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That Contribute to the Unequal Access to Health Care and Escalation of the Health Care Cost

This essay focuses on the comparing and contrasting the functionalist, conflict and symbolic interaction perspective on the health care system in Trinidad and Tobago and its problems. Functionalists note that health is essential to the preservation of the human species and organized social life. One way societies contain the negative effects of health problems and disease is through institutionalizing illness in a sick role.

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Conflict theorists note that some people achieve better health than others because they have access to those resources that contribute to good health and recovery should they become ill.

And finally, symbolic Interactionist theorists view sickness as a condition to which we attach socially devised meanings. For example, an increasing number of behaviors that earlier generations defined as immoral or sinful are coming to be seen as forms of sickness the medicalization of deviance. The ministry of health is in the business of promoting wellness and ensuring the availability of quality health care to the people of Trinidad and Tobago in an affordable, sustainable and equitable manner. Although some advances were made, problems and inadequacies in the delivery of health care persisted.

In addition, the Health Sector Reform Programme was developed with the aim of decentralizing the health services. The government of Trinidad and Tobago takes into account the WHO definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. (WHO, 1986). Health care therefore, is the prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions.

In an attempt to address the problems the government of Trinidad and Tobago via the ministry of health implemented, the plan to decentralize the health services which was cultivated by strengthening the policy-making, planning and management capacity of the health sector; Separating the provision of services from financing and regulatory responsibilities; Shifting public expenditures and influencing the redirection of private expenditures to high priority problems and cost-effective solutions; Establishing new administrative and employment structures, which encourage accountability, ncrease autonomy and appropriate incentives to improve productivity and efficiency; Educing preventable morbidity and mortality through promoting lifestyle changes and other social interventions. (Ministry of Health, 2000). Functionalism is based around a number of key concepts. Firstly, society is viewed as a system a collection of interdependent parts, with a tendency toward equilibrium. Secondly, there are functional requirements that must be met in a society for its survival (such as reproduction of the population). Thirdly, phenomena are seen to exist because they serve a function (Holmwood, 2005:87).

Conflict Theory states that the society or organization functions so that each individual participant and its groups struggle to maximize their benefits, which inevitably contributes to social change such as changes in politics and revolutions. The essence of conflict theory is best epitomized by the classic ‘pyramid structure’ in which an elite dictates terms to the larger masses. All major institutions, laws, and traditions in the society are designed to support those who have traditionally been in power, or the groups that are perceived to be superior in the society according to this theory.

This can also be expanded to include any society’s ‘morality’ and by extension their definition of deviance. Anything that challenges the control of the elite will likely be considered ‘deviant’ or ‘morally reprehensible. ‘ The theory can be applied on either the macro level (like the US government) or the micro level (a church organization or school club). Symbolic Interactionism: Herbert Blumer (1969), who coined the term “symbolic interactionism,” set out three basic premises of the perspective: firstly, Human beings act toward things on the basis of the meanings that the things have for them.

Secondly, the meaning of such things is derived from, or arises out of, the social interaction that one has with one’s fellows. These meanings are handled in, and modified through, an interpretive process used by the person in dealing with the things he/she encounters. Symbolic interactionism is a social constructionist approach to understanding social life that focuses on how reality is constructed by active and creative actors through their interactions with others Functionalism argues that any institution, group, or organization can be interpreted by looking at its positive and negative functions in society.

The positive functions of the health care system are the prevention and treatment of disease. Ideally, this would mean the delivery of health care to the entire population without regard to race – ethnicity, social class, gender, age or any other characteristic. According to arson the function of the health care system is to enable people to be healthy enough to do all the things they need to do to keep society functioning. (Talbot Parson, 1951).

For example, The Government of Trinidad and Tobago is committed to the development of a robust, effective and accessible health care system to ensure that its citizens enjoy long, healthy and productive lives. They will also develop programmes to identify and assess the nation’s health needs and further the training of our medical health personnel to adequately serve the population by focusing on disease screening and prevention, health promotion, improved management and access to health services. (Ministry of Finance, 2009/2010).

Functionalism also emphasis the systematic way that various social institution are related to each other together forming relatively stable character of society (The Health ministry’s Chronic Disease Assistance Programme (CDAP)) the government is also involved in health care through institution such as University of the West Indies that funds new research on various matters of health and health care policy). (TRHA, 2004) for instance, the introduction of the Tobacco Control Bill is an important element of our public health policy.

