Applied SociologyExperiencing Health and Disease

By C. Settley

Learning Outcomes

• 1. The student need to be able to give a historical overview of illness and review the theoretical approaches to health and disease

• 2. The student should be able to relate the concepts health, disease and illness in understanding how people experience and react to disease and illness patterns and demonstrate an understanding of the therapeutic relationship

The pre- agricultural period• Up to 8000-10 000 years ago• Hunters (males) & gatherers (females)• Made a living from hunting and fishing and collecting plants• They moved to new locations when food ran out• No formal institutions, no formal education. • Functions fulfilled by institutions in modern society as we

know it were performed by the nuclear family units. • Goods and services were exchanged as people had no money. • Food was shared among all. • No political leaders- ranks were determined by age and sex

The pre- agricultural period• Individual freedom- no one worked for someone

else. • No one had the right to issue commands. • Today, only a handful of hunter-gatherer societies

survive in the Amazon Basin and in Africa. • San people in Kalahari desert in Botswana.

Disease patters during the pre- agricultural period

• Hunter-gatherers were healthy as a result of their diet (raw fruits, leaves, lean meat, and fish).

• Diseases were mostly mild and were passed by intimate contact like TB and Herpes.

• Infectious diseases only later became major causes of disease and death as these people were on the move and did not live in large groups.

• Low life expectancy – not because of disease but due to environmental and safety hazards.

Agrarian Societies• Appeared worldwide between 3000BC and 300 AD• Small gardens were established and people then

became food producers• Due to stable food supply, people then became settled

down in permanent or semi-permanent villages…..cities then developed.

• The family- still the major social institution• Kinship- more clearly defined as people did not wish to

see their land being inherited by one other than family

Agrarian Societies

• Villages were headed by chiefs• Legal codes were developed• Inequalities in terms of wealth and power

Examples are traditional Zulu societies

Disease patterns during the agricultural period

• Different from hunter-gatherers• Less variety of foods• Diets were lower in fibre and higher in fat and salt• Resulted in diseases such as HPT, heart disease and

cancers• Grinding grain to make flour caused excessive wear

on people’s joints, causing arthritis• It became customary to cook food thus vitamins

were destroyed and toxins introduced.

Disease patterns during the agricultural period

• The result was that people now were of smaller stature and had weaker bones which lead to conditions such as anaemia

• Unsanitary conditions due to growth in population• Increasing infectious diseases

Classification of infectious diseases:GROUP EXAMPLE ENHANCING RATIONAL

Water-borne diseases Cholera More people=more waste. Caused the water to become contaminated

Food- borne diseases Dysentery People lived in close proximity. Disease were spread from animal to human

Vector- borne diseases Plague Due to population density and unsanitary conditions.

Air- borne diseases Tuberculosis

Industrialised societies• Developed about 200 years ago due to

industrialisation • Characterised by the use of machines rather than

animals or human power• More people in Urban than in rural areas. • Industrialisation- it reduced inequalities. Widened the

gap between rich and poor. • Urban areas- life became more impersonal, more jobs• Changes in the structure of society

Industrialised societies• The family’s functions have been reduced. • Other institutions like education now has an

increased importance (compulsory). • Politics and economics have been influenced• Capitalism • Industrialisation has reduced inequalities in

developed nations but not in developing societies• The gap between rich and poor is wider

DEFINITIONS

• 'Industrialization' The process in which a society or country (or world) transforms itself from a primarily agricultural society into one based on the manufacturing of goods and services

• ‘capitalism’ An economic and political system in which a country's trade and industry are controlled by private owners for profit, rather than by the state

Industrialised societies• Societies are now characterised by distinctive

cultures• Transportation and communication systems have

brought groups and societies into contact with other societies and ways of life

Industrial era of disease

• Changes brought about also affected the incidence and prevalence of disease

• Industrialisation was responsible for further increases in population size and density

• Meaning more people were exposed to old virulent infections and old urban sanitary diseases such as cholera and typhoid fever

• Influenza became a pandemic due to people becoming more mobile

Industrial era of disease

• Disease problems were acute because of sever exposure to poor nutrition, environmental pollutants

• The most dramatic improvement in health occurred in the 19th and 20th centuries

• Mortality as a result of TB declined in the west • This was due to sociocultural factors• Economic development caused improvements in people’s

diets as agricultural techniques developed and transportation became faster and more efficient

Industrial era of disease

• These factors had positive and negative consequences• Social changes like the decline in birth rate reduced the

demand for food and housing resources• Hygiene developments led to a decline in mortality• Water contamination was controlled and prevented• Infant mortality reduced • Milk sterilisation

Industrial era of disease

• Scientific medical technology responsible for the decline in infectious disease

• Vaccines• Chemotherapy• Measles• TB

THEORETICAL APPROAC TO HEALTH AND DISEASE• THE BIOMEDICAL MODEL OF HEALTH AND DISEASE• The Cartesian revolution: mind/body dualism -Descartes

• The church's main message was to simply believe in God without question but he could not do this without doubt. After questioning what was left once he doubted everything, Descartes found the existence of himself the only thing that survived. He reasoned that if he could question his own existence, he had to exist because there had to be someone doing the doubting.

