SO 215 Health and Society

Boston University

Summer 2020

Class Meetings: Monday, Wednesday 9:00-12:30 pm via Zoom, details below and on Blackboard
Class page: BU Blackboard
Professor: Alya Guseva
Office Hours: By appointment via Zoom
E-mail: aguseva@bu.edu

We are in the midst of an unprecedented pandemic with no end in sight, and no clarity of what our
lives are going to be like in the next few months. COVID-19 laid bare the structural problems at the
heart of the US healthcare system. Consider this: US is the only developed industrialized country that
does not guarantee access to healthcare as a basic human or citizen right; even after the passage of the
2010 Obamacare law, about 30 million people were left without health insurance. In the past two
months, 40 million Americans filed for unemployment, and since the vast majority of Americans
receive health insurance through their employment, lost jobs in many cases mean lost access to
healthcare, a devastating reality in any context, but particularly in the midst of a pandemic. Another
example: since American hospitals are typically paid based on volume of care they provide, and the
most revenue is generated from elective procedures, COVID-related closings are forcing some
hospitals, particularly smaller and rural ones, to furlough their staff to shut their doors permanently.
And one more: disproportionate toll of coronavirus on nursing homes and communities of color and
low-income communities brought into focal point the challenges of providing elderly care on the one
hand, and the role that social and economic inequality plays in disease patterns on the other. On top of
these problems, the US annual healthcare bill recently surpassed 3 trillion dollars; that’s a whopping
17.6% of our country’s Gross Domestic Product (GDP), the largest share of any national economy in the
world! Yet, we rank 31st in the world by life expectancy, 33 rd by maternal and 30th by infant mortality,
the worst among the developed world. This numbers place the US healthcare system in a category of
its own – unaffordable, inefficient and inequitable.

In the process of examining the healthcare system, we will pay special attention to the roles and
interests of all the healthcare players: doctors, nurses and others health care providers, hospitals and
other medical settings, insurance and pharmaceutical companies, the government and its various
agencies and, finally, the patients. We will also learn about the ways that other nations provide and
pay for their citizens’ health needs, and consider which of those approaches are “good ideas” and
could be used as blueprints to further the reforms.

In addition to this major topic, we will also look at other related issues. For instance, we will:
 discover that illness and good health – life chances -- are distributed very unequally across
different social groups (race, class, ethnicity, or even neighborhoods), and discuss why this
is so, and what are the consequences;
  analyze the medicalization phenomenon – a powerful trend of supplying medical
explanations for behaviors and states that were previously viewed as normal or explained in
terms of social deviance, and enlisting medical technology to treat them;
 characterize medical professional authority and the role it plays in shaping interactions
between doctors and patients, and address the kind of care that is provided by other health
providers, such as chiropractors, midwives and pharmacists;
 examine care provided in various healthcare settings: hospitals, ICUs, nursing homes and
hospices, focusing specifically on long-term care and end-of-life care options.

While the course is essential for those of you planning future careers in healthcare-related fields, at the
very least it should also help each of you (current and future patients!) to make sense of the incredibly
complex healthcare system that we currently have in the U.S.

The class will take place on Zoom, here are the details about the first meeting, after which you should
go to the same link:

When: May 20, 2020 09:00 AM Eastern Time (US and Canada)

Register in advance for this meeting: TBA

After registering, you will receive a confirmation email containing information about joining the
meeting.

BU HUB CAPACITIES:

This course fulfills the BU HUB CAPACITIES Social Inquiry I and Ethical Reasoning.

Students will learn how individuals are embedded within broader groups, categories, and communities
and understand how these larger social structures and forces constrain behavior and ultimately affect
our health. Through lecture, discussion, exams, and assignments, students will identify and apply major
concepts related to the delivery and financing of healthcare, including power differences between
different medical providers and payers, the history of healthcare reform in the US, social determinants
of health and the social construction of illness (Social Inquiry I).

Through lecture, discussion, exams, current health news postings and assignments, students will learn
to grapple with and make judgments on ethical questions related to health and healthcare, and
demonstrate the ability to reflect on ethical responsibilities faced by individuals, organizations,
societies, and/or governments in the field of health and healthcare (Ethical Reasoning).

COURSE MATERIALS:

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 Rose Weitz, Sociology of Health, Illness and Health Care, 8th edition (Belmont, CA:
Wadsworth/Thomson Learning, 2012). It was ordered through BU Barnes and Noble, can be rented
from the publisher on-line https://www.vitalsource.com/products/the-sociology-of-health-illness-
and-health-care-rose-weitz-v9781337025997
or from Amazon https://www.amazon.com/Sociology-Health-Illness-Care-Critical-ebook-dp-
B07PD1W5XK/dp/B07PD1W5XK/ref=mt_kindle?_encoding=UTF8&me=&qid=
Earlier editions will NOT work.
 The rest of the assigned readings can be found on BU Blackboard class site.
 Blackboard will also be the place where you take your Exams, submit your Assignments, check your
grades, access Slack for posting and discussing, and Zoom for class meetings.

