Lecture Notes, SOC 2020

Aging and Health

AGING
Perhaps one of the most profound changes in the last 100 years is the role that the aged play in
our society. Two things happened following the industrial revolution. The first is that life
expectancy increased dramatically. Prior to the mid-1800s, the chance of seeing your fifth
birthday was 10%. Antibiotics and childhood immunizations did not exist. Not only was
surviving childhood a gamble, but adults also fought to survive in these times. A cut that we
would have stitched up and lathered in Neosporin, healing within a few days, could likely and
often did turn into a serious fatal blood infection. The flu killed people by the thousands. In
1918 a flu epidemic that began in Kansas swept the world killing 100 million people at the end
of the pandemic. In 1952 nearly 60,000 Americans had polio, 21,000 were paralyzed and 3,000
died. Needless to say, when these diseases are left unchecked then people die at a younger age.
When they are controlled, people live longer. Infants born in 1850 had a life expectancy of
between 38 and 42 years. Children born in 2007 can expect to live well into their 70s. So now
we have a society that not only has more old people, but they are living to much older ages than
in previous generations. (See http://www.infoplease.com/ipa/A0005140.html )
Complicating this change in general demographics is the Baby Boom generation. This is the
generation born between roughly 1943 and 1964 (there is some debate on when the baby boom
ended, some marking it as early as 1960). The Baby Boom was a time after WWII when more
babies were born than we should have expected. Since the youngest of the baby boomers just
applied for Social Security, we will have more people in or approaching old age than any other
earlier generation. The predictions for 2020 are that we will have 2 people on social security of
every one person in the labor market. This is often referred to as the graying of America.
The aged in society are no longer revered for their wisdom and skills. When a culture is
dependent upon an oral history, then older individuals are important. They are the only link to the
past and hold an honored position. Also, they are able to assist with childcare and light manual
tasks in the home and so they remain productive. In these societies there may actually be a
gerontocracy, where the elders have the wealth, prestige and power in society. In our society,
we no longer refer to the aged as elderswe refer to them as elderly. The status of age is no
longer an honored title, but rather an adjective that implies frailty and dependence. Because
people live to older ages, health issues make the old in our society dependent. By age 85, 50% of
individuals have Alzheimers. Diabetes, heart disease, high blood pressure, and stroke are just a
few other things that plague the very old in our society. This means that families will be faced
with choices: put the senior in a nursing facility though that may be expensive, or care for them
at home though that may be too stressful. We have a society with a sandwich generation, adults
caring for young dependent children at the same time they are caring for old dependent parents.
The age of the population has grown to the point that we now break our older generations into
three categories. The young old are those individuals between 65 and 74. These people typically
enjoy good health, many may still be in the labor force, and they live independently. The older
old are those between 75 and 84. These people may still remain healthy and independent but are

