This
dissertation will assess and evaluate the social construction of health and
illness, and use patterns derived from statistics to show the inequalities in
provisions and access to health care. It will also attempt to offer an
explanation as to the reasons for these inequalities, with relation to some of
the sociological perspectives available.
The
biomedical model of illness which is accepted by the majority of the western
world today suggests that illnesses are a naturally occurring phenomenon.
Temporary physical ailments of the body with a specific aetiology, scientific
objectivity is used for their diagnosis. Health is the absence of illness or
disease. Social factors are irrelevant within this context and medical
professionals treat the human body like a machine, when it breaks down it may
be repaired with drugs or surgery (Haralambos 2004). Weberian sociologists, as
well as many others claim this model is not as effective as it suggests that
the medical institution relies upon belief in order to gain monetary reward and
keep medical professionals in their higher status within society. Marxists somewhat
support this viewpoint and suggest that doctors and medicine hide the true
social causes of illness such as poverty and class inequality and act as agents
for pharmaceutical companies and that healthcare exists purely as a profit
driven industry for those companies involved (Hallam 2005).
Possible
evidence to support the Weberian and Marxist arguments may be found within
current medical practices surrounding cancer treatment. Medical professionals
today are beginning to question the effectiveness of chemotherapy as a viable
treatment as evidence is emerging that it is ineffective in treating around 97%
of cancers (drheise 2013). Chemotherapy also has a devastating impact on
healthy tissue cells surrounding the cancer, causing them to secrete a protein which
supports tumour growth making further treatments ineffective (dailymail 2013),
meaning that chemotherapy could be a waste of time and money, all of which
benefits the medical professionals and corporations involved. Furthermore,
there are viable alternatives to chemotherapy that have been discovered which
can destroy cancer cells noninvasively with no undesirable side effects.
Scientists
in America have developed a treatment that has existed for over a decade and in
2010, successfully targeted and destroyed cancer cells in culture dishes and in
live mice with no damage to healthy cells (ncbi 2013). Meanwhile, the UK
government continues to invest billions of pounds on a redundant treatment
which offers fewer survival chances than 50%. It is possible that the companies
responsible for cancer treatment command a considerable amount of economic and
political power, as they are so wealthy that their value is more than a small country.
Revenue for AstraZeneca, the UK’s second largest drugs manufacturer had an
annual turnover of £33,591,000,000 in 2011 and £27,973,000,000 in 2012 (yahoo
2013).
McKeown
(1976) has also argued that social factors such as improved diets and
sanitation have contributed much more too improving people’s health and
decreasing mortality rates in the 18th and early 19th Century,
a considerable amount of time before the dominance of the biomedical model.
McKeown used statistical evidence from life expectancy and infant mortality
rates to corroborate his theory, as well as the decline of tuberculosis before
the vaccine was even introduced, arguing that the inoculation only served to
immunise the remaining minority still prone to the disease (Hallam 2005). If
his theory about tuberculosis were true, there would be no need for vaccines
today as most diseases have been eradicated, although recent outbreaks of
measles have been reported, there is no way of knowing for sure exactly how,
where or why the disease started (dailymail 2013).
The
biomedical model cannot be totally discredited. Advancements in modern medical
science and surgery have contributed to higher success and survival rates in
treating chronic diseases such heart and kidney failure and have led to a far
greater understanding of health and the human body in general, on a cellular as
well as anatomical level. Recent developments in treating HIV have made the
disease a chronic illness instead of a death sentence, and even more recently
scientists have cured the disease (newscientist 2013). The criticisms of the
biomedical model seem to lie mainly with the short term fixes to symptoms of
illness brought about from the stresses of life, or drugs which are used to
suppress symptoms and not cure ailments.
Statistical
evidence does not support the thesis that health and illness are a result of physiological
factors alone. Evidence suggests that there are patterns of ill health which
relate to the monetary disparity of the social classes such as morbidity and mortality
rates, affirming that social factors do indeed play a part in health and
illness, as well as gender and race to a lesser extent (Haralambos 2007).
Health and illness are socially constructed concepts, which mean that they are
a belief in a specific idea or type of behaviour, which has been developed over
generations, and people living within that society usually accept it as normal.
The
social model of illness is favoured by sociologists, who argue that health is
more than the absence of illness or disease. According to the World Health
Organisation (WHO) 1974, “health is not merely the absence of disease, but a
state of complete physical, mental, spiritual and social well-being.”
(Haralambos 2007). It looks at the environmental and social causes of illness and
tends to focus on the social distribution of health and illness (socialscience
2013). Feeling ill can be interpreted as a normal occurrence, and also what is
considered an illness changes with time; erratic thought processes, hormonal
changes, stomach cramps, headaches and a hang over after drinking alcohol or
general sickness bugs due to bacterial or viral infections may be chosen by an
individual to be interpreted as an illness, or to be treated as normal; by either
choosing to put up with it, treat it themselves or go see a doctor for
diagnosis, making morbidity rates difficult to quantify (Hallam 2005).
