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128 Cards in this Set

  • Front
  • Back
health consumerism (definition)
the shift of passive recipients of care to CONSUMERS of health care
health information and the internet (concerns 3)
1) self diagnosis: already knowing what drug you want coming in

2) googling: how to filter/judge information found on google

3) change in physician's role: they lose control of information:
- they say that pharma companies are getting more control because they advertise online
IMPT: health consumerism (3 types, examples)
1) cause marketing - products that support social/health causes
- cheerios & American Heart Association, Yoplait & Susan G Komen Race for Cure, Product Red & AIDS, TB, Malaria

2) disease mongering
- marketing strategies that target the healthy and well (invention of new diseases)
ex: anti-aging, sexual dysfunction, pre-osteoporosis

3) direct to consumer advertising
- illegal in Canada but there's spillover from USA
ex: viagara or cialix ads
mutual benefit marketing
the way that pharma companies label cause marketing
types of media (4)
mass media:

- broadcast: radio, TV

- print: books, flyers, magazines

- internet: blogs, podcasts, websites

new media:
- new media: social media, text messages etc.
democratization vs. corporatization of media
demo:
- people can create their own media sources (blogs)
- organizing can happen very quickly (fb, texting)

corp:
- mergers and media conglomerates that are more powerful now (Canwest)
IMPT: levels of media analysis (3) examples for each
1) production - relative interests of govt, business, professional societies
ex: if it bleeds, it leads (forced to write about eye catching headlines)

2) representation - the content of media messages
ex: mental illness is always talked about in the context of violence, viagara ads are just pictures

3) reception - media audiences and their responses, acception or rejection.
ex: pharma companies marketing often forms associations in your mind about the drug
IMPT: popular media representations of illness (3)
1. illness as a metaphor

2. illness as carelessness/failure/choice

3. illness as despair
IMPT: HIV/AIDS and media/cultural representation (2)
- early homophobic representations: gay bodies breaking down from too much sex & drugs
- private moral responsibilty
IMPT: who did the ACT UP! campaign? what were points (3)
the AIDS coalition to unleash power (lay/activist group):

- challenged the dehumanizing representation of AIDS

- argued that spread couldve been prevented by less indidvidual moral blaming

- art: "silence=death" image by Keith Hering
illness a a metaphor example, consequences (2)
- war metaphor for cancer

- often represented as an individual burden, not one of the govt or social gradients

- implies that individual can do something even though they usually cant
illness as carelessness example, consequences
HIV (shouldve used protection)

- targets individuals with specific sexual behaviours (gay men), shames their identity

- scare tactics regarding sex practices: dont always work for health
IMPT: illness as choice (2 examples)
- exercise for arthritis
*not always possible or effective

- prevention diet for breast cancer
* diet constrained by SES
illness as despair (example)
ex: laughing approach (Carl Simonton)

- people are not happy enough, this is why they get sick or are not getting better

- well duh, but happiness is not simple: socio-economic factors. this puts the blame on people.
IMPT: public health contemporary rep. of HIV/AIDS
- less targeted, more focus on community support
- might be more effective, not enough research comparing representation effectiveness
research methods for critiquing media rep of illness
QUALITATIVE: interviews of afflicted, autobiographical accounts, narratives, focus groups

eg: Glascow Media group
main critiques to media representations of illness (2)
- illusion of control: complex diseases are represented as controllable

- blames the individual, neglecting powerful groups and their interests
IMPT: is breast cancer the most common cancer among canadian women?
yes

- but 87% of ppl are alive 5 yrs after diagnosis
IMPT: representations of risk factors for breast cancer
individualized messages:
- attitude adjustment
-gender roles
- choosing to live, not die
- continuing gender roles
IMPT: the social movements for breast cancer (3)
1. susan g. komen race for the cure:
- popular, highly profiable
- normative (white, straight, rich)
- raises money for: screening and cure
- competitive for businesses to be linked to to this campaign

2. women & cancer walk
- challenges assumptions of equality & heteronormativity
- has a focus on intersectionality

