BSCI A213F Healthcare and Society - PDF

BSCI A213F Healthcare and society Topic 6: Society changes and health Social change and healthcare Leo Reeder (1972) identified three significant social change influencing healthcare 1. Shift in medicine away from the treatment of acute diseases toward preventive health services intend...

BSCI A213F Healthcare and society Topic 6: Society changes and health Social change and healthcare Leo Reeder (1972) identified three significant social change influencing healthcare 1. Shift in medicine away from the treatment of acute diseases toward preventive health services intended to offset the effects of chronic disorders. 2. The growing sophistication of the public with bureaucracy (See bureaucracy in Topic 2 and topic 9) 3. The development of consumerism and commercialization 1930-1950: Environmental Health Leading causes of disease and death: Infectious diseases E.g., pneumonia, influenza, tuberculosis, diarrhea Related to where people lived and worked What would you do in order to improve your health? Better sanitation and safety Cleaner food production Better water fluoridation Related to community life and environment Control of infectious diseases Occupational safety laws 3 1950-1970: Healthcare Leading causes of disease and death: A shift from infectious diseases to heart disease and cancer The focus: Sanitation and safety → detection and treatment of disease through clinical intervention Vaccination of childhood illnesses Improved maternal and prenatal care Detection and treatment of high blood pressure Result: rise of medical dominance 4 Medical Dominance Medical dominance: the power and authority held by the medical profession in shaping and controlling healthcare systems and policies. This dominance is based on the idea that medical professionals are the most knowledgeable and skilled experts when it comes to diagnosing and treating illnesses. Medical dominance in shaping health policy by: Influencing government (budget to healthcare, healthcare regulations, orthodox medicine is the only way to treatments) and the societal thinking about health (education) Ensuring medical control of key institutions, activities and practices Challenging Medical Dominance (White, 2017) Illness is a form of deviance BUT some illnesses are increasingly accepted in the society, e.g., high blood pressure, cancers Doctors: The most appropriate group to deal with these deviants (i.e., people whose characteristics fall far from social norms)? Who will be the more appropriate group to deal with them? 6 Challenging Medical Dominance (White, 2017) Doctors tend to define problems individualistically rather than socially E.g., alcoholism, depression, anxiety How will the problem be treated according to different definition? e.g., depression as personal (health) problem vs. depression as public issue 7 Challenging Medical Dominance (White, 2017) Overemphasis on the importance of patient compliance with the doctor’s orders What will happen if the doctor-patient relationship is unbalanced? E.g., communication patterns, diagnostic intervention Ultimate consequences? 8 Challenging Medical Dominance (White, 2017) Only the health problems (e.g., drug abuse) defined by doctors are “real” problems → what will happen? What about the problems created by doctors themselves? E.g., prescription habits of addictive drugs Focus on biomedical approaches to health and illness, at the expense of other factors such as social determinants of health and patient-centered care. 9  1. Critique of medicine as authoritarian and Criticisms to medicine imperialistic. dominance 2. Critique of the expanding role of medicine in the social control of deviant behavior. by sociology of 3. Critique of the political economy of health care at the time. Marxist and feminist, medicine portrayed medicine as authoritarian, as continuously seeking to expand its professional empire (in service to the capitalist ruling class and/or the patriarchal order), as detracting from rather than improving people’s health, and as depoliticizing social arrangements. The development of consumerism During the 1960s, the concept of the person as a “consumer” rather than a “patient” became established. Healthcare professions were regarded as “health providers,” so a new provider– consumer relationship emerged in direct opposition to the old physician–patient relationship with its emphasis upon patient dependency → places the consumer on a more equal basis with healthcare professions in the health care interaction. It also provides the philosophy behind the increased consumer involvement in health legislation and other matters, such as consumer interest health care groups. Medicalization of childbirth The deprofessionalization of healthcare professions However, increased consumerism and commercialization on the part of patients and greater government and corporate control over medical practice have resulted in the decline of the professional status of healthcare professionals. With many patients insisting on greater equality in the healthcare professionals –patient relationship and corporate health organizations that employ healthcare professionals seeking to control costs, maximize profits, and provide efficient services that are responsive to market demand, healthcare professionals are caught in the middle. Healthcare consumerism may lead to patient- centered care by patient empowerment (Park at el., 2022) Medicalization of childbirth Medicalization Medicine has taken