{"id":7891,"date":"2019-07-19T12:44:00","date_gmt":"2019-07-19T12:44:00","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/wmopen-introtosociology\/chapter\/introduction-to-health-in-the-united-states-and-abroad\/"},"modified":"2020-07-28T21:55:54","modified_gmt":"2020-07-28T21:55:54","slug":"health-in-the-united-states-and-abroad","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/suny-esc-introtosociology\/chapter\/health-in-the-united-states-and-abroad\/","title":{"raw":"Health in the United States","rendered":"Health in the United States"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning outcomes<\/h3>\r\n<ul>\r\n \t<li>Explain disparities of health based on gender, socioeconomic status, race, and ethnicity in the United States<\/li>\r\n \t<li>Explain mental health and disability issues as they relate to society in the United States<\/li>\r\n \t<li>Explain healthcare in the United States,\u00a0including healthcare reform (Affordable Care Act)<\/li>\r\n \t<li>Compare the healthcare system of the United States with that of other countries<\/li>\r\n<\/ul>\r\n<\/div>\r\nHealth in the United States is a complex and often contradictory issue. On the one hand, as one of the wealthiest nations, the United States fares well in health comparisons with the rest of the world. However, the United States also lags behind almost every industrialized country in terms of providing care to <em>all<\/em>\u00a0of its citizens, as well as in the comparative cost-effectiveness of its healthcare system. The following sections examine different aspects of health in the United States and how this compares with general\u00a0trends in\u00a0global health.\r\n\r\n[caption id=\"attachment_6204\" align=\"aligncenter\" width=\"486\"]<img class=\"wp-image-6204\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/2034\/2016\/05\/08173547\/6347508912_70eb94ea1c_o.jpg\" alt=\"One person with latex gloves on is holding another persons hand while they use a medical device to prick the finger for blood.\" width=\"486\" height=\"324\" \/> <strong>Figure 1<\/strong>. A patient has their blood glucose tested on World Diabetes Day (Photo courtesy of Gia Willow Alexa Annermarken\/flickr)[\/caption]\r\n<h2>Health and Inequality in the United States<\/h2>\r\n<h3>Health by Race and Ethnicity<\/h3>\r\n<section id=\"h21903_01\">\r\n<p id=\"import-auto-id1331522\">When looking at the social epidemiology of the United States, it is hard to miss the disparities among races.\u00a0Racial minorities exhibit lower life expectancy and a higher likelihood of death by heart disease and stroke.\u00a0In terms of infant mortality, indigenous populations have an infant mortality rate that is 60% higher than the rate for whites, while infants born to African American women exhibited the highest rate of infant mortality.[footnote]National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States; Baciu A, Negussie Y, Geller A, et al., editors. Communities in Action: Pathways to Health Equity. Washington (DC): National Academies Press (US); 2017 Jan 11. 2, The State of Health Disparities in the United States. Available from: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK425844\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK425844\/<\/a>[\/footnote]\u00a0According to a report from the Henry J. Kaiser Foundation (2007), African Americans also have a higher incidence of several other diseases and causes of mortality, from cancer to heart disease to diabetes. In a similar vein, it is important to note that ethnic minorities, including Mexican Americans and Native Americans, also have higher rates of these diseases and causes of mortality than whites.<\/p>\r\n<p id=\"import-auto-id2298586\">Lisa Berkman (2009) notes that this gap started to narrow during the Civil Rights movement in the 1960s, but it began widening again in the early 1980s. What accounts for these perpetual disparities in health outcomes\u00a0among different ethnic groups? Much of the answer lies in the level of healthcare that these groups receive. The National Healthcare Disparities Report (2010) shows that even after adjusting for insurance differences, racial and ethnic minority groups receive poorer quality of care and less access to care than dominant groups. The Report identified these racial inequalities in care:<\/p>\r\n\r\n<ol>\r\n \t<li>Black Americans, American Indians, and Alaskan Natives received inferior care when compared with white Americans for about 40 percent of measures.<\/li>\r\n \t<li>Asian ethnic\u00a0groups\u00a0received inferior care for about 20 percent of measures.<\/li>\r\n \t<li>Among whites, Hispanic whites received 60 percent inferior care of measures compared to non-Hispanic whites (Agency for Health Research and Quality, 2010). When considering access to care, the figures were comparable.<\/li>\r\n<\/ol>\r\n<h3>The Hispanic Paradox: The Curious Case of Hispanics in the United States<\/h3>\r\nRecent academic research by Lariscy, Hummer, and Hayward (2015)[footnote]Lariscy, Joseph T., Robert A. Hummer, and Mark D. Hayward. 2015. \u201cHispanic Older Adult Mortality in the United States: New Estimates and an Assessment of Factors Shaping the Hispanic Paradox.\u201d Demography 52(2015):1-14.[\/footnote] has sought to explore what is traditionally known as the Hispanic paradox of health. The paradox suggests that Hispanic older adult mortality is similar to that of whites and that it actually\u00a0<em>exceeds\u00a0<\/em>white life expectancy, despite their initial lower life expectancy\u00a0at birth and their socioeconomic disadvantage, which is comparable to the one found among African Americans. These scholars found that Hispanics, regardless of where they were born, exhibit higher life expectancy as adults than any other group. Foreign-born Hispanics living in the U.S. have an even higher life expectancy and exhibit lower mortality ratios for lung cancer and respiratory diseases, which is likely a result of lower rates of smoking. All of this despite their lower socioeconomic status\u2014this suggests that the protective influence of lower smoking prevalence among Hispanics is slightly offsetting their socioeconomic disadvantage.\r\n\r\n<p style=\"text-align: center\"><strong>Watch this video for a dynamic talk given by Dr. Camara Jones, MD, MPH, PhD on levels of health interventions and how racism impacts health and healthcare in the U.S.:<\/strong>\r\n[embed]https:\/\/www.youtube.com\/watch?v=OZxGYUS1DK0[\/embed]<\/p> \r\n\r\n<\/section><section id=\"h21903_02\">\r\n<h3>Health by Socioeconomic Status<\/h3>\r\n<p id=\"import-auto-id2395299\">Discussions of health by race and ethnicity often overlap with discussions of health by socioeconomic status, since the two concepts are intertwined in the United States. As the Agency for Health Research and Quality (2010) notes, \u201cracial and ethnic minorities are more likely than non-Hispanic whites to be poor or near poor,\u201d so many of the data pertaining to subordinate groups is also likely to be pertinent to low socioeconomic groups. Marilyn Winkleby and her research associates (1992) state that \u201cone of the strongest and most consistent predictors of a person's morbidity and mortality experience is that person's socioeconomic status (SES). This finding persists across all diseases with few exceptions, continues throughout the entire lifespan, and extends across numerous risk factors for disease.\u201d <strong>Morbidity<\/strong> is the incidence of disease.<\/p>\r\n<p id=\"import-auto-id3635995\">It is important to remember that economics are only part of the SES picture; research suggests that education also plays an important role. Phelan and Link (2003) note that many behavior-influenced diseases like lung cancer (from smoking), coronary artery disease (from poor eating and exercise habits), and AIDS initially were widespread across SES groups. However, once information linking habits to disease was disseminated, these diseases decreased in high SES groups and increased in low SES groups. This illustrates the important role of education initiatives regarding a given disease, as well as possible inequalities in how those initiatives effectively reach different SES groups.<\/p>\r\nNot unique to the United States, there is a pattern of social gradient in health based on education and socioeconomic status: wealthier and more educated households, on average, exhibit longer life expectancy at birth.\r\n\r\n[caption id=\"attachment_6170\" align=\"aligncenter\" width=\"769\"]<img class=\"wp-image-6170\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/2034\/2016\/05\/02134911\/2011.0746figex1.jpeg\" alt=\"Life expectancy at birth on the y axis and years of education on the x-axis. The graph shows that with years of education, life expectancy among latinos, white, and black females and males also rises, with a big jump between those who have completed either 12 years of education or 13-15 years. \" width=\"769\" height=\"360\" \/> <strong>Figure 3<\/strong>. Life expectancy at birth by years of education, disaggregated by race and gender.[\/caption]\r\n\r\n<\/section><section id=\"h21903_03\">\r\n<h3>Health by Gender<\/h3>\r\n<p id=\"import-auto-id1824448\">Women are affected adversely both by unequal access to and institutionalized sexism in the healthcare industry. According a\u00a0report from the Kaiser Family Foundation, women experienced a decline in their ability to see needed specialists between 2001 and 2008. In 2008, one quarter of females questioned the quality of her healthcare (Ranji and Salganico, 2011). In this report, we also see the explanatory value of intersection theory. Recall that feminist sociologist Patricia Hill Collins developed this theory, which suggests we cannot separate the effects of race, class, gender, sexual orientation, and other attributes. Further examination of the lack of confidence in the healthcare system by women, as identified in the Kaiser study, found, for example, women categorized as low income were more likely (32 percent compared to 23 percent) to express concerns about healthcare quality, illustrating the multiple layers of disadvantage caused by race and sex.<\/p>\r\n<p id=\"import-auto-id1773116\">We can see an example of institutionalized sexism in the way that women are more likely than men to be diagnosed with certain kinds of mental disorders. Psychologist Dana Becker notes that 75 percent of all diagnoses of Borderline Personality Disorder (BPD) are for women, according to the <em>Diagnostic Statistical Manual of Mental Disorders<\/em>. This diagnosis is characterized by instability of identity, of mood, and of behavior, and Becker argues that it has been used as a catch-all diagnosis for too many women. She further decries the pejorative connotation of the diagnosis, saying that it predisposes many people, both within and outside of the profession of psychotherapy, against women who have been so diagnosed (Becker).\u00a0This is an example of how BPD is a gendered medical condition.<\/p>\r\n<p id=\"import-auto-id2675265\">Many critics also point to the medicalization of women\u2019s issues as an example of institutionalized sexism. <strong><span id=\"import-auto-id2011094\">Medicalization<\/span><\/strong> refers to the process by which previously normal aspects of life are redefined as deviant and thus requiring medical attention. Historically and contemporaneously, many aspects of women\u2019s lives have been medicalized, including menstruation, premenstrual syndrome, pregnancy, childbirth, and menopause. The medicalization of pregnancy and childbirth has been particularly contentious in recent decades, with many women opting out of the institutional medical process and choosing a more natural childbirth, perhaps at home and with the aid of a midwife. Fox and Worts (1999) find that all women experience pain and anxiety during the birth process, but that social support relieves both as effectively as medical support. In other words, medical interventions are no more effective than social ones at helping with the difficulties of pain and childbirth. Fox and Worts further found that women with supportive partners ended up with less medical intervention and fewer cases of postpartum depression. Of course, access to quality birth care outside the standard medical models may not be readily available to women of all social classes,\u00a0and we again see the intersectionality of socioeconomic status and other markers of disadvantage or exclusion.<\/p>\r\n\r\n<div class=\"textbox exercises\">\r\n<h3>Link to Learning<\/h3>\r\nWatch <a href=\"https:\/\/www.youtube.com\/watch?v=VYc-Eq-vDuA\" target=\"_blank\" rel=\"noopener\">this video from Healthcare Triage<\/a> to learn more about the statistics and history of unjust medical treatment for black women in the United States and measures that can be taken to improve maternal care for black women.\r\n\r\n<\/div>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Think It Over<\/h3>\r\n<div id=\"sh1903_01\" class=\"exercise\">\r\n<div id=\"fs-id2745376\" class=\"problem\">\r\n<ul>\r\n \t<li>What factors contribute to the disparities in health among racial, ethnic, and gender groups in the United States?<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<h3>The State of Health in the United States: The Opioid Epidemic<\/h3>\r\nThe opioid epidemic, which is really a subset narrative of significant increases in fatal drug overdoses, affects all races, ethnicities, genders, geographical locations, and socioeconomic groups. By 2016, overdoses from heroin and other opioids kill over 27,000 people annually.[footnote]Nolan, Dan and Chris Amico (February 2016). <em>How Bad is the Opioid Epidemic?<\/em> Frontline. Retrieved from\u00a0<a href=\"https:\/\/www.pbs.org\/wgbh\/frontline\/article\/how-bad-is-the-opioid-epidemic\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.pbs.org\/wgbh\/frontline\/article\/how-bad-is-the-opioid-epidemic\/<\/a>.[\/footnote] (Note that \"opioid\" is a broad category that includes naturally-derived opiate substances like heroin as well as synthetic substances such as Oxycontin and fentanyl.) The opioid crisis is very closely linked to healthcare: a dozen states have more opioid prescriptions than people, suggesting that, on average, all individuals have been prescribed at least one drug.\u00a0As such, healthcare providers are directly involved in the crisis, albeit not the culprit of it. Here are a few facts and graphics from PBS (2017) about the opioid crisis:\r\n\r\n[caption id=\"attachment_6172\" align=\"aligncenter\" width=\"728\"]<img class=\"wp-image-6172\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/2034\/2016\/05\/02143744\/drug_motor_vehicle_2.png\" alt=\"Graph titled, &quot;Drug Overdose &amp; Motor Vehicle Accident Deaths&quot;. On the x-axis are the years 2000 to 2014, and on the y-axis are the number of deaths ranging from 15,000 to 50,000. The graph shows drugs causing more deaths than motor vehicles beginning in 2008. By 2014, motor accidents caused around 30,000 deaths with drugs at about 47,000.