Health and Illness Study Unit 4-1 PDF

Health and illness SOCY121:  Learning Outcomes At the end of this chapter you should be able to: ❑❑ Discuss the sociological perspectives and approaches to health and illness. ❑❑ Apply each of the perspectives to the South African context. ❑❑ Define the key concepts and pro...

Health and illness SOCY121:  Learning Outcomes At the end of this chapter you should be able to: ❑❑ Discuss the sociological perspectives and approaches to health and illness. ❑❑ Apply each of the perspectives to the South African context. ❑❑ Define the key concepts and provide appropriate examples within South Africa. ❑❑ Distinguish between the different standpoints offered in the theoretical perspectives presented  EQUALITY IS A STRUCTURAL CONDITION IN SOUTH AFRICA There are a variety of factors that contribute to make up inequality South Africa. This Unit 6 focuses on those that have to do with health. Core Concept 1 HEALTH AND ILLNESS relate to how individuals and groups relate to Health and well-being. This also looks at questions of mortality rates and life expectancy. Various sociological perspectives are used to provide possible explanations Bio-medical model ▪▪ Health constitutes freedom from disease ▪▪ Focus on physical processes, biochemistry and physiology of disease ▪▪ Based on empirical observation and induction WHO: Health is more holistic: o A state of complete physical, mental and social well‐being o Not absence of disease or infirmity and it is a dynamic state o Also includes spiritual wellbeing When a person becomes officially ill, depends on: o the individual’s perception of the various symptoms being experienced, and o whether the individual thinks those symptoms require professional attention ▪▪ Challenges – enduring inequalities: o Poor people are still excluded from health care and services o Access to health is influenced by income o Public vs private health care makes it unequal o Medical aid: those that can afford it are medically insured. ▪▪ Exclusion: o How individuals or groups experience economic vulnerability and social isolation o leads to lesser access or no access at all to socio‐economic services and well‐being Country 1990 2010 2017 Australia 77 82 82.4 Mozambique 43 52 59 Spain 77 82 83 South Africa 62 58 63.5 United Kingdom 76 80 81 Zimbabwe 61 51 61 Germany 75 80 81 Nigeria 46 51 54 Life expectancy: international comparisons, 1990, 2010 and 2017 (World Bank 2013; World Bank 2019a) (In Stewart and Zaaiman: 421).  SOCIOLOGICAL Functionalism Interactionism THEORIES ON HEALTH: various perspectives Marxism Feminism Core Concept 2 THE FUNCTIONALIST PERSPECTIVE Focuses on the functionality of health on individual’s ability to contribute to society, and illness is seen as a deviance: as it distinguishes the individual from contributing to societal functions.  The functionalist perspective ▪▪ Theory suggests: Through socialization of individuals in various societal institutions, individuals learn how to function effectively and bring harmony to society. ▪▪ Different roles learnt lead to stability and cooperation in society ▪▪ Talcott Parson’s 1951 The Sick Role: Illness: o Health and sickness are social phenomena o Illness is defined as deviance (actions/behaviours that are outside societal norms) o Sickness is a threat to society since it destablizes peoples functions in society (here social control is relevant)  The functionalist perspective ▪▪ Person who is sick: o Is unproductive in society (deviant) o Cannot fulfill their societal role(s) o Deviance needs to be controlled – thisis truein themedical profession also ▪▪ Functionalists: o Health = absence of illness o Thus, this view does not acknowledge a holistic sense of health  The functionalist perspective ▪▪ Critique of the functionalist perspective o Blind to differential experiences of health & illness: class, gender and ethnicity o Ignores differences in historical trajectories in development of health care o Idealizes a particular form of patient‐doctor relationship o The sick role can become illegitimate even when the medical profession has diagnosed it as such: for example society seeing HIV‐AIDS as the victims fault and thus his or her rights are withheld.  