3. Defining health and illness
• Sociologists interested in how terms such
as abnormality and disability are
constructed
• The meanings they have for society
• How different sociological paradigms
explain them
• Inequalities in health and health care
• Stigma of some illness patterns
4. Definitions of health
• Biomechanical / biomedical
• Lay definitions
• Functionalist explanations: Parson’s sick
role
5. Lay definitions
• Traditional / folk ideas about health e.g. catching
a cold
• Cultural differences e.g. Krause studied Asians
in Bedford: Sinking heart, Koro
• Age – Blaxter – young= physical fitness older =
getting on OK for my age
• Gender – Hilary Graham – men fewer
consutlatations, women medicalised through
pregnancy and childbirth and complications
• Social class expectations - fatalism
6. Traditional
• Western medical model relatively recent
• Used to be seen as “will of god”
• Punishment
• Declined with development of modernity
and rational thought
7. Medical definitions
• Doctors have power to define
• Western medicine:
– Illness always has a physical or psychological cause
– Can be classified and measured using science
– Cures available through drugs and surgery
– Cause almost always with physical body of the
individual
• VERY UN-SOCIOLOGICAL SEES INDIVIDUAL
RESPONSIBILITY RATHER THAN SOCIAL
CAUSES OF ILLHEALTH
• CONCEPT OF “VICTIM BLAMING”
8. Functionalist explanation
• Parson’s sick role
– Illness is deviance, has to be regulated in the
interests of consensus
– Person has to get agreement of GP to be ill
– If they are accepted into the sick role have rights and
obligations
• Rights to time away from regular duties e.g. work
• Responsibilities – to do all they can to get better quickly
• Some illnesses don’t fit – long term or chronic
illness e.g. schizophrenia, MS etc..
9. Questioning of medical model
• Some failures in medical treatments and science
have led to people being more sceptical
– E.g. contaminated blood products, mad cow disease
• Postmodernism – the break down of accepted
wisdom mean people more inclined to accept
complimentary medicine
• Coward- medical model ignores wider social
factors which affect health
11. Examining the body
• Objective difference:
– Genes
– Ageing
– Habits
• What we eat / drink / smoke / exercise
• Our work
• Our physical environmental conditions
• Our social environment
• Conclusion – our social circumstances influence
the state of our bodies
12. Examining the body
• Subjectively valued
– Concepts of attractiveness and ugliness
– E.g. thinness valued now but was sign of
poverty
– Body shape never neutral- careful construct
– Unfinished products e.g. tatoos
– Giddens: reflexive mobilization – divide
between our real selves and what we project ot
others
13. Disability
• Seen as impediment which stops them
functioning
• Oliver 1996 – society and environment just as
disabling e.g the way we construct buildings
• Impairment (loss of function) and handicap (the
effects of an impairment; disability (socially
imposed)
• Finkelstein - Seen as a problem following
industrial development – they don’t fit in
factories
• Concept of “personal tragedy”
• Dependence – have to be helped
14. Stigma
• Goffmann 2 types
– Discrediting – e.g. being in a wheelchair people see
the wheelchair and not the person and treat them
differently
– Discreditable – hidden, but would cause a problem if
people found out e.g. HIV
• Master status – some people accept this as their
only identity.
