Social-Conflict Analysis of Health and Medicine

Sociologists define health not just as the absence of disease, but more fully, as a state of physical, mental, and social well-being. This article discusses, from the social conflict perspective of sociology, the social context of health — how we define ourselves, and how others define us as healthy or sick — and how our social class affects our ability to receive medical care. Sociologists from the conflict perspective view medicine as having a monopoly on the definition of health and illness and how to treat illness, as well as whom to treat, calling this the medicalization of society.

Keywords Conflict Perspective; Demographics; Epidemiology; Health; Infant Mortality Rate; Life Expectancy; Medicalization of Society; Medicine; Sociological Imagination; Universal Healthcare

Sociology of Health & Medicine > Social-Conflict Analysis of Health & Medicine

Overview

The Conflict Perspective

The conflict perspective is a theoretical approach in sociology that views social interaction as a struggle for the resources of society between conflicting groups. Power struggles over control of society's and the world's resources characterize the conflict perspective. This conflict may be political, legal, economic, or even familial. The best-known conflict perspective is Marxism, which focuses on the expected clash between two social and economic groups: the bourgeoisie, or capitalists, and the proletariat, or workers. Karl Marx, the founder of Marxism, studied and wrote extensively about the exploitation of the workers by the capitalists in the workplace.

Other classical sociologists who are considered to subscribe to the conflict perspective include C. Wright Mills, who focused on the power elite in the United States and developed the notion of the sociological imagination. Using the sociological imagination, one can separate personal problems, such as loss of a job, from social problems, such as the recession of the economy, which can cause the job loss.

Sociologist Max Weber also subscribed to the conflict perspective, taking Marxism a step further, adding to the economic struggle between social groups the concepts of power (the ability to get what you want despite the objections of others) and prestige (the ability to influence people through a place of honor) (Kendall, 2006). An example of power that does not necessarily include economic power is the presidency of the United States. An example of prestige without economic or positional power might be Irena Sendler, a Polish woman nominated for the 2007 Nobel Peace Prize for her work in saving 2,500 Jewish infants and children during the Holocaust.

Global Health

Good health is a state of well-being, including the physical, the mental, and the social. Illness, then, is the opposite of health because it indicates a lack of well-being in one or more of these three areas. For example, globally, infectious diseases have not yet been properly addressed through vaccination processes for the multitudes, although these same diseases may no longer exist in wealthier countries. These diseases, for which there are modern cures, are killing thousands and reducing life expectancy considerably in the undeveloped world. But even in the United States, people tend to be overweight and contract diseases related to obesity such as diabetes and heart disease, indicating that money isn't always the answer to good health. Sick people often need help, and they seek out the assistance of the medical system, an institution that practices medicine and engages in the diagnosis, treatment, and prevention of illness.

Another measure of global health is infant mortality, because it is a primary indicator of health care (Schaefer, 2008). The rate of infant mortality is figured by the number of deaths of infants under the age of one year for every one thousand births in a year. For example, in low-income countries, the infant mortality rate is relatively high, with 6 percent of infants (sixty out of every thousand) dying in the first year of life in 2010, according to the World Health Organization (WHO); this was ten times the rate (six out of every thousand) recorded in high-income countries.

Politics and the economy play a part in global health. Consider the governments of some countries that will not allow Western medicine to assist within their borders, even though the well-being of the people is at stake. Or, consider the embargoes against food and medical supplies that the U.S. currently has in place for Cuba, causing innocent people to suffer.

Economics also affects global health. People who live in low-income countries often do not have the resources to learn about or to pay for medical attention for themselves or their children. The costs of Western medicine is usually beyond the means of many people in places like sub-Saharan Africa and Asia. Conflict theorists assert that global health could improve if research concentrated more on the diseases of the poor, rather than the cosmetic desires of the wealthy.

Further Insights

Demographics of Health in the U.S.

The United States is considered the richest country in the world, and many people see it as the home of the finest health care in the world, too. However, Americans are by far not the healthiest people in the world.

Age

The young and the old are hit hardest when it comes to illness, particularly chronic or long-term illness. According to a report from the Centers for Disease Control and Prevention (CDC), infant mortality in the United States declined 12 percent from 2005 to 2011, to a rate of about six infant deaths per thousand births (MacDorman, Hoyert, & Mathews, 2013). However, that rate was still considerably higher than countries in much of the rest of the developed world, according to WHO statistics; countries in western Europe, for example, experienced rates of more like two or three infant deaths per thousand births in 2010 (WHO, 2013).

