Social and Administrative
Pharmacy
Introduction to Sociology
Introduction
Initially, the idea that pharmacists might usefully study sociology may
appear a little odd. After all, pharmacists are surely concerned with
drugs use, an activity which requires a sound understanding of the
disciplines of physiology, pharmacology, pharmaceutical chemistry and
pharmaceutics.
Prescriptions need to be carefully checked and the therapeutic and
adverse effects of medicines thoroughly understood. But of course,
pharmacy is also "people work"; drugs are dispensed to patients
directly, or indirectly via other health professionals in the health care
team.
Furthermore, the general public seeks advice from pharmacists about
medicines, treatments, alternative therapies and other aspects of
their illness management and health maintenance. Pharmacists
therefore need to be good communicators who are equipped with the
appropriate skills for ensuring that they offer effective
pharmaceutical care.
A sociological understanding of the issues of health, illness and health
care can contribute to a deeper understanding of this people work.
Sociologists have contributed to a better understanding of the actions
and experiences of patients, the public, and health professionals who
work within the health care system. This has resulted in a better
appreciation of the nature of the relationships between health
professionals and patients.
Sociology is an academic discipline which makes use of a wide range of
research methods to study society and social behavior or social
actions.
Pharmacists, as a result of their school education and exposure to the
pharmaceutical sciences as undergraduates tend to define themselves
primarily as scientists. Students often approach sociology with
preconceived ideas of it being “vague”, “undisciplined” and at times
pretentious, marketing ideas that are little more than common sense.
In fact, sociology is a coherent discipline with a long tradition of
applying a scientific perspective to social behavior.
It is a science, generating and testing hypotheses, rigorously applying
robust methods of empirical investigation to generate data whose
analysis and interpretation leads to the formulation of theories. These
methods include social surveys, observations, analysis of language, and
interviews.
Throughout this module, we will refer to a range of key sociological
concepts which are outlined in the following table. For clarity, these
concepts have been reduced to their simplest terms, though we have
sought to retain their essence and indicate in the text how they are
likely to be important for the practice of pharmacy
.
Sociology
Sociological Perspectives on Health
The study of groups and group
interactions, societies and social
interactions, from small and personal
groups to very large groups.
SOCIOLOGICAL PERSPECTIVES AND THEIR APPLICATION
TO PHARMACY
Society
A group of people who live in a
defined geographic area, who
interact with one another, and who
share a common culture
The scope of sociology is difficult to define due to diverse and
diffused nature of its subject matter (namely, people and
society), and also due to many different approaches or
perspectives.
Culture
The group’s shared practices, values,
and beliefs.
Social facts
laws, morals, values, religious beliefs,
customs, fashions, rituals, and all of
the cultural rules that govern social
life,
While all the perspectives seek to understand how social
structures interact with individual behaviors, they vary in terms
of their level of analysis. Turner (1995) has usefully summarized
three levels of analysis (individual, social and societal), and he
illustrates the topics which might usefully be studied at these
levels.
Sociological Paradigm
Social location
Social marginalization
A broad viewpoint, perspective, or
lens that permit social scientists to
have a wide range of tools to
describe society, and then to build
hypotheses and theories
An individual’s place or location in the
society and includes race, class,
gender, sexuality, religion, age,
education, marital status, and political
view
A process of social exclusion in which
individuals or groups are relegated to
the fringes of a society, being denied
economic, political, and/or symbolic
power and pushed towards being
‘outsiders’
Power
An entity or individual’s ability to
control or direct others
Inequality
The existence of unequal
opportunities and rewards for
different social positions or statuses
within a group or society.
.
Sociological Perspectives and Topics of
Health and Illness
Level
Individual
Topic
Lay knowledge of
health, illness
experience
Perspective
Interpretative
approaches
Social
Cultural categories
of sickness
Structuralfunctionalismsociology of roles,
norms and
deviance
Societal
Health care
systems
Conflict
perspectives, e.g.
political economy
FIRST LEVEL: INDIVIDUAL
THIRD LEVEL: SOCIETAL
At the first level, sociologists examine people’s accounts of their
experiences of illness and how they maintain their health. The aim here
is to illuminate aspects of everyday life from the perspective of the
individual.
The “interpretive perspectives” are so called because they “interpret”
how people make sense of, and give meaning to, their lives or actions.
Attention is focused on how people interact at a face-to-face level;
how they see their lives, make sense of their social circumstances
and/or their physical symptoms.
Sociologists therefore talk to and observe people to try and find out
how they define their circumstances. To get an insight into how people
see their situation, and why they see things as they do, is not however
the same as saying that their view is ‘correct’. Indeed, this is the case
for any empirical sociological analysis – we can never access the
unequivocal truth. Rather, in gaining a range of views of an issue, we
can develop a fuller understanding.
This social perspective is not shared by all sociologists, and indeed an
alternative ‘societal perspective’ highlights ‘conflict’ rather than
cohesion.
SECOND LEVEL: SOCIAL
At the second level, sociologists use “social perspectives” to examine
what society regards as sickness, illness or disease. Disease categories
are not simply a reflection of biophysical processes within the body but
are also the result of social considerations.
It may seem ludicrous to us now, but until the early 1970s,
homosexuality was considered to be a sickness that had to be ‘treated’
because it was believed, by some, to be the result of physiological
dysfunctions. Sickness and disease can therefore be understood as
social as well as biological forms of deviance that are regulated and
controlled by social institutions.
Indeed, in our society one of the most powerful social institutions is
Medicine. In our society, to be ill involves adopting a certain social role
which involves obligations to get well and to seek expert help.
From this perspective, referred to as “structural functionalism”, illness
and disease prevent society functioning effectively, and consequently
we have health professionals to help us get better when we are ill.
Illness is a form of social deviance and the medical profession exists,
and is authorized, to help us get well. If we conform to the expected
norms and obligations then the smooth running of society is maintained.
The conflict perspective argues that the differential power and
economic rewards that are given to those in social authority lead to
social tension and conflict.
Social order is maintained more through coercion than consensus. A
variant of this perspective is the ‘political economy approach’ which
highlights the ways in which socio-economic factors create and
produce illness. For example, a major cause of illness in our society is
poverty and material disadvantage.
Another social determinant of illness that could be examined from
within this perspective would be the ways in which the pharmaceutical
industry has vested interests in ‘creating’ illness. For example, the
industry would stand to gain from encouraging both the medical and
pharmacy professions to treat mental health problems such as
depression with drugs, rather than by using less invasive therapies.
Thus, from this perspective those who are most powerful will have a
vested interest in supporting the medical model of health and disease.
CENTRO ESCOLAR UNIVERSITY
SCHOOL OF PHARMACY
MANILA
Ricardo Jr. N. Arellano
Social Administrative Pharmacy
Sociology for Pharmacist
What is Sociology?
 Sociology is an academic discipline which
makes use of a wide range of research
methods to study society and social
behavior or social actions.
- Society: a group of people who live in a
defined geographic area, who interact
with one another, and who share a
common culture (shared practices,
values, and beliefs)
Sociology vs. Common Sense
Sociology
Common Sense
Looks at society as a
Based on personal
whole
experiences through
various situations
Based on research
Based on individuals
and natural
Applicable to a large
Limited to a person’s
number of people from horizon
different backgrounds
Sociological Perspective (Paradigm)
A broad viewpoint, perspective, or lens that
permit social scientists to have a wide range
of tools to describe society, and then to build
hypotheses and theories
“Seeing the General in the Particular”
 Look for general patterns in the behavior of
particular people.
- Choosing partners in marriage.
1. Those who are sensitive to others,
easy to talk to, share feelings and
experiences (High-income women)
2. Those who are not heavy
drinkers/smokers, not violent, have
steady jobs. (Low-income women)
“What women expect in a marriage has a lot to do
with their social class position.”
“Seeing the strange in the familiar”
 Recognizing that things aren’t always what
they seem.
- Why did you choose CEU-Manila?
1. “It is closer to my home.”
2. “I can get a good job.”
3. “My girlfriend/ boyfriend goes to
school here.”
4. “I did not get into the school I really
wanted to go to.”
“In social reality, factors such as income, age, and
race influence your choice.”