• This led to the dualism theory, also known as the mind-body problem. Descartes theorized that if he existed, it was in two different ways: as a mind, or a non-physical entity, and as a body, a physical entity. For him, the problem lay in bridging the gap between the two. There was obviously a relationship between the mind and the body's interactions, but it was unclear to him exactly what it was other than the two were separate and distinct.

“I Think, Therefore I Am”

THEORETICAL APPROAC TO HEALTH AND DISEASE

• THE BIOMEDICAL MODEL OF HEALTH AND DISEASE• The Clinical method• The trend of combining theory and method.

• Institutionalisation of health care• Development of hospitals

THEORETICAL APPROAC TO HEALTH AND DISEASE

• THE BIOMEDICAL MODEL OF HEALTH AND DISEASE• The doctrine of specific aetiology• The germ theory of disease states that some diseases

are caused by microorganisms. These small organisms, too small to see without magnification, invade humans, animals, and other living hosts. Their growth and reproduction within their hosts can cause a disease.

THEORETICAL APPROACHED TO HEALTH AND DISEASE

• CHARACTERISTICS OF THE BIOMEDICAL MODEL OF HEALTH AND DISEASE

• Assumptions: • The mind and body can be treated separately• The body can be repaired like a machine in that it is

passive during treatment

THEORETICAL APPROACHED TO HEALTH AND DISEASE

• CHARACTERISTICS OF THE BIOMEDICAL MODEL OF HEALTH AND DISEASE

• Biomedicine adopts a technological imperative. The latest technological care.

• Biomedicine is reductionist. It reduces disease to chemistry and physics.

• Biomedicine is an objective science. Based on observation.

These assumptions and characteristics translate into medical practice that has the following features:

• The nature and causes of health and disease: Health is regarded as the absence of biological abnormality. All diseases have specific causes or origins.

• The patient: because of the body/mind, the focus is on the patient’s body.

• The nature of intervention: the focus is on cure, the aim being to manipulate the physical symptoms as to make them disappear.

Evaluation of biomedicine• 1. Criticism of biomedicine• Criticism from academic sources.

• 2. Successes of biomedicine. • Not without merit.• Pharmacological breakthroughs.

Evaluation of biomedicine• 3. Efficacy is exaggerated • Decline of mortality rate in Western societies.

• 4. Disregard for the social context of health and disease• Refers to the indifference regarding the social and

material causes of disease. • Germ theory. • Health status is not merely the consequence of

biological factors but related to social structures.

Evaluation of biomedicine• 5. Patient’s body is isolated from the person• Disregarding the link between physical health and

mental health. • 6. Medical control of women’s health• Significance thereof. Millennium goals. • Scientific method only way to obtain truth about

disease• Professional medical dominance

Evaluation of biomedicine• 7. Scientific method only way to obtain truth about

disease• Identifies the truth about diseases.

• 8. Professional medical dominance• Exceptional progress.

THEORETICAL APPROACH TO HEALTH AND DISEASE THE SOCIAL MODEL OF HEALTH AND DISEASE:

Social factors that affect health:

Behavioural factors• Individual social behaviour• Direct control• E.g. smoking habits, alcohol

consumption, eating habits, exercise routines

Cultural factors• Influences groups who

share common background• As a result of norms and

values within a neighbourhood or community or age group

THEORETICAL APPROACHED TO HEALTH AND DISEASE 1. THE SOCIAL MODEL OF HEALTH AND DISEASE:Social factors that affect health:

Environmental factors• Beyond the control of individuals• At home, such factors as overcrowding and lack of privacy• At work, factors such as extreme temperatures, poor

lighting, duct, noise• More generally, environmental pollution such as wastes,

nuclear radiation and industrial by-products can have serious consequences on health

The image below shows the variety of the factors which can affect our health

Health, disease and illness (behaviour)• Health (negative definitions)• - absence of disease• - absence of illness

