The student need to be able to give a historical overview of illness and review the theoretical approaches to health and disease 2. The student should be able to relate the concepts health, disease and illness in understanding how people experience and react to disease and illness patterns and demonstrate an understanding of the therapeutic relationship

1. Applied Sociology
Experiencing Health and Disease
By C. Settley

2. Learning Outcomes
• 1. The student need to be able to give a historical
overview of illness and review the theoretical
approaches to health and disease
• 2. The student should be able to relate the concepts
health, disease and illness in understanding how
people experience and react to disease and illness
patterns and demonstrate an understanding of the
therapeutic relationship

3. The pre- agricultural period
• Up to 8000-10 000 years ago
• Hunters (males) & gatherers (females)
• Made a living from hunting and fishing and collecting plants
• They moved to new locations when food ran out
• No formal institutions, no formal education.
• Functions fulfilled by institutions in modern society as we
know it were performed by the nuclear family units.
• Goods and services were exchanged as people had no money.
• Food was shared among all.
• No political leaders- ranks were determined by age and sex

4. The pre- agricultural period
• Individual freedom- no one worked for someone
else.
• No one had the right to issue commands.
• Today, only a handful of hunter-gatherer societies
survive in the Amazon Basin and in Africa.
• San people in Kalahari desert in Botswana.

5. Disease patters during the pre- agricultural
period
• Hunter-gatherers were healthy as a result of their
diet (raw fruits, leaves, lean meat, and fish).
• Diseases were mostly mild and were passed by
intimate contact like TB and Herpes.
• Infectious diseases only later became major causes
of disease and death as these people were on the
move and did not live in large groups.
• Low life expectancy – not because of disease but due
to environmental and safety hazards.

8. Agrarian Societies
• Appeared worldwide between 3000BC and 300 AD
• Small gardens were established and people then
became food producers
• Due to stable food supply, people then became
settled down in permanent or semi-permanent
villages…..cities then developed.
• The family- still the major social institution
• Kinship- more clearly defined as people did not wish
to see their land being inherited by one other than
family

9. Agrarian Societies
• Villages were headed by chiefs
• Legal codes were developed
• Inequalities in terms of wealth and power
Examples are traditional Zulu societies

10. Disease patterns during the agricultural period
• Different from hunter-gatherers
• Less variety of foods
• Diets were lower in fibre and higher in fat and salt
• Resulted in diseases such as HPT, heart disease and
cancers
• Grinding grain to make flour caused excessive wear
on people’s joints, causing arthritis
• It became customary to cook food thus vitamins
were destroyed and toxins introduced.

11. Disease patterns during the agricultural period
• The result was that people now were of smaller
stature and had weaker bones which lead to
conditions such as anaemia
• Unsanitary conditions due to growth in population
• Increasing infectious diseases

12. Classification of infectious diseases:
GROUP EXAMPLE ENHANCING RATIONAL
Water-borne diseases Cholera More people=more waste.
Caused the water to
become contaminated
Food- borne diseases Dysentery People lived in close
proximity. Disease were
spread from animal to
human
Vector- borne diseases Plague Due to population density
and unsanitary conditions.
Air- borne diseases Tuberculosis

13. Industrialised societies
• Developed about 200 years ago due to
industrialisation
• Characterised by the use of machines rather than
animals or human power
• More people in Urban than in rural areas.
• Industrialisation- it reduced inequalities. Widened
the gap between rich and poor.
• Urban areas- life became more impersonal, more
jobs
• Changes in the structure of society

14. Industrialised societies
• The family’s functions have been reduced.
• Other institutions like education now has an
increased importance (compulsory).
• Politics and economics have been influenced
• Capitalism
• Industrialisation has reduced inequalities in
developed nations but not in developing societies
• The gap between rich and poor is wider

15. DEFINITIONS
• 'Industrialization' The process in which a society or country (or world) transforms
itself from a primarily agricultural society into one based on the manufacturing of
goods and services
• ‘capitalism’ An economic and political system in which a country's trade and
industry are controlled by private owners for profit, rather than by the state