THE INTERACTIONISTS Core Concept 3 are interested in relations between individuals & how everyday interactions are negotiations of relations: as a result, certain ideas of health influence positive or negative interactions  The interactionists ▪▪ This view is concerned with human social interactions, and social meanings of illness ▪▪ Thus, it focuses on o How individuals think of themselves when experiencing an illness o How that shapes interactions ▪▪ Concept of ‘Stigma’: Goffman (1963) – o Stigma: e.g. HIV/aids is even officially labelled as HIV ‘status’ o a social process experienced or anticipated o characterised by exclusion, rejection, blame or devaluation o which result from experience, perception or anticipation o of an adverse social judgement about a person or group  The interactionists ▪▪ Goffman (1963): o Illness can lead to stigma – and thus can affect individual identity o Judgements about illness are value‐laden and not neutral o Stigma can result from physical differences and social stereotyping ▪▪ Susan Sontag (1991): o Treating illness as evil demoralizes, and can block patient recovery (Brown in Ferrant: 286) ▪▪ Stigma undermines efforts to deal with HIV-‐AIDS pandemic, e.g.: Illness is a process (Ferrante:286) o Prevents HIV testing due to the negative connotations of HIV o Hinders care‐seeking behavior upon diagnosis, due to denialism o Prevents quality of care given - HIV positive patients may not be as well taken care of The interactionists This perspective shows how social identities emanating from illnesses influence how those who are ill, will react to and deal with their illness  The interactionists Critique of Interactionism: o Interactionists give sociology insights on how health and illness are constructed from bottom‐up with various concepts to reflect health and illness are social constructions o This view explores the micro and social aspects of health and illness by individuals and groups, but ignores structural and systemic aspect more macro‐sociological in nature. o But all is not lost in this view: Foucault’s views on institutions and Goffman’s on Asylums share some aspects of an institutionalist view of how health & illness is constructed Core Concept 4 THE MARXIST PERSPECTIVE focuses on how the capitalist system is structured in a way that benefits the dominant group and thus health systems in such as a system will not necessarily be for the benefit of working class. ▪▪ Capitalists benefit from medicine – and this is done by control of the working class ▪▪ The emphasis is on conflict which arises from contradictory social positions and needs ▪▪ Origin of disease and health outcomes influenced by how capitalist system operates: o Health of workers affected by industrial diseases and injuries o Environmental pollution from big industry and mines o Communities affected: industrial pollution affects many communities in SA. ▪▪ Health concerns of workers not taken into account o As it increases the company’s cost to take care of workers o Health interventions can reduce profit margins and down productivity o Low wages, the unhealthy food industry, unequal income all affect workers health. ▪▪ Towards a critique of the Marxist view of health: o Marxists ignore the gains of capitalism, esp. In health technology & health of population o Marxists also tend to over-emphasize workers plight and not others (the disabled, unemployed and the like. o Still, health is commodified and privatized & very expensive in many countries (e.g. USA) See Stewart and Zaaiman on Conflict theory (420-423) and on Foucaults view of medicine. The Marxist perspective Core Concept 5 THE FEMINIST PERSPECTIVE is interested in drawing a focus on the unequal position women occupy in broader society and therefore on how their lack of access. to societal resources negatively impacts on their health outcomes.  The feminist perspective ▪▪ Focuses on women’s health concerns and explains differences in women and men’s illnesses, deaths and life expectancy ▪▪ Focus on the relationship between women’s social, economic and political positioning and their health: women’s illness, life expectancy and death are tied to being unequal in society. ▪▪ Challenges negative effects of patriarchy: mens high power, their regard & benefit are due to the motive of capitalism on womens health: for e.g. 26% in SA are ceasarian births ▪▪ Focus on minority statuses (race, sexual orientation) and impact on women’s health ▪▪ Is critical of a bio‐medical approach to health, & how medicine controls women’s health- care  The feminist perspective Arguments: ▪▪ Medical profession is male dominated ▪▪ Medical influence over women is considerable – impacted upon their lives ▪▪ Medicalisation is part of wider processes of social control ▪▪ Feminists advocates for improvement of women’s health ▪▪ An acknowledgement of intersectionality (multiple oppressions simultaneously – race, gender, sexuality, class) of women’s lives ▪▪ Take account of social determinants of women’s health Towards a critique of the feminist view: o many important arguments are made by feminists about female health o Feminism has many strands, recent research shows a neglect of males in