GRADING:

Your grade for the class will be calculated the following way:
 Midterm -- 30%
 Final -- 35%
 Two assignments – 10% each
 Minimum two “substantive” posts on the class Slack channel, responses to other posts will
count towards participation– 5% each
 Attendance and participation – 5%

Letter grades will follow the following scale:

93-100 % A
90-92% A-
87-89% B+
83-86% B
80-82% B-
77-79% C+
73-76% C
70-72% C-
60-69 D
>60 F

IMPORTANT COURSE DATES:

June 10 – MIDTERM (via Blackboard)

June 13 – HEALTH POLICY ASSIGNMENT IS DUE (NOON), submitted via Blackboard
June 27 – MEDICALIZATION ASSIGNMENT IS DUE (NOON), submit via Blackboard
July 1 – FINAL (via Blackboard)

CLASS POLICIES:
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  All class-related information is posted on the class Blackboard page. This is where you will find
the syllabus and the readings beyond those that are linked in the syllabus; Zoom links to our
class meetings; Slack tab to make your post and read others; the place to submit your
Assignments and take Exams. Check Announcements for up to date reminders and alerts. I
expect you to participate remotely in all class meetings. I record attendance, and I evaluate
your participation.
 Assigned readings have to be read BEFORE the class for which they are assigned.
 For the purpose of exam prep, students are responsible for ALL the material presented in the
readings, videos and lectures.
 The exams contribute 65% towards your class grade, and there is NO possibility to earn extra
credit in this class, so pace yourselves well: read assigned materials before each class meeting
and come prepared and ready to engage. Summer term goes by very quickly.

ACADEMIC CONDUCT:

Students must familiarize themselves with the Academic Conduct Code, which can be accessed at
https://www.bu.edu/cas/current-students/undergraduate/academic-conduct-code-2/ As it is defined
in the Academic Conduct Code, “Academic misconduct is conduct by which a student misrepresents his
or her academic accomplishments, or impedes other students’ opportunities of being judged fairly for
their academic work. Knowingly allowing others to represent your work as their own is as serious an
offense as submitting another’s work as your own.” Academic misconduct includes, cheating on
examinations, submitting the same paper to more than one class without obtaining consent of all the
instructors, knowingly allowing another student to represent your work as his or her own and
plagiarizing. Plagiarism comprises of “representing the work of another as one’s own. Plagiarism
includes but is not limited to the following: copying the answers of another student on an examination,
copying or restating the work or ideas of another person or persons in any oral or written work
(printed or electronic) without citing the appropriate source, and collaborating with someone else in
an academic endeavor without acknowledging his or her contribution. Plagiarism can consist of acts of
commission-appropriating the words or ideas of another-or omission failing to
acknowledge/document/credit the source or creator of words or ideas (see below for a detailed
definition of plagiarism).” It also includes failure to properly credit the contribution of another person
to the work you submit. I am required to report cases of suspected academic misconduct to the Dean’s
office. Penalties for violations of the Academic Conduct Code may include suspension or expulsion
from the University.

TENTATIVE CLASS SCHEDULE:

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Wednesday, May 20. Introduction to the Class

Wednesday, May 27. US Healthcare System.

READ:

 Chapter 8 in Weitz

 COVID-19 Focus: We knew coronavirus was coming, yet we failed.

Monday, June 1. History of Healthcare Reform in the US

READ:

 David Rothman, “A Century of Failure: Health Care Reform in America.”

 Jill Quadagno, “Why the United States Has No National Health Insurance: Stakeholder
Mobilization against the Welfare State, 1945-1996.”

 Covid-19 Focus: America’s Extreme Neoliberal Healthcare System is Putting the Country at Risk

Wednesday, June 3. Money and Profits in the Healthcare System

AT HOME LISTEN TO:

 “More is Less” on This American Life (about 1 hour)

http://www.thisamericanlife.org/Radio_Episode.aspx?episode=391

 “Paying till It Hurts”

http://www.npr.org/2013/08/07/209585018/paying-till-it-hurts-why-american-health-care-is-
so-pricey

READ:

 Atul Gawande, “The Cost Conundrum”

http://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum

 Atul Gawande, “Overkill” http://www.newyorker.com/magazine/2015/05/11/overkill-atul-

gawande

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  Guseva, Alya. 2013. “Commercialism in Healthcare,” in the Wiley-Blackwell Encyclopedia of
Health, Illness, Behavior, and Society, ed. by W. Cockerham, R. Dingwall and S. Quah.

 Guseva, Alya. 2013. “Consumerism in Healthcare,” in the Wiley-Blackwell Encyclopedia of

Health, Illness, Behavior, and Society, ed. by W. Cockerham, R. Dingwall and S. Quah.

 COVID-19 Focus: Hospitals Knew how to Make Money, then Coronavirus Happened

Primary care is being devastated by COVID. It must be saved.

Monday, June 8. Comparative Healthcare Systems.

READ:

 Chapter 9 in Weitz (up to pp. 210, only Germany, UK and Canada)

 Watch Sick around the World https://www.pbs.org/wgbh/frontline/film/sickaroundtheworld/

 How does the US healthcare compare with other countries?

