Sociology of health and illness
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The sociology of health and illness, sociology of health and wellness, or health sociology examines the interaction between society and health. As a field of study it is interested in all aspects of life, including contemporary as well as historical influences, that impact and alter our health and wellbeing.[1][2]
It establishes that, from our births to our deaths, social processes interweave and influence our health and wellbeing. These influences could be where we were brought up, how illness is understood and framed by immediate community members, or the impact that technology has with our health. As such, it outlines that both our health and the medical science that engages it are social constructs; that our way of knowing illness, wellbeing, and our interactions with them are socially interpreted.[3][4]
Health sociology uses this insight to critique long established ideas around the human body as a mechanical entity alongside disrupting the idea that the mind and body can be treated as distinct spaces. This biomedical model is viewed as not holistically placing humans within the wider social, cultural, economic, political, and environmental contexts that play a large part in how health and wellbeing are deprived, maintained, or improved. Alternative models include the biopsychosocial model[5][6] that aims to incorporate these elements alongside the psychological aspect of the mind.
This field of research acts as a broad school overlapping with areas like the sociology of medicine, sociology of the body, sociology of disease[7] to wider sociologies like that of the family or education as they contribute insights from their distinct focuses on the life-course of our health and wellness.[8]
Theoretical perspectives
The field of sociology of health and illness has been shaped by the perspectives and contributing works of various authors that have enabled its development. Many research studies touch on the relationship between the patient and doctor aswell as their environment within the healthcare system. One of the founders of the sociology of health and illness is Talcott Parsons, an American sociologist, who analyzed the relationship between patients and their doctors in his book The Social System written in 1951. In his sick role theory,[9] he argued that people who were sick adopted a social role, not just a biological condition. Those who were sick deviated from social roles were unable to fulfill their respective functions, thus if too many people claimed to be ill, this would create a dysfunctional society that needed regulating. Creating this mechanism would prevent people who were pretending to be sick to form a subculture of being sick. By developing the “sick role mechanism” patients and doctors had to abide by a set of “rights” and “obligations” that would monitor entry into the sick role. The “rights” of a patient constituted an exemption from performing their respective social roles, such as going to work or housekeeping with the further exemption being given to those severely ill. These rights were given if they maintained two obligations, the first being that they had to view being sick as undesirable and thus must find a way to get better. Second, after a while of being sick, the person must seek the help of a doctor and follow their advice in other to alleviate their illness. The “obligations” of the doctors were to be trained in their field, be motivated to help the patient, have objective and emotional detachment from the patient, and be bound by the rules of professional conduct. Their “rights” consisted of being able to examine the patient physically and ask about their personal life, and have a position of authority and autonomy in their professional practice. Lastly, receive status and reward from their important role in society. Parson’s perspective. In addition, Michel Foucault[10] published The Birth of the Clinic in 1963, in which he developed his theory of the “medical gaze[11]” referring to how doctors filter patient information into a biomedical paradigm, which focuses solely on biological factors excluding how social, environmental and psychological factors can influence a patient’s condition. According to Foucault doctors are trained to be doctor-oriented rather than patient-oriented, which creates a form of abusive power structure. Among these authors have contributed to the development of the field of health and illness by bringing in their perspectives at the time.
Historical background
Humans have long sought advice from those with knowledge or skill in
Stopping the spread of infectious disease was of utmost importance for maintaining a healthy society.[12] The outbreak of disease during the Peloponnesian War was recorded by Thucydides who survived the epidemic. From his account it is shown how factors outside the disease itself can affect society. The Athenians were under siege and concentrated within the city. Major city centers were the hardest hit.[14] This made the outbreak even more deadly and with probable food shortages the fate of Athens was inevitable.[14] Approximately 25% of the population died of the disease.[14] Thucydides stated that the epidemic "carried away all alike". The disease attacked people of different ages, sexes and nationalities.[14]
Ancient medical systems stressed the importance of reducing illness through
Those that were most concerned with health, sanitation and illness in the ancient world were those in the elite class.