The existence of chronic diseases tends to increase with age and people over age sixty-five, who are living longer and must look to medical institutions for their well being more often, more expensively, and more frequently. With 20 percent of the U.S. population expected to be over age sixty-five by 2050, the strain on the medical community and the cost to society could rise sharply (Kendall, 2006). Elders above the age of seventy-five in the U.S. are five times more likely to use health services and to be hospitalized than younger people in the mid-teens to mid-twenties age bracket (Schaefer, 2008).

Gender

Women live longer than men in the United States because of a biological advantage, which they have from birth. But the primary reason for the longevity of females compared to males is gender roles. Males take on dangerous occupations such as commercial fishing and mining, engage in violence, and are more likely to do unhealthy things like drinking alcohol heavily and smoking cigarettes. But this does not mean that women are generally healthier than men, even though they tend to live about five years longer, on average. Women have higher rates of chronic illness than men (Waldron, 1994), but tend to seek medical help sooner.

Race & Ethnicity

Certain racial and ethnic groups tend to live below the poverty line, and their health options can therefore be curtailed. The poor economic and environmental conditions experienced disproportionately by African Americans, Hispanics, and Native Americans contributes to higher mortality rates for these groups. For example, African Americans have higher death rates than whites from heart disease, pneumonia, diabetes, stroke, and cancer. According to the CDC, life expectancy for blacks in 2010 was 75.1 years compared to 78.9 years for whites (Kochanek, Arias, & Anderson, 2013). Some researchers argue that racial tension could be causing ill health such as hypertension among black Americans who experience lifelong prejudice and discrimination (Morehouse Medical Treatment and Effectiveness Center, 1999). Others point to the differences in health care coverage and inferior treatment because of the same prejudice and discrimination, which becomes a double-edged sword (Caesar & Williams, 2002).

Social Class

If you live in a wealthier neighborhood, your health can be affected positively. These living areas tend to offer opportunities for exercise, better selection of foods, and access to good jobs. Notice that fast food restaurants and mom-and-pop cigarettes-and-beer stores, for example, tend to hover around low-income areas, making healthy choices more of a challenge. Class, then, is related to health because of things like crowded and substandard housing, poor diet, and stress, all of which can contribute to ill health (Schaefer, 2008).

Lifestyle

People who live in rural areas have fewer health care options than those in the cities. Only 9 percent of doctors practice in rural areas, where 20 percent of the U.S. population resides. Those without adequate means of transportation to get medical care in the city could therefore suffer due to inadequate hospitals and facilities.

Other lifestyle factors such as drug use can affect health. Americans are well aware of the overuse of drugs, both illegal and legal, in their country. One legal drug, alcohol, is consumed at an average rate of 22 gallons of beer (more than either milk or coffee), one gallon of liquor, and two gallons of wine per person, per year, according to a 2003 U.S. Census Bureau finding. Nicotine found in cigarettes is also a legal drug with major health ramifications. Tobacco-related illness kills one out of every five people in the U.S. per year, according to the CDC.

Illegal drugs such as marijuana and its derivatives are consumed by about one-third of people over the age of twelve. If a pregnant woman smokes marijuana, her fetus can develop physical and neurological problems (Fishbein & Pease, 1996). Others who smoke marijuana can develop cancer and lung problems from inhaling the substance. Cocaine use (engaged in by about 1.6 million Americans in 2012) causes high rates of infection, heart disease, hypertension, and other medical problems (Substance Abuse and Mental Health Services Administration, 2013). Even prescription drugs are abused.

The Medicalization of Society

Conflict theorists point to the monopoly of the medical institution in defining health and illness and the treatment of illness, referring to this central role as the "medicalization" of society. Some would even argue that medicine has taken the place that state religions once had in influencing and controlling people (Schaefer, 2008).

Doctors can treat a wide range of illnesses from early development to old age. We look more and more to the experts for the advice that was once a form of folk medicine handed down from elders to the young. In fact some Latin communities continue to practice curanderismo, a holistic health style that relies on folk healers and home remedies (Schaefer, 2008). But most Americans are more and more influenced by medicine in the formal sense and avoid those practitioners who are outside the mainstream, such as acupuncturists, midwives, and chiropractors, giving the traditional medical institution a great deal of political, economic, and social power (Friedland, 2000).

The Flexner Report

Leading medical school faculty led by Abraham Flexner conducted research in 1910 to determine a proper model for medical schools to follow. The results called for establishing schools that were full-time research-oriented laboratories that spent most of their time on research rather than on teaching the practice of medicine (Kendall, 2006). Based on this report, most African American medical schools were closed in the U.S., and all but one medical school for women also closed. This meant that people of color and women were moved outside of the medical community for much of the twentieth century (Kendall, 2006).

