ASC 327 - MODULE Feb 18th 2024 Sent To Mary Douglass

KENYATTA UNIVERSITY
DIGITAL SCHOOL OF OPEN DISTANCE LEARNING

IN COLLABORATION WITH
SCHOOL OF HUMANITIES & SOCIAL SCIENCES
DEPARTMENT: SOCIOLOGY
WRITTEN BY:
DR FRANCIS P. KERRE DEPARTMENT SOCIOLOGY
VETTED BY:
DR. G. MORAA DEPARTMENT OF SOCIOLOGY
1
Table of Contents
Course Requirements.......................................................................................................................6
LESSON I. LESSON ONE: SOCIOLOGY AND ITS MAJOR CONCERNS............................7
Section 1.01 Introduction........................................................................................................7
Section 1.02 LESSON OBJECTIVES....................................................................................7
Section 1.03 SOCIOLOGY AS THE SCIENCE OF THE STUDY OF SOCIETY..............7
Section 1.04 Activity...............................................................................................................9
Section 1.05 SOME MAJOR CONCEPTS IN SOCIOLOGY................................................9
Section 1.06 SOCIETY...........................................................................................................9
Section 1.07 Types Of Social Groups...................................................................................10
Section 1.08 Socialization.....................................................................................................10
Section 1.09 Social Structure................................................................................................11
Section 1.10 Behaviour.........................................................................................................12
Section 1.11 Activity.............................................................................................................12
Section 1.12 THE ROLE OF SCIENCE IN SOCIOLOGY AND FOUNDING FATHERS
13
Section 1.13 SOME FOUNDING FATHERS......................................................................13
Section 1.14 SUMMARY:....................................................................................................15
Section 1.15 ACTIVITY.......................................................................................................16
Section 1.16 VIDEO LINK...................................................................................................16
Section 1.17 REFERENCE...................................................................................................16
LESSON II. THE EMERGENCE OF SOCIOLOGY OF HEALTH AND ILLNESS................17
Section 2.01 INTRODUCTION:...........................................................................................17
Section 2.02 OBJCTIVES OF THE LESSON......................................................................17
Section 2.03 SOCIOLOGY OF HEALTH AND ILLNESS.................................................17
Section 2.04 THE CONCEPTS IN THE STUDY OF HEALTH AND ILLNESS..............18
Section 2.05 DISEASE:........................................................................................................18
Section 2.06 ILLNESS..........................................................................................................20
Section 2.07 WHAT IS MEDICALISATION?....................................................................21
Section 2.08 TRADITIONAL HEALING AND TRADITIONAL HEALERS...................21
2
Blastar ,M (1983) Health And Lifestyle ;Pg 68, Tavistock/Rutledge London..............................22
Section 2.09 EPIDEMIOLOGY............................................................................................22
Section 2.10 WELLNESS.....................................................................................................23
Section 2.11 Social Factors Of Health And Illness...............................................................23
Section 2.13 SUMMARY.....................................................................................................24
Section 2.14 Video Links......................................................................................................24
Section 2.15 Further Readings..............................................................................................25
LESSON III. THEORIES AND MODELS OF HEALTH AND ILLNESS.............................26
Section 3.01 Introduction:.....................................................................................................26
Section 3.02 Lesson Objectives:...........................................................................................26
Section 3.03 SOCIOLOGICAL PERSPECTIVES ON HEALTH AND ILLNESS.............27
Section 3.04 MODELS OF HEALTH AND ILLNESS........................................................29
Section 3.06 WHY TAKE CULTURE INTO ACCOUNT IN HEALTH?..........................34
Section 3.08 SUMMARY:....................................................................................................35
Section 3.10 Further Readings..............................................................................................37
LESSON IV. HEALTH DETERMINANTS & HEALTH INEQUALITIES............................38
Section 4.02 Learning Objectives.........................................................................................38
Section 4.03 Definition: Determinants Of Health.................................................................39
Section 4.04 What Is Health Equity?....................................................................................39
Section 4.05 Dimensions Of Inequity In Health?..................................................................39
Section 4.06 Determinants Of Health....................................................................................40
Section 4.07 Barriers To Health............................................................................................42
Section 4.08 How Can These Be Reduced?..........................................................................43
Section 4.09 Gender..............................................................................................................45
Section 4.10 Why Gender?....................................................................................................45
Section 4.11 Inequalities In Quality Of Care........................................................................45
3
Section 4.13 SUMMARY:....................................................................................................46
Section 4.14 Video Link........................................................................................................46
Section 4.15 Further Reading:...............................................................................................47
LESSON V. ETHNO MEDICINE & ALTERNATIVE MEDICINE......................................48
Section 5.01 INTRODUCTION:...........................................................................................48
Section 5.02 LEARNING OBJECTIVES.............................................................................48
Section 5.03 THE DEVELOPMENT OF ETHNOMEDICINE AND ALTERNATIVE
HEALING 49
Section 5.04 Traditional Medicine & Medicinal Plants........................................................49
Section 5.05 WHO Def. Of TM Comprises..........................................................................49
Section 5.06 Main Types Of CAM:......................................................................................50
Section 5.07 COMPLEMENTARY & ALTERNATIVE MEDICINE.................................50
Section 5.08 Major Highlights In TM...................................................................................51
Section 5.09 Development Of TM In Kenya........................................................................51
Section 5.10 Why TM Is Still Popular..................................................................................51
Section 5.11 Four Important Subsectors Of TM Include......................................................52
Section 5.14 SUMMARY.....................................................................................................53
Section 5.15 Reference..........................................................................................................53
LESSON VI. PATIENT-PHYSICIAN RELATONSHIP AND ETHICAL JUDGEMENTS
(Circumstances In Which They May Occur).................................................................................54
Section 6.02 LESSON OBJECTIVES..................................................................................54
Section 6.03 PATIENT-DOCTOR RELATIONSHIP..........................................................54
Section 6.04 ETHICAL JUDGMENTS AND PRINCIPLES...............................................55
Section 6.05 BASIC PROFESSIONAL ETHICS AND PRINCIPLES................................56
Section 6.06 ETHICAL PRINCIPLES.................................................................................56
Section 6.07 Reasons For Self-Determination: -...................................................................57
Section 6.08 RIGHTS’ OF PATIENTS VERSUS PROFESSIONAL OBLIGATIONS OF
PHYSICIANS 58
4
Section 6.09 TRUTH TELLING AS AN ISSUE..................................................................58
Section 6.10 The Medical Codes...........................................................................................58
Section 6.11 ARGUMENT USED TO JUSTIFY LYING AND DECEPTION...................59
Section 6.12 CONFIDENTIALITY AS AN ISSUE.............................................................64
Section 6.13 THE HEALTH AND ILLNESS CODES AND CONFIDENCIALITY..........65
Section 6.14 WHEN CONFIDENCIALITY BECOMES AN ISSUE..................................65
Section 6.15 ARGUMENTS USED TO JUSTIFY PRINSIPLES OF CONFIDENCIALITY
66
Section 6.16 GROUNDS OF BREAKING CONFIDENCIALITY......................................66
Section 6.17 RIGHTS VS DUTIES TO BREACH CONFIDENCIALITY.........................67
Section 6.18 PATIENTS EXPECTATIONS TOWARDS CONFIDENCIALITY..............67
Section 6.19 OBLIGATION TO TREAT AIDS PATIENTS...............................................67
Section 6.20 PHYSICIANS PERCEPTIONS REGARDING OBLIGATION TO TREAT.68
Section 6.21 LAWS PERTAINING TO THE OBLIGATION TO TREAT.........................68
Section 6.22 RATIONAL FOR NO OBLIGATION TO TREAT........................................69
Section 6.25 SUMMARY:....................................................................................................71
Section 6.26 Further Reading................................................................................................71
LESSON VII. GOVERNMENT POLICY IN HEALTH CARE SYSTEM................................73
Section 7.02 LESSON OBJECTIVES..................................................................................73
Section 7.03 What Is Health Policy?.....................................................................................74
Section 7.05 LESSON SUMMARY.....................................................................................75
Section 7.07 Further Reading................................................................................................76
Section 7.08 GLOSSARY.....................................................................................................77
Section 7.09 SELF TEST QUESTIONS...............................................................................78
5
COURSE DESCRIPTION
Course Requirements
This course is structures as follows: definition and explanation of medical sociology, concepts
in sociology of health and illness, health ,diseases illnesses, sickness
Grade Breakdown:
Your grade in this course will be centered on three aspects as stated below, collectively will
generate your grade:
• ASSIGNMENT: 15%
• SIT-IN CAT: 15%
• EXAM: 70%
• TOTAL: 100%
*You should take every exam seriously in order to get a good grade.
Cheating and Plagiarism:

Kenyatta University is dedicated to the highest standards of academic honesty as well as
integrity. Students are anticipated to be acquainted with these standards concerning academic
honesty in addition to upholding University policies in this respect.
6
LESSON I. SOCIOLOGY AND ITS MAJOR CONCERNS
Section I.01 Introduction
This is the beginning section of this lesson one. In the introduction you will be able to learn what
sociology is all about and also define major concepts used in sociology. It is expected that the
knowledge advanced here will help you understand issues raised in sociology of health and illness.
However, before giving a comprehensive explanation of the term sociology and some of its major
concepts you are reminded to revise previous various explanations and definitions given by many
scholars stretching from early 1870s. Today, the philosophy behind the study of society remains the
same but its area has expanded more due to social changes taking place in societies.
Section I.02 LESSON OBJECTIVES
At the end of lesson the learner will be able to:

a) Learn sociology as science of the study of the society
b) Explain major concepts applied in sociology
c) Discuss theories of sociology and their founding fathers
Section I.03 SOCIOLOGY AS THE SCIENCE OF THE STUDY OF SOCIETY

Sociology as a discipline is studies society and the social life and how people in group interact.
These interactions influence how people behavior in everyday life including their health
behaviour
Sociology as compared to other social sciences is a young discipline. One could say, it is about a
hundred-and-fifty years old but there has been a rapid development of the subject in the last fifty
to sixty years.
7
The discipline took a new dimension in early 1950s because of rapid increase of populations and
the new lifestyles though much of the work was done by classical sociologists in early 1800’s.
Sociology as discipline emerged during the era of great discoveries that culminated in the
industrial revolutions and the development of science and technology.
These events created societies with social economic and challenges that became the interests of
scholars beyond mainstream sociologists.
Sociology seeks to study the society and to analyze it in terms of the social relations that have
particular patterns.
It is important to look into the following three questions to understand the concern of
sociologists:
 What factors influence the emergency of society?
In your fundamentals of sociology you learnt that the functions of one individual cannot
help him/her attain the goals or his /her basic needs. He/she needs other people hence,
group dynamics could be one of the factors. Individuals in groups make better and
informed decisions, their lives are organized and they produce more and collective
responsibilities in social economic activities are more sustainable.
 How and why societies continue to exist? Natural craving can be one reason why society
or groups of people continue to exist. All of us reproduce to replace the older generation
and those who are dying.
 What and in which ways make society change? Population increase implies that more
[people are born, more groups are formed and each individual in that group has his / her
own needs that must be addressed even if cannot be fully attained.
Groups such as gay lesbians and disables, single mothers, the youth have special needs
and society must embrace change to accommodate the needs and aspirations of such
groups
That historical transformation of society is ever lasting as long as human beings continue to
exists ( more on this can be found in the works of
In any society, there are five basic social institutions; family, political institutions, economic
institutions, religious institutions and educational institutions. They provide the identity, stability,
order an facilitate exchange of goods and services and communications
Sociology emerged as separate social science in 18th century Europe with its objective of
studying society. Augusto Comte, Spencer and Emile Durkheim were the first scholars to
establish the idea of society as a matter of concern with what was happening as results of new
developments influenced by industrial and French revolutions.
These classical sociologists examined societies and the social institutions that existed as part of
the whole.
.
8
Sociology is a relatively young discipline compared with the disciplines such as philosophy,
economics and political science, sometimes; people confuse it with social work. It is a science
like all other sciences since it applies theories and research in the study of society and the society
and the social problems that occurs within groups
The sociological understanding and research can help in better planning and in finding ways and
means of acceptance of improved practices, in the formulation of development policies and
programs. It is generally accepted that sociologists do not interfere with social process.
This subsection has explained the importance of studying sociology.

Students have also gained an insight into the importance of understanding social construction of
reality by evaluating the actions within the social structures that are the backbone of any society
and communities
Section I.04 Activity
1. What do you think influenced the development of the modern Kenyan society (consider
modern Kenyan society as starting from 1963)
2. After observing our society/ communities how has sociological knowledge helped you
understand what is going on in the society or communities?
Section I.05 SOME MAJOR CONCEPTS IN SOCIOLOGY

In this subsection you will be introduced to some of the concepts applied when studying
society.
Section I.06 SOCIETY
Society is a group people who live in one geographical area sharing some similarities in their
cultures, attitudes and other characteristics. Kenya, Tanzania, Namibia and Japan are examples
of society with diverse social structures and organizations.
Social Group
We all live in groups and our lives are shaped by the group that we grow and belong to from
childhood to adulthood.
Groups play an important part in our social life. As we join university or college our very
existence is to a large extent determined by various groups we belong to. We join dance, drama
and athletics groups to look for belonging and identity. In essence social groups play significant
part in our lives.
There are two major types of groups that exist in society.
9
Individual are born in a society. groups have their own functions and characteristics. In
sociology, the group is regarded as a distinct entity. It has already been stated that one of the
primary goals of sociology is to study human behaviour in groups.
Almost all groups have the following characteristics
1. identity
2. Sense of belonging and strong cohesion.
3. patterned ways of interaction (i.e., there is a regularity in the group members, based
totally on shared ideals, values and norms)
4. The interplay is sustained over a period of time.
5.
The memberships are formed with a purpose to satisfy group needs and group survival. It is
through the groups that the desires are met.
Section I.07 Types of Social Groups.
There are two major types of groups
1A primary group – close knit and intimate relations with an emotional involvement is
observed , for example in the families- is one wherein the participants have very close or t.
group members nurture ideas ideals and norms of individuals.
2. Secondary group
In this type of group members the elationship is mutual ,impersonal and for specific functions.
As a member of the student body in Kenyatta university you belong to a secondary group as you
engage with this large numbers of college students in a mutual and impersonal
manner.sometimkes the realtionship is casual such as among employees in an organization.
Section I.08 Socialization
We can define Socialization as the process through which a person, from birth through death, is
taught the norms, customs, values, and roles of the society in which they live. This process
serves to incorporate new members into a group so that they can behavein consistent
manner.individuals are socialized through various institutions the family, teachers , religious
leaders, peers, community, and media, among others.(Nickie Lisa Cole)
The process of Socialization occurs in two stages.

