CHAPTER 14

Nature of the Problem: Health Care and Illness (pp. 472-485)

Life expectancy in this century has increased from about 47 to over 76 years by 2000, partly as a result of improved living conditions, advanced technology, and application of medical knowledge. Larger numbers of people now fall victim to chronic debilitating illness with profound effects on the quality of life--these diseases are the major cause of death in the United States. There is concern about a resurgence of infectious diseases. The health problems we face vary by gender and age. AIDS is a disease that is receiving considerable public attention because of its mode of transmission and its deadly outcome. Mental illness is linked with stress and social change but is found in all societies. Mental disorders are classified in terms of etiology and as either organic or functional. The extent of mental illness is difficult to assess, but studies of hospitalization rates and estimates of "true" prevalence support the notion that mental illness and its symptoms are becoming increasingly more serious in our society.

In our health-oriented society, physical and mental illnesses cause disruptions in everyday life as well as fears for the future of those directly involved. The obvious impact of illness on the quality of life is the stress and suffering that illness imposes on people. Poor interpersonal relationships and ill health can become a vicious circle, while good relationships tend to promote good health. Inadequate medical care is related to the fact that medicine is still an inexact science, facilities are often inadequate and personnel incompetent, cost is high, and sources of care are distributed poorly among the population. Individual privacy and medical advances are in conflict, as in screening for control of genetic disease. Costs of health care to individuals and to families have been rising steadily to oppressive levels; costs to society in lost productivity are rising to substantial levels. The inadequate care of the mentally ill has been compounded by the deinstitutionalization movement that began in the 1960s. The history of medicine is marked by ongoing conflict between the advocates of medical advance and those who defend the freedom of the individual. An increasing amount of the nation's economic resources is channeled into the effort to combat illness and promote good health.

Sociocultural factors are involved in both the etiology of disease and the problems of inadequate care and access to care. Certain roles in society have been identified as particularly stress-inducing and therefore possible precursors to physical and mental disease. The role of a married woman is implicated in prevalence rates for all kinds of illness in women, while high stress levels of certain occupations predispose men to coronary heart disease. The rapid rate of social change-future shock-is, for many, a stressor. Elements of the industrial economy expose workers and neighborhoods to carcinogens, noise, and substance pollutants, but seem unresponsive to efforts at protection. A politics of illness exists, as evidenced by the stratification of illness patterns and the maldistribution of medical resources.

Long-standing attitudes, values, and the ideology of free enterprise perpetuate problems of treatment and inhibit efforts toward positive change. As in the case of drug and alcohol abuse, more money and effort have been expended on treatment of ill health than on prevention. Some treatment of mental disorders, however, has been of doubtful value. Continuing research is aimed at making prevention, diagnosis, and treatment of both physical and mental illnesses more effective. Innovative programs are needed to further ensure the more equitable delivery of all health-care services.