Gary McDonogh. Encyclopedia of Contemporary American Culture

Подождите немного. Документ загружается.

ER,

where procedures, diseases and healthcare issues are brought to wider attention.

Electronic information and consultation via the

Internet

have also begun to have an

impact on knowledge about conditions and treatments. Health also remains a staple o

everyday conversation, as in many other societies around the world.

The US constantly boasts of the most advanced healthcare system in the world,

ointing to flagship hospitals, research breakthroughs and striking contrasts in a century

of development. In a sense, this reflects the American sense of inventing the national

ody by boasting about its care. While these advances are important, continuing and

emergent conditions—sometimes related to the very sources of American wealth and

power—as well as divisions in health, disease and wellness underscore the complexity o

these themes in contemporary American culture.

Further reading

Baer, H.A., Singer, M. and Susser, I. (1997)

Medical Anthropology and the World

System: A Critical Perspective,

Westport: Bergin & Garvey.

Barrett, R.C., Kuzawa, T., McDade and Armelagos, G. (1998) “Emerging and Re-

emerging Infectious Diseases: The Third Epidemiological Transition,”

Annual Review

of Anthropology

27: 247–71.

Brown, K.M. (1991)

Mama Lola: A Voudou Priestess in Brooklyn,

Berkeley: University

of California Press.

Cassell, E.J.

The Nature of Suffering and the Goals of Medicine,

New York; Oxford:

Oxford University Press.

Crawford, R. (1984) “A Cultural Account of Health: Control, Release, and the Social

Body” in J.McKinlay (ed.)

Issues in the Political Economy of Healthcare,

London:

Tavistock Publishers, pp. 60–103.

Fuchs, V. (1986)

The Health Economy,

Cambridge, MA: Harvard.

Hahn, R.A. (1995)

Sickness and Healing: An Anthropological Perspective,

New Haven;

London: Yale University Press.

Henderson, G.E., King, N.M., Strauss, R.P., Estroff, S.E. and Churchill, L.R. (eds)

(1997)

The Social Medicine Reader,

Durham; London: Duke University Press.

Illich, I. (1976)

Medical Nemesis,

New York: Bantam. National Association for Public

Health Statistics and Information Systems: http://www.naphsis.org

Navarro, V. (1993)

Dangerous to Your Health: Capitalism in Healthcare,

New York:

Monthly Review Press.

Ryan, W. (1976)

Blaming the Victim,

New York: Vintage.

Snow, L.F. (1993)

Walkin’ Over Medicine,

Boulder: Westview Press.

Starr, P. (1982)

The Social Transformation of American Medicine,

New York: Basic

Books.

Waitzkin, H. (1991)

The Politics of Medical Encounters,

New Haven: Yale University

STEVE FERZACCA

GARY MCDONOGH

CINDY WONG

Encyclopedia of Contemporary American Culture 526

healthcare and reform

Healthcare in America is organized around a medical triad comprised by: (1) patients; (2)

roviders; and (3) payers. Each of these elements and their system of relationships have

evolved in a complex interaction of culture with a changing epidemiological

environment. America is split over the roles and responsibility of the collective versus

those of the individual. “We are all in this together” clashes with “He/she should have

known better.” As Americans have built systems to cope with health adversity the

European communitarian ideal clashes with the ideal of the

frontier

household fending

for itself in all things.

Over the last century

tobacco, alcohol

and lack of exercise have taken the place o

tuberculosis, measles and whooping cough as major health threats. In a society that often

seeks to place blame, a biological shift in potential culpability has accentuated the schism

etween communitarian and individualistic responses to healthcare. As we search for an

answer as to why Americans remain unable to reform the widely recognized failures in

their health system, the interplay between the new epidemiology responsibility and the

medical triad loom large.

The US healthcare system relies on private insurance companies serving large groups

assembled by the workplace. When insurance firms must assemble individual applicants

into groups for health insurance, the result is much more costly both administratively and

actuarially. Workplace-

ased insurance offers predictable gaps in any effort to cover the

whole population. Not everyone is employed and not everyone is employed in a firm

large enough to access low premiums and stable rates. The most glaring exclusions from

employment-

ased insurance have been the poor and the elderly. Medicaid (for the poor)

and Medicare (for the elderly) were piecemeal solutions that have staved off wholesale

abandonment of the market-

ased approach. The remaining uninsured are primarily

employed in small firms, earning wages high enough to disqualify them from Medicaid,

ut low enough so that payment of the substantially higher premiums (roughly 25 percent

of the earnings of a minimum-wage worker) is not an option. The uninsured continue to

number 10–15 percent of the population.