Primary socialization takes place within close families and relatives. We learn how to socialize
from an early age through our parents, siblings and those others who are close to us. It is a stage
where we are taught how to communicate, how to feed ourselves and observe rules and
regulations as pertained to the family.
Secondary socialization these stage of socialization takes place outside the close family
members. As we venture into our own world the influence of other adults institutes such as
10
schools churches and the neighborhood influence the way we communicate with others how we
ware and even the manner of greetings it is through this process that we learn to become both an
individual and a member of a community as well as creating our own identity. (Source any book
in sociology)
Social processes- according to sami kasha in the article ( 2016 YourArticleLibrary.com) the
concept of social process refers to some of the general and recurrent forms that social interaction
may take. The interaction or mutual activity is the essence of social life.
A good example of social process include people workng on a project . in this project group
members create social relationships, they cooperate ,compete for various positions, conflict
occurr due to different opinions. Horton and Hurt refers to social process as a repetitive form of
behaviour tha most of us engage in ( horton and Hurt
Section I.09 Social structure
In our fundamental sociology lectures students were introduced to the term social structures
otherwise referred to social system. No society or community can exist without forming a social
structure which include the family, economy, religion, politics and education this are the pillars
that support the community.
In his contribution Science, Tech, Math › Social Sciences in thought Co. He defines Social
structure as the organized set of social institutions and patterns of institutionalized relationships
that together compose society. Social structure is both a product of social interaction, and
directly determines it. Social structures are not immediately visible to the untrained observer;
however they are always present and affect all dimensions of human experience in society.
It is helpful to think about social structure as operating on three levels within a given society: the
macro, meso, and micro levels. (Ashley Crossman Updated March 02, 2017)
Social change- as population grows and developed many activity takes place that requires
adjustment e.g. In every society division of labour, different types of education system and
development of various religious organization are of the results of social change the need to
acquire knowledge influences the type of changes that people want all social institution go
through social changes that are necessary to accommodate individual and groups as they seek
better lifestyle.
Even wars and conflict contribute to social change. Health behaviors are also as results of
changes that happen when people seek health care services. According to C Settley in her book
Social change unit 1.1 the term refers to any significant alteration over time in behavior patterns
and cultural values and norms. By “significant” alteration, sociologists mean changes yielding
profound social consequences. Examples of significant social changes having long‐term effects
include the industrial revolution, the abolition of slavery, and the feminist movement.
Today's sociologists readily acknowledge the vital role that social movements play in inspiring
discontented members of a society to bring about social change. Efforts to understand the nature
11
of long‐term social change, including looking for patterns and causes, has led sociologists to
propose the evolutionary, functionalist, and conflict theories of change (discussed in the next few
sections).
All theories of social change also admit the likelihood of resistance to change, especially when
people with vested interests feel unsettled and threatened by potential changes.
Social conflict- according to Peter Ratcliffe Race Ethnicity and Change (UCL press
1994 )Social conflict is the struggle for agency or power in society. Social conflict or group
conflict occurs when two or more actors oppose each other in social interaction, reciprocally
exerting social power in an effort to attain scarce or incompatible goals and prevent the opponent
from attaining them. The topic of social conflict has well covered in Karl Marks work.
(Fundamentals of sociology Kamal Subedi- meaning nature and subject of sociology 2015)
Section I.10 Behaviour
From a sociological perspectives behaviour imply action that are visible such manner of
dressing, eating, greetings and any other social actions (Durkheim) Behaviour is relative and it
is a part of specific community culture. This also applies when individuals seek health care
services. (Alberto & Troutman, 2003).
In this subsection students have introduced basics of sociology and some of its major concepts
in order to gain deep knowledge and the role of sociology in the study of health and illness.
The knowledge of sociology and the role it play in examining social cause of disease, the history
of disease and the development of different type of healing methods has been the concern of
sociologist studying health issues. However, in this course we will not be able to cover all issues
taught in the fundamentals of sociology.
Section I.11 Activity

1. Identify the number of primary and secondary groups and bases of their relationships
2. What would you say are the characteristic of two types of groups present in a university
like Kenyatta
12
Section I.12 THE ROLE OF SCIENCE IN SOCIOLOGY AND FOUNDING FATHERS
Sociology and Science
In earlier attempts by scholars to study society, there was a challenge to find the right word for
the term Sociology. The word science was first coined by Comte who referred to it as science of
society. But this raised the question as to what science was.
Some thought of science as an approach whereas others thought of it in terms of the subject
matter. It was later agreed that since science was used to study society and consisted of scientific
approach with certain assumption and that the phenomena studied have a regularity and hence, a
pattern, observation and verification of social phenomena.
This type of Science at that time was renamed sociology a systematic approach to the study
of social phenomena.
 The systematic approach consists of:
 Defining the problem of the, study;
 Collecting data on the problem defined;
 Analyzing and organizing the data; which would help in formulation of hypothesis; and
 Further testing of the hypothesis and on the basis of this, develop new concepts and
theories.
If we look at sociology from that point of view of (its approach to the study of society), then
sociology can be considered to be a science.
Section I.13 SOME FOUNDING FATHERS

In this subsection you will be introduced to the founding father of sociology. All of them wrote
on the nature of society and group behaviour human behavior. In a way, they tried to understand
profound changes taking place in society in early years of modernization.
Auguste Comte (1798 - 1857)

Comte was of the founding fathers was sociology. He is regarded as the founder of modern
sociology. Comte is the first one to have used the word 'Sociology'.
He tried to create a new science of society which did not only explain the past of mankind but
also, predict its future course? He also felt that society moves through definite and fixed stages
and that, it progresses towards ever-increasing perfection.
According to Comte, for a society to develop it has to moves through three stages
 The theological or the religious
 The metaphysical or the philosophical
 The positive or the scientific stage.
In the first stage, People think all phenomena were caused by supernatural forces.
13
In the second stage abstract forces of either a religious or secular type are considered to be the
source of knowledge.
In the last stage, scientific laws are supposed to determine both the natural and the social worlds.
Comte talked about two broad areas -'social statistics', which deals with the orderly and, stable
aspects of social life and patterns of behavior (family, occupational, polity. etc.).
The second area called 'social dynamics' emphasizes the study of changes in a social system.
According to him, sociology was to be the queen of all sciences.
Emile Durkheim (1858-1917)
Durkheim was also interested in sociology and considered it a scientific discipline. He wrote a
book in 1895 entitled: Rules of Sociological Method. To him, social solidarity was one of the
main principles of human life.
He distinguished between two kinds of solidarity: 'mechanical solidarity' based on common

assumptions, beliefs, sentiments like those found in traditional societies and 'organic solidarity'
based on the division of labor and inter-related interests as found in industrial societies.
When solidarity is broken, there would be social disorganization and confusion in society.
Durkheim coined the phrase social facts, which, according to him, are external to the individual
but they exert pressure on the individual in the behavior pattern. For him society is a reality in
itself, that is, it is more than its parts.( groups of people are more stronger than an individual in
pursuit of any idea or goal)
Max Weber (1864-1920)
Weber explained that social action and social relations don’t mean the same. To him Social
action mean understanding the meanings human beings attach to their behavioral pattern.
The social behavior was not merely a mechanical learning of norms but how people interpreted
the social values. Weber was concerned with understanding of inter-relations between parts of
society and also, with comparative studies of different societies. He studied religion in different
societies.
His work on Protestant Ethics and the Spirit of Capitalism is one of the well known in sociology.
Through both these approaches, he tried to develop propositions having general validity. For
example, he classified authority into three types - charismatic, traditional and rational. These
concepts are still used in the study of leadership authority and power.
Karl Marx (1818-1883)
Marx has helped through his ideas in understanding the nature of society, particularly, how
conflicts occur. . Marx writes in 1848 that all history is a history of classes and class struggles.
14
The society gets divided between the oppressors and the oppressed-masters and slaves, lords and
serfs and in the modern times, capitalists and workers.
To analyze the structure of society, it was necessary to understand the forces of production and
relations of production.
The contradiction between the forces and the relations of production leads to class struggle.
According to him, each society dies in time because of internal conflicts and contradictions and
is replaced by a higher one.
In time, capitalism would be destroyed and there would emerge a classless society characterized
by absence of conflict, exploitation and alienation from this world.
Herbert Spencer (1820-1903)
Spencer also emphasized a total view of society. According to him, the study of sociology covers
the fields of family, politics, religion and social control, division of labor and social stratification.
He emphasized the study of whole more than the study of parts.
The individual institutions have significant relations. It is through a study of these inter-relations
that one can hope to understand society.
He indicated that the inter dependence of the various parts was functional, i.e., each of the part
performs different functions, which is necessary for the total well being of society.
A large number of sociologists, who are "functionalists", use Spencer's idea of the functional
inter dependence as a basis for their approach to the study of society.
Section I.14 SUMMARY:
This lesson was meant to give you a brief highlight of sociology as a discipline that forms the basis of
sociology of health and illness. In the whole lesson definitions and explanation of the subject matter were
given as well as theories to explain the causes and effects of events in society. It is expected that the
knowledge gain in this lesson will help you to have an understanding concepts and content used in the
lessons that follows in the health and illness.
15
Section I.15 ACTIVITY
1. What would you say is the difference between social sciences and other sciences? What are
their roles in society?
2. What major historical event shaped the discipline of sociology in recent years?
Section I.16 VIDEO LINK
https://www.youtube.com/watch?v=32KG_ba_NJc
https://www.youtube.com/watch?v=xJsmocete5Y
https://www.youtube.com/watch?v=D4lB4SowAQA
Section I.17 REFERENCE
For further readings see the information below

1. Talcott Parsons, The System of Modern Societies. Englewood Cliffs, NJ: Prentice-Hall,
1971, pp. 4-8.
https://www.marxists.org/reference/archive/spirkin/works/dialectical.../ch05-s04.htm
2. Durkheim, E. (2014). The rules of sociological method: and selected texts on sociology
and its method. Simon and Schuster.
3. Bankston III, C. L., Barnshaw, J., Bevc, C., Capowich, G. E., Clarke, L., Das, S. K., ... &
Esmail, A. (2010). The sociology of Katrina: Perspectives on a modern catastrophe.
Rowman & Littlefield Publishers.
4. Henslin, J. M., Possamai, A. M., Possamai-Inesedy, A. L., Marjoribanks, T., & Elder, K.
(2015). Sociology: A down to earth approach. Pearson Higher Education AU.
5. (Max Weber, Karl Marks Durkheim and Spencer-Introduction to Classical Sociology
Sociological Theory By Ritzer 4th Edition Sage Publishers 2000 Publishing N.Y
16
LESSON II. THE EMERGENCE OF SOCIOLOGY OF HEALTH AND
ILLNESS
Section II.01 INTRODUCTION:

In our first lecture we introduced you to the basic fundamentals of sociology and various concepts
used in the study of society.
We also explained to you the role of science and the founding fathers of sociology as a discipline.
That introduction was meant to help you understand the role of sociology in the study of health and
illness.
Welcome to this lesson two where you will learn about issues related to health and illness in society.
In this lesson you will also come across different concepts that are applied when evaluating health
status either as individual groups or communities.
Section II.02 OBJCTIVES OF THE LESSON
By the end of this lecture students should be able to:

1. Explain the meaning of sociology of health and illness
2. Describe the scope of sociology of health and illness.
3. Describe the emergency of sociology of health and illness

4. Explain social factors as one of the causes of health and illness problems.
Section II.03 SOCIOLOGY OF HEALTH AND ILLNESS
The study of Health and illness covers a wide range of health issues that affect individual and
groups in society. These includes among others the historical development of health and illness,
the concepts, theories, factors that determining health, doctor patient relationship, types of
healing, and ethical issues including policies and organization of health system.
17
Section II.04 THE CONCEPTS IN THE STUDY OF HEALTH AND ILLNESS
There is no single accepted definition what constitute the meaning of the term health. As
individuals and groups our understanding of health differs. Our view of health is likely to change
as we grow older and also differ if we take our gender into account. Women and men perceive
health from their gender experiences. (Crawford 1984)
WHO as one of the organizations responsible for overseeing health matters globally since 1940s
gave a holistic view of health? In that view health is defined as a state of complete physical,
mental and social well-being and not merely the absence of disease or infirmity”.
( WHO 1946).
However, in recent years there have been some improvement in the definition by the same
organization , for example in 1986, WHO defined health as an extent to which an individual or
group is able to realize aspirations ,to satisfy needs , and to change or cope with environment.
From that revised definition health is seen as resource for everyday life, not the object of living.
Health is a positive concept emphasizing social and personal resources as well as physical
capacities. (WHO 1986)
In his recent study Blaxter that positive health is associated with the ability to cope with stressful
situations and having strong support system.
People related their health to their relationships, their socio-economic status and their moods.
(Blaxter 1990) Here support system may imply the family or the employer. (My additional view)
Accordingly health has many different meanings that are linked to the social cultural contexts.
That means health is relative given that we belong to different societies and social cultural
groups. ( Blaxter 1990).
The multifaceted view of health encompasses the following dimensions: -Physical,Mental,Social

and cultural aspects
This indicates that health extends beyond the structure and function of the body and includes
feelings, values and the ability to reason and the nature of interpersonal relationships
Section II.05 DISEASE:
Various scholars in sociology of health and illness explains that peoples definitions concerning
health illness and diseases are socially determined.( Donald .L Patrick and others -sociology as
applied to health 1981)
From the above, there are two perceptions about disease.

From a medical perception disease is pathological abnormality diagnosed by means of signs and
symptoms. It is founded on immutable fact.
18
From a social conception, disease is socially and culturally conceived by specific groups or
community making it difficult to have a universal agreed definition. Thus perceptions of disease
are socially influenced over time and reflect the changing values of different groups in society.
( Menniger ,K –Changing concepts of disease.)
Diseases can be grouped as: -

 Communicable – [infectious]
 Non-communicable – [non-infectious]
 Emerging infectious diseases

This grouping is often based on the main causes. Majority of diseases in Africa are
communicable and they remain the most serious health problem and affect the economic
development of the country.
Communicable Diseases – [infectious

An illness due to a specific infectious agent or its toxic products that arises through transmission
of that agent or its products from an infected subject, animal or inanimate reservoir to a
susceptible host, either directly or indirectly via an intermediate plant or animal host, vector or
the inanimate environment.
They can also be defined as those that spread from person to person or from animals to people.
Communicable diseases have got some common characteristics: -

They are common
They are diverse and include vector-borne diseases [malaria, relapsing fever, yellow fever,
plague, schistosomiasis etc], emergence of antimicrobial-resistant bacteria, sexually transmitted
diseases (STIs), and vaccine preventable diseases.
The most common diseases in Africa are due to infection by organisms – bacteria, viruses,
protozoa, metazoa and fungi.
Some cause widespread outbreaks of disease, that is, epidemics.

These diseases occur in all ages but generally pose a greater threat in childhood. Many are
particularly serious (and more common) in infants and children due to extensive exposure,
immature immune system and malnutrition.
They are major cause of morbidity and mortality. Some cause severe disease, disability and
death.
Communicable diseases are to a great extent preventable in fairly simple measures (through
prevention and care)
Non-communicable Diseases – [non-infectious.

An illness arising from physical injury, trauma, immunodeficiency, genetic disorder, nutritional
deficiency, lifestyle, cancers, neurodegenerative disorders etc.
19
Emerging infectious diseases.
These are defined as infections that have increased in incidence during the last couple of decades
or whose incidence is predicted to increase in the near future.
Examples include viral, zoonotic and bacterial diseases such as Ebola, haemorrhagic fever, Lassa
fever, and those caused by new multi-drug resistant strains of endemic microbes.
The reasons behind these emerging infections are not well known, but likely factors include
increased population density, migration, ecological changes and deteriorating health
infrastructure.
Note:
Humans move towards classical health as they move away from disease and vice versa
Health of individual/population cannot be uniform because humans are an outbred population.
Section II.06 ILLNESS

When illness occurs, patterns of everyday are temporarily modified and interactions with others
become modified. This is because the ‘normal’ functioning of the body is a vital but often
unnoticed part of our lives.
Illness behaviour refers to ‘the way in which symptoms are perceived, evaluated, and acted upon
by a person who recognises some pain, discomfort or other signs of organic malfunction
(Mechanic and Volkart, 1961).
Illness behaviour is influenced by social and cultural factors in addition to (and sometimes
instead of) physiological condition. i.e. many people fail to see a physician or go very late in the
disease process despite the presence of serious symptoms, while many others see physicians
routinely for trivial or very minor complaints.
Illness has got both personal and public dimensions.

