Sociological Issues of Health and Epidemiology - Assignment Example

Health and Epidemiology: Sociological Issues Question In Adelaide a significant part of the population has an extremely low income (less than $300). In accordance with the statistics referred to the income level of population in Adelaide (see also Figure 1 in Appendices section) ‘in 2001, 13.9% (850,000) of Australian households received a weekly income of less than $300; the proportion of households with a low-income was higher in Non-metropolitan areas (16.3%) than in Metropolitan areas (12.6%); the Populated coastal region had the highest concentration of low income households (17.3%), followed by the Populated inland (16.6%), Regional city (15.3%) and Remote (13.3%); areas having the smallest proportion of low-income households included Roxby Downs [435] (1.8%) in South Australia; Groote Eylandt [710] (2.6%), Jabiru [710] (2.7%) and East Arnhem [710] (4.0%) in the Northern Territory’ (Interactive Social Atlas of Rural and Regional Australia, 2001, Income:45). The quality of medical services provided in this category of population should be characterized as quite low. On the other hand, an indicative example of the need for medical care in Australia is the percentage of people who had at least one long term medical condition. This percentage reached the level of 77% (as estimated in 2004-2005). Moreover, it should be noticed that only a limited part of the population is covered by health insurance (around half of the population aged 15 years and over); The ‘highest level of coverage was recorded in the 45-54 and 55-64 year age groups (61%) while the lowest was in the 25-34 year and 75 years and over age groups (around 41% had some form of private health insurance); the most common reason for not having private health insurance was "cant afford it/too expensive", reported by 64% of those without private cover’ (Australian Bureau of Statistics, National Health Survey, 2004-2005). The above figures prove that the access of a significant part of population in Australia (with a reference to the area of Adelaide) is not feasible due to the lack of appropriate financial support by the government. The coverage of the relevant cost by individuals should be considered as impossible if taking into account the statistics presented above regarding the financial level of the highest part of population in Australia. Moreover, it has been proved through a research made by the Australian Institute of Health and Welfare that there is a ‘strong association between health and social and economic factors and that people in poor circumstances generally have worse health than those in more advantaged conditions while social and economic disadvantages (e.g. poor education, unemployment and few assets) tend to occur together, and magnify the negative effects on health’ (Australian Government, Australian Institute of Health and Welfare, Determinants of Health, 2004-2005). In accordance with the above, the difficulty faced by poorer parts of population to access the medical services, should be considered as expected. However, it is in the ‘discretion’ of the government to intervene in order to change current inequalities in health (medical services provided) across the country. Question 2 In accordance with Lewis (1998, 62) ‘researchers need not be the disseminators and agents of change, but they may be prodded to seek partnerships with those who are; to paraphrase Karl Marx: Health services researchers have understood the world; the point is to change it’. The above researcher supports his arguments using the findings of the research made by Dr. John N. Lavis and colleagues regarding the international variations in practice. In accordance with Lewis (1998) the care provided to patients can be characterized as ‘better’ only under specific circumstances. Moreover, it is stated that ‘the very notion of “better” is defined by values, probabilities, preferences, risk assessments, technical capabilities and opportunity costs’ (Lewis, 1998, 62). The critical point in the study of Lavis and colleagues is, according to Lewis, the issue of ‘discretionary’ a term that is used a lot in the medical practice. However, Lavis et al. (1998, 29) admit that in order for their study to produce specific results regarding the types of discretionary care ‘further work is needed’. It should be noticed that the research of Lavis et al. (1998) referred to the comparison of trends ‘in hospital admission rates for mechanical neck and back problems between 1982 and 1992 in Ontario and the United States’. The results of the above study – which has been extended – showed that ‘the hospital-based medical or surgical treatment of mechanical neck and back problems provides an example of discretionary care; the higher admission rates for surgery in the US may reflect a larger supply of surgical specialists and imaging units’ (Lavis et al., 1998, 29). In other words, the study of Lavis et al. (1998) has proved the existence of discretionary care, however this study also proved the ‘inadequacy’ of sample used to provide specific indicators regarding the issue involved as the conduction of other studies had been considered as necessary. In this context, the view of Lewis regarding the capacity of doctors to set up profitable specialisms cannot be considered as proven through the empirical evidence related with this issue – the study to which Lewis refers is also an indicative example of the lack of sufficient data for the support of the Lewis argument. Regarding specifically Australia and the existence of specialisms and discretionary care, it has been proved by Wilkinson et al. (2005, 84) that ‘there is a long tradition of some general practitioners developing areas of special interest within their mainstream generalist practice; general practice is now becoming increasingly fragmented, with core components being delivered as separate and standalone services (eg, travel medicine, skin cancer, womens health)’. However, the above trends has been found to be related with a series of problems like the following ones: ‘loss of generalist skills among GPs, fewer practitioners working in less well-remunerated areas, such as nursing home visits, and issues related to standards of care and training’ (Wilkinson et al., 2005, 84). An indicative example of current trend in Australia regarding the phenomenon of multispeciality in the medicine sector is presented in the study of Wilson (2005). The specific study refers to the results of a 18-year survey (1983-2002) ‘of the surgical records of a general practitioner-surgeon in an urban general practice’. This survey referred to the cases of ‘211 patients each with multiple, elective, surgical problems (mostly non-major) treated at one operation’. In the above survey it has been proved that ‘having all surgical conditions treated in a single episode resulted in considerable savings in time, convenience and expense for both the patient and the health care system’ (Wilson, 2005, 337). In accordance with the above survey multispeciality in the medicine sector can enhance the performance of medical institutions involved especially in highly populated