\" width=\"728\" height=\"391\" \/> <strong>Figure 4<\/strong>. Data from 2014 shows that drugs kill more Americans that car accidents.[\/caption]\r\n<ol>\r\n \t<li>Drugs kill more Americans than cars do. The odds of dying from an accidental opioid overdose are 1 in 96, while the chances of dying in a motor vehicle crash are 1 in 103. Compare this to other leading causes of death: death from suicide (1 in 88) death from a fall (1 in 114),gun assaults (1 in 285), drowning (1 in 1,117), or choking (1 in 2,696). According to the CDC, 130 Americans die every day because of opioid overdoses.[footnote]Bursztynsky, Jessica (January 2019). <em>Americans more likely to die from opioid overdose today than car accident<\/em>. CNBC. Retrieved from<a href=\"https:\/\/www.cnbc.com\/2019\/01\/15\/americans-more-likely-to-die-from-opioid-overdose-than-car-accident.html\" target=\"_blank\" rel=\"noopener\">\u00a0https:\/\/www.cnbc.com\/2019\/01\/15\/americans-more-likely-to-die-from-opioid-overdose-than-car-accident.html<\/a>\r\n[\/footnote]<\/li>\r\n \t<li>The group analyzed preventable injuries and deaths in 2017 and found the odds of dying by accidental opioid overdose to be 1 in 96 and the odds of a motor vehicle crash 1 in 103.<\/li>\r\n \t<li>On average, 130 Americans die each day after overdosing on opioids, according to the Centers for Disease Control and Prevention.<\/li>\r\n \t<li>Opioids and heroin surpassed cocaine for most deaths. In 2014, Opiods caused 18,893 deaths from overdose, heroin caused 10,574, benzodiazephines caused 7,945, and cocaine caused 5,415.<\/li>\r\n \t<li>Opioids and heroin have affected all races. While studies shows that some doctors are less likely to prescribe narcotics and painkillers to minority populations, potentially decreasing the number of minorities with access to opioids, minority populations are still affected by the crisis, with rates of deaths by overdoses for whites and Native Americans rising the most between 2010 and 2014.<\/li>\r\n \t<li>Heroin affects younger populations; opioids older ones, especially those between ages 45 to 65.<\/li>\r\n<\/ol>\r\n[caption id=\"attachment_6173\" align=\"aligncenter\" width=\"1280\"]<img class=\"wp-image-6173 size-full\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/2034\/2016\/05\/02143750\/heroin_opioids_race.png\" alt=\"Graph titled, &quot;Overdose Deaths by Race in 2014 per 100,000 people&quot;. 4.4 whites died of heroin overdoses, while 7.9 from opioids. For blacks, 2.5 from heroin and 3.3 from opioids. For Latinos, 1.9 from heroin and 2.2 from opioids. For Native Americans, 3.7 from heroin and 8.4 from opioids. For Asians, 0.3 from heroin and 0.7 from opioids.\" width=\"1280\" height=\"529\" \/> <strong>Figure 5<\/strong>. All races and ethnic groups have been affected by the opioid crisis.[\/caption]\r\n<p style=\"text-align: center\"><strong>Watch this video to better understand the extent of the opioid epidemic in the U.S., the most detrimental drug crisis in American history, and a challenge faced by the medical field, sociologists, policymakers, and everyday people.<\/strong>\r\n[embed]https:\/\/www.youtube.com\/watch?v=oHlaz0kQlRE[\/embed]<\/p>\r\n<div class=\"textbox exercises\">\r\n<h3 class=\"title\">Medicalization of Sleeplessness<\/h3>\r\n<figure id=\"import-auto-id1306346\">\r\n\r\n[caption id=\"\" align=\"alignright\" width=\"250\"]<img src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/120\/2016\/04\/15204713\/Figure_19_03_01.jpg\" alt=\"A child asleep at his desk is shown here.\" width=\"250\" height=\"375\" \/> <strong>Figure 6.\u00a0<\/strong>Many people fail to get enough sleep. But is insomnia a disease that should be cured with medication? (Photo courtesy of Wikimedia Commons)[\/caption]<\/figure>\r\n<p id=\"import-auto-id2275051\">How is your \u201csleep hygiene?\u201d Sleep hygiene refers to the lifestyle and sleep habits that contribute to sleeplessness. Bad habits that can lead to sleeplessness include inconsistent bedtimes, lack of exercise, late-night employment, napping during the day, and sleep environments that include noise, lights, or screen time (National Institutes of Health, 2011a).<\/p>\r\nAccording to the National Institute of Health, examining sleep hygiene is the first step in trying to solve a problem with sleeplessness.\r\n<p id=\"import-auto-id2617271\">For many people in the United States, however, making changes in sleep hygiene does not seem to be enough. According to a 2006 report from the Institute of Medicine, sleeplessness is an under-recognized public health problem affecting up to 70 million people. It is interesting to note that in the months (or years) after this report was released, advertising by the pharmaceutical companies behind Ambien, Lunesta, and Sepracor (three sleep aids) averaged $188 million weekly promoting these drugs (Gellene, 2009).<\/p>\r\n<p id=\"import-auto-id2826508\">According to a study in the <em>American Journal of Public Health<\/em> (2011), prescriptions for sleep medications increased dramatically from 1993 to 2007. While complaints of sleeplessness during doctor\u2019s office visits more than doubled during this time, insomnia diagnoses increased more than seven-fold, from about 840,000 to 6.1 million. The authors of the study conclude that sleeplessness has been medicalized as insomnia, and that \u201cinsomnia may be a public health concern, but potential over-treatment with marginally effective, expensive medications with nontrivial side effects raises definite population health concerns\u201d (Moloney, Konrad, and Zimmer, 2011). Indeed, a study published in 2004 in the <em>Archives of Internal Medicine<\/em> shows that cognitive behavioral therapy, not medication, was the most effective sleep intervention (Jacobs, Pace-Schott, Stickgold, and Otto, 2004).<\/p>\r\n<p id=\"import-auto-id2266212\">A century ago, people who couldn\u2019t sleep were told to count sheep. Now they pop a pill, and all those pills add up to a very lucrative market for the pharmaceutical industry. Is this industry behind the medicalization of sleeplessness, or is it just responding to a need?<\/p>\r\n\r\n<\/div>\r\n<\/section><section id=\"sh1903\" class=\"short-answer\">\r\n<dl id=\"fs-id4995460\" class=\"definition\"><\/dl>\r\n<\/section>\r\n<h2>Mental Health and Disabilities<\/h2>\r\n<h3>Mental Health<\/h3>\r\n<p id=\"import-auto-id2768730\">The treatment received by those defined as mentally ill or disabled varies greatly from country to country. In the post-millennial United States, those of us who have never experienced such a disadvantage take for granted the rights our society guarantees for each citizen. We do not think about the relatively recent nature of the protections, unless, of course, we know someone constantly inconvenienced by the lack of accommodations or misfortune of suddenly experiencing a temporary disability.<\/p>\r\n\r\n<section id=\"h31903_01\">\r\n<p id=\"import-auto-id1625983\">People with mental disorders (a condition that makes it more difficult to cope with everyday life) and people with mental illness (a severe, lasting mental disorder that requires long-term treatment) experience a wide range of effects.<\/p>\r\n<p id=\"import-auto-id1898466\">According to the National Institute of Mental Health (NIMH),\u00a0one in five adults in the U.S. live with a mental illness, numbering 46.6 million in 2017.[footnote]National Institute of Mental Health (2017). Retrieved from <a href=\"https:\/\/www.nimh.nih.gov\/health\/statistics\/mental-illness.shtml\" target=\"_blank\" rel=\"noopener\">https:\/\/www.nimh.nih.gov\/health\/statistics\/mental-illness.shtml<\/a>.[\/footnote] The most common mental disorders in the United States are <strong><span id=\"import-auto-id2431689\">anxiety disorders<\/span><\/strong>.\u00a0It is important to distinguish between occasional feelings of anxiety and a true anxiety disorder. Anxiety is a normal reaction to stress that we all feel at some point, but anxiety disorders are feelings of worry and fearfulness that last for months at a time. Anxiety disorders include obsessive compulsive disorder (OCD), panic disorders, post-traumatic stress disorder (PTSD), separation anxiety disoder,\u00a0and both social and specific phobias.\u00a0The NIMH reports that the prevalence of any anxiety disorder is higher for females than for males, estimating the prevalence at 23.4 percent and 14.3 percent, respectively. Anxiety is a prominent mental condition; one in three U.S. adults experience any anxiety disorder at some point throughout their lives.<\/p>\r\n<p id=\"import-auto-id1338049\">The second most common mental disorders in the United States are <strong><span id=\"import-auto-id1591282\">mood disorders<\/span><\/strong>; roughly 10 percent of U.S. adults are likely to be affected yearly, while 21 percent are likely to be affected over the course of a lifetime (National Institute of Mental Health, 2017). Major mood disorders are depression, bipolar disorder, and dysthymic disorder. Like anxiety, depression might seem like something that everyone experiences at some point, and it is true that most people feel sad or \u201cblue\u201d at times in their lives. A true depressive episode, however, is more than just feeling sad for a short period. It is a long-term, debilitating illness that usually needs treatment to cure. And bipolar disorder is characterized by dramatic shifts in energy and mood, often affecting the individual\u2019s ability to carry out day-to-day tasks. Bipolar disorder used to be called manic depression because of the way people would swing between manic and depressive episodes. As with anxiety disorders, mood disorders are more prevalent among females than among males, and over 20 percent of adults in the U.S. experience a mood disorder at some point throughout their lifetime.<\/p>\r\nDepending on what definition is used, there is some overlap between mood disorders and <strong><span id=\"import-auto-id1885027\">personality disorders<\/span><\/strong>, which affect 9 percent of people in the United States yearly.\u00a0Unlike with other types of mental disorders, there is no significant gender difference, although 84 percent of individuals with personality disorders also had one or more other mental disorders.\r\n\r\nAfter a multilevel review of proposed revisions in the early 2010s, including reducing the number of listed personality disorders to six, the American Psychiatric Association Board of Trustees ultimately decided to retain the DSM-IV categorical approach in the new DSM-5 with the same ten personality disorders (paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, antisocial personality disorder, borderline personality disorder, histrionic personality, narcissistic personality disorder, avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder). Personality disorders represent \u201can enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it\u201d (National Institute of Mental Health). In other words, personality disorders cause people to behave in ways that are seen as abnormal and deviant to society but seem normal to them. During revisions to the DSM, there were proposals to broaden this definition, and there was heated debate over the appropriate labels and proper diagnosis for personality disorders. As you've learned in this module already, the label we give an illness can impact how the affected person views themself as well as how they are treated by others.\r\n<div class=\"textbox exercises\">\r\n<h3>Link to Learning<\/h3>\r\nInterested in seeing more statistics about mental health or specific mental disorders\/illnesses? Visit the\u00a0<a href=\"https:\/\/www.nimh.nih.gov\/health\/statistics\/index.shtml\" target=\"_blank\" rel=\"noopener\">NIMH statistics website.<\/a>\r\n\r\nYou can also watch this <a href=\"https:\/\/www.youtube.com\/watch?v=4E1JiDFxFGk\" target=\"_blank\" rel=\"noopener\">CrashCourse video covering the types of personality disorders.<\/a>\r\n\r\n<\/div>\r\n<figure id=\"import-auto-id2096801\">\r\n\r\n[caption id=\"\" align=\"alignright\" width=\"250\"]<img src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/120\/2016\/04\/15204715\/Figure_19_03_02.jpg\" alt=\"White, oval-shaped pills next to a pill bottle are shown here.\" width=\"250\" height=\"374\" \/> <strong>Figure 7.\u00a0<\/strong>Medication is a common option for children with ADHD. (Photo courtesy of Deviation56\/Wikimedia Commons)[\/caption]<\/figure>\r\n<\/section>\r\n<p id=\"import-auto-id2082903\">Another fairly commonly diagnosed mental disorder is Attention-Deficit\/Hyperactivity Disorder (ADHD), which statistics suggest affects 11 percent percent of children and 8 percent of adults on a lifetime basis (National Institute of Mental Health, 2017). ADHD is one of the most common childhood disorders, and it is marked by difficulty paying attention, difficulty controlling behavior, and hyperactivity. According to the American Psychological Association (APA), ADHD responds positively to stimulant drugs like Ritalin, which helps people stay focused. However, there is some social debate over whether such drugs are being over-prescribed (American Psychological Association) Consider\u00a0the opioid crisis in relation to this; do we begin over-prescribing drugs targeted at children, and perhaps <em>create<\/em> a dependency and cycle?\u00a0Some critics question whether this disorder is really as widespread as it seems, or if it is a case of over diagnosis. According to the Centers for Disease Control and Prevention, only 5 percent of children have ADHD. However, approximately 11 percent of children ages four through seventeen have been diagnosed with ADHD as of 2011.\u00a0Contrary to what is observed with many other types of mental disorders, ADHD is more prevalent among males than among females.<\/p>\r\n\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Think It Over<\/h3>\r\n<div id=\"sh1903_01\" class=\"exercise\">\r\n<div id=\"fs-id2745376\" class=\"problem\">\r\n<ul>\r\n \t<li>Do you know anyone with a mental disorder? How does it affect his or her life?<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<h3>Autism<\/h3>\r\nAutism Spectrum Disorders (ASD) have gained a lot of attention in recent years. The term ASD encompasses a group of developmental brain disorders that are characterized by \u201cdeficits in social interaction, verbal and nonverbal communication, and engagement in repetitive behaviors or interests\u201d (National Institute of Mental Health). Just over 1.5 percent of 8-year-old children were diagnosed as having ASD. Like with ADHD, ASD is more prevalent among boys than among girls, with boys being four times as likely to be diagnosed with ASD.\r\n<div>\r\n\r\n<span style=\"color: #6c64ad;font-size: 1em;font-weight: 600\">Disability<\/span>\r\n\r\n<\/div>\r\n<section id=\"h31903_02\">\r\n<figure id=\"import-auto-id1931787\">\r\n\r\n[caption id=\"\" align=\"alignright\" width=\"150\"]<img src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/120\/2016\/04\/15204716\/Figure_19_03_03.jpg\" alt=\"A blue handicapped accessible sign is shown here.\" width=\"150\" height=\"300\" \/> <strong>Figure 8.