SOCIOLOGY IN HEALTH
According to World Health Organization, health can be considered as a state of complete physical, mental and social well being of a person and not the mere absence of disease or infirmity. This means that the definition of health takes a holistic approach in that it does not assess health in terms of diseases or infirmity alone. This arises from the fact that there are many factors that determine the health status of a person. The well being of an individual is contributed by many integrating factors. The medical definition of health may be more leaned to presence or absence of a disease condition but the social definition of health includes many other factors which affect the functioning of a person. A person may be free of any illness or deformity but the social factors that surround that person may play a great role in determining the well being of that person.
Health of a person can be contributed by factors that affect the physical, mental and social well being of a person. What does this imply? This implies that the state of physical fitness, mental fitness and social life of a person is very crucial in determining the well being of an individual. Let’s take an example of a person where one of his/her closest friend has died. The bereaved will be left mourning for days. The bereaved is left with a great burden of a stressful life which adversely affects his/her wellbeing. This may at the end bring death as an aspect of serious illness due to the accompanying effect of that death. This means that although the person may be physically and mentally fit, the social effect of losing a loved one may be a great factor contributing to the health status of the person. (Department of Health, 2002)
There are two important reports that depicted the inequalities in health care, The Black report of 1980 and the Heath Divide Report of 1987. Both of these reports identified the failure by the HNS to address the issue of inequalities in health opportunities in the country. Both reports came out with clear indications of inequalities in British class system. The outcomes of the reports were further evidenced by the department of Health and Social Security which in 1993 also pointed out existence of differences in social class and geographical locations as reflected in mortality and morbidity rates. This report indicated the life expectancy at birth in 1994 was 78 years for women and 72 years for men. It also pointed out the increased likelihood of men dying from heat disease and women form cancer. Our analysis of the health inequality will be based on these two reports.
Concepts involved in the social construction of health and illness.
Social construction can be considered in terms of patterns of health as expressed in aspects of social class. Social construct tries to define social aspect of health that leads to heath status of individuals. It looks closely to health in terms of various factors like the health of family members, health of communities and heath of nations. Social construction is seen as a broader outlook in the health of a population in above perspectives.
Social construction looks at health in terms of health of family members. Using this outlook it seeks to look at factors that determine the health of family member. It recognizes the family as the basic unit of life in the society. Social construction seeks to look at the factors that affect the health status of member of a family which have an effect on the health of the community and that of the nation as a whole. Being the building block of a nation, the heath of family members is of paramount importance if a nation is to achieve overall heath well being. In most instances the factors that affect the family of family members will affect the health of the community and that of a nation but not in all instances. Let us look at this closely and the effects of these factors.
In a society, there are different families. Although there are segmentations in the society, the family can be considered as the basic unit of the society. A society is usually inhabited by different kinds of families in different classes and of different ethnic groups. In a society there may be two families one in an upper class segment and the other in a lower class segment. Usually the heath status of these families will be different. Looking at the family level, the level of income of these families will be a determinant of health status of its members. Hence at the family level, there will be factors that will be affecting the health status of its members. (Blane et al., 1996
At the society level, a society is affected by different communities that may be defined by different bonding factors. These factors may be religion, ethnic, class factors and others which may create different communities in the society. Again as there were factors affecting the health status of family members, there will be factors that will be affecting the heath status of different community members. One of the factors that have been found to contribute to health status of community members and which shows inequities in the heath care system has been the issue of ethnic groups and social classes in the society. It has been found out that minority ethnic groups have poor health status as compared to major ethnic groups. This has been found to be contributed by many different factors.
In a broad outlook, the health of different societies affects the health of a nation. A nation is made up of societies which together comprise one society under one name the nation. We may talk of a British society living in Britain but which is made of other small societies living in different parts of Britain. The health of a nation is determined by health policies that have been put in place by the government. It is to be understood that these health polices are very important in determining the health of the family members, communities and the nation as a whole.
