequal access to and institutionalized sexism in the healthcare industry . According to a recent report from the Kaiser Family Foundation , women experienced a decline in their ability to see needed specialists between 2001 and 2008 . In 2008 , one quarter of females questioned the quality of her healthcare . In this report , we also see the explanatory value of understanding and tion theory . Feminist sociologist Patricia Hill Collins developed the intersection theory , which suggests we not separate the effects of race , class , gender , sexual orientation , and other attributes . Further examination of the lack of in the healthcare system by women , as in the Kaiser study , found , for example , women categorized as low income were more likely ( 32 percent compared to 23 percent ) to express concerns about healthcare quality , illustrating the multiple layers of disadvantage caused by race and sex . We can see an example of institutionalized sexism in the way that women are more likely than men to be diagnosed with certain kinds of mental disorders . Psychologist Dana Becker notes that 75 percent of all noses of Borderline Personality Disorder ( are for women , according to the Diagnostic Statistical Manual of Mental Disorders . This diagnosis is characterized by instability of identity , of mood , and of behavior , and Becker argues that it has been used as a diagnosis for too many women . She further the tive connotation of the diagnosis , saying that it predisposes many people , both within and outside of the of psychotherapy , against women who have been so diagnosed . Many critics also point to the of women issues as an example of institutionalized sexism . refers to the process by which previously normal aspects of life are as deviant and needing medical attention to remedy . Historically and contemporaneously , many aspects of women lives have been , including menstruation , premenstrual syndrome , pregnancy , childbirth , and menopause . The of pregnancy and childbirth has been particularly contentious in recent decades , with 22 . A . 2011 ) Women health care Key from the Kaiser Women Health The Henry . Kaiser Family Foundation . 23 . Becker , Dana . Borderline Personality Disorder The disparagement of women through Retrieved ber 13 , 2011 from ?

HEALTH 87 many women opting against the medical process and choosing a more natural childbirth . Fox and that all women experience pain and anxiety during the birth process , but that social support relieves both as effectively as medical support . In other words , medical interventions are no more effective than social ones at helping with the of pain and childbirth . Fox and further found that women with supportive partners ended up with less medical intervention and fewer cases of postpartum depression . Of course , access to quality birth care outside the standard medical models may not be readily available to women of all social classes . The Lancet , an international general medical journal , is published weekly and available to read online without cost . In 2017 , they published a comprehensive series about inequality and health care in the United States . The Table of Contents for the series is linked here although it is free , you will need to log in to read the series of articles . of Mental and Health Mental and physical health have been socially constructed in the Western world to be viewed as separate , with mental disorders being stigmatized . Often mental illnesses such as depression or anxiety have been seen as something that a person should and could get over as opposed to a physical ailment such as a sprained ankle or strep throat that merits medical attention and assistance . Even physical illnesses such as or chronic fatigue syndrome , which are experienced by many more women than men , can be seen as in the patient head , leading to the potential miss of physical illnesses that need medical intervention . This leaves the patient with not only the physical symptoms , but also a potential lack of understanding amongst peers , family members , medical professionals , and . Eastern and Native cultures have long seen the connection between the mind and body and indeed , this connection is better understood in the United States and among other Western countries where dualism ( the separating of the spirit from the body ) prevails . Cancer , heart and respiratory disease death rates are all higher in people with mental illness . In addition , it is better understood how physical lifestyle choices such as exercise , diet , and drug use affect mental health and vice To read more about the relationship between physical and mental health , check out this brief article from here . Stigma An example of the relationship between mental health and stigma would be a person struggling with 24 . Fox , 1999 ) Revisiting the critique childbirth A contribution to the sociology of birth . Gender , 13 ( 25 . Mental Health Foundation . 2020 ) Physical health and mental health . Retrieved July , 2020 , from

