T h e Relative Impo r ta n ce o f Hea lth Dete rmin ants 107
T h e Sear c h fo r a Cau sa l Explan a t io n : Jason's Story 108
Pr itna ry a n d Secon da ry Deter n1i n a nts 110
Es ti111 ating th e Hea lth Be n efits o f Major Dete rm in an ts Il l
T h e Dete rm in a nts o f Good Healt h a n d 111 Hea lth 112
Chapte r Su111mary 115
Stud y Q u estio n s 117
Reco n1n1ended Read ings 117
Reco n1n1ended vVebs ites 118
Reco n1n1ended A u d iovisua l Sou rces 118
5 Ad dressing Sources of Inequa lity a nd Health D ispa r ities:
Socia l Class 119
Und e rs ta nd ing Social In e qu al ity 119
Socia l De ter n1in a n ts o f Healt h Disparit ies : l nc0111 e, Occupatio n , and
Educa t io n 121
T h e Socia l G r ad ie nt a nd H ea lth 126
l nc0111 e In equa li ty a nd Popu latio n H ea lth : T h e O n goi ng Debate 13 1
Expl anat io n s of the Socia l Gradie n t in Healt h 134
Ma teriali st a nd Neo -111ateria list Expla n atio n s 134
C ultu ra l Beh aviou ra l Expla n a tions 135
Psyc hosocia l Explana t ions 137
Toward a n l nter sect iona l T h eo ry o f H ea lth and So ci al C lass 139
Re duci n g Socia l Class Disparities in Healt h: ls It Poss ible to Close the Gap? 140
Chapte r Su111mary 143
Stud y Q u est io n s 144
Reco n1n1ended Read ings 144
Reco n1n1ended vVebs ites 144
Reco n1n1ended A u d iovisua l Sou rces 144
6 Ad dressing Sources of Inequa lity a nd Health D ispa r ities:
Gender 145
Hea lth a nd Ge nder 145
Ge nder D iffe re n ces i n Healt h 147
Wo n1en Li ve Lo n ger Than Men 147
T h e Ge nders Di ffer in Major Cau ses o f Death 149
Wo n1en Are Diag n osed as Suffe ri ng fro m Mo re Il l Health Tha n Me n 150
Wo n1en Mak e More Freque n t Use of Forn1al Health Care Tha n Men 151
s
Gender D iffe re n ces i n th e Social De tern1 i nants of Hea lth 153
Expl anat io n s of Gend er Di ffe re n ces i n Health an d Jll ness 155
T h e Ro le Accu 111 ul a t ion H ypo t hesis 157
T h e Ro le St rai n Hy p othesis 157
T h e Socia l Accep tability H ypo th esis 158
T h e Ris k-Tak ing H y p o t hes is 159
T h e Nu rt u rant Hypoth esis 162
Toward a n l nter sect ional T h eory of H ea lth and Gend e r 163
Chapter Su111mary 164
Stu dy Q u estio n s 165
Reco n1 n1ended Read in gs 165
Reco m n1ended vVeb s ites 165
7 Addressing Sources of Inequa lity and Health D ispar ities: Ethnicity and the Life Course 166
Health an d Et hn icity 166
Ethn ic D iffe rences in Healt h 168
A b o rigin al Peoples H ave Poore r Heath Outc0111es Due to So ci al Exclus ion 169
T h e Healthy -lm n1ig rant Effect De teriorates over Titue 173
Ethn ic D iffe rences in t he Pe rceptio n a n d Un d erst a nd in g o f Syn1p to m s 175
Ethn ic D iffe rences in Healt h- Ca re Beh aviou r 176
Ethn ic D iffe rences in t he Social De te n n i na n ts of H ea lt h 178
Expl anat io n s of Et h n ic Di ffe rences in Healt h and I llness 180
Bio logical Deten u in ist Expla n a ti o n s 180
Socioeconon1ic Explan a t ions 182
Cu ltu ra l Beh aviou ra l Expla n a tions 182
Toward a n l nter sect ional T h eo ry o f Hea lth and Eth nicity 183
Health a nd the Life Cou rse 184
T h e Li fe Cou rse a n d t h e Socia l Grad ient in Hea lth 189
Li fe Cou rse D iffere n ces in th e Socia l De tern1 i nants of Hea lth 189
Toward a n l nter sect ional T h eo ry o f Hea lth and the Life Course 191
Chapter Su111 m ary 192
Stud y Q u est io n s 194
Reco n1n1ended Read i ngs 194
Reco n1n1ended vVeb s ites 194
Reco n1n1ended Aud iovisua l Sources 194
8 Unravelling the Mystery of Healt h : An lntersectional Model 195
l ntersectio n a lity a nd H ealth D is p arities 195
Lifes ty le Behaviou rs a n d H ealth 198
Individualized Health Pron1otion 20 I
The Individualization of Health Lifestyles 203
Health Lifestyles or Health Behaviours? 209
Theo ri zing the lntersectionality of Hea lth 213
Health Lifestyles and the Structure-Agency Issue 214
P ierre Bourdieu and a Relational Theory of Health Lifestyles 2 17
An lntersectional Model of Hea lth and Hea lth Lifestyles 223
Chapter Su1nmary 227
Study Questions 229
Recon1n1ended Readings 229
Recon1n1ended Audiovisua l Sou rces 229
9 Discover ing the Hidden Dept hs of Heal th Care: Lay Be li efs, Socia l
S u p p ort, a n d Informal Care 233
The Iceberg of Hea lth Care 233
Hidden Components of the Hea lth -Ca re Syste1n 234
Lay Explanatory Bel iefs about Health Maintenance and Ill ness
Manage1nent 236
Popular and Professional Concept ions of Health and Illness 246
Self-Care Beliefs and Behaviour 249
Social Support, Helping Networks, and Hea lth 258