• Scambler & Hopkins: response – selective
concealement, medicalising behaviour,
condemning the condemners e.g. political action
• People with the “wrong” kind of lifestyle judged
16. Basic facts
• Differences in both life expectancy and
quality of healthy life vary greatly
• Social class gradient – 8 years at least
between highest and lowest class
• There are real social causes of health that
exist above lifestyle and genes
17. Explanations for health gradient
• Geography
• Social class
• Gender
• Ethnicity
• International
18. Geography
• North south divide
• Rural urban e.g. ambulance
access
• Bias in favour of some
parliamentary constituencies
• Poor vs rich areas – poor
people who live in rich areas
tend to live longer
19. Social class
• Life expectancy for all has risen but the gap has
got bigger
• Deaths from cancer and heart disease x2 for
people from manual backgrounds
• Morbidity higher for lower social classes
• Explanations:
– Artifact
– Social selection
– Cultural
– Material
– Accessibility of services
20. Gender and health
• Women live longer, higher morbidity,
higher mental health problems
– Biological genetic strength
– Social role keeps them safe e.g. from danger
– Work e.g. better health for women if they work
21. Ethnicity and Health
• Difficult to summarise because not homogenous
• Specific illnesses e.g. sickle cell
• Immigrants may have better health but adopt
lifestyle of host country
• Explanations:
– Poverty
– Racism
– Culture e.g. food
– Lack of culturally sensitive services
22. International perspective
• Varies widely
• Sub Saharan Africa difference
• Women in childbirth
• Poverty
• Health provision – Cuba has higher life
expectancy than US – lack of universal health
care in US
• Inequalities in wealth in some countries such as
US breed ill health and death
• Collective cultures have better health than
individualist = belonging improves health
24. Inverse care law
• Health service provision is not in
proportion to need. Those people who
need health care less tend ot have better
access to health care provision
• ICL – the more you need health care the
less there is available
25. Funding decisions are political
• Foundation trusts get more money and tend to
be in richer areas
• MPs fight to retain spending in their area
because of the strength of feeling the NHS
provokes (MPs have lost seats to campaigning
GPs who fight to keep a hospital or service
open)
• Health care commission found massive
differences
• Medical professions prefer some specialities
rather than others surgery over geriatric
medicine – more sexy / prestigious
26. The effect of private healthcare:
• People don’t have to wait
• Access to non NHS services
• Consultants choose to work in both
sectors, limiting their work for the NHS
• The NHS train staff who may then take
their skills to private sector
27. Demand
• Working class patients tend not to use services
as often
• Don’t go for screening and vaccinations –
preventative medicine
• Can’t afford to take time of work
• Can’t travel far for services
• Services on offer may not be culturally
acceptable
• Guilt – people who know they have a “poor”
lifestyle may avoid being “told off”
• Labelling – if someone is overweight then all
problems they have are ascribed to it
28. Gender
• Women live 7 years longer but not
necessarily in good health
• Women’s bodies suffer greater strain
• Women therefore under utilise based on
need
• Power over bodies medicalized e.g.
pregnancy, complications in childbirth and
menopause
• Breast screening take up varies
29. Ethnicity
• Lower use by some ethnic groups:
– Language barriers
– Lack of cultural sensitivity e.g. religious
constraints
– Different beliefs about health and illness e.g.
sinking heart, koro.
– Poverty – same issues as working class
under use
30. Age
• Most in need but use less in
relation to that need
• Feel guilt about use
• Geriatric medicine
Cinderella service
• However further sub divided
by class and geography e.g.
a poor older person in the
North East might fare
differently to a wealthy
elderly woman in London
32. Marxist
• Doyal – con them into belief that “capitalism
cares”
• NHS subtle form of social control
• Keeps the workforce healthy for as long as they
need to be workers
• Inequalities then are a result of how productive
people are or not
• Oldest, long term ill, learning difficulties less well
cared for (no value for capitalism)
• However some would argue NHS -free from
cradle to grave is antidote to capitalist views
33. Pluralist
• Understanding comes through knowledge
of structure
• Argues no one group has power
• But there is a power gradient
• The outcome of health care is the result of
the power struggle between different
interest groups and changes over time
e.g. Doctors, nurses ,politicians and
patients
35. Introduction
• Source of debate
• Less prominent than physical illness
• Often stigmatised
• 1:6 people aged 16-74 report serious
mental illness at sometime
• More women than men
36. Defining mental illness
• Two perspectives
– Social realism – accept that there are
conditions symptoms which can be called
mental illness. Varies though over time and
between cultures
– Social constructionists though suggest that all
is relative and that at different times and in
different places what is normal varies e.g. the
consumption of alcohol
37. Real or culturally created
• No one doubts the existence of mental
distress
• But how it is defined depends on cultural
differences
• It is seen by most as a continuum totally
culturally created at one end to medically
defined symptoms at the other.