\u00a0<\/strong>The handicapped accessible sign indicates that people with disabilities can access the facility. The Americans with Disabilities Act requires that access be provided to everyone. (Photo courtesy of Ltljltlj\/Wikimedia Commons)[\/caption]<\/figure>\r\nThe National Institute of Mental Health (NIMH) distinguishes between serious mental illness and other disorders. The key feature of serious mental illness is that it results in \u201cserious functional impairment, which substantially interferes with or limits one or more major life activities\u201d (National Institute of Mental Health). Thus, the characterization of \u201cserious\u201d refers to the <em>effect<\/em> of the illness (functional impairment), not the illness itself.\r\n<p id=\"import-auto-id3607517\"><strong><span id=\"import-auto-id2339821\">Disability<\/span><\/strong> refers to a reduction in one\u2019s ability to perform everyday tasks. The World Health Organization makes a distinction between the various terms used to describe handicaps that\u2019s important to the sociological perspective. They use the term <strong><span id=\"import-auto-id1195419\">impairment<\/span><\/strong> to describe the physical limitations, while reserving the term disability to refer to the social limitation.<\/p>\r\n<p id=\"import-auto-id1449730\">Before the passage of the Americans with Disabilities Act (ADA) in 1990, people in the United States with disabilities were often excluded from opportunities and social institutions many of us take for granted. This occurred not only through employment and other kinds of discrimination<span style=\"color: #ff6600\">,<\/span> but also through casual acceptance by most people in the United States of a world designed for the convenience of the able-bodied. Imagine being in a wheelchair and trying to use a sidewalk without the benefit of wheelchair-accessible curbs. Imagine as a blind person trying to access information without the widespread availability of Braille. Imagine having limited motor control and being faced with a difficult-to-grasp round door handle. Issues like these are what the ADA tries to address. Ramps on sidewalks, Braille instructions, and more accessible door levers are all accommodations to help people with disabilities.<\/p>\r\n<p id=\"import-auto-id2329133\">People with disabilities can be stigmatized by their illnesses. <strong><span id=\"import-auto-id1735654\">Stigmatization<\/span><\/strong> means their identity is spoiled; they are labeled as different, discriminated against, and sometimes even shunned. They are labeled (as an interactionist might point out) and ascribed a master status (as a functionalist might note), becoming \u201cthe blind girl\u201d or \u201cthe boy in the wheelchair\u201d instead of someone afforded a full identity by society. This can be especially true for people who are disabled due to mental illness or disorders.<\/p>\r\nAs discussed in the section on mental health, many mental health disorders can be debilitating and can affect a person\u2019s ability to cope with everyday life as well as their social interactions. This can affect social status, housing, and especially employment. According to the Bureau of Labor Statistics (2019), people with a disability had a higher rate of unemployment than people without a disability in 2018\u20148\u00a0percent compared to\u00a03.7\u00a0percent. This unemployment rate refers only to people actively looking for a job. In fact,\u00a0four out of\u00a0five people with a disability are considered \u201cout of the labor force;\u201d that is, they do not have jobs and are not looking for them. The combination of this population and the high unemployment rate leads to an employment-population ratio of\u00a019.1 percent among those with disabilities. The employment-population ratio for people without disabilities was much higher, at 65.9\u00a0percent (U.S. Bureau of Labor Statistics, 2019).[footnote]U.S. Bureau of Labor Statistics (2019). <em>Persons with a Disability: Labor Force Characteristics Summary<\/em>. Retrieved from <a href=\"https:\/\/www.bls.gov\/news.release\/disabl.nr0.htm\" target=\"_blank\" rel=\"noopener\">https:\/\/www.bls.gov\/news.release\/disabl.nr0.htm<\/a>.[\/footnote]\r\n<div class=\"textbox exercises\">\r\n<h3>Obesity: The Last Acceptable Prejudice<\/h3>\r\n<figure>\r\n\r\n[caption id=\"\" align=\"alignright\" width=\"250\"]<img src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/120\/2016\/04\/15204718\/Figure_19_03_04.jpg\" alt=\"A large man is shown here sitting on a beach next to a young girl.\" width=\"250\" height=\"364\" \/> <strong>Figure 9.\u00a0<\/strong>Obesity is considered the last acceptable social stigma. (Photo courtesy of Kyle May\/flickr)[\/caption]<\/figure>\r\n<p id=\"import-auto-id2819349\">What is your reaction to the picture above? Compassion? Fear? Disgust? Many people will look at this picture and make negative assumptions about the man based on his weight. According to a study from the Yale Rudd Center for Food Policy and Obesity, large people are the object of \u201cwidespread negative stereotypes that overweight and obese persons are lazy, unmotivated, lacking in self-discipline, less competent, non-compliant, and sloppy\u201d (Puhl and Heuer, 2009).<\/p>\r\n<p id=\"import-auto-id1380880\">Historically, both in the United States and elsewhere, it was considered acceptable to discriminate against people based on prejudiced opinions. Even after slavery was abolished in 1865, the next 100 years of U.S. history saw institutionalized racism and prejudice against black people. In an example of <span id=\"import-auto-id1225828\">stereotype interchangeability<\/span>, the same insults that are flung today at the overweight and obese population (lazy, for instance), have been flung at various racial and ethnic groups in earlier history. Of course, no one gives voice to these kinds of views in public now, except when talking about obese people.<\/p>\r\n<p id=\"import-auto-id2745705\">Why is it considered acceptable to feel prejudice toward\u2014even to hate\u2014obese people? Puhl and Heuer suggest that these feelings stem from the perception that obesity is preventable through self-control, better diet, and more exercise. Highlighting this contention is the fact that studies have shown that people\u2019s perceptions of obesity are more positive when they think the obesity was caused by non-controllable factors like biology (a thyroid condition, for instance) or genetics.<\/p>\r\n<p id=\"import-auto-id2298985\">Even with some understanding of non-controllable factors that might affect obesity, obese people are still subject to stigmatization. Puhl and Heuer\u2019s study is one of many that document discrimination at work, in the media, and even in the medical profession. Obese people are less likely to get into college than thinner people, and they are less likely to succeed at work.\u00a0Recent research finds that discrimination against obese people is still pervasive in employment.[footnote]Stuart W. Flint, Martin \u010cadek, Sonia C. Codreanu, Vanja Ivi\u0107, Colene Zomer, Amalia Gomoiu Front Psychol. 2016.\u00a0<em>Obesity Discrimination in the Recruitment Process: \u201cYou\u2019re Not Hired!\u201d<\/em> 7: 647. Published online 2016 May 3. doi: 10.3389\/fpsyg.2016.00647[\/footnote]<\/p>\r\n<p id=\"import-auto-id1363060\">Stigmatization of obese people comes in many forms, from the seemingly benign to the potentially illegal. In movies and television shows, overweight people are often portrayed negatively, or as stock characters who are the butt of jokes. One study found that in children\u2019s movies \u201cobesity was equated with negative traits (evil, unattractive, unfriendly, cruel) in 64 percent of the most popular children's videos. In 72 percent of the videos, characters with thin bodies had desirable traits, such as kindness or happiness\u201d (Hines and Thompson, 2007). In movies and television for adults, the negative portrayal is often meant to be funny. \u201cFat suits\u201d\u2014inflatable suits that make people look obese\u2014are commonly used in a way that perpetuates negative stereotypes. Think about the way you have seen obese people portrayed in movies and on television; now think of any other subordinate group being openly denigrated in such a way\u2014it is difficult to find a parallel example.<\/p>\r\n\r\n<\/div>\r\n<\/section><section id=\"sh1903\" class=\"short-answer\"><\/section>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>THINK IT OVER<\/h3>\r\n<div id=\"sh1902_ex01\" class=\"exercise\">\r\n<div id=\"fs-id2332371\" class=\"problem\">\r\n<ul>\r\n \t<li>If social epidemiologists studied the United States in the colonial period, what differences would they find between now and then?<\/li>\r\n \t<li>What do you think are some of the contributing factors to obesity-related diseases in the United States?<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<h2><span style=\"color: #6c64ad;font-size: 1em;font-weight: 600\">U.S. Healthcare<\/span><\/h2>\r\n<section id=\"fs-id1586622\">\r\n<p id=\"import-auto-id1169033059584\">Healthcare\u00a0coverage can broadly be divided into two main categories: <strong><span id=\"import-auto-id1169033166322\">public healthcare<\/span><\/strong> (government-funded) and <strong><span id=\"import-auto-id1169033110699\">private healthcare<\/span><\/strong> (privately-funded).<\/p>\r\nIn the United States, the healthcare system is more complex than what is found in other countries\u2014there is no uniform health system nor universal healthcare coverage provided, and it is more of a hybrid system that what is found in other developed nations. In 2014, 48 percent of healthcare spending came from private funds, both from businesses and individuals, 28 percent came from the federal government, and 17 percent came from state and local governments. Political changes have also resulted in drastic policy changes regarding healthcare.[footnote]Department for Professional Employees. (2016) <em>The U.S. Health Care System: An International Perspective.\u00a0<\/em>Retrieved from\u00a0<a href=\"https:\/\/dpeaflcio.org\/programs-publications\/issue-fact-sheets\/the-u-s-health-care-system-an-international-perspective\/\" target=\"_blank\" rel=\"noopener\">https:\/\/dpeaflcio.org\/programs-publications\/issue-fact-sheets\/the-u-s-health-care-system-an-international-perspective\/<\/a>.[\/footnote]\r\n<p id=\"import-auto-id1169033140349\">The two main public, government\u00a0funded healthcare programs are Medicare, which provides health services to people over sixty-five years old as well as people who meet certain standards for disability, and Medicaid, which provides services to people with very low incomes who meet other eligibility requirements. Other government-funded programs include service agencies focused on Native Americans (the Indian Health Service), Veterans (the Veterans Health Administration), and children (the Children\u2019s Health Insurance Program).<\/p>\r\n<p id=\"import-auto-id1169033102683\">The most recent U.S. census\u00a0(2011) divides private insurance into employment-based insurance and direct-purchase insurance. Employment-based insurance is health plan coverage that is provided in whole or in part by an employer or union; it can cover just the employee, or the employee and their\u00a0family. Direct purchase insurance is coverage that an individual buys directly from a private company.<\/p>\r\n<p id=\"import-auto-id1169033126124\">With all these insurance options, ranging from government-provided to employee-provided and individual-provided,\u00a0insurance coverage must be almost universal, right? Unfortunately, the U.S. Census Current Population Survey of 2013 showed that 18 percent of people in the United States had\u00a0no health insurance at all. Equally alarming, a study by the Commonwealth Fund showed that in 2010, 81 million adults were either uninsured or <strong><span id=\"import-auto-id1169033166084\">under-insured<\/span><\/strong>; that is, people who pay at least 10 percent of their income on healthcare costs not covered by insurance or, for low-income adults, those whose medical expenses or deductibles are at least 5 percent of their income (Schoen, Doty, Robertson, and Collins, 2011). The Commonwealth study further reported that while under-insurance had historically been an issue that low-income families faced, today it is affecting middle-income families more and more.<\/p>\r\n\r\n\r\n[caption id=\"\" align=\"alignleft\" width=\"250\"]<img src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/120\/2016\/04\/15204707\/Figure_19_04_01.jpg\" alt=\"A group of protesters holding signs protesting federal health care changes are shown here. Some signs reads, &quot;Obama! Get your hands off my healthcare it's unconstitutional!&quot;, and &quot;Stop spending stop tyranny&quot;.\" width=\"250\" height=\"375\" \/> <strong>Figure 10.\u00a0<\/strong>Some\u00a0in the United States worry that governmental oversight of healthcare represents a federal overstepping of constitutional guarantees of individual freedom. Others welcome a program that they believe will make healthcare accessible and affordable to everyone. (Photo courtesy of Fibonacci Blue\/flickr)[\/caption]\r\n<p id=\"import-auto-id1169033158696\">Why were\u00a0so many people uninsured or under-insured? Skyrocketing healthcare costs were\u00a0part of the issue. Many people cannot afford private health insurance, but their income level is not low enough to meet eligibility standards for government supported insurance. Further, even for those who are eligible for Medicaid, the program is less than perfect. Many physicians refuse to accept Medicaid patients, citing low payments and extensive paperwork (Washington University Center for Health Policy, n.d.).<\/p>\r\nHealthcare in the United States looks different today than it did just a few years ago\u2014a result of changes in policy, such as the Affordable Care Act (PPACA or ACA or \"Obamacare\").\u00a0You've probably heard of Obamacare at some point\u2014but what did it seek to do? Obamacare\u00a0expanded\u00a0eligibility to programs like Medicaid and CHIP, helped guarantee insurance coverage for people with preexisting conditions, and established regulations to make sure that the premium funds collected by insurers and care providers go directly to medical care. It also included an <strong><span id=\"import-auto-id1169033166370\">individual mandate<\/span><\/strong>, which required everyone to have insurance coverage by 2014 or pay a penalty in their taxes. A series of provisions, including significant subsidies, were\u00a0intended to address the discrepancies in income that are currently contributing to high rates of uninsurance and under-insurance.\r\n\r\nWhile the program has been controversial and something of a flashpoint for strongly partisan politics, in 2012 the U.S. Supreme Court upheld the constitutionality of the PPACA's individual mandate. According to Blumenthal (2014), by 2014,\u00a020 million people in the United States had gained health insurance under PPACA. This lowered the number of uninsured people to 13 percent.