less likely to be working and more likely to require some support services. Finally the oldest
old, those over 84, are likely to be in declining health and require many support services.
Aging is more problematic for women than for men. Women tend to live longer than men. As
men age they are likely to have an acute illness, like a heart attack, from which they do not
survive. Women typically have chronic illnesses, like glaucoma and diabetes, things that reduce
the quality of life and increase dependency but that are not fatal. So not only do women live
longer, but their health problems in old age are likely to be greater. Women are also likely to live
in poverty as they age. Many women in earlier generations did not work full time and so they
received spousal benefits from Social Security. When their spouse dies, they get a pay cut.
Unfortunately, poverty for the elderly in our society is so bad that the nation was scandalized in
the early 90s when reports found that this group had been forced to add dog and cat food to their
diet in order to stretch their food budgets.
Non-whites have a lower life expectancy in general than do whites. Non-white females live
longer than non-white males. The health outcomes are lower for non-whites for a variety of
reasons. This group tends to be impoverished more than their white counterparts. The history of
poverty likely means that health care and prevention throughout the life span has been
inadequate and so there is a higher rate of chronic illnesses in the non-white population (diabetes,
high blood pressure, etc).
Along with the reduced prestige associated with the elderly in society, we actually are
encountering the phenomenon of ageism. Ageism refers to the discrimination against
individuals due to their age. We see this in several ways. First, it is extremely hard for a 50 year
old to get a first job (or even a new job if unemployed) if they are on the job market, unless they
are applying for a job where age is associated with tenure and experience. An entry or mid-level
job is likely to go to a younger applicant (if nothing else they can be hired at a lower wage
because younger applicants tend to have less work experience). Recently widowed or divorced
women entering the labor force for the first time find it very hard to get work, and when they do
it is at a level well below the lifestyle they had experienced when they had a working husband.
Ageism also reaches into the community. Prior to Reagans first term in office, we had
mandatory retirement. At 65, you left your job, even if you were still able to work and wanted to
be productive. Reagan was older when elected than the mandatory retirement age, and so
he pushed Congress to pass a bill to eliminate mandatory retirement. You can work as long
as you want as long as you are able to do your job. On the surface, this seems like a very good
thing, given that life expectancy was increasing. However, one thing that retirement did was to
get one generation to leave the labor force thereby creating job vacancies for the next generation
to fill. When people stopped retiring, jobs got harder to find for younger workers (consider that
the average age of auto workers in Michigan is very close to retirement age since few new
workers have been hired for a long time). This created tension and anger for younger workers
with fewer openings in the market as they finished school. Ageism works both ways. The older
generation is society is typically frightened or threatened by the younger generation. There is
always the perception that the younger generation is out of control and destroying the culture.

Finally, the growing tensions between the generations have led to elder abuse. There are many
theories about the causes of elder abuse. Is the stress on the sandwich generation so great that
rage is driving abuse in previously non-abusive families? Elder abuse is hard to detect for a
variety of reasons. As we age, our skin gets thinner which makes us prone to injury. A fall that
would have bruised in younger years now may break an arm. A bump that would have gone
unnoticed may now leave a nasty bruise or torn skin. Also, elders are less likely to tell anyone
that they are being abused due to shame or guilt. They may feel responsible for creating a
stressful situation.
Can adult children be held responsible for their parent? Yes they can. Is this legal? Hard to say.
A few years ago a man with Alzheimers was found in an airport. He was dressed in all new
clothes and had no identification. He didnt remember his name. An investigation revealed that
he had been living with his daughter who had tried unsuccessfully to get her sibling to help out
with his care. She had finally gotten to her breaking point, dressed her father in new clothes and
dropped him off the airport, telling him that his son would meet him there. She believed that he
would be discovered quickly and without identification would be placed in a state assisted
nursing home. Problem solved. She was prosecuted for abandonment and neglect. Why she
was prosecuted? Certainly what she did was unethical to be sure. However, the law holds that
we are legally responsible for our children until they reach 18years of age. There is no
corresponding law that makes us responsible for our parents as they age. If this is the case,
shouldnt the brother who didnt help also be held accountable?
One of the things scientists are starting to consider is the fact that human development has been
gradual, and in the modern era it has taken millennia for humans to extend their life-spans.
200 years ago a long life was into a persons 40s, and 100 years ago most people thought living
to 50 was a good thing. Retirement set at 65 was cynical because by the beginning of the 20th
Century people lived into their late 60s and employers (the system was created in Prussia) were
confident most people would not have many years with a pension. Today we live well into our
70s and 80s and one of the major worries of financial advisors is that people may well outlive
their pensions and savings plans.
As we approach a wave of Baby Boomers retiring analysts speculate that we will see a major
change in social policy and societal viewsmuch like the changes that were wrought first as
these people were young adults and were part of the Student Movement for change, then as
young people supporting the Womens and Civil Rights Movements that changed the laws of the
land, and later as the spearhead of the Sexual Revolution we had so much fun discussing the last
lecture! By the 1980s and 1990s this generation fueled the great Consumer Society as we
experienced rising income and expectations, spending madly on homes, cars and luxury goods.
Today, as this generation can look over the fence at their imminent retirement we are embroiled
in a discussion about heath care, medical insurance, and the desire for our later years to continue
to provide for the quality of our day to day existence.
HEALTH
Health refers to the general mental, physical and emotional well being of the population. Our
understanding of health is culturally informed. What is healthy to us may be unhealthy to

