THE SOCIAL LIFE OF YOUR BODY
Health, Illness and Society
I’m going to die
…in about 46 years
Soaring Life Expectancy
Regional Life Expectancies Life Expectancy (boys born in 2002-04)
Kensington & Chelsea, 80.8
(National Statistics 2005)
Borough of Hammersmith and Fulham
Cancer Postcode lottery
Collectively, Britain is healthier than it has ever been
Life expectancies continue to rise and many major diseases have been wiped out
Conversely, health inequalities are rising
Globally, as economic growth brings new medical technologies the cost of access rises, placing significant pressures upon providers
Today we will
Consider how individual illness could be the focus of sociological investigation
Distinguish between social and medical models of health and disability
Discuss the role of class, ethnicity and gender in producing health inequalities
Examine the structural politics of health care
If people have ‘similar’ bodies, why do they have such different outcomes?
We seek to go beyond biological and individualistic explanations, asking:
How do social forces influence our bodies?
To what extent are health outcomes influenced by social forces?
In doing so we are investigating the relationship between society (social structures), individual choices (agency) and the body
Diseases are not just a failing of the body
Diseases occur within social conditions and are socially distributed
The produced and distribution of disease is determined by social structures like age, class, ethnicity and geography
Map of disease
The social construction of bodies
The body (and the natural world) does exist in isolation from the social world
The body doesn’t just tell us what is wrong with it, but it is interpreted – both scientifically and socially
The interpretation of what is a healthy body is socially constructed
Our health depends on our bodies, our behaviour and how we are treated, both medically and through social structures
Post-Humanism, for some
Eugenics is a philosophy advocating for the selection/removal of certain genes to improve humanity
Eugenics has been particularly controversial because of the use of sterilisation upon those with socially undesirable traits
However, improved technology has allowed for more subtle selection of desirable genes, such that it is becoming possible to have ‘a designer’ baby
Rapid advances are being made in medical technology such that futurists argue that functional immortality is becoming a possibility, for some…
The Sick Role
Functionalist Talcott Parsons, in arguing that people act rather than behave, suggests that we react to our body in socially defined circumstances rather than being dictated to by the body
Parsons argued that being sick is a social role – the sick role – characterised by submission to medical administration and social norms of what it means to be ill
The placebo effect demonstrates the influence of social conditioning upon the ill
Rights and Duties of the Sick
Withdrawal from social obligations
Exemption of responsibility for your condition
Desire to return to health
An obligation to seek qualified assistance
How do people act when they are sick? Is this socially influenced?
Disability as Division
Disability is one of the most profound divisions because of the relative inflexibility of most impairments
But the social inequality experienced by the disabled is also a form of institutional discrimination
How society conceptualises disability often determines the level of discrimination felt by the disabled
Medical conceptions of disability focus on the functional impairments faced by the disabled
The inability of the disabled to participate in some aspects of society can be explained by their specific impairment
Responses to this impairment focus on medical improvements
Conversely, the medical model ignores the conditions through which disability is experienced
Social Model ď‚¨
Focuses on the social restrictions faced by the disabled
Impairments may exist, but disability is caused by social organisation
The social model is the basis for sociological concepts of health, illness and disability
Disability as difference
The social model of disability demonstrates the influence of social structures upon health
Through social adjustments, physical or mental impairments can transition from division to difference
The physiology of health is recognised, but this physiology must be expressed within social conditions
Moreover, our social conceptions of what it means to be healthy and how health is achieved determine the way we respond to the aberrations in this status
What adjustments does Brunel make to reduce the disability of impaired people?
Basic Definitions Illness: The subjective state of feeling in ill-health Sickness: A social state or a social role Health: Bentham: ‘a state of being which is free from discomfort or, more positively, produces comfort’
World Health Organisation: ‘Health a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity’
Health as Division
Health, a state of normalcy, is distinct from other divisions in that it is transient
Illness is not a difference like ethnicity, but is something to be eradicated
Differences in health are socially structured and lead to social divisions: to be ill is to be substantially disadvantaged in comparison to others
Health and illness is also strongly related to other modes of division, specially class (income), ethnicity and gender
What social factor has the most influence health in Britain?