The present day sense of health being a public concern for the state began in the
Methodology
The Sociology of Health and Illness focuses on three areas: the conceptualization, the study of measurement and social distribution, and the justification of patterns in health and illness. By looking at these things researchers can look at different diseases through a sociological lens. The prevalence and response to different diseases varies by
A great deal of the time, mortality statistics take the place of the morbidity statistics because in many developed societies where people typically die from degenerative conditions, the age in which they die sheds more light on their life-time health. This produces many limitations when looking at the pattern of sickness, but sociologists try to look at various data to analyze the distribution better. Normally, developing societies have lower life expectancies in comparison to developed countries. They have also found correlations between mortality and sex and age. Very young and old people are more susceptible to sickness and death. On average women typically live longer than men, although women are more likely to have bad health.[17]
>80 77.5–80 75–77.5 72.5–75 70–72.5 | 67.5–70 65–67.5 60–65 55–60 50–55 |
Disparities in health were also found between people in different social classes and ethnicities within the same society, even though in the medical profession they put more importance in "health related behaviors" such as alcohol consumption, smoking, diet, and exercise. There is a great deal of data supporting the conclusion that these behaviors affect health more significantly than other factors.[17] Sociologists think that it is more helpful to look at health and illness through a broad lens. Sociologists agree that alcohol consumption, smoking, diet, and exercise are important issues, but they also see the importance of analyzing the cultural factors that affect these patterns. Sociologists also look at the effects that the productive process has on health and illness. While also looking at things such as industrial pollution, environmental pollution, accidents at work, and stress-related diseases.[17]
Social factors play a significant role in developing health and illness. Studies of epidemiology show that autonomy and control in the workplace are vital factors in the etiology of heart disease. One cause is an effort-reward imbalance. Decreasing career advancement opportunities and major imbalances in control over work have been coupled with various negative health costs. Various studies have shown that pension rights may shed light on mortality differences between retired men and women of different socioeconomic statuses. These studies show that there are outside factors that influence health and illness.[17]
International perspective
Africa
HIV/AIDS is the leading epidemic that affects the social welfare of Africa.[18] Human Immunodeficiency virus (HIV) can cause AIDS which is an acronym for Acquired Immunodeficiency Syndrome (AIDS), a condition in humans in which the immune system begins to fail, leading to life-threatening infections. Two-thirds of the world's HIV population is located in Sub-Saharan Africa. Since the epidemic started more than 15 million Africans have died by complications with HIV/AIDS.[18]
People who are a part of religious sub-groups of Sub-Saharan Africa, and those who actively and frequently participate in religious activities, are more likely to be at a lower risk of contracting HIV/AIDS. On the opposite end, there are many beliefs that an infected male can be cured of the infection by having sex with a virgin. These beliefs increase the number of people with the virus and also increase the number of rapes against women.[19]
Herbal treatment is one of the primary medicines used to treat HIV in Africa. It is used more than standard treatment because it is more affordable.[18] Herbal treatment is more affordable but is not researched and is poorly regulated . This lack of research on whether the herbal medicines work and what the medicines consist of is a major flaw in the healing cycle of HIV in Africa.[19]
Economically, HIV has a significant negative effect. The labor force in Africa is slowly diminishing, due to HIV-related deaths and illness. In response, government income declines and so does tax revenue. The government has to spend more money than it is making, in order to care for those affected with HIV/AIDS.[18]
A major social problem in Africa in regards to HIV is the orphan epidemic. The orphan epidemic in Africa is a regional problem. In most cases, both of the parents are affected with HIV. Due to this, the children are usually raised by their grandmothers and in extreme cases they are raised by themselves. In order to care for the sick parents, the children have to take on more responsibility by working to produce an income. Not only do the children lose their parents but they also lose their childhood as well. Having to provide care for their parents, the children also miss out on an education which increases the risk of teen pregnancy and people affected with HIV. The most efficient way to diminish the orphan epidemic is prevention: preventing children from acquiring HIV from their mothers at birth, as well as educating them on the disease as they grow older. Also, educating adults about HIV and caring for the infected people adequately will lower the orphan population.[20]
The HIV/AIDS epidemic is reducing the average life expectancy of people in Africa by twenty years. The age range with the highest death rates, due to HIV, are those between the ages of 20 and 49 years. The fact that this age range is when adults acquire most of their income means they often cannot afford to send their children to school due to the high medication costs. It also removes the people who could help aid in responding to the epidemic.[18]
Asia
Asian countries have wide variations of population, wealth, technology and health care, causing attitudes towards health and illness to differ. Japan, for example, has the third highest life expectancy (82 years old), while Afghanistan has the 11th worst (44 years old).[21] Key issues in Asian health include childbirth and maternal health, HIV and AIDS, mental health, and aging and the elderly. These problems are influenced by the sociological factors of religion or belief systems, attempts to reconcile traditional medicinal practices with modern professionalism, and the economic status of the inhabitants of Asia.
