Lecture note on:

Medical Sociology

Instructor: Woinshet Solomon

February, 2021
 Section One: Introduction to Medical sociology
1.1. Medical Sociology
MS is specialization within the field of sociology which
has an interest in the study of health, health behavior and
health institutions.
 It is the study of individual and group behaviors with
respect to health and illness.
 Therefore, “Medical” is a little simplistic, as the focus is
not only on medical professionals and their behaviors,
but also focuses on human behavioral responses to
health and illness.
 MS is concerned with individual and group responses
aimed at assessing wellbeing, maintaining health, acting
up on real or perceived illness, interacting with health
care systems, and maximizing health in the face of
psychological or functional derangement .
 Cont’d

MS also analyzes the impact of psychological

conditions resulting from our environment on our
health.
It deals with the social aspect of health and illness,
the social functions of health institutions and
organizations, the relationship of systems of health
delivery to other social systems, and the social
behavior of health care workers and those people who
are consumers of health care.
Also, MS is concerned with the social causes and
consequences of health and illness. It brings
sociological perspectives, theories and methods to
the study of health, illness, and medical practice.
 1.2 The Development of Medical Sociology

 MS was established as a specialized field in the US during

the 1940s.
 The first use of the term MS appeared as early as 1894 in
medical article by Charles McIntyire on the importance of
social factors in health.
 Elizabeth Blackwell in1902 (the first woman to graduate
medical school-Geneva Medical College in New York)
=essays on the relationship between medicine and society.
 However, these early publications were produced by people
more concerned with medicine than sociology.
 Bernard Stephen who published the first work from a
sociological point of view in 1927, titled Social Factors in
 Cont’d

1930s, such as Lawrence Henderson’s paper on the

physician and the patient as a social system that
subsequently influenced Talcott Parsons’s important
conceptualization of the sick role years later.

Henderson was a physician and biochemist at

Harvard, who became interested in sociological
theory and thought students [including] the new
sociology department when it was formed in the
early 1930s as bloom stated it clearly.
 Cont’d

 The earnest beginning (development) of medical sociology is

associated with events after the post world war II.
 A significant amount of federal funding (in USA) for socio-
medical research first became available.
 Under the sponsorship of the national institute of mental health,
medical sociology’s initial alliance with medicine was in
psychiatry.
 This strong cooperation was emanated from earlier researches
that showed the connection between social factors and mental
illness.
 For example the publication in 1958 of Social Class and Mental
Illness [a community study in New Haven- USA August
Hollingshead and Fredrick Redlich] produced important evidence
that social factors could be correlated with different types of
mental disorders and the manner in which people receive
 Cont’d

 Persons in the most socially and economically

disadvantaged segments of society were found to have the
highest rates of mental disorder in general and excessively
high rates of schizophrenia-the most disabling mental
illness in particular.
 This evidence called for the joint action between
sociologists and psychiatrists in projects as the study
attracted international attention is the best known single
study in the world of the relationship between mental
disorder and social class.
 The different funding from federal and private organizations
also helped stimulate cooperation between sociologists and
psychiatrists, with regard to socio- medical research on
problems of physical health.
 Cont’d
 when large scale funding first became available, the
direction of work in medical sociology in the United States
was toward applied or practical problem solving rather than
the development of theory.
 This situation had important consequences for the
development of medical sociology.
 Unlike law, religion, politics, economics, and other
institutions, medicine was ignored by sociology’s founders
in the late nineteenth century because it didn’t appear to
shape the structure and nature of society.
 Karl Marx’s collaborator Frederic Engles(1973) linked the
poor health of working class to capitalism in a dissertation
published in 1845, and Emile Durkheim(1951) analyzed
European suicide rates by taking the level of social integration into
account in 1897.
 Cont’d
 However, these and other classical sociological theorist did not
concern themselves with the role of medicine in society.

 Medical sociology did not emerge as an area of study in sociology

until the late 1940s, and did not reach a significant level of
development until the 1960s.
 Therefore, the field developed relatively late in the evolution of
sociology as an academic subject and lacked major statements on
health and illness from the classical theorists.
 The circumstance that affects medical sociology is the pressure to
produce work that can be applied to medical practice and the
formulation of health policy.
 Although the relationship between medical sociology and medicine has
been important, it has not always been harmonious(smart).
 Medical sociology inclined to side with patients and call attention to
cases of poor treatment, while some physicians have been contemptuous
(disrespectful ) of medical sociologists in clinical settings.
 Cont’d
 In many ways, medicine has been a better ally (supporter) of
medical sociology than sociology.
 While medical sociology is moving closer to sociology, it has
generally removed itself from a subordinate position to medicine.
There are four reasons for this development:-
 First, the shift from acute to chronic diseases as the primary causes
of death in contemporary societies has made medical sociology
increasingly important to medicine.
 This is because of the key roles of social behavior and living
conditions in the prevention, onset, and course of chronic disorders.
 Medical sociologists bring more expertise to the analysis of health-
related social conditions than physicians.
 Second, medical sociology has moved into a greater partnership
with medicine as it has matured and fostered a significant body of
research literature, much of it relevant to clinical medicine and
health policy.
 Cont’d
Third, success in research has promoted the
professional status of medical sociologists, in
relation to both medicine and sociology.
Fourth, medical sociology has generally set its own
research agenda, which includes medical practice
and policy as an object of study.
In the case of mismanagement, failure to police incompetent
practitioners, limited access to quality care for the poor, and
placing professional interest ahead of the public’s interest,
medical sociologists have been significant critics of medicine.
 In doing so, they have established themselves as objective
professionals.
 Cont’d
 However, a critical event occurred in 1951 that began the
reorientation of American Medical Sociology in a
theoretical direction.
 This was the appearance of Talcott Parsons’ book ‘The
Social System’.
 In this book he explained a relatively complex structural-
functionalist model of society, in which social systems are
linked to corresponding systems of personality and culture.
His concept of the sick role is also found in this book. He
also formulated an analysis of the function of medicine in
his view of the society.
 He presented an ideal representation of how Western
Society acts when sick.
 Cont’d
 The merit of the concept is that it describes a patterned set
of expectations defining the norms and values appropriate to
being sick, both for the sick person and others who interact
with that person.
 Parson also pointed out that physicians are invested by
society with the function of social control, similar to the
role played by priests, to serve as a means to control
deviance and its undesirable nature of the motivation to be
healthy.
 Robert Straus. He suggested that medical sociology had
become divided into two separate but closely interrelated
areas sociology in medicine and sociology of medicine. The
former is concerned for the practical application of medical
sociology [has practical orientation] while the latter is
devoted for the development of theoretical frame work [has
 1.3. Health and Medicine
 The use of the word ‘health’ to describe human ‘well
being’ is relatively recent. Difficult concept to define
 The idea of health is also related to other complex ideas
such as illness and disease. No single definition!
 but there many concepts such as health as normality, the
absence of disease or the ability to function (Blaxter, 2004)
 The most celebrated definition of health comes from
World Health Organization (WHO). It was formulated at the
start of WHO’s constitution, which was adopted on 22 July
1946.
 It reads as “Health is a state of complete physical, mental
and social well-being and not merely (only) the absence of
disease and sickness” (WHO, 1948).
 From the above definition of health [by WHO] there are
three focal dimensions of health. These dimensions are:
 Cont’d
1.Physical dimension- When all the organs are functioning
normal for the individuals’ age and sex.
2.Mental dimension-A level of cognitive (learning ability) or
emotional well being and the absence of mental disorder.
3.Social dimension –Refers to how well we get along with
others. When we are socially healthy; we have loving
relationship, respect others rights and give & accept help.
 WHO also view health as a resource for everyday life, not
as an object of living. It is a positive concept emphasizing
social and personal resources as well as physical
capabilities.
 It is the extent to which an individual or (group of individuals) is able
to realize aspirations and satisfy needs on one hand, and to change or
cope with the environment on the other hand.
 It is also the ability to lead socially and economically productive life.
 New philosophy of Health

