Essay on "To What Extent Are Health and Illness Social Rather Than Biological Conditions"

Essay 8 pages (2570 words) Sources: 8

[EXCERPT] . . . .

Sociology

Social Influences on Health and Illness

Socioeconomic inequalities in health have been observed persistently over the course of human history. These differences are manifest across individuals, communities, and societies and recent analyses suggest that for the most part they have increased over the past century, and even in the past few decades. The nature and size of these inequalities make them arguably the major problem of population and public health in America and many other societies. Socioeconomic inequalities in health have increasingly become a focus of health policy. It is still not fully understood why socioeconomic inequalities in health exists and persist, nor what policies are most likely and necessary to reduce these inequalities. In seeking this understanding, research has increasingly focused on socioeconomic differentials in health at the level of communities and societies as well as at the level of the individual (Albrecht, Fitzpatrick and Scrimshaw, 2003).

In contrast to the biomedical model, the biopsychosocial model see health as being determined by biological, psychological, and social factors. Use of the biopsychosocial model does not mean that we completely reject the biomedical model; instead it suggests that we recognize that the biomedical model does not lead to a complete understanding of health and illness. Although it is clear that the role of biology will always be important in explaining illness, the biopsychosocial model demands that we also pay attention to psychological and social influences (Schneider, Gruman and Coutts, 2005).

Over the last several decades, epidemiological studies have been enormously successful in identifying risk factors for major diseases. However, most of the research has focused attention on risk factors that are relatively proximal causes of disease such as diet, cholesterol level, exercise and the like. Social factors, which tend to be more distal causes of disease, have received far less attention. Epidemiology has been greatly successful in heightening public awareness of risk factors for disease (Link and Phelan, 1995).

In a study done by Koopmans and Lamers, (2005), the aim was to compare three indicators of psychological distress (PD) on the strength of their association with subjective or perceived health and to analyze to what extent these associations will change after adjusting for physical illness measures and other possible confounding variables. Data were used from a community-based sample of adults. Psychological distress was measured using three different instruments: the Negative Affect Scale of Bradburn, a nervousness scale, and a self-reported depressive complaint. Physical illness was measured by seven specific chronic conditions, a co-morbidity index of 17 conditions and two disability measures. Subjective health was assessed by a single question. Ordinary least square and logistic regression as well as structural equation modeling was used to analyze the data.

The relation between subjective health and PD is strongest in case nervousness and this, or negative effect, are used as indicators of PD. The measure of depressive complaints is less strongly, but still substantially, related to subjective health. After correction for physical illness variables, the change in strength of the association is slightest for depressive complaints and highest for nervousness. Only small variances between negative affect and nervousness were found. These measures, which were more contaminated by physical ill health than depressive complaints, have the strongest association with subjective health both before as well as after correction for physical illness components (Koopmans and Lamers, 2005).

Negative affect and nervousness are reliable and valid indicators of PD, which can be used to predict subjective health. However, for this purpose, a correction for the confounding effects of physical illness variables will be necessary. The depressive complaints measure is not only less predictive of subjective health but also less contaminated by physical illness variables, making it a better indicator of PD if correction for physical illness variables is not possible (Koopmans and Lamers, 2005).

Differences exist for many health outcomes, including cancer, cardiovascular disease, diabetes, and mortality. Although there was a national decrease in disparities between 1990 and 1998, some regions reported an increase in disparities during the same period. Environmental circumstances are thought to play a very important role in producing and maintaining health differences. Minority neighborhoods tend to have elevated rates of mortality, morbidity, and health risk factors compared with white neighborhoods, even after taking into account for economic and other characteristics (Gee and Payne-Sturges, 2004).

The stress exposure disease framework offers a theoretical framework in which to understand the relationships that exist among race, environmental conditions, and health. This framework shows that ethnicity is highly connected with residential setting, with minorities and whites often living apart from one another. A differential residential setting comes with a different exposure to health dangers. Neighborhood stressors and pollution sources make unfavorable health conditions, which are offset by neighborhood resources. Structural factors help determine the boundaries from which health promotion is possible and partially determine the contemporary state of stressors, resources, and pollution in a community (Gee and Payne-Sturges, 2004).

When community stressors and pollution sources overshadow neighborhood resources, the levels of community stress go up. Community stress is a state of environmental weakness that often explains individual stressors, which in turn lead to individual stress. Individual stress may then make people more open to illness when they are exposed to environmental hazards. Additionally, cooperation in individual and community health may further deteriorate community resources, leading to a vicious cycle. Therefore, it is important to include in the framework a return loop from health back to stress (Gee and Payne-Sturges, 2004).

A questioning of the routine separation of the sexes into distinct realms, culturally, socially and economically, whereby women are time after time less valued than men, brings about the development of feminism. Feminist politics depends on a premise that collective and concerted action can change the under-valuing of women and equality between the sexes is a legitimate social goal. Feminist activism tries to win for women the rights that men take for granted. Feminist theory tries to explain how differences between men and women have been standardized and maintained and why, even once women have been granted formal rights to equal treatment in the workplace, home and courts, gendered discrimination continues. Feminist theory turns on the proposal that the unwarranted mixture of sex with gender justifies sexist assumptions with the inferiority of women, or at least their inappropriateness for particular social roles, justified with reference to embodied sex differences. While biological distinctions between male and female can be seen in morphological, hormonal and functional differences, particularly after puberty, as a mammalian species we are relatively undifferentiated by sex, and characteristics associated with sex such as musculature, facial hair and height, exist on a spectrum. The routine conflation of sex imagined as two opposed categories, with gender, works to keep the polarized, binary gendered division intact as a cultural category (Bradby, 2009).

Interrogating the long standing surveillance that women live longer lives, but are more overwhelmed by symptoms compared with men and evaluating the contribution of employment and domestic responsibilities to rates of mortality and morbidity has been ongoing. In reaction to the feminist challenge, this work has sought to increase theories of gender as well as develop the evidence base on inequality addressing a variety of social characteristics, including gender and class (Bradby, 2009).

The rise in the proportion of women in the workforce to the content and quantity of women's work and stress has tremendous effects on their health. Many experts have argued that of the numerous studies of women's apparent excess morbidity undertaken, all too many have treated women as an undifferentiated category and concentrated on mental illness so as to confirm an association between paid employment and better mental health among women.

Disaggregation of women's work into domestic labor and paid employment confirmed that women with full- and part-time paid work were more likely to experience lower levels of physical and psychological symptoms than those who were housewives. Careful attention to the content and quantity of women's paid and unpaid work meant that statements about the benefits of paid work for women's health could be precisely circumscribed. With such thorough explanations of gender and work variables, it has become possible for similarities and differences within and across gender to emerge from other analysis. Given the severely gendered nature of our culture, it is hard to control for gender. Experts have shown that in the case of paid and unpaid work, even when doing the same occupation, men and women have different work roles and characteristics of that job may take on different significance because of different family tasks. The constant finding that women have a greater risk of depression compared with men has been confirmed to be largely the result of differences in roles and the stresses and expectations that go with them. This contributes to the case that it is the content and context of gendered roles that are important in explaining excess morbidity, rather than some inherent feature of women as a gendered group (Bradby, 2009).

Work on gendered health inequalities can be criticized as having a Western focus. The unfairness… READ MORE

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