Sociology vs. Psychology
Sociology
Psychology
Studies social relations
Deals with the science
to understand the
of behavior
structures of society
Links human behavior
Main focus is on the
to social conditioning
individuals
and different aspects of Curious about the
social life
functioning of individual
human minds
Studying Patterns: How sociologist view
Society
 The personal decisions an individual makes
do not exist in a vacuum.
- Cultural patterns and social forces put
pressure on people to select one choice
over another
Page 1 of 5
CENTRO ESCOLAR UNIVERSITY
SCHOOL OF PHARMACY
MANILA
Ricardo Jr. N. Arellano
Sociological Concepts:
Social Location
An individual’s place or
location in the society
and includes race,
class, gender, sexuality,
religion, age, education,
marital status, and
political view.
o This can limit
your choices.
Social marginalization
A process of social
exclusion in which
individuals or groups
are relegated to the
fringes of a society,
being denied economic,
political, and/or
symbolic power and
pushed towards being
“outsiders”
Power
Ability of an
entity/individual to
control or influence the
actions, beliefs, or
behavior of others.
Inequality
Different from Authority
predicated on
perceived legitimacy
”Accepted power”
The existence of
unequal opportunities
and rewards for
different social
positions or statuses
within a group or
society
o Racism
o Discrimination
o Housing
conditions
Studying Patterns: How Sociologist View
Society
 Sociologist try to identify these general
patterns by examining the behavior of large
groups of people living in the same society
and experiencing the same societal pressure
Social Pharmacy
 Concerned with the social institution of
pharmacy and society as it relates to
patients, medicines, and the work of the
pharmacist.
- Pharmaceutical Sociology
Why study Sociology?
 Social factors influence peoples’ health
(either in a health-promoting or damaging
way)
 Sociology can help pharmacists’ gain better
understanding of why people experiencing
health differently according to their social,
economic or political situations.
 The general public seeks advice from
pharmacists.
 Pharmacist are potentially able to influence
the beliefs and behavior of the patient.
Sociological Perspective on Health
Sociological Perspective (Paradigm)
 A broad viewpoint, perspective, or lens that
permit social scientist to have a wide range
of tools to describe society, and then to build
hypotheses and theories
 “Guide on thinking and research”
Micro-level
Macro-level
Study small groups and Trends among and
individual interactions
between large groups
and societies
Page 2 of 5
CENTRO ESCOLAR UNIVERSITY
SCHOOL OF PHARMACY
MANILA
Ricardo Jr. N. Arellano
Sociological Theories or Perspectives
Perspective
Level
Topics
Symbolic
Micro
One-to-one
interactionism
interactions and
communications
Structural
Macro
The way each
functionalism
part of society
functions
together to
contribute to the
whole
Conflict theory Macro
The way
inequalities
contribute to
social
differences and
perpetuate
differences in
power.
Structural-Functionalism
 “Society is a complex system of interrelated
and interdependent parts that work together
to maintain stability and order” –Émile
Durkheim
PartsSocial Structureshave social Function
Example: Familyteaching children how to live
society
Social Functionalism
Social Manifest: anticipated
functions consequences of a social process
Example:
College educationgain
knowledge, prepare for career, find
a good job.
Social Undesirable consequences for the
Dysfunction operation of society
Example:
College educationBad grades,
dropout, not graduating, not
finding suitable job
Conflict theory
 “Society as being made up of individuals in
different social classes who must compete
for social, material, and political resources”Karl Marx
 Division of labor
- Capitalist/ bourgeoisie- owner of
production
- Workers/ proletariat- sell their labor
Inequality
Conflict theory
StructuralFunctionalism
 Resulting from
 Inevitable and
groups with
desirable and
power
plays an
dominating less
important
powerful
function in
groups.
society
 Prevents and
 Important
hinders societal
positions in
progress as
society require
those in power
more training
repress the
and thus should
powerless
receive more
people to
rewards
maintain the
 A meritocracy
status quo.
based on ability
Latent: unsought consequences of
a social process
Example:
College educationmeet new
people, participate in ECA, find
partners


