Chapter "i A SOCIOLOGICAL PERSPECTIVE ON HEALTH, ILLNESS, AND THE BODY aE PPSETESE EEE SETAE TEESE ERTS individuals who enoy good beh shy think of themscves a foreanate: Butlck as ie todo with the roa! patterns of sae and moray that Preval in each society, The sng variations in health condons amon ‘mes and cut groue fet ierences in socal and pyle ‘nents And increasingly che forces ta shape ea atoms ar sen motion ty naman acvies a decison Indo, oi 9 ach soi = (say of eth lemphass ace Shara ik in, The ire of Ha srt Sr of Di ‘Newer WW Noro 1p. 8-0. «The Social Construction of the Body «The Social Construction of Ideas about the Body Health Beliefs and Practices “The Medical Model «The Centrality of Power in the Sociology of Health and Iliness +The Perspective of This Text2 ASOCOLOGICAL PERSPECTIVE ON HEAL, LINES, AND THE BODY Wren ink oft and ines we usually tink of eng propery and other healthy habits, of institutions such as hospitals, and of health profes sionals such as doctors and nurses. Although we may be dimly aware that health has its socal dimensions, we may not think of health as a topie for social scientists, Sociological analysis emphasizes that the occurrence of illness is not ran. dom. Different kinds of societies produce different patterns of illness and death. As Eckholm's statement on the preceding page shows, our material social and cul: ‘ural way of life is linked with our way of death. The sociology of health and il. ness studies such issues as how social and cultural factors influence health and ppeople’s perceptions of health and healing, and how healing is done in different Societies. Social structures and culturcl practices have concrete consequences for people's lives. ‘We like to think that a newborn infantis as yet untouched by these abstract forces and has possibilities for health imited only by the child's genetic makeup. [Even at birth, however, these abstract forces have begun to inscribe themselves on. the baby’s body. ‘The very life chances of this infant, inchuding the probabilities that she will ve, be well, aequire the skills for success in her culture, and achieve and maintain that success, are powerflly influenced by all of the social circum- stances and forces she will encounter throughout her life. In short, the baby's life chances, including possibilities for health and long life or sickness and death, are shaped or constructed by society itself ‘The baby's birth weight, for example, is influenced by her mother's dict, which in turn is partly a product of her society, her culture, and her socal class Other features of the mother’s social context have dizect consequences for the newborn's health, including the mother’s smoking or drug habits, the housing and sanitary conditions in which the infart is born, and the like. Later, whether the baby isa victim of cholera, bubonic phgue, schistosomiasis, or lead poisoning de- pends on public health measures taken in her environment. What other factors in the baby’s home life and environment will shape her sense of self and selfesteem, and her ability to cope with stress and manage her environment? As she matures, how will her gender, race, ethnicity, and social class influence her life chances? ‘Later in life, her experiences as a worker will place her in various physical environments and social relationships that will affect her health, Her culeure wil shape what she likes to eat, how she experiences stress, whether she drinks alcohol, and how she feels about her body. How she experiences the process of giving birth willbe shaped by her culture's meanings of childbirth as well as by the social con- text of birth, such as whether ic takes place in a hospital under the supervision of an obstetrician trained in Western notions of pregnancy as a medical problem, ‘The infant is born into a social structure and culture that also powerfully influence what will be considered illoess and how that illness will be treated. ‘When this person gets sick, socal forces play an important role in determining her chances of becoming well. How does she decide when she is sick and needs help? If she is sick, for example with a bad cold, how will others respond? If she develops multiple sclerosis, how will the atsudes and responses of others, and the [ASOCIOLOGICAL PERFECIVE ON HEALTH, LLNESS,ANDTHEECOY 3 ality other social and physical eaviconent affect her very life chances? What Ail appen she develops a stgmating ness, sch sleponyor AIDS? "What resources are avaiable to hes in-dealing wih her needs when PIF she approaches the meal system for bel how does she pay for? How do her foci esta, ace and sty to pay inuence the quality of her medial care? Tw de intl conten rma re Gor ame, pb tusa forpolt plate hospital, or snoring home compared to hotpce or home Cary hap detainees quay? In adn to the quay of Ie, even ay of deans Hnked wih such scl context Medical systems involve concrete crgtzatons that reflect the economic interes of uch groups a doctors and ober profesional, inurance compan, plaraceutcalndustric, manufactures of medical equipment, hora, earch Crganizations, goverment agencies, and medial schools, They all compete for esoures,influence policy, and try fo et alt care and research agendas Healh Care syste fer grea fom society to society in how dey define and meet the eed of nvidia izes. The baby's He chances ae intimately nertined, therefore, with these semingly remote soda orgaizaons Th rl Bsr eh ed he working of oil body. A penon's ie chances are nkher some determinate nora purely acc dena nom res Rates, a person's chances for ness and succes reco tay we very mc the esl of speciale ocalarangements, which are in eam produc of human voton and indeed erate policy choices made by ident $e groupe and individual Tn lrg pry ness, death, heath, and wellbeing axe focal produced ‘THE SOCIAL CONSTRUCTION OF THE BODY ‘comruisto male rb someting. hoy sce do net eal ae or produce bodies, bu they can influence, shape, and misshape them, Just a an tre can meld sy to conduc an bj (iach contained bythe phys properties of the clay), socal groups and the cultures they share can shape mem bers" bodies, Obvious examples of culeural shaping of the inzman body include the foot binding pracced in tradidonal Chinese society, the cradle boards used to spe infants’ heads among the Kwakiud Indians, the says and corsets worn by hineteenth-centary middleclass Europeaz and American women, and the high heels and pierced earings favored today. Simalaly, having co live in a polluted en- vironment orto stata desk, to work on am assembly line, orto bend overall day in a mine shaft are examples of social conditions that can indirectly shape the body and in turn the bodys health ‘A biologist lustrates the physical