Health

Vic Mensa 

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Defining health, illness and disability

Positive definintion (of health) - feeling fit and able to undertake any reasonable task

Negative definition - being free from pain and discomfort

Functional definition - able to perform a range of tasks

Factors influencing the publics definition:

- Cultural differences: Some Hindus/Sikhs living in bedford have 'sinking heart' (physical chest pain), which according to Krause (1989) is due to public shame

- Age differences: Older people tend to accept as 'normal' a range of pains which younger people will define as disability

- Gender differences: Men have fewer consultations with doctors than women. Women go through child birth and menopause. Men less likely to define themselves as ill.

- Social class: lower social class less likely to go to GP then more wealthy. 

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Medical definitions of health and illness

Bio-medical model of health - the conventional western model. It sees the body as very much like a biological machine, with each part of the body performing a function. The doctors job is to restore the funcitons by solving the problem of what is wrong. Ideas about the environment or the spiritual health of the person are not relevant.

Bio-medical model of health states:

- Illness is always based on an identifiable cause

- Illnesses can be identifie, classified and measured

- The cure usually lies in the physical body of the patient

- There is a reliance upon drugs or surgery

illness: perception of feeling unacceptably worse than normal body state 

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Disability

World health organisation (WHO) has distinguished between impairment, disability and handicap:

Impairment - refers to the abnormality of, or loss of function of, a part of the body

Handicap - refers to the physical limits imposed by the loss of function

Disability - the socially imposed restriction on people's abilities to perform tasks as a result of the behaviour of people in society

Types of Stigma:

- Discrediting: there are obvious types of stigma, such as being in a wheelchair

- Discreditable: here the stigma is one of potential, dependant on whether other people find out about the discreditable illness or disability.

'Master status' - When the stigma then completely dominates the way the person is treated, and any other attributes are seen as less important

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Health inequalities Part 1

Research has shown that health is closely linked to a number of social factors. These include geography, social class, gender and ethnicity.

Geographical differences - In the worst health areas (Mary Shaw Study), children under the age of 1 are twice as likely to die. There are 10x more women under 65 who are permenantly sick. Adults almost 3x as likely to state they have chronic ilness. Adults have 70% greater chance of dying before 65. (Reflects differences in income and levels of deprivation)

Gender - Women live longer than men,but more likely to visit GP more. They also have higher levels of mental illness.  It is suggested women are stronger biologically then men although they cann suffer from a range of female-related problems. Social role tends to prevent women taking risks. Women are less likely to smoke.

Ethnicity - 'Indian subcontinent' has highest level of CHD, while afro-carribeans have the least, All ethnic minority groups are less likely to die from cancer. Minority Ethnic groups have some of the lowest incomes, worst housing and highest unemployment in the UK. Some believe the link between health and ethnic groups are due to racism in society which puts stress upon people. Also difference in diet (indian - ghee) and lifestyle may influence health.

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Health inequalities Part 2

Social Class - mortality has fallen for both men and women in all social classes. Fallen faster for those in the higher social classes. Men in social class I expect to live 9yrs longer then men in social class V, while women in social class I expect to live 6yrs longer than women in V

Explanations: Artefact approach - statistical connection between social class and illness exaggerates the situation. Social selection - this approach claims that class does not cause ill health but that ill health may be significant cayse of social class. Culturaln explanation - cultural choices lead to the difference in health. i.e. manual workers consume twice as much white bread as professionals, have higher sugar consumptions and eat less fresh fruit. Further more 40% of men and 35% of women more likely to smoke regularly in Social class IV and V. Middle class people more likely to exercise. Lower class intake more alcohol. Structural explanation - Poverty is a key factor of health risks, poorer people have worse diets and housing conditions. Position at work, people with less responsibility more likely to have worse health. Other factors such as unemployment and industry play a role.

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Inequalities in the health services Part 1

Funding, which pays for services are influenced by:

Geographical inequalities: giving money to each health authority is based on 'the poorer should get more' this rarely happens. One reason is specialist teaching hospitals are only founs in richer areas of the counrty, Another reason is due to politcal pressures London always gets more.

Medical professions: the medical professions are extremely influencial in determining which areas of health care recieve funding. There are some areas that are seen as more important.

Hospitals and competence: hospitals have their own methods, some methods are better than others. Better hospitals (in terms of successful operations etc.) get more money. 