areas. For this reason the assumption made by Lewis regarding the capacity of doctors to set up profitable specialisms has to be considered as a personal view which has not been proved in the research made in the medical sector while any implications suggested by the above author can only involve in particular cases. Question 3 The study of Parsons refers to the obligations of patients and doctors inside a particular medical care environment – the type of the institution on which these rules should be applied is not specified by the above researcher so it can be derived that these rules/ principles can be applied within any medical care environment independently from its financial level and its administrative structure (public or private ownership). Specifically for doctors Parsons propose a series of obligations which include the following elements: ‘a. Act for the welfare of the patient (orientated towards the collective not the self); b. Be guided by the rules of professional behaviour, i.e. to treat all patients as equals and the same; c. Apply a high degree of skill and knowledge to the problem of illness and d. Be objective and emotionally detached (affective neutrality) (Parsons, 29). However, it seems that the above obligations are being considered by doctors only during the first period of their presence in the profession. After working for a significant period of time, doctors tend to be differentiated as of their priorities. More specifically in the survey under examination, while 47% of doctors consider that ‘patient care’ should be a priority for a doctor but this view refers to doctors that have just entered the profession. After a period of 11 years this view has changed and the relevant percentage has reduced to 30%. It seems that during their work, doctors face a series of ethical challenges which they cannot always face successfully. Moreover, these challenges have been proved to have a severe impact on the evaluation of critical situations even if this impact cannot be directly identified. In other words, what has primarily been considered as ‘offer to the human being’ becomes soon a ‘profession’. This assumption is verified also by the other results of the same survey. More specifically, when doctors are asked to state their views on the importance of ‘status and rewards’ in their profession, they respond primarily that ‘status and rewards’ were not among their priorities (a percentage of 40%) whereas the relevant percentage reached the 81%! after 11 years in the profession. The above results are also ‘verified’ by the results of another survey which was conducted in Australia. In this survey a ‘postal questionnaire was sent to all former registrars who completed the RACGP Training Program between 1994 and 1996’ (Shanley et al., 2002, 49). This survey which had as main objective to ‘evaluate factors influencing career experiences and career choices made by former general practitioner registrars and to ascertain the reasons for these career decisions’ led to the conclusion that ‘family circumstances are the most important issues under consideration, although male and female work patterns differed markedly; these differences reflect different priorities in balancing professional and personal demands’ (Shanley et al., 2002, 49). The above findings lead to the assumption that Parsons’ suggestions regarding the obligations of doctors should be restructured in order to reflect current trends in the medical profession. Question 4 In accordance with the Stanford Encyclopedia of Philosophy (2007) the main issue on Foucault’s study on modern control of sexuality is that it ‘parallels modern control of criminality by making sex (like crime) an object of allegedly scientific disciplines, which simultaneously offer knowledge and domination of their objects’. Moreover, Foucault’s critiques have been characterized more as ‘a matter of achieving a traditional philosophical goal -- the critique of contemporary claims to knowledge -- by new (historical) means’ (Stanford Encyclopedia of Philosophy, 2007). For Foucault, sexuality can be divided in two versions: the eastern and the western. Specifically, regarding the western version of sexuality as it has been viewed by Foucault the following comments could be made: Foucault viewed sexuality as an ‘example of regulation or panaptocism’ following the ‘the rise of preventative, social and community medicine indicating that doctors as the agents of medical surveillance were encroaching further and further into aspects of our lives’ (Social Process: History and Conceptual Frameworks, 10). Under these terms, sexuality obtains a significant importance for people’s lives. Specifically regarding the sexuality as it has been formulated in West, Foucault supported that this type of sexuality is related with two issues/ factors: power and confession. Both the above elements of sexuality should not be ‘interpreted’ in accordance with their traditional meaning. More specifically, power should be combined with truth and knowledge and they are these elements that create the connection between power and confession. As for confession, this does not refer to the traditional meaning of the term related with the religion. The term ‘confession’ here is used in order to explain the freedom from the pressure caused by the social principles – a view which is similar with Marx’s view on freedom as an element of the efforts of society to be ‘released’ from the pressures of the ‘hierarchical’ superior political powers. The western views of sexuality as it is related with power and confession have created the basis for Foucault’s critical approaches on sexuality. The people that have the right to exercise the above rights in each particular sector of the society, are those who dominate the social control over sexuality in general. References Australian Bureau of Statistics, available at http://www.abs.gov.au/ Australian Government, available at http://www.aihw.gov.au/ BRS Social Atlas, available at http://adl.brs.gov.au/mapserv/pdfatlas/index.html Lavis, J., Anderson, G., Taylor, V., Deyo, R., Axcell, T. (1998) Trends in hospital use for mechanical neck and back problems in Ontario and the United States: discretionary care in different health care systems. Canadian Medical Association Journal, 158-29-36 Lewis, S. (1998) Another day, another variation: when is enough, enough? Canadian Medical Association Journal, 158(1): 61-62 Shanley, B., Schulte, K., Chant, D, Jasper, A., Wellard, R. (2002) Factors influencing career development of Australian general practitioners. Australian Family Physician, 31(1): 49-54 Stanford Encyclopedia of Philosophy, Michel Foucault, available at http://plato.stanford.edu/entries/foucault/ Wilkinson, D., Dick, M., Askew, D. (2005) General practitioners with special interests: risk of a good thing becoming bad? The medical journal of Australia, 183(2): 84-86 Wilson, R. (2005) Multispecialty surgical conditions in general practice. The medical journal of Australia, 182(7): 337-339 Appendices Figure 1 – Low income households in Adelaide (Australia), 2001 (Source: Interactive Social Atlas of Rural and Regional Australia, map 42) Read More