Thirty years ago, people may have defined health primarily in doctors, hospitals and drugs. Today people have a much broader image of what it means to be healthy. People’s views of healthiness include; healthy eating, taking vitamins and regular exercise, to therapy, sensible drinking and healthy social relationships. Sociology of health is not confined to the narrow, area of medicine. According the World Health Organisation(WHO), health is ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’.
This is all-inclusive definition focuses on a positive view of health, rather than regarding health merely as not being ill. This definition could be argued as being overly idealistic and too broad as, in reality, most of us are not completely physically, mentally well at any one time. Using this definition we are unhealthy if we have a headache or are a bit fed up. Another problem is that it sees health as an absolute term in that it fails to take into account the notion that, within any given society, people understand different things by the concept of health – that it can change over time and between cultures.
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According to Dubos(1987) good health involves being able to function effectively. This implies that being healthy or ill are relative experiences/ concepts. From this standpoint, health means very different things to different people and the health of an individual can be judge against, for example, their gender, age and occupation. For example, a young, male professional athlete may well have a very different conception of health and wellbeing compared with an elderly, wheelchair-bound female.
This view that health is a relative concept will be explored in the subsection on the social construction of health and illness. Illch(2002) proposes a much more critical definition of health. He suggests that we can only function effectively and experience health and wellbeing if we can come to terms with and accept our less than perfect physical and mental condition. Illch argues that healthy people consciously accept the inevitability of ageing and ultimately, death. From this point of view, we are healthy when we accept that we are inevitably going to feel ill, pain and sickness and we take responsibility for this.
Illch is critical of medicines as it has robbed people of the capacity to deal with their own wellbeing. Bio-medical approaches Taylor and Field(2007) note: Medical research is focused primarily on biochemical or genetic processes underlying disease. Most medical work involves diagnosing and treating abnormalities within the body, and the education and training of most health professionals, particularly doctors, revolves around understanding the human body and intervening in the disease process. Evaluation of the bio-medical model of health
Sheeran(1995) has noted the increasingly successful practical applications of the principles of medical knowledge in the west. However, the sociology of health and illness has been built up around a critique of the medical model of understanding health and illness, and has raised several important criticisms. Defining health: it can be criticised for ‘failing to recognise the relativity of health and illness. ’ Also what counts as being healthy or ill is socially constructed. Furthermore, if a positive definition of health is adopted, then ill-health is a normal experience.
The cause of ill-health: the focus on treating symptoms by appling scientific or medical solutions ignores the wider social conditions which may have causec the illness or disease in the first place such as pollution or poverty. Research has also shown that ill-health is caused by multiple factors and, rather than illness being randomly distributed, there are definite social patterns by social class, gender and ethnicity. Medical treatment: -NHS has become firmly based on curative medicine and only a very small percentage of its total expenditure is given to health promotion and prevention strategies. The implications of a curative based system, is that the real causes of ill-health are never addressed. -health policy should focus on combating the risk factors associated with chronic illnesses such as smoking and excessive alcohol intake. -medicine is ineffective against new diseases such as Aids. The role of doctors: Only legitimate and successful definers and providers of healthcare. Foucault(1973) said the medical profession gained dominance by creating and controlling a new scientific language to describe the body which gives the profession status.
A much more critical examination of the role of doctors and medicine has been offered by Illch(2002) who claims medicine does more harm than good. ‘Iatrogenesis’ which means doctors cause illness. He argues that a vested interest in ensuring there is plenty of disease. The social construction of health and illness The term ‘social construction’ comes from the work of two interactionist sociologists, Berger and Luckmann (1966). Their argument is that both our everyday concepts and the so-called ‘taken for granted’ features of our world are created through social interaction.
Take, for example, the action of winking. A definition of winking is to close or open one or both eyes quickly. But this does not take into account the meaning attached to the action of winking. It is only through interaction with others together with the social context you are in, that winking could suggest to someone, ‘I know your secret’, or ‘I find you attractive’. We also know that winking is socially constructed because it means different things in different societies.
For example, in some Latin American cultures, winking is a romantic or sexual invitation. In Nigeria, Yorubas may wink at their children if they want them to leave the room. Many Chinese consider winking to be rude. In Hong Kong it is important not to blink one’s eyes conspicuously, as this may be seen as a sign or disrespect or boredom. What these examples show is that actions can only be interpreted through the meanings that people give them. When we say that something is socially constructed we don’t mean that is doesn’t exist.
Rather, the important characteristics of something (for example, crime statistics, disability, childhood) are defined by the attitudes, values and norms of behaviour that surround it in any given society, or part of society, and that these actually shape the reality of that thing. From this perspective the meanings of the words ‘health’ and ‘illness’ cannot be taken for granted as they mean different things to different people. There are many dimensions to the view that health and illness are socially constructed and this is summarised below.
