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The Social Context of Health, Illness and Recovery

The Social Context of Health, Illness and Recovery. Lyn Gardner Lecturer, Centre for Mental Health Studies NB this lecture is available at http://shswebspace.swan.ac.uk/HNGardnerLD/. What is Sociology?.

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The Social Context of Health, Illness and Recovery

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  1. The Social Context of Health, Illness and Recovery Lyn Gardner Lecturer,Centre for MentalHealth Studies NB this lecture is available at http://shswebspace.swan.ac.uk/HNGardnerLD/

  2. What is Sociology? ‘Sociology offers a distinct and highly illuminating perspective on human behaviour. Learning sociology means taking a step back from our own personal interpretations of the world, to look at the social influences which shape our lives. Sociology does not deny or diminish the reality of individual experience rather, we obtain a richer awareness of our own individual characteristics, and those of others, by developing a sensitivity towards the wider universe of social activity in which we are all involved.’ Giddens, A., 1989

  3. Thinking Sociologically • Published in 1990 by Zygmunt Bauman • ‘sociology is first and foremost a way of thinking about the human world’.

  4. THINKING SOCIOLOGICALLY ‘Those human actions and interactions that sociologists explore have all been given names and theorised about by the actors themselves. Before sociologists started looking at them, they were objects of commonsensical knowledge’. Bauman, Z., 1990

  5. Meddlesome Sociologists…. • The questioning and critical stance taken by sociology can sometimes be perceived as intrusive and unsettling, or even politically motivated (usually the left!) • Bauman recognises this: ‘In an encounter with that familiar world ruled by habits…sociology acts as a meddlesome and often irritating stranger…’ (cited in Kirby et al. 1997:3)

  6. Cont. Yet sociology adheres to ‘the rigorous rules of responsible speech’, argues Bauman. Thinking sociologically’helps us to understand other forms of life, inaccessible to our direct experience’ and accordingly we can ‘understand more fully the people around us’.

  7. Alan Bennett The well know English writer makes a similar point in his book Writing Home (1996) when he comments on the usefulness of sociology in providing insights into social life: ‘I go to sociology not for analysis or explications but for access to experiences I do not have and often do not want (prison, mental illness, birth marks)’.

  8. THE SOCIOLOGICAL IMAGINATION ‘The ability to recognise that personal troubles are in fact public ills – what we perceive as individual problems can be understood and explained only when we examine social, economic and political factors. Sociology, then, is about understanding the relationship between our own experience and the social structures we inhabit.’ C. Wright Mills, 1954

  9. USING A SOCIOLOGICAL IMAGINATION ‘The worker may have exploited a sociological imagination to question commonsense understandings of poverty…leading to a conceptualisation of poor people as victims of a social system predicated on inequality.’ Sullivan, 1987

  10. The Social Model of Health, Illness and Recovery • This model, or approach, suggests that social factors influence health: from mortality rates to recovery • Accordingly, it is important to look at the significant structural factors which may influence health, illness and recovery: social class/socio-economic status, gender and ethnicity, and the impact of poverty and mental illness

  11. HEALTH INEQUALITIES • Social circumstances across the entire life-course – from birth to late adulthood – influence people’s health and well-being. • Different socio-economic indicators – income, wealth, educational attainment and occupational group – are all related to and help explain people’s health status. • Health inequalities are produced by the clustering of disadvantage – in opportunity, material circumstances and behaviours related to health – across people’s lives.

  12. Social determinants of health (Acheson, 1998)Interaction of structural factors and individual behaviour

  13. SOCIAL STRATIFICATION THE RICH MAN IN HIS CASTLE THE POOR MAN AT HIS GATE GOD MADE THEM HIGH AND LOWLY, AND ORDERED THEIR ESTATE. All Things Bright and Beautiful, Mrs. C.F. Alexander, 1848.

