CH-9-10 Crime and Criminal Justice – Social Problems in a Diverse Society : Chapter Notes

This Document Contains Chapters 9 to 10 CHAPTER 9 Crime and Criminal Justice CHAPTER SUMMARY The Uniform Crime Report is the leading source of information on crimes reported in Canada; however, the number of crimes actually committed is probably much higher than the UCR reports. Categories of crime include violent crime, hate crime, property crime, occupational (white-collar) crime, corporate crime, organized crime, and youth crime. Gender, age, class, and racialization are factors in who gets arrested and convicted and for what types of crimes.. Functionalists use strain theory, social bond theory, and the subculture of violence hypothesis to attempt to explain why some people commit crimes and others do not. Conflict theorists suggest that people with economic and political power define as criminal any conduct that threatens their own interests; various feminist approaches focus on the intertwining effects of gender, class, racialization/ethnicity, and deviance. Interactionists use differential association theory and labelling theory to explain how a person’s behaviour is influenced and reinforced by others. The criminal justice system includes the police, the courts, and the prisons. These agencies have considerable discretion in dealing with crime and determining a punishment. LEARNING OBJECTIVES After reading Chapter 9, students should be able to: 1. Describe the principal sources of crime statistics and explain why official statistics regarding crime may be misleading. 2. Define, and distinguish between (a) violent crime, hate crime, and property crime, and (b) occupational and corporate crime. 3. Compare and contrast the four major sociological perspectives on crime. 4. List the components of the criminal justice system and state the function of each. 5. Explain how discretion may be necessary in all sectors of the criminal justice system but may also contribute to problems with that system. KEY TERMS corporate crime homicide occupational (white-collar) crime crime indictable offence organized crime criminal justice system labelling theory plea bargaining date rape mass murder primary deviance differential association theory medicalization of crime property crime punishment serial murder summary offence restorative justice social bond theory violent crime routine activities crime strain theory youth crime secondary deviance subculture of violence sexual assault hypothesis CHAPTER OUTLINE I. CRIME AS A SOCIAL PROBLEM A. Problems with Official Statistics 1) The Uniform Crime Report (UCR) is the leading source of information on crimes reported in Canada. a. It is published by the Canadian Centre for Justice Statistics (CCJS) based on data substantiated by police investigation. b. The crime rate reported by the UCR includes offences such as homicide, assault, sexual assault, break and enter, robbery, theft, motor vehicle theft, and fraud, but not violations such as traffic and drug offences. c. These statistics reflect only those crimes that are reported to law enforcement agencies. 2) Statistics Canada conducts victimization surveys which show that the number of crimes committed is much higher than the number of crimes reported. a. Responses to victimization surveys are based on recall, and some people do not remember specifically when a crime occurred. b. For various reasons, respondents may not be truthful. c. The surveys focus on theft and assault and do not measure workplace crimes, such as embezzlement or bribery, and organized crime. B. Defining Crime and Delinquency 1) Crime is the behaviour that violates the criminal law and punishable by fine, jail term, or other negative sanctions. Criminal law is divided into two major categories: summary offences and indictable offences. II. TYPES OF CRIMES A. Violent Crime 1) Violent crime includes homicide, attempted homicide, three levels of assault and sexual assault, robbery, and other offences like criminal negligence causing death. People are more afraid of violent crime than other types, since victims may be injured or killed, and violent crime receives the most attention. But most crime in this country is not violent. 2) Homicide is the unlawful, intentional killing of one person by another. Murder involves not only an unlawful act but also malice aforethought, the intention of doing a wrongful act. Some killers commit mass murder (killing four or more people at one time and in one place); others commit serial murder (killing three or more people over more than a month). Most serial killers are White males who can be categorized as one of four general types: visionaries, missionaries, hedonists, and power/control seekers. Men make up the vast majority of murder victims and offenders. The median age of accused males was 24, and the median age of male victims was 29 and female victims 35.5. In Canada, unlike the U.S., homicide is not an urban phenomenon since the murder rate for those living in areas with populations of 100 000 or less was slightly higher in 2008 than in larger populations. In the past, most murder victims knew their killers, but this pattern seems to be gradually changing. Firearms were used in nearly one third of all homicides, a fact that leads to the ongoing debates about gun control. 3) Sexual assault is thought by many to be a sexually motivated crime, but it is actually an act of violence in which sex is used as a weapon against a powerless victim. In Canada, sexual assault is classified into three levels, following assault classification generally: level one is categorized as the least harmful; level two involves a weapon; and level three is most serious and classified as aggravated assault. Date rape involves forcible sexual activity that meets the legal definition of sexual assault and involves people who first meet in a social setting. Statistics on sexual assault are misleading at best because it is often not reported. According to the 1993 Violence Against Women Survey 39 percent of women reported at least one incident of sexual assault since the age of 16. In most sexual assaults, the victim is young, female, and single. Often women may not report that they have been assaulted because they believe that nothing will be done about it. 4) Gang violence includes homicide, sexual assault, robbery, and aggravated assault, but the definition of “gang” used by police is quite broad. Typically, gangs are composed primarily of young males of the same ethnicity. In recent years, gang activity and gang-related violence have increased significantly not only in large metropolitan areas but also in smaller cities and suburbs. Some analysts have suggested that gang violence may be exacerbated by socialization of males for male dominance and by patriarchal social structures. 5) Another form of violent crime is hate crimes, which are motivated by the offender’s hatred of certain characteristics of the victim, e.g., national or ethnic origin, language, colour, sexual orientation, religion, gender, age, mental or physical disability, among other factors. In 2007, 785 crimes were classified as hate crimes, with ethnicity being the most frequently reported characteristic. B. Property Crime 1) Property crime includes breaking and entering, possession of stolen goods, theft, motor vehicle theft, and fraud. According to victimization surveys, the most frequent property crime is breaking and entering (B & E)–unlawful or forcible entry or attempted entry of a residence, industry, or business, with intent to commit a serious crime. Usually, burglaries involve theft. 2) According to victimization surveys, the young have a higher risk of being subject to property crime than older people, and risk of victimization is higher for families with incomes under $15 000 living in rental property or in inner-city areas. 3) Other non-violent property crimes include theft $5000 and under (unlawfully taking or attempting to take property other than motor vehicles from another person), auto theft (motives for which include: joyriding, transportation, vehicle used in another crime, and profit), shoplifting, and credit card fraud. 4) One crime that has more than doubled in the past 10 years is kidnapping/forcible confinement, which may be related to human trafficking. C. Crime Comparisons between Canada and the United Sates 1) Over the past 20 years, Canada has had a lower violent crime rate than the U.S. For example, in 2007, the U.S. homicide rate was three times the Canadian rate. . Two thirds of US homicides involve firearms versus one quarter in Canada. D. Occupational (white-collar) crime includes computer and other high tech crimes, and more traditional criminal endeavours such as employee theft, fraud (obtaining money or property under false pretences), embezzlement (theft from an employer), soliciting bribes or kickbacks, and insider trading of securities (offenders buy or sell stocks based on info not known by the public that they obtained as “insiders”). E. Corporate Crime 1) Examples of corporate crime include antitrust violations; deceptive advertising; infringements on patents, copyrights, and trademarks; unlawful labour practices involving the exploitation of employees; price fixing; and financial fraud. 2) One type of white-collar crime that has received recent attention is insider trading of securities. This crime involves an offender buying or selling stocks on the basis of information that is not public knowledge and is obtained as a corporate insider. 3) This white-collar offence comprises illegal acts committed by corporate employees on behalf of the corporation and with its support. Examples include, antitrust violations, deceptive advertising, infringements on patents or copyrights or trademarks, unlawful labour practices involving the exploitation or surveillance of employees, price fixing, and financial fraud. The economic effects of corporate crime are both direct (immense economic losses) and indirect (higher taxes, increased cost of goods and services, and higher insurance rates). F. Organized Crime 1) Organized crime enterprises include drug trafficking, prostitution, gambling, loan-sharking, money laundering, and large-scale theft such as truck hijackings. Organized crime thrives because of demand for illegal goods and services. 2) Some law enforcement and government officials are corrupted through bribery, campaign contributions, and favours intended to buy them off. G. Youth Crime 1) Many behaviours identified as youth crime are not criminal acts per se but are status offences—acts that are illegal due to the age of the offender—such as cutting school, purchasing and consuming alcoholic beverages, or running away from home. 2) There has been a decline in total youth crime since the early 1990s. The statistics for youth crime are still high. Whereas people aged 12 to 17 constitute less than 10 percent of the Canadian population, they account for 20 percent of all persons charged in Canada. Males account for most cases of all youth crime, despite media attention recently focussed on violent females. III. SOCIOLOGICAL EXPLANATIONS OF CRIME A. The Functionalist Perspective 1) Emile Durkheim believed the macrolevel structure of a society can produce social pressures that result in high rates of deviance and crime. a. He introduced the concept of anomie to describe the social condition in which people experience a sense of futility because social norms are weak, absent, or conflicting. b. Deviance and crime are most likely to occur in societies in which anomie is present. 