HEALTH AND ILLNESSES lecture (prepared by C. Hungwe)
The argument by the sociology of health and illnesses is that whether or not individuals
become ill and whether they recover, die or are left with residual handicaps, it does not
depend only on their genetic, inborn make up and on their subsequent exposure to various
kinds of disease agents; but health and illness are also determined by the social, economic
and cultural characteristics of the society in which people live and their position in the
society. Health is much more than a biological matter. It also has social/cultural causes
that require social/cultural treatments. Health and illness are very much related to
people’s beliefs, level of development, lifestyles and social class.
Definition of health= the condition of being sound in body, mind and soul especially
freedom from physical disease or pain. It is also simply the absence of disease or injury.
However, the WHO definition (in Eyles et al 1983) is: the state of complete physical and
mental well being and not merely the absence of disease or infirmity. The 4 components
of health are the physical, mental, social and spiritual. Because of the multi faceted
nature of health, very few people can be said to be completely healthy. Although health
and illness have an objective dimension, such as the presence of pain, they are also
affected by cultural beliefs. Pregnancy in some contexts is defined as an illness while in
others it is the highest state of health. In some African cultures one who claims to hear
voices or see visions is defined as healthier than others because of the spiritual
attachment yet in other areas that person is a candidate for mental institutions. Therefore
health has no real meaning without reference to economic and political conditions that
contain it.
To emphasise the cultural dimension of health one can discuss sub cultural groups that
for example, prohibit smoking, drinking, and promiscuity. Members in these subcultures
are generally healthier than outsiders. Rastafarians who prohibit consumption of red meat
also prevent the contraction of diseases such as gout associated with red meat.
Theories of health and illness
There are generally two approaches: the biomedical approach and the social construction
approach. The biomedical approach views diseases as objects that exists independent and
prior to their discovery and description by physicians. The social construction view
argues that diseases are human constructs that would not exist without someone
describing and recognising them.
Social class and illness
Social class determines life chances such as access to health facilities, good diet,
education, safe jobs etc. members of the upper class usually afford good medical
attention and eat well and are therefore less exposed to health risks than the working
class. This results in different problems for both the rich and poor. The rich suffer from
diseases of affluence such as obesity, gout, cancer and B.P. Most of which are caused by
overeating. Diseases of the poor include backache (because of the physical nature of their
jobs lots of bending and unbending), cholera, STDs, malaria, AIDS (cant afford
prevention costs of ARVs too much). Diseases of the poor are caused by the physical
nature of their work, exposure to unhealthy environments both at work and home and
high risk lifestyles such as prostitution.
Disease patterns also have an international dimension with more ill people in the
developing world than the developed.
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The social construction of illness and the sick role
The sick role is a culturally determined role. Tuckett (1976:334) argues that to be ill is
not simply to be in a biologically altered state, but also to be in a socially altered state
that is seen as both deviance and (normally) undesirable. People are supposed to assign a
sick role to the sick person. There are therefore mediators between the sick person and
those who assign a sick role. This is a relationship of power where those who are
powerful assign a sick role to the weak (for example parents assigning the role to
children, doctors to workers). Such people have the power to check on the genuineness of
the sickness. A person assumes the sick role when there are 3 conditions
 Where the individual can no longer perform their usual duties
 When the individual has to stay home (away from school or work)
 Where the individual has to consult a doctor and take medicines.
According to Parsons there are 3 elements of the sick role;
1. The individual is not held responsible for being sick (others sympathise).
2. The individual is exempted form normal duties
3. The individual has to agree to get help in order to be well. In other words,
if the individual does not agree to get help then he/she might not be
defined as ill but as pretending to be ill.
This therefore means that the sick role is not a permanent role but is only assumed when
one is sick. Eventually one must get out of it and assume normal duties.
Doctors and the sick role
Doctors and physicians assess claims by individuals to be unwell and prescribe what the
individuals must do to get well. They even prescribe task to be done or not done by the
individual (for example being excused from writing exams for students). The decision to
accept the sick role by the sick person is affected by the environment or context. One is
more likely to accept the role if it excuses him/her fro work, exams etc. however, one is
not likely t accept the role if it affects them negatively (for example, preventing you from
attending a party). When granting the sick role power plays an important part. Doctors
have power because of their training and experience. However, if the sickness is beyond
the doctor’s training and experience then one is denied the sick role, the doctor will argue
that the person is not ill but imagining to be ill.
Social class also lays a role in granting the sick role. The poor are less likely to get the
sick role than the rich because it is believed that the poor in many cases pretend to be sick
in order to avoid work. Again there are more discussions between the doctor and the rich
person than the doctor with the poor person. With the rich, even the patient has an input
towards their treatment. For the poor there are no discussions therefore medicine is not a
neutral field but an arena where class, power relations are very much involved. The
diagnosis of an individual is very much coloured by one’s background.
The professionalisation of medicine
The process of becoming a medical practitioner involves a lengthy period of rigorous
training. The practise of medicine is characterised b a number of factors;
1. A claim to a theoretical understanding of health and illness- what causes it and
remedies?
2. Rules for self regulation- professional ethics
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3. A claim to be performing a service to society and not pursuing individual
interests.
Medicine as a profession is restricted and monopolised. In traditional medicine one has to
have a special calling and go through sometimes-painful training. In modern medicine
one must be very intelligent and have the requisite entry points or qualifications and
undergo rigorous training at specified institutions. The practice of medicine is restricted
to graduates of these institutions. ZINATHA regulates traditional medical practitioners.
Even the language of medicine is confined to practitioners who communicate among
themselves and the patient is not involved in the communication. Not only is the
production of medical practitioners limited but also the reproduction of medical students
is also restricted. As a result the practice of medicine has come to be big business where
medical practitioners set fees to be paid for their services. Medicine has therefore come to
be a commodity and not a right; only available to those who can afford it.
References
Duff, R.S et al 1968 Sickness and Society NY: Harper and Row
Eyles, J. et al The social geography of medicine and health NJ: St Matins Press
Jones, K and Moon, G. 1987 Health, Disease and Society London: Routledge
Mishler, E.G.(ed) 1981 Social Contexts of Health Illness and Patient care London: CUP
Morgan, M. et al 1985 Sociological Approaches to Health and medicine London:
Routledge
Scambler, G. (ed) 1991 Sociology as applied to medicine London: Balliere Tindal
Tuckett, D. (ed) 1976 An Introduction to medical Sociology London: Tavistock
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