Recently, a new philosophy of health has been acquired.

These are
Health is a fundamental human right,
Health is the essence of preclusive life and not the
result of over increasing expenditure on medical care,
Health is intersectional,
Health is an integral part of development,
Health is central to the concept of quality of life,
Health involves individuals, state and international
responsibility,
Health and its maintenance is major social investment,
and
Health is world-wide social good.
 Wellness
• Wellness’- is highly inter linked concept, even used
interchangeably, with the term health.
• It was first used by a doctor called Halbert L. Dunn, USA, who
published a small booklet entitled "High Level Wellness" in 1961.
• It refers to a state of best well-being that is oriented toward
maximizing an individual's potential.
• This is a life-long process of moving towards enhancing your
physical, intellectual, emotional, social, spiritual, and
environmental well-being.
• Wellness is also defined as the integration of mind, body and
spirit.
• Overall, it is the ability to live life to the fullest and to maximize
personal potential in a variety of ways.
• It is the balance among the physical, intellectual, emotional, social,
occupational, spiritual, and environmental aspects of life.
 Cont’d

Illness is the subjective response of an individual, and

of those around him, to his being unwell.
It is the state of feeling ill or having a disease and
stands for what the patient feels when he goes to the
doctor.
It is the patient’s perspective and something a man
has. While illness is a patient‘s feeling, sickness is the
socially constructed meaning for illness. The society
gives some meaning for the unwell-beingness of an
individual.
Disease- is an abnormal condition affecting the body of an
organism that affects a particular part of the body. It is what
the patient has on the way home from the doctor’s office.
 1.4 Medicine
 Medicine is derived from the Latin word medicina,
meaning the art of healing. Thus, medicine is the art and
science of healing.
 It encompasses a range of health care practices evolved to
maintain and restore health by the prevention and treatment
of illness.
 medical technology and clinical expertise are pivotal to
contemporary medicine, successful face-to-face relief of
actual suffering continues to require the application of
ordinary human feeling and compassion, known in English
as bedside manner.
 For medical sociologists and from sociological point of
view, medicine is a social institution concerned with
combating diseases and improving health.
 1.5. Social Epidemiology
 Social epidemiology is one of the basic concepts in medical
sociology
 SE a branch of epidemiology (which is concerned with studying
the distribution and determinants of states of health in
populations) that studies the social distribution and social
determinants of states of health.
 aims for the identification of socio environmental exposure that
may be related to a broad range of physical and mental health
outcomes.
 Similar to other sub disciplines of epidemiology focused on
exposures (e.g., environmental or nutritional epidemiology) rather
than those areas devoted to the investigation of those disease(e.g.,
cardiovascular, cancer, or psychiatric epidemiology).
 Focus on specific social phenomena such as socioeconomic
stratification, social network and support, discrimination, work
demands, and control rather than on specific disease out comes.
 Cont’d

 is the study of how health and diseases are distributed

throughout a society’s population.
 Outbreak, frequency, distribution and determinants
[etiology] of disease as well as searching data for
management, evaluation and planning of services for the
prevention, control and treatment of disease are concerns of
social epidemiology.
1.6. The Importance of [Medical] Sociology to Health
• I. Sociology in medicine
A. Ecology and Etiology of Disease
 Even before sociology was recognized as a separate branch
of
inquiry, investigators studied how the incidence and prevalence
of illness were related to the location of individuals in society.
 B. Variations in Attitude and Behavior Regarding Health and Illness

 The Second major area that falls under the general term of
sociology in medicine deals with variations in attitude in
response to and behavior regarding problems of health and
illness, definitions of who is ill and who is not, conceptions
among different parts of the population as to what their health
needs are and differential utilization of various kinds of medical
facilities.
II. Sociology of Medicine
 Raises questions about medical workers, their institutions,
and organizations, and their relations with others in their orbit
of activity, in an effort to clarify what are essential sociological
questions.
 In this instance, application of a sociological perspective to
the medical world parallels the sociological examination of
 Cont’d
Sociology of medicine deals with the following topics:
1.The recruitment of physicians: What is/are the criterion/criteria to select
students for physician education? How physicians are selected for
employment? These and others are the concern of sociology of medicine.
2. The training of physicians: Sociologists directly contribute to training
of medical students in one of the following two ways:
 By helping educators from various departments in the medical school
introduce sociological knowledge and perspective into the courses
taught in these departments, and
 By teaching sociological courses that have been tailored to the need of
medical students.
C. Relations of physicians to others in Role-set
• The term ‘other’ here used to refer to patients, family, colleagues, and
collaborators.
D. Medical organization- The case of hospitals: Sociology of medicine
investigates the organization of medical organizations.
E. Development of Community health
 Section Two
2.1 Theoretical perspectives in Medical Sociology
What is theory?
 Theory is a set of logically interrelated statements that attempt to
describe and explain social events.
 The job of sociological theory is to explain social behavior in the real
world.
Example: recall Durkheim's theory that categories of people with low social
integration( men, protestants, the unmarried) are at higher risk of suicide.
 sociological perspective shifts our focus from individuals to social groups
and institutions.
 Different sociological perspectives on society give rise to different
accounts of the role of medical knowledge, and of the social causes of
disease.
 Sociologists make use of three major theoretical perspectives:
1. the structural- functionalist perspective
2. social conflict perspective
 1.Structural functionalism