2) Based on Durkheim’s theory, sociologist Robert Merton developed strain theory to explain why some people conform to group norms while others do not. When people are denied legitimate access to goals such as success, money, or other material possessions, some people seek to acquire them through deviant means. Merton identified five ways in which people adapt: a. Conformity occurs when people accept culturally approved goals and pursue them through approved means. b. Innovation occurs when people accept society’s goals but adopt disapproved means (e.g., shoplifting, theft, burglary) for achieving them. c. Ritualism occurs when people give up on societal goals but still adhere to the socially approved means for achieving them. d. Retreatism occurs when people abandon both the approved goals and the approved means of achieving them (e.g., a person who “drops out”). e. Rebellion occurs when people challenge both the approved goals and the approved means for achieving them and advocate an alternate set of goals or means. 3) According to sociologist Travis Hirschi’s social bond theory, the probability of delinquency and crime increases when a person’s social bonds are weak and peers promote antisocial values and violent behaviour. Social bonds consist of (1) attachment to other people, (2) commitment to conformity, (3) involvement in conventional activities, and (4) belief in the legitimacy of conventional values and norms. 4) According to the subculture of violence hypothesis, violence is part of the normative expectations governing everyday behaviour particularly among males in the lower classes. D. The Conflict Perspective 1) Conflict theorists explain criminal behaviour in terms of power differentials and economic inequality. According to Austin Turk, crime is not a behaviour but a status acquired when those with authority to create/enforce rules (e.g., lawmakers, police, judges) apply those rules to others. 2) Having roots in the work of Karl Marx, the radical-critical conflict approach argues that social institutions (such as law, politics, and education) make up a superstructure that legitimizes the class structure and maintains the capitalists’ superior position. People commit different types of crime based on their class position: crimes committed by low-income people typically involve taking things by force or stealth, while corporate or white-collar crime usually is committed by means such as paper transactions or computer fraud. Some critical theorists believe that affluent people commit crimes because they are greedy and continually want more than they have, whereas poor people commit street crimes such as robbery and theft to survive. E. The Interactionist Perspective 1) Criminal behaviour is learned through everyday interaction with others. According to sociologist Edwin Sutherland’s differential association theory, people learn the necessary techniques and the motives, drives, rationalizations, and attitudes of deviant behaviour from people with whom they associate. 2) According to labelling theory, no behaviour is inherently delinquent or criminal, but is defined as such by a social audience. 3) Sociologist Edwin Lemert expanded labelling theory by distinguishing between primary deviance (the initial act of rule breaking) and secondary deviance (accepting the label of deviant and continuing deviant behaviour). This second concept is important because it suggests that when people accept a negative label or stigma that has been applied to them, the label may contribute to the type of behaviour it initially was meant to control. Labelling may contribute to the acceptance of deviant roles and self-images. 4) Blaming crime on a medical condition, such as mental illness, or converting deviance to a medical condition, such as alcoholism, is known as the medicalization of crime. F. Feminist Perspective 1) Feminist scholarship focuses on who commits which types of crimes or engages in what kinds of deviant behaviour. a. Scholars using a liberal feminist framework believe that women’s delinquency or crime is a rational response to gender discrimination in society. b. A radical feminist approach is based on the assumption that patriarchy (male domination over females) contributes to crimes such as prostitution, which reflects society’s sexual double standard. c. Socialist feminism notes that women are exploited by capitalism and patriarchy. Because most females have relatively low-wage jobs and fewer economic resources, crimes such as prostitution and shoplifting become a means to earn money. IV. THE CRIMINAL JUSTICE SYSTEM A. Originally, the criminal justice system was developed to help solve the problem of social disorder and crime. Today, however, some people question whether it is the solution or part of the problem. B. The Police 1) Police officers have wide discretion (the use of personal judgement regarding whether and how to proceed in a given situation) as to who will be stopped and searched and which homes and businesses will be entered. 2) Some police departments have begun community policing as a means of reducing crime by integrating police officers into the communities they serve – proactively getting them out into the community recognizing problems and working with citizens to solve them. C. The Courts 1) Criminal courts are responsible for determining the guilt or innocence of people accused of committing a crime. a. In theory, justice is determined in an adversarial process: the prosecutor argues the accused is guilty, the defence attorney asserts the accused is innocent. b. In reality, judges wield a great deal of discretion. Working with prosecutors, they decide whom to release and whom to hold for further hearings and, in many instances, what sentences to impose on those persons who are convicted. 2) Since courts can try only a small fraction of criminal cases, an attrition process means that a third of all offences reported are cleared by police. About 15 percent of the total reports result in conviction. Many cases are resolved by plea bargaining, in which defendants (especially those who are too poor to pay an attorney) plead guilty to a lesser crime in return for not being tried for the more serious crime for which they were arrested. Only four percent of all reports result in a sentence to custody. D. Punishment and the Prisons 1) Punishment is seen as serving four functions: a. Retribution, in which a penalty against the offender assumes that the punishment should fit the crime. b. Social protection results from restricting offenders so that they cannot commit further crimes. c. Rehabilitation seeks to return offenders to the community as law-abiding citizens. d. Deterrence seeks to reduce criminal activity by instilling a fear of punishment. population. Canada’s rate is higher than most European countries, however. 2) Despite a recent decline in the number of people sentenced, there continues to be an overrepresentation of Indigenous and Black people in prison, reflecting a racist bias in the judicial system. E. Restorative Justice 1) In Canada, as well as in Europe, Australia, and New Zealand, the concept of restorative justice comprises diverse practices, including conferencing, sentencing circles, and victim-offender mediation. The point of restorative justice is to repair the harm caused by the criminal act. This form of justice may not work for all kinds of crime and enforcement may be difficult, but it does hold promise for youth offenders and other situations where restoration is possible. The concept is integral to many Indigenous cultures. ACCESSING THE REAL WORLD: ACTIVE ENGAGEMENT WITH PROBLEMS RELATED TO CRIME Focus on Community Action Ask students to find out how restorative justice happens in their communities. Have them find out what organizations are involved with the implementation of this program. What does the program consist of? Are there sentencing circles? Has restorative justice been successful in their communities? Have the students write a small report on their findings to be shared with each other in small groups. Did everyone come to the same conclusions? If there are no restorative justice programs in their community, have students go online and find a community that has had a successful restorative justice program. They should find out why it has been successful and make recommendations for getting an alternative justice program in to their own communities and compile a report with their findings. They could take the report to their local R.C.M.P. branch or turn it into a letter to the editor of a local newspaper. Focus on Theoretical Analysis Have students come up with various crime scenarios as a class. Be sure to have examples of all different kinds of crime, such as hate crimes, property crimes, violent crimes, corporate crimes, occupational crimes, and organized crimes. Next, put the students into groups of three or four. Each group should be assigned a different theory: strain theory or social bond theory (functionalist); radical critical-conflict approach (conflict); and labelling theory or differential association theory (interactionist). Each group should then choose one crime scenario for each kind of crime and analyze that crime from the standpoint of the theory they have been assigned. They should report their analyses back to the class. Does the class agree that one theory or theoretical lens is more useful for analyzing certain kinds of crimes or is there disagreement? Focus on Media Engagement Have students do research on how technologies (such as the internet) have provided new opportunities for people to commit crimes globally. They should find someone who has been the victim of a crime that involves new technologies, such as internet fraud or harassment through social networking sites. If they do not know anyone personally who has been the victim of this kind of crime, they should go online and search blogs and forums for people’s experience with various internet crimes. Have a class discussion on how rapid transportation, communications networks, and computer technologies have contributed to an array of new crimes and have made “older” crimes easier to accomplish in some situations and more difficult in others. Is victimization of people over the internet different than other crimes? APPLYING CRITICAL THINKING THROUGH DISCUSSION 1. How have new technologies changed the nature of law enforcement and the reporting of crimes over the past two decades? What new technologies may further enhance officials’ abilities to detect, apprehend, and convict offenders, and to acquire extensive information about crime, suspects, and offenders? Answer: Over the past two decades, new technologies have significantly transformed law enforcement and the reporting of crimes. These advancements have enhanced the efficiency, accuracy, and effectiveness of police work, enabling officers to better prevent, detect, and solve crimes. 