38. Labelling theory
• Do we just label that which is
inconvenient, challenging or different “ill”
• Once labelled a person has a real
disadvantage
• Whether one is labelled depends on who
benefits
• Rosenhan experiment showed the effect
of labelling and also how unscientific
definitions of mental illness were at that
time.
39. Foucault’s perspective (1965)
• Mental illness “invented” as part of
enlightenment
• Rational replaced irrational
• Irrational thinking was then seen as
deviant
• Asylums separated people
• Madness therefore is a modern invention
40. Mental illness and ethnicity
• Nazroo – people from south Asia have much lower rates
than ethnic Brits
• Afro-Caribbean have high levels of schizophrenia
(Labelling or genes?)
• Labelling theorists suggest that this is a result of racism
and inequality
• Nazroo says it doesn’t follow because Bangladeshi’s
more deprived on the whole but have better mental
health
• Perhaps something about the protective value of
collectivist cultures?
41. Mental illness and gender
• Women 1/3rd higher mental illness
• 3x more likely to suffer depression
• Feminists say women more likely defined
because male dominated sphere
• Real reasons – stress and poverty
42. Social Class and mental illness
• Poorest massively over represented
• Phelan - 40 years of evidence
• Strong relationship between poverty
• Putnam – describes “social capital” people
who have strong friendships and social
links
44. Doctors and prestige
• Amongst most highly paid and prestigious
in society
• Sociologist interested in how so much
power is located within one group
• Helps us also understand how other
groups such as lawyers have achieved
such high status and manage to hold onto
it.
45. 5 explanations
• Functionalist – benefits all of society
• Weberian – closed shop, keeps status
• Marxist – controls people and rewarded by
capitalists
• Foucault – they define prestigious
knowledge
• Feminist – best understood using their
control of women as a model
46. Funcionalist explanation
• Doctors keep society functioning (don’t forget
Parsons’ sick role)
• Barber (1963) – deal with people who are
vulnerable therefore have to have:
– Theoretical basis
– Highly trained
– Tested by exams
– Strict code of ethics
– Regulated by GMC
• Are these merely traits ?
• Until very recently still the preserve of white
middle class men
47. Weberian explanations
• Professionalism as a strategy
• Weber said that all occupational groups vie with
each other for power and status
• Number of techniques but they include:
– Trades unions (working class)
– Professions (middle classes)
• Professoinalisation has for dimensions
– Creations of esoteric knowledge
– Educational barriers
– Exclusion of competition (e.g. only lawyers can
approach the bar)
– Maintenance of privilege
• Cant and Sharma (1994) Chiropractors had to
subordinate themselves to the medical
profession to get recognised
48. Marxist explanations
• Navarro (1977) capitalists employ strategies to
distort reality for “proles”, medics are part of this
distortion.
• Medical profession explain illness by referral to
individual lifestyle and genes rather than poor
working conditions and poverty etc…
• Doctors keep people fit enough to work
• Doctors are gate keepers for sickness benefits
• Critics: this ignores good work of Doctors and
the good work they do, especially in the
workplace and with older adults
49. Foucault’s explanation
• Knowledge is power
• Control access to knowledge and you
maintain your power
• Doctors have constructed the notion of our
bodies as machines and championed
rational, scientific thought
• As a result they have gained considerable
financial and prestige rewards
50. Feminist explanations
• Oakley & Witz activities of doctors contribute to social
control of women by medicalising
• Historically women weren’t allowed in medical school
confined to nursing “handmaidens”
• Women had power as healers and midwives this was
taken away by doctors
• Lupton (1994) doctors have taken away control and
medicalised a number of normal female functions e.g.
childbirth and menopause as can be seen by increasing
interventions now 1 in 5 babies in UK born by Caesarean
• Victorian Britain – women’ depression was medicalised
and turned to drugs or surgery
51. Challenges to medical profession:
• Last 20 or so years decline in confidence
• Perhaps linked to rise of postmodernist ideas
and the breakdown of meta narratives
• Giddens:
– Decline in conformity, more individualism
– Disillusionment with professionals having monopoly of
knowledge
• Also better access to information (e.g. internet)
• Wider range of behaviours tolerated (e.g. being
gay is no longer defined as mentally ill)