consequences of social practices: Xr a society puts half cildren in resis and skins bu wars them nt to mov a ways that reveal thei underpants, while puting che other balf i jeans and overalls and encouraging them to climb trees and play ball and other active outdoor games it4 ASOCIOLOGICAL PERSPECTIVE ON HEALTH LLNESS, AND THEBOOY Inter, during adolescence, the half hat has wor trouser it exhorted to “eat ike a roving boy” we the al in skis warned wo watch ts weight and noe get fats it the hain fans wots around in sneakers oF boot, hile the half in skirts totes out om spe ees, then these ovo groups of people wil be biologically aswell as Social different Their muscles wil be feat a wil heir eens, poste, arms, legs and fet, handeye coordinaon,spatsl perception, and s0 on. They wil also be [ological diferent if as aduls, they spend eight hours a day siting in font of « ‘isl esplay terminal or work on & construction job orn amine. (Hubbard, cted in Vines 1088: 98-09 “Those things that happen to human bodies are closely related to the working and anatomy of the social body. Llness is not merely a physical experience but also ‘social experience. The sick body is not simply a closed container, encased in skin, that has been invaded by germs or traumatic blows; rather, it is open and con- nected to the world that surrounds it. Thus, the human body is open to the social body. Similarly, our material (or physial) environment, such as the urban land: scape, the workplace, or our foods, ae influenced by our culture, socal structare, and relationships. And these, in turn, influence our bodies. THE SOCIAL CONSTRUCTION OF IDEAS ABOUT THE BODY ‘eas, to0, are constructions. Every sosiety has many levels of shared ideas and practices regarding bodies: What is defined as healthy and beautiful in one society ‘might be considered unhealthly fat and ugly in another; what is seen as thin and Jean in one group might be defined as sickly in another. Aging may also be defined as a process to be either conquered, feared, accepted, or revered. Likewise, some societies picture the body as working ‘ike a machine, whereas others see it as a spiritual vessel Health Beliefs and Practices Because they are social construcions, our ideas of the body and its health and illness ate influenced by both our cilture and our social postion, such as lass for gender. Both cultural and social structural factors are important in understand: ing people's behavior and health. People act as they do not only because of their belief about health (Qhe cultural aspeas) but also because of suuctural specs, such as how power is distributed and relationships are organized. Thus, although wwe conceptually distinguish cultural and social structural aspects, in actuality they overlap. Galture is the beliefs, values, practices, and material objects shared by a people. Culture includes such elements as language, beliefs about the universe and the nature of good and evil, ideals such as justice or freedom, and more mundane ‘considerations such as what constitutes appropriate food, dress, and manners. It also encompasses objects that a people aroduce and share. Cooking utensils, auto ‘mobiles, plays, cemeteries, blueprints, crucifixes, tools, musical scores, and fags are among the items that represent cultura values and notions. [ASOCOLOSICAL PERSPECTIVE ON HEALTH LINESS,ANDTHEBODY. § How do our cultural conceptions of a person’s physical abilities affect those abilities? In our society, we used to believe that women were unable to carry heavy objects. Although biology contributes somewhat to women’s physical abil ties, so do cultural ideas. In a patriarchal society, women’s expectations that they, will be weak, together with the experience of being treated as weak because of thes social status, have a slfulfiling result: Women do not become strong. Cul ture can affect health by shaping behaviors, such as diet, or by influencing how ‘people change their envinunucuts, which im earn affect their health (Brown and Inhom, 1990). ‘Social structure (or social organization) is the relatively stable, ongoing pattern of socal interaction. Ina particular society, recognizable patterns of interac thon are appropriate to different social positons and relationships, such as parent: child, supervisoremployee, teacherstudent, and friendriend. Behavior in these relationships is regulated through a number of mechanisms, including social con trol and shared cultural values. Various persons in social relationships occupy di ferent social statuses. These relationships are often part of larger social ong nizational contexts; for example, the supervisor and employee positions may be part ofa business corporation. ‘One feature of social structure is how it is stratified. People can be stratified for ranked according to such dimensions as class, ethnicity, age, and gender Socioeconomic status (SES), or social class is often measured by income, occupa: tion, or wealth. A person’s socal location in socioeconomic stratification infu: ences how much power the individual has to manage his or her body and external tenviruament. Socioeconomic position can be used analytically to understand the Social location and power of neighborhoods and communities, as well as individu als (Lynch and Kaplan, 2000). ‘Other determinants of power affect health, The particular position of power sve occupy in our family (for example, child or parent) and our gender, race, and ethnicity are also all important factors. Ever health status (being chronically il, for instance) determines the stressors to which we are exposed and the coping resources available tous. Tin understanding health and illness, cultural aspects to consider might in clude people's eating and hygienic practices and their ideas about health, illness, ‘and healing. By contrast, structural elements might include a person's position and ‘dlaioaships in the workplace, fmsily, and medical settings, 25 well ax ch sncial status indicators as gender, race, age, and cass ‘Both scientific and nonscientifc ideas about health, illness, and the body are the result of social construction, as are the facts we assemble as evidence for our ideas about the world. All descriptions, including medical descriptions, are con: structions in that they include some information and exclude other information, ‘Similaly, definitions of health are social constructions. For example, the Ifemsatinal Dicionary of Medicine and Biology defines heath as “a state of well-being of an organ- {sm or part of one, characterized by normal function and unattended by disease” (Becker, 1986: v. 2, 1276). This definition delineates well-being only in terms of bodily functioning and the absence of disease. But are we necessaily healthy if we