  14. STRATIFICATION • DIVISION OF SOCIETY INTO HIERARCHICALLY ORDERED LAYERS • MEMBERS OF EACH LAYER BROADLY EQUAL, BUT INEQUALITY BETWEEN LAYERS

  15. SOCIAL CLASS ‘A large scale grouping of people who share common resources which strongly influence the type of lifestyle they are able to lead.’ (Giddens, 2001, p.282)

  16. LIFE CHANCES • ‘The chances of obtaining those things defined as desirable and avoiding those things defined as undesirable in society.’ (Haralambos, 1995)

  17. ‘Inequality in health is the worst inequality of all. There is no more serious inequality than knowing you’ll die sooner because you’re badly off.’ Frank Dobson, Secretary of State for Health, 1997.

  18. MEASURING SOCIAL CLASS:The Registrar General’s Scale In Britain, government statisticians have measured social class with the Registrar General’s Social Class (RGSC) scale since 1911

  19. R.G. SCALE I Professional e.g. lawyer, doctor. II Intermediate e.g. teacher, nurse. IIIN Skilled non-manual e.g. typist, shop assistant. IIIM Skilled manual e.g. carpenter, miner. IV Partly skilled manual e.g. farm worker. V Unskilled manual e.g. cleaner, labourer.

  20. REGISTRAR GENERAL’S SCALE • MEN ALLOCATED ON BASIS OF OCCUPATION • MARRIED/COHABITING WOMEN ON BASIS OF PARTNER’S OCCUPATION • CHILDREN ON BASIS OF FATHER’S OCCUPATION • SINGLE WOMEN ON BASIS OF OWN OCCUPATION

  21. MEASURING SOCIAL CLASS II The National Statistics Socioeconomic Classification (NS-SEC) In use since 2001 census Reflects: • growth of middle-class occupations • changing mature of kinds of work that people do • levels of social esteem that these jobs attract

  22. NS –SEC social class classification system

  23. Following an extensive review of the evidence, MacIntyre (1986) concluded that “occupational class (whether of self, father or husband) has repeatedly been shown to be associated with a diverse collection of health measurements, including death from all causes or from specific causes, physical or mental illness, height, weight for height, birth weight, blood pressure, dental condition, ability to conceive and self perceived health.” (p.395)

  24. THE BLACK REPORT • Commissioned at end of 1970s by Labour government, chaired by Sir Douglas Black. • To review evidence on inequalities in health & suggest policy recommendations. • Published in 1980 at start of Thatcher's new Conservative administration. • Not widely disseminated – only 260 copies printed.

  25. THE HEALTH DIVIDE • Subsequent edition published by Penguin in dual volume with Whitehead’s The Health Divide (1987) which updated the findings, edited by Peter Townsend and Nick Davidson. • This publication made the findings widely available and made for a shocking indictment on the state of the nation’s poor.

  26. THE ACHESON REPORT (1998) • An independent inquiry into inequalities in health • Commissioned by the Labour Government • Access via internet: www.archive.official-documents.co.uk

  27. EXPLANATIONS FOR INEQUALITIES • ARTEFACT • SOCIAL SELECTION THEORY • CULTURAL/BEHAVIOURAL • MATERIALIST

  28. ARTEFACT • Relationship between social inequality and health chances has been created by researchers - an artefact being something made by people. • Official mortality and morbidity statistics are unreliable and invalid.

  29. SOCIAL SELECTION EXPLANATION • Argues that health status influences social status • i.e. healthy people - upwardly mobile and unhealthy drift into lower social classes.

  30. CULTURAL/BEHAVIOURALEXPLANATIONS • Suggests that different social classes behave in different ways • i.e. the poorer health of lower social classes is caused by behaviour that damages health • the culture of higher social classes leads to better health and longer life expectancy

  31. LIMITATIONS TO CULTURAL/BEHAVIOURAL THEORY • Behaviour is often a result of economic circumstances • Lifestyle/behaviour make a bigger contribution to health for the affluent than for the poor

  32. ALSO • There are significant cultural variations within each social class • There is considerable cultural overlap between different social classes • Impact of other social factors such as ethnicity, gender, location and age

  33. MATERIALIST/STRUCTURAL EXPLANATION • Social class differences in health are caused by the different working and living conditions of the different social classes

  34. WORKING CONDITIONS • Manual occupations associated with higher rates of morbidity and mortality. • Unemployment associated with higher rates of morbidity and mortality.

