Describe the biomedical and socio-medical models of health. Compare patterns and trends of health and illness in three different social groups.

Ash Moorcroft

P4 – Describe the different concepts of ill health:

There are many concepts of health in sociology and I will describe these below using the sub-headings.

Disability:

Disability is a socially created condition that seriously limits the day to day life of the disabled person. Impairment is a physical problem such as physically, sensory, cognitive or intellectually. A physical impairment could be a missing leg that most other people have or a deformed hand which means the person may not be able to walk or hold things. Impairments could be present from birth or could occur during the individual’s life such as an accident at work. Disability is seen in sociology as a restricted opportunity to take an active role in society due to the physical or social barriers that society oppose against the individual. For example society physically restricts those who are disabled because not all buildings have access ramps and we do not provide leisure activities such as theme parks for those who are disabled. An emotional attitude of society could be that if someone has a leg missing then they will not be able to walk and should be put in a wheelchair however we could give the individual a prosthetic leg and teach them to walk with it.

This kind of attitude is said to cause a disabling environment where adaptations and other facilities are not in place to aid those who are disabled to take a full role in social life.

Iatrogenesis (doctor generated illness):

Iatrogenisis is a tem that refers to an illness that is generated by a medical activity or practice. Ivan Illich (1976) introduced the term and it was part of his criticism on the industrialised western world which is dominated and controlled by huge drug and health companies.

Illich believed that drugs actually make us more ill as we experience side-effects, for example; Paracetamol can cause drowsiness which could affect our day to day activities such as work. As well as side effects the hospitals that are supposed to make us better can also make us ill as there are many spreadable infections such as MRSA. Illich suggested there are three types of Iatrogenesis:

Clinical Iatrogenisis – the unwanted side-effects from medication and the contraction of further illness whilst in hospital. An example of this could be when people go into hospital for an outpatient appointment but end up contracting a hospital super bug, a super bug is a term used by the media to describe an illness that has become resistant to cleaning products and medications. For example, MRSA is a Methycilin resistant form of staphylococcus Aureus, it is called this because it has become resistant to the Methycilin that was used to try and kill it. The illness has formed immunity to the cleaning agents and medication so that it cannot be killed off.

Social Iatrogenisis - we are all too vulnerable to the giant medicine companies and most of us and willing to take tablets without actually knowing what they are doing to us. Illich also suggested that we have become mass consumers of medical products in a bid to try and live as long as we can. This could be because of the influences from our friends and family, we as individuals tend to talk to our friends about our health and recent immunisations such as the cervical cancer jab, although this jab isn’t well tested yet and hasn’t been around long enough to know for sure that there are not any long term side effects, for example, 18 year olds who have it could end up being infertile in twenty years time as a result.

Cultural Iatrogenisis – this term means that we are over-concerned with being at optimal health and are scared of illness and death; media has influenced us to want to be healthy all of the time. Illich suggests that this reinforces a negative view towards impairment and death. Cultural Iatrogenisis is present in the western world because of our views and opinions towards being ill. Most of us read some kind of magazine such as mens/womans health, these magazines tell us and persuade us what is good health and what isn’t. On the front of these magazines there are either very slim or muscled people. These make us insecure and think we are ill because we are too fat or too weak. These causes us to under eat in a bid to be ‘healthy’ according to these magazines, on the other hand the muscled photos make men feel they are inadequate and they take protein supplements such as Maxi Muscle which can make them ill.

The sick role:

The sick role is a position in society that a person takes up when they become ill, society allows someone to be ill but under the condition that they try and do all that they can to regain full health as soon as they can and return to society. Some people may go into hospital for a week, and this means that they have to take time out of work that society has to compensate for.

Parsons described the sick role as a temporary medically sanctioned form of deviant behaviour. Parsons says this because illness stops society functioning properly because individuals will use their illness

Clinical iceberg:

This is a preview of the whole essay

Clinical iceberg:

The clinical iceberg is the theory that the true level of illness in society cannot be displayed in official statistics and reports because some illnesses aren’t reported. For example, Mavis who is in her nineties and has lived through the war is unlikely to go to the doctor with a seasonal bug; Mavis has been ill but hasn’t reported it through her doctor or primary care trust. This means that when the official statistics of illness are released by government they are not accurate; this is because they may be two million Mavis’s out there who also do not bother going to see the doctor when they are ill.