Page 3 of 5
Symbolic Interactionism
Focuses on the relationships among
individuals within a society
“It looks at the world we create when we
assign meaning to interactions and objects.”
CENTRO ESCOLAR UNIVERSITY
SCHOOL OF PHARMACY
MANILA
Ricardo Jr. N. Arellano
Putting your thumb up
means yes.
Skull and crossbones
mean danger
A balance symbolizes
justice
Depends on your
experience
DOG
Sociological Perspectives on Health (Turner,
1995)
Level
Perspective
Topics
Individual
Interpretive/
Lay knowledge
Symbolic
on health and
interactionism illness
Social
Structural
Cultural
functionalism
categories of
sickness
Societal
Conflict theory Health care
systems
First Level: Individual
 Examines people’s accounts of their
experiences of illness and how they maintain
their health
 Interpretive perspective
- How people make sense of, and give
meaning to, their lives or actions.
Interpretive perspective
 Views social problems as arising from the
interaction of individuals
1. Socially problematic behaviors such as
crime and drug use are often leaned from
our interaction with people who engage in
these behaviors; we adopt their attitudes
that justify committing these behaviors, and
we learn any special techniques that might
be needed to commit these behaviors.
2. We also learn our perceptions of a social
problem from our interaction with other
people, whose perceptions and beliefs
influence our own perceptions and beliefs.
Page 4 of 5
CENTRO ESCOLAR UNIVERSITY
SCHOOL OF PHARMACY
MANILA
Ricardo Jr. N. Arellano
Second Level: Social
 Examines what society regard as sickness,
illness or disease- SOCIAL PERSPECTIVE
 Structural Functionalism
- Society is a complex system consisting of
various parts that work together for
smooth functioning
Structural Functionalism
 Good health and effective medical care are
essential for a society’s ability to function.
 Ill health impairs our ability to perform our
roles in society, and if too many people are
unhealthy, society’s functioning and stability
suffer.
The Sick Role (Parsons, 1951)
1. Sick people should not be perceived as
having caused their own health problem
2. Sick people must want to get well
3. Sick people are expected to have their illness
confirmed by a physician or other healthcare professional and to follow the
professional’s instructions in order to
become well.
Third Level: Societal
 Emphasize the importance of divisions in
society and the subsequent issues of
inequality and power.
 Conflict theory
- Society’s inequities along social class,
race and ethnicity, and gender lines are
reproduced in our health and health
care.
Conflict theory
 Hyperactive Children
- Good: Ritalin, a drug that reduces
hyperactivity was developed.
- Bad: It was diagnosed as ADHD, a
medical problem, which was very
lucrative with the physicians and drug
companies for Ritalin.
- It obscured the possible roots of their
behavior in inadequate parenting,
stultifying schools, or even gender
socialization, as most hyperactive kids
are boys.
 Medicalization
- The process by which non-medical
problems become defined and treated
as medical problems often requiring
medical treatment
- To increase their sales, pharmaceutical
companies engage in “selling sickness”
or “disease-mongering”: expanding
awareness of disease for which their
drugs can be prescribed, and increasing
the likelihood that people will see
themselves as having those disease.
Cene
Page 5 of 5
CENTRO ESCOLAR UNIVERSITY
SCHOOL OF PHARMACY
MANILA
Ricardo Jr. N. Arellano
Social Administrative Pharmacy
Health and Illness: Understanding in Public’s Perspective
Introduction
“Is aging a disease? How about obesity, insomnia, grief?”