\u00a0Three years later, by 2017, healthcare reform had lowered the number of uninsured people to the lowest it has ever been in the United States.\u00a0In 2017, less than 9 percent of the population was uninsured at some point during the year[footnote]Berchick, Edward R. and Emily Hood and Jessica C. Barnett. (2018)\u00a0<em>Health Insurance Coverage in the United States: 2017.<\/em>\u00a0Retrieved from <a href=\"https:\/\/www.census.gov\/library\/publications\/2018\/demo\/p60-264.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.census.gov\/library\/publications\/2018\/demo\/p60-264.html<\/a>.[\/footnote]\u2014a drastic drop relative to the alarming 18 percent in the early 2010s. Over half of the population was insured by an employer, over one third was covered by government-funded programs, and the rest were either covered by direct-purchase or by military funding.\r\n<figure id=\"import-auto-id1169033102735\"><\/figure>\r\n<p id=\"import-auto-id1169033126051\">The PPACA remains contentious and at the forefront of political debates. The Supreme Court ruled in the case of <em>National Federation of Independent Businesses v. Sebelius<\/em> in 2012, that states cannot be forced to participate in the PPACA's Medicaid expansion. This ruling has opened the door to challenges to the PPACA in Congress and the Federal courts, in\u00a0some state governments,\u00a0and among conservative groups and independent businesses.<\/p>\r\n\r\n<\/section>\r\n<p style=\"text-align: center\"><strong>Still confused about the healthcare system in the United States? Watch this video for clarification:<\/strong>\r\n[embed]https:\/\/www.youtube.com\/embed\/DublqkOSBBA[\/embed]<\/p>\r\n\r\n<section class=\"short-answer\">\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Think It Over<\/h3>\r\n<div id=\"fs-id1806480\" class=\"exercise\">\r\n<div id=\"fs-id1755079\" class=\"problem\">\r\n<ul>\r\n \t<li>What do you think are the best and worst parts of the PPACA? Why?<\/li>\r\n \t<li>Compare and contrast the healthcare system of the United States with the WHO\u2019s Sustainable Development Goals<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Coronavirus disease (COVID-19): A 21st Century global pandemic<\/h3>\r\nCOVID-19 is the infectious disease caused by the most recently discovered coronavirus (SARS-CoV-2). The virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. However, by February 2020, COVID-19 was declared a pandemic after rapidly spreading across countries in Europe, Asia, and the United States of America. The virus, which was not previously identified in humans, causes mild symptoms including dry cough, tiredness and fever. The World Health Organization (WHO) has reported that although most people recover from the disease without needing special treatment, about 1 out of every 6 people who gets COVID-19 becomes seriously ill and has difficulty breathing. At the end of June 2020, the number of confirmed cases, globally, was 10 million with roughly 500,000 deaths. According to the Centers for Disease Control and Prevention, by the end of June 2020 there were approximately 125,000 deaths due to coronavirus disease in the United States alone.\r\n<h4>COVID-19 and Health Disparities in the U.S.<\/h4>\r\nAs mentioned earlier in this module,\u00a0some people are more likely to experience severe illness during public health emergencies depending on age, race, socioeconomic status, and other variables. Hence, while the public at large is at risk of being infected by the coronavirus, early reports reveal that severe illness and death rates tend to be higher for older adults and racialized populations. Furthermore, other than access to care, several factors can explain differences in health outcomes across demographic groups. Physical and social living conditions, the need to work (many in healthcare settings which increase exposure to infection), access to healthy food options, and other social determinants of health particularly predispose individuals to pandemic infection. Not surprisingly, the pandemic has exposed longstanding structural inequalities in U.S. society that are deeply entrenched in how health care has been imagined and practiced throughout the nation's history.\r\n\r\nThe data confirm that record-breaking number of cases and deaths due to COVID-19\u00a0are disproportionately evident among racialized populations in the U.S. As of June 2020, a joint project of <a href=\"https:\/\/www.bu.edu\/antiracist-center\/\" target=\"_blank\" rel=\"noopener\">the Antiracist Research and Policy Center<\/a> and <a href=\"https:\/\/covidtracking.com\/race\/dashboard\" target=\"_blank\" rel=\"noopener\">the COVID Tracking Project<\/a> report the following findings, of the known cases where race was identified:\r\n<ul class=\"edTag\">\r\n \t<li>Nationally, African-American deaths from COVID-19 are nearly two times greater than would be expected based on their share of the population. In four states, the rate is three or more times greater.<\/li>\r\n \t<li>In 42 states plus Washington D.C., Hispanics\/Latinos make up a greater share of confirmed cases than their share of the population. In eight states, it's more than four times greater.<\/li>\r\n \t<li>White deaths from COVID-19 are lower than their share of the population in 37 states and the District of Columbia.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<div class=\"textbox exercises\">\r\n<h3>further research<\/h3>\r\n<ul>\r\n \t<li>Read a brief discussion about how the COVID-19 pandemic illuminates the effect of <a href=\"https:\/\/www.statnews.com\/2020\/06\/09\/systemic-racism-black-health-disparities\/\" target=\"_blank\" rel=\"noopener\">systemic racism on health care in the U.S.<\/a><\/li>\r\n \t<li>Consult <a href=\"https:\/\/covid19.who.int\/\" target=\"_blank\" rel=\"noopener\">the World Health Organization's COVID-19 Dashboard<\/a> for current global data on the pandemic.<\/li>\r\n<\/ul>\r\n<\/div>\r\n&nbsp;\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Glossary<\/h3>\r\n[glossary-page]\r\n[glossary-term]anxiety disorders:[\/glossary-term]\r\n[glossary-definition]feelings of worry and fearfulness that last for months at a time[\/glossary-definition]\r\n\r\n[glossary-term]disability:[\/glossary-term]\r\n[glossary-definition]a reduction in one\u2019s ability to perform everyday tasks; the World Health Organization notes that this is a social limitation[\/glossary-definition]\r\n\r\n[glossary-term]epidemiology:[\/glossary-term]\r\n[glossary-definition]the study of the incidence, distribution, and possible control of diseases[\/glossary-definition]\r\n\r\n[glossary-term]impairment:[\/glossary-term]\r\n[glossary-definition]the physical limitations a less-able person faces[\/glossary-definition]\r\n\r\n[glossary-term]individual mandate:[\/glossary-term]\r\n[glossary-definition]a government rule that requires everyone to have insurance coverage or they will have to pay a penalty[\/glossary-definition]\r\n\r\n[glossary-term]medicalization:[\/glossary-term]\r\n[glossary-definition]the process by which aspects of life that were considered bad or deviant are redefined as sickness and needing medical attention to remedy[\/glossary-definition]\r\n\r\n[glossary-term]mood disorders:[\/glossary-term]\r\n[glossary-definition]long-term, debilitating illnesses like depression and bipolar disorder[\/glossary-definition]\r\n\r\n[glossary-term]morbidity:[\/glossary-term]\r\n[glossary-definition]the incidence of disease[\/glossary-definition]\r\n\r\n[glossary-term]mortality:[\/glossary-term]\r\n[glossary-definition]the number of deaths in a given time or place[\/glossary-definition]\r\n\r\n[glossary-term]personality disorders:[\/glossary-term]\r\n[glossary-definition]disorders that cause people to behave in ways that are seen as abnormal to society but seem normal to them[\/glossary-definition]\r\n\r\n[glossary-term]private healthcare:[\/glossary-term]\r\n[glossary-definition]health insurance that a person buys from a private company; private healthcare can either be employer-sponsored or direct-purchase[\/glossary-definition]\r\n\r\n[glossary-term]public healthcare:[\/glossary-term]\r\n[glossary-definition]health insurance that is funded or provided by the government[\/glossary-definition]\r\n\r\n[glossary-term]social epidemiology:[\/glossary-term]\r\n[glossary-definition]the study of the causes and distribution of diseases[\/glossary-definition]\r\n\r\n[glossary-term]socialized medicine:[\/glossary-term]\r\n[glossary-definition]when the government owns and runs the entire healthcare system[\/glossary-definition]\r\n\r\n[glossary-term]stigmatization:[\/glossary-term]\r\n[glossary-definition]the act of spoiling someone's identity; they are labeled as different, discriminated against, and sometimes even shunned due to an illness or disability[\/glossary-definition]\r\n\r\n[glossary-term]underinsured:[\/glossary-term]\r\n[glossary-definition]people who spend at least 10 percent of their income on healthcare costs that are not covered by insurance[\/glossary-definition]\r\n\r\n[glossary-term]universal healthcare:[\/glossary-term]\r\n[glossary-definition]a system that guarantees healthcare coverage for everyone[\/glossary-definition]\r\n[\/glossary-page]\r\n\r\n<\/div>\r\n<\/section>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning outcomes<\/h3>\n<ul>\n<li>Explain disparities of health based on gender, socioeconomic status, race, and ethnicity in the United States<\/li>\n<li>Explain mental health and disability issues as they relate to society in the United States<\/li>\n<li>Explain healthcare in the United States,\u00a0including healthcare reform (Affordable Care Act)<\/li>\n<li>Compare the healthcare system of the United States with that of other countries<\/li>\n<\/ul>\n<\/div>\n<p>Health in the United States is a complex and often contradictory issue. On the one hand, as one of the wealthiest nations, the United States fares well in health comparisons with the rest of the world. However, the United States also lags behind almost every industrialized country in terms of providing care to <em>all<\/em>\u00a0of its citizens, as well as in the comparative cost-effectiveness of its healthcare system. The following sections examine different aspects of health in the United States and how this compares with general\u00a0trends in\u00a0global health.<\/p>\n<div id=\"attachment_6204\" style=\"width: 496px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-6204\" class=\"wp-image-6204\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/2034\/2016\/05\/08173547\/6347508912_70eb94ea1c_o.jpg\" alt=\"One person with latex gloves on is holding another persons hand while they use a medical device to prick the finger for blood.\" width=\"486\" height=\"324\" \/><\/p>\n<p id=\"caption-attachment-6204\" class=\"wp-caption-text\"><strong>Figure 1<\/strong>. A patient has their blood glucose tested on World Diabetes Day (Photo courtesy of Gia Willow Alexa Annermarken\/flickr)<\/p>\n<\/div>\n<h2>Health and Inequality in the United States<\/h2>\n<h3>Health by Race and Ethnicity<\/h3>\n<section id=\"h21903_01\">\n<p id=\"import-auto-id1331522\">When looking at the social epidemiology of the United States, it is hard to miss the disparities among races.\u00a0Racial minorities exhibit lower life expectancy and a higher likelihood of death by heart disease and stroke.\u00a0In terms of infant mortality, indigenous populations have an infant mortality rate that is 60% higher than the rate for whites, while infants born to African American women exhibited the highest rate of infant mortality.<a class=\"footnote\" title=\"National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States; Baciu A, Negussie Y, Geller A, et al., editors. Communities in Action: Pathways to Health Equity. Washington (DC): National Academies Press (US); 2017 Jan 11. 2, The State of Health Disparities in the United States. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK425844\/\" id=\"return-footnote-7891-1\" href=\"#footnote-7891-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a>\u00a0According to a report from the Henry J. Kaiser Foundation (2007), African Americans also have a higher incidence of several other diseases and causes of mortality, from cancer to heart disease to diabetes. In a similar vein, it is important to note that ethnic minorities, including Mexican Americans and Native Americans, also have higher rates of these diseases and causes of mortality than whites.<\/p>\n<p id=\"import-auto-id2298586\">Lisa Berkman (2009) notes that this gap started to narrow during the Civil Rights movement in the 1960s, but it began widening again in the early 1980s. What accounts for these perpetual disparities in health outcomes\u00a0among different ethnic groups? Much of the answer lies in the level of healthcare that these groups receive. The National Healthcare Disparities Report (2010) shows that even after adjusting for insurance differences, racial and ethnic minority groups receive poorer quality of care and less access to care than dominant groups. The Report identified these racial inequalities in care:<\/p>\n<ol>\n<li>Black Americans, American Indians, and Alaskan Natives received inferior care when compared with white Americans for about 40 percent of measures.<\/li>\n<li>Asian ethnic\u00a0groups\u00a0received inferior care for about 20 percent of measures.<\/li>\n<li>Among whites, Hispanic whites received 60 percent inferior care of measures compared to non-Hispanic whites (Agency for Health Research and Quality, 2010). When considering access to care, the figures were comparable.<\/li>\n<\/ol>\n<h3>The Hispanic Paradox: The Curious Case of Hispanics in the United States<\/h3>\n<p>Recent academic research by Lariscy, Hummer, and Hayward (2015)<a class=\"footnote\" title=\"Lariscy, Joseph T., Robert A. Hummer, and Mark D. Hayward. 2015. \u201cHispanic Older Adult Mortality in the United States: New Estimates and an Assessment of Factors Shaping the Hispanic Paradox.\u201d Demography 52(2015):1-14.\" id=\"return-footnote-7891-2\" href=\"#footnote-7891-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a> has sought to explore what is traditionally known as the Hispanic paradox of health. The paradox suggests that Hispanic older adult mortality is similar to that of whites and that it actually\u00a0<em>exceeds\u00a0<\/em>white life expectancy, despite their initial lower life expectancy\u00a0at birth and their socioeconomic disadvantage, which is comparable to the one found among African Americans. These scholars found that Hispanics, regardless of where they were born, exhibit higher life expectancy as adults than any other group. Foreign-born Hispanics living in the U.S. have an even higher life expectancy and exhibit lower mortality ratios for lung cancer and respiratory diseases, which is likely a result of lower rates of smoking. All of this despite their lower socioeconomic status\u2014this suggests that the protective influence of lower smoking prevalence among Hispanics is slightly offsetting their socioeconomic disadvantage.