1 S O C I A L A N D A D MI N I S TR A TI V E P H A R MA C Y

Module 2

The Social Context

of Health and Illness

Prepared by:
Ricardo Jr. N. Arellano
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Topics

Health and Illness:

Understanding in Public’s Perspective
Th e S o c i al C o n t e xt o f H e a l t h a n d

Social Determinants of Health

and Health Inequities
I l l n ess
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Health and Illness:

Understanding in Public’s
Perspective
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Introduction
“Is aging a disease?
How about obesity, insomnia, grief?”

• Disease is socially patterned.

– The chances of becoming ill are frequently related to a person’s social circumstances.

• The concept of disease is complex, comprising various dimensions of human

malady.
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Table 1. Different perspectives of human malady: Disease,

illness, and sickness investigated (Solomon, 2018)
Disease Illness Sickness
Field, Area, Profession, medical Personal, (experiential, Society, social
Primary and other health care existential) institutions, health
agents/ professions policy makers, lawyers
stakeholders

Basic Physiological, mental, Subjective experience, Social conventions,

phenomena genetic, environmental first- person negative norms, roles (including
entities or events experience, suffering, social prejudice)
pain
Access to Observations, Introspection, intuition, Participation,
phenomena examinations, interaction (language), interaction, social
through: measurements mental states studies
(psychology)
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Table 1. Different perspectives of human malady: Disease,

illness, and sickness investigated (Solomon, 2018)
Disease Illness Sickness
Knowledge Objective Subjective Inter- subjective
status

Altruistic Cure Care Resource allocation,

approach justice
Entitles to Examination, Attention, support, Economic support and
diagnostics, treatment moral and social compensation, sick
excuse, reduced leave, but may also
accountability result in discrimination
and stigmatization
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Case 1 (Disease + Illness + Sickness)

• Illness alters the person’s situation,
explains it to himself, and calls for
care
• Disease permits medical
explanation, attention, and action
• Sickness frees him from ordinary
duties of work and gives him the
right to economic support
• Examples: Heart disease, COPD,
Figure 1.
Visual outline of the triad disease, stroke
illness, and sickness
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Case 2 (Disease + Sickness)

• Conditions where certain signs or
(bio)markers are identified by the
medical profession before the
patient experiences any illness and
which leads to an entitlement to
treatment and economic support
(sickness).
• Examples:
–High BP (asymptomatic), HPV
Figure 1.
Visual outline of the triad disease,
illness, and sickness
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Case 3 (Disease + Illness)

• The medical profession is able to
recognize these conditions as
disease by various diagnostics, and
the person in question certainly
experiences them as negative, but
it does not qualify as sickness, as
they are expected to work
• Examples:
–Common colds
Figure 1.
–Headache after drinking alcohol
Visual outline of the triad disease,
illness, and sickness
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Case 4 (Illness + Sickness)

• Conditions where the person
certainly feels ill and society
entitles the person to have the
status of being sick, but where the
medical profession is not always
able to identify or detect disease.
• Examples:
–Pregnancy

Figure 1.
Visual outline of the triad disease,
illness, and sickness
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Case 5 (Disease)
• Asymptomatic instances
• Examples:
–genetic mutations

Figure 1.
Visual outline of the triad disease,
illness, and sickness
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Case 6 (Illness)
• Experienced by the person as
negative, but are neither
recognized as sickness by society
nor as disease by the medical
profession.
• Examples:
–An intense feeling of fatigue,
dissatisfaction, unpleasantness,
incompetence, anxiety, or sadness
Figure 1.
Visual outline of the triad disease,
illness, and sickness
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Case 7 (Sickness)
• Examples:
–Delinquency (does not conform to the legal
or moral standards of society)
–Dissidence (publicly disagreeing with and
criticizing the government or a powerful person
or group)
–Drapetomania (an overwhelming urge to
run away (from home, a bad situation,
responsibility))
–Masturbation
Figure 1. –Homosexuality
Visual outline of the triad disease,
illness, and sickness
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THE SYMPTOM ICEBERG

• The majority of symptoms
experienced by people are
not presented to a health
professional.

Figure 2.
The Symptom Iceberg
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Table 2. The response of adults in Great Britain to

minor ailments, n=2000 (BMRB, 1997)
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THE SYMPTOM ICEBERG

• There is a reservoir of untreated minor symptoms and
ailments within the community, some of which could be
dealt with by the pharmacist.

• Seemingly ‘minor’ ailments could be evaluated by the

pharmacist as to whether or not they are self-limiting,
treatable with an OTC medicine or warrant the attention of a
physician.
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ILLNESS BEHAVIOR
• a sociological concept which attempts to describe how people
respond to their symptoms
• Perspectives:
1.Individualistic approach
- stress the characteristics of the individual.
2.Collectivist approach
- emphasize the shared social norms and values that influence the actions of
people within social groups
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Figure 3.
Main determinants and consequences of
illness behavior (Sirri et al, 2013).
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LAY HEALTH BELIEFS

