JULIUS NYERERE SCHOOL OF SOCIAL SCIENCES

MODULE: SOCIAL INSTITUTIONS

COURSE CODE: SOCH121

PROGRAMME: SOCIOLOGY

LEVEL: 1.2

QUESTION: HEALTH AND MEDICINE

GROUP MEMBERS: TONDE TRACY A M214564

CHIGOHI GRACIOUS M215161

KADYAUSAVI MICHAEL P M213498

CHATYOKA KRISTAN T M215633

LECTURER: DR L. NHODO

LECTURER'S COMMENT: .........................................................................

MARK: .................................
Definition:

Health and illness

Sociologist have explained the nature of health, illness and medicine and they found in social
dimension to the concept of illness and health. Both health and illness vary across times and
cultures. It is arguable whether there is such thing as a normal body, as ideas of what is normal
also change. Health and illness are terms people use in everyday life without giving them much
thought. The definition of these terms gives rise to a considerable divergence in views and this is
reflected in academic debates about the nature of health and illness. Definition of health and
illness polarize between those that rely upon objective scientific criteria and those that are based
on people's subjective awareness. Health can be defined as the absence of disease that is there is
a traditional view of normal functioning body and a person can be defined when they are within
normal boundaries and as I'll when their organs are diseased. According to WHO (1974) health
is not merely an absence of disease but a state of complete physical, mental, spiritual and social
wellbeing

MARXIST/CONFLICT PERSPECTIVE on Health and illness

Marxism is considered a political, sociological and economic philosophy. Karl Marx and
Friedrich Engels are the god-fathers of Marxism. In Marxist discourse, health and illness is a
social phenomena and not a biological issue. Marxist theory says that heath and ill-health has to
be viewed as a social class problem that is linked to inequality-if people had a good standard of
living, there would be no ill-health population. The upper class have longer life expectancy and
enjoy better levels of health. Marxist believe that the definition of health and ill-health is
determined by the bourgeoisie. Marxist also believe that doctors only serve the interest of the
bourgeoisie as doctors are gatekeepers, they work together with the ruling class. They leave the
decision of whether you're healthy or unhealthy to work. Marxist believe that doctors act as
agents of social control to keep the workforce healthy, a healthy workforce is a productive
workforce. Doctors indirectly work for the capitalists as their job is to get people back to work as
quickly as possible. Medicine is a social institution and in capitalist societies, it is shaped by the
capitalist interest. Navarro (1985) said there are four parts to defining medicine as a capitalist.
He believes that medicine has become a market commodity, increasingly specialized and
hierarchical. He believes medicine has now become an extensive wage labour force, increasingly
profitable fir the two dominant capital interests (the financial and corporate sector). Last point
states that medicine is as organized as the national health care system but this does not mean it is
free from capitalist influence. According to conflict theorists, capitalism and the pursuit of profit
lead to commodification of health. Commodification of health refer to something not generally
thought of as a commodity as something that can be bought or sold in a marketplace. In this
view, people with money and power, the dominant group are the ones who make decisions about
how the health care system will be run. They therefore ensure that they will have health care
coverage while ensuring that subordinate groups stay subordinate through lack of access.
Alongside health disparities created by class inequalities are a number of disparities caused by
ageism, racism, sexism etc. When health is a commodity, the poor are more likely to suffer from
illnesses caused by poor diets, living and working in unhealthy environments and are less likely
to challenge the system.

Marxist claim that health problems are closely tied to unhealthy and stressful work
environments. Rather than seeing health and problems as the result of individual weakness, they
should be seen in terms of the unequal social structure and class. Patterns of mortality and
morbidity are closely related to occupations especially in the case of industries for example
industrial carcinogens (asbestos, metals and chemicals) are responsible for 10% of all male
cancers. It is the capitalist economy that defines health and medicine. Under the umbrella of this
system, 'the main goal of medicine is not health but profit.' While this theory is accurate in
pointing out inequalities in the health care system, it does not give enough credit to medical
advances that would not have been made without an economic structure to support and reward
researching: a structure dependent on profitability. In the criticism of power differentials
between doctor and patient, conflict theorists are dismissive of the hard-won medical expertise
possessed by doctors and not patients which render a truly egalitarian relationship more elusive.