Disease is socially patterned.
The chances of becoming ill are frequently related
to a person’s social circumstances.

The concept of disease is complex, comprising various
dimensions of human malady
Table 1. Different perspective of human malady: disease,
illness, and sickness investigated (Solomon, 2018)
Field, Area,
Primary/
agents
stakeholders
Basic
phenomena
Access to
phenomena
through:
Disease
Illness
Sickness
Profession,
medical and
other health
care
professions
Physiological,
mental,
genetic,
environmental
entities or
events
Observations,
examinations,
measurements
Personal,
(experiential,
existential)
Society, social
institutions,
health policy
makes,
lawyers
Social
convention,
norms, roles
(including
social
prejudice)
Participation
interaction,
social studies
Subjective
experience,
first-person
negative
experience,
suffering, pain
Introspection,
intuition,
interaction
(language),
mental states
(psychology)
Common colds
Heart disease
1.
2.
3.
4.
High BP (asymptomatic)
Pregnancy
Illness alters the person’s situation, explains it to
himself, and calls for care. Disease permits medical
explanation, attention, and action. Sickness frees him
from ordinary duties of work and gives him the right to
economic support. (B) Heart disease.
Conditions where certain signs or (bio) makers are
identified by the medical profession before the patient
experiences any illness and which leads to an
entitlement to treatment and economic support
(sickness). (D) High BP (asymptomatic)
The medical profession is able to recognize these
conditions as disease by various diagnostics, and the
person in question certainly experiences them as
negative, but it does not qualify as sickness, as they
are expected to work (A) Common colds.
Conditions where the person certainly feels ill and
society entitles the person to have the status of being
sick, but where the medical profession is not always
able to identify or detect disease. (D) Pregnancy.
Illness (First
person
perspective)
Table 1. Different perspective of human malady: Disease,
illness, and sickness investigated (Solomon, 2018)
Knowledge
status
Altruistic
approach
Objective
Subjective
Cure
Care
Entitles to
Examination,
diagnostics,
treatment
Attention,
support
Disease
Illness
Sickness
Professional
Personal
Society
Intersubjective
Resource
allocation,
justice
Economic
support and
compensation,
sick leave, but
may also
result in
discrimination
and
stigmatization
Disease
(Professional
perspective)
Sickness Sick role
(Societal
perspective)
Figure 1. Visual outline of the triad disease, illness, and sickness
Case 1 (disease + Illness + Sickness)

Illness alters the person’s situation, explains it to
himself, and calls for care

Disease permits medical explanation, attention, and
action

Sickness frees him from ordinary duties of work gives
him the right to economic support

Examples: Heart disease, COPD, stroke
Page 1 of 7
CENTRO ESCOLAR UNIVERSITY
SCHOOL OF PHARMACY
MANILA
Ricardo Jr. N. Arellano






5.
6.
7.