Uninsured patients have great difficulty in obtaining regular healthcare from private-

ractice doctors for chronic conditions. For acute care needs of the uninsured, hospitals

(but not private-

ractice doctors) are required by law to offer services to all regardless o

the ability to pay Uninsured patients still receive bills from hospitals that they simply

have no way of paying. Most US hospitals have adjusted to an environment that requires

writing off a certain amount of services as charity care.

Healthcare costs have been another primary source of dissatisfaction with the US

healthcare system. Even controlled for an aging population, US healthcare costs rise

Entries A-Z 527

faster than inflation. Although, at 14 percent of GNP, US healthcare costs are higher than

those of any other nation, stable high levels of costs would not be as much of a problem

for the economy as the destabilizing effects of rising costs relative to all other goods. For

employees whose rising productivity merits them increases in compensation the problem

comes home in the typical corporate letter that reads “Congratulations on your five

ercent raise in compensation; however, because the premium for your health insurance

has risen by twenty percent, your take-home pay will only rise by one percent.” For

governments committed to funding healthcare entitlements the problem is that tax

revenue goes up only as fast as growth plus inflation, but healthcare costs rise faster.

Govern ments must either raise revenues or control healthcare costs.

There is now consensus among health economists that the ultimate cause of rising

healthcare costs is the steadily increasing volume and intensity of services due to

technology. America is littered with cost-control efforts that have succeeded in achieving

one-time reductions in healthcare costs. But the rise in costs always resumes.

No obstacle impedes the introduction of new and costly technology to healthcare,

rovided the technology is safe. Although some technologies have the potential to lower

costs, many do not. The quintessential high-cost technology remains organ

transplantation, which can cost $500,000 per quality adjusted life year. Americans’

insistence on fighting

death,

disease and suffering at every turn frequently leaves no

medical options spared as long as there is any hope of success. Health insurers have

found themselves powerless in their recurrent efforts to restrain costly medical treatments

recommended by doctors. Although some customers might agree to forego coverage for

costly life-saving technologies in exchange for lower premiums, American society is

reluctant to enforce such contracts. American courts have not yet been able to say to the

disgruntled dying, “you chose to spend your money on something other than extensive

medical protection, now that you need expensive procedures you must bear the

consequences.”

By its nature, reform threatens those whose livelihood depends on the status quo. To

explain the perpetual failure of healthcare reform in the US it is necessary to invoke more

than the power of opponents to reform. America’s failure to provide better access to care

stems from the inability of the working uninsured to attract society’s consensus that their

hardship merits a social solution. For now, manifest opinion appears to be to withhold the

safety net from the uninsured until there is proof that neither their health woes nor their

lack of insurance can be solved through personal responsibility For rising healthcare

costs, stabilization will eventually come. One cannot live by healthcare spending alone.

The point at which stability comes will speak volumes about just how much money

Americans are willing to part with in order to maintain the battle against the onslaughts

of nature.

Further reading

Encyclopedia of Contemporary American Culture 528

Butler, P. (1988)

Too Poor to Be Sick,

Washington, DC: American Public Health

Association.

Ginzberg, E. (1990)

The Medical Triangle,

Cambridge, MA: Harvard.

DAVID BISHAI

health/organic food

The idea that certain foods—organic, unprocessed, raw and often vegetarian—are more

“fit” to eat than others and the promise of overall good health through diet are interwoven

in the fabric of three cultural meaning systems: holistic medicine,

hippie

counterculture

and

environmentalism

. Together, these discourses critically address the dominant

institutional social structure and encourage an alternative natural way of life.

With its rejection of the classic medical model and its focus on multiple aspects o

physical condition, “alternative” medicine has moved the body from physicians’ control

of physicians into the realm of personal responsibility Food becomes an important

component of healthy lifestyle choices, alongside exercise and emotional well-

eing.

Environmentalism’s decoding of social problems likewise speaks to individual

accountability in the salvaging of an endangered natural equilibrium. It encourages all but

abandonment of agricultural pesticides and large-scale, inhumane animal rearing in favor

of organic farming and a meatless diet. Foods like tofu, meatless burgers and nuts are the

dietetic signifiers of nutritional and political coherence. Finally the hippie and, more

recently

New Age

movements equate the natural with spirituality and peace, privileging

the cruelty free choice of a vegetarian diet.