1. Data Analytics and Predictive Policing: Advanced data analytics and predictive policing algorithms analyze large datasets to identify crime patterns and predict future criminal activities. These tools help allocate resources more efficiently and target high-crime areas, potentially preventing crimes before they occur. 2. Body-Worn Cameras: Body-worn cameras have become standard equipment for many police officers, providing transparency and accountability in interactions between law enforcement and the public. These devices record evidence that can be crucial in court proceedings and help resolve disputes about the conduct of officers. 3. Drones: Unmanned aerial vehicles (drones) are used for surveillance, search and rescue operations, and crime scene analysis. Drones provide real-time aerial footage and can access areas that are difficult or dangerous for officers to reach. 4. Biometrics: Technologies such as fingerprint, facial recognition, and DNA analysis have revolutionized the identification of suspects. Biometric databases enable quick cross-referencing, significantly speeding up the identification process and improving the accuracy of suspect matching. 5. Artificial Intelligence (AI): AI and machine learning algorithms assist in analyzing vast amounts of data from various sources, including social media, CCTV footage, and crime reports. These technologies help identify suspects, uncover crime networks, and predict criminal behavior. 6. Cybersecurity Tools: With the rise of cybercrime, law enforcement agencies have adopted sophisticated cybersecurity tools to combat hacking, identity theft, and other online crimes. Digital forensics teams use these tools to trace digital footprints and gather electronic evidence. 7. Mobile Technology: Smartphones and mobile apps allow citizens to report crimes quickly and provide real-time information to law enforcement. These tools also enable officers to access databases, file reports, and communicate more effectively while in the field. 8. Surveillance Systems: Modern surveillance systems, including CCTV and smart cameras equipped with AI, provide continuous monitoring of public spaces. These systems can automatically detect suspicious activities and alert authorities. 9. Automated License Plate Recognition (ALPR): ALPR systems scan and record vehicle license plates, helping to identify stolen vehicles, track suspects, and enforce traffic laws. These systems improve the ability to monitor and manage traffic-related offenses. 10. Social Media and Open-Source Intelligence (OSINT): Law enforcement agencies leverage social media and other open-source platforms to gather intelligence, monitor public sentiment, and track criminal activities. Social media monitoring tools help in identifying threats and coordinating responses. Future technologies poised to further enhance law enforcement capabilities include: 1. Enhanced AI and Machine Learning: Continued advancements in AI will lead to more sophisticated predictive policing models, improved facial recognition accuracy, and better natural language processing for analyzing communications. 2. Internet of Things (IoT): The proliferation of IoT devices will create vast networks of interconnected sensors and cameras, providing real-time data on various environments and enabling more comprehensive surveillance and crime detection. 3. Quantum Computing: Quantum computing has the potential to revolutionize data encryption and decryption, enhancing cybersecurity measures and enabling faster processing of large datasets for criminal investigations. 4. Augmented and Virtual Reality (AR/VR): AR and VR technologies could be used for immersive training simulations, crime scene reconstruction, and remote assistance in field operations. 5. Advanced Robotics: Robotics will play a larger role in dangerous law enforcement activities, such as bomb disposal, search and rescue missions, and hazardous material handling. 6. Blockchain Technology: Blockchain could enhance the security and transparency of evidence handling, ensuring tamper-proof records and improving the chain of custody for digital evidence. These emerging technologies will continue to evolve, offering new tools and methods for law enforcement to effectively combat crime and enhance public safety. 2. Why do you think that hate crimes have more severe psychological consequences and require longer recovery times than other crimes? Answer: Hate crimes often inflict deep emotional wounds that extend beyond the individual victim to entire communities, exacerbating feelings of fear, vulnerability, and distrust. Unlike other crimes, hate crimes carry an additional layer of psychological harm rooted in targeted identity-based prejudice, which attacks not just the person but their very sense of self and belonging. Victims often experience profound trauma, intensified by the realization that they were targeted solely because of who they are. This can lead to enduring psychological distress, including symptoms of post-traumatic stress disorder (PTSD), anxiety, depression, and diminished self-worth. Moreover, hate crimes can shatter victims' perceptions of safety and security, leading to ongoing hypervigilance and fear of future attacks. The ripple effects extend beyond the individual, affecting families and communities who share the victim's identity markers, fostering collective trauma and a sense of communal vulnerability. Recovery from such profound psychological wounds necessitates comprehensive support systems, including therapy, community solidarity, and societal efforts to address underlying prejudices. In contrast to other crimes, the psychological impact of hate crimes often lingers longer due to the complex interplay of personal, social, and systemic factors. Healing requires not only individual resilience but also societal acknowledgment, accountability, and efforts to combat bigotry and discrimination. 3. Does the functionalist, conflict, interactionist, or feminist perspective best explain why people commit corporate crimes? Organized crimes? Explain your answer. Answer: Each perspective offers unique insights into the motivations behind corporate and organized crimes. The functionalist perspective might argue that individuals engage in corporate crimes due to the dysfunction within the system itself. For instance, they might highlight how a hyper-competitive business environment or pressure to meet financial targets can incentivize unethical behavior. Similarly, organized crimes could be seen as a response to social inequalities or inadequacies in the legal system, where marginalized groups turn to illegal means for economic survival. On the other hand, the conflict perspective emphasizes power differentials and exploitation within society. From this viewpoint, corporate crimes stem from the pursuit of profit and maintaining control over resources, often at the expense of workers or consumers. Organized crimes may arise as a result of systemic injustices that push certain groups to operate outside the law, seeking power and wealth in environments where legitimate opportunities are limited. The interactionist perspective focuses on the role of social interactions and individual interpretations in criminal behavior. It suggests that people engage in corporate or organized crimes through learned behaviors and social influences within their environments. For example, individuals within corrupt corporate cultures might adopt unethical practices as they interact with colleagues who normalize such behaviors. Similarly, organized crime could be attributed to social networks that promote criminal activities as viable solutions to economic or social challenges. Lastly, the feminist perspective sheds light on how gender dynamics intersect with corporate and organized crimes. It highlights how patriarchal structures in corporations may facilitate unethical behavior, with male-dominated leadership often prioritizing profit over ethical considerations. Additionally, organized crime might exploit gender norms and inequalities, such as the trafficking of women and children for profit. Ultimately, each perspective offers valuable insights into the complex motivations behind corporate and organized crimes, with no single perspective providing a comprehensive explanation. Instead, a combination of these perspectives can offer a more nuanced understanding of the multifaceted factors driving such illicit activities in society. 4. How would you reorganize the criminal justice system so that it would deal more equitably with all people in this country and prevent problems like racial profiling? Answer: Reorganizing the criminal justice system to promote equity and mitigate issues like racial profiling requires a multifaceted approach. Here's a condensed plan: 1. Police Reform: Implement bias training and accountability measures within law enforcement agencies. Encourage community policing strategies to build trust between police and communities. 2. Legal Reforms: Revise sentencing guidelines to reduce disparities, particularly for non-violent offenses. Expand diversion programs and invest in rehabilitation rather than incarceration. 3. Judicial Reform: Ensure diverse representation in the judiciary. Provide education on implicit biases for judges and establish oversight mechanisms to monitor sentencing disparities. 4. Prosecutorial Accountability: Hold prosecutors accountable for discriminatory practices and incentivize fair and just outcomes over conviction rates. 5. Community Engagement: Foster partnerships between law enforcement and communities, involving citizens in policy-making and oversight committees. 6. Data Transparency: Mandate data collection on arrests, convictions, and sentencing to identify disparities and inform policy decisions. 7. Decriminalization: Reassess laws that disproportionately impact marginalized communities, such as drug offenses, and explore alternatives to incarceration. 8. Restorative Justice: Promote restorative practices that prioritize healing and rehabilitation over punitive measures, involving victims, offenders, and communities in the resolution process. 9. Investment in Social Services: Redirect resources from policing to community-based services like mental health support, substance abuse treatment, and affordable housing to address underlying issues contributing to crime. 10. Education and Economic Opportunities: Address systemic inequalities through investment in education, job training, and economic development in marginalized communities to reduce factors driving criminal behavior. By implementing these reforms comprehensively, the criminal justice system can shift towards equity, addressing the root causes of racial profiling and ensuring fair treatment for all individuals. 