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Inequalities in the health services Part 2

Ethinicity - there is a lower use of medical services by certain ethnic minorities. suggested reasons are:

1) Language barriers - until recently there was little attempt to provide translation facilities or to publicise the NHS in minority languages.  2) Cultural differences - ideas of modesty have meant that many women are unwilling to be seen by male doctors. 3) Poverty - ethnic minorities contain some of the lowest-income families.

Age - Older people see themselves as 'wasting the doctors time' if they consider that they may be consulting the doctors unnecessarily

Private Health Care-  greater inequalities in access to health care  exist between those who rely upon the NHS anf those who use the private sector. Private healthcare - for those who pay directly or have private health insurance. Inequality increased by:

 1) allowing those who can pay to have treatment without waiting, while nhs patients are on  waiting lists. 2) giving private patients access to services not available to nhs patients.            3) limiting no of hours worked by doctors in the NHS, who prefer to earn more money in  private sector.

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Mental health and mental illness

A mentally ill person is someone who acts in a way which is abnormal

Mental health is a continuum - at one end there is little doubt that the behaviour is so extreme that it can be defined as 'mental illness', but as we move away, the clarity of the mental illness becomes less and less clear

Once labelled there are a number of negative consequences for the person. Rosenhaim(1973) study:

Eight perfectly 'normal' researchers to enter a number of psychiartric institutions. New staff were asked to uncover these reaserchers who were just pretending to be ill, staff routinely judged people who were 'genuinely ill' as merely pretending.

Mental illness and ethnicity: ethnic minorities have higher chance of being defined as mentally ill. Two main reasons 1) some practices are seen as symptoms of mental illness (e.g. in afro-carribean culture) 2) pressure and stress from racism can lead to signs of mental illness.

Women and people of poorer areas are more likely to be mentally ill.

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Mental health and mental illness

A mentally ill person is someone who acts in a way which is abnormal

Mental health is a continuum - at one end there is little doubt that the behaviour is so extreme that it can be defined as 'mental illness', but as we move away, the clarity of the mental illness becomes less and less clear

Once labelled there are a number of negative consequences for the person. Rosenhaim(1973) study:

Eight perfectly 'normal' researchers to enter a number of psychiartric institutions. New staff were asked to uncover these reaserchers who were just pretending to be ill, staff routinely judged people who were 'genuinely ill' as merely pretending.

Mental illness and ethnicity: ethnic minorities have higher chance of being defined as mentally ill. Two main reasons 1) some practices are seen as symptoms of mental illness (e.g. in afro-carribean culture) 2) pressure and stress from racism can lead to signs of mental illness.

Women and people of poorer areas are more likely to be mentally ill.

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The medical professions in society Part 1

Views of doctors: 

  • Benefits society - functionalist
  • occupational strategy to get higher income and money, 
  • a means of controlling the populatioin - marxist view
  • they have controlled and marginilised women - feminist view
  • have emerged as a result of their ability to define knowledge - foucault

Barber (1963) argue that professions. especially the medical professions, are very important for society because they deal with people when their vulnerable. Real professions can be recognised with shared traits: 1) theoretical basis to their knowledge 2) fully trained to the highest possible standards 3) competence is tested by examination 4) regulate themselves through a committee.

 

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The medical professions in society Part 2

Professionalisation as a strategy: medical profession made for their own good. they aim to gain status and high financial rewards.

1) the production of a body of esoteric knowledge (complex body of knowledge only understood only by experts)

2) Educational barrier (only very best allowed to enter)

3) exclusion of competitors e.g. faith healers, herbalists....................etc.

4) Maintainence of privelege (fight all attempts to have others impose any control over them -clinical freedom-)

Marxist approach - small ruling class exploit society for its own benefit. Medical profession play an important role in this by misleading the population as to the reals cause of their illness.They point there finger away from the poor working conditions, poverty, poor housing and inequalities in society. To keep patients fit for work.

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The medical professions in society Part 3

Feminists approach - believe doctors control women, both as patients and as medical practitioners.

Feminist sociologists also claim that the male-dominated profession of medicine has successfully medicalised a number of female problems (childbirth & menopause).

Depression is higher in women due to the restricted role of women in society (according to feminists)

Foucault's (1976) approach - 'knowledge is power'.

Medicine has played a major part in constructing the way we think and act in contemporary society.In the process, the medical profession have gained considerable benefitsin terms of prestige and financial rewards.

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