16. Industrialised societies
• Societies are now characterised by distinctive
cultures
• Transportation and communication systems have
brought groups and societies into contact with other
societies and ways of life

17. Industrial era of disease
• Changes brought about also affected the incidence
and prevalence of disease
• Industrialisation was responsible for further
increases in population size and density
• Meaning more people were exposed to old virulent
infections and old urban sanitary diseases such as
cholera and typhoid fever
• Influenza became a pandemic due to people
becoming more mobile

18. Industrial era of disease
• Disease problems were acute because of sever exposure to
poor nutrition, environmental pollutants
• The most dramatic improvement in health occurred in the
19th and 20th centuries
• Mortality as a result of TB declined in the west
• This was due to sociocultural factors
• Economic development caused improvements in people’s
diets as agricultural techniques developed and transportation
became faster and more efficient

19. Industrial era of disease
• These factors had positive and negative consequences
• Social changes like the decline in birth rate reduced the
demand for food and housing resources
• Hygiene developments led to a decline in mortality
• Water contamination was controlled and prevented
• Infant mortality reduced
• Milk sterilisation

20. Industrial era of disease
• Scientific medical technology responsible for the
decline in infectious disease
• Vaccines
• Chemotherapy
• Measles
• TB

21. THEORETICAL APPROAC TO HEALTH AND
DISEASE
• THE BIOMEDICAL MODEL OF HEALTH AND DISEASE
• The Cartesian revolution: mind/body dualism -Descartes
• The church's main message was to simply believe in God without question
but he could not do this without doubt. After questioning what was left
once he doubted everything, Descartes found the existence of himself the
only thing that survived. He reasoned that if he could question his own
existence, he had to exist because there had to be someone doing the
doubting.
• This led to the dualism theory, also known as the mind-body problem.
Descartes theorized that if he existed, it was in two different ways: as a
mind, or a non-physical entity, and as a body, a physical entity. For him,
the problem lay in bridging the gap between the two. There was obviously
a relationship between the mind and the body's interactions, but it was
unclear to him exactly what it was other than the two were separate and
distinct.
“I Think, Therefore I Am”

22. THEORETICAL APPROAC TO HEALTH AND
DISEASE
• THE BIOMEDICAL MODEL OF HEALTH AND DISEASE
• The Clinical method
• The trend of combining theory and method.
• Institutionalisation of health care
• Development of hospitals

23. THEORETICAL APPROAC TO HEALTH AND
DISEASE
• THE BIOMEDICAL MODEL OF HEALTH AND DISEASE
• The doctrine of specific aetiology
• The germ theory of disease states that some diseases
are caused by microorganisms. These small
organisms, too small to see without magnification,
invade humans, animals, and other living hosts. Their
growth and reproduction within their hosts can
cause a disease.

24. THEORETICAL APPROACHED TO HEALTH AND
DISEASE
• CHARACTERISTICS OF THE BIOMEDICAL MODEL OF
HEALTH AND DISEASE
• Assumptions:
• The mind and body can be treated separately
• The body can be repaired like a machine in that it is
passive during treatment

25. THEORETICAL APPROACHED TO HEALTH AND
DISEASE
• CHARACTERISTICS OF THE BIOMEDICAL MODEL OF
HEALTH AND DISEASE
• Biomedicine adopts a technological imperative. The
latest technological care.
• Biomedicine is reductionist. It reduces disease to
chemistry and physics.
• Biomedicine is an objective science. Based on
observation.

26. These assumptions and characteristics translate
into medical practice that has the following
features:
• The nature and causes of health and disease: Health
is regarded as the absence of biological abnormality.
All diseases have specific causes or origins.
• The patient: because of the body/mind, the focus is
on the patient’s body.
• The nature of intervention: the focus is on cure, the
aim being to manipulate the physical symptoms as to
make them disappear.

27. Evaluation of biomedicine
• 1. Criticism of biomedicine
• Criticism from academic sources.
• 2. Successes of biomedicine.
• Not without merit.
• Pharmacological breakthroughs.

