Health and Illness can only be understood when taking into account their social and cultural context. Discuss

The Psychology of Health 1:

Essay Title

3) Health and Illness can only be understood when taking into account their social and cultural context. Discuss

The definition of the words ‘health’ and ‘illness’ can’t be taken for granted while they mean different things to different people. Some people who fell able to walk around the house without feeling much pain from arthritis would consider their condition healthy: on the other hand however a person who is in an excellent physical and mental condition wouldn’t accept the former as “healthy”. It is obvious therefore, the classification of ‘illness’ is basically contested, that is, there is no agreement about what is considered to be an illness. The World Health Organisation (WHO), for instance classifies health as ‘a state of complete physical, mental and asocial well-being, and not merely the absence of disease or infirmity.’ Health is a state of complete physical, mental and social well-being is very difficult to achieve according to Banyard (1996). This definition doesn’t take into account wider social, political and economic factors. It means that people who are not fulfilled are as well not healthy.

Health and illness has to be considered inside a specific socio-political, cultural and interactive background. It is common belief that all can explain what health and illness are, but yet the matter is not as simple as it appears. Cultural context should be taken into account while dealing with health and illness issues. In the past decade the world has undergone vast political, technological, and economic upheavals. The proportion of people who die from infectious diseases has fallen, the proportion who die from cancer and cardiovascular disease has risen. In most countries (with a number of tragic exceptions), life expectancy has risen, the proportion of people over 60 has increased, and the maladies of old age have become more important (Murray and Lopez 1996).

From the 17th century to the first decades of the 20th century illness was believed to be unavoidable. Some people believed that it was the work of the devil. Until the Second World War, doctors were able to do little to affect the course of most diseases, but their services were still in great demand. People had a tendency to die of acute illnesses for instance influenza, pneumonia and tuberculosis. Nowadays the illnesses that trouble societies are Chronic, such as Cancer, Heart disease and diabetes. Still, although these diseases can’t be healed, they are managed. The bio-medical model views physical illness as being related to an exact pathogen (disease-causing organism). The bio-medical model has dealt effectively with Infectious diseases such as tuberculosis, measles and chicken pox. Chronic diseases need a broader model so as to explain the causal factors and possible ways of dealing with such diseases.

The prevailing view of illness shared by many official health practitioners such as doctors, consultants and surgeons has been labelled the ‘Biomedical Aproach’ or the ‘Medical Model’. This view of illness achieved importance in the late 19th century in Britain. The medical model mainly supposes that illness is caused by bacteria, which means that the cause of illness can be identified. So the previous belief that illness is a result of an evil spirit entering the body has vanished completely. Illness can be identified and classified into dissimilar kinds, for instance diseases of the nervous system. Illnesses are recognized by medical officials, for instance doctors and not ‘lay’ people. The diagnosis of the symptoms is comparatively objective. Illnesses are quite self-evident and the majority of illnesses can be treated and cured. Although the medical model is claimed to dominate the health professions, the main assumptions of it are not held by all doctors, nurses and consultants, and some of the suppositions may be supposed to different degrees. The bio medical model sustains that the individual is healthy if the body is in normal working order. This of course has lots of weaknesses because in old age one experiences a lot of unlikeable symptoms so far this is perfectly normal and blind people would consider themselves as healthy .The biomedical model claims that diseases come from outside the body, attack the body and cause physical changes within the body. Such diseases are caused by a quantity of factors which include chemical imbalances, bacteria, viruses and genetic predisposition.

Another model, the Biopsychosocial model, recommends that health is seen as not inactive. Health can be characterised on a health-illness range. The model highlights the relation among psychological factors and illness. Human beings should be seen as multifaceted systems and illness is caused by a huge number of factors and not by a single underlying factor. Health psychology consequently tends to move away from a straightforward linear model of health and claims that illness can be caused by a mixture of biological (e.g. a virus), psychological (e.g. behaviours, beliefs) and social (e.g. employment) factors. Engel (1977, 1980) developed the bio psychosocial model of health and illness which reflects this approach. An effort was made to bring the psychological and the environmental models, called bio psychosocial model, together into the traditional biomedical model of health: some of the causative bio factors contain genetics, viruses, bacteria and structural defects. The health and illness psycho aspects have been described in terms of cognitions (e.g. health expectation), emotions (e.g. the way fear is treated) and behaviours (e.g. smoking, diets, exercise or alcohol consumption). The other aspects social of health ,the social ones, were studied in terms of social standards of behaviour (e.g. the socially accepted standards of smoking or not smoking), pressures for behaviour change (e.g. examine group expectations, parental demands), social principles on health (e.g. whether health was regarded as a good or a bad thing), social group and ethnicity. The psychosocial model demands for the whole person to be treated, not just the physical changes that have occurred. This can be achieved through studying behaviour change, encouraging changes in beliefs and coping strategies, and conformity with medical requirements.

