Sociology of health and illness

Critical approaches during the twentieth century claimed that health is a social construction, challenging the view held since the Enlightenment that medicine is an exact science. The sociology of health and illness looks at societal patterns regarding the causes and effects of human health. This field is interested in topics such as the social determinants of health, the impact of illness on society, social understandings of the body, health, and disease, and social relationships among health care workers and between them and the patients. Since the late twentieth century, there has been a growing focus of individuals and policy makers on healthy lifestyles and the role of alternative medicine, community care, and personal research.

Background

Sociology looks at phenomena through the perspective of the society and searches for causes and consequences that affect society as a whole. This perspective is useful for understanding issues of human health, as the social environment affects how individuals behave and how organizations work.

Modern Western medicine relies on a paradigm with origins in the age of Enlightenment (late seventeenth and eighteenth century) but developed since the nineteenth century, known as the “biomedical model.” In this model, medicine is an objective science and health is studied in terms of biological processes affecting the body and the mind separately. Health care is mainly provided to individuals by formal institutions.

This model was subject to criticism during the mid-twentieth century by postmodernist thinkers who rejected overarching theories explaining social phenomena. As such, they claimed that modern Western medicine is just one of many scientific and nonscientific medicine traditions and approaches to health and the body. Michel Foucault suggests that medicine should be understood in terms of contextual discourses about health. Modern medicine creates what he calls a “clinical gaze” as the body is regarded as an object of analysis that is independent from the person.

Theories developed in the 1970s have also challenged the biomedical approach. George Engel proposed the biopsychosocial model, which recognizes that health has biological, psychological, and social dimensions that are interlinked. Ivan Illich alerted to the “medicalization of life,” that is, the encroachment of medicine in spheres of life such as pregnancy, childbirth, aging, and death. This phenomenon leads to dehumanization and dependency on medical institutions and formal health care providers.

During the twentieth century, there was a major shift in the patterns of morbidity and mortality, with a decrease in the influence of infectious diseases, such as tuberculosis, and an increase of chronic and degenerative conditions, such as cancer and heart disease. These diseases are often linked to people’s lifestyles with regard to diet, physical exercise, substance abuse, stress, and exposure to poor environments. This evidence supports the idea that health care is the responsibility of the individual. Public health policies in many countries have then begun to place increased focus on the promotion of healthy behaviors through education and dissemination of information.

Overview

One of the main topics of the sociology of health and illness is the role of social determinants of health. Individuals face social and cultural constraints on behaviors linked to health opportunities and risks, and the relevance of these constraints differs across society, leading to different health outcomes according to age, gender, marital status, socioeconomic class, ethnicity, or sexuality.

Social relationships may also explain health outcomes. Social networks have an important role in the prevention of disease or mitigation of its effects. On the other hand, social stress is created by the pressures of society on the individual and may contribute to the deterioration of physical or mental health. The experiences and understandings of health and illness are also socially constructed. Individuals have beliefs about their own health and the health of others. These health beliefs depend on the geographical and social context and may change over time. Certain health conditions may be subject to prejudices and approached with moral discourses. This is, for example, the case with epidemics, especially in their early stages, before scientific knowledge about their causes is established.

In particular, attitudes toward mental illnesses, depression, chronic illnesses, disability, aging, and dementia tend to be rooted in social and cultural constructions of the body and mind. Attitudes on ethical issues in medicine, such as genetic research, euthanasia, and abortion, are also subject to the influence of discourses shaped by ideology and produced by political parties, activists, and mass media.

Health also has an impact on society, as the relationships within the family or workplace adapt to the illness of the individual. The impact of conditions such as mental illness and disability is especially important, as they increase the pressure on the social networks of support. The construction of relationships between people suffering from the same condition is relevant as it allows for the exchange of advice and experiences.

Health care institutions have become increasingly complex organizations since the twentieth century and also objects of sociological interest. The relationships within these organizations may follow certain patterns. The relationships between health care workers and institutional managers may be shaped by their different educational backgrounds, while the relationships among health care workers (for example, between doctors and nurses) may be sensitive to issues of status and gender.

The relationship between health care workers and patients is also an important object of study. Researchers have focused, for example, on the relationship of power of the health care worker over the patient due to the advantage given by medical knowledge. For this reason, the training of health care workers has increasingly emphasized questions of trust and communication. Doctors are also faced with ethical issues regarding disclosing the truth to patients and keeping confidentiality with others.

Finally, the role of the health care institution in society may change over time. The traditional understanding of medicine as an exact science implied the progressive exclusion of individuals without medical qualifications from the health care system. Nevertheless, the popularity of alternative medicines and community care has been growing since the late twentieth century. Since the appearance of the Internet, online forums have also become a major source of information, complementing or substituting some of the services provided by health institutions.

Bibliography

Collyer, Fran. Mapping the Sociology of Health and Medicine: America, Britain and Australia Compared. Basingstoke: Palgrave Macmillan, 2012. Print.

Engel, George L. “The Clinical Application of the Biopsychosocial Model.” American Journal of Psychiatry 137.5 (1980): 535–44. Print.

Ettorre, Elizabeth, ed. Culture, Bodies and the Sociology of Health. Burlington: Ashgate, 2010. Print.

Foucault, Michel. The Birth of the Clinic. London: Tavistock, 1976. Print.

Illich, Ivan. Medical Nemesis: The Expropriation of Health. New York: Pantheon, 1976. Print.

Kronenfeld, Jennie J., ed. Social Determinants, Health Disparities and Linkages to Health and Health Care. Bingley: Emerald Group, 2013. Print.

Newman, Matthew L., and Nicole A. Roberts. Health and Social Relationships: The Good, the Bad, and the Complicated. Washington, DC: American Psychological Association, 2012. Print.

Pescosolido, Bernice A., Jack K. Martin, Jane D. McLeod, and Anne Rogers, eds. Handbook of the Sociology of Health, Illness, and Healing: A Blueprint for the 21st Century. New York: Springer, 2010. Print.

Weiss, Gregory, and Lynne Lonnquist. The Sociology of Health, Healing, and Illness. 7th ed. Upper Saddle River: Prentice Hall, 2011. Print.