AQA Unit 2 Sociology of Health (3)

The Social Model of Health and Illness

The Social Model of health and illness suggests that social

factors are more important than biological factors when it
comes to defining and measuring health and illness. This
approach covers a range of important ideas and concepts –
this guide will focus on two key criticisms of biomedicine
identified by sociologists- the ‘clinical iceberg’ and the idea
that health and illness is a social process or construct rather
simply being a product of biological problems.

Health as a social process/construct

1. The clinical iceberg

The biomedical model of health strongly implies that only doctors are
capable of treating illness. Moreover, official morbidity statistics
are collected by counting patient visits to GPs as well as
admissions to hospitals.

However, the social model of health and illness points out that because
definitions of illness differ so widely, even within the same society, a
large number of people do not report their symptoms to a
doctor. Most people either self-medicate or are treated by the family.
Consequently, the official morbidity statistics only make visible a
small amount of illness – perhaps less than 10%. There may
therefore be a clinical iceberg of illness that never comes to the
attention of doctors. The biomedical model therefore exaggerates
the role of doctors in treating illness.

There is strong evidence that many people do not consult their doctor
for symptoms of disease that would respond to medical treatment.
Epsom’s (1978) research of 3160 people found that 57 per cent of
them showed physical signs of disease and would have benefitted from
seeing their GP. Scambler concludes that despite concerns expressed
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by GPs and A&E hospital departments that many people visit them for
trivial and unnecessary reasons, a significant clinical iceberg of
unreported symptoms exists in the UK. He argues that a substantial
number of people are enduring avoidable pain and discomfort and that
consequently the NHS is treating ‘only the tip of the sum total of ill-
health’.

Understand the concept – the clinical iceberg

This concept refers to the dark figure of unreported and unrecorded

illness that exists in society. Only a minority of ill people feel the need
to consult with their GP – most self-medicate by taking medicines
bought over the counter.

2. The social process of becoming ill

According to Jhyla this involves three stages; (1) recognition of

symptoms, (2) action- going to see a doctor and (3) diagnosis.
Howeve, these three stages often depend on a range of social factors
including power-relations, social class, ethnicity and culture,
religion,

The act of actually going to the doctor is often dependent on how

patients perceive doctors . For example, sociologists point out that the
doctor-patient relationship is not an equal relationship in terms of
power and status, and that the inequality that underpins the
interaction between a doctor and patient may result in some people
being very reluctant to visit their doctor.

For example, doctors overwhelmingly come from middle-class

backgrounds and this fact, along with the authority and
confidence they exude, may be interpreted by working-class patients
as threatening or condescending. Working-class people with little
education may therefore lack the confidence to visit their doctors.

There is some evidence too that cultural or ethnic differences may

also undermine the decision to take action with regards to illness. For
example, Asian, especially Muslim women prefer to see female

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doctors but there is a shortage of female GPs in those areas
with the largest concentration of Asian households.
Consequently, some of these women who need to visit a doctor are not
doing so for religious and cultural reasons.

The act of actually going to the doctor is often dependent on a

range of social factors too. For example, sociologists point out that the
doctor-patient relationship is not an equal relationship in terms of
power and status, and that the inequality that underpins the
interaction between a doctor and patient may result in some people
being very reluctant to visit their doctor. For example, doctors
overwhelmingly come from middle-class backgrounds and this fact,
along with the authority and confidence they exude, may be
interpreted by working-class patients as threatening or
condescending. Working-class people with little education may
therefore lack the confidence to visit their doctors.

There is some evidence too that cultural or ethnic differences may

also undermine the decision to take action with regards to illness. For
example, Asian, especially Muslim women prefer to see female
doctors but there is a shortage of female GPs in those areas
with the largest concentration of Asian households.
Consequently, some of these women who need to visit a doctor are not
doing so for religious and cultural reasons.

Consequently, the process of being recognized, diagnosed and

treated as ill may be undermined by social factors such as
social class, gender, ethnicity, religion, age and culture.

Scambler argues that a person’s chances of being recognized,

diagnosed and treated as sick are more likely to be influenced by
factors related to ethnicity, age, gender and social class rather than by
biology.

Subcultural or ethnic influences

There is some evidence that there may be some subcultural

differences in terms of how symptoms are interpreted by some ethnic

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groups especially with regard to the experience and reporting of pain.
Zborowski (1952) in a classic study of patients in New York found
that Irish-Americans reacted to pain by bravely enduring it or by
becoming less sociable. They were therefore less likely to seek help
from doctors. In contrast, patients from Italian or Jewish backgrounds
were more demanding of doctors and sought out sympathy for their
plight.

