Sociology of Health and Illness Dr Samira Alsenany

Content 1.CONCEPTS . OF HEALTH, ILLNESS, DISEASE, SICKNESS… General definitions, lay definitions, scientific and theoretical definitions The modern social model of health Sick role Social stigma

Reasons for Sociological Interest Ageing Population Structure in Developed Societies - demographic transition – decline in mortality/death rate all ages - increased life expectancy from birth - chronic diseases associated with later life (RA, stroke, CHD, dementia)

Reasons for Sociological Interest Problem faced by Medicine in managing /treating chronic illness - breakthroughs in treating older people (hip replacements, cataract surgery) BUT - doctors can only treat many illnesses of old age palliatively - minimise pain / help physical functioning Medicine looked to sociology - understand social psychological consequences of chronic illness - inform medical practice

Problems of definition Defining terms always problematic for social scientists a number of definitions of healthy and unhealthy or ‘normal’ and ‘pathological’ states, definitions vary between academic, professional and popular or ‘lay’ accounts also vary widely within and between disciplines. biological explanations differ from social constructionist accounts little agreement on the root causes and material conditions of illness. best way to approach questions on health and illness is to use a multi perspective approach

Time, space, place and context All concepts professional, academic and lay concepts are also culturally and historically specific. They vary from culture to culture and across time. Western Culture and obesity - a sign of ill-health thus socially undesirable In non-Western cultures -a sign of affluence thus socially desirable

What is health?

What is health? Health is to feel proud – when you can go out and you can hold you head up, look good. You don’t have so many hang-ups, and you think straight” (computer operator aged 25) ”Health is being able to walk around better and doing some work in the house when my knees let me” (woman aged 79). What is health? That is a silly question!” (driver aged 39)

What is health? health: a) well-being, welfare, safety, b) soundness of body; that condition in which its functions are duly and efficiently discharged illness: a) bad or unhealthy condition of the body (or, formerly, of some part of it); the condition of being ill. b) bad moral quality, condition, or character.

well-being: the state of being or doing well in life; happy, healthy, or prosperous condition; moral or physical welfare (of a person or community) disease: a condition of the body, or of some part or organ of the body, in which its functions are disturbed or deranged; a morbid physical condition

Scientific/theoretical attempts at a general definition of health (II) (Blaxter: Health, Polity 2004) health is function, because to be healthy is to manage one’s everyday tasks freely and without pain But: ’everyday tasks’ vary considerably, and environments rather than people may be non-functional health can also mean balance of body’s processes and systems

illness is the subjective experience of ill health disease is the medically defined pathology sickness is the social role of those defined as diseased or ill the sick role refers to the set of rights and obligations that surround illness and shape the behaviour of doctors and patients – Gabe et al.: Key Concepts in Medical Sociology, Sage 2004

Experience of health and illness 1- disease: to a malfunctioning in, or maladaption of, biological, physiological or chemical process in the body.

Disease and illness The terms disease and illness are conceptually distinct: A) disease is something an organ has: b) Illness refer to the experience of disease and as such deals with the subjective experiences of bodily disorder and feelings of pain and discomfort ( the human experience of sickness). In contrast, the term disease suggests a biologically altered state whereas illness relates to the diffuse con sequences of the disease process .

Important definitions for sociology of Health and Illness Morbidity- amounts of certain types of illness, heart disease, cancer etc -Subjective? Mortality – death. Relative health of social groups assessed by comparing infant mortality rates- Objective? Disease- can be used in two main 1). any pathological (unhealthy) condition, bodily or mental whether caused through accident or injury 2). it can be used to refer to a specific medically diagnosed condition with distinctive, recognised symptoms.- Subjective or objective?

sociology of health and illness the relationship between sociology and questions of health and illness as a two-way road: i) the task is to fit health and illness as social phenomena into existing theoretical and explanatory frameworks of sociology, or ii) the task is to create apt sociological concepts and theories for grasping health and illness as social phenomena

absence of disease may be part of health, but health is usually taken to be more than absence of disease (asymmetry between the concepts) illness without disease or sickness, disease without illness or sickness health as a state: am I healthy/ill now/today etc.? health as a status: am I basically a healthy or an unhealthy person?

WHO WHO declared in the year 1948: ”health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.”

Advantages of distinguishing between disease and illness 1- Recognition that will clear acknowledgement of the fact that physical impairment can have implications for social life of an individual. Definitions can vary over time and between individuals, groups and culture within same society at any one time. Help to produce a better understanding of individual and societal response .

The modern social model of health Basic assumptions: (1) a human being must not be taken as a mechanistic combination of biophysical functions but as an organistic whole, in which the sum counts for more than its parts (2) social factors do not affect a human’s health from ”outside” but partly constitute her/him and her/his healt

Lay Definition of health Health absent of disease Illness refer to the experiential aspect of bodily disorder and socio cultural factors. The study of illness behavior focuses on how individuals perceive, evaluate and react to symptoms. Some people consult a doctor when they feel unwell, while others with the same symptoms do not. Studies of health in families suggest that women are a major source of advice and support in families and the responsibility for health care is assigned to women.

Parson (1951) وSick role Parson (1951) developed the concept of the sick role to draw attention to the fact that illness is not purely a biological state but has a social dimension. That social expectations that are to applied to the sick According to Parson the sick role consists of four components, which highlight the rights and responsibilities attributed to the sick person.

persons’ sick role 1- The sick person is exempt from the normal social roles that the person takes for the duration of the illness. 2- sick persons are not responsible for their illnesses. 3-the sick person has the duty to get well 4- the sick person must seek competent technical help and cooperate with caregivers

Social stigma If health professionals want to maximize the well being of the people they treat, they must address stigma as separate and important factors in its own right ( Link et al, 1977). Goffman (1968) identifies three types of stigma: Physical deformities Blemishes of individual character Tribal stigma of race, nation, and religion.

Social stigma 1-Health care workers need to appreciate that coping with the social stigma can in some circumstances be more difficult than coping with the illness. 2- Some illness labels are more stigmatizing that others: this may be a result of: A- The visibility of the symptoms, B- the level of public ignorance surrounding the nature of the illness C- The general characteristics of those perceived to be suffers.

Epilepsy: a stigmatized condition Early part of the 20th century epilepsy linked with insanity. Today we ‘know’ that epilepsy caused by abnormal neurological activity that occurs as a result of damage or injury to the brain. However what we ‘know’ is subject to reinterpretation.

HIV infection and AIDS Individual with HIV and AIDS are stigmatised because their illness is: 1- Seen as both a product and producer of deviant behaviour 2-viwed as the responsibility of the individual. Perceived as a threat to the community Not very well understood by the lay community and viewed in a negative light by professional health care workers.

Thanks