It is generally accepted that there are various inequalities in health care provisions. These differences are valid according to various factors. The patterns of inequality in health care provisions varies depending on place, gender, age, year of births, ethnicity and many other factors. However it should be understood that these differences varies with different measure of health that are used in assessing the inequality.
There are different perspectives to health that have helped to shape the modern day’s health system. According to the Marxist perspective, the capitalist society defines health as the inability to work. This definition is mostly envisaged in the hands of the middle class professionals who diagnose who is ill and who is not ill. In this perspective the working class is more likely to be perceived as malingerers. In this perspective, ill health is seen as an objective of physical ailment which diverts attention from the class based inequalities of illness and disease. This perspective puts profit before health which drives the consumption pattern among the working class of the society. This perspective emphasizes more on profit before the health of the individual, which is reflected in the lifestyle.
On the other hand, the functionalist perspective views each institution as a function. It postulates that ill health is normal and must be identifies and resolved to satisfy the majority. It is this perspective that gives the health professionals high status in the society. Doctors assume the role of monitoring the patients and limiting their absence from work and family roles. According to this perspective, there are varieties in the health care and people have a choice to the health care to use. Hence the inequality in health here is brought by the fact that some people make better use of health facilities than others. This perspective puts more hope on the upcoming technology to help resolve the issues of medical care in the future.
According to the interactionist perspective, people derive meaning from events an act on their interpretations. People create meaning in their lives through symbolic communications and interpretations to make sense of the world. This perspective views health and illness as social constructs which results from labels attached by professionals following a process of negotiation which is actually due to the power of doctors and medical staff. In this perspective, doctors have a role in managing of the patients by restricting the information they give to the patients.
The feminist perspective view biological models which turn women into reproductive machines. According to this perspective there is protection of patriarchy by defining women as abnormal. This perspective represents the inequality in health that women suffer in the hands of men. It fights for gender equity in provision of health care.
The evaluation of the above perspective in health gives critical evidence that it is still difficult for us to exactly define health in the society. This is duet to the different perspective as expressed above which all seems to take one side. While the capitalist perspective will be arguing more on the need to have private health care, other perspective seems to stress the need to have public health care. The approach that has been taken by the government has been more of a capitalist approach although there is evidence that private health care can help in resolving health inequality. The feminist perspective tries to tackle the gender inequality in health care since it takes the biological model of women to emphasize the need to have more women access health care.
The relationship between culture and perceptions of health, including body image
Although there are many definitions of health, there are some key aspects of the definition that appear to be common. All the definitions have taken in the concepts of health to include culture, age, gender and class. As we described earlier, health is defined as “a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity” according to WHO (1948). This brings together different models that try to define health. Aliven Tarlov (1996) describes health as “an individual’s capacity in relation to aspirations and potential for living fully in the social environment”. This perhaps explains our cultural belief of health. We tend to believe that we are healthy if we are functioning properly which means we are going on with our daily duties as required. Our cultural perspectives of health is further integrated in our ethical approach to heath which shows that heath is seen as a reward for living according to the divine while ill heath is seen as a form of punishment for going against the divine powers. This means that our state of health is dependant on our characteristics.
The health of an individual is portrayed in different images of our body. The core of our heath is our biological functioning of out body. This is because if our body is not functioning well we will suffer from ill health. From our biological functioning there come aspects of physical and mental heath. This is determined by our biological functioning and our social life. Hence social life and the attendance to our daily roles depends our health. The wellbeing of all these factors defines our quality of life which is actually our state of health. Out health status further as individuals affects the heath status of our family and in larger extent our society since individuals makes up the families and the society.
Hence we can say that our body image and the image of our families and society is very dependant on our health. However there is a great interaction between those factors of health since sick individual make sick families which in turn make sick societies. Those are the factors that make the heath of a nation. It then translates that in our cultural perspective, there is a social dimension of interaction and reliability. While the society will want to have a heath population, it has the duty of ensuring that it plays its role in ensuring that the health of individual person is taken care of.