Info r ma l Care and Illness as Embodied Experience: Making Sense of Sickness and Maintain ing a Healthy Self-Identity 263
A Narrative Account: T he Meaning and Management of Pain 264
Chronic Il lness Work 268
Chapter Su1nmary 270
Study Questions 272
Recon1n1ended Readings 272
Recon1n1ended vVebs ites 272
10 Med ical izi ng Be ings an d Bo d ies: T h e Link be t ween
Pop u lat ion Health a n d Biomedical Ca r e 273
The Origins of the Bion1edical Model 275
Bedside Medicine 275
Hospital Medicine 277
Laborato ry Medicine 279
Basic Ideas of the Bion1edical Model 280
Mind-Body Dua l ism 281
Physical Reductionis1n 282
Specific Et io logy 282
T h e Machin e Metaphor 283
T h erapeut ic Focus on In dividualized Regitnen and Control 286
Medica l Don1ina n ce of t h e Health-Ca re System 288
Medica lizing Beings and Bodies 291
Explanat ions for Med icalization 293
Chapter Su1nmary 309
Study Question s 311
Recomn1ended Readings 311
Recomn1ended vVebs ites 311
Recon1n1ended Audiovisua l Sources 311
11 Mov ing beyond Biomedicine: Medical Plura lism 312
T h e Socia l Construction of Hea li ng: A Sociologica l Perspective on Med ica l Plu ra lisn1 3 13
T h e Histo rica l Pers istence of Med ica l P lura lism 315
Avoid ing the 'Stereotypes o f Ma rginal ity' in Social S tu d ies o f Alternat ive Med ic ine 3 17
Labell ing Alternat ive Med icine 318
T hree Streams ofCon1ple1nenta ry Alter n at ive Medicine Research 319
Explanat ions for th e Reviva l of Medical Pluralism 32 1
T h e Den1ographic Trans ition and Popu latio n Agi n g 321
Dissa t isfaction with Biomedicine 322
T h e Post1nodern Cond ition 322
Individualizatio n and Con stune rism 322
Crossing Cu ltures in Pursuit of Hea lth and We llness: Choosing Heal ing Practices 323
T h e Deve lopment of Cu ltural Diversity and Mu lticu ltu ral ism 325
Medica l Consun1eris111, the Marke t in g of Eth n ic ity, and Revi val of Med ica l Plu ralisn1 326
Integrative Medicine: Pr ospects for a New Med icine 329
Chap ter Su1nma ry 332
Study Questio n s 334
Recomn1ended Readings 334
Recomn1ended vVebs ites 334
Recon1n1ended Aud iovisual Sources 334
12 Ac h iev ing Healthy Futures 335
Toward a Soc io logical Understan ding o f Hea lthy Societies and Healthy People 335
Studying Health: Alternative Socio logical Paradigtns 336
Deve lop ing an l ntersectional Model of Healt h 337
Measurin g t h e Di n1en s io n s of Hea lt h: A M ixed -Me t ho d s Ap proach 337
Socia l De ter n1i nants of Healt h : Reflect io n s on vVhat We H ave Lea r ned 339
Str uc t u ra l a n d Per sona l Dete r min a nts o f H ealth 339
Sou rces of Socia l Inequality and H ea lt h Dispa rit ies: I ntersection s of Class, Gen d er, Et hn icity, and Age 340
Adopt ing a Li fe Cou rse Persp ect ive on th e P u rsu it of Healt h and Wellness 341
Life C h a n ces a n d Health C h o ices: The Str u cture -Agency Q u estion 342
Shared Respon sib ility fo r Ma k i ng Societies and People Hea lt hy 342
Person al Resp onsibility: lnfon nal Ca re and Healt h 343
Pro fess ional Respon s ib ility: Forn1al Ca re a n d Health 344
P ublic Responsi b il ity: The Govern a n ce o f H ealth 344
Healt h Po licy In it iatives: Lalond e and Beyond 346
T h e Ongoing Pursuit of Health a n d vVellness: Some Un a n swe red Quest io n s 350
How Does the Vis ion of a Health y Socie ty Differ fr 0111 th e Reality of Healt h - Ca re Reforn1? 351
l s It Possible to Re d ress Socia l I nequalities in H ealth? 353
Why l s It So Diffi cu lt to hnplement Health y P ubl ic Policy? 357
l s Well n ess Always Good for You r Hea lt h? 359
What Is Requ ired to Ren1ake t he Medica lized Soc iety into a Salutogen ic Society? 362
Study Question s 365
Recommended Readi n gs 365
Recon1n1ended vVebs ites 365
Glossary 366 References 373 Index 397
Pr eface
Our culture is preoccupied with pursuing heal th and wellness. Think, for example, how prominent ' health' is in our everyday language: healthy li ving, healthy eating, healthy environments, healthy arguments, healthy acti vity, healthy buildings, hea lthy re lationships, healthy workplaces, hea lthy bodies, hea l thy k ids, healthy commun it ies, healthy recipes, hea lthy minds, healthy agi ng, healthy schools, heal thy familie.s, hea lthy weight, healthy balance, healthy habits, healthy beginn i ngs, hea l thy endings. We use the term 'health ' to refer to these and many mor e aspects of everyday l ife. We r outine ly greet people with the fam i liar 'Hi. How are you? ' inquiring about their health status. The ma r ketpl ace is crowded with products and serv ices pr omisi ng more hea lth and higher levels of wellness.