Like the rest of the world, Asia is threatened by a possible pandemic of HIV and AIDS. Vietnam is a good example of how society is shaping Asian HIV/AIDS awareness and attitudes towards this disease. Vietnam is a country with feudal, traditional roots, which, due to invasion, wars, technology and travel is becoming increasingly globalized. Globalization has altered traditional viewpoints and values. It is also responsible for the spread of HIV and AIDS in Vietnam. Even early globalization has added to this problem – Chinese influence made Vietnam a Confucian society, in which women are of less importance than men. Men in their superiority have no need to be sexually responsible, and women, generally not well educated, are often unaware of the risk, perpetuating the spread of HIV and AIDS as well as other STIs.[22]
Confucianism has had a strong influence on the belief system in Asia for centuries, particularly in China, Japan, and Korea, and its influence can be seen in the way people chose to seek, or not seek, medical care.[citation needed] An important issue in Asia is societal effect on the ability of disabled individuals to adjust to a disability. Cultural beliefs shape attitudes towards physical and mental disabilities. China exemplifies this problem. According to Chinese Confucian tradition (which is also applicable in other countries where Confucianism has been spread), people should always pursue good health in their lives, with an emphasis on health promotion and disease prevention.[23] To the Chinese, having a disability signifies that one has not led a proper lifestyle and therefore there is a lack of opportunities for disabled individuals to explore better ways to accept or adapt to their disability.[23]
Indigenous healing practices are extremely diverse throughout Asia but often follow certain patterns and are still prevalent today. Many traditional healing practices include
Mental health issues are gaining an increasing amount of attention in the Asian countries.[citation needed] Many of these countries have a preoccupation with modernizing and developing their economies, resulting in cultural changes. In order to reconcile modern techniques with traditional practices, social psychologists in India are in the process of "indigenizing psychology". Indigenous psychology is that which is derived from the laws, theories, principals, and ideas of a culture and unique to each society.[23]
In many Asian countries, childbirth is still treated by traditional means and is thought of with regional attitudes. For example, in Pakistan, decisions concerning pregnancy and antenatal care (ANC) are usually made by older women, often the pregnant woman's mother-in-law, while the mother and father to be are distanced from the process. They may or may not receive professional ANC depending on their education, class, and financial situation.[26] Generally in Asia, childbirth is still a woman's area and male obstetricians are rare. Female midwives and healers are still the norm in most places. Western methods are overtaking the traditional in an attempt to improve maternal health and increase the number of live births.[27]
Asian countries, which are mostly developing nations, are
Australia
The health patterns found on the continent of
Australia has had treatment facilities for 'problem drinkers' since the 1870s. In the 1960s and 1970s it was recognized that Australia had several hundred thousand alcoholics and prevention became a priority over cures, as there was a societal consensus that treatments are generally ineffective.[30] The government began passing laws attempting to curb alcohol consumption but consistently met opposition from the wine-making regions of southern Australia. The government has also waged a war on illegal drugs, particularly heroin, which in the 1950s became widely used as a pain reliever.[30]
Experts believe that many of the health problems in the Pacific Islands can be traced back to European colonization and the subsequent globalization and modernization of island communities.[31] (See History of the Pacific Islands.) European colonization and late independence meant modernization but also slow economic growth, which had an enormous effect on health care, particularly on nutrition in the Pacific Islands. The end of colonization meant a loss of medical resources, and the fledgling independent governments could not afford to continue the health policies put in place by the colonial governments.[31] Nutrition was changed radically, contributing to various other health problems. While more prosperous, urban areas could afford food, they chose poor diets, causing 'overnourishment', and leading to extremely high levels of obesity, type 2 diabetes, and cardiovascular diseases. Poorer rural communities, on the other hand, continue to suffer from malnutrition and malaria.[31]
