Week 16
Sociology of Health and Illness

• Thought about how health and illness are structured by society
• Introduced the concept of the ‘sick role’
• Considered the concept of medicalisation and the impact of surveillance medicine

• Rational Choice and health education
• Candidacy for Coronary Heart Disease
• Health and lifestyles
• Rise of the expert patient?

• ‘Lay’ people in health research are not health professionals
• Concept used to explore the perspectives or behaviour of people in opposition to proscribed medical/health understandings
• Recently, moves to acknowledge that patients can be ‘experts’

• Early work on medicalisation emphasised the power and control of medicine
• Did not fully explain either health behaviour or patient- professional relationships
• Research grew into how beliefs impact on health

• Much health promotion can be linked to rational choice understandings
– Education about bad impacts, will change behaviour
• Patients seek medical advice, but do not necessarily follow it
– Fail to take prescription medicine
• Lay understandings can explain the complexity of health beliefs and behaviours

• The public is repeatedly told that smoking is bad for them.
• So why do people start or continue smoking?

• Smoking varies considerably by social class, gender and ethnicity
– 45% w/c adult men /15% m/c men
• Reasons include
– stress levels
– type of occupational
– understandings of relative risks
• Graham argued that it could be a way to manage poverty

• CHD is currently the biggest killer in the
UK.
– 1.4 million angina, 275,000 people heart attack
• What do you know about CHD?

• Davidson et al argue that ‘candidacy’ is a common perception in understanding CHD
– Type of person who should be careful
– Seeing yourself as a possible candidate
• Factors included
– Fat, unfit, smokers, heavy drinkers, stressed
– Family history, type of occupation
– Red faced, grey pallor, bad tempered, worriers

• Built into candidacy is an understanding that the ‘wrong’ people are affected
• Non-candidates have heart attacks
– Fate, destiny, chance
• Potential candidates do not have problems
– Lucky, good constitution

• Davidson et al argued that health promotion relies on simple messages which distorts epidemiological evidence
– ‘Fat = Bad’
• ‘Lay’ epidemiology notices the anomalies
– Fat survive whilst the thin drop dead
• Undermines the creditability of medical knowledge and encourages ‘fate’ as a predictor

• Do you recognise these ideas about candidacy and fate?
• How common are they amongst your family and friends?

• Blaxter & Patterson’s study of women found lots of different health problems
• Women held low expectations of health
– ‘Normal illnesses
• Women denied symptoms of illness
• The ability to function normally despite illness was prized
• Blaxter& Patterson (1982) Mothers and daughters London, Heinemann
Educational

• Younger women less interested in explaining health, and used more medical terms.
• Family and personal experiences are important
• External causes more acceptable than
‘natural’ processes –e.g. ageing.
• Often rejected suggestions that poor health caused by poverty

• Blaxter carried out a major study of what people think health is and what might determine health
• We cannot divide the population into health or unhealthy by lifestyle
– We tend to have both good and bad areas

• But Blaxter (1990) found that behavioural factors were seen as a main cause of illness
• Structural or environmental factors were not often mentioned
• Especially among those from workingclass backgrounds

• ‘Circumstances' are often more important than healthy or unhealthy behaviours
• ‘Unhealthy behaviour does not reinforce disadvantage to the same extent as healthy behaviour increases advantage’
• Blaxter, M (1990), Health and lifestyles. Routledge p233

• What do you think of the idea that stopping unhealthy behaviour may not have a significant impact?

• Recently ‘lay’ expertise has begun to be taken more seriously
– NHS Expert patient programme
– Successful challenges to medicalisation
– Self-help and campaign groups challenge professional decisions
• The internet is seen as the latest vehicle for promoting lay ideas

• Hardey has argued that professional power in medicine is built on control of expertise
• The internet presents a new challenge to this power relationship
• The internet also hides the boundaries between conventional, alternative and complementary medicine

• Lay models of health and illness are usually complex and sophisticated.
• They may draw on scientific explanations and everyday experiences
• Lay beliefs impact on attitudes, behavior and relationships with health professionals

• Health inequalities in social class
• Look in more detail about the lifestyle and environmental factors that influence health
• Individualising poverty