Lay understandings of health can provide alternative perspectives to medical understandings of health and illness. Research has found that lay people consider factors like stress, family history, and social class when assessing their own health risks rather than strictly following medical advice. The rise of the expert patient and internet has also challenged medical professional power by promoting lay knowledge and blurring boundaries between conventional and alternative medicine.

1. ‘Lay’ understandings
of health
Week 16
Sociology of Health and Illness

2. 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

3. Outline
• Rational Choice and health education
• Candidacy for Coronary Heart Disease
• Health and lifestyles
• Rise of the expert patient?

4. 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’

5. 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

6. 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

7. Smoking
• The public is repeatedly told that
smoking is bad for them.
• So why do people start or continue
smoking?

8. 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

9. 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?

10. ‘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

11. ‘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

12. 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

13. • Do you recognise these ideas about
candidacy and fate?
• How common are they amongst your
family and friends?

14. 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

15. 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

16. 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

17. 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

18. 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

19. • What do you think of the idea that
stopping unhealthy behaviour may not
have a significant impact?

20. 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

21. 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

22. 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

23. Next week
• Health inequalities in social class
• Look in more detail about the lifestyle and
environmental factors that influence health
• Individualising poverty