3. toxic tour
- black ribbons
- environmental activism: go to toxic waste dumps
pink ribbons inc.
- a critique of breast cancer campaigns
touches on the genderization/sexualization of health
IMPT: what is HPV? (2)
- low risk (asymptomatic/warts) and high risk (cancer in private parts): each have different vulnerabilities (you're way more likely to get the low risk one)
- HPV is very common and contagious
IMPT: is there a crisis in cervical cancer?
no, only in Aboriginals, not in general population
-most people are ok with regular pap smears
motvations behind devleoping gardasil (2)
1) financial desperation

2) potential for it to be a blockbuster drug
carvarix vs. gardasil
GSK vs. Merck
IMPT: multiplatform camapaign for marketing gardasil
1. pre approval
= motives to increase thinking about their product, not general knowledge

2. post-approval
make the committment
a pre-approval campaign funded by gardasil to get women to talk to their doctors about cervical cancer
make the connection
a pre-approval campaign funded by gardsil to get research on HPV and cervical cancer links, as well as give bracelets to celebrities to promote awareness
tell someone
- a preapproval campaign by merck that got women to basically talk to other women about HPV/cervical cancer.

- they bought neutral domain names to imply that they were neutral but it was funded by Merck
one less, I chose
post approval:
- campaign to young women about getting gardasil

I chose:
- a campaign to older women cause the young women caused some contreversy
critiques against national HPV vaccination programs
- diff vulnerabilities for diff populations of women
- not targeting guys, so its not like we're getting rid of the virus
- we dont know about long term effects or boosters
Fosket article main points (women's roles in breast cancer: magazines)
- breast cancer pop culture: personal responsibility, blame the victim ideology.

- women are responsible for:
detecting: co-optation from CRUCIAL ROLE to HELD RESPONSIBLE. detecting it has followed the dominant model of femininity

preventing:everything from having chilren, the right bras, abstaining, hormone balance, breastfeeding etc

surviving: always an optimistic outlook helped, and they are strong for surviving. but its not in their control that much.

whats lacking from media? race and class representation.
Orenstein article main points (coroprate giving)
- companies compete for access to Susan g Komen
- Breast Cancer Action is an activist group - Brenner: doesnt believe in corporate support
- prostate and AIDS want the attention breast cancer gets
IMPT: food as substance (2) vs. symbolic (2)
substance:
- source of nutrients needed for body
- deficiency/excess of these nutrients results in health disparities

symbolic:
- associated to feelings and social class
- historically and culturally shifting meaning
rickets
weak bones caused by lack of vitamin D
Competing ideologies/discourses of food
nutritional/medical vs. pleasure/ritual
>richard klein's eat fat
IMPT: fat phobia (3)
- dislike of fat on ourselves and others
- attached to moral implications of obesity (seen as deviance)
- the idealization of thinness (tyranny of thinness), this is linked to the prevalance of eating disorders
fat activism
- points out job/housing discrimination and stigma associated with being fat
IMPT: the levels of analysis for the interaction b/w material and symobolic aspects of food (3)
1) food industry
- production, preparation, processing

2) regulation
- FDA: is govt regulation inadequate?

3) consumption
- consumer characteristics/preferences/patterns
food industry (3 aspects, each has a criticism)
-production,
* environmental outcomes

- preparation/processing,
*e. coli outbreaks

- marketing/dist/retail
* misleading info, targeted outbreaks
regulation of food
- FDA: is govt regulation inadequate?
consumption of food (4)
- seen as over/under eating
- eating disorders are most fatal DSM
- more consumption of energy dense foods
- globesity: more than 1bil people in the world
IMPT: tyranny of thinness
a hypothesis used to explain the global trends in eating disorders
eating disorders , social trends (5)
- gendered
- culutrally bound (white, middleclass, western)
- areas of high media exposure
- globalization is happening
- increase in Japan and Pakistan and places where girls have exposure to western culture
IMPT ST ANSWER: the social (dys)functions of obesity (julier)
FUEL THE OBESITY INDUSTRY
- obesity is profitable for food, diet and exercise industries

OBSCURES POLITICAL FAILURES
- moral entrepreneurs scapegoat the obese for high healthcare costs

DIRTY WORK AND SCAPEGOATING
- there is blaming ppl for their bodies and job discrimination
IMPT SH ANSWER: the obesity-hunger paradox (5 explanations)
-the food insecure are at an increased risk of obesity

1) food related costs make you buy cheap, unhealthy things

2) food deserts (you cant find healthy foods)

