Pharmacy & Society - Social influences on health

Question 1

Definition of health

Answer 1

A state of complete physical, mental and social wellbeing, not merely the absence of disease or infirmity

Question 2

What and who influences your behaviour / decision‐making in relation to health?

Influences on behaviour

Answer 2

• Biological
– Hereditary (genetic) factors
– Sex
– Age

• Psychological
– Emotional State
– Personality traits
– Operant conditioning – Cognitive factors

• Social
– Type of area that people live in
– Social class / status
– Social contacts: Family / friends etc 
– Financial / employment status

• Cultural
– Religion
– Ethnicity

Question 3

Cultural beliefs

Answer 3

• Christian Scientist–no donation or receipt of organs
• Jehovah’s Witnesses–no blood transfusions
• Rastafarians are not usually willing to receive any treatment that will contaminate the body. They usually prefer alternative therapies such as herbalism or acupuncture.
• Muslims may refuse treatment with heparin etc that are derived from porcine sources

Question 4

Cultural health differences

Answer 4

• Incidence of some diseases vary with ethnic or cultural differences

E.g. Japan has low rate of breast cancer
E.g. Sickle cell anaemia is more prevalent in those of Afro‐Caribbean descent
E.g. Diabetes has higher incidence in Asian population

Question 5

Main determinants of health (Dahlgren and Whitehead, 1991)

Answer 5

• General socio-economic, cultural and environmental conditions
• Living and working conditions: Agriculture and food production, education, work environment, unemployment, water sanitation, health care services, housing
• Social and community networks
• Individual life style factors: Age, sex and hereditary factors

Question 6

Lifestyle influences on health

Answer 6

1. Eating habits / Diet
   • Poor nutrition has been linked with heart disease, stroke and some cancers
   • Limit salt consumption to 6 grammes a day
   • Reduce saturated fat consumption
2. Physical activity
   • The proportion of people engaged in physical activity
   declines after the age of 35 years
   • Children and young people–should under take a total of 60 minutes of moderately intense exercise each day
3. Alcohol
   • 2016 new guidelines: No safe amount of alcohol consumption
   • Men and women should not drink more than 14 units a week on a regular basis

4. Smoking
Smoking adversely affects:
• The heart
• The lungs
• Healing
• The immune system
And increases the risk of all cancers

Question 7

Studying health and illness

• Two main areas:

Answer 7

• Health psychology
‐ Understanding how biology, behaviour, and social context
influence health and illness

• Sociology of health & illness
‐ Examines the interaction between society and health
‐ Looks at how social aspects of life impacts on morbidity and mortality rates

Question 8

Parsons and the “sick role”

Answer 8

• Sociologist: functionalism
• Talcott Parsons saw “being sick” not as a condition but as a specifically structured social role

‘Rights’ of sick persons
• Temporarily “exempt” from normal roles
• NOT held responsible for the condition(no blame)
• Right to be looked after

Duties / Obligations
• Must try to “get well”
• Exemption from normal activities is temporary and conditional on them wanting and trying to get better
• Obligation to seek help from a qualified professional AND to co‐operate with them

Question 9

Problems with the sick role

Answer 9

Medical authority: paternalism
• Failure to comply may lead to transformation of illness into “madness” or “badness”
• Chronic illness – may violate “rules”
• Individuals may not be able to seek help
• Illness due to patient lifestyle choices = “blame”
• Inability to be relieved from normal duties
• Medicalisation of pregnancy
• Doesn’t deal with power imbalance e.g. malingering as a choice, Government or employer pressure

Question 10

Other sociological theories

• Foucault:

Answer 10

diffusion of power

Question 11

Other sociological theories

• Bourdieu:

Answer 11

habitus (socialised norms that guide behaviour)

Question 12

Other sociological theories

• Habermas:

Answer 12

lifeworld

Question 13

Lay perspectives on CHD risk – implications for health education

Answer 13

1. ‘Coronary candidacy’ or ‘the kind of person who gets heart trouble’ as a form of ‘lay epidemiology’
2. Candidacy as explanation & prediction in others, and explanation & risk assessment for self
3. Candidacy based on physical appearance (e.g. obesity), social information (e.g. FH) and personal information (e.g. high fatty food consumption)
4. Candidacy is fallible: explains some cases; others bad luck ‐‘Uncle Norman’ & ‘The Last Person’
5. Candidacy: a barrier to the aims of heath education

• Draws on Bourdieu’s concept of habitus
• Davison, Davey Smith & Frankel(1991)