Critics of the conflict approach say that its assessment of health and medicine is overly harsh and
its criticism of physicians’ motivation far too cynical. Scientific medicine has greatly improved
the health of people in the industrial world; even in the poorer nations, moreover, health has
improved from a century ago, however inadequate it remains today. Although physicians are
certainly motivated, as many people are, by economic considerations, their efforts to extend their
scope into previously nonmedical areas also stem from honest beliefs that people’s health and
lives will improve if these efforts succeed. Certainly there is some truth in this criticism of the
conflict approach, but the evidence of inequality in health and medicine and of the negative
aspects of the medical establishment’s motivation for extending its reach remains compelling.

FEMINIST PERSPECTIVE

Feminist perspectives have been influential in the field of public health as well as in medical
sociology and in the sociology of women's health and illness. Feminist political economy
approaches that are applied to health research have helped to explain the processes that make
women vulnerable to health inequities at a variety of levels. The first has to do with the health
care needs of women. For instance, women have different health needs than men and require
diversity in health services. Yet, biomedical research and biomedicine are often applied to
women in unfair ways that have health compromising consequences for women. For example,
women may experience pregnancy, birth and different types of health issues during their aging
and life course compared to men. However, health research and health care services often do not
meet women's needs. Furthermore, the Physician health study of coronary heart disease was
thought of as a male problem despite the fact that half a million women died of it each year in the
United States of America and despite that women's risk of it and other chronic illnesses is
influenced by a number of factors. Studies also show that in some societies, girls and women
experience inequities in the health care system due to discrimination because boys and men are
valued more than girls and women.

Feminist materialists who are focused on an analysis of health argue that women's health and
well-being are directly affected by determinants of health such as income and social status
because women are often paid lower wages than men. This economic disparity can influence
women's access to healthy food and nutrition, their participation in health-modifying and health-
impacting behaviors as well as access to health/medical, social, dental and other types of care.
Another problem that affects women's health and well-being is that women are often sex
segregated in the labor market. This means that women who participate in labor markets may do
so as a reserve supply/army of labor on either a daily, weekly, seasonally or part-time basis to
respond to demand and overproduction in manufacturing, retail, service and other sectors.
Feminist materialists also argue that the health problems women experience are related to their
discrimination and disadvantage while they carry out the gendered activities that make up their
daily lives. Specifically, the dual demands of women's work in the home and labor market have a
direct effect on the way women participate in the workforce as well as on the sex segregation of
women's work and women's wages. For example, if a job involves care work, it is often
performed by a woman, it is classified as unskilled and therefore it is lower-paid than that of men
in caregiving occupations. These types of disparities in women's working conditions result in
gender inequalities in income and wealth which make women vulnerable to poverty and also
vulnerable to poverty and also vulnerable to health problems.

INTERACTIONALIST

The interactionist approach emphasizes that health and illness are social constructions. This
means that various physical and mental conditions have little or no objective reality but instead
are considered healthy or ill conditions only if they are defined as such by a society and its
members (Buckser, 2009; Lorber & Moore, 2002). The ADHD example just discussed also
illustrates interactionist theory’s concerns, as a behavior that was not previously considered an
illness came to be defined as one after the development of Ritalin. In another example, in the late
1800s opium use was quite common in the United States, as opium derivatives were included in
all sorts of over-the-counter products. Opium use was considered neither a major health nor legal
problem. That changed by the end of the century, as prejudice against Chinese Americans led to
the banning of the opium dens (similar to today’s bars) they frequented, and calls for the banning
of opium led to federal legislation early in the 20th century that banned most opium products
except by prescription (Musto, 2002).In a more current example, an attempt to redefine obesity is
now under way in the United States. Obesity is a known health risk, but a “fat pride” movement
composed mainly of heavy individuals is arguing that obesity’s health risks are exaggerated and
calling attention to society’s discrimination against overweight people. Although such
discrimination is certainly unfortunate, critics say the movement is going too far in trying to
minimize obesity’s risks (Saulny, 2009).