5. Compare and contrast crime in the United States and Canada. Where do Canadians get most of their crime information? Answer: Crime in the United States and Canada exhibits both similarities and differences. While both countries experience various types of crime such as theft, assault, and drug offenses, the rates and patterns can differ significantly. The United States generally has higher crime rates compared to Canada, particularly in violent crimes like homicide and gun violence. This can be attributed to factors such as socio-economic disparities, access to firearms, and differences in law enforcement strategies. In terms of crime statistics, both countries rely on their respective national law enforcement agencies to collect and analyze data. In the United States, the Federal Bureau of Investigation (FBI) gathers crime information through the Uniform Crime Reporting (UCR) program, which collects data from local law enforcement agencies. In Canada, Statistics Canada compiles crime data through the Uniform Crime Reporting Survey (UCR), which collects information from police services across the country. Apart from official sources, Canadians also receive crime information from various media outlets such as newspapers, television news, and online platforms. Additionally, community organizations, advocacy groups, and government agencies play a role in disseminating crime-related information to the public through reports, studies, and awareness campaigns. Overall, while crime in both the United States and Canada is a complex and multifaceted issue, the approach to gathering crime information and disseminating it to the public shares similarities while reflecting the unique characteristics and priorities of each country. 6. Do you think that corporate crime or property crimes are more costly (both financially and socially) to society as a whole and why? Answer: Determining which is more costly, corporate crime or property crimes, is complex as both have significant financial and social ramifications. Corporate crimes often involve large-scale fraud, embezzlement, or environmental violations, impacting not only shareholders but also employees, consumers, and the environment. The financial toll of corporate crime includes direct losses, legal fees, regulatory fines, and damage to investor confidence. Socially, it erodes trust in institutions, damages communities, and can lead to job losses and economic instability. Property crimes encompass theft, burglary, vandalism, and arson, directly affecting individuals and businesses. While the financial impact of property crimes can be substantial, including the cost of stolen goods, property damage, and increased security measures, the social consequences may be more localized. Property crimes can instill fear, disrupt communities, and erode a sense of safety and security, particularly in areas with high crime rates. Ultimately, the comparative cost depends on various factors such as the scale and frequency of incidents, the extent of financial losses, and the long-term social repercussions. While corporate crimes often involve larger sums of money and affect broader segments of society, property crimes can have a more immediate and tangible impact on individuals and small businesses. Both types of crime impose significant burdens on society, underscoring the importance of prevention, enforcement, and rehabilitation efforts. 7. Do you think that crime statistics in Canada should collect information on the ethnic or racialized background of victims and accused like the U.S. does, and why? Should the collection of this data be limited to certain situations? What do you think the positive and negative outcomes of collecting these data are? Answer: The decision to include ethnic or racialized background data in crime statistics in Canada is a complex one. On one hand, collecting such data could provide valuable insights into patterns of victimization and perpetration within different communities, potentially helping to identify and address systemic inequalities and discrimination. It could also aid in developing targeted interventions and support services for communities disproportionately affected by crime. However, there are significant ethical and practical considerations to take into account. One concern is the potential for stigmatization and discrimination against certain communities if their ethnic or racial background is disproportionately associated with crime in the public consciousness. This could exacerbate existing tensions and stereotypes, leading to further marginalization and distrust within these communities. Additionally, there are challenges in accurately capturing and interpreting this data, including issues with self-identification and the potential for bias in reporting and recording practices. The collection of ethnic or racialized background data should be approached cautiously and with clear guidelines to ensure that it is done in a responsible and ethical manner. It should only be collected in situations where it is directly relevant to understanding and addressing the dynamics of crime and victimization, such as hate crimes or instances of racial profiling. Furthermore, safeguards must be in place to protect the privacy and rights of individuals whose data is being collected. Positive outcomes of collecting this data could include a better understanding of the intersectionality of crime and social factors, leading to more targeted and effective policies and interventions. It could also help to hold institutions accountable for addressing systemic inequalities and discrimination. However, there is also the risk of negative outcomes, including the reinforcement of stereotypes, increased stigmatization of certain communities, and potential misuse of the data for discriminatory purposes. Ultimately, the decision to collect ethnic or racialized background data in crime statistics should be made with careful consideration of the potential benefits and risks, in consultation with affected communities and experts in the field of criminology and social justice. Any such efforts must be accompanied by robust safeguards and mechanisms to ensure that the data is used responsibly and ethically to promote equity and justice. AUDIO-VISUAL MEDIA FOR FURTHER EXPLORATION 10-7 for Life—The story of the last two weeks of Carol Banks’ job as a police officer in Toronto. 1995. 56 mins. National Film Board of Canada, www.nfb.ca. Behind Closed Doors—This documentary presents an in-depth examination of domestic violence from a very personal perspective. It focuses on David, an abuser, and Margaret, a victim, who each discuss their difficult childhoods, their low self esteem, their feelings of shame, and their determination to break the patterns of violence that have governed their lives. 1993. 46 mins. Filmakers Library, www.filmakers.com. Circles—This is a film about a Yukon community’s innovative program that brings together traditional Aboriginal justice and the Canadian justice system. 1997. 57 mins. National Film Board of Canada, www.nfb.ca. Dragons of Crime: Climbing the Golden Mountain—The story of the spread of Asian organized crime from coastal China to Canada and the U.S. China-based gangs, trading in illegal immigrants, drugs, prostitution and forgery represent a significant threat to law and order in North America today. 1995. 45 mins. National Film Board of Canada, www.nfb.ca. High Risk Offender—This film tells the story of a high-risk parole office and the people whose lives it touches, prisoners guilty of everything from murder to white-collar crime. 1998. 57 mins. National Film Board of Canada, www.nfb.ca. Lizzie Borden Had an Axe—Labelled “The Trial of the Century” by news-media, the Lizzie Borden case remains a mystery. This film presents two possible scenarios and allows the viewers to come to their own conclusions about Lizzie Borden’s guilt or innocence in the murders of her parents. 2004. 50 mins. National Film Board of Canada, www.nfb.ca. Scam of the Century: Bernie Madoff and the $50 Billion Heist—This program examines the bizarre details of Madoff’s operation while exploring his motives and mind-set. 2009. 44 mins. Films for the Humanities and Sciences, http://ffh.films.com. The Eastman Tragedy —This film chronicles the true story of the 1978 deaths of a bus load of people, most with disabilities, in Quebec, due to lax inspections. No one was ever charged in the tragedy. 2006. 30 mins. National Film Board of Canada, www.nfb.ca. The Elusive Rapist—This film examines the infamous David Milgaard travesty where a Saskatoon man is convicted of rape in thin evidence. After spending almost 20 years in jail, Milgaard is finally exonerated using DNA evidence while the real rapist, Larry Fisher, is finally convicted. 2005. 47 mins. National Film Board of Canada, www.nfb.ca. The New Gulag: America’s Prisons—This video shows examples of how the prison-industrial complex actually works. In rural communities, prisons run by private companies are welcomed because they provide jobs and markets for a variety of goods and services. However, how are these prisons being run when making a profit is the end-goal of corporate owners and proprietors? 1997. 30 mins. Filmmakers Library, www.filmakers.com. CRITICAL READINGS Bereska, Tami M. 2008. Deviance, Conformity and Social Control in Canada (2nd edition). Toronto, ON: Pearson Education Canada. Coleman, James William. 2002. The Criminal Elite: Understanding White Collar Crime. (5th edition). New York, NY: Worth Publishers. Dodge, Mary. 2009. Women and White-Collar Crime. Upper Saddle River, NJ: Prentice Hall. Hackler, James C. 2007. Canadian Criminology: Strategies and Perspectives (4th edition). Toronto, ON: Pearson Education Canada. Horner, Jessie J. 2007. Canadian Law and the Canadian Legal System. Toronto, ON: Pearson Education Canada. Spalek, Basia. 2008. Communities, Identities, and Crime. Bristol, U.K.: Policy. Tanner, Julian. 2010. Teenage Troubles: Youth and Deviance in Canada (3rd edition). Dons Mills, ON: Oxford University Press. Totten, Mark D. 2001. Gangs, Guys and Girlfriend Abuse. Peterborough, ON: Broadview Press. Vago, Stephen and Adie Nelson. 2008. Law and Society (2nd Canadian edition). Toronto, ON: Pearson Education Canada. Woolford, Andrew. 