When we fall ill, we experience pain, discomfort, confusion and other challenges; and others are
affected as well.
People on close contact with us may extend sympathy, care and support.
They may struggle to make sense of the fact of our illness or to find ways to incorporate it into
the patterns of their own lives.
Others with whom we come to contact with may also react to illness; these reactions in turn help
to shape our own interpretations and can pose challenges to our sense of self.
Stages of illness experience
Edward Suchman (1965) devised an orderly approach for studying illness behaviour and
elaborated 5 key stages of illness experience as follows: -
20
 symptom experience
 assumption of the sick role
 medical care contact-
 dependent-patient role
 recovery and rehabilitation
Each stage involves major decisions that must be made by the individual that determine whether
the sequence of stages continues or the process is discontinued.
Section II.07 WHAT IS MEDICALIZATION?
Medicalization is the process that defines a condition or activity as a disease or an illness;

treatment of the conditions is then considered the responsibility of the medical professional.
The process by which health or behavior condition come to be defined and treated as medical
issues ie process of defining an increasing number of life’s problem as medical problems; rites of
passage in traditional community such as circumcision, traditional birth attendant and any other
traditional belief that can be considered from modern medical approach.
In essence medicalization describe the changes in social life and in social relation that create
readiness on the part of sub culture and the individual that belongs to them to accept modern
(medical) legitimations for health and illness where ones they were accepted tradition
legitimations
(Cornwell J 1994) Hard-Earned Lives : Account Of Health And Illness East London Tavistock
publication read page 119
Michael Sheaf (2005) Sociology and Health Care An Introduction For Nurses, Midwives And
Allied Health Professionals Open University Press Chapter 3.
Section II.08 TRADITIONAL HEALING AND TRADITIONAL HEALERS
As you may be aware healthcare services are sought from health practitioners. Today particular
in developing countries there are many people who still believe in traditional; methods of
treatment practiced by traditional healers. Most of this traditional healers belief in their culture
and they use different types of medicine collected from different roots or plants
Traditional healing is a process that involves health practices, approaches, knowledge and
beliefs while using ceremonies; plant, animal or mineral-based medicines; energetic therapies; or
physical/hands on techniques.
This method has a long history and one can say it is as old as humanities and was widely
practiced before the development of modern medicine and its practice. For further reading refer
to https://www.youtube.com/watch?v=KVvhU-DDVe8-
 Hakim G. M. Chishti (1998) The Traditional Healer'sHealing Arts Press | 416 pages
| ISBN 9780892814381 | May 1988] See also: Revised Edition of The Traditional
Healer Trade Paperback
21
Blastar ,M (1983) health and lifestyle ;pg 68, Tavistock/Rutledge London
Every tribe had some form of traditional healing for their peoples.
Traditional Healers are either born with their gifts or have spent much time developing their gifts
from a knowledgeable teacher. Traditional healing is very much like traditional ceremonies but
with fewer people. Many times it is done with just the healer and the patient.
Most traditional healers have some form of these general beliefs such as honoring, treating
disease and illness as a punishment and a believe that all diseases are intimately related to
our body, mind, emotion and spirit. It is also important for you to note that most of traditional
healers do their work with prayers.
The prayer can be spoken out loud, done privately in your thoughts, and many times the prayer is
through song and dance. They use different types of tools that they believe they present the value
of their gods (feathers, drums, leaves , specific types of soil).
Section II.09 EPIDEMIOLOGY
Epidemiology is the study of how often diseases occur in different groups of people and why.
Epidemiological information is used to plan and evaluate strategies to prevent illness and as a
guide to the management of patients in whom disease has already developed.
Like the clinical findings and pathology, the epidemiology of a disease is an integral part of its
basic description. The subject has its special techniques of data collection and interpretation, and
its necessary jargon for technical terms. This short book aims to provide an ABC of the
epidemiological approach, its terminology, and its methods. Our only assumption will be that
readers already believe that epidemiological questions are worth answering. This introduction
will indicate some of the distinctive characteristics of the epidemiological approach.
Sociological imagination on health and illness
This is a term commonly used in sociology and sociology of health and illness it tries to explain
the individual have issues they considered personal and others public. The matter of health is
perceive to be personal and also special according to C Writing Mills every individual consider
his personality and that of that of health practitioner as two separate scenarios where the
relationship is socially structured in addition this term helps us understand the history and
biography and the relation between the two within society. Meaning we much view our health
status as personal troubles as well as it been a public issue.
C.w mills 2000) The Sociological Imagination: fortieth anniversary edition, oxford university
press
Section II.10 WELLNESS
22
This is a process of periodically assessing risk factors and providing information, behaviour
change strategies and individual or group counselling that ultimately leads to the adoptions of a
wellness lifestyle.
Wellness is not driven by concerns about illness or longevity. It is a lifestyle helps people reach
their fullest potential as they interact within the family, lecture room or workplace in which
individuals take full responsibility for their health behaviour.
Wellness describes a highly developed level of health that encourages people to achieve their
human potential and it is promoted through ones initiatives to consult doctors ann health care
profession; creating personal nutrition awareness and proper exercise
Section II.11 Social factors of health and illness
1. A shift from acute, infectious diseases to chronic, denegerative (bone diseases) as major
source of morbidity and mortality
2. Increased focus on behaviouron behaviour factors related to health and illness.
3. Increased recognition of importance of the patient –doctor relationship
Increasingly complex structure of the health system

As we learnt from previous notes sociological perspectives were used to explain and add value in
establishing relationships between social factors and health, illness and healing.
When one gets sick or ill the first words during encounter with the doctor are more soxcail than
scientific or medical. In addition we all know that sickness in the family, groups and
communities is associated with social surroundings
To emphasize this point you need to look into the areas like slums, poor eatery places and
dumpsites, poor and open drainage systems to know that most diseases are influenced by these
environments.
Besides, cultural beliefs as communities resisted change and shun away from medical treatment
became the concern of sociologists. They wanted to know why people resist change and how
much that has an effect on their well being. (See medicalization)
We can say that sociological perspectives and models help us to understand why and what
impacts human behaviours have on health
Traditional systems such as rites of passage are celebrated through community cultures and both
sexes behave differently in social settings.
Circumcisions, dowry and burials are cultural specifics and different behaviours are observed
that create healthy risks.
Sociological theories: functionalism, conflicts interactionism help explain how social-structural
and, institutional forces on health and illness can be dealt with.
Epidemiology’
23
Health behaviour
Section II.12 Activity

How are health, illness, and disease distributed across both domestic and global populations? What
social factors account for health disparities across socially defined groups?
Section II.13 SUMMARY
Every discipline is built on strong understanding on the basis on which it is developed for example
sociology as a science of society is built on understanding terminology or concept that are applied in
everyday social life. In this lesson we have given concepts or terminologies that are core in the discipline
and explaining how this major terms and concepts are applied. You will find these concepts very useful; in
the study of health and illness because they sustain these subjects. For example concepts such as culture,
behaviour and groups are used in sociology and its sub-discipline with same meanings but defined within
the environment that they are applied
Section II.14 Video links
https://www.youtube.com/watch?v=jcMCDzo7khY
http://www.untvweb.com/program/polwatch/
https://www.youtube.com/watch?v=XnJJQAeqy8Y
Section II.15 Further Readings
Shonkoff, J. P., Boyce, W. T., & McEwen, B. S. (2009). Neuroscience, molecular biology, and the
24
childhood roots of health disparities: building a new framework for health promotion and disease
prevention. Jama, 301(21), 2252-2259.
Nugus, P., & Braithwaite, J. (2010). The dynamic interaction of quality and efficiency in the emergency
department: Squaring the circle?. Social Science & Medicine, 70(4), 511-517.
Oldfield, S. R., & Dreher, H. M. (2010). The concept of health literacy within the older adult population.
Holistic nursing practice, 24(4), 204-212.
LESSON III. THEORIES AND MODELS OF HEALTH AND ILLNESS
25
Section III.01 Introduction:
This lesson introduces you to the main theories and models in health and illness, or what we also
refer to as Approaches and Explanatory Models in health and Disease.
We begin by defining health which may appear to be quite simple, but there is no consensus about
what constitutes a healthy person. While health and disease are universal concepts, they are also
largely cultural constructs that is, the key to health and disease is cultural perception and experience
of these. There exists three main approaches for defining health, biomedical approach, the
psychological approach, and the sociological (or socio-cultural) approach.
In this lesson you will be introduced to three approaches their assumptions and critics of each
approach
Section III.02 Lesson Objectives:
By the end of this lesson student will be able to:

1. Learn models and theories applied in the study of health and illness
2. Describe the cause and effect of health and illness as explained by individual theorist in the
field of health and illness
3. Analyze the assumptions of each model and theory
Section III.03 SOCIOLOGICAL PERSPECTIVES ON HEALTH AND ILLNESS
The sociology of health and illness is concerned with the social origins of and influences on
disease, rather than with exploring its organic manifestation in individual bodies.
26
The sociology of medicine is concerned with exploring the social, historical and cultural reasons
for the rise to dominance of medicine – especially the biomedical model – in the definition and
treatment of illness.
These fields are closely related, since the way in which professional (or orthodox) medicine
defines and manages illness reflects wider social dynamics that shape the perception and
experience of disease.
------
It is important to note that culture contributes to differences in medical care as well as in how
health is defined. Researchers have shown that diseases are rooted in the shared meanings of
particular cultures.
Thus if social factors contribute to the evaluation of a person as ‘healthy’ or ‘sick’ how can we
define health?
One possibility is to you the WHO definition? – state of complete physical, mental, and social
well-being, and not merely the absence of disease and infirmity.
However, we also know that people define themselves as ‘health’ or ‘sick’ on the basis of criteria
established by each individual, relatives, friends, co-workers, and medical practitioners
The Sociological Perspective
Sociology is one of many perspectives that are used to acquire knowledge about the world.
History, biology, chemistry, anthropology, psychology, economics, political science, philosophy
and religion, clinical medicine, and other disciplines all contribute to our understanding of the
medical field.
Sociology’s primary focus is to understand social interaction, groups and organizations, and
how social context and the social environment influence attitudes, behaviors, and social
organization.
The sociological perspective requires an ability to think about things in a manner other than that
to which many individuals are accustomed. Often, we think very individualistically about human
behavior.
If a particular teenager begins smoking cigarettes, or a particular man is very reluctant to see a
physician when ill, or a particular medical resident feels abused by superiors, we may attempt to
understand the behavior by focusing on the particular individual or the particular situation.
However, sociology attempts to understand these behaviors by placing them in social context—
that is, by looking for social patterns and examining the influence of social forces or
circumstances that have an impact on individual behavior.
27
C. Wright Mills, an enormously influential sociologist, referred to this ability to see how larger
social patterns (public issues) influence individual behavior (personal troubles) as sociological
imagination (Mills, 1959).
Consider the following:
1. Almost all adult smokers began smoking as a teenager; few adults begin smoking.
2. Men are more reluctant than women to see a physician.
3. Pharmaceutical drugs are more expensive in the United States than in any other country.
How do we understand these very important social patterns that have a significant influence on
health and illness in the United States? Sociologists attempt to understand these patterns by
placing them in social context.
It is not just one adult smoker who started as a teen; that is the common pattern. So, we try to
find the social forces and the social arrangements that make it common for teens but not for
adults to initiate smoking.
It is not just one man who is more reluctant than one woman to see a physician. If so, there might
be an individual explanation.
But, rather, men in general have more reluctance than women in general, so we are talking about
some social force that influences men and women differently. What is it about living in the
United States that creates this greater physician a version for men?
Finally, it is not just one drug that is more expensive in the United States than in other countries.
If so, there might be something in particular about that drug. But, almost all drugs are more
expensive—many are much, much more expensive—so there must be some larger explanation.
This is what Mills meant when he said that sociologists try to identify and explain the “public
issues” (the larger social forces) that lead to “personal troubles.”
The Construction of Social Theories
Sociology is an effort to identify and describe social patterns and then to find cause-and effect
relationships that explain the patterns.
In Invitation to Sociology (1963), Peter Berger describes sociology as searching for the general
in the particular—attempting to determine how particular facts or individual behaviors may
generate as well as reflect social patterns.
Whether the focus is delinquency, family interaction, or medicine, sociologists attempt to

identify patterns in attitudes and behaviors.
28
Functionalism (or structural functionalism) views society as a system (a structure) with
interdependent parts (e.g., the family, the economy, and medicine) that work together to produce
relative stability.
Each of these parts is assumed to have positive consequences (or functions) and may have
negative consequences (or dysfunctions) for the society as a whole. When each part operates
properly, a stable and relatively harmonious society exists.
The views of functionalist are that societies such as Kenya, India, and united state define what
contribute to the meaning of science and the role of science in the study of health and illness.
Conflict theory views society as a system largely dominated by social inequality and social
conflict. This perception is explained as follows. In every situation members of society or
communities express different views some of which are incompatible. This incompatibility as
well as competition on any issue or lack of agreement produces conflict. In addition when
sections of the community are disadvantage particularly in resource allocation such as fewer
health centers, lack of doctors and paramedics there is a likely hood of people in those section
developing resistant which is perceived as a conflict for further explaination read the link below
https://www.boundless.com Sociological Perspectives on Health and Illness
Societies are viewed as being in a constant state of change, characterized by disagreements over
goals and values, competition among groups with unequal amounts of power, and hostility.
Conflict theorists perceive whatever societal order exists to be dictated by the most powerful
groups, rather than being based on the value consensus envisioned by functionalists.
Given this image of society, conflict theorists are skillful at utilizing a critical perspective about
it and at identifying social inequities.
In this regard, sociologists studying health and illness have a critical and perceived problems
when it comes to the problems and inequities in the health care system.
Section III.04 MODELS OF HEALTH AND ILLNESS
The biomedical approach
The biomedical model is the cornerstone of modern medicine. This model has dominated
medical practice because it has been seen to work.
It is based on a technically powerful science that has made a massive contribution to key areas of
health (for example, vaccination).
It is a model of disease and illness that regards them as the consequence of certain malfunctions
of the human body.
29
In this model, illness or disease is explained in impersonal and systematic terms (application of
the germ theory).
That is, if you are not sick, you are well. It has also established a large and profitable market for
major pharmaceutical companies such as Glaxo-Wellcome, Zeneca and Merck.
The biomedical model also underlies the official definition of health and disease adopted by
states and international authorities.
National governments and international agencies such as the World Health Organisation (WHO)
proclaim their long-term health goal to be the eradication of disease.
Sometimes they have been successful, as in the global elimination of smallpox.
The biomedical model is thus a universal perspective – sometimes referred to as the ETIC
perspective approach to health and disease (‘outsider perspective’).
According to Wolinsky (1988) and others, the biomedical model of disease makes four primary
assumptions or is based on the following assumptions:
Health and illness is defined solely in terms of physiological malfunction. Disease is seen as a
breakdown within the human body that diverts it from its normal state of being.
The biomedical model is a reductionist view based on the germ theory of disease developed in
the late 1800s. According to this view, disease is caused by a specific biological [and identical]
agent.
That is, that there is a specific identical agent behind every disease. Therefore, disease is a
temporary organic state that can be eradicated – cured – by medical intervention. In order to
restore the body to health, the cause of the disease must be isolated and treated (reductionist).
Disease is experienced by a sick individual, who then becomes the object of treatment. The
patient is a passive being whose ‘sick body’ can be treated separately from his or her mind. In
this view, Disease is an organic condition.
Thus, non-organic factors associated with the human mind are considered unimportant or are
ignored altogether in the search for biological causes of pathological symptoms.
We can say that the presence of disease, its diagnosis, and its treatment are all completely
objective phenomena – and symptoms and signs provide accurate and unbiased information from
which valid diagnosis can unfailingly be made.
Thus, according to this assumption, the mind and body can be treated separately. The model
holds that the sick body can be manipulated, investigated and treated in isolation, without
considering other factors.
30
The patient presents a sick body pathology rather than a whole individual. Emphasis is on curing
disease rather than the individual‘s well-being.
Medical specialists adopt a more sophisticated inspection of the body, which is a detached
approach in viewing and treating the sick patient.
According to Foucault (1977a) disease is a concept that denote the power of modern medicine to
define the human body].
This (ability to adopt a medical gaze) has brought considerable power and prestige to the medical
profession.
Again, in this view, the treatment is to be carried out in a neutral, value-free manner, with
information collected and compiled, in clinical terms, in a patient‘s official file.
From the onset of modern medicine it was only medical professionals who were capable of
defining health and illness. With involvement of social sciences this approach has now taken a
different dimension
Disease is treated after the symptoms appear – the application of medicine is a reactive healing
process. This view holds that medical specialists possess‚ ‘expert knowledge’ and offer the only
valid treatment of disease.
Here, trained medical specialists are considered the only experts in the treatment of disease. The
medical profession as a body adheres to a recognised code of ethics and is made up of accredited
individuals who have successfully completed long-term training.
There is no room for self-taught healers or ‘non-scientific’ medical practices. Disease is treated
in a medical environment – a surgery or a hospital – away from the site where the symptoms first
appeared.
The appropriate arena for treatment is the hospital, where medical technology is concentrated
and best employed. That is, the hospital represents the appropriate environment in which to treat
serious illnesses. These treatments often rely on some combination of technology, medication or
surgery.
Critics of Biomedical Model
The first assumption is considered to be faulty. Disease is socially constructed, not something
that can be revealed through ‚scientific truth‘.
For instance, studies have found that an individuals’ cultural background affects not only
reaction to symptoms but also how these symptoms are reported to physicians and that the
presentation of symptoms can influence diagnosis (Zola, 1966; Mechanic 1980).
31
The patient‘s opinion and experience of illness is crucial to the treatment. Critics argue that
people are not merely biological beings. Rather, the patient is an active, ‘whole’ being whose
overall well-being – not just physical health – is important.
Medical experts are not the only source of knowledge about health and illness. Alternative forms
of knowledge are equally valid. In reality, both the patient and her or his significant others are
involved in the process.
While one must not discount the power that society has granted to physicians for defining health
and illness, a great deal of diagnosis and treatment occur outside the physician’s office.
Healing does not need to take place in a hospital. Treatments utilizing technology, medication
and surgery are not necessarily superior e.g. bath birth
(ii) The sociological (or socio-cultural) approach
Sociologists have developed an alternative definition of health that emphasizes the social and
cultural aspects of health and illness.
This approach focuses on the individual’s capacity to perform roles and tasks and acknowledges
that there are social differences in defining health.
Capacity to Perform Roles and Tasks:
Objecting to the bio-medical model definition, Talcott Parsons (1972) suggested that health is
viewed as the ability to comply with social norms.
He defined health as ‘the state of optimum capacity of an individual for the effective
performance of the roles and tasks for which he has been socialized”.
NB: This definition is completely the opposite of the bio-medical approach. –