28. Evaluation of biomedicine
• 3. Efficacy is exaggerated
• Decline of mortality rate in Western societies.
• 4. Disregard for the social context of health and
disease
• Refers to the indifference regarding the social and
material causes of disease.
• Germ theory.
• Health status is not merely the consequence of
biological factors but related to social structures.

29. Evaluation of biomedicine
• 5. Patient’s body is isolated from the person
• Disregarding the link between physical health and
mental health.
• 6. Medical control of women’s health
• Significance thereof. Millennium goals.
• Scientific method only way to obtain truth about
disease
• Professional medical dominance

30. Evaluation of biomedicine
• 7. Scientific method only way to obtain truth about
disease
• Identifies the truth about diseases.
• 8. Professional medical dominance
• Exceptional progress.

31. THEORETICAL APPROACH TO HEALTH AND DISEASE
THE SOCIAL MODEL OF HEALTH AND DISEASE:
Social factors that affect health:
Behavioural factors
• Individual social behaviour
• Direct control
• E.g. smoking habits, alcohol
consumption, eating habits,
exercise routines
Cultural factors
• Influences groups who
share common background
• As a result of norms and
values within a
neighbourhood or
community or age group

32. THEORETICAL APPROACHED TO HEALTH AND DISEASE
1. THE SOCIAL MODEL OF HEALTH AND DISEASE:
Social factors that affect health:
Environmental factors
• Beyond the control of individuals
• At home, such factors as overcrowding and lack of privacy
• At work, factors such as extreme temperatures, poor
lighting, duct, noise
• More generally, environmental pollution such as wastes,
nuclear radiation and industrial by-products can have
serious consequences on health

33. The image below shows the variety of
the factors which can affect our health

34. Health, disease and illness (behaviour)
• Health (negative definitions)
• - absence of disease
• - absence of illness

35. Health, disease and illness (behaviour)
• Health (positive definitions)
• - health as an ideal state (opposite of negative
definitions, view health holistically)
• - health as the ability for effective role performance
(important for proper functioning in society,
optimum capacity)
• - health as a commodity (can be bought, sold, given)

36. Health, disease and illness (behaviour)
• Health (positive definitions)
• - health as a personal strength or ability (physical or
mental ability)
• - health as the basis for personal potential
(foundations for achievement, necessities of life)
• - health as a human right (See figure to follow. Also
refer to figure 3.3 in textbook)

38. Activity, PAGE 109
• Make a list of the qualities you would expect
someone to display if he/she were:
• PHYSICALLY HEALTHY
• SOCIALLY HEALTHY
• MENTALLY HEALTHY

39. Beliefs about health
• Perceptions. Eg “if you don’t belong to a medical aid, having
to wait in casualty to be seen by a doctor might take a few
hours”.
• Superstitions. Eg “A black cat crossing your path means bad
luck”.
• According to status and social background of the individual.
• ACTIVITY Page 113. Refer to Social, mental and physical health

40. Health, disease and illness (behaviour)
• Disease
• A biomedical term.
• Pathological changes of the biological organism
diagnosed by signs and symptoms.
• Can be defined by a licensed person, by means of
instruments and be monitored.
• Activity page 113!

41. Health, disease and illness (behaviour)
• Illness
• Refers to how people experience their symptoms.
• What meanings they ascribe to them.
• How they act upon them.
• Communicated by complaint.

42. 10 factors that determine how individuals
respond to symptoms of illness.
• 1) The visibility, recognisability or the perceived
importance of symptoms.
• 2) The extent to which a person’s symptoms are
perceived as serious.
• 3) The extent to which the deviant signs and
symptoms disrupt family life, work and other social
activities.

43. 10 factors that determine how individuals
respond to symptoms of illness.
• 4) The frequency of the appearance of the deviant
signs and symptoms, their persistence or the
frequency of their recurrence.
• 5) The tolerance threshold of those who are exposed
to and who evaluate the deviant signs and
symptoms.
• 6) The available information, knowledge and cultural
assumptions and understandings of the person
experiencing the deviant signs and symptoms and
who has to evaluate them.

