The Western World appears obsessed with "health", yet its definition remains illusive. Discuss

Health has always been a dominant concern of society, Virchow’s famous statement that medicine is nothing but politics on a grander scale has resonances not only for a sociological understanding of health but also for broader societal trends.  In this regards sociological investigations into health have been one of the recurring themes of the discipline . Indeed in many instances sociologists have worked with health professionals in some of the landmark studies associated with health.

The modern western world is dominated by images of health, of healthy bodies and the oppositional fear of illness. Illness and threats of illness are perhaps the most problematic of modern conditions . Health stories dominate our media, for example one need only look at the recent experience with the SARS virus to see not only western concerns over health but how these concerns can migrate and affect the global environment. Even with the sophistication of modern medicine endemic diseases and epidemics threaten society or are perceived to threaten society. HIV, cancer and new resistant and deadly types of viruses are all threats to the social order and threats also to the individual’s sense of order . Even relatively isolated outbreaks such as cases of food poisoning receive large amounts of public attention and serve to highlight the degree of importance which is attributed to health by citizens.

Away from western concerns we can see that a vast gulf exists between western and developing countries and their conceptions of and problems with health. The rise of chronic illnesses in the west as the prime incidence of illness contrasts starkly with the situation in much of the world where the main threats are from diseases long eradicated in the west.  Indeed global patterns of inequality are not the only one with western society replicating traditional patterns of inequality related to income in health status .
 
Thus what is healthy and crucially how a healthy society is to be measured and gauged varies tremendously and is related strongly to where one is in the world. Indeed insomuch as sociology has had an interest in health this is in turn a reflection of the interest which society itself has in health . To western societies health is a critical component of social policy, in many countries it attracts and consumes the largest amounts of public expenditure and in individual’s daily lives notions of health and illness dominate our conceptions of ourselves 

But what is it which we define as health and how do we define being sick. These questions are in turn related to what are the strategies we pursue in attaining our health related goals. The traditional medical model for answering these questions and defining the concepts involved is the bio-medical model and we can see the many sociological theories that have developed as arising out of dissatisfaction at the way in which the bio-medical model operates .

In this essay two of the most diametrically opposed models are examined, namely the bio-medical model above and the social constructivist model which has emerged since the late 1970s. These two theories represent critically different ways of conceiving of and thinking about health and illustrate also a much broader concern about trends in society reflected in and represented by these concerns with health and definitions of health.
Bio-medical Model

This is the model perhaps of most familiarity to people and it is also the model which dominates not surprisingly the medical professions themselves. It is we might say the scientific model of health . In its simplest form we can say that at the root of this model is a reductionist logic common to all of the scientific disciplines. In other words this model proposes that the incidences of disease and hence abnormal conditions of health are located within discrete disease causing factors . It is the biomedical model which has dominated expert thought on health since the Enlightenment and indeed even before this as Greek medicine sought to explain disease and health through reference to the various ‘humours’ which comprised bodily make-up. Its influence can be felt not only within the medical professions but also across a wider spectrum of society. It has coloured our perceptions of health but even more importantly also our perceptions of illness as the biomedical model is most concerned when aberrations to health occur rather than with the ideal health state. Thus biomedical models are about the incidence of disease rather than the absence of health. This is a vital point for consideration as it reflects some of the dominant practices in health care . As such the bio-medical model represents the scientific neutrality perspective of medicine and the story it tells is one of human progress towards the conquering of disease .

These twin precepts, namely reductionism and supposed neutrality and progress have been criticised heavily from sociology . It is fair to state however that despite the criticisms levelled at the bio-medical model, some of which we examine subsequently in our discussion of an oppositional framework to the above that many of the medical advances with which we are familiar may possibly have arisen only out of the application of such a model. Thus while criticisms about the reductionism inherent in the position may be valid it must be allowed that advances based on the bio-medical model have been in instances effective in the diagnosis and treatment of illnesses.

However there are limitations even on a scientific ground. The bio-medical model with its emphasis on prolonging life for as long as possible is now in a paradoxical position due to the fact that by prolonging life and increasing life expectancy more people now survive for a longer period of time thus becoming more at risk from suffering from chronic as opposed to acute illnesses for which techniques developed as a result of the bio medical have had very little efficacy .

The bio-medical model has thus far proved to be at an impasse in relation to chronic illnesses and due to the reason that chronic illnesses are now the major form of illness within western societies it is not surprising then to note a shift away from unqualified support of the bio medical model and its practitioners among the general public towards a support of alternative practices of medicine . Signs of this shift can be seen in the increased support for both alternative practices and also within governmental policy where we can see a detectable shift in strategy away from the bio medical model reliance on curative medicine towards a more public health orientated preventative medicine .

But while the bio-medical model seems to be undergoing revisions its most strident critic can it be argued originate from social constructivist critiques of health, healthcare and medical knowledge generally.


Social Constructivist


In contrast to the bio-medical model and indeed not only in contrast but in criticism also of that model is the theoretical framework offered by social constructivism. Drawing on primarily the work of the French theorist Michel Foucault social constructivism offers a radical conception of both the term health and the very processes of knowledge through which information about health is generated.