No assumption that the disease can be objectified* focus is on broader (more socially relevant)
than mere physiological malfunctioning the individuals own definition of his/her own health is
given centrality (rather than the physicians definition)
Definition is stated in positive terms. According to this def. health is not just the lack of
something – it is a positive capacity to fulfil one’s roles; it is not just a physiological condition –
it includes all the dimensions of individuals that impact on social participation.
Social Differences in Defining Health:
32
Twaddle (1974) sees health as being defined more by social than physical criteria. He views
health and illness as being on a continuum between the perfect state of health and the perfect
state of illness (death).
While ‘normal’ Health and Illness fall somewhere between the two extremes, what may be
considered a healthy state for one may be considered unhealthy by another.
Thus perception of health is relative to one’s culture (e.g. being ten pounds overweight is
suggestive of ill health in some cultures but is socially approved in others); and one’s position in
the social structure (e.g. back pain that may cause a salaried worker to miss a day of work might
be ignored by an hourly wage worker; case of common cold in Germany) and is influenced by
social criteria.
The psychological approach
The psychological definition of health asserts that individuals constantly make objective
evaluation of their own health. Originally, this assessment was assumed to focus solely on a
general feeling of overall well-being.
By psychological wellness also include

Personal** involvement including the good feeling associated with personal accomplishment,
receiving compliments, and interesting daily activities.
Long-term satisfaction, including the longer lasting happiness associated with positive personal,
familial, and work situations, and the absence of negative effects, including unhappiness,
loneliness, and criticism from others.
Research has affirmed that positive and negative processes are distinct psychologically and often
are not highly correlated. Being happy involve more and is different from not being sad. An
individual could be both happy and sad simultaneously.
(iv) Anthropological approaches to health
Although health and disease are universal concepts, they are also largely cultural constructs i.e.
the key to health and disease is cultural perception and experience of these.
Illness and death is largely perceived as cultural phenomena. Its based on cultural disease
causation that are largely personalistic.
Explanations of causation and labelling are engendered in culture e.g. attribution of ill health to
witchcraft, the evil eye, taboos and transgressions (e.g. of child malnutrition & HIV/AIDS in
selected communities), & supernatural forces – fatalism & resignation.
Ill health is experienced in a way that is influenced by prevailing cultural ideas. Whether an
illness is regarded as serious or harmless can vary from one culture to another. Such ideas affect
how the patient experiences the illness episode.
33
Examples – Hydrocile phenomenon among men is some coastal societies. The high prevalence
gives it normalcy and sometimes status
Schistosomiasis – the blood in urine is considered normal and sometimes as the parallel to
female menstruation (a popular concept in irrigation schemes)
Although culture plays a great role in disease causation, we should not lose site of role of socio-
economic factors such as people‘s living and working conditions (environment, gestures,
changing lifestyles, poverty and access to health services) – e.g. houses with no windows in
Kilifi
Section III.05 Activity
To what extent does culture contribute to ill health?
Section III.06 WHY TAKE CULTURE INTO ACCOUNT IN HEALTH?
It is important to view/study community health by employing an EMIC (insider approach). i.e.

what are their beliefs and practices? What are the practices relating to health and ill health?
Reduces stereotyping
Fosters cultural relativism versus ethnocentrisms
Allows to decipher how people view their own situation and how they solve their problems
The inside view (perception, meaning etc) sets the stage or basis for appropriate interventions
Understanding the concept of culture is important in understanding the bottlenecks to human

health and wellbeing
To understand culture is to understand human behaviour in relation to health. This is important in

facilitating:
 Planning, especially in rural and urban health policy formulation

 Administration of health projects
 Community health
 Medical and health services facilitation
 Social work and community development etc
Understanding culture means: Working with the people and NOT for the people.
Working with the people means:
 Involving the people
34
 Consulting the people
 Having rapport with the people
The aim is to facilitate.

 People-centred development in health
 People-driven health development
 Development/ growth from below
 Bottom-up strategy
 Grassroots-based development
 Visible community entry point
 Sustainable development initiatives
 Empathy
From a health practitioner's perspective, Being aware of the culture and language (and cultural
differences) of your cohort will lead to better provision and care.
Understanding and communicating with patients can lead to trust, a collaborative relationship
and ultimately medical adherence. So, “know thy patient” – Hippocrates [or know thy clients]
Section III.07 Activity
1. Holistic theories of health and illness have a wide scope identify those scope showing
how they can be put into the practice
2. Identify two models in the study of health and illness and show how this models are
applied in rural setting.
Section III.08 SUMMARY:
As you may recall in your first year of study, you were taught how to explain how things happen and the
impact in the groups, community and the society for example you need to know why people solemnize
marriages or why education system does not stop from primary school. The changes that take place in any
social institution are caused by some factors. This lesson has introduced to you classical sociologist
theory that are relevant in explaining health and illness conditions. Theories are developed to explain
cause and effects of phenomena as you might have experienced in the family, schools and colleges,
politics, religion and in the economy. For example the divorce has its cause but it has also its effects on
both parties and the children who have been born on that union. Theories in this lesson explain why
diseases occurs, why people make certain health decisions and how these occurrences and decisions
impact on society or a group of people these theories are also explained how health system is organized,
conflict when health resources are been shared and how the impact labeling and prejudices happen when
we know what causes this events we are able to tell the implication of these events on our health.
35
Section III.09 Video links
https://www.youtube.com/watch?v=XzEZCJnwpC4
https://www.youtube.com/watch?v=GL6sgw1Ql9M
https://www.youtube.com/watch?v=D7wzzEr9ZFQ
https://link.springer.com/content/pdf/10.1007/978-3-319-03986-2_5.pdf
Section III.10 Further Readings
Bryers, H. M., & Van Teijlingen, E. (2010). Risk, theory, social and medical models: a critical analysis of
the concept of risk in maternity care. Midwifery, 26(5), 488-496.
Phelan, J. C., Link, B. G., & Tehranifar, P. (2010). Social conditions as fundamental causes of health
inequalities: theory, evidence, and policy implications. Journal of health and social behavior, 51(1_suppl),
S28-S40.
Kessler, R. C., Green, J. G., Gruber, M. J., Sampson, N. A., Bromet, E., Cuitan, M., ... & Lara, C. (2010).
Screening for serious mental illness in the general population with the K6 screening scale: results from
the WHO World Mental Health (WMH) survey initiative. International journal of methods in psychiatric
research, 19(S1), 4-22.
36
LESSON IV. HEALTH DETERMINANTS & HEALTH INEQUALITIES
37
Section IV.01 Introduction:
This lesson will provide you with information that will help you to understand what makes people ill
or sick or what make diseases. It is a step towards strengthening your understanding of the major
factors that influence our health including what makes us sick, what causes disease and the
implication of our interaction with the environment
Welcome to this lesson which we shall begins by explaining to you factors that influence our overall
health and why there exists inequalities in accessing health care services (inequality in health
services)
Health and illness are to a large extent influenced by Social factors which also define personal health
status. E.g. personal definitions of health vary by life stage (age), gender, and perceived level of
health i.e. younger men perceive health in terms of physical strength and fitness, while their female
counterparts are more focused on energy, vitality, and the ability to cope.
Older men and women consider health in terms of satisfaction and a state of contentment and
happiness. Women of all ages often include social relationships in their definition, while men rarely
do so.
Disparities or inequalities exist when differences in health outcomes or health determinants are
observed between populations. The terms health disparities and health inequalities are often used
interchangeably. This lesson uses the terms health disparities and inequalities to refer to gaps in
health between segments of the population.
Section IV.02 Learning objectives
By the end of this lesson student should be able to:

1. Define the term determinant of health
2. Explain factors that determine health and illness
3. Describe the causes of disparities between different groups in accessing health care
38
Section IV.03 Definition: Determinants of health
Detrminant of health is a trm that explains the range of personal, social, economic and
environmental factors which determine the health status of individuals or populations. (WHO,
1998).
There are multiple and interactive factors which influence our health. This factor ranges from
social/cultural, economic, political and environmental factors.
The actions of individuals such as health behaviours and lifestyles, but also factors such as
income and cultural practice, social status, education, employment and working conditions,
access to appropriate health services, and the physical environments influence our health
These, in combination, create different living conditions which impact on health.
As explained by WHO Commission on the Social Determinants of Health, health is not simply
about individual behaviour or exposure to risk, but how the socially and economically structured
way of life of a population shapes its health.(WHO 1986)
http://www.who.int/social_determinants/en/
Def 2: Determinants of health

our income , education and family background create unequal status in accessing health care.
http://www.who.int/social_determinants/en/
Section IV.04 What is health equity?
EQUITY
A world in which any group of individuals defined by age, gender, race-ethnicity, class or
residence can achieve its full health potential
EQUITY-VIS-VIS INEQUITY
‘Health inclusion’: continued improvements in health for all but bringing the bottom up at the
same rate or faster than the top
‘Tolerable’ vs ‘intolerable’ inequalities: in the context of rapid change
Section IV.05 Dimensions of inequity in health?
How do we measure/determine equity or inequality?
 Equity strata: (social stratification aspects) - sex, race, ethnicity, region, education,
occupation, place
 Dimensions of health status across which inequities exist: risk, disease, death, social
consequences of illness
 Health care inequities: access, quality & cost of treatment
39
The unequal distribution of determinants underlies health inequalities.
 That is inequalities in:- ‘general socioeconomic & environmental conditions’ – unequal
access to good education, secure employment, income etc living & working conditions
from childhood to old age community resources lifestyle factors like cigarette smoking,
diet & physical activity
 All these factors are explained by the diagram shown below
Section IV.06 Determinants of Health
Promoting factors & Barriers
Health determinants model (Dahlgren & Whitehead, 1991)]
I: Demographic determinants of health?
Population dynamics are the most fundamental determinants of the need, demand, and use of
health care services.
These include population size, and demographic characteristics (e.g. births and deaths) are the
basic starting point for assessing the need for health services in a population.
Population size and composition have a tremendous impact on total health services use.
40
Therefore we need to get information on the total number of people in a population; we also need
to know about the distribution of population by age group, defined as the population pyramid.
The age structure of a population is vitally important for health services purposes. For instance,
the very young and the older population groups utilize considerably more health care services
than other age groups
An important current trend is the aging population.
Increase in older population groups suggest substantial increase in health services utilization
II: Personal behaviors &health (Individual Lifestyle factors)
 Habits e.g.
 Smoking
 Alcohol & drugs
 Sedentary lifestyle – no excercise
 Hygiene
 Sexuality issues
 Accidents and suicides
III: Socio-economic
Socio-economic status (SES) is an important determinant of health status; Health and illness are
not distributed evenly throughout the population. Instead, certain groups of people tend to enjoy
much better health than others.
Health inequalities are tied to larger socioeconomic patterns - people who are poorer, less well
educated or who have a lower status jobs tend to have poorer health.
Cross region divide – rich versus poor countries. Often, the poorest countries have the worst
health records e.g. IMR and Life expectancy rates
Infant mortality, and child mortality (death of newborns under 5 years) are closely connected to
maternal mortality (death of a mother due to childbirth).
WHO, 1995 noted that “every year in the developing world, 12.2 million children under 5 years
die, most of them from causes which could be prevented... They die largely because of world
indifference, but most of all they die because they are poor“.
Inverse Care Laws (poverty and health are closely related)

The rich consume more hospital and public health care than the poor
Immunization coverage strongly correlated with socioeconomic status.
Poor with illness don’t access care: They are twice more likely to seek self treatment; and even
more likely to do nothing
Poorer people live shorter lives and are more often ill than the rich.
Diseases of the poor include malaria, HIV/AIDS, TB, Typhoid etc
41
There is also a link between health, social class, gender, race, age and geography etc
The following are the impact of poverty on the health opf the people and it is considered as the
main killer of people who live in the developing countries. In those countries ,babies are not
vaccinated,lack of clean water and sanitation are not provided, lack of adequite Curative drugs
while treatments are not available to the majority of the population it is also the cause of
materanal death and mortality rate. Povertyreduced life expectancy; many children are
handicapped and others are born with disabilities (refer to sociodemographic differences in
health--the role of … - Link - Cited by 418)
III: Cultural
The impact of cultural beliefs on health is enourmous
Thus health care practioners must take into account cultural beliefs when treating patients
 Religious beliefs
 Diet
 Myths
 Dressing
 Initiation rites e.g instruments used
 Widow inheritance
Health care provision (or health services) should be culturally relevant to the populations they
are designed to serve i.e. Medical care professionals need to be able to communicate in the
language of those they serve and to understand the cultural preferences of those for whom they
seek to provide care.
The probability of success is enhanced if needed health professionals are from the same cultural
background as those they serve.
IV: Environmental
Effects of urbanisation and congestion and health - overcrowding

Pollution and health – water, air e.g. Typhoid, URTI, cholera,
Climatic conditions – global warming leading to:
 Catastrophies that affect health e.g Tsunami

 Low food production, poor access to food and nutritional problems
Section IV.07 Barriers to Health

Socio-cultural & Economic Barriers to Health Care Equity
Factors contributing to social inequalities in health?

 Poverty
 Accessibility
42
 Gender disparity
 Community behaviour
 Food insecurity
Section IV.08 How can these be reduced?

