1. ‘Lay’ understandings of health Week 16 Sociology of Health and Illness

2. Recap Thought about how health and illness are structured by society Introduced the concept of the ‘sick role’ Considered the concept of medicalisation and the impact of surveillance medicine

3. Outline Rational Choice and health education Candidacy for Coronary Heart Disease Health and lifestyles Rise of the expert patient?

4. Who are ‘lay’ people ‘Lay’ people in health research are not health professionals Concept used to explore the perspectives or behaviour of people in opposition to proscribed medical/health understandings Recently, moves to acknowledge that patients can be ‘experts’

5. Critique of Medicalisation Early work on medicalisation emphasised the power and control of medicine Did not fully explain either health behaviour or patient- professional relationships Research grew into how beliefs impact on health

6. Rational Choices? Much health promotion can be linked to rational choice understandings –Education about bad impacts, will change behaviour Patients seek medical advice, but do not necessarily follow it –Fail to take prescription medicine Lay understandings can explain the complexity of health beliefs and behaviours

7. Smoking The public is repeatedly told that smoking is bad for them. So why do people start or continue smoking?

8. Smoking Smoking varies considerably by social class, gender and ethnicity –45% w/c adult men /15% m/c men Reasons include –stress levels –type of occupational –understandings of relative risks Graham argued that it could be a way to manage poverty

9. Coronary Heart Disease CHD is currently the biggest killer in the UK. –1.4 million angina, 275,000 people heart attack What do you know about CHD?

10. ‘Candidacy’ Davidson et al argue that ‘candidacy’ is a common perception in understanding CHD –Type of person who should be careful –Seeing yourself as a possible candidate Factors included –Fat, unfit, smokers, heavy drinkers, stressed –Family history, type of occupation –Red faced, grey pallor, bad tempered, worriers

11. ‘Uncle Norman’ effect Built into candidacy is an understanding that the ‘wrong’ people are affected Non-candidates have heart attacks –Fate, destiny, chance Potential candidates do not have problems –Lucky, good constitution

12. Simple messages Davidson et al argued that health promotion relies on simple messages which distorts epidemiological evidence –‘Fat = Bad’ ‘Lay’ epidemiology notices the anomalies –Fat survive whilst the thin drop dead Undermines the creditability of medical knowledge and encourages ‘fate’ as a predictor

13. Do you recognise these ideas about candidacy and fate? How common are they amongst your family and friends?

14. Working class women’s health Blaxter & Patterson’s study of women found lots of different health problems Women held low expectations of health –‘Normal illnesses Women denied symptoms of illness The ability to function normally despite illness was prized Blaxter& Patterson (1982) Mothers and daughters London, Heinemann Educational

15. Working class women’s health Younger women less interested in explaining health, and used more medical terms. Family and personal experiences are important External causes more acceptable than ‘natural’ processes –e.g. ageing. Often rejected suggestions that poor health caused by poverty

16. Healthy/Unhealthy divide Blaxter carried out a major study of what people think health is and what might determine health We cannot divide the population into health or unhealthy by lifestyle –We tend to have both good and bad areas

17. Determinants of health But Blaxter (1990) found that behavioural factors were seen as a main cause of illness Structural or environmental factors were not often mentioned Especially among those from working- class backgrounds

18. Healthy/Unhealthy divide ‘Circumstances' are often more important than healthy or unhealthy behaviours ‘Unhealthy behaviour does not reinforce disadvantage to the same extent as healthy behaviour increases advantage’ Blaxter, M (1990), Health and lifestyles. Routledge p233

19. What do you think of the idea that stopping unhealthy behaviour may not have a significant impact?

20. The rise of the expert patient Recently ‘lay’ expertise has begun to be taken more seriously –NHS Expert patient programme –Successful challenges to medicalisation –Self-help and campaign groups challenge professional decisions The internet is seen as the latest vehicle for promoting lay ideas

21. Professional Challenge? Hardey has argued that professional power in medicine is built on control of expertise The internet presents a new challenge to this power relationship The internet also hides the boundaries between conventional, alternative and complementary medicine

22. Summary Lay models of health and illness are usually complex and sophisticated. They may draw on scientific explanations and everyday experiences Lay beliefs impact on attitudes, behavior and relationships with health professionals

23. Next week Health inequalities in social class Look in more detail about the lifestyle and environmental factors that influence health Individualising poverty