44. 10 factors that determine how individuals
respond to symptoms of illness.
• 7) Psychological factors that lead to the denial of
symptoms.
• 8) Needs competing with illness responses.
• 9) Competing possible interpretations that can be
assigned to the symptoms once they are recognised.
• 10) The availability of treatment resources, physical
proximity and the psychological and monetary costs
of taking action.

45. Stages of the illness experience (Suchman,
1979). See table 3.1, page 119
• Stage 1: Symptom experiences – Cognitive aspect
(believe something is wrong) – Physical experience of
symptoms – Emotional response (may consult others
and try home remedies
• Stage 2: Assumption of the sick role – Accepts the
sick role and seeks confirmation from family and
friends – Continue with treatment – Excused from
normal duties and expectations – Emotional
responses common – Seek professional health
advice

46. Stages of the illness experience (Suchman, 1979)
• Stage 3: Medical care contact – Seeks advice of a
health professional to: • Validate real illness • Explain
illness in understandable terms • Get reassurance
(may accept or deny diagnosis)
• Stage 4: Dependent client role – Becomes dependent
on the professional for help
• Stage 5: Recovery or rehabilitation – Relinquish the
dependent role – Resume former roles and
responsibilities – long term responsibilities and
permanent disability necessitate adjustment

48. Therapeutic Relationships
• The role of values in therapeutic relationships
• Individual values originate from the core of our
culture.
• It reflects a culture’s orientation to five recurring
human problems: human nature, the environment,
time, activity and relationships.

49. Therapeutic Relationships
• Models of therapeutic relationships
• The joint participation between two social entities
and also some degree of interaction over an
extended period of time.
• Behaviours are taken into account.

50. Therapeutic Relationships: 1. The paternalistic
model
TABLE 4.1 Parsons’ analysis of the roles of patients and doctors
Patient: sick role Doctor: professional role
Obligations and privileges: Expected to:
1.
Must want to get well as quickly as
possible
1
. Apply a high degree of skill and
knowledge to the problems of illness
2. Should seek professional medical advice
2
. Act for welfare of patient and community
and co-operate with the doctor rather than for own self-interest, desire for
money, advancement, etc
3. Allowed (and may be expected) to shed 3. Be objective and emotionally detached
some normal activities and
responsibilities (i.e. should not judge patients’ behaviour
(e.g. employment and household tasks) in terms of personal value system or
become emotionally involved with them)
4. Regarded as being in need of care and 4. Be guided by rules of professional 51
unable to get better by his or her own practice
decisions and will
Rights:
1 Granted right to examine patients
physically and to enquire into intimate
areas of physical and personal life
2. Granted considerable autonomy in
professional practice
3. Occupies position of authority in relation
to the patient
Reprinted with permission from The Free Press from Parsons (1951).

51. Therapeutic Relationships: 2. The consumerism
model
• A consumerist relationship describes a situation in
which power relationships are reversed; with the
patient taking the active role and the doctor
adopting a fairly passive role, acceding to the
patient’s requests for a second opinion, referral to
hospital, a sick note, and so on.

52. Therapeutic Relationships: The paternalistic and
consumerism model. A comparison.
• See table 3.5 on page 134 in textbook.
• END

53. Social Groups
Social interaction
• The ways in which people
respond to each other.
• The actions and reactions of
people.
Social group
• Consists of two or more
persons between whom,
contextually, a norm
regulated, discernable
pattern of interaction has
developed.
• These persons form a unit in
which the reaching of
certain common goals is
related to individual
motivations and needs.

54. Characteristics of a social group
• Group structure and group members
• A small group: between 2-20 members
• A group has structure
• Forms an orderly composition and create a
meaningful whole
• Define themselves as belonging to a group with
boundaries based on certain roles, responsibilities
and group norms

55. Characteristics of a social group
• There is a feeling of unity which is determined by
conformation and adherence to a common, agreed
upon goal
• Some groups limit their membership while others are
more open and admit outsiders more easily

56. Primary groups
• Primary groups
• Examples: a married couple, the family, the peer
group, & the friendship group
• In primary groups, people come into contact with
norms, values and positive and negative sanctioning
for the first time.
• Plays a role in the shaping of personality and
socialisation of the child.