It was the fashion some while ago to see diseases as lifestyle choices, to be fixed by persuading people to live differently--eat less fatty foods, give up smoking, straighten up and fly right. This is no longer so. We have now attended to the analyses (Marmot et al. 1997) that link health and disease directly with social status and social capital. Smokers die sooner, yes, but something about being poor disposes to smoking. Social stresses are manifested in pathology. Values like trust, hope and control of one's own life become vital.

The Marmot studies of British public ...

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The Marmot studies of British public servants have shown that health indices are tightly linked to rank. Those at the very bottom of the civil service hierarchy have heart disease rates four times higher than those at the top. It is not just that those at the bottom have the highest rates: there is a gradient of disease from the top of the British civil service hierarchy to the bottom. The less powerful you are, the less control you have over your own life, the worse your health is, in every respect.

Another point of view is the one that Blaxter (1990a) presented highlightening the variety of definitions that people use to measure whether they are healthy. The studies that focused on self-report health as a key measure must then be examined very carefully because the researcher will come up with many definitions of health. Any study of health and illness, including an essay or project on health, must make it clear that health is essentially contested. ‘Essentially contested’ means there is no single agreed definition. It has already been shown by Blaxter (1990a), sociologists such as Pill and Scott (1982) and Williams (1993) that meanings of health not only differ among people but as well among groups of people. Positive meanings of health-for instance being able to do tasks- have been found to be used more often by middle-class groups (d’Houtard and Field, 1984). However Calnan (1987) discovered that working-class women had very restricted views of health, for instance ‘health is getting through the day’. Even though Blaxter (1983) recommends that the short time allowed for the interview procedure might limit answers of ‘less educated people’.

Other variations among social groups may perhaps arise by younger age people might hold different views of health from older people. In the Western world, evidence-driven changes in our views of the determinants of health have led to greater attention being paid to such risk factors as inequity of income distribution, lack of control (at work and in the community), and social support (Marmot et al. 1997). These changes have enlarged our view of what constitutes health, into areas where medical expertise must negotiate a position with other influential sectors. Classifications might differ by gender and occupation. So the determinants of health could also be these closely related factors: how well you can cope with challenges, in what kind of environment you were brought up and what kind of community support you have

For the relationship between social class and health there are five explanations. These explanations are the artefact, social selection, culture, material/ structural and the health services. The first explanation, the artefact explanation, proposes that social class health inequities don’t exist in reality. They are only a product of the approaches researchers have used to measure social class and health disparity. The second explanation, the social selection, proposes that bad or good health causes social mobility. The third explanation which is the cultural explanation is the shared and cultured way of life in a group of people. The fourth explanation, which is the material/structural explanation, recommends that social class disparities in health are caused by the dissimilar working and living conditions of the dissimilar social classes. Researchers such as Whitehead (1992) and certainly the Black Report (Townsend and Davidson, 1982), claim that this clarification is essential to an understanding of social class distinctions in health. The cultural explanation implies that different social classes perform in different ways; the poorer health of the lower social classes is caused by the acting in ways that are more likely to damage their health. Alternatively the culture of the higher classes directs to better health and a longer life expectancy. A study of a coherent population over a long period of time started to come out --Michael Marmot's study of civil servants in Whitehall: 16,000 civil servants all working in the center of London. They are all middle class, all educated, all well housed, and all well fed. They are obviously in a hierarchy. The bottom, the secretaries and file clerks, may not be as well paid as the top, the senior civil servants, but there is no poverty. And they all have access to the National Health System.

Boulton et al. (1986) in his research examined a doctor-patient dialogue. He conducted a research involving 16 doctors from a great number of GPs and 328 patients with a different social background. The research presupposed the allocation of the patients according to their social class and occupation (using Hope-Goldthorpe classification). Studying the outcome of his study he discovered that middle-class patients showed a great interest in seeking further explanation, though both middle- and working- class patients, tended, at the same proportion, to show disbelief of their doctor’s view and advice and ready to dismiss it. The questions they asked their doctors varied; more questions came from the middle-class patients. The doctors gave to all of them explanations that didn’t really vary much. At the end Boulton et al. concludes that more evidence is needed if we want to study the change of attitude and behaviour of some patients after consulting their doctors towards their health

In the introduction it was said that health and illness do not exist in isolation but within a specific socio-political, cultural and interactive context. So cultural background has an significant effect on several features of people’s lives, counting their beliefs, diet, behaviour, perceptions, language, rituals, emotions, family structure, dress, religion, body image, concepts of space and of time, and attitudes to illness, pain and other forms of misfortune. Every one of which might have significant allegations for health and health care. The increase in life expectancy over the last 50 years has been due to better public health, better nutrition, and healthier lifestyles, rather than to the spectacular advance in medical knowledge and medical technology (Mackenbach 1996). Nevertheless the culture which somebody is born, or the culture somebody lives, is certainly not the only such influence. It is simply one, of a quantity of influences, on health-related beliefs and behaviours that include the environmental factors, educational factors, socio-economic factors and the individual factors.