responsibility for an ever greater proportion of deviant behaviors and bodily conditions by defining them as medical problems. Example: Diagnostic and Statistical Manual of Mental Disorders 1st edition: 106 mental disorders 4th edition: 297 mental disorders 5th edition: 341 mental disorder Medicalization occurs when nonmedical problems are defined as problems that need to be treated medically, usually as an illness or disorders. Example: certain physical differences like short stature, small female breasts, and male baldness. Medicalization of childbirth Medicalization of childbirth  Medicalization Freidson (1970) argued that medicine has established a jurisdiction far wider than justified by its demonstrable capacity to “cure.” Medical professions have been successful in gaining authority to define aberrant behaviors and even naturally occurring physical conditions as illness. Example 1 : hyperactivity at school by children is defined as Attention Deficit Hyperactivity Disorder (ADHD) and requires Ritalin (a drug). Example 2: treat aging as illness. → Creation the anti-ageing industry Source: The University of British Columbia Major force behind medicalization 1. The increasing commercialization of health products and services in the expansion of the medical marketplace. Consumers have become major players in the health marketplace through their purchase of health insurance plans and health products. 2. Insurance companies can counteract medicalization by restricting access, but there are other forces facilitating the process. 3. Doctors often play a major role in medicalization, for medicalization can increase their power, the scope of their practices, and their incomes. “Doctors are still the gatekeepers for medical treatment, but their role is more subordinate in the expansion or contraction of medicalization.” (Conrad, 2005). 4. Biotechnology has long been associated with medicalization, and the pharmaceutical industry is playing an increasingly central role in promoting its products directly to consumers, while in the future the impact of genetics may be substantial. The term “pharmaceuticalization of society” to describe the growth of the drug markets internationally through large-scale advertising campaigns directed at both physicians and the public at large, including drugs for nonmedical (enhancement) purposes. Consequences of Medicalization Medicalization can lead to unintended negative consequences. 1. Once a situation becomes medicalized, doctors become the only experts considered appropriate for diagnosing the problem and for defining appropriate responses to it. → The power of doctors increases while the power of other social authorities (including judges, the police, religious leaders, legislators, and teachers) declines. → Medical Dominance 2. Once a condition is medicalized, medical treatment may become the only logical response to it. 3. When doctors define situations in medical terms, they reduce the chances that these situations will be understood in political terms. Example: Some countries have removed political dissidents from the public eye by committing them to mental hospitals. 4. Medicalization can justify not only voluntary but also involuntary treatment. Yet treatment does not always help and sometimes can harm.  Consequences of Medicalization: Medicalization of deviance Medicalization of deviance is the view of deviance as a symptom of some underlying illness that needs to be treated by physicians. Thomas Szasz argues that mental illness is simply problem behaviors: some forms of “mental” illnesses have organic causes (e.g., depression caused by a chemical imbalance in the brain); while others are responses to troubles with various coping devices. Social experiences cause abnormal behaviors, and not some illness of the mind. Being mentally ill can sometimes lead to other problems like homelessness; but being homeless can lead to unusual and unacceptable ways of thinking that are defined by the wider society as mental illness.  Other critiques of medicalization Medicalization can lead to the overuse of medical interventions, and may ignore important social and cultural factors that contribute to health and wellness Medicalization can reinforce inequalities in healthcare, by prioritizing medical interventions over social and economic interventions that may be more effective in addressing social problems Demedicalization The dangers of medicalization have fostered a countermovement of demedicalization (Fox, 1977). A quick look at medical textbooks from the late 1800s reveals many “diseases” that no longer exist. Example: 19th century medical textbooks often included the health risks of masturbation. But nowadays medical textbooks describe masturbation as a normal part of human sexuality. Demedicalization Like medicalization, demedicalization often begins with lobbying by consumer groups. Example: 1. Medical ideology now defines childbirth as an inherently dangerous process, requiring intensive technological, medical assistance. However, growing numbers of American women have attempted to redefine childbirth as a generally safe, simple, and natural process and have promoted alternatives ranging from natural childbirth classes, to hospital birthing centers, to home births assisted only by midwives since the 1940s. 2. Alternative approaches to healthcare that challenge the assumptions of medicalization and promote a more holistic understanding of health and illness, such as CAM, patient- centered care, or community-based health promotion. 