Medical Sociology

Twelfth Edition
William C. Cockerham

Chapter 7
Illness Behavior

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Introduction
Illness behavior
Activity undertaken by a person who feels ill for
the purpose of defining that illness and seeking
relief from it

Self-care
A laypersons preventing, detecting, and treating
his or her own health problems

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Self-Care
Factors promoting self-care by laypersons:
1) Shift in disease patterns from acute to chronic
illnesses and the accompanying need to care for
symptoms that cannot be cured
2) Dissatisfaction with professional medical care that is
depersonalized
3) Recognition of the limits of modern medicine
4) Increasing awareness of alternative healing practices
5) Heightened consciousness of the effects of lifestyles
on health
6) A desire to be in control of ones own health when
feasible
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Sociodemographic Variables
Help-seeking behavior often involves
interaction between several variables acting in
combination to influence specific outcomes in
specific social situations even though research
tends to focus on one variable at a time, such
as age or ethnicity

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Age and Gender

Use of health services greatest among the
elderly
Older people are more likely both to be physically
disabled or ill and to have public insurance
(Medicare) coverage

Women more likely to visit doctors than men

Womans reproductive role accounts for less than
20 percent of all doctor visits
Higher visit rates by women are primarily the
result of their greater number of ailments
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Ethnicity
Influence on physician utilization appears
limited to providing a cultural context for
decision making within social networks
People belonging to close and exclusive
groups are either:
More likely to seek medical care if it is consistent
with cultural beliefs and practices
Less likely to seek medical care if cultural beliefs
support skepticism and distrust of professional
medicine
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Ethnicity and Social Networks

Lay-referral system
Consists of nonprofessionalsfamily members,
friends, or neighborswho assist individuals in
interpreting their symptoms and in recommending a
course of action

Influence of the social network on health

depends on the networks norms, values, and
cultural background
Works to suggest, advise, influence, or coerce an
individual into taking or not taking particular courses
of action
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Ethnicity and
Health Insurance Coverage

Copyright 2012 by Pearson Education, Inc. All rights reserved.

Ethnicity
and Health Insurance Coverage
Recent health reforms will change health
insurance coverage rates
The uninsured are mostly the working poor
Employers do not provide insurance
Earn too much to qualify for Medicaid
Cannot afford to purchase private insurance

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Socioeconomic Status
Influences not only which symptoms are perceived as
warranting medical care (with the poor ignoring more
symptoms), but also the frequency of doctor visits
Culture of poverty
A phenomenon in which poverty, over time, influences the
development of certain social and psychological traits
among those immersed within it
Traits include dependence, fatalism, inability to delay gratification,
and a lower value placed on health (being sick is not especially
unusual)

Tends to reinforce the poor persons disadvantaged social

position
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Socioeconomic Status
Kooss 1954 study of Regionville
Class I (most successful people in town)
Most likely to recognize symptoms as needing medical
attention

Class II (middle-class wage earners)

Class III (least skilled workers and poor)
Indifferent to most symptoms (said 10 of 17 symptoms
not serious enough to warrant medical care)
Cost, fear, and relative need, as well as group
expectations about symptoms important factors
inhibiting help-seeking
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Socioeconomic Status
Prior to the 1970
Upper classes visited doctors the most, followed by
middle class, with lowest classes visiting doctors the
least

Since the 1970

Lowest classes visit doctors the most, followed by
middle class, with upper class visiting doctors the least
Poor still do not visit doctors in proportion to actual
need for care and are often relegated to a lesserquality public health system

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Socioeconomic Status
Why do the poor show lower rates for use of health
services than actual need?
Dutton tested three possible explanations
Financial barriers
Weak Medicaid removed monetary barriers from seeking care
for the poor

Culture of poverty
Moderate support - Negative attitudes toward medical practices
and a willingness to ignore illness

Systems barrier
Strong support - Long waiting times, impersonal atmosphere of
bureaucracies, difficulties locating and traveling to particular
sources of care, and poor patient-physician relationships translate
into reduced medical care
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Future Patterns of Physician Utilization

Consumer orientation toward health services
Characteristic of the upper and middle classes
Individuals take responsibility for their own health and
deciding when to seek medical care

Passive orientation toward health services

Characteristic of the lower class
Influenced by an external locus of control and the
culture of poverty
Individuals more readily turn over control of health
issues to the medical system
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Recognizing and Coping

with Illness Symptoms
Mechanic names ten determinants for seeking medical care:
1)
2)
3)

Visibility and recognition of symptoms

Extent to which the symptoms are perceived as dangerous
Extent to which symptoms disrupt family, work, and other social
activities
4) Frequency and persistence of symptoms
5) Amount of tolerance for the symptoms
6) Available information, knowledge, and cultural assumptions
7) Basic needs that lead to denial
8) Other needs competing with illness responses
9) Competing interpretations that can be given to the symptoms once
they are recognized
10) Availability of treatment resources, physical proximity, and
psychological and financial costs of taking action

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Recognizing and Coping

with Illness Symptoms
Mechanics ten determinants operate at two
levels:
Other-defined level
Other people attempt to define an individuals
symptoms as illness and call those symptoms to the
attention of that person

Self-defined level
The individual defines his or her own symptoms

Mechanic sees illness behavior as a culturally

and socially learned response
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Recognizing and Coping

with Illness Symptoms
Suchmans stages of illness experience
When individuals perceive themselves becoming
sick, they pass through several stages, depending
upon their interpretation of their experience
1)
2)
3)
4)
5)

The symptom experience

The assumption of the sick role
Medical care contact
The dependent-patient role
Recovery and rehabilitation

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