<\/p>\n<p style=\"text-align: center\"><strong>Watch this video for a dynamic talk given by Dr. Camara Jones, MD, MPH, PhD on levels of health interventions and how racism impacts health and healthcare in the U.S.:<\/strong><br \/>\n<iframe loading=\"lazy\" id=\"oembed-1\" title=\"Dr. Camara Jones: Tools for a National Campaign Against Racism\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/OZxGYUS1DK0?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<\/section>\n<section id=\"h21903_02\">\n<h3>Health by Socioeconomic Status<\/h3>\n<p id=\"import-auto-id2395299\">Discussions of health by race and ethnicity often overlap with discussions of health by socioeconomic status, since the two concepts are intertwined in the United States. As the Agency for Health Research and Quality (2010) notes, \u201cracial and ethnic minorities are more likely than non-Hispanic whites to be poor or near poor,\u201d so many of the data pertaining to subordinate groups is also likely to be pertinent to low socioeconomic groups. Marilyn Winkleby and her research associates (1992) state that \u201cone of the strongest and most consistent predictors of a person&#8217;s morbidity and mortality experience is that person&#8217;s socioeconomic status (SES). This finding persists across all diseases with few exceptions, continues throughout the entire lifespan, and extends across numerous risk factors for disease.\u201d <strong>Morbidity<\/strong> is the incidence of disease.<\/p>\n<p id=\"import-auto-id3635995\">It is important to remember that economics are only part of the SES picture; research suggests that education also plays an important role. Phelan and Link (2003) note that many behavior-influenced diseases like lung cancer (from smoking), coronary artery disease (from poor eating and exercise habits), and AIDS initially were widespread across SES groups. However, once information linking habits to disease was disseminated, these diseases decreased in high SES groups and increased in low SES groups. This illustrates the important role of education initiatives regarding a given disease, as well as possible inequalities in how those initiatives effectively reach different SES groups.<\/p>\n<p>Not unique to the United States, there is a pattern of social gradient in health based on education and socioeconomic status: wealthier and more educated households, on average, exhibit longer life expectancy at birth.<\/p>\n<div id=\"attachment_6170\" style=\"width: 779px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-6170\" class=\"wp-image-6170\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/2034\/2016\/05\/02134911\/2011.0746figex1.jpeg\" alt=\"Life expectancy at birth on the y axis and years of education on the x-axis. The graph shows that with years of education, life expectancy among latinos, white, and black females and males also rises, with a big jump between those who have completed either 12 years of education or 13-15 years.\" width=\"769\" height=\"360\" \/><\/p>\n<p id=\"caption-attachment-6170\" class=\"wp-caption-text\"><strong>Figure 3<\/strong>. Life expectancy at birth by years of education, disaggregated by race and gender.<\/p>\n<\/div>\n<\/section>\n<section id=\"h21903_03\">\n<h3>Health by Gender<\/h3>\n<p id=\"import-auto-id1824448\">Women are affected adversely both by unequal access to and institutionalized sexism in the healthcare industry. According a\u00a0report from the Kaiser Family Foundation, women experienced a decline in their ability to see needed specialists between 2001 and 2008. In 2008, one quarter of females questioned the quality of her healthcare (Ranji and Salganico, 2011). In this report, we also see the explanatory value of intersection theory. Recall that feminist sociologist Patricia Hill Collins developed this theory, which suggests we cannot separate the effects of race, class, gender, sexual orientation, and other attributes. Further examination of the lack of confidence in the healthcare system by women, as identified in the Kaiser study, found, for example, women categorized as low income were more likely (32 percent compared to 23 percent) to express concerns about healthcare quality, illustrating the multiple layers of disadvantage caused by race and sex.<\/p>\n<p id=\"import-auto-id1773116\">We can see an example of institutionalized sexism in the way that women are more likely than men to be diagnosed with certain kinds of mental disorders. Psychologist Dana Becker notes that 75 percent of all diagnoses of Borderline Personality Disorder (BPD) are for women, according to the <em>Diagnostic Statistical Manual of Mental Disorders<\/em>. This diagnosis is characterized by instability of identity, of mood, and of behavior, and Becker argues that it has been used as a catch-all diagnosis for too many women. She further decries the pejorative connotation of the diagnosis, saying that it predisposes many people, both within and outside of the profession of psychotherapy, against women who have been so diagnosed (Becker).\u00a0This is an example of how BPD is a gendered medical condition.<\/p>\n<p id=\"import-auto-id2675265\">Many critics also point to the medicalization of women\u2019s issues as an example of institutionalized sexism. <strong><span id=\"import-auto-id2011094\">Medicalization<\/span><\/strong> refers to the process by which previously normal aspects of life are redefined as deviant and thus requiring medical attention. Historically and contemporaneously, many aspects of women\u2019s lives have been medicalized, including menstruation, premenstrual syndrome, pregnancy, childbirth, and menopause. The medicalization of pregnancy and childbirth has been particularly contentious in recent decades, with many women opting out of the institutional medical process and choosing a more natural childbirth, perhaps at home and with the aid of a midwife. Fox and Worts (1999) find that all women experience pain and anxiety during the birth process, but that social support relieves both as effectively as medical support. In other words, medical interventions are no more effective than social ones at helping with the difficulties of pain and childbirth. Fox and Worts further found that women with supportive partners ended up with less medical intervention and fewer cases of postpartum depression. Of course, access to quality birth care outside the standard medical models may not be readily available to women of all social classes,\u00a0and we again see the intersectionality of socioeconomic status and other markers of disadvantage or exclusion.<\/p>\n<div class=\"textbox exercises\">\n<h3>Link to Learning<\/h3>\n<p>Watch <a href=\"https:\/\/www.youtube.com\/watch?v=VYc-Eq-vDuA\" target=\"_blank\" rel=\"noopener\">this video from Healthcare Triage<\/a> to learn more about the statistics and history of unjust medical treatment for black women in the United States and measures that can be taken to improve maternal care for black women.<\/p>\n<\/div>\n<div class=\"textbox learning-objectives\">\n<h3>Think It Over<\/h3>\n<div id=\"sh1903_01\" class=\"exercise\">\n<div id=\"fs-id2745376\" class=\"problem\">\n<ul>\n<li>What factors contribute to the disparities in health among racial, ethnic, and gender groups in the United States?<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<h3>The State of Health in the United States: The Opioid Epidemic<\/h3>\n<p>The opioid epidemic, which is really a subset narrative of significant increases in fatal drug overdoses, affects all races, ethnicities, genders, geographical locations, and socioeconomic groups. By 2016, overdoses from heroin and other opioids kill over 27,000 people annually.<a class=\"footnote\" title=\"Nolan, Dan and Chris Amico (February 2016). How Bad is the Opioid Epidemic? Frontline. Retrieved from\u00a0https:\/\/www.pbs.org\/wgbh\/frontline\/article\/how-bad-is-the-opioid-epidemic\/.\" id=\"return-footnote-7891-3\" href=\"#footnote-7891-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a> (Note that &#8220;opioid&#8221; is a broad category that includes naturally-derived opiate substances like heroin as well as synthetic substances such as Oxycontin and fentanyl.) The opioid crisis is very closely linked to healthcare: a dozen states have more opioid prescriptions than people, suggesting that, on average, all individuals have been prescribed at least one drug.\u00a0As such, healthcare providers are directly involved in the crisis, albeit not the culprit of it. Here are a few facts and graphics from PBS (2017) about the opioid crisis:<\/p>\n<div id=\"attachment_6172\" style=\"width: 738px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-6172\" class=\"wp-image-6172\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/2034\/2016\/05\/02143744\/drug_motor_vehicle_2.png\" alt=\"Graph titled, &quot;Drug Overdose &amp; Motor Vehicle Accident Deaths&quot;. On the x-axis are the years 2000 to 2014, and on the y-axis are the number of deaths ranging from 15,000 to 50,000. The graph shows drugs causing more deaths than motor vehicles beginning in 2008. By 2014, motor accidents caused around 30,000 deaths with drugs at about 47,000.\" width=\"728\" height=\"391\" \/><\/p>\n<p id=\"caption-attachment-6172\" class=\"wp-caption-text\"><strong>Figure 4<\/strong>. Data from 2014 shows that drugs kill more Americans that car accidents.<\/p>\n<\/div>\n<ol>\n<li>Drugs kill more Americans than cars do. The odds of dying from an accidental opioid overdose are 1 in 96, while the chances of dying in a motor vehicle crash are 1 in 103. Compare this to other leading causes of death: death from suicide (1 in 88) death from a fall (1 in 114),gun assaults (1 in 285), drowning (1 in 1,117), or choking (1 in 2,696). According to the CDC, 130 Americans die every day because of opioid overdoses.<a class=\"footnote\" title=\"Bursztynsky, Jessica (January 2019). Americans more likely to die from opioid overdose today than car accident. CNBC. Retrieved from\u00a0https:\/\/www.cnbc.com\/2019\/01\/15\/americans-more-likely-to-die-from-opioid-overdose-than-car-accident.html\" id=\"return-footnote-7891-4\" href=\"#footnote-7891-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a><\/li>\n<li>The group analyzed preventable injuries and deaths in 2017 and found the odds of dying by accidental opioid overdose to be 1 in 96 and the odds of a motor vehicle crash 1 in 103.<\/li>\n<li>On average, 130 Americans die each day after overdosing on opioids, according to the Centers for Disease Control and Prevention.<\/li>\n<li>Opioids and heroin surpassed cocaine for most deaths. In 2014, Opiods caused 18,893 deaths from overdose, heroin caused 10,574, benzodiazephines caused 7,945, and cocaine caused 5,415.<\/li>\n<li>Opioids and heroin have affected all races. While studies shows that some doctors are less likely to prescribe narcotics and painkillers to minority populations, potentially decreasing the number of minorities with access to opioids, minority populations are still affected by the crisis, with rates of deaths by overdoses for whites and Native Americans rising the most between 2010 and 2014.<\/li>\n<li>Heroin affects younger populations; opioids older ones, especially those between ages 45 to 65.<\/li>\n<\/ol>\n<div id=\"attachment_6173\" style=\"width: 1290px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-6173\" class=\"wp-image-6173 size-full\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/2034\/2016\/05\/02143750\/heroin_opioids_race.png\" alt=\"Graph titled, &quot;Overdose Deaths by Race in 2014 per 100,000 people&quot;. 4.4 whites died of heroin overdoses, while 7.9 from opioids. For blacks, 2.5 from heroin and 3.3 from opioids. For Latinos, 1.9 from heroin and 2.2 from opioids. For Native Americans, 3.7 from heroin and 8.4 from opioids. For Asians, 0.3 from heroin and 0.7 from opioids.\" width=\"1280\" height=\"529\" \/><\/p>\n<p id=\"caption-attachment-6173\" class=\"wp-caption-text\"><strong>Figure 5<\/strong>. All races and ethnic groups have been affected by the opioid crisis.<\/p>\n<\/div>\n<p style=\"text-align: center\"><strong>Watch this video to better understand the extent of the opioid epidemic in the U.S., the most detrimental drug crisis in American history, and a challenge faced by the medical field, sociologists, policymakers, and everyday people.<\/strong><br \/>\n<iframe loading=\"lazy\" id=\"oembed-2\" title=\"The Facts on America&#39;s Opioid Epidemic\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/oHlaz0kQlRE?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<div class=\"textbox exercises\">\n<h3 class=\"title\">Medicalization of Sleeplessness<\/h3>\n<figure id=\"import-auto-id1306346\">\n<div style=\"width: 260px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/120\/2016\/04\/15204713\/Figure_19_03_01.jpg\" alt=\"A child asleep at his desk is shown here.\" width=\"250\" height=\"375\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 6.\u00a0<\/strong>Many people fail to get enough sleep. But is insomnia a disease that should be cured with medication? (Photo courtesy of Wikimedia Commons)<\/p>\n<\/div>\n<\/figure>\n<p id=\"import-auto-id2275051\">How is your \u201csleep hygiene?\u201d Sleep hygiene refers to the lifestyle and sleep habits that contribute to sleeplessness. Bad habits that can lead to sleeplessness include inconsistent bedtimes, lack of exercise, late-night employment, napping during the day, and sleep environments that include noise, lights, or screen time (National Institutes of Health, 2011a).<\/p>\n<p>According to the National Institute of Health, examining sleep hygiene is the first step in trying to solve a problem with sleeplessness.<\/p>\n<p id=\"import-auto-id2617271\">For many people in the United States, however, making changes in sleep hygiene does not seem to be enough. According to a 2006 report from the Institute of Medicine, sleeplessness is an under-recognized public health problem affecting up to 70 million people. It is interesting to note that in the months (or years) after this report was released, advertising by the pharmaceutical companies behind Ambien, Lunesta, and Sepracor (three sleep aids) averaged $188 million weekly promoting these drugs (Gellene, 2009).<\/p>\n<p id=\"import-auto-id2826508\">According to a study in the <em>American Journal of Public Health<\/em> (2011), prescriptions for sleep medications increased dramatically from 1993 to 2007. While complaints of sleeplessness during doctor\u2019s office visits more than doubled during this time, insomnia diagnoses increased more than seven-fold, from about 840,000 to 6.1 million. The authors of the study conclude that sleeplessness has been medicalized as insomnia, and that \u201cinsomnia may be a public health concern, but potential over-treatment with marginally effective, expensive medications with nontrivial side effects raises definite population health concerns\u201d (Moloney, Konrad, and Zimmer, 2011). Indeed, a study published in 2004 in the <em>Archives of Internal Medicine<\/em> shows that cognitive behavioral therapy, not medication, was the most effective sleep intervention (Jacobs, Pace-Schott, Stickgold, and Otto, 2004).