It is called the iceberg because an iceberg has an area you can see but an area below the water that cannot be seen but estimated to its actual size.

P5 – Compare patterns and trends of health and illness in three different social groups:

Gender and patterns of health and illness:

Life expectancy is higher in women than men; women tend to live for five years longer in the United Kingdom. Infant mortality rates for boys tend to be higher than for girls, the factors that could explain these are the risk factors, economic inequalities and the impact of the female role.

Risk factors are a term that is used to explain the activities that men are more likely to be engaged in and that can harm our health. For example; men tend to consume more alcohol and smoke, these activities are referred to as risky as they can have a detrimental effect on both our health and well-being. Smoking can cause chronic conditions such as emphysema and cancer, and alcohol can cause liver failure and likelihood to have an accident whilst drunk.

Women are less likely to engage in these kinds of activities and if they do they are said to do it in a safer way, women tend to smoke less and drink less. The behaviour of men aged between 17 and 24 can also affect the mortality rate because they are more likely to die in road traffic accidents.

As well as behaviours, money can also come into it. Women are said to be paid 18% less than men, this means men earn more and have more money than women. Women are therefore more likely to be a lone parent or on state benefits. This means that in later life women are less likely to be in poverty because they will not have private pensions and won’t have state pensions either because of their family responsibilities in younger life. There is a distinct pattern between poverty and health.

If women live alone and have less money then their finances will mean that they may cut back in areas such as food and medications, this could give them bad health and cause them to have a premature death.

The female role is where women stay at home to look after the children and house whilst the male is out at work earning to feed and support the family. Because the woman stays at home and doesn’t see as many people she is more likely to become depressed and have emotional disorders as a result. Working in the home is a repetitive and long job which could mean women spend a long time cleaning and don’t get much time to their self. This means they are working their joints harder and tiring their body out. This could cause them to get conditions such as arthritis, however, the exercise they will be getting form cleaning and cooking could mean that they have a healthy heart; this could help them to live longer compared to the male who could be an office worker and exercises very little.

Disease prevalence tend to be higher in women because they have a weaker immune system to men, this means they are more likely to become ill. However, this illness will build the immune system and make them a healthier person afterwards. In comparison to men who are less likely to get ill but when they get ill are more likely to be seriously ill with conditions such as MRSA. Disease incidence will therefore be higher in women than men.

The graph below shows a graph for each both men and women and the types of illnesses and diseases they are likely to get and the chance of them actually suffering from them. the graph shows that men are clearly more likely to get circulatory problems between the ages of 45 and 80, this could be because men begin to exercise less at this age in comparison to women that are more likely to still be doing housework and paid employment.

Ethnicity and patterns of health and illness:

It is hard to distinguish a link between ethnicity and the patterns of illness, because those of minority ethnic groups tend to live in similar conditions such as in poor inner city locations. These living conditions are linked with pollution and poverty. However, there is evidence that children from Asian backgrounds are more likely to get conditions such as rickets because of a vitamin d deficiency in their diets. Also most minority groups are more likely to have a shorter life expectancy, this could be because they have less opportunities due to the covert discrimination they face in terms of eligibility to benefits and poor housing.

The differences of the ethnic groups in the United Kingdom could also be to blame for a lower expectancy within those who are black or a minority ethnic group. This is because their language and culture could cause implications when trying to provide health and social care. For example, Muslims only eat Halal meat which might be hard to get hold of and therefore they may not eat it and could acquire a protein deficiency. Language could also be a factor because they may be hesitant to seek medical intervention because they may fear they are unlikely to be understood or they will be discriminated against.

Although it is not obvious the National Health Service will try to cater and provide for the needs of the majority of the population, therefore minority groups might be excluded from what the rest of society has. There have also been arguments that white middle class people receive better health care because they are not as likely to be discriminated against and have a more important role in society.

Those from a ethnic minority such as those who are black Caribbean are more likely to be unemployed compared to those who are white British. For black Caribbean there is a 15% chance of being unemployed compared to a 4% for the white British, this could make the black Caribbean’s poorer and live in worse conditions as a result which would affect their health negatively and cause a higher chance of getting a disease or having a premature death compared to a white British person.

The diagram below shows the religion of an individual and the ‘not good health rates’ as described by the government in 2001. The diagram shows that Muslims have the worst health and Jewish have the best, this could be because of their lifestyles, for example not eating certain meats. However, it could just be pure coincidence.

Social class and patterns of health and illness:

Standards of health, morbidity rate and life expectancy vary accordingly to the social group and class that we fit into. If I were to be the son of a very wealthy father then I am likely to have a longer life expectancy and better health than that of a child in a family of ten relying on state benefits because they will have less money and may be regarded as less important in society. As my father has more money he will be able to afford better food and will be able to pay for prescriptions.

The black report by Townsend et al (1980) explains this in depth in the next question. Social class affects our health and the prevalence of disease because if someone doesn’t have many assets or finances then they are likely to cut corners in their diet and cleanliness. This can be a contributing factor and a cause for disease and ill-health. However the higher classes will have disposable income to spend on these items and will have a better diet which will make them healthier and less likely to become ill. Also when the middle/higher classes are ill they have more money to be able to take time out of work and pay for prescriptions which helps aid a full recovery.

The graph below illustrates that the lower class manual workers have a shorter life expectancy than those who are professional and in the middle/higher class. However, in all cases women seem to live longer, this could be because of the traditional female role where women stay at home and cook, clean and look after the children which involves a lot of exercises which keeps them healthy.

M3 – Use sociological explanations for health inequalities to explain the patterns and trends of health in three different social groups:

And:

D2 – Evaluate the four sociological explanations for health inequalities in terms of explaining the patterns and trends of health and illness in three different social groups:

Sociological explanations for illness.

Sociologists have looked at explanations for these variations in health and illness. This was a result of the black report (1980).

The black report 1980 (Townsend et al) followed by the Acheson report 1998 provided a detailed explanation between social and environmental factors and health, illness and life expectancy.

The black report was seen by the government as a threat and therefore was suppressed from publication. It exposed substantial differences in the levels of health and illness between social classes.

The black report comprised of four explanations that could explain the differences in health and illness. The four sociological explanations were the statistical artefact explanation, natural or social selection, cultural or behavioural explanations and the material or structural explanations.

The statistical artefact explanation suggested that the differences could be biased because the statistics were not properly represented. This explanation would suggest that it is not social class that influences our health and well-being but that the age structure and patterns of employment of people in the lower classes that really explains the differences.

Natural or social selection suggests that it is not the low social class and poverty that causes illness and higher mortality rates but rather the other way around. People cause themselves to be in the lower class because they lack enthusiasm and energy to seek success in life. This however, s rejected because there is no evidence that ill health is caused by deprived circumstances rather than causing it.

However, to a certain extent I do agree with it, because those in the lower tend to want to stay at home and don’t enjoy work, therefore they keep them self in the poverty cycle. However, if those lower class people went out and tried to find success through further education and training then they would earn more and move to a better place and eat better food. This would help their health and get them into the middle class. An example; could be Sir Alan Sugar who had nothing to start with but built himself up to be in the upper class with millions of pounds.

Cultural or behavioural explanations focus on the idea that those in the lower classes smoke and drink more and do not eat good quality food. This poor lifestyle causes them to get chronic illnesses such as diabetes and heart disease. However, smoking and drinking could be a contributing factor because it is used as a coping mechanism. Sociologists say it is the lifestyle that causes these lifestyle choices.

In conclusion social class is a complex way of looking at a person’s status and role within society. The duties or status that an individual has will affect how they are regarded, for example; wealth, culture and employment can be used as a link to explain trends in health and illness.

The material or structural explanation suggest that those who are in social groups with lower life expectancy and infant mortality rates are higher suffer poorer health than other groups because of inequalities in wealth and income.

Poverty is associated with poor diets, poor housing, poor environments and dangerous employment. For example; someone who lives on a council housing estate is more likely to have a lower income and more dangerous hob than someone who lives in the countryside and owns their own home. The more dangerous job is likely to be a factory worker or machine operator.