• As this perspective, society as made up of a complex system whose parts

work together with the goal of promoting solidarity and stability.
• However, illness entails breaks in our social interactions, both at work and
at home.
• For functionalists, illness is dysfunctional that undermines the performance
of social roles and eventually hinders the operation of society.
• Emilie Durkheim: - SF macro level process important for human beings.
• Functionalism offers an explanation of human society as a collection of
inter-related substructures, the purpose of which is to sustain the over-
arching structure of society.
 SF is less concerned with the individual and his or her aims, beliefs and
consciousness, than with how our actions and beliefs function to maintain
the system as a whole.
 SF is based on the assumption that if too many people were to describe
themselves as ‘sick’ and in need of being exempted from their normal
range of social obligations, this would be ‘dysfunctional’ in the sense of
being disruptive for society as a whole.
 Cont’d
• The prominent functionalist thinker Talcott Parsons advanced the notion of
the sick role in order describes the patterns of behavior which the sick
person adopts in order to minimize the disruptive impact of illness.
• The contribution of Parsons is especially important in two areas: the Sick
Role and the Physician’s Role.
A). The sick role: According to Parsons, there are normative responses by
societal members when they are sick.
 He calls these patterns of behavior expected of the sick person as the sick
role.
 Society’s response to sickness is not only the provision of medical care but
also affording people the sick role.
 The sick role is a pattern of behavior that defines what is expected of and
appropriate for people who are ill.
 This role releases ill people from normal obligations such as going to work
or attending classes.
 Moreover, once the sick role is assumed, the patient must want to get
better and must do all the necessary activities to regain good health
including cooperating with health professional.
 Cont’d
B). The physician’s role: Physicians play
important role to evaluate people’s claims of
sickness and help restore to the normal regular
activities.
In the process physicians use their specialized
knowledge, expect the cooperation of patients in
providing the necessary information and
following the orders of a doctor to complete the
treatment.
However, the concept is applied to acute conditions
better than chronic illness (like heart disease) for
chronic illnesses are not easily reversible.
 Cont’d
• In addition, a sick person’s ability to assume the sick role
such as to take time off from work and regain health
depends on the patients resources because many working
poor, for instance, may not afford to assume the sick role.
• On the other hand, illness may not entirely be
dysfunctional and may have some positive consequences.

• Finally, Parsons’s analysis did not distribute fairly the

responsibility between patients and the doctors.
• The analysis gives doctors rather than patients the primary
responsibility for health.
• A more prevention-oriented approach gives each of us
individuals the responsibility to pursue health.
 2. Conflict Theory
 It is an approach which stresses on the socio-economic inequality in
power and wealth which in turn significantly affects the health status
and access to health care facilities.
 The social conflict analysis tries to link health and social inequality
by taking an indication from Karl Marx and it relates medicine to the
oppression of capitalism.
 Conflict theorists observe that the medical profession has assumed a
preeminence that extends well beyond whether to excuse a student
from school or an employee from work.
 Conflict theorists use the term medicalization of society to refer to
the growing role of medicine as a major institution of social control.
 Social control involves techniques and strategies for regulating
behavior in order to enforce the distinctive norms and values of a
culture.
 However, viewed from a conflict perspective, medicine is not simply
a “healing profession”; it is a regulating mechanism as well.
 Cont’d
• Researchers from social conflict perspective focus on three
major issues: access to medical care, the effects of profit
motive and the politics of medicine.
A). Access to Care: Health is important for every person. But
access to medical care may not be equally possible for every
person.
 The core of the argument here is that when individuals are
required to pay for medical care in capitalist societies it
would be the richest people who are going to have the best
health.
 Access to health becomes a more serious problem when there
is no universal coverage of basic health service.
 A conflict theorist argues that the experience of illness for the
 Cont’d
B) The Profit Motive: Some conflict theorists take the
analysis a step further and argue the real problem is not
access to medical care. Instead, the problem lies in the
character of the capitalist medicine itself.
The capitalist system being driven by profit motive turns
physician, hospitals and the pharmaceutical industry into
multimillion dollar corporations.
Therefore, the decision to perform surgery according to
social conflict theory reflects the financial interest of
surgeons and hospitals as well as the medical needs of
patients.
Finally, the social conflict scholars suggest that medical
care should be motivated by a concern for people and not
 Cont’d
C). Medicine as Politics: Here the argument questions
the impartiality of medical science.
Women and racial minorities had marginal role in the
history of medical science.
Moreover, conflict theorists argue that scientific
medicine explains illness exclusively in terms of
bacteria and viruses ignoring the damaging effects of
poverty.
social conflict analysis is another sociological view of
the relationship among health, medicine and society.
It has been specified that social inequality is the
reason for some people to better health than others.
 3. Symbolic Interactionism
 This theory was advanced by such American Sociologists as
Charles H Cooley (1864-1929), William I Thomas (1863-
1947) and George H Mead (1863-1931) in early 20 th century.
 The theory stresses the analysis of how our behavior depends
on how we define ourselves and others.
 It concentrates on process rather than structure, and keeps
the individual at the center.
A). The Social Construction of Illness: For symbolic
interaction advocates society is less a grand system and health
and medical care are socially constructed by people in
everyday interaction.
By implication, if both health and illness are socially
constructed, people in a poor society may view hunger and
 Cont’d
B). The Social Construction of Treatment: Erving Goffman
dramaturgical approach explains how physicians tailor their
surroundings including their offices and their behavior so that others
see them as competent and in charge.
 This explanation of Goffman could be further illustrated by the
process of reality construction of treatment when a woman
undergoes the gynecological examination carried out by a male
doctor.
 The situation is susceptible to misinterpretation because a man’s
touching of a woman’s genital is conventionally vied as a sexual
act and possibly an assault.
 To strengthen this assumption, a female nurse may be present
during the examination and treatment not only to assist the
physician but also to avoid the expression that a man and a
woman are alone in a room.
 Cont’d
C). The Social Construction of Personal Identity:
Symbolic interaction also gives insights into how surgery
can affect people’s social identity.
The reason why medical procedures can have
significant effect on how we think of ourselves is due
to the fact that some organs and other parts of the body
have cultural importance.
People who lose a limb in military combat for example
experiences serious worries about being as a much of a
person as before.
When women undergo breast surgery they face similar
reactions doubting their own feminine identity and
worrying that men will no longer find them attractive.
 4. Post-modernist

