Health and illness

The World Health Organization

(WHO) defined health
as a state of complete physical,
mental, and social well-being,
and not merely the absence of
disease or infirmity.
Most people define and describe
health as the following:

Being free from symptoms of disease and

pain as much as possible.
Being able to be active and to do what
they want or must.
Being in good spirits most of the time.
Illness and Disease

Illness
Highly personal state
Diminished functioning

Disease
Alteration in body functions
Results in reduction of capacities
Shortening of normal life span
Classifications of Illness

Acute
Severe symtpoms
Relatively short duration

Chronic
Lasts for 6 months or longer
Illness Behaviors

Coping mechanisms
Involves ways individuals:
Describe, monitor and interpret symptoms
Effects of Illness on
Client and Family
Brings change
Behavioral and emotional
Self-concept and body image
Lifestyle

Loss of autonomy
Change in lifestyle
Variables Influencing Health

Biologic dimension
Genetic makeup
Gender
Age
Developmental level
Infants
Toddlers
Adolescents
Older adults
Psychologic Dimension

Mind-body interactions affect health status

Increase susceptibility to organic disease
Precipitate organic disease

Mind’s ability to direct body’s functioning

Emotional reactions occur in response
Self-concept affects how we handle situations
Cognitive Dimension

Intellectual factors influencing health

Lifestyle
Living conditions
Patterns of behavior
Risk factors
Healthy lifestyle choices

Spiritual and religious beliefs

Jehovah’s Witnesses and blood transfusions
Jews perform circumcision on 8th day of life
Factors influencing health status, beliefs, and practices:

Internal factors
External factors
1. Internal factors
Biologic dimension genetic makeup, sex, age,
and developmental level all significantly
influence a person's health.
Psychological dimension emotional factors
influencing health include mind-body
interactions and self-concept.
Cognitive dimension include lifestyle choices
and spiritual and religious beliefs.
2. External factors

Environment.
Standards of living. Reflecting occupation, income,
and education.
Family and cultural beliefs. Patterns of daily living
and lifestyle to offspring( children).
Social support networks. Family, friends, or
confidant (best friend) and job satisfaction helps
people avoid illness.
Public Policy & Intervention
• Classic definition:

– Absence of disease

• World Health Organisation definition

– "health is (…) a state of complete

physical, mental and social well-being and not merely the
absence of disease or infirmity“
• http://www.who.int/about/en/
 Sociological Approaches
• Health and illness is not just natural or biological

• Health and illnesses are shaped, distributed and

understood in relation to social factors

• Relationship between social structures (class, gender,

ethnicity etc) and health
• Biological/genetic factors are always shaped by the
social circumstances

• Poverty creates illness rather than sick people become

poor

• Unhealthy ‘lifestyles’ are shaped

by economic and social circumstances
Problems of definition

Defining terms always problematic for social scientists

a number of definitions of healthy and unhealthy or ‘normal’ and
‘pathological’ states,
definitions vary between academic, professional and popular or ‘lay’
accounts
also vary widely within and between disciplines.
biological explanations differ from social constructionist accounts
little agreement on the root causes and material conditions of illness.
best way to approach questions on health and illness is to use a multi
perspective approach
Health is a relative concept

‘Good health may mean different things to an astronaut and a

fashion model, to a lumberjack and a member of the stock
exchange....’. (Dubos & Pines. 1980)
Blaxter (1983, 1990)

In her studies, she noted that most people would define health as the
absence of disease.
There were however variations amongst age groups.

Younger men = strength Older men = mental well-

being
Younger women = vitality and Older women = contentment
ability to cope
The social construction of Health

Social institutions and social norms, attitudes, values, behaviour and

beliefs are socially produced rather than naturally given or
determined

Sexuality and gender differences, illness, health and physical

strength are all social states/ behaviours/ codes etc that are products
of culture not biology.
 The social construction of Health
The concepts of both health and illness vary across time and culture
Culture to Culture

•Western Culture and obesity - a sign of ill-health thus socially

undesirable

•In non-Western cultures -a sign of affluence thus socially desirable

Time, space, place and context

All concepts professional, academic and lay concepts are also

culturally and historically specific.
They vary from culture to culture and across time.
Western Culture and obesity - a sign of ill-health thus socially
undesirable
In non-Western cultures -a sign of affluence thus socially desirable
Change over Time
Epilepsy in the Middle Ages was viewed as a violent possession
by malevolent or even divine forces.

