Health as a social construction

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Health as a social construction

• Health is an invented reality, in other words
  historically build and redefined in the course of
  time on behalf of observers, through their own
  operation, representation and communication.
• Health as a social construction is a whole of the
  signs and processes of the body, of the types of
  identity, of the styles of relationship that
  define a quality of the experience, built and
  transformed through interpersonal and collective
  processes.

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The relationships health-illness 3 approaches

• Dualism health and illness are two opposites
  health is absence of illness, and vice-versa.
• Holism health and illness penetrate each other,
  as an non-dividable whole.
• Relational approach Health and illness are
  two phenomena distinct but in relation between
  themselves a continuous process connects the two
  poles.

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The origins of the term Health

• SALUS (Latin word) salvation, in other words
  dismissal from a negative condition
• HOLOS (Greek word) totality, that is
  re-establishment of the original state of
  completeness

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5 meanings of Health

• Health as ideal state
• Health as physical and mental fitness
• Health as a consumer good
• Health as strength/ability of the individual
• Health as development of personal potentials

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The health-we-think

• Socially and historically differentiated
  conceptions give place to mental thoughts and
  health models that are often in competition with
  each other in society.
• At the moment there are 3 main models
• - bio-medical
• - behaviourism
• -social-psycho-somatic

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The bio-medical model (1)

• The approach is positivistic, westernised,
  consolidated between the end of the nineteenth
  century and the beginning of the twentieth
  century, it is based on the idea of a
  medical-scientific knowledge which can have an
  infinitive potential increment and is able to
  defeat any kind of illness.
• It is still the dominant approach today and is
  founded more and more on technological
  innovation.

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The biomedical model (2)

• Medicine is an objective science, which
  discovers the causes of illnesses and the
  remedies to bring health back.
• The health level of a population depends on the
  level of its medical-scientific (and
  technological) knowledge and the medical
  resources obtainable.
• Health is the absence of physiological
  abnormalities.

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Fundamentals employed by the bio-medical model

• Dualism mind-body (2 distinct realities)
• Mechanical metaphor (the body is a machine)
• Technological imperative
• Biological Adaptation (biological health)
• Specific aetiology

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Main criticism on the bio-medical model (1)

• The great reduction of mortality from infective
  diseases is linked only in part to medical
  intervention an important role was played by the
  general improvement of the conditions of life at
  all social levels (nourishment, hygiene, homes )
  
• The great investments in cure treatments and in
  applied technology in various factors (social,
  environmental, behavioural) which are at the
  origin of many of the current diseases.

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Main criticism on the bio-medical model (2)

• The emphasis on pharmacological aspects of
  treatments has given rise to pathologies actually
  caused by the medical intervention (iatrogenesis)
• The backing of medical treatments in daily life
  is sustained by strong economical-financial
  interests involved in the health system.
• The myth of healing provokes dependency and
  high expectations in the population, making
  people unaware of the healing in itself (which
  does not mean self-medication/treatment).

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Behaviourism model (1).

• Approach which originated from the
  dissatisfaction due to the limits of the
  bio-medical model, it mainly avails itself of
  knowledge in the psychological field
• The health of people is greatly linked to their
  behaviour, that is to the practice and habits of
  daily life.
• Emphasis on individual responsibility towards
  health.

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The behavioural model (2)

• The method emphasises education to health and the
  prevention of disease
• The 7 golden rules to prevention
• 1. Dont smoke
• 2. Sleep 7 hours per night
• 3. Have breakfast in the morning
• 4. Dont exceed the advised weight
• 5. Drink alcohol with moderation
• 6. Take exercise ever day
• 7. Dont eat between meals
• A 45 year old person who follows 6/7 of these
  rules has a higher life expectancy of 11 years
  more than a person that follows less than 4.

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Limits to the behavioural model

• The individual behaviours are often influenced by
  larger social phenomena/reasons the context
  influences the person, limiting and conditioning
  his effective choice possibilities (ex.
  Correlation between smoking and social
  condition).
• Many illness factors are however out of the
  individuals control (pollution, quality of food,
  ).
• The promotion of health can risk becoming a form
  of social control (ex. Prohibition in the USA).

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The socio-psycho-somatic model (1)

• Health is the process of reciprocal interaction
  between body, mind and external environment
  its principal components are physiology,
  behaviourism and emotions
• Re-interpretation, in relational key, of the OMS
  definition (a term of the forties) Health is
  the complete state of physical, mental and social
  wellbeing.

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The socio- phsyco -somatic model (2)

• Health is the capacity to solve problems and to
  control emotions through which one keeps and
  re-establishes a positive idea of himself and
  both the physiological and physical wellbeing
  (sense of coherence of the individual).
• The promotion of Health is achieved through a
  togetherness of interventions non only of
  medical-sanitary type, but also finalised to put
  the individual in the condition of developing the
  whole of his potential (quality of life,
  empowerment)

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Some queries that sociology poses to medicine

• Health and disease are social constructions,
  how does the communicative and relational process
  work inside which it forms their definition and
  their recognition?
• There are informative asymmetries for which some
  categories of actors keep the major power of
  definition of reality in respect to others?
• (Scientific paradigms doctor-patient
• What place has individual responsibility and
  social responsibility (and political) in defining
  health and disease? What autonomies are to be
  protected and which co-responsibilities are
  demanded?