Case 2 (Disease + Sickness)
Conditions where certain signs or (bio) makers are
identified by the medical profession before the patient
experiences any illness and which leads to an
entitlement to treatment and economic support
(sickness).
Examples:
High Blood pressure (Asymptomatic), HPV.

Case 3 (Disease + Illness)
The medical profession is able to recognize these
conditions as disease by various diagnostics, and the
person in question certainly experiences them as
negative, but it does not qualify as sickness, as they
are expected to work
Examples:
Common colds
Headache after drinking alcohol
Case 4 (Illness + Sickness)
Conditions where the person certainly feels ill and
society entitles the person to have the status of being
sick, but where the medical profession is not always
able to identify or detect disease.
Example:
Pregnancy
Disease
Illness
Sickness

Asymptomatic instances. Example: genetic mutations
(A) Disease.
Experienced by the person as negative, but are neither
recognized as sickness by society nor as disease by the
medical profession. Example: An intense feeling of
fatigue (B) Illness
Example: Homosexuality (C ) Sickness
Case 5 (Disease)
Asymptomatic instances
Examples:
Genetic mutations
Case 6 (Illness)
Experienced by the person as negative, but are neither
recognized as sickness by society nor as disease by the
medical profession.
Examples:
An intense feeling of fatigue, dissatisfaction,
unpleasantness, incompetence, anxiety, or
sadness.
Case 7 (Sickness)
Examples:
Delinquency (does not conform to the legal or
moral standards of society)
Dissidence (publicly disagreeing with and
criticizing the government or a powerful person or
group)
Drapetomania (an overwhelming urge to run
away (from home, a bad situation, responsibility)
Masturbation
Homosexuality
The Symptom Iceberg
The majority of symptoms experienced by people are
not presented to a health professional.
Figure 2. The Symptom Iceberg
Table 2. The response of adults in Great Britain to minor
ailments, n=2000 (BMRB, 1997)
Response
Percentage
Did not use anything
46
Used a prescription medicine 14
already in the house
Used an OTC medicine
25
Used a ‘home remedy’ (e.g.
9
hot-water bottle)
Saw a doctor or dentist
10
Saw a pharmacist
1
Page 2 of 7


The Symptom Iceberg
There is a reservoir of untreated minor symptoms and
ailments within the community, some of which could
be dealt with by the pharmacist
Seemingly ‘minor’ ailments could be evaluated by the
pharmacist as to whether or not they are self-limiting,
treatable with an OTC medicine or warrant the
attention of a physician.
CENTRO ESCOLAR UNIVERSITY
SCHOOL OF PHARMACY
MANILA
Ricardo Jr. N. Arellano


Illness Behavior
A sociological concept which attempts to describe how
people respond to their symptoms
Perspectives:
1. Individualistic Approach
Stress the characteristics of the individual
2. Collectivist Approach
Emphasize the shared social norms and values
that influence the actions of people within social
groups.
1.
2.
3.
4.





1.
Illness-Related
Variables
Use of health care
services
Patient-Related
Variables
Illness Behavior
Adherence to
medical regimens
2.
3.
4.
Doctor-Related
Variables
Response to
preventive
screenings
Main determinants and consequences of illness behavior (Sirri
et al, 2013)
Lay Health Beliefs (beliefs from non-professionals)