another culture. Medical sociologists are extremely important in our understanding of health.
Social epidemiology is the practice of tracking the origin of disease. One of the most well
known and important examples of epidemiology in recent years is the discovery of how AIDS
was being spread. The Centers for Disease Control (CDC) tracks any unusual outbreak of
disease. With the AIDS epidemic, the alert came from an individual who was tracking the
dispersal of antibiotics. She noticed that there were more treatments being prescribed in New
York and Los Angeles for a rare form of pneumonia and alerted the proper individuals. At the
same time, the tumor registry (a database for tracking cancers) showed an increase in Kaposis
sarcoma, a rare form of skin cancer that was likely to be seen in older Mediterranean males.
Another odd thing about the outbreak was that it was showing up in young men of all ethnic
backgrounds, also in New York and L.A. This triggered a study by the CDCs team of
epidemiologists. An epidemiological team includes medical doctors, sociologists, psychologists,
biologists, infectious disease experts and other disciplines as needed for the problem at hand.
This team began to talk to individuals that were affected by these outbreaks. Over time they
were able to trace this new infection back to a single individual, an airline steward. They were
also able to determine that the disease was sexually transmitted and appeared to be limited to the
homosexual population. Eventually, when it spread to others, the team was able to identify that
it was carried in the blood and through breast milk, putting anyone who had received a
transfusion at risk and showing that our blood supply was tainted. After a time, it also began to
show up in the intravenous drug using population, as they shared needles and passed infected
blood to one another.
More recent examples of epidemiological cases are the recent SARS epidemic, the recent E Coli
outbreak linked to tainted spinach, and the Swine Flu. The sociologist on this team would be
responsible for examining the behaviors of the infected parties and finding where their paths had
crossed. For example the SARs victims had either attended a recent religious convention in
China or had close contact with someone who had. All of the victims of the E Coli outbreak had
eaten raw spinach is some form in the preceding days.
Health, and health access is a function of income. Think about the things that we are advised to
do to stay healthy. Watch our intake of calories and fat. Exercise daily. Lower our stress. Get
regular physicals. Make healthy food choices. Obesity is currently an epidemic in our country
and the poorer you are; the more likely you are to be obese. Often physicians argue that they
dont understand why we are having such a problem since healthy guidelines are well publicized.
Those that are not obese are likely to blame the individual for their obesity.
If youve gone grocery shopping lately, you should have noticed that chicken, the healthiest
meat, is also the most expensive. Hamburger and organ meats (like liver) are the unhealthiest and
the cheapest cuts available. Fresh fruits and vegetables are the most expensive and canned are
the least expensive. Canned varieties also have the fewest nutrients. Eating healthy is the most
expensive way to eat. What about exercising? Fitness magazines are always touting that
everyone can walk and/or run so there is no excuse for not exercising. All you need is a good pair
of shoes. That good pair of shoes is expensive close to $130. How does the individual in a poor
neighborhood get out and walk or run? They likely work long hours and would have to go
outside with inappropriate shoes in an unsafe neighborhood after dark. Researchers of childhood
obesity urge parents to get their kids out on bicycles and ride bike trailsbut those at highest

