Health and Medicine in Modern Society

The ways in which a society understands and interacts with its medical system is the focus of this paper. Medical systems, treatments, and prevention services are constantly evolving. The development of new technologies provides a foundation for more intricate and complicated procedures. This broad topic encompasses the ways in which people across a vast range of cultures create meaning in health and illness. The notion of what it means to be healthy varies widely across cultures, as do the medical systems designed to treat illness. The ways in which we provide access to health care and the lack of access to health care for many people around the world are studied under the broader term of the sociology of health and medicine. Different cultures have created their own means of treating illness, and these systems have evolved over time to influence what many call modern or technological medicine.

Keywords Alternative Medicine; Cultural Divide; Disability; Folk Medicine; Homeopathy; Impairment; Socioeconomic Inequalities; Specialization; Stigma; Universal Health Care

Health & Medicine in Modern Society

Overview

With the introduction of antibiotics in the 1950s and the growth of the pharmaceutical industry, the way in which medicine is practiced has evolved significantly. The latter half of the twentieth century and the beginning of the twenty-first have witnessed a remarkable change, with the introduction of spectacular technologies such as the MRI, the CAT Scan, organ transplants, and arthroscopic and laparoscopic surgeries. These technological advances have sparked a worldwide change in the way we perceive the concepts of health and illness.

Illness & Identity

The ways in which illness has constructed a specific identity for people over the years has been drastically altered. Even as recently as the early twentieth century, illness was often mired in myth and notions of miasmas and other ill-conceived ideas. People who were sick were often identified by their sickness, and terms such as crippled, helpless, and vulnerable were applied. Today, many strive to develop a different construct around the notion of illness and identity.

To some researchers, such as the late medical sociologist Irving Kenneth Zola (1935–1994), science and medicine have been responsible for constructing very specific identities around the body and illness. Zola, a man with a disability, wrote about the ways in which this construct affects people both when they are ill and when they are not. Zola's work emphasizes that factors such as ethnicity and gender highly influence people when it comes to understanding and coping with illness. One of his most influential ideas was that of medicine as an institution of social control. According to Williams (1996):

Zola identified four ways in which the attaching process was taking place, leading to the medicalisation of society: through the expansion to what in life is deemed relevant to the good practice of medicine; through the retention of absolute control over certain technical procedures; through the retention of near absolute access to certain 'taboo' areas; and finally through the expansion of what in medicine is deemed relevant to the good practice of life. The consequence of these developments is that every aspect of our lives contains risks to health—living itself is injurious to health (p. 114).

The interrelationship between illness and identity is also affected by perceptions of gender. For women, notions of the ideal body shape, femininity, and sexuality can all be affected by illness. A woman who undergoes a mastectomy, for example, may begin to feel less womanly because society informs her that a woman with one breast is less womanly than a woman with two. "Body image is related to negotiated cultural messages about women's appearance and ideal body shape. Research shows, for example, that there is a connection between frequent media use and greater body dissatisfaction as etched in cultural ideals of femininity" (Fernandes, Papaikonomou, & Nieuwoudt, 2006, p. 855).

The norms and values of a society give meaning to the construct we know as the body and the state of being that we call illness. Together, society creates a meaning for the sick body versus the healthy body. When people become ill, they assume the identity of a sick person—that is, they may not be able to work, may have to go on short- or long-term disability, and may face restrictions on socializing, exercising, and other activities valued as part of a healthy lifestyle.

Cultural Beliefs about Illness

Our individual and collective beliefs about illness affect us. According to Donkin, Ellis, Powell, Broadbent, Gamble, & Petrie (2006), "[r]esearch suggests that patients' illness beliefs may be important in the area of cardiac symptoms" (p. 423). In a New Zealand study, researchers found that people of Maori, Asian, European, and Pacific Islander cultures all maintain different ideas about illness, treatment, and recovery (Donkin et al., 2006).

Zola's research bore out similar results. Williams (1996) noted, "From his comparison of prospective patients of Irish, Italian, and Anglo-Saxon origin, Zola was able to demonstrate that it would take different symptoms to bring these patients to the doctor…" (p. 111). In the end, Zola maintained that society is taking increasingly greater control over peoples' health care and that being sick is an institutionalized identity which is controlled by the medical profession.

It was perhaps in his work on disability-related issues that Zola made the most impressive impact. He pioneered the movement to define disability as a social construct and therefore as something located in society and not peoples' bodies. Zola recognized that people could have 'impairments,' but he separated that from the notion of disability. An impairment is the lack of function in a particular area of one's body. Disability is the social prejudice leveled against people with impairments and barriers to their full participation. When society locates disability in the body, it is a form of social oppression. That oppression is integral to the medicalization of disability and the human body (Williams, 1996).

