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CONCEPTS OF HEALTH DISEASE AND ILLNESS
As humans remain different in nature, so are their perceptions and response towards certain issues of their lives and well-being. The concept of health assumes to be a typical example of this and hence, poses debate about what it is. How do we manage illness, disease and sickness to draw a valid conclusion on its definition? This essay intends to discuss the meaning of health by exploring different definitions and their contradictions. It will also define illness while giving an example of illness experiences. Furthermore, the concept of disease will be discussed. Finally, I will explain the sick role while critically analysing and evaluating its features.
According to Townsend and Davidson (1988,p33), the term health is derived from the word “whole”, which is a recipient of the healing process. Therefore, an attempt to heal or cure in the medical field literally means, to make whole or restore health. It is this idea that influences medicine to adopt a mechanistic approach towards disease management thereby obscuring the understanding of health in the human context of well-being, which advocates for alternative or complementary approaches. This viewpoint reflects in some definition and the medical model discussed below.
“Health” as defined by the world health organization (1946) is the ‘state of complete physical, mental and social well-being and not merely the absence of disease. (Class handout) This would define health in an ideal world, which would apply to very few people. Seedhouse (1986) criticism of this definition believed that a more realistic view was needed. He went on to define health by postulating that “ a person’s optimum state of health is equivalent to the state of the set of conditions which fulfil or enable a person to work to fulfil his or her realistic and chosen biological potentials. Some of these conditions are of the highest importance for all people. Others are variable dependent upon individual abilities and circumstances.”
However, the World Health Organisation later re-defined health in 1984 as “the extent to which an individual or group is able on one hand to realize aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is therefore, seen as a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources, as well as physical capacities.”
This definition has been viewed from many different perspectives. Everyone is unique so the term “health” is a concept that varies from person to person and from one society to another. We all have our own personal views of being healthy. Many view health as being free of disease and illness and that as long as you are or feel “alright” you are healthy, but being “alright” does not mean being entirely without illness or disease.
From a laypersons’ point of view, my idea of “being healthy” would be to be free of illness and disease, to be physically, mentally, spiritually and emotionally stable and to be able to make independent choices and decision about my life. I also believe that a person’s health can be influenced by their lifestyle.
From a medical perspective, health would be defined as the absence of disease, illness or injury. The body is seen as a machine made up of many parts. The body and mind are viewed as separate parts; when there is a problem the body is broken down into parts, the problem found and rectified. The criticism of the medical view is that the medical view only deals with the cause of the disease or illness rather than the external factors affecting the person’s health. Within different sections of medicine, for example the mental health department, there are marked differences when explaining the origin of illness, disease, and treatments.
When trying to define health it is important to look at the different aspects and influences on health such as;
- Physical Health-to do with the body as whole
- Mental Health-to do with your state of mind and ability to be able to perceive and think clearly
- Emotional Health-deals with your coping mechanism when faced with emotional issues such as anger, grief, joy and sorrow
- Social Health-being able to maintain healthy relationships with other people
- Spiritual Health-being at peace with yourself
- Societal Health-dealing with social factors that may affect your health such as housing, employment, discrimination and poverty.
(This may of course vary from one individual to another depending on cultural and ethnic beliefs.)
Various studies have shown that social class and environment may influence a person’s health and illness. For e.g. living in poverty, damp housing and low income can cause raised child mortality rate of the lower class. The elderly in society are often diagnosed as sick because they are most vulnerable to illness; a large number of the elderly are in hospitals not because they are sick but because there is no one to look after them at home and also because health and welfare services fail to provide enough care in the community.
The health and illness that affect the social classes is often influenced by their environment for instance the child mortality rate of the lower classes can be caused by living in poverty, damp housing, low income, inadequate diet, through unemployment, all the issues which contribute to stress and depression as the lower class is caught in an never ending circle where each problem contributes to another and so lifestyles tend to stay the same. This diminishes hope and limits choices causing a threat to health. The lower classes also have the worst facilities of health care. Doctors and specialists who are able to choose the areas they work will more often choose middleclass areas where they will have the advantage of better staff and equipment. Hillary Graham’s work on women and smoking suggested that smoking might help women in poverty to cope because it is a method of relaxation, her way of having a break from the main interaction with small children.