  35. LIVING CONDITIONS • Blackburn (1991) suggests that low income damages health in 3 ways • 1. Lack of resources (for food and shelter) can make one vulnerable to physical illness.

  36. 2. Lack of control over one’s circumstances can be psychologically damaging • 3. Coping strategies adopted by those on low income may lead to behaviour that damages health

  37. Evidence Most sociologists conclude, as did the authors of the Black Report and Acheson Report, that differences in material circumstances are the main determinants of inequalities in health

  38. POVERTY, HEALTH AND SOCIAL EXCLUSION What contribution can sociology make to an understanding of poverty and its impact on health?

  39. DEFINING POVERTY ‘Poverty means going short materially, socially and emotionally. It means spending less on food, on heating, and on clothing than someone on an average income. Above all, poverty takes away the tools to build the blocks for the future – your life chances. It steals away the opportunity to have a life unmarked by sickness, a decent education, a secure home and a long retirement’. Oppenheim and Harker, 1996:4.

  40. Income inequalities lead to lower levels of social capital, largely through: ‘feelings aroused by social comparisons to do with confidence, insecurity and fears of inadequacy. Social hierarchy induces worries about possible incompetence and inadequacy, feelings of insecurity and feelings of inferiority’ (Wilkinson, 1999, p.262).

  41. SOCIAL CAPITAL, Wilkinson (1996) • A high degree of income inequality in a rich country: • Makes social divisions worse • Reduces levels of trust • Increases social anxiety and stress level

  42. DEFINING POVERTY Absolute Poverty Families are in poverty when their incomes are ‘insufficient to obtain the minimum necessities for the maintenance of physical efficiency’ B.S. Rowntree, 1941.

  43. Relative Poverty ‘Individuals, families and groups in the population can be said to be in poverty when they lack the resources to obtain the types of diet, participate in the activities and have the living conditions and amenities which are customary, or at least widely encouraged or approved, in the societies to which they belong.’ Townsend, 1979.

  44. SOCIAL EXCLUSION Refers to the ‘dynamic process of being shut out, fully or partially, from any of the social, economic, political and cultural systems which determine the social integration of a person in society.’ Walker and Walker, 1997.

  45. MANIFESTATIONS OF EXCLUSION • Social – isolated, weak or limited social network. • Economic – un/employment, insecure, low paid work. • Political – links to above re.work, not registered to vote,no voice/disempowered. • Cultural – little opportunity to engage in varied range of cultural activities.

  46. MEASURING POVERTY • No official poverty line in Britain • Researchers use statistical indicators such as benefit provision required to bring people's income up to subsistence level • Most commonly used threshold of low income is 60% of median (middle) income.

  47. SUBJECTIVE MEASUREMENTS OF POVERTY Opinion polls conducted on what ordinary people considered to be ‘necessities' for an ‘acceptable’ standard of living – producing ‘deprivation indices’.

  48. EXTENT OF POVERTY IN BRITAIN • In 2002/3 12.4 million people on incomes below this income threshold • This represents a drop of 1.5 million since 1996/97 • In 2002/3 3.6 million children were living in households below this income threshold • The Black Report concluded that ‘above all, we consider that the abolition of child poverty should be adopted as a national goal for the 1980s.’Townsend & Davidson, 1988.

  49. WHY ARE POOR PEOPLE POOR? Two main explanations: • Responsibility lies with the individual or group – ‘blame the victim’ • Structural forces in society shape disadvantage – ‘blame society’

  50. BLAME THE VICTIM • Poor people are poor because of the things they do and the choices they make. • Culture of poverty into which poor children are socialised. Transmitted across generations – people resign themselves to their plight. • Cycle of poverty

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