the gender question. Arguments: ▪▪ The need for autonomy and informed relationships between health professionals and women ▪▪ A need for critical engagement with the presentation of the biomedical view as universal COVID19: a negative impact on women’s health (UNDP.org) Core Concept 6 HEALTH INEQUALITIES are a result of gender, race and class differences among groups and individuals. These differences are socially determined and impact access to health of minority groups (in SA this is a majority) and thus leads to negative health outcomes for these groups Inequalities in health  Health inequalities ▪▪Race ▪▪Gender ▪▪Traditional vs Western medicine  Health inequalities ▪▪ Health inequalities: differences in access to, and the distribution of health provision and services depends on birthplace, where one stays, works and one's age. ▪▪ Socio‐economic position of individuals determines experience and access to health. ▪ Social determinants of health include: o Income levels o Employment o Levels of unemployment o Education levels o Lifestyle o Behaviours  Race and health inequality ▪▪ Race remains a significant factor for access to well‐being in post-1994 South Africa ▪▪ Socio-economic conditions impact black population (access to health): o Poverty o Unemployment o Limited access to resources o Visible in health status (e.g. HIV/aids 'status') ▪▪ Factors tied to mortality are mediated by race in South Africa, which are historically determined resources and well‐being in S.A. white life expectancy is 50% more than blacks ▪▪ Mens health can also be undermined, even if patriarchy is at play, as masculinity is a sense of the world held by both men and women.  Gender and health inequality ▪▪ Patriarchy or ruling masculinity do not necessarily benefit all men ▪▪ Ruling masculinity: A sense of the world that shape how men behave, think and relate to others, and when and how they die. ▪▪ Social factors explaining why men live and die: o Employment – direct risk to life (e.g.: soldiers, fire fighters) o Risk taking behavior – fighting, multiple sexual partners, dangerous sports o Alcohol  Gender and health inequality ▪▪ Women’s health needs are not necessarily equitably catered for ▪▪ Historically barred from access to economic resources ▪▪ Majority of them are poor (feminisation of poverty) Core Concept 7 Traditional medicine Diverse health practices, approaches, knowledge and beliefs incorporating plant, animal and/or mineral based medicines, spiritual therapies, manual techniques and exercises applied to maintain well-being and to treat, diagnose or prevent illness for humans. Two forms exist: traditional healing and African cosmology: The latter has been eroded and the former still exists. African views on disease causation: Naturalistic or Supernatural. For Naturalism: natural forces cause disease: body imbalances. Great knowledge exists of beneficial herbs, roots & berries. Illness is a progression rather than a symptom and reaction is in accordance with the cause. Unusual diseases: western science seeks explanations by germ theory or fungal infection. African traditional systems reject chance or accident of misfortune. Active psychological agent that is human, sorcerer or non-human agent (spirit or ancestor) or Super-deity or powerful being) intervenes. Multiple causes: immediate cause: what was done and who did it to the person. efficient cause: who or what did it to the victim ultimate cause: why it happened to a specific person  Traditional & alternative health Supernatural (personalistic) view: healers have specialist or magical skills to determine the who and why of an illness rather than just to discern the immediate cause. 5 cultural aspects of illness: spirit possession, sorcery, pollution, ancestral displeasure, disregard of cultural norms. Traditional treatment is holisitic as it is comprehensive for healing and curing. llness due to disturbance/imbalance: due to psychological, physical, material, interpersonal or spiritual reasons. Cures are: blood cleansing, charms, incisions, sacrifice or prayer & piercing (African acupunture) The Traditional Healers Act 22 (2001) identifies 4 types of traditional healers: Diviners diagnose mysteries (via bone throwing, clairvoyance or in by dreams or visions). Herbalists: extensive magical powers (no occult powers). Apprenticed by experts in the field. Faith healers are syncretic to reincorporate Christianity and traditional culture. Despite legal and Christian view of such healing having no ‘existence’, it survives in S.A. Complimentary and alternative medicine (CAM) also exist that is outside the conventional medicine (see Stewart and Zaaiman: pp: 448-449). Links between health as a human rights