Definition of social class within a theoretical framework in relation to health
In a normal definition, a social class can be defined as a group of people living in a society who share some common characteristics. The issue of social class however takes a broader meaning in terms of provision of heath but uses the same concept. Social class is an aspect of social construction and is a major determinant of inequalities in health. Reports have indicated differences in class systems in Britain which has affected access to health. These studies social class has been represented in terms of economic occupation of the person although this classification is still seen as a problem. (Bartley et al., 1997)
There emerge three main classes as far as matters providing health care concerned and all the three classes show different health demographics. There are upper class, middle class and lower class each with different health characteristics as defined by their lifestyles. These characteristics affect their health in the same way. For example Blaxter (1990) showed that if a middle and working class individual was subjected to the same level of stress and life style condition like a lower class person, then the middle class person will definitely fall ill.
The issue of class in the society her is portrayed as contributed by unequal distribution of resources in terms of income, job prospects and others. Wilkinson (1993), found out that countries with the highest life expectancy were not those which had wealth but rather those which had achieved some form of equity in distribution of resources among the population., hence the aspect of access to resources comes out strong as an important determinant of class and access to health.
Key points arguments of the main sociological theories of social class in relation to health
Sociologists have tried to put forward some theories which try to explain different aspect of social class that affect access to health care. There is a general agreement that the factor of distribution of resources is paramount to the definition of culture. However sociologists have also come up with the notion of ‘relative deprivation’ as a theory that can help to explain the social class inequality in health. It asserts that there is a tendency of relative deprivation which is expressed in the feeling that one is not living the life regarded as normal by others. This has an effect of eroding self esteem which leading to increased stress accompanied by behaviour which may have adverse effects on health of the individual. For example, one may skip the use of a necessary heath commodity in order to use other things which make them feel like others in other classes. This is mostly infested in matters concerning diets and essential medicine.
This concept is mostly seen in the lower class segment of the population who may try to use some commodities which is out of their income in order to feel like they are in the other class. In doing so, they forego some essential commodities needed for their heath. However the same concept may be observed in a population in the same class where someone in the same class may be struggling to be at per with others and in the process forego some important health needs. In the longer term the concept of relative deprivation may have adverse effects on the health of the individual.
In 1971, Tudor-Hart introduced the concept of inverse care law. This law asserts that the more care a social group needs, the less likely that they are likely to get it. This is contributed by many factors including the knowledge about the care needed and the actual barriers to access. In practical use, it has been shown that the lower class people needs more health care to their lifestyle pattern but at the same time they usually receive less care than the upper class groups due to some factors in access of health care like money, political and other issue. In his research Tudor found out that middle class group is more knowledgeable about services available than those in the lower class or upper class. This is because the middle class are more assertive in demanding for treatment than others. They are also well informed on health matters like preventative treatment than others. This is brought by the fact that the upper class is contented with their life since it as money to access health services while the lower class is busy on economic well being issues to mind about health care issues. There is also perception in provision of health service as it was found out that, health professionals treated patients differently according to their social class. It was also found out that middle class patients have greater input on decision regarding their heath care since they have better language skill and assurance than those in the lower class. (Choosing Health? A consultation on action to improve people’s health, Spring 2004)
Explain the relationships between class or gender or ethnicity and health
There are many factors that have led to class inequality in access to heath care. It has been shown that the middle class has been more assertive in fighting to access health services than other classes. The issue of class and access to health services has been portrayed in many researches. For example it has been shown that 17 percent of men aged 45 to 64 in the professional class reported long standing illness as compared to 48% of men in the unskilled class. This is further depicted in the study which showed that 25 percent of women in Class V are overweight as compared to 14 percent in class one. This is one of the factors of diet and lifestyle patterns in the classes. Different factors play part in bringing about inequalities in access to health service as were described above. But the leading factor has been identified as economic well being of the class and the education status of the class. In this particular issue, the middle class has been found to be assertive in fighting for better health than other classes. This is because they have the resources and the knowledge to do so. (Marmot, 1998)
However there are still some criticisms that arise from the two reports regarding the accuracy of the statistics. There is a possibility that some of the statistics may not be accurate enough to sustain their evidences. There is also a possibility that these statistics can appear better or worse than they actually are. For example, in terms of class there are more people in the lower social classes who are elderly and poor. At the same time the youthful and middle aged are better represented in the middle class. Hence the inequality that is being portrayed here can actually be as a result of differenced in age and not in social class. As with the biological nature of human being, the old are more likely to bee sick than the youth. This many be one reason for increased incidence of health inequality as per the social class. This criticism can also be evidenced in study by Marmot which concluded that that as the social class changes, the life style may remain the same over that period. This may affect ones health. Others like Power concluded from their study that class is not the leading factor to inequalities in heath but rather thee are other factors like inheritance at birth, social economic factors, early life, lifestyle, and others. But there is a general concession by sociologist that the difference in health between the classes is real.