The report did help to professionalize medicine in several ways by providing an education that required a rigorous knowledge of health, illness, and medicine. It gave autonomy and judgment to physicians who were allowed to determine what they considered to be the appropriate ways to deal with health issues. Because they were autonomous, doctors also became self-regulating, using their own licensing, accreditation, and regulatory associations requiring members to be held accountable. With this type of autonomy and self-regulating power, physicians expect and receive vast authority over lower-level medical personnel and their patients. They have control of the entire medical establishment and have consistently thwarted efforts by insurance companies, government, and citizen groups to develop cost controls (Kendall, 2006).

Health Care Costs

There are several ways that health care can be paid for, including the fee-for-service system currently used in the United States. Those who prefer this method point to what they call the true spirit of capitalism, which has created many advances in medicine spurred on by the prospects of high profits. But conflict theorists point to the inequities in this method, where those who can afford it get the best care and those who cannot afford as much, receive inferior care.

The fee-for-service type of health care used in the United States is considered an expensive system primarily because health care providers can set the fees without any regulation. Most people fall into one of several categories. Some have private health insurance policies for which they pay premiums and the insurance companies then pay the health care providers. Any additional money not covered by the health insurance company is the responsibility of the individual. Others have one of two national public health insurance policies, either Medicaid, for people at a low level income, or Medicare, which is for persons age sixty-five and over. Both of these programs are in fiscal trouble, however, with increasing numbers of people falling into poverty and becoming elderly.

Despite the existence of a variety of private and public insurance plans, more than 15 percent of Americans (close to 50 million) were not covered by health insurance, prior to the passage of the Patient Protection and Affordable Care Act in 2010, a major health care overhaul designed to drastically reduce the uninsured rate.

Besides the United States, most other countries offer some form of universal health care coverage for their citizens. The Canadian health care plan allows all citizens to receive medical services that are paid for by taxes generated from all tax-paying citizens. It was at first unpopular with physicians when it was instituted in 1962, but has continued to provide health care coverage for Canadians since then.

A socialized medicine plan does exist in countries such as the United Kingdom, whereby the government sets health care policies rather than leaving them to a private medical establishment and also controls and owns health care facilities and their budgets. The government also employs the health care workers, including physicians.

Proponents of a single-payer national health insurance plan for the U.S. argue that 60 percent of the American public favors this type of coverage. For a national health insurance plan to be effective, it must reduce administrative costs, allow patients to choose their health care provider, and it must ban for-profit health care providers. Such a plan must also put into place a retraining program for the thousands of insurance company employees who would lose their jobs if a national health insurance plan were to be implemented.

Inequalities in Health Care

Proponents of the conflict perspective in sociology are interested in who benefits and who loses in any social situation. The inequalities of health care both globally and in the U.S. have been a pressing issue for conflict theorists, where wealth and poverty dictate who receives quality medical attention for illnesses, whether physical, mental, or social, and who does not. Globally, there is a problem of distribution of health care professionals. In Africa, there is less than one doctor for every one thousand people, while in much of America, people enjoy 2.6 doctors for every thousand people (Schaefer, 2008).

It has already been noted that blacks, often regardless of their socioeconomic status, are part of a growing number of underserved people who receive inferior health care treatment. This inequality of access to adequate health care, which also touches the working poor, ex-offenders, laid-off workers, domestic and restaurant employees, day-care providers, part-time and contract employees, and even pastors of small parishes, is often blamed on continuing prejudice and discrimination not only in the medical field, but also in society in general (Treadwell, 2008).

Women have been particularly affected by the medicalization of society, according to conflict theorists. Childbirth has been relegated to a medical procedure attended by "official" medical personnel and not at home, attended by midwives, who were once the original family practitioners for whole communities (Ulrich, 1991). Cosmetic surgery has become a popular segment of medicine, offering women continued youth and slenderness. And women are more often than men excluded from medical research.

Many people in the world are dealing with the effects of poverty, which causes poor nutrition and a lack of access to medical help. Numerous organizations are working to change this, but they continually run into political and economic roadblocks in their efforts. Immigration contributes to the problem of having health care available in some countries and regions. Skilled workers, professionals and technicians who are greatly needed at home in India, Pakistan, and part of Africa, are immigrating instead to the West.

In the U.S., some people are becoming more health conscious, and the choice for healthier foods and exercise is contributing to some gains against diseases like heart disease and cancer. But obesity, especially among American children, is a chronic problem. Too many sedentary jobs and entertainments while sitting at computers are helping adults and children become and remain overweight.