88 HEALTH sion that also causes a physical symptom of weight gain or weight loss due to a lack of appetite or excessive hunger . Obesity and excessive thinness are both stigmatized in our culture , while the underlying mental or physical health condition may be ignored . Mental health disorders are treated and looked at differently than health struggles on a more physical level . Although we have seen a shift in media about mental illness from known celebrities coming forward , such as Demi , Chrissy , Steve Young , and Dan Reynolds , there is still a social stigma against mental health . Oftentimes , when someone is diagnosed with a physical ness such as cancer or heart disease , we see communities and families coming together . Unfortunately , we rarely see mental illness struggles come to the surface without holding a place of shame or guilt individuals , families and communities are often more reluctant to talk about and come together in the same way . When we speak about stigma , we speak of two different types the first stigma is social stigma , meaning the diced attitudes others have around mental illness and the treatment of mental illness . The second one is stigma , which is an internalized stigma that the individual who suffers from the mental illness has . Not only may the stigma around mental illness create painful emotions and a sense of invalidation for the individual , it can result in a reluctance to seek treatment , social tion , avoidance , isolation , and direct harm to Communities cal . The social and stigma WHY be of health attached to mental illness can be reinforced by common diagnoses compared to physical diagnoses . cultural misconceptions , social stereotypes , popular media representations , political leaders , and even some medical professionals and health care institutions . Health Insurance Coverage and Legislation Like all other health care in the United States , access to mental health care is highly dependent on access to medical insurance , But because the need for mental health support is not validated as fully as is the need for physical health support , insurance companies and government programs have frequently excluded or limited mental health coverage . This is an example of institutionalized or structural stigma . This practice has been changed through two major acts of legislation the Mental Health Parity and tion Equity Act ( passed in 2008 and The Patient Protection and Affordable Care Act , commonly referred to as the Affordable Care Act ( and also known as , passed by the Congress and signed into law by President Barack Obama in 2010 . In 2008 , federal lawmakers passed , which created an equity requirement for insurance providers who covered mental health services those services must be equivalent to the physical health coverage provided . It did not , however , require providers to provide mental health care coverage . So , expenses , and limits

HEALTH EQUiTY i 89 requirements were allowed to vary from state to state along with whatever insurance plan individuals could access . It was still the case that insurance holders did not have access to mental health treatment . In 2013 , 61 of insured people had access to mental health services and 54 of the insured had access to addiction The passage of the reduced the inequities in access to mental health and addiction treatment in two fundamental ways . First , it eliminated health insurance companies ability to deny coverage based on ing That gave consumers diagnosed with any mental or physical illness greater choice and more leverage when selecting an insurance company . In addition , it required insurance providers to include ten essential including services for those suffering from mental health disorders and problems with substance To read the list of all ten look here . While these improvements in the of mental health and addiction access are notable , they apply only to families who have access to certain kinds of health insurance , and not universally to all families in the United States . Structural stigma and overlaps with systemic racism , sexism , and classism . In Sleep , Discrimination , and Let focus on how these various disparities overlap with everyday behavior . A biological need that is mental to human health is sleep , yet the medical community still has much to understand and learn about its exact mechanisms . Sleep is a vital part of our daily routine , and we spend about of our time doing it . Quality sleep , and getting enough of it at the right times , is as essential to survival as food and water . In rats , death results from no sleep at 32 Research has not observed human death as a result of prolonged sleep deprivation , but paranoia and hallucinations can begin happening in as little as 24 hours without Without sleep you can form or maintain the pathways in your brain that let you learn and create new , and it harder to concentrate and respond quickly . Sleep is important to a number of brain functions , including how nerve cells communicate with each other . In fact , our brains and bodies stay remarkably active while we sleep . Recent suggest that sleep plays a housekeeping role that removes toxins in our brains that build we are awake . 26 . Health Pocket . 2013 , March ) Few existing health plans meet new essential health standards . 27 . Palmer , 2009 , May 11 ) Can you die from lack ?

