The Sociology of Health

Discuss (pairs; 5 mins): - Which of these people do you consider ‘normal’ or ‘abnormal’? - How would you suggest the ‘abnormal’ people could make themselves ‘normal’? - Which of these people do you consider ‘healthy’ and which ‘ill’?

Is there any such thing as a ‘normal body’? Discuss Is there any such thing as a ‘normal body’?

Unit G672 We are going to explore: What we mean by health and illness The view that health, illness, mental illness and disability are socially constructed Evidence of inequalities in health by gender, ethnicity and social class...and explanations for those inequalities Sociological views on the role of medical professionals in our society The rise of alternative medicine

Learning Objectives

Ext: - What conditions are required to regard yourself as ‘healthy’? Individually Write down your own definition of the word health. (In other words, if you refer to someone as ‘healthy’, what do you mean?) Ext: - What conditions are required to regard yourself as ‘healthy’?

An ‘official definition’ “A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.” World Health Organisation Any problems with this definition? For Homework, read up on the WHO; we’ll probably be referring to them a lot over this unit.

Problems with the definition Some argue that this definition is too broad. Very few people are physically, mentally and socially well at any one time. It is absolutist: It ignores the fact that understanding of ‘health’ can also change over time and between cultures.

Alternative definition: Dubos (1987) Good health is being able to function effectively. This suggests health is a more relative concept...For example, how would the different people on the first slide think ‘functioning effectively’ means.

Alternative definition: Illich (2002) We only function effectively and experience good health when we accept that it will not last. A healthy person is someone who has consciously accepted the inevitability of ageing, illness and – ultimately – death.

So... There is no single, simple, universally agreed definition of health. Health is a complex issue because its meaning varies between individuals, groups and societies.

Write your own single-sentence definition of each of the following: Individually Write your own single-sentence definition of each of the following: Disease Illness

Disease A specific biological or mental abnormality. The patient usually exhibits medically diagnosed symptoms. “Any pathological condition, bodily or mental, whether caused through illness, accident or injury.” (Taylor et al; 1996)

Illness The subjective experience of feeling unwell. Recognising that you are lacking in wellbeing. Illness is also referred to as morbidity (and death as mortality). You can feel ill but not have a disease...and you can also have a disease and not feel ill!

Copy and complete the table... (Individually; 5 mins) DISEASE Yes No I LLNESS Good health; Nausea in Pregnancy; Flu; Happiness; Chlamydia; Carrier of Typhoid; Feeling tired and lacking in energy; Measles...ADD FIVE MORE OF YOUR OWN.

So... Health, Illness and Disease are all interrelated. They are not separate categories; it may be easier to think of them as part of a continuum.

The Health-Death Continuum Healthy!!!  PRE-SYMPTOMATIC e.g. Pathological cell-division CHRONIC e.g. Diabetes, Arthritis TERMINAL e.g. some cancers SYMPTOMS – NO ACTION e.g. Smoker’s cough; Hangover SYMPTOMS – NON-MEDICAL ACTION e.g. Head cold ACUTE e.g. Infectious diseases Draw your own continuum and add examples of your own. Death 

The Biomedical Model of Health A.k.a. The Medical Model; The Mechanical Model

Discuss Historically (e.g. Pre-C19th) what sort of explanations might have been offered for illness?

Traditional Views Traditionally, illness was explained by these factors...or possibly just by the will of God. ...But then science came along and started changing our views of health and illness...

The Biomedical Model Over the past two centuries, this has become the dominant view of illness in Western societies. It is held by most Western medical practitioners and is the main approach found in the NHS. The Model is based on the following assumptions:

1. Health is biological normality When everything in your body is behaving/functioning ‘normally’, then you are healthy. Being healthy is the ‘normal’ way to be.

2. Illness/Disease is caused by identifiable factors. The cause for illness disease is something than can be identified – and is not the result of supernatural influence. For example: Bacteria, faulty genes, virus, accident...

3. Illnesses can be Identified! Illness and disease can be identified and classified into different types (e.g. Diseases of the nervous system). Identification and classification must be objective.

4. Identification should be done by professionals... Medical professionals/officials and not lay people are the only ones who should be identifying and classifying illness/disease.

5. Illness can be treated and cured For example, antibiotics can be used to treat infections. Treatment can involve removing the cause. The health of a society will therefore be dependent on its medical knowledge and medical resources.

Activity Study the excerpt from Red Dwarf and answer the questions provided.

Discuss Think back to a time when you have been ill: Did you seek medical advice? Was diagnosis and treatment based on the medical model?

Research – Small Groups Research and find out about three diseases and illnesses in contemporary society. For each one, identify the cause and the treatments/cures available. **There is a link to the NHS Website on the NCSociology site**

Strengths of the Biomedical Model It encourages research into illness, rather than assuming nothing can be done... ...Knowledge of causes helps us avoid illness. Many successful treatments have been developed as a result of research.

Criticisms of the Model It ignores the view that health and illness are relative and are socially constructed. Coward (1989) points out that it suggests health problems are individual are ignores the social factors which can cause illness.

Criticisms of the Model It focuses too much on treatment, rather than prevention. E.g. It was assumed the NHS would spend a short period of time curing illnesses when first set up, then focus on preventative measures. This never happened.

Criticisms of the Model It gives too much power to medical professionals. “The medical profession gained dominance by creating and controlling a new scientific language to describe the body which gives the profession status.” – Foucault (1973)

Iatrogenesis ‘Illness brought forth by the healer’ (Ivan Illich; 1976)

Discuss In what ways could a doctor make someone feel worse? Identify a min. 3 ways. (Pairs; 5 mins)

Iatrogenesis The problem of iatrogenesis is considered by many sociologists to be a key criticism of the biomedical view. It suggests that the medical profession can do more harm than good. There are three types of iatrogenesis.

1. Social Iatrogenesis It is in the interests of medical professionals to ensure there is lots of illness/disease around... ...They do this by turning normal health issues into medical problems.

1. Social Iatrogenesis Discuss – Pairs. How have the following things become medicalised? Pregnancy Worry Bad behaviour among children Ageing

2. Cultural Iatrogenesis Western medicine is centred around cure rather than prevention... ...Thus drugs and technology to treat illnesses has become big business. The effect of this is that we have become over-reliant on drugs and technology to manage our health and have lost our ability to cope with pain and illness.

3. Clinical Iatrogenesis Medical treatment itself can do damage. For example: Side effects of treatments Results of medical procedures that have gone wrong Illnesses such as MRSA contracted as a result of undergoing medical treatment http://www.youtube.com/watch?v=bNNJG27J7V0

Criticisms of the Iatrogenesis Critique Not all medical treatments produce side-effects Some problems benefit from being medicalised. If an issue is defined as a medical problem, it’s more likely to be researched and solutions found.

Group Activity Design a poster or leaflet promoting the Iatrogenesis concept e.g. Warning people not to always trust the medical profession! Include all three types, with your own examples and illustrations. 15 mins then present

Written Task Identify and explain two features of the biomedical model [17] Or ...Identify and explain two weaknesses of the biomedical model [17]