Early part of the 20th century epilepsy linked with insanity.

Today we ‘know’ that epilepsy is caused by abnormal neurological

activity that occurs as a result of damage or injury to the brain

However what we ‘know’ is subject to reinterpretation.

Disease and illness

The terms disease and illness are conceptually distinct:

a) disease is something an organ has:

b) Illness refer to the experience of disease and as such deals with the
subjective experiences of bodily disorder and feelings of pain and
discomfort ( the human experience of sickness).

In contrast, the term disease suggests a biologically altered state

whereas illness relates to the diffuse con sequences of the disease
process .
sociology of health and illness

the relationship between sociology and questions of health and illness

as a two-way road:

i) the task is to fit health and illness as social phenomena into existing
theoretical and explanatory frameworks of sociology, or
ii) the task is to create apt sociological concepts and theories for
grasping health and illness as social phenomena
Advantages of distinguishing
between disease and illness
Recognition that will clear acknowledgement of the fact that physical
impairment can have implications for social life of an individual.

Definitions can vary over time and between individuals, groups and
culture within same society at any one time.
Help to produce a better understanding of individual and societal
response .
The modern social model of
health
Basic assumptions:

(1) a human being must not be taken as a mechanistic combination of

biophysical functions but as an organistic whole, in which the sum
counts for more than its parts

(2) social factors do not affect a human’s health from ”outside” but partly
constitute her/him and her/his healt
Lay Definition of health

Health absent of disease

Illness refer to the experiential aspect of bodily disorder and socio cultural
factors.
The study of illness behavior focuses on how individuals perceive, evaluate
and react to symptoms. Some people consult a doctor when they feel unwell,
while others with the same symptoms do not.
Studies of health in families suggest that women are a major source of
advice and support in families and the responsibility for health care is
assigned to women.
 Sociological Approaches
• Medical knowledge is not just ‘scientific facts’

• It develops in relation to wider society

• The power relationship between health professionals and ‘patients’

impacts on individuals health
Social stigma

If health professionals want to maximize

the well being of the people they treat,
they must address stigma as separate
and important factors in its own right ( Link
et al, 1977).
Goffman (1968) identifies three types of
stigma:
Physical deformities
Blemishes of individual character
Tribal stigma of race, nation, and religion.
Social stigma

1-Health care workers need to appreciate

that coping with the social stigma can in
some circumstances be more difficult than
coping with the illness.
2- Some illness labels are more
stigmatizing that others: this may be a
result of:
A- The visibility of the symptoms,
B- the level of public ignorance
surrounding the nature of the illness
Epilepsy: a stigmatized condition
Early part of the 20th century epilepsy
linked with insanity.
Today we ‘know’ that epilepsy caused by
abnormal neurological activity that occurs
as a result of damage or injury to the
brain.
However what we ‘know’ is subject to
reinterpretation.
HIV infection and AIDS

Individual with HIV and AIDS are

stigmatised because their illness is:
1- Seen as both a product and producer of
deviant behaviour
2-viwed as the responsibility of the
individual.
Perceived as a threat to the community
Not very well understood by the lay
community and viewed in a negative light
by professional health care workers.
 Illness Behavior and
Perceptions of
Illness
Illness
 What is illness? How do people
determine when they are ill?
 What do people do (illness behavior) when
they feel ill? What variables affect a
person’s illness behavior? Who do they turn
to for help?
 What factors are involved in the decision to
seek a health professional?
 What others will give us when we’re sick, and
what is expected out of us when we’re sick
How do people determine when
they’re ill?
 Illness is a condition of pronounced deviation
from the normal healthy state
 Illness is a subjective experience

 When do patients report illness?