3) cheap food is deficient in vitamins and minerals

4) less likely to engage in exercise if poor because neighborhoods are dangerous

5) hunger produces physiological changes to make people crave certain foods (unhealthy)

6) Long hours working/multiple jobs: low SES, you dont have time to cook food

ex; The South Bronx: THE SAME PEOPLE ARE HUNGRY AND OBESE


2) food deserts
BMI calculation and limitations
weight / height
- doesnt take into account body composition or fat distribution
- inappropriate for children
IMPT: food inc (clip 1 and clip 2)
- highlights the racialized selection of poultry pickers
- exposure to antibiotics, bird-related diseases, psychosocial stress (debt load, autonomy)

CLIP 2 (CHOICE AND CONSTRAINED CHOICE)
- only a few companies and crops involved (illusion of diversity)
- corn is a commodity crop
- fed to cows: acid resistant e coli
IMPT: martin article main points (doctors and obesity)
- doctors need to stop treating patients who are overweight like a "weight loss" medical problem

- they shoudl ask the patients how they feel about their own weight & body perception
IMPT: canadian medicare (2 aspects)
1) publicly financed
- federal principles under Canada Health Act
- federal and provincial funding

2) privately delivered
- by hospitals, doctors, home care
IMPT: medicare coverage vs. not covered
- ESSENTIAL medical services: primary, prenatal, some surgeries

- NOT COVERED: dental, eye care
IMPT: delisting (2)
removal of medical coverage for a certain medical procedures or services

used as cost-containment mechanism

i.e. circumcision of male infants
IMPT SH ANSWER: history of canadian health care
1945 - Dominion-Provincial Conference on Reconstruction
- proposals for federally supported med insurance
- weakened post WW2 support from doctors (return of prosperity)

1958 Hospital Insurance and Diagnostic Services Act
- (50/50 cost sharing b/w federal and provincial)
- 1961: hospital insurance in all provinces
- medical profession concessions: professional autonomy maintained, they got to charge fee-for-service, determine what services are essential, and set their own fees.

1968 Medical Care Act
- full universal healthcare, not just in hospitals
- each province must set up its own healthcare system

1984 Canada Health Act
1) universality
2) portability
3) comprehensive services
4) Administration
5) Accessibility
- 50/50 funding
IMPT: who supported and opposed public health?
supported
- labour unions
- farm co-operatives

opposed
- medical profession
- life and health insurance companies
- drug medical and hospital supply companies
IMPT: julier article (13 functions of obesity)
- public health switch to physical activity rather than weight loss

- GANS (poor pay all): US has a history of casting away poor and need and then blaming them for their own marginalization

- thnking about the functionality of obesity helps us udnerstand the advantages given to people who are rich. same with obesity and thinness.

13 functions:
- dirty work (job discrimination)

- subsidize the affluent (plastic surgery ginea pigs)

- "epidemic" label - creates jobs, medicalization

- prolong the usefulness of goods (+ size clothing)

- template for deviance, making conventional norms legitimate (need a villian to have a hero)

- cant get out of the hole ()

- live vicariously through fat ppl (artwork of obese is seen as sexually driven)

- serve a cultural function (Big Mama eddie murphy)

- status affirmation (for those who are not obese)

- status mobility (for those who lose weight)

- are icons for their "battle" with obesity (oprah)

- take the blows of policy/cultural changes ()

- facilitate political process (are scape goats)
recommendations from julier (3)
- universal health care with preventative options
- food system with access to good food for everyone
- food industry with more focus on feeding than profit
IMPT: Sontag article (AIDS) main points
- AIDS: shows a moral problem to the world that you should be ashamed of (sexual promisciouty)
- people are seen to be as good as dead after testing positive: this is not proven true
- people HIV+ get fired because bosses think they will die, cant immigrate, seen as fragile
armstrong article main points
- from a political econcomy perspective
IMPT: starr main points (legitimization of hc)
medical authority:
legitimization
- based on unity (rise of hospitals)
- tecnhical competence
- also cause of tech. revolution (easier to access)
- cultural beilef shift to science

depdenency
- institutionalized - all docotrs immediate authority
- gatekeeping (surveillance)
- insurance/prescription writing

