THE SOCIAL LIFE OF YOUR BODY

Health, Illness and Society

I’m going to die

…in about 54 years

Soaring Life Expectancy

Regional Life Expectancies

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

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 structures?

In doing so we are investigating the relationship between social structures (class, ethnicity and gender), individual choices (agency) and the body

The essay question

We are now shifting focus from the literature review to the essay questions – The essay is due on Tuesday 6th January, 2015 2,000 words 70% of your final grade

Most essay questions involve more than one lecture topic

The most pertinent question to this lecture is:

Critically discuss the structural influences on health outcomes in Britain. To what extent does individual agency play a role in these patterns?

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

Social diseases

Diseases and illnesses are not just a failing of the body

Diseases are socially defined and measured, occur within social conditions and are socially distributed

The production and distribution of disease is determined by social structures like age, class, ethnicity and geography

Map of disease

The ‘Sick Role’

Functionalist social theorist 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

How do people act when they are sick?

Is this socially influenced?

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

Basic definitions

Illness: The subjective state of feeling in ill-health

Sickness: A social state or a social role: ‘I am sick’

Health: Jeremy 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’

The Importance of understandings

Medical Model Social Model

Medical Solutions Social Responses

Medical model

Medical conceptions of disability focus on the functional impairments faced by the disabled – health is defined by a lack of biological symptoms

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

Ill health is defined as a lack of well-being and thus the focus is 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

What adjustments does Brunel make to reduce the

disability of impaired people?

From division to 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

Common explanations of health

Health is genetically determined

Our lifestyle choices (agency) make us unhealthy

Or are health inequalities are determined by structural factors such as class, ethnicity and gender?

What social factor has the most influence on health in

Britain?

Socio-Economic Position (Class)

Back to class

In considering health inequalities, we return to the difficult question of social class - 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

The ‘Black Report’ of 1980 revealed shocking health inequalities between classes in Britain – The ‘death rate’ for men in social class V was twice as high as social class I

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 and live 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

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

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

Cultural & behavioural factors

Why would the unemployed be more likely to smoke?

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. Lack of education about food

2. Limited cooking skills

3. Limited money to buy healthier food

4. Working longer hours

5. Marketing campaigns for junk food aimed at kids

6. Children’s desire to live sedentary lifestyles

Structuring agency

One side sees these divisions 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, or capacity for agency through increased knowledge

Where have you received most of your information about how to

be ‘healthy’?

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 and living conditions

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

What roles have the most unhealthy working conditions?

Do the poor have less control over their lifestyle decisions?

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

Conversely, there tends to be more health variation within ethnicities than between them (Ruth Graham et al. 2013, p.348)

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 African-Caribbeans tend to be more prone to sickle cell anaemia

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

Religious and cultural practices

Forced changes in lifestyles

Language difficulties

Socio-economic restrictions

Travel and exposure to more cultures produces greater exposure to different diseases

The case of the Gypsy’s

Gypsy and traveller communities have significantly worse health outcomes than any other group

They often have ‘poor health expectations’, a sense of ‘fatalism’ about their health and low trust in health professionals

Consequently there is a very low take-up of health care services outside of the family

Those without a permanent address also face more difficulties in accessing care

If you were in charge of the NHS services in your borough, 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

Women live longer than men across almost every social 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 mode 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

Is it unjust that women live longer than men?

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.

Next Week…

The Next Week…

IMAGINED COMMUNITIES: MIGRATION AND THE POLITICS OF EXCLUSION

READING

McCrone, D. (2013) National Identity. In Payne, G. (2013) Social Divisions (3rd Ed.), Basingstoke: Macmillan.