 When they’re unable to engage in day-to-day
activities
 When they have decreased stamina
 When they feel pain, nausea, fatigue
 When they just don’t feel well
(DiMattteo & Martin,
Illness Behavior
 What do you do when you feel ill?
 Most people do not consult a doctor or a

health professional when they first feel

ill

 When and why do people seek

professional attention?
Illness Behavior
 Biological  The situation
predisposition  Access to health
 Nature of care
symptomatology  Availability of
 Learned patterns of secondary benefits
response (i.e., decreased
 Attribution responsibilities)

(Mechanic, 1995)
Illness Behavior
 Illnessbehavior is described as the state
when the individual feels ill and behaves in a
particular way

 Illness is a psychological concept:

 It has different meanings for different people
 It’s based upon an individual’s personal
evaluation of his/her bodily state and ability to
function
 Current paradox
 Americans are objectively healthier than they
use to be
 However, Americans report feeling worse

(DiMatteo & Martin,

2002)
Illness
 Often it is difficult to decide objectively
whether someone is ill or not
 Some suggest using scales that define illness
based on a total score of symptoms
 However, illness is a relative concept, and
is often functionally based

 Let’s
return to your thoughts on how you
know when your ill…
Symptoms
 Illnessis recognized because of the presence
of symptoms, either physical or mental

 People respond to symptoms in a variety of

ways including dismissing, ignoring, denying,
and/or maximizing their symptoms

 Ifwe experience unusual symptoms, which

are severe enough, we may feel that we are
ill and then behave in certain ways
Symptoms
 Illnessis recognized because of the presence
of symptoms
 Recognition of symptoms can be
affected by a patient's beliefs
and expectations
 Pennebaker and Skelton, 1981
 Anderson and Pennebaker, 1980
Pennebaker and Skelton, 1981
 Three groups
1. Participants were told that ultrasonic noise
may cause an increase in skin temperature
2. Participants were told that ultrasonic noise
may cause an decrease in skin temperature
3. Control group – did not receive any research
expectations
 Next participants were exposed to a tape of
‘ultrasonic noise’

 Results? Implications?
(DiClemente & Raczynski, 1999, p.
85)
Anderson and Pennebaker, 1980
 Participants placed their fingers on vibrating
sandpaper
 Group 1: expect pain
 Group 2: expect pleasant sensation

 Dependent variable
 Participants rated the pleasantness or
painfulness of the sandpaper experience

 Results?
(DiClemente & Raczynski, 1999,
p. 85)
 Symptoms

 Patient recognition of a symptom depends on

the cognitive schemata that the patient has of
the symptom
 The more we know, the more our awareness
of symptoms – diagnoses increase

 Health professionals themselves may be very

aware of physical symptoms and this may
contribute to professional stress
Symptom Reporting
 When do people decide it’s time to report
their symptoms?

 People do not necessarily report all of their

symptoms and certainly choose to whom they
report them
Symptom Reporting
 Factors that influence symptom
reporting:
 Number and persistence of
symptoms
 Extent of the social and physical disability
resulting from the symptoms
 Recognition and identification of the
symptom
 Perceived severity of the symptoms


culture
Cultural Influences on Illness
Behavior
 There are many cultural and demographic
influences on health and these affect illness
behavior

 ConsiderChinese traditional medicine with

Western medicine
Cultural Influences
 Chinese traditional medicine is based on the
forces of Yin and Yang and the interaction
of the five elements (metal, water, wood,
fire, and earth)
 Traditional Chinese doctors look to balance
the Yin and Yang by the use of acupuncture,
Chinese herbs, and massage

 Thiscontrasts with Western medicine which

uses drugs or surgery to treat symptoms
 Cultural Influences
 Culture and the cancer pain experience
 Taoism: Pain results when Qi is blocked.
Pain relief comes via removing the blockage and
living in harmony with the universe
 Buddhism: Pain is suffering; suffering is
relieved by following the 8 right ways (i.e., right
view, right intention, right speech, right action, right
livelihood, right effort, right mindfulness, and right
concentration)
 Confucian: Pain is an essential element
of life; hence, endurance is the key
(Chen, Dodd, & Pantilat,
2008)
Sociological and Demographic
Influences on Illness Behavior

 More illness is found in community surveys in

lower socio-economic groups

 However, people in higher socio-economic

groups are more likely to seek health care

 Older people consult their doctor less than

younger people do in relation to their level of
illness
Illness Representation
 Symptom recognition is not necessarily
enough to make people think that they are ill

 Symptoms on their own have no meaning

and are merely bodily sensations
 Different symptoms will be accounted for in
different ways

 Consider the symptom of a backache

Illness Representation
 Illness
representation will determine how
someone responds to potential health
threats
 Illness representation includes:
 Information about the illness
 Itssymptoms
 Possible causes
 Likely time course
 Potential consequences
Illness Representation

 Illness
representations interpret symptoms
and give them meaning

 The course of action taken will be

determined by the
representation
Symptoms
 Symptoms may also suggest the course of
the illness
 So, if symptoms disappear does this mean
the illness is over?