riskinner city and rural poorcannot afford bikes or live near safe bike paths. Also, it is not
only the poor in our society that are obese. The middle classes are also likely to be overweight.
Long work hours mean that many of us dont cook at home most nights. We stop for pizza or
fast food on the way home and settle exhausted in front of our T.V. sets when we get home. Ever
wonder why the commercials on evening television focus on beer and snack foodeither store
bought, or for home delivery or a quick trip through the drive through window.
Along with the poor, the elderly are likely to be unhealthy. Partly this is due to the fact that our
bodies run down as we age. Our eyesight diminishes, our hearts tire out and our bones become
more brittle. Since women live longer than men, females are more likely to have several health
conditions as they age. Men on the other hand are more likely to have one health issue that kills
them, like a heart attack or stroke. As mentioned above, as medicine improves our chances of
living longer we also need to expect a higher reliance on the medical profession to keep us
goingand that requires a growing pharmaceutical industry, medical technology, hospitals as
businesses, para-medical and medical technicians, in addition to more doctors and nurses.
We also have culturally induced behaviors that hurt our health. Smoking is one with Americans
continuing to smoke regardless of the health and economic consequences of the behavior. One
reason that people smoke is to self-medicate stress. Another is peer pressure, with teenager girls
currently the group most at risk to smoke (and develop smoking related illnesses). Another is
problem that is culturally driven is anorexia. The intense cultural pressure on females to be thin
and physically perfect has created a near epidemic of eating disorders. Females as young as 9
and 10 report that they want to lose weight or are on a diet. While the reality us that many of our
children are overweight, diets can get out of control for the adolescent. Also, for the first time,
we are seeing an increase in the number of males diagnosed with anorexia.
For the most part, we practice western medicine in the U.S., relying on intervention from a
trained physician. This may mean that we take drugs or have surgery. Either way, we go to the
doctor when we are ill, and the hospital when we are very ill. Holistic medicine is also gaining
popularity as an alternative for some and an addition to the health care needs of others. Holistic
medicine focuses on prevention as well as treatment and takes into account the complete physical
and social environment of the patient. So a patient being seen by a traditional physician for stress
might be prescribed an anti-anxiety medication for the stress and another medication for high
blood pressure. A holistic provider would try to identify the triggers for the stress in the persons
life and make recommendations on ways to reduce stress. They might teach the patient to
meditate or recommend exercise. Drugs might also be prescribed, but they would more likely be
the last choice of care than the first.
The difference between western and holistic or culturally normed medical practices can be
seen by the following parable: A village living close to a cliff has its members falling over and
breaking bones or experiencing serious harm, and soon the local hospital is over crowded.
Western medical practice is to advocate an expensive expansion in the hospital, building room
for more beds and hiring more doctors and nurses to deal with the problem. Sustainable,
culturally sensitive proposals call for building a fence at the top of the cliff. Now, this is
somewhat simplistic, but the point is that once we come to rely on technology and special
knowledge we forget that sometimes simpler and more effective solutions are possible.

Health Care in Comparative Perspective

It is little wonder that health care costs are skyrocketing, insurance is a major concern, and
industrial representatives and lobbyists press to keep us from doing anything that controls costs
(for example, many of you may know people who buy drugs in Canada, where prices and profits
are controlledsomething that we cannot or will not do in this country as industry groups fight
any legislation that would permit such across the board cost savings).
The US, despite the fact that we are one of the wealthiest countries in the world, our citizens still
have inadequate access to affordable health care and we spend more money out of pocket than
any other country of our economic status. In fact, we spend twice as much on medical care as
many European nations, yet American children are twice as likely to die before the age of 5 as
Czech children and American women are 11 times as likely to die in childbirth as Irish
Women (Kristof 2009, NYT, p. 11). Some employers offer health care to employees, and the
likelihood of coverage increases if the workplace is unionized. As Paul Krugman observed,
[T]he United States is the only wealthy country in which the economic catastrophe will also be
a health care catastrophein which millions of people will lose their health insurance along with
their jobs, and therefore lose access to essential care (2009, NYT, A23).
What do you suppose it is like for the working poor to access health care? The working poor
typically work longer hours and more than one job for lower wages than those in the middle
class. If someone works two jobs, for example McDonalds and Taco Bell, for the minimum
wage they may be putting in more than 40 hours a week, but both jobs are part time and will
have no health benefits. If they get sick, they will lose wages from work for the day. There little
incentive to call in sick if it costs you in your current paycheck, and may also result mean fewer
hours scheduled later if you are seen as unreliable. The sick individual may continue to work
until the infection forces them to seek medical care, infecting others in the process. When they
seek medical care, they not only lose the days wages, but also get an expensive bill they likely
cannot afford to pay. They eventually return to work, deeper in debt, struggling harder to make
ends meet with the missing wages. One remedy to this would be a non-punitive and
comprehensive medicine system that provides preventive care as well as dealing with sick people
(many insurers only pay for a remedy, not more than one general physical a year)..
National health care or socialized medicine treats health care as a right of citizens rather than a
privilege. In Canada for example, every citizen gets a medical card. It entitles them to treatment
without fee for most of what ails them. This results in a healthier country with less out of pocket
expenses. The criticism of this type of program centers on the concern that our taxes will
increase to cover the added costs. This is true; however many of us already pay huge
contributions to our health care, easily $400+ a month or more deducted from our pay for family
coverage if we have some. This doesnt include the costs of co-pays and drugs. In 2007, 57
million Americans had difficulty paying their medical bills, up 14 million from 2003. On
average, they had $2000 in medical debt and had been contacted by a collection agency at least
once (Gawande 2009, 26). When compared to all the costs of medical care now we would
likely pay less or usually no more than we already pay if health care was nationalized. Several
studies have compared the benefits Europeans get for their higher taxes against the taxes and
further out-of-pocket expenses Americans pay for all sorts of social services and it turns out