The health care system is notable for a number of negative functions; some may argued that the functionalistic perspective on medicine applies only to some conditions and people. It does not address chronic illness Those that contribute to disharmony and instability of society such as the Health risk factors for our population include tobacco use, abuse of alcohol, and lack of physical activity, inappropriate diet and obesity which are common to several chronic diseases.

Secondly, And without the current ability to cure patients regardless of how much they may want to get well or their doctors may try to make them well, that outcome will not occur. Finally, health care system does not function optimally because of the profit motive that is sometimes at odds with the function of providing health care.

For instance, some may not be able to afford the cost to get proper health care and it encourages medical professional to be in charge of treatment, leading, in that it does not support the growing interest and knowledge of patients who wants to take an active role with their physician in directing their own health care. The conflict perspective on health care focuses on issues involving equity and tension within the health care system although these theories cannot deny that modern health care can help people in maintaining or restoring their health.

Minorities, the lower class, and the elderly particularly elderly woman have less access to health care since they may not be insured (Navarro 1993, 2000) nevertheless, in Trinidad and Tobago such has been eliminated in that, the construction and upgrade of Primary Care Facilities is another initiative aimed at improving the health delivery system and facilitating the Government’s preventive and primary care approach to health.

Today, there are 103 health centres, strategically located to ensure increased public access to what today is an expanded range of primary care services. This also reduces the number of patients at our nation’s hospitals, thus securing better care services at all institutions and cost savings through more efficient use of resources. To the contrary the functionalist argues that relatively greater access of the middle and upper classes to medical care is good for society because the upper classes are more beneficial to society.

For instance Bearing that in mind, it could be argued that since the ruling class needs hard workers to accomplish their tasks so that the ruling class can become richer, having healthy workers would be beneficial because if a worker is unhealthy they will not be as productive and will be able to produce as many goods and services as a healthier worker. Symbolic interactionism take a micro look at health care rather than focusing on the structure of the larger system or its interrelationships with other parts of the society.

The symbolic interactionism holds that illness is partly socially constructed. The definition of illness and wellness are culturally relative. Sickness in one culture may be wellness in another. It is time dependent as well. Similarly health care system itself has a socially constructed aspect. The way we behave towards the ill, towards the doctor and towards innovating ventures such as HMO are all social creatures.

For instance, Symbolic interactionism has a concept by Calvin Cooley referred to as the ‘Looking Glass Self’, we see ourselves in terms of how we are viewed in society. If society views us as ill largely mentally but also physically we may come to perceive ourselves that way and behave accordingly. A person with a physical handicap may come to view themselves as flawed or defective and will behave that way. A person with a mental illness will act the way a person with mental illness s supposed to act. (Kendall, 2007). Marxist perspective it ensures that population remains healthy enough to contribute to the economic system, by working in offices and factories to produce profit for the ruling class. (Haralambos and Holborn, 2000, 295). Marxist theory of dialectic materialism, which explains the struggle of opposites, could have been used to explain the struggle of people to reverse the trend of not been able to afford quality health (Haralambos and Holborn, 2000,945).

One can also draw on the theoretical discussion on social interaction, particularly as it relates to historical events that facilitate this interaction. From a symbolic interactionist perspective we might look at the meanings of work that members of society learn. (Understanding Social Problems, 2009, 258). The concept developed by (Durkheim, 1893) that social solidarity within a culture as one of its most critical features in terms of health and social cohesion will explain why it is important to health and the people of Trinidad and Tobago.

Durkheim further argued that individuals and groups that were well integrated into society were less likely to take their own lives than others. The citizenry of the republic of Trinidad and Tobago have had their share of trials with the public health system such as the shortage of nurses, lack of equipment and delivery of medical services, overcrowding and the likes, these things are soon a thing of the past.

The government of the republic of Trinidad and Tobago has implemented the health sector reform policy and as well as the transformational plan, which would enable them to foster a healthy and productive population through preventive care to create and maintain a first class health care delivery system; and to develop and manage a comprehensive customer based public health system. These strategic objectives in the transformational plan have been employed and thus the institutional changes resulted in the establishment of the 811 number for the national emergency ambulance service.

The cabinet appointed technical advisory committee for chronic non- communicable disease, the development of infection prevention and control polices and guidelines to reduce the incidence of health care associated infections, the patients’ safety programme, the implementation of a clinical management system, electronic health records and laboratory information systems for HIV/AIDS as well as the ministry of health has intensified its efforts by increasing the number of trained nurses to 1,510 to fill nursing vacancies in our health nstitution by 2012-2015. (Narace, 2009),. They are too numerous to mention all, but it is still an on-going process to develop and efficient and equitable health sector for the citizenry.