2009. The Politics of Restorative Justice: A Critical Introduction. Halifax, NS: Fernwood. CHAPTER 10 Health, Illness, and Health Care as Social Problems CHAPTER SUMMARY The health care industry in Canada accounts for ten percent of the gross domestic product, yet this has not translated into better life expectancy for everyone, particularly not for Indigenous people. As people live longer, there has been a corresponding increase in chronic diseases, some of which produce significant disabilities. Gender, class, and Indigenous status affect individuals’ health level. Mental illness is a social problem: Approximately 10 percent of the population reported in the Canadian Community Health Survey some disorder or substance dependence. Before the current trend of deinstitutionalization, people with mental illness were treated in mental hospitals, which were examples of total institutions. Although Canada has universal health coverage, it is not without problems. Some consider Canada’s health care system to be in a “crisis.” Functionalist, conflict, feminist, and interactionist analysts offer different viewpoints on how health care problems might be resolved. LEARNING OBJECTIVES After reading Chapter 10, students should be able to: 1. Explain which aspects of health care are social problems. 2. Describe the kinds of health care that historically have been available in Canada. 3. Explain the “crisis” in Canada’s health care system. 4. Explain how racialization/ethnicity, class, education level, gender, and age affect health care. 5. Compare and contrast the sociological explanations for health care problems. KEY TERMS Ableism disability-free - medical-industrial complex acute diseases life expectancy medicalization chronic diseases iatrogenesis self-health management deinstitutionalization infant mortality rate total institution disability life expectancy CHAPTER OUTLINE I. HEALTH AND ILLNESS AS SOCIAL PROBLEMS A. According to the World Health Organization, health is a state of complete physical, mental, and social well-being. Health is not only a biological issue but is also a social issue. 1) The health care industry in Canada accounts for ten percent of the gross domestic product. Although people in the U.S. pay more for health services than people in other high-income nations (Canada spends less than $3326 per person, while the U.S. spends over $6400), these expenditures have not translated into better life expectancy for everyone. Overall, Canadian females life expectancy is 82.4 years, while for Canadian men it is 77.4 years. However, for Indigenous people of both sexes in Canada, the life expectancy is 6 years lower. 2) In high-income nations, life expectancy has increased as the infant mortality rate has decreased. The infant mortality rate in Canada is 5.3. B. Acute and Chronic Diseases and Disability 1) Increases in life expectancy in Canada and other high-income nations have occurred as vaccinations and improved nutrition, sanitation, and personal hygiene have virtually eliminated many acute diseases. However, in recent years, infectious diseases such as multi-drug resistant tuberculosis, Lyme disease, and HIV/AIDS have emerged as pressing health problems. 2) As people in high-income nations live longer, there has been a corresponding increase in chronic diseases, which are brought about by a variety of biological, social, and environmental factors. Among the most common sources of chronic disease and premature death are tobacco, which increases mortality among both smokers and passive smokers, and alcohol abuse. According to some analysts, we have chronic disease in our society because of the manufacturers of illness: those who promote illness-causing behaviour and social conditions. Because of the combination of longer life expectancies, disability-free life expectancy has also increased. C. Sex and Gender, Class, and Indigenous Status 1) A major survey found that larger percentages of Canadian females than Canadian males aged 12 and over reported such health problems as arthritis, high blood pressure, migraines, and bronchitis/emphysema, and are more likely to have a disability, though males were more likely to get heart disease and diabetes. The reasons for these differences could include factors that increase females’ life expectancies, such as: consuming lower levels of drugs, tobacco, and alcohol; not working in hazardous occupations, like mining and construction; and, having biological protection during the childbearing years, during which females have lower levels of heart disease. 2) According to the National Population Health Survey, people in lower-income groups had higher mortality rates than those in upper-income groups. These higher-income groups also were more likely to report that their health status was excellent than those of lower-income groups. The reasons for these differences is likely a combination of: being able to afford nutritious food; engaging in risky health behaviour like smoking, drinking, and drug use; working in dangerous industries; and living in some areas, like the North, far from medical care. 3) Indigenous people have higher rates of infectious diseases, like TB and AIDS, as well as for chronic conditions, like diabetes and cancer. The reasons for these differences are similar to those for class-related differences: high levels of poverty, with the accompanying poor housing, sanitary conditions, and lack of nutritious food; higher rates of risky health behaviour; and, being distant from medical care. 4) Regarding risky health behaviour, there were differences by gender. Male’s health was determined more by smoking and drinking and females more by exercise and weight. D. Disability 1) Some chronic diseases produce significant disabilities that significantly increase health care costs for individuals and for society; 14.4 percent, or 4.4 million people in Canada in 2006 had one or more physical or mental disabilities, and the number continues to increase for several reasons: a. With advances in medical technology, many people who formerly would have died from an accident or illness now survive, although they may live with some impairment. b. As more people live longer, they are more likely to experience chronic diseases that may have disabling consequences. c. People born with serious disabilities are more likely to survive infancy because of medical technology. However, only a small percentage of people with a disability today were born with it; accidents, disease, and violence account for most disabilities in this country. 2) Disabilities are an important social problem because people with disabilities have higher unemployment rates and lower incomes than those without disabilities. In 2001, 10.7 percent of disabled adults were unemployed, compared with only 5.9 percent on non-disabled adults. The reason for this is ableism—prejudice and discrimination against people because of a physical or mental disability. D. Obesity 1) A relatively new health risk—being overweight—is now affecting approximately half the Canadian population. Excess weight is linked to heart disease, Type II diabetes, certain forms of cancer, and stroke. According to the National Population Health Survey, 2.7 percent of Canadians aged 15 and older were underweight; almost half were of normal weight; one-third were overweight; and 14.9 percent were obese. Middle-aged people are the most likely to be obese. In Newfoundland, Labrador and New Brunswick, people had higher rates of obesity than in the rest of Canada. If the proportion of overweight to obese people in Canada was found worldwide, nearly one billion people would be afflicted. 2) On the other hand, people of size take exception to the prejudicial attitudes and discrimination they experience from society. They would call this ableism. Several organizations exist to change societies’ attitudes and behaviour toward people who are larger, including the International Size Acceptance Association. II. MENTAL ILLNESS AS A SOCIAL PROBLEM A. Mental illness is a social problem because of the number of people it affects, the degree of difficulty that exists in defining and identifying various types of mental disorders, and the manner in which treatment is provided. The Canadian Community Health Survey, published by Statistics Canada in 2003, reported that four percent of people reported symptoms of major depression, almost five percent reported anxiety, and when substance dependence is included, one in ten Canadians experienced mental health problems at some time within the 12 months of the interview. Rates of mental illness are generally affected by gender, class, and Indigenous status, however there were few differences found between men and women when substance abuse was included. People in lower social classes have higher rates of mental disorders than people in upper classes could be explained by the downward drift hypothesis. The suicide rate among Indigenous Canadians is three times higher than among non-Indigenous Canadians times for the 15 to 24 years age group). B. Treatment of Mental Illness 1) People who seek professional help for mental illness are treated with medications or psychotherapy, which is believed to help patients understand the underlying reasons for their problem. According to sociologist Erving Goffman, mental hospitals are a classic example of total institutions. Patients in mental hospitals are stripped of their individual identities by being required to wear institutional clothing and follow a strict regime of activities, meals, and sleeping hours. 2) Development of psychoactive drugs made possible the deinstitutionalization movement of the 1960s. In Canada, it occurred mainly between 1960 and 1976. Originally devised as a solution for the problem of “warehousing” mentally-ill patients in large, prison-like mental hospitals, deinstitutionalization is now viewed as the problem by many social scientists. Although advocates believed that the patients’ mental disorders could be controlled with proper medications and treatment from community-based mental health services, critics argue that deinstitutionalization resulted in many mentally ill people ending up residing on the street or in jails. III. THE “CRISIS” IN CANADIAN HEALTH CARE A. Development of the National Health Care System 1) The universal health care system emerged with many pieces of federal legislation and changes in funding, for example, the Medical Care Act of 1966 provided insurance for medical services, to which all provinces agreed in 1972, emphasizing five principles: universality; accessibility; comprehensiveness; portability; and, public administration on a non-profit basis. B. Current Issues in the Health Care System 1) Coverage of Care: with the restructuring of hospitals, closing of hospital beds, and increase of out-patient procedures, the need for home care has grown, in fact, demand seems to exceed supply. The cost of drugs can be a problem for those in home care since the cost of drugs outside hospitals is not covered by Medicare. The need for “pharmacare,” or government support for drug purchases, has increased. Needs for long term care, palliative care and dental care are also great and increasing in Canada. 