As was concluded in the Black Report, inequalities in income lead to inadequate diets, poor housing, and other material disadvantages that affect health. The Black Report also viewed material deprivation as a major cause of inequality in mortality rates between classes. This indicates that the difference in classes which is mainly as a result of difference in income can contribute differences in income and hence affect health. The difference in pay can be a great determinant of the health of a class. These reports give some radical conclusion which shows geographical and political factors that leads to health inequality. The post code Lottery shows varying amounts of allocation of funds to different areas with poor areas receiving fewer funds. For example, one is three times likely to be out of work on sickness benefits if one lives in the North East that in South East. This has been attributed to factors like traditional specialist teaching hospitals being located in richer areas, polecat plans in allocation of money, the influence of medical professionals in health funding, and many other factors.
The fact that the working class in more assertive in seeking medical help shows the failure by the NHS to provide equal services to all since they ascertain this group to be a representative of all groups. It is clear that those who are more assertive will receive more medical services than others. Hence there is need for the NHS to come up with a policy that seeks to address the medical needs of those in the lower class. But there are other factors including geographical and political factors that lead to health inequality as we have seen. Hence we can say that inequality in health according to class may not be shouldered on NHS alone but we should look closely at the above mentioned factors which could be the cause.
Theoretical explanations of health inequality relating to class or gender or ethnicity
It has been shown that there are inequalities in health with regard to gender class and ethnicity. There has been a lot of class work that has been carried out regarding the inequality in health in these perspectives. In regard to inequalities in health following the gender perspective, it has been shown that women appear to suffer from worse health than men. This follows the fact that women are likely to live longer life than men. It is this longevity of life that exposes women to more sufferings as compared to men. Women have a higher life expectancy than men and it is due to this increase life expectancy which exposes them to increased risk of chronic illness.
But the aspect of gender does not bring about health inequality alone. It has been shown that there are differences in gender health in different social calluses. For example, it has been documented hat lower class men aged 45 to 64 suffer from chronic illness than women of the same social class and age. This is one explanation of which shows that there are both aspects of gender and class are great determinants of health status of a person. This difference in social class as an aspect of gender inequality in health can be attributed to different lifestyle conditions. In the above example, women could be suffering from more chronic illness than men due to continued use of medical services and drugs in their lifetime which increases their risk of chronic illnesses.
In the same respect, it has been shown that medical activities are mostly dominated by men. Can this be a factor of inequality in health? In some way it may be a contributing factor although this may not have a great overall effect. However this may be contributed by the fact that medical professionals always work according to the prescribed code of services that guides their operations.
In most instances the difference between in health based on gender can also be contributed by some social and psychological factors. It has been found out that men might not consult their doctors when they fall ill than women do. In most cases men might have a feeling of the need to ‘soldier on’ as a way of not showing a kind of weakness by consulting their doctors. On the other hand, women have no any feeling of sort and they always consult their doctors whenever they feel ill. This might be one of the factors explaining the increased life expectancy of women as compared to men. In contrast to this doctors are likely to assign the sick role to women than they can do to men. This represents general social perspective of gender. Men feel that they were born strong and can ‘soldier on’ even in case of diseases than women can do. This represents a femininity view which is more attributed to frailty than the male.