Governments try to fu r ther ra ise heal th consciousness in order to get indiv iduals to behave in ways that will promote personal health and avoid potential health r isks. Healthy living is synonymous wi th desi re, virtue, vi tali ty, beauty, and goodness. ' If you have you r health, you have everything', the saying goes. Health per vades our wellness-oriented culture. De.spite i ts universali ty, hea lth is also intensely personal-seemingl y a private matter and a pe r sonal va lue. vVe closely safegua r d info r mat ion regarding hea l th, ca r efully conside r ing to whom we should d isclose our health concerns. Med ical records are subject to some of society's st r ictest p r ivacy laws. Additionally, like all th i ngs of va lue in our culture, health is unequally distributed within society, as are the conditions necessary for wellness. Not everyone is healthy or has equitabl e access to the resource.s that make people well. We a r e left wonder ing whether it is possi ble to address social i nequalities i n health.
Too often, the vision of achieving healthy futures gives way to never-ending debates focused on reform i ng the formal health-ca r e system, repai r ing medicare, and consuming health care rather than p r oducing population heal th . The dominance of biomedici ne leads to medicalizing beings and bodies, wh i le the goal of making people hea l thy gets lost amidst anxiety over the threat and treatment of ill ne.ss. Some people try moving beyond biomed icine by usi ng complementary and alternative forms of health care. It is easy to conclude that health is both public and p r ivate. It is everywhere in ou r culture, and yet not all members of our society share i t equally. The pu r suit of hea l th and wellness tru ly seems a mystery that leaves us unce r tain as to whether it is possible to make societ ies and people healthy.
By apply i ng the sociological i magi nat ion, th is book wi ll unravel the myster ies surrounding the pu r suit of health and wellness. Health and illness are related concepts, wi th health often unde r stood as merely the absence of d isease. Standard appr oaches to understandi ng health in ter ms of i llness a r e li m i ted by focusing on the d i stri bution of disease and the consumption of medical products and forma l heal th-care services. Rather than focusing on p r oducing health, these approaches concentrate on disease and death rates and consuming health ca r e provided by medica l pract i tioners (e.g., doctors) and inst i tutions (e.g., hospitals) . However, th is book shows that sickne.ss is only the t ip of the iceberg when it comes to studying health ! Researchers often overlook h idden depths of health ca r e
Preface and contri butions that lay beliefs, social support, and informal care make to the pursu i t of health and wellness. As a r e.suit, we know mor e about what makes us sick than we do about what makes us healthy. Th is book adopts an alter native perspective, consistent wi th a shift in hea lth sociol ogy, and concentrates on explo r ing facto r s that shape health and wellness. The focus is explicitly on health rather than illness. We will d iscover both the st r uctural and personal factors that cont r ibute to pu r suing health and wellness wh ile l earning about the i mpo r tance of healthy societies for hea lthy peopl e.
No single theory or associ ated methodology is abl e to completely unrave l the mystery of health i n all of its d imensions. Due to the multi-dimensional nature of health, this book consider s major theoretical paradigms used by sociologists for under standing hea lth and makes a case fo r adopt i ng an eclectic approach using mixed methods to measure the d i mensions of health. Extensive cover age is given to the l atest r esearch perspect ives on health, including i nter sectiona l analysis and a li fe course per spective. Detailed and upto-date infor mation is prov ided on socia l determinants of health and how society shapes the health of both popul ati ons and i ndi viduals. vVe p r e.sent the latest ev idence from i nternational and Canadian health r e.sea r cher s on factors that affect health. An intersect ional model of heal th is outlined to gu i de future research. Most impor tantly, this book is wr i tten i n straightforwa r d, easy-to-read language, wi th student-friend ly sociolog ical analyses of engagi ng curr ent events re lating to the pursuit of hea lth and wellness. Each chapter summarizes resea r ch in a manner that allows an undergraduate student to understand the majo r issues. It critically evaluates the exist i ng body of knowledge and identifies gaps as well as i mplications fo r future r esearch. Chapter s conclude with a brief summa r y of the ma i n points raised in the discussion, sample study quest ions, suggest ions for further read i ng, and Inter net resources. Throughout the text, biographic content boxes pe r sonalize the insights of some of the most r enowned scholars of health, med icine, and the body. Afte r read i ng this book, you wi ll understand that it is possible to create healthy societies and healthy peopl e, and you will gain a better appr eciation of factors that shape your pu rsu i t of heal th and wellness!
Acknowledgements
We would like to acknowledge the Oxfo r d Un iversity Pr ess staff who have contri buted i n different ways to this book, includ i ng Al an Mulder, Sales and Editor ial Representative; Katherine Skene, Supervisi ng Acqu isitions Edito r ; Nancy Rei lly, Acqu isitions Edi tor; and Jodi Lewchuk, Super vis ing Deve lopmental Editor. vVe are particularly gr ateful to Nancy Rei lly fo r her enthusiastic response to the initial book proposal and to Jod i Lewchuk for her ski llful gu idance and invaluable suppor t during the wri ting phase. We also sincerely appr eciate the insightful and instructive comments that we r eceived from the r ev iewers. It has been a very positi ve and r ewa r d i ng exper ience wor king with you all.
I n add i t ion, we would li ke to acknowledge the financial support p r ovided by the Faculty of Graduate Studies at the Universi ty of Man i toba for the graduate students i n the Department of Sociology who assisted us by carry i ng out liter ature searches and finalizing the list of refe r ences cited in the book.