Health, disease and illness (behaviour)• Health (positive definitions)• - health as an ideal state (opposite of negative

definitions, view health holistically)• - health as the ability for effective role performance

(important for proper functioning in society, optimum capacity)

• - health as a commodity (can be bought, sold, given)

Health, disease and illness (behaviour)• Health (positive definitions)• - health as a personal strength or ability (physical or

mental ability)• - health as the basis for personal potential

(foundations for achievement, necessities of life)• - health as a human right (See figure to follow. Also

refer to figure 3.3 in textbook)

Activity, PAGE 109

• Make a list of the qualities you would expect someone to display if he/she were:

• PHYSICALLY HEALTHY• SOCIALLY HEALTHY• MENTALLY HEALTHY

Beliefs about health

• Perceptions. Eg “if you don’t belong to a medical aid, having to wait in casualty to be seen by a doctor might take a few hours”.

• Superstitions. Eg “A black cat crossing your path means bad luck”.

• According to status and social background of the individual.

• ACTIVITY Page 113. Refer to Social, mental and physical health

Health, disease and illness (behaviour)• Disease• A biomedical term.• Pathological changes of the biological organism

diagnosed by signs and symptoms.• Can be defined by a licensed person, by means of

instruments and be monitored.• Activity page 113!

Health, disease and illness (behaviour)• Illness• Refers to how people experience their symptoms.• What meanings they ascribe to them.• How they act upon them.• Communicated by complaint.

10 factors that determine how individuals respond to symptoms of illness.

• 1) The visibility, recognisability or the perceived importance of symptoms.

• 2) The extent to which a person’s symptoms are perceived as serious.

• 3) The extent to which the deviant signs and symptoms disrupt family life, work and other social activities.

10 factors that determine how individuals respond to symptoms of illness.

• 4) The frequency of the appearance of the deviant signs and symptoms, their persistence or the frequency of their recurrence.

• 5) The tolerance threshold of those who are exposed to and who evaluate the deviant signs and symptoms.

• 6) The available information, knowledge and cultural assumptions and understandings of the person experiencing the deviant signs and symptoms and who has to evaluate them.

10 factors that determine how individuals respond to symptoms of illness.

• 7) Psychological factors that lead to the denial of symptoms.

• 8) Needs competing with illness responses.• 9) Competing possible interpretations that can be

assigned to the symptoms once they are recognised.• 10) The availability of treatment resources, physical

proximity and the psychological and monetary costs of taking action.

Stages of the illness experience (Suchman, 1979). See table 3.1, page 119 • Stage 1: Symptom experiences – Cognitive aspect

(believe something is wrong) – Physical experience of symptoms – Emotional response (may consult others and try home remedies

• Stage 2: Assumption of the sick role – Accepts the sick role and seeks confirmation from family and friends – Continue with treatment – Excused from normal duties and expectations – Emotional responses common – Seek professional health advice

Stages of the illness experience (Suchman, 1979) • Stage 3: Medical care contact – Seeks advice of a

health professional to: • Validate real illness • Explain illness in understandable terms • Get reassurance (may accept or deny diagnosis)

• Stage 4: Dependent client role – Becomes dependent on the professional for help

• Stage 5: Recovery or rehabilitation – Relinquish the dependent role – Resume former roles and responsibilities – long term responsibilities and permanent disability necessitate adjustment

Therapeutic Relationships

• The role of values in therapeutic relationships• Individual values originate from the core of our

culture.• It reflects a culture’s orientation to five recurring

human problems: human nature, the environment, time, activity and relationships.

Therapeutic Relationships

• Models of therapeutic relationships• The joint participation between two social entities

and also some degree of interaction over an extended period of time.

• Behaviours are taken into account.

Therapeutic Relationships: 1. The paternalistic model TABLE 4.1 Parsons’ analysis of the roles of patients and doctors

Patient: sick role Doctor: professional role

Obligations and privileges: Expected to:

1. Must want to get well as quickly as possible

1. Apply a high degree of skill and

knowledge to the problems of illness

2. Should seek professional medical advice 2. Act for welfare of patient and community

and co-operate with the doctor rather than for own self-interest, desire for

money, advancement, etc

3. Allowed (and may be expected) to shed 3. Be objective and emotionally detached

some normal activities and responsibilities (i.e. should not judge patients’ behaviour

(e.g. employment and household tasks) in terms of personal value system or

become emotionally involved with them)

4. Regarded as being in need of care and 4. Be guided by rules of professional 51

unable to get better by his or her own practice

decisions and will

Rights:

1 Granted right to examine patients

physically and to enquire into intimate

areas of physical and personal life

2. Granted considerable autonomy in

professional practice

3. Occupies position of authority in relation

to the patient

Reprinted with permission from The Free Press from Parsons (1951).