 Potential barriers to health care equity
 Political barriers
 Economic barriers
 Social barriers
 Cultural barriers (including language)
 Geographical distance
 Physical barriers
I: Geographical distance as a barrier
Distance and long travel times to health facilities remain key barriers to access in many rural
communities
Health care services less accessible for rural than urban women
Rural women face significantly longer travel times than women living in urban areas.
Travel costs in rural areas higher in rural than in urban areas

Communities living in poorer and more marginalized areas are more disadvantaged
II: Economic/ Financial barriers
Even where health care services are available, the cost of seeking care may delay or prevent poor
households from accessing them the cost of seeking care include direct costs (e.g. user fees),
indirect costs (e.g. costs for transportation) and opportunity costs (e.g. lost wages).
Such costs weigh more heavily upon poor households than non-poor.
The poor pay less than the non-poor in absolute amounts, with the rich spending, on average, 10
times more on health care than the poor.
The opportunity cost of seeking health care is likewise relatively higher for poorer than wealthier
households.
This is because the poor often earn income directly from their labour. Seeking care may divert
the labour and time of these people away from income-generating activities, thereby reducing
household income.
It is largely the poor who have no health insurance therefore no financial protection in times of
ill health i.e. the poor are underrepresented in insurance coverage poor households often borrow
money at high rates of interest or sell productive assets to cover the cost of seeking care
(payment in kind).
43
Often, and in many societies, women are the primary caregivers especially for children. Yet,
they are more likely to face additional financial constraints compared to the men.
This is because women are more likely to be employed in the informal sector, more likely to be
laid-off and less likely to be rehired than men
In many societies (especially developing countries), women have less control over the allocation
of household resources & assets, including income and may have little say in decision how to
spend money on health care
In patriarchal societies, women tend to have lower decision-making power and lower intra-
household bargaining power relative to that of their male partners.
The ability of women to make decisions benefiting their health and that of their children may
thus be curtailed.
The heavy demands placed on women’s time due to multiple productive and reproductive roles
may also mean that women have less time to time devote to seeking health care for themselves or
even their children
III: Socio-cultural barriers: (Including language & ethnicity-related)
Lack of knowledge and awareness
Generally lower levels of health-related knowledge and awareness among poor & marginalized
groups may result in low demand for health care services limited knowledge on health
prevention – may be linked to educational/literacy levels.
Lack of knowledge on when and where to seek and access appropriate health care. Health
information may not reach poor & marginalized populations for a variety due to
 Physical distance to health centres
 Low levels of education
 Linguistic & cultural barriers may make health information or other health-related
information, education and communication (IEC) inaccessible.
 Ethnic minorities and marginalized groups may face particular barriers when seeking
health care
 Marginalized have poor access to basic hygienic commodities e.g. safe drinking water,
toilets/latrines etc
 Migrant populations face special health challenges due to other barriers e.g.
 Language (communicating health). Language barriers affect patients’ quality of care i.e.
language barriers are associated with less health education, worse interpersonal care and
lower patient satisfaction. Source: Ngo-Metzger Q, Sorkin DH, Phillips RS, et al. J Gen
Intern Med 2007. 22(Suppl 2):324–30
 Social distance/alienation etc – psychological problems
Health care providers may be unresponsive to or may not understand the needs of ethnic
minorities (language, lack of cultural competence etc)
 Financial constraints which affect access to care
44
Section IV.09 Gender
 Women’s lower levels of literacy may mean that health information from sources e.g.
print media, may be beyond their reach, while restrictions on their mobility may limit
their exposure to new health-related ideas and practices
 Other gender-related barriers may likewise constrain women in seeking health care for
themselves and their children
 male dominance or lack of support & prejudice affect women’s and children’s access to
health services; as well as willingness to access and use services e.g. FP
Studies have found that poor women tend to be particularly sensitive to the behaviour of health
staff & may not access formal services when they perceive health care providers as disrespectful
and insensitive to their needs (more of a perception and may be based out of feeling powerless;
also a question of choice)
Section IV.10 Why Gender?
“ …. it is increasingly well recognized that there are differences in the factors determining
health and the burden of ill-health for women and men. The dynamics of gender in health are of
profound importance in this regard and they have long been overlooked.”
(World Health Organization, 1997)
Section IV.11 Inequalities in quality of care
More of policy & political aspects/barriers.Has to do with planning of health care. Is it inclusive
or exclusive? What health services are available? Where are they located? Serving what
population?
The poor families often receive lower quality care than the wealthy
Quality of care extended by health facilities serving poor and marginalized populations is
typically lower than of those serving non-poor populations
Facilities serving poor communities are less likely to have well trained staff or to be stocked with
appropriate drugs and equipment (many referrals as opposed to full integration of services;
prolonged waiting time)
The low quality of services may deter the poor from seeking health care e.g. in public facilities
Low quality health care contributes to the lower survival rates e.g. of children (life expectancy
for the poor e.g. Kenya 45 as opposed to 70 in Europe etc).
45
Section IV.12 Activity
1. Look around where you live or work and list some of the probable causes of poor health.
2. What are the strategies the Kenya government has put in place to reduce health inequalities
across all the segments of the population
Section IV.13 SUMMARY:
health and illness conditions have been explained of a long period of time as the concern of medical
doctors where Germ theory was used as the main factor that causes diseases however with the growth
of population and modernization many diseases and illness were attributed to various conditions that
existed in new environment such as urbanization and development of industries. The rise of social
sciences as discipline concerned with the studies of humanities and the social processes it was found
out that most diseases were caused by social cultural factors but not necessarily germs. In this lesson
we have explain that social factors or social determinant of health have been responsible for a health
and illness conditions. For example gender, age, education, income, family background and religious
belief all have the influence on the types of disease and illness that some of us get
Section IV.14 Video link
http://www.zocalopublicsquare.org/
https://www.youtube.com/watch?v=aS3-MZZyVNI
https://www.youtube.com/watch?v=h-2bf205upQ
Section IV.15 Further Reading:
Reading, C. L., & Wien, F. (2009). Health inequalities and the social determinants of Aboriginal
peoples' health. Prince George, BC: National Collaborating Centre for Aboriginal Health.
Currie, C., Zanotti, C., Morgan, A., Currie, D., de Looze, M., Roberts, C., ... & Barnekow, V.
(2009). Social determinants of health and well-being among young people. Health Behaviour in
School-aged Children (HBSC) study: international report from the, 2010, 271.
46
Reading, C. L., & Wien, F. (2009). Health inequalities and the social determinants of Aboriginal
peoples' health. Prince George, BC: National Collaborating Centre for Aboriginal Health.
LESSON V. ETHNO MEDICINE & ALTERNATIVE MEDICINE
Section V.01 INTRODUCTION:
47
In our second lesson you are introduced to the emergence of the study of health and illness from
medical point of view.
That introduction did not explain the role of traditional medicine or healing that is very popular
among some communities particularly in the developing countries in this lesson we will introduce
you to the term ethno medicine as well as alternative medicine which are basically traditional healing
Welcome to this lesson and as you read, you are advised to focus your mind in the community that
you come from and find out whether these kinds of healing methods are practiced and who demand
these services
Section V.02 LEARNING OBJECTIVES
1. Define Ethnomedicine and alternative healing

2. Explain the reasons why these practices are still present in most of the developing countries
3. Describe the differences between various concepts applied in this lesson
4. Explain challenges that practitioners of alternative and complimentary medicine face in their
practice
5. Differiate types of healers practicing traditional medicine in kenya
Section V.03 THE DEVELOPMENT OF ETHNOMEDICINE AND ALTERNATIVE

HEALING
Ethno medicine is a sub-field of ethno botany or medical anthropology that deals with the study
of traditional medicines: not only those that have relevant written sources (e.g. Traditional
48
Chinese Medicine, Ayurveda), but especially those, whose knowledge and practices have been
orally transmitted over the centuries.
Medical anthropologists have a longstanding interest in studying ethnomedicine, or the medical

systems of particular (usually non western) cultural groups.
They investigate how different cultures perceive the body as a locus of health and illness;
classify and interpret illnesses; practice preventive measures; offer therapeutic approaches
(including magical-religious techniques, use of medical substances, and mechanical techniques
such as dentistry and surgery); and involve specialists in treating illnesses
Barbara Miller, 2002.
Cultural Anthropology, Second Edition. Allyn & Bacon Publishers, Boston Ethno Medicine/Folk
Medicine
Ethno-medicine is any medical system linked to a particular language, group or community of
people.
Folk medicine is a culturally-specific way to treat physical, emotional-psychological and

spiritual afflictions that provides an alternative to the formal medical system.
Section V.04 Traditional Medicine & Medicinal Plants
WHO def of TM: - the sum total of all knowledge and practices whether explicable or not, used
in diagnosis, prevention, and elimination of physical, mental or social imbalance and relying
exclusively on practical experience and observations handed down from generation to generation
whether verbally or in writing.
TM: the health practices, approaches, knowledge and beliefs incorporating plant, animal and
mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly
or in combination to treat, diagnose and prevent illnesses or maintain well-being
Section V.05 WHO def. Of TM comprises

Broad diversity – body, mind, menta´l
 Inclusive
 Holistic
Unsystematic – no definite outline to approach in treatment of diseases
 Belief systems
 Culture-Bound syndromes
Cross-culturally, many locally specific disorders are labeled and their treatments outlined. This is
refered to as culture-bound syndromes (CBS) or ‚folk-illnesses‘ A CBS is a collection of signs
and symptoms that is restricted to a particular culture or a limited number of cultures
Milter Barbara 2002.
WHO & TM
49
WHO estimates that 65-80% of the world’s population use traditional medicine as their primary
form of health care Countries in Africa, Asia and Latin America use traditional medicine to help
meet some of their primary health care needs.
For example, in Africa, up to 80% of the population uses traditional medicine for primary health
care.
The use of herbal medicine which is the dominant form of medical treatment in developing
countries, has been increasing in developed countries in recent years
DEF 2
Complementary medicine - used together with conventional medicine. Example - aromatherapy

to help lessen a patient's discomfort following surgery.
Alternative medicine - used in place of conventional medicine. Example - a special diet to treat
cancer instead of undergoing surgery, radiation, or chemotherapy recommended by a
conventional doctor.
Section V.06 Main types of CAM:
(1) Alternative medical systems - eg, Homeopathy, Naturopathy

(2) Mind-body interventions - eg hypnosis, imagery, support groups
(3) Biologically-based treatments - eg, Herbal, dietary treatment,
(4) Manipulative and body-based methods eg, chiropractic, acupressure, osteopathy
(5) Energy therapies - eg, magnets, therapeutic touch
Section V.07 COMPLEMENTARY & ALTERNATIVE MEDICINE
“A group of diverse medical and health care systems, practices, and products that are not
presently considered to be part of conventional medicine.”“While some scientific evidence exists
regarding some CAM therapies, for most there are key questions that are yet to be answered
through well-designed scientific studies.” – NCCAM Are they safe? Do they work?
Section V.08 Major highlights in TM
Ingredients
Procedures – in diagnosis & treatment Practices

Measures – dosage in prescription (prescribing used in Tm)Furthermore, traditional medicine
therapies can be categorised as:- medication therapies, when they use herbal medicines, animal
50
parts and/or minerals, and as non-medication therapies, if carried out mainly without the use of
medication, as in the case of acupuncture or manual therapies Medical substances
Plant-based – over 400 plants supplements documented
Animal based – e.g sheep oil (fat) for diarrhoea, mothers milk (antidote for eye problems &
pollen sting), honey as a vehicle etc. It is both medicinal & symbolic (lamb blood, rhine horn for
ED (electron dysfuntion), antelope horn for protection & urine)
Mineral-based – oral (lime, chalk, soil), local & symbolic
KENYA
Section V.09 Development of TM in Kenya
Single mode of health care before arrival of missionaries 20th century missionaries set up
dispensaries, clinics, hospitals.They deliberately discredited and criminalised anything traditional
Witchcraft Act Cap 67 of 1925 stipulated that it was criminal to pretend that one can cure
diseases.
TM was avoided until WHO in 1978 urged member countries to utilise traditional systems in
health care TBA curriculum was developed in 1981.
Government called for research to evaluate the role and functions of TM & determine the extent
of its usefulness In 1985, the department of culture recognised TM as part of rich cultural
heritage.
TM was recognised under culture & social services not as medicine Kenya‘s committment to
conservation & sustainable utilisation of biological resources through convertion of biological
diversity (CBD) in 1994.
Medicinal & Aromatic plant series (MAPS) was recognised as an important biological resource
TM was recognised by AU 2001 – 2010 is the AU decade of African TM Areas that required
consideration include
Conservation Separation of medicinal & cultural efficacy Harmony in usage & dosage
Section V.10 Why TM is still popular

In this subsection you will note that tradition medicine has been retained in some
communities and with the support of the government because of the following reasons
i. Many people particulary in the developing countries still believe in traditional healing as
part of their culture (Belief systems)
ii. Majority of the people in the population do not have enough income to access modern
health care services
51
iii. Traditional healers are available within their communities and they influenced health
behaviour which discouragessome people to seek modern medical treatment
iv. There is a belief among middle and upper class population that traditional healing can
cure disease such as Hiv and Aids
Section V.11 Four important subsectors of TM include

Traditional healing and availabity of ethnomedine have their advantages which are:
Conservation of medicinal plants, Production & demystification Safety & efficacy and
Commercialisation (for sale)
Section V.12 Activity

1. Identify three types of groups of people who you think seek traditional healing services in this
country. What are their social- economic characteristics?
2. List five types of plants used as medicinal in Kenya. And identify the location they are found
3. Read Kenya government development strategic plan and vision 2030. Briefly explained the types
of government support offered to traditional healing practitioners
Section V.13 Video links
https://www.youtube.com/watch?v=iTOJ8c__rk8
https://www.youtube.com/watch?v=9EkwukyMV9o
https://www.youtube.com/watch?v=NmPi87lndzo
Section V.14 SUMMARY
In this lesson you have learnt that ethno medicine and traditional healing are part of most health system in
the world. You have also learnt different types of traditional healing services that are sought by various
groups of people because of their believes. In some countries including Kenya traditional healers are
supported by the government to compliment modern medical services.
52
Section V.15 Reference
Dass, S., & Mathur, M. (2009). Herbal drugs: ethnomedicine to modern medicine (pp. 153-71). K. G.
Ramawat (Ed.). New York, NY, USA:: Springer.
Payyappallimana, U. (2010). Role of Traditional Medicine in Primary Health Care: An Overview of

Perspectives and Challenging.
Lewu, F. B., & Afolayan, A. J. (2009). Ethnomedicine in South Africa: the role of weedy species. African
Journal of Biotechnology, 8(6).
*Kenya government strategic plan (2007-2012) and vision 2030
LESSON VI. PATIENT-PHYSICIAN RELATONSHIP AND ETHICAL

JUDGEMENTS
(circumstances in which they may occur)
53
Section VI.01 Introduction:
In this lesson you will be introduced to various concepts related to patient-physician relationship
that are often observed when patient met the doctors. You will also learn the types of obligation
that are expected when patient doctors interact
Welcome to this lesson and as you read, reflect your mind on many reports that have been written
regarding the behaviors of doctors when they meet the patients. It will be important for the sake of
learning to put this causes down and try to discuss them with other friends so that you can develop
strategies that can be form part of the policy.
Section VI.02 LESSON OBJECTIVES

1. Describe types of obligation biding patients-doctor relationship
2. Explain the meaning of the term ethics from health and illness practices.
3. Explain the main causes of behaviors of the medical doctors and health practitioners that are
commonly reported in the media
Section VI.03 PATIENT-DOCTOR RELATIONSHIP

All of us in our life time might visit a doctor for a particular health reason. In the study of health
and illness sociologist have examine the types of relationships that develop when that interaction
takes place. They have also examined that relationship from a number of view points and
particular the following has reported by Talcott Parsons in his famous doctor patient relationship.
One of this view point is that there must be a shared understanding between doctor and patient
who are each seen as acting out roles or socially prescribed patterns of behaviour.( Parsons 1951)
The other view point is given by Freidson who focused on the potential conflict that may arise in
this relationship.
These two approaches while emphasizing different aspect of the doctor patient relationship are
seen to contribute to the roles each one of them must play when such encounter occurs
Talcott Parsons are also well known in his theoretical analysis of modern society where he
described the roles of the patient and that of the doctor. Patient has an obligation to
54
(a) To seek help when s/he become unwell
(b) The sick person must be accorded special privileges until s/he get well
(c) The sick person must follow the doctors instructions just as the child is obligated to
follow the instructions from the parents
(d) The sick person must be exempted from the duty
The role of the doctor is to:

i. Help the sick person to get well
ii. Put the interest of the patient first before his own interest
iii. Be objective and emotionally ditached meaning the doctor should not judge patient
behaviour in terms of personal value system or become emotionally involved with them
iv. He has the right to examine patient physically and to enquire into intimate area of
physical and personal life
v. Has been granted autonomy by the power trusted to him as a medical doctor through the
oath
vi. He /she occupies a position or authority in that relationship
These obligations are critical for both parties and this study it has been emphasize that doctor
patient relationship must be respected such that he does not contribute to an ethical behaviour
from either party and what are the main causes of these behaviour pointed out as the main point
teaching of ethics is not designed to inspire people to be good; actually the contrary is true-a
certain moral goodness is expected in physicians, and if goodness is not present, education
probably will not create it.
Superior moral reasoning can enhance moral behavior, however, and this is the intention of
ethics education during residencies. Moral dilemmas originate when a person is morally
obligated to do two different actions but is unable to do both.
Both patients and doctors must adhere to ethical practices. They are expected to judge their
behaviour from ethical point of view. Ethical judgments focus on ‘rights’ of patients versus the
professional obligations of physicians
Professional and ethical obligations of physician in the physician-patient relationship
Touches on Truth-telling (to tell the patient he true condition of the illness) and keeping patients
sickness or health conditions secret (Confidentiality-in keeping the patient’s AIDS conditions
confidential)
Section VI.04 ETHICAL JUDGMENTS AND PRINCIPLES