An understanding of lay health beliefs is useful and
important because it serves to:
1. Enhance our understanding of the social impact and
meaning of health, disease and illness.
2. Enhance the health professional-patient relationship.
3. Allow the development of realistic approaches and
strategies in health education and promotion
4. Allow the development of appropriate health services
based on the perceived needs of sufferers rather than
on the perceptions of health care providers.
Page 3 of 7
Etiology of Illness (Chrismann, 1997)
Invasion: the rationale that the body is susceptible to
intrusion of matter or substance that are able to make
the body ill, such as microorganisms, toxic chemicals,
or spoiled food.
Degeneration: whereby the body is perceived and
expected to get progressively worse with age.
Mechanical: the structure or functioning of the body is
impeded as the result blockages, fractures,
breakdowns, etc.
Balance: the imperative of maintaining an equilibrium
between elements within the body and the
environment.
Health Belief Model (HBM)
Describe the impact that health beliefs have on health
behaviors
Attempts to identify motives which influence people’s
health-related actions and,
Tries to recognize those which are most vulnerable to
chance
HBM quantifies health beliefs.
Dimensions of HBM
Level of interest an individual expresses in health
issues (health motivation)
Their perceived vulnerability to illness (susceptibility)
The perceived seriousness of certain illnesses (severity)
The perceived value of taking health actions (benefits
and costs)
CENTRO ESCOLAR UNIVERSITY
SCHOOL OF PHARMACY
MANILA
Ricardo Jr. N. Arellano
(A) Perceived Barriers
(C) Perceived Severity
(B) Perceived Benefits
(D) Perceived
Susceptibility
1. “Across the UK, 194,990 people had tested positive for
coronavirus as of 9am on Tuesday, up from 190, 584 at
the same point on Monday. Find out how many cases
there are in your area.” (D) Perceived Susceptibility
2. “US Recorded 1,297 Coronavirus Deaths Past 24
Hours.” (C) Perceived Severity
3. “Family of New York woman blames
hydroxychloroquine combo for fatal heart attack.”
(A) Perceived Barriers
4. “Dr. Zelenko in NY has now treated 699 Coronavirus
patients with 100% success using
Hydroxychloroquinone.” (B) Perceived Benefits
Table 3. Health Belief Model constructs, definitions, and
examples (Wang et al, 2021)
Constructs
Perceived
Susceptibility
Perceived Severity
Perceived Benefits
Perceived Barriers
Definition of the
Constructs
The assessment of the
risk of getting COVID19 infection.
The assessment of
whether COVID-19 is a
sufficient health
concern
The benefits of
HCQ/Cq* in
prevention or
treatment of COVID19;
Positive statements or
reports about HCQ/CQ
*HCQ:
Hydroxychloroquinone;
CQ: Chloroquine
The side effects of
HCQ/CQ;
The unaffordable cost
of HCQ/CQ;
The inaccessibility of
HCQ/CQ;
Negative statements
or reports about
HCQ/CQ
Examples
“Across the UK,
194,990 people had
tested positive for
coronavirus as of
9am on Tuesday, up
from 190,584 at the
same point on
Monday. Find out
how many cases
there are in your
area.”
“US Recorded 1,297
Coronavirus Deaths
in Past 24 Hours.”
“Dr. Zelenko in NY
now treated 699
Coronavirus patients
with 100% success
using
Hydroxychloroquine“
“Family of New York
woman blames
hydroxychloroquine
combo for fatal
heart attack.”
“The number of users tweeting about COVID-19 health beliefs
was amplifying in an epidemic manner and could partially
intensify the infodemic.”
“It is “Unhealth” that both scientific and nonscientific events
constitutes no disparity in impacting the health belief trends on
Twitter…”
Health Belief Model (HBM)

Enable the researcher or health educator to identify
the likelihood and willingness of the individual to
comply with “desirable” health behaviors.