57. Primary groups
• This is where the child becomes familiar with
different forms of interaction.
• Eg when to take, when to give etc.
• The primary group is an expressive group.
• Expression of emotions (love, anger etc).
• Most important group for the individual.

58. Characteristics of the Primary group
• It generally has few members.
• There are face- to-face relationships. Involves
closeness, spontaneous and emotional involvement
and fairly intense relationships between the group
members. The bonds between these members are
warm and personal.
• The group gives its members emotional security.

59. Characteristics of the Primary group
• Membership of the group is a goal in its own right.
Belonging to the group is the most important goal for
the individual. The members of primary groups
cooperatively share their collective needs.
• There is constant contact between the members.
• The members interact in an informal manner. This
satisfy their need for intimacy.
• Each member is involved in such a relationship as a
unique and complete person.

60. Secondary groups
• Individuals who do not know each other well.
• Less face-to-face interaction.
• Interaction is formal.
• Group members do not support each other formally.
• Characterised by secondary relationships.
• Examples: work groups, church groups, the attorney
and his clients, etc.

61. Secondary groups
• Also referred to as formal organisations like
hospitals, Sasol.
• Important function in society.
• They are instrumental groups.
• Functions of maintaining order in a society.

62. Group dynamics defined
• The socio scientific study and knowledge of the way
in which people behave towards each other in the
context of small groups.

63. The importance of the small group are:
- Groups are inevitable.
- Occurs everywhere, at all levels of the population,
among rich and poor. It occurs in poorly developed
or highly developed societies. Most human activities
take place within the context of groups.

64. The importance of the small group are:
- Groups are powerful
- Their activities have an important influence on the
individual.
- A persons identity is formed by the groups he/she
belongs to.
- The position filled within the groups can influence
behaviour towards them.
- Influences self image and ideals.
- Membership to a group can be an advantage or
disadvantage.

65. The importance of the small group are:
- Groups have positive/negative results
- Groups have been responsible for achievements and
catastrophes.
- Group performance can be improved
- Research on productivity and performance quality.

66. Group Norms
- Rules of behavior created by the members in order
to maintain and ensure consistent behavior
- To prevent chaos
- Serves as basis for anticipating and predicting the
behavior of other members
- Norms are ideas on what the members should do;
- What they ought to do;
- What they are expected to do under any given
circumstance

67. Group Norms
- Norms are formed during interaction with group
members and come into operation once the majority
of group members accepts them.
- Related to two aspects of the group process
- Determined by the group goal. Regulates members’
behaviour.
- If a group strives to survive and to be effective, the
interaction must be co ordinated. Guarantees survival and
success of the group.

68. Group Norms
- Formal Norms: Nursing Act
- Informal Norms: Additionally created by the
individual groups

69. Group Size
• The number of members in a group plays an
important role in the way the group functions.
• - The smaller group would seem to be more accurate
and quicker at solving lesser problems, whereas
abstract problems and complex tasks are better dealt
with by larger groups.
• - It is clear that a larger group will function more
efficiently than a smaller group when the aim is to
solve a wide range of complex tasks.

70. Group Size
• Research shows that as a group grows in size :
• - There is less talking time per individual in the group.
• - Members have less time available to develop and
maintain relationships with each other.
• - Those who talk more than others become more visible
and influential………..a leader emerges.
• - Differences in the frequency of participation are
intensified.
• - Leaders gain more control over the group and the
direction in which the group in moving

71. Group Size
• Sub-groups begin to emerge.
• - The knowledge and potential abilities available to the
group increases.
• - There is a greater opportunity to meet people.
• - Members can retain a degree of anonymity.
• - Though there is a rise in productivity, job satisfaction is
diminished, members of the group are absent more often
and more work-related disputes arise.
• - More communication problems arise among the
members of the group.