In this subsection we will introduce you to the term ethics in relation to patient-doctor
relationship. Patient-doctor obligations can only be observed if the two parties adhere to ethical
practice and principles.
But what is ethics and how do you explain ethical principles?
We can define Ethics as a system of moral principles. These principles affect how people make
decisions and lead their lives.Ethics is concerned with what is good for individuals and society
and is also described as moral philosophy.The term is derived from the Greek word ethos which
can mean custom, habit, character or disposition.
55
Ethics covers the following dilemmas: how to live a good life; our rights and responsibilities; the
language of right and wrong moral decisions, what is good and bad
Health care ethics (a/k/a "medical" ethics or "bioethics"), at its simplest, is a set of moral
principles, beliefs and values that guide us in making choices about health care. At the core of
health care ethics are our sense of right and wrong and our beliefs about rights we possess and
duties we owe others.
Ethical principles are obligations and duties that are important in helping patient doctor -
relationships.
The principles help and guide health workers in their helping process e.g. by helping them
motivate or reinforce certain patient’s behaviors. They also help health workers involve
themselves and function in difficult stressful circumstances e.g. with hostile resentful patients or
with over dependent persons.
The principles can also be called rules and guides to procedural action and are believed to be
efficient in achieving desired goals. They can also be referred to as code of ethics.
Section VI.05 BASIC PROFESSIONAL ETHICS AND PRINCIPLES
Individualization – recognition and understading of each clients unique qualities, based upon the
rights of human beings to be treated not just as human beings but as this human being with his
personal differences.
Purposeful expression of feelings – recognition of clients need to express their feelings

(especially negative ones) freely. The S/worker should listen purposefully without condemnation
and provide encouragement when therapeutically useful
Section VI.06 ETHICAL PRINCIPLES
Individualization – recognition and understading of each clients unique qualities, based upon
the rights of human beings to be treated not just as human beings but as this human being with
his personal differences
Purposeful expression of feelings – recognition of clients need to express their feelings
(especially negative ones) freely.
The S/worker should listen purposefully without condemnation and provide encouragement
when therapeutically useful
Non-judgmental attitude – entails that it is not part of the h/work function to assign guilt or
innocence or degrees of client responsibility for causation of problems, although evaluative
judgments can be made about the attitudes, standards or actions of clients i.e. do not judge the
client but their behaviour the s/worker attitudes which involve both thought and feeling elements,
is transmitted to the client positively without making him feel guilty of his circumstances.
56
Reasons for the non-judgmental attitude h/workers have no legal rights to judge Judgmental is
incompatible with h/work values and philosophy whereby assistance is based on need rather than
worthiness.
The fear of being judged may lead to defense mechanism by the client hence the true picture may
never emerge Client-self determinism – recognition of the right and need of clients to freedom of
making their own choices and decisions in the h/work (helping) process. S/workers have a
corresponding duty to respect that right, recognize that need, and help activate (or stimulate)
clients potential for self-direction [by helping client to see and use variable and appropriate
personal and community resources].
However, the right to self-determination are limited by their capacity for positive and
constructive decision-making [e.g. young clients, persons with mental illness, over-dependent
clients, peer groups], by civil and moral law and by the function of the agency
Section VI.07 Reasons for self-determination: -
Every person has a responsibility to his own life in such a way as to achieve the goals of his life
as he has conceived them.
By exercising his responsibility through decision making, a client is able to enhance his
personality growth (e.g. kids who are overprotected) – ownership of the helping process
Confidentiality – is the preservation of secret information concerning the client which is

disclosed in the professional relationship.
Confidentiality is based upon a basic right of clients and as an ethical obligation for the s/worker,
as well as being essential for effective s/work service.
However, clients rights are not absolute and may be limited by a higher duty to self, by rights of
other individuals, the s/worker, agency or community.
Controlled emotional involvement [Empathy] – this is the S/worker’s sensitivity to client’s

feelings, an understanding of their meaning and a purposeful, appropriate response to them
This refers to an ability to experience someone else's feeling and perspective as if they were
one’s own, but however free from them
A high degree of self awareness is necessary for effective empathy
Reasons or aims of empathy
It meets the clients need for understanding & belonging

It gives a correct perspective for interpretation of the problems and feelings.
It makes a s/worker sober enough to tackle the problems
57
Listening with a sympathetic ear is a crucial skill in many helping situations.
Section VI.08 RIGHTS’ OF PATIENTS VERSUS PROFESSIONAL OBLIGATIONS OF

PHYSICIANS
These are closely related to the nature of medical profession, to the status of patients, and to
interactions between physicians and patients
They are creating new role demands for physicians and patients
They are increasingly becoming part of the formal and informal socialization process for health
care professionals
Section VI.09 TRUTH TELLING AS AN ISSUE
An important gauge of the relative status of patients in the physician-patient relationship is the
discretion felt by physicians to lie or in some manner intentionally deceive patients
This most commonly occurs when a physician learns some distressing news about a patient e.g. a
cancer diagnosis or some other life-threatening or chronic disease e.g. multiple sclerosis,
Alzheimer’s disease or AIDS.
E.g. case where a doctor diagnosis a male patient to have lung cancer in advanced stage
(malignant). Its too late for benefit from surgery, chemotherapy, or radiation.
Doctor feels that communicating this info to patient will depress and traumatize him that he will
simply give up and die. To try to provide even a few weeks of additional time, the doctor tells
the patient that the results are inconclusive and asks him to return in a couple of weeks for the
tests to be performed again.
Section VI.10 The Medical Codes

The narrative below will give you an understanding of the basis of ethical codes that were
developed during 1940’S.
Most of the existing codes of ethical behaviour for physicians are silent about the issue of lying
and deception. While the Hippocratic Oath includes numerous pledges by physicians to patients,
including confidentiality, nothing is said about truth-telling.
There is no reference to truth-telling in the 1948 World Medical Association Declaration of

Geneva in response to atrocities performed in World War II under the name of medical science;
or in the AMA’s Code of Ethics until 1980.
Some prominent ethical codes in medicine have addressed truth-telling and have occasionally
made a strong statement on its behalf
58
In 1972, the American Hospital Association’s “Patients Bill of Rights” clearly states that the
“patient has the right to obtain from his physician complete current information concerning his
diagnosis, treatment and prognosis in terms the patient can be reasonably be expected to
understand”.
The edited AMA’s 1992 Code of Medical Ethics states “the physician must properly inform the
patient of the diagnosis of the nature and purpose of the treatment of the treatment undertaken or
prescribed. The physician may not refuse to inform the patient”.
Further, the President’s Commission for the Study of Ethical Problems in Medicine and
Biomedical and Behavioral Research (1983) supports full disclosure of information to patients as
a way of increasing patient participation in actual decision making.
Section VI.11 ARGUMENT USED TO JUSTIFY LYING AND DECEPTION
Benevolent Deception. This is the most often cited justification for lying and deception by
physicians.
Many physicians believe that they have a professional duty to lie to patients if that is perceived
to be in the patient’s best interests.
The argument is supported by the rationale that physicians are employed by patients to provide
the best possible diagnosis and treatment.
Since physicians are not autonomous, they cannot and should not be expected simply to report
‘facts’.
Instead as persons with extensive training in the practice of medicine, they should be given
license to make judgments about what information would be beneficial for a patient to have and
what information would do harm to the patient and to act on these perceptions.
Guiora (1980) argued that – Too much has been made of ‘freedom of information’, while too
little consideration has been given to the idea of freedom from information.
It is argued that information is medicine that has to be titrated, properly dosaged based on proper
diagnosis.
In this context, diagnosis means an assessment of how information will affect the course of
illness, how much and what kind of information is the most therapeutic in face of the patient’s
preferred modes of coping.
Argument that patients typically are unable to comprehend the ‘whole truth’ of a matter, and
physicians, therefore, cannot be expected to try to provide it.
59
This situation is said to occur because most patients have limited medical knowledge and may
incorrectly (or at least incompletely) interpret terminology used by the physician E.g. conveying
a diagnosis of cancer.
Despite the tremendous progress made in the treatment of cancer and the steadily increasing rate
of cure for many cancers, the “C” word continues to carry frightening implications. Since
patients lack understanding of the disease and its treatment, the argument goes – “it would make
little sense to obligate physicians to communicate this diagnosis fully”.
Other example given e.g. by Mack Lipkin, 1979 – “How many patients understand that “heart
trouble” may refer to literally hundreds of different abnormalities ranging in severity from the
trivial to the instantly fatal?
How many know that the term ‘arthritis’ may refer to dozens of different types of joint
involvement?…most people’s ideas about the implications of medical terms are based on what
they have heard about a few cases, Many physicians believe that some patients prefer not to hear
the whole truth.
The argument is that although patients sometimes make explicit their desire to have the truth
couched in gentle language or withheld altogether, more often they communicate this preference
through body language, tone of voice, or a message that requires the physician to “read between
the lines”.
If this is the message being communicated, many physicians argues that it would be unethical for
them to reveal the truth.
Food for thought! Think of situations where any 3 of the above scenarios may occur.
Truth-telling is an unconditional duty. This views holds that

Physicians are always morally required to provide full information to patients and never to lie or
attempt to deceive them.
Four primary arguments are put forward to support this view

Truth telling is part of the respect owed to all people. To lie or to intentionally deceive another is
to denigrate that person’s worthiness and to treat that person as undeserving of a full and honest
account.
The legal requirement for informed consent from patients or research subjects implies a decision
maker who is fully informed and has complete access to the truth.
Veracity is consistent with the ideas of fidelity and keeping promises. When a patient solicits a
physician, he or she is entering an implied contract. In exchange for payment, the patient seeks
the best possible diagnosis, recommendations for treatment and (if agreed upon) the provision for
treatment.
60
Accordingly, any information learned by the physician about the patient should be provided to
the patient. After all, who can be said to ‘own’ that information? Does the physician own it and
have a right to parcel it out according to his or her discretion? Or does the patient own this
information? Those arguing in support say that the contract established between the patient and
physician requires that a full and honest account always be provided.
Lying or deception undermines a trusting relationship between patient and physician. If it is

assumed that patient trust in a physician is a desirable goal, and that this trust facilitates a
therapeutic relationship, then physicians must act in such a way as to maintain this trust.
Patients who learn that he or she has been intentionally deceived by a physician may never again
be able to trust fully information provided by that physician.
Accordingly, any information learned by the physician about the patient should be provided to
the patient. After all, who can be said to ‘own’ that information?
Does the physician own it and have a right to parcel it out according to his or her discretion?
Or does the patient own this information? – those arguing in support say that the contract
established between the patient and physician requires that a full and honest account always be
provided.
Lying or deception undermines a trusting relationship between patient and physician. If it is

assumed that patient trust in a physician is a desirable goal, and that this trust facilitates a
therapeutic relationship, then physicians must act in such a way as to maintain this trust.
Patients who learn that he or she has been intentionally deceived by a physician may never again
be able to trust fully information provided by that physician.
Sissela Bok (1991) argued – ‘the damages associated with the disclosure of sad news or risks are
rarer than physicians believe; and the benefits which result from being informed are more
substantial, even measurably so.
Pain is tolerated more easily, recovery from surgery is quicker, and cooperation with therapy is
greatly improved. The attitude that ‘what you don’t know wont hurt you’ is proving unrealistic; it
is what patients do not know but vaguely suspect that causes them corrosive worry (Bok,
1991:78)
Do patients want to know the truth? soap program sat 20.11.09 where the actor told the doctor
relating his potential full blindness. Doctor puzzled on whether to give the negative patient
results regarding the possibility of him ever seeing again.
Doctor wanted to disclose to the relative in the absence of the patients, but the patient insisted
that ‘doctor please tell me the truth no matter how bad’
The doctor in response said ‘if you insist, then I will tell you. Unfortunately I have negative
results that you are unlikely to ever see again.
61
Patient goes into a moment of depression and the doctor leaves, leaving the relative to comfort
the patient promising that a second opinion will prove that he will see again….
This is the kind of situation that we confront every day… question is, do patients really want to
know the truth, no matter how bad?
In the event that the results or diagnosis is not what they would ‘wish to hear’ what does this
mean to them?
How do they react? How devastating, how catastrophic… is it then ethically sound to give
patient truth that is more likely to ‘kill’ him/her?
Do patients want to know the truth?
Social surveys have found that most respondents express desire for truthfulness from physicians.
In an important early study, 89% of cancer patients, 82% without cancer, and 98% of patients
participating in a cancer detection program expressed a desire for honesty in a cancer diagnosis
(Kelly and Friesen, 1950).
In a 1980s telephone survey of 1250 persons in the US, 9 out of every 10 respondents (94%)
wanted all available information about a medical condition and treatment even if it was
unfavorable – irrespective of age, sex, race or social class (President’s Commission, 1983).
Food for thought!
Do Kenyan’s really want to be told the truth about HIV test results? If yes, why is VCT uptake
still so low? Is it that they just do not care about knowing their status?
Is it that they are scared about knowing the status results and perhaps say, ‘I better live without
knowing’? Is it that they do not want to confront the news of a ‘positive’ result, and would
nonetheless prefer to continue in risky behaviors (enjoy life) than know their status and begin to
‘live positively’?
Are physicians truthful with patients? Studies have been done on physicians attitudes regarding
full disclosure of information to patients.
In 1950s-60s many physicians reported that they sometimes withheld the truth from patients.
In 1970s some change began to appear. –Friedman’s 1970 survey of 178 physicians found that
one-quarter of physicians always told the patients the truth, 66% provided accurate information
and only 9% never gave honest cancer diagnosis.
A 1979 study by Novack et al. of 278 physicians found that 98% reported that their general
policy was to inform a cancer patient accurately, and two-thirds of these said they never very
rarely deviated from the policy.
Factors that mostly influenced the behavior of physicians included - patients most likely to be
given truth were: - those who had expressly asked for the truth; those judged to be high in
emotional maturity; the older patients; and those thought to be highest in intelligence.
62
Question: Does one’s social and demographic status influence physician’s willingness/ability to
tell the truth to the patient? Are physicians truthful with patients?
Trend show an increased propensity to tell the truth and a continued willingness to not be
elusive.
Most physicians have acknowledged that most patients want accurate information about
diagnosis ad prognosis, and most physicians have tendency to provide this.
However, in a scenario of a patient with full diagnosis of advanced lung cancer only 13% of
physicians said they would give a ‘straight statistical prognosis’ to the patient for this class of
disease (Presidents Commission, 1983).
Novak et al (1989) found that physicians who expressed willingness to deceive placed greater
emphasis on the consequences (or outcomes) of a medical encounter than adherence to a
principle of unconditional truth-telling.
A 1993 also found that American physicians seem to value ethical principles that support
disclosure of information to patients – both truth telling and informed consent – and give the
impression that patients have control over obtaining information.
BUT in reality, physicians continue to manage the information-giving process. They interpret the
principle of disclosure selectively, and in such a way that they share with patients only as much
information as they with them to have.
Thus, for a patient with a newly diagnosed terminal illness, physicians may emphasize possible
treatments and decision-making options and give extensive information about them, but give
much less information and play down grim prognosis information citing uncertainty and lack of
relevance to future actions.
This communication pattern is interpreted by physicians as showing compassion and respect for
the patient and the principle of disclosure while preserving as much hope for the patient as
possible.
Thus a very high percentage of physicians report themselves to be ‘unconditional truth-tellers’ –

yet it is not necessarily the case that they provide truthful diagnosis to patients.
Physicians are still in control of the information-giving process and they are not sharing as much
information as they have about the patient’s condition – thus maintain the power of the
profession, enhancing its ‘cultural authority’ over patients.
Section VI.12 CONFIDENTIALITY AS AN ISSUE
THE MEANING OF CONFIDENTIALITY
63
Should physicians be morally and legally required to disclose patient information?
What circumstances would justify bleach of confidentiality?

Should physicians maintain absolute confidentiality regarding information shared with them by
all patients in all circumstances?
Once information is revealed to another person, it is never again as ‘private’.
At this point the individual must rely on professionalism or goodwill.

This is the meaning of Confidentiality.
In the medical encounter, an individual patient who reveals information to a physician must now
count on the physician not to share the information with others.
Maintaining confidentiality means that the information goes no further.

Ever heard of ‘I have only shared this with you, please do not tell anyone else!’ - repeated 5
times to 5 people. Then all discover during gossip that she/he told someone else and told them -
I am only telling this to you.
Please do not tell anyone who is the villain here?