Slate . 28 . Waters , Chiu , 2018 ) Severe sleep deprivation Causes hallucinations and a gradual toward psychosis with increasing time awake . Frontiers in Psychiatry , 90 HEALTH Sleep affects almost every type of tissue and system in awn the body , from the brain , heart , and lungs to metabolism , i , lapse at heal ! Vale . 533 shows that a chronic lack of sleep , or getting poor quality ' i ' immune function , mood , and disease resistance . Research . Sever sleep , increases the risk of disorders including high blood . pressure , cardiovascular disease , diabetes , depression , and Increased lime Decreased obesity . All of these conditions would likely have a ' able effect on multiple dimensions of family life and how . mix of . I no it impacts the well being of a family as a whole . Type . For some surprising and health effects of sleep Fig 38 Effects of deprivation View this TED Talk One or more interactive elements has been excluded from this version of the text . You can View them online here ?

In 2010 a stud was that examined whether there were disparities in sleep quality based on poverty and . They found that a sleep disparity did exist in the study population , and poor sleep quality was strongly associated with poverty and race . Factors such as employment , education , and health status , amongst others , mediated this effect in participants experiencing poverty . The literature linking sleep and health continues to grow . This study illustrated how poor health is associated with an almost increased likelihood of poor sleep . It is important to note that the relationship between health and sleep quality is likely bidirectional or parallel sleep can influence health and vice 29 . Patel , Xie , 2010 ) Sleep disparity in the population Poor sleep quality is strongly associated with poverty and ethnicity . Public Health , 10 (

HEALTH EQUITY I 91 Short Sleep Duration ' Hours ) Behavioral Risk Factor Surveillance System United States Discrimination , and especially intersectional so crimination , appear to sleep , mental , and I I I I I physical health . The relationship between . I ' nation and poorer mental and physical health has as a been established amongst populations such as a women , racial and ethnic minorities , and members of groups . For instance , discrimination can harm , increase distress and mental 39 2010 . that Sleep ness symptoms , elevate risk for a wide variety of was strongly associated with poverty and race . physical illnesses and conditions , and undermine general indicators of Consider also the ways that poor and marginalized groups inhabit less desirable neighborhoods . The overlap of all social of health and feeling safe and secure in particular are likely to impact sleep . Recently , lack of sleep and less functionality during the daytime have been as integral aspects of the cycle of discrimination , stress , and overall mental and physical Licenses and Open Content , Shared Previously Disparities is adapted from Health Disparities by the Centers for Disease Control and . Public domain . Health by Race and Ethnicity , Healthy by Socioeconomic Status , and Healthy by Gender 30 . Brown , Chantal Griffin , A . 2018 ) Discrimination hurts The effect of discrimination on the development of chronic pain . Social Science Medicine , 204 , 31 . Garcia , A . 2014 ) The consequences of perceived discrimination for psychological A review . Psychological Bulletin , 140 ( 32 . Brenner , 2019 ) Does sleep partially mediate the effect of everyday discrimination on future mental and physical health ?

Social Science Medicine , 221 , 92 HEALTH are adapted from Health in the United States in Introduction to Sociology . License BY ?

In Focus Sleep , Discrimination and is adapted from Brain Basics standing Sleep by the National Institute of Neurological Disorders and Stroke National of Health . Public domain . Adaptations Changed just a few words and changed some to commas . Mortality rates for breast and colorectal cancer in the US . are lower than in comparable countries by . License . Percent of adults who made a or next day appointment when needed care , 2016 by . License . standardized hospital admission rate per population for asthma , congestive heart failure , hypertension , and diabetes , ages 15 and over , 2016 or nearest year by . License 30 . Pig ure . Potential Years of Life Lost have fallen steadily in the US . and in comparable countries by . License ig ure 37 . Right on by ol . Licensed under . in ure . Main health effects of sleep deprivation by Mikael . in ure 39 . Short sleep duration ( hours ) by . Public domain . All Rights Reserved Content Sleep is your superpower ( TED Talks . License Terms Standard YouTube license .