To Maxine, for constantly provid i ng food for thought. Your unconditiona l love and suppor t make all things possible
To Kevin, Sheryl, Justin, and Hayden, and to Nicole, Dave, and Jordan fo r the many ways that you have en r iched my li fe.
To vVally, my best fr iend and father, whose own pursuit of health and wellness has taught me so much.
To Annette, my aunt and ma i n prov ider of social support in all its forms
To Rayanne, the healthiest influence in my li fe.
C.J.F.
A.S.
PURSUING HEALTH AND WELLNESS
Understanding Hea lth and Wellness Sociolog ica lly
Part I, Under standing Hea lth and 'vVellness Sociologically, contains th r ee chapters. Chapter I, Introducing Health Sociology, begins with a discussion of the mystery of good hea lth and the impor tance of r ecogniz ing that health is a social constr uct. The concept of health consciousness is then introduced, and an effort is made to clari fy the dist i nction between produci ng hea lth and consum i ng health ca r e. Th is i ntroductory discussion is followed by a brief r eview of the origins of medical sociology and the factors that contr ibuted to the convergence of sociol ogy and medici ne. After out lin i ng the scope of early medical sociology, the focus sh i fts to the transition from medical to health sociology and the development of hea lth sociology in Canada. The first chapter concludes by emphasizing the need for a more theoretically o r iented sociologica l approach to under standing the pursu i t of health and we llness.
Chapter 2, Apply i ng the Sociologica l Imaginat ion to Hea lth, Illness , and the Body, p r ovides a d iscussion of alternative sociologi cal pa r ad igms for studying health, i llness, and the body. After summarizi ng t r aditional theoretical pe r spect ives ( i.e., health and illness as viewed from structu r al functiona list, conflict, and interactionist paradi gms), th is chapter i ncludes a discussion of fem i n ist social theo r y and health and i llness as gender ed experiences. The chapte r concludes by reviewing the contemporary sociology of the body pa r adigm, which h ighlights the i mpo r tance of understand i ng health and i llness as embodied cultu r a l facts.
Chapter 3, Measuri ng the Dimensions of Health, addresses the need for a better unde r standing of the relat ionship between meaning and measu r ement, the distinction between good hea lth (we llness) and i ll health (s ickness), and the process of hea lth status designation. The multi-dimensiona l nature of health is emphasized, and challenges facing popu lation health assessment are outl ined, including d i fficulties invol ved i n measuring both ill health ( the t r ad i t ional approach) and good health (t he positive aspects of heal th and we ll -bei ng). The salutogenic model of health is int r oduced as a conceptual framework fo r studying salutary facto r s that protect and promote good health. The chapter clari fies the d i fference between health inputs, health status, and heal th outcomes, and then rev i ews the advantages and disadvantages of a number of i nd icators typically used in measu r ing the health status of Canad i ans. Chapte r 3 ends with a call for a m i xed-methods appr oach to measur i ng the good health dimension of wellness (a nd the ill heal th dimension of sickness), combi ning standa r d quantitat ive methods, such as population health surveys, with more qua litative methods, such as nar r at ive accounts and health diary studies.
Introducing Health Sociology
Learn ing Objectives
In th is chapter, st udent s will be in trodu ced to a so cio logica l pe rspe ctive on hea lth and will gain a b etter u nderstan d ing of
• healt h as a 'so cial const ruct io n';
• t he d iffe rence bet ween a sociolo g ical unde rstandi ng of hea lth a nd wellness a nd one based on 'biolog ical det e rminis m';
• t he cu lt ural bases of 'health conscio u sness';
• t he sco pe of trad it iona l me d ical so cio logy a nd effort s to trans form the fi e ld into healt h sociolo g y; a nd
• t he d eve lopment of hea lt h socio lo g y in Ca nada.
Intr oduct io n: The Mystery of Good H ea lth
Have you ever wondered how it is possible fo r anyone to stay healthy? vVhen we a r e young, we a r e typically exposed to 'normal' childhood diseases such as chicken pox. As ch i ldren and adults we continuall y face the threat of contagious i llnesses that a r e 'go ing a r ound'. For example, i n our daily lives we routinel y encounter people who have 'common' cold symptoms, such as d i fficu lty breath i ng or sor e throats. Plus, there is the annual challenge of the flu season. T he olde r we get, the more li kely we a r e to have to deal with the increasi ng prevalence of ch r onic cond itions such as arth r itis o r hypertension ( h igh blood p r essure). Today we r out i nely hear about the potential threat of pandemics such as Acquired Immunodeficiency Syndrome (A IDS ) , Sever e Acute Respiratory Syndrome (SARS) , and HIN! influenza. Fi nally, we are lea r n i ng more about how threats to the environment are also threats to human hea lth. Despite all the r isks, most people manage to stay well and lead healthy and p r oductive lives.
vVhat types of factors contri bute to good health? How do peop le manage to p r otect their health and stay well? As Antonovsky consistently a r gued (1996, 1987, 1979), health r esearchers need to focus attention on finding answers to these quest ions i f they hope to be able to unravel what he descr ibed as the mystery of good health. At present, we know a g r eat deal about what makes us sick (as i llustrated by the cartoon below), but, in cont r ast, we have a very li m i ted understanding of what keeps us we ll. T he types of risk factors that contr ibute to ill heal th are quite fami li ar to us (e .g., cigarettes and fast food), but the ' ver y r a r e condition of good health • is st i ll somewhat a myste r y!
~ou \.\ive Very r.ll'e concl.i.tion. we call "{;;tool> "EALT1t" C-i~arett.es G ra~t .{:,oJ. shoul.l. take c are o~ il fairl1.1 cr,w~kl~ & we'll see 1:1«>tt ~(!;a1n in. ~nc. m.ontlt.~.