<\/p>\n<p id=\"import-auto-id2266212\">A century ago, people who couldn\u2019t sleep were told to count sheep. Now they pop a pill, and all those pills add up to a very lucrative market for the pharmaceutical industry. Is this industry behind the medicalization of sleeplessness, or is it just responding to a need?<\/p>\n<\/div>\n<\/section>\n<section id=\"sh1903\" class=\"short-answer\">\n<dl id=\"fs-id4995460\" class=\"definition\"><\/dl>\n<\/section>\n<h2>Mental Health and Disabilities<\/h2>\n<h3>Mental Health<\/h3>\n<p id=\"import-auto-id2768730\">The treatment received by those defined as mentally ill or disabled varies greatly from country to country. In the post-millennial United States, those of us who have never experienced such a disadvantage take for granted the rights our society guarantees for each citizen. We do not think about the relatively recent nature of the protections, unless, of course, we know someone constantly inconvenienced by the lack of accommodations or misfortune of suddenly experiencing a temporary disability.<\/p>\n<section id=\"h31903_01\">\n<p id=\"import-auto-id1625983\">People with mental disorders (a condition that makes it more difficult to cope with everyday life) and people with mental illness (a severe, lasting mental disorder that requires long-term treatment) experience a wide range of effects.<\/p>\n<p id=\"import-auto-id1898466\">According to the National Institute of Mental Health (NIMH),\u00a0one in five adults in the U.S. live with a mental illness, numbering 46.6 million in 2017.<a class=\"footnote\" title=\"National Institute of Mental Health (2017). Retrieved from https:\/\/www.nimh.nih.gov\/health\/statistics\/mental-illness.shtml.\" id=\"return-footnote-7891-5\" href=\"#footnote-7891-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a> The most common mental disorders in the United States are <strong><span id=\"import-auto-id2431689\">anxiety disorders<\/span><\/strong>.\u00a0It is important to distinguish between occasional feelings of anxiety and a true anxiety disorder. Anxiety is a normal reaction to stress that we all feel at some point, but anxiety disorders are feelings of worry and fearfulness that last for months at a time. Anxiety disorders include obsessive compulsive disorder (OCD), panic disorders, post-traumatic stress disorder (PTSD), separation anxiety disoder,\u00a0and both social and specific phobias.\u00a0The NIMH reports that the prevalence of any anxiety disorder is higher for females than for males, estimating the prevalence at 23.4 percent and 14.3 percent, respectively. Anxiety is a prominent mental condition; one in three U.S. adults experience any anxiety disorder at some point throughout their lives.<\/p>\n<p id=\"import-auto-id1338049\">The second most common mental disorders in the United States are <strong><span id=\"import-auto-id1591282\">mood disorders<\/span><\/strong>; roughly 10 percent of U.S. adults are likely to be affected yearly, while 21 percent are likely to be affected over the course of a lifetime (National Institute of Mental Health, 2017). Major mood disorders are depression, bipolar disorder, and dysthymic disorder. Like anxiety, depression might seem like something that everyone experiences at some point, and it is true that most people feel sad or \u201cblue\u201d at times in their lives. A true depressive episode, however, is more than just feeling sad for a short period. It is a long-term, debilitating illness that usually needs treatment to cure. And bipolar disorder is characterized by dramatic shifts in energy and mood, often affecting the individual\u2019s ability to carry out day-to-day tasks. Bipolar disorder used to be called manic depression because of the way people would swing between manic and depressive episodes. As with anxiety disorders, mood disorders are more prevalent among females than among males, and over 20 percent of adults in the U.S. experience a mood disorder at some point throughout their lifetime.<\/p>\n<p>Depending on what definition is used, there is some overlap between mood disorders and <strong><span id=\"import-auto-id1885027\">personality disorders<\/span><\/strong>, which affect 9 percent of people in the United States yearly.\u00a0Unlike with other types of mental disorders, there is no significant gender difference, although 84 percent of individuals with personality disorders also had one or more other mental disorders.<\/p>\n<p>After a multilevel review of proposed revisions in the early 2010s, including reducing the number of listed personality disorders to six, the American Psychiatric Association Board of Trustees ultimately decided to retain the DSM-IV categorical approach in the new DSM-5 with the same ten personality disorders (paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, antisocial personality disorder, borderline personality disorder, histrionic personality, narcissistic personality disorder, avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder). Personality disorders represent \u201can enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it\u201d (National Institute of Mental Health). In other words, personality disorders cause people to behave in ways that are seen as abnormal and deviant to society but seem normal to them. During revisions to the DSM, there were proposals to broaden this definition, and there was heated debate over the appropriate labels and proper diagnosis for personality disorders. As you&#8217;ve learned in this module already, the label we give an illness can impact how the affected person views themself as well as how they are treated by others.<\/p>\n<div class=\"textbox exercises\">\n<h3>Link to Learning<\/h3>\n<p>Interested in seeing more statistics about mental health or specific mental disorders\/illnesses? Visit the\u00a0<a href=\"https:\/\/www.nimh.nih.gov\/health\/statistics\/index.shtml\" target=\"_blank\" rel=\"noopener\">NIMH statistics website.<\/a><\/p>\n<p>You can also watch this <a href=\"https:\/\/www.youtube.com\/watch?v=4E1JiDFxFGk\" target=\"_blank\" rel=\"noopener\">CrashCourse video covering the types of personality disorders.<\/a><\/p>\n<\/div>\n<figure id=\"import-auto-id2096801\">\n<div style=\"width: 260px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/120\/2016\/04\/15204715\/Figure_19_03_02.jpg\" alt=\"White, oval-shaped pills next to a pill bottle are shown here.\" width=\"250\" height=\"374\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 7.\u00a0<\/strong>Medication is a common option for children with ADHD. (Photo courtesy of Deviation56\/Wikimedia Commons)<\/p>\n<\/div>\n<\/figure>\n<\/section>\n<p id=\"import-auto-id2082903\">Another fairly commonly diagnosed mental disorder is Attention-Deficit\/Hyperactivity Disorder (ADHD), which statistics suggest affects 11 percent percent of children and 8 percent of adults on a lifetime basis (National Institute of Mental Health, 2017). ADHD is one of the most common childhood disorders, and it is marked by difficulty paying attention, difficulty controlling behavior, and hyperactivity. According to the American Psychological Association (APA), ADHD responds positively to stimulant drugs like Ritalin, which helps people stay focused. However, there is some social debate over whether such drugs are being over-prescribed (American Psychological Association) Consider\u00a0the opioid crisis in relation to this; do we begin over-prescribing drugs targeted at children, and perhaps <em>create<\/em> a dependency and cycle?\u00a0Some critics question whether this disorder is really as widespread as it seems, or if it is a case of over diagnosis. According to the Centers for Disease Control and Prevention, only 5 percent of children have ADHD. However, approximately 11 percent of children ages four through seventeen have been diagnosed with ADHD as of 2011.\u00a0Contrary to what is observed with many other types of mental disorders, ADHD is more prevalent among males than among females.<\/p>\n<div class=\"textbox learning-objectives\">\n<h3>Think It Over<\/h3>\n<div id=\"sh1903_01\" class=\"exercise\">\n<div id=\"fs-id2745376\" class=\"problem\">\n<ul>\n<li>Do you know anyone with a mental disorder? How does it affect his or her life?<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<h3>Autism<\/h3>\n<p>Autism Spectrum Disorders (ASD) have gained a lot of attention in recent years. The term ASD encompasses a group of developmental brain disorders that are characterized by \u201cdeficits in social interaction, verbal and nonverbal communication, and engagement in repetitive behaviors or interests\u201d (National Institute of Mental Health). Just over 1.5 percent of 8-year-old children were diagnosed as having ASD. Like with ADHD, ASD is more prevalent among boys than among girls, with boys being four times as likely to be diagnosed with ASD.<\/p>\n<div>\n<p><span style=\"color: #6c64ad;font-size: 1em;font-weight: 600\">Disability<\/span><\/p>\n<\/div>\n<section id=\"h31903_02\">\n<figure id=\"import-auto-id1931787\">\n<div style=\"width: 160px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/120\/2016\/04\/15204716\/Figure_19_03_03.jpg\" alt=\"A blue handicapped accessible sign is shown here.\" width=\"150\" height=\"300\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 8.\u00a0<\/strong>The handicapped accessible sign indicates that people with disabilities can access the facility. The Americans with Disabilities Act requires that access be provided to everyone. (Photo courtesy of Ltljltlj\/Wikimedia Commons)<\/p>\n<\/div>\n<\/figure>\n<p>The National Institute of Mental Health (NIMH) distinguishes between serious mental illness and other disorders. The key feature of serious mental illness is that it results in \u201cserious functional impairment, which substantially interferes with or limits one or more major life activities\u201d (National Institute of Mental Health). Thus, the characterization of \u201cserious\u201d refers to the <em>effect<\/em> of the illness (functional impairment), not the illness itself.<\/p>\n<p id=\"import-auto-id3607517\"><strong><span id=\"import-auto-id2339821\">Disability<\/span><\/strong> refers to a reduction in one\u2019s ability to perform everyday tasks. The World Health Organization makes a distinction between the various terms used to describe handicaps that\u2019s important to the sociological perspective. They use the term <strong><span id=\"import-auto-id1195419\">impairment<\/span><\/strong> to describe the physical limitations, while reserving the term disability to refer to the social limitation.<\/p>\n<p id=\"import-auto-id1449730\">Before the passage of the Americans with Disabilities Act (ADA) in 1990, people in the United States with disabilities were often excluded from opportunities and social institutions many of us take for granted. This occurred not only through employment and other kinds of discrimination<span style=\"color: #ff6600\">,<\/span> but also through casual acceptance by most people in the United States of a world designed for the convenience of the able-bodied. Imagine being in a wheelchair and trying to use a sidewalk without the benefit of wheelchair-accessible curbs. Imagine as a blind person trying to access information without the widespread availability of Braille. Imagine having limited motor control and being faced with a difficult-to-grasp round door handle. Issues like these are what the ADA tries to address. Ramps on sidewalks, Braille instructions, and more accessible door levers are all accommodations to help people with disabilities.<\/p>\n<p id=\"import-auto-id2329133\">People with disabilities can be stigmatized by their illnesses. <strong><span id=\"import-auto-id1735654\">Stigmatization<\/span><\/strong> means their identity is spoiled; they are labeled as different, discriminated against, and sometimes even shunned. They are labeled (as an interactionist might point out) and ascribed a master status (as a functionalist might note), becoming \u201cthe blind girl\u201d or \u201cthe boy in the wheelchair\u201d instead of someone afforded a full identity by society. This can be especially true for people who are disabled due to mental illness or disorders.<\/p>\n<p>As discussed in the section on mental health, many mental health disorders can be debilitating and can affect a person\u2019s ability to cope with everyday life as well as their social interactions. This can affect social status, housing, and especially employment. According to the Bureau of Labor Statistics (2019), people with a disability had a higher rate of unemployment than people without a disability in 2018\u20148\u00a0percent compared to\u00a03.7\u00a0percent. This unemployment rate refers only to people actively looking for a job. In fact,\u00a0four out of\u00a0five people with a disability are considered \u201cout of the labor force;\u201d that is, they do not have jobs and are not looking for them. The combination of this population and the high unemployment rate leads to an employment-population ratio of\u00a019.1 percent among those with disabilities. The employment-population ratio for people without disabilities was much higher, at 65.9\u00a0percent (U.S. Bureau of Labor Statistics, 2019).<a class=\"footnote\" title=\"U.S. Bureau of Labor Statistics (2019). Persons with a Disability: Labor Force Characteristics Summary. Retrieved from https:\/\/www.bls.gov\/news.release\/disabl.nr0.htm.\" id=\"return-footnote-7891-6\" href=\"#footnote-7891-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a><\/p>\n<div class=\"textbox exercises\">\n<h3>Obesity: The Last Acceptable Prejudice<\/h3>\n<figure>\n<div style=\"width: 260px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/120\/2016\/04\/15204718\/Figure_19_03_04.jpg\" alt=\"A large man is shown here sitting on a beach next to a young girl.\" width=\"250\" height=\"364\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 9.\u00a0<\/strong>Obesity is considered the last acceptable social stigma. (Photo courtesy of Kyle May\/flickr)<\/p>\n<\/div>\n<\/figure>\n<p id=\"import-auto-id2819349\">What is your reaction to the picture above? Compassion? Fear? Disgust? Many people will look at this picture and make negative assumptions about the man based on his weight. According to a study from the Yale Rudd Center for Food Policy and Obesity, large people are the object of \u201cwidespread negative stereotypes that overweight and obese persons are lazy, unmotivated, lacking in self-discipline, less competent, non-compliant, and sloppy\u201d (Puhl and Heuer, 2009).<\/p>\n<p id=\"import-auto-id1380880\">Historically, both in the United States and elsewhere, it was considered acceptable to discriminate against people based on prejudiced opinions. Even after slavery was abolished in 1865, the next 100 years of U.S. history saw institutionalized racism and prejudice against black people. In an example of <span id=\"import-auto-id1225828\">stereotype interchangeability<\/span>, the same insults that are flung today at the overweight and obese population (lazy, for instance), have been flung at various racial and ethnic groups in earlier history. Of course, no one gives voice to these kinds of views in public now, except when talking about obese people.