Health, Illness, Sickness and Disease

Learning outcomes :

At the end of this lecture you will be able to:

• Define health, disease, illness and sickness

• Explain the differences between illness, disease and sickness
• Give examples of practices from folk sector, popular sector and professional sector of health
care

HEALTH :

• “Health is a state of complete physical, mental and social well- being and not merely the
absence of disease or infirmity.” (WHO)
• Threats to health are discussed as a malady , an umbrella term for unwanted conditions that
influence well-being.

Causes of some maladies :

• Germs such as bacteria, virus, and fungi;

• Physical factors such as cold, noise, vibration, radiation;

• Chemical factors such as pesticides, solvents;

• Our behaviors, such as smoking, drinking, and overeating;

• Our psychological concerns, such as worries, depression, and anxiety;

• Others’ behaviors, such as violence or traffic accidents. 


Different words are used to express maladies :

• Disease,

• Illness,

• Sickness

—> These are considered synonyms in English, but there are important distinctions among them.

DISEASE

• Some deviation from a (fixed) biological norm (dis-ease).

• “objective pathology”

• Disease as a biological problem involves abnormality in the body’s structure, chemistry, or

functions.

The doctor’s perspective :

• Scientific rationality
• Emphasis on objective, numerical measurement
• Emphasis on physicochemical data
• Mind-body dualism
• The view of “diseases” as entities
• Emphasis on the individual patient, rather than on the family or community

——————————————————————————————————————————
• “Disease” is what he has on the way home from the doctor’s office.
• “Disease” is something an organ has.
 ILLNESS

• Entirely personal feeling of unhealth.

• “the subjective experience of symptoms”

• Illness refers to a patient’s experience of something wrong, a sense of disruption in well-being

that may be the result of disease or caused by cultural beliefs (such as feeling that you are “too
fat” or being persecuted by witches, UFOs, or the CIA).

“ILLNESS BEHAVIOR” :

1.A disposition of the people

2.A result of an interaction between personal and environmental factors in populations

3.A response to the healthcare services system

4.A decision-making process

__________________________________________________________________________________

• “Illness” is what the patient feels when he goes to the doctor.

• “lllness” is something a person has.


Subjective experiences for “BEING ILL” :

• Perceived changes in bodily appearance: (Loss of weight, changes in skin color, hair falling
out)

• Changes in regular bodily functions: (Urinary frequency, heavy menstrual periods, irregular
heart beats, etc.)

• Unusual bodily emissions: (Blood in the urine, sputum or stools)

• Changes in the functions of the limbs: (Paralysis, clumsiness, tremor)

• Changes in five major senses: Deafness, blindness, lack of smell or loss of taste sensation.

• Unpleasant physical symptoms: Headache, abdominal pain, fever or shivering.

• Excessive or unusual emotional state: Anxiety, depression, nightmares or exaggerated fears.

• Behavioral changes in relation to others: Marital or work disharmony.


“ILLNESS” : A decision-making process :

• What has happened ?

• Why has it happened?

• Why has it happened to me?
• Why now?
• What would happen to me if nothing were done about it?
• What are its likely effects on other people (family, friends, employers, workmates) if nothing
were done about it?
• What should I do about it or to whom should I turn for further help?

Stages of illness :

• The symptoms experience stage —> The decision that something is wrong.

• Assumption of the sick role stage —> The decision that one is sick and needs
professional care.
• The medical care contact stage —> The decision to seek professional medical care.

• The dependent-patient role stage —> The decision to transfer control to the physician
and to accept and follow prescribed treatment.

• The recovery or rehabilitation stage —> The decision to relinquish the patient role
The social roles of illness :

- Illness provides release from unbearable pressure

• In the face of heavy social pressures, illness provides an attractive solution.

- Illness helps to account for personal failure

• To be sick implies an inability to fulfill tasks and acceptable avoidance of responsibilities.

- Illness may be used to gain attention

• For people who are lonely, who are unsure of their acceptance by others, illness is an
attractive device to gain attention

- Hospitalization may be a vacation

• Usually for the housewives, workaholics and the poor.

- Illness may be used as a social control device

• For example, the widowed mother is the chronic sufferer who plays on her children’s
feeling of guilt to ensure that they do what she wants and the daughter remains single all
her life, “devotedly” caring for her mother.