Using
the medicalisation of hyperactivity and exponential growth in prescriptions of
Ritalin in the USA and the UK as an example, psychiatrists and physicians have
successfully diagnosed ADHD as a medical illness using the biomedical model as
these individuals behaviour does not conform to the norm set by society
(Giddens 2009). Critically comparing the social model, however a whole
multitude of explanations can be offered for the deficit of attention in the
children affected. Children should not be blamed, punished or drugged for their
inability to conform within a classroom environment or unusual and
uncomfortable social settings for them, as the rigours and stresses of home
life today may be having an adverse effect on their behaviour. The consumerist
lifestyle attainable or not, rapid expansion of information technology, media,
gaming consoles, lack of exercise, high sugar diets and the disruption of
family lives, could all have an effect on their behaviour. Further stressors
for these children could be caused by increasing poverty, family disputes or
even a lack of fathers’ rights that could have led to fatherlessness in Britain
today. Damaging research has been revealed that single parent children are 75%
more likely to fail at school and 70% more likely to use drugs (dailymail
2011). By diagnosing and drugging these children, society has medicalised ‘bad
behaviour’ and legitimised the use of drugs to suppress this instead of
addressing the issue.
Socioeconomic
conditions have been linked to health inequalities for decades. Edwin
Chadwicks’ General Report on the Sanitary conditions of the Labouring
Population of Great Britain in 1842 revealed how the average mortality age at
the time was around 35 years old in Liverpool for the upper classes, whilst the
labouring classes were only 15 years old (ucel.ac.uk 2013).
The
Black Report, published in 1980 by the Department of Health showed that,
despite continued improvement of health in all social classes in the first 35
years since the conception of the NHS, co-relational links could still be found
between infant mortality rates, life expectancy and the inequality of medical
services dependant on socioeconomic position. In 1971 for example, the then
secretary of the state addressed the issues in a speech on the 27th
March, mortality rates of unskilled workers were nearly twice that of
professional workers, also the neo-natal mortality rate of unskilled fathers
was twice that of professional fathers, more or less the same differences
addressed by Edwin Chadwick in 1842 over 100 years previous (sochealth 2013).
Many
conclusions can be drawn from these types of co-relations and a number of
explanations have been offered for these inequalities in health. Cultural
explanations suggest that lower class people; enjoy a less healthy lifestyle,
eat cheaper food and less healthily, smoke and drink more, and exercise less
than the middle and upper classes. This could suggest that people of lower
class orientation indulge in more risky behaviour types which could affect
their health (ucel.ac.uk 2013); stories such as 28 year old Laura Ripley’s
would certainly corroborate this. After receiving life threatening surgery for
a gastric bypass operation to cure her obesity, the now 25 stone ‘benefits
claimant’ needs repeat surgery as she claims to be addicted to chocolate
(dailystar 2013). It could be that the mediocre lifestyle that is affordable to
lower classes individuals prevents them from participating in enjoyable
recreational or social activities leading them to seek comfort in eating out of
depression or boredom. It could also be possible that it drives some to engage
in criminal or entrepreneurial behaviours to fund their consumerist ways, or
merely to survive. Again, the medical profession has legitimised surgical
intervention in temporarily curing a “disease” and has failed to address the
issues raised by the social model. Depression and or anxiety can cause eating
disorders, instead of treating the underlying issues, modern medicine seeks to
offer a short term fix as a solution.
Another
possible correlation between the inequalities of health could be education as
lower socioeconomic status usually correlates to lower education standards.
Micheal Calnan’s 1987 study on how women of middle and working class status
interpreted the cause of cancer and showed that middle class women were aware
that smoking and heredity factors played a part in developing cancer, although
todays understanding of the disease has improved substantially thanks to
medicalisation. Lower class women were more fatalistic, believing that the
disease was a random occurrence and that everyone had an equal chance of
developing cancer. Pill and Scott (1986) also concluded that using home
ownership as a gauge for determining social class; social housing tenants were
more fatalistic towards ill health than home owners (Haralambos 2007). It is
possible that poorly educated people are considerably less informed or
misinformed about health issues, do not interpret their symptoms as illnesses
and believed that some forms of illness are inevitable. The fatalistic nature
of these women and poor education on health issues could also suggest that
lower class people prefer to enjoy life in the moment, not planning for the future
because of the uncertainty of death at any time, and the monotony of living by
hand to mouth under these conditions could lead to depression, anxiety issues
and possibly crime which would account for higher rates of mental illness and
criminal prosecutions amongst lower class individuals.