Antonovsky (1979 ) introduced a sa l u t ogeni c model of h e alth i n an effo r t to direct our attention from i ll health to the salutary facto r s that p r otect or enhance good heal th. H is intention was to formulate an approach that would contribute to an i mproved understand i ng of the ' or igins' of good health and the social conditions that fac i li tate health-protect i ve behaviours
By focus ing on hea lth i nstead of i llness, Antonovsky was hopeful that the sa lutogen ic model would p r ovide a gu ide for identifying and understandi ng the factors that make populat ions healthy. We w i ll examine the features of this model mo r e closely later i n the book when we discuss the determ i nants of good heal th versus ill hea lth ( Chapter 4, Making People Heal thy: Genera l Determinants of Health and 'vVellness) For the present, i t is suffici ent to acknowledge the influence of the salutogenic model on the approach adopted i n this book for exploring the meaning of good health and the soci al facto r s that contribute to the successful pursu i t of health and wellness.
The pr i ma r y purpose of this book is to provide a cr itical sociologica l framework for understand i ng the hea lth and hea lth-care behaviour of Canadians. Fi rst and foremost, th is book will focus explicitly on health rather than illness. Traditionally, medical sociol ogy focused primar i ly on the d istribution of disease , the organization of fo r mal medical se r v ices, and the rol e of med i cal pract i t ioners ( e.g. , doctors ) and i nst itutions ( e.g., hospitals) in caring for illness. Wh i le acknowledg i ng the trad itiona l med ica l sociology approach, we will shift our thinking about hea lth and i llness to a health soc iology perspective, considering not on ly ou r efforts to ma i ntain ' health ' but also the mo r e general pu r su i t of 'wellness' Drawing on the sci entific literature ava i lable, i t seems that while the two terms are somet i mes used interchangeabl y, the concept of wellness is much broader than hea lth and actually subsumes good health. For example, Br uhn and colleagues ( 1977: 2 10) argue that wh i le the mean i ngs of good hea lth and wellness differ, it is important to rea li ze that ' good health is a cont i nua l process that can evol ve i nto wellness.' In other words , good health is a necessary, but not a sufficient, cond i tion to attain wellness. Well ness is an i nclusi ve concept that incorporates not only good health but also quality of l i fe and sat i sfact i on with general liv i ng cond i tions ( Evans and Stoddart, 1990). I n other words, by providing a cr it i cal ana lysis i nformed by soci ol ogical theory and research, this book will help you understand the factors that shape the hea lth and wellness of Canad i ans.
H ealt h as a Social Cons t r ucti o n
'No social study that does not corne back to the problerns of biography, ofhistory and of their intersections within a society has co111pleted its intellectual journey.'
C. Wright MiUs, The Sociologica/ /111ngi11ntio11, 1959
This quotat ion is from the sociologist C. Wri ght Mills, who wrote a ve r y i mpo r tant book in which he expla i ned that the task and promise of sociology are to understand the dual process wherein society affects i ndi vidual behaviour that, in turn, in its totality affects society. The task of social science is to understand how the object ive structu r es of society (e .g., socia l r ol es, nor ms, i nst i tutions) influence individual, subject ive behaviour (e g., personal health-care behaviou r), and, in tu r n, how the totality of social behav iour serves to reproduce the rea li ty that is society. One place to begin our introduct ion to heal th sociology is by looki ng at how sociologists follow M i lls' advice to define and understand health. I n th is effort, we will contrast the sociological unde r standing of health and wellness with other unde r standings, some of which a r e popul ar in ou r culture.
Though most peopl e have some idea about what it means to be in good hea lth, heal th is not as st r a i ghtfor wa r d a concept to unde r stand as it may appear. Usually, it is not unt il sickness intrudes into a person's li fe that health and its i mpo r tance become clea r to the unfortunate sufferer and her friends, fami ly, and loved ones (Ca lnan and 'vVill iams, 1991; Id ler, 1979). It may be in the i ronic natu r e of heal th that it is best understood when it is gone, with health defined in relat ion to illness. Th i s not ion of health is too vague, however, to satisfy the socia l scientist trying to ga i n a more precise understanding of the mean i ng of good hea lth and the p r ocesses by wh ich people pursue health and wellness.
I n the classic book Man, Medicine and Enviro11111ent (1 968), Pu li tzer Pr i ze-w i nning bi olog ist Rene Dubas makes the point that the desi r e for health is per haps the most fundamental for any organism, and th is is certainly no less the case for what Dubas descri bes i n a later book as 'the human animal' (1969) Yet, when it comes to heal th, our social natu r e renders a un ique p lace for human bei ngs. Unlike an i mal s, the human pu r suit of hea lth is fa r more than an instinctual dr ive for survival and cannot be sat isfacto r i ly understood as such. For us, health and wellness are much more than biophysical conditions and a r e never expe r ienced or under stood simply at this level. The basic idea behind the sociological understand i ng of hea lth is r eflected in the quotation from M i lls: People's locations i n the social world affect our behaviour and, ultimately, ou r health and i llness. To illustrate, aspects of our behaviour, such as liv i ng i n automotive-intensive subu r ban cities or pollut i ng the environment, shape ou r society, which, in tu r n, affects ou r health. The idea that society shapes and is shaped by human behaviour is an i mpo r tant sociol ogical insight. Under standing biography, history, and thei r intersections is the mandate of sociology. It is health sociologists who systemat ically study the soci al aspects and d i ffe r ing interests in society that affect the human pursuit of good heal th and wellness . Chapte r 2, Applying the Sociological Imaginati on to Heal th, I llness, and the Body, will present alter native sociological pa r adigms for studying health.