 Foucault argued that in order to understand science and

medicine we have to think about them as ‘discourses’ about
the body, health and the natural world, rather than accepting
these disciplines as objective descriptions of reality.
 The concept of discourse is an important one within
contemporary sociology and represents a distinct way of
thinking, seeing and conversing about particular
phenomena.
 Post-modernist theory makes two main contributions to the
study of health and disease:
 First, we are offered a way of challenging the dominance of medicine
and questioning what appears to be scientific, true and objective
 Second, we can appreciate the way in which knowledge discourses
can be used to discipline us.
 CHAPTER THREE
3. Prominent(Projecting) Figures in Medical Sociology
3.1. Max Weber
He is one of the early sociologist and proponent of medical
sociology and developed the ideas of formal rationality
and life style and he identified two types of life style.
 Life conducts: self-direction behavior in behavior.
 Life chance: is a political theory of the opportunities each
individual has to improve his or her quality of life, and
associated with a person’s probability of finding
satisfaction of interests’ wants and needs.
Life chances are structural but life conduct is associated
with agencies (actions).
Both life chance and life conduct interact to one another so
as to shape the life style outcomes.
 Cont’d
Life conduct(way or behavior) Life chance
• A behavior/direction to - Age - Class circumstance
• Drink - Gender - Collectivity kinship
• Smoke - Race
 In general the interaction between life chance and life conduct become
cause for good/bad implication of people’s health.
 According to Weber class, status and power are three-component
theory of stratification in which social difference is determined.
 Class is a person's economic position, based on birth and individual
achievement.
 Status is one's social respect or honor, which may or may not be
influenced by class.
 Power is one's ability to get one's way despite the resistance of others.
 Power The ability to get one's way even in the face of opposition to
one's goals.
 Social class is a strong social determinant of health.
 Cont’d
 Health inequality refers to the unequal distribution of
environmental-hazards and access to health services
between demographic groups, including social classes, as
well as to the disparate health outcomes experienced by
these groups.
 Gender and race play significant roles in explaining
healthcare inequality;
 Socioeconomic status (SES) is the greatest social
determinant of an individual's health outcome.
Social determinants of health are also factors which
related with the economic and social conditions that
influence individual and group differences in health
 Talcott Parson

 According to Parson medical professionals are motivated by

factors other than making money, such as caring for their patients.
 Parsons goes on to make the important point that medicine is a
major institution for controlling deviance in modern societies
 It is not just a benign institution based on scientific care, but acts
to check the deviant tendencies of individuals, who otherwise
might try to escape their social roles.
 He argues that the strains of modern life may be so great as to
drive people into the sick role to escape their normal
responsibilities, and this tendency needs to be checked.
 His analysis shows how the medical profession acts to control
motivated deviance and provides an account of illness as a
response to social strain.
 Parsons’ concept of the sick role is a very useful concept for
problematizing the idea of disease as natural and biological, but is
limited in its focus on acute illness episodes/problems.
 Erving Goffman

 Goffman's main contribution to Sociology has been his

treatment of the interaction order as a distinct unit of
analysis .
 Dramaturgy, everyday life, the back and the front stage,
asylum, total institution, mental health in the interaction
Order.
 There are the roles that we play, and the stage that we
act out these roles.
 There is also an audience. Goffman sees this as how we
all interact with one another; social interaction is then a
performance.
 The study and theory behind this concept is referred to
 Cont’d
Deinstitutionalization- is the process of replacing long-
stay psychiatric hospitals with less isolated community
mental health services for those diagnosed with a mental
disorder or developmental disability.
It works in two ways:
 the first focuses on reducing the population size of mental
institutions by releasing patients, shortening stays, and
reducing both admissions and readmission rates;
 the second focuses on reforming mental hospitals'
institutional processes so as to reduce or eliminate
reinforcement of dependency, hopelessness, learned
helplessness, and other maladaptive behaviors.
 Michel Foucault

It is with the development of the category of

disease, the product of the professionalization of
medicine, that Foucault is concerned.
He calls attention to another important aspect of
modern society: that is an administered society, in
which professional groups define categories of
people as the sick, the insane, the criminal, the
deviant on behalf of an administrative state.
For him, medicine is a product of the administrative
state, policing normal behavior, and using
credentialed professionals to enforce compliance
with the ‘normal’.
 CHAPTER FOUR
4. Key Concepts in Medical Sociology

4.1. Health
 It is a state of complete physical, mental, and social well-being,
and not merely the absence of disease and infirmity (WHO).
 It also defined as the ability of a biological system to acquire,
convert, allocate, distribute, and utilize energy with maximum
efficiency.
 It is different from one society to another society.
 Any conceptualization of health therefore, depend on
understanding of how do called normal states of wellbeing are
constructed within particular social, cultural and historical
contexts.
 Sociologists, assess people’s health by how well they are able to
function in their daily lives and adapt to a changing
environment.
 Cont’d
Dimensions of health
• The definition given above by WHO indicates that health is
multidimensional, and that it has status physical, mental and social
dimensions. Also, health has spiritual, emotional, political, and so
on dimensions
A). Physical dimension:
• This indicates to the ability of human body structure to function
properly. It purely refers to the perfect functioning of the body
externally as well as internally.
B). Mental Dimension: deals with ability to process information and
act properly.
 Mental health implies:
i) control on emotions
ii) sensitive to the needs of others
iii) confidence in one’s own abilities
 Cont’d
C). Social Dimension
• The social dimension of health focuses on the ability to
interact with other individuals.
 A person with good social health needs to incorporate:
i) gets along well with people around
ii) has pleasant manners
iii) helps others
IV) fulfills responsibility towards others
D). Spiritual Dimension: this refers to the part of individual
which reaches out and struggle for meaning and purpose of life.
 It is intangible, which means it cannot be seen, or touched, we
can only fell it.
 This achievement is possible if only an individual has already
reached physical, mental and social dimension of health.
 Cont’d
E). Emotional Dimension: Emotion health deals with the
ability to cope, adjust, and adapt to the social environment.
 Emotions are the feelings which have great role in our
life and lead to the modification of attitude, conducive to
personal adjustment and wellbeing
F). Vocational Dimension: is the sub-domain of physical,
mental and social health.
 Vocational health emphasizes upon the problem of
livelihood and ensures the fulfillment of the economic
needs of an individual.
 Vocational satisfaction provides him social efficiency,
social status, social prestige, emotional stability and
 Cont’d
G). Educational Dimension: Education brings changes in one’s
behavior and attitude enabling him to understand his responsibility to
the society and to the nation. Therefore, health education has heavy
responsibility to discharge people from various health related
problems.
H). Nutrition Dimension: Good nutrition is a basic component of
health.
 It is of prime importance in the attainment of normal growth and
development, and in the maintenance of health throughout life.
I). Environmental Dimension: The internal environment of man
himself (an individual’s internal structure) and the external
environment which surround him (habitat) reflect the health status of
an individual, the society and nation.
 Sanitation is one of the aspects of environmental health, and that it
is the quality of living which expressed in terms of clean home,
 Cont’d
J). Curative and Preventive Dimension: This dimension deals
with the study and application of curative medicine and preventive
measures for the preservation of health of an individual.
4.2. Disease :-It is any condition which results in the disorder of
a structure or function in a living organism that is not due to any
external injury.
 The term disease broadly refers to any condition that
damages the normal functioning of the body. It is often
construed as a medical condition associated with
specific symptoms and signs.
 It may be caused by external factors such as pathogens or by
internal dysfunctions, particularly of the immune system, such as an
immunodeficiency, including allergies and and auto-immunity.
 Disease is often used more broadly to refer to any condition that
causes pain, dysfunction, distress, social problems, or death to the person
 Cont’d
 There are four main types of disease; these are
i) infectious diseases,
ii) deficiency diseases
iii) genetic diseases (both hereditary and non-hereditary), and
iv) Physiological diseases.
 Diseases can also be classified as communicable and non-
communicable.
 Other classifications of disease are:
 Acquired disease: simply means acquired sometime after
birth
 Acute disease: disease of a short-term nature (acute)
 Chronic disease: disease that is a long-term issue (chronic)
 Cont’d
 Congenital disease: disease that is present at birth.
 Genetic disease: disease that is caused by genetic mutation
 Hereditary or inherited disease: a type of genetic disease
caused by mutation that is hereditary (and can run in families)
 Iatrogenic disease: a disease condition caused by medical
intervention.
 Idiopathic disease: disease whose cause is unknown
 Incurable disease: disease that cannot be cured
 Primary disease: disease that came about as a root cause of
illness,
 Secondary disease: disease that is
a sequel or complication of some other disease or underlying
cause (root cause)
 Terminal disease -disease with death as an expected result
 4.2.1. Theories of Disease causation