2) Accessibility: the 2007 Canadian Community Health Survey shows that the vast majority of Canadians have a doctor, with 96 percent of adults indicating they had a regular doctor or a usual place of care, such as a walk-in clinic. While there are still Canadians with no regular doctor, this is not because of a doctor shortage. In Canada, 119 health regions have been designated so that healthcare within and between provinces can be addressed. Some health regions rank lower than others based on a variety of indicators such as life expectancy, low birth weight, incidence of flu, preventable hospital admissions, physicians and specialists per capita, among others. There are definite variations in health care service within Canada, where comprehensive services are supposed to be accessible to all citizens. 3) Costs and Payment Methods: while the overall costs of the health care system have risen, they have been contained: health care costs were only 10.7 percent of the GDP in 2008. Although Canada has a single-payer, public method of financing health care, a private segment now exists in our system--for cosmetic surgery, dental practice, eyeglasses, drugs outside hospitals, and other out-patient aids. This amounts to 30 percent of the total health care expenditures in 1998. In some countries with universal health care, people have an opportunity to pay for their own operations and thereby jump the public queue. This two-tier system of health care results in differential access: poorer access for those who cannot afford to pay. In June 2005 the Supreme Court of Canada ruled that the Quebec Government could not prevent people from paying for private insurance for procedures covered under the public system. This ruling has significant implications for the rest of Canada as well. 4) Supply and Demand of Health Care Professionals: after laying nurses off in the mid-1990s as a cost-cutting measure and after reducing positions in medical schools because of a fear of a surplus of doctors, Canada’s provinces and territories now face the looming possibility of a severe shortage of nurses and doctors. Not only is there a need for more professionals, but also their payments and organization of work are concerns. 5) Quality of Care: Two measures of quality of care are: Canadians’ rating of the system, and reports of different patterns of medical practice, including different rates of procedures, such as surgical operations, that might be expected to have close-to-uniform rates across the country. Although Canadians’ rating of their recent experience with doctors and general treatment by the system is high, the percentage rating the overall system as excellent has declined substantially. In terms of international comparisons, in 2008 the Conference Board of Canada rated several OECD countries’ health care systems, and Canada rated 10th out of 16 countries. 6) Use of Technology: large flows of information take place among providers of traditional, alternative, and robotic care (e.g., surgical procedures at a distance). Patients must be notified in advance about how their information is to be used and must give their permission. Besides improved ways of maintaining connections between providers, the system needs a better means of keeping track, across a variety of locations and databases, of the treatment of individual patients and drugs prescribed. Electronic Health Records (EHRs) have been promoted as a way of dealing with this problem and the federal budget of early 2009 made new money available to promote these EHRs. One controversial suggestion is to put a microchip on people’s health cards that has a detailed record of the person’s health history. IV. PERSPECTIVES ON ILLNESS AND HEALTH CARE PROBLEMS A. The Functionalist Perspective: Illness is a threat to society because it is necessary for all people to fulfill their appropriate social roles in order to have a smoothly functioning social system. When people become ill, they cannot fulfill their everyday responsibilities and instead adopt the sick role—patterns of behaviour expected from individuals who are ill: (1) sick people are not responsible for their incapacity; (2) they are exempted from their usual role and task obligations; (3) they must want to leave the role and get well; and (4) they are obligated to seek and comply with the advice of a medical professional. 1) Functionalists believe that problems in Canadian health care are associated with macrolevel changes such as the development of high-tech medicine, restructuring of the system, and an increase in demand for health care by consumers. The equilibrium of the system has been affected, and procedures must be implemented to restore the equilibrium. 2) Incremental changes should solve the problem: strengthened home care services; more equitable coverage of prescription drugs; wider adoption of blended compensation mechanisms for physicians; primary care reform; integrated regional services; quality improvement initiatives; and, better information gathering. B. The Conflict Perspective: Problems in health care delivery are rooted in the capitalist economy which views medicine as a commodity produced and sold by the medical-industrial complex. For example, the pharmaceutical companies have been well known to put profits first. 1) Radical conflict theorists argue that only when inequalities based on sex and gender, class, and racialization/ethnicity (and on occupation, neighbourhood, and region) are reduced and a system based on a different treatment model is developed will inequalities in health outcomes be reduced. 2) Some conflict theorists also call attention to the unintended negative effects of doctors and suggest that the doctor-patient relationship should be demystified. Iatrogenesis refers to problems caused by doctors and the health care system. There are three types of these problems: clinical iatrogenesis occurs when pain, sickness, and death result from medical care; social iatrogenesis occurs when the health care system creates dependency and ill health; and, cultural iatrogenesis occurs when the system undermines the ability of people to care for themselves. 3) Conflict theorists argue that if patients were given the information and resources they need for prevention, self-treatment, and home care, the need and demand for expensive medical care would be greatly reduced. C. The Interactionist Perspective 1) Interactionists believe that many problems pertaining to health and illness are linked to social factors that influence how people define our health care system. According to interactionists, we socially construct notions of crisis according to our desire to promote political objectives. 2) Interactionists also examine how individuals can construct their own health, to be producers rather than consumers of health. Through self-health management, individuals can engage in practices that promote their own health. Self-care comprises of four components: regulatory self-help consists of daily habits that affect health, like eating a balanced diet, getting rest, and exercising; preventive self-care consists of deliberate actions taken to reduce the risk of illness, such as brushing and flossing teeth; reactive self-care consists of determining what to do when one feels ill and may involve seeking over-the-counter remedies as well as seeking advice from friends or experts; and, restorative self-care consists of compliance with treatments and medications prescribed by professionals, or part compliance, according to self-determination. D. Feminist Perspective 1) Feminist theorists examine the extent to which women are treated in a disadvantageous manner in health or health care through processes like medicalization in which many of women’s natural conditions are treated as physical or psychological illnesses. 2) Some feminists have been critical of the traditional pattern of treating women according to findings from studies of men. Researchers have found that women and men are not the same when it comes to health problems and this should be treated differently. 3) Feminists are also concerned with the presence and treatment of women in the medical profession itself. Until recently, it was difficult for women to become doctors. In 2007, women constituted 33 percent of physicians in Canada. ACCESSING THE REAL WORLD: ACTIVE ENGAGEMENT WITH PROBLEMS RELATED TO HEALTH, ILLNESS, AND HEALTH CARE Focus on Community Action Have students find out about local AIDS services and interview staff and/or volunteers to learn more about the challenges encountered by medical professionals working in this field and how it has changed in recent years. What are the challenges facing clients of these organizations? Have these challenges changed in recent years? What are the gendered, racialized, and classed dimensions of the prevalence of HIV/AIDS in their communities? Have students form small groups and report their findings to each other. Have them discuss their reactions to their findings. Where they surprised by anything they learnt? How has this changed their perceptions about people living with HIV/AIDS in their communities? Focus on Theoretical Analysis Break the class into several groups of three. Each group should be assigned the task of becoming experts on both feminist and conflict theory. Each student in the group should focus on the medicalization of women’s physical and mental health (feminist theory) through the use of the medical-industrial complex (conflict theory). One student in each group should focus on pregnancy and child birth, another on premenstrual syndrome (P.M.S.) and menopause, and the third student should investigate the mental health of women (anxiety, depression, use of pharmaceuticals). Have students investigate how each of these issues has evolved over the past fifty years and how the medical-industrial complex and the medicalization of women’s bodies and minds have contributed to these issues. After researching each of their topics, the students should meet in their groups and share what they have learned about their specific topics. Focus on Media Engagement Have students view fictional portrayals of medicine on television in programs such as E.R., House, Private Practice, or Grey’s Anatomy to determine how physicians, nurses, other medical personnel, and patients are portrayed. If they do not have access to cable they could use websites such as www.tvshack.net or www.episodecentral.com to access streaming video. Make sure they take notes while they are watching so that they can report back to the class what they find. Next, have students come together as a class and discuss their findings. Ask students to compare images of medicine as shown in popular culture with everyday realities of health care, keeping in mind too, that the shows they were watching depict the U.S. medical system. How do images of the U.S. private medical system on television compare with what actually happens in hospitals and clinics across Canada? How are issues of racialization/ethnicity, class, gender, age, and disability shown in popular culture? How does this depiction compare with “real” life in Canada? APPLYING CRITICAL THINKING THROUGH DISCUSSION 1. How are racialization/ethnicity, class, and gender related to health care in Canada? How do these factors affect who is most likely to become a physician? A nurse? A patient? Answer: Racialization/ethnicity, class, and