Accor ding to the sociologica l appr oach, health represents a fundamental part of everyday life that is shaped by society and soci al r el ations. This perspective is r eflected by a groundb r eaking i nter national policy document t i t led The Ottawa Charter for Health
Pr01notio11, rel eased by the 'vVorld Health Organization in 1986. The Ottawa Charter prov ides guidel i nes that governments th r oughout the world wer e encou r aged to adopt fo r the i r population health promotion strategies. The first Inte r nat iona l Conference on Hea lth Pr omotion meeting i n Ottawa, Canada, 'was prima r il y a response to gr ow i ng expectations for a new public health movement around the wo r ld' (1986: 1) In the Ottawa Charter, i nter national expe r ts chose to define h ea l th as
a resource fo r ever yday life, not the objective ofl iving. Health is a pos it ive concept emphasizi ng social and personal resou r ces, as well as physical capacities. T herefor e, health p r omotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-bei ng. (Wo rld Health O r ganization, 1986: 1)
What was so novel about defini ng health i n this way, rather than in relation to ill ness, was that these experts identified a wide range of social, political, and environmental facto r s that influence health and well -bei ng beyond b iology alone. More specifically, they argued that 'the fundamental cond itions and r esources for health are: peace, shelter, education, food, income, a stable eco-system, sustainable resources, social j ustice, and equity' ('vVorld Health O r ganization, 1986: 1). This broad view of health allowed the author s of the Ottawa Charter to write, 'Professional and social groups and health per sonnel have a major respons ibil ity to mediate between differing i nterests in society fo r the pur suit of health' (1 986: 2). Although health may be viewed as a crucial resource fo r living, it is evident that we do not all experience health and wellness in the same way. Sociologists point out that our pur suit of health has impor tant social dimensions and reflects differing locations wi thin the structures of society. In keeping w ith the definition of health in the Ottawa Charter, health sociology understands health as a social construction; that is, both the health and illness of our bodies and the manner in which we understand these concepts are influenced by social facto r s.
Wh i le the term ' soc ial constr uction' has a long histor y in soc iological thought, p r obabl y the most noteworthy t r eatment comes from Peter Berger and T homas Luckman n's The Social Construction ofReality: A Treatise in the Sociology of Knowledge. Th is book, published in 1966, remains ' one of the most widely read and influential books in contemporar y sociology' (R itzer, 1992 : 387). T he pu r pose of Berger and Luckmann's book was to explor e the ways in which people in the course of their everyday lives and social interactions construct subjective mean i ngs that, i n tur n, ser ve as the bas is of the soci al real ity that is society. Real ity is seen to be creative ly shaped by people through social inter action. For the sociolog ist, aspects of our real ity such as the mean ing of good health are sa id to be soc ially constructed. Th is socio logical under standi ng of health as a social construction can be contrasted w ith the way in wh ich a doctor, for example, under stands health and i llness.
I n medical and biol ogical under standings of hea lth, human be i ngs a r e often described as little more than d i scr ete bundles of biochemica l and mechan ica l p r ocesses, and hea lth is defined clinically by physiological p r ocesses oper at i ng w ithin the l imits of certa i n predefined, scientifically measurable pa r ameters. For example, when you go to your family doctor for a physica l exam i nation, she will measure your blood pressu r e using technolog ical i nstruments such as a sphygmomanometer and stethoscope: an inflatable arm cuff to r estrict blood flow connected to a mer cury manometer to read your level of blood pressu r e and a device to listen to sounds with i n the body. If, after repeated measurements,
1 Introducing Healt h Soc io logy
you r blood pr essu r e r ead i ngs continue to fall with i n the h i gh range, you will be d i agnosed with ' hype r tension', or h igh blood pressure, a medical condition affecti ng five mill ion Canadians that can lead to stroke, hea r t attack, and k idney fa i lure ( Hea r t and Str oke Foundat ion of Canada, 2008 ) . Regardless of how you may report feeling, you are labelled ' hea lthy' i f your physi olog ical marker s are with i n the p r edefined parameters, and ' diseased' i f they are not. Indeed, hypertension is known as 'the silent killer' because a per son with high blood pressu r e experiences no symptoms.
Comment i ng on the biomedical conception of health, McKee notes that 'in contrast with the 'vVorld Health Organization's defin i t ion of health as " physical, mental, and social well-being, not merely the absence of disease o r infirmity", hea lth tends to be defined i n functiona l rather than exper iential terms, as the absence of disease ' (1988: 776). In other words, illness, scientifically labelled as disease, is understood by biomed icine in a functiona l rather than an experient i al way. As a result , d isease becomes reified. That is, disease is treated as a thing with a clearly defined r ea lity all its own: 'Th is appr oach, which posi ts a disease as a thing with an identity of its own, is known as the ontological defin i t ion of d isease. Thus, the disease and its associated symptoms become the focus of attent ion, rather than the whole patient ' (Berli ner and Sa lmon, 1979: 35) .
Understand i ng human bei ngs in te r ms of biologica l funct ion i ng has a long h istory i n Wester n thought and is descr ibed as ' b i o log ica l d e t ermi n i s m ', or the bel ief that human behav iou r can best be expl ained in terms of innate biological properties of individua ls, such as genes and biochemical processes. 'Ultimate ly, all human behaviou r -hence all human society-is governed by a chain of determ i nants that r uns from the gene to the indiv idual to the sum of behav iou r s of all indiv iduals. The determinists wou ld have it, then, that human nature is fixed by our genes' ( Rose, Lewontin, and Kamen, 1984: 6). In the West, science has offer ed us this view of ou r sel ves and a complex set of med ical practices and technologies based upon it and we have, by and large, accepted this biologicall y deter ministi c view of hea lth ( Lewont in , 1991 ) .