3. Gay and lesbian activists have at least partially succeeded in redefining homosexuality from a pathological condition to a normal human variation. 4. In recent years, books, magazines, television shows, and popular organizations devoted to teaching people to care for their own health rather than relying on medical care. Technological innovation and heathcare The impact to online search Internet has become a major source of medical information for many people recently. There was evidence of digital divide (數碼鴻溝), where women with high incomes and education were more likely to use the Internet for health information than those at the lower end of the social scale who lacked Internet access. (Pandey, Hart, and Tiwary, 2003) People with chronic illness actively used the Internet, primarily to supplement information provided by physicians. The availability of health information had changed dramatically and empowered those people to interact more knowledgeably with their doctors. The impact to online search Ample health information on the Internet and the increase in direct-to-consumer advertising are also important factors changing the knowledge base of patients and influencing the interaction between healthcare professions and patients, including challenges to healthcare professions authority (Timmermans & Chawla, 2009). Advancements in health technology Advances in health technology have had a significant impact on nursing practice Nurses are increasingly using technology to automate routine tasks, such as medication administration and documentation. This can improve efficiency and allow nurses to focus on direct patient care and other complex tasks. Example of using technology in nursing practices: Monitoring Medications Health Records Beds Reduced Errors Communication Telehealth Source: Senbekov at el. (2020) Advancements in medical technology: Example Electronic health records (EHRs) have become an essential tool for nurses in healthcare organizations nowadays EHRs allow nurses to access patient information quickly and easily, and to share information with other healthcare professionals EHRs can also improve patient safety by reducing the risk of medication errors and other adverse events Telehealth and remote monitoring technologies are becoming increasingly common in healthcare These technologies allow nurses to provide care to patients who are unable to visit a healthcare facility in person Telehealth and remote monitoring can improve access to care and reduce healthcare costs, while also allowing nurses to provide more personalized care to patients Advancements in medical technology: Example Robotics and artificial intelligence (AI) Robots can perform routine tasks, such as delivering medication or transporting patients, freeing up time for nurses to focus on direct patient care Robotics also can provide improved diagnostic abilities AI can analyze patient data and provide decision support, improving patient outcomes and the efficiency of nursing practice  Advancements in medical technology: Example Smart devices Smartphones and wearable devices offer remote health monitoring capabilities that can significantly reduce healthcare costs. Physicians can use these devices to remotely monitor various health parameters, eliminating the need for hospitalization or frequent doctor visits. Smartphones can serve as a platform for integrating additional sensors, allowing for the collection of primary health data. Continuous monitoring of health parameters, such as ECG, enables long-term monitoring of heart functions and qualitative analysis for outcome prediction. The integration of health-related data generated by wearable devices with existing medical data can aid in health monitoring, disease modeling, and containment efforts during outbreaks. In the context of global challenges like the COVID-19 pandemic, the use of smart devices for remote health monitoring is becoming increasingly important.  Telemedicine allows healthcare providers to evaluate, diagnose, and treat Advancements patients in remote locations using telecommunication technologies. Advantages of telemedicine include the ability to collect, store, and in medical exchange medical data. Moreover, telemedicine allows remote monitoring of patients, distance education, improving administration and management technology: of healthcare, integration of health data systems, and patient movement tracking. In fact, there are many options for using telemedicine in various Example sectors. (Senbekov at el., 2020) Limitations and challenges with medical technology Kamar at el. (2022) commented that the area of accurate clinical diagnostics with artificial intelligence faces numerous obstacles that must be resolved and improved constantly to treat emerging illnesses and diseases effectively. Technology can be expensive and may require significant investment in training and infrastructure It may also promote health inequality due to the expensive cost of using medical technology. It is also unlikely that the medical technologies will be able to challenge and transform the deeper underlying structural causes (social determinants of health) of poor health (Barry & Yuill, 2016).  