Common Explanations of Health
Health is genetically determined
The survival of the fittest: the sick are poor because they are sick
Our lifestyle choices make us unhealthy
Or are health inequalities are determined by structural factors such as class, ethnicity and gender?
The Importance of Understandings
Graham, H., and M.P. Kelly. 2004. Health Inequalities: Concepts, Frameworks, and Policy. London: National Health Service/Health Development Agency.
Socio-Economic Position (Class)
Back to class
In considering health inequalities, we return to the difficult question of social class
Specifically, should class be understood as a reflection of the economic organisation of society, or a set of behaviours?
Both unhealthy lifestyles and poor health are strongly correlated with poverty
But are these choices and the consequent health inequalities the result of unequal economic distributions, or poor choices embedded in class cultures?
Why are the poor so unhealthy?
There are a number of explanations for class correlated health inequalities, specifically:
The poor are poor because they make bad decisions (or have less capacity to make these decisions), and these failings are reflected in their lifestyle as well
Low income earners tend to work in poorer conditions that are more hazardous to health
Low income and less autonomy at work restricts access to health care and to healthy lifestyles
Cultural & Behavioural Factors
Critical conceptions of the link between poor health and social class suggest that lifestyle choices are the primary factor, positing that lower classes have a cultural deficit that leads them to make poor health choices, such as: Smoking (Unemployed people are twice as likely to smoke (39%) as those in employment (21%) Drinking excessive alcohol Poor diet (32% of school children regularly miss breakfast) Lack of exercise
If social class is defined by culture rather than economic position, some unhealthy behaviours are part of lower-class lifestyles
Smoking (see Graham, 2012) and poor diet (Wills et al, 2011), have been identified as markers of lower-class status and a reflection of poor education
These choices have significant consequences: Cribb et al. (2011) found that the quality of children's diet at 10 years was related to maternal education level
One side sees these as primary the result of individual choices, the other suggests that they are rooted in social circumstances (e.g. in occupational cultures)
Government policy strongly focuses on improving choices
Choices can be improved by increased knowledge
Where have you received most of your information about how to be â€˜healthyâ€™?
Poor and Fat?
The Department of Health claims that the poorest children are almost twice as likely to be obese than the richest (see also Sayed et al., 2011)
Conservative MP Anna Soubry: “When I walk around, you can almost now tell somebody's background by their weight,“
"The real reason why our obesity problem is going to get bigger in the years ahead is because our child poverty problem is going to get much bigger as a result of the government's own policies," Imran Hussain, Child Poverty Action group
Causes of Obesity ď‚¨
Explanations for child obesity are normally parent-focused. These include: 1. 2. 3. 4. 5.
Lack of education about food Limited cooking skills Limited money to buy healthier food Working longer hours Marketing campaigns for junk food aimed at kids Childrenâ€™s desire to live sedentary lifestyles
The physical organisation of society, which is strongly related to the economic organisation, has a significant affect on health and the production and distribution of disease
Social isolation is also a significant factor, as is quality of housing
Working conditions are less healthy for the ‘working classes’, including low autonomy, stress and higher risks of cancer
Marxist’s argue that the medical/technological focus on curing individual bodies is irrational, given that the cause of illness appears to be largely structural
Do the poor have less control over their lifestyle decisions? What roles have the most unhealthy working conditions?
Why are some minorities ill?