 If they are tightly joined to one another, then

if the symptoms improve, the illness may be
thought to have gotten better and the person
may stop treatment
Symptoms
 There is an asymmetrical relationship
between symptoms and the diagnostic
label:
 People with symptoms seek a diagnostic
label
 People given a diagnosis seek
symptoms

 Havingrecognized that they have

symptoms, what do people do?
Self Medication
 An Australian study evaluated the
actions taken by 360 people who had
minor symptoms or condition in the
previous two weeks
 Their actions included using:
 Left over prescription medicines
 Home remedies
 Over-the-counter medicines

(Wilkinson et al.,
1987)
Self Medication
 Elderly people were found to be twice as
likely to treat a minor illness with an over the
counter medication than any other option
 Because drugs are available without a
prescription, they may be thought to be
harmless
 Poly-pharmacy among elderly people is
very common and prescribed drugs may be
taken in combination with over the counter
medicines and the combination may change
their effectiveness
Self Medication
 The
practice of taking over the counter
medicines may begin in early adulthood
 Headaches are common in all age groups
 In a study of adolescents, it was found that
most of them used medication to cope
with headaches
Self Medication
 Self-medication is extremely common
 It has been suggested that those who
take non-prescription medicine may be
less likely to consult doctors
Parson (1951) Sick role

Parson (1951) developed the concept of

the sick role to draw attention to the fact
that illness is not purely a biological state
but has a social dimension.

That social expectations that are to applied

to the sick

According to Parson the sick role consists

persons’ sick role

1- The sick person is exempt from the

normal social roles that the person takes
for the duration of the illness.
2- sick persons are not responsible for
their illnesses.

3-the sick person has the duty to get well

4- the sick person must seek competent

technical help and cooperate with
 The ‘sick role’
• People could adopt the ‘sick role’ to opt out of social obligations
• So the ‘sick role’ can only be verified by a competent professional
• But fails to explain
• chronic illness
• those held responsible for their illness
• the impact of professional power
• patient rejection of the sick role
The Sick Role
 The sick role – any activity undertaken
for the purpose of getting well by those
who consider themselves ill

 This is a social role

 A patient who enters the sick role has both
rights and obligations
 There are positives and negatives to the sick
role
 The Sick Role
 Advantages  Disadvantages
 Exempt from many  Behaviors are
daily activities scrutinized
 Able to rest and be  Others may view
taken care of behaviors as
 Social support illegitimate attempt to
 Meaning gain advantages
 Confusion, discomfort,
 Workers
compensation, decreased
disability functioning, and
distress
The Sick Role
 People are not expected to will themselves
better by effort, and the illness is not
considered to be their fault
 However, the symptoms must be recognized
by others
 Sick people are expected to want to get
better
 They are also expected to seek professional
help if needed and to comply with health
recommendations
The Sick Role
 The (societal) obligations:
 The person’s symptoms must correspond
with a diagnosis recognized by society
 There must be overt symptoms before others
will recognize the illness
 The patient must accept the sick role, and is
expected to take steps to get well
The Sick Role—more (societal)
obligations
 Sick people are expected to remain
optimistic and cheerful and not display
distress

 Not everyone is willing to act sick and

some people may conceal their symptoms
to avoid becoming dependent
 In some conditions this is seen as desirable
The Sick Role
 Most believe being ill is temporary and in most
cases, this is true
 Chronic diseases bring about different
responsibilities and the person cannot stay in
the sick role forever
 Most people have symptoms of one sort or
another at any one time, but whether or not
they enter the sick role may be only
loosely related to the severity or
persistence of symptoms
Impact of Illness

On the Client On the Family

Behavioral and emotional Depends on:
changes Member of the family who is
Loss of autonomy ill
Seriousness and length of
Self-concept and body
the illness
image changes Cultural and social customs
Lifestyle changes the family follows
 Impact of Illness: Family Changes

Role changes
Task reassignments
Increased demands on time
Anxiety about outcomes
Conflict about unaccustomed responsibilities
Financial problems
Loneliness as a result of separation and pending
loss
Change in social customs