The symbolic interactionist approach has also provided important studies of the interaction
between patients and health-care professionals. Consciously or not, physicians “manage the
situation” to display their authority and medical knowledge. Patients usually have to wait a long
time for the physician to show up, and the physician is often in a white lab coat; the physician is
also often addressed as “Doctor,” while patients are often called by their first name. Physicians
typically use complex medical terms to describe a patient’s illness instead of the more simple
terms used by laypeople and the patients themselves. Management of the situation is perhaps
especially important during a gynecological exam. When the physician is a man, this situation is
fraught with potential embarrassment and uneasiness because a man is examining and touching a
woman’s genital area. Under these circumstances, the physician must act in a purely professional
manner. He must indicate no personal interest in the woman’s body and must instead treat the
exam no differently from any other type of exam.

Critics fault the symbolic interactionist approach for implying that no illnesses have objective
reality. Many serious health conditions do exist and put people at risk for their health regardless
of what they or their society thinks. Critics also say the approach neglects the effects of social
inequality for health and illness. Despite these possible faults, the symbolic interactionist
approach reminds us that health and illness do have a subjective as well as an objective reality.

FUNCTIONALIST

Functionalist regard health as a very important aspect of society. If everyone is ill, society can't
function, which will result in anarchy and the state will collapse. According to functionalists,
those who are sick are going against the norms of the society. They view those who are ill as
having an important social role to play that is those who are ill have to play the 'sick role'
meaning the ill have to do everything necessary to get better health in a short space of time for
example going to the doctors, staying at home and taking medication. The rights linked to this
approach was that you had to be free from social acts like going to work or college, paying tax,
another right is to be cared for. Parsons saw this as a main function of a family who cared for the
sick and other family members who relied on the family group. The responsibilities linked to this
approach involved the individual to take reasonable steps to improve so as to continue their
normal role in society as fast as possible. Also liaising with other health care professionals
especially doctors, nurses etc. Good health and effective medical care are essential for the
smooth functioning of society. Patients must perform the 'sick role' in order to be perceived as
legitimately ill and to be exempted from their normal obligations. The physician-patient
relationship is hierarchical: The physician provides instructions and the patient needs to follow
them. Ill-health impairs our inability to perform our roles in society and if too many people are
unhealthy, society's functioning and stability suffer.

This was especially true for premature death said Parsons because it prevents individuals from
carrying out all their social roles and thus represents a 'poor return' to society for the various
costs of pregnancy, birth, child care and socialization of the individual who ends up dying early.
Poor medical care is likewise dysfunctional for society as people who are ill face greater
difficulty in becoming healthy and people who are healthy are more likely to become ill.

TALCOTT PARSONS ON 'THE SICK ROLE'

Talcott Parsons, a founding father of medical Sociology described illness as a deviance, as health
is generally necessary for a functional society, which thrust the ill person into the sick role, (T.
Parson 1951). The sick role refers to the behavior expected of a person who is physically ill,
mentally ill or injured. Such expectations can be for the sick individual or for those in his family.
Parsons emphasized on 4 postulates which guided the regulation of assuming the sick role. These
are;

i) The person is not responsible for assuming the sick role, meaning to that the sick individual
had to be placed on sick role by medical experts.

ii) The sick person is exempted from carrying out some or all of normal social duties for example
work, family

iii) The sick person must try and get well, the sick role is only a temporary phase.

iv) In order to get well, the sick person needs to seek and submit to appropriate medical care.

Parsons did not disagree with the dominance of the medical model of health of health in
determining illness, yet he argued that being ill was not just a biological condition, but also a
social role. He argued that if too many people claimed to be ill, then this would have a
dysfunctional impact on society, hence the need for a regulating process into the assumption of
the sick role. For a person to be considered legitimately sick, said Parsons, several expectations
must be met. He referred to these expectations as the 'sick role'. i) First, sick people should not be
perceived as having caused their own health problems. If we eat high-fat food, become obese and
have a heart attack, we evoke less sympathy than if we had practiced good nutrition and
maintained a proper weight. If someone is driving drunk and smashes into a tree, there is much
less sympathy than if the driver had been sober and skidded on the road in icy weather. ii)
Secondly, sick people must want to get well, if they do not want to get well or, worse yet, are
perceived as faking their illness or malingering after becoming healthy, they are no longer
considered legitimately ill by people who know them or more generally, by society itself. ii)
Thirdly, sick people are expected to have their illness confirmed by a physician or other health-
care professionals and to follow professional's instructions in order to become well. If a sick
person fails to do so, he or she again loses the right to perform the sick role. If all these
expectations are met said Parsons, sick people are treated as sick by their family, their friends
and other people they know and they become exempt from their normal obligations to all these
people. Sometimes they're even told to stay in bed when they want to remain active.

