Sociology of health and illness

The sociology of health and illness, alternatively the sociology of health and wellness (or simply health sociology), examines the interaction between society and health. The objective of this topic is to see how social life affects morbidity and mortality rate, and vice versa.[1] This aspect of sociology differs from medical sociology in that this branch of sociology discusses health and illness in relation to social institutions such as family, employment, and school. The sociology of medicine limits its concern to the patient-practitioner relationship and the role of health professionals in society.[2] The sociology of health and illness covers sociological pathology (causes of disease and illness), reasons for seeking particular types of medical aid, and patient compliance or noncompliance with medical regimes.[2]

Health, or lack of health, was once merely attributed to biological or natural conditions. Sociologists have demonstrated that the spread of diseases is heavily influenced by the socioeconomic status of individuals, ethnic traditions or beliefs, and other cultural factors.[3] Where medical research might gather statistics on a disease, a sociological perspective on an illness would provide insight on what external factors caused the demographics who contracted the disease to become ill.[3]

This topic requires a global approach of analysis because the influence of societal factors varies throughout the world. This will be demonstrated through discussion of the major diseases of each continent. These diseases are sociologically examined and compared based on the traditional medicine, economics, religion, and culture that is specific to each region. HIV/AIDS serves as a common basis of comparison among regions. While it is extremely problematic in certain areas, in others it has affected a relatively small percentage of the population.[4] Sociological factors can help to explain why these discrepancies exist.

There are obvious differences in patterns of health and illness across societies, over time, and within particular society types. There has historically been a long-term decline in mortality within industrialized societies, and on average, life-expectancies are considerably higher in developed, rather than developing or undeveloped, societies.[5] Patterns of global change in health care systems make it more imperative than ever to research and comprehend the sociology of health and illness. Continuous changes in economy, therapy, technology and insurance can affect the way individual communities view and respond to the medical care available. These rapid fluctuations cause the issue of health and illness within social life to be very dynamic in definition. Advancing information is vital because as patterns evolve, the study of the sociology of health and illness constantly needs to be updated.[2]

Historical background

Wall painting found in the tomb of an Egyptian official known as the physicians tomb

Humans have long sought advice from those with knowledge or skill in healing. Paleopathology and other historical records, allow an examination of how ancient societies dealt with illness and outbreak. Rulers in Ancient Egypt sponsored physicians that were specialists in specific diseases.[6] Imhotep was the first medical doctor known by name. An Egyptian who lived around 2650 B.C., he was an adviser to King Zoser at a time when Egyptians were making progress in medicine. Among his contributions to medicine was a textbook on the treatment of wounds, broken bones, and even tumors.[7]

Stopping the spread of infectious disease was of utmost importance for maintaining a healthy society.[6] The outbreak of disease during the Peloponnesian War was recorded by Thucydides who survived the epidemic. From his account it is shown how factors outside the disease itself can affect society. The Athenians were under siege and concentrated within the city. Major city centers were the hardest hit.[8] This made the outbreak even more deadly and with probable food shortages the fate of Athens was inevitable.[8] Approximately 25% of the population died of the disease.[8] Thucydides stated that the epidemic "carried away all alike". The disease attacked people of different ages, sexes and nationalities.[8]

Physician in Ancient Greece treating a patient 480–470 BC

Ancient medical systems stressed the importance of reducing illness through divination and ritual.[6] Other codes of behavior and dietary protocols were widespread in the ancient world.[6] During the Zhou Dynasty in China, doctors suggested exercise, meditation and temperance to preserve one's health.[6] The Chinese closely link health with spiritual well-being. Health regimes in ancient India focused on oral health as the best method for a healthy life.[6] The Talmudic code created rules for health which stressed ritual cleanliness, connected disease with certain animals and created diets.[6] Other examples include the Mosaic Code and Roman baths and aqueducts.[6]

Those that were most concerned with health, sanitation and illness in the ancient world were those in the elite class.[6] Good health was thought to reduce the risk of spiritual defilement and therefore enhanced the social status of the ruling class who saw themselves as the beacon of civilization.[6] During the late Roman Period, sanitation for the lower classes was a concern for the leisured class.[6] Those that had the means would donate to charities that focused on the health of non-elites.[6] After the decline of the Roman Empire, physicians and concern with public health disappeared except in the largest cities.[6] Health and public doctors remained in the Byzantine Empire.[6] Focusing on preventing the spread of diseases such as small pox lead to a smaller mortality rate in much of the western world.[6] Other factors that allowed the modern rise in population include: better nutrition and environmental reforms (such as getting clean water supplies).[6]

The present day sense of health being a public concern for the state began in the Middle Ages.[9] A few state interventions include maintaining clean towns, enforcing quarantines during epidemics and supervising sewer systems.[9] Private corporations also played a role in public health. The funding for research and the institutions for them to work were funded by governments and private firms.[9] Epidemics were the cause of most government interventions. The early goal of public health was reactionary whereas the modern goal is to prevent disease before it becomes a problem.[9] Despite the overall improvement of world health, there still has not been any decrease in the health gap between the affluent and the impoverished.[10] Today, society is more likely to blame health issues on the individual rather than society as a whole. This was the prevailing view in the late 20th century.[10] In the 1980s the Black Report, published in the United Kingdom, went against this view and argued that the true root of the problem was material deprivation.[10] This report proposed a comprehensive anti-poverty strategy to address these issues.[10] Since this did not parallel the views of the Conservative government, it did not go into action immediately.[10] The Conservative government was criticized by the Labour Party for not implementing the suggestions that the Black Report listed.[10] This criticism gave the Black Report the exposure it needed and its arguments were considered a valid explanation for health inequality.[10] There is also a debate over whether poverty causes ill-health or if ill-health causes poverty.[10] Arguments by the National Health Service gave considerable emphasis to poverty and lack of access to health care. It has also been found that heredity has more of a bearing on health than social environment, but research has also proved that there is indeed a positive correlation between socioeconomic inequalities and illness.[10]

More recently, sociological studies following a life course perspective in health emphasised the limitations of the view linking health outcomes on individual agency only.[11]