HEALTH AND HEALTH INSURANCE I 93 HEALTH AND HEALTH INSURANCE Elizabeth Pearce Jessica Hampton and Christopher Byers Industrialized nations throughout the world , with the notable exception of the United States , provide their citizens with some form of national health care and national health insurance Although their healthcare differ in several respects , their governments pay all or most of the costs for health care , drugs , and other health needs . In Denmark , for example , the government provides free medical care and hospitalization for the entire population and pays for some medications and some dental care . In France , the government pays for some of the medical , hospitalization , and medication costs for most people and all these expenses for the poor , unemployed , and children under the age of ten . In Great Britain , the National Health Service pays most ical costs for the population , including medical care , hospitalization , prescriptions , dental care , and eyeglasses . In Canada , the National Health Insurance system also pays for most medical costs . Patients do not even receive bills from their physicians , who instead are paid by the government . Medical debt and bankruptcy due to dent or disease is a uniquely American problem . These national health insurance programs are commonly credited with reducing infant mortality , extending life expectancy , and , more generally , for enabling their to have relatively good health . Notably , the United States ranks 33 out of 36 countries who belong to the Organisation for Economic Cooperation and Development ( for infant mortality . The infant mortality rate in the United States is deaths per live infant births , as compared to the average rate of deaths per 1000 births . Five countries have death rates lower than per births . Their populations are generally healthier than Americans , even though healthcare spending is much higher per capita in the United States than in these other nations . In all these respects , these national health insurance systems offer several advantages over the healthcare model found in the United The Role of Health Insurance in the United States Medicine in the United States is big business . Expenditures for health care , health research , and other health items and services have risen sharply in recent decades , having increased tenfold since 1980 , and now cost the . Russell , 2018 ) Double standard Social policy in Europe and the United States ( Fourth edition ) field . Reid , 2010 ) The healing ofAmerica A global quest for better , cheaper , and fairer health care . Penguin Books .

94 I HEALTH AND HEALTH nation more than trillion annually . This translates to the largest per capita in the industrial world . Despite this expenditure , the United States lags behind many other industrialized nations in several important health indicators . US Expenditure , in Billions of Dollars ) US Health Care Expenditure ( Billions of Dollars ) 500 1980 1985 1990 1995 2000 2005 2010 Fig . Expenditures for health care have increased tenfold since 1980 . Access to Health Care Coverage and Insurance There are many insurance options in America , and we will see that they disproportionately some and disadvantage others based on factors like sex , income , geographical location , and ethnicity . In 2017 , some of the most common ways people accessed insurance was through private plans ( 56 ) direct purchase ( 16 ) or , through government plans Medicaid ( Medicare ( and military healthcare ( To learn more about how people accessed health insurance coverage , and who remained uncovered , watch this video provided by the United States Census Bureau . a One or more interactive elements has been excluded from this version of the text . You can View them online here ?

Census Bureau . 2017 ) Coverage numbers and rates by type of health insurance 2013 , 2016 , and 2017 table . Retrieved June , 2020 , from HEALTH AND HEALTH INSURANCE 95 The Affordable Care Act ( was created to make healthcare more affordable and to be less discriminatory in 2010 . In 2016 , section 1557 provided new regulations to the Affordable Care Act , including a way to enforce civil rights protections in healthcare by making it unlawful for health care entities to discriminate against protected populations if they receive any type of federal assistance . This included health companies participating in the Health Insurance Marketplaces , providers who accept Medicare , aid , and Child Health Insurance Program ( CHIP ) payments , and any state or local healthcare agencies , among others . This marked the first time that discriminatory practices on the basis of race , skin color , national origin , age , sex , disability in some cases , sexuality and gender broadly prohibited in the arena of public and private Some of the common ways that lower income families and individuals access insurance in Oregon are through programs like Medicaid and Children Health Insurance Programs ( CHIP ) which is referred to as Oregon Health plan ( in Oregon . Oregon Health Plan Income Limits for Application to Medicaid or Family Size for Adults for Children Medicaid is a federal and state funded program that is managed by individual states . It provides government insurance to those who need it . Each state has the power to decide who is eligible for it , and most states focus on individuals , and those with disabilities . With the expansion of the in 2014 , states had the choice to expand their Medicaid to serve more citizens Oregon is one of 37 states that elected to do so . For up to date information on each state , consult this Kaiser Family Foundation interactive map and narrative . 2016 , September ) The Affordable care act and civil rights The challenge 1557 ofthe able Care Act . Quarterly , Health Plans in Oregon . 2020 ) Oregon health plans made easy .