gender intersect in complex ways within the Canadian healthcare system, influencing access to healthcare services, health outcomes, and representation within the healthcare workforce. In terms of becoming a physician, individuals from racialized or marginalized communities, as well as those from lower socioeconomic backgrounds, often face barriers such as limited access to educational resources, financial constraints, and systemic biases in admissions processes. These barriers contribute to underrepresentation of these groups within the medical profession, perpetuating disparities in healthcare provision and exacerbating inequalities in access to care. Similarly, becoming a nurse can be impacted by these intersecting factors. While nursing may be perceived as more accessible than medicine due to shorter training durations and different entry requirements, individuals from marginalized backgrounds may still face obstacles such as discrimination, unequal opportunities for advancement, and economic barriers to education and training. As a result, the nursing workforce may also lack diversity and fail to reflect the communities it serves, potentially affecting the quality and cultural competence of care provided. When it comes to patients, racialization/ethnicity, class, and gender play significant roles in determining health outcomes and experiences within the healthcare system. Individuals from marginalized communities often face barriers to accessing timely and appropriate care due to factors such as systemic racism, language barriers, cultural insensitivity, and economic constraints. These disparities contribute to higher rates of preventable illnesses, poorer health outcomes, and increased healthcare utilization among marginalized populations. Moreover, gender intersects with these factors to further shape health experiences and outcomes. Women, for example, may encounter gender-specific barriers such as lack of access to reproductive health services or disparities in the treatment of chronic conditions. Transgender and non-binary individuals may face discrimination and challenges in accessing gender-affirming care. Additionally, gender roles and expectations can influence healthcare-seeking behaviors and attitudes towards health maintenance and prevention. Addressing these intersecting inequalities requires systemic changes within the healthcare system, including efforts to promote diversity and inclusion within the healthcare workforce, address structural barriers to education and training, implement culturally competent care practices, and prioritize equity in healthcare delivery. It also necessitates broader social and economic reforms to address the underlying determinants of health disparities, including poverty, discrimination, and social marginalization. By acknowledging and addressing the intersecting impacts of racialization/ethnicity, class, and gender on healthcare, Canada can work towards a more equitable and accessible healthcare system for all. 2. If, as some analysts believe, deinstitutionalization of mentally ill patients contributed to the homeless population on the streets and the lack of services for people who need professional attention, should the government begin a new policy of “re-institutionalization”? Why or why not? Answer: The issue of deinstitutionalization of mentally ill patients is complex and multifaceted. While it's true that deinstitutionalization led to the release of many individuals from psychiatric institutions into communities, contributing to the homeless population and a lack of adequate services, simply reverting to a policy of "re-institutionalization" may not be the most effective solution. Re-institutionalization could potentially address the immediate problems of homelessness and lack of professional services for the mentally ill by providing structured care and support. However, it raises significant ethical and practical concerns. Firstly, returning to large-scale institutionalization could violate the rights and autonomy of individuals with mental illnesses. It risks repeating the mistakes of the past, where institutionalized patients often faced neglect, abuse, and isolation. Secondly, re-institutionalization may not address the root causes of mental illness or provide holistic, community-based support systems necessary for long-term recovery and integration. It could perpetuate stigma and discrimination against individuals with mental health conditions, further marginalizing them from society. Instead of reverting to institutionalization, governments should focus on comprehensive approaches that combine community-based mental health services, affordable housing initiatives, social support programs, and advocacy for mental health awareness and destigmatization. Investing in early intervention, outpatient treatment, crisis intervention teams, and supportive housing models can help prevent individuals from reaching crisis points where institutionalization becomes necessary. Furthermore, policies should prioritize collaboration between government agencies, healthcare providers, social service organizations, and community stakeholders to ensure coordinated and holistic support for individuals with mental illnesses. Ultimately, the goal should be to provide accessible, person-centered care that respects the dignity and rights of individuals with mental health conditions, while addressing the systemic issues that contribute to homelessness and inadequate services. 3. In what ways are sex and gender, class, and Indigenous status intertwined with physical and mental illness? Consider causes and treatments. Answer: Sex and gender, class, and Indigenous status intersect with physical and mental illness in multifaceted ways, shaped by social, economic, and historical factors. 1. Sex and Gender: Biological differences between sexes can influence susceptibility to certain illnesses, such as hormonal conditions or reproductive health issues. Gender norms and expectations also impact health outcomes, with societal pressures often discouraging men from seeking help for mental health issues or stigmatizing women with certain conditions like eating disorders. Transgender individuals may face unique challenges accessing healthcare due to discrimination or lack of understanding from medical professionals. Treatment approaches need to be sensitive to diverse gender identities and tailored to address specific health needs, including hormone therapy or gender-affirming surgeries. 2. Class: Socioeconomic status profoundly affects health outcomes, with lower-income individuals facing greater barriers to accessing healthcare, nutritious food, safe living conditions, and education. Poverty is strongly correlated with higher rates of chronic illnesses like diabetes, cardiovascular disease, and mental health disorders due to increased stress, limited resources, and inadequate healthcare access. Addressing health disparities requires systemic interventions such as affordable healthcare, social welfare programs, and initiatives to reduce income inequality. Treatment should focus not only on medical interventions but also on addressing social determinants of health to ensure long-term wellness. 3. Indigenous Status: Indigenous populations often experience disproportionately high rates of physical and mental illness due to historical trauma, colonialism, forced displacement, and ongoing systemic discrimination. Factors such as loss of cultural identity, lack of access to traditional healing practices, and environmental degradation contribute to health disparities. Culturally sensitive healthcare approaches that incorporate Indigenous knowledge and practices are crucial for addressing these disparities. Healing must involve community-led initiatives that prioritize cultural revitalization, land sovereignty, and equitable access to healthcare resources. Overall, addressing the intersectionality of sex and gender, class, and Indigenous status with health requires comprehensive strategies that recognize and confront the complex interplay of social, economic, and cultural factors. Effective treatments must be holistic, inclusive, and rooted in principles of equity and social justice. 4. What future health care reforms, if any, are needed in Canada? Explain your answer. Answer: Healthcare reform in Canada is an ongoing discussion, with several areas warranting attention to ensure the system remains effective, efficient, and equitable. One crucial aspect is addressing wait times for medical services, including specialist consultations, diagnostic tests, and elective surgeries. Reducing these wait times requires increased funding for healthcare infrastructure, training more healthcare professionals, and implementing innovative strategies such as telemedicine. Another area for reform is improving access to mental health services. Mental health issues are prevalent across Canada, yet resources for diagnosis, treatment, and support remain inadequate. Investing in mental health programs, integrating mental health services into primary care, and reducing the stigma surrounding mental illness are essential steps in this regard. Additionally, there's a need to enhance primary care services to alleviate pressure on hospitals and emergency rooms. This includes expanding access to family physicians, nurse practitioners, and allied health professionals in underserved communities. Strengthening primary care can improve preventive care, chronic disease management, and early intervention, ultimately reducing healthcare costs and improving patient outcomes. Furthermore, addressing inequities in healthcare access among Indigenous communities and marginalized populations is imperative. Efforts should be made to address the social determinants of health, such as poverty, housing insecurity, and discrimination, which disproportionately affect these groups. Culturally sensitive healthcare services and increased funding for Indigenous-led health initiatives can help bridge these gaps. Lastly, improving coordination and integration of healthcare services across provinces and territories is essential for ensuring seamless care delivery, especially for patients with complex medical needs or those transitioning between different healthcare settings. This requires better information sharing, standardized protocols, and collaboration among healthcare providers. In summary, future healthcare reforms in Canada should focus on reducing wait times, enhancing mental health services, strengthening primary care, addressing healthcare disparities, and improving care coordination. By addressing these areas, Canada can build a more resilient and equitable healthcare system that meets the needs of all its citizens. 5. Do you or anyone you know have a mental illness? What do you think is required to help people with mental illnesses cope better with/in society? Answer: 1. Reducing Stigma: Education and awareness campaigns are crucial to combat stigma surrounding mental illness, fostering understanding and empathy in society. 