Before I begin to answer this question I want to look into what exactly is meant by the term “social construction”. To start with, it was a term coined by Peter L Berger and Thomas Luckmann when they published their 1966 book on The Social Construction of Reality. The actual term Social Construction means a phenomenon that is built up through social processes rather than being a natural occurrence. However because of the complexity of defining health I shall look into that later on.
I believe that health is socially constructed to an extent, for example social class affects a person’s health, as does their locality, the time period they live in, and so on. On the other side of the argument health is a biological construction as you cannot deny such things as micro-organisms that cause the diseases. In this essay I shall look at all these points of view and analyse to what extent I believe health is a social construction. As I stated earlier I would look further into the definitions of health as I believe it is important to understand the different views.
The World Health Organisation states health as, “Not merely the absence of disease and infirmity, but complete physical, mental and social well being” 1 implying that health is a set physical disorder. This has been disagreed with by a number of different sociologists. Stephen Moore states that, “Health is a socially constructed concept, rather than a biological one. ” 2 By which he means that people define themselves as healthy according to the social expectations of what constitutes health in their society.
For example, in our British society if you hear voices you would be considered mentally ill with Schizophrenia, whereas in some African societies they may be seen as a Shaman or hearing the voice of god. This leads us into the first argument for health being socially constructed, the fact that health differs through history and cross culturally. At the beginning of the 19th century the diseases that were infecting the majority of the public were life threatening infectious diseases such as Cholera, Syphilis and Typhoid. Whereas now, in the 21st century, our main diseases are cancer, and heart disease.
This change of diseases can be explained by our changing society. We have different jobs now, different social standards of cleanliness and a different set of attitudes towards life. McKeown believed that a key reason for this change was that people were becoming stronger and more resilient to diseases because of better nutrition, improved environmental conditions (e. g. Edwin Chadwick’s 1842 report on public health led to health reforms in Britain which vastly improved sanitary conditions), and behavioural change in our society.
Another explanation for the change in health is that in the past they used diseases as an explanation for undesirable behaviour. For instance, if a woman was behaving in an unacceptable manner (protesting or speaking against her husband) she was deemed to have hysteria. Or if a man was homosexual he was put into a mental institute for therapy (for instance Oscar Wilde). Today we understand that these are not illnesses, it is society that is changing. Also our acceptance of illnesses has changed, for instance our pain threshold. “What is illness today was normal bodily functioning 200 years ago”3.
Culturally, health differs as to what the society views illnesses as being, as we have looked at before with schizophrenia. In Africa women being fat is deemed desirable and healthy whereas in Britain it is seen as a medical condition, obesity. Another explanation for health differing between cultures is the actual different behaviours in the cultures. Asians, who drink less and smoke less than Britons, and as a consequence have lower levels of lung cancer and heart disease, however, they are more likely to suffer from diabetes as a result of their diet.
There is also a strong difference of health between social classes. This is predominately shown in British society. In a report called The Health Divide (1987 and repeated in 1992) it showed that the gap between the health in the middle class and working class is growing rather that narrowing. It was suggested in this report that it was because diseases in our modern society are closely linked with our lifestyle and behaviour, for instance smoking or poor diet.
Another report that looked into social class and health was called the Report of the Working Party on Inequalities in Health, or more widely known as the Black Report (named after Sir Douglas Black who wrote it). It was set up in 1977 by the Labour government and published in 1980. It showed that there was a pattern to the wealth and health experienced by the different social classes. It looked into four explanations as to why this is. The Artefact explanation stated that health inequalities were not real but a consequence of the use of misleading statistics and definitions of social class.
The Natural/Social selection explanation stated class is a consequence rather than a cause of poor health. The Structural/Material explanation states that it is a combined number of factors, low income, poor diet, inadequate housing and so on… The last explanation was Behavioural/Cultural explanation which states that the lower social groups fail to look after themselves properly (not having check ups, not visiting dentists… ). The report showed that the first two explanations were weak arguments, and highlighted the need for government action. Politics can play a part in health as well.
For instance, “Diphtheria has returned to Russia because the social consequences of the collapse of communism have destroyed the network of clinics that once immunised the population. “4 Also politics comes into play with things such as health care systems. In the United States of America, they have to pay for their health care. This also affects the social class divide as the wealthier can afford a more complete health insurance. In the United Kingdom we do not have this problem to the same extent, as we have the National Health Service (set up in 1948) that gives free health care to all.