Physicians also have a role to perform, said Parsons. First and foremost, they have to diagnose
the person's illness and decide how to treat it and help the person become well. To do so, they
need the co-operation of the patient, who must answer the physician's questions accurately and
follow the physician's instructions. Parsons thus viewed the physician-patient relationship as
hierarchical: the physician gives orders (or more accurately, provides advice and instructions),
and the patient follows them.

Critiques

Some of the main critics of the biomedical model of health and Parsons’ theory of sick role are
those of a Marxist persuasion. The Marxists argue that increasing medicalization has had
damaging effects and is driven by profit rather than the health of the population. Ivan Lllich
(1975) argued that going to seek medical advice and following it often leads to more serious
problems than the patient suffered in the first place. He called this “latogenesis” meaning doctor
induced illness. He says that medical experts will cause more damage to the already ill patient so
that he or she buys their medications. Therefore the Marxist viewed Parson’s concept on sick
role as a means to make profits for multi-national corporation.
Feminists have also criticized Parson’s theory on sick role. Ann Oakley (1974), suggested that
the rights of the sick role were not afforded to women in same way they are for men. When a
woman is ill, they are rarely excused from their normal social role of being the house keeper or
the mother.

MKS VS IKS in Medicine

Indigenous knowledge systems (IKS) comprises knowledge developed within indigenous

societies, independent of, and prior to, the advent of the modern scientific knowledge system
(MSKS). Examples of IKS such as Ayurveda from India and Acupuncture from China are well
known. IK covers diverse areas of importance for society, spanning issues concerned with the
quality of life - from agriculture and water to health. The IK resident in India and China have
high relevance to rural life, especially given the level of engagement with agricultural and health
technologies. The goal is to establish a heuristic whereby IK can be reviewed and evaluated
within particular contexts to determine if the IKS can lead to the development of appropriate
technology (AT) addressing that need sustainably. Although much work on cataloguing and
documenting IKS has been completed in these two countries, a paucity of attention has been paid
to the scientific rationale and technological content of these IKS. Evaluation of many indigenous
technologies reveal that many of these technologies can be classified as ‘appropriate’, focused on
basic needs of water, sanitation and agriculture, and many have origins in IKS that survived.
Thus, IKS must be validated, exploited and integrated into AT innovation and development

Indigenous knowledge (IK) and indigenous knowledge systems (IKS) refer to knowledge and
knowledge systems that are unique to a given culture [1]. Indigenous knowledge can be
differentiated from the modern scientific knowledge system (MSKS) and international
knowledge systems. The roots of MSKS rest on scientific research conducted and generated in
institutions of higher learning such as universities and research institutions. MSKS can be seen
as a component of society, part of the scientific and technological advancements of humanity;
this knowledge cannot be orally garnered or obtained through anything but rigorous academic
study. It is propagated through advanced study’s institutes, graduate research and education,
including internships and training workshops and modules. What should be understood most
clearly about the MSKS is that it is self-perpetuating, where the models for training and
development and career advancement all involve the reinforcement of existing systems of
research and knowledge propagation and development. Nevertheless, there are examples of
indigenous knowledge systems that have survived and even thrived despite the challenges
brought up through the MSKS such as Ayurveda and Unani and even acupuncture, which is
basically an indigenous Chinese medical knowledge system. The strength of IKS can be seen in
how these three systems have gained acceptance in various contexts, including the National
Institute of Health establishing centers of research and study for both acupuncture and Ayurveda
in the United States, as well as various governmental research centers that have been established
by the Indian government, for example, to research Unani. At its most elemental level, IKS can
be considered the foundation upon which local communities make determinations about local
issues. These decisions pertain to various areas of endeavor, including water and other resource
use, conservation and management, agriculture, health care issues, as well as providing
information and public outreach and education within a local community.