The
material explanation suggests that relative poverty, poor housing, and lack of
resources in education and health, as well as having higher risk occupations
all contribute to the inequalities in health of the lower classes. Recently, a
report backed by the British Medical Association shows a discrepancy in life
expectancy of about seven years across England in the poorer areas, rising to
seventeen in some areas of London. There is a difference of up to 28 years in
Glasgow, one of the poorest areas in Britain (bbc.co.uk 2013). More interestingly,
these very same issues seem to have been apparent for over half a century now
and have still not been solved, it seems that the government is finally taking
notice of the social model of illness. Health Secretary Jeremy Hunt has backed
the report which has made recommendations that include; better training and
education on social causes of illness as well as the recording of social
history alongside medical history allowing for referral to a number of medical
and social services.
The
term ‘post code lottery’ is the label that has been applied to the practice of
how NHS treatment funds are unequally distributed throughout society. Generally
speaking, there is a disparity in almost all aspects of funding for care,
dependant on the socioeconomic status of the area, the more wealthy areas have
considerably more than the rest (guardian 2000). In 2000, the government was
well aware of the post code lottery and had put it down to the way NHS funding
has been allocated since its conception, without restrictions by local
authorities and powerful health consultants on an ad-hoc basis. The government
is essentially blaming the wealthier areas for having more, because they used
the service more and applied for more treatments (Ibid). If this were the case,
that could indicate that either, the health of the wealthier areas was
considerably lower than that of the poorer ones, better educated people visit
the doctor more as they are more informed on health issues and worry more, or
from a Marxist perspective, more treatment is available to the more valuable
members of society. Valuable as in, the ones who earn the most and contribute
most to the economy and society as a whole, in terms of profit, who need to
remain fit for productivity.
The
Alzheimer’s treatment postcode lottery suggests that some areas are 53 times
more likely to be given drugs that could slow the onset of the condition and
that some areas successful diagnosis is 25% in the worst to 59% in the best
areas. Misdiagnosis by local GP’s is also being blamed for the inequalities, it
is the responsibility of local GP’s to diagnose the illness and campaigners are
claiming that up to 60% of cases go undiagnosed because of poor public
awareness as well as that of doctors of the symptoms, some doctors have been
criticised for not offering treatment as there is no cure (Borland, S 2011). Population
density could be a factor of inequalities as the areas receiving the most
dementia diagnosis and funding are more densely populated areas (ONS 2011).
Social
action theorists would argue that many more factors played a part in the
postcode lottery’s development. The patient doctor relationship, for example it
could be that the lack of education aforementioned means that lesser educated
people tend to interpret their symptoms as a normal occurrence and not
illnesses or do not inquire further about health issues, and tend not visit the
doctor as much. Cartwright and Anderson (1981) concluded in a survey that 25%
of doctors believed that more than half of people who visited them had symptoms
that were too trivial to warrant a visit (Haralambos 2007), that 25% could
represent the wealthier areas. Around 50% of the people surveyed between
January and September 2012 visited a doctor within the last 3 months. East
Yorkshire Primary Care Trust saw 52% of patients visit their doctor, whilst in
the wealthier areas in the South such as Kensington and Chelsea saw 59% (gp-patient.co.uk).
This could be further evidence to suggest that poorer areas of society tend to
visit GPs less, for many of the reasons already mentioned. Interestingly, a
charity organisation has adopted the label ‘postcode lottery’ which offers cash
prizes of up to £25,000,000 prizes for donations to charities, based on
postcodes. This is possibly conditioning television viewers to associate this
initiative with the label, instead of the inequalities in healthcare within the
NHS that has been apparent for decades (postcodelottery).
Geographical
information shows a correlate to differences in cancer rates dependant on
location, for example the overall cancer rate is 10% higher in the North
compared to the South. Lung cancer is 70% higher in the North East compared to
the South East and South West (wcrf-uk.org 2013), coincidently in 2010 smoking
statistics show that areas in the North smoke more than the South
(cancerresearchuk.org). Poorer areas are known to smoke and drink alcohol more
than wealthier ones, and both are carcinogenic substances known to contribute
to causing cancer, as well as many other symptoms and health problems associated
with second hand smoke and the damage caused by alcohol and related incidents
(gov 2013).
Social
factors such as rates of smoking, diet, poverty and wealth in specific areas
all seem to contribute to the inequalities in health and illness in the UK. It
is possible that the different habits of the social classes have also
contributed to the distribution of illness and in turn the way funding has been
allocated, although statistics for funding are not readily available for use.