96 HEALTH AND HEALTH Distribution of Adults in the Coverage Gap , by State and Region , 2018 Midwest was Other Expansion States 31 Total Million in the Coverage Gap Hi ) I ' may not Sum due to . i ( are no ' the ( rant in the northeast as all states in the northeast expanded ( tic aid SOURCE based on 2019 Medicaid levels and 2018 Fig . These graphs demonstrate that where you live affects your access to health care . Families who live in states that did not adopt the Medicaid expansion are more likely to have less access to health care . The government website about Medicaid ( provides state by state report cards on a wide variety of health access and health quality measures . This variance in Medicaid eligibility creates great inequity for families based on location . Those in states that have not expanded Medicaid face a much larger coverage gap , meaning that many more families do not have access to health care Those who are age or older can access healthcare insurance through Medicare , which is federally funded . Medicare covers about half of health care expenses for those enrolled , and many retirees who can afford to do so purchase private insurance or purchase additional coverage from Medicare itself to cover the Case Study Getting Tested for Carmen , a essential worker who works at a distribution center that ships masks in . A . 2020 , January 14 ) The Coverage gap Uninsured poor adults in states that do not expand Medicaid . Kaiser Family Foundation . 2020 , March ) Report to the Congress Medicare payment policy .

HEALTH AND HEALTH i 97 California , developed a severe enough cough in late March , 2020 , that the human resources department at her workplace told her to go home and not to come back to work until she was tested for the virus . has health insurance coverage through her employer she has a deductible , Tests were not widely available at this time , so she was directed by her doctor to go to an emergency room . She went to the closest one , a hospital owned by Universal Health Services , one of the largest care management companies in the United States . The Aid , Relief , and Economic Security Act ( aka CARES Act ) had passed the week before , and it had been widely publicized that testing and treatment would be free to individuals and covered by the federal government . Unfortunately , the legislation is full of loopholes , including for people like who need a test but were unable to get one due to the low supplies , Although she was given a chest and prescribed an inhaler , she was not tested . That means that not only was she for the in hospital and doctor fees , but she had to miss a week of work ( mostly unpaid ) putting a considerable strain on and her family . case is not isolated and is not to the Fig 312 , The patchwork of insurance , Access to , and coverage for , the test for the and and private novel ( aka ) within the pandemic payments inequitably affects lower income people illustrates how the patchwork of insurance , government programs and laws , and private payments inequitably affects people , whether or not they have health insurance coverage . To hear more about Carmen story , listen to this four minute recording from the series Bill of the Month . sections 2020 06 30 885053457 Who is Left Out ?

He who has health has hope and he who has hope has everything . Arabian Proverb 98 HEALTH AND HEALTH Most of the uninsured ( in the United States are working age adults aged 19 to 64 years old . Men are in these numbers over half of all people without health insurance coverage were male ( percent ) even though the population has more women than men . The uninsured are disproportionately concentrated in the The number of people without health insurance has been increasing steadily since 2016 of all Americans ( million people ) did not have health insurance at any point in the year of 2018 , according to the American Community Survey ?

Socioeconomic status plays a large part in access to healthcare . Occupation , education level , and chronic poverty all play contributing roles . The unique structure of tying health care insurance to ment in the United States perpetuates income equality . Income ties into important social of health including location of home , transportation , and quality of life . Medicaid , which is tied to income level , has limited medical coverage , and often does not cover dental or vision care for adults . Plans vary from state to state . Children , older adults , and people of color are disproportionately affected by health greater detail on adults aged who are uninsured review this 2019 report from the for Healthcare Research and Quality . A separate study showed that before the expansion of the in 2014 , about 41 of Hispanics , 26 of Blacks , and 15 of Whites were uninsured , while after expansion the rate of uninsured individuals decreased by for panics , for Blacks , and for Although the Fig . During the outbreak , many essential workers like nurses lacked personal protective equipment ( like masks . Census Bureau . 2018 , September 12 ) Who are the uninsured ?