The major problem with indigenous knowledge and indigenous knowledge systems reside in the
difficulty encountered in establishing what constitutes ‘indigenous’ in particular social,
geographical and cultural contexts. The difficulty for a society to come to agreement on what and
who is indigenous can be quite high, especially because of establishing a socially and culturally
accepted identification of what constitutes the indigenous groupings within a given country or
region. The conflict can range from groups that desire to be recognized as indigenous to groups
that find paternalistic offense in that identification. Global transcontinental migration drives the
mix of peoples of different backgrounds and ethnicities towards greater complexity and the
discourse has to dissect whether only communities that are native, aboriginal or tribal should be
included or the scope expanded to include other types of residents or migrants. The process of
classifying and providing tangible examples of indigenous knowledge systems, researchers,
educators and practitioners have developed a plethora of terms that can be linked closely to IKS.
These include such labels as traditional knowledge (TK), indigenous technical knowledge (ITK),
folk and local knowledge, environmental or ecological knowledge (EK), and sometimes it has
also been called people’s science. Despite the multitude of terms used to identify IKS, there are
generally accepted and received notions of what IKS comprise, specifically around the space of
traditional knowledge in diverse cultural surroundings and geographical spaces. Thus, what is
helpful is developing operational and characterizing ideas of what IK is, how it is developed, and
how it grows as a knowledge system within a particular cultural space. The main characterizing
feature of an IKS is that it is locally based, grounded in a particular culture and geography. The
oral tradition is strong in IKS, most of the knowledge being passed on orally, and through
mimicry and practical application. In general, IK can be considered the cultural and
technological product, or knowledge product, from a society or culture’s interaction and
engagement with daily living. Theoretical grounding is not IKS’s hallmark—that is, the
foundation of the MSKS. On the other hand, IKS is developed through daily engagement and
through trial and error to see what meets a particular community’s needs. The notion of the static
nature of IK has been disproved through numerous examples showing how IK can be changing
continuously, especially as a culture or a community develops and grows, and is subject to
changing environmental, cultural, physical and economic stressors. Because of its oral traditions,
IKS tend to be more transparent and openly accessible to communities. Intellectual property is
not a strong point in the IKS ecosystem—knowledge is supposed to be shared for the benefit of
the community and not for private gain. As described earlier, IKS are grounded in a specific
local culture and as such tend to be distributed through a given community according to different
bases; IK can be quite asymmetrical dispersed in a given community. The bases can be age,
seniority, gender, or sometimes based within a particular community sub-group or segment that
focuses on the particular activity the IKS is integral to—such as, for example, river keepers and
water masters clustered around rapine communities focused on water treatment and conservation.
IKS is often maintained and propagated through community members who are experts
recognized and accepted as such by the community. This standing may obtain from political
authority, particular ritualistic standing an individual may possess, or simply from being the most
respected authority with the most experience and acknowledged as such within a particular
community. In terms of knowledge organization and management, indigenous knowledge is
broadly seen as based in its function, which may include both technical and non-technical
aspects within a particular field of application. An excellent illustrative example of IKS being
employed in decision-making at the local level is the panchayathi raj form of local government
that involves all stakeholders at the grass roots level in governance decisions at the village level.

To summarize, indigenous knowledge and indigenous knowledge systems are based in

communities at the very grass roots level; this knowledge provides the critical socio-cultural
capital that is essential for communities to not only survive but also to go beyond and flourish
within the given contexts of that community’s geography, environment, culture and economy. At
the same time, IKS is not static—it changes as is required and in response to the various stressors
that a community faces, including environmental, social, public health and safety; IKS is also
informed through external interchanges and interactions that any community undergoes through
trade, exchange and other cross-boundary type interactions. Given the importance of IKS to a
community’s survival and flourishing, these knowledge bases and systems are critically
important for capacity building within a community.

SOCIAL INEQUALITIES IN HEALTH

Social inequalities are an uneven distribution of resources in society. These may be differences
in wealth, income, employment, education, and financial assets as well as differences in
opportunities. There are several inequality agents;

●place of residence (rural, urban etc.)

●race or ethnicity

●occupation

●religion

●socioeconomic status-Poor countries tend to have worse health outcomes compared to rich
countries. Levels of inequality also vary considerably even among countries with similar levels
of per capita income can have an impact on health equity.