The socially constructed perception of health is further influenced by the social class system (Registrar General Social Class Schema)
|11||INTERMEDIATE||MANAGER, NURSE, SCHOOL TEACHER|
|111N||SKILLED NON-MANUAL||CLERICALWORKER, SECRETARY, SHOP ASSISTANT|
|111M||SKILLED MANUAL||BUS DRIVER, BUTCHER, CARPENTER|
|1V||PARTLY SKILLED||POSTMAN, BUS CONDUCTOR|
Culture and medical influences of health
Unemployment and health – People who are unemployed tend to have much poorer health than those who work and areas where levels of employment are high have worse health records than areas with low levels of unemployment. For example, high death rates for unemployed men have been recorded in various recent studies, including the British Regional Heart Study of 1998 – 2000 and the O P C S Longitudinal study which found particularly high levels of lung cancer, suicide, accidents and heart disease (The Black Report). Illness is higher in the unemployed because the loss of job can lead to heavy smoking, drinking, stress poverty, depression and physically ill-health.
Housing and health – Housing has an important impact on health. Research has shown that the most significant risks from poor housing are associated with damp, which can contribute to diseases of the lungs and other parts of the respiratory system. Cramped living in poor conditions leads to accidents, sleeplessness, stress and the spread of infection. Research has shown that about a million homes in the U.K have inadequate standards of energy efficiency, putting the health of those who live in them at risk when it is cold. 100,000 houses the U.K have high levels of radon gas; this can increase the chance of developing lung cancer.
Eating junk food and other unhealthy foods – a healthy diet is an important way of protecting health. The amount of fruit and vegetables people eat is an important influence on health. Unhealthy foods, which include too much sugar, salt and fatty foods can lead to eating disorders such as obesity. It can also lead to other health problems like high blood pressure, high cholesterol levels, diabetes and coronary heart disease, cancer, stroke and tooth decay. Research suggests that a third of all cancers are the result of a poor diet.
Smoking and drinking too much – smoking is the biggest cause of disease which lead to early deaths in England. It is estimated to account for nearly a fifth of deaths each year – 120,000 lives in the U.K cut short or taken by tobacco. It can lead to health problems such as lung cancer, heart disease, chronic bronchitis, asthma, and cancer of the mouth, bladder, kidney and stomach. It is well known that heavy smokers carry five times the risk of non-smokers. In the last 30 years smoking has become strongly class-related. Mothers who smoke increase the risk of cot deaths to their babies. A recent study funded by the European Union estimated that passive smoking kills more than 20,000 people each year in Europe.
Alcohol – Many people who drink alcohol enjoy it and cause no harm to themselves or other people. Drinking too much is an important factor in accidents and domestic violence and can impair people’s ability to cope with everyday life, It has been estimated that up to 40,000 deaths could be alcohol related and in 1996 15% of fatal road accident involved alcohol. Alcohol when consumed in excess can lead to damage to the internal organs especially the liver as well as mental ill health.
The Black report published in the 1980s showed that there was a pattern to the wealth and health experienced by the different social classes, based on occupation the report showed health inequality and suggested that professionals fare better than managers, managers fare better than skilled workers and so on down the line. However there are also theories that try explaining the results of the Black report, suggesting that the system of health care is not such an important factor as other life circumstances that affect the health of different classes. The artefact theory suggests that the use of surveys for statistics is inaccurate because it fails to take into consideration the clinical iceberg where it is unknown how many people suffer illness as they don’t always report it also most health care happens in the home usually women treating symptoms by self care, in the case of postal surveys not everyone will respond and women often fill in forms for other family members. It is also unreliable because the figures relate to males of working age and not females and older and younger people and the statistics change all the time. However another study known as the Whitehall study gave evidence that there is a “real” relationship between social class and health outcome.
To explain inequalities in health and social class, which has been highlighted in explanations such as the artefact explanation, “theories of natural or social selection, materialist or structuralist, and cultural and behavioural explanations” (Townsend and Davidson 1988 p, 104). Therefore in theory, reducing inequalities in health will be adopting strategies that will modify or tackle the explanations given above. One-way of achieving this is already attained; though not specific in particular populations. This means identification of local inequalities targets such as that by “King’s Fund Policy Paper” which recommends strategies for reducing local inequalities in health and “Our Healthier Nation” which was set up by the government in England to improve the health of the worst off in society and to narrow the health gap.