Health outcomes are very different across ethnicities: Infant mortality among Pakistani-born mothers is twice the national average Only 40% of Bangladeshi children in the UK have a dentist compared to the national average of 90%, People of Indian origin are three times more likely to develop diabetes than the rest of the UK population. According to the 2011 census the ‘White Gypsy or Irish Traveller’ communities have twice the White British rates of limiting long-term illness
The prevalence of certain diseases and conditions within identifiable groups has led many to argue that there are genetic differences between these groups
There is a long medical history of dividing the population into races, despite the widespread biological rejection of the concept
When differences in health outcomes of an ethnicity are outlined, the go-to explanation is racial-genetic differences
Genetics may predispose us to disease, but it relies on a social environment to express it
Different attitudes to health and to receiving health care
Forced changes in lifestyles
Travel and exposure to more cultures produces greater exposure to different diseases
If you were in charge of the NHS, how would you improve the health of the Gypsy/Traveller communities?
Women are diagnosed as suffering from ill-health more often than men Medicialisation of reproduction Caretaker roles for family members
Women live longer than men across almost every sociological category
The gender divide of death
The Feminised Patient
Feminist health sociologists (see White, 2011, p.132) argue that patriarchal medical practices enforce passivity and dependence upon women
These forms of medicine define women by their biology and reproductive capacity which is contrasted to the healthy male body
To some degree the biological limitations of women’s reproduction defines the relationship between their body and society
The production of new medical reproductive technology risks turning women into science projects
Women and Mental Health
Women report higher levels of stress than men and are diagnosed with depression more often (approx. 18% to 11%)
This may relate to different forms of expression – Men are ‘bad’ while women are ‘mad’
Although the more expressive more of ill-health leads to increased medicialisation, it may also result in better health outcomes
Men behaving badly
Men’s health is shaped by gender roles and identities that often focus on instrumental performance
The stereotype is that men fail to seek medical advice (‘be a man’) for health problems, nor follow advice
Chronic or limiting illness is often hugely problem to men’s identity
Whilst considerable research exists on feminine health, much of the research around men focuses on men’s behaviour such as ‘Men also have a highly individualistic view of their health’ (White, 2011, p.151)
There is a lack of research on men’s health, and cancers more often faced by men tend to receive less publicity
Why do women live longer than men?
Our conceptions of health and illness drive the way we organise their treatment – should it be the responsibility of the ill, or of society?
Public health care is a system of collective responsibility for the health of society that take democratic belonging, rather than a privatised contractual obligations, as the main criteria for receiving treatment
The National Health Service (NHS) was created in 1948 and has a budget of £127.48 billion for the 2012/3 year
Free state health care is available in the vast majority of developed countries (with the notable exception of the USA), but it is rarely entirely free or totally state provided
The NHS under threat
Public health services are coming under increasingly pressure from the dual threats of population longevity and the expensive medical technology required to maintain this longevity
Many countries are seeking to transfer the burden of resourcing systems to the use (user-pays)
In order to increase ‘efficiency and competitiveness’, NHS services have been opened up to private providers, to the point that some argue that the NHS no longer exists as a public health system
Private health care allows for those who can afford it to go beyond the necessary limitations of public health systems
Public health systems must rationalise resources, which produces difficulties for those outside of the national priorities
Private health care also means the ‘commodification of medicine’ whereby the primary objective is profit, which distorts the care ethos
User-pays health care also puts greater emphasis on the un-well to take responsibility for their health
Should people be made to be financially responsible for their lifestyle choices?
Health and illness have strong biological aspects, but this is expressed within a social context
There are marked heath inequalities for different social groupings, particularly in relation to class, ethnicity and gender
The key question is whether this is due to biology, individual choices or structural constraints.
Our understanding of this question largely defines how health care is provided.
ASK Week â€“ Autumn 2013
4-8 November A whole week of academic skills workshops, events, appointments and drop-ins See ASK web site or BBL for details http://www.brunel.ac.uk/services/library/ask
The Academic Skills Service (ASK) is located in the library. We provide advice and support on writing, learning, maths and statistics
The Next Week… IMAGINED COMMUNITIES: MIGRATION AND THE POLITICS OF EXCLUSION
McCrone, D. (2006) National Identity. In Payne, G. (2006) Social Divisions (2nd Ed.), Basingstoke: Macmillan.