<\/p>\n<p id=\"import-auto-id2745705\">Why is it considered acceptable to feel prejudice toward\u2014even to hate\u2014obese people? Puhl and Heuer suggest that these feelings stem from the perception that obesity is preventable through self-control, better diet, and more exercise. Highlighting this contention is the fact that studies have shown that people\u2019s perceptions of obesity are more positive when they think the obesity was caused by non-controllable factors like biology (a thyroid condition, for instance) or genetics.<\/p>\n<p id=\"import-auto-id2298985\">Even with some understanding of non-controllable factors that might affect obesity, obese people are still subject to stigmatization. Puhl and Heuer\u2019s study is one of many that document discrimination at work, in the media, and even in the medical profession. Obese people are less likely to get into college than thinner people, and they are less likely to succeed at work.\u00a0Recent research finds that discrimination against obese people is still pervasive in employment.<a class=\"footnote\" title=\"Stuart W. Flint, Martin \u010cadek, Sonia C. Codreanu, Vanja Ivi\u0107, Colene Zomer, Amalia Gomoiu Front Psychol. 2016.\u00a0Obesity Discrimination in the Recruitment Process: \u201cYou\u2019re Not Hired!\u201d 7: 647. Published online 2016 May 3. doi: 10.3389\/fpsyg.2016.00647\" id=\"return-footnote-7891-7\" href=\"#footnote-7891-7\" aria-label=\"Footnote 7\"><sup class=\"footnote\">[7]<\/sup><\/a><\/p>\n<p id=\"import-auto-id1363060\">Stigmatization of obese people comes in many forms, from the seemingly benign to the potentially illegal. In movies and television shows, overweight people are often portrayed negatively, or as stock characters who are the butt of jokes. One study found that in children\u2019s movies \u201cobesity was equated with negative traits (evil, unattractive, unfriendly, cruel) in 64 percent of the most popular children&#8217;s videos. In 72 percent of the videos, characters with thin bodies had desirable traits, such as kindness or happiness\u201d (Hines and Thompson, 2007). In movies and television for adults, the negative portrayal is often meant to be funny. \u201cFat suits\u201d\u2014inflatable suits that make people look obese\u2014are commonly used in a way that perpetuates negative stereotypes. Think about the way you have seen obese people portrayed in movies and on television; now think of any other subordinate group being openly denigrated in such a way\u2014it is difficult to find a parallel example.<\/p>\n<\/div>\n<\/section>\n<section id=\"sh1903\" class=\"short-answer\"><\/section>\n<div class=\"textbox learning-objectives\">\n<h3>THINK IT OVER<\/h3>\n<div id=\"sh1902_ex01\" class=\"exercise\">\n<div id=\"fs-id2332371\" class=\"problem\">\n<ul>\n<li>If social epidemiologists studied the United States in the colonial period, what differences would they find between now and then?<\/li>\n<li>What do you think are some of the contributing factors to obesity-related diseases in the United States?<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<h2><span style=\"color: #6c64ad;font-size: 1em;font-weight: 600\">U.S. Healthcare<\/span><\/h2>\n<section id=\"fs-id1586622\">\n<p id=\"import-auto-id1169033059584\">Healthcare\u00a0coverage can broadly be divided into two main categories: <strong><span id=\"import-auto-id1169033166322\">public healthcare<\/span><\/strong> (government-funded) and <strong><span id=\"import-auto-id1169033110699\">private healthcare<\/span><\/strong> (privately-funded).<\/p>\n<p>In the United States, the healthcare system is more complex than what is found in other countries\u2014there is no uniform health system nor universal healthcare coverage provided, and it is more of a hybrid system that what is found in other developed nations. In 2014, 48 percent of healthcare spending came from private funds, both from businesses and individuals, 28 percent came from the federal government, and 17 percent came from state and local governments. Political changes have also resulted in drastic policy changes regarding healthcare.<a class=\"footnote\" title=\"Department for Professional Employees. (2016) The U.S. Health Care System: An International Perspective.\u00a0Retrieved from\u00a0https:\/\/dpeaflcio.org\/programs-publications\/issue-fact-sheets\/the-u-s-health-care-system-an-international-perspective\/.\" id=\"return-footnote-7891-8\" href=\"#footnote-7891-8\" aria-label=\"Footnote 8\"><sup class=\"footnote\">[8]<\/sup><\/a><\/p>\n<p id=\"import-auto-id1169033140349\">The two main public, government\u00a0funded healthcare programs are Medicare, which provides health services to people over sixty-five years old as well as people who meet certain standards for disability, and Medicaid, which provides services to people with very low incomes who meet other eligibility requirements. Other government-funded programs include service agencies focused on Native Americans (the Indian Health Service), Veterans (the Veterans Health Administration), and children (the Children\u2019s Health Insurance Program).<\/p>\n<p id=\"import-auto-id1169033102683\">The most recent U.S. census\u00a0(2011) divides private insurance into employment-based insurance and direct-purchase insurance. Employment-based insurance is health plan coverage that is provided in whole or in part by an employer or union; it can cover just the employee, or the employee and their\u00a0family. Direct purchase insurance is coverage that an individual buys directly from a private company.<\/p>\n<p id=\"import-auto-id1169033126124\">With all these insurance options, ranging from government-provided to employee-provided and individual-provided,\u00a0insurance coverage must be almost universal, right? Unfortunately, the U.S. Census Current Population Survey of 2013 showed that 18 percent of people in the United States had\u00a0no health insurance at all. Equally alarming, a study by the Commonwealth Fund showed that in 2010, 81 million adults were either uninsured or <strong><span id=\"import-auto-id1169033166084\">under-insured<\/span><\/strong>; that is, people who pay at least 10 percent of their income on healthcare costs not covered by insurance or, for low-income adults, those whose medical expenses or deductibles are at least 5 percent of their income (Schoen, Doty, Robertson, and Collins, 2011). The Commonwealth study further reported that while under-insurance had historically been an issue that low-income families faced, today it is affecting middle-income families more and more.<\/p>\n<div style=\"width: 260px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/120\/2016\/04\/15204707\/Figure_19_04_01.jpg\" alt=\"A group of protesters holding signs protesting federal health care changes are shown here. Some signs reads, &quot;Obama! Get your hands off my healthcare it's unconstitutional!&quot;, and &quot;Stop spending stop tyranny&quot;.\" width=\"250\" height=\"375\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 10.\u00a0<\/strong>Some\u00a0in the United States worry that governmental oversight of healthcare represents a federal overstepping of constitutional guarantees of individual freedom. Others welcome a program that they believe will make healthcare accessible and affordable to everyone. (Photo courtesy of Fibonacci Blue\/flickr)<\/p>\n<\/div>\n<p id=\"import-auto-id1169033158696\">Why were\u00a0so many people uninsured or under-insured? Skyrocketing healthcare costs were\u00a0part of the issue. Many people cannot afford private health insurance, but their income level is not low enough to meet eligibility standards for government supported insurance. Further, even for those who are eligible for Medicaid, the program is less than perfect. Many physicians refuse to accept Medicaid patients, citing low payments and extensive paperwork (Washington University Center for Health Policy, n.d.).<\/p>\n<p>Healthcare in the United States looks different today than it did just a few years ago\u2014a result of changes in policy, such as the Affordable Care Act (PPACA or ACA or &#8220;Obamacare&#8221;).\u00a0You&#8217;ve probably heard of Obamacare at some point\u2014but what did it seek to do? Obamacare\u00a0expanded\u00a0eligibility to programs like Medicaid and CHIP, helped guarantee insurance coverage for people with preexisting conditions, and established regulations to make sure that the premium funds collected by insurers and care providers go directly to medical care. It also included an <strong><span id=\"import-auto-id1169033166370\">individual mandate<\/span><\/strong>, which required everyone to have insurance coverage by 2014 or pay a penalty in their taxes. A series of provisions, including significant subsidies, were\u00a0intended to address the discrepancies in income that are currently contributing to high rates of uninsurance and under-insurance.<\/p>\n<p>While the program has been controversial and something of a flashpoint for strongly partisan politics, in 2012 the U.S. Supreme Court upheld the constitutionality of the PPACA&#8217;s individual mandate. According to Blumenthal (2014), by 2014,\u00a020 million people in the United States had gained health insurance under PPACA. This lowered the number of uninsured people to 13 percent.\u00a0Three years later, by 2017, healthcare reform had lowered the number of uninsured people to the lowest it has ever been in the United States.\u00a0In 2017, less than 9 percent of the population was uninsured at some point during the year<a class=\"footnote\" title=\"Berchick, Edward R. and Emily Hood and Jessica C. Barnett. (2018)\u00a0Health Insurance Coverage in the United States: 2017.\u00a0Retrieved from https:\/\/www.census.gov\/library\/publications\/2018\/demo\/p60-264.html.\" id=\"return-footnote-7891-9\" href=\"#footnote-7891-9\" aria-label=\"Footnote 9\"><sup class=\"footnote\">[9]<\/sup><\/a>\u2014a drastic drop relative to the alarming 18 percent in the early 2010s. Over half of the population was insured by an employer, over one third was covered by government-funded programs, and the rest were either covered by direct-purchase or by military funding.<\/p>\n<figure id=\"import-auto-id1169033102735\"><\/figure>\n<p id=\"import-auto-id1169033126051\">The PPACA remains contentious and at the forefront of political debates. The Supreme Court ruled in the case of <em>National Federation of Independent Businesses v. Sebelius<\/em> in 2012, that states cannot be forced to participate in the PPACA&#8217;s Medicaid expansion. This ruling has opened the door to challenges to the PPACA in Congress and the Federal courts, in\u00a0some state governments,\u00a0and among conservative groups and independent businesses.<\/p>\n<\/section>\n<p style=\"text-align: center\"><strong>Still confused about the healthcare system in the United States? Watch this video for clarification:<\/strong><br \/>\n<iframe loading=\"lazy\" id=\"oembed-3\" title=\"US Healthcare System Explained\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/DublqkOSBBA?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<section class=\"short-answer\">\n<div class=\"textbox learning-objectives\">\n<h3>Think It Over<\/h3>\n<div id=\"fs-id1806480\" class=\"exercise\">\n<div id=\"fs-id1755079\" class=\"problem\">\n<ul>\n<li>What do you think are the best and worst parts of the PPACA? Why?<\/li>\n<li>Compare and contrast the healthcare system of the United States with the WHO\u2019s Sustainable Development Goals<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"textbox key-takeaways\">\n<h3>Coronavirus disease (COVID-19): A 21st Century global pandemic<\/h3>\n<p>COVID-19 is the infectious disease caused by the most recently discovered coronavirus (SARS-CoV-2). The virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. However, by February 2020, COVID-19 was declared a pandemic after rapidly spreading across countries in Europe, Asia, and the United States of America. The virus, which was not previously identified in humans, causes mild symptoms including dry cough, tiredness and fever. The World Health Organization (WHO) has reported that although most people recover from the disease without needing special treatment, about 1 out of every 6 people who gets COVID-19 becomes seriously ill and has difficulty breathing. At the end of June 2020, the number of confirmed cases, globally, was 10 million with roughly 500,000 deaths. According to the Centers for Disease Control and Prevention, by the end of June 2020 there were approximately 125,000 deaths due to coronavirus disease in the United States alone.<\/p>\n<h4>COVID-19 and Health Disparities in the U.S.<\/h4>\n<p>As mentioned earlier in this module,\u00a0some people are more likely to experience severe illness during public health emergencies depending on age, race, socioeconomic status, and other variables. Hence, while the public at large is at risk of being infected by the coronavirus, early reports reveal that severe illness and death rates tend to be higher for older adults and racialized populations. Furthermore, other than access to care, several factors can explain differences in health outcomes across demographic groups. Physical and social living conditions, the need to work (many in healthcare settings which increase exposure to infection), access to healthy food options, and other social determinants of health particularly predispose individuals to pandemic infection. Not surprisingly, the pandemic has exposed longstanding structural inequalities in U.S. society that are deeply entrenched in how health care has been imagined and practiced throughout the nation&#8217;s history.<\/p>\n<p>The data confirm that record-breaking number of cases and deaths due to COVID-19\u00a0are disproportionately evident among racialized populations in the U.S. As of June 2020, a joint project of <a href=\"https:\/\/www.bu.edu\/antiracist-center\/\" target=\"_blank\" rel=\"noopener\">the Antiracist Research and Policy Center<\/a> and <a href=\"https:\/\/covidtracking.com\/race\/dashboard\" target=\"_blank\" rel=\"noopener\">the COVID Tracking Project<\/a> report the following findings, of the known cases where race was identified:<\/p>\n<ul class=\"edTag\">\n<li>Nationally, African-American deaths from COVID-19 are nearly two times greater than would be expected based on their share of the population. In four states, the rate is three or more times greater.<\/li>\n<li>In 42 states plus Washington D.C., Hispanics\/Latinos make up a greater share of confirmed cases than their share of the population. In eight states, it&#8217;s more than four times greater.<\/li>\n<li>White deaths from COVID-19 are lower than their share of the population in 37 states and the District of Columbia.<\/li>\n<\/ul>\n<\/div>\n<div class=\"textbox exercises\">\n<h3>further research<\/h3>\n<ul>\n<li>Read a brief discussion about how the COVID-19 pandemic illuminates the effect of <a href=\"https:\/\/www.statnews.com\/2020\/06\/09\/systemic-racism-black-health-disparities\/\" target=\"_blank\" rel=\"noopener\">systemic racism on health care in the U.S.