Statistical evidence which shows an increase in diagnosis of prostate cancer of
35% between 1998 and 2007, and a decrease of 20% in lung cancer and a 32% in
bladder cancer (wdrf-uk.org 2013) This could suggest that government awareness
campaigns and health polices such as cancer awareness, and the damages of
alcohol and tobacco are having a positive effect (gov.uk 2013).
What
remains to be seen is the impact of the savage cuts coming to the NHS.
Ambulance crews are proposed to be replaced with emergency care assistant roles
with three to six weeks training (Wright 2013) possibly meaning inadequate
emergency care, a stealth privatisation of the ambulance service could already be
underway as public spending has increased from £1,900,000 in 2010-11 to
£7,900,000 in 2012-2013, an increase from £400,000 to £4,200,000 in 2012-2013
on private ambulance services (bbc 2013). In other regions, spending is also
increasing for a number of years (bbc 2011). Britain’s leading medical body the
Academy of Medical Royal Colleges has voiced concern over the government’s
plans to privatise parts of the NHS (Helm 2013) and how in some areas one nurse
now covers 250,000 patients in out-of-hours overnight shifts in the place of a
GP (Borland 2013) which could lead to lower standards of care. £1,000,000,000
will be diverted from the NHS to increase spending on social care, in an
attempt to keep people out of hospitals who can be cared for at home (Wright
2013), which could benefit the patients.
According to WHO, health is not
merely the absence of disease, but a state of complete physical, mental,
spiritual and social well-being. Spiritual awareness is not part of the
cultural norm in the UK today, numbers of practicing Christians has fallen
dramatically especially in younger people aged between 18 and 24 to 36%
(humanism 2013). About a quarter of adults in the UK are obese (bbc 2013),
poverty could also be restricting social interaction and damaging individuals
mental wellbeing. According to statistics, society is not meeting the criteria
set out by WHO in order to achieve health. It is possible that religion offers some
form of mental health protection from the harsh realities of the world, and
without it, some people struggle to accept the random and often cruel nature of
life, and accept their insignificant place in the infinite universe, resulting
in mental health issues.
The
Marxist theory analyses the inequalities in all aspects of a capitalist society;
in this instance it examines the power structure of the medical institution.
Doctors are seen as agents for the pharmaceutical companies who are using
medicine to mask the true causes of illness and in essence, capitalists are
causing the illnesses themselves and profiteering from it. Webarian
sociologists would somewhat agree, further adding that doctors reinforce the
social hierarchy and compliance with the biomedical model in order to remain in
their higher socioeconomic positions. Interactionists who support the social
model of illness argue that many factors play a part in health and illness, if
indeed a symptom can be interpreted as an illness at all. Deviations from what
is deemed normal behaviour or social constructs within society are sometimes
labelled as an illness, or punished with drugs. Alternative treatments could be
being suppressed for monetary gain.
There
are many reasons and explanations offered for the inequalities in health and
illness, as well as the inequalities in provisions and access to health care,
some of which have been addressed in this dissertation. Possible correlations
have been made between lower socioeconomic conditions attributing to lower
standards of health, and there are slight variations between gender and race, however
it is fairly conclusive that the wealthier people are, the healthier they will
be. It is evident that occupation, diet and lifestyle all play a big part in
the development of illnesses, all of which are affected by socioeconomic
status. Government health policies may be having a positive effect on society
as diagnosis rates for breast and prostate cancer are up, and new cases of lung
cancer are down as the stop smoking and cancer awareness, as well as reducing
alcohol consumption polices have been implemented, however there is still a
disparity of funding throughout the UK in all aspects of care.
Education,
or the lack of also seems to play a part in health and illness distribution,
although it is possible that a poor education leads to either unemployment or
underemployment and in turn poverty, poor education on health issues could have
contributed to short life expectancy in the past, but statistical evidence
suggests that recent attempts by the government via health policies and via
various media outlets are having a positive effect over recent decades.
Population density could also have an effect on statistics.
By
combining the advancements made by the mechanistic biomedical model with the
empathy proposed by the social model, further advancements could be made in
reducing the inequalities in health, illness and distribution of treatment. The
human body is viewed as a complex machine and our understanding of it has
vastly improved over the last 50 years, however as has been discussed, it is
evident social aspects do play a part in health and illness. The social causes
of illness are being acknowledged more recently by the government, although
sociologists such as Chadwick (1842) and McKeown (1976) were aware of these
social causes over 150 years ago. The advancements and advantages of the
biomedical model cannot be denied as understanding of health and illness has
improved dramatically and continues to progress in curing diseases such as
cancer and HIV, however as it has been highlighted, it cannot explain the
patterns of inequality, and in some instances in the case of mental illness
(ADHD) for example, the model is being applied to a behaviour which does not
apply to physiological factors alone, as with obesity.
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