The argument is particularly attractive to health
educators because if it is possible to identify ways in
which behavior can be changed they could act upon
and advise those who do not subscribe to healthy
actions.
Introduction
Health and disease are not simply biologically determined
phenomena. Rather, the chances of becoming ill are frequently
related to a person’s social circumstances. Disease is socially
patterned. By this we mean that some groups of people in
society are more likely to suffer from certain ailments than
others. This module explores the three prominent perspectives
on human malady: disease, illness, and sickness; the concept of
illness behavior, as well as the importance of lay knowledge and
beliefs about health and illness in healthcare practice
Health is influenced by many factors, which may generally be
organized into five broad categories known as determinants of
health: genetics, behavior, environmental and physical
influences, medical care and social factors. The social
determinants of health (SDH) are the circumstances in which
people are born, grow up, live, work and age, and the systems
put in place to deal with illness. These circumstances are in turn
shaped by a wider set of forces: economics, social policies, and
politics. Health inequities are avoidable inequalities in health
between groups of people within countries and between
countries. These inequities arise from inequalities within and
between societies. Social and economic conditions and their
effects on people’s lives determine their risk of illness and the
actions taken to prevent them becoming ill or treat illness when
it occurs. This module discusses social determinants of health as
underlying, contributing factors of health inequities.
*HCQ:
Hydroxychloroquine;
CQ: Chloroquine
Page 4 of 7
CENTRO ESCOLAR UNIVERSITY
SCHOOL OF PHARMACY
MANILA
Ricardo Jr. N. Arellano
M2 Lesson 1: Health and Illness: Understanding in
Public’s Perspective (1/3)
DISEASE, ILLNESS, AND SICKNESS
There are many heated debates about the concept of disease: Is
aging a disease? What about obesity, electromagnetic
hypersensitivity, insomnia, and grief? How can we understand
myalgic encephalomyelitis, chronic fatigue syndrome, and Lyme
disease? In such cases, we often confer with definitions of
disease to decide.
For example, it is covered by a personal perspective—i.e., how it
feels to be ill (illness); a professional perspective—i.e., how health
care professionals define, detect, predict, and handle disease
entities (disease); and a social perspective—i.e., how a person’s
social role is defined or changed by social norms and
institutions (sickness). These perspectives focus on different
phenomena and entities, they comprise different types of
knowledge, and they call for different actions from health care
professionals. Table 2.1 gives a summary of the main features of
the three perspectives on human malady.
Table 1. Different perspectives of human malady:
Disease, illness and sickness investigated
Field, Area
Primary agents/
stakeholders
Basic
phenomena
Access to
phenomena
through
Knowledge
status
Altruistic
approach
Entitles to:
Results in:
Disease
Profession,
medical and
other health
care professions
Physiological,
mental, genetic,
environmental
entities or
events
Observations,
examinations,
measurements
(by the natural
sciences and by
the use of
technology)
Objective
Illness
Personal,
(experiential,
existential)
Cure
Care
Examination,
diagnostics,
treatment
Attention,
support, moral
and social excuse,
reduced
accountability
Subjective
experience, firstperson negative
experience,
suffering, pain
Introspection,
intuition
(phenomenology),
interaction
(language),
mental states
(psychology)
Subjective
Hence, the concepts of disease, illness, and sickness highlight
different perspectives on important aspects of human life. These
concepts reflect medical professional, personal, and social
perspectives, respectively. Moreover, each concept calls for
action. Disease calls for actions by health professionals with the
goals of identifying, treating, and handling the entities and
events and to care for the person. Illness changes the selfconcept, relationships, and activities of the individual (e.g.,
making the person call for help). Sickness is a determination of
the social status of the person being sick, in particular, with
regard to entitlement to treatment and economic rights and
exemption from social duties, such as work (sick leave).
FREQUENCY OF SYMPTOMS: THE SYMPTOM ICEBERG
Today, we realize that the majority of symptoms experienced by
people are not presented to a health professional. Most people
either fail to perceive their symptoms, or ignore, tolerate or self
treat them. The fact that the majority of symptoms are not
presented to a health professional has been referred to by
Hannay (1979) as the ‘symptom iceberg’.
Sickness
Society, social
institutions,
health policy
makers, lawyers
Social
conventions,
norms, roles
(including social
prejudice)
Participation,
interaction,
social (science)
studies
Inter-subjective
Resource
allocation justice
Economic
support and
compensation,
sick leave, but
may also result
in discrimination
and
stigmatization
Source: Solomon, M., Simon, J., & Kincaid, H. (2018). DISEASE,
ILLNESS, AND SICKNESS.
An evidence of the frequent experience of symptoms was found
in a study of the incidence of illness amongst 2,000 adults in
Great Britain (British Market Research Bureau, 1997)
Response
Percentage
Did not use anything
46
Used a prescription medicine 14
already in the house
Used an OTC medicine
25
Used a ‘home remedy’ (e.g.
9
hot-water bottle)
Saw a doctor or dentist
10
Saw a pharmacist
1
The existence of a ‘symptom iceberg’ has significant
implications for health care and pharmaceutical care delivery.
There is a reservoir of untreated minor symptoms and ailments
within the community, some of which could be dealt with by the
pharmacist. Seemingly ‘minor’ ailments could be evaluated by
the pharmacist as to whether or not they are self-limiting,
treatable with an OTC medicine or warrant the attention of a
physician.
Page 5 of 7
CENTRO ESCOLAR UNIVERSITY
SCHOOL OF PHARMACY
MANILA
Ricardo Jr. N. Arellano