Ethnical implication to medical technology There are also a variety of ethical implications around the use of AI in healthcare. Healthcare decisions have been made almost exclusively by humans in the past, and the use of smart machines to make or assist with them raises issues of accountability, transparency, permission and privacy. (Davenport & Kalakota, 2019) Watch: https://news.now.com/home/local/player?newsId=497378 Implications of health technology for the healthcare workforce Davenport and Kalakota (2019) concluded the limited incursion of health technology (AI) into the industry thus far, and the difficulty of integrating AI into clinical workflows and EHR systems, have been somewhat responsible for the lack of job impact. It also seems increasingly clear that AI systems will not replace human clinicians on a large scale, but rather will augment their efforts to care for patients. Many healthcare providers have expressed concern about the lack of emotion in AI and robots, suggesting that this is the element that will never replace human caregivers (Huston, 2013). Healthcare professionals may move toward tasks and job designs that draw on uniquely human skills like empathy, persuasion and big- picture integration, especially emotional labor is a core component of nurses' role). Perhaps the only healthcare providers who will lose their jobs over time may be those who refuse to work alongside health technology and AI. Nursing skill and technology (Huston, 2013) Implication of new technology to nursing (Brown at el., 2020) New Technology and nursing management Four challenges nurse leaders will face in integrating this new technology (Huston, 2013) 1. Balancing the Human Element with Technology The human connection is the art of nursing and nurses need to be actively involved in determining how best to use technology to supplement, not eliminate, human resources. 2. Balancing Cost and Benefits Access to technology is often dependent on a person’s ability to pay for that technology; many healthcare disparities still exist in this regard. 3. Training a Technology Enabled Nursing Workforce and Assuring Ongoing Competency Nursing is an information-based profession that provides health care, and that it is technology that helps us bring all that information to the point of care. →Who train nursing about recent technology? 4. Assuring that Technology Use is Ethical Nurse leaders must increasingly ask “how” and “why” technology should be implemented. What parameters need to be put into place to determine its ethical use? Sociological questions to health technology Nettleton (2020) commented that although the pace of technological change in healthcare is fast, many sociological questions and issues arise: 1. What is the interplay between the construction of medical knowledge and technological practices? 2. How are medical interventions experienced and deployed by patients and healthcare professionals? 3. How do novel readings of the physical body (對身體的新穎解讀) invoke shifts in social relations, responsibility, and notions of the self? 4. To what extent are relationships patients and healthcare professionls change by innovative technological forms?"  References Barry, A. M., & Yuill, C. (2016). Understanding the sociology of health: An introduction. Sage, 284 – 196 (chapter 16). Brown, J., Pope, N., Bosco, A. M., Mason, J., & Morgan, A. (2020). Issues affecting nurses’ capability to use digital technology at work: An integrative review. Journal of Clinical Nursing, 29(15–16), 2801–2819. https://doi.org/10.1111/jocn.15321 Cockerham, W. C. (2021). Medical sociology. Routledge, 235 – 330 (Chapter 10 – 13). Davenport, T., & Kalakota, R. (2019). The potential for artificial intelligence in healthcare. Future healthcare journal, 6(2), 94–98. https://doi.org/10.7861/futurehosp.6-2-94 Davis, J. E. (2016). Medicalization, Social Control, and the Relief of Suffering. In W. C. Cockerham, (Ed.). The new Blackwell companion to medical sociology, (pp 211 – 241). John Wiley & Sons. Fox, R. C. (1977). The medicalization and demedicalization of American society. Daedalus, 9-22. Huston, C. (2013). The impact of emerging technology on nursing care: Warp speed ahead. The Online Journal of Issues in Nursing, 18(2). https://doi.org/10.3912/OJIN.Vol18No02Man01 Kumar, Y., Koul, A., Singla, R., & Ijaz, M. F. (2023). Artificial intelligence in disease diagnosis: a systematic literature review, synthesizing framework and future research agenda. Journal of ambient intelligence and humanized computing, 14(7), 8459–8486. https://doi.org/10.1007/s12652- 021-03612-z  References Nettleton, S. (2020). The sociology of health and illness. John Wiley & Sons. Park, S. Y., Yun, G. W., Friedman, S., Hill, K., & Coppes, M. J. (2022). Patient-Centered Care and Healthcare Consumerism in Online Healthcare Service Advertisements: A Positioning Analysis. Journal of patient experience, 9, 23743735221133636. https://doi.org/10.1177/23743735221133636 Reeder, L. G. (1972). The patient-client as a consumer: Some observations on the changing professional- client relationship. Journal of Health and Social Behavior, 13, 406–412. Senbekov, M., Saliev, T., Bukeyeva, Z., Almabayeva, A., Zhanaliyeva, M., Aitenova, N., Toishibekov, Y., & Fakhradiyev, I. (2020). The Recent Progress and Applications of Digital Technologies in Healthcare: A Review. International Journal of Telemedicine and Applications, 2020, 8830200–18. https://doi.org/10.1155/2020/8830200 Timmermans, Stefan and Neetu Chawla (2009) “Evidence-based medicine and medical education.” Pp. 139– 155 in Handbook of the sociology of medical education, C. Brosnan and B. Turner (eds.). London: Routledge. Weitz, R. (2016). The sociology of health, illness, and health care: A critical approach. Cengage learning, 211 – 241 (Chapter 10).