2020 , from 20 . November , 2020 ) Health insurance coverage in the United States 10 . 2019 , une ) Research adults ever uninsured during the calendar year , Agency for Healthcare Research and Quality . 11 . Levy , Wolfe , 2016 ) Effect of the affordable care act on racial and

HEALTH AND HEALTH INSURANCE 99 difference in rates for those have closed , there is still a sizable gap that needs to be addressed in order to effectively address equity in access to health care . Even with these improvements , vast inequities exist state to state , because a family who is poor enough to receive Medicaid in one state is not poor enough in another state , especially those who have not expanded Medicaid . Geography matters . Although our country has a rhetoric of equality , family and health laws vary state to state , which reinforces inequalities . Eligibility ranges from having an income that is 40 of the Federal Poverty Line ( to having an income that is 138 of the quite a difference ! Lack of health insurance has consequences because people are less likely to receive preventive health care and care for various conditions and illnesses . For example , because uninsured Americans are less likely than those with private insurance to receive cancer screenings , they are more likely to be diagnosed with more advanced cancer rather than an earlier stage of In an analysis published in 2009 , researchers found that there was a 25 higher risk of death for adults ( aged 17 to 64 ) who were uninsured than those who . had private ethnic disparities in health insurance coverage . of Public Health , 106 ( 12 . A . 2018 , September 11 ) pushed uninsured rate down to 10 in 2016 . Care . 13 . Ward , Bian , Chen , 2008 ) Association tus and ethnicity with cancer stage at diagnosis for 12 cancer sites A retrospective analysis . The Lancet Oncology , 08 ) 14 . Bor , 2009 ) Health and mortality in us adults . Health , 99 ( 12 )

100 HEALTH AND HEALTH INSURANCE Research and Drug Access Pharmaceutical research and sales are a gargantuan ness in the United States . The cost of developing any new drug is estimated to be about one billion dollars . Financing comes from the federal government and organizations at the discovery research level large sums of money are pumped into the initial stage of development is typically funded by companies , which can be for or companies . companies may be funded by venture capitalists or as a part of larger . Funding for companies is a bit Fig 314 The Cost of developing any new drug is gaining access to federal and foundation funding takes 10 be abOU . staff time and expertise . The unequal and inequitable funding opportunities put at a disadvantage , because they have to invest more time in writing requests for grants and funding from government corporations . The cost of drugs in the United States increased dramatically starting in the 19905 . It is important to note that American families are not accessing more medications than people in comparative countries . In fact , Americans use fewer prescription drugs and are more likely to use less expensive generic prescriptions . It really comes down to price per pill they simply cost more in the United States than in other 15 . Institute of Medicine ( US ) Forum on Drug Discovery , Development , and Translation . 2009 ) Current model for ing drug development From concept through approval . National Academies Press . 16 . 2019 , February ) Why the US has higher drug prices than other countries . The Conversation . 1256

HEALTH AND HEALTH I 101 spending per capita each year Of the countries shown below , Sweden spends the least for pharmaceuticals per capita , at 351 , while the US , spends the most at , wen Netherlands Austral a 5427 Came Gem Switzerland 3783 UW Pa The , ri , vi . Fur ?

can Fig . Pharmaceuticals cost more in the United States than in other countries . pharmacological companies have the upper hand in terms of distribution and overall on the decisions for research and funding for new medications in the United States . A company that has a mission of profit for its employees and public shareholders could be seen as having an ethical dilemma when selling its product might benefit those groups , but may not be the best course of action for the people who need those medicines to maintain their basic health . It is for this reason that most countries ( excluding the United States ) do not allow drug research companies to and create state contracts with those companies in order to keep 17 costs low . In Focus The Opioid Epidemic An example of the power of drug companies can be found in the opioid epidemic . The opioid began in the United States in the . While medications like heroin and morphine have been used for pain management for thousands of years , they became more popular during World War II , when heroin and morphine were used to treat war veterans and people who have experienced trauma and wounds from battle . Families in the United States with members who have difficulty navigating proper pain management have found opioids to be one solution . Prescriptions for these medications were given out and dispensed very , even for temporary pain , starting in the century . As usage increased dramatically in the , 17 . Gross , Perez , 1994 ) International pharmaceutical spending controls France , many , Sweden , and the United Kingdom . Health Care Financing Review , 15 (