Therapeutic Relationships: 2. The consumerism model

• A consumerist relationship describes a situation in which power relationships are reversed; with the patient taking the active role and the doctor adopting a fairly passive role, acceding to the patient’s requests for a second opinion, referral to hospital, a sick note, and so on.

Therapeutic Relationships: The paternalistic and consumerism model. A comparison.

• See table 3.5 on page 134 in textbook.

• END

Social Groups

Social interaction• The ways in which people

respond to each other.• The actions and reactions of

people.

Social group• Consists of two or more

persons between whom, contextually, a norm regulated, discernable pattern of interaction has developed.

• These persons form a unit in which the reaching of certain common goals is related to individual motivations and needs.

Characteristics of a social group

• Group structure and group members• A small group: between 2-20 members• A group has structure• Forms an orderly composition and create a

meaningful whole• Define themselves as belonging to a group with

boundaries based on certain roles, responsibilities and group norms

Characteristics of a social group

• There is a feeling of unity which is determined by conformation and adherence to a common, agreed upon goal

• Some groups limit their membership while others are more open and admit outsiders more easily

Primary groups

• Primary groups• Examples: a married couple, the family, the peer

group, & the friendship group• In primary groups, people come into contact with

norms, values and positive and negative sanctioning for the first time.

• Plays a role in the shaping of personality and socialisation of the child.

Primary groups

• This is where the child becomes familiar with different forms of interaction.

• Eg when to take, when to give etc. • The primary group is an expressive group. • Expression of emotions (love, anger etc).• Most important group for the individual.

Characteristics of the Primary group

• It generally has few members. • There are face- to-face relationships. Involves

closeness, spontaneous and emotional involvement and fairly intense relationships between the group members. The bonds between these members are warm and personal.

• The group gives its members emotional security.

Characteristics of the Primary group• Membership of the group is a goal in its own right.

Belonging to the group is the most important goal for the individual. The members of primary groups cooperatively share their collective needs.

• There is constant contact between the members. • The members interact in an informal manner. This

satisfy their need for intimacy. • Each member is involved in such a relationship as a

unique and complete person.

Secondary groups

• Individuals who do not know each other well. • Less face-to-face interaction. • Interaction is formal.• Group members do not support each other formally. • Characterised by secondary relationships. • Examples: work groups, church groups, the attorney

and his clients, etc.

Secondary groups

• Also referred to as formal organisations like hospitals, Sasol.

• Important function in society. • They are instrumental groups. • Functions of maintaining order in a society.

Group dynamics defined

• The socio scientific study and knowledge of the way in which people behave towards each other in the context of small groups.

The importance of the small group are:

- Groups are inevitable. - Occurs everywhere, at all levels of the population,

among rich and poor. It occurs in poorly developed or highly developed societies. Most human activities take place within the context of groups.

The importance of the small group are:- Groups are powerful- Their activities have an important influence on the

individual. - A persons identity is formed by the groups he/she

belongs to. - The position filled within the groups can influence

behaviour towards them. - Influences self image and ideals. - Membership to a group can be an advantage or

disadvantage.

The importance of the small group are:- Groups have positive/negative results- Groups have been responsible for achievements and

catastrophes.

- Group performance can be improved- Research on productivity and performance quality.

Group Norms- Rules of behavior created by the members in order

to maintain and ensure consistent behavior- To prevent chaos- Serves as basis for anticipating and predicting the

behavior of other members- Norms are ideas on what the members should do;- What they ought to do;- What they are expected to do under any given

circumstance

Group Norms- Norms are formed during interaction with group

members and come into operation once the majority of group members accepts them.

- Related to two aspects of the group process

- Determined by the group goal. Regulates members’ behaviour.

- If a group strives to survive and to be effective, the interaction must be co ordinated. Guarantees survival and success of the group.

Group Norms- Formal Norms: Nursing Act- Informal Norms: Additionally created by the

individual groups

Group Size• The number of members in a group plays an

important role in the way the group functions.• - The smaller group would seem to be more accurate

and quicker at solving lesser problems, whereas abstract problems and complex tasks are better dealt with by larger groups.

• - It is clear that a larger group will function more efficiently than a smaller group when the aim is to solve a wide range of complex tasks.