Societal view of health in particular in multi-cultural Britain today varies from one culture to another. In societies what appears to be abnormal or unacceptable is often labelled as disease, conflicts arise because what accounts for illness differs from place to place and from time to time. This then probes the discussion of disease, illness and the sick-role.
Disease-refers to a medical conception of an “abnormality in function or structure”(Dingwall, 1976) of any part process or system of the body. Disease can be defined as an objective state of ill health by the discovery of abnormalities in contrast to illness, which could be defined as subjective. Disease thus defined may bear little relationship to the subjective experience of illness i.e.; pain, distressed. The detection of disease is often based on abnormal results of “test” such as those for high blood pressure, or routine smear test for women. However what is apparently normal for one individual may not be for another, or for the same person at a different age or under different circumstances. This makes it difficult to designate cut-off points between normality and abnormality, “test” such as for blood pressure. Some people who may be considered as having high blood pressure have none of the common symptoms associated with high blood pressure and are perfectly well. Unlike illness which is subjective to personal feelings of being ill with symptoms, it is possible to be diseased without feeling ill but then again symptoms of illness like stomach ache or chest pain, may be actually related to the onset of a chronic or degenerative disease, this may not be apparent for a long period of time e.g.; multiple sclerosis.
Social scientist view health and disease as socially constructed by the environment, even though new technology over time has brought improvements in sanitation and reduced risk of major epidemics; it has brought about dangerous levels of chemicals with the result that the major killers in modern industrial societies are heart disease and cancer.
Illness-is the term given to a subjective feeling of unwellness such as pain, discomfort, disability etc. This can occur in the presence or absence of any disease and it is largely what determines whether or not people consult a doctor or take medication. Many illnesses experience pain, aches, discomfort, nausea or weaknesses. It can be influenced by a range of psychosocial components, i.e.; social support, society’s perception, work status, demands and resources and personal characteristics. Many doctors when confronted with illness look for disease, if found the disease is treated but the illness, which may or may not be related to the disease, remains untreated. If no disease is found, the doctor may tend to scold or even accuse the patient of malingering or being a hypochondriac both of which are morally judgemental terms.
The importance of the difference between illness and disease is it depends on a number of social and psychological factors. It is possible to feel ill without having a disease or to have a disease without feeling ill. This may pose problems for the layperson who may find it difficult to differentiate between self-limiting minor illness and the signs and symptoms of potentially serious disease (ARMS, 1983). High levels of illness are seen as a threat to society thus the medical profession serves to ensure the satisfactory performance of social roles, yet critics might argue that their intervention has actually increases the number of people diagnosed as sick, this could be due to the pattern of medicine and drugs prescribed and their side effects. In society what appears to be abnormal or unacceptable is often labelled as disease, this may arouse conflict because society’s conception of illness varies from place to place and from one era to another.
The sick role
The sick role was initially recognised by Talcott Parsons in “The Social System” his interest was to explain the stability of society as a system of social roles where everyone did his/her fair share in keeping the system on an equilibrium level. In effect people who claimed to be “sick” were seen as a threat to their “obligations and sense of duty”(Nicky Hart 1991 p, 97). In order not to be seen as an excuse for getting out of customary duties, agents of social control were put in place to create an officially sanctioned “sick role”. By doing so, the individual sufferer was able to gain social recognition for any symptoms while society were able to isolate and regulate what might become an outbreak of “role obligation evasion” which would “infect” other people.
According to Parsons there are two dimensions of the sick role which implies four major expectations; two rights and two duties.
Rights- The sick person is temporarily relieved from their normal social roles. The more severe the sickness the greater the exemption.
The sick person cannot be held responsible for their condition. A person’s illness is usually considered to be beyond their control.
Obligations- The sick person is under obligation to try and get well as exemption from normal responsibilities is seen as only temporary.
The person is obliged to seek help, usually from a doctor in the process of trying to recover.
Parson’s also suggests that the specific rights and duties of the sick role reflected two underlying characteristics, which are seen as both vulnerable and deviant.