- Illness may be a device to expiate sinful feelings

• If an antiseptic does not sting, if a medicine does not taste bad, and if a hypodermic
injection does not give pain, then it is valueless for some people. This may be a reflection
of the conviction that man must pay with sufferings for his sins

Folk Illness :

• Where many people in a culture or community agree about a pattern of symptoms and
signs, and its origin, significance and treatment, it becomes a folk illness, with a recurring
identity.

• This identity is more loosely defined than medical ‘diseases’ and is greatly influenced by the
socio-cultural context in which it appears.

Examples of Folk Illnesses :

• Nazar : in Turkey
• Susto : throughout Latin America;
• Amok :in Malaysia;
• Windigo :in north-eastern America;
• Narahatiye qalb (‘heart distress’) in Iran;
• Dil ghirda hai (‘sinking heart’): in the Punjab, India;
• Koro : in China;
• Brain fag : in parts of Africa;
• Tabanka : in Trinidad;
• Nervios :in much of Latin America;
• Vapid unmada : in Sri Lanka;
• Crise de foie : in France;
• High blood : in the USA;
• Colds and chills : in much of the English speaking world.
 SICKNESS

• The external and public mode of unhealth embodied in more or less fixed “social roles” of
unhealthiness

• “the expected behavior of someone who is ill”

• The sick role focuses on social expectations for the behaviors of a person diagnosed as
suffering from a malady, for instance, being excused from work or school.

Sectors of health care :

In looking at any complex society, one can identify three overlapping sectors of health care:

• The popular sector


• The folk sector

• The professional sector

THE POPULAR SECTOR

• This is the lay, non-professional, non- specialist domain of society, where ill-health is first
recognized and defined, and health care activities are initiated.

• It includes all the therapeutic options that people utilize without any payment and without
consulting either folk healers or medical practitioners.

Among these options are :

• Self-treatment or self-medication;
• Advice or treatment given by a relative, friend, neighbor or workmate;
• Healing and health care activities in a cult or self-help group;
• Consultation with another lay person who has special experience of a particular disorder or
treatment of a physical state.

In this sector :

• The main arena of healthcare is the family;

• The main providers of healthcare are women,
usually mothers and grandmothers, who diagnose most common illnesses and treat with
the materials at hand.
• It has been estimated that about 70-90 % health care takes place within this sector, in both
Western and non-Western societies.

THE FOLK SECTOR

• Certain individuals specialize of healing which are sacred or secular, or a mixture of the two.

• Especially largeinnon-Western societies,

• There is a wide variation in the types of folk healer found in any society:
• From purely secular and technical experts like bone-setters, midwives, tooth extractors or
herbalists, to spiritual healers and shamans.
• In the Western world, modern medicine views most folk healers as quacks, charlatans who
pose a danger to their patient’s health.

 THE PROFESSIONAL SECTOR

• This sector includes the organized, legally sanctioned healing professions such as:

physicians of various types and specialities;

para-medical professions such as nurses, midwives and physiotherapists.

• In most countries, scientific medicine is the basis of professional sector but, traditional
medical systems may also become “professionalized” to some extent (Ayurvedic medical
colleges in India)

• It is important to realize that Western scientific medicine provides only a small proportion of
health care in most countries of the world.

Constitution of the World Health Organization: Principles :

• Health is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity.
• The enjoyment of the highest attainable standard of health is one of the fundamental rights of
every human being without distinction of race, religion, political belief, economic or social
condition.
• The health of all peoples is fundamental to the attainment of peace and security and is
dependent on the fullest co-operation of individuals and States.
• The achievement of any State in the promotion and protection of health is of value to all.
• Unequal development in different countries in the promotion of health and control of
diseases, especially communicable disease, is a common danger.
• Healthy development of the child is of basic importance; the ability to live harmoniously in a
changing total environment is essential to such development.
• The extension to all peoples of the benefits of medical, psychological and related knowledge
is essential to the fullest attainment of health.
• Informed opinion and active co-operation on the part of the public are of the utmost
importance in the improvement of the health of the people.
• Governments have a responsibility for the health of their peoples which can be fulfilled only
by the provision of adequate health and social measures.