It is most essential that in understanding the ‘position’ of culture it should constantly be seen in its exacting context. This perspective is made up from historical, economic, social, political and geographical rudiments, and means that the culture of every group of people, at some exacting point in time, is constantly prejudiced by several other issues. For instance, people may well act in an exacting way, for example eating particular foods, not because it is their background to do so, but for the reason that they are just too poor to do otherwise. Consequently, in understanding health and illness it is essential to avoid ‘victim blaming’-that is, seeing the poor health population as the only consequence of its ethnicity, as an alternative of looking as well at their economic or social position.

It has been proved that poverty may result in poor nutrition, overcrowded living conditions, physical and psychological violence, psychological stress, and drug and alcohol abuse. This brings another important factor we have to consider, Economy. The uneven distribution of wealth and recourses, together among countries and within every country itself, can lead to poverty and rise of illnesses. As a paradigm of this, is the Black Report of 1982 by Townsend and Davidson, which showed how, in the UK, health may well obviously associate with wages, and people in the lower social classes had more illness and a much higher mortality than their fellow citizens in the more influent classes. Zaidi, (1988) argued that in the developing world as well, no matter what the local culture is, poor health is related with a low wage as this affects the housing, etc., that individuals are capable to afford. Unterhalter’s study in 1982 for instance, of infant mortality rates between dissimilar cultural societies in Johannesburg, South Africa, from 1910 to 1979 found very much upper rates between blacks and other non-white groups than between whites. This is obviously related with the economic and social inequalities forced on them by the apartheid method. Thus culture should be considered only as a part of a compound mix of influences on what individuals think and how they live their lives.

There are cases where the influence of culture in medical care is over- emphasised in interpreting how some individuals present their symptoms to health professionals. Lopez and Hernandez in 1986 proposed that symptoms or behaviours may be credited to the individual’s ethnicity, while they are actually because of a fundamental physical or mental disorder. In the same way, physical disorders might be confused with mental illness in particular cultural contexts. Therefore Weiss (1985) has explained how, in India and somewhere else, several cases of cerebral malaria have been incorrectly detected as mental illness.

Some of the central features of all societies in the world are the relations of beliefs and practices with ill health. This has been demonstrated by Medical anthropology researches of the socio-cultural. All these are correlated to beliefs about the cause of a vast range of misfortunes, ill health being just one form. I f we really want to study the beliefs and traditions of a culture about ill health we certainly have to consider it as part of the wider culture because all these are closely linked together. In order to be able to understand people’s reactions to illness, death or other misfortunes you must study and understand the type of culture they have grown up in or acquired- that is, of the ‘lens’ through which they are perceiving and interpreting their world. Additionally to the study of culture it is as well essential to observe the state of the social organisation of health and illness in that society, which includes the ways in which people have become declared as ill, the ways that they present this illness to other people, the attributes of those they present their illness to, and the ways that the illness is dealt with.

Different social and cultural groups utilize different languages of distress in communicating their suffering to others, including doctors. Within any community, each group usually has varying perceptions of illness; some depend on age, gender, culture ethnicity, religion and social rank-. A late study was conducted on children and the way they are able to recognize and experience illness and medical treatment. The research suggests that children do have their own unique understanding of illness, the factor that causes it and the way it should be treated; they guess how and why it has happened to them, The European union carried out a study between 1990-1993 on children 7 to 12 years old. The research was the COMAC Childhood and Medicines Project (Trakas and Sanz 1996, Bush, Trakas & Sanz 1996); it was carried out in nine European countries and examined children’s experience of illness and medicines. One of the research methods included a drawing-interview. At this method children had to draw of the last time they were ill and then to talk and answer to questions about the meaning of their drawing. The results were interesting because they had both differences and similarities among different countries. The way children understood illness was very different from one country to another. The factors of culture played a very important in this study. Nearly in all cases, children stressed the key role their mother played as the main care-giver. If we look in Botsis and Trakas’s study (1996) in Athens, Greece, we will see that most of the kids had drawn their mothers ‘serving hot tea, asking others if they wanted fresh juice, carrying thermometers and arranging flowers’. It was noticeable that fathers were very rarely anywhere in the drawing. A study that took place in Spain had similar results. The explanation they could give to the results of the researches were that children had been greatly influenced by the world of the adults and had assimilated most of their culture and habits.