<\/a><\/li>\n<li>Consult <a href=\"https:\/\/covid19.who.int\/\" target=\"_blank\" rel=\"noopener\">the World Health Organization&#8217;s COVID-19 Dashboard<\/a> for current global data on the pandemic.<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"textbox key-takeaways\">\n<h3>Glossary<\/h3>\n<div class=\"titlepage\">\n<dl>\n<dt>anxiety disorders:<\/dt>\n<dd>feelings of worry and fearfulness that last for months at a time<\/dd>\n<dt>disability:<\/dt>\n<dd>a reduction in one\u2019s ability to perform everyday tasks; the World Health Organization notes that this is a social limitation<\/dd>\n<dt>epidemiology:<\/dt>\n<dd>the study of the incidence, distribution, and possible control of diseases<\/dd>\n<dt>impairment:<\/dt>\n<dd>the physical limitations a less-able person faces<\/dd>\n<dt>individual mandate:<\/dt>\n<dd>a government rule that requires everyone to have insurance coverage or they will have to pay a penalty<\/dd>\n<dt>medicalization:<\/dt>\n<dd>the process by which aspects of life that were considered bad or deviant are redefined as sickness and needing medical attention to remedy<\/dd>\n<dt>mood disorders:<\/dt>\n<dd>long-term, debilitating illnesses like depression and bipolar disorder<\/dd>\n<dt>morbidity:<\/dt>\n<dd>the incidence of disease<\/dd>\n<dt>mortality:<\/dt>\n<dd>the number of deaths in a given time or place<\/dd>\n<dt>personality disorders:<\/dt>\n<dd>disorders that cause people to behave in ways that are seen as abnormal to society but seem normal to them<\/dd>\n<dt>private healthcare:<\/dt>\n<dd>health insurance that a person buys from a private company; private healthcare can either be employer-sponsored or direct-purchase<\/dd>\n<dt>public healthcare:<\/dt>\n<dd>health insurance that is funded or provided by the government<\/dd>\n<dt>social epidemiology:<\/dt>\n<dd>the study of the causes and distribution of diseases<\/dd>\n<dt>socialized medicine:<\/dt>\n<dd>when the government owns and runs the entire healthcare system<\/dd>\n<dt>stigmatization:<\/dt>\n<dd>the act of spoiling someone&#8217;s identity; they are labeled as different, discriminated against, and sometimes even shunned due to an illness or disability<\/dd>\n<dt>underinsured:<\/dt>\n<dd>people who spend at least 10 percent of their income on healthcare costs that are not covered by insurance<\/dd>\n<dt>universal healthcare:<\/dt>\n<dd>a system that guarantees healthcare coverage for everyone<\/dd>\n<\/dl>\n<\/div>\n<\/div>\n<\/section>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-7891\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Introduction to Health in the United States and Abroad. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Florencia Silveira for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Health and Medicine. <strong>Authored by<\/strong>: OpenStax CNX. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/cnx.org\/contents\/AgQDEnLI@10.1:X5DRDy9q@3\/Introduction-to-Health-and-Medicine\">https:\/\/cnx.org\/contents\/AgQDEnLI@10.1:X5DRDy9q@3\/Introduction-to-Health-and-Medicine<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em>. <strong>License Terms<\/strong>: Download for free at http:\/\/cnx.org\/contents\/02040312-72c8-441e-a685-20e9333f3e1d@3.49<\/li><li>World Diabetes Day. <strong>Authored by<\/strong>: Gia Willow Alexa Annermarken. <strong>Provided by<\/strong>: Flickr. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.flickr.com\/photos\/oskarannermarken\/6347508912\/in\/photostream\/\">https:\/\/www.flickr.com\/photos\/oskarannermarken\/6347508912\/in\/photostream\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>2015u201316 Zika virus epidemic. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/2015%E2%80%9316_Zika_virus_epidemic\">https:\/\/en.wikipedia.org\/wiki\/2015%E2%80%9316_Zika_virus_epidemic<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Dying at the Hospital Door: Ebola Virus Outbreak . <strong>Provided by<\/strong>: The New York Times. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=xUBpoyKxArU\">https:\/\/www.youtube.com\/watch?v=xUBpoyKxArU<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>Population Health: Crash Course Sociology #43. <strong>Provided by<\/strong>: CrashCourse. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=D9SWRByzDSo&#038;list=PL8dPuuaLjXtMJ-AfB_7J1538YKWkZAnGA&#038;index=44\">https:\/\/www.youtube.com\/watch?v=D9SWRByzDSo&#038;list=PL8dPuuaLjXtMJ-AfB_7J1538YKWkZAnGA&#038;index=44<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><li>Animated Map of Zika&#039;s Spread. <strong>Provided by<\/strong>:  Business Insider. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=rLOWl8lyr6M\">https:\/\/www.youtube.com\/watch?v=rLOWl8lyr6M<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><li>Exhibit 1 Life Expectancy At Birth, By Years Of Education At Age 25, By Race And Sex, 2008. <strong>Authored by<\/strong>: S. Jay Olshansky, Toni Antonucci, Lisa Berkman, Robert H. Binstock, Axel Boersch-Supan, John T. Cacioppo, Bruce A. Carnes, Laura L. Carstensen, Linda P. Fried, Dana P. Goldman, James Jackson, Martin Kohli, John Rother, Yuhui Zheng, and John Rowe. <strong>Provided by<\/strong>: Health Affairs. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.healthaffairs.org\/doi\/full\/10.1377\/hlthaff.2011.0746\">https:\/\/www.healthaffairs.org\/doi\/full\/10.1377\/hlthaff.2011.0746<\/a>. <strong>License<\/strong>: <em>All Rights Reserved<\/em><\/li><li>Graphs on the Opioid Epidemic. <strong>Authored by<\/strong>: Dan Nolan and Chris Amico. <strong>Provided by<\/strong>: Frontline. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.pbs.org\/wgbh\/frontline\/article\/how-bad-is-the-opioid-epidemic\/\">https:\/\/www.pbs.org\/wgbh\/frontline\/article\/how-bad-is-the-opioid-epidemic\/<\/a>. <strong>License<\/strong>: <em>All Rights Reserved<\/em><\/li><li>US Healthcare System Explained. <strong>Provided by<\/strong>: The Infographics Show. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?time_continue=3&#038;v=DublqkOSBBA\">https:\/\/www.youtube.com\/watch?time_continue=3&#038;v=DublqkOSBBA<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-7891-1\">National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States; Baciu A, Negussie Y, Geller A, et al., editors. Communities in Action: Pathways to Health Equity. Washington (DC): National Academies Press (US); 2017 Jan 11. 2, The State of Health Disparities in the United States. Available from: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK425844\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK425844\/<\/a> <a href=\"#return-footnote-7891-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-7891-2\">Lariscy, Joseph T., Robert A. Hummer, and Mark D. Hayward. 2015. \u201cHispanic Older Adult Mortality in the United States: New Estimates and an Assessment of Factors Shaping the Hispanic Paradox.\u201d Demography 52(2015):1-14. <a href=\"#return-footnote-7891-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-7891-3\">Nolan, Dan and Chris Amico (February 2016). <em>How Bad is the Opioid Epidemic?<\/em> Frontline. Retrieved from\u00a0<a href=\"https:\/\/www.pbs.org\/wgbh\/frontline\/article\/how-bad-is-the-opioid-epidemic\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.pbs.org\/wgbh\/frontline\/article\/how-bad-is-the-opioid-epidemic\/<\/a>. <a href=\"#return-footnote-7891-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-7891-4\">Bursztynsky, Jessica (January 2019). <em>Americans more likely to die from opioid overdose today than car accident<\/em>. CNBC. Retrieved from<a href=\"https:\/\/www.cnbc.com\/2019\/01\/15\/americans-more-likely-to-die-from-opioid-overdose-than-car-accident.html\" target=\"_blank\" rel=\"noopener\">\u00a0https:\/\/www.cnbc.com\/2019\/01\/15\/americans-more-likely-to-die-from-opioid-overdose-than-car-accident.html<\/a>\r\n <a href=\"#return-footnote-7891-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-7891-5\">National Institute of Mental Health (2017). Retrieved from <a href=\"https:\/\/www.nimh.nih.gov\/health\/statistics\/mental-illness.shtml\" target=\"_blank\" rel=\"noopener\">https:\/\/www.nimh.nih.gov\/health\/statistics\/mental-illness.shtml<\/a>. <a href=\"#return-footnote-7891-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-7891-6\">U.S. Bureau of Labor Statistics (2019). <em>Persons with a Disability: Labor Force Characteristics Summary<\/em>. Retrieved from <a href=\"https:\/\/www.bls.gov\/news.release\/disabl.nr0.htm\" target=\"_blank\" rel=\"noopener\">https:\/\/www.bls.gov\/news.release\/disabl.nr0.htm<\/a>. <a href=\"#return-footnote-7891-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><li id=\"footnote-7891-7\">Stuart W. Flint, Martin \u010cadek, Sonia C. Codreanu, Vanja Ivi\u0107, Colene Zomer, Amalia Gomoiu Front Psychol. 2016.\u00a0<em>Obesity Discrimination in the Recruitment Process: \u201cYou\u2019re Not Hired!\u201d<\/em> 7: 647. Published online 2016 May 3. doi: 10.3389\/fpsyg.2016.00647 <a href=\"#return-footnote-7891-7\" class=\"return-footnote\" aria-label=\"Return to footnote 7\">&crarr;<\/a><\/li><li id=\"footnote-7891-8\">Department for Professional Employees. (2016) <em>The U.S. Health Care System: An International Perspective.\u00a0<\/em>Retrieved from\u00a0<a href=\"https:\/\/dpeaflcio.org\/programs-publications\/issue-fact-sheets\/the-u-s-health-care-system-an-international-perspective\/\" target=\"_blank\" rel=\"noopener\">https:\/\/dpeaflcio.org\/programs-publications\/issue-fact-sheets\/the-u-s-health-care-system-an-international-perspective\/<\/a>. <a href=\"#return-footnote-7891-8\" class=\"return-footnote\" aria-label=\"Return to footnote 8\">&crarr;<\/a><\/li><li id=\"footnote-7891-9\">Berchick, Edward R. and Emily Hood and Jessica C. Barnett. (2018)\u00a0<em>Health Insurance Coverage in the United States: 2017.<\/em>\u00a0Retrieved from <a href=\"https:\/\/www.census.gov\/library\/publications\/2018\/demo\/p60-264.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.census.gov\/library\/publications\/2018\/demo\/p60-264.html<\/a>. <a href=\"#return-footnote-7891-9\" class=\"return-footnote\" aria-label=\"Return to footnote 9\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":9,"template":"","meta":{"_candela_citation":"[{\"type\":\"original\",\"description\":\"Introduction to Health in the United States and Abroad\",\"author\":\"\",\"organization\":\"Lumen Learning\",\"url\":\"\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Health and Medicine\",\"author\":\"OpenStax CNX\",\"organization\":\"\",\"url\":\"https:\/\/cnx.org\/contents\/AgQDEnLI@10.1:X5DRDy9q@3\/Introduction-to-Health-and-Medicine\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"Download for free at http:\/\/cnx.org\/contents\/02040312-72c8-441e-a685-20e9333f3e1d@3.49\"},{\"type\":\"cc\",\"description\":\"World Diabetes Day\",\"author\":\"Gia Willow Alexa Annermarken\",\"organization\":\"Flickr\",\"url\":\"https:\/\/www.flickr.com\/photos\/oskarannermarken\/6347508912\/in\/photostream\/\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"original\",\"description\":\"Modification, adaptation, and original content\",\"author\":\"Florencia Silveira for Lumen Learning\",\"organization\":\"Lumen Learning\",\"url\":\"\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"copyrighted_video\",\"description\":\"Population Health: Crash Course Sociology #43\",\"author\":\"\",\"organization\":\"CrashCourse\",\"url\":\"https:\/\/www.youtube.com\/watch?v=D9SWRByzDSo&list=PL8dPuuaLjXtMJ-AfB_7J1538YKWkZAnGA&index=44\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"},{\"type\":\"cc\",\"description\":\"2015u201316 Zika virus epidemic\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/2015%E2%80%9316_Zika_virus_epidemic\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"copyrighted_video\",\"description\":\"Animated Map of Zika\\'s Spread\",\"author\":\"\",\"organization\":\" Business Insider\",\"url\":\"https:\/\/www.youtube.com\/watch?v=rLOWl8lyr6M\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"},{\"type\":\"cc\",\"description\":\"Dying at the Hospital Door: Ebola Virus Outbreak \",\"author\":\"\",\"organization\":\"The New York Times\",\"url\":\"https:\/\/www.youtube.com\/watch?v=xUBpoyKxArU\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"},{\"type\":\"copyrighted_video\",\"description\":\"Exhibit 1 Life Expectancy At Birth, By Years Of Education At Age 25, By Race And Sex, 2008\",\"author\":\"S. Jay Olshansky, Toni Antonucci, Lisa Berkman, Robert H. Binstock, Axel Boersch-Supan, John T. Cacioppo, Bruce A. Carnes, Laura L. Carstensen, Linda P. Fried, Dana P. Goldman, James Jackson, Martin Kohli, John Rother, Yuhui Zheng, and John Rowe\",\"organization\":\"Health Affairs\",\"url\":\"https:\/\/www.healthaffairs.org\/doi\/full\/10.1377\/hlthaff.2011.0746\",\"project\":\"\",\"license\":\"arr\",\"license_terms\":\"\"},{\"type\":\"copyrighted_video\",\"description\":\"Graphs on the Opioid Epidemic\",\"author\":\"Dan Nolan and Chris Amico\",\"organization\":\"Frontline\",\"url\":\"https:\/\/www.pbs.org\/wgbh\/frontline\/article\/how-bad-is-the-opioid-epidemic\/\",\"project\":\"\",\"license\":\"arr\",\"license_terms\":\"\"},{\"type\":\"copyrighted_video\",\"description\":\"US Healthcare System Explained\",\"author\":\"\",\"organization\":\"The Infographics Show\",\"url\":\"https:\/\/www.youtube.com\/watch?time_continue=3&v=DublqkOSBBA\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"}]","CANDELA_OUTCOMES_GUID":"43b48e2b-ef91-4f88-ba1e-d3d54c548cb7","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-7891","chapter","type-chapter","status-publish","hentry"],"part":7899,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/suny-esc-introtosociology\/wp-json\/pressbooks\/v2\/chapters\/7891","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/suny-esc-introtosociology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/suny-esc-introtosociology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-esc-introtosociology\/wp-json\/wp\/v2\/users\/29"}],"version-history":[{"count":36,"href":"https:\/\/courses.lumenlearning.com\/suny-esc-introtosociology\/wp-json\/pressbooks\/v2\/chapters\/7891\/revisions"}],"predecessor-version":[{"id":9102,"href":"https:\/\/courses.lumenlearning.com\/suny-esc-introtosociology\/wp-json\/pressbooks\/v2\/chapters\/7891\/revisions\/9102"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/suny-esc-introtosociology\/wp-json\/pressbooks\/v2\/parts\/7899"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/suny-esc-introtosociology\/wp-json\/pressbooks\/v2\/chapters\/7891\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/suny-esc-introtosociology\/wp-json\/wp\/v2\/media?parent=7891"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-esc-introtosociology\/wp-json\/pressbooks\/v2\/chapter-type?post=7891"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-esc-introtosociology\/wp-json\/wp\/v2\/contributor?post=7891"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-esc-introtosociology\/wp-json\/wp\/v2\/license?post=7891"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}