For the health soc iol ogist, however, heal th is not understood solely as a biophysical state exper ienced i n the same manner by all people in all times and p laces, but, r ather , as a socially constructed exper ience that varies according to cultu r al factors. Th is is what it means when health sociologists refer to health as a soci al construction. To fully understand health in a sociological per spective, you have to take into account indiv idua l differences and cultural dimensions invol ved i n health, as well as the healthiness of society. People's awareness of hea lth and their r esponses to illness va r y not only from i nd i vidual to indiv idua l because of the uniqueness of each per son's b iogr aphy, but also from cultu r e to culture. Hea lth soc iol ogy, then, is the branch of sociology that attempts to generate under standings of the social and cu ltura l contexts with i n which the meaning of good health is interpreted, i llness is r ecognized, and the pursuit of health and wellness occu r s.
Heal t h Consciousness: Producing Health versus Consuming Heal t h Care
'Hi, how are you?' This fam i lia r ph r ase is typically used to start conversations with others. Why do we gene r ally ask about the health and wellness of other people when we greet
them? The obvious answer is that th is custom is part of our cul tural tradi t ion ( like a handshake) and is learned through informal socialization in social settings such as the fam i ly and school. However, th is is not a complete expl anation for the reason why we inqu i r e about the hea lth status of others when we meet and greet them. Asking about health is a way of acknowledging ou r interest in the other person and establishing a basis for social interaction. The cul tural practice of sta r t i ng conversations wi th a question about hea lth reflects the fundamental importance that we attach to good heal th i n our society.
Lau, Ha r tman, and Ware (1986 : 26) contend that ' researcher s have frequently assumed that all people uniform ly place a very h i gh val ue on heal th' and, as a resu lt, 'the concept of hea lth as a value is one that has been surpr isi ngly underutilized i n hea lth research.' Few studies actually exam i ne the va lue that people attach to health in thei r personal lives. To correct this situati on, Lau, Hartman , and Ware developed a shor t measure of health as a va lue . The measure requires the person to rank the relative importance of health ( i.e., physica l, mental , and soci al well-being) compared to other aspects of l ife. In add i t ion, respondents are asked to indicate the extent to which they agree wi th common healthrelated expressions, such as 'If you don't have your hea lth, you don't have anything', or 'There is nothing more important than good health.' Results generally i nd i cate that hea lth is the most h ighly ranked va lue held by members of the study popu lation. Research has al so shown that people in Western culture regard a comm i tment to wellness as a moral vi rtue (Con rad, 1994). There is growing ev idence that we do indeed value health and wellness very highly.
We certainly spend a great deal of time talking about health vVe not only regularly ask about the health of others but we also constantly disclose i nformation about our own health to family members, fr iends, and co-worker s. Stop and th i nk about how many of your da i ly conversat ions at home, at school , or at work focus on hea lth-related topics. How much time do you spend each day talki ng about health? Gould (1990 : 233) contends that 'people who th i nk about hea lth a lso talk about i t.' In other words, our level of health consciousness may be reflected, in part, by the extent to which we ta lk about hea lth.
Hea l th co n sciousness can be defined as the degree to wh ich an i ndiv idual is aware of and attent ive to her own health. This awareness is a fundamental aspect of everyday social life and involves mon i toring our health status, assessing and interpreting the cond i t ion of our m i nds and bodies, and engag i ng in a wide variety of heal th actions as a routine part of our soci al practice. As we wi ll explore in Chapter 8, Unravelling the Mystery of Health: An Inter sectional Model, health consciousness, or the degr ee to which we focus on our health, is likely related to everyday hea lth behav i ours such as our eating habits and the extent to which we pay attent ion to hea lth informat ion (Kask utas and Greenfield, 199 7).
To assess your level of health consciousness, try answer i ng the questions in Box I.I.
Today we a r e bombarded by an ever-increasing amount of health i nformation from a wide diversity of sources. Most newspapers and popu lar magazines have regula r hea lth col umns , such as the popular hea lth advice column by Dr. G i fford-Jones syndicated i n over si xty Canadian newspapers. Plus, ther e a r e a tremendous number of speci ali zed publications that now focus enti r el y on health, fitness, and d i et. This point i s vivid ly illustrated by br owsi ng in your favo u r ite bookstore and not i ng the amount of she l f space devoted to tit les categorized as health, wellness, fitness, or nutrition books. Among dayt i me television's most popul ar shows are those that feature medical experts offer ing health advice,
Discovering Diverse Content Through Random Scribd Documents
Han. Shoot him; you see he vos a nice dog; he vos the image of you.
Lena.Oh, Hannis!
Han. Und I thought dot mebbe you might wear him in your locket, or haf him stuffed into a pracelet or something like dot.
Lena.You vos joking.
Han. Shust you go und tell dot dog dot he vos a liar. You vill see vedder I vos joking.
Lena.An’ is a dog all dat you haf bringed me?
Han.No, Lena, I have brought you somedings else.
Lena.Vell, vot?
Han.I don’t vant to tell you.
Lena.Why not?
Han.You wud make fun of me, tell me dot I vos too fresh, und had petter go wash my mouth oud with salt.
Lena.No I von’t.
Han.Promise id.
Lena.Yes.
Han. Vell, dear, I vill gif mineself avay. Lena, you vos a nice leetle Yarman girl.
Lena.Dot fact vos gray-headed.