As it has been shown in this essay, to understand health and illness, their social and cultural context should always be taken into account.

References

Books

Banyard, P. (1996). Applying Psychology to Health. London: Hodder & Stoughton.

Bennett, P. (2000). An Introduction to Clinical Health Psychology. Buckingham: Open University Press.

Blaxter, M. (1990a). Health and Lifestyles. London: Tavistock

Bowling, A. (1995). Measuring Disease. Buckingham: Open University Press.

Bush, P. J., Trakas, D. J., Sanz, E. J. et al. (1996). Children, Medicines and Culture. Pharmaceuticals Products Press: Haworth Press.

Calnan, M. (1987). Health and Illness: The Lay Perspective. London: Tavistock

Connor, M., & Norman, P. (1995). Predicting Health Behaviours. Buckingham: Open University Press.

Hardey, M. (1998). The social context of health. Philadelphia: Open University Press

Helman, G. C. (2000). Culture, Health and Illness. London: Butterworth Heinmann

Murray, C. and Lopez, A. (1996). The global burden of disease. Harvard: Harvard University Press.

Ogden, J. (2004). Health Psychology: A Textbook. Buckingham: Open University Press.

Penny, G., Bennett, P., & Herbert, M. (1994). Health Psychology: A Lifespan Perspective. Amsterdam: Harwood.

Senior, M. and Viveash, B. (1998). Health and Illness. London: Macmillan

Stroebe, W. (2000). Social Psychology and Health. Buckingham: Open University Press.

Taylor, S. (1999). Health Psychology. Boston: McGraw-Hill.

Townsend, P. and Davidson, N. (1982). Inequalities in Health: The Black Report. Penguin

Trakas, D. J. and Sanz, E. (1996). Childhood and Medicine Use in a Cross-cultural Perspective: A European Concerted Action. European Commission.

Williams, F. (1993). ‘Anthropology: Care’, in J. Bornat et al., Community Care. London and Milton Keynes: Macmillan and Open University Press

Whitehead, M. (1992). ‘The Health Divide’, in Inequalities in Health. Harmondsworth: Penguin

World Health Organization (1979). Formulating Strategies for Health for All by the Year 2000: Guiding Principles and Essential Issues. WHO.

Articles

Blaxter, M. (1983). ‘The cause of disease: women talking’, Social science and Medicine, vol. 17.

Botsis, C. and Trakas, D. J. (1996). Childhood and Medicine use in Athens. In: Disrupted Lives (D. J. Trakas and E. Sanz), pp. 221-44. University of California Press.

Boulton, M. D., Tuckett, A., Olesen, and A., Williams. (1986). ‘Social class and the general practice consultation’, Sociology of Health and Illness, vol. 8, no. 4.

d’Houtard, A. and M. Field (1984). ‘The Image of Heath: variations in perceptions of social class in a French population’, Sociology of Health and Illness, vol. 6.

Lopez, S. and Hernandez, P. (1986). How culture is considered in evaluation of psychopathology. J. Nerv. Ment. Dis., 176, 598-606.

Mackenbach, J. (1996). The contribution of medical care to mortality decline. Journal of Clinical Epidemiology 49(11): 1207-13

Marmot, M.G., Bosma, H., Hemingway, H. and Brunner, E. (1997). Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet 350(9073): 235-9.

Pill, R. and Scott, N. (1982). ‘Concepts of illness causation and responsibility: some preliminary data from a sample of Working class mothers’, Social Science and Medicine, vol. 16, no. 1.

Trakas, D. J. (1996). Children’s account of illness: comparisons of children’s interviews from the COMAC Childhood and Medicines Project. In: Disrupted Lives (D. J. Trakas and E. Sanz), pp. 293-311. University of California Press.

Unterhalter, B. (1982) Inequalities in Health and disease: the case of mortality rates for the city of Johannesburg, South Africa, 1910-1979. Int. J. Hlth. Serv., 12, 617-36

Weiss, M.G. (1985). The interrelationship of tropical disease and mental disorder: conceptual framework and literature review. Part 1- Malaria. Cult. Med. Psychiatry, 9, 121-200.

Zaidi, S. A. (1988). Poverty and disease: need for structural change. Soc. Sci. Med., 27, 119-27.

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