On the other hand there are some obvious differences that are attributed to biological make of the gender. According to biological perspective, in some aspects of life like reproduction, women are generally exposed to more health condition which makes them seek medical services more than men. It has also been found that there are high rates of heart disease among men before the age of 50 than in women. This can be attributed to the fact that men lack some hormones like Oestrogen which protects women from such conditions. There are also some lifestyle conditions like excessive drinking, smoking, and others which are associated with men which bring about the difference. This explains cultural behaviours in gender which exposes men to health risks than women. Although women engage less in these behaviours, they are likely to suffer from more health effects than men when they engage in such behaviours.
Taking a social perspective sociologist argues that gender socialization and the role of men and women in the society leads to difference in behaviours which is a major factor leading to inequalities in health. While men are likely to remain more closed on their health conditions, women are likely to be more open and seek help from their peers and others. Social perspectives of the gender plays a role in diagnose of disease and their treatment. For example, in most societies, heart diseases is always seen as a man’s disease and for those in executive professions which is of a sedentary nature and hence doctors will take less chances of screening and diagnosing the condition in women and those working in manual work professions since we have a perspective of them being less exposed to the condition. But there are some researches that conquer with our perspective. It has been shown that babies from manual social background are 11/3 times more likely to be of low birth-weight than those from non-manual background. Those children born in manual background are 11/2 times likely to dies as infants than from non manual background. (Department of Health, 1998)
However the finding of these reports can be criticized in many fronts on issue concerning gender inequalities in health. First we understand that there are many differences between men and women on issues of health. Using a biological perspective, there are many obvious differences between men and women that lead to inequality in health. The fact that women visit physicians more than men can be a factor of biological health needs rather than health inequality. From our above analysis it is clear there are hormonal differences in health for between men and women that can as well lead to seemingly health inequalities. The above cultural perspectives can also lead to health inequality. Hence we can say that the presentation of the two reports could be attributed to many other factors rather than failure by the NHIS to provide health to all genders.
Inequalities in healthcare provision in relation to class or ethnicity
According to researches that have been carried out, there are evidence that there are inequalities in the provision of health care according of ethnicity and health. This has been due to the perception that the society has on health issues as far ethnic classes are concerned. From many researches that have been carried out, 50 percent of the ethnic minority members describe themselves as having fair or poor health as compared to 30 percent expressed by the indigenous population. Ethnicity has been described as one of the pattern expressing inequality in health care provision. The above statistics reveals a pattern of inequality in access to health care in the society with ethnicity being central to it.
This has been expressed as resulting from perception that the society has on ethnic groupings of the population. Many of the ethnic grouping that have been interviewed have expressed that they are discriminated in provision of health services. It has also been found that majority of the ethnic groups have short life expectancy than majority of the populations. What could be contributing to this aspect?
There are many factors that could be contributing to these factors. One of the greatest factors could be discrimination in health care which limits access to health care. This discrimination becomes a barrier to health care access to the minority groups. With the unbalanced access to heath care, life expectancy of most of these minority groups continues to fall.
But on other hand researches have revealed some peculiar results which show that all ethnic minority groups have lower levels of cancer than the rest of the population. This could be attributed to the prevalence of conditions that contributes to development of cancer. This could be a factor of lifestyle conditions since majority of the minority ethnic groups don’t live an affluent lifestyle.