Traditional diets in the Pacific are very low in fat, but since World War II there has been a significant increase in fat and protein in Pacific diets. Native attitudes towards weight contribute to the obesity problem. Tongan natives see obesity as a positive thing, especially in men. They also believe that women should do as little physical work as possible while the men provide for them, meaning they get very little exercise.[31]
Europe
The largest endeavors to improve health across Europe is the
The study of
Before people seek medical help they try to interpret the symptoms themselves and often consult people in their lives or use 'self-help' measures.
The Finnish study examined 127 patients and the results have been different from findings in other countries where there is more 'lay consultation'. Half of the respondents did not have any lay consultation before coming to the doctors office. One-third did not try any self-treatment and three-quarters of the sample consulted the doctor within three days of symptoms developing.[34] Possible explanations are that in Finland there is an aspect "over-protectiveness" within their health care system. Many[who?] might conclude that the Finnish people are dependent and helpless but the researchers of this study found that people chose to consult professionals because they trusted them over some lay explanation. These results echo similar studies in Ireland that explain this phenomenon as being based in a strong work ethic. Illness in these countries will affect their work and Finnish people will quickly get treatment so they can return to work. This research out of Finland also describes that this relationship between patient and doctor is based on:
- national and municipal administrative bureaucracies that demand more output and more satisfied patients
- the public demanding better care
- nurses criticizing physicians for not taking a holistic view of patients
- hospital specialists wanting better/earlier screening for serious illnesses (e.g. cancer).[34]
The conflict between medical and lay worlds is prominent. On one hand many patients believe they are the expert of their own body and view the
In Europe, sociology of health and illness is represented by the European Society for Health and Medical Sociology (ESHMS).
North America
North America is a fairly recent settled continent, made up of the United States, Canada, Mexico, Central America, and the Caribbean. It was built by an amalgamation of wealth, ideas, culture, and practices. North America is highly advanced intellectually, technologically, and traditionally. This advantageous character of North American nations has caused a high average
North America's primary
The
South America
There are many diseases that affect South America, but two major conditions are malaria and Hepatitis D. Malaria affects every country in South America except
The first sign of Hepatitis D was detected in 1978 when a strange and unrecognizable internuclear antigen was discovered during a liver biopsy of several Italians who developed HBV infections. Scientists initially thought that it was an antigenic specificity of HBV, but they soon found that it was a protein from another disease altogether. They called it "Hepatitis Delta Virus" (HDV). This new virus was found to be defective. HDV needed HBV to act as a helper function in order for it to be detected. Normally Hepatitis B is transmitted through blood or any type of blood product. In South America Hepatitis D was found to be fatal. Scientists are still unsure in what way this disease was being transmitted throughout certain South American countries. Sexual contact and drug use are the most common means of transmission. HDV is still considered an unusual form of hepatitis. Agents of this virus resemble that of plant viroids. It is still hard to tell how many stereotypes exist because HDV is under the umbrella of HBV. HDV causes very high titers in the blood of people who are infected. Incubation of Hepatitis D typically lasts for thirty five days. Most often Hepatitis D is a co-infection with Hepatitis B or a super-infection with chronic hepatitis. In terms of super infections there are high mortality rates, ranging seventy to eighty percent; in contrast with co-infections which have a one to three percent mortality rate. There is little information with the ecology of Hepatitis D. Epidemics have been found in Venezuela, Peru, Columbia, and Brazil. People who are treated for Hepatitis B have been able to control Hepatitis D. People who have chronic HDB will continue to get HDV.[39]