Americans pay more for fewer services. One study put the cost of universal health care if enacted
in the US at about $104 billion (Krugman 2009, A23).
A universal health care system seems an insurmountable political and economic challenge in the
US. Indeed, large corporations and professional associations of medical professionals such as the
AMA have opposed the establishment of a single-payer system similar to Canada and European
countries. Socialized medicine in these countries have roots in health care reform movements
over a long period of time, but that took hold relatively recently: Britain enacted universal health
care coverage in 1945, Canada in 1966, Australia in 1974 (Gawande 2009, 26). Gawande
examines the historical roots of socialized medicine among the advanced industrialized countries
from which to extract lessons for health care reform in the US.
Another criticism is that we will not be able to select our own doctors, or we will be put on
waiting lists for essential treatment. In reality, this is already true. Since the introduction of
HMOs (Health Maintenance Organizations) and PPOs (preferred provider organizations) true
choice in physician has been eliminated. Both of these insurance programs require you to see
physicians who have agreed to a structured fee plan. In exchange for charging less for a
procedure, the insurance company sends all of its patients to the doctor. Doctor salary increases
accrue due to higher volume of patients offsetting the lower cost of procedures per patient. This
also translates into less time for care as overbooked medical staff offer less personalized care.
Just think about the time you wait in the outer office, and then in examining room, only to see
you doctor for just a few minutes (often later than the appointment) as the doctor is in a hurry to
get through the patient load for the day. Another problem with these plans is that pre-approval is
required for procedures or there are strict rules on how and when to make a referral to a
specialist. This means that your doctor examines you and decides what needs to be done. S/he
then asks the insurance company for permission to do the procedure. The insurance company
then decides if the treatment is warranted, even though they have not seen you and the decision
maker may not even be a physician.
Another reality of health care is that you are indeed put on a waiting list for treatment. Most of
you have likely been to an ER and undergone the triage process. This means that the severity of
your symptoms is ranked and you are seen in order of severity, not arrival. If you need an organ
transplant, you are also ranked by your need, and may be ranked by your age and lifestyle as
well. If we have two equally needy patients, one a 17 year old with their entire life ahead of
them and one a 70 year old, who will get the new heart? Does the new liver go to the hepatitis
victim who was not responsible for their infection or the alcoholic who destroyed their liver?
Celebrity status may bump you up the list. Mickey Mantle (a famous baseball player from the
50s and 60s), David Crosby (a member of an 80s group Crosby, Stills and Nash) and Larry
Hagman (JR on Dallas, Major Nelson on I Dream of Jeannie) all needed liver transplants due to
alcohol and substance use. Each was able to get a nearly immediate transplant due to celebrity
and money.
Some argue that our current economic crisis offers a window of opportunity similar to the
conditions that faced FDR when he enacted Social Security during the Great Depression. The
depression of the 1930s, like the serious recession of 2009, highlights the need to shore up and

build a stronger social safety net (Krugman 2009, A23). Obamacare has begun to fill in the gaps,
but the program relies on state-wide insurance exchanges rather than a federal system.
Gawande, Atul. 2009. Getting There from Here: How Should Obama Reform Health Care?
The New Yorker, January 26: 26-33.
Kristof, Nicholas. 2009. Our Greatest National Shame. The New York Times (Week in Review)
February 15: 11.
Krugman, Paul. 2009. Health Care Now. The New York Times January 30: A23.