2. Accessible Treatment: Ensure affordable and accessible mental health services, including therapy, medication, and support groups, to provide individuals with the resources they need to manage their conditions effectively. 3. Early Intervention: Implement screening programs and increase access to mental health care in schools, workplaces, and communities to identify and address issues early, preventing escalation. 4. Supportive Environments: Foster environments that promote mental well-being, including supportive workplaces, inclusive communities, and stigma-free spaces where individuals feel comfortable seeking help. 5. Peer Support: Encourage peer support networks where individuals with similar experiences can connect, share resources, and provide mutual support, reducing feelings of isolation. 6. Holistic Approach: Emphasize holistic approaches to mental health care, incorporating physical health, nutrition, exercise, and mindfulness practices into treatment plans. 7. Crisis Intervention: Develop robust crisis intervention services, including hotlines, crisis centers, and mobile response teams, to provide immediate support during periods of acute distress. 8. Family and Social Support: Educate families and friends on how to support loved ones with mental illness, fostering understanding, empathy, and effective communication. 9. Policy Reform: Advocate for policy changes to prioritize mental health care, including insurance coverage parity, funding for mental health services, and integration of mental health into primary care settings. 10. Research and Innovation: Invest in research to better understand mental illness, develop new treatments, and improve existing interventions, ensuring that care remains evidence-based and effective. By addressing these factors comprehensively, society can create a more supportive and inclusive environment for individuals living with mental illness, enabling them to lead fulfilling lives and participate fully in their communities. 6. How have you seen the medical-industrial complex at work in Canada’s health care system? What can we do to prevent this U.S. phenomenon from happening or reversing its damage in Canada? Answer: In Canada, the concept of the medical-industrial complex, though not as pronounced as in the United States, can still be observed in various aspects of the healthcare system. This complex refers to the intertwined interests of healthcare providers, pharmaceutical companies, insurance firms, and other stakeholders, which can sometimes prioritize profit over patient well-being. One example is the influence of pharmaceutical companies on prescribing practices and drug pricing, which can potentially lead to overprescription and inflated healthcare costs. To prevent or mitigate the impact of the medical-industrial complex in Canada's healthcare system, several measures can be taken: 1. Transparency and Regulation: Implementing strict regulations and transparency measures concerning interactions between healthcare providers and pharmaceutical companies can help reduce conflicts of interest and ensure that medical decisions are based on patient needs rather than financial incentives. 2. Promotion of Evidence-Based Medicine: Emphasizing evidence-based medicine and independent research can help healthcare professionals make informed decisions about treatments and medications, reducing the influence of pharmaceutical marketing tactics. 3. Public Awareness and Advocacy: Educating the public about the potential risks associated with overmedicalization and overprescription can empower patients to make informed decisions about their healthcare and advocate for policies that prioritize their well-being over profit. 4. Investment in Primary Care and Prevention: Emphasizing primary care and preventive measures can reduce the reliance on costly medical interventions and pharmaceuticals, ultimately leading to better health outcomes and reduced healthcare expenditures. 5. Healthcare System Reform: Continuously evaluating and reforming the healthcare system to ensure that it remains patient-centered and accessible to all Canadians, regardless of socioeconomic status, can help prevent the medical-industrial complex from gaining a foothold. By implementing these strategies and remaining vigilant against the influence of profit-driven interests, Canada can maintain a healthcare system that prioritizes the health and well-being of its citizens while mitigating the negative effects of the medical-industrial complex. 7. Do you think that taxing junk food and applying government restrictions on certain food additives will help Canada’s problem with obesity? Why or why not? What other suggestions do you have for helping Canadians deal with the number of overweight and obese people in this country? Answer: Taxing junk food and implementing government restrictions on certain food additives can be part of a multifaceted approach to address obesity in Canada, but they are not standalone solutions. While taxing unhealthy foods may deter some consumers and generate revenue for public health initiatives, it may not significantly reduce obesity rates on its own. Similarly, restricting certain additives can promote healthier eating habits, but it's only one piece of the puzzle. To effectively combat obesity, a holistic approach is needed. This includes education campaigns to raise awareness about nutrition and healthy eating habits from an early age. Schools play a crucial role in promoting physical activity and providing nutritious meals. Additionally, creating environments that facilitate physical activity, such as safe and accessible parks, bike lanes, and walking trails, encourages people to lead active lifestyles. Supporting initiatives that make healthy foods more affordable and accessible, such as subsidies for fruits and vegetables or incentives for grocery stores to stock healthier options, can also make a significant impact. Moreover, promoting workplace wellness programs and incentivizing employers to prioritize employee health can contribute to reducing obesity rates. Addressing socioeconomic factors like poverty and food insecurity is essential, as these can contribute to unhealthy eating habits and limited access to nutritious foods. By implementing policies that address social determinants of health, such as affordable housing, living wages, and equitable access to healthcare, Canada can create conditions that support healthier lifestyles for all its citizens. Ultimately, addressing obesity requires a comprehensive approach that considers the complex interplay of individual behaviors, environmental factors, socioeconomic circumstances, and public policies. By combining strategies that target multiple levels of influence, Canada can make meaningful progress in combating the obesity epidemic and improving the health and well-being of its population. AUDIO-VISUAL MEDIA FOR FURTHER EXPLORATION A Country Doctor—Set against a backdrop of growing need for rural doctors in Canada, this film follows a small rural town’s search for a doctor who is willing to stay in the community. 2002. 61 mins. National Film Board of Canada, www.nfb.ca. Big Bucks, Big Pharma—This film pulls back the curtain on the multi-billion dollar pharmaceutical industry to expose the insidious ways that illness is used, manipulated, and in some instances created, for capital gain. 2006. 46 mins. Media Education Foundation, www.mediaed.org. Drug Deals: The Brave New World of Prescription Drugs—This film provides an in-depth investigation into the impact that industrial funding may have on the goals and ethics of medicine. 2001. 50 mins. National Film Board of Canada, www.nfb.ca. Emergency! A Critical Situation—This film asks the question: After years of budget cuts and restructuring, how is our health-care system holding up? 1999. 52 mins. National Film Board of Canada, www.nfb.ca. First Break—This film addresses the issues and experiences of the first episode of mental illness in a person’s life. 1997. 51 mins. National Film Board of Canada, www.nfb.ca. Hospital City —This film examines the workings of a contemporary health facility in St. Johns Newfoundland. 2004. 48 mins. National Film Board of Canada, www.nfb.ca. Shameless: The ART of Disability—Art and activism are the starting point for a funny and intimate portrait of five surprising individuals with diverse disabilities. Packed with humour and raw energy, this film follows the gang of five from B.C. to Nova Scotia as they create and present their own images of their disabilities. 2006. 71 mins. National Film Board of Canada, www.nfb.ca. The Long Walk—This film follows the efforts of Ken Ward, the first Indigenous Canadian to go public with his HIV (then AIDS) diagnosis, in working with First Nations populations for prevention and treatment of the epidemic. 1998. 49 mins. National Film Board of Canada, www.nfb.ca. The Weight of the World—This documentary looks at obesity and demonstrates beyond doubt that obesity is a human created epidemic. 2003. 51 mins. National Film Board of Canada, www.nfb.ca. Unlearn—This film documents three people’s experiences with mental illness and the stigma that accompanies it. 2006. 12 mins. National Film Board of Canada, www.nfb.ca. CRITICAL READINGS Chappell, Neena L. and Margaret J. Penning. 2009. Understanding Health, Health Care, and Health Policy in Canada: Sociological Perspectives. Don Mills, ON: Oxford University Press. Findlay, Deborah A. and Leslie J. Miller. 2002. Through medical eyes: the medicalization of women’s bodies. Health, illness, and Health Care in Canada. (3rd edition). (Ed.) B. Singh Bolaria and Harley D. Dickinson. Eds. Scarborough, ON: Nelson Canada. Foss, Mark and Tony Frine. 2008. Science in Nursing and Health Care (2nd edition). Toronto, ON: Pearson Education Canada. Gallivan, Joan and Suzanne Cooper ed. 2009. Pathways, Bridges, and Havens: Psychosocial Determinants of Women’s Health. Sydney, N.S.: Cape Breton University Press. Lexchin, Joel. 2002. Profits first: the pharmaceutical industry in Canada. Health, illness, and Health Care in Canada (3rd edition). (Ed.) B. Singh Bolaria and Harley D. Dickinson, Eds. Scarborough, ON: Nelson Canada. McGibbion, Elizabeth A. 2009. Anti-racist Health Care Practice. Toronto, ON: Canadian Scholars’ Press. Poole, Gary, Deborah Hunt Matheson, and David N. Cox. 2008. The Psychology of Health and Health Care: A Canadian Perspective (3rd edition). Toronto, ON: Pearson Education Canada Segall, Alexander and Neena L. Chappell. 2001. Health and Health Care in Canada. Toronto, ON: Prentice Hall. Waldram, James B (Ed.). 2008. Aboriginal Healing in Canada: Studies in Therapeutic Meaning and Practice. Ottawa, ON: Aboriginal Healing Foundation. Weiss, Gregory L. and Lynne E. Lonnquist. 2009. The Sociology of Health, Healing, and Illness. Upper Saddle River, NJ: Pearson Prentice Hall. Instructor Manual for Social Problems in a Diverse Society Diana Kendall, Vicki L. Nygaard, Edward G. Thompson 9780205663903, 9780205718566, 9780205885756