(beliefs from non-professionals)
• An understanding of lay health beliefs is useful and important
because it serves to:
1. Enhance our understanding of the social impact and meaning of
health, disease and illness.
2. Enhance the health professional–patient relationship.
3. Allow the development of realistic approaches and strategies in
health education and promotion.
4. Allow the development of appropriate health services based on the
perceived needs of sufferers rather than on the perceptions of health
care providers.
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ETIOLOGY OF ILLNESS
(Chrismann, 1977)
1. Invasion: the rationale that the body is susceptible to intrusion of
matter or substances that are able to make the body ill, such as micro-
organisms, toxic chemicals, or spoiled food.
2. Degeneration: whereby the body is perceived and expected to get
progressively worse with age.
3. Mechanical: the structure or functioning of the body is impeded as the
result of blockages, fractures, breakdowns, etc.
4. Balance: the imperative of maintaining an equilibrium between
elements within the body and between the body and the environment.
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HEALTH BELIEF MODEL (HBM)

• Describe the impact that health beliefs have on health
behaviors.
• Attempts to identify motives which influence people’s
health-related actions and,
• Tries to recognize those which are most vulnerable to
change
HBM quantifies health beliefs.
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HEALTH BELIEF MODEL (HBM)

• Dimensions of HBM
1. level of interest an individual expresses in health issues
(health motivation)
2. their perceived vulnerability to illness (susceptibility)
3. the perceived seriousness of certain illnesses (severity)
4. the perceived value of taking health actions (benefits
and costs)
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Table 3. Health Belief Model constructs, definitions,

and examples (Wang et al, 2021)

Constructs Definition of the Constructs Examples

Perceived The assessment of the risk of “Across the UK, 194,990 people
getting COVID-19 infection. had tested positive for
Susceptibility
coronavirus as of 9am on
Basic phenomena Physiological, mental, genetic, Subjective
Tuesday, up experience, first-at the
from 190,584
environmental entities or events person negative
same point experience,
on Monday. Find out
suffering,
how manypaincases there are in
your area.”
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Table 3. Health Belief Model constructs, definitions,
and examples (Wang et al, 2021)
Constructs Definition of the Constructs
Perceived The assessment of whether
COVID-19 is a sufficient health
Severity
concern.
Basic phenomena Physiological, mental, genetic,
environmental entities or events
Th e S o c i al C o n t e xt o f H e a l t h a n d I l l n ess
Examples
“US Recorded 1,297
Coronavirus Deaths in Past 24
Hours.”
Subjective experience, first-
person negative experience,
suffering, pain
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Table 3. Health Belief Model constructs, definitions,
and examples (Wang et al, 2021)
Constructs Definition of the Constructs
Perceived The benefits of HCQ/Cq* in
prevention or treatment of
Benefits
COVID19; Positive statements or
Basic phenomena Physiological, mental, genetic,
reports about HCQ/CQ.
environmental entities or events
*HCQ: Hydroxychloroquine; CQ:
Chloroquine
Th e S o c i al C o n t e xt o f H e a l t h a n d I l l n ess
Examples
“Dr. Zelenko In NY has now
treated 699 Coronavirus patients
with 100% success using
Subjective experience, first-
Hydroxychloroquine.”
person negative experience,
suffering, pain
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Table 3. Health Belief Model constructs, definitions,

and examples (Wang et al, 2021)

Constructs Definition of the Constructs Examples

Perceived The side effects of HCQ/CQ; “Family of New York woman

The unaffordable cost of blames hydroxychloroquine
Barriers
HCQ/CQ; combo for fatal heart attack.”
Basic phenomena Physiological, mental,
The inaccessibility genetic,
of HCQ/CQ; Subjective experience, first-
environmental entitiesororreports
Negative statements events person negative experience,
about HCQ/CQ suffering, pain

*HCQ: Hydroxychloroquine; CQ:

Chloroquine
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“The number of users tweeting about COVID-19

health beliefs was amplifying in an epidemic
manner and could partially intensify the infodemic.”

“It is “unhealthy” that both scientific and

nonscientific events constitute no disparity in
impacting the health belief trends on Twitter…”
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HEALTH BELIEF MODEL (HBM)

• Enable the researcher or health educator to identify the
likelihood and willingness of the individual to comply with
‘desirable’ health behaviors.

• This argument is particularly attractive to health educators

because if it is possible to identify ways in which behavior
can be changed they could act upon and advise those who
do not subscribe to healthy actions.
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References:
• British Market Research Bureau Ltd (1997). Everyday Healthcare Study of Self-medication
in Great Britain, London, The Proprietary Association of Great Britain.
• Harding, G., & Taylor, K. M. G. (2015). Pharmacy Practice, Second Edition.
• Parsons, T. (1951). The social system. New York, NY: Free Press.
• Sirri L, Fava G, A, Sonino N, (2013). The Unifying Concept of Illness Behavior. Psychother
Psychosom. 82:74-81.
• Solomon, M., Simon, J., & Kincaid, H. (2018). Disease, Illness, And Sickness.
• Taylor, K., Nettleton, S., & Harding, G. (2018). The Social Context of Health and Illness: An
introduction.
• Wang H, Li Y, Hutch M, Naidech A, Luo Y. (2021). Using Tweets to Understand How
COVID-19–Related Health Beliefs Are Affected in the Age of Social Media: Twitter Data
Analysis Study. J Med Internet Res. 23 (2):e26302
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