Or on a pulpit, ladies and gentleman I want to introduce this convert to you… he was a thief, a
rapist, a trouble-maker… but now he belongs to the Kingdom of heaven. Halleluyah! Somebody
say AMEN! is this a bleach of privacy or intrusion.
Case of feathers released from a mountain top. Difficult to re-collect/gather them!
Confidentiality Def: is the preservation of secret information concerning the client which is
disclosed in the professional relationship. Confidentiality is based upon a basic right of clients
and as an ethical obligation for the health worker, as well as being essential for effective
h/s/work service.
However, clients’ rights are not absolute and may be limited by a higher duty to self, by rights
of other individuals, the s/worker, agency or community.
The idea of privileged communication comes from the legal system, which operates on the basis
of testimonial compulsion – individuals with pertinent information can be required to present
that information in a court of law.
But if professional secrecy is valued, an in order to foster a close and trusting relationship
between individuals and selected professionals, information shared with these professionals may
be exempt from testimonial compulsion.
The information or communication is said to be ‘privileged’ in this sense. Since most countries
do have constitutional provisions covering confidentiality of information shared with physicians,
states have developed privileged communication statutes to fill this void.
Under the statutes, the physician cannot be compelled to reveal in acourt of law information
received from a patient.
64
However, states have also identified certain types of information that physicians are legally
obligated to share with proper authorities – e.g. info on certain health conditions (primarily
communicable disease e.g. TB, STD), gunshot wounds, and suspected or clear physical or sexual
abuse of children.
Physicians may be sued for malpractice for wrongfully disclosing pertinent information under
one or more of three legal theories.
An authorized disclosure of confidential information
An invasion of privacy
A violation of an implied contract between physician and patient
Section VI.13 THE HEALTH AND ILLNESS CODES AND CONFIDENCIALITY
The principle of confidentiality has been firmly rooted in codes of medical ethics.
The classic reference to the importance of confidentiality occurs in the Hippocratic Oath – ‘what
I may see or hear in the course of the treatment or even outside of the treatment in regard to the
life of men, which on no account one must spread abroad, I will keep to myself holding such
things shameful to be spoken about’.
This statement is credited with influencing all subsequent efforts to note the ethical
responsibilities of physicians.
Today the ethical code for nearly every medical group includes some reference to confidentiality.
The AMA’s Code of Medical Ethics states that “The physician should not reveal confidential
communications or information without the express consent of the patients, unless required to do
so by law (1992).
Section VI.14 WHEN CONFIDENCIALITY BECOMES AN ISSUE
There are 3 situations in which medical confidentiality may be an issue

Accidental or not so accidental “slips of the tongue” that physicians commit when chatting with
family, friends, or colleagues.
Fortunately, most health care professionals are careful not to let information about patient slip,
though these “irresponsible” breaches do occur – often when inhibitions have been lowered by
exhaustion or too much alcohol.
Results from the increasingly large number of persons who have access to patient information
and data. More and more allied health workers have access to patients and patient records; and
more and more agencies, including public health agencies, 3rd-party payers, medical peer review
65
committees, employers, credit investigation agencies, social welfare agencies, and medical
researchers have a legal right to patient data.
The most intriguing ethical question and most difficult legal question occur in situations which
physicians must make a conscious decision about whether or not to violate confidentiality.
Section VI.15 ARGUMENTS USED TO JUSTIFY PRINSIPLES OF CONFIDENCIALITY
Sissela Bok, in Lying: Moral Choice in Public and Private Life (1879), summarized 4
justifications for physicians to protect the privacy of information shared by patients.
Protection of the patient’s autonomy over personal information

Enhancement of the physician-patient relationships
Respect for the patient Opportunity for the individuals to communicate more freely with the
physician.
Another rationale by Justice William P. Clark (1976) described 3 reasons why confidentiality
ought not to be broken.
Individuals needing treatment will be more likely to seek help

Individuals seeking assistance will be more likely to provide full disclose – unless of course if
they are Kenyans who are taught that to lie is a virtue!!– e.g. 18 year girl who says she has got
only one name, knows fathers only one name, does not know any of her relatives, does not know
home of origin, yet has completed school! etc… difficult to believe her.
Trust in the psychotherapist will be enhanced – maintaining confidentiality, rather than breaking
it, will minimize tragedies in the long run because those needing help will not be dissuaded from
seeking it.
Section VI.16 GROUNDS OF BREAKING CONFIDENCIALITY
Confidentiality can be broken for 3 compelling reasons.

Benefit to the patient himself. E.g. temporary depressed or traumatized individual who threatens
to commit suicide or to engage in some disreputable, out-of-character behavior.
To get assistance to prevent the action, the physician may need to break confidentiality and
disclose the stated intention of the person.
However, physicians must be sure that an action contemplated by a patient really is product of
irrational mind.
If confidentiality conflicts with the rights of an innocent 3rd party.

Question remains on whether the best way is to inform the innocent 3rd parties of impending
danger, even though that means a bleach of confidentiality.
Danger or threat to the rights or interests of society in general.
66
E.g. reporting of certain diseases to proper authorities e.g. detecting a serious medical condition
in a patient whose occupation influences the safety or lives of others e.g. epileptic airline pilot,
pilot with failing eyesight.
Section VI.17 RIGHTS VS DUTIES TO BREACH CONFIDENCIALITY
In certain situations where physicians have a ‘right’ to break confidentiality, can we necessarily
conclude that they have a ‘duty’ to do so?
Is this an obligation or moral responsibility?
Where serious harm is likely to occur (e.g. epileptic railroad signaler) – Bok (1982) argues that
the duty to warn in overriding.
Patients have no right to entrust this type of physicians and expect them to remain silent.
Also physicians have no right to promise confidentiality about such information.
In obligatory, it may compromise professional autonomy
Difficulties e.g. in determining which patients are serious about certain threats and the questions
about stated threats, and the questions about the required severity of threats (is a broken arm
sufficiently serious) make this requirement impossible for physicians.
Section VI.18 PATIENTS EXPECTATIONS TOWARDS CONFIDENCIALITY
Not much has been written on this.
Few studies showed general patients satisfaction on physicians conduct with regard to
confidentiality.
Physicians more likely to share information in the discussion of cases than patients realized
Research also suggests that certain patient characterizes influence likelihood of breaching
confidentiality
Section VI.19 OBLIGATION TO TREAT AIDS PATIENTS
In the short time that HIV/AIDS has become a global health concern, much attention has been
devoted to the complex ethical question related to the disease.
The ‘rights’ and the ‘moral duties’ of patients with HIV/AIDS and of physicians and other health
care providers who treat them, and of the companies which insure them all contain important
issues.
One of the questions raised is whether physicians have a professional obligation to treat AIDS
patients.
67
Section VI.20 PHYSICIANS PERCEPTIONS REGARDING OBLIGATION TO TREAT
Considerable evidence suggests that a sizeable percentage of physicians do not want to treat
AIDS patients and do not believe that they have a professional obligation to do so.
Studies done in New York (e.g. Somogyi et al, 1990) 62% of family physicians believed that
physicians have a right to refuse to care for a patient simply because he or she is infected with
the AIDS virus.
HISTORICAL PERSPECTIVE ON OBLIGATION TO TREAT PATIENTS
How did physicians in earlier times view the issue of obligation to treat contagious diseases?
In the early years, many physicians fled from patients with contagious diseases and cities with a
large disease population, but many others, often at considerable personal risk, remained to care
for these patients (Amundsen 1977).
Section VI.21 LAWS PERTAINING TO THE OBLIGATION TO TREAT
Several legal principles focus on the issue of treatment obligation.

American common law is firmly grounded on notions of individual liberty and economic
freedom that support the proposition that absent some special relationship; no citizen owes any
other citizen anything.
As applied to the practice of medicine, the general rule, sometimes denoted the ‘no duty rule’, is
that a physician is not obligated to treat any particular patient in the absence of a consensual
doctor-patient relationship.
In the absence of a prior agreement or a statutory or regulatory prohibition, physicians (like other
citizens) can, in deciding whether to accept patients, discriminate among them on the basis of all
sorts of irrelevant and invidious criteria: from race to religion, to personal appearance and
wealth, or by specific disease, like AIDS.
The special relationship referred to pertains to the obligation to treat of emergency room
physicians, physicians in consensual doctor-patient relationship, and physicians with a
contractual obligation (through health care institution or health plan)
Hippocratic Oath.
It is unclear as to whether this oath specifies any legal obligation to treat.

A line in the oath, “into whatsoever houses I enter, I will enter to help the sick” has been
interpreted by many to be stating a prescribed duty of physicians, one neither obligating, nor by
the assumption of personal risk..
Some contend that the line attaches only very loosely to ‘obligation to treat’ and does not offer
sufficient detail to clarify a complex matter like treating AIDS patients.
68
Section VI.22 RATIONAL FOR NO OBLIGATION TO TREAT
A key aspect of the “no obligation” position is that physicians ought to be free to select their
patients.
Part of the highly valued autonomy (freedom) in medicine lies in not being told which patients
must be seen.
Many physicians wish to exercise this freedom of selection by excluding AIDS patients.
Factors that are used as specific justifications for no obligation to treat AIDS patients include
Excessive risks. Many physicians are fearful of contracting HIV from patients – many more
afraid of contracting HIV than any other disease. Those who perceived the greatest risk were
most likely to believe in the no obligation position.
There is a feeling that physicians have overreacted to the possibility of risk given that the risk of
HIV infection and AIDS after a single accidental exposure to HIV at work is 0.5% (1 in 200) or
less (CDC, 1988).
Questionable benefits. Lack of long-term benefits in treating AIDS patients – after all he (she)
is going to die anyway, why bother? The argument is that physicians are not obligated to provide
unnecessary useless care, and some procedures (e.g. cosmetic surgery on a dying patient) hardly
could be said to be ethically obligatory
Obligations to other patients. It is argued that by treating AIDS patients, the physician risks
contracting AIDS, which would make it impossible for him/her to care for his/her other patients.
Moreover, other patients might discontinue their relationship with the physician when they learn
he or she is seeing AIDS patients – fear of losing patients
Obligation to self and family. Perception that the physicians medical care is not worth
jeopardizing the physicians life or health. This perception has been questioned on the ground that
this is a judgmental process about the relative value of the individuals involved. Could it because
most of the patients are likely to be gay or IDUs? – homophobic attitude i.e. “homosexuals who
contract AIDS are getting what they deserve”
Financial liability – that AIDS patients are financial risk to a practice, that they drive away
other patients, and that they create considerable legal liability.
Some physicians fear that they might unknowingly contract HIV and transmit it to their spouse
and/or children
Medical practitioners, philosophers, ethicists, lawmakers, and social scientists have reflected on
reasons why there may be an obligation to treat.
The nature of the profession. i.e. the inherent nature of the profession of medicine. Professions
represent special statuses involve more training and greater commitment than other careers and
69
are rooted in a special idea of service to others – objective of medical profession is devotion to a
moral ideal, in particular healing the sick and rendering the ill health and well.
Thus the physician is committed to help and betterment of other people selflessly caring for the
sick Profession is chosen but obligation is neither chosen nor transferable
The Social Contract. – Contract made between society and the medical profession. i.e.
physicians have an obligation to treat the sick and vulnerable in exchange from the near
monopolistic powers they have been given over the practice of medicine.
Thus, potential danger in doing so does not exempt the physician from fulfilling this obligation
The Dependent Patient. Physicians are linked to patients in ways that extend beyond an explicit
or implicit contract. i.e. that there is something unique about the physician-patient relationship.
It takes on a moral dimension especially in cases of dependent patient in need of the

profession’s services.
Section VI.23 Activity
In many societies medical doctors and traditional healers are accused of behaving unethically
towards the patients. List five types of behaviors and explain their causes.
As patients visit doctors and other health care professional what types of obligations should both
parties have towards each other
What role, if any, should empathy and compassion play in the care of patients in the emergency
department?
Section VI.24 Video link
https://stanfordconnects.stanford.edu/
https://www.youtube.com/watch?v=lMpkRFw0ZA0
https://www.youtube.com/watch?v=dzNKAXEAsqQ
Section VI.25 SUMMARY:
70
Have you ever asked yourself how you should behave or what obligations do you have during the
interactions with your doctor? Not many patients think about the two questions especially when they
have diseases or illnesses that require urgent attention.
In this lesson, we have defined the term ethics and explained to you that, in any patient –doctor
interactions the relationship should be built on mutual understanding that both parties have to behave
in a way that will not compromise that relationship.
Ethical behaviors must be observed. We have also explained that each party i e the patient and the
doctor have obligations that will make the interactions conducive and favorable. For example,
patients must listen to the doctor’s advice and try to follow instructions that will make the healing
process faster. On the other hand, doctors have an obligation to be objective and emotionally
detached( meaning the doctor should not judge patient behaviour in terms of personal value system or
become emotionally involved with them)
The lesson has discussed various ethical principles and value judgments that you will find useful in
your study
Section VI.26 Further Reading
Murphy, P., Cocohoba, J., Tang, A., Pietrandoni, G., Hou, J., & Guglielmo, B. J. (2012). Impact of
HIV-specialized pharmacies on adherence and persistence with antiretroviral therapy. AIDS patient
care and STDs, 26(9), 526-531.
Cappi, V. (2014). Guardare ma non toccare: lo sguardo del medico oltre lo schermo. Auscultazione
della pratica medica contemporanea.
Farin, E., Gramm, L., & Schmidt, E. (2013). The patient–physician relationship in patients with
chronic low back pain as a predictor of outcomes after rehabilitation. Journal of behavioral
medicine, 36(3), 246-258.
71
LESSON VII. GOVERNMENT POLICY IN HEALTH CARE SYSTEM
72
Section VII.01 Introduction:
Student should note that Kenya government has a comprehensive health policy
which are been implemented by the two level of government: national government and devolved
government this policies are comprehensive and innovative in order to deal with emerging trends
of infectious and non- communicable disease.
The Kenya health policy 2012-2030 and 2014-2030 are derived from the new constitution of
Kenya 2030 are vision 2030 and other global commitment. The information regarding health
policies are critical for student taking this course for further readings see the information below
1. (Kenya development plan 2005-2012-2017 , Kenya constitution 2010 and vision 2030)
2. WHO (2013a). Position Statement: Health in All Policies in the African Region.
Brazzaville, Regional Office for Africa.(
www.afro.who.int/sites/default/files/2017-06/hiap-report-africa-region.pdf)
Section VII.02 LESSON OBJECTIVES

1. Understand health policy as a strategy for health
2. Explain different type of Kenya government health policies available
3. Describe Kenyan government health policies direction according to constitution 2010 and
vision 2030
Section VII.03 What is health policy?
73
Health services in every society or the country is a very important determinant of an improved
economy. Health people have a higher level of productivity and they live and work longer
especially where the government has a well developed healthcare system.
Kenya like any other developuing country has an elaborate health policy that cuts across
different social classes.however, before discussing the health policy strategies, types, and how
they are implemented let us define the term health policy.
According to WHO (2017) Health policy refers to decisions, plans, and actions that are
undertaken to achieve specific health care goals within a society. An explicit health policy can
achieve several things: it defines a vision for the future which in turn helps to establish targets
and points of reference for the short and medium term. It outlines priorities and the expected
roles of different groups; and it builds consensus and informs people.
This definition fits well with what the Kenyan government has been striving to give to its people.
The country’s health policy is well documented in the Kenyan constitution of 2010 with a more
elaborate plan of action explained in vision 2014/2030.
There are different types of policies available in Kenya. This includes HIV, maternal mortality
and mobility;child health care policy; public and private health insurance policies; mental health
policy. These are just some of the policies available to Kenyan public (for further information
read 2010 constitution and vision 2014 /2030).
Vision 2030 and various Kenya government development plan strategy document have well
documented information regarding health policy. It is therefore important for student to be
familiar with the document and try to understand the positive impact health policies in the Kenya
have on the population: reduction of maternal death; Hiv/Aids; improvement in child care;
mental patients and the elderly through improved national health insurance services.
However, there has been strong government incentives to educate and encourage Kenyan
population on the need to use available policies for their own benefit for example child
immunization, free maternity and other reproductive health policies; the elderly and disable
persons, health support and revised national insurance service and others of its kind that has been
made cheaper and easy to access for the majority of the population.
Section VII.04 Activity