 The Best Health Care System in the World: Which One Would You Pick?

 COVID-19 Focus: The Stark Differences in Countries’ Coronavirus Deaths, Explained

Wednesday, June 10 -- MIDTERM (1 hour 15 min)

IN THE REMAINING TIME WATCH: https://bu.kanopy.com/video/sickness-and-wealth

Healthcare Assignment DUE Saturday, June 13, at noon (submit through Blackboard)

Monday, June 15. Social Determinants of Health

READ:

 Chapter 3 in Weitz until p. 52

 Jo C. Phelan, Bruce G. Link and Parisa Tehranifar. 2010. “Social Conditions as Fundamental
Causes of Health Inequalities: Theory, Evidence, and Policy Implications.”

 COVID-19 Focus: Class and Covid: How the Less Affluent Face Double Risks

Wednesday, June 17. Social Determinants of Health (cont.)

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 READ:

 Chapter 3 in Weitz the rest

 David R. Williams and Michelle Sternthal. 2010. “Understanding Racial-ethnic Disparities in

Health: Sociological Contributions”

 Nothing Protects Black Women from Dying in Pregnancy and Childbirth

 COVID-19 Focus: “A Terrible Price”: The Deadly Racial Disparities of Covid-19 in America
 Can Estrogen and Other Sex Hormones Help Men Survive?

Monday, June 22. Social Construction of Illness. Medicalization.

READ:

 Chapter 5 in Weitz.

 Peter Conrad, The Medicalization of Society, Chapter 7 “The Shifting Engines of Medicalization,”
Chapter 8 “Medicalization and its Discontents”

 “Generation Adderall”
https://www.nytimes.com/2016/10/16/magazine/generation-adderall-addiction.html?_r=0

 COVID-19: Focus: “Straight-Up Fire” in His Veins: Teen Battles New Covid Syndrome

Wednesday, June 24. Profession of Medicine. Medical Professional Training. Other healthcare
providers

READ:

 Chapter 11 in Weitz.

 Chapter 12 in Weitz

 COVID-19 Focus: Trauma on the Pandemic’s Front Line Leaves Workers Reeling

Medicalization Assignment is DUE June 27, Saturday, at noon (submit through Blackboard)

Monday, June 29 Health Care Settings. Long-term and End-of-life Care.

READ:

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  Chapter 10 in Weitz.

 Building better nursing homes

 COVID-19 Focus: As COVID Ravages Nursing Homes, a New Push for Better Senior Housing

IN YOU WANT TO LEARN MORE ABOUT PAYING FOR LONGTERM CARE: “Live Long and Pay for It:
America's Real Long-Term Cost Crisis”

Wednesday, July 1
No class meeting. Final exam

ASSIGNMENTS

Healthcare Reform Assignment (600-800 words)

Think back to all we learned about the problems of the current US healthcare system and how we got
to this point historically. Consider the various criteria by which healthcare systems are evaluated.
Which are the most important to you, if you had to prioritize? Now think about the kinds of healthcare
systems that other countries have developed. Finally, imagine that you were put on a task force to
develop a set of policy recommendations for a healthcare reform in the United States. Your proposal
should have three parts:

1. Briefly characterize the main problems that you are going to address, make sure you explain
why these are the most important to tackle;
2. State what specifically you propose; be bold about your prescriptions, and persuasive enough
to convince the reader that these specific policies should get us to solve the problems you
identified; are you borrowing ideas from other countries’ healthcare systems?
3. Which stakeholders (societal actors, interest groups) are likely to support or resist your
proposals and why?

Rely on class materials though abstain from direct quotations (you have no space for this!)

Medicalization Assignment (600-800 words)

What do you think is going to be the next medicalized condition? Your goal in this assignment is to
write a short essay (up to one page) describing this hypothetical new medicalized condition and
imagining the implications of having it medicalized. Here are the steps:

1. State what the condition is (you can invent a legitimately-sounding name for it and explain why
you think it is likely to be medicalized). Be creative, but realistic. Make sure you focus on
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 something that is not already medicalized. If you are unsure whether a particular idea would
work here, do not hesitate to ask Prof. Guseva via email.
2. Next, think about who would push for this condition to be recognized, and why. Who would
benefit? Potential sufferers? Their families? Parents, if the condition is found in kids? The
medical profession? Any other profession (lawyers, teachers, etc.)? Pharmaceutical companies?
3. Now think about the consequences of medicalizing this condition. What are the advantages (for
whom?) and downsides (for whom?) of having it medicalized?

To gain some inspiration, recall the three paths of medicalization (medicalization of previously deviant
conditions, medicalization of natural processes and the expansion of existing medical categories).
Thinking through these categories can perhaps help you unleash your imagination. The important
consideration is that what you describe should not already be considered a medicalized condition,
even if it is still contested (so restless leg syndrome won’t do), nor should there be treatments
available. If you are proposing medicalization through “expansion of existing medical categories” make
sure the new definition creates new categories (such as “pre-diabetic” or “pre-hypertensive”). When in
doubt about your idea, ask.