The disparaging adjective “junk” associated with food that is salty starchy or, like

McDonald’s,

fatty fast and cheap, coupled with a growing multimillion nutritional

supplement and animal protein substitutes industry suggests health food is here to stay.

MARIAELENA BARTESAGHI

Hell’s Angels

motorcycles

Helms, Jesse

Entries A-Z 529

b. 1921

Republican senior senator of North Carolina, Helms was elected to the US Senate in

1972. A staunch fiscal and social conservative who is considered an extremist by his

opponents, Helms opposes

abortion, affirmative action

and homosexuality but supports

school-sponsored prayer. Chairperson of the Foreign Relations Committee, Helms

supports efforts to streamline the number of government foreign-

olicy agencies.

Concerned with humanrights abuses, he called for the revocation of China’s most-

favored-nation status. He serves on the Senate Agriculture, Nutrition and Forestry and

Rules and Administration committees. His seat is up for reelection in 2002.

KATE M.KENSKI

Hemingway, Ernest Miller

b. 1899; d. 1961

Nobel and

Pulitzer-Prize-

winning novelist, correspondent and essayist whose laconic

prose with its subsumed emotions emphasizes a virile

masculinity

of struggle that also

permeated the author’s life. Hemingway participated in—and created lasting fictional

works about—lives of men in war and its aftermath (

A Farewell to Arms,

1929;

For

Whom the Bell Tolls,

1940), the lost generation abroad (

The Sun Also Rises,

1926),

bullfighting (

Death in the Afternoon,

1932), hunting (“Snows of Kilimanjaro,” 1952) and

deep-sea fishing (

The Old Man and the Sea,

1952). Often on the move, Hemingway spent

long periods in Paris, civil-war Spain and

Cuba,

as well as Key West,

Florida

. His

dramatic death, presumably suicide, raised questions about the masculinity he represented

and his adjustments.

GARY McDONOGH

Hendrix, Jimi

b. 1942; d. 1970

Born in

Seattle, WA,

Hendrix developed his unique left-handed technique (on a right-

handed guitar) while playing back-up on tour for R&B artists like Sam

Cooke

and Little

Richard. After a short period living in

New York

City, NY, he moved to London and

ecame a big influence in the emerging music scene in England (particularly with

guitarists like Syd Barrett of Pink Floyd, and John McLaughlin). His band, the Jimi

Hendrix Experience, recorded several hits, including “Purple Haze” and Bob

Dylan’s

Encyclopedia of Contemporary American Culture 530

“All Along the Watchtower,” and soon his popularity spread back in the United States.

Hendrix’s performance of “The Star-Spangled Banner,” at the

Woodstock

Festival in

1969, turned the anthem into suitable accompaniment for pictures of the dropping o

Napalm in Vietnam, and revealed the subversive political potential of

rock music

. He

died after a bout of mixing

alcohol

and drugs.

Further reading

Greig, C. (1999)

Icons of Black Music,

San Diego: Thunder Bay Press.

ROBERT GREGG

Henson, Jim

b. 1936; d. 1990

Master puppeteer and creator of the unmistakable Muppets. Henson broke into

television

via early morning local

children’s

television (1955–61), where he and his wife

Jane Nebel worked with hand and stick puppets. Stardom came with

Sesame Street

(1969–), for which he created lively and enduring characters Kermit the Frog, Big Bird,

Oscar the Grouch, Bert and Ernie, and others who have been companions for and teachers

to generations of children worldwide. Not only are these characters colorful and cuddly—

as later marketing has shown—but they also attract us by their humanity—fears and

questions, selfishness (Miss Piggy, created by collaborator Frank Oz, has become a

satiric icon for the “me”-generation) and dealing with difference. Henson continued to

experiment in other venues like

Saturday Nïght Liυe

(1975–6), but needed English

support to produce his variety format

Muppet Shows

(1976–81), with guest stars from

Milton Berle to Steve Martin, and movies like the

Muppet Moυie

(1979). Henson’s

London studios, The Creature Shop, run by the family and with associations with

Disney,

have changed the way animals and fantasy creatures appear in movies like

Dark Crystal

(1983) and

Babe

(1997).

Further reading

Bacon, M. (1997)

No Strings Attached,

New York: MacMillan.