AUTHORITY TO INCOME
- defining limits of public health(care)
-they our autonomy as a body of professionals
IMPT: zola (medicine social control) article
-psychiatry is not the only medicine that has social control

medicaliazaiton has social control by:
- expansion into healthy aspects of life
- absolute control over technical prodcedures
- they have exlcusive access to personal life
- what is needed for "health"
IMPT: johnson article main points (Dutch childbirth) (4)
- more in control of their environment,
- the difficulty and normalcy of pain in giving birth,
- fulfillment and empowerment from childbirth
- motherhood and importance of the midwife caregiver role
IMPT: macdonald article on new midwiferey in Canada
natural birth - fighting the biomedical/technocratic model of pregnancy

- contributes to gender expectations > women are naturally competent and knowing

- natural birth contemporarily means combining midwifery logic of caring and choice with technology and hospital space
IMPT: zadorozynji (comparing PP care across countries) articel main points
- postpartum care is shaped by welfare state policies and cultural norms.

- warm-postmodern is the way to go

- Netherlands has the best system, politcally and culturally. Because it combines state + familial provided care (makes familial care an option rather than a neccessity).
questions about regulation of MEDICARE (&Canada Health Act) afterwards (2)
- healthcare costs skyrocket after HCA 1984
- 1987: Ontario doctors went on strike, the politically conservative ones.
barriers to health under medicare in Canada (5)
- prescriptions
- transportation
- discrimination
- time/energy/scheduling
-dependents
IMPT: differences between canada and quebec healthcare (2)
- castonguay-nepveau commission caused coordinated services in the same places: CLSCs.
- focus on preventative care

rest of canada doesnt really have this
IMPT: Armstrong and Armstrong, is health system in crisis??
no
health care expidentures failed to keep up with _____
population growth
which healthcare costs are out of control?
pharma (private sector)
IMPT: health care reforms (2), consequences of reforms (4)
1) cutbacks in health care services
closures
reductions
earlier discharge/reduced length of stay (LOS)
delisting
proposals to shift costs to users, privately

2) privitization strategies

3) Canada Health and Social Transfer
- the federal govt is withdrawing

reforms
-access
-utilization
quality of care
health care workers
Romanov report (2), Kirby (1)
-improving health care reforms: aboriginal health and pharmacare

- introducing health tax
critiques of premises for health care reforms (3)
1. Therapeutic nihlism
- intention to switch focus to upstream but no follow through

2. Healthism & Discourse of Health Promotion
model that attaches health not only to medical services but also to various other issues, such as lifestyle
‘make the sick pay’

3. Alleged efficiency of private sector/market mechanisms
assumes that application of market principles to health care will take care of our issues
current issues in canadian healthcare (2)
privatization and downsizing
IMPT: WHO ratings of health systems (4), performance measures (5)
**WHO beleives healthcare is a fundamental right**

1. France
8. Oman
30. Canada
37. USA

Overall level of population health (outcomes)
Health inequalities (or disparities) within the population (health gradient)
Overall level of health system responsiveness (does it do its job)
Distribution of responsiveness within the population (range of services)
Distribution of health system’s financial burden within the population (accessibility)
IMPT SH ANSWER: FR vs. US vs CAN healthcare systems
FRANCE
- every citizen covered by a sickness fund + prespcription drug coverage
- sickness fund is like a health tax
- fund partially reimbourses patients


IMPT FEATURES
- solidarite: cUSA
- private/corporatized
- insurance (60% through employer): often covers HMOs (funded providers) but not always PPOs (preffered providers)

public component to USA healthcare
- 30% is covered by govt: elderly, veterans, disabled, children, poor
- recently: some prescription insurance for elderly, disabled

gaps in coverage
- 15% have no insurance, 50% underinsured

SPENDING
- highest costs in the world ($8000 per person) overall, govt spending higher than public systems.
- usage is below median for dev., countries
health care reforms and attempts in US (4)
- 1912 roosevelt: physicians defeated this

- 1974 nixon: medical industries defeated this

- 1990 clintons: public health reforms met with opposition that said ppl derserve right to shop around for health. HIPA Act: keep insurance if switching jobs

2009 Obama: continued children's health insurance program
- PPAC act: affordable govt supported insurance
> not meant to establish single payer, public system
IMPT: French HC system (coverage, impt feature, gaps, costs)
FRANCE

COVERAGE
- every citizen covered by a sickness fund + prespcription drug coverage
- sickness fund is like a health tax
- fund partially reimbourses patients