102 HEALTH AND HEALTH pharmaceutical companies assured the medical community and patients that these drugs were not It is now known that addiction to these and other substances often starts with tion and progresses to a more dangerous level of use if left unchecked . THE OPIOID EPIDEMIC BY THE NUMBERS People died every day lrom People misused drug overdoses prescription opioids in 2018 its ! million People died lrom People had an opioid use People used herein overdosing on opioids disorder in 2018 in 2013 million People used heroin People misused attributed to for me lust lime prescription ori heroin lor the lime ( in ending February 2019 ) I ?

a Sun run Dim ) one on opioid other than ( ma methadone period . rims , swam ending February ) Fig . This 2019 chart illustrates the current opioid epidemic , which is estimated to kill people a day . Private lawsuits and action a be an to ein the earl in the United States . It has been found that companies failed to follow government regulations related to drug production and regulation such as tracking and investigating suspicious orders of these medications . Both ( Oxycodone ) and generic drug manufacturers were guilty of these actions , although generic 18 . Department of Health and Human Services . September , 2019 ) About the epidemic . 2020 , from

HEALTH AND HEALTH I 103 manufacturers remained unchecked for longer . Companies made billions of dollars of during this same period Lawsuits against drug companies and distributors by the federal government , multiple states , Native can tribes , and local municipalities show promise for compensation . Examples include allegations of deceptive business practices , fraud , lax monitoring , and oversaturation of the These actions resulted in not only individual negative consequences but have also contributed to systemic breakdown in communities . The ripple effects on families and communities are difficult to quantify . While overdoses and deaths can be counted , loss and grief is immeasurable . Diminished parenting , loss of employment , loss of housing , and ken relationships all affect families , schools , workplaces , and communities . The effects of drug addiction and trauma are generational we will not know how many families have been affected by this until well into the future . Keeping our Families Healthy If you were to spend a few minutes brainstorming a list , what would you include as the most important requirements to keeping your family healthy ?

While this chapter has focused on health care and health as important aspects of health management , the authors of this text would like to emphasize that health care starts with access and related to exercise , diet , relationships , work , sleep , intellectual , addictive substances , education , and social life . This is our list perhaps you have other aspects to add ! Importantly , those individual and family decisions are directly impacted by the social institutions and processes at the core of the United States . Past and present laws , policies , practices , and biases that create and reinforce inequities mean that families live with vastly different access to resources , including food , safe and stimulating outdoor environments , time , work environments , social life , and health care . 19 . 2020 , June 18 ) DEA database shows generic drug manufacturers contributed most to the opioid epidemic . 20 . 2017 ) Drug companies liability for the opioid epidemic . New , 377 ( 24 )

104 I HEALTH AND HEALTH INSURANCE PHYSICAL DISTANCING IN PUBLIC PARKS AND TRAILS Do not use parks or . ins if you an I Share the and warn Mun , ol your . and as you pus . Ba in ocean to restrooms I ! Fig . Tips for physical distancing outside during the Pandemic . For example , many families live without easy access to recreational trails and playgrounds . The Housing Now chapter of this text details the ways in which laws , regulations , and lending corporations have actively in pushing groups into these areas . We must pay attention to these past and the ways that they impact present families health . During the current ( 2020 ) Pandemic , it is becoming clear that the virus is transmitted more easily in crowded spaces indoors than in the outdoors . There is a disproportionate number of cases and deaths amongst populations in the United States , and it is possible that lack of access to outdoor spaces plays a role . So at the same time that this lack of resources makes it more difficult to maintain everyday physical and mental health , it may also tribute to illness , hospitalization , loss of employment , and even death during the pandemic . This video from the American Medical Association features an interview with Doctor and explains how funding , data collection and the overlap with structural discrimination affect the rates of the virus . 21 . and Wood , 2020 , May 30 ) Growing data show Black And Latino Americans bear the brunt .

