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Sociology of Health and Illness Sociological Perspectives for Health and Social Care 2008

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HEALTH <ul><li>b) soundness of body; that condition in which its functions are duly and efficiently discharged </li></ul><ul><li>health is normality , which is disrupted by any physiological, biochemical or psychological d eviance </li></ul><ul><li>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.” </li></ul>

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Illness, disease, sickness, the sick role <ul><li>illness is the subjective experience of ill health </li></ul><ul><li>disease is the medically defined pathology </li></ul><ul><li>sickness is the social role of those defined as diseased or ill </li></ul><ul><li>the sick role refers to the set of rights and obligations that surround illness and shape the behaviour of doctors and patients </li></ul>

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Two different views of Illness <ul><li>”… illness is a kind of rest, when you can be free of your everyday burdens…For me, illness is breaking off from social life, from life outside and social obligations” (unknown) </li></ul><ul><li>health is abnormality , because practically nobody is totally healthy ever But: minor inconvenience is clearly less significant than e.g. terminal illness </li></ul>

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The biomedical model of health <ul><li>Those who subscribe to the biomedical model place particular emphasis on the biological causes and manifestations of disease and ill-health. Their basic premise is that the human body is a machine made up of a number of divisible and abstractable parts. As such, any malfunction (such as disease) is an ‘engineering’ problem which is capable of being tackled by technical means. This, in turn, gave rise to the doctrine of specific aetiology: for every disease there is a single and observable cause that can be isolated. The principal strength of the biomedical model is that there is a considerable amount of evidence to support its basic assumptions, in that specific causes for particular diseases have been found. </li></ul>

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Biomedical model: Assumptions and criticisms <ul><li>The modern biomedical model of disease (Blaxter: Health , Polity 2004) </li></ul><ul><li>(1) Doctrine of specific aetiology (or cause) </li></ul><ul><li>But: multiple causes and intervening factors behind diseases </li></ul><ul><li>(2) Assumption of generic disease </li></ul><ul><li>But: symptoms often treated like disease </li></ul><ul><li>(3) Deviation from the normal </li></ul><ul><li>But: normality/abnormality is no self-evident but value-laden fact </li></ul><ul><li>(4) Scientific neutrality </li></ul><ul><li>But: medicine is embedded in society </li></ul>

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Biomedical model <ul><li>The biomedical model is criticised for being </li></ul><ul><li>i) repair- not prevention-oriented, </li></ul><ul><li>ii) technology-centred, </li></ul><ul><li>iii) expensive, </li></ul><ul><li>iv) injurious, </li></ul><ul><li>v) naively utopian </li></ul>

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The social model of health <ul><li>In the social model the health of individuals and communities is seen as the result of complex and interacting social, economic, environmental and personal factors. Thus, for those who adhere to the social model, the determinants of health are far more varied and broader in scope than those found in the biomedical model. Because of the range of its determinants, the potential for allocating responsibility for ill-health is much greater. </li></ul>

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The modern social model of health <ul><li>Basic assumptions: </li></ul><ul><li>(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 </li></ul><ul><li>(2) social factors do not affect a human’s health from ”outside” but partly constitute her/him and her/his health </li></ul>

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Problems of social models of health <ul><li>The social model gives rise to many possibilities for apportioning blame and has resulted, on the one hand, in ‘victim blaming’ and, on the other, in pointing the finger at deficiencies in public policy and the behaviour of business and industry. With respect to ‘victim blaming’ there are those who argue that ill health is primarily, or even exclusively, due to individual actions (such as smoking) or inaction (failure to wear a crash helmet for example). In their view, far more responsibility should be placed on the shoulders of individuals for adopting lifestyles which will </li></ul><ul><li>minimize the risks of becoming ill. </li></ul><ul><li>Those who draw attention to the part played by government and business take the view that responsibility for behaviour and health should not be laid solely at the door of the individual. People are influenced and constrained by the social, economic and physical environment in which they live and the organizational setting within which they work. Thus the failure of governments to provide adequate housing may result in individual behaviour which is damaging to health and can also lead directly to an increase in respiratory disease. Similarly, in seeking to maximize profits some businesses will market goods and services which are known to be damaging to health. </li></ul>