IMPT FEATURES
- solidarite: chronic/severe illness and contributions by rich/poor are scaled
- preventative care

GAPS
- supplementary insurance is available (limiting)
- direct upfront payment for your portion

COSTS
- prices set by private sector, health care costs are higher.
- doctors are salaried (wages lower)
IMPT: US Healthcare (Coverage, Gaps, Costs)
USA
- private/corporatized
- insurance (60% through employer): often covers HMOs (funded providers) but not always PPOs (preffered providers)
RE: public component to USA healthcare
- 30% is covered by govt: elderly, veterans, disabled, children, poor
- recently: some prescription insurance for elderly, disabled

GAPS
- 15% have no insurance, 50% underinsured

COSTS
- highest costs in the world ($8000 per person) overall, govt spending higher than public systems.
- usage is below median for dev., countries
IMPT: aboriginal health practices (variations, similiarities, treatments)
variations among communities in practitioners, treatments

similarities in disease causation ideas (natural & supernatural)

- treatments
- spruce bark (vitamin C)
- willow bark (salycin)
- anesthetics – childbirth
- emetics (vomiting)
- diuretics (urination)
- plant extracts (antibodies)
- cataract removal
- spiritual (for serious illness)
>> serious illnesses seen as penalties (moralizing)
legacy of aboriginal health practices (4)
legacy
- practices marginalized or outlawed
- oral traditions lost because of residential schools & outlaw
- replaced with European systems
- any records that remain are by colonizers (bias)
early surgeons were also
barbers, who did surgeries on the surface and it was dangerous
allopathic practioners
nowadays aka biomedical practitioners, back then dencounced allopathic doctors
IMPT: professionalization of medicine 4)
- 1869: self-regulatory licensing and professional recognition

- 3 early types of medical education: apprenticeship, proprietary schools, university system

- imptance of scientific breakthroughs & medicine

- happened by flexner report
IMPT: the Flexner Report (recommendations, consequences)
- pushed to evaluate medical schools to ensure scientific and standardized knowledge
- standardized length of curriculum
- full time faculty
- integration with university system
- medical research

- closure of rural, underfunded, and schools for Black ppl (more than half of schools)
- made schools more expensive,
- changed face of medicine (to white men)
- organizational changes: increase in self-regulating medical associations
ideological work to make medicine professional (2)
- campaigns against traditional, Aboriginal healers

- struggles for social mobility (ie. power)
- factors determining power of profession (3)
- esoteric knowledge: has been eroded with time

- social distance: white coat, stethoscope

- homogeneity of group: makes it easier to organize
4 types of medical practice
- self-employed/solo-practice

- partnership practices

- group practices (CLSCs)

- employed by govt or company (hospital)
payment arrangement for physicians
- 90% fee-for-service, very few salaried
key issues in modern medicine
- changes to organization and funding
* more dictated by pharmas
* increased hospital administration

- shifting perceptions of bio-medicine
* less respect for MDs

- use of complementary and alternative medicine
* increasing use of CAM
* Regulated Health Practitioners Act - nurse-practitioners can now do a lot of what MDs do
IMPT: business of being born key points
- better childbirth outcomes ouside US, Europe uses midwives
- hospital is a business, not service (moves women in and out quick as possible)
-
IMPT: domino effect of medical interventions to childbirth (3)
-pitocin (speeds up birth, increases pain of labour)
- need epidural for pain relief (puts baby in distress)
- this causes c-section
physicians (male vs. female)
- more male historically, now more women
- but women are GPs not specialty doctors as much
early nursing in canada (17th century)
1) close ties to christianity

2) viewed as unskilled work
IMPT: florence nightingale model of nursing (4)
- first nurse training program
- made nurses hygenic, domestic, and interpersonal
- was made to be care not cure model (aux. to medical profession)
- gendered heirarchy
crimean war
helped nurses gain respectability as a profession, but limited to the role of serving the physician and made concessions that worked against professionalization
IMPT: exploitation of nruses under nightingale model in Canada
- inexpensive labour
- more tasks, not proportional increase in benefits
- doctors were moral guardians: trained nurses
- nurses were physician extenders
IMPT: physician extenders (2)
- nurses were physician extenders:

- constant surveillance
- long work hours (zola: hands of doctors)
streams of nursing (2), consequences of this (3)
degree & diploma streams.