Although people can choose to go private and pay for insurance that allows them “better” health care. For the argument that Health is a social construction, relativist sociologists hold a strong point of view. Bury (1987) argued that, “Social constructionism is a relativist critique of medical definitions”5. To go further, some relativists argue that science itself is flawed. There are two main types of relativist sociologists, Social and ‘Strong Programme’. Social relativism believes, “A disease results from a subjective, social, evaluative label applied to an objective biological condition.
Social relativist sociologists criticise those who agree objectively to medical definitions of illness and health. They believe that all concepts of illness and disease are subjective evaluations or social constructions, but influential groups like doctors are able to impose their concepts of disease on lay people. The ‘Strong Programme’ relativists believe that everything is subjective, that it is impossible to have an objective truth. They believe that all medical systems (e. g. Western scientific medicine, Acupuncture… ) are as valid as each other.
They believe that biological knowledge is “an ideologically biased product of the society which it is located… that serves the interests of powerful groups”. 7 Although relativism can be heavily criticised itself, as Western medicine has a progressively good record and is compatible with many complementary therapies and medical beliefs. Rogers (1991) criticised relativists as being ethnocentric, that in the third world countries the biological reality of sickness has always been noticeable. They only condemn it in our western society, where we don’t have to worry about the dangers of famine and such.
The constructionist argument relies deeply on the analogy between deviance and illness. That illness is defined as deviation from the norm. There are a lot of problems in using this as an explanation. What do you define the norm as? What is normal for one person, or society may be abnormal for another, it is subjectively defined by a society. Also many physical illnesses are not simply deviant behaviour, nor are they voluntary. The main argument against the idea that health is socially constructed is the medical view. One perspective of the medical view is the germ theory.
It was developed by Louis Pasteur in 1861, he found that germs in the air caused decay. In the 1880’s Robert Koch stained bacteria and isolated certain bacteria that he claimed caused diseases. The germ theory states that disease occurs through the actions of invisible micro-organisms also known as aetiology. This theory fails to explain why so many people are exposed to infectious micro-organisms yet only a relatively few develop diseases. There is also a strong emphasis on drug-related treatment and lack of emphasis on disease prevention.
It doesn’t take into account the subjective feelings of the patient, or the environment. It has been criticised as dehumanising, “Doctor is viewed as a mechanic treating a defective machine. “8 It ignores the links between mind and body, and physical and mental well-being. The medical model of health has also been accused of diverting the attention away from the social and environmental causes of disease and focuses mainly on medical treatment and medical surroundings. A further criticism of the medical model of health is that it causes iatrogenesis.
Illich (1990) views that “medical establishments have a vested interest in “sponsoring” sickness by creating unrealistic health demands”9 the medical establishment have brought pregnancy, ageing and all the “natural” human conditions into social iatrogenesis. Illich asserts that the cause of iatrogenesis is located in industrialisation, in the bureaucratisation of industrial societies. The Marxist view on iatrogenesis is slightly different. Navarro believes that iatrogenesis is caused by capitalism, that the healthcare specialists don’t cause iatrogenesis but administer it on behalf of the capitalist class.
He explains this as the fact that capitalist economies are geared towards creating a profit through increasing people’s level of consumption of merchandise and services. Therefore the capitalists who own medicine, drug and health companies have an interest in increasing their profit. McKeown comes up with yet another idea for the cause of iatrogenesis, that we are misusing our healthcare resources by using technology all the time, and our obsession with technology and drugs is causing an iatrogenic epidemic.
Some studies to support this show that 20 percent of hospital patients suffer from iatrogenic disease, and more people die from adverse reactions to drugs than on the road each year. We cannot completely dismiss the medical model of health, it has done considerable amount to help health care. The medical model has helped to increase our comfort levels, for instance, we have better eyesight, and can even cure some cases of blindness, we have inoculations and vaccines against infectious diseases, we have drugs to control diabetes, and defibrillators to resuscitate the heart when it stops.
Although, it has been shown that cases of disease were already dropping before inoculations and vaccines were used. For instance, cases of Whooping Cough were about 1500 per million in 1870, by 1910 they were already down to around 500 per million, and in 1950 when the vaccination became widely available there were already less then 200 cases per a million. 10 To say that health is entirely a social construction would be a misjudgement. I believe that health is a variety of different causes and catalysts.
The definition of health differs from each individual and from each society. Health is a complex interaction of social class, environment, medical definitions, subjective definitions and the interests of the leaders of society. I believe that health will never be able to be judged as one idea or another, and to be sociologically exact in the topic of health is almost impossible due to the difficulties of obtaining objective data and the severe conflicts between theories.