Health Care & Social Inequality

It is a sad reality that millions of people do not have equal access to health care. There are two levels to this problem. One is the lack of access due to the poverty of nations, and the other is lack of equality in health care in Western countries. There is perhaps no country which exemplifies this latter problem more so than the U.S. "Socio-economic inequalities in health reflect differential social circumstances that are divided along social class lines" (Prus, 2007, p. 276). People interact with medical systems on a micro and macro level—that is, a personal level and a population level (Prus, 2007). Both on a personal and a population level, there are people who are at a significant socioeconomic disadvantage.

Socioeconomic Status

There is a significant amount of research to demonstrate that socioeconomic status and health are strongly interrelated. People who are poor often suffer from a higher degree of illness. Some are beginning to suggest that access to health care is becoming one of the greatest signs of social inequality. There are those who look to countries with universal health care, such as Canada, as the answer. Yet, even there, some disparities have been recorded. Sin, Svenson, Cowie, and Man (2003) suggest that some of the reasons may include the following: "…poor health habits, crowded living conditions, inconsistent patterns of immunization and parental care, obesity, standard nutrition, and poor physical fitness…" (p. 54). This analysis suggests that unless poverty and social inequalities are dealt with at a root level, universal health care may not make much of a difference in peoples' quality of health. According to Lantz, Lichentenstein, and Pollack (2007):

The overarching goal of improving health status has become displaced by the immediate goal of increasing access to health services. As a result, we have a fragmented and beleaguered health care safety net; and insufficient policy attention is being paid to socioeconomic conditions that give rise to health vulnerability in the first place (p. 1253).

This comment concerns the situation in the U.K., where universal health care has existed for a very long time. These researchers point out that for far too long, public policies in the U.K. have ignored the root causes of poverty, which are far more debilitating than the actual ability to access the health care system. By framing the health care problem as one of access, governments sidestep the issue of having to deal with the larger problem. "Medicalized framing of health vulnerability can be an effective strategy to defend policy benefits/transfers to the disadvantaged by sidestepping social and political debates over the deservingness or worthiness of vulnerable populations" (Lantz et al., 2007, p. 1255).

Poverty in the Third World

The issue of health inequality is affected by what some people call the cultural divide. In the Western world there is access to the most advanced technologies and medicines available in the world today, but this is generally not the case in developing countries. Africa is a continent besieged by AIDS, primarily because modern treatments are not widely available. There is no doubt that the world is witnessing a cultural divide when it comes to equality of access to modern health care. "HIV/AIDS affects many different populations, and occurs in every country in the world; however, a disproportionate number of those affected live in the poorer countries of the world" (Fenton, 2004, p. 1186).

Some would suggest that poverty is in fact the greatest barrier to creating good health worldwide. "Poverty remains the world's biggest health problem, underlying the HIV/AIDS crisis, the high mortality attributed to tuberculosis and malaria, and the…deaths of children every day from preventable and treatable causes" (McCoy, et al., 2006, p. 2179).

Integrating Medical Systems - Culture & Medicine

A new sociological phenomenon is the movement to accept folk medicine and alternative medicine into the modern or conventional health care systems. It is not unusual for some pharmacies or health food stores to sell Chinese medicines, homeopathic remedies, herbal tinctures, and other alternative forms of medicine. There are significant differences between the biomedical approach and the foundations of alternative medicine. According to Mizrachi, Shuval, and Gross (2005), "alternative practitioners often view the great mind-body divide in biomedical theory and practice as an obstacle to reaching a cure" (p. 25).

Folk medicine has been around since the dawn of humanity. Despite this, there tends to be a poor understanding of such forms of healing in societies that no longer rely heavily on traditional medicine. According to Berger (2006), "part of the problem lies in applying a set of poorly defined and overlapping terms, like 'alternative', 'traditional', 'complementary' and 'folk' medicine, to many very different therapeutic modalities carried out in quite different settings" .

Portman and Garrett (2006) point out that the many tribes which combine to create American Indian culture have a long and rich tradition of folk medicine. Some of the healers who practice within these cultures are shamans, herbalists, and medicine men and women. One of the key concepts in American Indian medicine is a mantra that is becoming popular the world over: "wellness is harmony in mind, body and spirit; unwellness is disharmony in mind, body, and spirit" (Portman & Garrett, 2006, p.456). While biomedical or conventional doctors may not yet have a clear understanding of these systems of healing, it is clear there is a growing interest in and demand for them.