Describe the main functions of public health related to population health assessment, health
surveillance, disease and injury prevention, health promotion and health protection.
74
Section VII.05 LESSON SUMMARY
Systems developed within organization are meant to achieve specific goals through
various strategies that are suitable for a particular organization or society. Health
systems are developed according to the needs and expectations of the members of
society. People look at their conditions and discuss how best this condition can be
improved. These discussions create policies or what we call statement of purpose that
is developed by the government. these policies are expected to help individual in
society to have an access to various services offered by the government. Health
policies articulate what the government what to do, how to do it for who and why. We
have explained in this lesson health policies that are available for Kenyans as they seek
affordable health services. Such health policies include maternal health care policy,
child care policy, people with disability policy and etc
Section VII.06 Video link
https://www.youtube.com/watch?v=yN-MkRcOJjY
http://thefilmarchive.org/
http://www.khanacademy.org/video?v=LMHxxvbzFqc.
75
Section VII.07 Further Reading
Andersen, R. M., Rice, T. H., & Kominski, G. F. (2011). Changing the US health care system: Key issues
in health services policy and management. John Wiley & Sons.
Francesca, C., Ana, L. N., Jérôme, M., & Frits, T. (2011). OECD health policy studies help wanted?
Providing and paying for long-term care: providing and paying for long-term care (Vol. 2011). OECD
Publishing.
Shortliffe, E. H., & Cimino, J. J. (Eds.). (2013). Biomedical informatics: computer applications in health
care and biomedicine. Springer Science & Business Media.
Berendes, S., Heywood, P., Oliver, S., & Garner, P. (2011). Quality of private and public ambulatory health
care in low and middle income countries: systematic review of comparative studies. PLoS medicine, 8(4),
e1000433.
76
Section VII.08 GLOSSARY
Socialization- is the process through which a person, from birth through death, is taught the norms, customs,
values, and roles of the society in which they live.
Social change- as population grows and developed many activity takes place that requires adjustment e.g. in
every society division of labour, different types of education system and development of various religious
organization are of the results of social change the need to acquire knowledge influences the type of changes
that people want all social institution go through social changes that are necessary to accommodate individual
and groups as they seek better lifestyle.
Behaviour- from a sociological perspectives behaviour imply action that are visible such manner of dressing,
eating, greetings and any other social actions (durkheim) behaviour is relative and it is a part of specific
community culture.
Disease: various scholars in sociology of health and illness explains that peoples definitions concerning health
illness and diseases are socially determined.
Illness -when illness occurs, patterns of everyday are temporarily modified and interactions with others become
modified.
Medicalization- is the process that defines a condition or activity as a disease or an illness; treatment of the
conditions is then considered the responsibility of the medical professional.
Epidemiology- is the study of how often diseases occur in different groups of people and why.
Wellness- is a process of periodically assessing risk factors and providing information, behaviour change
strategies and individual or group counselling that ultimately leads to the adoptions of a wellness lifestyle.
Determinants of health -is a term that explains the range of personal, social, economic and environmental
factors which determine the health status of individuals or populations. (who, 1998).
Equity- a world in which any group of individuals defined by age, gender, race-ethnicity, class or residence
can achieve its full health potential
Confidentiality – is the preservation of secret information concerning the client which is disclosed in the
professional relationship.
Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals
within a society.
77
Section VII.09 SELF TEST QUESTIONS
Q1. One of the objectives of this course is to explain the relationships’ between diseases, illnesses
and sickness and the status of the people in a country like Kenya. Elaborate with examples
Q2. Discuss classical sociologists’ contribution in the field of medical sociology. Limit your answers
in the three prominent sociologists.
Q3. Distinguish medicalization of society from social epidemiology? Use specific cases to illustrate
your answers.
Q4. Modernization process has increased the utilization of modern medicine in the population
worldwide. However the use of alternative medicine is still very popular. What factors are
influencing this popularity?
Q5. Discuss five types of disease that are rise in Kenya. What is attributing to this rise?
Q6. Most diseases and illness are said to be socially constructed. How would you explain this
statement? Does social constructed also include cultural construction?
Q7. Discuss any case that you are familiar with that is known to have infringed on the right of a
patient? What should the government do to medicine practitioners who behave unethically in their
profession?
Q8. Many cases of strange disease are being reported and sometimes not reported by those affected
in remote part of Africa including Kenya. There are some arguments that both medicalization and
demedicalization have played parts in influencing these attitudes. Discuss.
Q9. What factors lead to the development and growth of medical sociology? Why was there a
resistance to accept social explanation of disease and illness?
Q10. Discuss one theory of health and illness. How does this theory explain the implications of HIV
and AIDS and one of the reproductive diseases?
Q11. Discuss the implication of Karl marks theory of health system in Kenyan society
Q12. Explain how sociological studies have helped you to acquire knowledge on disease, illness and
personal hygiene
Q13. Explain five social/cultural factors that determine gender inequality in access to health care in
Kenya. What should the Kenya government do to minimize gender inequality in health sector?
Multiple choices
78
Multiple Choice/ Section
Services Research: Past Accomplishments and Future Policy Challenges,” which of the following is
true?
A. Health disparities are primarily a consequence of access to health services.
B. Health disparities are likely more a consequence of determinants of health and illness than of access to
health services.
C. Increased use of medical technology will reduce health disparities over time.
D. To improve health outcomes for the population as a whole, it is important for the government to
reduce regulation on delivery of health services. E. In health services delivery, quality of care is
determined almost entirely by which services are provided.
2. In their essay on “Income Inequality and Social Dysfunction,” Richard Wilkinson and Kate Pickett
propose that socioeconomic status and health are related such that: ‘
A. In both developing and industrialized nations, socioeconomic status is closely associated with physical
health.
B. In industrialized nations, improvements in a nation's socioeconomic status (as measured by per capita
GDP) typically result in significantly increased overall population health.
C. In industrialized nations, overall population health is related to how equitably resources are distributed
among members of that population.
D. A and B above E. A and C above
Q3. When considering the field of Sociology of health and illness(referred to by various names, including
the Sociology of Health, Illness, and Health Care) which of the following is true?
A. The discipline of Sociology has, from the beginning, embraced an examination of health and
medicine.
B. Early medical sociologists typically carried out studies that addressed questions for which physicians
and/or health organizations wanted answers.
C. Medical sociologists have always questioned the assumptions of physicians and the organized health
care system.
Q4. Which of the following is true of an “upstream” approach to health?
A. It places major responsibility for health in the hands of each individual and his or her choices
B. It is the approach to health care typically followed by health care practitioners in the United States
today.
C. It includes a recognition that health is primarily a result of the amount and quality of health care a
person receives.
D. All of the above E. None of the above
79
Q1. According to Eric Wright and Brea Perry, in “Sociology of health and illnessand Health
Q5. Over time, which of the following has had the greatest impact on improving the overall health
of a population?
A. Development of new medical technology
B. Community/Public Health vaccination programs
C. Improvement in social conditions D. An integrated health care delivery system E. Development

of new drugs and treatment procedures
Q6. Which of the following is true of the history of health care reform in the United States?
A. All proposed plans for health care reform have focused on universal coverage for U.S. citizens
B. President Obama is the first sitting American president to take up the issue of health care
reform.
C. One aspect of every proposed plan has been an attempt to curve the rising costs of health care.
D. the entire above E. None of the above
Q7. According to Otis Brawley in his book, How We Do Harm, which of the following is true of
health care and the health care system in the United States?
A. To improve overall health outcomes, the U.S. health care system needs to focus more attention
on providing responsive acute care.
B. Since each patient is unique, to reduce harm in the system, providers need to pay more attention
to their clinical experience and focus less on statistical findings.
C. Our health care system produces many bad outcomes at both ends of the socioeconomic
spectrum, due in large part to overtreatment of those who are rich or who have good health
coverage and to under-treatment of those who are poor.
D. A and B above E. All of the above
Q8. With regard to the impact of “race” and health in the United States, which of the following is
true?
A. Minorities get sick at younger ages and die sooner than do whites.
B. The determinants of poorer health among blacks when compared to whites are many
and complex, and research demonstrates that discrimination and racism contribute to this relatively
poorer health.
C. While there are significant differences in morbidity and mortality between races, nearly all of
these differences are due to the relationship between race and socioeconomic status.
Q9. According to Amartya Sen in “Equality of What,” which of the following is true?
A. When considering equality, one must focus on/identify the space in which equality is desirable
(that is, one must focus on what type of equality is most desired).
B. Equality in one area will consequently result in inequalities in other areas.

80
C. Every theory of distributive justice justifies certain types of inequities.
D. A and B above E. All of the above
Q10. Which of the following is true of health, illness, and health care in developing nations?
A. Since most developing countries have successfully addressed the issue of malnutrition, the
current health challenge that needs to be addressed is to ensure access to clean drinking water. B.
The patterns of illness found in the least developed nations are similar to those found in the
United States and Europe before the 20th century.
C. The structural adjustment policies of organizations such as the International Monetary
Fund and the World Bank have contributed to overall improvement of health in developing
nations.
D. B and C above E. All of the above
Q11. According to guest speaker, Dr. Marty Fenstersheib, which of the following contributes the
most to health?
A. Biology and Genetics
B. Clinical Care
C. Health Behaviors
D. Social and Economic Factors
E. The Physical Environment
Q12. Which of the following is true of sociological imagination?

A. It is human insight as applied to social institutions, including medicine.
B. It is the ability to find solutions to social problems through imagination.
C. It allows for an understanding of the connections between personal experiences and larger
social patterns.
D. It is the ability to make sense of human experience through the use of scientific principles and
analytic insight. E. All of the above
Q13. According to the CDC, in 2012, there were 210,828 people in the United States diagnosed
with lung cancer.
This number represents that year’s:
A. incidence of lung cancer
B. indicator of lung cancer
C. morbidity of lung cancer
D. mortality of lung cancer
E. prevalence of lung cancer
Q14. In the United States, which of the following is true?

A. While women have higher rates of mortality, men have higher rates of morbidity.
B. Those of lower socioeconomic status have less access to health preserving resources than their
higher socioeconomic counterparts and therefore have less favorable overall health outcomes.
C. Those in the higher socioeconomic gradients have greater morbidity but lower mortality than
their lower socioeconomic counterparts.
D. Of all “races”/ethnicities, Native Americans have the shortest life expectancies.
81
E. Compared with other industrialized countries, the U.S. rate of infant mortality is low.
Q15. Which of the following is true of illness symptoms?
A. They are clinical indications of illness that can be directly observed by physicians. B. They
include swelling, temperature abnormalities, and blood in the urine.
C. They include headaches, back pain and stomach cramps.
D. A and B above.
E. All of the above.
Q16. Explain 5 ways that race, class, and gender affect health
Q17. Discuss how health and illness are shaped by cultural and social factors
Q18. Explain the social and cultural differences in the distribution of disease
Q19. What is the relationship between traditional medicine and complementary and alternative
medicine (CAM)
Sample questions for Introduction to Epidemiology
Note: Questions can be multiple choice (indicate the one correct answer) or multiple response
(squares  indicate all answers that are correct).
Q20. To be causally associated with disease, the etiological factor should fulfill the following
criteria:
Indicate all that apply.
 The factor is present in all subjects with the disease.

 Elimination of the factor reduces risk of the disease.
 The exposure to this factor should precede the development of the disease.
 The factor is more prevalent among those with the disease than among those without the
disease.
Q21. At the start of a cohort study the exposure is determined with the help of a questionnaire.
During the study there is no "loss to follow-up". At the end of the follow-up time the number of
cases is known and is divided into exposed and unexposed. The odds ratio (OR) is used as the
association measure. Which comment is the most appropriate here?
Researchers should have better calculated the risk ratio (=incidence proportion ratio).
The OR has no useful interpretation.
Researchers should have better calculated the incidence rate ratio.
The OR approaches the incidence rate ratio.
Q22. During a study of 20 years five people are followed to measure the occurrence of upper
respiratory tract infection. As this infection can occur more than once, all disease events are
included in this study.
1 person is lost to follow-up after 1.5 years.
2 persons died respectively after 10 and 15 years from a different cause.
1 person got the first respiratory tract infection after seven years and the second infection after 12
years of follow-up. Both infections take half a year of recovery. This person is followed-up until
the end of the study.
One person is followed-up the whole period without occurrence of disease.
82
What is de incidence rate in this study ?
0.06 per person-year
Q23. An epidemiologist in Tanzania wants to study the efficacy of iron supplementation for the
prevention of HIV infection. He wants to make sure that only subjects who are (still) free of HIV
infection are enrolled in his trial. Therefore, he screens a large group of people using a diagnostic
test. Based on the outcome of the test, he decides who could participate in his iron
supplementation trial.For this purpose, it is very important that the diagnostic test has a high...
sensitivity
positive predictive value
specificity
negative predictive value
Q24. An epidemiologist performed a double-blind, randomized, placebo-controlled trial to

examine the effect of fish oil supplementation on memory complaints. In the group that received
fish oil, 19% of the participants forgot to take their daily supplements during the study whereas
this was only 3% in the placebo group. Is this a problem?
Yes, because this affects the external validity of the study.
Yes, because the study outcome can be biased.
No, because participants and investigators were blinded towards the type of treatment in both
groups
No, because all confounders were equally distributed over both groups due to randomization
Q25. An epidemiologist wants to assess the effect of tea drinking on blood pressure. He decides
to do an intervention study.
Which of the following measures does not increase the internal validity of the study?
Careful monitoring of blood pressure during the study
Inclusion of a control group
Randomization
Random selection of participants from the general population
Q26. Explain types of health policies for children, women and men in Kenya. What are the three
challenges that the government face in implementing these challenges.
Q27. What factors lead to the development and growth of medical sociology? Why was there a
resistance to accept social explanation of disease and illness? (10 marks)
Q28. Discuss the implication of Karl marks theory of health system in Kenyan society
Q29. What Is Gender Role? How Does Gender Role Influence Stress. (Be Specific on the Role
and How Women and Men Suffer From Stress Separately)
Q30. The process of urbanization creates opportunities for urban diseases. Mention 5 types of
unban diseases and explain their distribution channels.
83
84

ASC 327 - MODULE Feb 18th 2024 Sent To Mary Douglass

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

ASC 327 - MODULE Feb 18th 2024 Sent To Mary Douglass

Uploaded by

Copyright:

Available Formats

KENYATTA UNIVERSITY

DIGITAL SCHOOL OF OPEN DISTANCE LEARNING

DR FRANCIS P. KERRE DEPARTMENT SOCIOLOGY

DR. G. MORAA DEPARTMENT OF SOCIOLOGY

Cheating and Plagiarism:

Section I.01 Introduction

Section I.02 LESSON OBJECTIVES

At the end of lesson the learner will be able to:

Section I.03 SOCIOLOGY AS THE SCIENCE OF THE STUDY OF SOCIETY

This subsection has explained the importance of studying sociology.

Section I.04 Activity

Section I.05 SOME MAJOR CONCEPTS IN SOCIOLOGY

Section I.06 SOCIETY

Section I.07 Types of Social Groups.

There are two major types of groups

Section I.08 Socialization

The process of Socialization occurs in two stages.

Section I.09 Social structure

Section I.10 Behaviour

Section I.11 Activity

Sociology and Science

Section I.13 SOME FOUNDING FATHERS

Auguste Comte (1798 - 1857)

Emile Durkheim (1858-1917)

He distinguished between two kinds of solidarity: 'mechanical solidarity' based on common

Max Weber (1864-1920)

Karl Marx (1818-1883)

Herbert Spencer (1820-1903)

Section I.14 SUMMARY:

Section I.16 VIDEO LINK

Section I.17 REFERENCE

For further readings see the information below

Section II.01 INTRODUCTION:

Section II.02 OBJCTIVES OF THE LESSON

By the end of this lecture students should be able to:

3. Describe the emergency of sociology of health and illness

Section II.03 SOCIOLOGY OF HEALTH AND ILLNESS

The multifaceted view of health encompasses the following dimensions: -Physical,Mental,Social

Section II.05 DISEASE:

From the above, there are two perceptions about disease.

Diseases can be grouped as: -

Communicable Diseases – [infectious

Communicable diseases have got some common characteristics: -

Some cause widespread outbreaks of disease, that is, epidemics.

Non-communicable Diseases – [non-infectious.

Section II.06 ILLNESS

Illness has got both personal and public dimensions.

Stages of illness experience

Section II.07 WHAT IS MEDICALIZATION?

Medicalization is the process that defines a condition or activity as a disease or an illness;

Section II.08 TRADITIONAL HEALING AND TRADITIONAL HEALERS

Section II.09 EPIDEMIOLOGY

Sociological imagination on health and illness

Section II.10 WELLNESS

Section II.11 Social factors of health and illness

Increasingly complex structure of the health system

Section II.12 Activity

Section II.13 SUMMARY

Section II.14 Video links

Section II.15 Further Readings

LESSON III. THEORIES AND MODELS OF HEALTH AND ILLNESS

Section III.02 Lesson Objectives: