INTERACTIONIST MODEL: This is a sociological approach which focuses on the influence of small groups on our behaviour rather than the power of large institutions. These theorists believe that our behaviour is driven by how, in smaller groups, we interpret situations- how we see ourselves in relation other people in the group, how we see other members and how they see us.
The interactionist, or social action, approach distinction with the structuralist perspectives in that focus is not on the great institutions and how they are arranged and function and connect with each other. Instead, the focus is on small groups and how they influence individual behaviour and shape society. Interactionists may possibly study groups as diverse as teenage gangs, staff, patients and visitors on hospital wards or social interaction in school classrooms. For example:
- How do different people see themselves?
- Do some have more power than others?
- Who are the formal leaders?
- Are there some informal leaders who actually have power in the group?
Social action or interactionist theorists do no not hold the view that we are programmed by the socialisation process. They see individuals as influenced by the socialisation process but having the power to choose how they will actually behave. We create our own roles. These theorists focus on the aspects of sociology that are concerned with behaviour in small groups and how those groups influence our behaviour. They have very little interest in social structure as a whole. They see our behaviour as driven by how we interpret situations, how we see ourselves and other people and how they see us. For the social action theorist, the key aim of the sociologist is to recognise how individuals interpret situations and behave in small-group face-to-face situations.
- Criticisms of the social action approach
Social action theorists, even though they emphasise individual choice, understand that there are social roles even if they are not clear. They do not, however, study where they come from. They are criticised for paying not enough attention to issues of control in society. Even though they would say that social roles are only imprecisely defined, they do not explain where these roles come from and they do not give explanation of why people mostly behave in very unsurprising ways.
POSTMODERNISM: Postmodernism is a draw near to sociology, or understanding society, that focuses on the fast change and insecurity in our society- some would even say chaos. Postmodernists would recommend that we can no longer talk about established institutions like the family, religion or the economy because nothing is staying the same. Domestic schedule is so various these days that social institutions like ‘the family’ are in a circumstance of constant change. It is no longer possible to talk of the ‘typical’ family. Postmodernists hold the analysis that, because of the constant change, structuralist perspectives to value society. The institutions have become fragmented. Individuals and groups of people make their own individual lifestyle decisions, choosing from the many leisure activities and consumer goods that are now accessible.
COLLECTIVISM: Collectivism is an advance to providing health and care services, underpinned by a government dedication to provide care and support for the helpless. This is funded through taxation and national insurance. This is contrasted with the New Right, the ones who deem welfare to be the responsibility of the individual and their family and that the condition should play a minimal role. Collectivism and the New Right are examples of political responses to the position of government in our society and, for our purposes, their rejoinder to meeting identified areas of welfare need. In all societies there are groups of individuals who are potentially susceptible. These may include children, older people, and people with physical impairments and those with mental health needs. In some societies the care of these people will be seen as the liability of the individual or their family; in other societies it will be seen as the responsibility of religious groups, the commune or the local community.
The Cross-party agreed that the state should take a collective dependability to:
- Tackle poverty through a wide range of welfare benefits including Family Allowance, unemployment and sickness benefit and retirement pensions
- Fight disease throughout the National Health Service
- Combat ignorance through the expansion of secondary education for all
- Eliminate squalor through the building of council houses
- Get rid of indolence by supporting policies full employment and the development of labour exchanges.
THE NEW RIGHT: The post-war collectivist approach to welfare remained largely in position for over a generation and was not seriously challenged or questioned in anticipation of the election of Margaret Thatcher’s government in 1979. The outlook of this government was that the state should participate as small a role as achievable in the provision of welfare. They believed that welfare should be mainly seen as the responsibility of the individual and their family. The new right regarded state support as intrusive and supporting a dependency culture. Mrs Thatcher and her government were of the analysis that the welfare state generated humanity in which people relied on state benefits rather than preparation for the future and taking accountability for the needs of themselves and their families. The collectivist approach to welfare considers that care needs are the responsibility of the state. This is disparity with the New Right, who truly believes the meeting of care needs to be mainly the responsibility of the individual and their family.
P2) Describe different concepts of health
Understanding different concepts of health and ill health
It will come as no shock that sociologists have an immense complexity in agreeing on a definition of what it means to be healthy. Health can be defined in terms of the ‘absence of disease’, occasionally described as a negative approach to health. This is compared with a positive definition such as that provided by the World Health Organisation (WHO) (1974): ‘not merely an absence of disease, but a state of complete physical, mental, spiritual and social well being’.
In the health and care quarter, care professionals would adopt a holistic approach to care and support. They perceive their role as addressing the needs of the ‘whole’ person rather than particular issues or acknowledged problems.
Positive definition of health: A view that health is feeling fit and well in body, mind and spirit. A Positive definition of health and well-being has to consist of the 'maintaining' of it. For example, Kerry bowie could be viewed as an example of Positive health and well-being as although she is popular, has a loving family, and is very intelligent - she knew she needed to lose weight to improve her health and well being and did so successfully. So the 'maintenance' aspect of this definition is what makes it 'positive' otherwise it reads as a 'holistic' definition.
Negative definition of health: A view that health is the absence of disease. An individual with a negative concept of health would define it as simply being free from pain or discomfort. It is the absence of illness or disease that would indicate being healthy for a person with this perception. Having this view, you may do very little to preserve what you see as your healthy status, and see good health as average, or take it for granted. Some people who have this kind view would see the fact that they had not visited the doctor for years as a sign that they were healthy. Some believe that they are healthy and that if there was something wrong with them they would actually know about it but that’s not how it always goes. An individual with this concept of health is unlikely to view themselves as ill if they are a bit run down or depressed or if they have a cold or a headache.
(WHO) World Health Organisation definition of health: ‘Health is a state of complete physical, mental and social well being, not merely the absence of disease or in infirmity’ (WHO 1946)
An individual who has complex needs, for example a young mother who has multiple sclerosis, may be supported by a range of professionals. These would include a GP, a community nurse, an occupational therapist, a social worker and a health visitor, often referred to as a multi-disciplinary team. They will each have their particular roles and responsibilities for her care and support but they would also want to carry out a holistic assessment; they will recognise the importance of the young woman’s wider needs when providing their specialist care.
Holistic Approach to health and illness: An approach to care that addresses the physical, intellectual, emotional, social and spiritual health of the client. This is an approach that attempts to meet the needs of ‘whole person’. It is actually an approach to life. Rather than focusing on illness or specific parts of the body, this ancient approach to health considers the whole person and how he or she interacts with his or her environment. The goal is to achieve maximum well-being, where everything is functioning the very best that is possible.
P3) Describe the biomedical and socio-medical models of health
Models of health
Biomedical model- An approach to health and illness which identifies health as the absence of disease.
The biomedical model of medicine has been around since the mid-nineteenth century as the predominant model used by physicians in the diagnosis of disease. This view underpins the policies and practice of the National Health Service (NHS). The main principle of the health services is to treat disease and health professionals will use scientifically tested methods to address diagnosed illnesses. Sociologists believe that the focus on the individual patient for whom a cure should be found is a restriction of this model; there is little regard paid to environmental and social factors that may lead to ill health. The biomedical model of health looks at individual physical functioning and describes bad health and illness as the presence of disease and ill symptoms as a result of physical causes such as injury or infections and doesn't look at social and psychological factors.
Biomedical concentrates on the individual as for socio-medical it does not concentrate on the individual.
Socio-medical model- An approach to health and illness with a focus on the social and environment factors that influence our health and well-being, including the impact of poverty, poor housing, diet and pollution.
The social model of health looks at how society and our environment affect our everyday health and well-being, including factors such as are social class, poverty, poor housing, diet, pollution and income. Poor housing and poverty causes respiratory problems, and in reaction to these causes and start of ill health, the socio-medical model aimed to encourage society to include better housing and introduce programs to undertake poverty as a result.
Research designates that life expectancy went up and death rates began to fall, especially infant mortality rates, with the improvements in sanitation and the provision of clean water, the building of new council houses and generally improved standards of living in the late-nineteenth/early –twentieth centuries.
The socio-medical model assembles more simply with the conflict theorists than the functionalists. The conflict theorist explains the shorter life expectancy and the relatively higher rates of ill health with the poor as a significance of the inequalities in society and the life situations of the disadvantaged. The poor mostly have inadequate diets; live in damp houses, often inner city areas where the impact of unemployment and environmental pollution is possibly very high. The verdict groups in society, the politicians and the owners of industries, are not willing, they would say, to make the changes that would be required to protect the poor from ill health and disease.
P4) Describe different concepts of ill health
A disabled person is a person with impairment who experiences disability. Disability is the result of negative interactions that take place between a person with impairment and her or his social environment. Impairment is therefore part of a negative interaction, but it is not the cause of, nor does it justify disability.
Impairment: the restrictions on day-to-day activity caused by a physical or mental dysfunction or abnormality, for example, the loss of a limb, a sensory impairment or a learning difficulty such as Down’s syndrome.
Disability: sociologists will often refer to disability as the restrictions that arise for a person with impairment because of the attitudes and the lack of appropriate services and facilities to meet their needs.
Iatrogenesis or ‘doctor-generated’ illness
Iatrogenesis refers to illness generated by medical activity and practice. Particular areas of concern include the side effects of drugs, the risks attached to medical drugs trials and concerns about infections spread within hospitals. There were three major types of Iatrogenesis, which was introduced by Ivan Illich and was part of his more universal attack on, and criticism, of industrialised society and its large bureaucratic institutions. The three major types of Iatrogenesis;
- Clinical Iatrogenesis- the unwanted side-effects of medical intervention
- Social Iatrogenesis- medicines has expanded a great deal of power and status with the aim of people too quickly and easily place themselves in the hands of the professional and become mass consumers of medical products.
- Cultural Iatrogenesis- society becomes over-concerned with great health, so making it complicated to develop optimistic attitudes towards impairment and to cope suitably with death.
The Clinical Iceberg
Official statistics on levels of illness are often called ‘the clinical iceberg’ because it is thought that the levels of illnesses are largely concealed, and this is because when individuals become ill they do not automatically wish to seek professional help. This may be for a wide variety of reasons.
For example, Medical Statistics are created based on information from the doctors; these statistics go on to make government policies on healthcare. According to Last (1963) as much as 94% of illness is not reported to doctors.
The Sick Role
The sick role which was introduced by Talcott Parsons, a functionalist, this refers to the prospect others have of a person recognised as ill-exempt from their normal activities but expected to co-operate with professional staff and take reasonable steps to get better. The common idea is that the individual who has fallen ill is not only physically sick, but now remains to the specifically patterned social role of being sick. ‘Being Sick’ is not simply a ‘state of fact’ or ‘condition’, it contains within itself regular rights and responsibilities based on the social norms that surround it. The theory outlined two rights of a sick person and two responsibilities:
- The sick person is exempt from normal social roles
- The sick person is not responsible for their condition
- The sick person should try to get well
- The sick person should seek technically competent help and cooperate with the medical professional
Mortality Rate
Mortality rate is a measure of the number of deaths due to a specific cause and the death rate which is expressed as the number of deaths per thousand each year. A mortality rate of 9.5 in a population of 100,000 would mean 950 deaths per year in that entire population, or 0.95% out of the total.
P5) Compare patterns and trends of health and illness in three different social groups
In order to answer this criterion I will need to compare patterns and trends of health and illness in three different social groups. The three different social groups that I chose are social class, gender and age and in order to compare patterns and trends of health and illness I will be using graphs to show my understanding.
Percentage of Heart problems in Age and Gender
According to Fig.1 the female percentage had a higher risk of suffering from heart disease within the age groups of 18-44 years. In Fig.1 from the ages of 45 and over the male percentage seemed to become higher and there was a big gap each time. However, it all totals up to the male having a higher chance of risk with heart problems and in age it’s mostly the elderly that have a higher chance of suffering from heart disease. From the age of 75 years and over the male have a higher percentage of suffering from heart disease by 94 rate per 1,000 population.
Fig. 1
Percentage of Heart Problems in Ethnicity
According to Fig.2 within both male and female, non-Hispanic white male individuals have a higher chance of suffering from heart disease, more than the females of that ethnic group. However, in ethnic groups such as non-Hispanic black, Hispanic and Asians, the females have a higher risk of heart disease. Overall in total the male have a greater chance of suffering from heart disease even though in three different ethnic groups the females had a higher chance of suffering from heart disease, but the total in male percentage of non-Hispanic and non-Hispanic other races of male percentage overtook the female percentage. Furthermore, in total of Fig.2 the male have a greater risk of suffering from heart disease.
Fig.2
M1) Use two sociological perspectives to explain different concepts of health
In order to answer this criterion I am going to use two sociological perspectives to explain different concepts of health. The two sociological perspectives I am going to use are feminism and functionalism.
Functionalists approach to health is generally taken to mean the view that society’s structures and organisations operate towards an organic model of growth and development – all parts serving the greater needs of the whole.
The functionalism perspective
Functionalism is one of the core perspectives of sociology. Functionalism holds that everyone and everything in society, no matter how strange it may seem, serves a purpose. Functionalism addresses society as a whole in terms of the function of its constituent elements; namely , , and between manifest functions and latent functions. Functionalists also typically have the belief that most members of a society share a consensus on the topic of their core beliefs and values.
Parsons (1951) was very interested in many aspects of the management of illness; he is well remembered for his emphasis on the social importance of the sick role. He stressed the motivation involved in being sick and recovering from it. That is, people have to make a choice that if they are sick and in need of treatment. Since being sick means choosing to withdraw from the normal patterns of social behaviour, it amounts to a form of deviance, and hence the efficient functioning of the social system depends on the sick being managed and controlled.
Features that define sick role
Sick people are legitimately exempted from normal social responsibilities associated with work and the family. E.g. from going to college. People who are sick cannot just make themselves get better they will always need professional help from doctors and get medical treatment. Sick individuals are obliged to recover from their illness, being sick is only tolerated if there is a desire to return to health. Furthermore, those who are very ill are therefore expected to seek professional treatment or to be cared for.
The Marxism perspective
The basic assumption from which Marx started is that all human activity stems from the need to ensure survival; therefore without the existence of food and shelter no other activity is possible. Marx believed that the structure of society mirrors this relationship, the means by which any society produces goods, or as Marx put it the 'base' shapes the institutions and relationships or 'superstructure' of that society.
Marxism is concerned more about conflict rather than stability. Economic system shapes a society that is why the class system has produced two distinct classes, the bourgeoisie and the proletariat i.e. those who own the means of production and those that sell their labour.
Marxism and health
The NHS makes sure that there are benefits for the bourgeoisie by ensuring that the workers remain well enough to work. Workers may understand their inequality but believe the system is fair (false consciousness). Some of the Marxists argue that the ‘free’ health service is a victory for the proletariat. However, doctors and nurses who ensure that people go back to work are seen to be working in the interest of the employers rather than their patients. The government allows companies to make profit from products that cause ill health such as tobacco, alcohol and junk food. But factories still continue producing this kind of toxic waste and large cars pollute the atmosphere severely. Conflicting the functionalists, who see ill health as random occurrence, conflict models see levels of illness as related to differences in social class e.g. there is high levels of illness and lower life expectancy in areas where there is poverty, unemployment and a lot of environmental pollution.
M2) Explain the bio-medical and socio-medical models of health
In order to answer this criterion I will need to explain the bio-medical and socio-medical models of health. I will also include a case study to link to this criterion.
BIO-MEDICAL
The bio-medical model of health looks at characters physical functioning and expresses bad health and illness as the presence of disease and symptoms of illness as a result of physical causes such as injury or infections. It does not take social and psychological factors into consideration. It is dominated by considerations of genetically determined disease and biological status, and vulnerability or struggle to trauma and disease. The social model of health looks at how society and our environment affect our everyday health and well-being, and includes factors such as social class, occupation, education, income and poverty, poor housing, poor diet, and pollution.
Biomedical model of health involves the use of medical resources to treat symptoms of ill health such as going to the doctor and them asking what your symptoms are and treating them with anti-biotic.
SOCIO-MEDICAL
The socio medical model of centres on the social factors that supply to health and well being in society. When this model considers social factors, it particularly looks at the impact of poverty, poor housing, diet and pollution. E.g. poor housing and poverty are causes to respiratory problems, and in response to these causes and origins of ill health, the socio-medical model aimed to encourage society to include better housing and introduce programs to tackle poverty as a solution.
Socio-medical looking at life style to analyse what could be causing symptoms for example looking at a persons housing to see if their poor housing conditions are causing their health problems.
CASE STUDY
Aziz and Tamsela have four young children. Tamsela’s elderly parents live with them. Their 3-bedroom house is in deprived and rather depressing area of London. Their house is in a poor state of repair; it is damp and very expensive to keep warm in winter. Neither Aziz nor Tamsela is currently in paid work.
The family is in poor health. In the wainter the children seem to have permanent colds. Tamsela suffers from asthma and her father has bronchitis. Tamsela’s mother is depressed and has been prescribed drugs for this condition.
Bio-medical & Socio-medical effects of health
Aziz and Tamsela live in a three bedroom house which is in a poor state of repair and a lot of damp, it may cause for their health to be at risk and they can catch many illnesses. During the winter they will need to keep warm but it it very expensive for them since neither of the parents are working or getting paid so they suffer in the cold and dirty house. The family is in very poor health, their children have permanent colds in winter and they can never seem to get rid of this because they don’t have money for medicine. Both the parents are sick. However, tamsela’s mother who is also living with them is suffering frm depression and she has been prescribed some drugs from the doctors. The family do not have a good life, they are suffering from poor housing, poor diet, pollution within the air because they are living in a poor and unhealthy area and there is a lot of stress going on.
M3) Use sociological explanations for health inequalities to explain the patterns and trends of health illness in three different social groups.
In order to answer this criterion I will be using sociological explanations for health inequalities to explain the patterns and trends of health illness in three different social groups.
Social class and patterns of health and illness
Despite the caution with which official statistics must be treated, there is overwhelming evidence that standards of health, the incidence of ill health or morbidity and life expectancy vary according to social group in our society and especially to social class. Members of the higher social class live longer and enjoy better health than individuals of the lower social class groups. The most influential modern studies that consider the reasons for this difference are THE BLACK REPORT ( Townsend et al, 1980) followed by THE ACHESON REPORT (1998).
The Black Report considered four types of explanantion that might account for the difference in levels of illness and life expectancy experienced by different social classes.
The four possible sociological explanantions were:
- the statistical artefact explanantion
- natural or social selection
- cultural or behavioural explanation
- material or structural explanation
Ethnicity and patterns of health and illness
Evidence for a link between race or ethnicity and illness is difficult to systematically study because there difficulties of definition. A high proportion of people from minority ethnic groups live in areas which are deprived and associated poor housing, pollution and relatively high unemployment. There is a higher incidence of rickets in children from the Asian sub-continent because of a deficiency of vitamin D in their diet, most minority ethnic groups have a shorter life expectancy and most minority ethnic groups have a higher infant mortality rate.
Age and patterns of health and illness
Many individuals over retirement age are fit, healthy and making valued contributions to the society through paid work, volutary activities and playing important roles in the care and support of their families. In fact, the 2001 census revealed that 342,032 people aged 65 and over provided 50 hours or more unpaid care per week.
In 2003, 60 per cent of people aged 64-74 and 64 per cent of people aged 75 and over reported a long standing illness (General Household Survey 2003). In addition, during a three month period in 2003, 24% of people over the age of 75 had attended the casualty or out-patient department of a hospital, compared with 14% of people of all ages (General Household Survey 2003).
Local patterns in health and illness
There are regional variations in patterns of health and illness. Mortality and morbidity rates vary in different parts of the country nd also within towns and cities in the UK. It doesn’t come to no surpise when the poorer regions and the poorer parts of cities have higher levels of illness recorded. For example it has been said that there are regional trends in the incidence of lung cancer across the UK.
- The statistical artefact explanation
The researchers of the statistical artefact are working on The Black Report suggested that the differences could be explained by the fact that the statistics themselves produced biased picture- that of all those people in the lowest social classes, there was a higher proportion of older people and people working in traditional and more dangerous industries and so it would be expected that they has younger people working in offices, call centres and other service industries. More recent studies have shown that even when the researchers account for this bias in employment and age, they still find a link between low social class and high levels of illness, and lower life expectancy.
- Natural or social selection
This explanation suggests that it is not low social class and the associated low wages, poverty and poorer housing that cause illness, higher levels of infant mortality rates and lower life expectancy for adults- it is infact the other way round. Individuals are in the lower social class because of their poor health, lack of energy needed for success and promotion.
- Cultural or behavioural explanation
This explanation focuses on the behaviour and lifestyle choices of people in the lower social classes. There was ecidence that people in the lower social class smoked more, drank more heavily, were more likely to eat junk food and not exercise enough. The poor lifestyle choices were linked to a range of chronic illnesses including heart disease, some forms of cancer, bronchitis, and diabetes.
- Material or structural explanation
Material explanations claim that those social groups for whom life expectancy is shorter, and for whon infant mortality rates are higher, suffer poorer health from other groups because of inequalities in wealth and income. Poverty and persistently low incomes are associated with poorer diets, poor housing in poor environment, and more dangerous and insecure emploment.