• In this section you will be familiarized with the theories on

causes of disease, especially from its social dimension.
• Developing a complete understanding of the social causes
of disease will expand the border of your knowledge about
what causes a disease.
• Scholars suggest different etiologies of diseases depending
on their field of specialization, among these causes are
social factors which are the interest of sociologists.
• Before the emergence of modern medicine, for example,
disease was widely attributed (ascribed) to variety of
spiritual and mechanical forces.
• It was interpreted as a punishment by God for sinful
behavior or the result of an imbalance in body elements.
 Cont’d
 In 19th century, ideas about disease started to be influenced by two
developments which provided a philosophical and empirical basis
for the biomechanical approach to modern medical practice.
 Both approaches to disease causation denied the influence of social
as well as psychological factors in disease onset.
 However, these ideas have been criticized for their mono-causal
view of disease and have been modified by multicultural models of
disease onset.
A). Germ Theory
 this theory argued that microorganisms are the cause of many
diseases.
 In the latter half of 19th century as the works of Ehrlich, Koch and
Pasteur revealed that the prevailing health problems of the time
were the product of living organism which entered the body through
food, water, air or the bites of insects or animals. For e.g, Koch
identified and isolated the bacillus which cause tuberculosis.
 Cont’d
B). The Multi-causal Models of Disease(page 117ppt of
determinants of health)
 Exposure to an agent does not necessarily lead to disease.
 Disease in the epidemiological triangle approach is understood
as the product of and interaction between an agent, a host and the
environment.
 Moreover, host and environmental factors determine exposure
and or susceptibility to the harmful agents in questions.
 So, all disease including infectious ones has multiple causes.
 For example, some of the factors implicated in heart diseases are
high blood pressure, blood cholesterol levels, diet, smoking,
physical inactivity, personality type and stress.
 Disease can be prevented by modifying factors which influence
exposure and susceptibility.
 Cont’d
C). For General susceptibility:
 Some social groups have higher mortality and morbidity rates from all
causes.
 This reflects an imperfectly understood general susceptibility to health
problems.
 This probably results from the complex interaction of the environment,
behavior and lifestyle.
D. Socio-environmental Approach (Refined model of general
susceptibility)
 Health is powerfully influenced by the social and physical environments
in which we live.
 Risk conditions integral to the environment damage health directly and
through the physiological, behavioral and psychological risk factors
they endanger.
 Improving health requires political action to modify these environments.
 Cont’d
4.3. Illness
 It is a feeling, an experience of unhealthy which is entirely personal,
internal to the person of the patient.
 It actually refers to the state of a person in comparison to a medical
condition.
 Also, it used to describe a person who is in a poor state of health.
 A person that is ill is usually feeling discomfort, distress or pain of
some kind.
The Five Causes of Illnesses
 First, there are External Influences- various atmospheric
conditions that continuously affect our bodies.
 Second are the Psychological Influences- All of the stress is
related to the 7 Emotions:- Anger, Happiness, Worry, Sadness, Fear,
Over-Thinking and Shock.
 The stress results from your emotional response to situations and conditions.
 Cont’d
The third cause of illness is related more to lifestyle and is
considered non-internal and non-external.
 Too much mental work can damage the Heart, blood and
Anger resulting in restlessness, forgetfulness and digestive
problems such as loose stools.
The forth cause of illness is referred to as Ultra 3D Energy
Fields.-Ultra 3D Energy Fields consist of a couple of
different types of Energy Fields.
The fifth and final cause of illness is known as
Karma(Feeling).
 Karma(Feeling) is Cause and Effect.
 What you did in the past will return to affect you in the
future.
 4.4. Sickness

 It is the external and public mode of unhealthy.

 Sickness is a social role, a status, a negotiated position in a
given society, a bargain struck between the person
henceforward called ‘sick’, and a society which is prepared
to recognize and sustain him.
 It is related to a different phenomenon, namely the social
role a person with illness or sickness takes or is given in
society, in different arenas of life.
 One type of data concerning a more limited aspect of
sickness is that relating to sickness absence from work.
 The possibility of doing a job or playing an important social
part depends on the actual conditions in society, in the labor
market, and in the person’s abilities to cope with these
conditions.
 Medicalization
 The concept of medicalization was devised by sociologists to explain
how medical knowledge is applied to behaviors which are not self-
evidently medical or biological or even medical, but over which
medicine has control (Conrad, 1992).
 The concept of medicalization is another major contribution of
medical sociology to medical practice and the understanding of
human health.
 Medicalisation describes how ordinary issues (usually non-medical)
are defined as medical problems, thus requiring medical attention in
terms of diagnosis, prevention, and treatment.
 Medicalization is a social process through which a previously normal
human condition (behavioral, physiological or emotional) becomes a
medical problem in need of treatment under the influence of medical
professionals.
 In other words, medicalization involves defining a problem in medical
terms, usually as an illness or disorder, or using a medical
 Cont’d

There is a growing tendency to define all social

abnormalities or deviance as medical problems.
Medicalisation also provides a way to eliminate
mystical explanations of social events and gives room
for the application of biomedical science to objectively
explain such social events.
Medicalization postulates that medicine has increased
its relevance and domains in the management of
human society.
Implicit in Parsons' concept of sickness as a form of
deviance is the idea that medi­cine is (and should be)
an institution for the social control of deviant behavior.
 Cont’d
"medicalization" occurs "when previously non
medical problems are defined and treated as medical
problems, usually in terms of illnesses or disorders