Viewpoints

Disease Mongering

Disease mongering is the effort by those who seek to increase profits, such as pharmaceutical companies, or others with similar financial interests, by increasing purchases of a drug using the traditional marketing tactic of convincing people that they need a certain product. In this case, the product is medical intervention. Usually, a so-called disease is described with nonspecific symptoms that are practically unnoticeable, or in some cases, could be debilitating. The market for treatment is increased by labeling a person's experience as pathologic, and by defining systems as a disease in itself. For example, high cholesterol is actually a risk factor for disease such as heart attack, but is now being marketing as a disease itself.

An example of a condition that could be very mild in many people, or even temporary, that has been marketed heavily is restless leg syndrome. People sometimes have a jittery leg. It is an everyday occurrence that does not necessarily cause sickness. To be sure, some people may have disabling symptoms of restless leg syndrome. But for many others, the problem is mild and nothing to be concerned about. It is good to help people who have a disease, but it is not good when companies try to convince people that they are sick when they are not (Woloshin & Schwartz, 2006).

Media Influence

Notice the number of drug-related advertisements during a typical evening watching television. The number of these commercials is astounding, with one after another aired during prime time. But to stop this type of disease mongering that exploits people's fears of getting a disease that could severely limit or even kill them, opponents find themselves pitted against the greed factor: power and money. There is apparently a huge profit in disease mongering for pharmaceutical companies. Opponents of these tactics urge the medical profession to disentangle itself from the pharmaceutical industry. Often, doctors rely on subjective information about a drug that has been researched and designed by the drug company itself. In addition, the medical profession needs to define better limits on when it decides when medical intervention is necessary for a person's health. The current practice of labeling people "at risk" for certain diseases almost requires that the patient be treated for the possible risk, which means taking drugs much earlier than might be medically necessary. Disease mongering is a rich business; it preys on citizens of wealthier countries who can afford to pay for the prevention of a possible health risk, rather than serving the citizens of poor countries whose populations may contain the most illnesses (Heath, 2006).

There are some ethical considerations with disease mongering, as well. Can households be allowed to go bankrupt because they cannot afford to pay the staggering medical bills that not only a fee-for-service system, but also disease mongering, too often create? What about the notion of "caveat emptor," or buyer beware? Is scaring people into purchasing drugs touted as the cure for their health problems without knowing the other possible risks of those drugs, ethical? The public scare regarding the popular arthritis drug Celebrex, which can cause cardiovascular thrombosis and hypertension, is a case in point. Celebrex is still on the market and being prescribed to patients by their doctors (Reinhardt, 2008).

Conclusion

Conflict theorists argue that capitalist countries like the U.S. focus more on profits than on helping people. They sacrifice the health and safety of the people, and government agencies fall short when it comes to correcting this. Health care reform advocates feel that in order to achieve optimum access to health care resources for all people regardless of age, race, gender, or social status, big changes must occur in the American health care system, as by equalizing costs through a universal health care plan.

Terms & Concepts

Conflict Perspective: A theoretical approach in sociology that views social interaction as a struggle for the resources of a society between conflicting groups.

Demographics: Factors such as age, sex, or race/ethnicity

Epidemiology: The study of the incidence and spread of disease.

Health: A condition of physical, mental, and social well being.

Infant Mortality Rate: Measured by how many infants under the age of one who die, for every thousand births in a year.

Life Expectancy: The estimated span of life for people in a particular group.

Medicalization of Society: The growing role of medicine as a major social institution of social control.

Medicine: The institution that diagnoses, treats, and sometimes prevents illness.

Sociological Imagination: Developed by C. Wright Mills, it observes the differences between private troubles and social issues.

Universal Healthcare: A program that provides health care coverage for all citizens of a country, paid for by tax revenues.

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Braithwaite, K. (2008). Health is a human right, right? American Journal of Public Health Supplement, 98. Retrieved September 24, 2008 from EBSCO online database, Academic Search Premier. http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=34060827&site=ehost-live

Leighton, K. (2003). A social conflict analysis of collective mental health care: Past, present and future. Journal of Mental Health, 12, 475. Retrieved November 6, 2013 from EBSCO online database, SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=10665388

Mahar, M. (2006). Money-driven medicine: The real reason health care costs so much. New York: Harper Collins.

Molina, N. (2011). Borders, laborers, and racialized medicalization: Mexican immigration and US public health practices in the 20th century. American Journal of Public Health, 101, 1024–1031. Retrieved November 6, 2013 from EBSCO online database, SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=61353896

National Academies. (2008). Knowing what works in health care: A roadmap for the nation by Institute of Medicine. Washington, DC: National Academies Press.