‘Lay’ understandingsof 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 newchallenge 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