Han.Und, Lena, I lofe you.
Lena.Oh, my, vasn’t you ashamed.
Han.Yes, I vos plushing beneath my bosom protector. But for all dot I lofe you. Lena, nod——
[EnterByron Smith L.2 E.Stalkstragicallyforward.Haltsandpoints fingeratHannis andLena.
Byron.Ha—ha! what is this that looms before my vision!
’Tis love’s young dream!
’Tis Cupid’s victory won. Two hearts with but a single thought, Two souls that beat as one!
Han.Is this a lunatic asylum, Lena?
Lena. Oh, no, dot vas only the poet dot board mit the mistress. How you vas dis evening, Mr. Smith?
Byron.Fair maiden, I stoop to kiss your snow-white hand.
Han. No, sir, not dis week. Dis vos my girl, I do all her kissing by gontract. Shust you mind your pisness and I’ll mind yours.
Byron. My nut-brown sylph, tell me, I pray, who this uncouth barbarian is?
Han.(Jumpingup.) Hold my coat, Lena.
Lena.Vot for?
Han. He has insulted you. I vill preak his fist wit mine head. He called you a nut-brown maid. You vas a white Dutch girl. By Shumping Shadrach I will pull out his teeth with mine boot.
Lena.Shust you sit on an ice-box, Hannis, he means no harm.
Byron.You are right, my starry-eyed gazelle.
Han.Vhy don’t you call her a plack-eyed camel, und be done wid id?
Byron.Presumptuous meddler, I am a poet.
Away with dross, with sordid gold, I would not be a miser old; But with my pen, my rapid pen, I’m sure I’ll charm the hearts of men!
Han.Haf you been drinking vhisky, my friendt?
Lena.Don’t make fun of him, Hannis; dot vos peyewtiful poetry.
Han.I know von man dot would gif a thousand dollars to hear dot.
Lena.You do?
Han.Yes; he vos stone deaf in poth eyes. But I say, Mr. Poet.
Byron.Say on, Lucullus.
Han. My name vos Hannis, not Bluecollars. But as I vos saying— don’t you think, Mr. Poet, dot three vos company, two vos a crowd?
Byron.What does the gifted bard of Avon say about that? Ah, now I remember!
Two lovers alone in silent joy, A blue-eyed maiden, a black-haired boy; It might be better, it could be worse, Another person would be a curse.
Han.Then vhy don’t you dake a tumbles and fly avay mit yourself?
Byron.I do not understand you.
Lena.Don’t mind him, Mr. Smith; I love your poetry.
Byron.Thanks; shall I give you another specimen?
Han.For heaven’s sake; hush!
Lena.Please do, Mr. Smith.
Byron. This is the seventeenth stanza of my lovely dirge, “Life.” There are three thousand and two more verses:
Life is a mockery, Life is a cheat——
Han.(Interrupting.) Ven ve vos hungry, There’s nothing to eat!
Byron.What mean you, sir, by basely changing my lines?
Han. Pring an almanac und find oud. There vos a nice dog outside, Mr. Fresh.
Byron.A dog—a dog—a little dog, A puppy small, but sharp, Watching in all of puppyish glee, His master’s Hebrew harp.
Han. No, sir; he vosn’t vatching any harp. Just yer go oud und feel of his teeth to see how oldt he vos.
Byron.I am happy here.
Han. I vosn’t. Say, Mr. Poet, von day there vas a feller coom to see his gal.
Byron.Come to ask her would she marry, Begged her to no longer tarry, Love had marked her for his quarry.
Han.Dot vos id. Vell, there vos anudder veller.
Byron.Ah, yes:
A sneaking rival, hump-backed, old. With broad acres and heaps of gold.
Han. I could schwear to it. The sucker that I vas delling about, looked as if he vosn’t rich enough to puy a pound of air. Vell, he kept coming in und boddering dem lovers all the dime.
Byron.Base hell-hound.
Han. Dat might haf peen his name. But vot vould you haf done to dot Canarsie cod-fish?
Byron.I would have clutched him by the neck. And hauled him down—down—down! And when they asked me where he was, Like the tempest’s howlings I’d repeat, “Down—down in hell! ’Twas there I sent him!”
Han.You vould do dot?
Byron.Assuredly.
Han. Mr. Gall, I vill take your vord at you! (Jumps up and seizes Byron.) I pounced him up—up—up! Und vhen dey send me a postal card asking vhere he vos, I repeaded like a dempest howl: “Send him a linen duster, he need it.” [Biz. ofstruggle. Hannis gets Byron down,andstandson him. Lena rushesforward,sinkson herknees byhisside.]
Lena.Spare him, Hannis.
Han.Queen Elizabeth Tilton, interceding for the life of Owen Murphy. [Tableau.
THE END.
Transcriber’s Notes:
The author for this book is listed in other sources as Aaron A. Warford.
Some advertising is likely missing from this transcription because the source copy was missing its back cover.
Punctuation has been made consistent.
Variations in spelling and hyphenation were retained as they appear in the original publication, except that obvious typographical errors have been corrected.
The following changes were made:
The notation 1 2 for fractions was changed to 1/2.
p. 9: Sentence was moved to this page from p. 13 (Hopeis like love, but subdued.)
p. 12: Table labled “‘BLACK SLAYER.’ Scene Plot. ACT FIRST.” was moved to this page from p. 13.
p. 13: Table labled “‘BLACK SLAYER.’ PROPS.” and the paragraphs immediately above and below the table were moved to this page from pp. 10-11.
p. 45: Pete.changed to (Pete.) ((Pete.) My own Rebecca,)