What is the core component of the social constructivist viewpoint then? In order to consider what social constructivism has to say about health we must consider what the theory has to say about how knowledge is constructed. Unlike the positivistic biomedical model which assumes that there are priori conditions of both health and disease which are to be uncovered through the application of rigorous scientific methods of discovery social constructivists contend that it is the very scientific methods themselves which generate the conditions to which they ascribe states of both health and illness . Thus for social constructivists rather than a curative holistic manner being at the heart of modern medicine instead their lies a layer and totality of a surveillance regime epitomized by the investigation and social control ascribed to medical practitioners over those who are deemed ill or not healthy .

This has radical implications for an understanding of health and it has been the source of contested debates about the veracity of such claims. The most successful applications of these theories have been in the field of mental health reflecting Foucault’s own concerns but the application of these theories to other aspects has gone hand in hand with a developing and burgeoning sociology of the body. Building on Foucault’s works the sociologist Bryan turner has suggested that the problems of bodies for societies have been of how to regulate and control these bodies within space and time so as to ensure the effective ordering and management of society. In other words how the Hobbesian problem of social order can be solved through bodily regulation .

If we follow this line of thinking health then becomes less what we think it is and more about what constructs are built up around health through the operative processes of various discourses. In this respect so social constructivist in opposition to positivistic disciplines suggest that subject precedes object, or that through the categories which are generated by discourses we then come to define these categories and further integrate them into a disciplinary base

As such then in relation to health, what matters most is not whether we are sick or not but whether we perceive ourselves to be sick, or whether we are perceived to be sick by society and more critically the experts who are custodians over the knowledge of who is sick or not. Thus the reductionism of the bio-medical model is rejected as there are neither simple single explanations for disease nor any simple definitions of health but rather a complex negotiated set of perceptions arising out of discourses.

Therefore these two models offer us diametrically opposed conceptions of health. In relation to the bio-medical model for example we can see the desire and motivation to prolong life through the use of any and all means. From this we can begin to understand the current tensions for example in relation to euthanasia where medical professions are for the most part predominantly aligned with keeping patients alive, even if it is against their express wishes.

Similar problematic aspects of the biomedical model can be detected when we examine the emergent phenomena of the New Genetics which can be seen in its most negative light as taking the reductionist element of the biomedical model to even new extremes .  Indeed the biomedical model may be argued to be taking on even more ascriptions by utilizing genetic knowledge to encompass a much wider spread of ‘disorders’ under the remit of health. Hence we see the rise of media stories related to the discovery of genes for criminality, alcoholism and other genes for conditions which we may have previously perceived as being a function of social problems rather than them being a medical one.

However the social constructivist position is not without its faults either. While a measure of success can be determined through research as to the history of insanity or in sexuality and what constitutes a disorder in terms of a person’s healthy sexuality it is less clear how social constructivism can deal with health issues which have a verifiable physical manifestation . Thus while we can point out that a discourse of knowledge, control and/or surveillance surrounds those who unfortunately suffer from some disease, such as diabetes for example, the incidence of disease also exists in a measurable way.

However we can continue the line of thinking advanced by social constructivist theory to suggest that what is important is the way in which this knowledge of those who suffer from diabetes informs the process by which they are treated yet social constructivism must still deal with the fact that the people involved and who are diagnosed with diabetes do indeed suffer from a disease with fatal consequences if left untreated.

Thus not all medical conditions are socially constructed in terms of their effects but what is socially constructed is the ways in which we perceive the person suffering from an illness and the strategies and techniques which are developed with dealing with the person who suffers from the illness.  It is perhaps in this regard that the most valuable insights of social constructivist viewpoints in relation to health may be gleamed.

Therefore the emergence of major public health movements in the western world must be considered as to whether they represent a layer of surveillance and control or whether they are a response of governments to changing healthcare needs . Whether or not a new paradigm for health will emerge as a result of social constructivist critiques (as well as other critiques of the bio-medical model) remains to be seen but social constructivism in particular offers intriguing insights into how our conceptions of health and illusive definitions of it are constructed.

References

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Annandale, E. (1998); The Sociology of Health and Medicine: A Critical Introduction, Polity Press, Cambridge UK

Baggot, R. (2004); Health and Health Care in Britain, 3rd Ed., Palgrave, Basingstoke UK

Cant, S. and Sharma, U. (2000); ‘Alternative Health Practices and Systems’ in Albrecht G. L., Fitzpatrick, R. and Scrimshaw, S. C.; Handbook of Social Studies in Health and Medicine, Sage, London UK

Clarke, A. (2001); The Sociology of Health Care, Pearson, Harlow UK

Foucault, M. (1976); The Birth of the Clinic, Tavistock, London UK

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Lippman, A. (1991); ‘Prenatal Genetic Testing and Screening’; American Journal of Law and Medicine, Vol XVII Nos. 1 and 2

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Rubinstein, R.A., Scrimshaw S.C. and Morrisey, S.E. (2000) Albrecht G. L., Fitzpatrick, R. and Scrimshaw, S. C.; Handbook of Social Studies in Health and Medicine, Sage, London UK

Stam, H.J. (2002); ‘Theorising health and illness: Functionalism, subjectivity and reflexivity’ in Marks, D.F. [ed], The Health Psychology Reader, Sage, London UK

Turner, B. (1996); The Body and Society, Sage, London UK

Turner, B. (2000); ‘The History of the Changing Concepts of Health and Illness: Outline of a General Model of Illness Categories’ in Albrecht G. L., Fitzpatrick, R. and Scrimshaw, S. C.; Handbook of Social Studies in Health and Medicine, Sage, London UK

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