It is because of these differences and deprivation that cause the class system and differences in levels of health and well-being. The black report presented evidence that to support the material explanation. Shaw et al (1999) completed a review that concluded the major factors that contributed to these differences in health and illness were a social factor. A consequence of poverty in an environment is poor health and a lower life-expectancy.

The statistical artefact explanation would say that the statistics that are represented about gender are not necessarily true and could be biased because women may experience the same level of ill health as men but do not report it and this would be part of the clinical iceberg. Also the surveillance of disease would not necessarily be factual either as statistics could be falsely represented to explain why women live longer. It would explain the differences in gender and ethnicity as also miss-represented because many ethnicities will be hesitant to see a doctor because they feel they will not be treated equally and could be discriminated against. I think someone who is white British will be more likely to see a doctor because they have grown up here and know the system and the way things work however a Muslim migrant from Pakistan may be hesitant. In regards to social class the statistical artefact would say that the patterns of employment affect an individual’s health more than their class because employment means money. The statistics could also be miss-interpreted because the lower classes may be less likely to see the doctor because they may not see them self as ill as most other people around them might be ill.

Natural/social selection would suggest that class has nothing to do with whether or not a person becomes ill, if there is a highly mortality or disease prevalence rate. It is rather the other way around because higher illness and death rates cause un-employment. Natural/social selection would also say that gender has nothing to do with a person becoming ill because it is natural that humans become ill as we cannot be resistant to every germ and ‘bug’ that goes around. Although, I think men become ill less often than men because they are physically stronger and are have more strength to fight infection. Ethnicity could have a small affect on whether or not a person becomes ill because someone from a completely different continent is less likely to have the same immunity to bugs as us. For example, in their country of origin chicken pox might not exist and when they come here they might catch it many times because they didn’t catch it when they were younger.

The cultural/behavioural explanation would say that it is the choice of the person to choose what will make them healthier and less healthy. For example; ethnicity, if a religion forbids all meat then the believer is less likely to be as healthy because they won’t have as much of a protein intake. It would say that gender could have an impact because a culture may see women as needing to stay at home and therefore are less likely to be exposed to as many viruses and bugs, however, men will be out working and in contact with more people. This could make the man more likely to become ill or have a serious accident. In terms of class, it is down to the behaviour of the individual, if they have money but decide to spend it on things which are detrimental to their health such as cigarettes and alcohol then yes they will be more likely to be ill with conditions such as cancer and diabetes. However, if they choose to buy health supplements and healthy food then they will be a healthier person who is less likely to be ill. If a person is wise in the sense of their behaviour then they will be less likely to engage in dangerous activities such as street racing, which could cause a serious injury If it went wrong.

The material/structural explanation would say it is more to do with what a person has or has access to that will help them be a healthier person. In terms of social class the higher classes will have more materials to use to be healthier such as medicines and food however the lower classes won’t. There is also debate that white middle class people are treated better in society by the health care service and society, this also relates to ethnicity because if a person isn’t white then they might be treated less fairly. This same argument could be used for gender because men are said to more dominant in the world because we have patriarchal societies. Therefore, men could be treated better than women when they see the doctor because it is assumed that men will have a better job and earn more than women.

I think the material and cultural explanation explains health and illness better because I believe it is down to what people have and what they choose to do with what they have that influences their health. Because of state benefits and the national assistance act we all have the same minimum amount of finances and human rights, but it is our choice on what we spend our finances on. If we choose to smoke then it is partly our own fault if we develop cancer or give it to those around us. The statistical artefact explanation however, does illustrate that the statistics presented by the government may not necessarily be accurate and concise because certain illnesses do not get reported and documents in the same way as crime.

Natural and social selection explains why some people get ill and why some diseases are more prevalent but it doesn’t offer a way to solve the inequalities in society like the material explanation does. If a person is given the chance to escape their situation they will are likely to grasp it with both hands and seek a better life and living conditions which will improve their health, however, the statistical artefact explanation doesn’t. On the other hand, the statistical artefact shows the need to try and source the people who do not report their illnesses.

References:

Annual population survey, office for national statistics.

Book 1.

Class notes.