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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) 

Glasgow, 69.3

Kensington & Chelsea, 80.8

(National Statistics 2005)


Borough of Hammersmith and Fulham


Cancer Postcode lottery


The Paradox 

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


Our Questions 

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


Social Diseases 

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 Model 

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 

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

Medical Model

Social Model

Medical Solutions

Social Responses


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?


Infant Mortality


Mental Health


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 


Unhealthy Class 

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


Structuring Agency 

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 ‘healthy’?


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 

Explanations for child obesity are normally parent-focused. These include: 1. 2. 3. 4. 5.

6.

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 Children’s desire to live sedentary lifestyles


Economic Conditions 

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?


Ethnic Differences


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 


Ethnic Genetics 

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


Possible Issues 

Different attitudes to health and to receiving health care

Forced changes in lifestyles

Religious practices

Language difficulties

Socio-economic restrictions

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?


Gender Differences


Well Women 

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?


The NHS 

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


Privatised Health 

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?


Summary 

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 – 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

READING

McCrone, D. (2006) National Identity. In Payne, G. (2006) Social Divisions (2nd Ed.), Basingstoke: Macmillan.


The social life of your body ii