HEALTH AND HEALTH INSURANCE 105 One or more interactive elements has been excluded from this version of the text . You can View them online here ?

Institutionalized inequities have been during the current pandemic . Crowded work environments such as facilities food deserts less health insurance , less access to health care and virus testing as measured by geography and transportation options and greater likelihood to experience discrimination , stress , and lack of sleep , are some of the factors that contribute to greater numbers of Black , Native , and lies being affected by the These overlapping factors are discussed throughout this text . It is important to recognize the role of activism in alleviating all social problems , including the problem experienced by so many families in the United States poor health that could be improved by adequate health care . There is hope there are many countries that have differing successful models of health care that give all citizens access . In this country there are multiple groups , many led by physicians or other medical professionals , that are working to create or modify systems so that all individuals and families can access the basic health care that they need . Two organizations that are prominent are Health Care for ALL Oregon and Physicians for a National Health Program . The United Nations Universal Declaration of Human Rights Article 25 health as a human right . Article 25 . Everyone has the right to a standard of living for the health and of himself and of his family , including food , clothing , housing and medical care and necessary social services , and the right to security in the event of unemployment , sickness , disability , hood , old age or other lack of livelihood in circumstances beyond his control . Motherhood and childhood are entitled to special Fig . The United Nations health as . care and assistance . All children , whether born in or out a human right . of wedlock , shall enjoy the same social Some nations and all industrialized nations , with the United States as the notable 22 . Center for Disease Control and Prevention . 2020 , June 25 ) in racial and ethnic minority groups . Retrieved July , 2020 , from 23 . United Nations . 1948 , December 10 ) Universal Declaration of Human Rights . Retrieved July , 2020 , from

106 HEALTH AND HEALTH tion , have adopted some form of universal healthcare system since the 1948 adoption of this Declaration . The irony is that the framework for the human rights declaration came from the United States and the work of ident Franklin Delano Roosevelt and his wife and Eleanor The United States does not have an actual health care system , but rather multiple systems of health insurance accessed via ment , via family as by government structures , block programs , and federal programs for groups such as people who are indigent , disabled , or older . In other words , not all lies . While families in the United States strive to make the best choices for themselves , they are limited by the existing access to resources needed to be as healthy as possible . Some of these inequities were created by past laws and practices . But those , and others , can be adjusted and changed . The societal and governmental to the standards of health and as in the United Nations Declaration of Human Rights is a way to begin . Licenses and Open Content , Shared Previously Health Care and Health Insurance A Comparison is adapted from Global Aspects of Health and Health Care in Social Problems by Anonymous . License . Adaptation edited for clarity and accuracy . Figure . US Expenditure ( in Billions of Dollars in Problems by Anonymous . License . Based on data from Statistical . Census . Figure . Distribution of Adults in the Coverage Gap by State and Region 2018 by . License . Figure . Chicago 2012 by . License . Figure 314 . Money Behind Health Care by . License . Figure . Retail spending per capita each year by The Conversation . License Based on data from The Commonwealth Fund . 24 . Health care as a human right . Human Rights Magazine , 43 ( 2020 , from

HEALTH AND HEALTH INSURANCE 107 . The Opioid Epidemic by the Numbers by the US Department of Health and Human Services . Public domain . Universal Declaration of Human Rights by the United Nations . License and Health Insurance Health Insurance Presentation by US Census . Public domain . Open Content , Original . Image by Katie . License BY . All Rights Reserved Content . in Public Parks and Trails ( National Recreation and Dark Association . Image used with permission . for April 21 2020 ( American Medical Association . License Terms Standard YouTube license .