In cases of lack of access to free health care, it has been found that it is the minority groups that suffer. This is because there are obvious differences in economic income in the population which limits their ability to access heath care factors like health insurance. The level of income of a population has been described as one of the most important factor that determines the health status of a person. As was earlier described in our definition of heath, there are many faceting factors that determine the health status of a person. Economic well being is one of the factors that bring about peace of mind and social well being of a person. It has been found that majority of the ethnic minorities do not have access to economic opportunities as compared to the rest of the population which actually affects there mental and social well being. Think of a person who has to spend days looking for a job. This translates to a lot of mental torture and social struggles. At the end of the day this person will be stressed. It has been observed worldwide that poor health is found in areas inhabited by poor population. (Aston, 1992)
Health inequalities in class are manifested in many ways. Some studies have expressed that social calls is not a determinant of the health status of the population but in some ways it is a real factor. It is to be understood that social class comes with different lifestyle conditions. Lets us take two examples to illustrate this. Think of those in the lower class of the society and their lifestyle conditions taking in some factors that affect health like diet, smoking, drinking, stress and exercise. It is to be found out that those in the lower class of the society will have some of these factors affecting their health status like stress and diet and to some extent smoking and drinking. At the same time think of the diet of a person in the lower class and in the upper class. Are their diet patters similar in any way? No. you will find that those in the upper class will be likely to suffer from lifestyle condition like diabetes, cancer, heart disease and others because of their eating pattern. The heath status of the upper class may not be affected by stress but this will definitely be a factor affecting the health status of those in the lower class who are struggling to make their ends meet.
Hence we can crictsized the findings of the report on the ground that there are many factors that could be contributing to the seeming factor of ethnicity. Difference in class may manifest itself very much in ethnicity and hence expose a factor of health inequality. The aspects of language barrier, cultural differences and poverty arising from difference in class could contribute to health inequality with ethnicity more than failure by NHIS.
According to the two reports, there are inequalities in health care that needs to be addressed. It can be concluded that these inequalities are vested in different perspective of social life including gender, class, ethnicity and others. Overall it can be said that the middle class has more access to health services since it is more assertive, has more knowledge on health services and can afford private heath services. From the report we can also say that wealthier people are more likely to avoid illness that leads to increased mortality rates within the working class. Hence there is need for the NHS to move fast and address these inequalities. Although it may take some year to bridge the gap, government investment in education and closing the income gap may go a long way in helping to address the issue.
Aston, J. (1992): Health Cities. Buckingham: Open University Press
Bartley, M. Blane, D. & Montgomery, S. (1997): Socioeconomic determinants ofHealth. British Medical Journal, Vol. 314: 388-455
Blane, D., Brenner, E. & Wilkinson, R. (1996): Health and Social Organization. London: Routledge
Blane, D., Smith, D. & Bartley, M. (1994): Social Selection: Social Class Differences in Health. Sociology of Health and Illness, Vol. 15: 2-7
Blaxeter, M.(1990): Patterns of Behaviour in Health. British Health and Lifestyle Survey. Journal of Social and Clinical Psychology, Vol. 14: 45-89
Choosing Health? A consultation on action to improve people’s health, Spring 2004. Retrieved from http://188.8.131.52/search?q=cache:FvhWqEBnNpgJ:www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4075852.pdf+Choosing+Health?+A+consultation+on+action+to+improve+people’s+health+Department+of+Health+Spring+2004&hl=en&ct=clnk&cd=l.htm on 29th February 2008
Department of Health (2002): Tackling Health Inequalities. Cross-cutting review, November 2002
Department of Health (1998): Our Healthier Nation. London: HMSO
Marmot, M. (1998): Improving the social environment to improve health. Lancet, 351: 43-67
Marmot, M. G. , Rose, G., Shipley, M., & Thomas, B. (1967): Alcohol and Mortality. Lancet, 8220: 579-584
Tarlov, A., Ware, J., Kosinsikt, M. & McHorney, W. (1996): Comparison of Methods for the scoring and statistical analysis of SF-36 Health Profile. Medical Care 33
Wilkinson, R. G. (1993): The Impact of income inequality on life expectancy. London: Avebury
WHO (1948): WHO Definition of Health.
Source by Charles Kelly