Applications

Public Policy & Health Care

There is a need to address the ways in which policy can affect and improve health care both on an individual level and for the population as a whole. In order to begin the process, governments must address the root causes of poverty and not focus only on access to health care systems.

In countries where a fee for service system exists, there is a need to implement policies which support one medical system everyone can access—not one system for the rich and another for the poor. Additional policies are required to revamp the insurance system which refuses people life-saving procedures and necessary treatments in order to cut costs. Unfortunately, the current approach in many countries focuses on helping people gain access to the 'system' but does not in any way deal with the true disparities—socioeconomic inequalities and poverty.

Another area of public health policy that must be addressed is that of much needed support for preventative medicine. Elders (2005) reports, "We need educational strategies, access strategies, prevention strategies, intervention strategies, leadership strategies, political strategies as well as strategies of compassion" (p. 807). There is a need for policy to establish preventative care and public health education as two top priorities for any medical system. In this way, the system becomes proactive rather than reactive.

There are other areas of society's health that have yet to be properly addressed. One of the key areas is the health of seniors. People in the Western world are living longer and more vital lives. The health care system must be able to respond. Another area that needs to be addressed is that of health care in inner-city urban areas and rural areas. Both are typically underfunded and poorly supported (Elders, 2005).

Global Health

The World Health Organization (WHO) was established to provide leadership on global health issues. As stated earlier, the cultural divide and increasing poverty in many developing countries have combined to create an international health crisis. Some researchers suggest that their initiatives have been less than effective. "WHO must be far more proactive. WHO must demand further discussion about establishment of new, stable, and sustainable sources of global public financing for health" (McCoy et al., 2006, p. 2179). As an organization, WHO must engage in initiatives at the level of socioeconomic policies to make changes that can affect the millions of people at risk.

One of the primary difficulties with addressing health policy on a global level is that health care is a national responsibility. However, when countries collapse, go into recession, engage in warfare, or become politically unstable, it becomes an enormous challenge to try and enforce health care policies. The responsibility falls to WHO to provide direction on implementing policies that can affect meaningful change. McCoy, et al. note, "Additionally, WHO must help to bring order to the chaotic proliferation of global health initiatives, many of which are characterized by selective vertical health programmes within countries" (2006, p. 2180).

There are many national health care systems which must be rehabilitated. In addition, many countries require financial and technical support to establish a modern health care system. On both a national and global level, public health care policy and leadership are required to create equitable health care systems and erase health inequalities.

Conclusion

The sociology of health and medicine is an extremely broad topic that could include several other categories, such as the politics of health care, the evolution of the medical practitioner, universal health care and others. There is no one approach to understanding medicine or health care. These are highly connected to cultural beliefs, norms, and values. In the United States, a highly technological system of conventional medicine dominates. In other areas of the world such as the European Union, conventional and alternative medical practitioners work side by side. It is not unusual for a biomedical doctor and a homeopathic doctor to work together in a UK hospital. Alongside these issues, the world needs to address the root causes of poverty, which leaves millions of people without proper health care. Both on a micro level and on a macro level, health care inequality is an issue that dominates public health.

Terms & Concepts

Alternative Medicine: A branch of medicine that embraces a wide range of various medical systems from different cultures that are not based in biomedicine. Some of these include Chinese medicine, homeopathy, and herbalism.

Cultural Divide: Refers to the fact that modern health care technologies and knowledge are available primarily in wealthy, developed nations but not in poor, developing countries. The availability of proper health care is divided between rich and poor nations.

Disability: The state whereby persons with various impairments are socially constructed as disabled by society through a system of barriers—physical, social, and educational.

Folk Medicine: A form of indigenous medicine that has been developed through cultural traditions.

Impairment: Loss of a function in the body, either temporary or permanent.

Socioeconomic Inequalities: Differential social circumstances that are divided along social class lines.

Specialization: Best recognized and documented at the post-registration level where a profession recognizes a specialist technology or skill in healthcare delivery that extends beyond the core, pre-registration training for that discipline.

Stigma: A stigma is a distinguishing mark that establishes a border between a stigmatized person and others and attributes negative characteristics to this person.

Universal Health Care: A system in which all citizens under a specific government are guaranteed health care. These can be different in structure but similar in aim. For example, both France and Canada have universal health care, but their systems operate under different parameters.

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Suggested Reading

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Brown, J.HU. (1978). The politics of health care. Cambridge, Mass: Ballinger Publications Company.

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