Some medical sociologists have expressed concern

that medicine has taken responsibility for an ever
greater proportion of deviant behaviors by defining
them as medical problems
• Medicalization postulates that medicine has increased
its relevance and domains in the management of
human society.
Medicine has thus become a powerful factor of social
 CHAPTER FIVE
5. The Social Context of Health
5.1. Age and Health
 The age affects health lifestyles because people tend to take
better care of their health as they grow older.
 This is reflected in showing more careful food selection,
more relaxation, and abstinence or reduces use of tobacco
and alcohol.
 The rise in life expectancy has brought a
corresponding increase in the growth of the elderly
population.
 They are likely to have not only a higher standard of
living but also increased political power, because of
their larger numbers and experience with the political
 Cont’d
5.2. Gender
 In pre-industrial societies, including those in Europe, the
life expectancies of men and women were approximately
the same.
 This was the situation until the mid­1800s, when women began
living longer on average than men and continue to do so today in
most of the world.
 Modernization appears to have benefited the longevity of women
the most.
 So what should be kept in mind is "that men and women
essentially suffer the same types of problems; but what
distinguish the sexes are the frequency of those problems
and the pace of death."
 For example, heart disease is the leading cause of death for women
after age 66, but becomes the number one killer of men after age
 Cont’d
 The result is that as of 2002, the average life expectancy in
the United States of white females was 80.3 years compared
to 75.1 years for white males.
 The same advantage applies to black females who had an
average life expectancy in 2002 of 75.6 years compared to
68.8 years for black males.
 Men have significant health infe­riority in terms of life
expectancy because of the combined result of two major
effects:
(1) biological and
(2) social-psychological.
 The male of the human species is at a bio­logical
disadvantage to the female.
 Cont’d
The fact that the male is weaker physiologically than the female is demonstrated by higher mortality
rates from the prenatal and neona­tal stages of life onward.
Neonatal males are also more prone to certain circulatory disorders of the aorta and pulmonary artery
and are subject to more severe bacterial infections.
social-psychological
Another factor contributing to excess male mortality rates may be occupational competition and the
pressure associated with a job.
Men and boys continue to drink more frequently and drink larger quantities at one time than women and
girls.
Accidents, for example, cause more deaths among males than females, which reflects a difference in sex
roles.
Men tend to be more women in both work and play.
High accident rates amoaggressive than ng males may be attributed to the male's increased expo­sure to
dangerous activities, especially those arising from high-risk occupations.
The most dangerous job in the United States (according to the Bureau of Labor Statistics) is commercial
fisherman, followed by (in order) logger, airplane pilot, structural metal­worker, taxi driver, construction
laborer, roofer, electrical worker, truck driver, farm worker, and police officer.
 Another factor contributing to excess male mortality rates may be occupational competition and the
pressure associated with a job.
 The lifestyle of the business executive or professional with an orientation toward "career" and drive
toward "success," marks of the upwardly mobile middle-class male, is thought to contribute strongly to
the development of stress among such men.
 Thus, it would seem that both the male sex role and the psychodynamics of male com­petitiveness are
significant factors affecting male longevity.
 Cont’d
5.3. Race
 One reflection of social inequality in the United States is the
differences among the health profiles of racial groups.
 Asian Americans have typically enjoyed high levels of health, with
blacks being especially disadvantaged.
 Hispanics and Native Americans also have health disadvantages
relative to whites.
 Comparisons of the health of racial minorities with whites in the
United States will be reviewed in this section.
5.4. Social and cultural change
 Early studies of social factors and disease onset dealt with the effect
of socio-cultural change.
 Important issues of studies included industrialization, urbanization,
and migration, social, occupational and geographic mobility.
 Unemployment has also been given much emphasis in relation to its
 Cont’d

 living in an urban community found an interesting result in

relation to social support.
 i.e., people with few social contacts were more likely to
deteriorate in physical and psycho-social functioning than people
with high levels of contact with others.
 Among the important points that fall under social support is
marriage.
 Mortality rate in general tends to be higher for the single,
divorced and the widowed when compared with married
people.
 So, it is the quality of contact which is more important.
Moreover, quality of interpersonal contact could be a matter
of perception.
 In other words, quality did not exist in the form of relationship but
in the perception and expectations of the person being supported.
 Cont’d
 So, if social support is the belief in its existence, the
people with strong beliefs should be more protected from
illness than those without.
 In general, social support encompass fairly broad
category of events. It includes practical assistance,
financial help, the provision of information and advice
and psychological support.
 CHAPTER SIX
6. Health Behavior and Illness Behavior