Vulnerability- Due to the threatening symptoms and the possibility of being exploited by others, the sick are perceived as vulnerable. In this view they are passive, trusting and prepared to wait for medical help, they must therefore be looked after. This however makes them vulnerable to exploitation, as they may have to undergo physically and sometimes emotionally invasive. Social regulation is therefore needed to protect the vulnerability of the patient.
Deviance- on the other hand sees sick people as a social threat, it is important to identify people that are genuine sick than from those such as malingerers, and hypochondriacs who use it as an excuse to evade their societal responsibilities, this is normally done by the medical profession who act as gate keepers against this form of deviance.
Parsons concept of the sick role has been criticized on a number of accounts;
Not every sick person complies with the sick role; this is due to the fact that some do not like to be dependent or vulnerable, some avoid the public sick role because their disease is stigmatised whilst others simply cannot afford to stop working. Another criticism is while some people are not to be blamed for their illness/disease, people who suffer from HIV/AIDS, STD’s are often blamed for their condition and are not accepted as legitimately sick. And finally people who suffer from chronic illnesses such as diabetes or blindness are expected to continue their role as far as they are able while people with acute illnesses are expected to adopt the rights and obligations of the sick role.
Parsons saw the sick role as a means of stabilising society by upholding the sense of duty and obligation that individuals feel towards one another. This is achieved through the institutionalisation of sickness as an official social role to be monitored and controlled by doctors. It means that medical treatment has the object of making the symptoms disappear, not only in the physical sense but also in a motivational sense. The doctor’s social control function is to guide the patient back to full participation in society as soon as possible, thereby reducing the length of “absenteeism” from customary social roles. This would require that doctors be willing to recognise the importance of the mental as well as the physical dimensions of illness and to extend their therapeutic approach to counselling their patients and encouraging them to conquer physical disability.
From researching for this assignment it seems to me that the concept of health is a socially constructed phenomenon in that society influences our behavior and moulds our perception of health. This, of course, varies depending on the class, cultural beliefs, ethnic background and society in which we live. Inequalities in health are prevalent in our society today. It’s existence between social classes, men and woman and age has been clarified in the black report and in governmental publications such as “Our healthier nation” and local organizations such as “The King’s Fund policy paper” When we are healthy we are able to benefit from life’s opportunities. Although some factors that influence our health are beyond our control, such as age, sex and heredity, influencing factors like our eating habits, life styles, social relationships and our environment can be adjusted to promote our well-being.
I think that there is a need for a holistic approach to health promotion. The government has put in place strategies to help reduce inequalities in health by “ensuring that the needs of people who have suffered the effects of inequality for too long are placed at the center of plans for health and social improvement”. This is a good start as far as reducing inequalities is concerned but the government also needs to make sure that these people who have suffered the effects are not only aware of this proposal or by making health, housing, education, or employment opportunities more accessible but trying to educate people in promoting their own health for example
- Teaching them how to avoid products, which are harmful to our health such as smoking, alcohol, junk food and illegal drugs by providing counseling, self-help groups leaflets and open day seminars.
- Learning ways to detect signs of illness or disease like unusual lumps or persistent symptoms.
- Making a visit to the doctor a learning experience rather than an ordeal by empowering individuals.
- Providing periodic health screening programmes.
This assignment has been very useful in that it has given me a whole new perspective on the concept of health, illness and disease. It has made me aware of how I see society and how society sees me. It has also enabled me to reflect on my health and has given me a way forward in promoting my family’s health. It has also raised my awareness of the different aspects of health because I thought being healthy was just physical, I now realize that it involves our emotional, social, spiritual and mental well being as a whole.
- Health Promotion Foundations for Practice (second edition)
Jennie Naidoo and Jane Wills (2000)
- Inequalities in Health ( The Black Report)
Peter Townsend and Nick Davidson (1980)
- The Sociology of Health and Medicine
Nicky Hart (1991)
- Our Healthier Nation ( Reducing Inequalities: An Action Report)
Department of Health (1998)
- Local Inequalities Targets
A Kings Fund Policy Paper – Liz Kendall (1999)
- Class Handouts-Health Studies
- The Health Divide
Margaret Whitehead (1988)
- Health And Deprivation – Inequalities and the North
Peter Townsend, Peter Phillimore and Alastair Beattie (1988_
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