Group Size• Research shows that as a group grows in size :• - There is less talking time per individual in the group.• - Members have less time available to develop and

maintain relationships with each other.• - Those who talk more than others become more visible

and influential………..a leader emerges.• - Differences in the frequency of participation are

intensified.• - Leaders gain more control over the group and the

direction in which the group in moving

Group Size• Sub-groups begin to emerge.• - The knowledge and potential abilities available to the

group increases.• - There is a greater opportunity to meet people.• - Members can retain a degree of anonymity.• - Though there is a rise in productivity, job satisfaction is

diminished, members of the group are absent more often and more work-related disputes arise.

• - More communication problems arise among the members of the group.

Group SizeGroups with even & odd numbers of members

- Even numbers of members may divide into 2 cliques of equal size- differences and conflicts are not easily solved.

• - Uneven numbers where majority or minority opinion or decision is possible-groups is more inclined to reach consensus and to have open discussion on relevant issues.

Dyads(2 person groups) &Triads(3-person groups)

• Dyads are less inclined to disagree or convey messages.

• - No majority decision can be enforced.

• - More information is exchanged•- Members make more effort to convince each other.•- Triad has advantage-in event of a disagreement, the 3rd member may sway the balance and force majority decision.

Group Cohesion

- Cohesion stresses the strength and pattern of interpersonal attraction in the context of the group.

- Sociologists agree that cohesion refers to the degree to which members are motivated to remain in the group

Four factors to determine Cohesion in a group

• 1) The personalities of the group members.• 2) The psychological or material factors that act as

incentive to continue group membership.• 3) The expectation that certain positive ( or even

negative) consequences will result from membership.• 4) The cost of membership as opposed to the

rewards obtained, compared with other activities which might involve a higher cost and a lesser reward.

Factors promoting Group Cohesion

• -Clarity of group aim.• - Status in the group.• - Group atmosphere.• - Group size.• - Group norms.• - Co-operation and competition.• - Similarities among members

The influence of cohesion on the groupResearch findings show that groups with strong cohesion spend less time and energy on maintaining the group and consequently have more success in achieving their group objectives. • Satisfaction of members.• Participation and loyalty.• Influence over members.• Group norms.• Effective support

Group Leadership

• Leadership is the most important role in the group structure.

• - Effective functioning depends on coordinated group activities and achievement of group objectives.

• - Shaw (1981:319)defines the leader as “the group member role) who exerts more positive influence (leadership) over other group members, or as the member who exerts more positive influence over others than they exert over him/her”

Group Leadership

• - The nursing professional as a leader must exhibit a strong influence over the members of her nursing team.

• - This influence must be exercised in a positive manner so as not to alienate or intimidate her team members into a state of “subservient” behavior

The Emergence of Leaders• Situational View- Situational leadership theory proposes that effective leadership requires a

rational understanding of the situation and an appropriate response, rather than a charismatic leader with a large group of dedicated followers (Graeff, 1997; Grint, 2011).

- Situational leadership in general and Situational Leadership Theory (SLT) in particular evolved from a task-oriented versus people-oriented leadership continuum (Bass, 2008; Conger, 2010; Graeff, 1997; Lorsch, 2010).

- The leader focuses on the required tasks or focuses on their relations with their followers.

- Originally developed by Hershey and Blanchard (1969; 1979; 1996), SLT described leadership style, and stressed the need to relate the leader’s style to the maturity level of the followers.

- Task-oriented leaders define the roles for followers, give definite instructions, create organizational patterns, and establish formal communication channels (Bass, 2008; Hersey & Blanchard, 1969; 1979; 1996; 1980; 1981).

The Emergence of Leaders• Transactional View• Transactional leadership focuses on the exchanges that occur between

leaders and followers (Bass 1985; 1990; 2000; 2008; Burns, 1978). - These exchanges allow leaders to accomplish their performance objectives,

complete required tasks, maintain the current organizational situation, motivate followers through contractual agreement, direct behavior of followers toward achievement of established goals, emphasize extrinsic rewards, avoid unnecessary risks, and focus on improve organizational efficiency.

- In turn, transactional leadership allows followers to fulfill their own self-interest, minimize workplace anxiety, and concentrate on clear organizational objectives such as increased quality, customer service, reduced costs, and increased production (Sadeghi & Pihie, 2012). Burns (1978) operationalized

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www.slideshare.net/kiranbajracharya/profession-and-professionalism-in-pharmacy

• http://www.interfaces.com/blog/2013/09/health-and-human-rights/ • http://www.south-africa-tours-and-travel.com/khoisan.html • http://people.opposingviews.com/cartesian-revolution-8222.html• https://en.wikipedia.org/wiki/Germ_theory_of_disease