6.1. Health Behavior

 Health-oriented behavior does not only involve those
activities concerned with recovering from disease or injury;
but also involves the kinds of things that healthy people do to
stay healthy.
 Medical sociologists divide health-oriented behavior into two
general categories: health behavior and illness behavior.
 Health behavior refers to those activities undertaken by
individuals for the purpose of enhancing their health,
preventing health problems or achieving a positive body
image.
 Illness behavior where by a person who feels ill is engaged in
some activities for the purpose of defining that illness and
 Cont’d
 It includes instead people in good health as well as the
physically handicapped as well as persons with chronic
illness like diabetes and heart disease that seek to control
or contain their illness through diet, exercise, and other
forms of health behavior.
 For most other people, however, their health behavior is
primarily intended to delay their lives and maintain their
health (Goldstein 1992).
 Yet regardless of the underlying motivation, it is clear that
health-promoting behavior and lifestyles are spreading in
many societies
 The focus in medical sociology is not on the health
behavior of an individual, but on the transformation of this
behavior into its collective form-health lifestyles
 Cont’d
6.2. Health Lifestyles
 Health lifestyles are collective patterns of health-related
behavior based on choices from options available to people
according to their life chances.
 A person's life chances are largely determined by his or her
class position that either enables or constrains health lifestyle
choices.
 The behaviors that are generated from these choices can have
either positive or negative consequences on body and mind,
but nonetheless form an overall pattern of health practices
that constitute a lifestyle.
 Health lifestyles include contact with medical professionals
for checkups and pre­ventive care, but the majority of
activities take place outside the health care delivery system.
 Cont’d
 These activities typically consist of choices and practices,
influenced by the individual's probabilities for realizing
them, that range from brushing one's teeth and using
automobile seat belts to relaxing at health spas.
 For most people, healthy lifestyles involve decisions about
food, exercise, relaxation, personal hygiene, risk of
accidents, coping with stress, smoking, alcohol and drug
use, as well as having physical checkups.
 As WHO, there are two era that had been used by different
society.
The one was “medical era," in which the dominant
approach to health was mass vaccination and the exten­
sive use of antibiotics to combat infection, and which
was used by underdeveloped societies.
 Cont’d
However, currently, advanced societies are entering into
a "post medical era" in which physical well-being is
largely undermined by social and environmental factors.
 (social and environmental factors) these factors include
certain types of individual behavior (smoking, overeating),
failures of social organi­zation (loneliness), economic factors
(poverty), and the physical environment (pollution) that are
not amenable to direct improvement by medicine.
 Generally, 'medical era' health policy has been concerned
mainly with how medical care is to be provided and paid
for, in the new 'post-medical' era it will focus on the
attainment of good health and well-being."
 Cont’d
 Currently, the role of health lifestyles has taken as a means to improve
the health of people. This is because:
1.There has been a growing recognition among the general public that the
major disease patterns have changed from acute or infectious illnesses to
chronic diseases-like heart disease, cancer, and diabetes-that medicine
cannot cure.
2. Numerous health problems, such as AIDS and cigarette-induced lung
cancer, are caused by particular styles of living.
3. There has been a virtual campaign by the mass media and health care
providers, emphasizing lifestyle change and individual responsibility for
health.
 Therefore, strategies on the part of individuals to adopt a healthier
lifestyle have gained in popularity.
 Thus, self-control over the range of personal behaviors that affect
health is the only remaining option.
 This means the person will be confronted with the decision to
 Cont’d
6.2.1. Max Weber’s Views on Lifestyle
 In Weber's view, Marx's concept of class is not the whole
story in determining someone's social rank; rather, status
(prestige) and power (political influence) are also important.
 A status group refers to people who share similar material
circumstances, pres­tige, education, and political influence.
Moreover, members of the same status group share a similar
lifestyle.
 Weber argued that one's lifestyle is not based on type of
production, rather than a reflection of the types and amounts
of goods and services one uses or consumes.
 Cont’d
 Thus, for Weber, the difference between status groups does
not lie in their relation­ship to the means of production as
suggested by Marx, but in their relationship to the means of
consumption.
 This view applies to health lifestyles because when
someone pursues a healthy style of life, that person is
attempting to produce good health according to his or her
degree of motivation, effort, and capabilities.
 The lower class viewed health largely as a means to an end
(work), while persons with higher socioeconomic status
regarded health as an end in itself (vitality and enjoyment).
 In both situations, health was something that was to be
consumed, not simply produced.
 Cont’d
 Weber's ideas about lifestyles are important for several reasons.
1.First, his work led to the development of the concept "socioeconomic
status," or SES in sociology, as the most accurate reflection of a person's
social class position.
 The location of a person in the social hierarchy of society is
determined not by income alone, but typically by a combination of
three indicators: income, education, and occupational status.
2. Second, lifestyle is a reflection of a person's status in society, and
lifestyles are based on what people consume, rather than what they
produce.
3. Third, lifestyles are based upon choices, but these choices are
dependent upon the individual's potential for realizing them. And this
potential is usually determined by the person's socioeconomic
circumstances.
4. Fourth, although particular lifestyles characterize par­ticular
socioeconomic groups, some lifestyles spread across class boundaries
 Cont’d
6.2.2. Theory on Health Lifestyles
 Cockerham identified four categories of socio-structural variables that
have the potential to shape health life styles. The categories are 1)
class circumstances, 2) age, gender, race/ethnicity 3)
collectivities(shared or communal); and 4) living conditions.
 Class circumstances influences lifestyle forms that upper and middle
class lifestyles are healthier than those of the lower class.
 Structural variables including class circumstances provide the social
context for socialization and experiences.
 Also, age, gender and race/ethnicity affects health lifestyles because
people end to take better care of their health as they grow older.
 Collectivities affect health lifestyles. They are group of actors whose
members are linked together through particular relationships such as
kinship, work, religion and politics.
 Collectivities influence their members’ health lifestyles are because
members have shared norms, values, ideals and social perspective
which are capable of influencing the behavior of its members.
 Cont’d
 Living condition is the other structural variables that pertaining to
differences in the quality of housing and access to basic utilities
(like electricity, sewers, and safe piped water), neighborhood
facilities (like parks, recreation, grocery stores) and personal safety.
 So, the conditions within which a person lives can have either a
positive or negative impact on implementing a healthy lifestyle.
6.3. Preventive Care
 As noted earlier in this chapter, healthy lifestyles generally take
place outside of the formal health care delivery system, as people
pursue their everyday lives in their usual social environment.
 Preventive care refers to routine physical examinations,
immunizations, prenatal care, dental checkups, screening for heart
disease and cancer, and other services intended to ensure good
health and prevent disease or minimize the effects of illness if it
occurs.
 Cont’d
6.3.1. Preventive Care and the Poor
 While there is evidence that participation in health lifestyles
that do not involve con­tact with physicians and other health
personnel can spread across social class boundaries, there is
other evidence showing that the poor remain least likely to
use preventive care.
 Low-income women receive less pre­natal care, low-income children
are significantly more likely to have never had a routine physical
examination, and other measures like dental care, breast examina­
tions, and childhood immunizations are considerably less common
among the poor.
 The reason for this situation is that many low-income persons do not
have a regular source of medical care, health facilities may not be
near at hand, and costs not covered by health insurance may have to
be paid out of the individ­ual's own pocket-and this factor can be a
significant barrier in visiting the doctor when one feels well.
 Cont’d

6.3.2. The Health Belief Model signature

 One of the most influential social-psychological
approaches designed to account for the ways in which
healthy people seek to avoid illness, is the health belief
model of Irwin Rosenstock (1966) and his colleagues (M.
Becker 1974).
 The health belief model is derived to a great extent from
the theories of psychologist Kurt Lewin, who suggested
that people exist in a life space composed of regions with
both positive and negative valences (values).
 An illness would be a negative valence and would have the
effect of pushing a person away from that region, unless
doing so would cause the person to enter a region of even
greater negative valence (for example, risking disease might be less
negative than failing at an important task).
 Cont’d

 Thus, a person's behavior might be viewed as the result of

seeking regions that offer the most attractive values.
 Within this framework, human behavior is seen as being
dependent upon two primary variables:
(1) the value placed by a person upon a particular outcome, and
(2) the person's belief that a given action will result in that
outcome.
 Accordingly, the health belief model suggests that preventive
action taken by an individual to avoid disease "X" is due to
that particular individual's perception that he or she is
personally susceptible and that the occurrence of the disease
would have at least some severe personal implications.
 Although not directly indicated, the assumption in this model
is that by taking a particular action, susceptibility would be
reduced, or if the disease occurred, severity would be reduced.
 Cont’d
 The perception of the threat posed by disease "X,"
however, is affected by modifying factors.
These factors are demographic, socio-psychological,
and structural variables that can influence both
perception and the corresponding cues necessary to
instigate action.
 The health belief model has been employed successfully in
several studies of (preventive) health behavior, such as
dietary compliance (M. Becker et al. 1977) and ethnic
differences in managing hypertension (c. Brown and Segal
1996).
 Cont’d