ILLNESS BEHAVIOR
The presence of symptoms alone does not determine the use of
health services. Instead, use of these services is determined by
how individuals respond to these symptoms.
The study of ‘illness behavior’ is the study of behavior in its
social context, rather than in relation to a physiological or
pathological condition.
Illness behavior is a sociological concept which attempts to
describe how people respond to their symptoms. This implies
that the way in which symptoms are perceived, evaluated and
acted upon is influenced by people’s previous health-related
experiences and an individual’s social environment.
There are two perspectives on illness behavior which have been
identified and termed as ‘individualistic’ and ‘collectivist’
approaches.
1. Individualistic approaches stress the characteristics of
the individual.
2. Collectivist approaches emphasize the shared social
norms and values that influence the actions of people
within social groups.
The experience of illness is defined according to the prevailing
norms and values of a society or community. It is not the
symptoms themselves that are significant in comprehending
illness behavior, but the way in which the symptoms are defined
and interpreted. Symptoms which are considered to be normal
in one context may be considered to be abnormal in another.
This ‘normalizing’ process is a common and frequent part of
everyday life. However, when symptoms prevent a person from
behaving ‘normally’, as expected by themselves or others, then
the symptoms may no longer be considered ‘normal’.
For example, whether two individuals with a persistent cough
experience this symptom in the same way will depend on a
number of social factors. A person living in a damp house may
interpret their early morning hacking cough as ‘normal’, not as
something out of the ordinary, an everyday experience shared
by neighbors which does not require presentation to a health
care professional. A person with a similar cough living in a
centrally heated house might perceive this symptom quite
differently – as a sign of possible serious illness requiring urgent
professional health care. We can see, then, that people evaluate
their physical and/or emotional sensations in terms of their
existing knowledge, experience and advice from other people.
Hence, when we talk of illness behavior we are saying that
responses to symptoms are learned in accordance with the
individual’s social environment.
Main determinants and Consequences of Illness
behavior
As a major component of clinical encounters, illness behavior
involves several variables related to health care efficacy and
outcomes. Figure 1 illustrate the concept of illness behavior
indicating ways in which given symptoms may be perceived,
evaluated and acted upon at an individual level. Illness behavior
may vary greatly according to illness-related, patient-related
and doctor-related variables and their complex interactions
This review article presents the concept of illness behavior which
may provide a unifying framework and useful insights to
observations and findings that would otherwise remain
scattered and unrelated in the medical literature.
LAY HEALTH BELIEFS
As we have seen, people’s responses to symptoms are many,
varied and diverse. Ideas and beliefs about health are derived
from many sources and have also been the subject of study by
medical sociologists.
The ideas of individuals with regard to health and illness are
referred as “lay health beliefs”. An understanding of lay health
beliefs is useful and important because it serves to:
1. Enhance our understanding of the social impact and
meaning of health, disease and illness.
2. Enhance the health professional–patient relationship.
3. Allow the development of realistic approaches and
strategies in health education and promotion.
4. Allow the development of appropriate health services
based on the perceived needs of sufferers rather than
on the perceptions of health care providers.
Page 6 of 7
CENTRO ESCOLAR UNIVERSITY
SCHOOL OF PHARMACY
MANILA
Ricardo Jr. N. Arellano
ETIOLOGY OF ILLNESS
Comparative studies of lay beliefs about the etiology of illness
have helped us to appreciate that people’s ideas and
beliefs. The search for an explanation of the cause of illness is
important to people who experience that illness.
Chrisman (1977), in a review of the literature from different
cultures on lay ideas about the etiology of disease, identified
four commonly used explanations to account for the pathology
of the body in the event of ill-health.
1. Invasion: the rationale that the body is susceptible to
intrusion of matter or substances that are able to
make the body ill, such as micro-organisms, toxic
chemicals, or spoiled food.
2. Degeneration: whereby the body is perceived and
expected to get progressively worse with age.
3. Mechanical: the structure or functioning of the body is
impeded as the result of blockages, fractures,
breakdowns, etc.
4. Balance: the imperative of maintaining an equilibrium
between elements within the body and between the
body and the environment.
HEALTH BELIEF MODEL
It has been suggested that there must be a relationship between
health beliefs and behavior. The Health Belief Model (HBM)
describe the impact that health beliefs have on health
behaviors. It attempts to identify motives which influence
people’s health-related actions and tries to recognize those
which are most vulnerable to change. The dimensions of the
HBM are:
1. the level of interest an individual expresses in health
issues (health motivation)
2. their perceived vulnerability to illness (susceptibility)
3. the perceived seriousness of certain illnesses (severity)
4. the perceived value of taking health actions (benefits
and costs).
An assessment of these perceptions, it is argued, will enable the
researcher or health educator to identify the likelihood and
willingness of the individual to comply with ‘desirable’ health
behaviors. This argument is particularly attractive to health
educators because if it is possible to identify ways in which
behavior can be changed they could act upon and advise those
who do not subscribe to healthy actions.
Ram
Cene
Page 7 of 7