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‘Lay’ understandingsof health
Week 16Sociology of Health and Illness
Recap
• Thought about how health and illness are structured by society
• Introduced the concept of the ‘sick role’
• Considered the concept of medicalisation and the impact of surveillance medicine
Outline
• Rational Choice and health education
• Candidacy for Coronary Heart Disease
• Health and lifestyles
• Rise of the expert patient?
Who are ‘lay’ people
• ‘Lay’ people in health research are not health professionals
• Concept used to explore the perspectives or behaviour of people in opposition to proscribed medical/health understandings
• Recently, moves to acknowledge that patients can be ‘experts’
Critique of Medicalisation
• Early work on medicalisation emphasised the power and control of medicine
• Did not fully explain either health behaviour or patient- professional relationships
• Research grew into how beliefs impact on health
Rational Choices?
• Much health promotion can be linked to rational choice understandings– Education about bad impacts, will change
behaviour
• Patients seek medical advice, but do not necessarily follow it– Fail to take prescription medicine
• Lay understandings can explain the complexity of health beliefs and behaviours
Smoking
• The public is repeatedly told that smoking is bad for them.
• So why do people start or continue smoking?
Smoking
• Smoking varies considerably by social class, gender and ethnicity– 45% w/c adult men /15% m/c men
• Reasons include – stress levels – type of occupational– understandings of relative risks
• Graham argued that it could be a way to manage poverty
Coronary Heart Disease
• CHD is currently the biggest killer in the UK.– 1.4 million angina, 275,000 people heart
attack
• What do you know about CHD?
‘Candidacy’
• Davidson et al argue that ‘candidacy’ is a common perception in understanding CHD– Type of person who should be careful– Seeing yourself as a possible candidate
• Factors included– Fat, unfit, smokers, heavy drinkers, stressed– Family history, type of occupation– Red faced, grey pallor, bad tempered,
worriers
‘Uncle Norman’ effect
• Built into candidacy is an understanding that the ‘wrong’ people are affected
• Non-candidates have heart attacks– Fate, destiny, chance
• Potential candidates do not have problems– Lucky, good constitution
Simple messages
• Davidson et al argued that health promotion relies on simple messages which distorts epidemiological evidence– ‘Fat = Bad’
• ‘Lay’ epidemiology notices the anomalies– Fat survive whilst the thin drop dead
• Undermines the creditability of medical knowledge and encourages ‘fate’ as a predictor
• Do you recognise these ideas about candidacy and fate?
• How common are they amongst your family and friends?
Working class women’s health
• Blaxter & Patterson’s study of women found lots of different health problems
• Women held low expectations of health– ‘Normal illnesses
• Women denied symptoms of illness• The ability to function normally
despite illness was prized
• Blaxter& Patterson (1982) Mothers and daughters London, Heinemann Educational
Working class women’s health
• Younger women less interested in explaining health, and used more medical terms.
• Family and personal experiences are important
• External causes more acceptable than ‘natural’ processes –e.g. ageing.
• Often rejected suggestions that poor health caused by poverty
Healthy/Unhealthy divide
• Blaxter carried out a major study of what people think health is and what might determine health
• We cannot divide the population into health or unhealthy by lifestyle– We tend to have both good and bad areas
Determinants of health
• But Blaxter (1990) found that behavioural factors were seen as a main cause of illness
• Structural or environmental factors were not often mentioned
• Especially among those from working-class backgrounds
Healthy/Unhealthy divide
• ‘Circumstances' are often more important than healthy or unhealthy behaviours
• ‘Unhealthy behaviour does not reinforce disadvantage to the same extent as healthy behaviour increases advantage’
• Blaxter, M (1990), Health and lifestyles. Routledge p233
• What do you think of the idea that stopping unhealthy behaviour may not have a significant impact?
The rise of the expert patient
• Recently ‘lay’ expertise has begun to be taken more seriously– NHS Expert patient programme– Successful challenges to medicalisation– Self-help and campaign groups challenge
professional decisions
• The internet is seen as the latest
vehicle for promoting lay ideas
Professional Challenge?
• Hardey has argued that professional power in medicine is built on control of expertise
• The internet presents a newchallenge to this power relationship
• The internet also hides the boundaries between conventional, alternative and complementary medicine
Summary
• Lay models of health and illness are usually complex and sophisticated.
• They may draw on scientific explanations and everyday experiences
• Lay beliefs impact on attitudes, behavior and relationships with health professionals
Next week
• Health inequalities in social class
• Look in more detail about the lifestyle and environmental factors that influence health
• Individualising poverty
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