‘Lay’ understandings of 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 new challenge 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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