GARY McDONOGH

Entries A-Z 531

Hepburn, Audrey

b. 1929; d. 1993

Female actor. Surviving Nazi occupation in Holland to become a dancer and model,

Hepburn brought both ethereal beauty and European style to American movies from her

Hollywood

debut in

Roman Holiday

(1953) onwards. Hepburn moved easily between

casual humor and graceful elegance in films like

Funny Face

(1957) or

Breakfast a

Tiffany’s

(1961). Nominated for five Academy

Awards,

she essentially retired from the

screen after

Wait Until Dark

(1967). Before her death, she became a UNICEF

ambassador; in the 1990s she continued to be revered as a

fashion

icon.

ee also:

actors

GARY McDONOGH

Hepburn, Katharine

b. 1907

Female actor. A patrician presence of

New England

heritage on stage and screen.

From

A Bill of Divorcement

(1932) onwards, Hepburn’s intellectual style and range won

her four Oscars, as well as eight other nominations. Several of her roles shaped views o

the upper class and profes-sional women—in

Philadelphia Story

(1940) or five movies

with her lover Spencer Tracy whose gender balancing and sparkling dialogue set high

standards. As she aged, Hepburn explored a variety of new personae in

The African

Queen

(1951), with Humphrey

Bogart,

the

western

Rooster Cogburn

(1976) and the

autumnal

On Golden Pond

(1981).

ee also:

actors

GARY McDONOGH

Heston, Charlton

b. 1923

Male actor. Heston’s career became identified with larger-than-life heroes/hunks,

Encyclopedia of Contemporary American Culture 532

especially Moses in the

Ten Commandments

(1954) and

Ben-Hur

(Oscar, 1959). He also

took this he-man persona into less likely ethnic castings as a Mexican policeman in

Touch of Evil

(1958), or the Spanish

El Cid

(1961) and to science-fiction apocalypses like

lanet of the Apes

(1968) and

Soylent Green

(1973). This image also has intersected with

his conservative politics, including his role as active spokesperson for the

National Rifle

Association,

of which he became president in 1998.

ee also:

actors

GARY McDONOGH

heterosexuality

ormative sexual practice in the United States, entailing sexual and other relations

etween those gendered as male and those gendered as female, usually in dyadic couples.

Reinforced by media images of love and romance, by legal and religious covenants o

marriage

and by social interactions, this norm is generally only called into question by

recognition of alternative practice or calls to avoid implicit prejudices (heterosexist

speech, for example) in politically sensitive settings. Given the widespread acceptance o

the way “things are,” questions about heterosexuality—whether as a general practice or

in reference to a specific figure like a celebrity—also evoke intense responses and

defenses.

GARY McDONOGH

CINDY WONG

high school

Secondary education generally constituted by 9th, 10th, 11th and 12th grades

(corresponding roughly to ages 14–17). It is separated from elementary education by an

intermediate stage of middle school (grades 5–8) or junior high (grades 7 and 8), often

housed in separate buildings. High school represents a crucial and difficult period o

transition both academically and socially Academically it entails specialization,

differentiation and competition—a transition to

college

for many although some will only

complete the education legally required of them (leaving when grade level or age

ermits). Socially and psychologically moreover, this is a time of changing sexuality

independence, experimentation and peer relations which produces a strong group culture

among

teenagers,

as well as sometimes highly charged relations with parents and

Entries A-Z 533

educators. Hence, concerns with

education

and growth intersect with fears about

violence, security sexuality, drugs and adjustment in American images of high school.

In 1965, 11,610,000 students in grades nine to twelve were enrolled in public schools

in the US, with an additional 1,400,000 in

private schools

. By 2000, numbers in public

schools had risen to 13,357,000, a rise projected to continue, while those in private

schools remained constant. In 1960, 41.4 percent of Americans completed four years o

high school, while in 1997 this had risen to 82.1 percent (dropouts constitute roughly 5

percent of the high-school population). These numerical changes are only part of the

changing meaning of high schools. High schools were primary sites for integration and

racial conflicts from the 1950s onwards, for example. They also have been caught in the

decline of

inner cities

(with aging “problem” schools), the rise of

suburbs

with a new

consumer ethos,

class

and racial divisions and demands for huge student parking lots.

