The social construction of health and illness
The biomedical model says illness is a fault in the body. Doctors use science to find and fix it. Health means having no disease.
Sociologists add a social model. They say ideas of health and illness are socially constructed: society shapes them.
- Across cultures: some groups see hearing voices as a spiritual gift; others as illness.
- Over time: conditions have been added to or removed from official lists of illnesses as attitudes changed.
- Between groups: older people may accept aches as "normal"; younger people may see a doctor.
Disease, illness and sickness
- Disease: what a doctor diagnoses.
- Illness: how the person feels.
- Sickness: the social role others give them.
The sick role
Talcott Parsons (functionalist) said being sick is a social role. The sick person is excused from work or school and not blamed, but must want to get well and seek medical help. Doctors act as gatekeepers to this role (for example, signing a sick note).
Medicalisation
Medicalisation means turning normal life events (sadness, childbirth, ageing, shyness) into medical problems to be treated.
Unequal health chances
Health is not shared equally. Patterns found in many countries:
- Social class / income: poorer groups die younger and spend more years in poor health. Each step up the ladder brings better health, a social gradient.
- Gender: women usually live longer but report more ill health; men take more risks and visit doctors less.
- Ethnicity: some minority groups have higher rates of certain illnesses, linked to poverty, discrimination and access.
- Region: rural areas and poorer neighbourhoods often have worse outcomes.
Four explanations
- Artefact: the gap is partly created by how class and health are measured. Critics: it remains whatever measure is used.
- Social selection: poor health pushes people down the class ladder (they lose work), so illness causes low class.
- Cultural / behavioural: lifestyle choices (smoking, diet, exercise, use of check-ups) differ between groups. Critics: this blames the victim.
- Material / structural: low income brings damp housing, risky jobs, pollution, poor food and stress. Marxists say capitalism puts profit before health.
Most sociologists think material factors explain the largest part, with culture and selection adding smaller parts.
Access to health care
The inverse care law (Julian Tudor Hart, 1971) says: the availability of good medical care tends to vary inversely with the need for it. Those who need it most get least.
Barriers to access
- Cost: fees, medicines, travel, lost wages.
- Distance and supply: fewer doctors and hospitals in poor or rural areas.
- Time: workers in insecure jobs cannot take time off.
- Cultural capital: middle-class patients often speak confidently and ask more questions, so they may get longer consultations.
- Language, gender norms and stigma.
Countries organise care differently: free public systems paid from taxes, insurance-based systems, and private fee-paying care. India has public hospitals and health insurance schemes alongside a large private sector; many families still pay out of pocket.
Mental illness
Interactionist (social constructionist) view
- Mental illness is partly a label given to behaviour that breaks social rules.
- Once labelled, people face stigma: they may be avoided, lose jobs or be treated as dangerous.
- The label can become a master status and a self-fulfilling prophecy.
- Erving Goffman studied "total institutions" (old mental hospitals) and found patients lost their identity there.
- Labels can be shaped by class, gender and ethnicity of patients and doctors.
Structuralist (realist) view
- Mental illness is real and causes real suffering.
- It has social causes: poverty, unemployment, discrimination, isolation, family breakdown.
- That is why rates differ between groups.
Critics of labelling say it ignores real suffering; critics of the structural view say diagnosis itself can be biased.
Medicine and the health industry
- Functionalists: medicine keeps society healthy and working. Doctors are trusted experts who put patients first, and the profession is rewarded for its skill.
- Marxists: health care is an industry that makes profit (drug companies, private hospitals, insurers). Medicine treats individuals and hides the social causes of illness, such as poverty and bad working conditions.
- Feminists: medicine was long male-controlled; it has medicalised women's bodies (childbirth, menopause) and sidelined traditional female healers such as midwives.
- Ivan Illich: too much medicine causes harm, called iatrogenesis: clinical (side-effects, infections), social (people depend on doctors for everything) and cultural (we lose the ability to cope with pain and death).
- Postmodernists: people now choose from many sources, including the internet and alternative medicine, so doctors' authority is weaker.
Try it at home
Ask two older relatives what they did when they had a fever as children. Compare with what your family does today. What changed: the illness, or how society deals with it?
Key formulas and definitions
- Biomedical model: illness = body fault; cure = doctor + science.
- Social model: health and illness are socially constructed.
- Disease (diagnosed) ยท Illness (felt) ยท Sickness (social role).
- Sick role (Parsons): excused from duties, not blamed; must want to recover and seek help.
- Health inequality explanations: Artefact, Social selection, Cultural/behavioural, Material/structural.
- Inverse care law: care is least available where need is greatest.
- Labelling โ stigma โ master status โ self-fulfilling prophecy.
- Iatrogenesis (Illich) = harm caused by medicine.
Worked examples
1. Two workers catch the same chest infection. One is a bank manager, the other a daily-wage construction worker. Use sociology to explain why their health outcomes might differ.
1) Material: the manager has paid sick leave, money for medicine and a dry home; the labourer loses a day's wage if he rests and may live in damp, crowded housing. 2) Access: the manager can book a private appointment quickly; the labourer may face long queues (inverse care law). 3) Sick role: the labourer may not be able to 'take' the sick role because he cannot afford to stop working. So the same disease can lead to very different outcomes.
2. A government says health gaps exist because poorer people smoke more and eat badly. Which explanation is this, and give one criticism.
This is the cultural/behavioural explanation. Criticism (material view): people's choices are limited by money, stress and where they live. Cheap, filling food is often less healthy, and smoking can be a way to cope with stress. Blaming individuals ignores these structural causes.
3. Explain how a diagnosis of mental illness could become a self-fulfilling prophecy.
1) A person is labelled 'mentally ill'. 2) Others start to treat them differently, for example avoiding them or not trusting them at work. 3) The label becomes their master status, more important than their other roles. 4) They begin to see themselves through the label and may act in line with it. 5) Their behaviour then seems to 'prove' the label was right.
Common mistakes
- Saying sociologists think illness is 'not real'. They argue the meaning and response to illness are social, not that bodies never get sick.
- Mixing up social selection (illness causes low class) with material explanations (low class causes illness).
- Thinking the inverse care law means poor people never get care. It means care is less available relative to need.
- Saying the sick role means anyone can stop work freely. The sick person must try to get well and seek medical help.