●gender-Gender can make a significant difference due to social attitudes about the value of men
and women. For example, parents might be more likely to take a son to get immunized than a
daughter because of social customs that value men over women.

●education-Other equity agents like education also explain health outcomes. Education increases
health literacy, which is the ability to obtain, read, understand and use health care information to
make appropriate health decisions and follow instructions for treatment. Those with higher
education levels and a good financial situation live longer and have fewer health problems than
those who have lower education and poorer economy. These social inequalities can be studied at
a country, county and municipal level. There are substantial social inequalities in health in
especially between educational groups. Women and men with the highest education live 5-6
years longer and have better health than those with the lowest education. The differences are
increasing, especially among women. When comparing groups in society, we find systematic
differences in health. The higher the education and income the group has, the higher the
proportion of the group’s members have good health (Norwegian Directorate of Health, 2005;
Huisman, 2005). These are known as social inequalities in health. Health improves with every
step on the socioeconomic ladder. A higher education is associated with better health. The same
applies to income. Not only does the next poorest have better health than the poorest, we see that
the richest on average have slightly better health than the next richest. Social inequalities in
health apply to almost all diseases, injuries and ailments. We see differences among all age
groups and among men and women. These involve many lost days and years of good health and
quality of life. Social inequalities are unfair and represent a loss for individuals, families and
society. The total health potential of the population is not fully utilized. If someone is married,
has a university or college education and has a spouse with the same level of education, their life
expectancy is 8–9 years higher than for unmarried people who have only completed lower
secondary education (Kravdal, 2017).

#Inequalities in health among children and adolescents-There are differences in health at all ages,
among children, adolescents, adults and the elderly. There is higher infant mortality, lower birth
weight and a higher risk of premature birth in groups with lower education (Dahl, 2014).There is
a higher proportion of children and adolescents who report poor health in families with lower
socioeconomic status than higher socioeconomic status (Elstad, 2012).Adolescents from homes
with high socioeconomic status more frequently report a higher quality of life, better health and
less psychological distress than children from homes with lower socioeconomic status.

#Health inequalities among the elderly-Consequently, there would be small differences among
those who have lived long lives. However, recent studies suggest that differences continue into
old age (Moe, 2012; Kinge, 2015a).Among the eldest there are differences in expected remaining
life years. Among 65-year-olds, the expected remaining lifetime is about 4 years longer for those
who have a higher education than for those with lower education.90-year-old men and women
with higher education can expect to live three months longer than men and women with lower
secondary education. Statistically, elderly people with low socioeconomic status have more
illnesses and health problems than those with high socioeconomic status. The "World Report on
Ageing and Health" highlights that this group also has the fewest resources to take care of their
own health (Beard, 2015).Social inequalities in health apply to virtually all diseases, injuries and
disorders (Dahl, 2014). Social status affects health, although the reverse can be the case that
health problems can interfere with education and career, and consequently lead to a low
socioeconomic position. Meanwhile, financial and work problems can increase the risk of health
problems and diseases. People with low socioeconomic status are at higher risk for mental
disorders (WHO, 2014).To explain social inequalities in health, mortality and life expectancy,
we have to look at both disease patterns and lifestyle habits.

Health and social conditions are inter-related. Health and lifestyle habits such as smoking, diet
and physical activity are closely linked to social conditions, local communities, housing and
living conditions (Dahl, 2014). Some causal relationships are probably influential throughout life
(Blane, 2013) and the interaction between factors is important. Basically, all conditions that
affect public health and which are unevenly spread will help to create and sustain social
inequalities in health. To even out any health differences, one can begin with the underlying
factors.

a) Basic social conditions affect the entire causal chain

b) Lifestyle, social support and other physical and social environmental factors directly affect
health.

c) Health services can counteract inequalities created earlier in the causal chain. Employment
and adaptive education can also help to alleviate inequalities.

d) Lifestyle habits are primarily a result of the environment and living conditions. Factors such
as economy, education, and living and working conditions may therefore affect health and the
risk of disease, both in a positive and negative way.
e) Efforts to improve living conditions, such as employment, education and living environment
can help to promote health. This will also reduce social inequalities in health and increase life
expectancy in all groups.

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