6.4. Illness Behavior

• Illness behavior refers to the varying ways individuals
respond to bodily indications, how they monitor internal
states, define and interpret symptoms, make attributions,
take remedial actions and utilize various sources of
informal and formal care.
• In the identification of symptoms, some people recognize
particular physical symptoms like pain, high fever, or
nausea.
• Based on these symptoms they seek out physicians for
treatment.
• Body changes which could be used as symptoms of illness
are disruptive, painful and visible which are the basic
determinants of medical help seeking especially if the
discomfort is severe.
 Cont’d
• Social factors would either encourage or
discourage a person from seeking medical
treating.
• The identification of these social factors is of great
significance to those individuals or groups who
are concerned with the planning, organization and
implementation of health care delivery systems.
• This understanding has tremendous impact upon
the structuring of health services for living in a
community both in terms of providing better
medical care and making that care more accessible
to the people who need it.
 Cont’d
6.5. Self-care
• Self-care is the most common response to symptoms of
illness by people through­out the world.
 Self-care includes taking preventive measures (like consuming
vitamin supplements), self-treatment of symptoms (such as taking
home remedies or over-the-counter drugs), and managing chronic
conditions (for instance, use of insulin by a diabetic).
• Self-care may involve consultation with health care
providers and use of their services.
• self-care consists of both health and illness behavior.
• It essentially consists of a layperson's preventing,
detecting, and treating his or her own health
problems.
 Cont’d

 In modern societies, a number of factors have pro­moted interest in

self-care on the part of laypersons. These factors include:
1. The shift in disease patterns from acute to chronic illnesses and the
accompanying need to displace medical intervention from an emphasis
on cure to care
2. Growing public dissatisfaction with medical care that is
depersonalized
3. Recognition of the limits of modern medicine
4. The increasing visibility of alternative healing practices
5. Heightened consciousness of the effects of lifestyles on health; and
6. A desire to exercise personal responsibility in health-related matters.
 More recent research indicates that access to the Internet, with its
abundance of medical information, has also encouraged self-care.
 Thus, it would appear that self-care is becoming increasingly important
and commonplace.
 Cont’d

6.6. Socio-demographic Variables

 The socio-demographic variables which affect the health
status of people as well as health seeking behavior and the
utilization of health care services are sex, age, ethnicity and
socio-economic status.
Sex
 Use of health services is greater for females than for males
and is greatest for the elderly.
Age
 Perhaps it is obvious that people more than 65 years of age
are in poorer health and are hospitalized more often than
other age groups.
 It is also clear that elderly people are more likely to visit
physicians than younger people.
 Cont’d

Socioeconomic Status
 It was believed that lower-class persons tended to under-utilize
health services because of the financial cost and/or culture of
poverty.
 The culture of poverty is a phenomenon in which poverty, over
time, influences the development of certain social and
psychological traits among those trapped within it.
 The poor have higher rates of disability due to illness and that the
poor also tend to be more likely to seek symptomatic care.
 The non-poor, in turn, are more likely to seek preventive care,
which is aimed at keeping healthy people well, instead of waiting
to seek help when symptoms appear.
 Therefore, the poor appear to have more sickness and, despite
the significant increase in use of services, still do not obtain as
much health care as they actually need.
 Cont’d

 Using the data collected in Washington, D.C, Dutton (1978)

had tested the three different explanations concerning why
the poor would show lower use rates in relation to actual
need than the non-poor:
(1). financial coverage explanation:-According to this
explanation, the poor can­not afford to purchase the services
they need because the cost is high, income is low, and
insurance programs are inadequate.
(2) the culture of poverty explanation:-The atti­tudes and
characteristic of poor people tend to retard use of services.
 For example, the poor may view society and professional
medical practices as less than positive as a result of their life
experiences.
 Dutton found the culture of poverty explanation to have
 Cont’d
 As income decreased, belief in preventive checkups and
professional health orienta­tion also decreased while degree
of social alienation increased.
 Thus, Dutton argues that attitudes related to the culture of
poverty do play an important role in explaining differ­ences
in the use of health services between income groups,
particularly the use of preventive care

(3) the systems barrier explanation:-

 This explanation focused on organizational barriers inherent
in the more "public" system of health care typically used by
the poor, such as hospital outpatient clinics and emergency
rooms.
 Cont’d
This type of barrier not only pertains to difficulty in
locating and traveling to a particular source of care,
but also includes the general atmosphere of the
treatment setting, which in itself may be impersonal
and alienating.
 For example, the very massiveness of modern
medical organization is itself a hindrance to health
care for the poor.
 Cont’d
 There are ten determinants that indicates whether a person will
seek medical care:
(1) visibility and recognition of symptoms;
(2) the extent to which the symptoms are perceived as dangerous;
(3) the extent to which symptoms disrupt family, work, and other
social activities;
(4) the frequency and persistence of symptoms;
(5) amount of tolerance for the symptoms;
(6) available information, knowledge, and cultural assumptions;
(7) basic needs that lead to denial;
(8) other needs competing with illness responses;
(9) competing interpretations that can be given to the symptoms once
they are recognized; and
(10) availability of treatment resources, physical proximity, and
psychological and financial costs of taking action.
 Cont’d

 These determinants work at two distinct levels: other-

defined and self-­defined.
1. The other-defined level is, the process by which other
people attempt to define an individual's symptoms as
illness and call those symptoms to the attention of that
person.
2. Self-defined is where the individual defines his or her own
symptoms.
 The ten determinants and two levels of definition interact to
influence a person to seek or not seek help for a health
problem.
 6.6. Suchman stage of illness experience

 Suchman's (1965) analysis of the stages of illness

experience demonstrates how individuals draw upon their
knowledge and experience of their bodily states to
recognize symptoms of illness and 'do something about it in
Western culture.
 According to Suchman, when individuals perceive
themselves becoming sick they can pass through as many
as five different response stages, depending upon their
interpretation of their particular illness experience. These
stages are:
(1) The symptom experience:-The illness experience begins
with the symptom stage, in which the individual is
confronted with a decision about whether "something is
wrong."
 Cont’d
(2) The assumption of the sick role:-If the decision is made to accept
the symptom experience as indicative of an illness, the person is likely
to enter Suchman's second stage of the sick role.
 Here the person is allowed to relinquish normal social obligations
provided permission is obtained from ill person's lay-referral
system.
(3) Medical care contact:- At this stage, the person attempts to obtain
legitimation of his or her sick role status and to negotiate the treatment
procedure.
(4) Dependent-patient role:-If both patient and physician agree that
treatment is necessary, the person passes into the dependent-patient
stage.
 Here the person undergoes the prescribed treatment, but still has the
option either to terminate or to continue the treatment.
(5) Recovery and rehabilitation:-In this stage the patient is expected
to relinquish the sick role and resume normal social roles.
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