If health and illness were objective, scientific, absolute facts, then everyone would interpret symptoms in the same way; all societies would have the same methods of diagnosis, and treatment and illness would be randomly distributed. Sociologists point out that this is not the case. Health and illness as relative To say that health and illness are relative is to say that definitions of what is healthy and what describes illness are not given facts; they vary from person to person (within societies), from society to society (cross culturally), and over time.
A person’s ideas about health and illness are related to and reflect their theories of disease, illness and treatment. As Taylor et al. (1996) note, ‘Ideas about health and illness vary because they are created, passed on and modified as part of the process of living together in societies. As such, they are social constructions. And it is because they are social constructions that the concepts of health and illness are relative’. Health as relative: within societies (lay definitions) Health and illness can be said to be relative concepts if people have different definitions.
In the Health and Lifestyle survey, Blaxter (1990) surveyed a random sample of 9000 individuals about their definitions of, and views about, health. One of the criticisms of the bio-medical model of health is that, by focusing on disease, it ignores lay people’s views and experiences of their own health. Doctors are qualified professional definers of health and their patients and not as expertly informed. However, as Blaxter points out, since health must in part be subjectively experienced, lay people may actually be better informed.
Blaxter found that individuals have many different definitions, which she classified as negative or positive. Negative definitions of health see health as being free from symptoms of disease / disability, whereas positive definitions associate health with physical fitness or as psychological or social wellbeing. Blaxter found some social patterns in definitions of health. She noted, for example, that the way in which health is defined differs according to age and gender. Younger men tended to speak of health in terms of physical strength and fitness, whereas young women favoured ideas of energy, vitality and ability to cope.
In middle age, concepts of health become more complex, with an emphasis on total mental and physical wellbeing. Older people, particularly men, think in terms of function, or the ability to do things, though ideas of health as contentment, happiness, a state of mind – even the presence of disease or disability – are also prominent. In addition to Blaxter, other studies have shown that definitions of health not only vary between individuals but also between groups of people.
Williams (1983) carried out a study of elderly people in Aberdeen and he identified three lay concepts from his interview data: health as the absence of disease health as a dimension of strength, weakness and exhaustion health as functional fitness There is also some evidence to suggest a relationship between types of belief and social class. For example, D’houtard and Field (1984) in a study of 4000 people in France, found that respondents form non-manual backgrounds had more positive conceptions of health than those from manual backgrounds, who revealed more negative definitions.
In the UK research has found that working-class women are more likely to hold functional conceptions of health (the ability to participate in normal social roles). For example, a study by Pill and Stott (1982) quotes one woman as saying that ‘ that good mother’ just keeps going: ‘Being married….. well, I haven’t had much wrong with me and I think that it is partly down to the fact that I haven’t got time to worry about anything being wrong. Not only that, I think with a family you can’t afford to be ill’ (pp. 49-50) The relationship between beliefs and social class, however, should not be overstated.
Calnan (1987) did not find clear distinctions between the classes. When asked about their own health, both working and middle-class women were likely to offer negative definitions of health. A secondary analysis of Blaxter’s data to compare the health beliefs of Asian, African-Caribbean and white groups (Howlett et al. , 1992) found that compared with white respondents, Asians were more likely to define health in functional terms, and Afro-Caribbean’s were more likely to describe health in terms of energy and physical strength.
They were also more likely to attribute illness to bad luck. This supports the argument that groups in society with the least power are more likely to hold fatalistic views on the causes of illness. A study of two Cantonese-speaking communities in the UK (Prior et al. , 2002) found that health was related to happiness and inner contentment. To be happy was both equated to, and a necessary feature of, being healthy. Health as relative: between societies What health means and how it is recognised varies between cultures.
Although most societies differentiate between health and illness, they differ widely in their beliefs about the causes of, and solutions to, illness. Furthermore, societies differ in the levels of discomfort and pain which are accepted as normal, and different societies may interpret similar symptoms very differently. As Taylor et al. note, ‘whether a person feels healthy or ill is determined within a cultural context’ (1996, p423) Health as relative: over time Another aspect to health and illness as relative concepts can be seen when we examine changing conceptions with one society over time.
For example, until 1957, homosexuality was classifies as a mental illness and men who ‘admitted’ to being homosexual often had to undergo ‘treatment’ such as aversion therapy. Such a belief would not be tolerated in today’s society where sexual equality is now enshrined in law. A further example is offered by Helman (1978) who examined the beliefs that people had about ‘catching’ colds, chills and fevers. He found that folk beliefs state that you are more likely to ‘catch’ a cold if your head, neck and feet are uncovered.
Catching a cold was seen as the result of carelessness: it was everyone’s responsibility to dress properly, avoid going out with wet hair etc. Health and illness as social products Further support for the notion that health and illness are socially constructed comes from examining the social distribution of illness. If illness were purely biological, it would be randomly distributed among the population. However, as the section on health inequalities shows, illness is patterned according to factors such as social class, gender and ethnicity.