High schools must respond to these multiple changing demands, extremely diverse

opulations and contradictory needs while also constrained, in the case of public schools,

y limited finances. Academic programs, for example, have become more costly in terms

of computers and equipment required for sciences, libraries and research materials and

changing demands for first- and second-language learning. Given the juxtaposition o

students from different class and ethnic/racial backgrounds at the same school, moreover,

school systems face the choice of dividing programs (tracking by strata of tested

intelligence or career goals) or constructing an academic “middle ground” that will

frustrate special students. Magnet schools, specializing in sciences, arts or other fields,

represent an alternative for larger school systems (see

Fame,

1980). At the same time,

schools may be forced to cut teacher-intensive programs like art or drama to balance their

budgets, or rely on

television

and large classes to deal with mass education. Private and

arochial schools control selection of students more closely and raise funds for specific

activities, but they too, strain to compete and balance the needs of mass projects against

individual changes and demands.

Counseling has also become increasingly necessary and complex, dealing with issues

ranging from home life to learning disabilities to multicultural issues. Concern with

gender

stereotyping (male athletes versus cheerleaders) and sexuality including gay

issues, have also become prominent. In many areas, from sexual education and driver’s

education to civic involvement, the high school must take over roles previously managed

by the

family

Other services in high school include food, basic healthcare and, increasingly security

Lunch and breakfast may entail a form of

welfare

or a competition for privilege to escape

campus.

In addition, high schools incorporate expanding extra-curricular activities, including

sometimes massive sports programs, journalism (

newspapers,

yearbooks, literary

magazines), travel, bands and orchestras, drama, volunteer and community service, pre-

rofessional formation (Future Farmers of America, Future Teachers) and other interests,

generally under faculty supervision. These promote both interests and leadership among

students, training for citizenship outside the classroom (or filling résumés for college

Encyclopedia of Contemporary American Culture 534

applications and scholarship competitions). They may also become sites for intense

competition among students for internal and external recognition. Such activities may

also raise questions of

freedom

and censorship, for example, in the case of school

newspapers, or the rights of students as citizens, in the case of drug tests for participation

in activities.

American high schools, moreover, are

community

institutions, especially in the case

of consolidated public institutions with several thousand students. Through social

reproduction of community and parental involvement, programs in sports may become

community surrogates. High-school events, whether crises or celebrations (school plays,

commencement,

conflict), are rallying points for a wide range of views and

participation. At the same time, high schools reflect divisions of

race

and

class

within

their catchment pools, and have proved vulnerable to violence, censorship, political

debate and social crises, from integration in the 1950s to

guns

and school shootings in the

1990s. American news media, for example, have often explored perceived high school in

terms of threats of drugs,

alcohol, tobacco

and sexuality. In the

Cold War

period, the

impact of anti-American ideologies through teachers and materials was also prominent,

although this has given way to concerns with covert agendas of culture and sexuality

The intensity of concern with high school is magnified by its role as a shared

experience in American society and by the consumer power of high-school students, who

are primary targets for

advertising

and consumption in

fashion,

music,

Hollywood

and

fast food

. This creates a

mall

culture as a spatial displacement of high school itself (as

soda shops figured as a hang-out in postwar generations). Hence, depictions of high

school pervade American literature and

mass media

. although they illustrate distinctive

paradigms. One is the celebratory/nostalgic vision of movies like

American Graffiti

(1973) or

Grease

(1978) and long-running

television

series like

Happy Days

(ABC,

1974–84) or

The Wonder Years

(ABC, 1988–93), which build on postwar generations o

“innocent” high-school films (

teenage

werewolves, beach movies, etc. in the

1950s/1960s). Nostalgic issues are also sorted out in “high-school reunions,” like

Peggy

Sue Got Married

(1986) and/or episodes of television

sitcoms

Others have seen high school from the point of view of outsiders created by a

conformist peer culture—J.D.Salinger’s controversial classic

Catcher in the Rye

(1951)

Jim Carroll’s

Basketball Diaries

(film, 1995, linked by mass media to the Columbine

High School massacre) or the television series

Freaks and Geeks

(1999–). These

sometimes coincide with media representations of high schools as places of serious social

malaise (

Asphalt Jungle,

1950;

Dangerous Minds,

1998).

Other popular genres have combined celebration and

soap-opera

sexuality (the long-

running

Beverly Hills 90210

(FOX, 1990–2000),

Dawson’s Creek

(WB, 1998–) or the

movie

Can’t Hardly Wait,

1999). Still others show teenage difference and experience

(

Breakfast Club,

1985;

Pretty in Pink,

1986) or provide social commentary (

Heathers,

1989;

Clueless,

1995;

Election,

1999). High-school depictions, however, rarely deal with

complex academic issues. As both a complex formative experience and one whose

articipants seek knowledge, guidance and shared experience, depictions of high school,

Entries A-Z 535