72. Group Size
Groups with even & odd
numbers of members
- Even numbers of members
may divide into 2 cliques of
equal size- differences and
conflicts are not easily solved.
• - Uneven numbers where
majority or minority opinion
or decision is possible-groups
is more inclined to reach
consensus and to have open
discussion on relevant issues.
Dyads(2 person groups)
&Triads(3-person groups)
• Dyads are less inclined to
disagree or convey messages.
• - No majority decision can be
enforced.
• - More information is
exchanged
•- Members make more effort to
convince each other.
•- Triad has advantage-in event of
a disagreement, the 3rd member
may sway the balance and force
majority decision.

73. Group Cohesion
- Cohesion stresses the strength and pattern of
interpersonal attraction in the context of the group.
- Sociologists agree that cohesion refers to the degree
to which members are motivated to remain in the
group

74. Four factors to determine Cohesion
in a group
• 1) The personalities of the group members.
• 2) The psychological or material factors that act as
incentive to continue group membership.
• 3) The expectation that certain positive ( or even
negative) consequences will result from
membership.
• 4) The cost of membership as opposed to the
rewards obtained, compared with other activities
which might involve a higher cost and a lesser
reward.

75. Factors promoting Group Cohesion
• -Clarity of group aim.
• - Status in the group.
• - Group atmosphere.
• - Group size.
• - Group norms.
• - Co-operation and competition.
• - Similarities among members

76. The influence of cohesion on the group
Research findings show that groups with strong
cohesion spend less time and energy on maintaining
the group and consequently have more success in
achieving their group objectives.
• Satisfaction of members.
• Participation and loyalty.
• Influence over members.
• Group norms.
• Effective support

77. Group Leadership
• Leadership is the most important role in the group
structure.
• - Effective functioning depends on coordinated group
activities and achievement of group objectives.
• - Shaw (1981:319)defines the leader as “the group
member role) who exerts more positive influence
(leadership) over other group members, or as the
member who exerts more positive influence over
others than they exert over him/her”

78. Group Leadership
• - The nursing professional as a leader must exhibit a
strong influence over the members of her nursing
team.
• - This influence must be exercised in a positive
manner so as not to alienate or intimidate her team
members into a state of “subservient” behavior

79. The Emergence of Leaders
• Situational View
- Situational leadership theory proposes that effective leadership requires a
rational understanding of the situation and an appropriate response,
rather than a charismatic leader with a large group of dedicated followers
(Graeff, 1997; Grint, 2011).
- Situational leadership in general and Situational Leadership Theory (SLT) in
particular evolved from a task-oriented versus people-oriented leadership
continuum (Bass, 2008; Conger, 2010; Graeff, 1997; Lorsch, 2010).
- The leader focuses on the required tasks or focuses on their relations with
their followers.
- Originally developed by Hershey and Blanchard (1969; 1979; 1996), SLT
described leadership style, and stressed the need to relate the leader’s
style to the maturity level of the followers.
- Task-oriented leaders define the roles for followers, give definite
instructions, create organizational patterns, and establish formal
communication channels (Bass, 2008; Hersey & Blanchard, 1969; 1979;
1996; 1980; 1981).

80. The Emergence of Leaders
• Transactional View
• Transactional leadership focuses on the exchanges that occur
between leaders and followers (Bass 1985; 1990; 2000; 2008;
Burns, 1978).
- These exchanges allow leaders to accomplish their performance
objectives, complete required tasks, maintain the current
organizational situation, motivate followers through contractual
agreement, direct behavior of followers toward achievement of
established goals, emphasize extrinsic rewards, avoid unnecessary
risks, and focus on improve organizational efficiency.
- In turn, transactional leadership allows followers to fulfill their own
self-interest, minimize workplace anxiety, and concentrate on clear
organizational objectives such as increased quality, customer
service, reduced costs, and increased production (Sadeghi & Pihie,
2012). Burns (1978) operationalized

81. References
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Van Schaik.
• Pretorius, E., Matabesi, Z. & Ackermann, L. (2013). Juta’s Sociology
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