In the UK, Krause (1989) found that Hindu and Sikh Punjabis living in
Bedford often visited the doctors with chest pains. However, doctors
rarely found anything physically wrong with them. Krause found that
these ethnic minority subcultures called this pain ‘sinking heart’ (dil
ghirda hai) and claimed it was caused by deep emotional upset
brought on by public shame. Krause found no evidence of any other
subculture responding to emotional distress or disgrace in this way.

Age

Blaxter found that as people age, they gradually re-define health and
accept greater levels of pain. The elderly may therefore not respond to
pain or discomforting symptoms by consulting a doctor if they believe
they can cope with their everyday routine.

Gender

Graham (2002) suggests that dominant definitions of masculinity in

the UK stress men’s toughness and their ability to cope with pain.
Consequently, some men may be less likely to define themselves as ill
or as needing medical attention. On the other hand, socialisation into
feminine roles requires girls and women to recognise that being a
woman may require regular medical check-ups because of the nature
of their biology. Visiting the doctor is a routine activity for many
women.

Social class

Blaxter’s research also showed that working-class people were far

more likely to accept higher levels of ‘illness’ than middle-class people.

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Blaxter describes working-class people as ‘fatalistic’– that is, they
accept poor health and pain as ‘one of those things’ and tolerate a
higher level of discomfort before they consider themselves ill enough
to visit the doctor.

Jylha (2009) argues that culture, age, gender and class often
overlap in influencing people’s decision to see a doctor or not but she
argues that defining oneself as sufficiently ill enough to seek medical
advice also depends on the ill person having sufficient knowledge to
recognise their symptoms are problematical. In other words, people
need to recognize that the symptoms that they are experiencing are
signs of illness. However, this is not as straightforward as it sounds
because people may be ill and not realise it. Jylha notes that
recognition and knowledge about illness depend on a range of factors:

 Some people may not recognise their symptoms as a problem

because they associate particular types of illness with
other social groups. For example, a person in their thirties
who develops early stage Alzheimer’s may associate such an
illness with the elderly and fail to seek help.

 People often fail to recognise that an illness is sufficiently

serious to seek medical treatment. For example, stomach
cancer is a major killer of young men. However, evidence
suggests they do not visit the doctor once symptoms show
themselves. Instead they tend to dismiss the early symptoms as
part and parcel of their heavy drinking, fast-food lifestyle.

 Some victims of disease may feel socially embarrassed by the

symptoms of their disease and consequently fail to seek medical
treatment. For example, some people may be reluctant to have
what they see as the private parts of their bodies examined by
medical professionals.

 Some may view health and illness in terms of costs and

benefits. For example, a person may feel that seeking medical
help is a cost which infringes on the benefits of going to work
and earning a wage, looking after their children etc because it
might mean taking time off work to go into hospital.
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The moral dimension of seeking medical help

Finally, there is often a moral dimension to defining health and illness,

and this too may affect a person’s decision to seek medical help. Some
illnesses are seen as contentious either because the ill person’s
lifestyle is seen by the media or society as contributing to their
medical condition or because there is no consensus among
doctors that the condition actually exists. For example, people
who develop medical problems because of alcoholism, heavy smoking,
over-eating, sexual disease, etc are increasingly negatively judged and
blamed for their illnesses by the media, politicians and society. People
who fit into these categories may be reluctant to seek help because of
the stigma attached to their behavior. It is also argued by some
doctors that ‘diseases’ such as Myalgic Encephalomyelitis (ME),
Chronic Fatigue Syndrome and Gulf War Syndrome do not actually
exist. Again, people who present symptoms of these diseases may be
fearful of being labelled as idle rather than ill, and consequently
reluctant to consult with doctors.

The sick role: sickness as deviance

The moral dimension of sickness was explored by the functionalist

sociologist Talcott Parsons (1975) who argued that being sick was
potentially a form of deviance because it prevents a person
undertaking their normal social functions. He believed that if workers
used sickness as an excuse not to work then this could become a
threat to the smooth running of the economy and therefore society
and social order. However, he believed that society controls this
potential deviance through a social system of duties and obligations
known as ‘the sick role’.

This role involves patients having to convince doctors that they are
genuinely ill by conforming to certain rules of behaviour, e.g. by
submitting themselves to the care of doctors and by exempting
themselves from leisure-based activity. If they do so, doctors

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legitimate their illness and this entitles the worker to be officially
excused from work.