- has fragmented the profession
- some are paid more, some are paid less
- people view nurses poorly (since not all nurses are qualified to do the same things and ppl dont realize this)
barriers to contemporary change in nursing in canada
- cut backs on skilled nurses

_physician resistance
IMPT: occupational ghetto/pink collar ghetto (2)
- work that requires a lot of time/effort, but has low pay, prestige and social mobility

- done by women
home care and unpaid care
- increased care responsibilities
- lowest cost care providers (so they are devalued)
- a growing body because of privatization of healthcare

- assumptions that its women who will do this care
- that it comes naturally to them, NOPE its skilled work
-
representation of nursing and consequences
- that it is natural and innate behaviour for women (easy, not hard)
- results in lower pay
aversion
a tradiitonal birthing practice to move babies into the right position for birth (before c-sections existed)
IMPT: reasons why childbirth left the home, entered the hospital (3)
- changes to the legal status of childbirth (midwives illegal)
- shifting public perceptions (media, influence)
- technology access and provision at the hospital
Electronic fetal health monitoring (4)
- used to monitor fetal distress (heart rate)
- almost completed ineffective (cochrane)
- heart rate not will correlated with distress
- causes dystosia (slow birth): because it restricts movement
twilight sleep (2)
- scopolamine, caused amnesia
- caused slow labour and aspxiation of babies
contemporary management of pregnancy & childbirth (3)
- increasing interventions (cascade of interventions)
- induction using c-section, vacuum, forceps
c-sections
recommended use is 15%,
- negative health outcomes:
- a surgery, can have complications
debate about elective cesarean
- downstream: media talks about women being selfish
- this only accounts for 1% of births
IMPT: Alternative Birth Movement (3)
- 1960s-70s, growing dissent, reaction to twlight sleep
- rebirth in midwife practice
- struggle for rights to practice
current midwifery legislation
legal in most provinces
-integration into maternity care in some places

forces against legaliization:
- medical profession
-path dependency
- sexism/gender discrimination
path dependency
- people become dependent on the current path (its hard to change when set in a habit)
home birth rate in netherlands
30%
trends in postpartum care (2)
- decreasing length of stay:
- to save costs
- argument that women dont need it

in canada: options are uneven, there are regional differences
IMPT: disabilities umbrella (3)
- impairment
* deaf, blind, etc.

- activity limitation
* poor driving because of visual impairment

-participation restriction
* difficulty in social/interactional things (not allowed to partipicate because of assumptions)
WHO definition of disability (3)
- physical, sensory, cognitive, developmental
- mental illness
-chronic illness
IMPT: chronic vs. acute illness
-long lasting
- irreversible
- varying of impact

vs.

- end in short time period
IMPT: how old is old?
UN: 60 years
non-communicable diseases
- the leading cause of death for old people all over the world (60+)
double burden of disease
dev. countries have NCD & infectious disease both
disability trends (2)
- increases with age
- women have it more
chronic illness
- accounts for 87% of disabiltiy
- about 67% of direct health care costs
increases in death from the following chronic illnesses (4)
- cardiovascular deaths in women
- cancer
- diabetes
- obesity
IMPT: biomedical approach to CI, disability and aging (3)
- individual's physical or mental deficit
- aimed at finding cures

CI
- current system designed for curative, acute care
- medicine was never for people with disabilities

Aging
- care for them is less rewarding
IMPT: social approach to disability, CI, and aging (4)
- disability results from complex interactions

- do not neccessarily need to be fixed

- removal of barriers is key

- disability is preventable: its more often acquired over the course of life than congenital

- ex: low SES causes disability and vice versa
IMPT: demographic transition of disease
- pop. aging/”greying” of world
- 60+ age group is fastest growing age group in world
- decreasing fertility rates
- increasing longevity
- activity limitations and likelihood of impairment increase after certain age
consequences of biomed model of aging (4)
- curative approach is really expensive
- responsibility given to informal carers
- overtechnilization of care (and maybe privatization)
- continuum of need/dependency (rather than interdependence)
IMPT: zola article on aging main points
- technologization causes bias of short term over long term solutions
- leads to objectification of people reciving the care
- pushing care home can result in tehcnology taking over the home
- we need to recognize that peopel will get sick but we need to still value them instead of always trying to cure