Another disease that affects South America is HIV and AIDS. In 2008 roughly two million people had HIV and AIDS. By the end of 2008 one hundred and seventy thousand people were infected with AIDS and HIV. Seventy seven thousand people died from this disease by the end of that year. Brazil has the most people that are affected with AIDS and HIV in South America. In Brazil sixty percent of the inhabitants are HIV positive because of drug use. Usually this disease is transmitted by either drug use involving needles or unprotected sex. Sharing needles and being infected with HIV and AIDS is most common in Paraguay and Uruguay. South America is trying to get treatment to the thousands of people infected by this disease. Brazil is offering generic AIDS prescriptions that are much less expensive than the name brand drugs. One hundred and eighty-one thousand inhabitants in Brazil who were infected are being treated. That accounts for eighty percent of those who needed immediate help. This aid from the government has had positive results. Statistics show that there was a fifty percent decrease in mortality rates, approximately sixty to eighty percent decrease in morbidity rates and a seventy percent decrease in hospitalization of infected people.[40]
In very remote areas of South America, traditional healers are the only forms of health care people have.[41] In north Aymara and south Mapuche, where the indigenous groups have the strongest voices, they still heavily use traditional medicine. The government in Chile has implemented an Indigenous Health System to help strengthen the health care system. Even with Chile's indigenous groups, Chile still has the best public health services in South America.[citation needed] They also have the lowest mortality rates in the area. Their health care policies are centered around family and community wellbeing by focusing on the strategies for prevention health strategies. Reports have shown an increase in mental health issues, diabetes, and cardiovascular diseases.[42]
South America's economy is developing rapidly and has a great deal of industries.[citation needed] The major industry in South America are agriculture. Other industries are fishing, handicrafts, and natural resources. Its trade and import-export market is continually thriving. In the past South American countries moved slowly in regards to economic development. South America began to build its economy ever since World War II. South America's largest economies are Brazil, Chile, Argentina, and Columbia. Venezuela, Peru, and Argentina's economy are growing very rapidly.[43]
Journals
- Sociology of Health and Illness
- Social Science and Medicine
- Health: An Interdisciplinary Journal for the Social Study of Health
- Illness and Medicine
- Social Theory and Health
- Health, Risk and Society
See also
References
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- ^ "Epidemics: Malaria, AIDS, Other Disease: Postcolonial Africa | Encyclopedia of African History - Credo Reference". search.credoreference.com. Retrieved 2020-02-05.
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- ^ a b c Morgan, Myfanwy (1988). "Managing hypertension: beliefs and responses to medication among cultural groups". Sociology of Health & Illness, Vol. 10, No. 4.
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Further reading
- Nettleton, Sarah (2006). The Sociology of Health and Illness. Polity. ISBN 0-7456-2828-1.
- Conrad, Peter (2008). The Sociology of Health and Illness. Macmillan. ISBN 978-1-4292-0558-0.
- Porter, Dorothy (1999). Health, Civilization, and the State A History of Public Health from Ancient to Modern Times. Routledge. ISBN 978-0-415-12244-3.
- United Nations Industrial Development Organization (1978). Technologies from Developing Countries. ISBN 978-0-7619-6400-1.
- Seale, Gabe, Wainwright, Williams. Sociology of Health & Illness, Vol. 33 2011 ISSN 1467-9566